CHAPTER ONE

INTRODUCTION

1.1  Background of the study

Nutrition is essential for life. Growth and development of an individual is determined by the quality of food consumed. The nutritional status of any person is dictated by the quality and quantity of nutrients absorbed and the body’s ability to use them for its metabolic needs. People who have a good nutritional status have no malnutrition. Malnutrition is the condition that occurs when the body is not getting the right amount of vitamins, minerals and other nutrients, required to maintain healthy functioning of tissues, organs and the body system in general, (John, 2013). The most vulnerable group prone to malnutrition is children due to their weak immune system. Children are prone to diseases, infection and malnutrition because their immune system are not fully developed are dependent on others for their basic need, and this stage of life is a critical stage that requires growth and development, hence the need for sufficient nutrients that will aid them in their growth and development, (UNICEF, 2013).

Generally, under-five children’s nutritional status is accepted as an indicator for the nutritional status of any community (John, 2013).The nutritional need of children is higher than that required for an adult this is because adult have strong immune system and they care and cater for their basic needs; what happens to this children is a reflection of the whole population and is used to measure the nutritional status of a population. Children are very important in the world and they constitute about 20% of a whole population, over 40% children in the world are stunted and more than 20% show chronic malnutrition which is quite challenging (INDEPTH, 2014).

According to 2015, UNICEF, WHO and world bank group released updated child malnutrition estimates for the 1990-2014 period, which represent the most recent global and regional figures after adding 62 new surveys from 57 countries to join the data set, global in 2014 there were estimated 667million children under 5 in the world; 159 million were stunted, 41 million were overweight and 50million were wasted.

Malnutrition contributes almost half of all children’s death, that is, more than 3 million per year (Robert & Black, 2013). It continues to be an issue in Nigeria owing to a myriad of factors. According to the 2012 Nigeria Standardized Monitoring and Assessment of Relief and Transition (SMART) survey, global acute malnutrition has a prevalence of between 6.4% and 13.1% and severe acute malnutrition between 0.7% and 2.2% (SMART, 2012). According to the Nigeria Demographic and Health Survey (NDHS, 2014), the percentage of stunting in Nigerian children under-five years declined from 41% in 2008 to 37% in 2013. However, the percentage of children who are wasted increased from 14% in 2008 to 18% in 2013. This indicates an ongoing deprivation among Nigerian children (NDHS, 2014).

Malnutrition refers to both under nutrition and over nutrition (Uthman, 2009).stunting, wasting, and underweight are among those anthropometric indicators commonly use to measure malnutrition in a population of under 5 children. Underweight (low weight- for age) reflects both low height –for-age and low-weight-for-age) and therefore reflects both cumulative and acute exposure of malnutrition (Janevic, Petrovic, Bjelic&Kubera 2010). Under nutrition, which is focus of this study, conversely has been estimated to be an underlying cause for around half of all child deaths worldwide. It has different types of measurements (Black, Allen, Bhutta, Caufield&Onis, (2008).

Malnutrition is often to refer to under nutrition  where there is not enough calories, protein, or micro nutrients (young, 2012). The two main types of under nutrition are protein – energy malnutrition and micro nutrient deficiency. Protein – energy malnutrition is  the most important type of malnutrition that manifest in under. Five years children and has two severe forms; marasmus (lack of protein and calories) and kwashiorkor (lack of protein). Common Micro nutrient deficiencies are lack of iron, iodine and vitamin A (Young, 2012).

under nutrition is   more common in developing countries aside under-five children certain groups have higher rates of under nutrition including women who are pregnant or breast feeding and the elderly under nutrition becomes more common due to physical, psychological and socials factors ( Ronnie, Rosenthnal, Micheal, Zenilman Mark and Katic, 2011).

A malnourish child with marasmus, the child appears emaciated with marked loss of subcutaneous fat and muscle wasting. The skin of a marasmic child is xerotic, wrinkled and loose and has no clinical dematosis, kwashiorkor typical presents with a failure to thrive,Oedema, moon faces, and a swollen abdomen (Pot belly), which lead to poor growth and development of a child  (Krawinkle, 2005).

For a child to be properly fed, to avoid malnutrition he/she must absorb or consume the right quality and quantity amount of food at the right number of times a day. Children 6-to-25 months of age should receive foods from the four main food groups which would provide the appropriate nutrients such food include fruits, vegetables, eggs, milk, fish, meat and grams, children should receive solid, semi solid, or soft foods two –to – four times daily (WHO, 2014).

 1.2 Statement of the Problem

Poor nutrition causes health problems. malnutrition is a poor condition that occurs when people do not consistently consume or absorb the right amounts and typed of food and essential nutrients (CS-SUNN, 2014). Each year about 1 million Nigerian children die before their 5th birthday (NDHS, 2014) malnutrition accounts for 11% of the global burden of disease. it is the number one risk to health worldwide (FAO,2010). Each year it kills 3.5 million children under five years old and impairs hundreds of thousands of growing minds (FAO, 2010). Malnutrition is implicated in about 40% of the 11 million deaths of children under five years in developing countries, lack of immediate and exclusive breastfeeding in infancy causes an additional 1.5 million of these deaths (UNICEF, 2010).

