Chapter One

Introduction

1.1 Background of Study

Malnutrition is a health condition resulting from eating food that contains either insufficient or too

many calories, carbohydrates, vitamins, proteins or minerals. (Davis JN, Oaks BM, Engle-Stone,

2015). It is a state of under- or overnutrition, evidenced by a deficiency or an excess of essential

nutrients (Zhang N, Ma G. Interpretation of WHO guideline, 2017). Good nutrition is the basic need

for children to thrive, grow, learn, play and participate. Section 28(1) (c) of the Bill of Rights in the

South African Constitution guarantees every child the right to basic nutrition, shelter, basic

healthcare services and social services that are related to the best interests of the child. Access of

every child to sufficient food may be the responsibility of parents and child to determine the

fulfilment of this right. Malnutrition often steals dreams from their young lives and hangs their

future in the balance. (Vollmer S, Harttgen K, Kupka, 2019). It remains a major public health

concern for children under the age of 5 years in many low- and middle-income countries because it

is still the leading underlying cause of child mortality in these countries. (Clark H, Coll-Seck AM,

Banerjee A, et al). Children are more vulnerable to macro- and micronutrient deficiencies caused by

high demand for food during their years of growth. (Pomati M, Nandy, 2018). The effects of

malnutrition in children under the age of 5 years include underweight, stunting, wasting with or

without oedema (previously known as marasmus and kwashiorkor, respectively) and even death

(Tebeje NB, Biks GA, Abebe SM, Yesuf ME, 2020).

Malnutrition is the most severe consequence of food insecurity amongst children under the age of 5

years. Acute malnutrition can lead to morbidity, mortality and disability, as well as impaired

cognitive and physical development with an increased risk of concurrent infections (Wali N, Agho K,

Renzaho AMN, 2019). Physical and mental health development is a fundamental right of a child, and

1
their optimum level of health can be accessed with good nutritional support (Koetaan D, Smith A,

Liebenberg A, et al).

Figure 1 demonstrates the consequences of malnutrition under the age of 5 years.

On 1 April 2016, the United Nations General assembly declared a decade of action on nutrition to

address all forms of malnutrition by 2025 (May J, Witten C, Lake L, Skelton A. The slow violence of

malnutrition. S Afr Child Gauge 2020 [serial online] 2020). The Sustainable Development Goal

(SDG)-2 (end hunger, achieve food security and improve nutrition), SDG-3 (ensure healthy lives and

promote well-being for all ages) and the Global strategy for Women’s, Children’s and Adolescent’s

health also set the relevant nutritional outcome targets by 2030(World Health Organization (WHO).

The global strategy for women’s, children’s and adolescent’s health, 2016).

Despite the ample support from the United Nations International Children’s Emergency Fund

(UNICEF), World Health Organization (WHO) and World Bank towards achieving nutritional

freedom, we are still far from the world without malnutrition (UNICEF, WHO, World Bank. Levels

and trends in child malnutrition: Key findings of the 2020 Edition of the Joint Child malnutrition

estimates. Geneva: WHO, 2020; vol. 24, no. 2, p. 1–16). The WHO report published in March 2020

revealed insufficient progress towards the World Health Assembly targets set for 2025 and the SDG

set for 2030. According to the WHO 2020 report, about 144 million children under 5 years have

stunted growth, 47 million children are wasted and 14.3 million are severely wasted, whilst 38.3

million are overweight or obese (Drammeh W, Hamid NA, Rohana AJ. Determinants of household

food insecurity and its association with child malnutrition in sub-Saharan Africa: A review of the

literature. Curr Res Nutr Food Sci. 2019). According to the 2016 South Africa Demographic and

Health Survey (SADHS), the prevalence rate of wasting was found to be 2.5% and underweight was

6%, whilst the stunting rate remained high at 27.0% amongst children under 5 years. Around 45% of

deaths reported amongst children under the age of 5 years are linked to undernutrition (Kalu RE,

2
Etim KD. Factors associated with malnutrition among under five children in developing countries: A

review. Glob J Pure Appl Sci. 2018).

