Department of Community Medicine,

And Primary Health Care,

Bingham University, Jos campus,
Jos, Plateau state.
27th may,2023.

To:
Chairman Ethical Research Committee,
Bingham University Teaching Hospital.
Through:
HOD Community Medicine.

Dear Sir,

APPLICATION FOR ETHICAL CLEARANCE LETTER

We Paul Longnan Silas, Randawa Sandra Silas, Rindaps Isaac and Riyin-Rimam Andenyangtso Ali
are 600 level final year students humbly request for your permission to carry out research titled
"NUTRITIONAL STATUS AMONG CHILDREN UNDER 5 IN JOS NORTH LGA ,
PLATEAU STATE, NIGERIA" in view of the requirement for the award of the MBBS degree.

We are aware of the ethical principles that govern research involving human subjects, and we
assure you that the study will be conducted in accordance with these principles. we have
attached the following documents for your review: Consent note and Project proposal.
Data Management Plan: Hard copy and electronic data will be stored in a lock file cabinet,
access will be limited to the principal investigator and supervisor of the study.
We will be available to answer any questions or provide additional information regarding the
study upon request.
Thank you for considering our request for ethical clearance.

Yours Sincerely,

600 level medical students

Community Medicine Department
Bingham University Teaching Hospital
 CONCEPT NOTE

TITLE:
NUTRITIONAL STATUS AMONG UNDER 5
CHILDREN IN JOS NORTH LOCAL GOVERNMENT
AREA

BY

PAUL LONGNAN SILAS BHU/15/01/01/0083

RANDAWA SANDRA SILAS BHU/15/01/01/0036
RINDAPS ISAAC BHU/15/01/02/0233
RIYIN-RIMAM ANDENYANGTSO ALI BHU/16/01/01/0318

GROUP CONTACT PERSON:

RIYIN-RIMAM ANDENYANGTSO ALI
aliriyin@[Link]
09121484457

PROJECT SUPERVISOR:
ASSOCIATE PROFESSOR LUCY IDOKO
lidoko@[Link]
08033068073

©2023
 INTRODUCTION

Nutrition explains how the body metabolizes food and how the nutrients help maintain bodily
functions [1]. Nutrients are substances in food that provide energy and help the body function
properly. There are six essential nutrients: carbohydrates, proteins, fats, vitamins, minerals,
and water. A balanced diet is adequate in proportion to the body’s needs. Proper nutrition is
key to good health and is defined by an individual's adherence to a balanced diet. Inadequate
intake of these nutrients leads to poor physical, mental and multiple nutritional deficiencies
and development of the body.

An individual’s nutritional status is determined by differences in food utilization and food

consumption. Changes in food intake and bioavailability directly or indirectly reflect
nutritional status. Nutritional status can be normal, undernourished, or overnourished. Under
and overnutrition are considered malnutrition.

Malnutrition is a deficiency, excess, or imbalance in an individual's energy and/or nutrient

intake. The term malnutrition covers three general conditions; undernutrition including
wasting (low weight for height), stunting (low height for age), and underweight (low weight
for age); micronutrient malnutrition, including micronutrient deficiency (lack of essential
vitamins and minerals) or micronutrient excess; and overweight, obesity and non-
communicable diseases related to eating habits (eg heart disease, diabetes.) [2]

Child malnutrition is a major public health problem, particularly in many low- and middle-
income countries. This not only negatively affects the country's productivity, but also affects
the economic and social hardships faced by the vulnerable. Undernutrition is associated with
suboptimal brain development, which has a negative impact on cognitive development,
educational performance, and economic productivity in adulthood.

In 2016, approximately 155 million children under the age of 5 were stunted, and 41 million
were overweight or obese. About 45% of deaths in children under 5 are related to
malnutrition. At the same time, the number of overweight and obese children in these
countries is increasing [2].

Preventable and treatable diseases kill more than 10 million children under the age of 5 every
year. Almost all of these deaths occur in poor countries [3].

Malnutrition accounts for more than a third of deaths among children under five [4].
According to data from the 2013 Nigeria Demographic and Health Survey, the rates of
stunting, underweight, wasting, and overweight were 37, 29, 18, and 4% respectively.[5]

Conflicts between farmers and herdsmen are a concern in Central North Benue and Plateau
states. This situation has led to high rates of migration, destruction of livelihoods, and a lack
of sustainable income-generating services in the affected areas which have resulted in
problems of food security, maternal care practices, healthy environments, and health facility
assessments.[6]

The 2007 World Health Organisation (WHO) growth chart reference provides height for age
and BMI for age when assessing underweight (low BMI for age), overweight and obesity
(high BMI for age), and stunting (short for age). This chart reference would be used in the
assessment of under 5 children in this study.

