CHAPTER 1

INTRODUCTION
This is a research proposal that aims to study malnutrition in children under the age of five
years.The research aims at finding out the causes of malnutrition and come up with solutions that
will help mitigate the problem.The research is to be carried out in Eldoret town to children under
the age of 5years.

BACKGROUND
Adequate Nutrition is the fundamental right of every human being. Poor nutrition is cited as the
major factor in more than half of all child deaths in Kenya - a significantly higher proportion
than those claimed by other infectious diseases. Malnutrition is not just a stark manifestation of
poverty, it is also the non-income face of poverty and it helps perpetuate poverty (World Bank
Report, 2012). Nutritional status is defined as the condition of the body resulting from the intake,
absorption and utilization of food. It is determined by a complex interaction between
internal/constitutional factors and external environmental factors: Internal or constitutional
factors like: age, sex, nutrition, behavior, physical activity and diseases. External
environmental factors like: food safety, cultural, social and economic circumstances (Joshi et al,
2012)

STATEMENT OF THE PROBLEM

Malnutrition refers to a pathological state resulting from a relative or absolute deficiency or
excess of one or more essential nutrients. It is a state of nutrition where the weight for age,
height for age and weight for height indices are below -2, Z-score of the NCHS
reference. Malnutrition continues to be a major public health problem in developing countries. It
is the most important risk factor for the burden of disease causing about 300, 000 deaths per year
directly and indirectly responsible for more than half of all deaths in children. Health and
physical consequences of prolonged states of malnourishment among children are: delay in
their physical growth and motor development; lower intellectual quotient (IQ), greater
behavioral problems and deficient social skills; susceptibility to contracting diseases. Major
types of nutritional problems in developing countries are under- nutrition and nutritional
disorders which are resulting from inadequate food intake both in quality and quantity,
particularly of calories, protein, vitamins and minerals; and parasitic infection and disease.

PURPOSE OF THE STUDY

Studying malnutrition among children is crucial for several reasons:

1. Health Impact: Malnutrition is a leading cause of childhood illness and mortality.

Understanding its causes and effects helps in reducing the burden of diseases such as stunting,
wasting, and micronutrient deficiencies.

2. Long-term Development: Malnutrition in early childhood can lead to long-lasting cognitive,

physical, and emotional developmental impairments. Studying it allows for early intervention to
support healthier growth and better learning outcomes.

3. Public Health Interventions: Research on child malnutrition guides policymakers in designing

effective nutrition programs, improving food security, and allocating resources where they're
most needed to prevent malnutrition.

4. Economic Consequences: Malnutrition contributes to the cycle of poverty, as affected children

may grow up with reduced productivity and increased healthcare costs. By studying the problem,
solutions can be devised to break this cycle.

OBJECTIVES OF THE STUDY.

The objectives of a research study on malnutrition among children typically aim to investigate
various aspects of the issue in order to better understand and address the problem. Some key
objectives include:

1. Identifying Prevalence: To assess the prevalence and patterns of malnutrition (such as stunting,
wasting, underweight, and micronutrient deficiencies) in specific populations or regions.

2. Understanding Causes: To explore the underlying causes of malnutrition, including factors

such as poverty, poor dietary practices, limited access to nutritious food, lack of clean water,
inadequate healthcare, and maternal malnutrition.

3. Examining Risk Factors: To identify socio-economic, environmental, cultural, and

demographic risk factors that contribute to higher rates of malnutrition among children.
4. Assessing Health Impacts: To investigate the short- and long-term health consequences of
malnutrition on children's physical and cognitive development, as well as their vulnerability to
infections and diseases.

RESEARCH QUESTIONS
Here are several research questions about malnutrition among children that could guide studies
on this topic:

1. Prevalence and Trends

What is the current prevalence of malnutrition among children in [specific region/country]?

How have trends in childhood malnutrition changed over the last decade, and what factors have
contributed to these changes?

Are certain demographic groups (e.g., urban vs. rural, lower-income vs. higher-income) more
affected by childhood malnutrition?

2. Causes and Risk Factors

What are the primary socioeconomic, environmental, and cultural factors contributing to
malnutrition among children in [specific region/country]?

How do maternal education and maternal nutrition influence childhood malnutrition rates?

What role do food insecurity and poor access to clean water play in childhood malnutrition?

How do infectious diseases (e.g., diarrheal diseases) exacerbate malnutrition in children?

3. Impact of Malnutrition

How does malnutrition in early childhood affect long-term cognitive development and academic
performance?

What are the long-term health outcomes for children who experience chronic malnutrition in
their early years?

How does malnutrition in children influence the prevalence of other health conditions, such as
anemia or stunting?
4. Interventions and Solutions

What are the most effective community-based interventions for addressing malnutrition in
children?

How do nutrition education programs impact the feeding practices and dietary habits of parents
or caregivers of malnourished children?

How successful have micronutrient supplementation programs (e.g., Vitamin A, Iron) been in
reducing malnutrition among children?

How does the integration of nutrition-sensitive agriculture programs affect childhood

malnutrition rates?

