FACTORS CONTRIBUTING TO MALNUTRITION AMONG UNDER FIVE YEARS

CHILDREN IN KACHIBORA SUBCOUNTY, KITALE.

BY

………………………………………….

………………………………………….

A RESEARCH REPORT SUBMITTED IN PARTIAL FULFILLMENT OF THE

REQUIREMENT FOR THE AWARD OF CERTIFICATE IN NUTRITION AND
DIETETICS AT THE RIFT VALLEY INSTITUTE OF SCIENCE AND TECHNOLOGY.

AUGUST 2011.

i.

i
Table of Contents
ACKNOWLEDGEMENT...................................................................................................................v
DECLARATION................................................................................................................................vi
LIST OF ABBREVIATIONS AND ACRONYMS..........................................................................vii
ABSTRACT.......................................................................................................................................viii
CHAPTERONE...................................................................................................................................1
INTRODUCTION...............................................................................................................................1
1.1 BACKGROUND.........................................................................................................................1
1.2 STATEMENTOFTHEPROBLEM..............................................................................................2
1.3 STUDY OBJECTIVES...............................................................................................................2
1.3.1 GENERAL OBJECTIVE......................................................................................................2
1.3.2 SPECIFIC OBJECTIVES.....................................................................................................2
1.4 RESEARCH QUESTIONS.........................................................................................................2
1.5 JUSTIFICATION OF THE STUDY...........................................................................................3
1.6 STUDY SCOPE..........................................................................................................................3
1.6.1 GEOGRAPHICAL SCOPE..................................................................................................3
1.6.2 CONTENT SCOPE..............................................................................................................3
1.6.3 TIME SCOPE.......................................................................................................................3
1.7 CONCEPTUAL FRAMEWORK................................................................................................4
CHAPTER TWO...................................................................................................................................5
LITERATURE REVIEW......................................................................................................................5
2.1 CHILD RELATED FACTORS OF MALNUTRITION OF CHILDREN UNDER FIVE
YEARS..............................................................................................................................................5
2.1.1 SEX OF CHILD...................................................................................................................5
2.1.2 AGE OF THE CHILD..........................................................................................................5
2.1.3 BIRTH ORDER....................................................................................................................5
2.1.4 BIRTH INTERVAL.............................................................................................................6
2.2 MATERNAL RELATED FACTORS OF MALNUTRITION OF CHILDREN UNDER FIVE
YEARS..............................................................................................................................................6
2.2.1 MATERNAL EDUCATION................................................................................................6
2.2.2 MARITALSTATUS.............................................................................................................6
2.2.3. MATERNALOCUPPATION..............................................................................................7
2.2.4 MATERNAL AGE AT BIRTH............................................................................................7
2.3. SUMMARY OF THE LITERATURE REVIEW.......................................................................7
CHAPTER THREE...............................................................................................................................8

ii
 METHODOLOGY............................................................................................................................8
3.1 RESEARCH DESIGN..............................................................................................................8
3.2 RESEARCH SETTING...............................................................................................................8
3.3 TARGET POPULATION............................................................................................................8
3.4 SAMPLE DESIGN......................................................................................................................8
3.4.1 SAMPLE SIZE.....................................................................................................................8
3.4.2 SAMPLING TECHNIQUE..................................................................................................8
3.5 DATA COLLECTION METHOD..............................................................................................9
3.5.1 ADMINTRATION OF DATA COLLECTION INSTRUMENTS.......................................9
3.5.2 RELIABILITY AND VALIDITY........................................................................................9
3.6 DATA ANALYSIS PROCEDURE.............................................................................................9
3.7 ETHICAL CONSIDARATION...................................................................................................9
CHAPTER FOUR...............................................................................................................................11
RESEARCH FINDINGS AND DISCUSSION...................................................................................11
4.0 INTRODUCTION.....................................................................................................................11
4.1 DEMOGRAPHIC CHARACTERISTICS OF RESPONDENTS..............................................11
4.1.0 DEMOGRAPHIC CHARACTERISTIC OF RESPONDENTS..........................................11
4.2 LEVEL OF MALNUTRITION IN CHILDREN.......................................................................12
4.2.0 LEVEL OF MALNUTRITION IN CHILDREN................................................................12
4.3 FACTORS CONTRIBUTING TO MALNUTRITION.............................................................12
4.3.0 Malnutrition in relation to parent`s education.....................................................................12
4.3.1 Malnutrition according to parents income, family size and marital status...........................13
CHAPTER FIVE.................................................................................................................................15
5.1DISCUSSION.............................................................................................................................15
5.1.1 CHILD RELATED FACTORS..........................................................................................15
5.1.2 MATNERL RELATED FACTORS...................................................................................15
5.1.3 Prevalence of malnutrition in under fives...........................................................................16
5.2CONCULUSION........................................................................................................................17
5.3 RECOMMENDATIONS...........................................................................................................17
REFERENCES....................................................................................................................................18
APENDIX (QUESTIONNAIRE)........................................................................................................19
APPENDIX 2......................................................................................................................................20

