Discuss Prevalence of Malnutrition Among Children Under Five

Discuss Prevalence of Malnutrition Among Children Under Five

The sustenance of life depends greatly on water, therefore, the demand for potable water increases continually in line with world populationgrowth. Recently, many African cities have undergone unprecedented growth in population through migration from rural areas which has led to the growth of cities into sprawling “mega-cities” with large areas of unplanned sub-standard housing with few services. The unplanned expansion of such cities leads to a serious pollution threat to the groundwater and uncontrolled industrial and commercial activity add to the pollution threat (UNEP, 2002). This has been a major problem in developing countries; provision of drinking water has become expensive and difficult. The mainsource of potable water in many of these cities is groundwater, commonly from shallow hand-dug wells and deeper water supply boreholes. In Nigeria, like many other developing countries, open waste dumping system has been the major management option of solid waste disposal. In previous years, management system has been based on collection and dumping out of the city boundaries in conformity with the concept of “out of sight out of mind” (Arukweet al, 2012). But in recent times, the siting and development of residential quarters near waste sites are common due to shortage of building land to cope with the increasing rate of migration and consequent population explosion (Ikemet al., 2002).Prevalence of Malnutrition Among Children Under Five Essay


Adequate nutrition is vital for healthy growth and development during childhood [1]. Malnutrition refers a pathological state resulting from relative or absolute deficiency or excess of one or more essential nutrients [2]. Wasting, stunting, and underweight are among those anthropometric indicators commonly used to measure under nutrition in a population of under-five children [3]. According to the World Health Organization (WHO), wasting, stunting, and underweight are defined as Z-scores less than −2 standard deviations of weight for height, height for age, and weight for age, respectively [4]. Wasting and stunting reflect acute and chronic exposures for nutritional deficiency, respectively. In addition, underweight reflects both acute and chronic exposures for nutritional deficiency [5, 6].Prevalence of Malnutrition Among Children Under Five Essay

Malnutrition among children is one of the most important causes of morbidity and mortality in the world, particularly in developing countries [7]. It is the most important risk factor for the burden of disease causing about 300,000 deaths per year directly or indirectly responsible for more than half of the all deaths in children [8]. Globally, approximately 60 million and 13 million of children are affected with moderate and severe acute malnutrition, respectively [9]. Worldwide reports show that 21.9%, 13.4%, and 7.3% of under five years of age are stunted, underweight, and wasted, respectively [10]. The WHO also estimated that about 5.4 million under-five children die each year with 2.7 million deaths occurred in Sub-Saharan African countries including Ethiopia [11].

Many studies reported the health and physical consequences of child malnutrition include delaying their physical growth and motor development, lower intellectual quotient (IQ), greater behavioral problems, deficient social skills, and susceptibility to contracting diseases. Child malnutrition may also lead to higher levels of chronic illnesses in adult life which may have intergenerational effects, as malnourished females are more likely to give birth to low-weight babies [12, 13].Prevalence of Malnutrition Among Children Under Five Essay

Malnutrition is not a simple problem with a single and simple solution. Multiple and hierarchically interrelated determinants are involved in causing malnutrition [14]. The most immediate determinants are inadequate dietary intake and disease which are themselves caused by a set of underlying factors: household food insecurity, poor maternal/child caring practices, and lack of access to basic health services including lack of safe water supply and unhealthy living environment such as open defecation [15, 16]. In turn, these underlying causes themselves are influenced by economic, political, and sociocultural conditions; national and global contexts; capacity, resources, environmental conditions, and governance [17].

The Ethiopian government has been implementing a number of strategies such as the 2004 National Strategy for IYCF practices, the 2005/2006 National Nutrition Strategy, and the 2008 National Nutrition Program [18–20]. Furthermore, the government has planned to reach the zero-level under nutrition by 2030 [21]. As a result, the country has demonstrated a promising progress in reducing child malnutrition over the past decades. Though the problem of under nutrition has decreased in the country, it still continues to be one of the countries with the highest burden of malnutrition among under-five children in the world causing a significant obstacle to achieving better child health outcomes [22]. The prevalence of underweight and stunting among young children are the highest among Sub-Saharan African countries. Moreover, 51% of under-five children’s deaths are associated with malnutrition where its causes are multifaceted Prevalence of Malnutrition Among Children Under Five Essay

