TITLE PAGE

ASSESSMENT OF NUTRITIONAL STATUS OF UNDER FIVE CHILDREN AND THE

ASSOCIATED FACTORS IN BABANDODO PRIMARY HEALTH CARE ZARIA CITY,
KADUNA STATE

Abstract
Malnutrition is among the leading cause of deaths in children below age five in the
developing countries. For MDG goal to be met, under-five malnutrition is to be reduced
to the barest minimum if not eradicated. This is aim at assessing the nutritional status
among under -five children in Babandodo primary health care Zaria city. A descriptive
cross sectional survey design was used in a sample size of 272 mothers with 544 under-
five children. Questionnaire, observational checklist and instrument for anthropometric
measurement were used to collect data using convenient sampling technique. Data
collected were analyse using descriptive statistics, hypothesis were tested using chi-
square at 0.05 significant level. Result show that 196(36.1%) of the children were
underweight with 250(46.0%) of them been stunted and 138(25.4%) wasted, out of
36.1% underweight children, 112(20.6%) were boys and 84(15.4%) girls. In addition,
of the 25.4% wasted 72 (13.2%) boys and 66(12.1%) were girls. Also mother’s level of
education was a significant predictor for weight- for-age (p=0.042 AOR: 2.300, 95%
CI: 1.032 – 5.127), and mother’s age for being a strong predictor for child wasting with
p= 0.012 AOR: 3.462, 95% CI: 1.313 – 9.131). To improve nutritional status of under-
five children, education of the mothers/care givers should be made compulsory.
Information on good nutritional practices should be provided by health worker at all
level of health care. Government should provide at least one square meal which is
fortified with adequate nutrient for all under-five children.

CHAPTER ONE
1.0 INTRODUCTION
This chapter deals with background of the study, statement of the problem, objective of
the study, research questions, significance of the study, scope of study and operational
definition of terms.

1.1 Background to The Study

Nutrition is an important part of a child’s growth and development, especially the first

two years of life which are considered to be the window of opportunity where we can

improve the wellbeing of a child (WHO, 2016). Nutrition is involved in each life cycle,

starting in the womb (foetal), infant, child, adult, and elderly. The period of the first two

years of life is considered to be a critical period, because growth and development

occurs very rapidly during this period. Poor Nutrition during this period can cause

malnutrition that creates permanent disorders, which means, it cannot be recovered

even if the nutritional needs can be fulfilled (Jafar, 2014). Malnutrition is a pathological

state resulting from inadequate nutrition. It is broadly classified as under- nutrition, as a

result of insufficient intake of energy and other nutrients, and over-nutrition due to

excessive consumption of energy and other nutrients (Susanne, 2015). While nearly 12

million children die each year in developing countries mainly from preventable causes,

the death of over 6 million (55%), are either directly or indirectly attributable to

malnutrition; mainly under nutrition (UNICEF, 2017). Malnutrition is said to be the

underlying factor of about 80% of childhood deaths in Nigeria

Federal Ministry of Health (FMOH, 2013). Studies have shown that many of these

children are wasted, stunted or malnourished. According to a cross-sectional descriptive

study by Badake, Maina, Mboganie, Muchieme, Kihoro, Chelemo and Mutea (2014) to
determine the nutritional status of children under five years and associated factors in

Mbeere South District in Kenya. Result shows that up to 39% of the children were

stunted; 7.1% were wasted; and 18.1% underweight. The prevalence of stunting and

wasting was significantly higher in boys than in girls (χ =6.765, P =.034) and (χ=

13.053, P = .036), respectively. Similarly Sufiyan, Bashir, and Umar (2015); using a

multistage sampling technique aimed to assess the effect of maternal literacy on the

nutritional status of children under-five in Babban-dodo, Zaria, North-western Nigeria,

revealed that out of the 300 children studied, 87 (29%) were found to have

underweight, 21 (7%) were wasted, and 93 (31%) were stunted, majority (65%) of the

mothers/caregivers have no form of formal education and a significant statistical

association between maternal literacy status and occurrence of malnutrition was found

(specifically stunting) among the children studied (X2 = 26.2, df = 1, P < 0.05). More

also, Galgamuwa, Iddawela, Dharmaratne and Galgamuwa (2017), in Sri- Lanka,

reviewed that a total of 547 children who participated in the study 35.6%, 26.9% and

32.9% of children were under weight, stunting and wasting respectively.

Furthermore Gupta, Chakrabarti and Chatterjee (2016), in a cross-sectional study

aimed to evaluate the effect of various maternal factors on the prevalence of

underweight, stunting and wasting among under-five children in University of Calcutta,

India. The findings reveal that prevalence of underweight and stunting among children

was higher where mother’s age was below 20 years indicating that mother’s age

showed significant effect (p=0.0045) on the prevalence of stunting which implies that

the risk of early marriage of females can result in developing long term under nutrition
of child. Other studies have attributed malnutrition among under- five to occupation and

education of mothers or caregiver (Adenike, Abayomi, Olufemi, and Olayinka, 2006).

Also, Akorede and Abiola (2013), in Akure Ondo revealed that household size had a

negative correlation with the nutritional status of the children (underweight) (r = -0.14;

p<0.05), however household income was positively correlated with nutritional status of

the infants (Stunting) (r = 0.18; p<0.05). Other factors according to Akorede are level of

mothers education which positively correlated with nutritional status of the children

(stunting) (r = 0.23; p<0.05) and hygienic practice (food preservation) which positively

correlate between infants nutritional status (under-weight) (r = 0.15; p<0.05). Similar

findings was also reported by Sufiyan, Bashir, and Umar (2016) in North-western

Nigeria, were majority (65%) of the mothers/caregivers have no form of formal

education. There was a significant statistical association between maternal literacy level

and occurrence of malnutrition (specifically stunting) among the children studied. (X2

= 26.2, df = 1, P < 0.05). Adetoro and Amoo (2014); using data from the Nigeria

Demographic and Health Survey (NDHS) to investigate the predictors of child (aged 0-

4 years) mortality in Nigeria, also revealed that the cross- tabulation analysis shows that

that mortality rate was highest (49.14%) for children of illiterate mothers and lowest

(13.29%) among mothers with higher education while in the logistic regression

analysis, education of both parents and occupation of mothers were found statistically

significant to reduction in child mortality rate.

1.2 Statement Of Problem

 Under nutrition can lead to substantial problems in mental and physical development. In

children, the impact of under nutrition on the cognitive abilities may lead to poor school

achievement in later years. Under nourished children can also suffer several diseases

from nutrient deficiencies. From the researchers’ observation when on community

posting to Babandodo primary health care Zaria city, they marvel at how frail and

malnourish some of the children in this community are looking, this generated the

curiosities that lead to this study.

Decipite the intervention of UNICEF, WHO, individual, government and other NGO'S

the route of malnutrition is on the increase. It is based on the above that the researcher

developed interest to assess the nutritional status of under five children in Babandodo

primary health care, Zaria city.

1.3 Objective of the study

1. To assess the socio-demographic status of mothers attending primary health

care Babandodo Zaria city.