iii
DEDICATION

This project is dedicated to all my immediate family members who have financially
supported me up to this level.

Also special dedication goes to my friends and group members who have always been
inspiring and encouraging me during my studies all along. May almighty God bless you all.

iv
 ACKNOWLEDGEMENT
First I would like to thank the Almighty father for giving me strength and guiding me since
the start of this project. I would also want to acknowledge my course mates for helping me
whenever I faced a challenge in the project

I also thank my supervisor Madam Dean Koros for the guidance he has offered me towards
this project.

v
 DECLARATION
I declare that this is my own and original work and has never been presented before the
award of any kind in this institution or any other college.

SIGN…………………….

NAME……………………….

INDEX; …………………..

DATE………………………….

This report has been submitted to the department of Health and Applied Sciences of the Rift
Valley Institute of Science and Technology with the approval of Madam. Dean Koros as the
supervisor

SIGN…………………………

Date …………..

vi
LIST OF ABBREVIATIONS AND ACRONYMS
ACC: Administrative Committee on Coordination
AIDS: Acquired Immunodeficiency Syndrome.
AMREF: African Medical and Research Foundation
ANC: Antenatal Care BMI: Body Mass Index
DHO: District Health Officer
DM: Diabetis Mellitus
EU: European Union
FAO: Food and Agriculture Organization
GDP: Gross Domestic Product Hep
B: Hepatitis
B HIV: Human Immunodeficiency Virus
IPD: Inpatient Department.
MCH: Maternal and Child Health
MoH: Ministry of Health
MUAC: Mid Upper Arm Circumference
OPD: Outpatient Department x
PEM: Protein Energy Malnutrition
PHC: Primary Health Care
SCN: Sub-committee on nutrition
TB: Tuberculosis
UKAID: Development United Kingdom Agency for International
UNICEF: United Nations International Children’s Emergency Fund
USAID: United States Agency for International Development
WFP: World Food Program
WHO: World Health Organization.

vii
 ABSTRACT

Malnutrition is one of the major causes of mortality and morbidity among children below five
years of age in Kachibora sub-Location. In order to understand the causes of malnutrition
among children who are less than 5 years of age, a study was conducted in Kachibora Sub-
location, Kitale to find out the factors responsible for malnutrition of children less than five
years. The data was collected from Kachibora Sub-location by use of a structured
questionnaire which involved child related factors (sex of child, age of child, birth order and
birth interval), maternal related factors (age of mother at birth, marital status, maternal
occupation and maternal education level) and anthropometric measurements. Anthropometric
data included weight, height/length and age of the children. It was found out that birth
interval, maternal occupation and maternal education level were the major factors influencing
malnutrition. It was found out that stunting was more prevalent in children whose mothers
were peasants and those whose mothers didn’t have any education level attained. The same
trend was observed in children whose birth interval was less than 2 years. However, there
was no significant relationship between marital status and malnutrition of children below 5
years of age. In conclusion therefore, it’s important to note that the study is essential in
pointing out the occupation, maternal education level and birth interval that contribute to
malnutrition in Kachibora Sub-county. Based on the findings therefore, the study
recommends the practice of other practices that reduces on the prevalence of malnutrition
such as exclusive breastfeeding followed by timely complementary feeding among those less
than 3 years.