1.2 Causes of Malnutrition

Malnutrition amongst children under the age of 5 years is a result of a complex interaction of

availability, accessibility, and utilization of food and healthcare services. Nutrition-specific factors

include inadequate food intake, poor caregiving and parenting, improper food practices and

infectious comorbidities. Nutrition-sensitive factors include food insecurity, inadequate economic

resources at the individual, household, and community levels. Limited or poor access to education,

healthcare services, infrastructure and poor hygienic environment are other nutritional sensitive

factors that adversely affect the children under the age of 5-year nutritional status (May J, Witten C,

Lake L, Skelton A. The slow violence of malnutrition. S Afr Child Gauge 2020 [serial online] 2020).

Figure 2 demonstrates the theoretical framework for the causes of malnutrition under the age of 5

years. The major factors affecting the nutritional status of children under the age of 5 years are

classified into the following three categories.

3
1.3 Individual Level Factors

The risk factors for malnutrition on the basis of individuals include age, gender, birthweight,

breastfeeding and childhood comorbidities. Teenage pregnancy, lower maternal education, low

birthweight, lack of breastfeeding and personal food preference are also individual determinants of

malnutrition of children under the age of 5 years. Although low birthweight is an individual factor, it

is influenced by maternal health and nutritional status, as well as food security at the household or

community level.

1.4 Household-Level Factors

At the household level, age, gender, geographical area, level of maternal education, family income,

household size, food security and healthcare access are important factors that had a significant

association with child malnutrition. (Drammeh W, Hamid NA, Rohana AJ, 2021). Malnutrition is an

economic problem at the household level, which is accompanied by poverty, disturbed family

structure, and ignorance of health and wellness of children. The National Income Dynamics Study –

Coronavirus Rapid Mobile Survey (NIDS-CRAM) reported strong evidence of rapid increases in

household and food insecurity during the coronavirus disease-19 pandemic. Lack of awareness of the

nutritional quality of food, cultural and community beliefs about food and inappropriate feeding

habits all lead to malnutrition amongst children under the age of 5 years. The nurturing care that

children receive early in their life provides the basis for prospective nutritional status, with children

of teenage mothers and younger household heads being more likely to be undernourished.

1.5 Community-Level Factors

The indicators of childhood malnutrition at the household level are influenced by place of residence,

household infrastructure, income and ethnicity. (Hone T, Macinko J, Millett, 2022). The area of

residence is a proxy indicator to determine the nutritional status of children for environmental risks,

availability of health and wellness services, and shared community and cultural beliefs. Most of the

South African villages have poor dwellings with poor access to basic services, including water,

4
sanitation, electricity and healthcare facilities, which increased the risk of childhood malnutrition

under the age of 5 years. (World Health Organization (WHO). The global strategy for women’s,

children’s and adolescent’s health. (2016–2030). The external force that influences food availability,

accessibility and utilization is highly influenced by politics, ideology, pandemics, economics and

climate. (Koetaan D, Smith A, 2023). Community wealth, community education level, prevalence of

communicable diseases (e.g. human immunodeficiency virus [HIV], Tuberculosis [TB], etc.), and

the distance of community to healthcare facilities also have a great influence on the child nutritional

status.

1.6 Aim and Objectives

The primary aim of addressing malnutrition is to improve the health and well-being of individuals

and communities by ensuring adequate nutrition for all, and the objectives include reducing

undernutrition, preventing and managing overnutrition, and promoting healthy dietary practices. This

involves tackling both undernutrition, like stunting and wasting, and overnutrition, including obesity,

and promoting sustainable food systems.

Aims:

 Eradicate malnutrition in all its forms:

This includes undernutrition (e.g., stunting, wasting, underweight) and overnutrition (e.g., obesity).

 Improve overall health and well-being:

Adequate nutrition is crucial for physical and cognitive development, immune function, and

preventing chronic diseases.

 Promote sustainable food systems:

Ensuring access to nutritious and affordable food for all, while minimizing environmental impact.

 Reduce health care costs:

Addressing malnutrition can reduce the burden on healthcare systems by preventing nutrition-related

illnesses.