2. To examine the nutritional status of the under five children attending

primary health care Babandodo Zaria city.

3. To assess the relationship between nutritional status of the under-five

children and socio-demographic characteristics of their mothers.

4. To determine factors associated with nutritional status of under five

children.
 1.4 Research Question

1. What is the soico demographic status of mother's attending primary

health care Babandodo Zaria city?

2. What are the nutritional status of under five children attending primary

health care Babandodo Zaria city?

3. What is the relationship between nutritional status of under five children

and the socio demographic characteristics of the mother's?

4. What are the factors associated with nutritional status of under five

children?

1.5 Significance of the study

Findings from this study will reveal the nutritional status of the under-five children

in Babandodo primary health care Zaria city, this will be useful in programme

planning strategies, assessment and evaluation to better nutritional status of the

children and to enhance mothers’ nutrition knowledge, improve perception on the

importance of immunization and antenatal services. This will further help to reduce

child morbidity and mortality. Findings from this study will add to the existing

literatures and may be used to increase the knowledge of the mothers on required

nutrition for under-five children in Babandodo primary health care Zaria city.

The study will equally add to the existing body of knowledge on the subject matter.

Students undergoing research work similar to the present study who may wish to

use this work as a reference material or a spring board for their own work will find
this work really useful.

1.6 Scope of the study

The study is on assessment of nutritional status of under five children and the

associated factor among mother's attending Babandodo primary health care Zaria

city, Kaduna state

1.7 Operational definition of terms

Assessment: the action or an instance of making a judgement about something.

Nutrition: the study of food and liquid requirements of human beings or animal for

normal physiological function, including energy need, maintenance, growth ,activity

, reproduction and lactation.

Status: a state or condition

Factor: one of the contributing causes in any action.

Primary health care: refers to essential health care that is based on scientifically

sound and socially acceptable methods and technology which makes universal

health care accessible to all individual and family in a community through their full

participation, and at a cost that the community, can afford to maintain at every stage

of development in the self reliance and self determination.

 CHAPTER TWO
REVIEW OF RELATED LITERATURE

2.0 INTRODUCTION
Literature is abundant in the area of nutritional status both in developed and developing
countries, including Nigeria. The available literature was organized and presented under the
following. Conceptual framework nutrition and nutrients, nutritional status, socio demographic
factors associated with nutritional status . Theoretically framework precedemodel. Empirical
review.

2.1 Conceptual Framework

This section examines the concepts of nutrition, nutrients, status, nutritional status, and primary
school children, socio-demographic factors associated with nutritional status. These concepts
have been defined by many and in different ways. A few of such definition relevant to this work
was reviewed.
2 1.1 Nutrition and nutrients.
Nutrition has been defined by many scholars in different ways, although there is a common
conceptual focus. Parks (2013) defined nutrition as the science of food and its relationship to
health. It is concerned primarily with the part played by nutrients in body growth, development
and maintenance. Alade (2015) defined nutrition as the branch of science which deals with food,
the nutrients and other substances therein; their action, interaction and balance in relation to
health and disease and the processes by which human beings ingest, absorbs, transports, utilizes
and excretes food substances from the body. Nutrition as defined by Basevanthappa (2016) as a
combination of dynamic process by which the consumed food is utilized for nourishment and
structural and functional efficiency of every cell of the body. Nutrition can be defined as food or
nourishment needed to keep children growing, healthy and viable. It also refers to the process of

providing or receiving food or other life-supporting substances (Stevie, 2014). Nutrition can

