The Prevalence and Factors Associated with Malnutrition Among Children Aged 6-59 Months Inbushenyi District

ABSTRACT Bushenyi has persistently registered highest levels of childhood malnutrition in the whole of Uganda despite being referred to as "the food basket" of the country. Malnutrition is a major public health problem of developmental concern with both health and socio-economic consequences. High prevalence is in developing countries which contribute up to 50% of the world's under-five mortality. This study determined the prevalence and factors associated with malnutrition among children aged 6-59 months in Bushenyi district. This was a community house survey that was carried out to collect information on nutritional status of children and associated risk factors in Bushenyi district. This was a cross-sectional study that used both qualitative and quantitative methods of data collection. Multistage random sampling and stratified sampling were used to select study areas and households with children 6-59 months, respectively. Stunting, wasting and underweight levels were determined using anthropometric measurements ofH/A,W/H and WIA respectively using the US NHCS Reference Standards, The study enrolled 274 study participants aged 6 -59 months identified by probability and non-probability sampling methods between July to December 2015. Data was analysed in SPSS using descriptive and linear regression analysis. Results showed that 150 out of the 274 studied children had malnutrition with prevalence of (54.7%), mild malnutrition was 104 (69.3%), moderate malnutrition was 35 (23.3%), severe malnutrition was 11 (7.3 %). Stunting levels were high amongst girls at 62% as compared to the 38% of the boys who were stunted. Malnutrition was associated with some factors like family size of more than three people, parental/care takers education level of non formal with the analysis showing that an increase in mother's education level decreased the rate of malnutrition among children. This study concluded that there is high prevalence of malnutrition in Bushenyi district with high rates of stunting and underweight among boys than girls. This study showed that factors associated with malnutrition in Bushenyi district include family size, level of education, weaning of children, the socio-economic status in families and behavioural factors. The study recommended community nutritional interventions to address the root causes of malnutrition within Bushenyi .Further research is therefore needed to confirm and/or obtain explanation regarding high prevalence of malnutrition.

TABLES OF CONTENTS

DECLARATION ................................................................................................................................... !

SUPERVISOR'S APPROVAL ........................................................................................................... !!

DEDICATION .................................................................................................................................... III

ACKNOWLEDGEMENTS ............................................................................................................... IV

TABLES OF CONTENTS .................................................................................................................. V

LIST OF TABLES .......................................................................................................................... VIII

LIST OF EQUATIONS ....................................................................................................................... X

ABBREVIATIONS ............................................................................................................................ XI

ABSTRACT ....................................................................................................................................... XII

CHAPTER 1: ......................................................................................................................................... 1

INTRODUCTION ................................................................................................................................. !

1.0 INTRODUCTION ........................................................................................................................... !

1.1 BACKGROUND TO THE STUDY ............................................................................................... 2

1.1.1 HISTORICAL BACKGROUND TO THE STUDY ................................................................. 2

1.1.2 THEORETICAL BACKGROUND ............................................................................................ 3

1.1.3 CONCEPTUAL BACKGROUND ..................................................................................................... .4

1.1.4 CONTEXTUAL BACKGROUND ...................................................................................................... 5

1.1.4.1 GLOBAL BURDEN ..................................................................................................................... 5

1.1.4.2 AFRICAN BURDEN .........................•.......................................................................................... 5

1.1.4.3 MALNUTRITION BURDEN IN UGANDA ..................................................................................... 6

1.2 STATEMENT OF THE PROBLEM ............................................................................................ 6

1.3 OBJECTIVES OF THE STUDY ........................................................................................................... 7

1.3.1 Broad objective ...................................................................................................................... 7

1.3.2 Specific objectives .................................................................................................................. 7

1.3.3 RESEARCH QUESTIONS .............................................................................................................. S

1.4 SCOPE OF THE STUDY .................................................................................................................... 8

1.4.1 CONTENT SCOPE ......................................................................................................................... 8

1.4.2 GEOGRAPHfCAL SCOPE ............................................................................................................... 8

1.5 JUSTIFfCAT!ON OF THE STUDY ....................................................................................................... 8

1.5.1 ACADEMIC JuSTIFICATION OF THE STUDY ................................................................................. 8

1.5.2 COMMUNITY JUSTIFICATION OF THE STUDY .............................................................................. 9

1.6 DESCRIPTION OF THE CONCEPTUAL FRAMEWORK ...................................................................... 1 0

CHAPTER 2: LITURA TURE REVIEW .......................................................................................... !!

