CHAPTER ONE

INTRODUCTON

1.1 BACKGROUND OF THE STUDY

Malnutrition remains a major public health challenge in developing countries. It is one of

the most important risk factors for the burden of disease causing about 300,000 deaths
per year directly and indirectly responsible for more than half of all deaths in children. In
Nigeria, it is one of the main causes of morbidity and mortality among other diseases
(Demissie and Worku, 2013). Malnutrition is simply defined as the imbalance of
nutrients in the body. It could be over nutrition or under nutrition. Globally in 2020, 149
million children under 5 years of age were estimated to be stunted (too short for age), 45
million were estimated to be wasted (too thin for height), and 38.9 million were
overweight or obese. Among children under 5 years of age, 45% of deaths are linked to
under nutrition. These mostly occur in low- and middle-income countries. At the same
time, in these countries, rates of childhood overweight and obesity are rising (WHO,
2020).

Malnutrition refers to getting too little or too much of certain nutrients. It can lead to
serious health issues, including stunted growth, eye problems, diabetes, and heart
diseases (Lizzie streit, 2018). Malnutrition also known as the deficiency of nutrition is
one of the major health problems faced by children in developing countries (Mengistu et
al., 2013). Malnutrition can be classified as under nutrition which result due to
insufficient intake of nutrient and energy, and over nutrition which occurs due to
excessive consumption of nutrient and energy (Sufiyan et al., 2012). The double burden
of malnutrition adversely affects the growth, health, intellectual development, and school
attendance of school-aged children. Through its effects on health, the double burden of
malnutrition increases the costs of health care, reduces productivity, and slows economic
growth, which in turn can perpetuate a cycle of poverty and ill-health. Malnutrition is not
exclusively a problem of extreme poverty, nor only of the young, but affects all
communities around the world and people of all ages including pregnant women. Despite
impressive progress in reducing hunger and poverty, about 800 million people worldwide
continue to suffer from undernourishment.
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Food choice is defined as a process by which people select, acquire, prepare and consume
foods, which results from the competing, reinforcing and interacting influences of a
variety of factors (Karanja et al., 2022). Diets, nutrition and health outcomes are in part,
consequences of interrelated food choice factors which poses challenges for
implementing interventions aimed at addressing malnutrition and dietary challenges in
LMICs (FAO and WHO, 2019). Poor diets and undesirable dietary patterns have been
found to be associated with the development of negative health outcome including
cardiovascular diseases, diabetes, obesity and some cancers. There is a belief that
children with poor dietary habits are likely to become adults with poor diets. It is also
noted that childhood food habits persist into late adolescence or adulthood. Once school
children, enter into the outside world of formal education, they are vulnerable subjects to
myriad forces which influence life time attitudes and behaviours, food choices and habits.
The influencing factors include: taste preference, family, school practices, media
messages and other children (Abdollahi et al., 2011).

Improving the educational status of parents, especially mothers, on nutrition, sanitation

and common disease prevention strategies should logically reduce the rate of mortality
and morbidity influenced by malnutrition. It is said that the way to a child’s stomach is
through the mind of the mother. Quality of food taken, choices and quantity are all at the
discretion of the mother or care giver. This problem is very crucial in sub–Saharan
African, where access to formal education for a girl child in certain communities is still a
major burning challenge. The burden of malnutrition has been directly linked to poverty,
quality of food intake, excessive disease and poor health status. Economic growth and
human development require well-nourished populations who can learn new skills think
critically and contribute to their communities.

Economic development is normally accompanied by improvements in a country’s food

supply and the gradual elimination of dietary deficiencies, thus improving the overall
nutritional status of the country’s population. However, the Food and Agriculture
Organisation (FAO) reports point out that increasing urbanization in poor countries has
consequences which are not always positive. In countries with widespread deprivations,
when food supply becomes more abundant, there occur changes in diets, patterns of work

2
and leisure which is often referred to as Nutrition Transition. The diet shifts toward a
higher energy density with a larger role of fat and sugars and foods. The greater saturated
fat intake, reduced fruit and vegetable intake and reduced intake of complex
carbohydrates and dietary fibre may have negative consequences. The dietary changes
long with reduced physical activity result in obesity and an epidemic of non-
communicable diseases in developing countries

1.2 STATEMENT OF PROBLEM

Malnutrition continues to be a major public health problem in children in all developing

countries. Globally in 2020, investigation revealed that 149 million children under age 5
were estimated to be too short for age, 45 million were estimated to be too thin for height,
and 38.9 million were overweight or obese. Furthermore, around 45% of deaths among
children under 5 years of age were linked to under-nutrition which is prevalent in low and
middle-income countries (WHO, 2020). In Nigeria, it is one of the main cause of
morbidity and mortality among other diseases. Malnutrition causes Nigeria billions in lost
revenue through reduced economic productivity, days away from work due to illness and
money spent on treating ailments (World Bank, 2014). The negative impacts of
malnutrition are seen in families and communities in various aspects such as
economically, medically and socially. Lack of mother’s education and knowledge about
malnutrition in children under five years of age could be the contributing factors of
malnutrition among children in Nigeria. Therefore, this study intends to examine
malnutrition and the factors affecting food choice of children between age 0 and 5
because it is imperative for mothers to have detailed knowledge of nutrition for the
wellbeing and healthy development of their children.

1.3 AIMS OF THE STUDY

This study intends to examine malnutrition and the factors affecting food choices among
children under five years of age in Obafemi Owode local government Mowe, Ogun State,
Nigeria.

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1.4 OBJECTIVES OF THE STUDY

Specifically, the study sought to;

i. Discover whether children have adequate knowledge of the proper nutritional intake
with the help of their parents.

ii. Determine the extent of prevalence of malnutrition in children between age 0 and 5.

iii. Determine whether the food choices of children contribute to the high level of
malnutrition in the communities.

iv.Examine factors that affect food choices in children such as poor income status,
family background, cultural beliefs, food security and food choices.

1.5 SIGNIFICANCE OF THE STUDY

This study is will be of benefit to the government because it will help them in in
formulating policies that will enhance the proper management of malnutrition in the
country.

Children health administrators will be able to invent the ideal ways of putting in place a
proper nutrition intervention.

It will also assist mothers to have a better understanding of their roles in educating their
children on the effect of malnutrition and its related factors.

1.6 SCOPE OF THE STUDY

This study focused on malnutrition and the factors affecting food choice in children under
five years of age using Obafemi-Owode Local Government Area of Ogun State as a case
study. Specifically, this study focuses on discovering whether mothers have adequate
knowledge of the proper nutritional intake of their children, determining the extent of
prevalence of malnutrition in children, determining whether the food choices of their
children contribute to the high level of malnutrition to the communities, and examining
the factors affecting food choices in children.

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1.7 RESEARCH QUESTIONS

i. Does mothers have adequate knowledge of the proper nutritional intake of their
children?
ii. What is the extent of prevalence of malnutrition in children and its effect on their
immediate community?
iii. What are the most effective interventions in combating malnutrition in low-
income communities?
iv.What role does cultural dietary practices play in the prevalence of malnutrition in
children how can the nutrition be monitored?

1.8 RESEARCH HYPOTHESES

H1 There is no significant relationship between the knowledge gathered by mothers and

proper nutritional intake of their children
H2 There is no significant relationship between the extent of prevalence of malnutrition
in children and its effect on their immediate communities
H3 There is no significant relationship between the most effective interventions in
combating malnutrition and its impact on low-income communities.
H4 There is no significant relationship between cultural dietary practices and prevalence
of
malnutrition in children even when monitored with intervention strategies.

1.9 DEFINITION OF TERMS

Malnutrition: Malnutrition refers to a condition where there is imbalance between the

nutrient a person consumes and the nutrients their body requires for proper growth,
development and maintenance of health. It can be under nutrition, where a person does
not receive enough essential nutrients, and over nutrition, where there’s an excess of
certain nutrients while lacking others (WHO).
Nutritional Status: This is a condition of the body, influenced by the level of nutrients
in the body and the ability of those levels to maintain normal metabolic integrity.
Under Nutrition: This is defined as the insufficient intake of energy or nutrients
required to meet an individual's needs to maintain good health (Maleta 2006). In other
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words, it is a condition where an individual is not getting enough calories, protein or
micronutrients.
Over Nutrition: This is refers to as a form of imbalanced nutrition arising from
excessive intake of nutrients, leading to accumulation of body fat that impairs health.
This can result in weight gain, obesity and various health issues such as diabetes,
cardiovascular diseases, and metabolic disorders.
Food: Food is any substance that is consumed to provide nutritional support to the body.
It is usually of plant or animal origin and contains essential nutrients such as
carbohydrates, protein, fats, vitamin or minerals.
Food Choices: It refers to the decisions individuals make about what they eat. These
decisions can be influenced by factors like personal taste, cultural background, health
considerations, dietary restrictions, and ethical beliefs.
Macro nutrients: These are the essential nutrients required by organisms in large
quantities for growth, energy production and bodily functions. They are carbohydrates,
protein and fats.
Micro nutrients: These are the essential nutrients that the body the body require in small
quantity for proper growth, development and overall function. They include vitamins and
minerals.
Diseases: It refers to a deviation from the normal functioning of the body or mind, often
characterized by specific symptoms and signs.
Morbidity: This refers to the state of being diseased or the prevalence of disease within a
specific a specific population or group. It encompasses the overall burden of illness,
including both the number of people affected by a particular condition and the impact of
that condition on their and quality of life.
Mortality: This refers to the state of being subject to death or the occurrence of death.

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 CHAPTER TWO

LITERATURE REVIEW

2.1. INTRODUCTION
This chapter reviews literature related to the issue of malnutrition among children under
the following subheadings; Malnutrition and types, prevalence and impact of
malnutrition, food choices and factors affecting food choices, challenges in food choices,
ways of promoting healthy food choices, theoretical orientation, empirical related studies
and interventions to address malnutrition.