5
  Boost economic growth:

Healthy individuals are more productive, contributing to economic development.

 Achieve Sustainable Development Goals:

Malnutrition reduction is directly linked to several SDGs, particularly SDG 2: Zero Hunger.

Objectives:

 Reduce child undernutrition:

This includes reducing stunting (low height-for-age), wasting (low weight-for-height), and

underweight (low weight-for-age) in children under five.

 Improve maternal and infant nutrition:

Addressing the nutritional needs of pregnant and breastfeeding women and infants is critical for their

health and the child's development.

 Promote healthy dietary practices:

Encouraging balanced diets with sufficient vitamins and minerals, and promoting healthy eating

habits from a young age.

 Strengthen healthcare systems:

Integrating nutrition services into primary healthcare and improving access to quality nutrition

interventions.

 Address food insecurity:

Ensuring access to sufficient, safe, and nutritious food for all populations, especially vulnerable

groups.

 Enhance community resilience:

Empowering communities to address malnutrition through education, income-generating activities,

and sustainable food production.

 Monitor and evaluate progress:

Tracking malnutrition rates and the effectiveness of interventions is crucial for improving strategies.

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1.7 Problem Statement

Malnutrition, encompassing both undernutrition and overnutrition, is a serious public health problem

with far-reaching consequences, particularly for children under five. It is a major underlying cause of

death in this age group, significantly increasing the risk of mortality from common infections and

hindering physical and cognitive development. Malnutrition also contributes to a cycle of poverty,

impacting productivity and economic growth.

1.8 Scope of Study

This research work encompasses and investigates the prevalence, causes, consequences, and

prevention of both undernutrition and overnutrition, including related health issues. It involves

examining dietary inadequacies, infections, socio-cultural factors, and the interplay of various health

systems. The study of malnutrition also extends to understanding its developmental, economic,

social, and medical impacts on individuals, families, communities, and nations.

1.9 Justification of Study

Studying malnutrition is crucial due to its widespread impact on health, development, and

socioeconomic well-being. It's a significant public health problem, particularly affecting children

under five, and contributes to morbidity and mortality. Understanding the causes and consequences

of malnutrition is essential for developing effective interventions to improve individual lives and

promote societal progress.

 Public Health Significance:

Malnutrition, encompassing both undernutrition and overnutrition, is a major contributor to ill health

and mortality, with undernutrition being a primary factor in many child deaths. It is a global issue,

but particularly prevalent in low- and middle-income countries.

 Impact on Child Development:

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Malnutrition, particularly during critical periods of growth like infancy and early childhood, can lead

to stunting, wasting, and micronutrient deficiencies, hindering physical and cognitive

development. This can have long-lasting consequences for an individual's health, education, and

economic potential.

 Intergenerational Cycle of Malnutrition:

Malnutrition in mothers can lead to low-birth-weight babies, who are more susceptible to

malnutrition themselves, perpetuating a cycle of ill health across generations.

 Economic Burden:

Malnutrition increases healthcare costs, reduces productivity, and slows economic growth,

contributing to poverty.

 Impact on Immune Function:

Malnutrition can impair immune function, making individuals more vulnerable to infections and

hindering their response to treatment.

 Need for Effective Interventions:

Studying malnutrition helps identify specific risk factors and allows for the development of targeted

interventions, such as nutritional education, supplementation programs, and food security initiatives.

 Ethical Considerations:

Ensuring adequate nutrition is a fundamental human right, and addressing malnutrition is a moral

imperative to protect vulnerable populations.

8
 Chapter Two

Literature Review

2.1 Introduction

Nearly half of all deaths in children under 5 are attributable to under nutrition; under nutrition puts

children at greater risk of dying from common infections, increases the frequency and severity of

such infections, and delays recovery.

The reference population is based on the WHO Child Growth Standards, 2006 some children can

suffer from more than one form of malnutrition - such as stunting and overweight or stunting and

wasting. There are currently no joint global or regional estimates for these combined conditions, but

UNICEF has a country-level dataset with country level estimates, where re-analysis was possible.