JUSTIFICATION OF THE STUDY

Malnutrition among children is a critical global health issue that has long-term consequences on
physical and cognitive development, ultimately hindering the growth and potential of future
generations. Despite significant advances in healthcare and nutrition, the prevalence of
malnutrition remains high in many parts of the world, particularly in low- and middle-income
countries. Malnutrition, including both undernutrition (such as stunting, wasting, and
micronutrient deficiencies) and overnutrition (leading to obesity), is a multifaceted problem
influenced by factors like poverty, food insecurity, inadequate healthcare, poor sanitation, and
lack of proper nutrition education. Understanding the root causes of malnutrition and its impact
on child health is essential for designing effective interventions and policies to reduce its
prevalence. This research aims to examine the underlying factors contributing to malnutrition,
assess the health and developmental outcomes in children affected by it, and explore the efficacy
of current nutritional programs. By identifying gaps in existing efforts and understanding the
unique challenges faced by different populations, this study will provide critical insights to
improve strategies for combating child malnutrition, promoting healthier communities, and
achieving better overall child health outcomes. The results of this research will be instrumental in
guiding policymakers, health practitioners, and organizations working to reduce child
malnutrition worldwide.
SIGNIFICANCE OF THE STUDY
Significance the findings of the study will be helpful to

a) Encourage local people to improve current nutritional status by improving feeding pattern and
habit of children, pregnant and lactating women.

b) Serve as helpful guide to plan suitable nutritional and health programs for this community
based on the facts and figures discovered from this study.

c) Provide information to government and voluntary institution like NGOs and INGOs about
nutritional status as well as different demographic factors.

d) Encourage government and other stake holders for the development of programs and policies
related to nutrition.

e) Discover the problems related to nutrition, care practices and feeding behavior of this
community.

f) Act as tool to reflect sanitary condition, socio-economic variables, degree and types of
malnutrition and condition of 6 to 60 months age group child.

g) Identify individual or group of people who are at risk of being malnourished and who need
special care and attention.

ASSUMPTION OF THE STUDY

Research on malnutrition among children typically assumes several key factors that contribute to
its prevalence and impact. One major assumption is that malnutrition is primarily caused by
nutritional deficiencies, where children lack essential nutrients such as proteins, vitamins, and
minerals, leading to stunted growth, weakened immune systems, and developmental delays. It
also assumes that socioeconomic factors play a significant role, with children from lower-income
households or developing countries being more vulnerable to malnutrition due to limited access
to adequate food, clean water, and healthcare. Geographical and environmental factors are often
considered, with research assuming that children in rural, conflict-affected, or disaster-prone
areas experience higher rates of malnutrition due to food insecurity and disrupted supply chains.
Furthermore, it is assumed that a lack of knowledge among caregivers about proper feeding
practices contributes to malnutrition, as inadequate breastfeeding, inappropriate complementary
feeding, and poor food hygiene are common risk factors.

SCOPE OF THE STUDY

The scope of the study done will be supporting and informing policy dialogue, strengthen
knowledge and support policy development to implement intervention programs for the
improvement of nutritional status of said age group children. This study will be able to
categorize the severity of different form of malnutrition that had habitat in children. The study of
nutritional status in society give the real image of condition of household occurrence of at
national level and help to introduce intervention to uplift their status as healthy living. It is the
study which generate the level of education on health, hygiene, sanitation, occupation, living
standard, pattern care of children feeding , knowledge in food habit food consumption
situation in particular moment. Nutritional status related survey is one of the best method
to interact directly with people and most applicable method to bring out change in the faulty
living practices

LIMITATIONS OF THE STUDY

Some limitations to studying child malnutrition in Kenya include:

Sample size: The study sample may not be nationally representative.

Study design: The study design may be inadequate, such as being a single cross-sectional survey
that can't define trends over time.

Reference standards: The study may have used outdated reference standards for child growth.

Recall bias: The data collected may be susceptible to recall bias, especially if the child was
brought in by a guardian.

Social desirability bias: The data collected may be susceptible to social desirability bias.

Interviewer bias: The data collected may be susceptible to interviewer bias.

Anthropometric measures: Technical errors in anthropometric measures can lead to

misclassification of children's nutritional status.
THEORETICAL FRAMEWORK
Malnutrition refers to a state of either under-nutrition or over-nutrition. Under-nutrition occurs
when the diet a person consumes does not meet their body’s requirement for growth and
development whereas over-nutrition occurs when a person consumes too many calories

Key Theories and Concepts

a) Ecological Systems Theory (Bronfenbrenner)

This theory suggests that a child’s development, including their nutritional status, is shaped by
multiple layers of their environment. Key systems include:

Microsystem: Immediate environments like family, caregivers, and school settings that directly
influence children’s diet and nutrition.

Mesosystem: Interactions between microsystem elements, such as the relationship between a

child's home and the local healthcare system or school nutrition programs.

Exosystem: Broader influences like community resources, employment opportunities for parents,
or local policies related to food security.

b) Social Determinants of Health

This framework underscores that health, including nutrition, is largely shaped by social,
economic, and environmental conditions:

Income: Low-income families face food insecurity, which directly impacts children's nutrition.

