A COMPARATIVE STUDY OF THE HEALTH STATUS OF MOTHERS AND

THEIR PRE-SCHOOL CHILDREN IN ILORA AND OLUWATEDO, OYO STATE,

NIGERIA.

ABSTRACT
In Nigeria, the malnutrition rates for all age groups of children less than five years have
increased steadily over the past six years. According to the GHS Annual Report, 2007, it
peaks in the 12-23 months age group. In 2007, almost eight percent (7.8%) of children aged
0-11 months were found to be malnourished. This shows a steady increase from 4.1% in 2005
to 4.9% in 2006 to the current figure. For children aged 12- 23 months, 10.1% were
malnourished in 2007 as compared to 8.2% in 2006. The highest rate of 28.2% was recorded
by Upper West region, while Brong-Ahafo recorded the lowest rate of 3.3%. The
malnourished rate among children 24-59 months age group was 7.3% in 2007 as compared to
6.2% in 2006.
The general objective of the study was to examine, the extent to which parents’
characteristics, health behaviour, and household determinants relate to the nutritional status of
the children less than five years in Ilora and Oluwatedo Area of Oyo State.

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 CHAPTER ONE

INTRODUCTION
1.0 Background Information

Children less than five years worldwide are known to be vulnerable and susceptible in many
respects, especially on matters on health. Nutritional deficiencies and malnutrition generally
affect children more than any other group. Poor nutrition occurs in developing countries, as
well as in more prosperous areas of the world. WHO Progress Report (2002) indicates that
hunger and malnutrition remain the most devastating problems to the world’s poor and needy.

As many as 800 million persons worldwide are affected by malnutrition. More than half the
childhood deaths in developing countries are related to malnutrition (Benson,and others.,
2004). Nearly 30% of humanity suffers from one or more of the multiple forms of
malnutrition (WHO, 2000). In a recent series of articles on child survival published in the
lancet, Daelmeans and Saadeh, (2003), highlighted the importance of addressing childhood
malnutrition as a prerequisite for achieving internationally agreed goals to reduce
malnutrition and child mortality. Child growth is therefore internationally recognized as an
important public health indicator.

Several efforts are being made globally and locally to reduce the malnutrition burden
especially in developing nations. The forth Millennium Development Goals (MDG) intends
among others to reduce under-five mortality by 2/3rd by the year 2015. This has led to the
development of a more integrated and holistic strategies in a manner as to ensure maximum
benefits to the vulnerable groups especially children. The major intervention in this direction
has been that relating to establishing and promoting exclusive breast feeding and promoting
nutritionally adequate diets for children less than five years. In 1979 WHO and UNICEF
recommended an exclusive breastfeeding (EBF) period of 4-6months however, WHO expert
committee in 2001, upon assessing the extent of EBF concluded that for optimal nutritional
status of a child, an EBF period of 6month must be adhered to. Field studies show that
complementary foods introduced between four and six months of age replace nutrients from

2
breastfeeding and confer no advantage on growth or development (Dewey and others, 1999;
and Gupta and other, 2002).
Consequently, UNICEF and the Ministry of Health, Nigeria recommended exclusive
breastfeeding for the first six months of the infant’s life. More than 95% of children less than
five years in Africa are currently breastfed but this is often inadequate because many people
feed their infants with water and other liquids alongside the breast milk. As a result, the rate
of exclusive breastfeeding is particularly low in West Africa (Linkage, 2002).

Prolonged breastfeeding is common and the median duration ranges between 16 and 28
months. The statistics in Sub-Saharan Africa shows that: 28% of infants are exclusively
breastfed up to 6 months; 65% of children 6-9 months with complementary feeding; and 38%
of children less than five years are stunted. The trend in various countries in West Africa
varies. As far as exclusive breastfeeding is concerned, the trend is as low as 6% in Burkina
Faso, 10% in Cote d’Ivoire, 18% in Togo and 17% in Nigeria. In relation to the practice of
complementary feeding with breast milk for aged 6-9 months the rates are: 49% in Burkina
Faso, 54% in Cote d’Ivoire, 65% in Togo and 63% in Nigeria (UNICEF, 2004).

In Nigeria, the Nigeria Health Services (GHS) and Teaching Hospitals acting within the
policy frame work of the Ministry of Health (MOH) is implementing a strategy called High
Impact and Rapid Delivery (HIRD) of intervention. The interventions include strategies of
improving exclusive breast feeding, complementary feeding, de-worming among others for
children less than five years in particular (GHS, 2007). This initiative which begun in 2005 is
aimed at preventing avoidable deaths due to ill-health resulting from infection and more
importantly malnutrition among children less than five years.

Under the supervision of the Regional Health Administration, Ashanti Region, Ilora and
Oluwatedo Area of Oyo State, bedevilled with the problem of malnutrition among children
under five, is implementing the HIRD intervention. Efforts in this direction include health
education, promoting of better nutrition for children, and ensuring breast feeding. In fact,
there is a comprehensive and integrated effort at the health facility and community levels in
Ilora and Oluwatedo to ensure that children are properly taken care of by their parents,
nutrition wise.

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1.1 Problem Statement

Malnutrition include under nutrition, specific nutrient deficiencies, and over nutrition; and it
kills, maims, retards, cripples, blinds, and impairs human development on a truly massive
scale worldwide.

In Nigeria, the malnutrition rates for all age groups of children less than five years have
increased steadily over the past six years. According to the GHS Annual Report, 2007, it
peaks in the 12-23 months age group. In 2007, almost eight percent (7.8%) of children aged
0-11 months were found to be malnourished. This shows a steady increase from 4.1% in 2005
to 4.9% in 2006 to the current figure. For children aged 12- 23 months, 10.1% were
malnourished in 2007 as compared to 8.2% in 2006. The highest rate of 28.2% was recorded
by Upper West region, while Brong-Ahafo recorded the lowest rate of 3.3%. The
malnourished rate among children 24-59 months age group was 7.3% in 2007 as compared to
6.2% in 2006.

The rate of malnutrition among children less than 5 years in Ashanti region as compared to
others regions is suggested to be relatively low (GHS, 2007), however, in nominal terms, the
regions recorded one of the highest cases. Ilora and Oluwatedo Area of Oyo State, a Ilora and
Oluwatedo in the Ashanti region, is predominantly rural with high cases of malnutrition that
affect children less than five years. In 2004, Ilora and Oluwatedo recorded a malnutrition rate
of 6.9% which decreased to 5.5% in 2005 (DHA, 2006). Even though the rate is decreasing,
Ilora and Oluwatedo has expressed concern about the trend and is unable to predict the
socially related causes coupled with interventional factors that have accountant for the trend.
This research is intended to examine the extent to which malnutrition status of children in
Ilora and Oluwatedo is related to the social and economic characteristics of their parent and
also with reference to access to health services interventions on malnutrition.

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1.2 Rationale for the Study

It is a known fact that our children are the greatest assets of a country. They are the future
leaders. Providing optimum health to children in terms of physical, social, and intellectual
development should thus be a priority concern of everybody. Malnutrition has been a problem
worldwide which has been tackled in various ways but the problem still lives with us. In fact
it continues to kill millions of children daily. There continue to be several challenges in
unraveling the intervention barriers in terms of caregivers’ attitude and perception about the
nutritional status of their children. More complex understanding is the behavioral or socio-
demographic influences of the caregiver that affect the child. The consequence of the
negligence of caregivers in ensuring better nutritional care of the children is obvious.

In Nigeria, under-five mortality has been increasing over the past decade. According to the
GHS, 2007 annual report, under-five mortality have increased from 108/1000 live births in
1998 to 111/1000 live births in 2003. Admittedly, a major contributory factor has been poor
nutrition care to children less than five years. The children who are very vulnerable and
susceptible to infection are exposed to poor nutritional regimen by caregivers resulting in
avoidable deaths.

The findings of the study would inform better contextual planning and management of
malnutrition generally, and that related to children less than five years in particular. It would
provide the framework by which specific indicators could be used to assess the risk of
malnutrition for a child thereby implementing the appropriate measures to curtail it. The
indicators intended to be deduced from the characteristics and health behaviour of the
mothers, would inform policy makers and health professionals generally, as to possible
markers that can guide the design and implementation of intervention to prevent malnutrition.

1.3 Research Questions

1. What socio-economic characteristics of parents significantly influence the nutritional

status of children less than five years at Ilora and Oluwatedo Area of Oyo State?

