FACTOR ASSOCIATED WITH MALNUTRITION AMONG UNDER FIVE

CHILDREN IN RACHUONYO SUB COUNTY HOSPITAL IN HOMABAY,

KENYA

CANDIDATE NAME: ACHIENG’ NAIMA

INDEX NO: 7311011632

PAPER NO: 2916/307

CENTRE NAME: MAWEGO TECHNICAL TRAINING INSTITUTE,

P.O BOX 286-40222,

OYUGIS

COURSE NAME: DIPLOMA IN NUTRITION AND DIETETICS

NAME OF SUPERVISOR: MR STEPHEN KOGA

SUBMITTED TO KENYA NATIONAL EXAMINATION COUNCIL IN

PARTIAL FULFILMENT FOR AWARD OF DIPLOMA IN NUTRITION
AND DIETETICS

SERIES: JULY 2023

 DECLARATION

I declare that this project was clearly designed and worked on by myself hence is my own work

and has never been presented to any other college, institution or university.

NAME: ACHIENG’ NAIMA

Signed …………………………Date………………………..

NAME OF SUPERVISOR: MR. STEPHEN KOGA

Signature …………………………………………..

Date ……………………………………………….

ii
 DEDICATION
The research project is dedicated to my mother Monica Jomo. Her never endings, support and

encouragement through my life is a gift that I will never take for granted and I am forever in

debited to her. This project is also dedicated to my siblings; Felix Ochieng and Aggry Jomo.

May you continue to pursue the best version of yourselves with unrelenting vivacity and

endurance.

iii
 ACKNOWLEDGEMENT
My sincere thanks to the almighty God for guiding and enabling me to work on this research and

gain academic insight into topic. I am also grateful to my supervisor Mr. Stepehen Ochieng Koga

for the support and guidance he has accorded the project.

iv
 ABSTRACT

The main purpose of this study was to investigate factors associated with malnutrition among

children under five years within Rachuonyo Sub-county hospital in Homabay county Kenya. The

objectives of this study were to investigate the possible causes of malnutrition, the socio-

demographic characteristics of the caregivers and also to find out their nutrition status. The study

shall be carried out in the month of January to April 2023 and to be submitted in June 2023. Data

shall be collected by use of questionnaires in the field and personal observation to form a sample

of the respondents by simple random sampling. Data shall be presented by the use of bar graphs

and charts. The researcher is going to use a descriptive cross-sectional research design as it is

simple and easy to use. The study expects to have reliable information that could be used by

nutritionist and other health service provider to improve nutrition status of Rachuonyo sub-

county hospital and even in Homabay and Kenya at large. According to conclusion the study

analysis confirms that the effect in this research can be possible causes of malnutrition such

inadequate dietary intake, lack of knowledge and maternal age at birth. Socio-demographic

characteristics of the caregiver such as age group, gender and training and education and

nutrition status of the children can be of different types such as stunting, wasting and severe

wasting and overweight. The researcher recommends that health care providers to educate the

public on the importance of good nutrition practice. The healthcare providers also to educate the

public on how to prevent and manage malnutrition by educating on frequent growth monitoring,

exclusive breastfeeding and giving food supplements.

v
 ABREVIATION
DHS Demographic and Health surveys

WHO World Health Organization

UNICEF United Nations International Children Emergency Fund

SAM Severe Acute Malnutrition

HAZ Height for Age

WHZ Weight for Height Z-score

WAZ Weight for Age Z-score

SPSS Statistical Package for Social Sciences

WBG World Bank Group

PCM Protein Calorie Malnutrition

HIV Human Immuno-deficiency Virus

vi
Table of Contents
DECLARATION..............................................................................................................................................ii
DEDICATION................................................................................................................................................iii
ACKNOWLEDGEMENT.................................................................................................................................iv
ABSTRACT....................................................................................................................................................v
ABREVIATION..............................................................................................................................................vi
CHAPTER ONE..............................................................................................................................................1
INTRODUCTION.......................................................................................................................................1
1.1 Background information....................................................................................................................1
1.2 Statement of the problem.................................................................................................................5
1.3 Purpose of the study..........................................................................................................................5
1.4 Objectives..........................................................................................................................................5
1.5 Research question.............................................................................................................................6
1.6 Hypothesis.........................................................................................................................................6
CHAPTER TWO.............................................................................................................................................7
LITERATURE REVIEW................................................................................................................................7
2.1 Introduction.......................................................................................................................................7
2.2 Causes of malnutrition among children below five years..................................................................7
2.2.1 Inadequate dietary intake...........................................................................................................7
2.3 Social demographic characteristics of care of children under five years.........................................11
2.4 Nutrition status of children under five years...................................................................................14
CHAPTER THREE........................................................................................................................................17
3.0 RESEARCH METHODOLOGY.............................................................................................................17
3.1 Introduction.....................................................................................................................................17
3.2 Research design...............................................................................................................................17
3.3 Population of the study...................................................................................................................18
3.3.1 Target population.....................................................................................................................18
3.4 Sample and sampling methods........................................................................................................18
3.4.1 Sampling size............................................................................................................................19
3.5 Data collection.................................................................................................................................20
3.5.1 Data collection..........................................................................................................................20
3.6 Data collection procedures..............................................................................................................21