2.2. CONCEPTUAL FRAMEWORK

2.2.1. Concepts of Malnutrition and its Nature in Nigeria Context
Malnutrition has been defined in various ways. The World Health Organization (WHO,
2016) defines malnutrition as: “Deficiencies, excesses or imbalances in a person’s intake
of energy and/or nutrients.” The United Nations Children's Fund (UNICEF, 2012) says:
“People are malnourished if their diet does not provide adequate nutrients for growth and
maintenance or if they are unable to fully utilize the food they eat due to illness (under-
nutrition). They are also malnourished if they consume too much energy (over-
nutrition).” The Food and Agriculture Organization of the United Nations (FAO, 2017)
gives the following definition: “Malnutrition results from deficiencies, excesses or
imbalances in the consumption of macro- and/or micronutrients.” In short, malnutrition
occurs when there are deficiencies, excesses or imbalances in the energy, macronutrients
or micronutrients that a person obtains. This might happen because their diet does not
contain a sufficient variety of foods to provide nutrients in the appropriate amounts,
either providing less than or more than is appropriate. Their body is unable to absorb or
make use of certain nutrients optimally. For example, various intestinal worms can cause
loss of iron and protein and decreased absorption of nutrients (UNICEF, 2012). Diarrhoea
due to poor sanitation can also lead to poor absorption of nutrients. Their body loses too
much of particular nutrients, even if the nutrients are present in the diet.
Malnutrition in children under 5 years remains a vital public health problem because it
contributes to mortality and morbidity in children (WHO, 2013). Poverty, low SES, and
the presence of infectious diseases are among the variables correlated with malnutrition.
7
Moreover, deficiencies in energy and protein intake results in proteinenergy malnutrition,
which is a common form of malnutrition. Malnutrition is comprised of undernutrition and
overnutrition. Undernutrition consists of wasting, stunting, and underweight, as seen in
Kwashiorkor where there is a severe lack of protein in the diet with evidence of severe
weight loss and retention of fluids in the abdomen, ankles, and feet (Butler, 2018) or
marasmus, a severe form of malnutrition where intake of nutrients and energy is too low
for a child’s needs with the presence of wasting or the loss of body fat and muscle
(Mehta, 2018). The later are long-term consequences of malnutrition

When children consistently fail to consume the required quantity and types of food that
supplies important nutrients to their body, it culminates in malnutrition. Available
evidence has shown that malnutrition contributes to nearly half of all forms of child
mortality in the world (Black et al., 2013). Globally, about 45% of deaths among children
under 5 years are attributed to malnutrition, and these occur mostly in developing and
low-income countries (Black et al., 2013).

According to a UNICEF report in 2017, there were 151 million children under 5 years of
age who were stunted, 51 million wasted, 16 million severely wasted, and 38 million
overweight, globally. In regions of the globe, South Asia and Africa were reported to
have the highest rate of child malnutrition in the world, accounting for about 33% of all
malnourished children globally. In Africa, it was reported that 9.4% of children under 5
years were undernourished due to wasting (UNICEF, 2017). In spite of the reduction in
malnutrition globally, malnutrition in children under 5 years in Nigeria has been on the
increase in past decade (Kalu & Etim, 2018). Kalu and Etim (2018) attributed the
increasing malnutrition among children in Nigeria to rising poverty, absence of exclusive
breastfeeding, and household, child, maternal, and socioeconomic factors.

Malnutrition, therefore, portends a great danger and imminent threat to the lives of
children, especially those under 5 years of age. Therefore, given the public health
importance of malnutrition to child health, in particular, and life expectancy, generally, it
is pertinent to understand the risk factors of malnutrition in the Nigerian context.

8
Malnutrition in children under 5 years remains a vital public health problem because it
contributes to mortality and morbidity in children (WHO, 2013). Poverty, low SES, and
the presence of infectious diseases are among the variables correlated with malnutrition.
Moreover, deficiencies in energy and protein intake results in proteinenergy malnutrition,
which is a common form of malnutrition. Malnutrition is comprised of undernutrition and
overnutrition. Undernutrition consists of wasting, stunting, and underweight, as seen in
Kwashiorkor where there is a severe lack of protein in the diet with evidence of severe
weight loss and retention of fluids in the abdomen, ankles, and feet (Butler, 2018) or
marasmus, a severe form of malnutrition where intake of nutrients and energy is too low
for a child’s needs with the presence of wasting or the loss of body fat and muscle
(Mehta, 2018). The later are long-term consequences of malnutrition

When children consistently fail to consume the required quantity and types of food that
supplies important nutrients to their body, it culminates in malnutrition. Available
evidence has shown that malnutrition contributes to nearly half of all forms of child
mortality in the world (Black et al., 2013). Globally, about 45% of deaths among children
under 5 years are attributed to malnutrition, and these occur mostly in developing and
low-income countries (Black et al., 2013).

According to a UNICEF report in 2017, there were 151 million children under 5 years of
age who were stunted, 51 million wasted, 16 million severely wasted, and 38 million
overweight, globally. In regions of the globe, South Asia and Africa were reported to
have the highest rate of child malnutrition in the world, accounting for about 33% of all
malnourished children globally. In Africa, it was reported that 9.4% of children under 5
years were undernourished due to wasting (UNICEF, 2017). In spite of the reduction in
malnutrition globally, malnutrition in children under 5 years in Nigeria has been on the
increase in past decade (Kalu & Etim, 2018). Kalu and Etim (2018) attributed the
increasing malnutrition among children in Nigeria to rising poverty, absence of exclusive
breastfeeding, and household, child, maternal, and socioeconomic factors.

Malnutrition, therefore, portends a great danger and imminent threat to the lives of
children, especially those under 5 years of age. Therefore, given the public health

9
importance of malnutrition to child health, in particular, and life expectancy, generally, it
is pertinent to understand the risk factors of malnutrition in the Nigerian context.

Malnutrition does not affect just the current health status, it also influences the future
health status of patients or individuals as it has been found that adulthood health is linked
to early childhood health outcomes.
Increasing prevalence of children malnutrition, including those under 5 years in Nigeria,
has become an important public health issue. In developing countries, 60 million children
under 5 years are malnourished, and 11 million of them are Nigerian children (Kalu &
Etim, 2018). According to the National Food and Nutrition Policy (2014), malnourished
children under 5 years in Nigeria recorded the highest number in subSaharan Africa, and
second highest in the world. In 2018, the National Nutrition and Health Survey of Nigeria
reported that Akwa Ibom State was among the states in Nigeria with high malnutrition of
children under 5 years. Akwa Ibom state also had the worst undernutrition status of
children under 5 years in the South-South region of Nigeria (National Nutrition and
Health Survey, 2018).

Low intake of calories, conflicts, political instability, poor implementation of government

policies, and inadequate health interventions are some risk factors that influence
malnutrition in children below age 5 (Adedeji et al., 2019; Kalu & Etim, 2018; Ozoka,
2018). Other factors that impact malnutrition in children include health and nutritional
status of the mothers during pregnancy, breastfeeding, and socioeconomic,
environmental, demographic, and health system factors (Adedeji et al., 2019; Jude et al.,
2019; Kuku-Shittu et al., 2016; Ozoka, 2018). Recent data on socioeconomic and
demographic risk factors influencing children under 5 in Nigeria, and Akwa Ibom State
in particular, however, are unpublished. A number of studies on malnutrition in children
under 5 in Nigeria considered the North-East (Adedeji et al., 2019), South-East (Jude et
al., 2019) and North-Central (Kuku-Shittu et al., 2016) geopolitical regions.

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2.2.2. TYPES OF MALNUTRITION
2.2.2.1. Under Nutrition
Undernutrition is defined as the insufficient intake of energy and nutrients to meet an
individual's needs to maintain good health (Maleta, 2006). Undernutrition is caused by
unbalanced diets that lack all the necessary nutrients (macronutrients and micronutrients)
which are required by the body. It can lead to impaired physical growth, restricted
intellectual skills, low school performance, reduced working capacity, and rooted
disability in adult life. Nigeria is ranked amongst the top ten countries with the highest
prevalence of undernutrition in children while about 2,300 children die daily in Nigeria as
a result of malnutrition. Undernutrition can be classified as stunting, wasting, and being
underweight. Stunting is characterized by low height-for-age and is the result of long-
term nutritional deficiency. Wasting is low weight-for-height, which indicates short-term
poor nutritional status. On the other hand, underweight is a low weight-for-age that
shows reduced public situations in both the long and shor term poor nutritional status
(Engidaye et al., 2022).

2.2.2.2. Over Nutrition

Overnutrition is a form of imbalanced nutrition arising from excessive intake of nutrients,

leading to accumulation of body fat that impairs health (Mathur and Pillai, 2019).
Overweight and obesity are currently an epidemic affecting both developed and
developing countries. Among people aged 18 and above in 2016, an estimated 2 billion
and 650 million were overweight and obese, respectively. Overweight contributes to 3.4
million mortalities annually. Overnutrition is strongly associated with several non-
communicable diseases, including coronary heart diseases, stroke, type 2 diabetes, and
hypertension (Badru and Alabi, 2018). Despite improvements in deaths related to
malnutrition and communicable diseases, non-communicable diseases (diabetes,
hypertension, cardiovascular diseases, and others) are becoming the leading causes of
mortality (70%) and contribute to a larger share of the disease burden. The crisis of
overnutrition has increasingly been reported from countries where hunger is still endemic
(Chopra et al., 2019).

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2.2.3. Prevalence and Impact of Malnutrition

The first 1,000 days of a child's life offer a unique window of opportunity for preventing
undernutrition and its consequences. Malnutrition is a direct underlying cause of 45
percent of all deaths of under-five children.

Nigeria has the second highest burden of stunted children in the world, with a national
prevalence rate of 32 percent of children under five. An estimated 2 million children in
Nigeria suffer from severe acute malnutrition (SAM), but only two out of every 10
children affected is currently reached with treatment. Seven percent of women of
childbearing age also suffer from acute malnutrition. Exclusive breastfeeding rates have
not improved significantly over the past decade, with only 17 percent of babies being
exclusively breastfed during their first six months of life. Just 18 percent of children aged
6-23 months are fed the minimum acceptable diet.

The States in northern Nigeria are the most affected by the two forms of malnutrition –
stunting and wasting. High rates of malnutrition pose significant public health and
development challenges for the country. Stunting, in addition to an increased risk of
death, is also linked to poor cognitive development, a lowered performance in education
and low productivity in adulthood - all contributing to economic losses estimated to
account for as much as 11 percent of Gross Domestic Product (GDP).