5
2. Does maternal health seeking behaviour and child morbidity have a relationship with the
nutrition status of the children less than five years in Ilora and Oluwatedo?
3. What is the extent of relationship between household feeding practices, water sources and
sanitation on the incidence of malnutrition in Ilora and Oluwatedo?
4. What proportion of children less than five years is malnourished and does the distribution
relate to the child’s sex, and age?

1.4 Objectives

1.4.1 General Objectives

The general objective of the study was to examine, the extent to which parents’
characteristics, health behaviour, and household determinants relate to the nutritional status of
the children less than five years in Ilora and Oluwatedo Area of Oyo State.

1.4.2 Specific objectives

1. To explore the relationship between the socio-economic characteristics of parents

and the nutritional status of children less than five years in Ilora and Oluwatedo.
2. To examined the influences of maternal health seeking behaviour of matter and
childhood morbidity among malnutrition children less than five years in Ilora and
Oluwatedo.
3. To determine how household feeding practices, water sources and refuse disposal
and how these relate to the nutritional status of children less than five years in Ilora
and Oluwatedo.
4. To estimate the proportion of malnutrition forms among the children and the relation
between it and their sex, and age.
5. To make recommendation to stakeholders from the evidence gathered as to how
malnutrition occurrence could be reduced in Ilora and Oluwatedo.

1.5 CONCEPTUAL FRAMEWORK

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Figure 1.1: A conceptual frameworks showing the factors that influences malnutrition
directly or indirectly

MALNUTRITION

Inadequate Incidence of
Dietary intake Disease

Insufficient Inadequate Insufficient Unhealthy

household Food maternal care Health environment
security services

Inadequate
Education
Poor
Resources control: sanitation and
Human, economic Inadequate
and organizational water supply

Political and
ideological
superstructure

Economic structure

Potential resources

SOURCE: UNICEF 1998

Access to good nutrition is directly influenced by food intake, health status and caring
practices. Adequate care for women and children encompassing all measures and behaviours

7
that translates into availability of food and health resources into good child growth and
development. Consumption of unsafe water and inadequately protected water sources,
coupled with inappropriate disposal of waste and unhygienic conditions in and around homes,
has significant implication for the spread of infectious diseases and contribute immensely to
the incidence of diarrhoea. Persistent diarrhoea in children is a major cause of malnutrition.

Women who are malnourished are more likely to face reproductive health problems that can
lead to maternal and infant death. Improved nutrition reduces the severity of some diseases
and minimizes the incidence of others.
A fundamental determinant of nutritional status is food security, which in turn is determined
by the availability of and access to food supplies. Availability of food is defined as the
capacity of the country to ensure the physical presence of food supplies at all times to all
people, either through local production or through importation. Access to food is defined as
the ability of people to obtain, whenever required, food supplies for their basic requirements.
Health, Educational, Roads, Agricultural and other social infrastructure are necessary in
ensuring a well-integrated approach that ensures the individual becomes well informed and
equipped in accessing and using the right food sources to improve his or her health status.
The lack of these would affect the nutritional status of the child. Underpinning this is the
economic status of the country and how it fuels the quality of services provided by these
structures to solve deficiencies in the malnutrition dynamics. Political will and power both
local and National is therefore relevant in addressing the state nutrition in the Nation and
more especially among children less than five years.

1.6 Scope of the Study

This study focuses mainly on household characteristics with more particular attention to
parents. These characteristics include socio-demographic, economic, food availability,
educational level among others. It also focus of maternal health seeking attitudes in terms of
use of antenatal care (ANC) services, time of use of the service and influences relating care
giving of the child such as practices of on exclusive breast feeding and complementary
feeding.
The study therefore did not examine socio-political structures that support or affect the
nutritional status of children less than five years in Ilora and Oluwatedos. In other words, the

8
impact of health, agricultural, educational and leadership structures and their influences on
the nutritional status of the child, were not directly examined under this study.

CHAPTER TWO
LITERATURE REVIEW

2.0 Introduction

Child growth is internationally recognized as an important public health indicator for

monitoring nutritional status and health in populations. Children who suffer from growth
retardation as a result of poor diets and recurrent infection tend to have more frequent
episodes of severe diarrhoea and are more susceptible to several infectious diseases such as
malaria, meningitis and pneumonia. A number of studies (Brown, 1998 Ojeifeitimi and
others., 2003; and Benson,and others.,2004) have demonstrated the association between
increasing severity of anthropometric deficits and mortality. The substantial contribution to
child mortality of all degrees of malnutrition is now widely accepted. In addition, there is
strong evidence that impaired growth is associated with delayed mental development, poor
school performance and reduced intellectual capacity (WFP, 2005). This chapter therefore
reviews the concept of malnutrition, influences of social, economic, and health related factors
affecting children less than five years.

2.1 Brief concept of malnutrition and causes

Malnutrition literally means “bad nutrition” and it entails both over- and under-nutrition. In
relations to trends of malnutrition in nations, the later is much prevalent in developing
countries including Nigeria. The World Food Programme (WFP) defines malnutrition as “a
state in which the physical function of an individual is impaired to the point where he or she
can no longer maintain adequate bodily performance process such as growth, pregnancy,
lactation, physical work or resisting and recovering from disease” (WFP, 2005). Malnutrition
can result from a lack of macronutrients (carbohydrates, protein and fat), micronutrients
(vitamins and minerals), or both. Macronutrient deficiencies occur when the body adapts to a
reduction in macronutrient intake by a corresponding decrease in activity and an increased
use of reserves of energy (muscle and fat), or decreased growth. Consequently, malnourished

9
individuals can be shorter (reduced growth over a prolonged period of time) and/or thinner
than their well-nourished counterparts. 'Hidden Hunger', or micronutrient malnutrition, is
widespread in developing countries. It occurs when essential vitamins and/or minerals are not
present in adequate amounts in the diet. The most common micronutrient deficiencies are iron
(anaemia), vitamin A (xerolphthalmia, blindness), and iodine (goiter and cretinism). Others,
such as vitamin C (scurvy), niacin (pellagra), and thiamin or vitamin B1 (beriberi), also can
occur during acute or prolonged emergencies when populations are dependent on a limited,
unvaried food source.

2.2 Measuring nutritional status of children less than 5 years

Anthropometric measurements provide one of the most important indicators of a child’s

nutritional status. In combining the infant’s spine length, weight and age data, three indices of
physical growth used in describing children’s nutritional status are height-for-age, weightfor-
age and weight-for-height.

Height-for-age: This index provides an indicator of linear growth retardation. Children with
height-for-age below minus two standard deviations (-2SD) from the median of the reference
population, are considered short for their age, or stunted.
Children who are below minus three standard deviations (-3SD) from the reference
population median are severely stunted. Stunting in children, may be the result of inadequate
nutrition over a long period of time or the effects of recurrent or chronic illness. Height-
forage, therefore, represents a measure of the outcome of under nutrition in a population over
a long period, and does not vary appreciably with the season of data.

Weight-for-age: This is a composite index of height-for-age. Children whose weight-

forheight measures are below minus two standard deviations (-2SD) from the median of
reference population are considered underweight for their age while those with measures
below minus three standard deviation (-3SD) from the reference population are severely
underweight. Being underweight for one’s age, could mean that a child is stunted, or wasted,
or stunted and wasted (GSS, 2003)

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Weight-for-height: This measure body mass in relation to body length. Children whose
weight-for-height measures are below minus two standard deviations (-2SD) from the median
of the reference population, are too thin for their height or wasted, while those with measures
below minus three (-3SD) from the reference population are severely wasted.

2.3 Influence of socio-economic characteristics on children nutritional status

Findings from studies which have investigated the association between nutritional knowledge
and child nutritional status are inconsistent. Whereas some studies (e.g. Ruel and others.,
1992; Glewwe, 1999; Webb & Block, 2003) found significant association between maternal
nutrition knowledge and child nutritional status, social characteristics of parents, especially
mothers have been identified by some scientist (Ojeifeitimi and others, 2003; Agnarsson, and
others., 2005) as related to the nutritional status of children. A study on the socio-cultural
influences on infant feeding decisions among women in Kwa-Zulu Natal showed that
mothers’ age has a greater influence on the food practices and choices for children less than
five years. Mothers of older age intended to be independent as to the choice of food they gave
to their children than those younger (Thairu,and others., 2005). Mothers socio-demographic
and economic characteristics, plays a major role in determining the nutritional status of
children less than five years. According to Mckeever and Miller (2004), a child nutritional
status is enhanced by the mothers’ background characteristics, including age, employment
status and educational status.