2.2 Growth Standard

Prevalence children under 5 affected by stunting, wasting and overweight are estimated by

comparing actual measurements to an international standard reference population. In April 2006, the

World Health Organization (WHO) released the WHO Child Growth Standards to replace the widely

used National Center for Health Statistics (NCHS)/WHO reference population, which was based on

a limited sample of children from the United States of America. The new standards are the result of

an intensive study project involving more than 8,000 children from Brazil, Ghana, India, Norway,

Oman and the United States. Overcoming the technical and biological drawbacks of the old reference

population, the new standards confirm that children born anywhere in the world and given the

optimum start in life have the potential to reach the same range of height and weight. It follows that

differences in children's growth to age 5 are more influenced by 5 nutrition, feeding practices,

9
environment and health care than by genetics or ethnicity. The new standards should be used in

future assessments of child nutritional status. It should be noted that because of the differences

between the old reference population and the new standards, prevalence estimates of child

anthropometry indicators based on these two references are not readily comparable. It is essential

that all estimates are based on the same reference population (preferably the new standards) when

conducting trend analyses.

2.3 The Joint Malnutrition Estimates Methodology

The UNICEF-WHO-World Bank JME Working Group was established in 2011 to address the call for

harmonized child malnutrition estimates that would be instrumental in benchmarking progress on

child malnutrition. The first edition of the JME was released in 2012 and provided estimates for

stunting, wasting, severe wasting, underweight and overweight, as well as a detailed description of

the methodology (UNICEF & WHO, 2012). Since its inception, the JME outputs have comprised a

harmonized country-level dataset of primary data (e.g., national estimates based on household

surveys), as well as regional and global model-based estimates.

For the first time in 2021, the JME also includes country-level modelled estimates for stunting and

overweight based on updated methodology (Mclain et al. 2019) developed by the JME Working

Group in partnership with the University of South Carolina. The regional and global figures for

stunting and overweight are now also based on these country model outputs, while they remain based

on the previously applied sub-regional model for wasting and severe wasting (UNICEF & WHO,

2012). Additional work is ongoing to update methods for wasting and severe wasting for which

available data are not as stable as for stunting and overweight The IME process for the 2021 edition

involved the following steps (1) updating of the country dataset of primary sources (eg, national

household surveys), (0) application of a country level model for stunting and overweight to generate

annual estimates; (iii) generation of regional and global aggregates for stunting, wasting. severe

10
wasting and overweight; and (iv) consultation with countries before finalizing and disseminating the

2021 estimates. These parts of the JME are described in more detail below.

2.4 The Joint Malnutrition Estimates Dataset of Country Estimates

The JME dataset of country estimates requires the collection of national data sources that contain

information on child malnutrition, specifically that collected data on the height, weight and age of

children under 5, which can be used to generate national-level prevalence estimates for stunting,

wasting, severe wasting and overweight. These national-level data sources are mainly comprised of

household surveys e.g., Multiple Indicator Cluster Surveys (MICS), Demographic and Health

Surveys (DHS), Standardized Monitoring and Assessment of Relief and Transition (SMART)

surveys, and Living Standards Measurement Study (LSMS). Some administrative data sources (e.g.,

from surveillance systems) are also included where population coverage is high.

As of the latest review closure on 31 January 2021, the primary source dataset contained 997 data

sources from 157 countries and territories, with nearly 80 per cent of children living in countries with

at least one date point on stunting, wasting and overweight that is less than 5 years old. The dataset

contains the point estimate, and where available, the standard error, the 95 per cent confidence

bounds and the un weighted sample size. Where Micro data are available, the JME uses estimates

that have been recalculated to adhere to the global standard definition (UNICEF & WHO, 2019).

Where Micro data are not available, reported estimates are used, except in cases where adjustments

are required to standardize for: (i) use of an alternate growth reference from the 2006 WHO Growth

Standards; (ii) age ranges that do not include the full 0-59-month age group; and (iii) data sources

that were only nationally representative for populations residing in rural areas. Further details related

to data source compilation, re-analysis of Micro Data, and data source review are provided elsewhere

(UNICEF & WHO, 2020).