viii
ix
 CHAPTERONE

INTRODUCTION

1.1 BACKGROUND
Good nutrition status is a fundamental factor in the attainment of complete social, mental,
economic and physical potentials of an individual, communities and the whole population in
general. Malnutrition is a public health problem which is unacceptably high and progress to
reduce it in most regions of the world is slow as shown in the fourth report on global
nutrition.( ACC/SCN;2000)

Of the stunted 160 million children under 5 years in 2011, 65 million were in Africa. Of the
53 million wasted children globally in 2011, 13.4 million were from Africa and of the 34
countries that accounted for 90% of global burden of malnutrition, 22 are in Africa
(UNICEF; 2010, WHO; 2011, World Bank; 2010)

Malnutrition contributes to nearly half of all deaths in children under five years and is
widespread in Asia and Africa. Between 2000 and 2011 stunting declined from 32.4 to 20.6%
and the number of children affected fell from 198 million to 155 million. In 2006, about two
out of every four stunted children lived in south Asia and one in three lived in Sub Saharan in
Africa (UNICEF ;2015 , WHO;2008, World bank; 2001)

Much as Kenya is endowed with good climate and resources which favors farming and food
security, malnutrition still continues being a major health challenge particularly in children
below five years especially in Western part of Kenya which is considered to have relative
food security (FAO; 2009)

In Kenya, 28% of the children below 60 months are stunted while 9% are severely stunted,
4% are wasted and 1% are severely wasted whereas 11% are underweight and 2% severely
underweight.(KDHS; 2008)

Children suffering from malnutrition are often screened using methods such as measurement
of BMI, MUAC, Waist circumference as well as screening for any form of morbidity
(AMREF; 2009)

Malnutrition described as a medical condition resulting from deficiency, excess or

imbalances in a person`s intake of nutrients (WHO; 2008)

1
1.2 STATEMENTOFTHEPROBLEM
Malnutrition is one of the leading causes of mortality and morbidity in children under five
years in Kachibora level 4 hospital. In the past two years according to weekly epidemiology
reports from the facility, malnutrition has consistently accounted for approximately 40% of
all OPD attendance of children and 39% of all hospital admissions in the pediatric ward. Of
the above figure 33% of children under five were stunted while 15% were underweight.

This figures do not differ much with the regional and national trends. A survey which was
conducted in 2010 by UNICEF in Kenya indicated that nationally, the prevalence of
malnutrition is at 40% with 38% of children stunted and 16% wasted.

Despite the fact that the western regions is the food basket for the country and Kachibora
level 4 hospital is implementing National Health Strategic Plan which include ; Nutrition
intervention programs as a core, malnutrition in Kachibora level 4 hospital among children
under five years has remained one of the leading causes of OPD visits and IPD admission.
Therefore this study will focus on investigating the factors associated with malnutrition
among children under five years in Kachibora Sub location, Kenya.

1.3 STUDY OBJECTIVES

1.3.1 GENERAL OBJECTIVE

To determine the factors associated with malnutrition among children under five years at
Kachibora sub county, Kenya.

1.3.2 SPECIFIC OBJECTIVES

i. To determine the prevalence of malnutrition among children under five years in
Kacibora Sub location.
ii. To assess child related factors associated with malnutrition among children under five
years at Kachibora sub location.
iii. To assess maternal related factors associated with malnutrition among children below
five years at Kachibora sub location.

1.4 RESEARCH QUESTIONS

i. What is the prevalence of malnutrition among children under five years in
Kachiborasub county?
ii. What is the effect of child related factors on malnutrition in children below five
years in Kachiborasub county?

2
1.5 JUSTIFICATION OF THE STUDY
According to the KDHS report 2009, nutrition indicators for young children and their
mothers have not improved over the past 10 years all over the country.

