CHAPTER ONE

INTRODUCTON

1.1 Background of the Study

Malnutrition remains a major public health challenge in developing countries. It is one of the

most important risk factors for the burden of disease causing about 300,000 deaths per year

directly and indirectly responsible for more than half of all deaths in children. In Nigeria, it is

one of the main causes of morbidity and mortality among other diseases (Demissie and Worku,

2013). Malnutrition is simply defined as the imbalance of nutrients in the body. It could be over

nutrition or under nutrition. Globally in 2020, 149 million children under 5 years of age were

estimated to be stunted (too short for age), 45 million were estimated to be wasted (too thin for

height), and 38.9 million were overweight or obese. Among children under 5 years of age, 45%

of deaths are linked to under nutrition. These mostly occur in low- and middle-income countries.

At the same time, in these countries, rates of childhood overweight and obesity are rising (WHO,

2020).

Malnutrition refers to getting too little or too much of certain nutrients. It can lead to serious

health issues, including stunted growth, eye problems, diabetes, and heart diseases (Lizzie streit,

2018). Malnutrition also known as the deficiency of nutrition is one of the major health problem

faced by children in developing countries (Mengistu et al., 2013). Malnutrition can be classified

as under nutrition which result due to insufficient intake of nutrient and energy, and over

nutrition which occurs due to excessive consumption of nutrient and energy (Sufiyan et al.,

2012). The double burden of malnutrition adversely affects the growth, health, intellectual

development, and school attendance of school-aged children. Through its effects on health, the

double burden of malnutrition increases the costs of health care, reduces productivity, and slows

economic growth, which in turn can perpetuate a cycle of poverty and ill-health. Malnutrition is
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not exclusively a problem of extreme poverty, nor only of the young, but affects all communities

around the world and people of all ages including pregnant women. Despite impressive progress

in reducing hunger and poverty, about 800 million people worldwide continue to suffer from

undernourishment.

Food choice is defined as a process by which people select, acquire, prepare and consume foods,

which results from the competing, reinforcing and interacting influences of a variety of factors

(Karanja et al., 2022). Diets, nutrition and health outcomes are in part, consequences of

interrelated food choice factors which poses challenges for implementing interventions aimed at

addressing malnutrition and dietary challenges in LMICs (FAO and WHO, 2019). Poor diets and

undesirable dietary patterns have been found to be associated with the development of negative

health outcome including cardiovascular diseases, diabetes, obesity and some cancers. There is a

belief that children with poor dietary habits are likely to become adults with poor diets. It is also

noted that childhood food habits persist into late adolescence or adulthood. Once school children,

enter into the outside world of formal education, they are vulnerable subjects to myriad forces

which influence life time attitudes and behaviours, food choices and habits. The influencing

factors include: taste preference, family, school practices, media messages and other children

(Abdollahi et al., 2011).

Improving the educational status of parents, especially mothers, on nutrition, sanitation and

common disease prevention strategies should logically reduce the rate of mortality and morbidity

influenced by malnutrition. It is said that the way to a child’s stomach is through the mind of the

mother. Quality of food taken, choices and quantity are all at the discretion of the mother or care

giver. This problem is very crucial in sub–Saharan African, where access to formal education for

a girl child in certain communities is still a major burning challenge. The burden of malnutrition

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has been directly linked to poverty, quality of food intake, excessive disease and poor health

status. Economic growth and human development require well-nourished populations who can

learn new skills think critically and contribute to their communities.

Economic development is normally accompanied by improvements in a country’s food supply

and the gradual elimination of dietary deficiencies, thus improving the overall nutritional status

of the country’s population. However, the Food and Agriculture Organisation (FAO) reports

point out that increasing urbanization in poor countries has consequences which are not always

positive. In countries with widespread deprivations, when food supply becomes more abundant,

there occur changes in diets, patterns of work and leisure which is often referred to as Nutrition

Transition. The diet shifts toward a higher energy density with a larger role of fat and sugars and

foods. The greater saturated fat intake, reduced fruit and vegetable intake and reduced intake of

complex carbohydrates and dietary fibre may have negative consequences. The dietary changes

long with reduced physical activity result in obesity and an epidemic of non- communicable

diseases in developing countries

1.2 Statement of Problem

Malnutrition continues to be a major public health problem in children in all developing

countries. Globally in 2020, investigation revealed that 149 million children under age 5 were

estimated to be too short for age, 45 million were estimated to be too thin for height, and 38.9

million were overweight or obese. Furthermore, around 45% of deaths among children under 5

years of age were linked to under-nutrition which is prevalent in low and middle-income

countries (WHO, 2020). In Nigeria, it is one of the main cause of morbidity and mortality among

other diseases. Malnutrition causes Nigeria billions in lost revenue through reduced economic

productivity, days away from work due to illness and money spent on treating ailments (World

3
Bank, 2014). The negative impacts of malnutrition are seen in families and communities in

various aspects such as economically, medically and socially. Lack of mother’s education and

knowledge about malnutrition in children under five years of age could be the contributing

factors of malnutrition among children in Nigeria. Therefore, this study intends to examine

malnutrition and the factors affecting food choice of children between age 0 and 5 because it is

imperative for mothers to have detailed knowledge of nutrition for the wellbeing and healthy

development of their children.

1.3 Aims of the Study

This study intend to examine malnutrition and the factors affecting food choices among children

under five years of age in Obafemi Owode local government Mowe, Ogun State, Nigeria.

1.4 Objectives of the Study

Specifically, the study sought to;

i. Discover whether children have adequate knowledge of the proper nutritional intake with the

help of their parents.

ii. Determine the extent of prevalence of malnutrition in children between age 0 and 5.

iii.Determine whether the food choices of children contribute to the high level of malnutrition in

the communities.

iv.Examine factors that affect food choices in children such as poor income status, family

background, cultural beliefs, food security and food choices.

1.5 Significance of the Study

This study is will be of benefit to the government because it will help them in in formulating

policies that will enhance the proper management of malnutrition in the country.

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Children health administrators will be able to invent the ideal ways of putting in place a proper

nutrition interventions.

It will also assist mothers to have a better understanding of their roles in educating their children

on the effect of malnutrition and its related factors.

1.6 Scope of the Study

This study focused on malnutrition and the factors affecting food choice in children under five

years of age using Obafemi-Owode Local Government Area of Ogun State as a case study.

Specifically, this study focuses on discovering whether mothers have adequate knowledge of the

proper nutritional intake of their children, determining the extent of prevalence of malnutrition in

children, determining whether the food choices of their children contribute to the high level of

malnutrition to the communities, and examining the factors affecting food choices in children.

1.7 Research Questions

i. Does mothers have adequate knowledge of the proper nutritional intake of their children?

ii. What is the extent of prevalence of malnutrition in children and its effect on their immediate

community?

iii.What are the most effective interventions in combating malnutrition in low-income

communities?

iv.What role does cultural dietary practices play in the prevalence of malnutrition in children

how can the nutrition be monitored?

1.8 Research Hypotheses

H1 There is no significant relationship between the knowledge gathered by mothers and proper

nutritional intake of their children

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H2 There is no significant relationship between the extent of prevalence of malnutrition in

children and its effect on their immediate communities

H3 There is no significant relationship between the most effective interventions in combating

malnutrition and its impact on low-income communities.

