Assessment of Nutritional status for under five years old children live in Hamar Jajab IDPs,...
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Imam University
Faculty of Health science
Department of Nutrition
Title of the Thesis
Assessment of Nutritional status for under five
years old children live in Hamar Jajab IDPs
Supervisor Student
Dr: Omar Ahmed Ali Mr: Mohamed Abdinur
Academic year
2014-2015
Assessment of Nutritional status for Under five years old children live in Hamar Jajab IDPs Mogadishu, Somalia
Imam University Faculty of Health Science Department of Nutrition
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Work Declaration
I Mohamed Abdinur hereby declare that the work in this research is entirely my own
work, except where stated. Research was gathered using online data and printed texts and
all work referenced is included in a reference list. No help was wanted from an external
professional agency and there was no use of other students past work has not been
submitted as an exercise for assessment at this or any other University.
Signed:________________
Name: Mohamed Abdinur
Date: ____/_____/________
Assessment of Nutritional status for Under five years old children live in Hamar Jajab IDPs Mogadishu, Somalia
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Research Approval
This research was carried out under my close supervision as the university supervisor; I
therefore acknowledge it is authenticity and approved as the student's partial fulfillment
for the award of Bachelors degree in Nutrition at Imam University.
Signed: _________________
Name: Dr. Omar Ahmed Ali
Date: ____/_____/_______
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Thesis Committee Approval letter
We are Thesis Committee for Imam University; we hereby declare that this book titled
Assessment of Nutritional status for under five years old child live in Hamar Jajab
District is correct
Names: Signatures:
……………………………………………… ……………………………….
……………………………………………… ……………………………….
……………………………………………… ……………………………….
Dean Faculty of Health science
I Dean Faculty of health science, I hereby certify that Mohamed Abdinur Mohamed’s
book is accurate and conform to the law of the University of Thesis preparation
Name:…………………………………………………………………
Signature:……………………………… Date:……………………..
Assessment of Nutritional status for Under five years old children live in Hamar Jajab IDPs Mogadishu, Somalia
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Acknowledgment
Honor due to Allah who created the creation and much thanks to him for allowing me to
be one of his creations, and make this thesis possible to be completed in a time.
I would like to express my sincere gratitude and appreciation to my supervisor Dr. Omar
Ahmed Ali for his insights, guidance and encouragement during the trying times and all
Imam University Administration staff and Lecturers, also I would also like to express
thanks to my beloved mother (Addei Suleiman Moallim Hussein) and all my dear
brothers and sisters who gave me their support and precious advice and encouraged me to
complete my educational course until now.
In addition, I would like to acknowledge the help that I have received from my close
friends, Finally, I would like to express my relatives who were constantly supporting and
encouraging me to conclude my thesis.
Assessment of Nutritional status for Under five years old children live in Hamar Jajab IDPs Mogadishu, Somalia
Imam University Faculty of Health Science Department of Nutrition
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Abstract
In this study, I studied the Assessment of Nutritional status under five years old Children
in Hamar Jajab IDPs. The major objective of the study was to know nutritional status for
the Children IDPs who are the most Vulnerable and susceptible to became Malnourished
then others.
Using Simple random sampling technique, I selected 50 respondents from 200
Households live in IDP Camp in Hamar Jajab District Mogadishu-Somalia with the use
of questionnaire as instrument; Data was analyzed using descriptive statistics of mean
and frequency (percentage). Results: Number of screened children was 50, 4% ware
Severe Acute malnutrition (SAM), 14% were Moderate Acute Malnutrition (MAM) and
82% were Normal based on the findings, the researcher suggests that, make it sustainable
for current Nutrition programmes existing with inclusive development projects for the
IDPs such income generation activities to be self reliance.
The research also concludes that most of Mothers doesn’t well understand the necessary
need of child nutrition. So that in this study I recommended that this needs extra
researchers should launch researches on Nutritional Status as to check, intervene or
minimize the effects may result from malnutrition in community through mobilizing and
health education for community workers, and Make free from harmful.
Assessment of Nutritional status for Under five years old children live in Hamar Jajab IDPs Mogadishu, Somalia
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Table of contents
Contents Pages
Work Declaration……………………………………………………………………….....ii
Research Approval……………………………………………………………………….iii
Thesis committee Approval………………………………………………………………iv
Acknowledgment…………………...…………………………………………………….v
Abstract…………………………………………………………………………………...vi
Table of
Contents………………………………………………………………………...viiii
List of Tables…………………………………………………..………………………..,,xi
List of Figures……………………………………………………………………………xii
Appendixes……………………………………………………………………………...xiii
Abbreviations…………………………………………………………………................xiv
CHAPTER ONE
1.0 Introduction………………………………………………………………………1
1.1 Problem statement……………………………………………………………......3
1.2 Justification………………………………………………………………………3
1.3 Objectives of the study…………………………………………………………...4
1.4 Research questions……………………………………………………………….4
1.5 Scope of the study………………………………………………………………..4
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CHAPTER TWO
2.0 Literature review………………………………………………………………………5
2.1 Introduction……………………………………………………………………………5
2.1.1 Scientific definition……………………………………………………………….....5
2.2 Nutritional Status…………………………………………………………….………..6
2.3. Nutrition of under five years children………………………………………………...7
2.3.1 Macronutrients………………………………………………………………………7
2.3.2 Micronutrients…………………………………………………………………….....7
2.3.3 Water………………………………………………………………………………..8
2.4 Breastfeeding………………………………………………………………………….8
2.4.1 Breast-milk Composition……………………………………………………………9
2.4.2 Initiating breastfeeding………………………………………………………..…...10
2.4.3 Breastfeeding benefits……………………………………………………………...10
2.5 Definition of malnutrition……………………………………………………………10
2.5.1 Types of Malnutrition………………………………………………………….......10
2.5.2 Causes of malnutrition……………………………………………………………..10
2.6 Malnutrition of Under five years…………………………………………………….11
2.6.1 Under-nutrition………………………………………………………………….....13
2.7 Protein energy malnutrition………………………………………………………….13
2.7.1 Vitamins deficiencies………………………………………………………………13
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2.7.2. Vitamin A Deficiency……………………………………………………………..14
2.7.3 Vitamin B1 deficiency……………………………………………………………..14
2.7.4 Vitamin B2, B5 and B6 deficiencies……………………………………………….14
2.7.5 Vitamin C deficiency……………………………………………………………....14
2.7.6 Vitamin D deficiency……………………………………………………………....15
2.7.7 Zinc deficiency……………………………………………………………………..15
2.7.8 Iodine deficiency……………………………………………………………...……15
2.8 Risk factors increasing malnutrition…………………………………………………16
2.9 Sign and symptoms of Malnutrition…………………………………………………16
2.10 Measurement of malnutrition……………………………………………………….18
2.11 Treatment of malnutrition…………………………………………………………..20
2.11.1 Treatment of malnutrition at home……………………………………………….21
2.11.2 Treatment of malnutrition at the hospital…………………………………………21
2.11.3 Treatment of malnutrition for those who are unable to take food by mouth……..22
2.11.4 Treatment of malnutrition in pregnant women…………………………………...22
2.11.5 Treatment of malnutrition in children…………………………………………….23
2.12 Prevention of malnutrition………………………………………………………….23
CHAPTER THREE
3.0 Research methodology…………………………………………………….................25
3.1 Introduction…………………………………………………………………………..25
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3.2 Material & Methods………………………………………………………………….25
3.3 Ethical consideration…………………………………………………………………26
3.4 Study Area…………………………………………………………………………...26
3.5 Study design………………………………………………………………………….26
3.6 Methods of Data collection…………………………………………………………..26
3.7 Sampling Techniques………………………………………………………………...26
3.8 Sample Size…………………………………………………………………………..27
3.9 Data analysis and Interpretation method..…………………………………………...27
CHAPTER FOUR
4.0 Data analysis and interpretation……………………………………………………..28
4.1 Introduction…………………………………………………………………………..28
4.2 Socio-demographic Variables……………………………………………..................28
4.3 Usual Dietary intake and assess adequacy I summarized into……………………….37
4.4 Breastfeeding and Complementary feeding pattern of the mothers….........................45
4.5 Anthropometric index for children…………………………………………………..51
CHAPTER FIVE
5.0 Discussion, Conclusion and recommendations…………………………………........54
5.1 Discussion………………………………………………...……………………….....54
5.2 Conclusion …………………………………………………………………………..57
5.3 Recommendation ………………………...………………………………………….58
References………………………………………………………………………………..59
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List of tables
Tables Pages
Table 4.1 Gender of the children………………………………………………………...29
Table 4.2 Age of children in year………………………………………………………..30
Table 4.3 Age of Mother/respondent……………………………………………………31
Table 4.4 Level of Education of Mother………………………………………………...32
Table 4.5 Total number of Household member in the House………………………...…33
Table 4.6 Occupation of Household Head………………………………………………34
Table 4.7 Source of water of the Household…………………………………………….35
Table 4.8 Family income per month…………………………………………………….36
Table 4.9 Cereals grain and products……………………………………………………37
Table 4.10 Legumes and legume products………………………………….…………..38
Table 4.11 Nuts and Seeds………………………………………………….…………..39
Table 4.12 Vegetables and vegetable products……………………………….………...40
Table 4.13 Fruits……………………………………………………………….……….41
Table 4.14 Milk and Milk products…………………………………………….………42
Table 4.15 Meat Fish and Eggs product………………………………………….……..43
Table 4.16 Oils and Fats………………………………………………………….……..44
Table 4.17 Time initiating breastfeeding………………………………………….……45
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Table 4.18 Food or drink given to infants before breast Milk flow……………….……46
Table 4.19 Period after birth the baby was given other food/fluid apart from breast
milk………………………………………………………………………………………47
Table 4.20 Duration of breastfeeding…..………………………………………………..48
Table 4.21 Immunization status for children………………………………………...…..49
Table 4.22 Knowledge of Mother for Nutritional status on her children………..………50
Table 4.23 Age of a child in month…………………………………..………………….51
Table 4.24 Weight of child in Kg………………………………………….………….…51
Table 4.25 Weight of child in Kg………………………………………….………….…52
Table 4.26 MUAC of child in cm………………………………………………….…....52
List of figures
Figures Pages
Figure 4.1 Gender of child………………………………………………………………29
Figure 4.2 Age of children in year………………………………………………………30