The prevalence of underweight was 30.6%, overweight was 2.1% and normal weight for
age nutritional status was 67.3%. More males (19.6%) than females (11%) accounted for
prevalence of underweight. Majority (25.7%) of underweight under five years children
were in the age group of 0-11 months, 4.6% in age group 12-29 months and 0.3% in age
group 30-39 months (Ogunniyi et al., 2023).

2.2.4. Contributing Factors of Malnutrition

Malnutrition remains a significant concern, particularly among children. Various factors

contribute to malnutrition in these areas:
 Poverty: The communities often face higher poverty rates compared to urban
areas. Limited financial resources can hinder access to nutritious foods and proper
healthcare, increasing the risk of malnutrition.
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  Lack of Exclusive Breastfeeding: Proper infant nutrition begins with exclusive
breastfeeding. Inadequate breastfeeding practices can lead to malnutrition among
infants.
 Inadequate Food Intake: The availability of diverse and nutritious food options
in rural areas may be limited. Inadequate food intake, particularly among children,
can result in malnutrition.
 Maternal Nutrition during Pregnancy: Poor maternal nutrition during
pregnancy can lead to low birth weights and a higher risk of malnutrition among
infants.
 Illnesses: Common illnesses like diarrhea and acute respiratory infections can
impact a child's nutritional status. Frequent illnesses can lead to malnutrition if not
properly addressed.
 Limited Access to Vitamin Supplements: The lack of access to vitamin
supplements or fortified foods can contribute to nutritional deficiencies.
 Large Family Sizes: Households with larger family sizes may struggle to provide
adequate nutrition for all members.
 Food Insecurity: Food insecurity, which can be exacerbated by economic
constraints, can result in inconsistent access to nutritious foods.
 Lack of Nutrition Education: Access to nutrition education and awareness
programs may be limited, resulting in lower levels of health and nutrition
knowledge among residents.
 Social Inequality: Disparities in access to resources and opportunities can further
exacerbate malnutrition in children.
2.2.5. Contributing Factors of over nutrition
Over nutrition, characterized by excessive nutrient intake and obesity, is increasingly
becoming a concern, several contributing factors include:
 Changing Dietary Patterns: As communities undergo economic development
and urbanization, dietary patterns may shift towards high-calorie, processed foods.
 Economic Development: Economic growth can lead to increased access to
calorie-dense foods, contributing to overnutrition.

13
  Urbanization: The influence of urban lifestyles, including sedentary behavior and
dietary choices, can extend to rural communities.
 Double Burden of Nutrition: Some regions experience a "double burden" of both
undernutrition and overnutrition, where undernutrition remains a concern
alongside the rise of overnutrition.
 Prevalence of Non-Communicable Diseases: Overnutrition is strongly
associated with non-communicable diseases such as diabetes, hypertension, and
cardiovascular conditions.
 Nutritional Transition: As societies transition from traditional diets to more
Westernized eating patterns, overnutrition becomes more prevalent.
It's important to note that while addressing overnutrition, efforts must also
continue to combat undernutrition in these areas, as both can coexist and pose
significant public health challenges.
2.2.6 Overview of Food Choices
The food choices for infants aged 0-5 years are crucial for their growth and development.
For infants under 6 months, breast milk or formula is recommended as the primary source
of nutrition. As they transition to solid foods, introducing a variety of fruits, vegetables,
grains, and proteins is important to ensure they receive essential nutrients. Avoiding
added sugars and excessive salt is also key. Consulting with a pediatrician or a
nutritionist can provide personalized guidance based on the child's needs and any
potential allergies or dietary restrictions. Children ages 1-2 years should eat
approximately a1/2serve of fruit and 2-3 serves of vegetables each day,2-3 years should
eat 1serve of fruit and 2.5 serves of vegetables each day.it is important to offer the child
healthy snacks. Offering small, planned snacks is much better than allowing them to
graze all day. Encourage healthy eating habits by choosing snacks based on nutritious
foods, eating fruit and vegetables everyday will help the child grow strong and healthy
(Karanja et al., 2022).

Food choices refer to the decision’s individuals make about what they eat. These
decisions can be influenced by factors like personal taste, cultural background, health
considerations, dietary restrictions, and ethical beliefs (Drewnowski et al., 2010). The

14
decision-making process governing food choices have been increasingly understood in
the context of the dimensions of the food environment (Karanja et al., 2022). Food
environment describes the spaces within which consumers interacts and make decisions
about what to acquire, prepare and consume based on physical and economic access,
quality of foods, convenience and exposure to marketing information (HPLE, 2017).
Diets, nutrition and health outcomes are in part, consequences of interrelated food choice
factors which poses challenges for implementing interventions aimed at addressing
malnutrition and dietary challenges in LMICs (FAO and WHO, 2019).

Empirical studies on malnutrition and the factors affecting food choices in children aged
0-5years Children who experience poor nutrition during the first 1000 days of life are
more vulnerable to illness and death in the near term, as well as to lower work capacity
and productivity as adults (FAO and WHO, 2019). These problems motivate research to
identify basic and underlying factors that influence risks of child malnutrition. Based on a
structured search of existing literature, Karanja et al., (2022) identified 90 studies that
used statistical analyses to assess relationships between potential factors and major
indicators of child malnutrition: stunting, wasting, and underweight. Our review
determined that wasting, a measure of acute malnutrition, is substantially understudied
compared to the other indicators. We summarize the evidence about relationships
between child malnutrition and numerous factors at the individual, household,
region/community, and country levels. According to them, the results identify only select
relationships that are statistically significant, with consistent signs, across multiple
studies. Among the consistent predictors of child malnutrition are shocks due to
variations in climate conditions (as measured with indicators of temperature, rainfall, and
vegetation) and violent conflict. Limited research has been conducted on the relationship
between violent conflict and wasting. Improved understanding of the variables associated
with child malnutrition will aid advances in predictive modeling of the risks and severity
of malnutrition crises and enhance the effectiveness of responses by the development and
humanitarian communities. Malnutrition is preventable, yet remains a major public health
challenge. This condition affects one in five children and contributes to nearly half of all
deaths during childhood globally (Black et al. 2013). Children who have poor nutrition

15
during their first 1000 days of life attain lower levels of education and have lower work
capacity and productivity as adults. Malnourished children also face increased likelihoods
of being overweight, of developing chronic illnesses such as cardiovascular disease,
diabetes and cancer, and of suffering from mental health issues later in life (Haddad et al.
1994; Hoddinott et al. 2013). After having suffered of malnutrition during early
childhood, girls face increased likelihoods of having children that are born too early or
underweight (UNSCN 2010).

2.3.2. Factors Affecting Food Choices in children

Food choices are influenced by a multitude of factors, encompassing social, economic,

cultural, and environmental dimensions:
 Limited Access to Healthy Food Options: Many areas suffer from limited access
to fresh, nutritious, and culturally suitable foods due to the absence of grocery
stores and farmers' markets. Residents often rely on convenience stores and fast-
food outlets, which offer more processed and less nutritious options. This
phenomenon is known as "food deserts" (Walker et al., 2010).
 Economic Constraints: Economic limitations can prevent individuals or
from affording nutritious food choices. This financial constraint may lead to the
selection of cheaper but less healthy alternatives. Additionally, limited access to
public transportation and long distances to grocery stores can increase food
expenses (Drewnowski et al., 2010).
 Cultural and Traditional Influences: Cultural practices and traditions
significantly shape food choices in children. Dietary habits often revolve around
cultural identity, with certain foods holding cultural significance. These influences
can vary widely among different communities and impact dietary patterns (Satia et
al., 2001).
 Limited Health Literacy: Low levels of health literacy and awareness about
healthy eating practices can affect food choices. Individuals with higher education
and health knowledge tend to make better dietary choices (Contento et al., 2006)..
Some communities may have fewer resources for health education and awareness,

16
 making them susceptible to the influence of food marketing (Hastings et al.,
2004).
 Agricultural Practices and Local Food Production: The types of crops and
livestock grown in areas can affect the availability of certain foods and dietary
patterns. Local food production reduces the need for long-distance transportation,
promoting sustainability (Thompson et al., 2010).
 Psychological Factors: Psychological factors such as taste preferences, cultural
norms, and attitudes toward health shape food choices. Personal preferences,
cravings, emotions, and past experiences with food also play a significant role
(Smith et al., 2009).
 Environmental Factors: Environmental elements, including limited access to
grocery stores, geographic isolation, and economic constraints, impact food
choices. Availability and accessibility of food options influence choices, as people
tend to select foods that are easily accessible (Glanz et al., 2004).
 Media and Advertising: Media platforms and advertising campaigns shape food
preferences and perceptions, especially in areas with limited access to diverse food
options. Exposure to advertisements promoting unhealthy foods can contribute to
poor dietary habits (Jilcott Pitts et al., 2017).
 Health and Nutrition Knowledge: Understanding the principles of balanced
nutrition and wellness practices can impact food choices. Limited access to
nutrition education and awareness programs can result in lower health and
nutrition knowledge levels in rural communities (Johnson et al., 2008).
These multifaceted factors collectively influence food choices, highlighting the need for
comprehensive strategies that consider social, economic, cultural, and environmental
dimensions to promote healthier dietary habits and improve overall well-being.
2.3.3. Contributing Factors of Food Choices in Urban Settings
According to Johnson et al., (2008), urban environments introduce unique influences on
food choices which include:
 Food Accessibility: These refers to the availability and affordability of nutritious
food for all individuals, regardless of their geographical location or economic
status. It encompasses factors such as proximity to grocery stores, transportation
17
 options, and economic barriers that may hinder people from obtaining healthy and
affordable food.
 Economic Status: In urban settings, food choices can be influenced by various
factors, including income levels, accessibility to diverse options, and cultural
preferences, urban planning and policies play a role in shaping food environments,
impacting the economic status of food choices for resident.
 Cultural Diversity: Cultural diversity refers to the existence of various cultural
groups with distinct traditions, beliefs, and practices within a society. Embracing
diversity fosters mutual understanding and enriches the social fabric by promoting
tolerance and appreciation for different perspectives.
 Advertising: Advertising of food choices in urban settings plays a significant role
in influencing consumer decisions. It often reflects current dietary trends and
cultural preferences, shaping people's perceptions of what's available and
desirable.
 Health Awareness: In urban settings, health awareness of food choices is crucial
due to increased access to processed foods. Promoting education on balanced
nutrition and encouraging the availability of fresh, nutritious options can
contribute to better overall health in urban populations.
 Dietary Restrictions: Dietary restrictions in urban settings often result from a
combination of factors, including cultural preferences, health considerations, and
lifestyle choices. Access to diverse food options in cities can make it easier for
individuals to adhere to specific diets, such as vegetarianism, veganism, or gluten-
free diets.
 Ethical Beliefs: Ethical considerations, such as sustainability and animal welfare,
can influence food choices in urban settings.
 Convenience: Urban lifestyles often prioritize convenience, leading to increased
consumption of fast food and processed meals.
The complex interplay of these factors shapes the dietary landscape in urban areas,
impacting the health and nutrition of their residents.