be termed as the procedure wherein one nourishes oneself with the intake of nutrients in the
form of food. The principal motive for such a process is that it is essential for growth and
development of the body. It is also crucial in the substitution of tissues (Robard, 2013).
Holford (200l14) defined nutrition as the science that deals with all the various factors of which
food is composed and the way in which proper nourishment is brought about. The intake of food
and supplements in the body is utilized for maintaining health, growth and energy. This is made
possible with the basic nutrients available in the food. In this study, nutrition is a combination of
dynamic process by which the consumed food is utilized for nourishment and structural and
functional efficiency of every cell of the body.
Harper(2014) defined nutrients as a substance present in food and used by the body to
promote normal growth, maintenance, and repair. The major nutrients needed to maintain health
are carbohydrates, fats, proteins, minerals, vitamins, and water. For good nutrition children
should eat a well-balanced diet, that is, one that provides an adequate amount of each of the
classes of nutrients each day, furnishing at the same time adequately but not excessive number of
calories for their body’s energy needs. Children require relatively larger amounts of nutrients and
calories because of their rapid growth. Payne and Hahn (2013) opined that nutrients are elements
in foods that are required for the growth, repair and regulation of body processes. The food
required for proper nutrition fall roughly into six major classes carbohydrates, proteins, fats,
vitamins, minerals, and water.
Carbohydrates (starches and sugars) provide a readily available energy source. Panebianco
(2019) posited that surplus carbohydrates are also converted by the body to glycogen and fat, the
storage forms of calories for energy and to some of the amino acids used in protein synthesis.
Basavanthappa (2018) emphasized that carbohydrates which are the main source of energy are
required by school children to carry out daily activities and exercise. Examples of sources of
carbohydrates are cereal, millet, white rice, maize, yam, cassava, potatoes.
Protein in the diet provides amino acids for forming body proteins. Insel and Roth (2015) posited
that it includes the structural proteins for the building and repairing of tissues, and the enzymes
for carrying out the metabolic processes. Payne and Hahn (2016) added that protein may be used
as a source of energy when the preferred fat and carbohydrate supply runs low. A body that is in
the process of building itself (such as that of growing primary school children) will need a
greater proportion of proteins than the one that is fully grown and utilizes protein merely for
repair of worn-out tissues. Children may require two to three times one gram of protein per
kilogram of body weight per day (Halbert, 2017). Protein includes meat, eggs, cheese, milk,
vegetables, beans, and grains. Protein deficiency retards growth in children, delays healing, and
hampers the functioning of various body organs.
Fats (fats and oils) in the diet provide a concentrated source of energy. Insel and Roth (2019)
emphasized that one gram of fat supplies about 9 calories as opposed to only 4 calories per gram
of carbohydrates and protein. Fats in the body act as a source of stored energy, supply physical
protection and insulation for tissues and form important portions of cell membrane structure. Fats
also aid in the absorption of the fat-soluble vitamins (vitamins A, D, E and K) from the intestine
and its excess can lead to overweight, heart disease. Milk, butter, meat, and oils are important
sources of fat (Payne & Hahn, 2014)
Vitamins are classes of organic compounds categorized as essential nutrients. Parks (2016)
opined that vitamins are required by the body in very small amounts for normal growth,
maintenance of health, vision, resistance to infection. Deficiency of vitamins exposes school
children to poor growth, scurvy, pellagra, and reduces resistance to infection. Sources of
vitamins are carrot, green, spinach, liver, milk, apricots (Payne & Hahn, 2015).
Mineral are composed of inorganic materials necessary for formation of body structures, and for
maintenance of health. The most important minerals are iron, calcium, phosphorus, potassium,
sulphur, sodium, chlorine, and magnesium. Those required in less quantity are iodine copper,
zinc, cobalt, fluorine, manganese. They are found in root crops, green vegetables, milk, broccoli
and fruit. Deficiency of minerals in children leads to decrease sense of taste and appetite, hair
loss, poor growth and development, (Parks, 2019).
Water is very essential to the body. It provides the medium for nutrient and waste transport;
controls body temperature, and plays a key role in nearly all the body of children’s biochemical
reactions. Sources of water are fruits, vegetable, fruits and vegetable juice, milk and iron
caffeinated soft drink. The deficiency leads to dehydration and death (Payne & Hahn, 2014). All
these nutrients combined in a balanced proportion and used by body entails the term nutrition.
Good nutrition requires a satisfactory diet, or which is capable of supporting the primary school
children consuming it, in a state of good health by providing the desired nutrients in required
amounts. It must provide the right amount of fuel to execute normal physical activity. If the total
amount of nutrients provided in the diets is not sufficient, a state of under nutrition will develop.
Westenhoefer (2021) ascertained that adequate nutrition of school aged children will also ensure
they grow to their full potential, and provide the stepping stones to a healthy life. Adequate
nutrition will help children develop maximal intelligence (IQ) and well being. Malnutrition and
its consequences will be prevented by eating the right kinds and amounts of foods.
(Benton,2017). Children need good nutrition because their bodies are growing and developing.
(Heber, 2018).Harvey (2019) emphasized that poor growth and development will result if the
whole children’s health are of poor status.
2.1.2 Nutritional status.
Status is the state or condition of a person or thing (Anderson, 2004). Hornby (2005) defined
status as the situation at a particular time. Merriam (2007) referred to status as a particular state
which when it is not normal can be adjusted as the case may be, and this definition was adopted
in this present study.
David (2017) defined nutritional status as a state of the body in relation to the consumption and
utilization of nutrients. Winstead (2019) defined nutritional status as the state of a person’s
health in terms of the nutrients in his or her diet. Jeejeebhoy, Detsky and Baker (2020) defined
nutritional status as intake of a diet sufficient to meet or exceed the needs of the individual that
will keep the composition and function of the otherwise healthy individuals within the normal
range. Nutritional status is the state of the body’s nutritional health (Whitney, Cataldo,
Debmyne & Rolfes, 2017). Rashed (2018) added that nutritional status is the current body status
of a person or a population group, related to their state of nourishment (the consumption and
utilization of nutrients). He further maintained that it is determined by a complex interaction
between internal constitutional factors like age, sex, nutrition, behaviour, physical activity and
disease and external environmental factors like food safety, cultural, social and economic
circumstances. In this study nutritional status was referred to as the state of a person’s health in
terms of the nutrients in his or her diet.
The presence of under nutrition in children is indicated using these three anthropometric
parameters (weight-for-age, height-for-age and weight for-height) and by comparing them with
internationally accepted reference standards. Children that have a low height-for-age, a z-score
below two standard deviations of the reference population mean (-Z2-score), such children are
categorized as “stunted”. Similarly, WHO (2015) stated that a low weight-for-age is diagnostic
of an “under- weight” children, while a low weight-for-height is indicative of “wasting”
children..
Schapiro (2016) explained that the nature of children seems obvious in terms of what they value
when making choices and their philosophical importance seems negligible due to their childish
thinking but parents should acknowledge that their children have wills though they are
essentially the property of their parents by properly guiding and setting good eating examples for
them to do likewise. Lefrancois (2017) asserted that the trend of physical growth that continues
through children’s growth is gradual decrease in the growth of fatty tissue, coupled with
increased bone and muscle development and if children are well nourished, between the age of 6
to 12 year old, they grow (4.4 to 6.6 cm) and gain about 5 to 7 pounds (roughly between 2 and
2.75kg) each year. Mclaren, Burman, Belton and Williams (2018) opined that school age
children are often blamed for their poor eating habits, which include eating junk foods and fast
foods. These foods also tend to be low in nutrients such as calcium vitamin A and high in
sodium. Although excessive intake of ‘fast’ or ‘junk’ foods may jeopardize the nutritional status
of school age children, their inclusion as part of a well-balanced diet is not of concern. However,
there could be a “junky” diet if a child ate one type of food in excess and did not follow the
general principles of good nutrition, including a varied selection from all the basic food groups.
Kings and Burgess (2020) lamented that school age children need to eat good mixed meal so
that they grow properly and have plenty of energy to work, play and learn. Whitney, Cataldo,
Debnyne and Rolfes (2019) indicated that sound nutrition throughout childhood promotes
normal growth and development, facilitates academia and physical performances; help prevent
obesity, diabetes, heart disease, cancer and other degenerative diseases. They maintained that
candy, cola and sweet must be limited in children’s diets because children cannot be trusted to
choose nutritious foods on the basis of taste alone, the preference for sweets is innate, and
children naturally gravitate to them.
Furthermore, Whitney et al (2017) asserted that common sense dictates that it is unreasonable to
expect anyone to learn and perform work when no fuel has been provided. By the late morning,
discomfort from hunger may become distracting even if a child has eaten breakfast. Chronically,
underfed children suffer more and the problem children face when attempting morning school
work on an empty stomach appears to be at least partly due to low blood glucose. The average
child up to the age of ten years or so need to eat every 4 to 5 hours to maintain a blood glucose
concentration high enough to support the activity of the brain and nervous system because the
brain is the body’s chief glucose consumer, and a child’s brain is as big as an adult. A child’s
liver is the organ responsible for storing glucose (as glycogen) and releasing it into the blood as
needed. A child’s liver cannot store more than about 4 hours worth of glycogen, hence, the need
to eat fairly often. Teachers who are aware of the later-morning slump in their classrooms wisely
request that a mid morning snack be provided, it improves classroom performance all the way to
lunchtime.
2.1.3 Socio-demographic factors associated with nutritional status of primary school
children.
Gender is meaning assigned to male and female (Hesse-Biber & Carger, 2020). Gender is
defined by Food and Agricultural Organization (FAO, 2015)) as ‘the relations between male and
female.  Kabeer (2013) referred gender as the social construction of relationship between males
and females. In the context of nutrition, female are more likely to reduce their food intake as a
coping strategy in favour of other household members in situation where food is in short supply.
Lefrancois (2016) emphasized that the growth spurt in height and weight during the period of
children’s growth are generally more rapid in males where as females tend to retain a higher
percentages of body fat.
Age has influence on nutritional status of school children. Caliendo (2015) emphasized that few
primary school children are capable of planning a well-balanced diet each day without some
adult assistance, nor are they usually able to prepare complete meals that will meet their needs
because it is not enough simply to feed a child with sufficient calories to prevent hunger; it is
also necessary to be sure that the diet includes adequate amounts of milk, breads and cereals,
meat, fruits, and vegetables to provide necessary protein, vitamins, and mineral. Unfortunately,
the staggered scheduling in some families may make this arrangement impractical
Bender and Bender (2017) pointed out that age of school children contributes to the choice of
food they consume. During the primary school period there is an increasing tendency to consume
more foods that are low in nutritive value and high in calories. Children of this age begin to be
increasingly independent, particularly with regard to snacks. The small amount of financial
independence resulting from allowances, odd jobs, and paper routes enables males and females
to buy candy or pop, both of which fill little nutritional need and are superfluous in the primary
school children’s diet.
Level of education of parents has strong influence on nutritional status of primary school
children. This means that children with good access to diet and health are due to information
received about nutrition which is capable of changing their nutritional status. Also, the more
knowledge about the nutrition the parent, caregiver and guardian have the better the nutritional
status of children (Mclaren, Burman, Belton & William, 2017). Gill, Prasada and Shrivastava
(2018) opined that school children have little or no knowledge of what constitute adequate diet
so they go for candy, cola and other concentrated sweets which are nutrient deficient. Some of
them skip meals for fear of not liking a particular food without considering the implication which
could be poor performance in school, illness, wasting, stunting and underweight. Akinsola
(2016) posited that the major problem was the insufficient knowledge and understanding of how
to plan and choose good food and when the diet is deficient in any diet for a long period disease
can occur.
Reports from researchers indicate that location has influence on nutritional status. According to
Sunder Lal et al (2019) higher proportions of rural children are suffering from protein energy
malnutrition (PEM) compared to urban areas. Urban slum areas have as much prevalence of
PEM as in rural areas and more often the situation of PEM in urban slum areas may be worse
than rural areas because of poor living conditions and presence of all the risk factors for
malnutrition. As opined by Florentino, Villavieja and Lana (2020) that children from urban area
tends to consume more total food, more animal foods, fats and more beverages. Higher intake
of calories, protein, iron, and vitamins A, with less physical activities results in higher proportion
of over nutrition and a lower proportion of under nutrition. Anwer and Awan (2013 emphasized
that the difference between rural and urban children was significant. Urban children now spend
time at sedentary in-door activities such as watching television or playing computer games.
However, rural children perform more physical activities with less food available and, as a
consequence, tend to be underweight.
Children from rural area are of large low-socio economic group. This has effect on their diet
which is deficient in all nutrients except carbohydrate, iron and thiamine. The effect is that they
suffer from malnutrition, sign of protein-calorie deficiency, vitamin A, vitamin D and essential
fatty acid deficiency, and malnutrition has a dampening effect on their growth potential
particularly during the spurt period.(Adesola,2016).Hence urban children were over nourished
more than their rural compatriots.
Income had influence on the nutritional status of primary school children.Lucas and Gill (2014)
opined that household food shortages may be temporary, seasonal or persistent and have many
causes including low income and low food production.Also middle income groups eat twice as
much fat and have much more obesity, underlying causes are environmental and social factors
such as sedentary lifestyles, availability of transport and fat-rich fast meals. This is in line with
FAO (2015) report that household must have sufficient income to purchase the food they are
unable to grow.
Qureshi (2017) opined that cash income per capita is often substantially higher in urban
communities than in rural population but nutritional standards are often lower .In some families
money is used for the necessities of life other than food.for these reasons the cash available for
food may be reduced while in the urban perishable,protective foods are usually less readily
available and there is practically no opportunity for the urban as opposed to the rural dwellers to
produce his own food.The commonly employed monthly system of wage payment also leads to
difficulties in that there is considerable variation from week to week in the food consumption of
monthly paid workers.Perhaps it is not suprising to find that pay day is often the family feast
day,and expensive food stuffs,meat,eggs and milk are eaten at the beginning of the month,ewhile
towards its end the staple food predominates and the number of meals may be reduced,families
tend to economize on food and to be extravagant in other things
Number of children in the family (family size) is a contributing factor in the nutritional status of
primary school children. It must be taken to mean that standard of living; naturally falls if the
size of family increases and income remains constant. The ideal family size in Nigeria according
to National population policy (2018) classification is six (parents and children). Any number less
or equal to six is regarded as small family, while number greater than six constitutes larger
family size in this study. Typically large family size has significant relationship with much
greater risk of poverty (Maxwell 2015)
 NUTRITIONAL STATUS