Available reports in Kachibora sub county are limited to prevalence and magnitude of
malnutrition do not capture their causes; therefore this study will focus on investigating the
causes of malnutrition and coming up with recommendations or suggestions which may be
of help in addressing the situation . The study will also provide data to the stakeholders of
the hospital as well as the leaders on setting up strategies to solve the problem.

1.6 STUDY SCOPE

1.6.1 GEOGRAPHICAL SCOPE

The study was conducted at level 4 which is a 120 bed capacity hospital located at Kachibora
sub county.

The hospital provides health care to the population of Kachibora sub county and neighboring
communities. It provides services ranging from preventive, curative and rehabilitative care to
patients in the surrounding areas.

1.6.2 CONTENT SCOPE

This study focused on the causes of malnutrition among the children in the age group of 0-5
years living in Kachibora sub location. Respondents were drawn from parents and caregivers
of children who visited the facility for OPD and IPD services. The major two independent
variables are child factors which include sex of child, age the child, birth order and birth
interval and maternal factors that include age of mother, maternal education, marital status
and maternal occupation.

The interaction of the two factors led to malnutrition manifested as stunting, wasting and
underweight.

1.6.3 TIME SCOPE

The approval for the study was obtained in July 2011 .Data was collected in June 2011,
analyzed in June 2011 and submitted in August 2011.

3
1.7 CONCEPTUAL FRAMEWORK
INDEPENDENT INDEPENDENT
VARIABLES VARIABLES

Child factors Maternal factors

 Sex of the  Maternal

child education
 Age of the  Marital
child status
 Birth  Maternal
order occupation
 Birth  Maternal age
Interval at birth

OUTCOME

Malnutrition index

 Stunting
 Wasting
 Underweight

4
 CHAPTER TWO

LITERATURE REVIEW

2.1 CHILD RELATED FACTORS OF MALNUTRITION OF CHILDREN UNDER

FIVE YEARS
There are a number of demographic variables that researchers have found important in
influencing malnutrition under fives This study however focused on a few of them included;
sex of child ,age of child, birth order, birth interval and mother`s age at birth.

2.1.1 SEX OF CHILD

From the reviewed literature there seems to be a consensus that malnutrition among children
below five years is greater among boys as compared to girls. The cause of this discrepancy is
not well established in literature however it is believed that boys are more influenced by
environmental stress than girls (Henry et al; 2009 , Wahiga ;2009).According to the study
done at Kachibora , Kitale reported that there was a significant between sex of child and
malnutrition. Male children were more likely to be malnourished due to increased attention
paid to females.

2.1.2 AGE OF THE CHILD

Recent studies have found out that younger children are less likely to be malnourished than
younger children. This is due to the fact that weaning and less breast milk make them less
vulnerable to malnutrition. However, after weaning the children get adequate nutrition when
they get used to complementary feeding (Sallie Kipsang; 2008) It is important to note that
specific ages, a child`s nutritional status is sensitive to feeding, weaning practices, care and
exposure to infection. The low risk to malnutrition may be as a result of protective effect of
breast feeding since almost all children are breastfed through their first year of life. Higher
rates of malnutrition after the 12 months are linked ti in appropriate food supplementation
during weaning period.

2.1.3 BIRTH ORDER

Research findings indicate that malnutrition is rare among under five children of birth order
2-3 and that higher birth order (+5) is positively associated with child malnutrition ( Bubo
Maria ;2006)

Worthy to note is that few studies according to the literature research have been conducted on
the subject of the child birth order and malnutrition among under five children.

5
The KDHS showed in 2010 that unwanted birth and child mortality increased with higher
birth order.

2.1.4 BIRTH INTERVAL

In another study conducted previously, children within the first birth interval were 1.66 times
more likely to be stunted than children whose preceding birth intervals was less than two
years were 1.30 times significantly more stunted as compare to children of preceding birth
interval of 24 months or above. Similar results were observed from underweight children.

A meta-analysis found out that both short birth intervals (59 months and above) were
associated with significantly greater risk for adverse perinatal outcomes such as preterm
birth, low birth weight and smaller size for gestation age.