In a study of 300 women in rural Nigeria, Ojeifeitimi and others, in assessing determinants of
nutrition status among children less than five years, found that there was a strong association
between age of the mother, occupational status and employment and the risk of under
nutrition among the children. He elaborated that the extent of women independence from the
partners has a resultant effect on the nutritional status of the children (Ojeifeitimi and
others.,2003).

In a study in Volta Region, Nigeria, Appoh and Krekling, 2005, showed evidenced that
maternal nutritional knowledge and socio-economic status influences the nutritional status of
their children. The study which enrolled a sample of 110 mothers, showed that there was a
strong association between the marital status of mothers and the nutritional status of their

11
children. In addition, maternal knowledge and practices on breastfeeding was a significant
indicator for the nutritional status of the child (Appoh and Krekling, 2005). Specifically,
marital status, educational status, and socio-economic status had a significant association with
the nutritional status of the child.

As far as household food security is concerned, there has been an average increase of over
75% in hectares of land under cultivation resulting in increases in production above 50% for
all the crops (MOH Nutrition Unit, 2002). During periods of bumper harvest of foods such as
vegetables, fruits, roots crops and plantain, the inadequate preservation and storage facilities
lead to waste, lowered prices and extended periods of scarcity (MOH Nutrition Unit, 2002).

2.4 Maternal health care and child morbidity relationship with malnutrition

Having malaria was the only independent predictor associated with stunting, anaemia, and
iron-deficiency. There is an urgent need to improve traditional complementary foods in the
studied communities in terms of energy density, amount of fat in the diet, and bioavailability
of macro and micronutrient. (Mark, and others. 2006). The GHS reports that incidence of
malaria, diarrhoea and measles are factors contributing to child mortality and malnutrition
(GHS, 2007).

2.5 Feeding practices, water and sanitation and malnutrition

Feeding practices have a lot of implication for the nutritional status of the child. Mothers’
knowledge about nutritious meals for the children influences how the child is fed. According
to Adigrata, 2000, 31% of mothers with babies 0 – 2 years consider cow’s milk as best for
growth of children. Some mothers consider breast milk as harmful when mothers get
pregnant. (Wolde and others., 2002). Knowledge of exclusive breastfeeding by mothers often
leads to an improvement in complementary feeding practices ((Lisa, and others., 2000). In
India an interventional study where nutritional education was given to mothers to improve
awareness about infant feeding in the variety, quantity, quality and consistency of
complementary feeding showed that, 80% initiate breast feeding after 3 days of birth, 54.3%
absence of exclusive breastfeeding 86% delayed complementary feeding practices which
were inadequate in quality, quantity, frequency and consistency (Sethi and others., 2002). In

12
a similar study in south India, mothers were counseled about the choice of appropriate
complementary foods and feeding frequency. The intervention group had improved feeding
practices such as avoiding of feeding bottle and increased various type of complementary
food improvement (Hague and others., 2002). Time of introduction and type of
complementary food given to an infant are very important for the child’s nutritional status.
According to current recommendations (WHO 1995, 1998; Agnerson and others., 2005),
complementary feeding should be introduced into child’s diet starting around the age of 6
months. Castle and others, 2001 observed, a strong association was found between age of
introduction of complementary feeding and child nutritional status. Significantly more
mothers of malnourished children (34%) introduced complementary feeding before 6 months
of age than mothers of well nourished children (5%). A scientific review on complementary
feeding has revealed that porridge, (koko), and other forms of food given to children less than
five are inadequate (Brown, 1998)

The world through the MDG framework, have consented to the objective of halving the
proportion of people without sustainable access to safe drinking water and basic sanitation by
2015. In Nigeria, the Government of Nigeria has passed the Millennium Development Act,
ACT 702 that sets out the framework and also provides the political commitment for ensuring
the achievement of the MDGs including issues relating to access to water and improved
sanitation. The Ministry of Works and Housing in collaboration with the Ministry of Local
Government is implementing a rural water and sanitation policy to ensure that people in rural
settings achieve this feet by 2015 (UN, 2006). As at 2006, and estimated 50 – 75% of people
in rural settings in developing nations including Nigeria were using improved drinking water
sources (UN, 2006). Investments in sanitation and other social sectors especially with an
emphasis on access to women and girls to these services and resources are among the most
important policy tools for improving nutrition. Evidence comes from Zimbabwe, where
explicit policies were followed to redress the lack of access of many communities to basic
services after independence in 1980. (World Bank, 2006)

2.6 Malnutrition rates among children less than 5 years.

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GHS has reported an increasing trend of malnutrition over the past five years. According to
the agency’s annual report, 2006, the malnutrition trends in the children 0-11, 12 – 23 and 24
– 59 months have showed an increase over the period 2003 - 2006. The trend is high in
mostly the three northern regions of Nigeria. Ashanti region, recorded a low malnutrition
among the 0-11 and 24 – 59 months groups. These were 1.8% and 2.3% respectively. Among
the 12 – 23 months group that of the region was above 3.3%.

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 CHAPTER THREE
RESEARCH METHODOLOGY

3.0 Study Design

The study was a descriptive study with an analytical cross-sectional design conducted to
access the determinants of malnutrition in Ilora and Oluwatedo Area of Oyo State. Data was
collected during August 2008, the harvest season. The crop this year was good in comparison
with that of 2006 and 2007, There were occasional outbreaks of malaria before and during the
data collection period. For women, who are the main caretakers, the harvest season is one of
the busiest periods of the year. Although the food security situation is usually good during
harvesting, child care tends to suffer. Data was collected randomly on a section of the
population. The already existing data at the health facility was also reviewed
3.1 Study Area

Ilora and Oluwatedo has an estimated 2007 population of 172,599.

3.2 Study Population

The study included all households within the communities with children less than five years.
The eligibility criteria included: mothers with children less than five years and who have
lived in the community for at least 6 months.

3.4 Sample Size

With a population of 172, 599 and an estimated 20% of the population which is 3,460
children less than five years, 200 sample size was determined using EPI STAT CALC version
4.0.3 software. A malnutrition prevalence rate of 23% and a margin of 5% error and a power
of 95% confidence interval.

3.5 Sample Technique

A simple random sampling was made. The data was collected from all the four sub-Ilora and
Oluwatedos. In each sub-Ilora and Oluwatedo, 50 households were chosen; making the total
number two hundred (200) two communities from each were chosen. The communities were

15
listed according to numbers. The numbers were written on a piece of paper. Each paper was
folded and was put in a box and some selected people were asked to pick from the box. Any
number that was picked, the community with that number was selected. Choosing the
households was done by counting the houses from the chief’s palace, each third house was
chosen but if a house is chosen and there is no pre-school child then the next house will be
selected.

3.6 Data Collection Techniques and Tools

3.6.1 Pre-testing of Tools

Three National service participants were used as field assistants. They were trained in basic
interviewing techniques and in taking weight and height measurements. Translations of
questions into Nigerian language “Yoruba”, the local language were agreed upon to ensure
consistency.
The tools for this study were pre-tested at Amansie East Ilora and Oluwatedo and to be
presice Bekwai on fifty (50) mothers and children, on the 4 th to 7th August 2008. The
necessary modifications were made. Pre-testing was done at Ilora and Oluwatedo because it
has the same characteristics of Ilora and Oluwatedo Area of Oyo State.

3.6.2 Structured Interviews

Structured interviews were conducted using pre-tested questionnaires administered to mothers

with children less than five years. Information was collected on the demographic
characteristics of household members and socio-economic factors. Child-related data, such
as age, gender, breastfeeding, child feeding, nutritional status and occurrence of illness were
collected. Sanitary conditions such as source of water, presence of latrine and waste disposal
were also gathered.

3.6.3 Anthropometric Technique

Anthropometric measurements such as weight and standing height were taking of each child
using the standard techniques by W.H.O (WHO, 2005). For children who were less than two
years old, recumbent length was measured instead of standing height.

16
Weight Measurements were taken from all children below the age of five years using the
Salter hanging scale. Weight measurements were taken to the nearest 0.1kg.

Standing Height was measured using a “microtoise” attached to a smooth straight wall. The
subject was made to stand without shoes, with feet at right angle, his back flat against the
wall, and his eyes looking straight ahead. The subject was requested to stand as erect as
possible, with heels on the ground. The headpiece of the “microtoise” was then gently
lowered, crushing the hair and making contact with top of the head. Height was recorded to
the nearest 0.1cm.