Nutrition

Food Nutrients
Demographic factors
Carbohydrate
Gender
Protein Children Age
c Fat
Level of Education
Mineral
Location
Vitamin
Income
Water
Number in family

Height-for-age (Stunting) Height-for-weight Weight-for-age Normal (Well nourished))

Over-weight
Figure I: Diagrammatic (Wasting) (Underweight)
representation of conceptual framework of Nutritional status of
primary school children

2.2 Theoretical Framework

Theories and models of human behaviour attempt to explain the reasons behind alterations in
individual’s health behaviour patterns, (National Institutes of Health-NIH (2003). These theories
cite environmental, personal and behaviour characteristics as the major factors in health
behavioral determination. The theoretical framework relevant for the study was the precede
model.

The Precede model

The precede model developed by Green, Kreter, Deed, and Patridge (2017) has served as a
theoretical framework in health plans aimed at diagnosing the health problems of a community,
understanding the factors that influence the people’s behaviour and developing interventions to
promote healthy behavior. Ottoson and Green (2015) maintained that the model are six phases
grouped into four thus; epidemiological and social diagnosis, behavioral diagnosis, educational
diagnosis (predisposing, enabling and reinforcing factors) and administrative diagnosis.The
present study anchored on the phases that related to the study thus the first phase is
epidemiological and social diagnosis is based on identification of health problem like nutritional
status of primary school children whether some of them are underweight, wasted and stunted.
The second phase (behavioural diagnosis) involves intervention that should be focused to the
identified nutritional status.
The third phase(educational diagnosis) is to identify the factor that nurture the existence of the
nutritional status, whether predisposing factor like level of education of some parents as it
concerns adequate diet, the age of the children which detects their perception, attitude and value
to a particular food nutrient because it tastes sweet, enabling factors such as income and access
to all the food nutrients and when not available the school children are prone to the consequences
of poor nutrition and reinforcing factors like family size and members, classmates and peer-
group whether the food eaten among these children are influenced as a result of what their
family members give to them and what they see them eat or the peer- group eats junk food and
skip morning food, with these their nutritional status may be hampered. The other phase geared
toward intervention that will empower the children to eat adequate diet such as nutrition
education program, parents eating with their children for them to learn how to eat good food.
Precede model is a participatory model for creating successful community health promotion and
other public health interventions. It is based on the premise that behavior change is by and large
voluntary; improving nutritional status of school children are more likely to be effective if
adequate diet are planned and eaten with the active participation of children who would have to
implement them(Ransdell,2014). Akinsola (2016) asserted that there are factors that can
 predispose an individual to adopt or not adopt a behavior or practice. These include level of
knowledge, attitudes, perception, beliefs and values-for example, some people in believe that pot
belly and hair loss, which often results from kwashiorkor in children, is not a sign of disease but
part of growth and development process among children. Therefore, they believe that
kwashiorkor cannot be prevented or cured; the factor responsible for this is the level of
knowledge about the cause of the disease.
Malnutrition of primary school children may be attributed to some socio-demographic variables
of gender, age, location, income, family size and level of education indicated in this study which
may predispose school children to stunting, wasting and underweight and some may be normal.