H4 There is no significant relationship between cultural dietary practices and prevalence of

malnutrition in children even when monitored with intervention strategies.

1.9 Definition of Terms

Malnutrition: Malnutrition refers to a condition where there is imbalance between the nutrient a

person consumes and the nutrients their body requires for proper growth, development and

maintenance of health. It can be under nutrition, where a person does not receive enough

essential nutrients, and over nutrition, where there’s an excess of certain nutrients while lacking

others (WHO).

Nutritional Status: This is a condition of the body, influenced by the level of nutrients in the

body and the ability of those levels to maintain normal metabolic integrity.

Under Nutrition: This is defined as the insufficient intake of energy or nutrients required to

meet an individual's needs to maintain good health (Maleta 2006). In other words, it is a

condition where an individual is not getting enough calories, protein or micronutrients.

Over Nutrition: This is refers to as a form of imbalanced nutrition arising from excessive intake

of nutrients, leading to accumulation of body fat that impairs health. This can result in weight

gain, obesity and various health issues such as diabetes, cardiovascular diseases, and metabolic

disorders.

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Food: Food is any substance that is consumed to provide nutritional support to the body. It is

usually of plant or animal origin and contains essential nutrients such as carbohydrates, protein,

fats, vitamin or minerals.

Food Choices: It refers to the decisions individuals make about what they eat. These decisions

can be influenced by factors like personal taste, cultural background, health considerations,

dietary restrictions, and ethical beliefs.

Macro nutrients: These are the essential nutrients required by organisms in large quantities for

growth, energy production and bodily functions. They are carbohydrates, protein and fats.

Micro nutrients: These are the essential nutrients that the body the body require in small

quantity for proper growth, development and overall function. They include vitamins and

minerals.

Diseases: It refers to a deviation from the normal functioning of the body or mind, often

characterized by specific symptoms and signs.

Morbidity: This refers to the state of being diseased or the prevalence of disease within a

specific a specific population or group. It encompasses the overall burden of illness, including

both the number of people affected by a particular condition and the impact of that condition on

their and quality of life.

Mortality: This refers to the state of being subject to death or the occurrence of death.

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 CHAPTER TWO
LITERATURE REVIEW
2.1. Introduction

This chapter reviews literature related to the issue of malnutrition among children under the

following subheadings; Malnutrition and types, prevalence and impact of malnutrition, food

choices and factors affecting food choices, challenges in food choices, ways of promoting

healthy food choices, theoretical orientation, empirical related studies and interventions to

address malnutrition.

2.2. Conceptual Framework

2.2.1. Concepts of Malnutrition and its Nature in Nigeria Context

Malnutrition has been defined in various ways. The World Health Organization (WHO, 2016)

defines malnutrition as: “Deficiencies, excesses or imbalances in a person’s intake of energy

and/or nutrients.” The United Nations Children's Fund (UNICEF, 2012) says: “People are

malnourished if their diet does not provide adequate nutrients for growth and maintenance or if

they are unable to fully utilize the food they eat due to illness (under-nutrition). They are also

malnourished if they consume too much energy (over-nutrition).” The Food and Agriculture

Organization of the United Nations (FAO, 2017) gives the following definition: “Malnutrition

results from deficiencies, excesses or imbalances in the consumption of macro- and/or

micronutrients.” In short, malnutrition occurs when there are deficiencies, excesses or

imbalances in the energy, macronutrients or micronutrients that a person obtains. This might

happen because their diet does not contain a sufficient variety of foods to provide nutrients in the

appropriate amounts, either providing less than or more than is appropriate. Their body is unable

to absorb or make use of certain nutrients optimally. For example, various intestinal worms can

8
cause loss of iron and protein and decreased absorption of nutrients (UNICEF, 2012). Diarrhoea

due to poor sanitation can also lead to poor absorption of nutrients. Their body loses too much of

particular nutrients, even if the nutrients are present in the diet.

Malnutrition in children under 5 years remains a vital public health problem because it

contributes to mortality and morbidity in children (WHO, 2013). Poverty, low SES, and the

presence of infectious diseases are among the variables correlated with malnutrition. Moreover,

deficiencies in energy and protein intake results in proteinenergy malnutrition, which is a

common form of malnutrition. Malnutrition is comprised of undernutrition and overnutrition.

Undernutrition consists of wasting, stunting, and underweight, as seen in Kwashiorkor where

there is a severe lack of protein in the diet with evidence of severe weight loss and retention of

fluids in the abdomen, ankles, and feet (Butler, 2018) or marasmus, a severe form of malnutrition

where intake of nutrients and energy is too low for a child’s needs with the presence of wasting

or the loss of body fat and muscle (Mehta, 2018). The later are long-term consequences of

malnutrition

When children consistently fail to consume the required quantity and types of food that supplies

important nutrients to their body, it culminates in malnutrition. Available evidence has shown

that malnutrition contributes to nearly half of all forms of child mortality in the world (Black et

al., 2013). Globally, about 45% of deaths among children under 5 years are attributed to

malnutrition, and these occur mostly in developing and low-income countries (Black et al.,

2013).

According to a UNICEF report in 2017, there were 151 million children under 5 years of age

who were stunted, 51 million wasted, 16 million severely wasted, and 38 million overweight,

globally. In regions of the globe, South Asia and Africa were reported to have the highest rate of

9
child malnutrition in the world, accounting for about 33% of all malnourished children globally.

In Africa, it was reported that 9.4% of children under 5 years were undernourished due to

wasting (UNICEF, 2017). In spite of the reduction in malnutrition globally, malnutrition in

children under 5 years in Nigeria has been on the increase in past decade (Kalu & Etim, 2018).

Kalu and Etim (2018) attributed the increasing malnutrition among children in Nigeria to rising

poverty, absence of exclusive breastfeeding, and household, child, maternal, and socioeconomic

factors.

Malnutrition, therefore, portends a great danger and imminent threat to the lives of children,

especially those under 5 years of age. Therefore, given the public health importance of

malnutrition to child health, in particular, and life expectancy, generally, it is pertinent to

understand the risk factors of malnutrition in the Nigerian context.

Malnutrition in children under 5 years remains a vital public health problem because it

contributes to mortality and morbidity in children (WHO, 2013). Poverty, low SES, and the

presence of infectious diseases are among the variables correlated with malnutrition. Moreover,

deficiencies in energy and protein intake results in proteinenergy malnutrition, which is a

common form of malnutrition. Malnutrition is comprised of undernutrition and overnutrition.

Undernutrition consists of wasting, stunting, and underweight, as seen in Kwashiorkor where

there is a severe lack of protein in the diet with evidence of severe weight loss and retention of

fluids in the abdomen, ankles, and feet (Butler, 2018) or marasmus, a severe form of malnutrition

where intake of nutrients and energy is too low for a child’s needs with the presence of wasting

or the loss of body fat and muscle (Mehta, 2018). The later are long-term consequences of

malnutrition

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When children consistently fail to consume the required quantity and types of food that supplies

important nutrients to their body, it culminates in malnutrition. Available evidence has shown

that malnutrition contributes to nearly half of all forms of child mortality in the world (Black et

al., 2013). Globally, about 45% of deaths among children under 5 years are attributed to

malnutrition, and these occur mostly in developing and low-income countries (Black et al.,

2013).