The developing fetus in the womb and preschool children constitutes the most vulnerable group, (Black, 2013). Malnutrition continues to be an issue of public Health concern in Nigeria owing to a myriad of factors. Early childhood begins from the uterus to new birth and then to postnatal life in the intrauterine life, the nutritional status of the unborn fetus determine on the quality and quantity of food consumed or absorbed by the mother and this nutrient will determine the outcome of the new born and even the postnatal life is a continuity of human development. Poor nutrition in the first 1000days of the children’s lives can have irreversible consequences and for millions of children, it means they are forever stunted; stunted children are more susceptible to sickness, they enter adulthood more likely to become overweight and prone to non-communicable disease (hamel et al., 2015). MNDs inflicts anaemia, cretinism, blindness on tens of millions of people, increase childhood and maternal mortality, stunted, growth, cognitive impairment, increase risk of infectious illness or dying from diarrhoea, measles, malaria and pneumonia, provokes birth defects, compromise   immune systems and causes individuals to live below their capabilities and their prospects of the nations (UNICEF, 2013; Horton & Ross, 2013).

The main indicator for malnutrition is stunting (when children are too short for their age). Stunted children have poor physical growth and development of the brain, preventing them from thriving and living up to their full potentials. According to NDHS (2014) report, the prevalence of stunting is 37%, underweight is 29% while wasting is 18% in children under-five years (NDHS, 2014). According to NNPC and ICF international Nearly 4 out of 5 Nigeria children do not meet the World Health Organization’s recommendation for exclusive breastfeeding during the first six months of life and about 70% of children of 6 to 23 months are not receiving the minimum acceptable diet (NNPC & ICF, 2013).

According to Candyce et al (2015), 4.4% of 3643 children in cross river state were malnourished. This was linked to poor care of women in pregnancy and child birth which in turn poses a long term risk on the health status of the child (Candyce et al, 2015).

Normal growth and development of a child depends upon the nutritional status of the new born which is related to the nutritional status of the mother and the nutrients intake of the infants, the nutritional status of a child is of paramount importance for the proper physical, mental and social development of a child especially in early childhood (UNICEF, 2013). Up to 1 million Nigerian children under 5 years are affected by severe acute malnutrition (SAM) each year especially in the rural communities (Children Investment Foundation, 2014). These children have severely low weight for their height and are at risk of dying unless given urgent attention, (Children Investment Foundation, 2014). Malnourished children have an increased risk of disability and are highly predisposed in infectious diseases and premature death.

There are factors which influence malnutrition among the vulunerable group which links to the poor physical growth and development of the under-five children year, the factors include poverty, ignorance, lack of food disease condition, educational level, large family size and disaster [WHO, 2010; Akanbiem, 2014; Gulat, 2010] . and magnitude of these factors vary from one place to another (URT, 2010.)

Nutritional surveys which could provide relevant information in Calabar- South in Cross River State like in other rural communities, data on nutritional status is mainly based on periodic demographic and health surveys. As a result, there is limited information on levels and causes of under- five children years malnutrition, especially in rural communities evidence shows that urban children generally have a better nutritional status than their rural counterparts. (Smith et al, 2005;URT, 2010). Knowledge on the prevalence of malnutrition and determinations of the nutritional status particularly in rural areas is essential in designing appropriate and context relevant program responses. This is because a large proportion of the malnourished reside in rural communities. To fill this knowledge gap in the policy and academics literature in calabar south area, the objectives of the study will assess the factors that influence occurrence of malnutrition in rural area of calabar-south local government area of cross river state.

1.3 Objectives of the study

The general objective of the study is to determine the prevalence of malnutrition among children under-five in Calabar South Local Government Area of Cross River State.

The specific objectives of this study are to:

    determine the rate of stunting among children under-five years in Calabar South Local Government Area.

    determine the rate of wasting among under-five children in the study area.

    determine the rate of underweight among under five children in the study area.

    assess the knowledge and practice of caregivers on nutrition that impact on malnutrition.

    identify factors that influence occurrence of malnutrition in this age group in the study area.

        Research Questions

    What is the level of stunting rate among children under-five years in Calabar South Local Government Area?

    Are there gender differences in the prevalence of malnutrition among under-five children in Calabar South Local Government Area?

    Does there exist any age differences in prevalence of malnutrition in calabar-south LGA

    What is the knowledge and practice of mothers on nutrition that impact on malnutrition among under five children in calabar south local government area.

    What factors influence occurrence of malnutrition in this age group in Calabar South Local Government Area.

1.4       Significance of the Study

This study will help provide data on the existing level of knowledge on malnutrition among under-five years children in Calabar South Local Government Area. It will help in providing baseline information on the prevalence of malnutrition in Calabar South LGA. This study will contribute to the data pool of malnutrition in Nigeria. It will also help in the development of interventions targeted at reducing the prevalence of malnutrition among children under-five years in Calabar- South LGA. Thus, promoting general over all development

1.5     Limitation to the Study

Based on the fact that the study is concern with the type of nutrition provided to their children , which is sensitive, caregivers may give socially desirable answers. This data will not be supported by clinical and biochemical confirmation of types of malnutrition. In addition it will not be supported data from health facilities in the area.

1.6  Definition of Terms

    Prevalence: This will be refer to asthe total number of disease cases in a given statistical population at a given time.

    Malnutrition: this will be refer to as lack of food nutrients in the body or lack of adequate nourishment.

    Under five: This will be refer to Children who are below 59 months.

    Stunting: Will be refer to as children who are too short for their age.

    Wasting: will be refers to a child that the normal body weight, looking thin and emaciated.

    Underweight: will be refers to as a child whose body weight is too low for his/her age or to healthy

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