According to the Ethiopian Demographic and Health Survey (EDHS) 2016 report, about 9.7% of the children were wasted, 28.7% of the children were underweight, and 44.4% of the children were stunted with wide regional variations [17, 22]. In Afar Regional State, the prevalence of wasting, stunting, and underweight among under-five children were 19.5%, 50.2%, and 40.2%, respectively, which is the highest as compared to the national average and across other regions [22]. Other earlier studies from other specific regions and localities of the country also indicated the prevalence of wasting in the range 11%–24%, stunting 35–49%, and underweight Prevalence of Malnutrition Among Children Under Five Essay

Although the prevalence of child malnutrition is relatively well documented among agrarian communities and urban dwellers of Ethiopia, evidence on the nature, prevalence, and factors affecting for child malnutrition in pastoralist communities is limited. And, national estimates are also usually not a reflection of the local estimate of child malnutrition. Afar regional state, where pastoralist communities mainly resides, has been identified as one of the hotspot regions in the country with high food insecurity, higher child malnutrition rates, and recurrent onset of droughts [28]. This indicted that investigating the problem and identifying its causative factors within this context is an important step to design appropriate strategies to mitigate the problem. Therefore, with this background in mind, this study aimed to assess the prevalence and associated factors with malnutrition among under-five children in Dubti district, Afar Regional State, Northeast Ethiopia.

2. Methods
2.1. Study Design and Setting
The study was conducted in Dubti district located at a distance of 850 km from the capital, Addis Ababa, and 80 km from the regional capital, Semera, in Northeast direction of Ethiopia. The district has 13 kebeles (the smallest administrative units). The total population of the district was estimated to be 65,314, of which 34,870 and 30,444 are males and females, respectively, as projected from the 2007 census of the district [29].Prevalence of Malnutrition Among Children Under Five Essay

Most of the pastoral community’s income depends on animal breeding. The district has two public health centers, ten health posts, and two private clinics providing health services. The most common childhood illnesses in the district are malnutrition, diarrhoeal diseases, malaria, pneumonia, and measles [28]. A community-based cross-sectional study was conducted from March 01–25, 2017 in the district to assess the prevalence and associated factors with malnutrition among under-five children in Dubti district, Afar Regional State, Northeast Ethiopia, through door-to-door visits. Each child had 6–59 months of age and his/her mother/care giver was chosen by systematic random sampling method and involved in the study.

2.2. Study Populations
All children aged 6–59 months old, and their mothers were the target for the study, whereas the study population consisted of a sample of all households with 6–59 months old children who were residing in the randomly selected kebeles. Those study participants who were residents of the study area for less than 6 months, children’s mother who was seriously ill and difficulty to communicate, and children with physical deformities that hinder height measurements at the time of data collection were excluded from the study.Prevalence of Malnutrition Among Children Under Five Essay

2.3. Sample Size and Sampling Procedure
Sample size was determined based on a single proportion population formula using z2 × p × q/d2 considering the following assumptions: 95% confidence level, estimated proportion (P) of wasting (19.5%), stunting (50.2%), and underweight (40.2%) taken from the previous EDHS report for Afar Regional State [22] and margin of error of 5%. Accordingly, the calculated sample size for prevalence of stunting was relatively largest (n = 384) and was taken as the sample size for this study. Considering design effect of 2% and 10% nonresponse rates, the final sample size was 844.

A multistage cluster sampling method was used to enroll the study participants from the pastoral communities. First, six out of the thirteen kebeles were selected by lottery method. Next, the total number of 6–59 months old children in the selected kebeles was taken from the respective households using the registration at health posts. Then, the calculated sample size (844) was proportionally allocated to the selected kebeles based on the total number of households with 6–59 months children in each kebele. Finally, participants were selected using systematic random sampling technique after identifying the first household randomly and proceeded to the second participant based on the Kth interval. Whenever there were two or more 6–59 months old children, the youngest child was selected to avoid recall bias.Prevalence of Malnutrition Among Children Under Five Essay

2.4. Data Collection Procedures
The questionnaire was developed from the Ethiopian Demographic and Health Survey (EDHS) [22] and other relevant literatures based on the study objectives. The questionnaire was translated in to the local language, Afaraff, for data collection. The questionnaire consisted of socioeconomic and demographic factors, child feeding and caring practices, maternal health factors, environmental health related characteristics, and anthropometrics measurements.