Precede model of nutritional status

Educational diagnosis Behavioral diagnosis Epidemiological and social diagnosis

Identify health problem

*Predisposing factor (level of Intervention to (stunting, wasting and
education of the parents, age, identify under weight)
location, gender, family size) nutritional status
*Enabling factor (income and
access to adequate diet)
*Reinforcing factor (Parents
and peer-group

Children

Height-for-age Height-for-weight Weight-forage Well nourished Over-weight

(Stunted) (wasting) (under weight)

Adapted from (Green et al.2015) because the theory has the phases that related to the present
study.

Figure II Theoretical Framework

2.3 Empirical Review
A good number of researches have been conducted on nutritional status. Those related to this
study was reviewed and presented.
A study carried out by Shariff, Bond and Johnson (2019) on nutritional status of primary school
children from low income households in Kuala Lumpur. Growth status in relation to gender and
age factors in urban primary school children (6-10 years old) was examined. The cross-sectional
design was employed and the sample consisted of 4212 boys (53%) and 3793 as girls (47%)
through a random selection. Questionnaire and anthropometric measurement were used for data
collection. Analysis was done using mean, percentages and chi-square.
The results indicated that approximately 52 per cent (n = 4149), 50 per cent (n=3893) and 30 per
cent (n = 2568) of the school children were underweight, stunted and wasted respectively among
these low incomes school children. However, the majority of these undernourished children were
in the mild category. Prevalence of overweight ( > 2SD of NCHS/WHO reference media) was
found in 5.8 per cent of the sample. For both, prevalence of under-nutrition and over-nutrition,
more boys than girls were found to be under weight, stunted, wasted and overweight. Height for-
age (P < 0.05) and weight for-height (P < 0.001) showing that children’s weight has been
adapted to their short statures. Efforts recommended addressing health and nutrition problems
among school children included health and nutrition monitoring using existing growth data
collected by schools and interventions.
Anuarzain, Lim, low and Harun (2015) conducted a research on nutritional status of school
children and factors affecting nutritional status, in Selangor, Malaysia using cross- sectional
design and a population of 1,405 primary school children (aged 9-10years from 54 national
primary schools). Data collection was by questionnaire and physical examination of blood
sample with finger pricking technique and analysis used were percentages and mean. The finding
of the study indicated that the mean weight and height were 32.30kg and 135.18cm respectively.
The mean BMI was 17.42kg/m2, with 1.2 per cent of the school children underweight, 76.3 per
cent normal, 16.3 per cent overweight and 6.3 per cent were obese. Nutritional status was
significantly related to blood pressure, history of breastfeeding, eating fast food, taking
canned/bottled drink, income and educational level of parents.
Also the nutritional status between sexes and locations (rural and urban) were also found. The
prevalence of overweight and obese children was of concern. There was thus an urgent need for
the school Health program to periodically monitor the school children’s eating habits and
physical growth. Appropriate counseling on nutritional intake and physical activities should be
given not only to school children but also to their teachers and parents or caregivers.
A study was carried out by Oninla, Owa, Onevade and Taiwo (2016) to determine and compare
the nutritional status of children attending urban and rural public primary schools in Ife Central
Local Government Area of Nigeria. The cross-sectional survey design was used and the schools
were stratified into urban and rural and studied schools were selected by balloting. A total of 749
pupils (366 and 383 children from the rural and urban communities respectively) were studied.
Questionnaire and anthropometric measurement was used for data collection. Mean, percentages
and chi square were used for data analysis.
The finding indicated that underweight, wasting and stunting were 6 1.2 per cent, 16.8
per cent and 27.6 per cent respectively. In the rural area there were 70.5 per cent, 17.8 per cent
and 35.8 per cent, while in the urban they were 52.2per cent, 15.9 per cent and 19.8 per cent,
respectively. The mean nutritional indices (weight for age, weight for Height and Height-for-
Age) were found to be significantly lower among the rural pupils than urban pupils (P<0.001 in
each case), showing that malnutrition (underweight, wasting and stunting) constituted major
health problems among school children in Nigeria, particularly in the rural areas. Therefore,
prevention of malnutrition was recommended to be given a high priority in the implementation
of the ongoing primary health care programmes with particular attention paid to the rural
population.
Amuta and Houmsou (2009) carried out a study to assess the nutritional status of school age
children (6-17 years) in Markurdi, capital of Benue state-Nigeria. The cross-sectional survey
design was used. Random selection of 304 populations of school children was employed.
Questionnaire and anthropometric measurement was used for data collection comparing it to
National Centre for Health Statistics (NCHS)/ World Health Organization (WHO) standard,
mean and percentages were used for data analysis.
The findings revealed that the prevalence rate of under nutrition was (50.66%) and schools
located in the slum parts of Markurdi recorded the highest rate of under nutrition with (78.33%)
stunting and (73.33%) wasting respectively. Males recorded a relatively higher rate of under
nutrition 162 (57.44%) than females 142 (44.65%). This revealed that the average of school child
in Markurdi is undernourished. Poor nutrition of children did not only affect the cognitive
development of children but also likely to reduce the work capacity in future.
Hasan (2014) conducted a study on identifying the prevalence of malnutrition among 500
children of Government schools of Azad Nager, Bangalor South Asia among children aged 8 to
14 years. The cross-sectional survey design was used. Questionnaire and food intake diary were
used, (B.M.I) for age was calculated and compared with WHO (2016) reference standards. The
cross-sectional survey design was used and the subjects were selected through random sampling
procedures of pupils (382 boys and 118 girls).Percentages and chi-square was the method of data
analysis.
The result shows that 68 per cent of pupils were malnourished and prevalence of malnutrition in
male and female was 57.94 per cent and 42.0 6 per cent respectively. The malnutrition may be
due to inadequate dietary intake of food and most children are from low socio-economic
background, the need for more calories, protein and micronutrients for the children of
government schools cannot be over emphasized.
Oldewage and Egal (2018) carried out a cross-sectional research on nutritional knowledge and
nutritional status of primary school children in Qwa Qwa, with a purposively selected Public
school of 540 numbers using a sample of all 142 school pupils aged 9 to 13 years with the
measuring instrument including a nutrition knowledge questionnaire for data collection. Method
of data analysis was with SPSS to determine percentages of respondents.
The result revealed that the mean age of the respondents was 11.2 years and they had deficient
intakes of all the nutrients, except for protein, carbohydrates and thiamine. About 53.1 per cent,
17.1per cent and 14.3 per cent of the respondent did not meet 100 per cent of estimated average
requirement (EAR) for protein, carbohydrates and thiamine respectively. Only 2.8 per cent was
severely stunted and 11.3 per cent stunted. About 12.0 per cent were overweight and more
among the girls (15.7%) than boys (8.3%). The respondents showed average nutrition knowledge
in the majority of the questions. It was recommended that a nutrition education programme be
developed and implemented for this group of children for improving food choices.
Akor, Okolo and Okolo (2017) carried out a study on nutritional status of newly enrolled primary
school children in Jos, Plateau Nigeria. The cross-sectional survey design was used. Seven
hundred and sixty four (764) apparently healthy newly enrolled pupils were randomly selected
using a multi-stage proportionate sampling from both public and private schools. Anthropometric
measurement was used for data collection and mean, percentages and rank order correlation
coefficient were used for data analysis.
The result indicated that pupils from private schools were significantly taller (118.2 ± 6.52) than
their public school counterparts (115.7±8.44), P = 001. The prevalence of underweight, stunting
and wasting was 10.3, 11.1 and 2.4 per cent respectively. Stunting occurred in a higher
proportion of boys than girls. Poor nutritional status was significantly commoner in public school
pupils than private school pupils. These findings suggested that malnutrition (underweight
wasting and stunting) was not uncommon among newly enrolled school children and it
underscored the need for institution and sustenance of a food programme among school children.
 CHAPTER THREE
METHODOLOGY