According to a UNICEF report in 2017, there were 151 million children under 5 years of age

who were stunted, 51 million wasted, 16 million severely wasted, and 38 million overweight,

globally. In regions of the globe, South Asia and Africa were reported to have the highest rate of

child malnutrition in the world, accounting for about 33% of all malnourished children globally.

In Africa, it was reported that 9.4% of children under 5 years were undernourished due to

wasting (UNICEF, 2017). In spite of the reduction in malnutrition globally, malnutrition in

children under 5 years in Nigeria has been on the increase in past decade (Kalu & Etim, 2018).

Kalu and Etim (2018) attributed the increasing malnutrition among children in Nigeria to rising

poverty, absence of exclusive breastfeeding, and household, child, maternal, and socioeconomic

factors.

Malnutrition, therefore, portends a great danger and imminent threat to the lives of children,

especially those under 5 years of age. Therefore, given the public health importance of

malnutrition to child health, in particular, and life expectancy, generally, it is pertinent to

understand the risk factors of malnutrition in the Nigerian context.

Malnutrition does not affect just the current health status, it also influences the future health

status of patients or individuals as it has been found that adulthood health is linked to early

childhood health outcomes.

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Increasing prevalence of children malnutrition, including those under 5 years in Nigeria, has

become an important public health issue. In developing countries, 60 million children under 5

years are malnourished, and 11 million of them are Nigerian children (Kalu & Etim, 2018).

According to the National Food and Nutrition Policy (2014), malnourished children under 5

years in Nigeria recorded the highest number in subSaharan Africa, and second highest in the

world. In 2018, the National Nutrition and Health Survey of Nigeria reported that Akwa Ibom

State was among the states in Nigeria with high malnutrition of children under 5 years. Akwa

Ibom state also had the worst undernutrition status of children under 5 years in the South-South

region of Nigeria (National Nutrition and Health Survey, 2018).

Low intake of calories, conflicts, political instability, poor implementation of government

policies, and inadequate health interventions are some risk factors that influence malnutrition in

children below age 5 (Adedeji et al., 2019; Kalu & Etim, 2018; Ozoka, 2018). Other factors that

impact malnutrition in children include health and nutritional status of the mothers during

pregnancy, breastfeeding, and socioeconomic, environmental, demographic, and health system

factors (Adedeji et al., 2019; Jude et al., 2019; Kuku-Shittu et al., 2016; Ozoka, 2018). Recent

data on socioeconomic and demographic risk factors influencing children under 5 in Nigeria, and

Akwa Ibom State in particular, however, are unpublished. A number of studies on malnutrition

in children under 5 in Nigeria considered the North-East (Adedeji et al., 2019), South-East (Jude

et al., 2019) and North-Central (Kuku-Shittu et al., 2016) geopolitical regions.

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2.2.2. Types of Malnutrition

2.2.2.1. Under Nutrition

Undernutrition is defined as the insufficient intake of energy and nutrients to meet an individual's

needs to maintain good health (Maleta, 2006). Undernutrition is caused by unbalanced diets that

lack all the necessary nutrients (macronutrients and micronutrients) which are required by the

body. It can lead to impaired physical growth, restricted intellectual skills, low school

performance, reduced working capacity, and rooted disability in adult life. Nigeria is ranked

amongst the top ten countries with the highest prevalence of undernutrition in children while

about 2,300 children die daily in Nigeria as a result of malnutrition. Undernutrition can be

classified as stunting, wasting, and being underweight. Stunting is characterized by low height-

for-age and is the result of long-term nutritional deficiency. Wasting is low weight-for-height,

which indicates short-term poor nutritional status. On the other hand, underweight is a low

weight-for-age that shows reduced public situations in both the long and shor term poor

nutritional status (Engidaye et al., 2022).

2.2.2.2. Over Nutrition

Overnutrition is a form of imbalanced nutrition arising from excessive intake of nutrients,

leading to accumulation of body fat that impairs health (Mathur and Pillai, 2019). Overweight

and obesity are currently an epidemic affecting both developed and developing countries.

Among people aged 18 and above in 2016, an estimated 2 billion and 650 million were

overweight and obese, respectively. Overweight contributes to 3.4 million mortality annually.

Overnutrition is strongly associated with several non-communicable diseases, including coronary

heart diseases, stroke, type 2 diabetes, and hypertension (Badru and Alabi, 2018). Despite

improvements in deaths related to malnutrition and communicable diseases, non-communicable

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diseases (diabetes, hypertension, cardiovascular diseases, and others) are becoming the leading

causes of mortality (70%) and contribute to a larger share of the disease burden. The crisis of

overnutrition has increasingly been reported from countries where hunger is still endemic

(Chopra et al., 2019).

2.2.3. Prevalence and Impact of Malnutrition

The first 1,000 days of a child's life offer a unique window of opportunity for preventing

undernutrition and its consequences. Malnutrition is a direct underlying cause of 45 percent of all

deaths of under-five children.

Nigeria has the second highest burden of stunted children in the world, with a national

prevalence rate of 32 percent of children under five. An estimated 2 million children in Nigeria

suffer from severe acute malnutrition (SAM), but only two out of every 10 children affected is

currently reached with treatment. Seven percent of women of childbearing age also suffer from

acute malnutrition. Exclusive breastfeeding rates have not improved significantly over the past

decade, with only 17 percent of babies being exclusively breastfed during their first six months

of life. Just 18 percent of children aged 6-23 months are fed the minimum acceptable diet.

The States in northern Nigeria are the most affected by the two forms of malnutrition – stunting

and wasting. High rates of malnutrition pose significant public health and development

challenges for the country. Stunting, in addition to an increased risk of death, is also linked to

poor cognitive development, a lowered performance in education and low productivity in

adulthood - all contributing to economic losses estimated to account for as much as 11 percent of

Gross Domestic Product (GDP).

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The prevalence of underweight was 30.6%, overweight was 2.1% and normal weight for age

nutritional status was 67.3%. More males (19.6%) than females (11%) accounted for prevalence

of underweight. Majority (25.7%) of underweight under five years children were in the age

group of 0-11 months, 4.6% in age group 12-29 months and 0.3% in age group 30-39 months

(Ogunniyi et al., 2023).

2.2.4. Contributing Factors of Malnutrition

Malnutrition remains a significant concern, particularly among children. Various factors

contribute to malnutrition in these areas:

 Poverty: The communities often face higher poverty rates compared to urban areas.

Limited financial resources can hinder access to nutritious foods and proper healthcare,

increasing the risk of malnutrition.

 Lack of Exclusive Breastfeeding: Proper infant nutrition begins with exclusive

breastfeeding. Inadequate breastfeeding practices can lead to malnutrition among infants.

 Inadequate Food Intake: The availability of diverse and nutritious food options in rural

areas may be limited. Inadequate food intake, particularly among children, can result in

malnutrition.

 Maternal Nutrition during Pregnancy: Poor maternal nutrition during pregnancy can

lead to low birth weights and a higher risk of malnutrition among infants.

 Illnesses: Common illnesses like diarrhea and acute respiratory infections can impact a

child's nutritional status. Frequent illnesses can lead to malnutrition if not properly

addressed.

 Limited Access to Vitamin Supplements: The lack of access to vitamin supplements or

fortified foods can contribute to nutritional deficiencies.