Figure 4.3 Age of Mother/respondent…………………………………………………...31
Figure 4.4 Level of Education of Mother……………………………………………….32
Figure 4.5 Total number of Household member in the House…………………………..33
Figure4.6 Occupation of Household Head……………………………………………....34
Figure 4.7 Source of water of the Household………………………………………...…35
Figure 4.8 Family incomes per month…………………………………………………..36
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Figure 4.9 Cereals grain and products…………………………………………………..37
Figure 4.10 Legumes and legume products……………………………………………38
Figure 4.11 Nuts and Seeds…………………………………………………………….39
Figure 4.12 Vegetables and vegetable products………………………………………..40
Figure 4.13 Fruits………………………………………………………………………41
Figure 4.14 Milk and Milk products…………………………………………………...42
Figure 4.15 Meat Fish and Eggs product………………………………………………43
Figure 4.16 Oils and Fats………………………………………………………………44
Figure 4.17 Time initiating breastfeeding……………………………………………...45
Figure 4.18 Food or drink given to infants before breast Milk flow…………………..46
Figure 4.19 Period after birth the baby was given other food/fluid apart from breast
milk…..............................................................................................................................47
Figure 4.20 Duration of breastfeeding…………………………………………………48
Figure 4.21 Immunization status for children………………………………………….49
Figure 4.22 Knowledge of Mother for Nutritional status on her children……………..50
Figure 4.23 Results from Anthropometrics…………………………………………….53
Appendixes
Appendix A Survey Questionnaires……………………………………………………..61
Appendix B Timelines……………………………………………………………….…..65
Appendix C: Events……………………………………………..……………………….66
Appendix D: Budget………………………………………………………………….….67
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Abbreviations and acronyms
BMI Body Mass Index
FAO Food and Agricultural Organization of the United Nations
FSANU Food Security and Nutrition Analysis unit
HH Household
MOH Ministry of Health
MSF Medicine Sans Frontier
MUAC Mid-Upper Arm circumference
OTP Outpatient Therapeutic Programme
PEM Protein Energy Malnutrition
SC Stabilization center
SFP Supplementary Feeding Program
UNICEF United Nations Children's Fund
WFP World Food Programme
WHO World Health Organization
99 Missing value
Assessment of Nutritional status for Under five years old children live in Hamar Jajab IDPs Mogadishu, Somalia
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CHAPTER ONE
1.0 Introduction
Nutritional status is defined as the evident state of nutrition of an individual. A person is
said to have a good nutritional status if he shows no evidence of malnutrition, whether
open or latent. Nutrition is the aspect of science that interprets the relationship of food to
the functioning of living organisms. It includes the uptake of food, liberation of energy,
elimination of wastes and the biochemical synthesis that are essential for maintenance of
normal growth and development (Laditan, 1983).
The nutritional status of any person is his/her health as dictated by the quality of
nutrients consumed, and the body’s ability to utilize them for its metabolic needs.
Thus, being nutritionally vulnerable, under-5 children’s nutritional status is generally
accepted as an indicator of the nutritional status of any particular community. It has been
estimated that approximately one out of every three Under-5 children is chronically
malnourished and thereby subjected to a pattern of ill health and poor development in
early life with malnutrition being associated with more than half of all deaths of children
worldwide (UNICEF, 1998).
Early childhood starts from in-uterus to new birth and then through postnatal life. In
intrauterine life, the nutritional status of the unborn fetus depends largely on the adequacy
of the dietary intake of the mother and this determines the outcome of birth of the new
born. Postnatal life is a continuum in human development. Normal growth and
development depend largely upon the nutritional status of the new born which is in turn,
related directly to the nutrition of the mother and inherited characteristics and to the
dietary intake of the infant.
In early childhood, nutritional status is of paramount importance for a child’s later
physical, mental and social development.
Assessment of Nutritional status for Under five years old children live in Hamar Jajab IDPs Mogadishu, Somalia
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The inadequate or excessive intake of nutrients may result from disease factors that affect
digestion, absorption, transport, and utilization of nutrients (UNICEF, 1990).
Malabsorption of nutrients may result from genetic cum environmental conditions or
illness. The most critically vulnerable groups are the developing fetus, preschool
children, women before and during pregnancy, and lactating women. Malnutrition affects
all levels of development physically, mentally, socially, psychologically and
physiologically. It thus multiplies the effect of prevailing disease or mortality in children
and infants (UNICEF, 1998).
Anthropometric measurements, though difficult to apply to young children, are
commonly used to determine the prevalence of Protein-Energy-Malnutrition. They
provide the most valid indicator of a population’s nutritional status and the most reliable
indices for determining nutritional status, especially in rural African settlements. This
technique is usually preferred because it is non-invasive, relatively simple and can be
easily carried out and interpreted without requiring professional expertise. It deals with
techniques highly useful on wide spread field basis, and rests on well adopted
classification. It is the readily available method of assessing nutritional status. Through
proper assessment, it can be employed to determine how well or how poor a particular
group or individual feeds. (UNICEF, 1990).
Whatever knowledge gathered from such assessment will help the group or individual to
step up or lower food intake for better health.
In this study, a combination of anthropometry, dietary assessment and socioeconomic
status were used to determine the nutritional status of Under-5 children, since they have
been known to give fairly accurate results (Tanner and Whitehouse, 1962). The study was
therefore designed to establish and provide baseline information on the health and
nutritional status of the target group, by determining the impact of parental socio-
economic status on the growth, nutritional status and the future outlook of Under-5
children in the study location.
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1.1 Problem statement
The right to adequate food is recognized in several instruments under international law
(Amos, 2009). Despite this recognition, globally, half of the almost 10 million children
under the age of five who die annually do so from a combination of malnutrition and
easily preventable disease. The world Health Organization estimates that Approximately
150 million children younger than 5 years in developing countries are underweight and
an additional 200 million children are stunted (WHO, 2007).
In Somalia malnutrition under five children contributes major current health problems
(morbidity and mortality) in several ways. Under nutrition remains a devastating problem
in many developing countries affecting over 815 million people causing more than one –
half of children death. 10,11Although WHO, UNICEF and Somali’s National
breastfeeding policy recommended that infants be exclusively breastfed from birth to 6
months and continue breastfeeding to 24 months and beyond for optimal survival, growth
development unfortunately only 9.00% of infants under six months of age are exclusively
breastfed in Somalia( World Bank, 2006) . The poor breastfeeding and inadequate
complementary feeding explained the protein energy malnutrition level in children as
they grow older.
1.2 Justification
Food insecurity has become a growing humanitarian problem in most developing
countries due to population increase, rural-urban migration, widespread poverty and
increasing cost of food. (MSF-F, 2008). In Somalia number children under five years in
hospitals are increasing so that it’s crucial to assess nutritional status among children less
than five years.
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1.3 Objectives of the study
A) General Objectives
To assess the nutritional status for under five years old children in Hamar Jajab IDPs
B) Specific objectives are as follows:
• To assess the socio economic status of subjects parent in Hamar Jajab IDPs.
• To determine the anthropometric indices of under-five children in the study area.
• To determine the usual dietary intake of the subjects and assess the adequacy.
• To assess the knowledge and practice of mother regarding to infant feeding,
breastfeeding and immunization.
1.4 Research questions
1. What are socio economic statuses of subject’s parent in Hamar Jajab IDPs?
2. What is the anthropometric index of under-five children in the study area?
3. How the usual dietary intake of the subjects and assess the adequacy?
4. What are the knowledge and practice of mother regarding to infant feeding,
breastfeeding and immunization?
1.5 Scope of the study
This study looks for assessment of nutritional status for under five years old children in
Hamar Jajab IDPs in Mogadishu by used Anthropometric index such MUAC, Weight for
Height and started at November, 2014 ended February 2015. All the data collected from
the target population were analysis thought SPSS software.
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CHAPTER TWO
2.0 Literature review
2.1 Introduction
Malnutrition: The World Health Organization (WHO) says that malnutrition is the
largest contributor to child mortality globally, currently present in 45 percent of all cases.
Underweight births and inter-uterine growth restrictions are responsible for about 2.2
million child deaths annually in the world. Deficiencies in vitamin A or zinc cause 1
million deaths each year.
WHO adds that malnutrition during childhood usually results in worse health and lower
educational achievements during adulthood.
2.1.1 Scientific definition
Nutrition is the provision of adequate energy and nutrients time to the cells for them to
perform their physiological function (of growth, reproduction, defense, repair, etc).
(WHO, 1999).
Malnutrition exactly means “bad nutrition “and technically includes both over- and
under- nutrition. In the context of developing countries, under-nutrition is generally the
main issue of concern, though industrialization and changes in eating habits have
increased the prevalence of over-nutrition. within the context of World Food Programme
(WFP) programs and assessments, malnutrition refers to under-nutrition unless otherwise
specified. 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 and
resisting and recovering from disease.” 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
individuals can be shorter(reduced growth over a prolonged period of time) and/or
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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, vitamin A, and iodine. Others, also can occur during
acute or prolonged emergencies when populations are dependent on a limited, unvaried
food source.