18
2.3.4. Challenges in Food Choices
Glanz et al., (2004) challenges associated with making informed food choices within
modern society according to which are as follow:
 Nutritional Quality vs. Convenience: This challenge revolves around the trade-
off between convenience and nutritional value. People often opt for fast-food or
ready-to-eat meals due to their convenience, even though be high in unhealthy
fats, sugar, and salt, contributing to health issues like obesity and heart disease.
 Limited Fresh Produce Accessibility: In many areas, they may lack essential
nutrients especially urban environments, it can be challenging to access fresh fruits
and vegetables. Convenience stores and fast-food outlets are more prevalent than
grocery stores with fresh produce. This lack of accessibility can result in
inadequate intake of vitamins and minerals, which are crucial for overall health.
 Marketing and Advertising Challenges: Unhealthy foods are often aggressively
marketed, particularly to children. This can lead to poor dietary choices and health
problems, as consumers may be influenced by appealing advertisements. There is
also the concern of misleading or deceptive advertising, where products are
portrayed as healthier than they are in reality, which can misguide consumers.
 Processed Foods and Their Impact: Processed and ultra-processed foods have
become staples in many diets. These foods often contain artificial additives,
preservatives, and unhealthy trans fats. Consuming them in excess can lead to
various health problems, including weight gain, heart issues, and high blood
pressure.
 Economic Constraints on Food Choices: The perception that healthier foods are
more expensive can deter individuals from making nutritious choices. This
perception can be valid in some cases, as healthier options like organic produce or
specialty items tend to be pricier. Economic constraints can push people towards
cheaper, less nutritious, and more processed foods, potentially impacting their
health negatively.
 Cultural and Social Influences: Cultural norms, family traditions, and social
pressures play a significant role in shaping dietary preferences. What is considered
acceptable or taboo food can be heavily influenced by cultural factors.
19
 Additionally, social gatherings and peer interactions can sway food choices. The
globalization of diets and the prevalence of social media further complicate these
influences, sometimes leading individuals away from traditional, healthier diets.
 Misinformation and Its Impact: Misinformation about nutrition and dietary
trends can lead to confusion and poor food choices. In today's digital age,
misinformation spreads quickly through social media and unreliable websites.
People may adopt diets lacking essential nutrients or avoid beneficial foods based
on false claims. Relying on credible sources, such as registered dietitians and
scientific studies, is crucial for making informed choices.
 Time Constraints and Food Choices: Modern lifestyles often leave individuals
with limited time for meal preparation. As a result, people may opt for fast-food or
convenience options that require minimal preparation. This shift can lead to less
healthy diets and contribute to obesity and chronic health issues.
 Food Deserts and Access to Nutritious Options: Food deserts are areas where
residents have limited access to affordable and healthy food choices. Grocery
stores and fresh produce markets are scarce, and convenience stores with limited
healthy options often prevail. This lack of access can result in poor dietary habits
and an increased risk of diet-related health problems for the affected communities.
 Portion Sizes and Dietary Choices: The size of food portions can greatly
influence calorie intake and dietary balance. In some cultures, and restaurant
settings, larger portion sizes are promoted, contributing to overeating. People may
struggle to accurately estimate portion sizes, leading to either excessive calorie
consumption or inadequate nutrition. This "portion distortion" can distort
perceptions of what constitutes a standard serving.
 Emotional Eating and Its Impact: Emotional eating is the tendency to use food
as a coping mechanism for emotional states like stress, sadness, or boredom.
Emotional eaters often gravitate toward high-calorie, comforting foods.
Additionally, stress can trigger cravings for sugary and fatty foods due to
physiological responses like cortisol release. Breaking the cycle of emotional
eating often requires strategies like mindfulness, cognitive-behavioral therapy, and
developing healthier emotional regulation skills. Establishing a strong support
20
 system and finding alternative ways to manage emotions, such as physical activity
or relaxation techniques, can also be effective.
2.3.5. Promoting Healthy Food Choices
According to Kilanowski, (2017); promoting healthy food choices in children both in
rural and urban settings involves:
 Raising Awareness: Educating communities about the factors that influence food
decisions, including cultural, economic, and environmental factors.
 Regulating Food Marketing: Implementing regulations to control the marketing
of unhealthy foods, especially to children.
 Supporting Local Initiatives: Encouraging and supporting local initiatives that
promote access to fresh and nutritious foods, such as farmers' markets and
community-supported agriculture.
 Nutrition Education Programs: Developing and implementing nutrition
education programs to improve health and nutrition knowledge.
 Encouraging Healthier Food Environments: Creating environments that make it
easier for individuals to make healthy choices, such as providing access to safe
and accessible walking and biking routes.
 Collaboration: Collaborating with stakeholders, including government agencies,
healthcare providers, and community organizations, to develop and implement
effective strategies.

2.4. THEORETICAL FRAMEWORK

2.4.1. Health Behavior Theory
Health Behavior Theory is a critical component of the theoretical orientation, as it delves
into the intricate decision-making processes that underpin food choices and nutrition.
Two influential theories in this domain are the Health Belief Model (HBM) and the
Social Cognitive Theory (SCT), which provide valuable insights into the cognitive
factors influencing these behaviors. The Health Belief Model (HBM) posits that
individuals make health-related decisions based on perceived susceptibility to a health
problem, the severity of that problem, and the perceived benefits of taking a specific
action, and the perceived barriers to taking that action (Rosenstock et al., 1988). In the
context of Obafemi Owode, caregivers' perceptions of their children's vulnerability to
21
malnutrition, their understanding of the severity of malnutrition's consequences, and their
belief in the effectiveness of certain dietary choices can significantly impact food
decisions. For example, if caregivers perceive that malnutrition is a significant health
threat and that providing a diverse diet can prevent it, they are more likely to make
nutritious food choices for their children.
2.4.2 Social Cognitive Theory (SCT)
The Social Cognitive Theory (SCT), developed by Bandura (1986), emphasizes the role
of social learning and observational experiences in shaping health behaviors. In rural
communities like Obafemi Owode, where traditional knowledge and practices often
influence dietary choices. SCT helps us understand how caregivers learn about food
choices from their social networks and how these choices are transmitted to children. For
instance, if caregivers observe their peers making nutritious food choices for their
children and witness positive health outcomes, they are more likely to adopt similar
practices.
In this research, I will employ the health behavior theories to investigate how these
cognitive factors interact with socio-economic and cultural determinants to shape food
choices and nutritional behaviors among caregivers and children in Obafemi Owode. By
examining how caregivers perceive the health benefits of certain foods, their confidence
in providing nutritious meals, and the influence of social learning on their decisions, we
aim to provide a comprehensive understanding of the intricate web of factors that
contribute to the nutritional landscape in this rural community. This knowledge will
inform targeted interventions to improve the nutritional status of children in Obafemi
Owode, ultimately reducing the prevalence of malnutrition.
2.4.3. Intersectionality Theory
Intersectionality theory, initially developed by Kimberlé Crenshaw in 1989, is a critical
framework that recognizes individuals' complex and interconnected social identities and
how these intersecting identities shape their experiences and access to opportunities. In
the context of child malnutrition in Obafemi Owode, applying intersectionality theory is
crucial for a comprehensive understanding of the factors contributing to nutritional
disparities among children according to this theory include:

22
  Multiple Intersecting Identities: In Obafemi Owode, children do not experience
malnutrition in isolation; rather, their nutritional status is influenced by a myriad
of factors, including gender, age, and socio-economic status. These identities
intersect, creating a complex web of experiences and challenges. For example,
young girls may face unique nutritional vulnerabilities due to both their age and
gender, which could result in differential access to nutritious foods compared to
boys.
 Gender Roles and Food Allocation: One aspect of intersectionality theory relevant
to our study is the examination of how gender roles within household’s impact
food allocation and access to nutritious meals. In many communities, traditional
gender roles assign responsibilities for food preparation and distribution, and these
roles may influence the types of foods allocated to boys and girls. Understanding
these dynamics is essential for crafting targeted interventions to address gender-
specific nutritional disparities.
 Interaction with Socio-economic Factors: Additionally, intersectionality theory
emphasizes how intersecting identities interact with broader socio-economic
factors. In Obafemi Owode, socio-economic status significantly affects access to
resources, including food. Low-income households may struggle to afford
nutritious foods, and this economic constraint may be compounded by gender and
age-related factors. Therefore, an intersectional analysis allows us to explore how
gender, age, and socio-economic status interact to produce varying nutritional
outcomes among children.
 Policy Implications: Applying intersectionality theory can inform policy and
program development. By recognizing that children's nutritional experiences are
shaped by a complex interplay of identities and factors, policymakers can design
interventions that target specific vulnerabilities while considering the broader
socio-cultural context. For example, programs aimed at improving food security
may need to account for the differing needs of girls and boys within households to
ensure equitable access to nutritious meals.
Incorporating intersectionality theory into my research in Obafemi Owode will enable a
more nuanced and holistic examination of child malnutrition, helping us uncover the
23
underlying factors and dynamics that contribute to nutritional disparities among children
with diverse identities and experiences.
2.4.4 Social Determinants of Health Framework
The Social Determinants of Health (SDOH) framework, as elucidated is a comprehensive
approach that underscores the multifaceted interplay between socio-economic factors and
health outcomes. In the context of Obafemi Owode, a region marked by alarmingly high
poverty rates (NBS, 2020), the SDOH framework serves as an indispensable tool to
dissect and understand the intricate web of factors influencing children's nutritional well-
being.
One of the pivotal elements within this framework is income disparities. Poverty is a
pervasive issue in many rural Nigerian communities, including Obafemi Owode. Low
household income directly affects a family's ability to access nutritious foods and
maintain healthy dietary practices. For instance, limited financial resources may result in
households prioritizing cheaper, calorie-dense foods over more nutritious options,
ultimately compromising children's health and development. Parents with higher levels of
education tend to be more knowledgeable about proper nutrition and healthcare practices
for their children. They are also better equipped to navigate the healthcare system and
access crucial information about child nutrition and well-being. Moreover, access to
healthcare services is a critical factor within the SDOH framework. In areas like Obafemi
Owode, limited access to quality healthcare facilities can hinder early detection and
management of malnutrition in children. This lack of healthcare access may result in
delayed interventions, exacerbating the nutritional challenges faced by children (WHO,
2021).
By applying the SDOH framework, our research aims to delve into the complex
dynamics of how income disparities, parental education levels, and healthcare
accessibility collectively contribute to malnutrition among children in Obafemi Owode.
This framework will serve as a guiding lens to comprehensively examine the socio-
economic determinants of child malnutrition and inform the development of targeted
interventions to mitigate its impact on the community.