2.2 MATERNAL RELATED FACTORS OF MALNUTRITION OF CHILDREN

UNDER FIVE YEARS
A lot has been written about the socio-economic determinants of malnutrition among children
under five by several researchers in both developed and developing countries. The study
focused on maternal education, maternal age at time of birth, marital status and maternal
occupation.

2.2.1 MATERNAL EDUCATION

Mother`s education level affects child`s nutrition through her choices and health seeking
skills related to nutrition, hygiene, preventive care and disease treatment. Mother`s
responsibility to care for herself during pregnancy and her child through the most vulnerable
stages of life. The study found out that the mother`s associated with good nutrition practices
and particularly child`s nutrition. The above study pointed out that fact that spend most
women with low education spend more time in farming and get limited time to attend to their
children and prepare for them nutritious meals ,unlike their educated counterparts who
normally focus on good child nutrition practices even when they are absent from home most
of the time. Education helps mothers gain additional knowledge about the adequate intake of
food for their children in terms of correct quantity, quality and frequency.
It also determine her income and this helps her access proper nutrition for the child as well
as health services.

2.2.2 MARITALSTATUS
There’s a growing awareness on the importance of both parents participating in child’s
upbringing, and the involvement of men in the feeding of young children (UNICEF; 2007)

6
However the area of child care and nutrition has been characterized by limited inclusion of
men in majority of the communities

2.2.3. MATERNALOCUPPATION
Previous study found out that mother’s occupation is one of the determinants of under-five
malnutrition in most developing countries. The study revealed that

Children from mothers who were laborers or farmers and had a greater prevalence of stunting
,underweight and wasting that from those who had good jobs or housewives (Phoenix ;2013)
This was because working women rarely got time to take care of their children. They also
leave their children at home with other siblings who may neglect feeding them following the
right frequency and this sometimes worsened the problem of malnutrition .It is also common
for mothers to fail to provide complementary foods including protein foods including protein
foods since most of them can’t afford them.

2.2.4 MATERNAL AGE AT BIRTH

It has been associated with malnutrition among the children below five years .There was a
case in point that children whose mothers were less than 20years at the time of birth were
1.22 times more likely to be stunted ,wasted and underweight compared to children whose
mothers were 20years and above at the time of birth (Nure;2012)

2.3. SUMMARY OF THE LITERATURE REVIEW

Whereas the literature reviewed indicates that malnutrition among children below five years
is determined by several factors , a need to find out if similar factors are responsible for
malnutrition in the population attending Kitale level (IV) hospital in Kachibora sub location
is quite important .This is part of the research gap that this study seek to examine.

7
 CHAPTER THREE

METHODOLOGY
The chapter comprises the research design , research setting, target population Of the study,
sample size determination and sampling procedure, data collection and analysis procedure,
ethical consideration, low data were managed and potential limitation of the study.

3.1 RESEARCH DESIGN

Researcher used a cross-sectional design survey to children who attended the hospital during
data collected period of one week. Quantitative research method is used to describe variables
and examine the relationship among variables. Therefore, a quantitative approach was used in
the study in order to determine factors that contribute to malnutrition basing on the number of
children under five years affected.

3.2 RESEARCH SETTING

The research was conducted in Kachibora level four hospital located in Kitale in a pediatric
department. The pediatric department receives around twenty five [25] children per day
according to the information from document of pediatric.

3.3 TARGET POPULATION

The target population is defined as all elements, object substance that meet certain criteria
[Burns, 2009].The study was done among all children attending, Kachibora level four
hospital. Specifically, the study population include all under five children who attended
during the research period.

3.4 SAMPLE DESIGN

3.4.1 SAMPLE SIZE

Sample is a group selected from a population for observation in study [Ann .H, 2010]. The
sample size is two hundred and twelve children [212] from a sample size of 450 children
according to information obtained at the hospital documents indicating that they received
about [25] children below 5 years on average per day, the sampled children were covered in 7
days, and therefore study about 25 children per day.