According to the World Health Organization (WHO) malnutrition has three commonly
used comprehensive types named stunting, wasting and underweight measures by height
for age, weight for height and weight for age indexes respectively (WHO, 1995).
2.2. Nutritional Status
Nutritional status is defined as the evident state of nutrition of an individual.
A person is said to have a good nutritional status if he shows no evidence of malnutrition,
whether open or latent. Nutrition is the aspect of science that interprets the relationship of
food to the functioning of living organisms. It includes the uptake of food, liberation of
energy, elimination of wastes and the biochemical synthesis that are essential for
maintenance of normal growth and development (Laditan, 1983).
The nutritional status of any person is his/her health as dictated by the quality of
nutrients consumed, and the body’s ability to utilize them for its metabolic needs.
Thus, being nutritionally vulnerable, under-5 children’s nutritional status is generally
accepted as an indicator of the nutritional status of any particular community and it has
been estimated that approximately one out of every three Under-5 children is chronically
malnourished and thereby subjected to a pattern of ill health and poor development in
early life with malnutrition being associated with more than half of all deaths of children
worldwide.
Early childhood starts from in-utero to new birth and then through postnatal life. In
intrauterine life, the nutritional status of the unborn fetus depends largely on the adequacy
of the dietary intake of the mother and this determines the outcome of birth of the new
born. Postnatal life is a variety in human development. Normal growth and development
Assessment of Nutritional status for Under five years old children live in Hamar Jajab IDPs Mogadishu, Somalia
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depend largely upon the nutritional status of the new born which is in turn, related
directly to the nutrition of the mother and inherited characteristics and to the dietary
intake of the infant.
In early childhood, nutritional status is of paramount importance for a child’s later
physical, mental and social development.
The inadequate or excessive intake of nutrients may result from disease factors that affect
digestion, absorption, transport, and utilization of nutrients. The most critically
vulnerable groups are the developing fetus, preschool children, women before and during
pregnancy, and lactating women. Malnutrition affects all levels of development
physically, mentally, socially, psychologically and physiologically. It thus multiplies the
effect of prevailing disease or mortality in children and infants (UNICEF, 1998).
2.3. Nutrition of under five years children
People eat foods that contain the nutrients necessary for life. Nutrients may be divided
into categories:
2.3.1 Macronutrients
Protein, fat and carbohydrates are macronutrients that make up the bulk of a diet and
supply the body’s energy. In resource-poor populations, carbohydrates ( i.e. starches and
sugars) are often a large part of the diet (80%) and the main source of energy. Fats are
also important in cell formation. Proteins are required to build new tissue and derived
mostly from animal origin such as milk, meat and eggs, and from cereals and pulses.
Animal by-products contain essential amino acids that cannot be produced by the body
but must be eaten to promote growth and food health. (UNICEF, 2010)
2.3.2 Micronutrients
There are around forty different micronutrients that are essential for good health. Formal
functional point of view. Micronutrients can be divided into two classes: type I and type
II. Type I micronutrients, or functional nutrients, include nutrients that are required for
the hormonal, immunological, biochemical and other processes of the body. They include
Assessment of Nutritional status for Under five years old children live in Hamar Jajab IDPs Mogadishu, Somalia
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iodine, iron, vitamins A and C among others. Deficiencies in type I micronutrients do not
affect growth directly (i.e. the individual can have the normal growth with appropriate
weight and still be deficient in micronutrients) and thus a deficiency in type I
micronutrients cannot be identified by anthropometric measurements. Deficiencies in
type I micronutrients will cause major illness such as anaemia, scurvy and impaired
immunity.
Type II micronutrients, or growth nutrients, include magnesium, sulphur, nitrogen,
essential amino acids, phosphorus, zinc, potassium, sodium and chloride. They are
essential for growth and tissue repair. Type II micronutrients are required only in small
quantities by every cell and system, but the correct balance is essential for good health. A
deficiency in any of the type II micronutrients will lead to growth failure, measured by
stunting and /or wasting. replacement of all these nutrients, in the correct balance, is
essential for recovery from malnutrition and restoration from acute illness.
(UNICEF2010).
2.3.3 Water
Most of the body is water. Water is necessary for good nutrition as well as for
maintaining hydration. Only half of the body’s water is obtained through drinks, the rest
being absorbed from foods and produced by the body. Water often needs to accompany
in order to provide good dilution and absorption of nutrients. (UNICEF, 2010)
2.4 Breastfeeding
Breast milk is a valuable, readily available resource with extensive short- and long-term
benefits for both mother and infant. It is essential that health professionals understand the
benefits and management of breastfeeding and that this topic be included in their
education and training. Health professionals can thus insure the improved health and
development of almost all infants, children (Gartner Lm, Newton ER. 1998)
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2.4.1 Breast-milk Composition
Human milk is radically different from cow’s milk and even from prepared infant
formula, despite attempts to modify formulas to make them similar to breast-milk.
Breast-milk is extremely low in protein ( about 0.9g/100 mL) compared with raw cow’s
milk, which has nearly four times the concentration of protein. Infant formulas are diluted
to provide a low protein concentration that is comparable to human milk, but the protein
structure( which is more difficult for young infant to absorb) remains the same as that
cow’s milk. In some formulas, the ration of whey to casein is altered to make is
comparable to breast-milk in which they is dominant. Because breast-milk’s
concentration of protein is very low, infants need to breastfeed frequently. Human milk
proteins contain antibodies known as secretory IgA that are structured specifically to
resist digestion. The infant in breast-milk are very different from those infant formulas
and are absorbed better than those from animal or vegetable sources. Breast-milk also
contains hundreds of micronutrients, including free amino acids, essential fatty acids,
minerals, growth factors, cytokines, and other chemical agents that contribute to virtually
every aspect of infant growth and development, May of bioactive agents to enhance the
infant’s development.
Breast-milk composition varies during the course of breastfeeding colostrums, the initial
milk, is higher in protein and lower in fat and lactose concentrations than mature milk.
Throughout the course of lactation, secretory IgA concentration gradually declines,
allowing the infant’s own immune system to develop and lose its dependency on the
mother’s sources. Because the mother and infant share the same environment, the mother
develops and secretes specific antibodies to the viruses and bacteria to which the infant is
exposed. This response is rapid, requiring only a few days. These dynamic changes in the
composition of breast-milk show how well it adapts to meet the needs of the infant.
Furthermore, breast-milk contains everything that the healthy, full-term infant requires
for about the first 6 months of life, including water and most vitamins and minerals.
(Lawrence RA.1999).
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2.4.2 Initiating breastfeeding
Breastfeeding is established most successfully when it is begun during the first hour birth.
The infant and mother should remain together throughout the recovery and postpartum
period, with no interruptions in the “rooming-in” (American Academy of Pediatrics,
1997).
2.4.3 Breastfeeding benefits
Breastfeeding provides infants with significant protection against a variety of infectious
diseases, particularly in areas of the world with poor sanitation and contaminated water
and food supplies. Epidemiological studies in the United States and other developed
countries have shown that, compared with formula-fed infants, breastfed infants have
fewer and less severe bacterial and viral diseases, including meningitis, gastroenteritis,
otitis media, pneumonia, botism, urinary tract infections, (American Academy of
Pediatrics, 1997).
2.5 Definition of malnutrition
Malnutrition, dietary condition caused by a deficiency or excess of one or more essential
nutrients in the diet. Malnutrition is characterized by a wide array of health problems,
including extreme weight loss, stunted growth, weakened resistance to infection, and
impairment of intellect, Severe cases of malnutrition can lead to death (UNICEF,1998).
2.5.1 Types of Malnutrition
•Under nutrition: too little 1) Protein Energy Malnutrition (PEM) 2) Micronutrient
deficiencies.
•Over nutrition: too much 1) Obesity 2) Chronic diseases (diabetes, hypertension) (WHO
1999).
2.5 .2 Causes of malnutrition
In generally there are two main causes of malnutrition
A. Immediate causes of Malnutrition
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B. Underlying causes of malnutrition
Immediate causes of Malnutrition
Malnutrition, is defined as an imbalance between the supply of nutrients and the body’s
demand for growth, maintenance, and specific functions ( World Health Organization ,
WHO) in other words, adequate nutrition is indispensable for physical development and
maintenance, resistance to disease and capacity to work.
Malnutrition is the effect of an unbalanced diet and/ or disease ( e.g. tuberculosis, HIV)
inadequate food intake ( in quality or quantity) leads to increased sensitivity for
infections .
Infections often cause nutrient mal-absorption and reduced food intake such appetite,
nausea what can lead to malnutrition, (MSF,2006) P 2.
Underlying causes of malnutrition
At the household and community level, the UNICEF Framework of Underlying causes of
Malnutrition and mortality identifies three underlying factors that influence nutritional
status: Household food security, health and environment, and social and care
environment. These factors are interrelated and need to be assessed; interventions should
address insufficient access to food, poor water/sanitation, inadequate health services and
inadequate care for the vulnerable. In many developing countries long-term (chronic)
malnutrition is widespread - simply because people do not have enough food to eat,
(MSF, 2006) p 2.
2.6 Malnutrition of under five years
Is the consequence of much food insecurity, which stems from poor food quality and
quantity, severe repeated infections or combinations of all three. These conditions are
linked to the standard of living and whether basic needs can be met. A lack of knowledge
on the nutritional needs of children and the benefits of breastfeeding contributes to
childhood malnutrition. The extent of hunger has also been associated with low energy
intake, low micronutrient intake and poor income levels. This affects growth patterns
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negatively. Malnutrition can cause physical, cognitive and psychological impairment,
which over time causes permanent learning disabilities.
