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1.0 Background Information

Children 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 (2002) 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., 2004). Nearly 30% of humanity suffers from one or more of the multiple forms of malnutrition (WHO, 2000). In a recent series of articles on child survival published in the lancet, Daelmeans and Saadeh, (2003), 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) intends among others to reduce children age 15 mortality by 2/3rd by the year 2015. This has 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 at age 15 years. In 1979 WHO and UNICEF recommended an exclusive breastfeeding (EBF) period of 4-6years 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 years 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 years of the infant’s life. More than 95% of children age 15 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, 2002). 

In Ghana, the Ghana Health Services (GHS) 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 (HIRD) of intervention. The interventions include strategies of improving exclusive breast feeding, complementary feeding, de-worming among others for children age 15 in particular (GHS, 2007). 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 age 15.

1.1 Problem Statement

Malnutrition include under nutrition, specific nutrient deficiencies, and over nutrition; and it kills, maims, retards, cripples, blinds, and impairs human development on a truly massive scale worldwide. 

In Ghana, the malnutrition rates for all age groups of children age 15 have increased steadily over the past six years. According to the NSB Annual Report, 2007, it peaks in the 12-23 years age group. In 2007, almost eight percent (7.8%) of children aged 0-11 years 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 years, 10.1% were malnourished in 2007 as compared to 8.2% in 2006. The highest rate of 28.2% was recorded by Upper West region, while Brong-Ahafo recorded the lowest rate of 3.3%. The malnourished rate among children 24-59 years age group was 7.3% in 2007 as compared to

6.2% in 2006.

1.2 Significance of the Study

 It is a known fact that our children are the greatest assets of a country. They are the future leaders. Providing optimum health to children in terms of physical, social, and intellectual development should thus be a priority concern of everybody. Malnutrition has been a problem worldwide which has been tackled in various ways but the problem still lives with us. In fact it continues to kill millions of children daily. There continue to be several challenges in unraveling the intervention barriers in terms of caregivers’ attitude and perception about the nutritional status of their children. 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. 

In Ghana, children age 15 mortality has been increasing over the past decade. According to the GHS, 2007 annual report, children age 15 mortality have increased from 108/1000 live births in 1998 to 111/1000 live births in 2003. Admittedly, a major contributory factor has been poor nutrition care to children age 15. The children who are very vulnerable and susceptible to infection are exposed to poor nutritional regimen by caregivers resulting in avoidable deaths.

The findings of the study would inform better contextual planning and management of malnutrition generally, and that related to children age 15 in particular. It would provide the framework by which specific indicators could be used to assess the risk of malnutrition for a child thereby implementing the appropriate measures to curtail it. The indicators intended to be deduced from the characteristics and health behaviour of the mothers, would inform policy makers and health professionals generally, as to possible markers that can guide the design and implementation of intervention to prevent malnutrition. 

1.3 Research Questions

1.      What socio-economic characteristics of parents significantly influence the  nutritional status of children age 15 at Egor local government area, Edo State?  

2.      Does maternal health seeking behaviour and child morbidity have a relationship with the nutrition status of the children age 15 in the district?

3.      What is the extent of relationship between household feeding practices, water sources and sanitation on the incidence of malnutrition in Ego local government area?     

4.      What proportion of children age 15 is malnourished and does the distribution relate to the child’s sex, and age?

1.4 Objectives

1.4.1 General Objectives

The general objective of the study was to examine, the extent to which parents’ characteristics, health behaviour, and household determinants relate to the nutritional status of the children age 15 in Egor local government area.

1.4.2 Specific objectives

1.          To explore the relationship between the socio-economic characteristics of parents and the nutritional status of children age 15 in Egor local government area.

2.          To examined the influences of maternal health seeking behaviour of matter and childhood morbidity among malnutrition children age 15 in the district.

3.          To determine how household feeding practices, water sources and refuse disposal and how these relate to the nutritional status of children age 15 in the district.

4.          To estimate the proportion of malnutrition forms among the children and the relation between it and their sex, and age.

5.          To make recommendation to stakeholders from the evidence gathered as to how malnutrition occurrence could be reduced in the district.


Figure 1.1: A conceptual frameworks showing the factors that influences malnutrition directly or indirectly

   SOURCE: UNICEF 1998                                                      

Access to good nutrition is directly influenced by food intake, health status and caring practices. Adequate care for women and children encompassing all measures and behaviours that translates into availability of food and health resources into good child growth and development. Consumption of unsafe water and inadequately protected water sources, coupled with inappropriate disposal of waste and unhygienic conditions in and around homes, has significant implication for the spread of infectious diseases and contribute immensely to the incidence of diarrhoea. Persistent diarrhoea in children is a major cause of malnutrition.

Women who are malnourished are more likely to face reproductive health problems that can lead to maternal and infant death. Improved nutrition reduces the severity of some diseases and minimizes the incidence of others.

A fundamental determinant of nutritional status is food security, which in turn is determined by the availability of and access to food supplies. Availability of food is defined as the capacity of the country to ensure the physical presence of food supplies at all times to all people, either through local production or through importation. Access to food is defined as the ability of people to obtain, whenever required, food supplies for their basic requirements.

Health, Educational, Roads, Agricultural and other social infrastructure are necessary in ensuring a well integrated approach that ensures the individual becomes well informed and equipped in accessing and using the right food sources to improve his or her health status. The lack of these would affect the nutritional status of the child. Underpinning this is the economic status of the country and how it fuels the quality of services provided by these structures to solve deficiencies in the malnutrition dynamics. Political will and power both local and National is therefore relevant in addressing the state nutrition in the Nation and more especially among children age 15.

1.6   Scope of the Study

This study focuses mainly on household characteristics with more particular attention to parents. These characteristics include socio-demographic, economic, food availability, educational level among others. It also focus of maternal health seeking attitudes in terms of use of antenatal care (ANC) services, time of  use of the service and influences relating care giving of the child such as practices of on exclusive breast feeding and complementary feeding. 

The study therefore did not examine socio-political structures that support or affect the nutritional status of children age 15 in the Egor LGA. In other words, the impact of health, agricultural, educational and leadership structures and their influences on the nutritional status of the child, were not directly examined under this study.

1.7 Organisation of work

This report is organised in six chapters. The first chapter describes the background of the study, problem statement and defines the objectives and the scope of the study. The second section reviews related literature on malnutrition generally and examines findings made from other authors on the subjects. The third section gives a description of the methods, materials, tools and procedures used in gathering information and analysing the results. It also highlights the ethical and assumptions underpinning the conduct of this study. The fourth chapter focuses on presentation of results in the forms of tables and charts arranged in accordance with the objectives of the study. The fifth and sixth chapters are on the discussion, and conclusions and recommendations respectively. The discussion session elaborates what could account for the observations made and further its implication on the management of malnutrition among children age 15. In addition, it does so by examining other findings relative to other settings especially those in Ghana. The conclusion and recommendation session of the report would bullet issues noted in the findings and also suggest what can be done by an identifiable agency to solve the problem.

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