3.0 Design: a descriptive cross-sectional survey design was used for this study.

3.2 Setting: This study was carried out in Babandodo primary health care Zaria city,
Kaduna state

3.3 Target population: all the house hold in the community that has a mother or
mother figure with under- five children.

3 4 Sample Size And Formula: the study sample was 272 households each with a
mother and 544 children under- five years 0-59 months of age. The difference between
the number of households and the number of children is due to the fact that some
households had more than one child under five, and both were taken for the study. The
size was determined statistically by applying the population proportion sample size
determination formula i.e. n = z2 P (1- P) / d2. This was arrived by using previous
study that the children under five years with malnutrition are 80.0%, and an estimated
difference between the actual proportion and the research value to be 0.05 at 95%
confidence level n=z²p (1-p)/d² sampling distribution of proportion theory (Anyiwe,
2014) Where; n
= desired minimum size.
z= standard normal deviate (which equates to 1.96 at a = 0.05).
 p = prevalence rate (80%) 1-p=1-0.80=0.2
d= precision (level of error) =0.05 Therefore, n= (1.96²x0.80x0.2)/0.05 =
245
In order to provide an allowance for non-respondents (attrition) a 10% margin was
given, amount to d= n/ (1- nrr) , d= 245/1-0.1
d= 272.

3.5 Sampling Technique: A purposive sampling technique was used to select the
community among other communities in the local government area. Which was divided
into 10 districts with each district having 27 house hold? All the house hold who were
willing to participate and meet the criteria were all included in the study using
convenient sampling technique

3.6 Inclusion Criteria: Mothers living in the Babandodo primary health care Zaria city
and that has under-five children living with them for the past 5 year and houses with
mothers and under five year children.

3.7 Instrument Data Collection: The instrument that will be used for this study is a self-
structured questionnaire and instrument for anthropometric measurement including a
checklist for physical examination
Section A elicits bio-data information of under-five year children
Section B was on the maternal knowledge on nutritional status of the children

Checklist for Physical Examination: The checklist is used for general inspection
of oral hygiene, skin, eye and hair for any sign of malnutrition.

Weighing balance and measuring tape: this was used for measuring the weight of
the child and their height in kilogram (kg) and metre (m) respectively. The
anthropometric measurements made were used to determine indexes like weight-
for-age, weight-for-height, and height-for-age which were used to classify the
children as underweight, wasted and stunted. The nutritional status of the children
was determined using the International Reference Population defined by U.S
National Centre for Health Statistics (NCHS) and Centres for Disease Control and
Prevention (WHO 2009). Height- for-age (HAZ), weight-for- height (WHZ), and
weight-for- age (WAZ), the children were classified as stunting, wasting, and being
under-weight, if the HAZ, WHZ, and WAZ were < 2 standard deviation (SD).
The length measurement was taken twice and an average of the two computed. In
cases of large variances, the measurements were repeated until an acceptance
variance was obtained.

3.8Validity of Instrument:The instrument for was validated by two expert in

nutrition from university of Kaduna state teaching hospital and an in measurement
and statistic from university of Kaduna state.

3.9 Reliability of Instrument: Test-retest reliability of the research instrument was

established during pretesting. The questionnaire was pre-tested on 10 mothers and
their respective children under-five aged children, in another nearby community
(Uzebu Community), the structured questionnaire was then rephrased in the light of
the responses were respondent friendly and also the reliability of the other
instrument was aloe tested by ensuring that they were up to the required standard.
Test retest reliability was established by examining the consistency of pre-test
responses and reliability co- efficient calculated. The reliability co-efficient was
0.67 and therefore the questionnaire was considered reliable.

3.10 Method of Data Analysis: three males and two females with at least
secondary school education who lives in the community were recruited as research
assistant. The research assistants were trained by the principal researcher on the
study objectives, purpose and interviewing techniques based on the research
instrument. The training also included demonstrations and practice in taking of
anthropometric measurements and aloe on how to do physical examination through
observation. Data were collected with the help of the research assistant on a daily
basis from one house to another with three of the research assistants administering
the questionnaire while the other two research assistants took anthropometric
measurements and observed the children for any sign of malnutrition until the whole
household of the community were exhausted. This takes a period of six (6) weeks.

3.11 Ethical consideration: ethical approval was obtained from the ethical
committee of Babandodo primary health care Zaria city, Kaduna state. The
informed consent was from each participant prior the administration of the
instrument. They were assured that all information given will be treated
confidentially.
 CHAPTER FOUR
DATA PRESENTATION AND ANALYSIS

RESULT

Objective one: Socio-demographic characteristics of under-five and mothers in

Babandodo primary health care Zaria city,

Table I reveals that majority 284 (52.2%) of the children are males, while 260
(47.8%) are females. 206(37.9%)which is majority are aged 21 – 40 months, 0 –
20 months old children were 202 (37.1%), 136 (25.0%) were 41 – 60 months old. The
mean age of the children was
28.90 ± 0.96 months. Children in the 10.1 – 14.0 kg category had 188 (34.6%), 140 (25.7%)
were in the 4 – 10.0 kg category. 122(22.4%), 52 (9.6%) and 42 (7.7%) are the in 14.1 – 18.0
kg, 18.1 – 22.0 kg and 22.1 & above weight categories respectively. The mean weight of the
children was 14.06 ± 5.12 kg. The height of the children showed majority of the children 150
(27.5%) were in the 76 – 85 cm and 86 – 95 cm category respectively. 96 – 105 cm height
category had 102 (19.0%) children, 66 (12.0%) were in the 66 – 75 cm category, while 44
(8.0%) was in the 55 – 65 cm height category and 32 (6.0%) in the 105.1 and above category.

Socio-demographic characteristic of mothers

Table II shows the demographic characteristics of the mothers in this study. The table
shows that majority 139 (51.1%) of the mothers are in the age group 26 – 35

years while the least number of respondents 23 (8.5%) are in the age group 36 years
and above with a mean age of 28.21 ± 0.35 yrs. Mothers with Secondary education
were more with 112 (41.2%) of the respondents while no formal education had the
least mothers with 14 (5.1%). 172 (63.2%) of the mothers in this study were
married, 63 (23.2%) were single while 4 (1.5%) were divorced. 208 (76.5%) of the
mothers were
Christians, 37 (13.6%) Muslim, 25 (9.2%) practice traditional religion while 2
(0.7%) practiced other religion. 73 (26.8%) of the mothers are self-employed, this
was closely followed by the civil servants with 71 (26.1%) mothers, farmers had the
least number of mothers with 4 (1.5%). Majority 79 (29.0%) of the mothers receive
monthly income of between N10,000 – N30,000, while 73 (26.8%) of the mothers
monthly income is between N5,000 – N10,000. Only 34 (12.5%) mothers receive
monthly income of <N5,000. Mothers that had only 2 children were majority 100
(36.8%), 137 (50.3%) of the mothers have 1 under five child each respectively.

