CHAPTER ONE
INTRODUCTION
1.1
INTRODUCTION
A Child is precious to his parents, to
his family, community, and nation and to the world at large. In fact a child is
a citizen of the world and thus it becomes the responsibility of the population
of the whole universe to look after the interests of the children all
over. The young children needs love for
growth but also adequate nutrition and health facilities, so that he can grow
up to compete at his optimum level (Satya,
1983) They are regarded as the most vulnerable group in the society and
hence the need for them to be catered for.
Thus Protein-energy malnutrition (PEM)
is a global nutritional and public health issue that affect these vulnerable
children particularly in the developing country. PEM has a pattern and
prevalence that vary significantly not only among the different nations of the
world but also within the different regions of the same country (Ulasi &
Ebenebe, 2007). The incidence rate of PEM varies from country to country,
depending on the biological characteristics and socioeconomic status of the
population (Hamidu J. L et.al.,
2003).It has been recognised that PEM is not only a major public health problem
in the developing countries but that it also affects certain communities in the
developed countries mainly resulting from poor nutritional intake, bad hygiene
practices and frequent infections. It is an important indicator of health and
development of nations, therefore it is extremely important to contain it with
adequate preventive and curative measures.
According to the 2012 Nigeria
Standardized Monitoring and Assessment of Relief and Transitions (SMART)
survey, global acute malnutrition has a prevalence of between 6.4 and 13.1 per
cent and severe acute malnutrition between 0.7 and 2.2 per cent. United Nations
Children’s Fund (UNICEF) in 2007 estimated that 1.1million children are
threatened with severe acute malnutrition in the sub-Saharan Africa, which is
fuelled by poverty, insecurity and lack of access to clean water. Between
2000-2006 29 per cent of under-fives in Nigeria were estimated to be suffering
from underweight, moderate and severe PEM (UNICEF, 2007). In 2008, World Health
Organisation (WHO) child growth standards estimated the percentage of
underweight under-five children to be 23 per cent. In a study done by Odunayo
and Oyewole (2006) in Ifewara, a rural community in Osun state, Nigeria, the
prevalence of PEM using the modified Wellcome Classification was found to be
20.5 per cent whereas the prevalence of underweight using the World Health
Organization/National Centre for Health Statistics(WHO/NCHS) standards was 23.1
per cent. Recent data from the World Health Organization, had reported that about
60% of all deaths, occurring among children aged less than five years in
developing countries, could be attributed to malnutrition. It has been
estimated that nearly 50.6million under five children were malnourished and
almost 90% of these children were from developing countries (Faruque Ahmed, 2008).
The World Health Organization (WHO)
defines malnutrition as "the cellular imbalance between the supply of
nutrients and energy and the body's demand for them to ensure growth,
maintenance, and specific functions." The term protein-energy malnutrition
(PEM) applies to a group of related disorders that include marasmus, kwashiorkor, and intermediate states
of marasmus-kwashiorkor. The term marasmus is derived from the Greek word marasmos,
which means withering or wasting. Marasmus involves inadequate intake of
protein and calories and is characterized by emaciation. The term kwashiorkor
is taken from the Ga language of Ghana and means "the sickness of the
weaning." Cecily Williams, a British nurse first used the term in 1933,
and it refers to an inadequate protein intake with reasonable caloric (energy)
intake. Oedema is characteristic of kwashiorkor but is absent in marasmus (Scheinfeld,
2013).