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 3.7 Data processing and analysis...........................................................................................................21
CHAPTER FOUR..........................................................................................................................................22
4.0 RESEARCH FINDINGS AND ANALYSIS...............................................................................................22
4.1 Introduction.....................................................................................................................................22
4.2 Respondent rate..............................................................................................................................22
4.3 What are the causes of malnutrition among children under five years...........................................22
4.3.1 Inadequate Dietary intake........................................................................................................22
4.3.2 Lack of knowledge....................................................................................................................23
4.3.3 Maternal age at birth................................................................................................................24
4.4 What are the socio-demographic characteristics of the care givers of children under 5 years.......24
4.4.1Gender.......................................................................................................................................24
4.4.2 Age group.................................................................................................................................25
4.4.3 Regular training and education.................................................................................................26
4.5What are the nutrition status of children under five years?.............................................................26
4.5.1 Stunting....................................................................................................................................26
4.5.2 Wasting and severe wasting.....................................................................................................27
4.5.3 Overweight...............................................................................................................................28
CHAPTER FIVE............................................................................................................................................29
5.0 DISCUSSIONS, CONCLUSIONS AND RECOMMENDATIONS...............................................................29
5.1 Introduction.....................................................................................................................................29
5.2 Discussion........................................................................................................................................29
5.2.1 The possible causes of cause of malnutrition among children under 5 years...........................29
5.2.2 The socio-demographic characteristics of the care givers........................................................29
5.2.3 Nutrition status.........................................................................................................................30
5.3 Conclusions......................................................................................................................................30
5.4 Recommendations...........................................................................................................................30
REFERENCES..............................................................................................................................................31

viii
 CHAPTER ONE

INTRODUCTION

1.1 Background information

Malnutrition, mainly under nutrition among children is prevalent globally. Particularly in the

development countries, including Burkina Faso in 2014, 95, 159 and 50 million of children of

five years suffered from underweight, stunting and wasting respectively. Malnutrition contributes

to nearly half of all deaths in these children in Asia and across Sub- Saharan Africa. The

previous studies using demographic and health surveys (DHs), data also reported that child

malnutrition still remained public health concern. According to DHs, 2011in Nepal, the

prevalence of underweight, stunting and wasting is 29, 41 and 11% respectively among children

under five years. In neighboring countries of Burkina Faso, the prevalence of underweight in the

range of 18% in Jordan and 41.7 in India 35.6%of children were stunted in the range of 8.7in

Jordan and 5.17in Niger and 12.8% of children were wasted in using the data from 121 DHs in

36 low-and middle home countries (Stratton, 2007).

Nutrition status is one the best indicators of children’s well-being. The causes of child

malnutrition and numerous multifaceted poverty is usually considered as the primary cause of

malnutrition. Bain et al, reported that insecurity, poverty, parental education, climate change,

government policies and socio-economic inequalities were potential causes of malnutrition in

sub-Saharan African countries. Additionally, the previous studies find that, other factors such as

the presence of diarrhea or acute respiratory infections, household food insecurity, maternal

education and no consumption of vitamin supplements or fortified food is an important

contributor to child malnutrition. According to the world health organization (WHO), the
1
corresponding critical thresholds for underweight, stunting and wasting are 19, 29,9%

respectively. Therefore, the present study aimed to assess the factors associated with malnutrition

among children less than five years in Burkina Faso using DHs is data, and the results could be

the reference for the implementation of new strategies to reduce malnutrition among children

less than five years in Burkina Faso. (UNICEF, WHO, 2008)

The world health organization (WHO) in recent report estimated that there are 178 million

malnourished children across the globe, and at any given moment. Malnutrition contributes

between 3.5 and 5 million annual deaths among under five years children. UNICEF estimated

about 195 millions of children suffering from malnutrition across the globe. This consequently

affects the intelligence level of children, their behavior and school performance. The impaired

mental development is taken as the most serious long term handicap associated with under with

under five year’s malnutrition

In Sub-Saharan Africa, 41% of under five children are malnourished and deaths from

malnutrition are increasing on a daily basis in the region. In Uganda, malnutrition remains a

serious health and welfare problem affecting the under five children to whom it contributes

significantly to mortality and morbidity. According to Uganda demographic and health survey of

2011, four in ten Ugandan children under five years of age 33%are stunted. (Short for their age),

6% are wasted, (thin for their age) and 14% are underweight. These statistics of Nakaseke to

Nakasongola in Uganda. The Ugandan government has put in place a number of initiatives

aimed at reducing prevalence of malnutrition in the country; the 2004/2005 Uganda vision 2040

and 2010-2015 national development plan.

2
Malnutrition refers to a state of either under-nutrition or over nutrition. Under nutrition occurs

when the diet a person consumes does not meet their body requirements for growth and

development whereas over nutrition occurs when a person consumes too much calories. Good

nutrition and feeding practices are critical to child’s growth and development especially during

the first two years of life. Under nutrition impaired a child’s immunity, which can lead to

recurrent infection and impaired physical and cognitive development

Under nutrition is a major cause of morbidity and mortality especially in low- to middle- income

countries. Globally, malnutrition contributes to more than 3 million on deaths among children

less than five years annually. UNICEF estimates that, in Kenya, 239,446 children suffer from

moderate cute malnutrition (SAM) under-nutrition also contributes to about 3500 death among

children less than five years in Kenya. Stunting has also been linked to development of non-

communicable diseases and lower adult productivity later in life. Children less than five years

who are prone to recurrent infectious disease, such as diarrheal illnesses, respiratory tract

infection, tuberculosis and malaria often have under nutrition as co-morbidity.