Education: Parents with lower educational levels may lack knowledge about proper nutrition or
may struggle to prepare healthy meals.

Healthcare Access: Limited access to healthcare services means malnutrition is often detected
too late, and preventive measures may be unavailable

c) Health Belief Model (HBM)

This model focuses on how individual perceptions of health risks and benefits influence
behavior. In the context of malnutrition, it can be used to explore:

Perceived Susceptibility: How parents perceive the risk of their children becoming malnourished.
Perceived Severity: How serious they believe malnutrition is and its long-term effects on their
child.

Based on the theories, intervention strategies include:

Policy and Education: Develop policies that promote nutrition education, improve access to
healthy food, and raise awareness about the risks of malnutrition (e.g., government campaigns,
school programs).

Community-based Programs: Implement programs that provide free or subsidized nutritious

foods and healthcare access for low-income families.

CONCEPTUAL FRAMEWORK
A conceptual framework on malnutrition among children highlights the various factors
contributing to malnutrition in children, its consequences on their health and development, and
potential interventions to mitigate its impact. It takes into account the unique nutritional needs of
children and the specific factors that influence their nutritional status. Here's a detailed
conceptual framework:

1. Key Concepts and Variables

Malnutrition in Children: This includes both undernutrition (e.g., stunting, wasting, underweight)
and overnutrition (e.g., obesity).

Nutritional Status: The overall health condition of a child as determined by their diet, growth
indicators (height-for-age, weight-for-age, etc.), and biochemical markers.

2. Causes of Malnutrition in Children

The causes of child malnutrition can be divided into immediate, underlying, and basic causes.

a. Immediate Causes

Inadequate Dietary Intake: Poor-quality diet, insufficient food, or inappropriate feeding practices.

Inadequate breastfeeding (e.g., not breastfeeding exclusively for the first 6 months).

Insufficient complementary feeding (e.g., lack of nutrient-rich foods after 6 months).

Infectious Diseases: Diarrheal diseases, respiratory infections, and parasitic infections that
contribute to poor nutrient absorption and increased nutritional needs.

Micronutrient Deficiencies: Lack of essential vitamins and minerals like iron, vitamin A, iodine,
and zinc, which are crucial for growth and immune function.

b. Underlying Causes

Household Food Insecurity: Limited access to nutritious food due to poverty, poor food
distribution, and lack of purchasing power.

Poor Health Environment: Lack of access to clean water, sanitation, and hygiene, leading to a
higher incidence of infections and diseases that impair nutrition.

Inadequate Care: Limited knowledge about child feeding practices, poor maternal care, lack of
proper child health supervision, and low maternal education.

Socioeconomic Factors: Poverty, low education, and limited access to healthcare all contribute to
an increased risk of child malnutrition.

c. Basic Causes

Political and Economic Systems: National policies that affect food production, distribution, and
economic stability. This also includes government investments in nutrition, healthcare, and social
protection programs.

Cultural Norms and Practices: Cultural beliefs about feeding practices, such as early weaning,
preferences for certain types of foods, or taboos that limit a child's access to diverse diets.

Global Factors: External factors like global food prices, climate change, and international trade
policies that influence food security at the national or household level.

3. Consequences of Malnutrition in Children

Malnutrition in children leads to immediate and long-term consequences:

Physical Health: Growth retardation (stunting), wasting, weakened immune systems, increased
vulnerability to infections, and higher mortality rates.
Cognitive Development: Stunted growth and nutrient deficiencies, especially in the early years,
can impair brain development, leading to cognitive delays, learning difficulties, and poor
educational outcomes.

Behavioral and Social Issues: Children suffering from malnutrition may experience delayed
motor skills, speech, and social development. Long-term malnutrition can contribute to social
exclusion and stigma.

Economic Impact: Malnutrition contributes to reduced productivity in adulthood, perpetuating

cycles of poverty and limiting economic growth for entire populations.

4. Interventions and Solutions

Interventions must address the underlying causes and immediate needs of children to improve
their nutritional status. Some key interventions include:

a. Improved Infant and Young Child Feeding Practices

Exclusive Breastfeeding for the first six months of life to ensure optimal nutrition and immune
protection.

Complementary Feeding: Providing nutritious, age-appropriate foods after six months to meet
the growing child’s nutritional needs.

Micronutrient Supplementation: Providing supplements like vitamin A, iron, zinc, or folic acid to
prevent or correct deficiencies.

OPERATIONAL DEFINITION OF TERMS

HBM- health belief model

LMIC-low to middle income countries

NCHS-National Center for Health Statistics

UNICEF-United Nations International Children's Emergency Fund

 CHAPTER TWO
LITERATURE REVIEW
INTRODUCTION
Malnutrition in children remains a significant global health challenge, particularly in low- and
middle-income countries. It encompasses both undernutrition (stunting, wasting, and deficiencies
in essential nutrients) and overnutrition (obesity and related chronic diseases), each of which can
have lasting effects on a child's physical and cognitive development. Undernutrition, often linked
to poverty, food insecurity, and inadequate healthcare, can lead to impaired growth, weakened
immune systems, and higher susceptibility to infections, while also affecting long-term
educational and economic outcomes. Conversely, overnutrition, driven by poor dietary patterns
and sedentary lifestyles, is increasingly prevalent in urban areas and poses a rising threat to
children's health, contributing to the growing incidence of childhood obesity.