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2.5 Country-Level Model for Stunting and Overweight Estimates Rationale

National surveys are administered sporadically, resulting in sparse data for many countries. This

hampers efforts to monitor the community, city, state and countries' progress towards targets, such as

the SDG targets. The use of statistical models at country level is important to enable comparisons

across countries at the same year, filling in the gaps. In addition, statistical models are an efficient

way to adjust for unwarranted variability.

2.6 Model Description

The technical details of the statistical models are provided elsewhere (UNICEF & WHO, 2020).

Modeled at logit (log-odds) scale using a penalized longitudinal mixed model with a heterogeneous

error term. The quality of the models was quantified with model-fit criteria that balance the

complexity of the model with the 5 closeness of the fit to the observed data. The proposed method

has important characteristics, including non-linear time trends, regional trends, country-specific

trends, covariate data and a heterogeneous error term. All countries with data contribute to estimates

of the overall time trend and the impact of covariate data on the prevalence. For overweight, the

covariate data consisted of linear and quadratic socio-demographic index (SDI)**, and data source

type. The same covariates were used for stunting, plus an additional one of the average health system

accesses over the previous five years (UNICEF & WHO, 2020).

2.7 Model Outputs

Annual country-level modelled estimates from 2000 to 2020 on stunting and overweight were

disseminated by the JME in 2021 for 155 countries with at least one data point (e.g. from a

household survey) included in the country dataset of primary sources described in section 2.1 above.

Modelled country estimates were also produced for an additional 49 countries, used solely for

generation of regional and global aggregates. Modelled estimates for these 49 countries are not

shown because they did not have any household surveys in the JME country dataset or because the

modelled estimates remained pending final review at the time of publication. The results for the 204
12
countries can be used to calculate estimates and uncertainty intervals for any groups of countries

aggregated. The uncertainty intervals are important in monitoring trends, especially for countries

with sparse data and where primary data sources present large primary data source sampling errors

(SSE). When only sparse data are available in the most recent period, the inclusion of a survey can

affect a substantial change in the predicted trajectory. For this reason, uncertainty intervals are

needed to enhance trend interpretability in terms of the caution level employed. The uncertainty

intervals for the new JME method have been tested and validated with various data types.

2.8 Generation of Regional and Global Estimates

Different methods were applied to generate regional and global estimates for stunting and overweight

compared to wasting and severe wasting for the 2021 edition of the JME as described below. In

short, results from the new country-level model were used to generate the regional and global

estimates for stunting and overweight, while the JME sub-regional multi-level model (UNICEF &

WHO. 2012, de Onis et al. 2004), was used to generate the global and regional estimates for wasting

and severe wasting.

2.9 Stunting and Overweight

Global and regional estimates for all years from 2000 to 2020 were derived as the respective country

averages weighted by the country’s under-5 population from The United Nations World Population

Prospects, 2019 Revision, using model- based estimates for 204 countries. This includes 155

countries with national data sources (e.g. household surveys) included in the JME country dataset

described in section 2,1 above. It also includes 49 countries with modelled estimates generated for

development of regional and global aggregates but for which country modelled estimates are not

shown because they did not have any household surveys in the JME country dataset or because the

modelled estimates remained pending final review at the time of population. Confidence interval

were generated based on bootstrapping metho2.8 WASTING AND SEVERE WASTING: The

wasting and severe wasting prevalence data from national data sources described in se section 2.1
13
above were used to generate the regional and global estimates for the year 2020 using the JME sub-

regional multi-level model (UNICEF & WHO, 2012, de Onis et al. 2004), applying population

weights for children under 5 years of age from The United Nations World Population Prospects,

2019 Revision.

2.10 Country Consultations

For the estimates presented in the 2021 edition of the JME, joint UNICEF-WHO country

consultations were conducted from November 2020 to January 2021. The purpose of these

consultations was to explain the updated methodology for stunting and overweight estimates to

national governments; to ensure the estimates included all recent and relevant country data for

stunting, wasting and overweight; and to engage with and receive feedback from national

governments on the estimates.