The Kenya demographic health survey 2014 report that 26%of children less than five years are

stunted, 4% are wasted and 11%are underweight. Malnutrition remains a public health concern

in western Kenya. Therefore identifying factors associated with malnutrition is vital and

preventing the development of long term deleterious effects. This study aimed to identify

clinical, demographic and socio-economic factors associated with malnutrition in children less

than five years for public health action (Levitz 2011, UNICEF 2007).

Worldwide, over 100 million children under the age of five years die every year from

preventable and treatable illnesses despite effective health interventions. At least half of these

3
deaths are caused by malnutrition. Malnourished children have lowered resistance to infection;

therefore, they are most likely to die from common childhood ailments such as diarrhea diseases

and respiratory infections. Malnourished children that survive are likely to suffer from frequent

illness, which adversely affects their nutritional status and locks them into a various cycle of

recurring sickness, faltering growth and diminished learning ability. In developing countries,

malnutrition is a major health problem (accordingly this study was used to assess the nutritional

status and examine the characteristic related to malnutrition in children less than five years of

age.). (Saloojax. 2007)

Nutrition status of children is an indicator of the level of development future potential of the

community. The nutritional status of an infant and children under five years of age is of

particular concern since their early years of life are crucial for optimal growth and development.

Nutritional deficiencies affects long term physical growth and development and may lead to high

level of illness and disability in adult life. Moreover, high prevalence of malnutrition jeopardize

future economic growth by reducing the intellectual and physical potential of entire population.

The primary determinants of malnutrition as a conceptualized by several researchers relate to

unsatisfactory food intake and or severe and repeated infection (Rowland et al 1988, Schroeder

et al; 1994; UNICEF, 1998). The interactions of these conditions with the nutritional status and

overall health of the child, and by extension of the population in which the child is raised have

been showing in the UNICEF conceptual framework of child survival; the model characterizes

the correlated of malnutrition as factors that impair access to food, maternal and childcare, and

healthcare. It is these very factors that impact the growth of children consequently, the

assessment of children’s growth is a suitable indicator for investigating the well-being of

children’s growth as well as for examining the households access to food health and care

4
(UNICEF, 1998;de onis et al, 2013). The objective of this study was, therefore, to evaluate the

three indicators of malnutrition namely stunting, wasting and underweight among children less

than five years of age in Mbeere south district (UNICEF, 1998; de onis et al, 2013).

1.2 Statement of the problem

Malnutrition in children below five years is a devastating and costly public health problem

associated with high morbidity and mortality in developing world. Malnutrition impairs growth

and development in children delaying recovery from diseases and injury, predisposing to

infections as well-being (Stratton 2007). A study conducted in Rachuonyo sub county hospital in

Homabay County to investigate risk factor for severe childhood malnutrition in a high HIV

prevalence found that despite of the increasing contribution to HIV to the development of severe

malnutrition, traditional risk factors such as poor nutrition, parental disadvantages and illness,

poverty and social inequality remains important contribution to the prevalence of severe

malnutrition in under five in Rachuonyo sub . (UNICEF, 2012)

Therefore the purpose of this research is to investigate the factors associated with malnutrition in

children who are under five years in Rachuonyo sub county hospital is to help the facility know

the number of under five children who are malnourished and make proper plan accordingly

1.3 Purpose of the study

The purpose of the study is to investigate the possible factors associated with malnutrition among

children under five years in Rachuonyo Sub-County hospital in Homabay County

1.4 Objectives
i. To investigate the causes of malnutrition in children under five years in Rachuonyo sub

county hospital in Homabay County

5
 ii. To determine the socio-demographic characteristics of the care givers of the children

under five years in Rachuonyo sub county hospital in Homabay County

iii. To determine nutritional status of the children under five years in Rachuonyo sub

county hospital in Homabay County.

1.5 Research question

i. What are the causes of malnutrition in children under five years in Rachuonyo sub county

hospital in Homabay County?

ii. What are the socio-demographic characteristics of the care givers of the children under

five years in Rachuonyo sub county hospital in Homabay County?

iii. What is the nutritional status of the children under five years in Rachuonyo sub county

hospital in Homabay County?

1.6 Hypothesis
Ho: There is no relationship between socio economic status of the care givers and the nutritional

status of under five children in Rachuonyo sub-county in Homabay County.

Hi: There is relationship between socio-economic status to the caregivers and nutritional status

of under five children in Rachuonyo sub county hospital in Homabay county.

6
 CHAPTER TWO

LITERATURE REVIEW

2.1 Introduction
This chapter presents a review of significant theoretical and empirical literature in relation to the

research objectives being analyzed. The purpose of this study is to investigate factors associated

with malnutrition in children below five years in Rachuonyo Sub county Hospital in Homabay

County.

This section will elaborate on the possible causes of malnutrition among children below five

years, socio-demographic characteristics of the care givers of children below five years, and their

nutritional status of the children below five years in Rachuonyo Sub county Hospital in

Homabay County.

2.2 Causes of malnutrition among children below five years

There are a number of causes of malnutrition among children below five years that researchers

have found. This study however focused on a few of them that includes; inadequate dietary

intake, diseases, marital status, education, maternal occupation, maternal age at birth, birth

interval. (Rue, 2014)

2.2.1 Inadequate dietary intake

7
Inadequate dietary intake of both macronutrients e.g. carbohydrates, protein and fats, and

micronutrients e.g. vitamins and minerals has serious implications for health and well-being.

Micronutrients play a large role in immune functioning.