In Nigeria, there are few studies on school children that use the WHO growth chart as a tool
to assess nutritional status. This study is therefore set out to determine the prevalence and risk
factors of malnutrition among under-five children in Plateau State, Jos North LGA using the
WHO reference chart.

STATEMENT OF PROBLEM

Around 7.7% of children worldwide were wasted, 24.5 percent were stunted, and 15% were
underweight in 2015.[7] Sub-Saharan Africa (SSA) accounts for one-third of all
undernourished children worldwide, with West Africa and East Africa having the highest
prevalence, according to the 2015 Millennium Development Goal (MDG) report. Despite
ongoing efforts to improve childhood nutrition, malnutrition in children under 5 remains a
significant challenge in many regions, particularly low-income countries.[8] This study is
aimed at determining the nutritional status of children under 5 in Jos North LGA and also
identifying factors that contribute to malnutrition in this age group. This project will involve
conducting a comprehensive assessment of the nutritional status of children under 5 in Jos
North LGA including measuring their weight, height, mid-upper arm circumference, and
other indicators of nutritional status. The project will also examine the underlying causes of
malnutrition such as poverty, inadequate access to food, poor feeding practices, and limited
access to health care in this location.
JUSTIFICATION

Assessing the nutritional status of under 5 and identifying risk factors in this population is of
great importance because the strength of a community is determined by the development of
the children in said community.[9] If children that later grow up to be adults who take care of
the community are malnourished or have poor practices towards nutrition, it is likely that
their ignorance might play a great deal in malnutrition practices and it is unlikely that they
would be able to identify the signs and symptoms of malnutrition and recommend required
interventions such as medical help.

The nutritional status of children under the age of five has been linked to a number of factors,
according to a number of studies. However, the factors that contribute to malnutrition vary
from country to country or even region to region in the studies that have been carried out thus
far. Jos North Local Government Area has its own special characteristics in terms of socio-
economic, water and sanitation, food security and feeding practices which will be explored in
this research.

OBJECTIVES

General Objective: To assess the nutritional status of children under 5

Specific Objectives:

1. To determine nutritional status among children under 5 in Jos North.

2. To assess the prevalence of malnutrition among children under 5 in Jos

North.

3. To find out the feeding practices engaged in by caregivers of children

under 5.

4. To identify factors that contributes to malnutrition in this population.

RESEARCH QUESTIONS

1. How is the nutritional status of children under 5 using anthropometric

measurements in Jos North?

2. What is the mother’s level of awareness on the nutritional status of children under
5 years old?
 3. What factors affect the nutritional status of children under five?

4. What are the feeding practices engaged in by mothers of under-five children?

HYPOTHESES

HO: There is no relationship between caregivers’ level of awareness of nutritional status and
nutritional status of U-5 children in Jos North LGA

H1: There is a relationship between caregivers’ level of awareness of nutritional status and
nutritional status of U-5 children in Jos North LGA.
 METHODOLOGY

STUDY BACKGROUND

Nigeria's 12th-largest state is Plateau. It was founded on February 3rd, 1976, and Jos is its
capital. Its entire size is 30,913 km 2, and its GDP (gross domestic product) is $1,587 per
person. It has a population of about 3.5 million people and gets its name from the Jos
Plateau. It includes natural rock, hill, and waterfall formations. Jos North is a local
government area in Plateau State, Nigeria. It was created in 1987 and has 20 political wards.
Its headquarters are in the city centre of Jos. The postal code of the area is 930. It has an area
of 291km2 and a population of 429,300 at the 2006 census. The ethnic groups found in this
area include Afidzere, Anaguta, Bache, Irigwe and Berom.

Jos North Local Government area is domiciled in the city centre of Jos as the headquarters
location with major district of Gwong and many other villages which are Babale, Dong,
Fudawa, Furaka, Gwafan, Gwash, Jos Jarawa, Kabong, Larantos, Nabgar, Nabor, Nagohom,
Naraguta, Nassarawa A, Nupkins, Rigiza, Rusau, Tudun Wada, Targwong, Zakaliyo, Zangam
and Zangan.