The global number of child deaths under the age of five, recorded in 2006 by UNICEF,
WHO, United Nations Population Division (UNPD) and United Nations 3 Statistics
Division (UNSD), was just below 10 million, which is a 60 percent decrease since the
1960s. During 2007, UNICEF recorded 9.2 million child deaths under the age of five,
globally. Child mortality and poverty are linked with one third of child deaths caused by
malnutrition. Globally, per region, 4.8 million child deaths were recorded in Sub-Saharan
Africa; 900 000 in East Asia and the Pacific; 3.1 million in South Asia; 400 000 thousand
in the Middle East and North Africa; and 300 000 in Latin America. According to the
United Nations Children’s Fund, 26 000 children die daily from preventable causes,
(UNICEF, 2007).
In South Africa, estimates of under-five mortality during 2005 ranged between 69 and 76
per thousand, approximately 60 000 per annum. Results from the National Food
Consumption Survey and Fortification Baseline concluded that children aged between
one and three years are most vulnerable to poor nutritional status. Malnutrition and lack
of access to clean water increase the risk of mortality. During 2000, child deaths caused
by malnutrition accounted for 12 percent of child deaths and unsafe water usage and
practices accounted for 9.3 percent.
Education of children may assist in reducing poverty. Globally, 101 million children of
primary school age are not attending school. Children are deprived of education because
of illness, being forced to care for siblings, or because they have been orphaned and
placed with caregivers who are unemployed and income is minimal. Over 140 million
children globally, between the ages of seven and 18, have never attended school.
Lack of proper education and illiteracy amongst caregivers, parents and children
contribute to the growing malnutrition epidemic. Children are not equipped to make
suitable food choices and are dependent on caregivers and parents to make choices. The
choices are, unfortunately, reflective of the poor income status. Although studies have
been done to assist in assessing nutritional status, very little has been done on nutrition
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education as a strategy to improve the quality of life and address malnutrition. The main
purpose of this study was to assess the nutritional status of primary school children within
a community and promote nutrition education with the aim of improving nutrition
knowledge and food choices, to encourage a better quality of life into adulthood (WHO
and UNICEF 2009).
2.6.1 Under-nutrition
Under-nutrition is a condition caused by a lack of food of good nutritional value
combined with interaction from infections. Micronutrient deficiency is caused by
poverty, food insecurity, lack of knowledge, and lack of distribution of adequate
resources.
Body mass index (BMI) for age, is used to classify the nutritional status of a child. BMI
is calculated by dividing the weight, in kilograms (kg), by the height squared in meters
(m) (UNICEF 1998).
2.7 Protein energy malnutrition
Protein energy malnutrition (PEM) is now regarded as a dangerous form of malnutrition
basically caused by a lack of energy and protein. Kwashiorkor is a form of malnutrition
caused by inadequate protein intake, while marasmus is caused by a lack of energy and
protein within the diet.
Estimated globally, 854 million people are undernourished, with 820 million of these
living in developing countries. Poverty is associated with malnutrition and the level of
PEM is also affected by political, economic, seasonal and climatic conditions, education
and sanitation levels, food production and prevalence of disease
PEM is associated with poor weight gain, slow linear growth and behavioral changes
such as irritability, anxiety and attention deficit (FAO 2004).
2.7.1 Vitamins deficiencies
The three most prevalent micronutrient deficiencies include Iodine Deficiency Disease
(IDD), Iron Deficiency Anaemia and Vitamin A Deficiency.
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According to the WHO, World Food Programme (WFP) and UNICEF (2007), an
estimated two billion people across the globe are deficient in key minerals and vitamins.
2.7.2 Vitamin A Deficiency
Vitamin A is fat-soluble vitamin derived from 2 sources: retinol ( from Animal products)
and carotenes ( from many vegetables). Vitamin A is required for the functioning of the
visual system, growth and development, maintenance of epithelial cellular integrity,
immune function, and reproduction. Vitamin A deficiency is associated with an increased
susceptibility to infections, ocular defects that may progress to blindness and other
problems such as retardation of growth and development.
2.7.3Vitamin B1 deficiency
Vitamin B1 (thiamine) is water-soluble Vitamin necessary for the metabolism of
carbohydrates, fat and alcohol. It is also necessary for the proper function of the central
and peripheral nervous system and the cardiac muscles. There is no body stock of
Vitamin B1. All excess is lost in urine. Thiamine deficiency results in beriberi and
usually occurs simultaneously with other Vitamin B deficiencies (MSF, 2006) p141.
2.7.4 Vitamin B2, B5 and B6 deficiencies
B-complex deficiencies incidence is under – estimated, since symptoms are non- specific
and may be masked by other deficiencies. These deficiencies are often found in
association with other B deficiencies. A population may develop signs when the diet is
composed of refined food (white bread, polished rice) ( MSF, 2006) p143.
2.7.5 Vitamin C deficiency
Vitamin C (ascorbic acid) is a water - soluble vitamin with minimal body tissue reserve
(excessive amounts are excreted in the urine). Vitamin C is essential for collagen
formation to maintain the integrity of cells, wound healing and growth, it is an important
anti-oxidant and helps the absorption of iron. Vitamin C deficiency results in scurvy.
Clinical cases are usually observed when the daily intake of vitamin C is below
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10mg/day. Scurvy can be fetal is untreated. Vitamin C is destroyed during cooking (MSF,
2006) p 144.
2.7.6 Vitamin D deficiency
Vitamin D � is a fat soluble vitamin formed in the skin by exposure to sunlight and
found in fish liver oils and egg yolks. Synthesis in the skin is normally the main source of
vitamin d ( after sunlight exposure, even of short periods: 10 to 15 min/day). Only 10%
are obtained from the dietary sources, Vitamin D is essential for the Absorption of
calcium and bone mineralization. It can be stored in the body. inadequate exposure to
sunlight and low dietary intake lead to Vitamin D deficiency, Vitamin D deficiency
results in disease of abnormal bone: rickets in children and osteomalacia in adults (MSF,
2006) p145.
2.7.7 Zinc deficiency
Zinc status affect mutable physiological and metabolic functions such as physical growth,
immune- competence, reproductive function, and neurobehavioral development, Zinc
plays a central role in the immune system ( cellular and humoral immunity), Zinc is
important cell replication and for wound healing.
Clinical features of severe zinc deficiency include: growth retardation, hair loss, diarrhea,
delayed, eye and skin lesion, loss of appetite, impaired taste sensation, increased
susceptibility to infections mediated, and behavior changes, (MSF, 2006) p141.
2.7.8 Iodine deficiency
Iodine is a mineral necessary for the population of thyroid hormones and for normal
thyroid function. In the fetus, iodine is necessary for the development of the nervous
system during the first trimester of pregnancy. Iodine is stored in the thyroid gland;
excess is released in the urine Cassava and cabbage inhibits iodine absorption, Iodine
deficiency results in goiter and cretinism (MSF, 2006) p139.
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2.8 Risk factors increasing malnutrition
Risk factors may increase malnutrition is one of the following Weakened immune system
HIV/AIDS, Diabetes , End-stage kidney disease, Certain cancers, Cancer treatment, such
as chemotherapy, chronic diseases, medical complications, limited access or availability
of food , inadequate household food security, inadequate social and care environment in
house and local community, (UNICEF 2010).
Poverty Currently 1.2 billion people live in absolute poverty. Seventy per cent of the
poor are located in rural areas. By 2020 the world population will increase by one-third to
7.5 billion people, with nearly 85% living in developing countries. The number of
absolute poor is not expected to decline sufficiently by 2010. Most possibly the majority
are those in South Asia and Sub-Saharan Africa (Nutrition Policy Paper # 16, Nov 1997).
2.9 Sign and symptoms of Malnutrition
Symptoms of malnutrition are easily distinguishable among both adults and children.
They may be outlined as follows.
A) Symptoms of malnutrition in children
Symptoms of malnutrition in children include:
• Growth failure. This may be manifested as failure to grow at a normal expected
rate in terms of weight, height or both.
• Irritability, sluggishness and excessive crying along with behavioral changes like
anxiety, attention deficit are common in children with malnutrition.
• The skin becomes dry and flaky and hair may turn dry, dull and straw like in
appearance. In addition, there may be hair loss as well.
• Muscle wasting and lack of strength in the muscles. Limbs may appear stick like.
• Swelling of the abdomen and legs. The abdomen is swollen because of lack of
strength of the muscles of the abdomen. This causes the contents of the abdomen
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to bulge out making the abdomen swollen. Legs are swollen due to edema. This is
caused due to lack of vital nutrients. These two symptoms are seen in children
with severe malnutrition.
• There are classically two types of protein energy malnutrition (PEM) in children.
These are Marasmus and Kwashorkor.
• In Marasmus there may be obvious weight loss with muscle wasting. There is
little or no fat beneath the skin. The skin folds are thin and the face appears
pinched like an old man or monkey. Hair is sparse or brittle.
• In Kwashirkor the child is between 1 and 2 with hair changing color to a listless
red, grey or blonde. Face appears round with swollen abdomen and legs. Skin is
dry and dark with splits or stretch marks like streaks where stretched.
• In nutritional dwarfism the patient appears stunted in growth.
B) Symptoms of malnutrition in adults
The most common symptom is a notable weight loss. For example, those who have lost
more than 10% of their body weight in the course of three months and are not dieting
could be malnourished.