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  Large Family Sizes: Households with larger family sizes may struggle to provide

adequate nutrition for all members.

 Food Insecurity: Food insecurity, which can be exacerbated by economic constraints,

can result in inconsistent access to nutritious foods.

 Lack of Nutrition Education: Access to nutrition education and awareness programs

may be limited, resulting in lower levels of health and nutrition knowledge among

residents.

 Social Inequality: Disparities in access to resources and opportunities can further

exacerbate malnutrition in children.

2.2.5. Contributing Factors of over nutrition

Over nutrition, characterized by excessive nutrient intake and obesity, is increasingly becoming a

concern, several contributing factors include:

 Changing Dietary Patterns: As communities undergo economic development and

urbanization, dietary patterns may shift towards high-calorie, processed foods.

 Economic Development: Economic growth can lead to increased access to calorie-dense

foods, contributing to overnutrition.

 Urbanization: The influence of urban lifestyles, including sedentary behavior and

dietary choices, can extend to rural communities.

 Double Burden of Nutrition: Some regions experience a "double burden" of both

undernutrition and overnutrition, where undernutrition remains a concern alongside the

rise of overnutrition.

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  Prevalence of Non-Communicable Diseases: Overnutrition is strongly associated with

non-communicable diseases such as diabetes, hypertension, and cardiovascular

conditions.

 Nutritional Transition: As societies transition from traditional diets to more

Westernized eating patterns, overnutrition becomes more prevalent.

It's important to note that while addressing overnutrition, efforts must also continue to

combat undernutrition in these areas, as both can coexist and pose significant public

health challenges.

2.2.6 Overview of Food Choices

The food choices for infants aged 0-5 years are crucial for their growth and development. For

infants under 6 months, breast milk or formula is recommended as the primary source of

nutrition. As they transition to solid foods, introducing a variety of fruits, vegetables, grains, and

proteins is important to ensure they receive essential nutrients. Avoiding added sugars and

excessive salt is also key. Consulting with a pediatrician or a nutritionist can provide

personalized guidance based on the child's needs and any potential allergies or dietary

restrictions. Children ages 1-2 years should eat approximately a1/2serve of fruit and 2-3 serves

of vegetables each day,2-3 years should eat 1serve of fruit and 2.5 serves of vegetables each

day.it is important to offer the child healthy snacks . Offering small, planned snacks is much

better than allowing them to graze all day. Encourage healthy eating habits by choosing snacks

based on nutritious foods, eating fruit and vegetables everyday will help the child grow strong

and healthy (Karanja et al., 2022).

Food choices refer to the decision’s individuals make about what they eat. These decisions can

be influenced by factors like personal taste, cultural background, health considerations, dietary

17
restrictions, and ethical beliefs (Drewnowski et al., 2010). The decision-making process

governing food choices have been increasingly understood in the context of the dimensions of

the food environment (Karanja et al., 2022). Food environment describes the spaces within

which consumers interacts and make decisions about what to acquire, prepare and consume

based on physical and economic access, quality of foods, convenience and exposure to marketing

information (HPLE, 2017). Diets, nutrition and health outcomes are in part, consequences of

interrelated food choice factors which poses challenges for implementing interventions aimed at

addressing malnutrition and dietary challenges in LMICs (FAO and WHO, 2019).

Empirical studies on malnutrition and the factors affecting food choices in children aged 0-

5years Children who experience poor nutrition during the first 1000 days of life are more

vulnerable to illness and death in the near term, as well as to lower work capacity and

productivity as adults (FAO and WHO, 2019). These problems motivate research to identify

basic and underlying factors that influence risks of child malnutrition. Based on a structured

search of existing literature, Karanja et al., (2022) identified 90 studies that used statistical

analyses to assess relationships between potential factors and major indicators of child

malnutrition: stunting, wasting, and underweight. Our review determined that wasting, a measure

of acute malnutrition, is substantially understudied compared to the other indicators. We

summarize the evidence about relationships between child malnutrition and numerous factors at

the individual, household, region/community, and country levels. According to them, the results

identify only select relationships that are statistically significant, with consistent signs, across

multiple studies. Among the consistent predictors of child malnutrition are shocks due to

variations in climate conditions (as measured with indicators of temperature, rainfall, and

vegetation) and violent conflict. Limited research has been conducted on the relationship

18
between violent conflict and wasting. Improved understanding of the variables associated with

child malnutrition will aid advances in predictive modeling of the risks and severity of

malnutrition crises and enhance the effectiveness of responses by the development and

humanitarian communities. Malnutrition is preventable, yet remains a major public health

challenge. This condition affects one in five children and contributes to nearly half of all deaths

during childhood globally (Black et al. 2013). Children who have poor nutrition during their first

1000 days of life attain lower levels of education and have lower work capacity and productivity

as adults. Malnourished children also face increased likelihoods of being overweight, of

developing chronic illnesses such as cardiovascular disease, diabetes and cancer, and of suffering

from mental health issues later in life (Haddad et al. 1994; Hoddinott et al. 2013). After having

suffered of malnutrition during early childhood, girls face increased likelihoods of having

children that are born too early or underweight (UNSCN 2010).

2.3.2. Factors Affecting Food Choices in children

Food choices are influenced by a multitude of factors, encompassing social, economic, cultural,

and environmental dimensions:

 Limited Access to Healthy Food Options: Many areas suffer from limited access to

fresh, nutritious, and culturally suitable foods due to the absence of grocery stores and

farmers' markets. Residents often rely on convenience stores and fast-food outlets, which

offer more processed and less nutritious options. This phenomenon is known as "food

deserts" (Walker et al., 2010).

 Economic Constraints: Economic limitations can prevent individuals or

from affording nutritious food choices. This financial constraint may lead to the selection

of cheaper but less healthy alternatives. Additionally, limited access to public

19
 transportation and long distances to grocery stores can increase food expenses

(Drewnowski et al., 2010).

 Cultural and Traditional Influences: Cultural practices and traditions significantly

shape food choices in children. Dietary habits often revolve around cultural identity, with

certain foods holding cultural significance. These influences can vary widely among

different communities and impact dietary patterns (Satia et al., 2001).

 Limited Health Literacy: Low levels of health literacy and awareness about healthy

eating practices can affect food choices. Individuals with higher education and health

knowledge tend to make better dietary choices (Contento et al., 2006).. Some

communities may have fewer resources for health education and awareness, making them

susceptible to the influence of food marketing (Hastings et al., 2004).

 Agricultural Practices and Local Food Production: The types of crops and livestock

grown in areas can affect the availability of certain foods and dietary patterns. Local food

production reduces the need for long-distance transportation, promoting sustainability

(Thompson et al., 2010).

 Psychological Factors: Psychological factors such as taste preferences, cultural norms,

and attitudes toward health shape food choices. Personal preferences, cravings, emotions,

and past experiences with food also play a significant role (Smith et al., 2009).

 Environmental Factors: Environmental elements, including limited access to grocery

stores, geographic isolation, and economic constraints, impact food choices. Availability

and accessibility of food options influence choices, as people tend to select foods that are

easily accessible (Glanz et al., 2004).

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  Media and Advertising: Media platforms and advertising campaigns shape food

preferences and perceptions, especially in areas with limited access to diverse food

options. Exposure to advertisements promoting unhealthy foods can contribute to poor

dietary habits (Jilcott Pitts et al., 2017).