The study will be carried out in six Nursery schools and a Comprehensive Primary Health
Care Center within Apata, Jos North L.G.A. Among which include:

1. Learning Field International Academy Apata (a population of 150 children under

the age of 5).

2. Messiah Christian Academy Apata with a population of 52 children under the age
of 5.

3. Verdad Nursery and Primary School Apata (92 children under the age of 5.

4. St. Michaels Anglican Nursery and Primary School Apata (200).

5. United Baptist Model School Apata (150).

6. Efficiency Private School, Apata (29).

7. Comprehensive Primary Health Care Center, Apata with a population of average 85

children who come for child welfare clinic yearly.

STUDY POPULATION

The study populations are children between 0 to 59 months of age and their caregivers
attending nursery schools and a Comprehensive Primary Health Care Center in Apata Jos
North Local Government Area.
STUDY DESIGN

This will be a cross-sectional descriptive study.

SAMPLE SIZE DETERMINATION

The minimum sample size for this study will be determined using Kish method for sample
size calculation

n = Z2pq/e2, where:

n = minimum sample size

z = standard normal deviant at 95% confident interval = 1.96

e = level of precision (margin or error allowable), usually 0.05

q= 1- p

p = 32% (0.32)

q = 1 – 0.32 = 0.68

n = (1.962 x 0.32 x 0.68) / (0.05)2

n = 334.37 which is approximately 334 + 33.4 (for non response and attrition) = 367.4
approximately 367.

INCLUSION CRITERIA

Children under 5 whose parents or caregivers have consented to participate in this study

EXCLUSION CRITERIA

Children under 5 whose parents or caregivers have not consented to participate in this study.

SAMPLING TECHNIQUE

1. How we selected the location.

Random sampling based on proximity to Bingham University Teaching Hospital, also

based on case presentations of members of the community to Bingham University
Teaching Hospital.

2. How we selected the schools in this location.

Schools were initially selected using simple random sampling technique through the
Plateau State-Basic Education list and further selected based on positive response
from the administration and number of pupils under 5 in each school.
 3. How to distribute our sample size in each of these locations.

A particular number of children were selected from each location. Out of 758 children
distributed in 7 locations, a proportional allocation based on size of the class in
schools and presentation on welfare clinic days in primary health care using the
formula:

Proportion (p) = Number of children in particular location/Total Number of Children in all

locations (t) x Sample size (n).

p=Number of children in each location/t x n

a. Learning Field International Academy - number in class = 150, 150/758 X 367= 73

b. Messiah Christian Academy - number in class = 52, 52/758 X 367 = 25
c. Verdad Nursery and Primary School - number in class = 92, 92/758 X 367 = 45
d. St. Michaels Anglican Nursery and Primary School - number in class = 200, 200/758
X 367 = 97
e. United Baptist Model School - number in class = 150, 150/758 X 367 = 73
f. Efficiency Private School - number in class = 29 , 29/758 X 367 = 14
g. Comprehensive Primary Health Care Center - number of children who come for child
welfare clinic = 85, 85/758 X 367 = 41

We would select the children based only from Daycare to Nursery 3 that is from ages 0
months to 59 months. It will be based on Systematic Sampling Technique.

Using the formal SI=N/n where:

SI = sample interval

N = population size

n= sample size

The Sample interval for the study calculated is 758/367 = 2

In each school the number of questionnaires will be divided by number of classes. If the
number of students in a particular class are not up to the required number, the remaining
questionnaires will be distributed to the other classes.

Children in each class will be given numbers 1 and 2 then the children numbered 2 will be
selected randomly within the sample interval for the study. The first student to be counted as
1 will be decided by sitting position closest to the entrance of the classroom.

In the primary health care centre numbers 1 and 2 will be given then children with numbers 2
will be selected randomly within the sample interval for the study.
DATA COLLECTION METHOD

A questionnaire developed by the researchers (shown in Appendix II) to be interviewer-

administered by researchers will be used to collect data) from eligible participants.
Information to be collected will include socio-demographic factors, feeding practices, factors
that contribute to malnutrition, child health care, immunization and anthropometric
measurements of children under 5 in the study population. The measurements to be taken will
be Height/Length, Weight, Mid Upper Arm Circumference, Head Circumference and
Body Mass Index. The height/length, mid upper arm circumference and head circumference
will be measured using a measuring tape, the weight will be measured using a weighing
scale.