3.4.2 SAMPLING TECHNIQUE

Inclusion criteria; All patients under five years present in the pediatric department during the
study period were included in the study. Exclusion criteria; All patients aged above five
years, children who did not attend pediatric department were not included in the study.
The sample was selected using a non probability convenient purposive sampling. It was done

8
on all children basing on the criteria that, children are under five years present in pediatric
department during the study period. [Ray 2005] provided a simplified formula to calculate
sample size. The simplified formula assumes a 95 percent confidence level and the maximum
variance [p=0.05].e=margin of error 1-0.95=0.05. Formula is [n=N [1+N[e]2 N is the
population size which is equal to 450 , n is sample size , e specifies the desire level where
e=1, n=450[+450[0.05]2= 212 sample size is 212 children.

3.5 DATA COLLECTION METHOD

We used anthropometric measure checklist to diagnose malnutrition in children. Check list
cover s the age, sex, weight, height then the comparison of weight for height, height for age
and weight for age. Also we used questionnaire to interview parents. This questionnaire was
targeting a variety of factors contributing to malnutrition. Some of the factors were parent
income, residential areas and mostly eaten food in order to find out if they are nutritious or
not.

3.5.1 ADMINTRATION OF DATA COLLECTION INSTRUMENTS

On research, we first gave explanation to parents about research and confidentiality. Then,
parents who could write were given questionnaire to fill whereas others were helped to
complete questionnaire, to determine whether a child is malnourished or not. We also used
anthropometric measures to asses the height, middle upper arm circumference [MUAC] and
weight. We used a check list and reference chart of [WHO] to note the data.

3.5.2 RELIABILITY AND VALIDITY

The English questionnaire was translated in Kiswahili and mother tongue of respondents to
facilitate comprehension. After translation, primary data was collected using observation
method and interview method to asses feasibility of study five days. We also found that some
parents did not understand well on some questions therefore, those questions were edited to
be more understandable.

3.6 DATA ANALYSIS PROCEDURE

We performed data analysis using statistic package [sp]. Each data was given a code to be
captured on in the computer. Data were checked and explored through graphic display and
were analyzed, interpreted and summarized.

3.7 ETHICAL CONSIDARATION

We received recommendation letter from the research board and then and then requested
permission from Kachibora level five hospital. After getting permission, consent was
requested from parents. Finally we began to collect data.
9
 CHAPTER FOUR

RESEARCH FINDINGS AND DISCUSSION

4.0 INTRODUCTION
This chapter contains the descriptive demographics details of result, extent of malnutrition,
factors contributing to malnutrition such as parent education, family incomes, family size and
the level at which impact malnutrition. Also distribution of malnutrition according to sex,
gender and age.

4.1 DEMOGRAPHIC CHARACTERISTICS OF RESPONDENTS

The gender of children on the table below 4.1.0 shows the percentage of male 65.1 percent
were more than female 34.9 percent .Age of children most of them were above two years of
age with 26.4 percent and 28.8 children being two to three years to five years respectively.
The least were below two years with 15.6 percent being below 6 months,13.2percent being
between 7 months to 1 year then 16 percent from 1 to 2 years. Residence of children family,
most of them were from the rural areas with 71.2 percent with a few of them from urban
areas with 28.8 percent.

4.1.0 DEMOGRAPHIC CHARACTERISTIC OF RESPONDENTS

This summarizes the demography of respondents including gender, age and residence of
respondents

Gender of children frequency percent

Male 138 65.1
Female 74 34.9
Total 212 100
Age of children
Below 6 months 33 15.6

7months to1year 28 13.2

1year to 2 years 34 16.0

2years to 5 years 56-61 26.4-28.8

Total 212 100

Residence of children`s family
Rural 151 7.2
Urban 61 28.8
Total 212 100

10
4.2 LEVEL OF MALNUTRITION IN CHILDREN
In the table below 4.2.0 those that were assessed 5.9 percent were malnourished while 48.1
were not. Wasting, from 212 samples assessed 1.4 percent were wasted. On stunting 47.6
percent we stunted while 52.4 were not.