REVIEW LITERATURE ACCORDING TO OBJECTIVES

Prevalence of Malnutrition in Children

Malnutrition is prevalent worldwide, with the World Health Organization (WHO) estimating that
approximately 45% of deaths among children under five years old are linked to undernutrition.
The prevalence varies according to region, with sub-Saharan Africa and South Asia showing the
highest rates of undernutrition. Studies indicate that stunting, wasting, and underweight are
common markers for malnutrition in children, while obesity rates are rising globally in high-
income countries.

Socioeconomic, Cultural, and Environmental Factors

A wide range of factors contribute to childhood malnutrition:

Socioeconomic Status: Lower socioeconomic status is one of the most significant risk factors for
malnutrition, as families with limited resources often cannot afford sufficient or nutritious food.
Poor access to healthcare, inadequate sanitation, and poor living conditions further exacerbate
the issue.
Cultural Practices: Certain cultural beliefs and practices may hinder proper nutrition for children.
For example, preferences for specific foods, or misconceptions about feeding practices, may
result in nutrient deficiencies. In some cultures, there is a tendency to prioritize male children
over female children, which can lead to imbalanced feeding practices and increased malnutrition
risk for girls.

Interventions and Public Health Programs

Numerous interventions have been developed to address childhood malnutrition, including:

Food-Based Interventions: The provision of micronutrient supplements (e.g., vitamin A, iron)

and fortified foods can help address nutrient deficiencies. School feeding programs and
community-based nutritional support have shown promising results in reducing malnutrition in
some regions.

Healthcare-Based Interventions: Programs focused on improving maternal and child healthcare,

including prenatal care, breastfeeding support, and the treatment of childhood illnesses, are
crucial in combating malnutrition. The promotion of exclusive breastfeeding for the first six
months of life and the introduction of appropriate complementary foods at the right time can play
a significant role in reducing undernutrition.

CHAPTER SUMMARY AND GAPS IN LITERATURE

Despite significant progress in addressing child malnutrition globally, gaps still persist in
understanding and mitigating its impact. One major gap lies in the uneven distribution of
resources and interventions, with many low- and middle-income countries facing challenges in
accessing adequate nutrition programs. Additionally, while the relationship between poverty and
malnutrition is well-documented, more research is needed on the specific socio-cultural factors
that contribute to undernutrition in different regions. There is also limited focus on the long-term
effects of malnutrition, particularly its impact on cognitive development and economic
productivity in adulthood. Moreover, gaps remain in the integration of nutrition with other
sectors, such as education, healthcare, and sanitation, which are critical to addressing the
multifaceted nature of malnutrition. Bridging these gaps is essential for designing more effective,
context-specific interventions to reduce child malnutrition worldwide.
 CHAPTER 3
METHODOLOGY
INTRODUCTION
Methodology refers to the system of methods, principles, and rules used in a particular discipline
or study. It outlines the approach that researchers or practitioners use to collect data, conduct
analysis, and derive conclusions in a structured, logical manner. In essence, methodology is the
framework or set of processes guiding how research or an intervention is carried out to achieve
its objectives.

RESEARCH DESIGN
A community based cross-sectional survey will be conducted to assess the nutritional status and
associated factors among children aged 6-60 months which includes a) Anthropometric
measurement of 6 - 60 months children at household level. b) General household survey by the
application of questionnaire to the parents of children under study to find out the situation of
household

Study Area
The study will be conducted at Eldoret town, Uasin Gishu county, Kenya. Eldoret is located in
the Rift valley region.Eldoret has a total population of 45483 and 7166 under five year children.
(Source: Kenya census 2019)

Target Population
Source population or universe of the study will be all 6-60 months children living in the Voi
town and the study population will be children of 6-60 months age randomly selected and
included in the study. Inclusion and exclusion criteria Inclusion criteria: - Children aged 6-60
months who live in Eldoret town will be included in the study. Exclusion criteria: - The study
participants who are seriously ill or who are not available at household during the time of survey
will not be included in the study.
Sampling Procedure and Sample Size
Cluster sampling technique followed by simple random sampling will be used to select children
from households. The basic criterion for the selection of household sample is that the household
containing at least one child of 6-60months of age will be included in the sample.

Sample Size The sample size is determined by using a single proportional formula assuming the
prevalence rate of malnutrition to be 50% in the survey area, 95% confidence interval (CI), 8%
margin of error (d) and 10% non-response rate is added to the total calculated sample size.
Calculation of sample size for infinite population: -

Research Instruments
Instruments and equipment‘s necessary for the conduction of the survey are:
a) Weighing Machine :- Weighing machine with the capacity of 100kg and having the least
count of 0.1Kg.(1piece)

b) Height measuring scale ( standiometer) :- 1 Piece c) MUAC Tape :- For measuring mid-upper
arm circumference.(1piece)

PILOTING OF RESEARCH INSTRUMENTS

The piloting phase typically involves several key steps:

Selection of Sample: A small sample of children from the target population is selected for
piloting. This sample should be representative of the age and gender distribution of the larger
study population.