This is usually measured using the body mass index or the BMI. This is calculated by the
weight in kilograms divided by the height in meters squared. A healthy BMI for adults
usually lies between 18.5 and 24.9. Those with a BMI between 17 and 18.5 could be
mildly malnourished, those with BMIs between 16 and 18 could be moderately
malnourished and those with a BMI less than 16 could be severely malnourished.
Other symptoms include:
• Weakness of muscles and fatigue. The muscles of the body appear to waste away
and may be left without adequate strength to carry out daily activities.
• Many people complain of tiredness all day and lack of energy. This may also be
due to anemia caused by malnutrition.
• Increased susceptibility to infections.
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• Delayed and prolonged healing of even small wounds and cuts.
• Irritability and dizziness.
• Skin and hair becomes dry. Skin may appear dry, and flaky and hair may turn dry,
lifeless, dull and appear like straw. Nails may appear brittle and break easily.
• Some patients suffer from persistent diarrhea or long term constipation.
• Menstruation may be irregular or stop completely in malnourished women.
• Depression is common in malnutrition. This could be both a cause as well as an
effect of malnutrition. (Medical.net).
2.10 Measurement of malnutrition
Classification of malnutrition
In emergency situations where acute forms of malnutrition are predominant, the weight –
for height index is the appropriate tool to quality acute malnutrition in the population (
along with the assessment of oedema and MUAC). Furthermore, these do not require the
determination of age what is often difficult in these situations, (MSF, 2006) p17.
Acute and chronic malnutrition
Acute malnutrition (Wasting) Chronic malnutrition (stunting in children)
Weight –for-height Height-for age
Weight-for-age weight-for age
Mid-upper arm circumference Body mass index
Body mass index
Two systems of classification are used when defining acute malnutrition in individuals or
in population :
• Individuals: Moderate acute or severe acute.
• Population: severe acute and global acute. Global acute malnutrition refers to the
total cases of moderate acute and severe acute malnutrition in a population.
The main anthropometric indices are used for children and adolescents W/H, bilateral
oedema and MUAC and for adults bilateral oedema, MUAC and BMI.
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Weight –for-height
W/H does not require any specification of age; it is therefore a useful tool in crisis
situations, where age is often difficult to obtain. W/H can identify minor deterioration or
improvement in nutritional status of individual children, (MSF, 2006) p 18.
Height-for-age
H/A is an index of chronic malnutrition, when nutrition is inadequate for a long period of
time, children grow slowly. The height is reduced, compared to other children of the
same age. This is called “stunting”. H/A reflects an individual’s nutritional status over
time. H/A should not be used as a criterion for the admission of children into feeding
programmes.
Weight-for-age
W/A can be used to identify both chronic malnutrition (stunting) and acute malnutrition
(wasting). W/A is used to minor the individual growth of children; this is generally done
using” the Road to Health Chart” in clinics.
Since W/A does not differentiate between acute and chronic malnutrition, is should not
be used as a criterion for the admission of children into feeding programmes aiming at
actually malnourished children, (MSF, 2006) p 20.
Mid Upper Arm Circumference (MUAC)
MUAC is particularly sensitive to acute weight loss, as it reflects the peripheral wasting
of muscle and subcutaneous adipose tissue. MUAC findings provide a rapid indication of
the risk mortality.
Persons with MUAC below 110mm are at risk of death (only valid for older than 1 year).
MUAC remains relatively stable between the ages 1 and 60 month, so that only one cut
off point can be used. Agencies use different cut off values, the most commonly used cut
off points are given below.
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MUAC cut-off points for children 1-5year
Acute malnutrition MUAC
Severe <110mm
Moderate ≥110-125mm
Global <125mm
At risk of malnutrition ≥125-135mm
Body Mass Index (BMI)
BMI expresses the bodyweight of an individual in relation to his/her height. BMI is used
for adolescents and adults, and varies according to genotype (ethnicity), gender and age.
Since there is a considerable inter- and ultra-population variation, there is no universal
standard reference for BMI. Therefore, it is necessary to verify whether proposal cut-off
points correspond to the clinical state of adult populations, including history of acute
malnutrition or chronic disease. BMI is not used in pregnant women, as their weight
changes throughout pregnancy and therefore the BMI the BMI does not reflect the
nutritional status of the women.
Body mass index = .
Example: an adult of 1.60 m weighting 40 kg has a BMI of 40/(1.60x1.60) = 15.6kg/m2.
(MSF 2006) p 19/20.
2.11 Treatment of malnutrition
Malnutrition is caused by lack of essential nutrients in diet. Treatment depends on several
factors. These include the severity of malnutrition; the underlying cause of the
malnutrition; ability to feed oneself; and ability to eat and digest food normally. In
addition age, mental status and place of living of the patient is also considered.
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These factors determine the plan of therapy as well as where the patient is treated – at
home or under supervision of a nutritional expert or a dietician or other health
professionals or at the hospital.
2.11.1 Treatment of malnutrition at home
This is suitable for patients who are able to eat and digest food normally. Treatment at
home involves:
• The diet planner and advisor discuss the diet with the patient and makes
recommendations and diet plans to improve nutrient intake.
• In most patients with malnutrition the intake of protein, carbohydrates, water,
minerals and vitamins need to be gradually increased.
• Supplements of vitamins and minerals are often advised.
• Those with protein energy malnutrition may need to take protein bars or
supplements for correction of the deficiency.
• The Body Mass Index is regularly monitored to check for improvement or
responsiveness to dietary interventions.
• Occupational therapists and a team of physicians of different specialties may be
necessary for people with disability who cannot cook or shop for themselves or
those who have mental disorders, dementia or long term illnesses.
• Those who have difficulty in swallowing, chewing or eating may need to be given
very soft or food easy for eating.
2.11.2 Treatment of malnutrition at the hospital
The team of physicians and health care providers who manage malnutrition patients
includes a gastroenterologist who specializes in treating digestive conditions, a dietician,
a nutrition nurse, a psychologist and a social worker.
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Nasogastric tube feeding and intravenous infusion or parenteral nutrition may be done in
the hospital for moderate to severely malnourished patients who are unable to take food
via the mouth.
2.11.3 Treatment of malnutrition for those who are unable to take food by mouth
Some patients are completely unable to take food by mouth. These patients may be
treated by feeding with artificial tubs that are inserted via the nose into the stomach. This
is called the nasogastric tube and special nutrient preparations in liquid form are given via
these tubes. Nasogastric tubes are designed for short-term use and may be used for up to
six weeks.
In some patients a tube may be surgically implanted directly into the stomach. It opens
outside over the abdomen. This is called a percutaneous endoscopic gastrostomy, or PEG,
tube. Nutrients in the form of liquids may be given via PEG tubes. This is useful in
patients with esophageal cancers or other pathologies that make feeding via the mouth
and esophagus difficult. These last for around two years and may be replaced thereafter.
Some individuals may need to be given nutrients in the form of injections via infusion
directly into the veins of the arms. This is known as parenteral nutrition. This can be done
at home under supervision but more often than not, hospital admission may be needed.
2.11.4 Treatment of malnutrition in pregnant women
Pregnant women require more calories and nutrients than non pregnant women as their
fetus grows. This requirement, however, does not translate into “eating for two” as this
may lead to excess calorie intake leading to maternal obesity but malnutrition alongside
as the vital nutrients may be lacking in diet. Iron, folic acid and other vitamins and
minerals need to be supplemented in women who are pregnant with or without
malnutrition as these are often required in higher amounts that normal diet can provide.
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2.11.5 Treatment of malnutrition in children
During growth years the requirement of nutrients usually is high and such demands need
to be met adequately. Regular visits to the pediatrician for assessment of adequate growth
in height and weight is essential. Malnutrition causes more problems in children than any
other age group as they may lead to growth (both physical and mental) retardation and
susceptibility to repeated infections. Children with Protein energy malnutrition (PEM)
need to be identified. This includes children with Marasmus and Kwashiorkor. These
children require aggressive therapy.
Children with long term diseases need therapy for malnutrition. This includes additional
nutrients, vitamins and mineral supplements etc. The underlying disease also needs to be
treated adequately to prevent malnutrition. Children with severe malnutrition need
therapy in the hospital. This includes parenteral nutrition and slow introduction of
nutrients by mouth. Once their condition stabilises then they can gradually be introduced
to a normal diet (Online news Medical Health).
2.12 Prevention of malnutrition
Malnutrition is a preventable and treatable cause of childhood morbidity and mortality. In
Bangladesh, about 47.5% of children under 5 years of age are moderately to severely
undernourished (NIPORT, 2004).
Although inadequate food intake as a result of household food insecurity is one of the
important contributors to child malnutrition, the UNICEF conceptual framework also
recognizes disease and poor caring practices as equally important causes of malnutrition
[UNICEF, 1990].
Caregivers might not make the best use of available resources because of lack of
knowledge of optimal feeding behaviors and inappropriate cultural beliefs and practices
regarding feeding [Allen LH, Gillespie SR]
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Growth faltering among children aged 6 to 12 months is a global phenomenon, and this
period is the window of opportunity to reverse malnutrition among children [Moore AC,
Akhter S, 2006].
Interventions that provide counseling to caregivers on the initiation and continuation of
appropriate and adequate complementary feeding early in life, along with improved
hygiene and caring practices may effectively begin malnutrition [Health Popul Nutr
2005].
The present study aims to address an important public health question: whether and to
what extent a nutrition education program, especially one designed for parents of infants
aged 6 to 9 months, can prevent malnutrition in children from various community
settings, and if so, whether the impact of the intervention is sustained after its
discontinuation. A healthy balanced diet is recommended for prevention of malnutrition.