Insufficient macronutrients intake can results in stunting growth in children as well as weight

loss. Micronutrients such as vitamin A, zinc and large number and others are essential to a

number of responses, and deficiencies can lead to suppressed immunity, which in turn increases

risks of acquiring infections. In addition, inadequate dietary intake can also weaken immune

system.

Through changes in mucus membrane of the body; mucosa linings are an essential part of our

defense against infections and damage increases susceptibility to infection. Also deficiency in

there macronutrients such as protein, fats and carbohydrates provoke protein calorie malnutrition

(pcm) and when combined with micronutrients deficiencies, they are among the most important

nutritional problems with hundreds of millions of pregnant women, elderly and young children

particularly affected. In South Africa, poor households are known to spend a disproportionate

portion of their income on staple foods, primarily maize meals. Fruits and vegetables are

generally considered less essential and are more expensive and this increases the risks of

micronutrients deficiencies. (Orrmond and Rue 2013).

For health consequences include premature birth, low birth low weight, infection, and elevated

risk of death. Later physical and cognitive development is impaired, resulting in lowered school

performance, for pregnant women, anemia contributes to 20%of all maternal deaths (WHO

2013) iodine deficiency disorders jeopardize children’s mental health often their lives. Serious

iodine deficiency during pregnancy may result in still births, abortions and congenital

8
abnormalities such as cretinism, a grave, irreversible form of mental retardation that affects

people living in iodine deficient areas of Africa and Asia. Iodine deficiency disorders also cause

mental impairment that lowers intellectual process at home, at school and at work. It also affects

over 740 million people, 13% of the world’s population. Fifty million people have some degree

of mental impairment caused by iodine deficiency disorders (WHO, 20213)

Lack of knowledge

Mother’s education level or lack of knowledge on nutrition affects child’s nutrition through her

choices and health seeking skills related to nutrition, hygiene, preventive care and disease

treatment. Mother’s responsibility to care for herself during pregnancy and her child through

most vulnerable stages of its life significantly affects malnutrition of children below five years.

Several studies have found out that mother’s education is associated with good nutrition

practices of children below five years.(Babatunde, 2014, Olwendo et al; 2013, webb and Block;

2015, shrimp ton et al; 2013 )

The above studies pointed out the fact that most women with low education spend more times in

gardens and feed their children on less nutritious foods. Women who spend little time in

gardening get limited time to attend to their children and prepare for them nutritious meals unlike

their educated counterparts who normally focus on good child nutrition practices even when they

are absent from home most of the time.

Education helps mothers gain additional knowledge about the adequate intake of food for their

children in terms of correct quantity, quality and frequency. It also determines her income and

this helps access proper nutrition for the child as well as health services.

9
There is also a negative association between the mothers’ education and malnutrition of children

below five years, however, (Sommertelt et al, 2016). The higher the level of mothers’ education,

the lower the percentage of under five children classified as under nourished. According to the

study, malnutrition is most of prevalent among children whose mothers attend primary school. In

some countries, malnutrition levels are fairly similar among children whose mothers attend

primary or secondary school while elsewhere there is a greater similarity with children whose

mothers attended primary school or had formal schooling.

With increasing mothers’ level of education, the proportion of children who are malnourished

goes down as found out in Uganda Demographic and health survey of 2017 (UBOS and Macro

International Inc; 2018). This results in consisted with findings of Webb and Block (2015) that

highlighted the importance of human capital investment in improving child nutrition status. This

implies that educated mothers are better aware about the nutrition requirements of their children

by providing improved health care (Babafunde; 2013).

In similar study in Bangladesh, children of mother with no education and primary education

were 28% and 33% respectively, more stunted than children of mothers with secondary or higher

education. Wasted and underweight children also showed similar results. Children whose

mothers have no education or have primary education are more times significantly stunted and

underweight than children whose mothers had secondary or higher level. However, for wasting

children whose mothers had primary or secondary education had 0.87 times lower odds of

wasting than those of mothers with higher education (Nure et al; 2013)

Mother’s education is associated with more efficient management of limited household resource,

greater utilization of available health care services, better health promoting behaviors, lower

10
fertility as well as child centered caring practices. All these consequences result into a reduction

in malnutrition among under five children in Kenya

From the above study, children whose mothers had primary or no education were less likely to

be stunted, underweight or even wasted, perhaps because most of them are unemployed and are

able to stay home and care for their children

Maternal age at birth

Mother’s age at birth has been associated with malnutrition among children below five years. A

case in point was found in Bangladesh where children whose mothers were less than 20 years at

the time of birth were 1.22 times more likely to be stunted, wasted and underweight compared to

children whose mothers were 20 years and above at the times of birth (Nure et al;2013). Bachon

in the Uganda settings identified some common risk factors for protein energy malnutrition. The

severely malnourished infants mostly from young mothers had low weight at birth with less

access to breastfeeding which is essential for the infants’ protein intake. 34% of children

received supplementary food by three months and some mother’s breast feeding earlier.

A number of studies have reported that mother’s age at birth is one of the most important

determinants of malnutrition among children below five years. It has been suggested that risk is

greater in younger mothers particularly those below 24 years because they are not ready to take

care of a child, including, providing all the necessary attention required for the baby. Similarly

under than five malnutrition is higher also among children whose mothers gave birth when they

are older especially after35 years. This attributes to the fact that giving birth to babies with

weight (Shrimpton et al; 2014)

11
Contrary to the above, however, it is important to note that children of the younger mothers are

traditionally cared for their grandmothers in Turkey and this was associated with low level of

malnutrition among children of younger mothers less than 24 years. (Ergin et al; 2017).