14
 Chapter Three

Research Methodology

3.1 Other Notes on the Joint Malnutrition Estimates

Explanation as to why trends are shown for stunting and overweight but only most current estimate

for wasting and severe wasting: The JME on wasting and severe wasting are based on national-level

prevalence data alone and thus do not reflect the cumulative cases (incidence) that occur over the

course of a year (Isanaka et al 2021). Wasting is a relatively short-term condition, which means that

an individual child can be affected more than once in a calendar year (i.e., can recover but then

become wasted again in the same year). The global prevalence-based estimates of 45.4 million

children under 5 affected by wasting and 13.6 million affected by severe wasting in 2020 should

therefore be cirsed as an underestimate of the number of children affected and in and of mestroent

that year.

Wasting is also affected by seasonality, meaning that prevalence may vary greatly between the pre-

harvest season (which is often associated with food shortages, heavy rains and related diseases that

can affect nutrition status) and the post- harvest season (which is often associated with higher food

availability and weather patterns that are less likely to cause disease). Yet the country data that feed

into the JME can be collected during any season. This means that prevalence for any given survey

might be at a high or low; or it may fall somewhere in between if data are collected across seasons.

The lack of incidence data for wasting and severe wasting is a main reason why the JME does not

present annual trends for these forms of malnutrition. Since the prevalence data are collected
15
infrequently (every 3 to 5 years) in most countries and measure wasting at one point in time, it is not

possible to capture the rapid fluctuations in wasting over the course of a given year or to adequately

account for variations in seasons across survey years. In contrast, stunting and overweight are

relatively stable over the course of a calendar year, making it possible to track changes in these two

conditions over time with prevalence data.

3.2 Estimating Country-Level Progress

Country-level progress in reducing malnutrition prevalence is evaluated by calculating the actual

average annual rate of reduction (AARR) achieved by the country "to date", and comparing this to

the AARR needed in order to achieve target. For more information about how to calculate country-

level AARR, please click here to read a technical note. A Nutrition Targets Tracking Tool which

provides AARR levels for different scenarios is also available to investigate progress towards the

2025 World Health Assembly (WHA) nutrition targets for each country.

Footnotes

**SDI is a summary measure that identifies where countries or other geographic areas sit on the

spectrum of development. Expressed on a scale of 0 to 1, SDI is a composite average of the rankings

of the incomes per capita, average educational attainment, and fertility rates of all areas in the Global

Burden of Disease study.

3.3 Population of the Study

The target population of the study area consists of all the malnourished children ranging from 0-5

years in Gwagwa. The researcher used a total of 100 respondents out of the whole population in the

study area.

16
3.4 Sample and Sampling Techniques

For the purpose of this study, 100 children were selected to be used from the entire population in

Gwagwa in AMAC. The sample technique used was simple random techniques to sample the

required numbers of the respondents.

3.5 Instrument for Data Collection

The instrument for data collection is a structured items questionnaire which is subdivided into four

(4) sections. Thus, Section A [Bio data], Section B [Research Question One], Section C [Research

Question Two] and Section D [Research Question Three] Respectively.

3.6 Procedure for Data Analysis

The uses of descriptive frequency statistical section A (Bio data) with the formula.

X/Y x 100/1

That is: X =Number of respondents

Y=Total number of respondents

100= Percentage

X = EFX/F=95

45 x 100/95=48.4

25 x 100/95= 26.3

20 x 100/95=21.6

5 x 100/95=5.3

17
 Chapter Four

4.0 Introduction

This chapter deals with the presentation and analysis of all the data collected. The data were

collected through the use of questionnaire. Hundred [100] copies of the questionnaire were

distributed to the respondent in Gwagwa. Out of the total number of distributed, [95] questionnaires

were filled and returned in which 5 copies out of the [100] were missing.

Table 1 below indicates that the majority of respondent under the age are 47.4% at age of 21-31

while the respondent between the ages of 10-20 are 31.6% and the respondent of adult are 21.0%.

