Perceived Socio-cultural Factors Influencing Nutritional Status of Children Below 5 Years in Selected Rural Communities in Enugu State
CHAPTER ONE
Objectives Of Study
The specific objectives of the study are to:
- determine the influence of family structure on the nutritional status of children.
- determine the influence of the socio-economic status of the family on nutritional status of
- identify the religious and cultural practices that influence the nutritional status of
- determine the influence of maternal education on the nutritional status of children.
CHAPTER TWO
LITERATURE REVIEW
This chapter presents related materials reviewed from books and journals such as published and unpublished articles from University libraries and internet materials. This presentation will be done under the following headings: Conceptual Review – concept of malnutrition, classification of malnutrition, normal anthropometric measurement for children below 5 years, prevalence of malnutrition in developing countries, influence of family structure on malnutrition, influence of socio-economic status of the family and maternal education on malnutrition, relationship between superstitious/religious/cultural beliefs on breastfeeding; Theoretical Framework- Leininger’s theory of culture care, diversity and universality; Empirical Review of related studies and Summary Of Literature Review.
Conceptual Review Concept of Malnutrition
Malnutrition is the condition that results from taking an unbalanced diet in which certain nutrients are lacking, in excess (too high an intake), or in the wrong proportions (Sullivan et al, 2010). A number of different nutrition disorders may arise, depending on which nutrients are under or overabundant in the diet.
Malnutrition is a medical condition caused by an improper or insufficient diet (Katsilambros, 2011). Malnutrition is technically a category of diseases that include: under nutrition, obesity and overweight, and micronutrient deficiency among others (WHO, 2012). However it is frequently used to mean just under nutrition from either inadequate calories or inadequate specific dietary components for whatever reason (Katsilambros, 2011).
People who are malnourished may not consume adequate calories and protein for growth and maintenance, (under nutrition or protein-energy malnutrition), consume too many calories (over nutrition)or have abnormal nutrient loss (due to diarrhoea or chronic illness) or increased energy expenditure (secondary malnutrition)Under nutrition encompasses stunting, wasting, and deficiencies of essential vitamins and minerals collectively referred to as micronutrients(WHO, 2012).
The term “severe malnutrition” is often used to refer specifically to protein-energy malnutrition. Protein-energy malnutrition (PEM) is often associated with micronutrient deficiency (Duggan, John & Watkins, 2008). Two forms of protein- energy malnutrition are kwashiorkor and marasmus, and they commonly coexist (Katsilambros, 2011).
Kwashiorkor (‘displaced child’) is mainly caused by inadequate protein intake resulting in a low concentration of amino acids. The main symptoms are oedema, wasting, liver enlargement, hypoalbuminaemia, steatosis, and possibly depigmentation of skin and hair (Katsilambros, 2011). Kwashiorkor is identified by swelling of the extremities and belly, which is deceiving of actual nutritional status (Chowdhury et al, 2009)
Marasmus (‘to waste away’) is caused by an inadequate intake of both protein and energy. The main symptoms are severe wasting, leaving little or no oedema, minimal subcutaneous fat, severe muscle wasting, and non-normal serum albumin levels (Katsilambros, 2011). Marasmus can result from a sustained diet of inadequate energy and protein, and the metabolism adapts to prolong survival. It is traditionally seen in famine, food restriction, or anorexia (Katsilambros, 2011). Conditions are characterized by extreme wasting of the muscles and a gaunt expression (Chowdhury et al, 2009).
Classification of Malnutrition
Anthropometry is used to assess nutritional status and growth retardation and todifferentiate between acute or chronic malnutrition. The clinical findings and biochemicalcriteria are not effective to use for classification if the disease is not advanced, but can help to confirm a diagnosis (Torún, 2006).
The three combinations of anthropometric measurements that are usually used to categorize malnutrition are: low weight-for-age, an indicator of underweight; low height-for-age, an indicator of stunting; and low weight-for-height, an indicator of wasting.
CHAPTER THREE
RESEARCH METHODS
This chapter presents a description of the research design, area of study, population of the study, sample and sampling procedure, instrument for data collection, validity of instrument, reliability of instrument, ethical consideration, procedure for data collection and method of data analysis.
Research design
The cross-sectional descriptive survey research was used. According to Basavanikappa (2010), this design is one which collects data about various variables from the sample at one point of time in order to uncover relationship existing among those variables. This design was successfully used by scholars for similar studies (Walsh, 2010 & Senbanjo et. al., 2009). It is therefore, considered appropriate for this study.
Area of study
The area of study is Enugu East Local Government Area of Enugu State. The Local Government is politically made up of rural/indigenous and urban constituency. The rural/indigenous constituency is made up of one homogenous people known as Nike and traditionally it has twenty four (24) autonomous villages out of which 5 will be randomly selected.