There are various anthropometric
variables for classifying PEM. Acute malnutrition, for instance, is
measured by weight for height or bilateral oedema, while chronic malnutrition
is measured by height for age. The WHO recently defined Severe Acute
Malnutrition by a very low weight for height (below -3z scores of the median
WHO growth standards), visible severe wasting, or the presence of nutritional
oedema. Wasting (marasmus) and various forms of kwashiorkor are,
therefore, forms of Severe Acute Malnutrition. One of the oldest
classifications of PEM (Wellcome Working Group) used weight for age and the
presence or absence of oedema to arrive at a spectrum, with marasmus and
kwashiorkor at either end of the spectrum. Besides
macronutrient deficiency, deficiencies in iron, iodine, vitamin A, and zinc are
the main manifestations of malnutrition in developing countries, and indirect
factors such as high rate of unemployment, poverty, illiteracy, and
overcrowding contribute to the development of PEM. In addition, natural disasters
are increasingly contributing to food shortage in Africa as the continent is
not immune to the effects of climate change. According to a report published by
the World Food Programme in mid-2011, an estimated 9 million people in the horn
of Africa alone need humanitarian assistance as severe drought combines with
conflicts to push the poorest and weakest, especially children, to the edge of
survival. Food and nutrition education, in the presence of widespread food
shortages, ends up in teaching people to eat what they cannot afford or do not
have and, thus, has only limited potential. PEM is associated with as much
as 50-60% of under-five mortality in poor countries and a myriad of
morbidities (Ubesie and Ibeziakor, 2012).
Therefore, beyond the health care
settings, there is urgent need to address the various persisting social
determinants of PEM in Nigeria, such as poverty, illiteracy, unemployment,
corruption, inequalities, and inequities. According to Odion (2009) cited in
Anger, 70% of the over 140 million Nigerians currently live below the poverty
line of 1 dollar per day. The first goal of the millennium development
goal (MDG) is eradication of extreme poverty and hunger, but recent Africa
Development Bank report revealed that the number of Africans that will be
living below the poverty line is instead projected to increase by 2015 (Ubesie &
Ibeziakor, 2012).
This study seeks to investigate the age
and sex prevalence of PEM in the under-5s, the prevalence of diarrhoea among
the under-fives with PEM, the level of maternal education and occupation and
also their feeding practices. We will also use the anthropometric index of
weight and the presence of oedema to determine the prevalence of PEM.
1.2 STATEMENT OF PROBLEM
Protein energy malnutrition (PEM)
remains a major public health issue in the developing countries of the world of
which Nigeria is a part and it appears to be recalcitrant due to the high level
of poverty, overcrowding and HIV/AIDS in the developing countries. In fact
poverty is the underlying factor of majority of PEM in the developing
countries. Statistical data from the World Bank shows that as at 2010 68% of
Nigerians live on <1.25 dollars per day (World Bank Report, 2011). The trend
of people living below the poverty line was similar in pattern with the trend
of the severe malnourished (< -3SD) among preschool children (Central Bureau
of Statistics, 2000).
It is estimated that about 182 million
or 1 in 3 children under the age of five years in developing countries mostly
in sub-Saharan Africa are malnourished. Furthermore, approximately, 6.6 million
of the 12.2 million under five deaths occurring annually in third world
countries are attributable to malnutrition(Ulasi & Ebenebe, 2007).PEM is
associated with as much as 50-60% of under-five mortality in poor countries and
a myriad of morbidities.
Efforts made by the Nigerian government
(like improving the living standards of families, empowering mothers with the
aim of augmenting family income and educating parents on appropriate feeding
practices to tackle this menace), has been grossly inadequate.
1.3 GENERAL OBJECTIVE
To determine the prevalence of protein
energy malnutrition in under five children of Esuk Atu Community.
1.4 SPECIFIC OBJECTIVES
1) To determine the prevalence of PEM in
under five children in Esuk Atu Community using anthropometric indices.
2) To determine the age specific and sex
specific prevalence of PEM in under five children in Esuk Atu Community.
3) To identify the sociodemographic
factors of mothers of under five children with PEM in Esuk Atu Community.
4) To determine the feeding practices of
under five children with PEM in Esuk Atu Community.
5) To determine the prevalence of diarrhoea
in under-five children with PEM in Esuk Atu Community.
1.5 RELEVANCE OF THE STUDY
Malnutrition is amongst the major
causes of morbidity among the under-fives especially in the developing
countries. The study will identify the contribution of illnesses and feeding
practices to PEM in under-fives in Esuk Atu Community and the educational
status and occupation of their mothers.
This will assist in developing a health education intervention and
Government policy that will reduce the prevalence of under-five malnutrition in
Esuk Atu Community.
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