24
2.4.5 Cultural Ecological Model
The Cultural Ecological Model, rooted in the pioneering work of Bronfenbrenner (1977),
offers a comprehensive framework for examining the intricate interplay between cultural
influences and the surrounding environment in shaping human behavior. In the context of
our research on malnutrition among children in rural Nigeria, particularly in Obafemi
Owode, this theoretical approach provides a nuanced lens through which we can
understand the profound impact of cultural practices and traditions on food choices and
nutritional behaviors.
In rural Nigeria, cultural practices and traditions are deeply ingrained in daily life. These
traditions not only shape how individuals relate to their environment but also dictate what
foods are deemed acceptable, how they are prepared, and when they are consumed. For
example, the preference for locally grown crops like millet or sorghum can be traced back
to centuries-old cultural norms. The cultural significance of these crops extends beyond
their nutritional value; they may be integral to religious rituals, seasonal festivals, or
community gatherings.
Moreover, the Cultural Ecological Model helps us recognize that cultural factors do not
operate in isolation but are intricately intertwined with the local food environment. The
availability and accessibility of foods in the area are influenced by cultural preferences
and practices. In Obafemi Owode, where access to markets and transportation
infrastructure can be limited, cultural factors may strongly shape the locally available
food choices.
Understanding how these cultural factors interact with the local food environment is
essential for gaining insights into the types of foods that are accessible, acceptable, and
ultimately consumed by children in this region. For instance, we may find that cultural
norms favoring certain staple foods may contribute to imbalanced diets or hinder the
adoption of more diverse and nutritious options.
By applying the Cultural Ecological Model to my research in Obafemi Owode. I aim to
uncover the intricate web of cultural influences and environmental factors that impact
food choices among children. This holistic perspective will guide my efforts to develop
contextually relevant interventions aimed at improving the nutritional status of children
under Fifteen years of age in the community.
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2.4.3. Food Security Framework
The Food Security Framework, as defined by the Food and Agriculture Organization
(FAO), provides a comprehensive lens through which to assess the nutritional well-being
of populations. It encompasses four interconnected dimensions: availability, access,
utilization, and stability (FAO, 2021). In the context of Obafemi Owode, a rural area
grappling with food security challenges, this framework becomes particularly relevant.
 Availability: This dimension of food security examines the physical presence of
diverse and nutritious food options within the local food system. In rural regions
like Obafemi Owode, the availability of such foods can be hindered by factors
such as limited agricultural diversity and seasonal variations in food production. It
is imperative to explore how the local food environment in Obafemi Owode
influences the types of foods that are accessible to households, especially those
with children under fifteen years of age.
 Access: Access to food is a critical dimension of food security, encompassing both
physical and economic aspects. In Obafemi Owode, limited access to diverse and
nutritious foods is a pressing concern, particularly for households with low
incomes. Investigating the barriers to food access, such as transportation
constraints and affordability issues, will shed light on the challenges faced by
families in ensuring their children have access to a balanced diet.
 Utilization: Utilization of food refers to the ability of individuals to consume and
absorb nutrients effectively. Even when food is available and accessible, poor
dietary practices can lead to malnutrition. In the context of Obafemi Owode, it is
crucial to examine dietary patterns and nutritional knowledge among caregivers to
understand how food utilization practices may contribute to malnutrition among
children. By utilizing the Food Security Framework, we will comprehensively
investigate the complex issue of food security in Obafemi Owode, shedding light
on how each dimension affects the nutritional status of children under fifteen years
of age. This framework will guide our examination of the availability of diverse
food options in local markets, the barriers to food access, utilization patterns, and
the stability of food access, contributing to a nuanced understanding of
malnutrition in this specific rural community.
26
2.5. EMPIRICAL STUDIES ON MALNUTRITION AND THE FACTORS
AFFECTING FOOD CHOICE OF CHILDREN
A study by Dewanti et al., (2022) was conducted to analyze the factors affecting the
choices of healthy diet among adolescents in rural areas in Indonesia. This cross-sectional
study was conducted on a sample size of 160 respondents with a population of 1,143
from 10 different high schools. The sample size was calculated using the Open Epi
software. The data on factors or reasons behind the choice of healthy diet was taken using
the Food Choice Questionnaire (FCQ), while the data on the choices of healthy foods was
taken using a structured questionnaire, both of which had been tested for validity and
reliability. The collected data were analyzed using the Spearman Rank test. The main
reasons that can influence adolescents to pick healthy diets in rural area were for
healthiness concerns, the natural contents of the foods, and body weight control (BW)
(p=<0.005). It is therefore recommended from this study that adolescents should optimize
their knowledge and skills in food selection, especially healthy food.

In KwaZulu-Natal South Africa, Pillay et al., (2021) conducted a study to assess the
nutritional status, using selected anthropometric indices and dietary intake methods, of
four rural communities. Purposive sampling was used to generate a sample of 50
households each in three rural areas (Swayimane, Tugela Ferry, and Umbumbulu and 21
households at Fountain Hill Estate). The Estimated Average Requirement cut-point
method was used to assess the prevalence of inadequate nutrient intake. Stunting (30.8%;
n = 12) and overweight (15.4%; n = 6) were prevalent in children under five years, while
obesity was highly prevalent among adult females (39.1%; n = 81), especially those aged
16–35 years. There was a high intake of carbohydrates and a low intake of fibre and
micronutrients, including vitamin A, thus, confirming the need for a food-based approach
to address malnutrition and micronutrient deficiencies, particularly vitamin A deficiency.

This study was carried out on malnutrition and the factors affecting food choice using
Okat community in Onna local government of Akwa Ibom State as a case study. 147
respondents and 141 were validated. Self-constructed and validated questionnaire was
used for data collection. The collected and validated questionnaires were analyzed using
frequency tables, and mean scores. The hypotheses was tested using Chi-square

27
Statistical tool. The result of the findings reveals that rural dwellers does not have
adequate knowledge of the proper nutritional intake. The study also revealed that the
factors affecting the food choices includes: poor income status, family background, lack
of proper nutritional knowledge, cultural beliefs, inadequate food security. Therefore, it is
recommended that to reduce the present high rate of malnutrition, the study suggests the
targeting of women with education programmes and provision of clean water, including
the enforcement of healthy environment in the areas.

A study was conducted to compare dietary practices and nutritional status of children in
rural and urban communities of Lagos State, Nigeria. Comparative-analytical study was
conducted using the multistage sampling technique to select the study cases. A total of
300 mother–child pairs were studied, including 150 each from rural and urban
communities. The data collected include demographics, socioeconomic characteristics,
feeding practices and anthropometric measurements of the participants. Food intake data
was collected using 24-h dietary recall. Malnutrition in children was determined by
calculating the prevalence of low height-for-age (stunting), low weight-for-age
(underweight), and low weight-for-height (wasting) using the World Health Organization
cutoff points. The prevalence of exclusive breastfeeding for 6 months (25.3% vs. 28.7%;
P = 0.516), use of formula feeds (48.7% vs. 44%; P = 0.077), and mean age of child at
introduction of semisolid foods (7.54 ± 4.0 months vs. 8.51 ± 7.3 months; P = 0.117)
were not significantly different between urban and rural communities. The diversity of
food choices and frequencies of consumption were similar in children between urban and
rural communities. However, prevalence levels of underweight and stunted children were
significantly higher in rural than that of urban communities (19.4% vs. 9.3%, P < 0.001
and 43.3% vs. 12.6%, P < 0.001, respectively).

Factors evaluated as affecting child nutrition a total of 49 factors were evaluated in

relation to wasting, stunting, and/or underweight by multiple studies. This list includes 12
factors measured at the individual level; 25 factors measured at the household level
(including five factors pertaining to mothers); eight factors measured at the
region/community level; and four factors measured at the country level. Analysis of
disaggregated data at the individual and/or household level featured in 89% of the