There are four major food groups that include:
1. Bread, rice, potatoes, and other starchy foods. This forms the largest portion of
the diet and provides calories for energy and carbohydrates that are converted to
sugars which provide energy.
2. Milk and dairy foods – Vital sources of fats and simple sugars like lactose as well
as minerals like Calcium.
3. Fruit and vegetables – Vital sources of vitamins and minerals as well as fiber and
roughage for better digestive health.
4. Meat, poultry, fish, eggs, beans and other non-dairy sources of protein – These
form the building blocks of the body and help in numerous body and enzyme
functions (Online news Medical Health).
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CHAPTER THREE
3.0 Research methodology
3.1 Introduction
The research consist of the following sections: research Materials and methods, research
Ethical consideration, Study area, research design, data gathering procedure Sampling
technique and data analysis.
Methodology illustrates the choices undertaken in the process of carrying out an inquiry.
Silverman (2005) defined methodology as, “choices we make about the cases to study,
methods of data gathering and other forms of data analysis, etc., in planning and
executing a research study.
3.2 Material & Methods
This study was conducted at Hamar Jajab IDPs in Mogadishu. Children Under five years
living in Hamar Jajab IDPs randomly was selected, each child for the study was
underwent different anthropometric measurement such as Weight, Height and mid-arm
circumference by Bangle test.
Mid Upper Arm Circumference (MUAC): Normal MUAC for a child between 1-5 years
of age is greater than 13.5 cm. If the MUAC is 12.5-13.5, the child has mild to moderate
malnutrition and if it is less than 12.5 cm it is suggestive of severe malnutrition. This is
useful for screening a large number of children but less useful in long term growth
monitoring. The techniques to measure mid arm circumference include accurate
measurement with a tape and a simple bangle test. Bangle test using plastic bangles of an
inner diameter of 3.7 cm (Red Bangle) and 4 cm (Yellow bangle) the bangle was passed
up the forearm and the upper arm to decide if the upper mid-arm circumference was
below or above 12.6 cm.
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3.3 Ethical consideration
The study was followed by the regulations outlined in the University’s ethical approval
process which identifies ethics procedure policies and principles. This means that ethics
approval was sought for all questionnaires.
3.4 Study Area
Hamar Jajab district is a district in the southeastern Banadir region of Somalia. Border
line with South: Indian Ocean, East: Hamar weyne, North: Waaberi and West: Wadajir.
Also a sector of the national capital Mogadishu, it contains the Port of Mogadishu.
3.5 Study design
This study was cross sectional study, and used for questionnaire design, which is
commonly in public health research. This choice is based on the fact that the researcher
seeks to answer with “5 W and H” the research strategy of this study will be used for
qualitative and quantitative approach to accomplish the objectives of the study because it
is easy to determine its trustiness and accuracy of the objectivity of quantitative studies.
3.6 Methods of Data collection
The data obtained from the questionnaires
For Appropriate analytical techniques were used depending on the variables or the
characteristics being considered. Descriptive and inferential statistical techniques were
used for quantitative data including socio-economic and demographic information,
anthropometry, food intake to generate frequencies and percentages using statistical
package for social sciences (SPSS) Version 16.0.
3.7 Sampling Techniques
The sampling techniques was used in this study is a probability sampling procedure
particularly Simple random sample were used to select the sample.
This study was conducted through simple random sample. Population of 200 HH living in
Hamar Jajab IDPs was conducted Nutritional Status Survey. To get 50 Children from the
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above HH, interval number four were used as to get chance for every Under five year old
child live this IDP and used systematically up to end.
3.8 Sample Size
Sample size required to carry out using the Assessment of nutritional status on children in
Somali. The sample size was driven from the probability of Simple Ransom sample
calculation as follows:
My study population was 200 Households. Selected from 50 through simple random, the
interval number was 4
The sample was (50) respondent out of the study population to obtain. In this study the
sample of the study was reached through the Simple random sample technique.
3.9 Data analysis and Interpretation method
Although data analysis has multiple approaches, in this study, Statistical Package for the
Social Sciences software (SPSS) was used for test of hypothesis and Graphics were
engaged for interpreting data collection by the questionnaire.
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CHAPTER FOUR
4.0 Data analysis and interpretation
4.1 Introduction
This chapter presents the findings, analysis and interpretation of the study and it is mainly
highlight the Socio-demographic data, Dietary intake assess and adequacy, Breastfeeding
and complementary feeding pattern of the mother and Anthropometric index for children
then findings for the study to be presented, interpretation, also analysis the results of all
above variables from this study.
4.2 Socio-demographic Variables
The socio-demographic data which have been taken includes:
1) Gender for the children, 2) Age of child 3) Age of Mother 4) Educational
status of the Mother 5)Total Number of Household members 6)
occupational level of Household head7) Source of water of Household and 8)
family income per month.
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Table 4.1 Gender of the children
Gender of child
Frequency Percent Cumulative Percent
Boys 32 64% 64
Girls 18 36% 100
Valid
Total 50 100% 100
Source: Primary data
Figure 4.1 Respondents by Gender of the children
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Table 4.2 Age of children in year
Age of Children in Year
Frequency Percent Cumulative Percent
0 to 1 year 10 20% 20
1 to 2 Year 22 44% 64
3 to 4 Year 11 22% 86
4 to 5 Year 7 14% 100
Valid
Total 50 100% 100
Source: Primary data
Figure 4.2 Respondents by Age of the children in year
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Table 4.3 Age of Mother/respondent
Age of mother
Frequency Percent Cumulative Percent
15 to 30 Year 37 74% 74
31 to 40 Year 10 20% 94
41 and Above 3 6% 100
Valid
Total 50 100% 100
Source: Primary data
Figure 4.3 Age of mother/ respondents
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Table 4.4 Level of Education of Mother
Level of education of mother
Frequency Percent Cumulative Percent
No formal education 41 82% 82
Primary Education 7 14% 96
Secondary Education 2 4% 100
Valid
Total 50 100% 100
Source: primary data
Figure 4.4 Respondents by Educational level of the mother
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Table 4.5 Total number of Household member in the House
Total number of HH member live in the House
Frequency Percent Cumulative Percent
1 to 4 21 42% 42
5 to 8 16 32% 74
9 to 13 8 16% 90
13 and above 4 8% 98
Missing 1 2% 100
Valid
Total 50 100% 100
Source: Primary data
Figure 4.5 Total HH members in the House
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Table 4.6 Occupation of Household Head
Occupation Level of HH Head
Frequency Percent Cumulative Percent
Self Employee 10 20% 20
Unemployed looking for work 21 42% 62
Retired 4 8% 70
Worker 11 22% 92
Student 3 6% 98
Missing 1 2% 100
Valid
Total 50 100% 100
Source: Primary data
Figure 4.6 respondents by Occupation of the HH head
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Table 4.7 Source of water of the Household
Source of Water of HH
Frequency Percent Cumulative Percent
Pipe Water 32 64% 64
Filtered Water 6 12% 76
Borehole 8 16% 92
Well 1 2% 94
Missing 3 6% 100
Valid
Total 50 100% 100
Source: Primary data
Figure 4.7 respondents by source of water of the HH
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Table 4.8 Family incomes per month
Family incomes per month
Frequency Percent Cumulative Percent
$0-50 3 6% 6
$51-100 27 54% 60
$101-150 7 14% 74
$151-200 5 10% 84
$201-250 4 8% 92
$251-300 4 8% 100
Valid
Total 50 100% 100
Source: primary data
Figure 4.8 Family incomes per month
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4.3 Usual Dietary intake and assess adequacy I summarized into:
1) Cereals grain and products 2) Legumes and legume products 3) Nuts and Seeds 4)
Vegetables and vegetable products 5) Fruits 6) Milk and Milk products 7) Meat Fish and
Eggs product and 8) Oils and Fats.
Table 4.9 Cereals grain and products
Cereals grain and products
Frequency Percent Cumulative Percent
Once a day 14 28% 28
Twice a day 31 62% 90
Three times a day 3 6% 96
Above 4 times a day 1 2% 98
Missing 1 2% 100
Valid
Total 50 100% 100
Source: Primary data
Figure 4.9 Cereal grains and products
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Table 4.10 Legumes and legume products
Legumes and legume products
Frequency Percent Cumulative Percent
Once a day 8 16% 16
Twice a day 29 58% 74
Three times a day 3 6% 80
Above 4 times a day 1 2% 82
None 9 18% 100
Valid
Total 50 100% 100
Source: Primary data
Figure 4.10 Legumes and legume products
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Table 4.11 Nuts and Seeds
Nuts and Seeds
Frequency Percent Cumulative Percent
Once a day 10 20% 20
Twice a day 20 40% 60
Three times a day 5 10% 70
Above 4 times a day 2 4% 74
None 13 26% 100
Valid
Total 50 100% 100
Source: Primary data
Figure 4.11 Nuts and Seeds
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Table 4.12 Vegetables and vegetable products
Vegetable and vegetable products
Frequency Percent Cumulative Percent
Once a day 23 46% 46
Twice a day 15 30% 76
Three times a day 5 10% 86
Above 4 times a day 2 4% 90
None 5 10% 100
Valid
Total 50 100% 100
Source: Primary data
Figure 4.12 Vegetables and vegetable products
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Table 4.13 Fruits
Fruits
Frequency Percent Cumulative Percent
Once a day 14 28% 28
Twice a day 11 22% 50
Three times a day 8 16% 66
Above 4 times a day 3 6% 72
None 14 28% 100
Valid
Total 50 100% 100
Source: Primary data
Figure 4.13 Fruits
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Figure 4.14 Milk and Milk products
Table 4.14 Milk and Milk products
Milk and Milk products
Frequency Percent Cumulative Percent
Once a day 7 14% 14
Twice a day 35 70% 84
Three times a day 4 8% 92
None 4 8% 100
Valid
Total 50 100% 100
Source: Primary data
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Figure 4.15 Meat Fish and Eggs product
Table 4.15 Meat Fish and Eggs product
Meat Fish and Eggs product
Frequency Percent Cumulative Percent
Once a day 9 18% 18
Twice a day 28 56% 74
Three times a day 2 4% 78
None 10 20% 98
99 1 2% 100
Valid
Total 50 100% 100
Source: Primary data
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Table 4.16 Oils and Fats
Oils and Fats
Frequency Percent Cumulative Percent
Once a day 12 24% 24
Twice a day 35 70% 94
Above 4 times a day 2 4% 98
Missing 1 2% 100
Valid
Total 50 100% 100
Source: Primary data
Figure 4.16 Oils and Fats
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4.4 Breastfeeding and Complementary feeding pattern of the mothers.