WHAT IS TO BE MEASURED

Weight

❖ For children who cannot stand on their own or those from 0 to 2 years:
● The mother will remove her shoes and step on the digital body weighing scale
to be measured alone first.
● After the mother’s weight appears on display, while she is still standing on the
weighing scale, it will be reset to zero.
● The baby will be given to the mother to hold and the weight will be checked
again and recorded.
❖ For the child 2 years and older and those who can stand on their own:
● The child will be weighed alone.
● The child will be undressed to the minimal clothing
● The child will stand on the weighing scale and the reading will be taken to the
nearest 0.1kg and recorded.
● These measurements will be compared to the WHO weight for age:

Males; 3.3 at birth, 4.5-6.4 from 0-3 months, 7.0-7.9 from 4-6 months, 8.3-8.9 from 7-9
months, 9.2-9.6 from 10-12 months, 9.6-14.3 from 12-36 months, 14.3-18.2 from 36-59
months

Females; 3.2 at birth, 4.2-5.8 from 0-3 months, 6.4-7.3 from 4-6 months, 7.6-8.2 from 7-9
months, 8.5-8.9 from 10-12 months, 8.9-13.9 from 12-36 months, 13.9-18.0 from 36-59
months.[10]

Height/Length

❖ For children who cannot stand on their own or those from 0 to 2 years:
● The child will be laid on a flat surface or board with the head end fixed
compressing the hair.
● With the feet joined together side by side, a tape will be used to measure from
the head to the heel and recorded to the nearest 0.1cm
❖ For the child 2 years and older and those who can stand on their own:
 ● The child will be made to stand against the wall barefooted.
● The eyes will be facing forward without bending the head downward or
upward.
● A mark will be made on the wall while compressing the hair against the scalp
of the head.
● The reading will be taken and recorded to the nearest 0.1cm.
● These measurements will be compared to the WHO height/length for age in
cm(+/-5):

Males; 49.9 at birth, 49.9~61.4 from 0-3 months, 63.9-67.6 from 4-6 months, 69.2-72.0 from
7-9 months, 73.3-75.7, from 10-12 months, 75.7-96.1 from 12-36 months, 96.1-109.4 from
36-59 months.

Females; 49.1 at birth, 49.1-59.8 form 0-3 months, 62.1-65.7 from 4-6 months, 67.3-70.1
from 7-9 months, 71.5-74.0 from 10-12 months, 74.0-95.1 from 12-36 months, 95.1-108.9
from 36-59 months.[10]

Mid upper arm circumference

● The child’s arm will be exposed from the elbow to the fingers.
● With the forearm flexed, a measuring tape will be used to measure from the
acromion process to the elbow.
● Midpoint of the distance between the acromion and elbow it will be marked,
the tape wrapped round the arm to take the measurement and recorded.
● These measurements will be compared to the WHO MUAC for age in cm:

Males; 13.5-14.2 from 3-6 months, 14.4-14.5 from 7-9 months, 14.6-14.6 from 10-12
months, 14.6-15.7 from 12-36 months, 15.7-16.5 from 36-59 months

Females; 13.0-13.8 from 3-6 months, 13.9-14.1 from 7-9 months, 14.1-14.2 from 10-12
months, 14.2-15.6 from 12-36 months, 15.6-16.8 from 36-59 months.[10]

Head circumference

● The child’s head will be made steady and any cap removed.
● The measuring tape will be wrapped round the head from the occiput to the
glabella.
● Readings will be taken and recorded.
● These measurements will be compared to the WHO head circumference for
age in cm (+/-2):

Males; 34.5 at birth, 34.5-40.5 from 0-3 months, 41.6-43.3 from 4-6 months, 44.0-45.0 from
7-9 months, 45.4-46.1 from 10-12 months, 46.1-49.5 from 12-36 months, 49.5-50.7 from 36-
59 months
Females; 33.9 at birth, 33.9-39.5 from 0-3 months, 40.6-42.2 from 4-6 months, 42.8-43.8
from 7-9 months, 44.2-44.9 from 10-12 months, 44.9-48.5 from 12-36 months, 48.5-49.9
from 36-59 months.[10]

Body Mass Index

● This will be calculated using the child’s already measured length/height and
weight.
● The formula to calculate the Body Mass Index is as follows:

Weight (in kg) ÷ squared length/height (in meters)

DATA MANAGEMENT

After data collection, data analysis will be conducted using SPSS (statistical package for
social sciences) version 27.0. Diagrams will be used to characterize and illustrate responses
and chi-square and t-test used to determine association between level of awareness and
potential factors observed to influence knowledge profile. Tests of significance will be
determined at e=0.05

OUTCOME VARIABLES AND MEASURES

The outcome variables and measures for nutritional status of children under 5 will be
generally assessed under the following;

1. Assessment of nutritional status of under 5 children

This can be done using the ABCD methods. These refer to the following:

[Link]- To assess growth in these children, different measurements

including length/height, weight, mid upper arm circumference and head
circumference will be used.