Objective two: Nutritional status of the under- five children in Babandodo

primary health care Zaria city,

Table III shows the nutritional status of the children in Evotubu Community. This
analysis shows that 36.1%
(196) of the children in Babandodo primary health care Zaria city Community are
underweight with 63.9% (348) children normal weight, 46.0% (250) of the children
are stunted with 147 (54.0%) of normal height and 25.4% (138) of the children in
Babandodo primary health care Zaria city Community are wasted and 406 (74.6%)
of normal weight-for-height.

Gender differences in under-five nutritional status in Babandodo primary

health care Zaria city community

Table IV shows the Gender differences in under-five nutritional status among

under-five children in Babandodo primary health care Zaria city. The table indicate
that of 36.1% (196) underweight children, 20.6% (112) were boys with 15.4%
(84) being girls under five years children. In addition, wasting affected 25.4% (138)
of the children, of which 13.2% (72) and 12.1% (66) were boys and girls
respectively. Moreover, out of 46.0% (250) who were stunted under five children,
24.3% (132) were boys while 21.7% (118) were girls.

Age (months) difference of under-five nutritional status in Babandodo primary

health care Zaria city community

Table V shows the age (months) difference of under-five nutritional status in

Babandodo primary health care Zaria city. The table showed that 9.2% (50), 11.4%
(62) and 15.4% (84) underweight under five children were within 0 – 20, 21 – 40
and 41 – 60 months age categories, respectively. Moreover, of 46.0% stunted
children, 17.3% (94), 16.9% (92) and 11.8% (64) fell within 0 – 20, 21 – 40
and 41 – 60 months age categories, respectively. Also, wasting followed similar
pattern as the underweight data with 12.1% (66), 7.4% (40) and 5.9% (32) of under
five children from 0 – 20, 21– 40 and 41 – 60 months age brackets, respectively

Table I. Demographic characteristics of child.

Variable N=544
Frequency Percent(
%)
Sex
Male 284 52.2
Female 260 47.8
Total 544 100
Age of children (months)
0 – 20 months 202 37.1
21 – 40 months 206 37.9
41 – 60 months 136 25.0
Mean age 28.90 ± 0.96 months
Total 544 100
Weight of children (kg)
4 – 10.0 140 25.7
10.1 – 14.0 188 34.6
14.1 – 18.0 122 22.4
18.1 – 22.0 52 9.6
22.1 & above 42 7.7
Mean weight 14.06 ± 5.12 kg
Total 544 100
Height of children (cm)
55 – 65 44 8.0
66 – 75 66 12.0
76 – 85 150 27.5
86 – 95 150 27.5
96 – 105 102 19.0
105.1 & above 32 6.0
Mean height 86.05 ± 13.46 cm
Total 544 100

Objective three: Relationship between nutritional status of the under-five children

and socio- demographic characteristics of their mothers

Predictors of nutritional status of child/children

Table VI is a multinomial logical regression analysis which shows that the mother’s
level of education was a significant predictor for weight-for-age with a p value of 0.042
(AOR: 2.300, 95% CI: 1.032 – 5.127), and mother’s
age for be a strong predictor for child wasting with p- value of 0.012 (AOR: 3.462, 95%
CI: 1.313 – 9.131). All
other demographic characteristics were found not to be a predictor of weight-for-age,
height-for-age and wasting respectively.

Table II. Socio-demographic characteristic of mothers.

Variable N=272
Frequency Perc
ent
Mothers’ Age
17 - 25yrs 110 40.4
26 - 35yrs 139 51.1
36 & above 23 8.5
Mean age 28.21± 0.35 years
Mothers’ Level of Education
No formal education 14 5.1
Primary Education 24 8.8
Secondary Education 112 41
.2
Vocational Training 65 23.9
Tertiary Education 57 21.0
Marital Status of Mothers
Single 63 23.2
Married 172 63.2
Divorced 4 1.5
Widowed 8 2.9
Cohabiting 25 9.2
Religion
Christian 208 76.5
Muslim 37 13.6
Traditional 25 9.2
Others 2 0.7
Mothers’ Occupation
Unemployed 37 13.6
Apprentice 35 12.9
Trader 52 19.1
Farmer 4 1.5
Self-employed 73 26.8
Civil servant 71 26.1
Mothers Income
< N₦5000 34 12.5
₦N5000 - ₦N10000 73 26.8
₦N10000 - ₦N30000 79 29.0
₦30000 - N₦50000 46 16.9
>₦N100000 40 14.7
Number of Children
1 53 19.5
2 100 36.8
3 84 30.9
4 17 6.3
5 12 4.4
6 6 2.2
Number of Under five
1 137 50.3
2 114 41.9
3 13 4.8
5 6 2.2
6 2 0.7

Table III. Nutritional status of child/children.

Variable N=272
Frequen Percen
cy t
Weight-for-Age
Underweight 196 36.1
Normal weight 348 63.9
Height-for-Age
Stunted 250 46.0
Normal 294 54.0
Wasting
Wasted 138 25.4
Normal 406 74.6

Table IV. Gender differences in under-five malnutrition in Babandodo primary

health care Zaria city.

Male Female Total

Malnutrition F % F % F %
Status
Weight-for-Age
Underweight 112 20.6 84 15.4 196 36.1
Normal weight 180 29.4 188 34.6 384 63.9
Height-for-Age
Stunted 132 24.3 118 21.7 250 46.0
Normal 142 26.1 152 27.9 294 54.0
Weight-for-
Height
Wasted 72 13.2 66 12.1 138 25.4
Normal 202 37.1 204 37.5 406 74.6

Table V. Age (months) difference of under-five malnutrition in Babandodo

primary health care Zaria city.

0 - 20 21 - 40 41 - 60 Total
months months months
 F % F % F % F %
Malnutrition Status
Weight-for-Age
Underweight 50 9.2 62 11.4 84 15.4 196 36.1
Normal weight 136 25.0 166 30.5 104 19.1 294 63.9
Height-for-Age
Stunted 94 17.3 92 16.9 64 11.8 250 46.0
Normal 108 19.9 114 21.0 72 13.2 294 54.0
Weight-for-Height
Wasted 66 12.1 40 7.4 32 5.9 138 25.4
Normal 136 25.0 166 30.5 104 19.1 406 74.6

Table VI. Predictors of nutritional status of child/children.