A structured-interviewer-administered questionnaire in a face-to-face manner was used to collect the data from mothers of children 6–59 months of age. Six health-extension workers for data and two BSc nurse supervisors who are fluent speakers of the local languages (Afaraff) including the principal investigator were involved in the data collection process. Prior to the interview, verbal informed consent was obtained from all participants after explaining about the objective of the study, and it was confirmed that the information will be kept confidential.Prevalence of Malnutrition Among Children Under Five Essay

2.5. Measurements
Anthropometric measurements such as weight and height of children were taken using the standard anthropometric measurement procedures outlined in the measurement guide prepared by the Food and Nutrition Technical Assistance (FANTA) project in 2007 [30]. Body weight was measured using a weighing scale in light clothing with no jackets or coats, shoes, and additional clothing to the nearest 0.1 kg on a new calibrated portable scale.

Height of children was measured using a portable stadiometer with no shoes; the shoulders, buttocks, and the heels touched the vertical stand with the head in Frankfurt’s position to the nearest 0.1 cm. For children with 6–23 months of age, recumbent length and for children 24–59 months of age, standing height to the nearest 0.1 cm were measured. MUAC was measured by marking midway between shoulder tip and the elbow tip on the vertical axis of the upper arm with the arm bent at right angle and between the lateral and medial surface of the left arm [30, 31]. Age of each child was also collected from the mother and counter-checked using vaccination cards or other forms of informal recording. All anthropometric measurements were taken twice, and the average of the two measurements was calculated and recorded.Prevalence of Malnutrition Among Children Under Five Essay

The 2006 WHO Anthro 3.2.1 software was used to convert weight, height, and age of child (months) into height-for-age (HAZ), weight-for-age (WAZ), and weight-for-height (WHZ) Z-scores to assess malnutrition taking sex in to consideration. Anthropometric classifications were based on global standards: <−3 SD, <−2 SD, and ≥−2 SD. Children with HAZ, WAZ, and WHZ below −2 SD of the median of reference population were considered as stunted, underweight and wasted, respectively. Children with HAZ, WAZ, and WHZ below −3 SD were also considered as severely stunted, wasted, and underweight, respectively. Moreover, these variables were considered as the dependent variables during statistical analysis. The dichotomous variables stunting, underweight, and wasting were defined as 1 = for stunted and 0 = for not stunted, 1 = for underweight and 0 = for not underweight, and 1 = for wasted and 0 = for not wasted, respectively [16, 32].Prevalence of Malnutrition Among Children Under Five Essay Child feeding practices such as exclusive breastfeeding (EBF) were understood as feeding a child only breast milk without anything else for the first six months of life, with the exception of medicines for therapeutic purpose [33]. A 24-hour recall method (from sun rise to sun rise) was used to assess dietary diversity practices. This was based on the mother’s recall of foods given to her child in the previous 24 hours prior to the interview date. Then, minimum dietary diversity was estimated using information collected from the 24-hour dietary recall. Minimum dietary diversity was fulfilled if a child had received food from four or more food groups from the seven WHO food groups in the last 24 hours preceding the survey [34]. The seven food groups used included were grains, roots, and tubers; legumes and nuts; dairy products (milk, yogurt, and cheese); flesh foods (meat, fish, poultry, and liver/organ meats); eggs; vitamin-A rich fruits and vegetables; and other fruits and vegetables. Moreover, minimum meal frequency was fulfilled if breastfed child with the of age 6–8 months and 9–59 months received a minimum of two or three meals with one to two snacks and three or four meals with one to two snacks per day, respectively [33, 34].Prevalence of Malnutrition Among Children Under Five Essay ORDER HERE NOW Food security status of the households was determined based on nine standard Household Food Insecurity Access Scale (HFIAS) questions that were developed for this purpose by Food and Nutrition Technical Assistance (FANTA). The respondents were asked about the amount and variety of meal eaten and the occurrence of food shortage for the household members, causing them not to eat the whole day or eat at night only, in the past four weeks before the survey. Then, food-secure households were coded “1” and food-insecure ones “0” for further analysis [35, 36]. Child immunization status of children (full, partial, or never) was also checked by observing the immunization card, and if not available, mothers were asked to recall it. BCG vaccination was checked by observing scar on right (also left) arm. 2.6. Data Quality Control To ensure data quality, the English version questionnaire was translated into the local language Afaraff and then back to English to maintain its consistency. Pretest was conducted on 42 subjects (5% of the sample) in kebeles not in the study for necessary modification. Two-day training was given to the data collectors and supervisors before the actual date of data collection. Continuous supervision was done by the supervisors and principal investigator on daily bases.Prevalence of Malnutrition Among Children Under Five Essay 2.7. Statistical Analysis Data entry and analysis was done using EPI data 3.1 and SPSS version 20.0, respectively. Anthropometric indices were calculated using the 2006 WHO Anthro 3.2.1 Software. Descriptive analysis was used to describe the percentages and frequency of sociodemographic characteristics and other relevant variables in the study. Bivariate and multivariable logistic regression analysis was used to identify the factors associated with child malnutrition. Both crude and adjusted odds ratios together with their corresponding 95% confidence intervals were computed to see the strength of association between the outcome and independent variables. All independent variables that were associated with the outcome variables (wasting, stunting, and underweight) in bivariate analysis (with value < 0.20) were included in the final multivariable logistic analysis. A value of < 0.05 was considered to declare the result as statistically significant. The Hosmer–Lemeshow test was performed for model fitness in the final model, and value > 0.05 was considered a good fit. The result was presented in text, tables, and graphs based on the types of data.