Weight for age is an index that will be used to assess children who may be
underweight.

Height-for age is an index that will be used to assess stunting (chronic malnutrition) in
these children.

Weight-for-height is an index that will be used to assess wasting (acute malnutrition)

in these children.
 [Link]/biophysical methods- This involves collecting blood, feces or/ and
urine samples to carry out investigations, especially to determine long standing
nutrient deficiencies however, this will not be carried out in this study.

[Link] methods-Clinical methods of assessing nutritional status will involve

checking signs of nutrient deficiency at specific places on the body or asking the
patient whether they have any symptoms that might suggest nutrient deficiency from
the patient. Clinical signs of nutrient deficiency include:pallor, bitot’s spots on the
eyes, pitting oedema, goiter and severe visible wasting

[Link] methods- Dietary methods of assessment will include looking at past or

current intakes of nutrients from food by individuals in this group to determine their
nutritional status. We will ask what the family or the mother and the child have eaten
over the past 24 hours and use this data to calculate the dietary diversity score.

2. Environmental factors- The availability and accessibility of healthy food options can
be influenced by environmental factors eg climate, geographic location, economic
conditions. Areas where fresh foods and vegetables are not available, people may
rely on heavily processed foods which tend to be higher in calories, sodium and
unhealthy fats.
3. Socioeconomic status of parents/caregiver- Undernutrition is higher in low income
household and overnutrition commonly seen in high income households
4. Health status- Good nutrition is essential for maintaining optimal health, poor
nutrition increases the risk of developing health problems such as obesity, diabetes
etc. a balanced nutrition helps to promote health and well being of individuals
5. Cultural and religious beliefs- These affect food choices as some cultures have
preference for high fat diet while others for plant based diets. Some religions may
require certain dietary restrictions such as fasting during certain times of the year or
avoiding certain types of meat.
 QUESTIONNAIRE

SECTION A: SOCIODEMOGRAPHIC FACTORS

N/B: respondent to please tick ( ) where appropriate

1. Gender a. Male[ ] b. Female[ ]

2. Marital status a. Single[ ] [Link][ ] [Link][ ]

3. Religion a. Christian[ ] [Link][ ] [Link]……………………….

4. Age …………..

5. Age of spouse………

6. Level of education [Link][ ] [Link] [ ] [Link] Secondary[ ]

7. Level of education of spouse [Link][ ] [Link] [ ] [Link] Secondary[

]

8. Occupation [Link][ ] [Link] trader[ ] [Link][ ] [Link] servant[ ] e.

Other…………………………..

9. Occupation of spouse [Link][ ] [Link] trader[ ] [Link][ ] [Link] servant[ ]

e. Other…………………………..

10. Tribe a. Hausa [ ] b. Igbo [ ] c. Yoruba [ ] d. Other……………….

11. Relationship to child or children a. Father[ ] b. Mother[ ] c. Sibling[ ] [Link] [ ] e.

Aunt[ ] [Link]…………

12. Number of children……..

13. Child information:

NAME AGE IN MONTHS SEX

14. Total family income per month:........

SECTION C: FEEDING PRACTICES

15. Do/did you breastfeed your child? Yes[ ] No[ ]

16. How many times do you breastfeed your child in a day?...........................

17. How long did you breastfeed for?

a. No breastfeeding at all[ ] b. Breastfeed <6 months[ ] c. Breastfeed for 6 months[ ]

d. Breastfeed >6 months[ ]

18. If you breastfeed, which of the following methods of breastfeeding did you use in the
first 6 months? a. Exclusive Breast feeding [ ] b. Breastfeeding with
additional feeding of child [ ]