 Health and Nutrition Knowledge: Understanding the principles of balanced nutrition

and wellness practices can impact food choices. Limited access to nutrition education and

awareness programs can result in lower health and nutrition knowledge levels in rural

communities (Johnson et al., 2008).

These multifaceted factors collectively influence food choices, highlighting the need for

comprehensive strategies that consider social, economic, cultural, and environmental dimensions

to promote healthier dietary habits and improve overall well-being.

2.3.3. Contributing Factors of Food Choices in Urban Settings

According to Johnson et al., (2008), urban environments introduce unique influences on food

choices which include:

 Food Accessibility: These refers to the availability and affordability of nutritious food

for all individuals, regardless of their geographical location or economic status. It

encompasses factors such as proximity to grocery stores, transportation options, and

economic barriers that may hinder people from obtaining healthy and affordable food.

 Economic Status: In urban settings, food choices can be influenced by various factors,

including income levels, accessibility to diverse options, and cultural preferences, urban

planning and policies play a role in shaping food environments, impacting the economic

status of food choices for resident.

21
 Cultural Diversity: Cultural diversity refers to the existence of various cultural groups

with distinct traditions, beliefs, and practices within a society. Embracing diversity

fosters mutual understanding and enriches the social fabric by promoting tolerance and

appreciation for different perspectives.

 Advertising: Advertising of food choices in urban settings plays a significant role in

influencing consumer decisions. It often reflects current dietary trends and cultural

preferences, shaping people's perceptions of what's available and desirable.

 Health Awareness: In urban settings, health awareness of food choices is crucial due to

increased access to processed foods. Promoting education on balanced nutrition and

encouraging the availability of fresh, nutritious options can contribute to better overall

health in urban populations.

 Dietary Restrictions: Dietary restrictions in urban settings often result from a

combination of factors, including cultural preferences, health considerations, and lifestyle

choices. Access to diverse food options in cities can make it easier for individuals to

adhere to specific diets, such as vegetarianism, veganism, or gluten-free diets.

 Ethical Beliefs: Ethical considerations, such as sustainability and animal welfare, can

influence food choices in urban settings.

 Convenience: Urban lifestyles often prioritize convenience, leading to increased

consumption of fast food and processed meals.

The complex interplay of these factors shapes the dietary landscape in urban areas,

impacting the health and nutrition of their residents.

22
2.3.4. Challenges in Food Choices

Glanz et al., (2004) challenges associated with making informed food choices within modern

society according to which are as follow:

 Nutritional Quality vs. Convenience: This challenge revolves around the trade-off

between convenience and nutritional value. People often opt for fast-food or ready-to-eat

meals due to their convenience, even though be high in unhealthy fats, sugar, and salt,

contributing to health issues like obesity and heart disease.

 Limited Fresh Produce Accessibility: In many areas, they may lack essential nutrients

especially urban environments, it can be challenging to access fresh fruits and vegetables.

Convenience stores and fast-food outlets are more prevalent than grocery stores with

fresh produce. This lack of accessibility can result in inadequate intake of vitamins and

minerals, which are crucial for overall health.

 Marketing and Advertising Challenges: Unhealthy foods are often aggressively

marketed, particularly to children. This can lead to poor dietary choices and health

problems, as consumers may be influenced by appealing advertisements. There is also the

concern of misleading or deceptive advertising, where products are portrayed as healthier

than they are in reality, which can misguide consumers.

 Processed Foods and Their Impact: Processed and ultra-processed foods have become

staples in many diets. These foods often contain artificial additives, preservatives, and

unhealthy trans fats. Consuming them in excess can lead to various health problems,

including weight gain, heart issues, and high blood pressure.

 Economic Constraints on Food Choices: The perception that healthier foods are more

expensive can deter individuals from making nutritious choices. This perception can be

23
 valid in some cases, as healthier options like organic produce or specialty items tend to be

pricier. Economic constraints can push people towards cheaper, less nutritious, and more

processed foods, potentially impacting their health negatively.

 Cultural and Social Influences: Cultural norms, family traditions, and social pressures

play a significant role in shaping dietary preferences. What is considered acceptable or

taboo food can be heavily influenced by cultural factors. Additionally, social gatherings

and peer interactions can sway food choices. The globalization of diets and the

prevalence of social media further complicate these influences, sometimes leading

individuals away from traditional, healthier diets.

 Misinformation and Its Impact: Misinformation about nutrition and dietary trends can

lead to confusion and poor food choices. In today's digital age, misinformation spreads

quickly through social media and unreliable websites. People may adopt diets lacking

essential nutrients or avoid beneficial foods based on false claims. Relying on credible

sources, such as registered dietitians and scientific studies, is crucial for making informed

choices.

 Time Constraints and Food Choices: Modern lifestyles often leave individuals with

limited time for meal preparation. As a result, people may opt for fast-food or

convenience options that require minimal preparation. This shift can lead to less healthy

diets and contribute to obesity and chronic health issues.

 Food Deserts and Access to Nutritious Options: Food deserts are areas where residents

have limited access to affordable and healthy food choices. Grocery stores and fresh

produce markets are scarce, and convenience stores with limited healthy options often

24
 prevail. This lack of access can result in poor dietary habits and an increased risk of diet-

related health problems for the affected communities.

 Portion Sizes and Dietary Choices: The size of food portions can greatly influence

calorie intake and dietary balance. In some cultures, and restaurant settings, larger portion

sizes are promoted, contributing to overeating. People may struggle to accurately

estimate portion sizes, leading to either excessive calorie consumption or inadequate

nutrition. This "portion distortion" can distort perceptions of what constitutes a standard

serving.

 Emotional Eating and Its Impact: Emotional eating is the tendency to use food as a

coping mechanism for emotional states like stress, sadness, or boredom. Emotional eaters

often gravitate toward high-calorie, comforting foods. Additionally, stress can trigger

cravings for sugary and fatty foods due to physiological responses like cortisol release.

Breaking the cycle of emotional eating often requires strategies like mindfulness,

cognitive-behavioral therapy, and developing healthier emotional regulation skills.

Establishing a strong support system and finding alternative ways to manage emotions,

such as physical activity or relaxation techniques, can also be effective.

2.3.5. Promoting Healthy Food Choices

According to Kilanowski, (2017); promoting healthy food choices in children both in rural and

urban settings involves:

 Raising Awareness: Educating communities about the factors that influence food

decisions, including cultural, economic, and environmental factors.

 Regulating Food Marketing: Implementing regulations to control the marketing of

unhealthy foods, especially to children.

25
  Supporting Local Initiatives: Encouraging and supporting local initiatives that promote

access to fresh and nutritious foods, such as farmers' markets and community-supported

agriculture.

 Nutrition Education Programs: Developing and implementing nutrition education

programs to improve health and nutrition knowledge.

 Encouraging Healthier Food Environments: Creating environments that make it easier

for individuals to make healthy choices, such as providing access to safe and accessible

walking and biking routes.

 Collaboration: Collaborating with stakeholders, including government agencies,

healthcare providers, and community organizations, to develop and implement effective

strategies.

2.4. Theoretical Framework

2.4.1. Health Behavior Theory

Health Behavior Theory is a critical component of the theoretical orientation, as it delves into the

intricate decision-making processes that underpin food choices and nutrition. Two influential

theories in this domain are the Health Belief Model (HBM) and the Social Cognitive Theory

(SCT), which provide valuable insights into the cognitive factors influencing these behaviors.