Recumbent Length was taken among subjects less than 2years of age, using an infantometer
or wooden length board. The child was laid on the board, which is a flat surface. The head
was positioned firmly against the fixed head board with eyes looking vertically. The knees
were extended by firm pressure and the feet were fixed at right angles to the lower legs.
Similar to standing height, length was recorded to the nearest 0.1cm

3.6.4 Key Informant Interview

Key Informants such as Ilora and Oluwatedo Nutrition Officer, Officer in charge of
rehabilitation centre, nutrition unit, the deputy director of nursing services who is also in
charge of maternal and child health, Focal person for community child growth promotion and
also personnel at kids ward at Ilora and Oluwatedo hospital were interviewed about policies
and programmes they have put in place to help children in Ilora and Oluwatedo concerning
their nutritional status and also resources available in the communities to improve nutritional
status of children.

3.7 Data Analysis

Data collected were cleaned and analysed using Statistical Package for Social Sciences
(SPSS) version 15.0.3. A template was designed and data entered. Entered data was run in
frequencies and variables cross tabulated for purpose estimating descriptive and inferential
trends. For the later, Chi square or Fisher’s Exact test were used and also p-values estimated

17
was appropriate. A probability value (p-value) of less than 0.05 was considered to be
statistically significant at 95% confidence interval.

3.8 Ethical Consideration

Permission was sought from the Department of Community Health, to carry out this study.
Permission was also sought form Ilora and Oluwatedo Area of Oyo State Health Directorate
as well as the management of the health institutions to be surveyed. Informed consent was
obtained from all the respondents of the survey and participants of the focused group
discussions. The purpose, the methods and eventual use of the study findings was also
explained to the respondents. They were assured of the confidentiality of their responses and
the right to refuse to partake was made known to them. They were also assured that their
responses would not be associated with them now or in the future and that it would also not
affect their association with any institution in or outside Ilora and Oluwatedo now or in the
future. They were to volunteer to participate.

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 CHAPTER FOUR

DATA ANALYSIS

4.0 Introduction

This section of the study covers the findings. The findings are shown based on the
predetermined objectives as indicated in chapter one. They are presented in tables and graphs.
4.1Socio-demographic characteristics
Figure 4.1 Summary of background characteristics of respondents (N=200)

100 94.5 91
90 81.5
74.5
percentage (%)

80 68.7
70 59 56.7
60
50
40
30
20
10
0
20 -29 Married <4 >4 JHS Christians employed

Age Marital status No. children No. dependants Education Religion Employment

Demographic Characteristics

Source: Author’s field data, 2008

Over fifty percent (59.0%) of the respondent had age ranges of 20 – 29 years and a mean age
of 27.53, with a + standard deviation of 2.63. Ninety four percent (94.5%) of them were
married with 56.7% having less than four children. The average number of children for the
respondent was 2.85+ 1.50 standard deviation More than sixty percent (68.7%) of the
household had more than four dependants. As far as educational level is concerned, 4.0% had
had no formal education, 19.5% primary education and 74.5% Junior Higher School. Out of
the 200 respondents, 163 representing 81.5% were employed. Farming, trading and
tradesman ship were the incoming earning employment engaged by the respondent forming,

19
68.1%, 30.7% and 1.2% respectively. Over half (53.5%) of their partners were engaged in
farming and in their view, the jobs earned them (94.5%) enough to meet their food and other
needs.

Mothers with children less than 5 years in Ilora and Oluwatedo Area of Oyo State are
relatively young, educated and energetic and engaged in farming and trading. The
independence of women contributes significantly and is a good indicator for the quality of
care provided their children. Having had basic education presupposes that they were exposed
to basic skills of improving life style through better nutritional and sanitation care.

The Millennium Development Goal Report, in assessing its fourth objective of reducing child
mortality recognised the relevance of maternal education and income levels doubles children
survival (UN, 2006), since such parent can perform the protective role to children less than
five years. Engaging in farming also could reflect the level of food security at home and
therefore implication for the quality of food to the children. These strong characteristics
could be stymied by the level of dependents in the household. About half, 43.3% had had
more than four deliveries and were staying with other relatives increasing the household
dependents to more than four inhabitants. This is reflected in about 70% of the households.
The increased number of dependants, coupled with the high dependency could affect the
quality and quantity of food shared. In fact, in most setting as described above, the children
suffer (Ojeifeitimi and others., 2003). Little food is given to them and most of the shared
protein is taking by the adults such as observed elsewhere (Brown 1998; and Benson, and
others., 2004). Usually, they don’t have their served plates but are fed when the adults are
eating together in the same bowl. A similar observation was made by Sethi and others. 2002
in India. Caring for the children could be influenced by having a permanent partner who is
employed and also educated. Since only 6% of the women were unmarried, partners of the
women could provide additional support to ensure food and financial security required to
improve the nutritional status of the children. Evidence from the study suggest that, the
collaborative efforts of both parents of children less than five years is yielding results and in
most respect providing adequate food security for the household which is also observed
(Mark,and others. 2006). The parents are able to earn enough income to meet other needs for
the household.

20
Table 4.1: Background characteristics of respondents

Variable Frequency (N = 200) Percentage (%)

Age
< 20 years 13 6.5
20 – 24 years 56 28.0

25 – 29 years 62 31.0
Type of employment (n=163) 15.0
30 – 34 years 30
Farming 111 68.1
19.5
35 years and above 39
Trading 50 30.7
Mean = 27.53 + 2.67; Min = 16; Max = 39
Tradesman 2 1..2
Marital
Partnersstatus
occupation
Single
Farming 11
107 5.5
53.5
Married
Trading 189
54 94.5
27.0
Number children
Tradesman 26 13.0
<Public/Civil
4 servant 85
13 56.7
6.5
4 or more
Earning meet food and other needs 65 43.3
Earn enough Mean = 2.85 + 1.2 189 94.5
Number dependants
Don’t earn enough 11 5.5
<4 43 31.3
4 or more 107 68.7
Mean = 6.59 + 2.99
Education level
None 8 4.0
Primary 39 19.5
Junior High 149 74.5
Senior High 2 1.0
Tertiary 2 1.0
Religion
Christianity 182 91.0
Islam 18 9.0
Employment status
Employed 163 81.5
Not employed 37 18.5

21
Source: Author’s field data, 2008

4.2 Influence of socio-economic characteristics on malnutrition

As detailed in Table 4.2 below, marital status (p=0.31), educational level (p=0.13), religion
(p=0.60) and earning enough to meet food and other needs (p=0.75) did not have any
significant relationship with the malnutrition status of children. However, the number of
children (p=0.02), number of dependants (p=0.01), employment status (p = 0.05), age of
mother (p=0.00), had signification relationships with the nutritional status of the child. As
indicated by Ilora and Oluwatedo Nutrition officer “…large family size, poverty and teenage
pregnancy are the causes of malnutrition here”. On the distribution of age of mothers, there
was a fair distribution of malnutrition across the age groups. Out of the 64 children identified
as malnourished, 58 representing 90.6% were from households with 4 or more dependants.

The distribution of adequately nourished children in relation to educational level, depicted

that, all (2) the mothers who had obtained secondary education had none of their children
being well nourished. It is noteworthy, that over seventy percent of children malnourished
(79.7%) and those well nourished (72.1%) had mothers who had obtained Junior High School
level of education. In addition, 37.5% (3/8) of the mothers with no formal education had their
children being malnourished. Even though religion did not show a significant relationship
with the weight of the child, 50.0% children of Muslim mothers were malnourished. It was
also observed that out of the 64 malnourished children, 89.1% had mothers who claimed they
were employed and 77.9% of adequately nourished children, said that they met the food
needs of their children. Out of the 11 mothers who indicated that they did not earn enough to
meet the food and other needs of their children, 4 representing 36.4% had their children being
underweight and the rest, 63.6% had children with normal body weight as shown in Table 4.2
below.
It was evident from the findings that the age of the mother had a strong relationship with the
nutritional status of the child. Teenage pregnancy, mothers below age 18 years, might have
been in the plight as a result of role identification crisis. This results from peer influences and
wanting to be seen to be also capable of behaving like adult (Appoh and Krekling, 2005).

This psychological attitude exposes them to early sex. This is not to suggest that they are not
biologically prepared to conceive (Mamiro,and others. 2005), rather, that they are socially

22
and economically incapable of controlling and managing the demands of child rearing. Such
young women may not have been married and therefore would gain little or no social and
financial support from their partners. In addition to this social dynamics is the issue of the
risk of given birth to an underweight child at that age if the necessary nutritional requirements
during pregnancy are not met?