19. If not exclusive breast feeding, what other types of milk or formula do you give your
child?..............

20. Do you wash your hands before feeding your child? a. Yes[ ] b. No[ ]

21. Do you often clean and sanitise your child’s feeding bottles, cups and pacifiers? YES[ ]
NO[ ] if yes, how……….

22. Do you check the expiry dates of packaged foods before feeding them to your child? YES
[ ] NO [ ]

23. What types of solid food do you usually give your child? a. Pap [ ] [Link] [ ] c. d. e.
Others…..

24. How often does your child eat fruits and vegetables?

a. Daily[ ] b. Weekly[ ] c. Monthly[ ] d. Never [ ]

25. What are the common foods eaten in your household?(multiple answers allowed) a.
Grains [ ] b. Roots and tubers [ ] c. Tuwo [ ] d. Meat [ ] e. Fish [ ] f. Cereal [ ] g.
Vegetables [ ] h. Others…..
26. How many times does your family eat per day? a. Once [ ] b. Twice [ ] c. Thrice [ ]

27. Do you limit coke, fanta, sprite, bobo juice or snacks in your child’s diet? a. Yes [ ] b. No
[ ]

28. How often do you offer them?.......

29. Have you received any information or counselling regarding nutrition and feeding
practices for children under 5? a. Yes [ ] b. No [ ]

30. What are the sources of information?(multiple answers allowed) a. Health facility [ ] b.
Newspaper/flyer/posters [ ] c. Relatives/friends [ ] d. Church [ ] e. Radio [ ] f. Television[ ]
g. Mosque [ ] h. Telephone [ ] g. Others…..

31. How do you handle mealtime distractions such as televisions?.....................

32. Do you give your child any supplements or vitamins? a. Yes [ ] b. No [ ] Specify if
yes………….

SECTION D: FACTORS THAT CONTRIBUTE TO MALNUTRITION

33. From which of the following does your family get water? (multiple answers allowed) a.
Pipe Borne water [ ] b. Well water [ ] c. Rain water [ ] d. Stream/Pond/River [ ] e.
Public water tap[ ] f. Water sellers [ ] g. Water tankers [ ] h. Borehole [ ] [Link]
water [ ]

34. How do you purify(make water safe) your water used for drinking in your house?
(multiple answers allowed) a. Not done [ ] b. Boiling [ ] c. Filtration [ ] d. Use of Alum
[ ] e. Others(specify)..................

35. What method of sewage disposal does your household use?(multiple answers allowed)

a. Pit Latrine [ ] b. VIP Latrine [ ] c. Flush to septic tank [ ] d. Bush/Open place[ ] e.

Others(specify).......

36. Food storage practices: Refrigerated [ ] Not refrigerated [ ] Others(specify).....

37. Do you wash your hands after using the toilet? Yes [ ] No [ ]

38. Do you buy food from outside vendors? Yes [ ] No [ ]

39. Are there any cultural beliefs or practices that influence feeding practices in your
household? YES [ ] NO [ ]

40. How often do you take your child for medical check-ups? ……
41. Do you monitor your child’s growth and development? a. Yes [ ] b. No [ ]

42. How do you monitor your child’s growth and development?.....

43. How often do you monitor your child’s growth and development? a. Weekly [ ] b.
Monthly [ ] c. 2 monthly [ ] d.> 2 monthly [ ] e. <6 monthly [ ] f. 6 monthly [ ]

44. Are there any medical conditions that affect your child’s appetite or ability to eat? YES [ ]
NO [ ]. Specify…………..

45. Do you face any challenges in providing a balanced diet to your child? YES [ ] NO [ ]
Specify…………..

SECTION E: CHILD HEALTH

46. How many children were born into this household in the last 12 months?

If none, indicate Zero [ ] If any, indicate the number born [ ] Male…….. Female……..

47. Major health problems affecting children in this household………………….

48. Has your child experienced any illness in the past month? Yes [ ] No [ ] Specify
………

49. Has your child experienced any feeding difficulties or lack of appetite in the past month?
YES [ ] NO [ ]

50. Has your child experienced diarrhoea in the past month? YES [ ] NO [ ]

51. Has your child experienced any vomiting in the past month? YES [ ] NO [ ]

52. Has your child experienced any fever in the past month? YES [ ] NO [ ]

53. Has your child experienced any abdominal pain in the past month? YES [ ] NO[ ]

54. Where does your child receive treatment when ill?(multiple answers allowed) a. Health
centre [ ] b. Private Clinic [ ] c. General Hospital [ ] d. Chemist Shop[ ] e.
Pharmacy [ ] f. Traditional healer[ ]

55. Has there been any death among children u-5 in the family within the last 12 months,
kindly indicate

If no death, indicate Zero[ ] If any, indicate the number[ ] Male[ ] Female[ ]

56. Possible cause of death…………………………

SECTION F: ANTHROPOMETRIC MEASUREMENT

Sex Age (months) Weight Height MUAC BMI (kg/m^2)

Do you have any questions for me/us?? Yes____. NO______

If yes, state________________________________

Thank you for your time.