Calibration of the Machine: The weighing machine should be calibrated before use to ensure
accurate weight readings. Calibration could involve verifying the machine with known weights
to check for any discrepancies.
VALIDITY AND RELIABILITY OF THE RESEARCH
INSTRUMENTS
Validity refers to the accuracy and truthfulness of the instruments, it reflects the concept it
intended to measure while reliability refers to consistently of the measurement.A reliable
measurements produces consistent results.

DATA COLLECTION PROCEDURES

Effective data collection is critical for assessing child malnutrition and understanding the factors
contributing to it. The procedures must be designed to ensure the accuracy, reliability, and
validity of the data while accounting for ethical considerations. Below are the key steps in the
data collection process for a research proposal on child malnutrition.

1. Study Design and Sampling

The first step in data collection is defining the study design and sampling method, which will
determine how data will be collected and from which population.

Sampling Method: The sample should be representative of the target population. A stratified
random sampling method is commonly used, particularly in large, heterogeneous populations.
This ensures that children from various demographic and socioeconomic backgrounds are
included, which will improve the generalizability of the results.

Inclusion/Exclusion Criteria: Clear criteria should be established. Inclusion criteria might include
children aged 0-5 years, while exclusion criteria could involve children with known chronic
diseases unrelated to nutritional factors.

2. Data Collection Tools and Instruments

The selection of appropriate tools and instruments for data collection is crucial to ensure accurate
measurements of malnutrition.

Anthropometric Measurements: The primary tool for assessing malnutrition will be

anthropometric measurements, including:
Weight and Height/Length Measurements: A calibrated digital weighing scale and a stadiometer
or length board will be used to measure weight and height/length. Weight-for-age, height-for-age,
and weight-for-height indices will be calculated to identify stunting, wasting, and underweight.

Questionnaires: Socioeconomic and demographic data will be collected through structured

questionnaires, which may include questions about the family’s income, maternal education,
access to healthcare, and food security. These factors will help identify potential risk factors for
malnutrition.

Health Data: Health records or interviews with caregivers will provide information about any
underlying illnesses, breastfeeding practices, vaccination status, and other health-related factors.

DATA ANALYSIS TECHNIQUES

Data analysis is a critical step in understanding the factors contributing to child malnutrition and
assessing the effectiveness of interventions. The choice of analysis techniques will depend on the
type of data collected (e.g., anthropometric measurements, dietary intake, socioeconomic factors)
and the research objectives (e.g., prevalence estimation, correlation analysis, or intervention
evaluation). Below is an overview of the data analysis techniques that can be used in a research
study on child malnutrition.

Measures of Central Tendency:

Mean: To calculate the average weight, height, or dietary intake

Mode: Useful for identifying the most common value, such as the most frequently consumed
food item in a food frequency questionnaire.

Anthropometric Data Analysis

The most commonly used method to assess nutritional status in children is comparing
anthropometric measurements (weight, height, or MUAC) against standard growth references
(e.g., WHO Child Growth Standards). This is done by calculating Z-scores, which show how far
a child’s measurement deviates from the median value of a reference population in terms of
standard deviations.
Qualitative Data Analysis

In addition to quantitative data, qualitative data (e.g., interviews, focus group discussions) may
be collected to understand the contextual factors contributing to malnutrition, such as cultural
practices, health beliefs, and community perceptions of nutrition.

ETHICAL ISSUES
Ethical Issues in Child Malnutrition Research

Research on child malnutrition involves vulnerable populations and sensitive data, so ensuring
ethical integrity throughout the study is critical. Below are key ethical issues to consider when
conducting research on child malnutrition.

1. Informed Consent

Informed consent is a fundamental ethical requirement in all research, especially in studies

involving children. Since children cannot legally provide consent themselves, informed consent
must be obtained from a parent or legal guardian.

2. Privacy and Confidentiality

Protecting the privacy of participants and ensuring the confidentiality of collected data is
essential in any research. This is particularly important when dealing with sensitive health data
like nutritional status and medical History

3. Minimizing Harm and Ensuring Child Safety

One of the most significant ethical concerns in child malnutrition research is ensuring that no
harm comes to children during the study, either physically or psychologically.

4. Exploitation and Coercion

: There is a risk of exploitation when researching vulnerable populations, particularly in settings

where families are economically disadvantaged or under-resourced

CHAPTER SUMMARY
Methodology enables reliable and desirable results.Methods of data collection and techniques of
data analysis are important to ensure accurate data is collected.
Ethics ensures a safe research environment both for the researcher and the participants.