The Health Belief Model (HBM) posits that individuals make health-related decisions based on

perceived susceptibility to a health problem, the severity of that problem, and the perceived

benefits of taking a specific action, and the perceived barriers to taking that action (Rosenstock et

al., 1988). In the context of Obafemi Owode, caregivers' perceptions of their children's

vulnerability to malnutrition, their understanding of the severity of malnutrition's consequences,

and their belief in the effectiveness of certain dietary choices can significantly impact food

26
decisions. For example, if caregivers perceive that malnutrition is a significant health threat and

that providing a diverse diet can prevent it, they are more likely to make nutritious food choices

for their children.

2.4.2 Social Cognitive Theory (SCT)

The Social Cognitive Theory (SCT), developed by Bandura (1986), emphasizes the role of social

learning and observational experiences in shaping health behaviors. In rural communities like

Obafemi Owode, where traditional knowledge and practices often influence dietary choices. SCT

helps us understand how caregivers learn about food choices from their social networks and how

these choices are transmitted to children. For instance, if caregivers observe their peers making

nutritious food choices for their children and witness positive health outcomes, they are more

likely to adopt similar practices.

In this research, I will employ the health behavior theories to investigate how these cognitive

factors interact with socio-economic and cultural determinants to shape food choices and

nutritional behaviors among caregivers and children in Obafemi Owode. By examining how

caregivers perceive the health benefits of certain foods, their confidence in providing nutritious

meals, and the influence of social learning on their decisions, we aim to provide a comprehensive

understanding of the intricate web of factors that contribute to the nutritional landscape in this

rural community. This knowledge will inform targeted interventions to improve the nutritional

status of children in Obafemi Owode, ultimately reducing the prevalence of malnutrition.

2.4.3. Intersectionality Theory

Intersectionality theory, initially developed by Kimberlé Crenshaw in 1989, is a critical

framework that recognizes individuals' complex and interconnected social identities and how

these intersecting identities shape their experiences and access to opportunities. In the context of

27
child malnutrition in Obafemi Owode, applying intersectionality theory is crucial for a

comprehensive understanding of the factors contributing to nutritional disparities among children

according to this theory include:

 Multiple Intersecting Identities: In Obafemi Owode, children do not experience

malnutrition in isolation; rather, their nutritional status is influenced by a myriad of

factors, including gender, age, and socio-economic status. These identities intersect,

creating a complex web of experiences and challenges. For example, young girls may

face unique nutritional vulnerabilities due to both their age and gender, which could

result in differential access to nutritious foods compared to boys.

 Gender Roles and Food Allocation: One aspect of intersectionality theory relevant to our

study is the examination of how gender roles within household’s impact food allocation

and access to nutritious meals. In many communities, traditional gender roles assign

responsibilities for food preparation and distribution, and these roles may influence the

types of foods allocated to boys and girls. Understanding these dynamics is essential for

crafting targeted interventions to address gender-specific nutritional disparities.

 Interaction with Socio-economic Factors: Additionally, intersectionality theory

emphasizes how intersecting identities interact with broader socio-economic factors. In

Obafemi Owode, socio-economic status significantly affects access to resources,

including food. Low-income households may struggle to afford nutritious foods, and this

economic constraint may be compounded by gender and age-related factors. Therefore,

an intersectional analysis allows us to explore how gender, age, and socio-economic

status interact to produce varying nutritional outcomes among children.

28
  Policy Implications: Applying intersectionality theory can inform policy and program

development. By recognizing that children's nutritional experiences are shaped by a

complex interplay of identities and factors, policymakers can design interventions that

target specific vulnerabilities while considering the broader socio-cultural context. For

example, programs aimed at improving food security may need to account for the

differing needs of girls and boys within households to ensure equitable access to

nutritious meals.

Incorporating intersectionality theory into my research in Obafemi Owode will enable a more

nuanced and holistic examination of child malnutrition, helping us uncover the underlying

factors and dynamics that contribute to nutritional disparities among children with diverse

identities and experiences.

2.4.4 Social Determinants of Health Framework

The Social Determinants of Health (SDOH) framework, as elucidated is a comprehensive

approach that underscores the multifaceted interplay between socio-economic factors and health

outcomes. In the context of Obafemi Owode, a region marked by alarmingly high poverty rates

(NBS, 2020), the SDOH framework serves as an indispensable tool to dissect and understand the

intricate web of factors influencing children's nutritional well-being.

One of the pivotal elements within this framework is income disparities. Poverty is a pervasive

issue in many rural Nigerian communities, including Obafemi Owode. Low household income

directly affects a family's ability to access nutritious foods and maintain healthy dietary practices.

For instance, limited financial resources may result in households prioritizing cheaper, calorie-

dense foods over more nutritious options, ultimately compromising children's health and

development. Parents with higher levels of education tend to be more knowledgeable about

29
proper nutrition and healthcare practices for their children. They are also better equipped to

navigate the healthcare system and access crucial information about child nutrition and well-

being. Moreover, access to healthcare services is a critical factor within the SDOH framework.

In areas like Obafemi Owode, limited access to quality healthcare facilities can hinder early

detection and management of malnutrition in children. This lack of healthcare access may result

in delayed interventions, exacerbating the nutritional challenges faced by children (WHO, 2021).

By applying the SDOH framework, our research aims to delve into the complex dynamics of

how income disparities, parental education levels, and healthcare accessibility collectively

contribute to malnutrition among children in Obafemi Owode. This framework will serve as a

guiding lens to comprehensively examine the socio-economic determinants of child malnutrition

and inform the development of targeted interventions to mitigate its impact on the community.

2.4.5 Cultural Ecological Model

The Cultural Ecological Model, rooted in the pioneering work of Bronfenbrenner (1977), offers a

comprehensive framework for examining the intricate interplay between cultural influences and

the surrounding environment in shaping human behavior. In the context of our research on

malnutrition among children in rural Nigeria, particularly in Obafemi Owode, this theoretical

approach provides a nuanced lens through which we can understand the profound impact of

cultural practices and traditions on food choices and nutritional behaviors.

In rural Nigeria, cultural practices and traditions are deeply ingrained in daily life. These

traditions not only shape how individuals relate to their environment but also dictate what foods

are deemed acceptable, how they are prepared, and when they are consumed. For example, the

preference for locally grown crops like millet or sorghum can be traced back to centuries-old

30
cultural norms. The cultural significance of these crops extends beyond their nutritional value;

they may be integral to religious rituals, seasonal festivals, or community gatherings.

Moreover, the Cultural Ecological Model helps us recognize that cultural factors do not operate

in isolation but are intricately intertwined with the local food environment. The availability and

accessibility of foods in the area are influenced by cultural preferences and practices. In Obafemi

Owode, where access to markets and transportation infrastructure can be limited, cultural factors

may strongly shape the locally available food choices.

Understanding how these cultural factors interact with the local food environment is essential for

gaining insights into the types of foods that are accessible, acceptable, and ultimately consumed

by children in this region. For instance, we may find that cultural norms favoring certain staple

foods may contribute to imbalanced diets or hinder the adoption of more diverse and nutritious

options.