Age of Respondents

Table:1 Age of Respondents

Age Frequency Percentage %

10-20 30 31.6

21-31 45 47.4

Adult 20 21.0

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 Total 95 100

Table 2 Result indicates that majority of respondent are male at 63.2% while, the minor respondents

are female at 36.8%.

Table:2 The Gender Report

Gender Frequency Percentage %

Male 60 63.2

Female 35 36.8

Total 95 100

Table 3: The outcome shows that the majority of respondent are single at 21.1% while the majority of

those married is at 26.3%, Widow is 21.1% and Divorced is 31.6%.

Table:3 The marital status of Respondents

Marital Frequency Percentage %

Single 20 21.1

Married 25 26.3

Widow 20 21.1

Divorced 30 31.1

Total 95 100

Table 4: The result indicates that the majority of respondent are Primary 36.8,Secondary 42% and

Tertiary 21.1%.

Table:4 Educational status

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Education Frequency Percentage %

Primary 35 36.8

Secondary 40 42

Tertiary 20 21.1

Total 95 100

Table 5 shows that majority of respondent are house wife 42%, Civil servant 2.1% and Business

36.8%.

The table shows occupational status

Housewife 40 42

Civil servant 20 21.1

Business 35 36.6

Total 95 100

Chapter Five

Summarily, the case of malnutrition should not be overlooked because every developing human

needs to be educated on how to prevent malnutrition among children of developing age.

20
5.1 RECOMMENDATION

(1) Government should strategize means of impounding economic value to ensure adequate financial

circulation.

(2) Mothers of child bearing age should be educated on the benefits of nutrition and effect of

malnutrition to health during ANC.

(3) People should be encouraged to practice baby friendly [Exclusive breast feeding].

(4) Parents should be encouraged to eat healthy. (5) Parents should give children what they need not

what they want.

(6) Parent should be educated on how to combine and prepare nutritious meals for children to feed

well.

REFERENCES

(1) de Onis M, Blossner M, Borghi E, Morris R, Frongillo EA. Methodology for estimating

regional and global trends of child malnutrition. International Journal of Epidemiology 33:1260-

1270.

(2) deOnis, M., et al. (2018). Prevalence thresholds for wasting, overweight and stunting in

children under 5 years. Public health nutrition, 22(1), 175-179.

(3) Isanaka S, Andersen CT, Cousens S, et al. Improving estimates of the burden of severe

wasting: analysis of secondary prevalence and incidence data from 352 sites. BMJ Glob Health.

2021;6(3):e004342. Doi:10.1136/bmjgh-2020-004342.

(4) McLain AC, Frongillo EA, Feng J, Borghi E. Prediction intervals for penalized longitudinal

models with multisource summary measures: an application to childhood malnutrition. Statistics in

Medicine 38:1002-1012, 2019.

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(5)United Nations Children’s Fund, World Health Organization, The World Bank. UNICEF-WHO-

World Bank Joint Child Malnutrition Estimates. (UNICEF. New York; WHO, Geneva; The World

Bank, Washington, DC, 2012).

(6) UNICEF & WHO 2019. Recommendations for data collection, analysis and reporting on

anthropometrie indicators in children under 5 years old. Geneva: World

Health Organization and the United Nations Children’s Fund (UNICEF), 2019. Licence:

CC BY-NC-SA 3.0 IGO. Accessed online 23 October 2021, url:

[Link] anthropometric-indicators-in-

children-under-5/

(7) UNICEF-WHO-World Bank 2020. SDG Indicators 2.2.1 on stunting, 2.2.2a on wasting and

2.2.2b on overweight: Country consultation background document for 2021 edition of the Joint

Malnutrition Estimates. (also available at:

[Link]

QUESTIONIARE

Age of Response

Age 10 – 30 30 21 – 31 45 Adult 20

Gender Report

Male 60 Female 32

22
Marital Status of Respondents

Single 20 Married 25 Widows 20 Divorced 30

Education Status

Primary 35 Secondary 40 Territory 20

Occupational Status

Housewife 40 Civil Servant 20 Business 35

23