2.0 INTRODUCTION ............................................................................................................................ II

2.1 NUTRITION ................................................................................................................................... II

2.2 PREY ALENCE OF MALNUTRITION ................................................................................................ 12

2.3 PATTERNS OF MALNUTRITION ..................................................................................................... 13

2.4 FACTORS ASSOCIATED WITH MALNUTRITION ............................................................................. I4

2.4.1 ENVJRONMENTALFACTORS ...................................................................................................... I4

2.4.2 BREAST FEEDING/WEANING PRACTICE .................................................................................... 15

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2_.j_] P Ill NTM/ CRE CiiVLR Ell I !CATION I.FYEL ............................... . . ................ 16

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~ iTR!T!()N WITt f C0-,RB!Dr! IES ................................... "······· ......... 17

CHAPTER 3: ......................... , ............................................................................................................. 18

STUDY M ETH 0 DO LOGY ............................................................................................................... 18

3.1 INTROIJli('TION ............................................................................................................................ 18

3.2 STIJIJY DESIGN ............................................................................................................................ 18

3.3 STUDY LOCATION ........................................................................................................................ 18

3.4 TARGET POPULATION .................................................................................................................. 18

3.5 STUDY SAMPLES .......................................................................................................................... I9

3.6 SAMPLING PROCEDURE ................................................................................................................ 19

3.6.1 STAGE I .................................................................................................................................... 19

3 .6.2 STAGE 2 .................................................................................................................................... I 9

3.6.3. STAGE 3 ................................................................................................................................... 19

3.6.4 STAGE 4 .................................................................................................................................... 19

3. 7 SAMPLE SIZE DETERMINATION .................................................................................................... 20

3.8 DATA COLLECTION METHODS ..................................................................................................... 20

3.9 DATA PROCESSING AND ANALYSIS .............................................................................................. 21

3.10 FIELD WORK ARRANGEMENT ..................................................................................................... 22

3 .I I QUALITY CONTROL. ................................................................................................................... 22

3.11.1 RELIABILITY ......................................................................................................................... 22

3. I I .2 VALIDITY .............................................................................................................................. 23

3.12 INCLUSION AND EXCLUSION CRITERIA ...................................................................................... 23

3.12.1 INCLUSION CRITERIA ............................................................................................................. 23

3 .12.2 EXCLUSION CRITERIA ........................................................................................................ 23

3.13 ETHICAL CONSIDERATION AND APPROVAL.. ............................................................................. 23

3.13.1 INSTITUTIONAL CONSENT: ..................................................................................................... 23

3.13 .2. PRIVACY AND CONFIDENTIALITY .......................................................................................... 24

3.13.3. INFORMED CONSENT ............................................................................................................. 24

3.13 .4. JUSTICE .................................................................................................................................. 24

3.13.5. RESPECT FOR HUMAN RIGHTS ............................................................................................... 24

3.13 .6 BENEFITS AND RJSKS .............................................................................................................. 25

3.14 LIMITATIONS AND DELIMJTATIONS ........................................................... ? ............................... 25

3.15 DISSEMINATION OF THE STUDY FINDINGS ............................................................................... 25

CHAPTER 4: ....................................................................................................................................... 26

RESULTS ............................................................................................................................................ 26

4.0 GENERAL INTRODUCTION ........................................................................................................... 26

4.1 GENERAL CHARACTERTSTICS OF THE STUDY ............................................................................... 26

4.1.0 DEMOGRAPHIC CHARACTERISTICS OF SURVEYED CHILDREN .................................................. 26

OBJECTIVE l: ..................................................................................................................................... 28

4.1.2 PREVALENCE OF MALNUTRITION ............................................................................................. 28

CHAPTER 5: ....................................................................................................................................... 35

DISCUSSIONS,CONCLUSIONS AND RECOMENDA TIONS .................................................... 35

5. 0 GENERAL lNTRODUCTIONS ......................................................................................................... 35

5.1 PREVALENCE OF UNDER-NUTRITION ........................................................................................... 35

5.2 PATTERNS OF MALNUTRITION ..................................................................................................... 35

5.3 FACTORS ASSOCIATED WITH SEVERE MALNUTRITION ................................................................ 38

5.4 co-morbidities in severe malnutrition ........................................................................................ 39

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5.5 CONCLLISION .............................................................................................................................. -1 I

5.6 RECOJVIMENDATIONS .............................................................................................................. -12

REFERENCES .................................................................................................................................... -12

APPENDICES ..................................................................................................................................... 46

APPENDIX 1: SELF-ADMINISTERED QUESTIONNAIRE (ENGLISII VERSION) .......................................... .46

APPENDIX II: INFORMED CONSENT FORM ........................................................................... .48

CONSENT FORM .............................................................................................................................. 48

APPENDIX Ill: LETTER OF INTRODUCTION .......................................................................... 50

APPENDIX IV: MAP OF BUSHENYI OISTRICT ......................................................................... SI

APPENDIX V: NUTRITION CLASSIFICATION CHART .......................................................... 52