By applying the Cultural Ecological Model to my research in Obafemi Owode. I aim to uncover

the intricate web of cultural influences and environmental factors that impact food choices

among children. This holistic perspective will guide my efforts to develop contextually relevant

interventions aimed at improving the nutritional status of children under Fifteen years of age in

the community.

2.4.3. Food Security Framework

The Food Security Framework, as defined by the Food and Agriculture Organization (FAO),

provides a comprehensive lens through which to assess the nutritional well-being of populations.

It encompasses four interconnected dimensions: availability, access, utilization, and stability

(FAO, 2021). In the context of Obafemi Owode, a rural area grappling with food security

challenges, this framework becomes particularly relevant.

31
 Availability: This dimension of food security examines the physical presence of diverse

and nutritious food options within the local food system. In rural regions like Obafemi

Owode, the availability of such foods can be hindered by factors such as limited

agricultural diversity and seasonal variations in food production. It is imperative to

explore how the local food environment in Obafemi Owode influences the types of foods

that are accessible to households, especially those with children under fifteen years of

age.

 Access: Access to food is a critical dimension of food security, encompassing both

physical and economic aspects. In Obafemi Owode, limited access to diverse and

nutritious foods is a pressing concern, particularly for households with low incomes.

Investigating the barriers to food access, such as transportation constraints and

affordability issues, will shed light on the challenges faced by families in ensuring their

children have access to a balanced diet.

 Utilization: Utilization of food refers to the ability of individuals to consume and absorb

nutrients effectively. Even when food is available and accessible, poor dietary practices

can lead to malnutrition. In the context of Obafemi Owode, it is crucial to examine

dietary patterns and nutritional knowledge among caregivers to understand how food

utilization practices may contribute to malnutrition among children. By utilizing the Food

Security Framework, we will comprehensively investigate the complex issue of food

security in Obafemi Owode, shedding light on how each dimension affects the nutritional

status of children under fifteen years of age. This framework will guide our examination

of the availability of diverse food options in local markets, the barriers to food access,

32
 utilization patterns, and the stability of food access, contributing to a nuanced

understanding of malnutrition in this specific rural community.

2.5. Empirical Studies on Malnutrition and the Factors Affecting Food Choice of Children

A study by Dewanti et al., (2022) was conducted to analyze the factors affecting the choices of

healthy diet among adolescents in rural areas in Indonesia. This cross-sectional study was

conducted on a sample size of 160 respondents with a population of 1,143 from 10 different high

schools. The sample size was calculated using the Open Epi software. The data on factors or

reasons behind the choice of healthy diet was taken using the Food Choice Questionnaire (FCQ),

while the data on the choices of healthy foods was taken using a structured questionnaire, both of

which had been tested for validity and reliability. The collected data were analyzed using the

Spearman Rank test. The main reasons that can influence adolescents to pick healthy diets in

rural area were for healthiness concerns, the natural contents of the foods, and body weight

control (BW) (p=<0.005). It is therefore recommended from this study that adolescents should

optimize their knowledge and skills in food selection, especially healthy food.

In KwaZulu-Natal South Africa, Pillay et al., (2021) conducted a study to assess the nutritional

status, using selected anthropometric indices and dietary intake methods, of four rural

communities. Purposive sampling was used to generate a sample of 50 households each in three

rural areas (Swayimane, Tugela Ferry, and Umbumbulu and 21 households at Fountain Hill

Estate). The Estimated Average Requirement cut-point method was used to assess the prevalence

of inadequate nutrient intake. Stunting (30.8%; n = 12) and overweight (15.4%; n = 6) were

prevalent in children under five years, while obesity was highly prevalent among adult females

(39.1%; n = 81), especially those aged 16–35 years. There was a high intake of carbohydrates

and a low intake of fibre and micronutrients, including vitamin A, thus, confirming the need for a

33
food-based approach to address malnutrition and micronutrient deficiencies, particularly vitamin

A deficiency.

This study was carried out on malnutrition and the factors affecting food choice using Okat

community in Onna local government of Akwa Ibom State as a case study. 147 respondents and

141 were validated. Self-constructed and validated questionnaire was used for data collection.

The collected and validated questionnaires were analyzed using frequency tables, and mean

scores. The hypotheses was tested using Chi-square Statistical tool. The result of the findings

reveals that rural dwellers does not have adequate knowledge of the proper nutritional intake.

The study also revealed that the factors affecting the food choices includes: poor income status,

family background, lack of proper nutritional knowledge, cultural beliefs, inadequate food

security. Therefore, it is recommended that to reduce the present high rate of malnutrition, the

study suggests the targeting of women with education programmes and provision of clean water,

including the enforcement of healthy environment in the areas.

A study was conducted to compare dietary practices and nutritional status of children in rural and

urban communities of Lagos State, Nigeria. Comparative-analytical study was conducted using

the multistage sampling technique to select the study cases. A total of 300 mother–child pairs

were studied, including 150 each from rural and urban communities. The data collected include

demographics, socioeconomic characteristics, feeding practices and anthropometric

measurements of the participants. Food intake data was collected using 24-h dietary recall.

Malnutrition in children was determined by calculating the prevalence of low height-for-age

(stunting), low weight-for-age (underweight), and low weight-for-height (wasting) using the

World Health Organization cutoff points. The prevalence of exclusive breastfeeding for 6

months (25.3% vs. 28.7%; P = 0.516), use of formula feeds (48.7% vs. 44%; P = 0.077), and

34
mean age of child at introduction of semisolid foods (7.54 ± 4.0 months vs. 8.51 ± 7.3 months; P

= 0.117) were not significantly different between urban and rural communities. The diversity of

food choices and frequencies of consumption were similar in children between urban and rural

communities. However, prevalence levels of underweight and stunted children were significantly

higher in rural than that of urban communities (19.4% vs. 9.3%, P < 0.001 and 43.3% vs. 12.6%,

P < 0.001, respectively).

Factors evaluated as affecting child nutrition a total of 49 factors were evaluated in relation to

wasting, stunting, and/or underweight by multiple studies. This list includes 12 factors measured

at the individual level; 25 factors measured at the household level (including five factors

pertaining to mothers); eight factors measured at the region/community level; and four factors

measured at the country level. Analysis of disaggregated data at the individual and/or household

level featured in 89% of the reviewed articles. Most analyses did not include any covariates

measured at the regional/community or country levels (e.g., (Ekbrand and Halleröd 2018)). Thus,

fewer articles are available with which to evaluate the consistency of relationships of factors at

the regional/community and country levels than at the individual and household levels. Of the 49

factors, 18 have been evaluated by multiple studies in relation to each of the three standard

measures of child malnutrition. The subsequent presentation of results is restricted to instances of

prevailing evidence of statistically significant relationships indicating risk factors or mitigating

factors, according to a majority of relevant reviewed studies. Eight of the 12 factors measured at

the level of individual children exhibited statistically significant relationships for the following

factors: child’s sex and age, if they were a multiple at birth (twin, triplet, etc.), and diarrhea

status. Seven of the 10 factors evaluated in relation to stunting exhibited statistically significant

associations. These associations identified five risk factors: child’s sex and age, their birth order,