This is more reflective of such circumstance considering the low economic standing of most
of these young women in a relatively rural setting in Nigeria. Worthy of note is that majority
of the women who had children malnourished were 35 years and above, page 28. In fact,
53.8% of women in this age group had malnourished children. This is also a risk group not
only for outcomes of pregnancies but related complications to the mother.
In the context of this study, children delivered by women of this age could be underweight, a
risk factor for malnutrition. The tendency to give birth at this old age may be attributed to
several factors among which are social perspectives of the number of children that a woman
should have. This is corroborated by the fact that the number of children the women had also
had a significant (p=0.01) effect on their nutritional status. The number of children the
women had could affect the quality and quantity of food served the children thereby affecting
their nutritional status (Brown, 1998; and WFP 2005). Majority (59.4%) of the children
malnourished were of mothers who had more than four children. This may be because they
had little to spend on the nutritional needs of their children.

In addition, the lack of care could expose the children to many risk factors including diseases.
Worsening the situation is the extended family systems that is more strengthened in such
largely rural setting (Lisa, and others., 2000; and Appoh and Krekling, 2005)., such as pertain
in Ilora and Oluwatedo Area of Oyo State. Couples are required to reciprocate the benefits
they had from the external family, fending for members when they are of age and or have
married.
Even though this provides the needed support relating to fending for the children thereby
relieving the parents of certain stress, it has implication for the economic and nutritional
demands. Its replica effect on the nutritional status of the children is reflected in this study as
the number of dependants in a household also had significant (p=0.02) relationship with the
nutritional status of the child.

23
It is evident that the occupation engaged by the respondent had an association (p=0.05) with
the nutritional status of the child. Even though this suggests that their earning patterns may
affect the nutritional status of the child, it could not explain the phenomenon since it did not
influence the nutritional status of the child. It could be that, at the relative youthful age, the
mothers gets to engaged in work to be seen as responsible, unfortunately their earnings are
not enough to reflect on the nutritional status of the children even though from their
perspective the job is giving them adequate earnings.
Educational status, religious affiliation also did not relate to the nutritional status of the
children. The level of enlightenment of the educated had not been applied to meeting the
nutritional need of their children so as to differentiate them from those who had not had
formal education. The manifestation of this observation might have evolved from the
socialisation concept of infant feeding. In many cultures, feeding practices and habits are
informed by the indigenous practices which usually are enculturated irrespective of one’s
educational level. The low levels of formal education of majority of the mothers may
influence to large extent, their inability to reappraise these practises to the benefits of the
children but only to be engulfed by what pertains. This is not to suggest that the feeding
culture of children is poor but, just to highlight the uniformity and no difference of the
nutritional status of children less than five years among educated and non-educated mothers.
It is also worth noting, that the efforts of Ilora and Oluwatedo health administration, in
educating and promoting proper food habits does not seem to influence differently, the
practises of both educated and non-educated mothers in Ilora and Oluwatedo.

Table 4.2: Relationship between socio-economic factors and malnutrition

Variable Malnourished Adequately Chi square or (n = 64) nourished

Fisher’s Exact; (n=136) p-value

Age
< 20 years 3 (4.7%) 10 (7.4%) 10.45 (0.00)
20 – 24 years 17 (26.6%) 39 (28.7%)
25 – 29 years 15 (23.4%) 47 (34.6%)
30 – 34 years 8 (12.5%) 22 (16.2%)

24
 35 years and above 21 (32.8%) 18 (13.2%)
Marital status
Single 2 (3.1%) 9 (6.6%) 1.02 (0.31)
Married 62 (96.9%) 127 (93.4%)
Number of children
<4 26 (40.6%) 80 (58.8%) 5.79 (0.02)
4 or more 38 (59.4%) 56 (41.2%)
Dependants
<4 6 (9.4%) 32 (23.5%) 6.26 (0.01)
4 or more 58 (90.6%) 104 (76.5%)
Educational status
No education 3 (4.7%) 5 (3.7%) 7.00 (0.13)
Primary 8 (12.5%) 31 (22.8%)
JHS 51 (79.7%) 98 (72.1%)
SHS 2 (3.1%) 0 (0.0%)
Tertiary 0 (0.0%) 2 (1.5%)
Religion
Christianity 63 (98.4%) 135 (99.3%) 0.60 (0.73)
Islam 1 (1.6%) 1 (0.7%)
Employment status
Employed 57 (89.1%) 106 (77.9%) 3.55 (0.05)
Not employed 7 (10.9%) 30 (22.1%)
Earning meet food and other need
Earn enough 60 (93.8%) 129 (94.9%) 0.10 (0.75)
Don’t earn enough 4 (6.3%) 7 (5.1%)

Source: Author’s field data, 2008

4.3 Influence of Maternal health seeking behaviour and child morbidity on nutritional
status of children less than five years

Morbidity rate within the past 6 months among the children as indicated by the respondents
was 70.5% compared to and the rest, 29.5% who had not been sick in the same period. Child
25
morbidity in the household had an association (p=0.05) with the nutrition status of the child.
This was noted by the pediatrician that “…illness example HIV…” accounted for the
malnourished state of some of the children. All malnourished children were from mothers
who had attended ANC. Those who did not use ANC services had their children well
nourished.

Accessing ANC during pregnancy did not have a relationship (p=0.35) with the nutritional
status of the children. One hundred and forty six (146) out of the 198 respondents, who used
ANC services, used it in the first trimester. This represents 73.7%. The women do not attend
ANC regularly because “…when the centre [referring to the rehabilitation centre] used to
provide food, they came but now, the number has reduced because the food is
finished”[Nutrition Officer]. As far as provision of funds to the health facility was concerned,
none of them used their own funds. Majority, 97.9% (194/198) said funds for accessing ANC
services were provided by husbands. The source of funding however, did not have any
association (p = 1.00) with the nutritional status of the child.

On being overruled to attend ANC, out of the 198 respondents who used ANC, 188 forming
94.9% said they were not overruled when they decided to use the service. Interestingly their
independent decision did not influence (p=0.39) the nutritional status of the children. In fact,
96.9% of malnourished children were of mothers whose decision to use ANC was not
overruled. On the other hand, out of the 10 respondents who said their decision was
overruled, 8 had their babies having a well nourished status.

The practice of breast feeding was also assessed with more attention to time period of
breastfeeding children. Whereas 37.0% of the respondents stopped breast feeding in less than
24 months, 63.0% continued breast feeding for 24 months or more. Despite this, 57.8% of the
children malnourished were breastfed for 24 months or more. Length of time of breast
feeding therefore did not have any association with the nutritional status of the child (p=0.35)
as detailed in Table 4.3 below. Out of the 200 respondents, 37.0% gave water and food to
their children before 6 months.

There was a significant (p=0.03) relationship between early introduction of water and food
before 6 months and the nutritional status of the child. Over 60% of the children

26
malnourished were given water and food after 6 months, as against 43.9% of the children
well nourished. Partners (48.0%), in-laws/parents (42.0%) and other relatives (10.0%) were
those who took care of the children when the mother is away. The type of person who took
care of the child does affect (p=0.00) the nutritional status of the child.

The health status of the child is an important indicator for its nutritional status. The incidence
of malaria and diarrhoea has been well documented to contribute to the loss of appetite with
consequential loss of weight among children. In tropical and rural setting such as Ilora and
Oluwatedo Area of Oyo State, these diseases are endemic and children less than five years are
most susceptible. Out of the 200 children assessed, 141 had fallen ill within the last 6 months.
Obviously, this might have affected their growth and therefore the cumulative weight.
Malnutrition among children less than five years in Ilora and Oluwatedo is associated with
the incidence of child morbidity. In fact children who had fallen sick were 2.01 times more
likely to be malnourished than children who had not been sick in the same period.

ANC services utilisation is presumed to influence outcome of delivery and secondarily affect
the manner in which attendant implement the nutritional education and advice given. The fact
that all the children malnourished were of former ANC attendants is a major concern. The
lack of consistency in attending to ANC could have accounted for this. These mothers even
though used the health facility in the first trimester, the may not have continued as also
observed in GHS Annual report, 2007. Mothers’ ability to assimilate and implement the
content of nutritional information provided at the health facilities could be impeded by many
factors among which is lack of available resources including food ingredients and income.
Interestingly, only 4 out of the 64 women indicated their earnings were not enough to feed
and meet other family needs. Obviously the tangibility of this evidence cannot explain the
influences but could be suggested that there may be poor adherence to the use of the health
messages on nutrition.