ETHICAL CONSIDERATIONS

Ethical approval and clearance for this study will be obtained from Bingham University
Teaching Hospital Ethical Committee (BHUTHREC), while permission will be obtained
from the schools and health Centre and written consent will be obtained from the participant.

INFORMED CONSENT FORM

Dear Respondent,

We are final year medical students of the College of Medicine and Health Sciences in
Bingham University, Karu. Our names are Randawa Silas Sandra, Isaac Rindaps, Riyin-
Rimam Ali and Paul Silas Longnan. We are conducting a research titled “nutritional status
among children under 5 in Jos North Local Government Area.”

PURPOSE: The purpose of this study is to assess the nutritional status and prevalence of
malnutrition among children under 5 in Jos North LGA
RESEARCH DESCRIPTION: When you enter this programme, you will be explained to
what the study is about and the objectives of study, after which you will fill this questionnaire
as your participation and measurements such as weight, height, head circumference, and mid
upper arm circumference will be taken for children under 5.

POTENTIAL RISKS AND DISCOMFORT: This study does not involve any known risk
as no invasive procedure will be carried out nor any sample obtained from you as a part of
this study.

POTENTIAL BENEFIT: The potential benefits of participating in this study are

1. Obtaining knowledge and understanding or added knowledge (if previously

enlightened) about types of food essential for children’s growth, importance of
balanced diets and importance of key nutrients such as vitamins and minerals.
2. Identification of risk factors and early signs of malnutrition in children so appropriate
measures are taken early.
3. Adequate nutrition plays a significant role in boosting the immune system and
reducing the risk of infections and diseases. This research can inform you about the
link between nutrition and prevention of conditions such as stunting, wasting,
anaemia and vitamin deficiencies.
4. Identification of warning signs and early indicators of nutrient deficiencies and
growth disorders.
5. For minors, consent will be taken and signed by their caregivers upon receiving full
scope of the study and the questionnaires.

CONFIDENTIALITY: Please be assured that the highest level of confidentiality will be

adhered to. To this end, all information you provide be held in confidence and neither your
responses or identification be made known to anyone. All information taken from this study
will be coded, no names or other identifying information will be used when discussing or
reporting data. The files and data collected will be safely kept and secured.

AUTHORIZATION: By signing this form, you authorise the use of and disclosure of your
information for this research.

COMPENSATION: There will be no compensation for this study.

VOLUNTARY PARTICIPATION: Your participation in this study is completely

voluntary, and if you decide not to participate in this study, we assure you that it will not
affect your relationship with the researchers. You are free to withdraw at any time you don't
feel comfortable or choose not to continue. If you perhaps ever want to withdraw from this
study, the researchers will love to be appropriately informed and information collected prior
withdrawal may still be included in this study. However, we hope you are willing to
participate since your information and views on this matter are very important.
COST: There is no cost for participating in this study.

EXPECTED DURATION: This will not exceed the time you use to fill this questionnaire

CONTACT INFORMATION: The research team can be contacted via Randawa Sandra
Silas(0803 974 5384, sandrasilas0930@[Link]), Rindaps Isaac (08178134573,
rindapi4@[Link]), Riyin Rimam Ali (09121484457, aliriyin@[Link]) and Paul
Longnan Silas(09159396576, psilas713@[Link]).

LIMITATIONS OF STUDY

1. Ethical concerns: This means refusal of parents or caregivers to participate in study.

2. Cultural and environmental factors: These can affect this research because many
different cultures may have different beliefs about what constitutes a healthy diet,
which can make it difficult to compare results in this population.

3. Language barrier in non english speaking participants

REFERENCES

1. Shilpa N Bhupathiraju, Frank Hu Overview of nutrition

[Link]
overview-of-nutrition#:~:text=Nutrition%20is%20the%20process%20of,foods%20that
%20nourish%20the%20body. 2023

2. World Health Organization. Malnutrition.

[Link] 2021

3. Black RE, Morris SS, Bryce J. Where and why are 10 million children dying every year?
Lancet. 2003;361:2226–34.

4. United Nations Children's Fund . The state of the world's children 2009. Special edition:
celebrating 20 years of the convention on the rights of the child. New York: United
Nations Children's Fund; p. 92. 2009.

