ABSTRACT

Malnutrition is one of the major causes of mortality and morbidity among under-five children in Sub Saharan Africa. To understand the determinants of malnutrition among under –five children, a study was conducted in Araba and  kalmalo  districts of Illela l/g  to Understand the determinants in these districts

The source of data was household demographic and socio-economic characteristics which included anthropometric data on under five children in Araba and Kalmalodistric.

It was found out that  Children aged 39-59 months were less likely to be underweight than those aged less than  twelve months. Findings also revealed that stunting was more prevalent among children of peasant farmers than the pastoralists. There was however no significant relationship between child wasting and selected child characteristics.

In conclusion, it is worthy to note that the study is essential in pointing out the particular age-groups among under five children as well as the occupations that contribute to malnutrition in  the districts of Araba and  kalmalo. Based on the findings, the study recommends exclusive breast feeding and proper complementary feeding especially among those aged less  than three years. Special arrangement could also be put in place to have children of mothers engaged in cultivation brought regularly for breastfeeding. 

TABLE OF CONTENTS

DECLARATION  …………………………………………………………………………………  i

APPROVAL BY SUPERVISORS  …………………………………………………………  ii

DEDICATION  …………………………………………………………………………………….iii

ACKNOWLEDGEMENTS  ………………………………………………………………….  iv

ABSTRACT  ……………………………………………………………………………………….  v

LIST OF ACRONYMS/ ABBREVIATIONS  …………………………………………  ix

CHAPTER ONE: INTRODUCTION  …………………………………………….  1

1.1 Background to the study  ………………………………………………………………….  1

1.2 Problem Statement  …………………………………………………………………………. 4

1.3 Main objective  ………………………………………………………………………………..6

1.4 Specific objectives  …………………………………………………………………………..6

1.5 Hypotheses  …………………………………………………………………………………….6

1.6 Scope of the study  …………………………………………………………………………….7

1.7 Conceptual frame work  ……………………………………………………………………..7

1.8 Significance of the study  …………………………………………………………………..9

1.9 Structure of the dissertation  ……………………………………………………………..10

CHAPTER TWO:LITERATURE REVIEW  ……………………………………..11

2.1 Introduction  …………………………………………………………………………………11

2.2 Malnutrition among under-five Children  ……………………………………………11

2.3 Child related factors of under five malnutrition …………………………13

2.4 Maternal factors of malnutrition among under-five children .19              

2.5 Summary of the literature review  ……………………………………………………  27

CHAPTER THREE:METHODOLOGY  ………………………………….   28

3.1 Introduction  ………………………………………………………………………………….28

3.2 Study Population  ………………………………………………………………………..  28

3.3 Data Source  ………………………………………………………………………………  28

3.4 Study Variable Specification  ………………………………………………………. 29

3.5 Anthropometric analysis  …………………………………………………………….. 31

3.6  Data analysis  …………………………………………………………………………..  32                                      

3.7 Limitations of the study  ……………………………………………………………..  33

CHAPTER FOUR:MALNUTRITION AMONG CHILDREN UNDER FIVE YEARS …………… 34

4.1 Introduction  ……………………………………………………………………………..  34

4.2 Background characteristics of children and caretakers  …………….34

4.3 Levels of malnutrition among under five children  …………………………  41

4.4 Relationship between child and maternal factors with malnutrition among under-five children  ……………………………………………………… 44

4.5 Determinants of malnutrition among under-five children in Araba and Kalmalo districts.  ……………………………………………………………………………..  51

CHAPTER FIVE:SUMMARY, CONCLUSIONS  AND RECOMMENDATIONS  …………….  55

5.1 Introduction  ………………………………………………………………………………  55

5.2 Summary of findings …………………………………………………………………….63

5.3 Conclusion  ………………………………………………………………………………….63

5.4 Recommendations  ……………………………………………………………………….64

5.5 Areas for further studies ……………………………………………………………….65

REFERENCES  ………………………………………………………………………………  66

APPENDICES  ………………………………………………………………………………  72

APPENDIX I: RESEARCH INSTRUMENT  …………………………………….  76

APPENDIX II: A MAP SHOWING STUDY AREA   

LIST OF TABLES

Table 4.1: Under five Child factors …..34                                                                   

Table 4.2: Maternal factors  of malnutrition among under-five children  ……  38

Table 4.3: Immunization status of under-five children in Araba and kalmalo Districts……………………………………………………………………………….  40