28
reviewed articles. Most analyses did not include any covariates measured at the
regional/community or country levels (e.g., (Ekbrand and Halleröd 2018)). Thus, fewer
articles are available with which to evaluate the consistency of relationships of factors at
the regional/community and country levels than at the individual and household levels.
Of the 49 factors, 18 have been evaluated by multiple studies in relation to each of the
three standard measures of child malnutrition. The subsequent presentation of results is
restricted to instances of prevailing evidence of statistically significant relationships
indicating risk factors or mitigating factors, according to a majority of relevant reviewed
studies. Eight of the 12 factors measured at the level of individual children exhibited
statistically significant relationships for the following factors: child’s sex and age, if they
were a multiple at birth (twin, triplet, etc.), and diarrhea status. Seven of the 10 factors
evaluated in relation to stunting exhibited statistically significant associations. These
associations identified five risk factors: child’s sex and age, their birth order, if they were
a multiple at birth, and short birth interval. Two mitigating factors were also identified: if
a professionally trained assistant was present at the birth and if Vitamin A supplements
had been used. The results indicated that two of the four factors evaluated in relation to
underweight were statistically significant risk factors: child’s age and if they were a
multiple at birth. According to our review, therefore, all three anthropometric measures
of malnutrition were associated with two individual-level risk factors: age and multiple at
birth. Of the 25 household-level factors, just four of the 17 factors exhibited statistically
significant associations: mother’s education, mother’s BMI, wealth/assets, and access to a
health care center (Fig. 1b). All were evaluated as being mitigating factors. Eleven of the
25 factors evaluated in relation to stunting yielded statistically significant associations.
The relationships identified three risk factors: rural, indigenous, and altitude. In addition,
eight mitigating factors were identified: mother’s education, father’s education, mother’s
BMI, mother’s height, pregnancy care, wealth/assets, quality of household materials, and
food aid or supplemental feeding. Five of the 13 factors evaluated in relation to
underweight yielded statistically significant associations. Only one relationship identified
a risk factor: rural residence. Four mitigating factors were also identified: mother’s
education, mother’s BMI, wealth/assets, and quality of toilet. According to our review,
therefore, all three anthropometric measures were associated with three household-level
29
risk factors: mother’s education (either years of education or specific levels relative to no
education), mother’s BMI, and wealth/assets (encompassing different indices). The eight
factors measured at the region/community level is split between measuring features of the
environment, including climate conditions, and features related to conflict. Wasting had a
statistically significant association with excessive rainfall as a risk factor and growing
season rainfall as a mitigating factor. Stunting had a statistically significant association
with extreme temperatures as a risk factor. Underweight only exhibited a statistically
significant association with drought as a risk factor. Several of the reviewed studies
analysed vegetation quality, employing either the normalized difference vegetation index
(NDVI) or the enhanced vegetation index (EVI), with varying operationalization. In
particular, vegetation quality during the previous growing season has been evaluated in
multiple studies of both wasting and stunting, yielding findings that vary by context.
Statistically significant associations were observed between stunting and three factors
that reflect distinctive operationalization of the role of conflict. Conflict in the
surrounding region, conflict exposure (days or months), and whether a child was born
during a conflict were all identified as risk factors for stunting. At the country level,
national per capita GDP was identified as a mitigating factor for wasting, stunting, and
underweight (Fig. 1d). Female education (encompassing national rates of female literacy
and female secondary enrolment) was identified as a mitigating factor for stunting and
underweight. Both the national average female-to-male life expectancy ratio and the
dietary energy supply per capita were identified as mitigating factors for underweight.

About 60% of the reviewed studies employed standard variations of multivariate

regression techniques, such as linear, generalized linear (e.g., logit), or multilevel models.
Only 5% of studies used explicit multilevel statistical techniques, modelling
simultaneously the relationships between malnutrition and covariates at the individual,
household, and regional/community levels (e.g., (Ekbrand and Halleröd 2018)). Other
studies that did not estimate multilevel models instead included covariates aggregated to
higher levels, introduced dummy variables for geographic regions, or adjusted for within-
spatial-unit correlation via clustered standard errors (e.g., (Rashad and Sharaf 2018)).
Five articles used quantile regression, which fits a model through quantiles of the

30
dependent variable, rather than the mean (e.g., (Asfaw 2018)). This approach has the
advantage of allowing for heterogeneous treatment effects for different segments of the
distribution of child malnutrition. For example, a given factor may exhibit a stronger
association with weight-for-height z-scores for children who are undernourished (i.e., the
left tail of the distribution), relative the association observed for children whose nutrition
status is near the center of the distribution. A majority of reviewed studies relied on
cross-sectional analysis of either data from single surveys or a pooled dataset comprising
multiple cross-sectional surveys. Just five of the studies capitalized on panel data
involving repeated waves of data collection for the same children or households over
time. The remaining studies employed a diversity of approaches, including time-series
analysis of repeated cross-sections of countries or subnational regions. Among the
reviewed studies, the most common source of malnutrition measures was Demographic
and Health Survey (DHS) data (27 studies). Five of the reviewed studies used Living
Standards and Measurements Survey (LSMS) data. The remaining studies employed
other country-specific surveys, with India’s National Family Health Survey (4 studies)
and Ethiopia’s Rural Household Survey (2 studies) featuring in multiple cases In terms of
causal identification strategies, 17% of the reviewed studies directly leveraged the
availability of data collected from repeated measurement over time, estimating either
unit-level fixed effects or difference-in-differences models (e.g., (Lucas and Wilson
2013)). A further 9% of articles featured an instrumental variables strategy (e.g.,
(Yamano et al. 2005)) and another 6% of articles resorted to matching techniques (e.g.,
propensity score) to control for selection bias and minimize problems of sample
imbalance. The remaining studies exhibited a variety of other approaches, including
decomposition analysis (Block et al. 2004; Rodriguez 2016) and a regression
discontinuity design (Ali and Elsayed 2018). Among the reviewed studies, attention to
the temporal relationship between malnutrition and potential factors was limited and
uneven, constraining the ability to ascertain any general patterns. The lack of such
examination of the impact of climate and conflict shocks is especially conspicuous. A
common approach has been to measure deviations in conditions during the survey period
relative to long-run average conditions, within a suitable sub-national geographic area
surrounding the survey cluster. The implicit assumption is that the deviations in
31
conditions exert a contemporaneous impact on malnutrition. Select studies used models
specifying factors with time lags. For example, Johnson and Brown (Johnson and Brown
2014) tested one- and two-year lagged measures of shocks in vegetation, but the results
of these estimations were not presented because the observed effects were not statistically
significant. Kinyoki et al. (2016) tested lags measures of conflict during the three months
prior to survey and the period from 3 to 12 months prior to the survey, finding that both
variables have statistically significant associations with wasting and stunting. Howell et
al. (Howell et al. 2018) tested yearly lagged values of conflict days and deaths in an
analysis of stunting and wasting. Another approach in studies that have modelled the
effects of conflict shocks on child malnutrition is cohort analysis. The effect of the shock
is gauged based on birth timing relative to the shock, evaluating how the “during” shock
cohort differs from the “before” shock and “after” shock cohorts (Grace et al. 2015).

2.6. INTERVENTIONS TO ADDRESS MALNUTRITION

Addressing malnutrition in children requires a multi-pronged approach such as:
 Promoting Exclusive Breastfeeding: Encouraging and supporting mothers to
practice exclusive breastfeeding for the first six months of an infant's life.
 Enhancing Access to Nutritious Foods: Initiatives to improve access to fresh and
healthy foods, such as community gardens and mobile markets.
 Nutrition Education: Providing nutrition education and awareness programs to
empower individuals and families to make informed choices.
 Targeting Socio-Economic Disparities: Addressing poverty and social inequality
to ensure that all community members have equal access to nutritious foods.
 Healthcare Access: Improving healthcare access and the treatment of common
illnesses like diarrhea and respiratory infections in children.
 Food Security: Implementing measures to enhance food security and safety,
reducing the risk of malnutrition.
 Community-Based Interventions: Engaging communities in developing and
implementing strategies tailored to their specific needs.

32
These interventions should be context-specific and involve collaboration among
healthcare providers, community leaders, and policymakers to create sustainable
solutions.

33
 CHAPTER THREE

RESEARCH METHODOLOGY

3.1 INTRODUCTION
This chapter presents the methodology and procedures adopted in carrying out the
research. As a survey research design, the study required the collection of data from
respondents in order to find out their opinion on malnutrition and the factors affecting
food choice of children in Obafemi Owode Local Government Area of Ogun State
through the use of questionnaire.

3.2 RESEARCH DESIGN

This study examined adopted descriptive survey research design because it described the
given variables without manipulation and found suitable for studying large population.
Research design means structuring of investigation aimed at identifying variable and their
relationship to one another. This is use for the purpose of obtaining data to enable
researcher test hypothesis or answer research questions in relation to the malnutrition and
the factors affecting food choice of children in Obafemi Owode Local Government Area
of Ogun State

3.3 AREA OF THE STUDY

The study area for this research work was Obafemi owode Local Government Area of
Ogun State, headquarter in the town of Owode at 6°57′N 3°30′E, and has an area of 1,410
km². It is bounded in the north by Odeda Local Government and Oyo State, in the east by
Sagamu and Ikenne Local Governments and in the south by Ifo Local Government and
Lagos State.

3.4 POPULATION OF THE STUDY

A sample is the subset of population selected for a study and the sample selected for this
study was purposive sampling technique where participants which are the children
between 0 and 5 years of age were selected based on their nutritional status and with the
help of their mother in order to have quality and smooth process of data collection in

34
Obafemi Owode local government area of Mowe, Ogun State, Nigeria. The total
population of Obafemi Owode local government is estimated to be around 230,000
people, having a total population of children aged 0-14years to be around 88,004 people.
The total population of children between this age brackets (0-5) according to google
search was 9,722 and for the purpose of the study, 10% of the 9,722 for sampled as the
sample size for the study which make the final sampled to be 972.

3.5 RESEARCH INSTRUMENTS

These are the tools or methods used in collecting data from respondents. Questionnaire
was used as research instrument for this study to gather necessary data from the sampled
respondents which was titled ‘Malnutrition and the Factors Affecting Food Choice of
Children Questionnaire’ (MFAFCCQ). The instrument contained research items prepared
in line with the research questions. In the questionnaires, the researcher made each item
of the questionnaire clear and understandable to encourage the respondents to answer all.

3.6 VALIDITY OF THE INSTRUMENT

This refers to the degree to which an instrument actually measures what it was designed
to measure. In order to ensure that the instrument used for this study measures what they
are supposed to measure, face validity was adopted to allow experts in the field to
examine the questionnaire for adequacy.

3.7 RELIABILITY OF THE INSTRUMENT

An instrument is reliable if it measures under the same circumstances consistently from

one time to another what is set out to measure. That is, reliability of a questionnaire may
be estimated by a second administration of the instrument comparing responses with
those of the first administration. For this study therefore, Test-Retest technique was used
in determining the reliability of the instrument, and the instrument was found reliable.

3.8 ADMINISTRATION OF THE INSTRUMENT

The instrument used was personally administered on the respondents by the researcher. A
total number of 972 questionnaire were administered on respondents.

35
3.9 METHOD OF DATA COLLECTION

The data used for this study was collected by the researcher after the respondents have
put down their opinion on this study. A total number of 972 questionnaire was distributed
while 300 were retrieved and this was considered as population for the study.

3.10 DATA ANALYSIS

In order to analyze the collected data, simple percentage with frequency distribution table
was used for both Section A (demographic data) and Section B (analysis of research
questions).