2.8. Ethical Considerations
Ethical clearance was obtained from the College of Health Sciences of Samara University, Research and Ethical Review Committee (RERC). Then, officials at different levels in the study area were communicated through letters from Afar National Regional Health Bureau. Letters of permission were obtained from district administrative and health offices. Verbal informed consent was obtained from each participant prior to the interview after explaining the purpose of the study.Prevalence of Malnutrition Among Children Under Five Essay

Introduction Malnutrition is the most common nutritional disorder in developing countries and it remains one of the most common causes of morbidity and mortality among children worldwide. Aim To identify the prevalence of malnutrition (underweight, stunting and wasting) among children under 5 years old living in Khartoum state, Sudan. Material and methods A cross-sectional community-based descriptive study was conducted, to collect primary information from households using a scientific questionnaire, anthropometric measurements (mid-upper arm circumference – MUAC, weight and length/height), and clinical evaluations of the malnourished children to check the presence of severe protein energy malnutrition (PEM). Results and discussion The results showed that socioeconomic factor, poor nutrition, and mothers’ knowledge and feeding practices led to increase in the prevalence of malnutrition. MUAC indicator showed that 20.9% of children were badly nourished and 79.1% of the children were well nourished. In addition, to poor economic situation, the study found that about 15.4% of children were underweight, 8.8% were moderate underweight and 6.6% were severe underweight. The prevalence of wasting was 21.1% (12.3% moderate and 8.8% severe) and the prevalence of stunting was 24.9% (15.1% moderate and 9.7% severe). The World Health Organization standard showed that the prevalence of global malnutrition, moderate malnutrition and severe malnutrition was 12.8%, 8.0% and 13.6%, respectively. The National Center for Health Statistics reference showed that the prevalence of global malnutrition, moderate malnutrition and severe malnutrition was 23.1%, 10.2% and 12.9%, respectively. Conclusions We conclude that improvements in child feeding, and better maternal education are needed to maintain the children’s nutritional status.Prevalence of Malnutrition Among Children Under Five Essay