Time of attending ANC also affected the nutritional status of the children significantly
(p=0.00). The late attendance to ANC poses a risk for the manifestation of preventable
pregnancy complications that could have affected the growth of the foetus and consequently
the outcome of delivery. Surprisingly, majority, 85.9% of mothers who had attended ANC,
had malnourished children, raising an issue of adherence. This is presumed from the evidence

27
that early visitors of ANC as per GHS protocol are educated early about risk behaviour
including exposure to infection, such as malaria and parasitic infections that has a negative
toll on foetus weight and total growth. The assumption is that the adherence to this protocol
would reduced delivery of underweight babies and hence improves the nutritional status. In
addition the lack of adherence to breastfeeding and complementing practises after the baby
has been delivered could be a contributory factor since the length of breastfeeding in
particular did not influence the (p=0.35) nutritional status of the child. Thus, if the requisite
nutritional practices are not continued from pregnancy throughout the total childhood period
of the baby, its nutritional status may be compromised.

Water sources of rural areas are usually unwholesome. The use of streams, hand dugs wells
and boreholes are predominant in Ilora and Oluwatedo Area of Oyo State. These water
sources are exposed to contamination from varied sources but are the major domestic sources
which includes the preparation of food for infants and children less than five years. Giving
water and food within 6 months had a significant association (p=0.03) with the malnutrition
trend among the children in Ilora and Oluwatedo.

The MOH through its service agencies is promoting the use of exclusive breastfeeding. This
is in line with the WHO recommendation which is aimed at reducing infections usually
diarrhoea among children less than five years. The promotion exercise is usually confronted
with many social influences on the new mothers. Which influence results from not only
practices in society but largely implemented by relatives who are suppose to provide support
for caring for the baby in the absence of the mother. Mother in-law parents as evidenced in
this study, contribute significantly to this practice. In the absence of the mother water and
other food sources are provided because, she would not be around to breast feed the baby.

Table 4.3: Influence of Maternal health seeking behaviour and child morbidity on nutritional
status of the child

Variable Malnourished Adequately Chi square or

(n = 64) nourished Fisher’s
(n=136) Exact;
p-value
28
Child morbid
within last 6 51 (79.7%) 90 (66.2%) 3.80
months
13 (20.3%) 46 (33.8%) (0.05)
Child has
been sick
No child
has been sick
Attending ANC
Attend ANC 64 (100) 134 (98.5%) 0.21
Don’t attend 0 (0.0%) 2 (1.5%)
ANC
Time of first ANC
visit 55 (85.9%) 91 (67.9%) 7.85
43 (32.1%) (0.00)
st
1 trimester 9 (14.1%)
2nd and above
trimester
Provider of funds
for ANC 0(0) 0(0) 0.67
Self 63 (98.4%) 131 (97.8%) (1.00)
1 (1.6%) 2 (1.5%)
Husband/partner
0 (0.0%) 1 (0.7%)
Parent
Mother-in-law
Decision to attend
ANC overruled 2 (3.1%) 8 (6.0%) 0.73
Decision 62 (96.9%) 126 (94.0%) (0.39)
overruled
Decision not
overruled
Length of time of
breast feeding 27 (42.2%) 47 (34.6%) 1.09
< 24 months 37 (57.8%) 89 (65.4%) (0.35)
24 months and
above
Give water and
food within 6
months 25 (39.1%) 74 (56.1%) 4.98
Give water and 39 (60.9%) 58 (43.9%) (0.03)
food
Don’t give
29
water and food
Care giver when
mother is away 19 (29.7%) 77 (56.6%) 14.65
Partner 39 (60.9%) 45 (33.1%) (0.00)
In-law/parent 6 (9.4%) 14 (10.3%)
Other relatives

Source: Author’s field data, 2008

4.4 Influence of feeding practices, water source and sanitation on child malnutrition

As shown in Figure 4.2 below, 91.5% of the women gave porridge to the children as for
breakfast, ampesi/kenkey with beans (72.5%) as lunch, and fufu and soup (94.5%) for supper
About four percent (4.5%) of the respondents said that they fed their children once a day. The
rest, 85.5% and 7.0% fed the children twice and thrice respectively. The number of times a
child was fed did not have any association (p=0.11) with the nutritional status of the child.
The practise of children eating together from the same bowl/plate also did not have any
relationship (p=0.19) with their malnutrition status. It is worthy of note that 79.4% and 87.3%
of children malnourished and well nourished respectively, did not eat from the same
bowl/plate together.

Pipe borne (20.0%), Boreholes (66.0%), Hand dug wells (13.5%) and streams (0.5%) were
the source of water used by the respondents. The source of water for the children have a
significant association (p=0.00) with their nutritional status. The type of toilet facility used
per household also did have an association (p=0.00) with the nutritional status of the child as
detailed in table 4.4 below. All the respondents disposed off refuse by crude dumping.

Feeding practices as has been alluded above contributes significantly to exposure to infection
by children less than five years. This coupled with poor water sources and sanitation only
increases the susceptibility levels of the child to malnutrition. In Ilora and Oluwatedo Area of
Oyo State, porridge, ampesi/kenkey plus beans, and fufu and soup, are the predominant food

30
given to children understudied. Plantain, Maize and cassava are the main farm crops in Ilora
and Oluwatedos.
These crops provide a readily available food for the family and the child less than five years.
They are highly of carbohydrate content and in most rural settings little protein is added to
complement for a nutritionally adequate diet. The number of times and the form with which
the food ate, together or not, does not significantly affect the nutritional status of children less
than five years.

The sources of water and toilet facility however, have a significant indication for nutrition
status of the child. The MDG report in 2006, estimated that about 25% of people in Nigeria
do not have access to quality waters. The trend observed in this study suggest that the use of
wells and pipe borne is similar to the estimated percentage of 50-75% as indicated in the
MDG report (UN, 2006). Even though, stream is less used, hand dug wells and boreholes
could constitute source of contamination and subsequently infections leading to
malnutrition’s. Waters from these sources are wrongfully presumed to be wholesome by the
mothers because its colourless nature hence not boiled before used for the complementary
feeding. This exposes the children to infection, as explained above and consequently
malnutrition. Faeco-oral transmission of organisms to children is a contributory factor to the
manifestation of malnutrition among them. Poor toileting practices, where children are not
well cleaned after toileting and hands washed thoroughly exposes them to infection. At the
younger age of less than five, the oro-anal development results in putting hands in mouth to
and from part of the body and from outside environment.

Crude dumping is the order of the day in Ilora and Oluwatedo Area of Oyo State. The practice
could account for the possible exposure of water sources to contamination. Contamination
from faeces and other sources are possible could consequently results in the spread of
diseases among the vulnerable, mostly children less than five years. A proper waste disposal
and total management of Ilora and Oluwatedo waste could prevent the incidence of
contamination of water sources and hence illness including diarrhoea among children less
than five years.

31
Figure 4.2: Major meals given to children per feeding time

100 91.5 94.5

90
Percentage (%)

80 72.5
70
60
50
40
30
20
10
0
Porridge Ampesi/kenkey + Fufu+ soup
beans
Breakfast Lunch Supper
Food type per time

Source: Author’s field data, 2008

Table 4.4: Influence of feeding practices, water source and sanitation on child malnutrition

32
Variable Malnourished Adequately Chi square or
(n = 64) nourished Fisher’s Exact;
(n=136) p-value
Number of times fed per day
Once 1 (1.6%) 8 (6.2%) 4.34 (0.11)
Twice 61 (95.3%) 110 (84.6%)
Thrice 2 (3.1%) 12 (9.2%)
Eating together
Children eat together 13 (20.6%) 16 (12.7%) 2.04 (0.19)
Children don’t eat together 50 (79.4%) 110 (87.3%)
Source of water used
Stream/pond 0 (0) 1 (0.7%) 30.97 (0.00)
Hand dug wells 20 (31.3%) 7 (5.1%)
Borehole 27 (42.2%) 105 (77.2%)
Pipe-borne 17 (26.6%) 23 (16.9%)
Toilet facility used
Pit latrine 58 (90.6%) 100 (73.5%) 10.43 (0.00)
KVIP 4 (6.3%) 33 (24.3%)
Water closet 2 (3.1%) 3 (2.2%)
Disposal of refuse -
Crude dumping 64 (100.0%) 136 (100.0)

Source: Author’s field data, 2008

4.5 Malnutrition estimate among children in Ilora and Oluwatedo

The mean age of the children was 10 months, an average height of 66.24 cm and a weight of
7.89 kg as shown in Table 4.5 below. About 36% of the children were females. Severe
malnutrition was identified in 23% of the children, 9% malnourished and rest (68%)
adequately nourished. Fig 4.3 There was no relationship (p=0.82) between the sex of the
children and malnutrition status however, the age of the children had an association (p=0.00)
with its nutritional status as shown in table 4.6 below. According to the key informants the
trend of malnutrition in Ilora and Oluwatedo is decreasing because of the rehabilitation

33
interventions sited at Pramso and food supplements supports from the Catholic Relief
Services (CRS).