Table 4.4: Levels of malnutrition among under five children in Araba and Kalmalo districts  …………43                                           

Table 4.5: Bivariate associations between child and maternal factors with malnutrition among under-five children  ………………………………………………..44

Table 4.6: Determinants of malnutrition among under five children in Araba andKalmalo   districts  ………………………………………………………  51

LIST OF ACRONYMS/ ABBREVIATIONS

AfrII:   Africa Innovations Institute

BCG:    BacilleCalmette-Guerin

BMI:   Body Mass Index

CDP:   Child Days Plus

DHS:   Demographic and Health Surveys

EPI:   Expanded Programme on Immunization

FAO:   Food and Agricultural Organization

MAAIF:   Ministry of Agriculture, Animal Industry and Fisheries

MoH:   Ministry of Health

NPA:   National Planning Authority

TASO:   The AIDS Support Organization

UNICEF:   United Nations Children’s Fund

WHO:   World Health Organization

CHAPTER ONE

INTRODUCTION                          

1.1 Background to the study

The World Health Organization (2013) estimates that thereare 178 million children that are malnourished across the globe, and at any given moment, 20 million are suffering from the most severe form of malnutrition. Malnutrition contributes to between 3.5 and 5 million annual deaths among under-five children. UNICEF estimates that there are nearly 195 million children suffering from malnutrition across the globe. In 1997, the World Health Organization had observed that 60% of the deaths occurring among all the underfive children in developing countries were attributed to malnutrition (Murray and Lopez., 1997). Most of the damage caused by malnutrition occurs in children before they reach their second birthday, in the time when the quality of a child’s diet has a profound impact on his or her physical and mental development.

It has been estimated by the global burden of disease study that under-five malnutrition alone has caused approximately half (15.9%) of the global loss of Disability Adjusted Life Years (DALYs) that is the sum of years of life lost from premature mortality years lived with disability  adjusted for severity (Faruqueet al., 2008). 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 underfive malnutrition.

Malnutrition among under-five children is one of the most important public health problems in developing countries especially Sub-Saharan Africa (Gulati, 2010) and about 35% of under-five deaths in the world are associated with malnutrition.    An estimated 230 million under-five children are believed to be chronically malnourished in developing countries.

Similarly, about 54% of under-five deaths are believed to be associated with malnutrition in developing countries. In Sub-Saharan Africa, 41%  of under-five children are malnourished and deaths from malnutrition are increasing on daily basis in the region.  Malnutrition continues to be a significant public health problem throughout the low income countries, particularly in Sub-Saharan Africa and South Asia (Kimokoti and Hamer, 2008).

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 2006, nearly four in ten Ugandan children under-five years of age (38 percent) are stunted (short for their age), six percent are wasted (thin for their height), and sixteen percent are underweight  (UBOS &Macro International Inc, 2007).

The Nigerian Demographic Health Survey (NDHS).conducted in 2008 showed that the nutritional situation in Nigeria was 14% wasting, 23% underweight, and 41% stunting. Underweight levels increased when compared with the 2003 NDHS. Twenty four out thirt­­y-six state (67%) had more than 2% severe Acute Malnutrition(SAM) level and 19 out 36(53%) had level of Global Acute Malnutrition (GAM) above 10%. The state most affected are in the north-east and north west zone of Nigeria, particularly the Sahel Regionbordering Niger and Chad with stunting level above 50% and wasting levels above 20%.

The Uganda food and nutrition policy focuses on nutrition and childhood development as one of the goals with an aim of improving child health especially among those under-five years.

This policy is being formulated to address nutrition priority problems with assistance from international and local agencies like UNICEF, Save the Children, Plan International and TASO. The 2004/2005 Uganda food and nutrition policy reform focuses on policies and guidelines on anaemia, breastfeeding, HIV/AIDS and a number of other nutrition related disorders prevalent in the country (MoH and MAAIF, 2005).

The Ugandan government has put in place tremendous efforts in reducing the prevalence of malnutrition in the country through effective nutrition programs which act directly on feeding practices. However, the yield would be more significant if the government acted through factors that affect under-five child malnutrition. In addition, addressing the plight of women by strategically targeting their economic, education, and health status can improve nutrition at household level since women are the principle providers and care givers of children at this level.