ABSTRACT

Malnutrition remains one of the major problems confronting children in Sub-Saharan Africa (SSA). The nutritional status of children influences their health status, which is a key determinant of child survival. Therefore improvement of children’s nutritional status increases the chances of child survival and is considered as a precondition for their contribution to community as well as human development. The study was carried out to examine the strategies for reduction of malnutrition in children 0-5 years at Ika south LGA, Delta state.

Quantitative descriptive survey design was used. A semi structured questionnaire and a vignette was used to elicit information from 133 mothers and caregivers of children 0-5 years. From the study majority of respondents were able to mention causes of malnutrition. Causes cited included, poor feeding practices, which 85.7% caregivers agreed to, 85.7% also mentioned poor environmental and personal hygiene, 85.7% mentioned poor child care, and 86.9% mentioned poor birth spacing as a cause of malnutrition. Eighty seven percent of respondents agreed that cases of malnutrition can be managed by taking the child to the health centre, and majority (74.4%) of caregivers also disagreed that malnutrition was as a result of spiritual illness/curse and it can be prevented.

Although, caregivers did exhibit some knowledge on malnutrition, it would be beneficial to reinforce their education with regards to the three categories of malnutrition. Especially stunting, explaining the consequences of long term malnutrition. This is very important given the fact that many cases of stunting go unnoticed to the untrained eye. Good nutrition in the first 1,000 days of a child lays the foundation for health.

CHAPTER ONE

INTRODUCTION

1.1   Background to the study

Children less than five years worldwide are known to be vulnerable and susceptible in many respects, especially on matters on health. Nutritional deficiencies and malnutrition generally affect children more than any other group. Poor nutrition occurs in developing countries, as well as in more prosperous areas of the world. WHO Progress Report (2012) indicates that hunger and malnutrition remain the most devastating problems to the world’s poor and needy.

As many as 800 million persons worldwide are affected by malnutrition. More than half the childhood deaths in developing countries are related to malnutrition (Benson, and others., 2014). Nearly 30% of humanity suffers from one or more of the multiple forms of malnutrition (WHO, 2010). In a recent series of articles on child survival published in the lancet, Daelmeans and Saadeh, (2013), highlighted the importance of addressing childhood malnutrition as a prerequisite for achieving internationally agreed goals to reduce malnutrition and child mortality. Child growth is therefore internationally recognized as an important public health indicator.

Several efforts are being made globally and locally to reduce the malnutrition burden especially in developing nations. The forth Millennium Development Goals (MDG) intended among others to reduce under-five mortality by 2/3rd by the year 2015. This led to the development of a more integrated and holistic strategies in a manner as to ensure maximum benefits to the vulnerable groups especially children. The major intervention in this direction has been that relating to establishing and promoting exclusive breast feeding and promoting nutritionally adequate diets for children less than five years. In 1979 WHO and UNICEF recommended an exclusive breastfeeding (EBF) period of 4-6months however, WHO expert committee in 2001, upon assessing the extent of EBF concluded that for optimal nutritional status of a child, an EBF period of 6month must be adhered to. Field studies show that complementary foods introduced between four and six months of age replace nutrients from breastfeeding and confer no advantage on growth or development (Dewey and others, 1999; and Gupta and other, 2002).

Consequently, UNICEF and the Ministry of Health, Ghana recommended exclusive breastfeeding for the first six months of the infant’s life. More than 95% of children less than five years in Africa are currently breastfed but this is often inadequate because many people feed their infants with water and other liquids alongside the breast milk. As a result, the rate of exclusive breastfeeding is particularly low in West Africa (Linkage, 2012).

Prolonged breastfeeding is common and the median duration ranges between 16 and 28 months. The statistics in Sub-Saharan Africa shows that: 28% of infants are exclusively breastfed up to 6 months; 65% of children 6-9 months with complementary feeding; and 38% of children less than five years are stunted. The trend in various countries in West Africa varies. As far as exclusive breastfeeding is concerned, the trend is as low as 6% in Burkina Faso, 10% in Cote d’Ivoire, 18% in Togo and 17% in Nigeria. In relation to the practice of complementary feeding with breast milk for aged 6-9 months the rates are: 49% in Burkina Faso, 54% in Cote d’Ivoire, 65% in Togo and 63% in Nigeria (UNICEF, 2014).

In Nigeria, Health Services and Teaching Hospitals acting within the policy frame work of the Ministry of Health (MOH) is implementing a strategy called High Impact and Rapid Delivery of intervention. The interventions include strategies of improving exclusive breast feeding, complementary feeding, de-worming among others for children less than five years in particular (NHS, 2017). This initiative which begun in 2005 is aimed at preventing avoidable deaths due to ill-health resulting from infection and more importantly malnutrition among children less than five years.

The need for adequate nutrition for early childhood development cannot be overemphasized. This is because the provision of ample nutrition for infants facilitates healthy growth, proper organ formation and functioning, a strong immune system, as well as neurological and cognitive development (Black et al., 2010). Economic growth and human development require well- nourished populations who can learn new skills, think critically and contribute to their communities (Lui et al, 2012). The cognitive skills of children are developed by the extent to which they receive adequate nutrition for subsequent development. Studies have also shown that more than one-third of under-five deaths are ascribed to under-nutrition or malnutrition (Rice et al., 2010; Burke et al., 2011).