About a quarter of the children less than five years in Ilora and Oluwatedo were malnourished
which is about twice that of the national average and regional average (GHS, 2007). Twenty
three percent were severely malnourished and 9% moderately malnourished. This implies that
one out of every five children less than five years old was malnourished which is extremely
high.
The high malnutrition rate has implication for the quality of social services generally
including health and agriculture. It also reflects the state of economic standing of households
in Ilora and Oluwatedos. Poverty is conceived as one of the predominant determinant of
malnutrition which contributes to a cycle of malnutrition for generations. Even though the sex
distribution of the children did not influence their nutritional status, their age did significantly
(p=0.00). Most of the children were infants, and over 56% of them constituted those severely
malnourished, and 61.1% among those moderately malnourished. The lack of attention for
these children could result in retarded growth debilitating to the social and economic growth.

Table 4.5: Descriptive statistics of background characteristics of respondents

Variable Mean SD 95 % C.I.

Age 10.00 months 10.79 [10.51, 13.52]

Height 66.24 cm 24.26 [65.23, 71.98]
Weight 7.89 kg 3.33 [7.43, 8.36]

Source: Author’s field data, 2008

34
Figure 4.3: Distribution of malnutrition of children

Source: Author’s field data, 2008

Table 4.6 Influence of characteristics on the malnutrition

Variable Severely Moderately Adequately Chi square or

malnourished malnourished nourished Fishers exact,
p-value

Sex
Female 18 (39.1%) 7 (38.9%) 48 (35.3%) 0.34 (0.82)
Male 28 (60.9%) 11 (61.1%) 88 (64.7%)
Age of child (months)
< 12 months 26 (56.5%) 11 (61.1%) 81 (59.6%) 14.53 (0.00)
12 – 24 months 14 (30.4%) 3 (16.7%) 42 (30.9%)
25 - 36 months 6 (13.0%) 1 (5.6%) 13 (9.6%)
37 months – 59 mths 0 (0) 3 (16.7%) 0 (0)

Source: Author’s field data, 2008

35
 CHAPTER FIVE
SUMMARY, CONCLUSION AND RECOMMENDATIONS

5.0 Conclusion

5.1.1 Influence of socio-economic characteristics on nutritional status of the child

a. Maternal age is a significant indicator for determining the nutritional status of a child.

b. The number of children and dependants in a household has a corresponding effect on

the nutritional status of children less than five years in Ilora and Oluwatedo.

c. Employment status even though has an implication of determination of the nutritional

status does not result in earnings that actually determines the distribution of
nutritional status among children less than five years in Ilora and Oluwatedo.

5.1.2 Influence of Maternal and Child health seeking behaviour on nutritional status of
the child
a. The morbidity of children less than five years in Ilora and Oluwatedo Area of
Oyo State, affect their nutritional status and could explain the high
malnutrition observed in this study.
b. The time of ANC attendance does have a relationship with incidence of
malnutrition in among children less than five years in Ilora and Oluwatedo
even though majority of those malnourished were of mothers who attended the
ANC in the first trimester.
c. Introduction of water and food before 6 months as a strong indicator of the
nutritional status of children less than five years in Ilora and Oluwatedo. Water
and food sources used may be contaminated and account for morbidity among
this group.

5.1.3 Influence of feeding practices, water source and sanitation on child malnutrition
a. Porridge and fufu with soup is the predominant food given to children less than five
years. Most of the children are fed twice or more, the quality and quantity of these

36
 food sources is a factor for accounting for the malnutrition levels among this group of
children in Ilora and Oluwatedo.
b. Source of domestic water and toilet facilities in the household determines the
nutritional status of the child. Crude dumping in Ilora and Oluwatedo is a factor to the
sanitations situation predisposes children to infection and hence malnutrition.

5.1.4 Malnutrition estimate among children in Ilora and Oluwatedo

a. The malnutrition level among children less than five years in Ilora and Oluwatedo is
very high. It is significantly related the age of the children rather that their sex group.
The younger the child the more likely they are susceptible to malnutrition.

5.2 Recommendation

5.2.1 Community and Opinion Leaders should:

a. Educate and reinforce social services interventions and promotions on feeding
children less than five years with adequately nutritious diets.
b. Should encourage parents to farm and use protein sources in addition with the readily
available carbohydrate sources to complement the food given to children less than five
years in Ilora and Oluwatedo.
c. Initiate a community action in the management of water sources so as to ensure that
water used for domestic purposes particular for children less than five years are safe.
d. Create awareness and use community labour to ensure safe disposal of waste
including faecal matter so as to prevent contamination of water sources.

5.2.2 Ilora and Oluwatedo Health Administration should:

a. Intensify education on proper nutritional practices especially during ANC services in
health facilities and at outreach sites.
b. Give refresher training to public health nurses on the predictors of malnutrition among
children less than five years. This should highlight risk of maternal age, employment
status and dependants per household.
c. Encourage mothers who attend ANC, to observe cleanliness during the preparation
and feeding of children less than five years.

37
5.2.3 Ilora and Oluwatedo Assembly should:
a. Provide social infrastructure including wholesome water and toilet services in each
household in addition proper waste management service.
b. Build and integrate community support for the prevention of diseases affecting
children less than five years.

5.2.4 Parents should:

a. Control the number of children they have as an increased number of children does not
only pose a health risk to especially the mother, but more important, affect children
less than five years in the household.
b. Observe proper hygiene especially in the use of toilet facilities and water used for
children less than five years
c. Ensure that the use of preventive tools including Insecticide Treated Nets (ITN),
Measles immunisation and malaria prophylaxis to prevent the incidence of illness that
is a significant factor accounting for the malnutrition in Ilora and Oluwatedo.
d. Inform relatives who take care of their children in their absence not to give the child
food and water which is a predictor for malnutrition among the children less than five
years in Ilora and Oluwatedo.

5.3 CONCLUDING REMARKS

This study has shown that the social and economic characteristics of household play a role in
the provision of the nutritional needs for children less than five years. There is therefore the
need for more integrative efforts of parents, communities, health managers and political
administrators to improve the nutritional status of children less than five years.

38
 REFERENCE

Agnarsson I, Mpell, G. Gunnlaaugsson, Y. Hofuander, T. Greider(2001), Infant feeding

practices during the first months of life in a rural area, Tanzania, East Africa Medical
Journal. 78 (1) 9-13

Appoh, L.Y. and Krekling, S. (2005) Maternal nutritional knowledge and child nutritional
status in the Volta Region of Nigeria Maternal and Child Nutrition pp. 100–11

Benson, T,and others. 2004.Crossing Boundaries to Reduce Malnutrition: An Institutional

Study of Agriculture and Nutrition in Uganda, Mozambique, and Nigeria. Report
submitted to ICRW under the Agriculture-Nutrition Advantage project. Washington, DC

Brown, K.H.,and others., 1998, Complementary feeding of young children in developing

countries: A review of current scientific knowledge. Geneva: World Health
Organisation.

Castle S., Yoder P.S. & Konate M.K. (2001) Introducing Complementary Foods to Infants in
Central Mali. ORCMacro: Calverton, MD, USA.

Daelmans B & Saadeh R (2003). Global initiative to improve complementary feeding. SCN
News 27, 10–18.

Ilora and Oluwatedo Health Administration, 2006, Annual Report. Bosomtwe, Nigeria.

Gupta, A., Maathur G.P, and Jagdish C., (2002), World Health Assembly recommends
exclusive breastfeeding for the first six months

Dewey, K G. Cohen, R.J.Brown, K.H. Vera, L.I (1999) Age of introduction of

Complementary foods and Growth and Low-Birth-Weight, Breastfed Infants. American
Journal of Clinical Nutrition (1) 2 pp 32-45.

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Lartey, A. (2008) Maternal and child nutrition in Sub-Saharan Africa: challenges and
interventions. Proceedings of the Nutrition Society (2008), 67, 105–108

McKeever P. & Miller K.L. (2004) Mothering children who have disabilities: a Bourdieusian
interpretation of maternal practices. Social Science and Medicine, 59, 1177–1191.

Nigeria Statistical Services, (1998). Nigeria Demographic and Health Survey Report. Accra.

Nigeria Health Services, (2007) Annual Report, Accra

GSS. 2003. Nigeria Demographic and Health Survey. Calverton, MD: Nigeria Statistical
Service and Macro International.

Glewwe P. (1999) Why does mother’s schooling raise child health in developing countries:
evidence from Morocco. Journal of Human Resources, 34, 124–159.