Variable Weight-for-age Height-for-age Wasting

s 95% CI 95% CI 95% C
Ad for Ad for Ad f
jus Adjusted jus Adjusted jus Adjuste
p OR P OR P OR
t Low Upp t Low Upp t Low
ed er er ed er er ed er
OR OR OR
Mot 0.11 2.03 0.85 4.87 0.17 0.53 0.21 1.32 0.01 3.46 1.31
hers’ 1 5 0 3 5 5 6 1 2* 2 3
Age
Mothers 0.04 2.30 1.03 5.12 0.22 0.71 0.41 1.22 0.67 1.15 0.58
2* 0 2 7 5 7 9 8 2 9 5
’ Level of
Educatio
n
Marital 0.15 0.86 0.70 1.06 0.81 0.96 0.71 1.30 0.14 1.59 0.85
8 2 1 0 5 5 6 1 5 6 2
Status of
Mothers
Mothe
rs’ 0.08 0.64 0.38 1.06 0.55 1.35 0.49 3.68 0.48 0.75 0.34
Occup 6 1 6 6 6 2 6 3 1 5 6
ation
Religion
0.49 0.83 0.50 1.38 0.22 0.61 0.28 1.33 0.88 0.95 0.50
1 7 6 6 0 7 5 5 1 2 0

Mot
hers 0.11 0.63 0.36 1.11 0.63 0.82 0.38 1.78 0.15 0.65 0.35
Inco 2 7 5 2 1 9 6 1 4 0 9
me
*significant p<0.05
DISCUSSIONS

The study shows that majority 284 (52.2%) of the children are males, while 260

(47.8%) are females. 206(37.9%), with a mean age of 28.90 ± 0.96 months and a mean

weight of 14.06 ± 5.12 kg. Also, it shows that majority 139 (51.1%) of the mothers are

in the age group 26 – 35 years with a mean age of 28.21 ± 0.35 yrs. Mothers with

Secondary education were more with 112 (41.2%) while no formal education had the

least mothers with 14 (5.1%). 73 (26.8%) of the mothers are self-employed, this was

closely followed by the civil servants with 71 (26.1%) mothers, farmers had the least

number of mothers with 4 (1.5%). 79 (29.0%) of the mothers receive monthly income

of between N10,000 – N30,000, while 73 (26.8%) of the mothers monthly income is

between N5,000 – N10,000. Only 34 (12.5%) mothers receive monthly income of less

than N5, 000.

The study revealed that 196(36.1%) of the children in were underweight with

250(46.0%) of been stunted and 138(25.4%) wasted. Furthermore the study indicate

that of 36.1% underweight children, 112(20.6%) were boys and 84(15.4%) being girls.

In addition, of the 25.4% wasted 72 (13.2%) boys and 66(12.1%) were girls. Moreover,

out of 46.0% who were stunted, 132(24.3%) were boys while 118(21.7%) were girls.

84(15.4%) of the underweight were within 41 – 60 months, age categories, respectively.

94(17.3%) of the stunted were within 0 – 20months, similarly 66 (12.1%) wasted

children were within 0 – 20, months. Badake, et al (2010) in Kenya who reported that

up to 39% of the children were stunted; 7.1% were wasted; and 18.1% underweight and

that the prevalence of stunting and wasting was significantly higher in boys than in girls
(χ =6.765, P =.034) and (χ= 13.053, P = .036), respectively. The findings above were

better than the result of this present study however it is similar in terms of ratio of boys

to girls who are wasted and stunted. Collaborating the findings of this index study is

Mu’awiyyah, Bashir, Umar (2015) in Zaria, North-western

Nigeria, who revealed that out of the 300 children studied, 87 (29%) were found to

have underweight, 21 (7%) were wasted, and 93 (31%) were stunted. Also the findings

of Lahiru, Devika, Dharmaratne and Galgamuwa (2014) in sri-Lanka, who reported that

of 547 children aged participated in the study were up to 35.6%, 26.9% and 32.9% of

children were under weight, stunting and wasting respectively agrees with the findings

of the present study. This implies that the nutritional status of under-five children is still

not encouraging and there is need for proactive action in order to reduce the mortality

and morbidity arsing from these poor nutritional status. It is pertinent to note that

despite the educational level of the mothers in the present study, there is still poor

nutritional status of their children, though one can say in general that the percentage of

the children with good nutritional status is higher compared to those that were wasted

stunted and underweight, there is still need for improvement.

Findings also revealed that the mother’s level of education was a significant predictor

for weight-for-age (p= 0.042; AOR: 2.300, 95% CI: 1.032 – 5.127), and mother’s age

for be a strong predictor for child wasting (p=0.012; AOR: 3.462, 95% CI: 1.313 –

9.131), however

all other demographic characteristics were found not to be a predictor of weight-for-

age, height-for-age and wasting respectively. Similar findings was reported by Akorede

and Abiola (2013), Ondo State, Nigeria, were household income was positively

correlated with nutritional status of the infants (Stunting) (r = 0.18; p<0.05), also level

of mothers education was positively correlated with nutritional status of the children

(stunting) (r = 0.23; p<0.05). Sufiyan, et al (2012), in Zaria, Nigeria, also reported a

significant statistical association between maternal literacy status and occurrence of

malnutrition (specifically stunting) among the children studied. (X2 = 26.2, df = 1, P <

0.05). Similar findings were also reported by Akorede and Abiola (2013) in Akure,

were the level of mothers education was positively correlated with nutritional status of

the children (stunting) (r = 0.23; p<0.05). However, Adenike, et al (2006) in Ile-ife

differs from the findings of this study, as they reported that mother age was negatively

correlated, while occupation had a positively correlation with under-five. These

differences might largely due to geographical location of the respondents, never the less

education of the girl child should be made compulsory in the country since these are the

potential mothers of tomorrow, and the levels of education and exposure have a long

way to go with their knowledge on nutritional practices of their children. Being

educated will stimulate them to search for good nutritional practices for their children

without being taught, it will also help them read so that they will be able to read and

understand some of the nutritional message that are in print. Maternal and child health

center should be made accessible to our communities to help in educating mothers

and prevent malnutrition among under five children.

 CHAPTER FIVE

CONCLUSION AND RECOMMENDATIONS

CONCLUSION

The nutritional status of children influences their health status, which is a key

determinant of human development. The study has shown that the nutritional status

of the under-five children is very poor compare to the standard growth rate required

of them. These have been associated to the mother factor because for these children

to be well nourished and of good nutritional status it depends largely on the mother

or the care giver especially during the first five years of the child of life.

RECOMMENDATIONS

The mother is the principal provider of the primary care that the child needs during

the first five years of life, therefore education of these mothers will play an

important role in the health of the under-five children, because the type of care they

will provides depends to a large extent on their knowledge and understanding of

some aspects of basic nutrition and health care which can be improve or enhance by
quality education.

 Maternal and child health center should be made accessible to our

communities to help in educating mothers and prevent malnutrition among

under five children.

 Information on good nutritional practices should be provided by health

worker at the all level of health care especially at the primary health center to

enhance the nutritional knowledge of the mothers visiting these centres.

 Government should provide at least one square meal which is fortified with

adequate nutrient for all under-five children, this should be residents at each

primary health centre where these mother can visit on daily basis to get the

children fed.
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