The Local Government is located just few kilometers from the state capital the city center. The population of the Enugu East Local Government Council Area is estimated at 277.119 (Nigeria’s 2006 population census, 2007).
Geographically Isi-uzo and Nsukka Local Government Councils bound the Local Government Area in the North, in the West by Udi Local Government and in the South and East by Enugu South and Nkanu West Local Government Council respectively.
Population of the study
The total population of Enugu East L.G.A of Enugu State is 277.119 (Nigeria 2006 population census, 2007). However, the target population (mothers of children below 5 years in Enugu East L.G.A) is unknown as there is no statistical evidence of the population. Women between the age range of 18- 49 years were chosen because these women were still in their reproductive or child bearing ages and were usually the ones who are often saddled with the responsibility of child care and nurturing which involves feeding the children.
CHAPTER FOUR
Presentation of Results
This chapter focused on the presentation of results from data analysis. Out of the total number of 384 questionnaires administered, 376 were correctly/ fully completed giving a total return rate of 97.9%.
- Table 1 above presents the frequency distribution of the demographic characteristics of the study participants. Of the 376 participants, none was below 20yrs of age. The majority were between 24 – 29yrs (34%) followed by 33% who were between 20 – 24yrs, very few 3.2% were above 40yrs.
- The occupation of the respondents on the same table showed that majority 39.6% were business women, followed by 24.2% who were students, 13.3% civil servants, 8.2% housewife, 7.7% health workers, 5.9% farmers and the least 0.5% teachers and clergy.
- The table also showed that the respondents were predominantly secondary school certificate holders (226, 60.1%) while 27.1% and 10.4% of them had tertiary and primary education respectively, only 2.4% had no formal education.
CHAPTER FIVE
DISCUSSION OF FINDINGS
Discussion of Major Findings
This chapter presented the discussion of major findings, implications of the findings, limitation of the study, suggestions for further studies, summary of the study, conclusions and recommendations.
Discussion of Major Findings
Influence of family structure on nutritional status of the children
The influence of family structure on nutritional status of children among the study participants was relatively high. The study revealed that the grand mean score of 3.29 which is greater than the criterion mean score of 2.5 confirms that separation of a child from his mother (3.50), neglect caused by divorce (3.73), leaving care of children for older siblings (3.03), large families (2.92), and single parent families (3.23) all have been identified as factors that have a negative impact on the nutritional status of children thereby leading to poor nutritional status. This finding is in consonance with that of Tarrant, 2010 who found that more than a quarter of children in developing countries are underweight, stunted, wasted and suffer from certain diseases because of the separation of a child from his mother/his father, which could be as a result of broken homes, death or even the presence of a new pregnancy. It also coincided with the study of Oyira et al, 2010 which showed that though divorce is not usually a cultural practice in Africa, separation of a more temporary kind could be a major social factor in the development of protein energy malnutrition in Nigeria and Northern Cross River state in particular.
Influence of Socio-Economic Status on Nutritional Status of the children.
The result showed that nutritional status can be influenced by the occupation of the breadwinner of the family with a mean score of 3.45, the person who controls the family finances influences (intentionally or unintentionally) both the food fed to the children and their nutritional status, the family diet was agreed to be better when the mother is in controlling finances than when the father does with mean score of 2.91. When the mother has little or no control over family funds, dietary arrangements may become haphazard. Poor wage and poor living conditions (inadequate water supply, inadequate sanitation were also found to be associated with poor nutritional status with a mean score of 3.34 and 3.66 respectively. This is in line with the study done by Osibegun (2008) who found that nutritional status is compromised where people are exposed to high levels of infection due to unsafe and or insufficient water supply and inadequate sanitation. It is also in line with Lucas and Gilles (2010) who noted that poverty is the main determinant of energy and nutrient malnutrition as evidenced by study done in rural Bangladesh household that emphasized that poor families are more likely to have malnourished children.
Religious and Cultural Practices that Influence the Nutritional Status of the children.
The result of the study indicated that some religious and cultural practices like the believe that mothers transmit pain to the child through breast milk (3.07), discarding of colostrums (3.17), eating less during pregnancy in order to prevent birth complications caused by large babies (2.49), denying children some proteinous food like egg, meat and fish (3.48 and 3.53) are held strongly by the majority of the respondents which can lead to poor nutritional status although few of them with a mean score of 2.03 believe that breast feeding should be stopped once a new pregnancy has started.