RECOMMENDATIONS
Addressing child malnutrition requires a multi-faceted approach that involves both immediate
nutritional support and long-term systemic changes. Key recommendations include improving
access to diverse, nutrient-rich foods, particularly in underserved areas, and promoting
breastfeeding as it provides essential nutrients in the early stages of life. Early intervention
programs that monitor growth and development can identify malnutrition early, allowing for
timely treatent. Additionally, increasing nutrition education for families can help them make
informed food choices, even with limited resources. Strengthening healthcare systems to address
both acute and chronic malnutrition is crucial, as well as enhancing sanitation and water access
to reduce the risk of infections that exacerbate malnutrition. Governments and international
organizations should collaborate to provide financial and technical support to communities,
ensuring that nutrition programs are both sustainable and culturally appropriate. Lastly,
addressing the underlying causes of malnutrition, such as poverty, inequality, and lack of
education, is essential for creating lasting improvements in child health.

CONCLUSION
In conclusion, addressing malnutrition in children is critical for ensuring the healthy
development of future generations. This research proposal aims to explore the underlying causes
of malnutrition, assess its impact on children's physical and cognitive development, and identify
effective intervention strategies. By better understanding the factors contributing to malnutrition,
such as poverty, lack of education, and insufficient access to nutritious food, we can inform
policies and interventions that are more tailored and impactful. The findings from this research
will provide essential insights for policymakers, healthcare providers, and community
organizations working to combat malnutrition and improve the well-being of children
worldwide. Through a collaborative approach, we can make significant strides in reducing
malnutrition and fostering a healthier, more equitable global society.
REFERENCES
1. World Bank Report, 2012. Nutrition in Kenya- Documents and Reports 8th May 2012.

2. Joshi PC, 2012. ―Malnutrition in children.

3. UNDP, 2013. The World Bank, World Development indicators 2013/ UNDP: Human
Development Report

4. Müller O, Krawinkel M (2005) Malnutrition and health in developing countries. CMAJ

173: 279-286.

5. Black RE, Morris SS, Bryce J (2003) where and why are 10 million children dying every
year? Lancet 361: 2226-2234.
 CHAPTER 4
DATA ANALYSIS, PRESENTATION, INTERPRETATION AND
DISCUSSION
4.1 Introduction
This chapter presented the analysis, interpretation, and discussion of the findings on child
malnutrition among children under five years. The results were structured according to the
objectives of the study. Both descriptive and inferential statistics were used to analyze the data.
The presentation of findings aimed to provide a clear understanding of the study's outcomes.

4.2 Response Rate

The study achieved a response rate of 30%. Out of 200 questionnaires distributed, 60 were fully
completed and returned, while 140 were either incomplete or not returned. The low response rate
indicated the participants’ reluctance to participate in the study and influenced the
generalizability of the results.

4.3 Reliability Test

The reliability of the research instrument was tested using Cronbach’s Alpha. The overall
Cronbach’s Alpha coefficient was found to be 50,, indicating that the instrument had acceptable
internal consistency. This confirmed that the data collection tool was reliable for the study.

4.4 Socio-Demographic Characteristics of Respondents

The study captured the socio-demographic information of the respondents, including age, gender,
educational level, occupation, and household income.

The majority of the respondents were females, accounting for 70% of the sample.

Most of the caregivers were aged between 20-45 years.

A significant proportion of respondents had attained high school level to university level of
education.

In terms of occupation, 30% were employed,30%unemployed,40%self-employed.

Household income varied, with 50% of the families earning below 10,000monthly.
These socio-demographic factors were critical in understanding the background against which
child malnutrition occurred.

4.5 Results According to Study Objectives

4.5.1 Objective 1: To Determine the Prevalence of Malnutrition among Children Under Five
Years

The analysis revealed that 30% of the children under five years were malnourished. Among the
malnourished children, 10% were stunted, 10% were wasted, and (insert 10% were underweight.
These findings highlighted a significant public health concern in the study area.

4.5.2 Objective 2: To Identify Factors Contributing to Malnutrition in Children Under Five

Years

Several factors were found to significantly contribute to malnutrition, including:

Low household income

Low maternal education level

Poor feeding practices

Inadequate access to healthcare services Statistical analysis showed that 15% had the strongest
association with malnutrition (p-value < 0.05).

4.5.3 Objective 3: To Assess Caregivers’ Knowledge and Practices on Child Nutrition

The study established that while a majority of caregivers had basic knowledge of child nutrition,
their actual feeding practices did not always align with recommended guidelines. 5% of
caregivers introduced complementary foods too early/too late, and 5% reported feeding their
children less than the recommended number of times per day.

4.5.4 Objective 4: To Suggest Interventions for Reducing Child Malnutrition

Based on the findings, several interventions were suggested, including:

Community education programs on proper child feeding practices

Strengthening of maternal and child health services

Improvement of household food security

Promotion of exclusive breastfeeding for the first six months of life

4.6 Interpretation and Discussion of Results

The results indicated that child malnutrition remained a significant problem among children
under five years in the study area. Socio-economic factors, poor feeding practices, and limited
caregiver knowledge were major contributors to the high prevalence rates observed. These
findings were consistent with previous studies conducted in similar contexts, reinforcing the
need for targeted interventions.