5. National Population Commission (Nigeria), ICF International. Nigeria Demographic and

Health Survey 2013. Rockville, Maryland, USA: National Population Commission, ICF
International; p. 10. 2014.

6. Paul Omorogbe How 22 states in Nigeria face risk of malnutrition, food insecurity in
2022. [Link]
food-insecurity-in-2022/. 2022
7. World Health Organization. World Health Statistics Report. 2010

8. United Nations. The Millennium Development Goals Report. 2015.

9. Galgamuwa, L.S., Iddawela, D., Dharmaratne, S.D. et al. Nutritional status and correlated
socio-economic factors among preschool and school children in plantation communities,
Sri Lanka. BMC Public Health 17, 377 (2017)

10. WHO Child Growth Standard [Link]

CONSENT FORM

Dear Respondent,
We are final year medical students of the College of Medicine and Health Sciences in
Bingham University, Karu. Our names are Randawa Silas Sandra, Isaac Rindaps, Riyin-
Rimam Ali and Paul Silas Longnan. We are conducting a research titled “nutritional status
among children under 5 in Jos North Local Government Area.”

PURPOSE: The purpose of this study is to assess the nutritional status and prevalence of
malnutrition among children under 5 in Jos North LGA

RESEARCH DESCRIPTION: When you enter this programme, you will be explained to
what the study is about and the objectives of study, after which you will fill this questionnaire
as your participation and measurements such as weight, height, head circumference, and mid
upper arm circumference will be taken for children under 5.

POTENTIAL RISKS AND DISCOMFORT: This study does not involve any known risk
as no invasive procedure will be carried out nor any sample obtained from you as a part of
this study.

POTENTIAL BENEFIT: The potential benefits of participating in this study are

1. Obtaining knowledge and understanding or added knowledge (if previously

enlightened) about types of food essential for children’s growth, importance of
balanced diets and importance of key nutrients such as vitamins and minerals.
2. Identification of risk factors and early signs of malnutrition in children so appropriate
measures are taken early.
3. Adequate nutrition plays a significant role in boosting the immune system and
reducing the risk of infections and diseases. This research can inform you about the
link between nutrition and prevention of conditions such as stunting, wasting,
anaemia and vitamin deficiencies.
4. Identification of warning signs and early indicators of nutrient deficiencies and
growth disorders.
5. For minors, consent will be taken and signed by their caregivers upon receiving full
scope of the study and the questionnaires.

CONFIDENTIALITY: Please be assured that the highest level of confidentiality will be

adhered to. To this end, all information you provide be held in confidence and neither your
responses or identification be made known to anyone. All information taken from this study
will be coded, no names or other identifying information will be used when discussing or
reporting data. The files and data collected will be safely kept and secured.

AUTHORIZATION: By signing this form, you authorise the use of and disclosure of your
information for this research.

COMPENSATION: There will be no compensation for this study.

VOLUNTARY PARTICIPATION: Your participation in this study is completely
voluntary, and if you decide not to participate in this study, we assure you that it will not
affect your relationship with the researchers. You are free to withdraw at any time you don't
feel comfortable or choose not to continue. If you perhaps ever want to withdraw from this
study, the researchers will love to be appropriately informed and information collected prior
withdrawal may still be included in this study. However, we hope you are willing to
participate since your information and views on this matter are very important.

COST: There is no cost for participating in this study.

EXPECTED DURATION: This will not exceed the time you use to fill this questionnaire

CONTACT INFORMATION: The research team can be contacted via Randawa Sandra
Silas(0803 974 5384, sandrasilas0930@[Link]), Rindaps Isaac (08178134573,
rindapi4@[Link]), Riyin Rimam Ali (09121484457, aliriyin@[Link]) and Paul
Longnan Silas(09159396576, psilas713@[Link]).

I,_______________________________________________one of the selected participants

have read/ listened to the information in the consent and understand what is required of me. I
understand that my participation is voluntary, I know enough about the purpose, objectives
and methods of this study. I also understand that I can withdraw at any time, without giving a
reason. Therefore, I agree to participate in the study.

Participant signature_____________, Date_________________