4.2.0 LEVEL OF MALNUTRITION IN CHILDREN

Malnutritio frequency percent
n
Yes 110 51.9
No 102 48.1
Total 212 100
Wasting
Yes 3 1.4
No 209 98.6
Total 212 100
Stunting
Yes 101 47.6
No 111 52.4
total 212 100

4.3 FACTORS CONTRIBUTING TO MALNUTRITION

4.3.0 Malnutrition in relation to parent`s education

Parent`s education level highly affect the nourishment of the child, higher parents education,
lower child level of malnutrition

Child level of malnutrition child malnourishment

Parents education ye no total

s
None 43 47 90
Primary 34 39 73
Secondary 31 7 38
university 2 9 11

11
4.3.1 Malnutrition according to parents income, family size and marital status

Parent maritals

more than one partner

widow

one patner

FAMILY SIZE

one to four
more than five

12
family resource

Wrk for people

farming
trade
salary

13
 CHAPTER FIVE

5.1DISCUSSION

5.1.1 CHILD RELATED FACTORS

The result of the study showed that female children were more malnourished constituting
60.9% as compared to males .The research also showed that boys are more affected by
environmental stress compared to girls and more male children get malnourished compared to
female (Kachibora Level 4 hospital 2011).Through this discovery the reason that resulted to
the ranges between the age of 13-36 months which is 56.5% and then a similar rate of 21.7%
for those less than 12 months and above 36 -59 months. The above results also correlate with
those according to (KDHS;2007)which reported that malnutrition increased with the age of a
child through the first three years of life . The findings were in acceptance that young
children were less likely to be malnourished than older children because of breastfeeding ,
however after weaning the children begun to get inadequate nutrition when they got used to
complementary feeding. (WHO;2001)

The research further indicated that malnutrition was higher in the birth order 5and above
43.5% followed 3-4 30.4%and the smallest observed in birth order 1-2 26.1%. This is in
acceptance with the study that was done in kitale ;( Kachiborasubcouny 2011) The result
showed that most of the children of birth order more than 2 had high chances of wasting and
stunting. Finally the results indicated that the highest prevalence rate In the birth intervals of
5 years and above. The above study corresponds with the study done in Kenya ,Kitale county
(Kachibora sub-county 2011) which indicates that children within the first birth intervals
were 1.66 more likely to be stunted than those above24 months .Malnutrition was higher in
birth intervals less than 24 months 41%since it was an important indicator of nutritional
status of the child.

5.1.2 MATNERL RELATED FACTORS

The highest rates of malnutrition was being observed in mothers less than 20 years in the time
of birth which indicated 43.5% and lowest among children whose mothers were between 30-
39 years at the time of birth .Children whose mothers were below 20 years of age at birth
were 1.22 times more likely to be stunted ,wasted and underweight compared to children
whose mothers were 20 years and above .The maternal age of 40+was associated with higher
likelihood of giving birth to low birth weight children( WHO;2011).

14
The results on maternal education level showed a high percentage of malnutrition whose
mothers had no education being 56 5% and lowest among in children whose mothers had
tertiary education being 8.7%. The results showed that the higher the education level the
lower the rates of result was more attention was paid to female children unlike their male
counterparts. Therefore the sex of the child was statistically in the study conducted in
kachibora level 4 hospital.

Result of the study indicated that majority of the malnourished children

malnutrition .The study also suggested that educated mothers were better aware about
nutrition requirements by providing improved health care to their children(KDHS;2011). The
results obtained from marital status indicated that a similar pattern of malnutrition was 26.5%
among married women and 21.5% of single mothers. The results showed a constant pattern of
malnutrition contrary to findings in Turkana which showed that under 5 malnutrition was
higher among unmarried rural and separated women compared to married ones ,on the other
hand the higher the rate of malnutrition was highly likely to be among unmarried women
perhaps because of the high rates of maintaining families hence failing to provide nutritious
supplements to the under 5 children (kachibora level 4 hospital 2011) . The results on
maternal occupation showed a positive correlation with other previous studies and researches
carried out ,this was common for non-working mothers to fail to provide complementary
foods to their children this foods included proteins since most of them cat afford them.