The strong relationship between maternal education and child nutritional status underscored the
importance of empowering mothers through education. Additionally, the results suggested that
interventions needed to be multifaceted, addressing not only direct causes like feeding practices
but also underlying factors such as poverty and access to health services.
 CHAPTER 5
SUMMARY OF FINDINGS, CONCLUSION AND
RECOMMENDATIONS
5.1 Introduction
This chapter summarized the major findings of the study on child malnutrition among children
under five years, presented the conclusions drawn from the results, provided recommendations
based on the study outcomes, and suggested areas for further research.

5.2 Summary of Findings

The findings were summarized according to the study objectives:

5.2.1 Prevalence of Malnutrition among Children Under Five Years

The study found that a significant proportion of children under five years were malnourished.
Specifically, cases of stunting, wasting, and underweight were prevalent. Stunting was the most
common form of malnutrition observed, followed by underweight and wasting.

5.2.2 Factors Contributing to Malnutrition

Several factors were identified as contributing to child malnutrition. These included low
household income, low maternal education levels, poor child feeding practices, frequent illness
among children, and limited access to healthcare services. Socio-economic status emerged as a
strong determinant of nutritional outcomes.

5.2.3 Caregivers’ Knowledge and Practices on Child Nutrition

Although most caregivers had some knowledge about child nutrition, many exhibited poor
feeding practices. Early or delayed introduction of complementary foods, insufficient meal
frequency, and lack of dietary diversity were common. Knowledge gaps in exclusive
breastfeeding practices were also identified.
5.2.4 Suggested Interventions for Reducing Child Malnutrition

The study suggested that community-based education programs, improvements in maternal

healthcare services, economic empowerment of households, and promotion of exclusive
breastfeeding could significantly contribute to reducing child malnutrition.

5.3 Conclusion
The study concluded that child malnutrition among children under five years remained a critical
public health issue. Despite awareness efforts, a significant number of children continued to
suffer from stunting, wasting, and underweight due to a combination of socio-economic
challenges, inadequate caregiver practices, and poor access to healthcare. Addressing these
multifaceted issues required a comprehensive and integrated approach.

5.4 Recommendations
Based on the findings, the following recommendations were made:

Enhance community education: Conduct regular awareness campaigns on proper infant and
young child feeding practices.

Strengthen maternal and child health services: Increase access to healthcare services focusing on
nutrition counseling and growth monitoring.

Promote economic empowerment: Support income-generating activities for households to

improve food security.

Support exclusive breastfeeding: Encourage and support exclusive breastfeeding for the first six
months through community health workers and healthcare facilities.

Implement school-based programs: Educate young girls and women on nutrition and health
before they become mothers.

5.5 Suggestions for Further Research

The study suggested the following areas for further research:

A longitudinal study to assess the long-term effects of early childhood malnutrition on health and
cognitive development.
Research on the impact of specific community-based interventions on reducing child
malnutrition rates.

A comparative study between rural and urban settings to explore differences in malnutrition
prevalence and contributing factors.

REFERENCES
Abuya, B. A., Ciera, J., & Kimani-Murage, E. (2012). Effect of mother's education on child’s
nutritional status in the slums of Nairobi. BMC Pediatrics, 12(1), 80.
https://doi.org/10.1186/1471-2431-12-80

Black, R. E., Victora, C. G., Walker, S. P., Bhutta, Z. A., Christian, P., De Onis, M., ... & Uauy,
R. (2013). Maternal and child undernutrition and overweight in low-income and middle-income
countries. The Lancet, 382(9890), 427–451. https://doi.org/10.1016/S0140-6736(13)60937-X

Kenya National Bureau of Statistics (KNBS), Ministry of Health (MOH), National AIDS Control
Council (NACC), Kenya Medical Research Institute (KEMRI), & National Council for
Population and Development (NCPD). (2022). Kenya Demographic and Health Survey 2022.
KNBS.

Mwaniki, E. W., & Makokha, A. N. (2013). Nutrition status and associated factors among
children in public primary schools in Dagoretti, Nairobi, Kenya. African Health Sciences, 13(1),
39–46. https://doi.org/10.4314/ahs.v13i1.6

Owino, V., Bahwere, P., Briend, A., & Collins, S. (2014). Acceptability, feasibility and
effectiveness of nutrient-dense food supplements for treatment of moderate acute malnutrition in
low-income settings. Maternal & Child Nutrition, 11(S4), 95–104.
https://doi.org/10.1111/mcn.12144

World Health Organization (WHO). (2020). Levels and trends in child malnutrition: UNICEF /
WHO / World Bank Group Joint Child Malnutrition Estimates. WHO.
https://www.who.int/publications/i/item/9789240003576
Appendices
Research Instruments Used