This situation corroborates the observation of Hossaini, 2008 who found that colostrums is discarded in Ubanese culture and seen as being harmful, they also have the believe that breast feeding is not only about transmission of nutrition from mother to child but also about transmission of physical pain, given that abdominal cramping postpartum is essentially universal due to uterine involution, a mother can deny her child of breast milk so as not to transmit the pain she is feeling to him/her. The practice of giving children egg, meat and fish were being restricted because of the belief that it will predispose them to stealing is widely believed by the respondents and this can lead to otein- energy malnutrition.
Influence of maternal education on the nutritional status of the children
Most of the mothers in this rural Nigerian community had at least secondary education 60.1%. There exist a relationship between educational level of mothers and the nutritional status of their wards as shown by the result that indicated that 33.3% of children malnourished were from mothers with no formal education, 48.7% were from mothers with primary education while 15.9% and 7.8% were from mothers with secondary education and tertiary education respectively. It shows that the more educated a mother is, the more likely she is to be receptive to developmental initiatives such as childhood survival strategies. This has a positive effect of improved family nutrition and less risk of childhood malnutrition. This corroborates with UNICEF, 2008 which states that women play key roles in maintaining household food security and in caring for children on a day-to-day basis, both of which are extremely important factor influencing a child’s nutritional status. Maternal education has a lot of roles to play; an educated mother not only could take better care of child nutrition, but also help prevent infant mortality and mortality to a large extent.
Implication of the findings
Malnutrition is a major childhood killer disease and is responsible for over 60 percent of avoidable maternal and infant mortality. Therefore, the socio-cultural factors influencing nutritional status like family structure, socio-economic status religious and cultural practices and maternal education should be addressed by the nurses through community health outreach programmes in order to educate and encourage the mothers on the adequate and affordable ways of meeting the nutritional needs of their children.
Limitations of study
The researcher encountered certain difficulties in the cause of this research and they include:-
- Some of the responses given by the respondents may have been estimations or even exaggerations. This has also been reported in similar
- The challenging terrain to access the communities
Summary of the study
This study assessed the socio-cultural factors that influence the nutritional status of children in selected communities in Enugu East L.G.A., Enugu State. The study was designed to:-
- Determine the influence of family structure on nutritional status of
- Determine the influence of socio-economic status of the family on family structure of
- Identify the religious & cultural practices that influence nutritional status of children.
- Determine the influence of maternal education on the nutritional status of children
Literature was reviewed under conceptual review and empirical studies, which were based on the objective and hypothesis raised. Descriptive survey research design was employed and a sample of 384 was drawn from the study population. Validated questionnaire was administered to the respondents and their responses were analyzed with the aid of statistical package for social sciences (SPSS) software version 20, using descriptive (frequency, percentage, means and standard deviation and inferential (one sample t-test) was used to compare the means with a criterion (cutoff) mean for significance. Hence means greater than the cutoff of 2.50 was regarded as positive response and vice versa. Level of significance was set at P < 0.05.
The study revealed that family structure with a grand mean score of 3.29 + 0.24, socio-economic status of the family (2.91 + 0.21), certain religious and cultural practices of the family (2.77 + 0.64) and maternal education have a negative impact on the nutritional status of children.
Conclusion
Based on the findings of this study, the following conclusions have been made.
- Family structure has a great influence on nutritional status of children with a grand mean score of 3.29. Separation of children from mother, neglect caused by divorce, leaving care of children to older siblings, large families and single parent families all have a negative impact on the nutritional status of
- Socio-economic status of the family like the occupation of breadwinner, the person who controls the finance, poor ways and poor living conditions (inadequate water supply, inadequate sanitations), with a grand mean score of 2.91 has a negative influence on the nutritional status of children.
- Religious and cultural practices like believe that mothers transmit pain to child through breast milk, discarding of colostrums, eating less during pregnancy in order to prevent birth complications caused by large babies, denying children of egg, meat and fish are held strongly by the mothers and all can have a negative impact on the nutritional status of
- Maternal education has a strong influence on the nutritional status of children. Educated mothers had less number of children malnourished than uneducated
Recommendations
Based on the findings, the following recommendations are made.
- Health care personnel should educate mothers on factors that lead to poor nutritional status. Improvement on nutritional status of children can be achieved through increasing client’s knowledge especially in the rural areas to discourage those detrimental practices that lead to
- The importance of exclusive breast feeding and the use of locally available, highly nutritious food resources as weaning diet should be taught during ante- natal period and community outreach
- Women empowerment should be encouraged as it promises improved family finances, better food security and better childhood
- Government should be involved to help improve the socio-economic level of the people through the provision of employment opportunities, provision of adequate water supply, affordable health facilities and other social
Suggestions for further studies
There is need to further investigate if similar situations exist in other local government areas in the state. This study should be replicated by other researchers in order to strengthen the foundation for interpreting results.
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