Hague M.F., M.Hussain, A.Sarkar,M.M.Hogue, F.A.Ara, Sultan (2004), Breastfeeding

counseling and its effects on the prevalence of exclusive breastfeeding, J. Health Popul
Nutri,Vol 20(4), 312-6

LINKAGES (2002), Policy Context and Consensus. Nigeria

Lisa. C,and others., 2000. Explaining Child Malnutrition in Developing Countries: A

CrossCountry Analysis, Research Report 111 Washington, D.C..
National Immunization Days (NIDs).

Mark, L., Wahlqvisti, and Lee, M. 2006. Nutrition in Health Care Practice. J Med Sci: 26(5):
157 - 164
MOH Nutrition Unit, (2002) Annual Report. Accra.

Ojeifeitimi E.O.O.O. Owolabi, A., Aderonmu, A.O., and Esimai, S.O., (2003). A study on
under nutritional status and its determinants in a semi-rural community of Ile-Ife,Osun
State, Nigeria,Nutri.Health, (17)1, 21-27

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Ruel M.T., Habicht J., Pindtrup-Anderson P. & Grohn Y. (1992) The effects of maternal
nutrition knowledge on the association between maternal schooling and child
nutritionstatus in Lesotho. American Journal of Epidemiology, 135, 904–914.

Sethi V, S.Kashyap, V.Seth (2003),Effect of nutrition education of mothers on infant feeding

practices,Indian J. Pediatrics,Vol.70(6), 463-466

Thairu, L.N.and others., (2005). Socio-cultural influences on infant feeding decisions among
HIV-infected women in rural Kwa-Zulu Natal,South Africa. Maternal and Child Nutrition pp.
2-10

UNICEF, 1998. Strategy for improved nutrition of children and women in developing
Countries. New York: United Nations Children’s Fund.

UNICEF (2004) The State of the World’s Children. Availableat: http://www.unicef.org/files/

Webb P. & Block S. (2003) Nutrition knowledge and parental schooling as inputs to child
nutrition in the long and shortrun. Food Policy and Applied Nutrition Program Working
Paper 3.

Webb P. & Lapping K. (2002) Are the determinants of malnutrition the same as for food
insecurity? Recent findingsfrom 6 developing countries on the interaction between food
and nutrition security. Food Policy and Applied Nutrition Program. Discussion Paper 6.

World Food Programme,(2005). A Manual: Measuring and Interpreting Malnutrition and

Mortality. Geneva.

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the World Health Organization, 73, 165–174

WHO (1998). Complementary Feeding of Young Children in Developing Countries: A

Review of Current Scientific Knowledge. World HealthOrganization: Geneva, Switzerland.
WHO, 2004. Inheriting the world. The atlas of children's health and the environment.
Geneva: World Health Organization.

41
 QUESTIONNAIRE

STRUCTURED INTERVIEW GUIDE FOR HOUSEHOLDS ESPECIALLY MOTHERS AND

CARE GIVERS

Determinants of malnutrition status in children less than five years in B .A .K. Ilora and Oluwatedo.

INTRODUCTION

I am carrying out this research as part of academic work. Could you please spare me few minutes of

your time and respond to the items below as honestly as possible. Information provided will be treated

as private and confidential.

A. SOCIO DEMOGRAPHIC DATA

1. Age…………………………………………………………………………….

2. Sex……………………………………………………………………………..

3. Marital status…………………………………………………………………

a. Single b. Married c. Widowed/Separate/Divorce

4. Place of residence…………………………………………………………….

5. Highest education level

a. No education ( )

b. Non-Formal education ( )

c. Primary education ( )

d. junior high school ( )

e. senior high school ( )

f. Tertiary education ( )

6. Religious Denomination

a. Christianity ( ) b. Animist ( ) c. Moslem ( ) d. Traditionalist ( )

Others (specify)………………………………

42
B. SOCIO-ECONOMIC DATA

8. Occupation

Are you employed? Yes ( ) No ( )

9. If yes, what type of job do you do?

Farming ( ) Trading ( ) Tradesman ( ) Public/ Civil Servant ( )

Others (specify)……………………..

10. If Farmer, state

Subsistent ( ) Semi-Commercial ( ) Commercial ( )

11. If Trader/ Tradesman/Public/Civil Servant, do you have a regular cash income/ are you a

salaried worker ?

a. Yes, professional – teacher, nurse, accountant, administrator

b. Yes, clerical/ secretarial

c. Yes, seamstress, hairdresser etc.

d. Yes, trader/food seller

e. Yes, labourer/ domestic worker

f. Others (specify)………………..

g. No ( )

12. Do you receive any form of financial subvention?

Yes ( ) No ( )

13. If yes, in what form?

a. Regular b. Casual
14. What is the Occupation of the father?

Farmer ( ) Trader ( ) Tradesman ( ) Public/Civil Servant ( )

Others(specify……………….......

15. Does he earn enough to buy food and essentials for all the family?

Yes ( ) No ( )

43
C. ADEQUATE FOOD SECURITY AND FOOD INTAKE

16. Do you have any land on which you grow food?

Yes ( )

No ( )

17. Are you able to provide food for the family throughout the year?

Yes ( ) No ( )

18. How many people do you feed in your household? ………………………………..

D. INCIDENCE OF DISEASE

19. How many children do you have?

a. 1 b. 2 c. 3 d. Others (specify) ………………………………….

20. If more than one, what are the intervals between their births? .................................... 21.

Has your child been falling sick? Yes ( ) No ( )

22. If yes, what type of sickness? ……………………………………………..........

23. Have you lost a child before? Yes ( ) No ( )

24. If yes, what killed him or her? …………………………………………………..

E. MATERNAL AND CHILD CARE

25. Do you attend ANC when you are pregnant? Yes ( ) No ( )

26. When do you start anti- natal clinic when you are pregnant? ……………………

27. Who usually decides on your going to ANC ?

Self ( ) Husband/ Partner ( ) Parent ( ) Mother- in- law ( )

Others (specify)…………………….................................................................

28. Who provides the money for your expenses during ANC ?

Self ( ) Husband/ Partner ( ) Parent ( ) Mother- in- law ( )

Others (specify)……………………...................................................................

29. Is there any one who can overrule the decision to go to ANC ?

Yes ( ) No ( )

44
30. Do you give breast milk to your child as soon as you deliver? Yes ( ) No ( )

31. How long do you breastfeed your children?

……………………………………………………………………………………

32. Do you give water and complementary food to your children the first six month?

Yes ( ) No ( )

33. Who takes care of your children when you are away?

…………………………………………………………………………………

F. FEEDING PRACTICE

34. How many times do you feed your family a day, especially the children?

a.4 times ( ) b.3 times ( ) c. 2 times ( ) d. once ( )

35. What type of food do you give to your children?

Morning:………………………………………………………………………

Afternoon:……………………………………………………………………..

Evening:……………………………………………………………………….

36. Do the children eat together?

Yes ( ) No ( )

G.WATER AND SANITATION

37. Source of water

Stream/ Pond ( ) Hand dug well ( ) Bore – Hole ( ) Pipe- borne ( )

TOILET FACILITY

38. What type of toilet facility?

Pit Latrine ( )

Bucket latrine ( )

KVIP ( )

45
 Water closet ( )

Free range ( )

39. How do you dispose off your refuse? ………………………………………………..

46
INTERVIEW GUIDE FOR KEY INFORMANT

All interviewees will be personnel in the area of caring of the health of children.

Date of interview ………………………………………………………………

Time started …………………………………………………………………….

Time ended ……………………………………………………………………...

Interview number ……………………………………………………………….

1. Profession

2. Age

3. Sex

4. Duration of service

5. What policies and programmes have been put in place in your Ilora and Oluwatedo

concerning nutritional care of children under five years of age?

………………………………………………………………………………………………

………………………………………………………………………………………………

……………………………………………………………………………….

6. (a) How are these policies and programmes benefiting the children and society as a

whole?

………………………………………………………………………………………………

………………………………………………………………………………………………

………………………………………………………………………………

(b)Do the parents utilize the available services ?

……………………………………………………………………….............................

7. (a) Are there malnourish children in Ilora and Oluwatedo?

47
 ………………………………………………………………………...................
………………………………………………………………………..................

(b) If yes, what are the causes of malnutrition?

………………………………………………………………………................

………………………………………………………………………................

8. What factors have you put in place to curb the situation?

……………………………………………………………………........................

……………………………………………………………………........................

9. Has there been any improvement?

……………………………………………………………………..........................

………………………………………………………………………........................

48