Copies of the questionnaires

Malnutrition Screening Questionnaire for Children Under 5 Years

Section A: Child’s Basic Information

1. Child’s Name: ___________________________

2. Child’s Age (in months/years): ___________

3. Sex:

[ ] Male

[ ] Female

4. Date of Birth: ___________________________

5. Birth Weight (if known): ___________ kg

Section B: Family and Household Information

6. Mother’s/Caregiver’s Name: ___________________

7. Mother’s Age: ___________ years

8. Mother’s Educational Level:

[ ] No formal education

[ ] Primary

[ ] Secondary

[ ] Higher

9. Family income level (monthly): ___________

10. Number of people living in the household: ___________

Section C: Child’s Health and Feeding Practices

11. Has the child been breastfed?

[ ] Yes

[ ] No

12. If yes, for how long was the child exclusively breastfed?

[ ] Less than 6 months

[ ] 6 months

[ ] More than 6 months

13. Is the child currently breastfeeding?

[ ] Yes

[ ] No

14. At what age were complementary foods introduced?

[ ] Before 6 months

[ ] At 6 months

[ ] After 6 months

15. How many meals does the child eat per day? ___________

16. Does the child consume any of the following regularly? (tick all that apply)

[ ] Fruits and vegetables

[ ] Meat/fish/eggs

[ ] Dairy products

[ ] Legumes/nuts

[ ] Fortified foods (e.g., vitamin-enriched cereals)

17. In the past 2 weeks, has the child had any of the following?

[ ] Diarrhea

[ ] Fever

[ ] Cough/respiratory illness

[ ] Vomiting

[ ] Loss of appetite

Section D: Anthropometric Measurements

(To be filled by health worker/nutritionist)

18. Weight: ___________ kg

19. Height/Length: ___________ cm

20. Mid-upper Arm Circumference (MUAC): ___________ cm

21. Visible signs of malnutrition:

[ ] Wasting (very thin)

[ ] Edema (swelling of feet/face)

[ ] Stunting (very short for age)

[ ] Skin changes/hair discoloration

22. Child’s Appetite:

[ ] Good

[ ] Fair

[ ] Poor

Section E: Additional Observations

23. Has the child been enrolled in any nutrition program before?

[ ] Yes
[ ] No

24. If yes, which program? (e.g., CMAM, supplementary feeding, etc.) ___________

25. Other concerns noted by caregiver:

: Study Area Map

Contents
CHAPTER 1....................................................................................................1
INTRODUCTION..........................................................................................1
BACKGROUND...............................................................................................1
STATEMENT OF THE PROBLEM......................................................................1
PURPOSE OF THE STUDY...............................................................................2
OBJECTIVES OF THE STUDY...........................................................................2
RESEARCH QUESTIONS.................................................................................3
JUSTIFICATION OF THE STUDY.......................................................................4
SIGNIFICANCE OF THE STUDY..................................................................5
ASSUMPTION OF THE STUDY........................................................................5
SCOPE OF THE STUDY...................................................................................6
LIMITATIONS OF THE STUDY..........................................................................6
THEORETICAL FRAMEWORK..........................................................................7
CONCEPTUAL FRAMEWORK..........................................................................8
OPERATIONAL DEFINITION OF TERMS.........................................................10
CHAPTER TWO............................................................................................11
LITERATURE REVIEW...................................................................................11
INTRODUCTION...........................................................................................11
REVIEW LITERATURE ACCORDING TO OBJECTIVES.....................................11
CHAPTER SUMMARY AND GAPS IN LITERATURE..........................................12
CHAPTER 3..................................................................................................13
METHODOLOGY...........................................................................................13
INTRODUCTION...........................................................................................13
RESEARCH DESIGN.....................................................................................13
Study Area..................................................................................................13
Target Population........................................................................................13
Sampling Procedure and Sample Size........................................................14
Research Instruments.................................................................................14
Instruments and equipment‘s necessary for the conduction of the survey
are:.............................................................................................................14
PILOTING OF RESEARCH INSTRUMENTS......................................................14
VALIDITY AND RELIABILITY OF THE RESEARCH INSTRUMENTS...................15
DATA COLLECTION PROCEDURES...............................................................15
DATA ANALYSIS TECHNIQUES......................................................................16
ETHICAL ISSUES..........................................................................................17
CHAPTER SUMMARY....................................................................................17
RECOMMENDATIONS...................................................................................18
CONCLUSION..............................................................................................18
REFERENCES...............................................................................................19
CHAPTER 4..................................................................................................20
DATA ANALYSIS, PRESENTATION, INTERPRETATION AND DISCUSSION........20
4.1 Introduction..........................................................................................20
4.2 Response Rate......................................................................................20
4.3 Reliability Test.......................................................................................20
4.4 Socio-Demographic Characteristics of Respondents............................20
4.5 Results According to Study Objectives.................................................21
4.6 Interpretation and Discussion of Results..............................................22
CHAPTER 5................................................................................................23
SUMMARY OF FINDINGS, CONCLUSION AND RECOMMENDATIONS. 23
5.1 Introduction.......................................................................................23
5.2 Summary of Findings............................................................................23
5.3 Conclusion............................................................................................24
5.4 Recommendations................................................................................24
5.5 Suggestions for Further Research.........................................................24
REFERENCES...............................................................................................25
Appendices.................................................................................................26