2.3 Social demographic characteristics of care of children under five years

Under nutrition in children under five years is a major risk factor to child deaths with an

estimated 2.2 million deaths associated with it. Under nutrition in children especially stunting

has been linked with lower human capital, impaired cognitive development and lower

performance in school. Sub-Saharan Africa and south Asia are home to majority of the world’s

chronically under nourished children than elsewhere in the world (Babatunde, 2011).

The number of children who are left orphans in the world due to loss of parents has increased in

recent years. An estimated 153 million children in the world are orphans with more with more

than one in children orphaned in Sub-Saharan Africa. The orphaned children population in

Ghana has been estimated to be over 1.1 million. HIV/AIDS infection is by far the major culprit

in living children orphaned in most cases. Children who have lost one or both parents is said to

be orphans and includes children below 18 years of age. The extended family is an important

care provider to orphans in Sub-Saharan Africa, while majority of them are also institution zed in

orphanage (Nure et al, 2011)

Being an orphan may take children more vulnerable to under nutrition, as maternal and paternal

level factors and household food availability which is linked to child nutritional well-being are

more likely to be inadequate. However, studies has reported mixed results about how the

nutritional status or orphans compare with their counterparts, non-orphans and dietary diversity

of orphans has received little study. There is scarcity of data on the nutritional status and dietary

diversity of orphans in Ghana and the Brong Ahafo region in particular. Some socio-

12
demographic factors such as age, of the mother, surrogate mother, income level, Religion

literacy level, maternal level of education, sex of the child could influence nutritional status of a

child but may display different scenarios in urban setting due to unique and unpredictable urban

slum environment. A study conducted by Islam et al, revealed significant relationship between

social-economic status and literacy of parents on prevalence of height for age, weight- for-height

and weight for age. In this cycle socio –economic status focused on income levels while literacy

was focused on whether parents could read and write. Low income and maternal literacy is also

recently identified as a key factor determining HAZ, WHZ and WAZ

However, this study covers a wide geographical raising a gap as to whether a similar pattern will

be displayed in more specific closed urban slum settings. There seems to be a linkage between

maternal level education and nutritional status of children in Kenya. Direct knowledge to mother

transfer to mothers’ literacy and numeracy skills acquired from formal education enhance ability

to caregivers to recognize illness and take appropriate action in relation to child well-being.

Religion affiliation of a household of education of a mother has a strong linkage with nutritional

status of children less than five years. Religion’s attribution has strong influence on food

consumption pattern and indirect to influence nutritional status as some religious doctrines

restrict consumption of certain foods.

This paper focuses on influence, age of the mother or surrogate mother, maternal level of

education and literacy level on nutritional status within fast growing urban settings in Kyushu

city, Kenya, many studies seems to focus on general rural population with a few urban

Limited focus on unique setting of public health concern. Where urban informal settlements

become an ignored risk settings. This is a major gap that this study intended to fix and made

13
clear for the purpose of scholarly comparisons. Based on this background this paper explored the

selected socio-demographic determination of nutritional status of children under five within

Obunga informal settlement in Kisumu County (UNICEF, WHO, World Bank and County

Income Group classification 2021).

2.4 Nutrition status of children under five years

Nutrition status of children is an indicator of the level of development and future potential of the

community. The nutritional status of infants and children under five years of age is of particular

concern since the early years life is crucial for optimal growth and development (presculek et

al ;). Nutritional deficiencies affect long term physical growth and development and may lead to

high level of illness and disability in adult life. Moreover, high prevalence of malnutrition

jeopardizes future economic growth by reducing the intellectual and physical potential of entire

population. (Kabubo-mariara et al; 2013).

Under nutrition among children remains common in many part of the world. According to World

Health Organization (WHO), about 178 million children under five years worldwide are too

short for their age group; while 115are underweight. The report shows that stunting rate among

children is higher in Africa and Asia than elsewhere. In Kenya, 35% of children under five are

stunted, while the proportion severely stunted is 14%, 16% are under weight. (Low weight for

age), and 4% are severely underweight (KNBS 2015)

The primary determinants of malnutrition as a conceptualized by several researchers relate to

unsatisfactory food intake and or severe and repeated infections. (Rowland et al; 2014 and

Schroeder et al; 2015, UNICEF; de on is et al; 2013.)

14
The objective of this study was therefore to evaluate the three common indicators of malnutrition

namely stunting, wasting and underweight among children below five years of age in Mbeere

South District in Kenya as a basis of formulating appropriate policies and evidence-based

interventions for reducing the incidences of child malnutrition.

The above statement gives out several types of malnutrition; which are stunting, underweight and

overweight (UNICEF, WHO, World Bank, 2021).

1. Stunting

We are still far from a world without malnutrition. While the 2021 edition of the UNICEF –

WHO – World Bank groups joined malnutrition estimates shows that stunting prevalent has been

declining since the year 2000, more than 1 in 5 – 149.2 million children under 5 were stunted in

the year 2020.

In 2020, three regions had very high stunting prevalence with approximately a third of children

affected (UNICEF, WHO, World Bank Group, 2021). On the other hand, two regions, Europe

and Central Asia and Northern America had low stunting prevalence. However, vast disparities

within regions can exist in Latin America and the Caribbean, for example despite the 11.3

percent regional prevalence, some individual countries are faced with high and very high

prevalence, while other have very low prevalence below 2.5 percent.