1.2   Statement of problem    

The majority of deaths due to malnutrition occur at home due to improper care. Even with hospital care, the estimated value is between 30-50% and is likely to be 75% by 2020 (WHO Fact Sheet, 2012). According to Antwi (2012) despite the high prevalence rate of SAM (severe acute malnutrition) in Nigeria, the opportunity for such children to be diagnosed in clinical settings is mostly missed. Recent epidemiology of severe malnutrition in Sub-Sahara Africa demonstrates a shift towards higher fatality rates among children who require clinical and hospitalization services such as those with HIV or exposed to HIV (Aitpillah, 2015). According to scholars the shift can be ascribed to high percentage of HIV infected children representing 20-50% (Heikens et al., 2008; Aitpillah, 2015). In Nigeria, the malnutrition rates for all age groups of children less than five years have increased steadily over the past six years. According to the NHS Annual Report, 2007, it peaks in the 12-23 months age group. In 2007, almost eight percent (7.8%) of children aged 0-11 months were found to be malnourished. This shows a steady increase from 4.1% in 2005 to 4.9% in 2006 to the current figure. For children aged 12- 23 months, 10.1% were malnourished in 2007 as compared to 8.2% in 2006. The highest rate of 28.2% was recorded by the Western region, while Eastern region recorded the lowest rate of 3.3%. The malnourished rate among children 24-59 months age group was 7.3% in 2007 as compared to 6.2% in 2006.

The rate of malnutrition among children less than 5 years in Southern region as compared to other regions is suggested to be relatively low (NHS, 2017), however, in nominal terms, the regions recorded one of the highest cases. Even though the rate is decreasing, the region has expressed concern about the trend and is unable to predict the socially related causes coupled with interventional factors that have accountant for the trend. This research is intended to examine the extent to which malnutrition status of children is related to the social and economic characteristics of their parent and also with reference to access to health services interventions on malnutrition. In other words, the study seeks to determine the strategies in the reduction of malnutrition in children 0-5 years at Ika South LGA, Ime-Obi in Delta state.

1.3   Objectives of the study

The general objective of this study is to examine the Prevalence of Malnutrition among Children underage five children 0-5 years at Ika South LGA, Ime-Obi in Delta state. Specifically, the study seeks to;

1.   Examine the prevalence level and perceptions about malnutrition in children under-five years

2.   Determine the causing factors that contribute to malnutrition in children under-five years

3.   Examine the influences of maternal health seeking behavior and childhood morbidity among malnutrition children less than five years in Ika South LGA

4.   Examine the management and control practices of malnutrition in children under-five years in Ika South LGA

1.4   Research questions

The following questions were formulated based on the research problem and objectives;

1.   What is the prevalence level and perception about malnutrition in children under-five years?

2.   What are the causing factors that contribute to malnutrition in children under-five years?

3.   What are the influences of maternal health seeking behavior and childhood morbidity among malnutrition children less than five years in Ika South LGA?

4.   What are the management and control practices of malnutrition in children under-five years in Ika South LGA?

1.5   Significance of the study

Providing optimum health to children in terms of physical, social, and intellectual development should be a priority concern of the society. Malnutrition has been a problem worldwide which has been tackled in various ways but the problem still thrives. In fact it continues to kill millions of children regularly. There continue to be several challenges in unraveling the intervention barriers in terms of caregivers’ attitude, perception about the nutritional status of their children and strategies for reduction and control of malnutrition. More complex understanding is the behavioral or socio-demographic influences of the caregiver that affect the child. The consequence of the negligence of caregivers in ensuring better nutritional care of the children is obvious.

The findings of this study would inform better contextual planning and management of malnutrition generally, and that related to children 0-5 years in particular. It would provide the framework by which specific indicators could be used by health managers and stakeholders to assess the risk of malnutrition for a child thereby implementing the appropriate measures and strategies to control it. The findings of the study would also inform policy makers and health care professionals generally, as to possible markers that can guide the design and implementation of intervention to prevent malnutrition among children 0-5 years.

1.6   Scope of study

This study covers the assessment of strategies in the reduction of malnutrition in children 0-5 years. The study was delimited to Ika South LGA, Ime-Obi in Delta state, since the whole state could not be studied due to certain financial and time constraints. The variables covered in the study include the prevalence level and perception about malnutrition in children under-five years, the causing factors that contribute to malnutrition in children under-five years, the influences of maternal health seeking behavior and childhood morbidity among malnutrition children less than five years, and the management and control practices of malnutrition in children under-five years in Ika South LGA.

1.7   Operational definition of terms

Malnutrition - Is all forms of bad nutrition which includes both under nutrition and over nutrition

Stunting - Occurs when a child suffers from a long term nutrient deficiency and or chronic illness, so there is only weight gain but height is affected

Under Weight- Is an effect of both wasting and stunting and is therefore a composite indicator of general malnutrition

Wasting - Reflects a recent loss as highlighted by a small weight

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