ABSTRACT
Prevalence and determinants of malnutrition among 499
under-five (U5) children and their mothers (496) in Kuje Area Council, Federal
Capital Territory was investigated through a cross-sectional survey using
cluster sampling techniques based on probability proportion to size of
Emergency Nutrition Assessment (ENA) for Standardized Monitoring and Assessment
for Relief and Transitions (SMART) methodology. Malnutrition in the study area
is unacceptably high with Global and Severe Acute Malnutrition at 12.8% and
5.4% respectively, stunting at 40.3% and underweight at 24.4%. For the mothers
only 1.9% were underweight with about half (46%) overweight / obessed. Crude
death rate was fifty-nine deaths per thousand live births (59/1000) with U5
years children mortality rate of 78/1000 and morbidity rate 17.2%. Majority of
the children (79.5%) had fever, followed by cough (32.5%), malaria (29.8%),
diarrhoea (27.3%). Mean U5 years children serum concentrations of Iron, Zinc,
Calcium, Phosphorus, Vitamin A, Vitamin D and Haemoglobin levels respectively
are 80.50±17.90µg/dl, 164.9±105.1mg/dl, 8.4±1.3mg/dl, 6.4±2.2mg/dl, 229.8±33.0
nmol/L, 89.1±82.1µg/L, 11.7±1.4g/dl, while that of their mothers are
85.69±30.69µg/dl, 153.76±97.28mg/dl, 8.54±0.98mg/dl, 5.82±1.90mg/dl, 131.76±130.98nmol/L,
118.11±115.28 µg/L, 12.55±1.03g/dl respectively. Feeding practices shows 30.6%
initiated breastfeeding within 30 minutes of birth and 22.4% exclusively
breastfed for up to 6 months. Determinants of malnutrition at P < 0.05
include childcare, place of delivery, immunization status, early initiation to
breastfeeding, exclusive breastfeeding practices, use of colostrum and age.
There is high prevalence of double burden of malnutrition among under-five
children and their mothers in Kuje Area Council with multifactorial
determinants.
CHAPTER ONE
1.0 INTRODUCTION
1.1 Background
Malnutrition is insufficient, excessive or imbalanced
consumption of dietary energy and nutrients. It manifests in different forms,
such as undernutrition, overnutrition and micronutrients malnutrition and
results from either inadequate or excessive availability of energy and
nutrients (Brown et al., 2011). Malnutrition can occur in two forms; Primary
malnutrition which results when a poor nutritional state is dietary in origin
and secondary malnutrition is precipitated by a diseased state, surgical
procedure, or medication. Diarrheoa, alcoholism, AIDS, and gastrointestinal
tract bleeding are examples of conditions that may cause secondary malnutrition
(Brown et al., 2011).
Malnutrition in early childhood is associated with functional
impairment in adult life as malnourished children are physically and
intellectually less productive when they become adults. It decreases the
educational achievement, labour productivity and economic growth of a country.
Children that are malnourished tend to have increased risk of morbidity and
mortality and often suffer delayed mental development, poor school performances
and reduced intellectual achievement. Concurrent high levels of malnutrition
worsen the health status and development potential of a child (Smith and
Haddad, 1999).
Globally, nutritional status is considered the best indicator
of the well-being of an individual (Dasgupta et al., 2014). The nutritional
status of a child is of particular concern because, early years of life are
crucial for future growth and development. Under-five children represent the
vulnerable and the most important target group where malnutrition plays a pivotal role in their mortality and morbidity along
with delayed mental and motor development during these formative years
(Dasgupta et al., 2014).
A widely used conceptual framework published by UNICEF in
1990 identifies three main underlying determinants of nutritional status:
availability and access to food, the quality of feeding and care giving
practices, and the health of the surrounding environment and access to health
care services. Each of these determinants is a necessary but not sufficient
condition on its own to good nutrition (ARDD World Bank, 2007)
1.2 Statement of
Research Problem
The challenges of hunger and inadequate intake of food
nutrients which hampers the nutritional status of children and women still
remains an issue of concern in Nigeria. Worldwide, almost 7 million children
die each year before they reach their fifth birthday, while India (24%) and
Nigeria (11%) together account for more than one-third of all under-five
deaths. Globally, undernutrition is responsible, directly or indirectly, for at
least 35% of deaths in children less than 5 years of age (WHO, 2010; You et
al., 2011; UNICEF, 2014). The under – 5 mortality rate in Nigeria is 128 deaths
per 1000 live births, which implies that one in every eight children born die
before reaching their fifth birthday (NDHS, 2013).