In this Part I concentrated on the following variables
1) Time initiating breastfeeding 2) Food or drink given to infants before breast Milk flow
3) Period after birth the baby was given other food/fluid apart from breast milk
4) Duration of breastfeeding 5) Immunization status for children 6) Knowledge of Mother
for Nutritional status on her children.
Figure 4.17 Time initiating breastfeeding
Table 4.17 Time initiating breastfeeding
Time initiating Breastfeeding
Frequency Percent Cumulative Percent
30 or Less 38 76.0 76.0
Between 30 and 1 hr 7 14.0 90.0
More than 1 hr 4 8.0 98.0
Missing 1 2.0 100.0
Valid
Total 50 100.0
Source: Primary data
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Table 4.18 Food or drink given to infants before breast Milk flow
Food or drink given infant Before breast milk Flow
Frequency Percent Cumulative Percent
Water alone 31 62% 62
Sugar water 5 10% 72
Tea or Herbal water 2 4% 76
Infant formula 8 16% 92
Other milk 2 4% 96
None 1 2% 98
Missing 1 2% 100
Valid
Total 50 100% 100
Source: Primary data
Figure 4.18 Food or drink given to infants before breast Milk flow
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Table 4.19 Period after birth the baby was given other food/fluid apart from breast milk
Period after birth the baby was given other food/fluid apart from breast milk
Frequency Percent Cumulative Percent
1-30 days 17 34% 34
1-2 month 6 12% 46
3-4 month 14 28% 74
5-6 month 11 22% 96
Above 6 months 2 4% 100
Valid
Total 50 100% 100
Source: Primary data
Figure 4.19 Periods after birth the baby was given other food/fluid apart from breast milk
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Table 4.20 Duration of breastfeeding
Duration of Breastfeeding of the mother
Frequency Percent Cumulative Percent
0-6 months 13 26% 26
6-9 months 16 32% 58
9-11 months 13 26% 84
11-14 months 4 8% 92
14-24 months 4 8% 100
Valid
Total 50 100% 100
Source: Primary data
Figure 4.20 Duration of breastfeeding
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Table 4.21 Immunization status for children
Immunization status for children
Frequency Percent Cumulative Percent
Complete immunized 4 8% 8
Partially immunized 44 88% 96
Never 2 4% 100
Valid
Total 50 100% 100
Source: Primary data
Figure 4.21 Immunization statuses for children
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Table 4.22 Knowledge of Mother for Nutritional status on her children
Knowledge of mother for nutritional status on her child
Frequency Percent Cumulative Percent
Well Understand 18 36% 36
Not Understand 31 62% 98
Missing 1 2% 100
Valid
Total 50 100% 100
Source: Primary data
Figure 4.22 Knowledge of Mother for Nutritional status on her children
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4.5 Anthropometric index for children.
this is the back bone of my study, because of the most important tool that can be identify
the Child weather Malnourished or not is the Anthropometric measurement, as to apply
those measurement I pick up the following three main important tools: 1) Age of a child
in month 2) Weight of child in Kg 3) Height of child in cm and finally Mid Upper Arm
Circumference (MUAC).
Table 4.23 Age of a child in month
Age of a child in month
Frequency Percent Cumulative Percent
6-11.99 7 14% 14
12-23.99 19 38% 52
24-35.99 7 14% 66
36-47.99 10 20% 86
48-59.99 7 14% 100
Valid
Total 50 100% 100
Source: Primary data
Table 4.24 Weight of child in Kg
Weight of child in Kg
Frequency Percent Cumulative Percent
3.5-6.6 1 2% 2
6.7-9.8 20 40% 42
9.9-12.0 13 26% 68
12.1-15.2 11 22% 90
15.3-18.4 4 8% 98
>18.5 1 2% 100
Valid
Total 50 100% 100
Source: Primary data
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Table 4.25 Weight of child in Kg
Weight of child in Kg
Frequency Percent Cumulative Percent
3.5-6.6 1 2% 2
6.7-9.8 20 40% 42
9.9-12.0 13 26% 68
12.1-15.2 11 22% 90
15.3-18.4 4 8% 98
>18.5 1 2% 100
Valid
Total 50 100% 100
Source: Primary data
Table 4.26 MUAC of child in cm
MUAC of child in cm
Frequency Percent Cumulative Percent
<11.5 2 4% 4
11.6-12.4 7 14% 18
>12.4 41 82% 100
Valid
Total 50 100 100
Source: Primary data
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Overall results from Anthropometric Measurements shows as follows chart
Figure 4.23 Results from the research
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CHAPTER FIVE
5.0 Discussion, Conclusion and recommendations
5.1 Discussion
Malnutrition in early childhood is one of a serious dominated public health problem in
the developing countries.
There are an estimated 1.1 million internally displaced persons (IDPs) across Somalia of
which 635,000 live in the assessed (13) major settlements; ~60% of the assessed IDPs are
concentrated in Banadir/ Mogadishu, the Rates of acute malnutrition improved slightly or
remained stable since Gu 2013 – exception being Qardho IDPs and Berbera IDPs
(FSNAU 2013-14).
In my research shows that children in this research 82% of them had Normal 14% had
moderately acute malnutrition, 4% had Severely acute malnutrition see figure (4.23).
FSNAU(2013-2014) found that Global Acute Malnutrition (GAM, 12.0%) and median
Severe Acute Malnutrition (SAM, 1.9%) rates are lower, compared to six months ago
(14.9% and 2.6%, respectively) as well as one year ago (14.2% and 2.6%, respectively)
The finding of this study support FSNAU’s finding where Malnutrition rate was found to
be predominated form, among the 50 children included in the study 64% were males and
36% were females (table, 4.1).
This finding agrees with many other studies carried out in Somalia where it was found
that more males suffer from malnourished than females as their numbers in the
community are very.
In this study illiteracy was found to be high amongst the parents particularly mothers.
The result showed that the majority of the mothers respondents 82% were illiterate while
14% were Basic and 4% were Secondary see table (4.4).
Maternal education has been stressed as factor of great importance in etiology of
malnutrition. The same studied indicates that the prevalence of malnutrition varies
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according to education of mother being significantly lower among children of more
educated mothers (secondary or higher) than among children of mothers with no or
primary education this is probably because more education provides the knowledge of the
rules of hygiene, feeding and weaning practices and the interpretation of symptoms and
enhances timely action childhood illness (Kirkwood, 1991; Diame, 1990). The majority
of the mother’s respondents according to their occupation 42% were Unemployed/house
wife while 22% were worker, 20% were self employee, 8% were Retired6% were student
and 2% were not responding see (table 4.6).
Family income is one of the most important determinants of the standard of the living,
economic and social welfare. The study showed that the 74% were low income less than
150 dollar per month, while 26% were moderate income 150-300 dollar so there was
significant difference between the forms of Malnutrition and family income.
Once of the main factors determining the nutritional status is food intake which in turn
depends on the family purchasing power. Probably no other single factor has such a
major effect on all components of nutritional status as income.
The relative importance of income, compared to other factors in etiology of malnutrition
seems to vary from one country to another.
In Nigeria Morly (1969) found that insufficient money was the biggest single factor in the
etiology of malnutrition, he found that there is a correlation between low income and
growth retardation, on the other hand Behar (1966) found that poor diet given to children
in central America is not primarily economic or the result of limited availability of food
but it is due to ignorance of the child nutritional needs.
Many workers have emphasized the family size as an etiological factor in the etiology of
Malnutrition. Raw (1992) in India found that when family size reached five, the
proportion of severely malnourished children increased.
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In this study showed that the majority of the respondents according to the family size
42% were having 1-4 persons 32% were having 5-8 persons 16% were having 9-13
persons 2% were missing while 8% were more than 13 persons (table 4.5).
The majority of mother’s respondents according to the Duration of breastfeeding 42%
were breastfed their babies while 58% partially breastfed their babies. Bay waning is
meat complete stoppage of breast feeding culturally and according to Holly Koran most
of people used to prolong breastfeeding up to the second year. The study display the
weaning practice of mothers conducted where most of them 26% were starting weaning
to their children between (9-11), 8% were between (11-14), 8% were between (14-24)
while 32% were between (6-9), and 26% weaned less than 6 months, see (figure4.20).
The vaccination completed course is protect the diseases, the most of the mother’s
conducted them 8% were children completed their course of the immunization
/vaccination while 88%were partially Immunized, they was taking to vaccine because
they less than 9 months,4% were not updating to vaccination they were never taking to
vaccine. See figure (4.21).
Knowledge of mother in practice of nutritional status on her child is very important only
about 36% of mother’s have well understand , 62% were not understand while 2% not
responded.