5.1.3 Prevalence of malnutrition in under fives

The results from the study showed malnutrition prevalences at 32.9%with stunted children
being the highest with 20%, wasting 8.6%and underweight 4.3%.The results are lower than
the national prevalence rates by (KDHS;[Link] reports that 56% below children of 60
months were malnourished where 38% of the malnourished children are stunted 55 are waste
and 13% are underweight . Furthermore to note were the higher rates of stunting 8.65as
compared to 5%rported by (KDHS;2011) .However the higher prevalence of stunting
20%obsrved in the results of the study correlates with the rates of the highest rates of
malnutrition reported by( KDHS 2008) . The impact or random sampling might have been the
reason to the decrease in the prevalence of malnutrition as compared to national report by
KDHS .

The lower levels of malnutrition from the study were due to the fact that malnutrition was not
highest to the southwestern region of kachiborasubcounty in kitalecounty .

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5.2CONCULUSION
Results from the study analysis confirms that maternal occupation ,maternal education level
and birth intervals are the most significant factors which affect malnutrition in children who
are 5 years and below of age . To a smaller extent ,age of child and age of mother at birth
have significant effect on the malnutrition of the child .Keeping this in mind ,there is need to
lay emphasis on a particular maternal occupation ,maternal education levels as well as birth
intervals that pose a risk of malnutrition for effective preventive strategies in response to
malnutrition in under- fives children

5.3 RECOMMENDATIONS
1. The district health care providers should educate the public on importance of good
nutrition practices of children specially those below 5 years of age. They should be educated
on the right foods that make up a balanced diet necessary for the growth requirements of
children .

[Link] health care providers should educate the disadvantages of early pregnancies that
predispose to under-five malnutrition since the young mothers are also growing at the time of
pregnancy and birth of the child .

3. The health are providers should educate the public on other practice that reduce on
malnutrition like exclusive breastfeeding and should be advisd on how and when to introduce
supplementary feeds during the growth cycle of the children.

4. The policy editors should work hard to make education a priority and affordable by even
the poor Kenyans since low or no education is associated with high rates of malnutrition .

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REFERENCES
Henry ei 2007 boys are influenced by environmental stress compared to girls

AMREF2009 anthropometric measurements like BMI,MUAC Waist circumference

KDHS 2008 stunted, underweight, severely wasting, severely stunted

FAO 2009 food security in western part of kachibora

UNICEF 2006

WHO 2008 two out of four stunted children in south Asia

WORLD BANK 2001

ACC/SCN 2000 low birth weight ,stunting,wasting

RAY 2005 Provided a simplified formula to educate sample size

ANN H 2010 sample a group selected from a population for observant in a study

BURNS 2009 target population is defined as a all element , object or substance of certain
criteria

WHO 2007 malnutrition is highest if birth intervals is less than 24 months

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APENDIX (QUESTIONNAIRE)
PART ONE :Child factors

1. Sex of child male( ) female ( )

2. Age of child (months)
<12 ( ) 12-36 ( ) 37-59 ( )
3. Birth order
1-2 ( ) 3-4 ( ) 5+ ( )
4. Birth intervals 1-2 ( ) 3-4 ( ) 5+ ( )

PART TWO :Maternal factors

5. Age of mother at birth (years)
<20 ( ) 20-29 ( ) 30-39 ( ) 40+ ( )
6. Maternal education
None ( ) primary ( ) secondary ( ) tertiary ( )
7. Marital status
Married ( ) single ( ) separated ( ) widowed ( )
8. Maternal occupation
Peasant farmer ( ) business ( ) civil servant /NGO staff ( ) other ( )

[Link] of the child……………………(kg)

[Link]/length of the child …………………………(cm)

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APPENDIX 2

DATE ACTIVITY
Day 1 Presentation of letter of introduction to
hospital administration
Day 2 to day 6 Establishing of contact with research
assistants.
Civic education of research assistants
Testing of sample questionnaires with
research assistants
Day 7 to day 14 Data collection
Day 15 to day 45 Data processing
Data analysis
Writing of research report
Day 46to day 60 Printing and handing I o the report .

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