In 2020, 22 percent or more than one in five children under age of 5 worldwide had stunted

growth. That is overall infants are positive between 2000 and 2020, stunting prevalence globally

declined from 33 percent to 22 percent and the number of children affected fall from 203.6

million to 149.2 million. In 2020, nearly two out of five children with stunting lived in South

15
Asia while other two out of five lived in Sub-Saharan Africa (UNICEF, WHO, World Bank

Group, 2021).

2. Wasting and severe wasting

According to UNICEF, WHO, World Bank Group, (2020) edition, 45.4 million suffered from

wastage. In 2020 globally, 45.4 million children under five were wasted in which 13.6 million

were wasted. This translates into a prevalence of 6.7 percent and 2.0 percent respectively. In

2020, more than half of all children affected by wasting live in South Asia and nearly a quarter in

Sub-Saharan Africa with similar proportion for children affected by severe wasting. At 14.7

percent south Asia’s wasting prevalence present a situation regaining serious needs for

intervention with appropriate treatment programs. Under five wasting and severe wasting are

highly sensitive to change. Thus estimates for this indicator are only reported for the latest year

(2020). In 2011, wasting affected at least 52 million children (Black, R.E et al, 2013).

3. Overweight

Middle East and North Africa had the highest overweight prevalence in 2020 with 12.0 percent

affected, followed by North America 9.1 percent, Eastern Europe and Central Asia at 8.7

percent. The lowest overweight prevalence in 2020 was seen in South Asia at 2.2 percent

followed by West and Central Africa at 3.4 percent. East Asia and Pacific are the highest number

of overweight children in 2020 with 12 million affected, followed by Middle East and North

Africa with an estimated 5.9 million overweight (UNICEF, WHO, World Bank Group, 2021).

Overall this two regions account for nearly half of all children affected by overweight in world

and have experienced the largest increase in the number of children affected by overweight

between 2000 and 2020. Maternal overweight and obesity result in increased maternal morbidity

16
and infant mortality. A child overweight is becoming an increasingly important contributor to

adult obesity, diabetes and non-communicable diseases. The high percent and future disease

burden caused by malnutrition in women of productive age, pregnancy and children in the first 2

years of life lead to intervention focused in these groups (Black, R.E, LH, Bhutan Z.A et al,

2008).

CHAPTER THREE

3.0 RESEARCH METHODOLOGY

3.1 Introduction
This chapter details the methodology that was used in conducting the research study. It presents

the research design and focuses on the following; population, sampling method, data collection

tools and data analysis method.

3.2 Research design

The descriptive cross-sectional research design used in this study carried out between January

2023 and April 2023.Cross-sectional research involves; gathering data, describes phenomenon

and then organizes, tabulates and describes data collection in the form of graphs and charts in

order to help the reader to understand the distribution of data (Cooper and Schindler, 2011).

The descriptive cross-sectional research design used in this study was a case study design of

investigating factors associated with malnutrition in children under five years in Rachuonyo sub

county Hospital in Homa Bay county. A case study focuses on specific individuals selected from

the total population of the community in the same area (kappel, 2015).

17
The descriptive cross-sectional research design has the following benefits over explanatory and

qualitative research design; it allows you to analyze facts and help in developing an in-depth

understanding of the research problem, it helps in determining the behavior of people in a natural

setting, in such a type of investigation, it can be utilized in both qualitative and quantitative

research methods of gathering facts, it is cost-effective and quick, it can also be used for many

purposes which makes it a very versatile method of gathering data, it only takes less time for

performing such type of research and with descriptive research, you can get rich data that’s great

for future studies (SagarArgal, 2021).

3.3 Population of the study

3.3.1 Target population

The study population was composed of two wards in Rachuonyo sub- county; Kokwanyo-Kakelo

and Wang`chieng` Ward each comprising of a target population of 100 women of the productive

age and men. The study population refers to the total collection of elements which one would

like to study and make inference (Cohen, anion and Marrison, 2013).

The population however refers to the individual participant or object on which the measurement

is taking; it is the unit of study (Cooper and Schindler, 2011)

The population of this study comprises of two wards; Kokwanyo-Kakelo and Wang`chieng`

ward each having a target number of 100 women of productive age(18-40 years) and men

because they are the caregivers of the under five children who are the foundation of the research

questions. The study population comprises of the targeted women and men come from different

villages within those two wards (kokwanyo-kakelo and Wang`chieng` ward).

3.4 Sample and sampling methods

18
Cooper and Schindler(2021),states that sampling refers to the process by which part of the

population is selected and conclusions are drawn from the entire population,

Saunders(2007)defines research design as the general plan of how the research questions would

be answered. According to Shona (2019), sampling is the specific group of individuals that you

will collect data from. The simple random sampling was the preferred methods of sampling in

the study because every member of the population shall have an equal chance of being selected,

and tools like random number generator or other techniques that are based entirely on chance are

used (Shona, 2019).

The sampling frame include the whole population .Random sampling ensures the results

obtained from your sample should approximate what would have been obtained if the entire

population had been measured (Shadish et al, 2002).

The simplest random sample allows all the units in the population to have an equal chance of

being selected.

3.4.1 Sampling size

The following Fisher`s Formula was used to determine the sample size.

2 p ( 1− p)
z
N= 2
d

Where;

N-minimum sample size.

Z−is the total value for standard deviation corresponding to 95% significance level (1.96).