36
 CHAPTER FOUR
DATA PRESENTATION, ANALYSIS AND DISCUSSION

4.0 INTRODUCTION

This chapter presents the result of the study in order of the research questions raised as
well as the discussion of the result. Section A contains the demographic analysis and
section B contains the analysis of the research questions.

4.1 DEMOGRAPHIC DATA ANALYSIS

SECTION A: Analysis of Demographic Characteristics

Table 4.1.1: Gender Distribution of Children between the age 0 and 5

Gender Frequency Percentage

Male 158 52.7
Female 142 47.3
Total 300 100

Table 4.1.1 above shows the gender of the studied participants which are the children
between the age of zero and five and out of the 100 participants who were studied, 52.7%
were male while 47.3% were female. The result proved that the number of male studied
was a bit higher than that of female.

Table 4.1.2: Distribution of respondent According to Age Group

Age Frequency Percentage

Under 2 93 31
2-4 181 60.3
5 years 26 8.7
Total 300 100

Table 4.1.2 above data shows that 31% of the respondents fall between the ages of zero
and two, 60.3% of the distribution was between the ages of 2 and 4 while 8.7% of the

37
total population represent children only for 5years. Therefore, from the data gathered it
was evident that children between the age of two and four were more than the other age
(0-2 and 5years only) distribution used for the study.

Table 4.1.3: Cultural Background of the respondent

Cultural Background Frequency Percentage

Ogodo 93 31
Egungun 181 60.3
Bolojo 26 8.7
Total 300 100

Table 4.1.3 above shows the different culture existing among the people of Obafemi
Owode which is related to the different types of dance practices, this is because only the
dance was mentioned as their culture. The findings gave an insight into the types of dance
practices by the respondents where 31% of Obafemi Owode family under research dances
Ogodo, Egungun dance was 60.3 and Bolojo 8.7%. This means that family under
research that egungun is their cultural dance take highest position out of the three cultural
dances existing in the Obafemi Owode.

Table 4.1.4: Parents Occupation of the Respondent

Occupation Frequency Percentage
Business 77 25.7
Civil Servants 61 20.3
Unemployed 40 13.3
Seasonal Trade 122 40.7
Total 300 100

The table 4.1.4 above shows the Occupation, of three hundred mothers where 25.7%
mothers were doing business (at whole sales and retails level), 20.3% worked as civil
servants, 13.3 were unemployed and 40.7% were seasonal trade such as selling of
different type of fruit presently available in the market and then jump to any other type of
trade that is lucrative after that season.
38
Section B: Feeding Habits
4.2 Research Questions and Analysis on Malnutrition and the Factors Affecting
Food Choices of Children
s/n Items Frequency Percentage
1 Is the child breastfeeding, bottle feeding
or mixed feeding?
breastfeeding 60 20.0
bottle feeding 116 38.7
mixed feeding 124 41.3
2 How frequent is the child feeding in 24
hours?
1-3 times 30 10
4-6 times 172 57.3
7-10 times 80 26.7
11-14 times 18 6
3 Apart from breast milk is there any
supplementary foods?
Yes 282 94
No 18 6
4 When was the child weaned?
6 months 64 21.3
1 year 135 45
1 ½ years 68 22.7
2 years 33 11
5 When was the child introduced to
supplementary foods?
1-3 months 38 12.6
4-5 months 185 61.7
6 months 77 25.7
Others - -

39
6 What are the weaning foods?
Staples only 128 42.6
Staples, Legumes & Fruits 61 20.3
Staples, Fats, Oil & animal foods 43 14.3
Staples, Vegetables, Animal foods & 38 12.6
Fruits
Staples, Vegetables, Fruits, Legumes, Fats 24 8
& oils
Staples, Legumes, Fruits, Vegetables, Fats 6 2
& oils and Animal foods
7 How frequent is the food given?
1-2 month 77 25.7
3-4 month 122 40.7
5-6 month 61 20.3
Above 6 months 40 13.3
8 What type of food does he/she takes?
Staples 128 42.6
Legumes 61 20.3
Fruits 43 14.3
Vegetables 38 12.6
Fats & oils 18 6
Animal foods 12 4
9 Staples (How many days in a month)
1 – 7 days 67 22.3
8 – 14 days 42 14
15 – 21 days 103 34.3
22 – 30 days 88 29.4
10 Legumes (How many days in a month)
1 – 7 days 42 14
8 – 14 days 26 8.6

40
 15 – 21 days 155 51.6
22 – 30 days 77 25.6
11 Fruits (How many days in a month)
1 – 7 days 187 62.3
8 – 14 days 58 19.3
15 – 21 days 32 10.6
22 – 30 days 23 7.6
12 Vegetables (How many days in a month)
1 – 7 days 155 51.6
8 – 14 days 69 23
15 – 21 days 48 16
22 – 30 days 28 9.3
13 Fat & Oil (How many days in a month)
1 – 7 days 179 59.6
8 – 14 days 82 27.3
15 – 21 days 29 9.6
22 – 30 days 10 3.3
14 Animal Food (How many days in a
month)
1 – 7 days 155 51.6
8 – 14 days 69 23
15 – 21 days 48 16
22 – 30 days 28 9.3
15 He/She is frequently taken to hospital for
regular health check-ups?
Yes 118 39.3
No 182 60.6
16 Has the child experienced any significant
illness or health issues in the past year?
Yes 89 29.6

41
 No 211 70.3
17 Has the child received all recommended
vaccinations for their age?
Yes 89 29.6
No 211 70.3
18 Has the child's weight and height been
regularly monitored by a healthcare
professional?
Yes 112 37.3
No 188 62.6
19 Have you noticed any signs of
malnutrition in the child, such as poor
weight gain, lethargy, or slow growth?
Yes 157 52.3
No 143 47.6
20 Does the child have any underlying
medical conditions that may affect their
nutritional status?
Yes 53 17.6
No 247 82.3

The table 4.2 above shows the response to each item of the research questions on
malnutrition and the factors affecting food choices among children under five years of
age in Obafemi Owode local government Mowe, Ogun State, Nigeria. The findings
revealed how often the children below six months breastfed from their mothers. Out of
300 children 20% were breastfed, 38.7% were bottle-fed while 41.3% were mixed fed.
However, 10% baby were breastfed only one to three times a day, 57.3% babies were
breastfed four to six times, 26.7% were fed seven to ten times a day while 6% babies
were fed eleven to fourteen times a day. This means that babies fed between four to six
times have the highest percentage, the reason was due to the fact that majority of their

42
parents were business men and traders. It was also noted that apart from the breast milk,
94% of mothers do give their children supplementary foods while 6% continue feeding
them with only breast milk.

According to the results in the above table showing the period when the child was
weaned, it revealed that only 21.3% of children were weaned at six months, 45% of
children were weaned at age 1 year, 22.7% were weaned at age 1 and half year, another
11% were weaned at 2years. However, there was requirement that each child is weaned at
the age of 2 years old, but in this case the findings shows that most of them were weaned
at 1 year.

It was as well revealed from findings of the study from the table above that out of 300
under five children who underwent research, 12.6% were introduced to supplementary
foods between 1 to 3 months, 61.7% between 4 to 5 months and 25.7% were introduced
to supplementary foods at exactly 6 months. This shows a slight difference in the
population of children who were introduced to supplementary foods at right and wrong
time. Meanwhile children between 4 to 6 months shows the highest percentage of 61.7%,
this means that 61.7% children were introduced to supplementary food between 4 to 5
months.

The table above also shows the weaning food and how frequent the food is served among
the children and family members in that family. The statistical data table showed that
34% of children were served 2 times in a day, 42% of children were served 3 times in a
day, 12% of children were served 4 times in a day and another 12% of children were
served more than 4 times in a day. Those who were almost served for four and more
times were the babies from six months of age.

According to the table above on food consumption, the food group of staples for 22.3%
children consumed it between 1-7 days, 34% consumed it between 8-14 days, 34.3%
children consumed it between 15-21 days while 29.4% consumed it between 22-30 days.
This means that there was high intake of staples almost every day. Such food includes
rice, cassava and potatoes etc. For Legume consumption, most people eat beans, ground
nuts and soya. According to the table above 14% households eat legumes between 1 to 7

43
in 30 days, 8.6% households eat legumes 8 to 14 days in a month, 51.6% households eat
legumes 15 to 21 days in a month and 25.6% households eat legumes almost every day in
a month. On fruit consumption, such as Mango, Banana, Pawpaw, tangerines etc. Out of
300 households, 62% households eat fruits between 1 to 7 days, 19.3% households eat
fruits 8 to 14 days, 10.6% households eat fruits 15 to 21 days while 7.6% eat fruits
between 22 to 30 in a month.

On vegetable consumption, most family eat them almost every day (22 to 30) days while
the least household, that is out of 300 households only 51.6% household eat vegetables
between 1 to 7 days in a month while 9.3% eat vegetables between 22-30 days. On fats
and oils 59.6% households eat them between 1 to 7days and only 3.3% households eat fat
& oil between 22 to 30days. On animal foods, 51.6% households out of 300 households
eat foods like pork, chicken and meat between 1 to 7 days in a month while some other
families eat less than previous mentioned household but the least of the consuming
household was 9.3% between 22 to 30days.

The results above show that there was equal proportionate of those who were sick for
long time and those who were not sick for long time. Sick children were 50%, and those
who were not sick were 50%. On the kind of diseases affecting the under five children,
out of 50% children who were affected by different kinds of diseases, children affected
by Malaria were 18%, children affected by Pneumonia representing 18%, children
affected by diarrhea representing 10% and children affected by Malnutrition representing
4% while 150 children which represent 50% were not affected by any other disease.
More than half of under-five children suffered from different health status condition.
Children affected having body rashes representing 16%, children affected with diarrhea
representing 10%, children affected with fever representing 2%, and the remaining
children were having breathing difficulty representing another 4%. However, 48%
children were not affected in any way on their health.

CHAPTER 5
DISCUSSION OF FINDINGS
44
5.0 INTRODUCTION

This chapter entails summary of findings drawn from the data presentation, conclusion
and recommendations made on the basis of these findings.