Nigeria Demographic and Health Survey (NDHS) revealed that
under-5 mortality rate decreased from 201 deaths per 1,000 live births to 128
deaths per 1,000 live births from 2003 to 2013 (NDHS, 2003; NDHS, 2013).
However, Nigeria did not achieve the millennium development goals (MDGs) target
of reducing the under-5 mortality to 64 deaths per 1,000 live births and the
infant mortality to 30 deaths per 1,000 live births (FMOH, 2014).
The estimated maternal mortality ratio in Nigeria of 545
deaths per 100,000 live births in 2008 has increased to 576 deaths per 100,000
live births in 2013 (NDHS, 2008; NDHS, 2013). The NDHS (2008) also reported
that 12% of Nigerian women are too thin, but 22% are overweight or obese. The
proportion of overweight women is almost twice as high in urban areas as in
rural areas (31% compared with 17%) and increases with age, education, and
wealth.
Micronutrients deficiencies in Nigeria has remained a great
public health concern. The last national Food consumption and micronutrient
survey conducted over a decade ago 2001-2003, 29.5% of preschool children had
Vitamin A deficiency, 24.8% of Nigerian children under 5 suffered from marginal
vitamin A deficiency while 8% of pregnant women in Nigeria had night blindness.
About 20% of the population were at risk of inadequate intake of zinc, 76.1% of
pre-school children, 62% non-pregnant women and 66.7% of pregnant women were
anaemic. One major cause of anaemia is iron deficiency (Maziya-Dixon et al.,
2004; Aminu, 2010; FMOH, 2013). An increased visibility of the problem of
"hidden hunger" arising from micronutrient deficiencies is noticed in
communities of the FCT. This calls for commitment of all stakeholders as a
public health priority to undertake measures to make ending micronutrient
deficiencies most especially, vitamin A, zinc, iodine, folate and iron
deficiencies in FCT.
The findings from MICS survey in 2011 indicated a high
prevalence of malnutrition amongst under-five children in the Federal Capital
Territory (FCT). It showed that the prevalence of vital nutrition assessment
indicators in FCT such as moderate (-2SD) stunting was 65.1%, moderate wasting
14.2%, and moderate underweight 46.8% (MICS, 2012). There is recently a
reduction in these indices according to the report of NDHS (2013) which indicated overall stunting to be 29.6%, wasting
18.8%, underweight 16% in the FCT. Concurrent high levels of malnutrition
worsen the health status and development potential of a child and makes every
strategy for health, education and prosperity an uphill struggle.
1.3 Justification
The mortality indices for children in Nigeria are ranked
among the worst in the world. Nigeria ranks 9th in global assessment of
under-five mortality rate and approximately one million children die annually
in Nigeria before their 5th birthday (UNICEF, 2014). The role of adequate and
sustainable surveillance particularly for nutrition assessment of children in
the community cannot be over-emphasized, considering the efforts in promoting
optimal childhood nutrition, growth and development.
Although several studies and attempts to reduce child
mortality in Nigeria have been conducted, yet progress on reaching the desired
target is still limited. Many of the previous studies were descriptive in
nature and lacked detailed analysis of socioeconomic and proximate determinants
of child and maternal malnutrition (Ajieroh, 2009).
None or little effort has been devoted to examining the key
determinants of malnutrition among under-five children and their mothers in
communities of Kuje Area Council of the FCT that will effectively guide
nutrition interventions.
MICS survey in 2011 indicated a high prevalence of malnutrition
amongst under-five children in the Federal Capital Territory (FCT). Hence, this
study will provide information that can be used for nutritional surveillance
and targeting programmes that would focus more on populations most affected. More importantly, the
survey will be instrumental for generating information that will form the basis
for developing interventions for nutrition and other health programmes in the
FCT as a whole.
1.4 Aim and
Objectives of Study
1.4.1 Aim
The aim of the study was to determine the burden of
malnutrition, specific determinants causing it by assessing the nutritional
status among under-five children and their mothers in Kuje Area Council of the
Federal Capital Territory.
1.4.2 Specific objectives;
The specific objectives of the study include;
1. Assessment of nutritional status and prevalence of
malnutrition among under-five children mother pair in Kuje Area Council of
Federal Capital Territory.
2. Determine morbidity and crude death rate among under-five
children and their mothers.
3. Determine micronutrient (Vitamins A, Iron, Iodine, Zinc,
Vitamin D, Calcium and Phosphorus) status of the under-five children and their
mothers.
4. Establish the determinants of malnutrition in the study area.
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