19
P-prevalence of characteristics being estimated (in this case prevalence of acute malnutrition,

=7%) (WHO Guideline for interpreted management of acute malnutrition in Kenya, 2009).

d=margin error, set at= 0.05

n=1.96^2×0.07×0.93/0.05^2

=100

100+15 allowance for spoilt data=115.

3.5 Data collection

3.5.1 Data collection

The type of data collected was primary data and the collection tool was self- administered

questionnaire given to individual. Cooper and schindler (2011), states that data collection method

refers to the process of gathering data after the researcher has identified the type of information

needed which is; the investigative questions the researcher must answer, and has also identified

the desired data type nominal, ordinal, interval and ratio for the researcher of these questions and

also ascertained the characteristics of the sample units. That is; whether a participant can

articulates his or her ideas, thoughts and experiences. Questionnaire is the process of collecting

data through an instrument consisting of a series of questions and prompts to receive a response

from individuals it is administered to. Questionnaires can be used to ask questions that have

close –ended answers (Quentin, 2021).

The first part of questionnaires collected demographic data of the respondent such as age sex

(gender) and the marital status. The second part was concerned with factors associated with

20
malnutrition among children under five children. There multiple choice options representing

levels of preference, these are; strongly disagree, disagree, neutral, agree or strongly agree.

According to Debois, 2019, questionnaires are one of the most affordable ways to gather

quantitative data, especially self- administered questionnaire, where you don’t have to hire

surveyors to perform face to face interviews, a part from being expensive, is also a practical way

to gather data, questionnaire is easy and quick to collect results, they allow you to gather

information from a larger audience, most questionnaires providers are quantitative in nature and

allows you to only analysis of results and finally in questionnaires, you are able to ask as many

questions as you like.

3.6 Data collection procedures

This stated with recruitment of few research assistants preferably the community health

volunteers in those areas .The data was collected by the researcher by use of structured

questionnaires which were administered by the researcher as participants filled questionnaires in

the process of data collection, there was supervision from the researcher which ensured complete

data collection.

3.7 Data processing and analysis

The purpose of data analysis is to reduce accumulated data to manageable size, developing

summaries, looking for patterns and applying statistical techniques (Cooper and Schindler,

2011). The data was entered into Epi-data version 3.1 and then exported to SPSS software

program version 25 for analysis. Percentage, frequencies and summary statistics were computed

to describe the study.

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 CHAPTER FOUR

4.0 RESEARCH FINDINGS AND ANALYSIS

4.1 Introduction
This chapter discusses the results of the findings of the data analyzed from questionnaires. The
data was analyzed based on the research objectives and questionnaires used in statistical tool to
generate frequency distribution charts, tables and results are hereby presented.

The chapter is divided into various sections, the sections presents the introduction and the
respondents rate and questions on: the possible causes of malnutrition among children under 5
years, socio-demographic characteristics of the care givers of children under 5 years and to
investigate nutrition status of children under 5 years.

4.2 Respondent rate

100 questionnaires were distributed to the population and 96 were received after cleaning the
data by carefully scrutinizing the data to ensure all questions were filled appropriately, 92
remained giving this study a response rate of 92%. The response rate is the extent to which the
final set of data includes sample members and is calculated from the number of people with
whom interviews are completed, divided by the total number of people in the entire sample.
Including those who refused to participate and those who were unavailable (Kolter, 1997).

4.3 What are the causes of malnutrition among children under five years

22
4.3.1 Inadequate Dietary intake
The respondents were asked whether inadequate dietary intake can cause malnutrition among
children under 5 years and the results shows that4% strongly disagreed, 11% disagreed, 21%
were neutral, 54% agreed and 10% strongly agreed. This result shows that majority of people
support that inadequate dietary intake cause malnutrition.

Inadequate dietary intake

60

50

40

30

20

10

0
Strongly disagreed Disagreed Neutral Agreed Strongly agreed

Figure 4.1: inadequate dietary intake

4.3.2 Lack of knowledge

The respondents were asked to indicate whether lack of knowledge do cause malnutrition among
children under five years and the results shows that 2% strongly disagreed, 7% disagreed, 20%
were neutral, 44% agreed and 29% strongly agreed. This result shows that majority of the people
think that lack of knowledge cause malnutrition among under five children

23
 Lack of knowledge
50
45
40
35
30
25
20
15
10
5
0
Strongly Disagreed Neutral Agreed Strongly agreed
disagreed

Figure 4.2: Lack of knowledge

4.3.3 Maternal age at birth

The respondents were asked to indicate whether maternal age at birth can cause malnutrition
among children under five years or not and the results were as follows; 22% strongly disagreed,
33% disagreed, 20% were neutral, 44% agreed and 29% strongly agreed. This result shows that
majority of the people think that lack of knowledge cause malnutrition among under five
children

Maternal Age at birth

35
30
25
20
15
10
5
0
Strongly Disagreed Neutral Agreed Strongly agreed
disagreed
Figure 4.3: Maternal age at birth

24
4.4 What are the socio-demographic characteristics of the care givers of children
under 5 years

4.4.1Gender
The respondents were asked to indicate their gender and the results obtained were 72 respondents
were female representing 72% and 28 were male representing 28% thereby indicating that
Kokwanyo Kakelo and Wang’chieng ward have more females as compared to male gender.