5.1 SUMMARY OF FINDINGS

According to results explained above, they have greater meaning to the malnutrition
issues in health of all under five in Obafemi Owode Local Government Area of Ogun
State. Looking at the sample size there was almost equal proportion of male and female
child. Males are relatively more than females in the representation of true population.
This however, has brought so much pressure in caring of children, feeding them and even
educating them due to increased number of children in households.
According to WHO (2021), there has been almost 70% of under five children being
affected by malnutrition yearly, and almost five cases of malnutrition appear each month.
During the study, it was stipulated that almost 74 children were receiving malnutrition
treatment at Ogo Oluwa Clinic and Maternity and were mostly on diet like F75 and F100
milk, and Peanut butter (Chiponde) in order to boost their health status to a better state.
Most cases at the clinic had increased due to poor feeding habits, food choices for the
under-five children and eating behavior of their households.
The 2021 WHO’s Survey showed that most nations are heavily affected by the under-five
malnutrition. 52% of families had shown challenge to nourish their children due to
inadequate nutritious food and as well as a result of present economy situation. This has
been reason why most families fail to nourish their children’s health with adequate
nutritious food and most families were into petty trade. There are many challenges for
them to find adequate foods for their families to feed themselves and children. More than
half of millions of people in the country are facing food shortage that is why most
families have to look for food and then mind about nutrition of children. Most families
work very hard to buy food and necessities to sustain the family needs which might not
be enough to cater for the children.
Since three quarter of children who went under study were from two to three years old
and their pattern of eating was supposed to be at least three times main course meals

45
because they were still growing up. 36% of these children were eating only twice a day,
putting them at even greater risk of malnutrition. In relation to UNICEF 2007a; WHO
2001a, says malnutrition in children is the consequence of much food insecurity, which
stems from poor food quality and quantity. Head of nutrition in the Ministry of Health,
Janet Guta also seconded that Household food insecurity is one of the contributing factors
to malnutrition which leads to stunting and is a bog challenge in Obafemi Owode.
It has been shown that most of the families in Obafemi Owode lack knowledge about
child health and nutritious meals. Most of them had expressed that, as long as they were
not sick there was no need to visit the hospital. Mothers in hospital are taught on the
importance of exclusively breastfeeding young babies below six months. The results
showed that 2% were breastfeeding less than 6 times per day since they opted to give
babies water and porridge. The assessment revealed that, their thinking is that the baby
goes hungry if they are giving breast milk alone and as well will not disturb their daily
activities when fed with other supplements. Only 4 % of children were breast feeding
from 7 to 10 times giving us an equal proportionate of those who are following exclusive
breastfeeding and those who are not.
Similar studies, according to kleges, 1991 says that parental attitudes certainly affect
children’s eating habits, dietary surveys show that young children are not eating
recommended amount of nutritious foods. Most women weaned their children at the age
of one year representing 36% of children weaned at that age. It is recommended that
children be weaned at the age of two years, so that they do not lack nutrients for body
development. Under-five children who were weaned at two years were 2%. Careless,
weaning will put children at risk of malnutrition and opportunistic infections since in the
breast milk they lack major nutrients that can nourishment their system.
46% of under-five children were introduced to supplementary foods at four to five
months, with foods such as yoghurt, cow milk, porridge and freezes. This practice may
make it easy for babies to develop complications of the gastrointestinal since at that age
the baby’s gastrointestinal system is not well developed. 52% of children under study had
history of malnutrition, pneumonia, fevers, and Diarrhea. This is similar to the study of
Brian J, 2004, saying that poor diet result in many diseases affecting physical
development of under-five children.
46
Poverty is one of the contributors to the food choices at household level. 42% of parents
were not employed, this showed income challenges as the least were civil servants. This
affected their meal patterns and most of families ate twice a day with their children. This
is similar to the statement of Timothy Bonyonga a Motherhood specialist which opined
that most women get pregnant at early stage since they failed school and because of
influence from parents, for they would want to attain some money through marriage.
Most of them who are married below 20 years of age are not prepared for food, care and
support for their children. The end result is child malnutrition, less thinking and poor
brain development. According to the results of this study more than half of children were
affected with different kinds of diseases which include; malaria, pneumonia, severe
respiratory diseases, diarrhea and malnutrition. According to a report by UN World Food
Program (WFP), almost half of all children 1under five in some part of Africa were
affected by stunting in 2012 and 350,715 children were underweight.

5.2 CONCLUSION
Poverty is the leading cause of food insecurity which has led to poor food choices for the
underfive children. However, parental attitude, lack of knowledge, meal patterns, food
availability are the contributing factors to food choices. Most children have developed
pneumonia, malaria, diarrhea and malnutrition as main effects of poor sanitation, lack of
health nutritious foods, and improper caring for children.

5.3 RECOMMENDATIONS
The government and non-governmental organizations such as USAID, WHO, Save the
Children, WFP etc. need to work continually in close partnership in dealing with
malnutrition. Resources such as drugs, food porridge, peanut butter and Milk for children
with malnutrition need to be adequate for all affected children. This is why government
must continually involve the nongovernmental health organization to increase the funds
in order to have quality health outcome in children’s status.

Empowering of all health professionals like Doctors, Nurses, and Disease Control
Assistants through continuation of training in child health and health care. This later

47
improves the skills of professionals in promotion of improved food choices through
health education. It will also help in the prevention of malnutrition cases and diseases
such as Malaria, Pneumonia, and Diarrhea which commonly leads to death of most
under-five children.

The government should also invest considerable amounts of money in the Maternal Child
Health sector (MCH) since nutritional issues affect a lot of women, pregnant mothers and
under five children. If more funding and support is given to this sector, there will be
improved health of both mothers and their children.

There is need of non-governmental health organization in collaboration with the

government to develop research-based programs that will contribute in the alleviation of
malnutrition issues and poverty reduction which has heavily affected the local
government under study and the nation at large. About 10.7 percent of those who would
now be aged between 15 and 64 died as children because of under nourishment. Such
people would have helped the country in different fields of Agriculture, Health,
Environment and Nutrition, hence promoting development of a country.
Research based work shall help in depicting levels and effects of food choices. It will also
help in finding possible means on balancing and control the rate of malnutrition in the
country and attain a free nation of malnutrition cases in under-five children.

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52
 APPENDIX
DEPARTMENT OF PUBLIC HEALTH

FACULTY OF SCIENCE

HILLCITY UNIVERSITY, LIBERIA.

…………………………………………

…………………………………………

…………………………………………

Dear Respondent,

I am a final year student of the above mentioned school and department conducting a
research on the topic: "Malnutrition and the Factors Affecting Food Choice of Children".

I hereby solicit your assistance in all ways possible to enable me conduct successful
research. You are required to complete with assurance that all information supplied will
be treated as confidential. For each of the statements below, indicate your level of
agreement or disagreement ticking (√) the appropriate column.

Thank you for your cooperation.

Section A: Demographic Characteristics:

Child’s gender: Male ( ) Female ( )

Age of child 0–2( ) 2–4( ) 5years only ( )

Cultural Background: Ogodo ( ) Egungun ( ) Bolojo ( )

Parents’ Occupational Status: Business ( ) Civil Servant ( ) Unemployed ( ) Seasonal

Trade ( )

53
SECTION B: FEEDING HABITS

PART 1: Children from Birth to 24 Months

1. Is the child breastfeeding/ bottle feeding / mixed feeding?

Breastfeeding ( ) Bottle-feeding ( ) Mixed Feeding ( ) Others ( )

2. How frequent is the child feeding in 24 hours? 1-3 times ( ) 4-6 times ( ) 7-10 times
( ) 11-14 times ( )

3. Apart from breast milk is there any supplementary foods? Yes ( ) No ( )

4. When was the child weaned? 6 months ( ) 1 year ( ) 1 ½ years ( ) 2 years ( )

5. When was the child introduced to supplementary foods? 1-3 months ( ) 4-5
months ( ) 6 months ( ) Others ( )

6. What are the weaning foods?

Staples only ( )

Staples, Legumes & Fruits ( )

Staples, Fats, Oil & animal foods ( )

Staples, Vegetables, Animal foods & Fruits ( )

Staples, Vegetables, Fruits, Legumes, Fats & oils ( )

Staples, Legumes, Fruits, Vegetables, Fats & oils and Animal foods ( )

7. How frequent is the food given? 1-2 month ( ) 3-4 month ( ) 5-6 month ( )
above 6 months ( )

PART 2: Food Intake Assessment for Children from 2 To 5 Years

8. What type of food does he/she takes?

FOOD GROUPS INTAKE

PER
54
 MONTH

STAPPLES; Maize, rice, wheat, cassava, potatoes, banana

LEGUMES; soya, beans, beans, g/nuts, ground, beans, peas, cow
peas, pigeon peas
FRUITS; mango, banana, pawpaw, tangerines, lemon, guavas,
peaches
VEGETABLES;,tomato, carrot,egg plants, pumpkins
FATS AND OILS; margarine, c/oil, milk, milk products, avocado
pears, poultry, soya beans, g/nuts, sunflower
ANIMAL FOODS; fish, pork, eggs, insects, chicken, meat

9. Staples 1-7 days ( ) 8-14 days ( ) 15-21 days ( ) 22-30 days ( )

10. Legumes 1-7 days ( ) 8-14 days ( ) 15-21 days ( ) 22-30 days ( )

11. Fruits 1-7 days ( ) 8-14 days ( ) 15-21 days ( ) 22-30 days ( )

12. Vegetables 1-7 days ( ) 8-14 days ( ) 15-21 days ( ) 22-30 days ( )

13. Fats & Oils 1-7 days ( ) 8-14 days ( ) 15-21 days ( ) 22-30 days ( )

14. Animal Foods 1-7 days ( ) 8-14 days ( ) 15-21 days ( ) 22-30 days ( )

PART 3: Healthcare Monitoring and Malnutrition Indicators

15. I frequently take my child(ren) under five for regular health check-ups?

Yes ( ) No ( )

16. Has the child experienced any significant illnesses or health issues in the past year?

Yes ( ) No ( )

17. Has the child received all recommended vaccinations for their age?

Yes ( ) No ( )

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18. Has the child's weight and height been regularly monitored by a healthcare
professional?

Yes ( ) No ( )

19. Have you noticed any signs of malnutrition in the child, such as poor weight gain,
lethargy, or slow growth?

Yes ( ) No ( )

20. Does the child have any underlying medical conditions that may affect their
nutritional status?

Yes ( ) No ( )

Thank you for taking your time to fill this questionnaire. Your responses will
remain confidential.

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