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5.2 Conclusion
Somalia is a country with unacceptably high rates of acute malnutrition. One in nearly
eight children under 5 suffers from acute malnutrition at the time of the assessments. The
situation among IDPs is worse (about one in six).
51,000 children under 5 are suffering from severe acute malnutrition and are at higher
risk of death and disease, a slightly higher proportion (25 %) in Deyr 2013/4 compared to
20 % in Gu 2013 or 21% in Deyr 2012/13 (FSNAU 2013-14). Currently 203,000
children <5 yrs are estimated to be acutely malnourished (approximately the same
number as in Gu 2013). Sixty eight percent of these children are in South-central Somalia
(FSNAU 2013-14).
All types of malnutrition exist; Moderate acute malnutrition and sever acute malnutrition
has been n found. The study was showed a general tendency for early weaning. There is
no supplementary diet or special cooking for infant and young children. Income of the
most of the IDPs were found to be at low level and further reduced by rising market
prices. Infection comes as the main causes of malnutrition in many cases. Most of the
children admitted MCH were have diarrhea. IDPs from which mother’s came generally
lacking facilities for piped water supplies and suitable latrines. Female education which is
necessary for the assimilation of nutrition education stands at low percentage and in most
cases is the confirmed to illiteracy level. Improvement in nutrition cannot be achieved as
an isolated strategy it will depend on an all round socio-economic uplift of the
population. This will required the co-ordinate effort of all disciplines including
agriculture, education, community development, economic and health services.
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5.3 Recommendation
• Mother usually expert in breast feeding, health authorities especially ministry of
health have to continue this practice, and to prolong its duration as long as
possible.
• Mass immunization program to immunize all children against preventable
diseases.
• Program control malaria and diarrheal diseases.
• To give health education at all levels including school, University, health services
and community level.
• Provide training courses in health and nutrition education targeting to: Para-
medical staff and auxiliaries and the women welfare worker of the social
development department.
• Use in Growth charts for regular weighing of children at all health services
because it helps to detect early malnutrition as well as getting the educational
messages to the mothers.
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References
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of nutrition intervention. ACC/SCN Nutrition Policy Paper 2001;19:27
2. American Academy of Pediatrics, Work group on Breastfeeding. 1997.
Breastfeeding and the use of human milk (Policy statement no. Rep929)
3. FSNAU 2013-14 Post Deyr Seasonal Food Security and Nutrition Assessment in
Somalia)
4. Gartner Lm, Newton ER. 1998. Breastfeeding: Role of the obstetrician. ACOG
clinical Review 3:1-15
5. Gillespie S. Nutrition and poverty. Papers from the ACC/SCN 24th Session
Symposium Kathmandu March 1997, Geneva, ACC/ SCN Symposium Report.
Nutrition Policy Paper # 16, Nov 1997. Geneva: United Nations, 1997.
6. http://www.news-medical.net/health/Treatment-of-malnutrition.aspx and
www.savethechildren.org/.../Acute-Malnutrition-Summary-Sheet.pdf
7. Laditan, A.A., 1983. Nutrition and physical growth in children Nigeria. J. Nut.
Sci., 4: 5-10.
8. Lawrence RA.1999. Breastfeeding: a guide for medical Profession (5th ed.)
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10. Nutrition guidelines L016NUTG01E MEDECINS SANS FRONTIERS (MSF),
May 2006 2nd ed.
11. Pages 30-33 FAO. 2004. International Year of Rice fact sheets (available at
www.fao.org/rice2004/en/ factsheets.htm). http://www.news-
medical.net/health/Symptoms-of-malnutrition.aspx
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12. Somali guidelines for Management of Acute malnutrition United Nations
Children’s Fund (UNICEF, 2010)
13. The United Nations Children's Fund (UNICEF) presents this report on
malnutrition and its impact on children and families. 1998
14. UNICEF The state of the World’s children. Oxford University Press, Oxford
1998.
15. UNICEF. Strategy for improved nutrition of children and women in developing
countries. A UNICEF Policy Review. New York: UNICEF, 1990
16. United Nations System Standing Committee on Nutrition and the United Nations
Children’s Fund, 2007.
http://www.who.int/nutrition/topics/statement_commbased_malnutrition/en/
17. WHO et. Nutrition Essentials: A Guide for Health Managers, 1999 Robert
Mwadime (AED/LINKAGES), Training Materials from RQHCC 5-day ENA
course for Planners, Makerere University, Uganda
18. WHO. Physical Status: The Use and Interpretation of Anthropometry – Report of
a WHO Expert Committee. Technical Report Series 854. Geneva, World Health
Organization, 1995. http://whqlibdoc.who.int/trs/WHO_TRS_854.pdf
19. World bank, Nutritional report, 2006
20. World Health Organization and United Nations Children’s Fund, 2009.
http://www.who.int/nutrition/publications/severemalnutrition/9789241598163/en/
index.html
21. World Health Organization, Nutritional report, 2007
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Appendix A: Questionnaire on Assessment of Nutritional status of under five years old
Children in Hamar Jajab IDPs
Part I: Socio demographic characteristics:
Gender of child
1. Boy 2. Girl
Age of child
1. 0 -1 2. 1-2 3. 3-4 4. 4-5
Mother age
1. 15-30 2. 31-40 3. 41 above
Mother Educational status
1. No formal education 2. Primary education 3. Secondary
education 4. College 5. University
Total number of Household member
1. 1-4 2. 5-8 3. 9-13 4. 13 above
Primary occupation of household head
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1. Self employee 2.Unemployed – looking work 3.Retired
4. Worker 5. Student 6.Other: _________
Primary Source of water of household
1. Pipe water 2. Filtered water 3. Borehole 4. Well 5. Other:_______
Family income per month in (USD)
1. 0-50 2. 51-100 3. 101-150 4. 151-200 5. 201-250 6.251-300
7. 301-350 8. 351-400 9. 401-45 10. 451-500 11. 501 above
Part II: Usual Dietary intake and assess adequacy
Intake of mother within last 24 hours
Cereals, grain and products
1. Once a day 2. Twice a day 3. Three times a day 4.Above 4 times a day
Legumes and legume products
1. Once a day 2. Twice a day 3. Three times a day 4.Above 4 times a day 5.
None
Nuts and seeds
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1. Once a day 2. Twice a day 3. Three times a day 4. Above 4 times a day 5.
None
Vegetable and vegetable products
1. Once a day 2.Twice a day 3. Three times a day 4. Above 4 times a day 5.
None
Fruits
1. Once a day 2. Twice a day 3. Three times a day 4.Above 4 times a day 5.
None
Milk, milk products and beverages
1. Once a day 2.Twice a day 3. Three times a day 4.Above 4 times a day 5.
None
Meat, fish and eggs products
1. Once a day 2. Twice a day 3. Three times a day 4. Above 4 times a day
5. None
Meals
1. Once a day 2. Twice a day 3. Three times a day 4. Above 4 times a day
Oils and fats
1. Once a day 2. Twice a day 3. Three times a day 4. Above 4 times a day
5. None
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Part III: Breastfeeding and Complementary feeding pattern of the mothers
Time of initiating breastfeeding
1. 30 or less 2. Between 30 and 1 hr 3. More than 1 hr
Food or drink given to infants before breastmilk flow
1. Water alone 2. Sugar water 3. Tea or herbal water 4. Infant formula
5. Other milk 6. Other 7. None
Period after birth the baby was given other food/fluid apart from breast milk
1. 1-30 days 2. 1-2 month 3. 3-4 month 4. 5-6 month 5. Above 6 months
Duration of breastfeeding of the mothers
1. 0-6 month 2. 6-9 month 3. 9-11month 4. 11-14 month 5. 14-24 month
Immunization status for children
1. Complete immunized 2. Partially immunized 3. Never
Knowledge of mother for nutritional status on her child
1. Well understand 2. Not understand
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Part v : Anthropometric index for children
Age in month _____ Weight in kg______ Height in cm______
MUAC in cm _____
Appendix B: Timelines
Phases November, 2014 December,
2014
January, 2015 February,
2015
Weeks 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
Topic
Selection
X
Research
proposal
X X X
Literature
Review
X X X
Developed
Questionnaire
X X
Pilot
Survey
X
Revised
Questionnaire
X
Data
Collection
X
Assessment of Nutritional status for Under five years old children live in Hamar Jajab IDPs Mogadishu, Somalia
Imam University Faculty of Health Science Department of Nutrition
66
Data Entry
and analysis
X
Data Reading
and Review
X
Final
Draft
X X
Appendix C: Events
Date Activities
5 November 2014 Approved research topic
20 Nov, 2014 Submitted research Proposal
26 Nov,2014 Approved Research Proposal
30 Nov, 2014 Submitted Literature review or Chapter two
25 Dec,2014 Approved Literature review
30 Dec, 2014 Final Examination
1 Jan,2015 Rejected Research Methodology
6 Jan, 2015 Approved research Methodology
29 Jan, 2015 Approved Research Questionnaire
30 Jan - 8 Feb, 2015 Survey on data collection
Assessment of Nutritional status for Under five years old children live in Hamar Jajab IDPs Mogadishu, Somalia
Imam University Faculty of Health Science Department of Nutrition
67
21 Feb,2015 Submitted draft of thesis to the Supervisor
26 Feb, 2015 Submitted Final to the Imam University
15 June, 2015 Defended thesis book
Appendix D: Budget
Expenses Cost in (Dollars)
Travel cost (rent) $140.00
Phone and Internet charge $120.00
Refreshments $60.00
Stationary $70.00
Computer Software/printing/ ink cartridge $300.00
Miscellaneous $150.00
Total $840.00