Gender

28

Male
Female

72

Figure 4.4: Gender

4.4.2 Age group

The respondents were asked to indicate their age groups and the results were shows that 17% of
the respondents are below 24 years of age, 26% are between 26-30 years, 28% are between 33-
35 years, 20% are between 36-40 years while 9% are above 40 years of age

25
 Age group
30%

25%

20%
Percentage

15%

10%

5%

0%
Less than 25 years 26-30 years 31-35 years 35-40 years Above 40 years
Age group

Figure 4.5: Age group

4.4.3 Regular training and education

The respondents were asked to indicate whether they have been regularly trained or educated to
acquire knowledge and skills on malnutrition, causes, effects and how to prevent and manage
malnutrition and the results show that 20% strongly disagreed, 26% disagreed, 13% were neutral,
36% agreed while 15% strongly agreed. This results show that an equal number of the
respondents both agreed that they undergo regular training to acquire knowledge, skills and
attitudes towards their nutritional status.

26
 Training and Education
30%

25%

20%
Percentage

15%

10%

5%

0%
Strongly Disagree Neutral Agree Strongly agree
disagree
Training and Education

Figure 4.6: Training and education

4.5What are the nutrition status of children under five years?

The respondents were asked to answer the above questions using the strongly disagreed,
disagree, neutral, agree and strongly agree. The results of the study were as follows

4.5.1 Stunting
The respondents were asked to indicate whether stunting is one type of malnutrition or not and
the results shows that 46% strongly disagreed, 20% disagreed, 19% were neutral, 11% agreed
while 49% strongly agreed and this result shows that the majority of the respondents they
strongly disagreed.

Stunting
60%

50%

40%
Percentage

30%

20%

10%

0%
Strongly disagree Disagree Neutral Agree Strongly agree
Stunting

27
Figure 4.7: Stunting

4.5.2 Wasting and severe wasting

The respondents were asked to indicate whether wasting and severe wasting is one of the types
of malnutrition and the results shows that 23% strongly disagreed, 42% disagreed, 9% neutral,
12% agreed while 4% strongly agreed. This results shows that majority of the people think that
wasting and severe wasting are not one type of malnutrition

Wasting and severe wasting

45%
40%
35%
30%
Percentage

25%
20%
15%
10%
5%
0%
Strongly disagree Disagree Neutral Agree Strongly agree
Wasting and severe wasting

Figure 4.8: Wasting and severe wasting

4.5.3 Overweight
The respondents were asked to indicate whether overweight is a type of malnutrition or not and
the results shows that 1% strongly disagreed, 6% disagreed, 19% were neutral, 58% agreed while
16% strongly agreed. This result indicates that majority of people agreed that overweight is a
type of malnutrition.

28
 Overweight
70%

60%

50%

40%
Percentage

30%

20%

10%

0%
Strongly disagree Disagree Neutral Agree Strongly agree
Oerweight

Figure 4.9: Overweight

CHAPTER FIVE

5.0 DISCUSSIONS, CONCLUSIONS AND RECOMMENDATIONS

5.1 Introduction

29
This chapter summarizes the study. The chapter gives the study summary and discussions guided by the

study objectives. The chapter also gives the study conclusions that have been derived from the study

findings and finally the chapter proposes recommendations from this study categorized by

recommendations for improvement and those for additional studies.

5.2 Discussion

5.2.1 The possible causes of cause of malnutrition among children under 5 years.
The study reveals that inadequate dietary intake can cause malnutrition. The study results that 54% of the

respondents agreed showing that majority of people are supporting opinion that lack of adequate

vegetables and fruits intake may increase the risk of micronutrients deficiencies. The results also showed

that lack of knowledge can lead to child malnutrition, 44% of the respondents agreed, showing that

majority of people were aware that child malnutrition can be caused by lack of knowledge. Furthermore

the study results on maternal age at birth as one of the causes of child malnutrition shows that 33% of the

respondents disagreed. This indicates that the majority of the people were not aware that maternal age at

birth can cause malnutrition.

5.2.2 The socio-demographic characteristics of the care givers.

The study reveals that the females were more than males in Kokwanyo Kakello ward with 72% while

males were having 28% showing that the majority of people in those areas are mainly females and this

may result to low income at household levels hence leading to under nutrition.

The results obtained from the age groups of the care givers shows that age of 33 – 35 years represented by

28% were the majority of the care givers of children under five years.

5.2.3 Nutrition status

The study results further indicates that stunting is not one of the types of malnutrition. This implies when

42% of the respondents strongly disagreed. This shows that the majority of the people are not aware of

stunting as a type of malnutrition by indicating strongly disagreed, but according to the study by

30
(UNICEF, WHO, WBG, 2021) shows that 2020, three regions had very high stunting prevalence with a

third of children affected. The results obtained from wasting and severe wasting indicates that42% of the

respondents disagreed. This indicates that the majority of people didn’t agree. Finally, the results

indicated that 58% agreed that overhead is a type of malnutrition. This shows that the majority of the

people are aware that overweight is one of the types of malnutrition.

5.3 Conclusions
Results from the study analysis confirms that inadequate dietary intake and lack of knowledge can be the

possible cause of malnutrition among children under five years. To a small extent maternal age at birth

also causes child malnutrition, keeping this in mind there is need to lay emphasis on particular dietary

intake, knowledge as well as maternal age at birth that pose a risk of malnutrition for effective preventive

strategies in response to malnutrition of under five children.

According to the results analysis, overweight is one of the type of malnutrition, stunting and wasting are

also types of malnutrition according to few responses.

5.4 Recommendations
i. Pregnant women to be encouraged to attend antenatal care clinics during pregnancy period

and to be educated on the benefits of ANC clinics.

ii. Health care providers should educate public on importance of good nutrition practices of

children especially under five years

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