Dumpsites have been identified as one of the major threats to soil and water resources, receiving a mixture of municipal, commercial and mixed industrial wastes. The depressions into which solid wastes are often dumped include valleys and excavations. Studies on the effects of unlined waste dumps on the host soil andunderlying shallow aquifers have shown that soil and groundwater system can be polluted due to poorly designed waste disposal facilities (Amadiet al., 2012). Uncontrolled waste dumpsites threaten the groundwater supply as movement of leachates from dumpsites through the soil and the aquifers pose a risk to the environment and human health. Waste placed in dumpsites or open dumps are subjected to groundwater underflowor infiltration from precipitation (Moret al., 2006). The presence and potential exposuresof the community to groundwater contaminants may contribute to the predilection of human health impacts, from simple poisoning to cancer, heart diseases and teratogenicabnormalities (Su, 2008).Prevalence of Malnutrition Among Children Under Five Essay

Release of pollutants through leachates from both functional and abandoned dumpsites pose a high risk to nearby soil and groundwater if not adequately managed (Ikemet al., 2002). Leachate percolating into the groundwater is a mixture of highly complex contaminants such as potentially toxic metals(lead, mercury, cadmium, chromium etc) ; persistent organic pollutants (POPs) (dioxins, furans, polycyclic aromatic hydrocarbons (PAHs), polybrominateddiphenyl ethers PBDEs); inorganiccompounds (such as ammonium, sulphates, chlorides) and as well as bacterial contamination – total coliform and feacal coliform (Moret al., 2006; Longe and Balogun, 2010; Oyeku and Eludoyin, 2010; Agrawaetal., 2011 and Galarpe and Parilla, 2012). Therefore considering possible impact to surrounding environment brought by dumpsites is inevitable.Prevalence of Malnutrition Among Children Under Five Essay

Despite the enormous resources and efforts that have been committed to waste management, refuse collection and disposal remains a major problem in Kaduna metropolis. Kaduna is one of the most populous cities in Nigeria; hence enormous pressure is put on the environment due to huge amounts of solidwaste generated daily. The residents make a heavy demand on resources and at the same time, generate large quantities of solid waste. Generally, these wastes are not treated; they are transferred to the several dumpsites, where they are openly burnt. The overwhelming environmental significance and impact of leachates on soil and nearby groundwater and surface water has becomea great concern because of its serious threat to the quality of life of human beings that depends largely on water to sustain their livelihood.Prevalence of Malnutrition Among Children Under Five Essay

Kaduna and its environs is littered with several dumpsites among which are those located atKurminMashi, Kakuri, SabonGari and Tudun Wada. Thisresearch work is to cover that of Tudun Wada as a result of its proximity to the residential houses, the population density of the area and also its old age of waste accumulation. Therefore, soil samples and groundwater from Tudun Wada around a dumpsite are assessed for the level of soil pollution and groundwater contamination through leachates percolation from the dumpsite.Prevalence of Malnutrition Among Children Under Five Essay

1.2 Statement of the Problem

Environmental impact assessment of potential health hazards facilities on their immediate environment ought to be a routine exercise by appropriate bodies such as KEPA to proactively prevent outbreak of preventable diseases. However, the unprecedented rate of growth of such facilities in Kaduna is so overwhelming, thereby requiring the intervention of unsolicited but enlightened workers such as the academics for this routine monitoring.

1.3 Significance of the study

Effect of extent of environmental contamination of the groundwater and immediate soil in the area of study will be established by the work. Mitigation and amelioration measures will be suggested, hence negative health issues related to water and soil pollution will be minimized as a result of the work.

1.4 Aim and objectives of the study

The aim of this research is to assess the impacts of a refuse dumpsite in Tudun Wada,

Kaduna on the quality of groundwater and arable soil within the area.Prevalence of Malnutrition Among Children Under Five Essay

The Objectives are:

The assessment of the level of impact of the dumpsite on the quality of the immediate soil and groundwater.

Suggestion of mitigation and amelioration measures.

1.5 Scope of the study

This research is to cover the assessment of impacts of the refuse dumpsite in Tudun Wada, Kaduna on the quality of its surrounding soil and groundwater and to provide remediation and amelioration measures were the following parameters will be analyze, pH, conductivity, Totao dissolved solid, Dissolved Oxygen, Biological Oxygen Demand, Total alkalinity, Chloride content, Total hardness, Nitrate, Phosphate, Copper, Cadmium, Chromium, Iron, Lead, Zinc, Total coliform count and Hetet Prevalence of Malnutrition Among Children Under Five Essay

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