35
if they were a multiple at birth, and short birth interval. Two mitigating factors were also

identified: if a professionally trained assistant was present at the birth and if Vitamin A

supplements had been used. The results indicated that two of the four factors evaluated in

relation to underweight were statistically significant risk factors: child’s age and if they were a

multiple at birth. According to our review, therefore, all three anthropometric measures of

malnutrition were associated with two individual-level risk factors: age and multiple at birth. Of

the 25 household-level factors, just four of the 17 factors exhibited statistically significant

associations: mother’s education, mother’s BMI, wealth/assets, and access to a health care center

(Fig. 1b). All were evaluated as being mitigating factors. Eleven of the 25 factors evaluated in

relation to stunting yielded statistically significant associations. The relationships identified three

risk factors: rural, indigenous, and altitude. In addition, eight mitigating factors were identified:

mother’s education, father’s education, mother’s BMI, mother’s height, pregnancy care,

wealth/assets, quality of household materials, and food aid or supplemental feeding. Five of the

13 factors evaluated in relation to underweight yielded statistically significant associations. Only

one relationship identified a risk factor: rural residence. Four mitigating factors were also

identified: mother’s education, mother’s BMI, wealth/assets, and quality of toilet. According to

our review, therefore, all three anthropometric measures were associated with three household-

level risk factors: mother’s education (either years of education or specific levels relative to no

education), mother’s BMI, and wealth/assets (encompassing different indices). The eight factors

measured at the region/community level is split between measuring features of the environment,

including climate conditions, and features related to conflict. Wasting had a statistically

significant association with excessive rainfall as a risk factor and growing season rainfall as a

mitigating factor. Stunting had a statistically significant association with extreme temperatures as

36
a risk factor. Underweight only exhibited a statistically significant association with drought as a

risk factor. Several of the reviewed studies analysed vegetation quality, employing either the

normalized difference vegetation index (NDVI) or the enhanced vegetation index (EVI), with

varying operationalization. In particular, vegetation quality during the previous growing season

has been evaluated in multiple studies of both wasting and stunting, yielding findings that vary

by context. Statistically significant associations were observed between stunting and three factors

that reflect distinctive operationalization of the role of conflict. Conflict in the surrounding

region, conflict exposure (days or months), and whether a child was born during a conflict were

all identified as risk factors for stunting. At the country level, national per capita GDP was

identified as a mitigating factor for wasting, stunting, and underweight (Fig. 1d). Female

education (encompassing national rates of female literacy and female secondary enrolment) was

identified as a mitigating factor for stunting and underweight. Both the national average female-

to-male life expectancy ratio and the dietary energy supply per capita were identified as

mitigating factors for underweight.

About 60% of the reviewed studies employed standard variations of multivariate regression

techniques, such as linear, generalized linear (e.g., logit), or multilevel models. Only 5% of

studies used explicit multilevel statistical techniques, modelling simultaneously the relationships

between malnutrition and covariates at the individual, household, and regional/community levels

(e.g., (Ekbrand and Halleröd 2018)). Other studies that did not estimate multilevel models

instead included covariates aggregated to higher levels, introduced dummy variables for

geographic regions, or adjusted for within-spatial-unit correlation via clustered standard errors

(e.g., (Rashad and Sharaf 2018)). Five articles used quantile regression, which fits a model

through quantiles of the dependent variable, rather than the mean (e.g., (Asfaw 2018)). This

37
approach has the advantage of allowing for heterogeneous treatment effects for different

segments of the distribution of child malnutrition. For example, a given factor may exhibit a

stronger association with weight-for-height z-scores for children who are undernourished (i.e.,

the left tail of the distribution), relative the association observed for children whose nutrition

status is near the center of the distribution. A majority of reviewed studies relied on cross-

sectional analysis of either data from single surveys or a pooled dataset comprising multiple

cross-sectional surveys. Just five of the studies capitalized on panel data involving repeated

waves of data collection for the same children or households over time. The remaining studies

employed a diversity of approaches, including time-series analysis of repeated cross-sections of

countries or subnational regions. Among the reviewed studies, the most common source of

malnutrition measures was Demographic and Health Survey (DHS) data (27 studies). Five of the

reviewed studies used Living Standards and Measurements Survey (LSMS) data. The remaining

studies employed other country-specific surveys, with India’s National Family Health Survey (4

studies) and Ethiopia’s Rural Household Survey (2 studies) featuring in multiple cases In terms

of causal identification strategies, 17% of the reviewed studies directly leveraged the availability

of data collected from repeated measurement over time, estimating either unit-level fixed effects

or difference-in-differences models (e.g., (Lucas and Wilson 2013)). A further 9% of articles

featured an instrumental variables strategy (e.g., (Yamano et al. 2005)) and another 6% of

articles resorted to matching techniques (e.g., propensity score) to control for selection bias and

minimize problems of sample imbalance. The remaining studies exhibited a variety of other

approaches, including decomposition analysis (Block et al. 2004; Rodriguez 2016) and a

regression discontinuity design (Ali and Elsayed 2018). Among the reviewed studies, attention to

the temporal relationship between malnutrition and potential factors was limited and uneven,

38
constraining the ability to ascertain any general patterns. The lack of such examination of the

impact of climate and conflict shocks is especially conspicuous. A common approach has been to

measure deviations in conditions during the survey period relative to long-run average

conditions, within a suitable sub-national geographic area surrounding the survey cluster. The

implicit assumption is that the deviations in conditions exert a contemporaneous impact on

malnutrition. Select studies used models specifying factors with time lags. For example, Johnson

and Brown (Johnson and Brown 2014) tested one- and two-year lagged measures of shocks in

vegetation, but the results of these estimations were not presented because the observed effects

were not statistically significant. Kinyoki et al. (2016) tested lags measures of conflict during the

three months prior to survey and the period from 3 to 12 months prior to the survey, finding that

both variables have statistically significant associations with wasting and stunting. Howell et al.

(Howell et al. 2018) tested yearly lagged values of conflict days and deaths in an analyses of

stunting and wasting. Another approach in studies that have modelled the effects of conflict

shocks on child malnutrition is cohort analysis. The effect of the shock is gauged based on birth

timing relative to the shock, evaluating how the “during” shock cohort differs from the “before”

shock and “after” shock cohorts (Grace et al. 2015).

2.6. Interventions to Address Malnutrition

Addressing malnutrition in children requires a multi-pronged approach such as:

 Promoting Exclusive Breastfeeding: Encouraging and supporting mothers to practice

exclusive breastfeeding for the first six months of an infant's life.

 Enhancing Access to Nutritious Foods: Initiatives to improve access to fresh and healthy

foods, such as community gardens and mobile markets.

39
  Nutrition Education: Providing nutrition education and awareness programs to

empower individuals and families to make informed choices.

 Targeting Socio-Economic Disparities: Addressing poverty and social inequality to

ensure that all community members have equal access to nutritious foods.

 Healthcare Access: Improving healthcare access and the treatment of common illnesses

like diarrhea and respiratory infections in children.

 Food Security: Implementing measures to enhance food security and safety, reducing the

risk of malnutrition.

 Community-Based Interventions: Engaging communities in developing and

implementing strategies tailored to their specific needs.

These interventions should be context-specific and involve collaboration among healthcare

providers, community leaders, and policymakers to create sustainable solutions.

40
 CHAPTER THREE
RESEARCH METHODOLOGY
3.1. Introduction
This chapter presents the methodology and procedures adopted in carrying out the research. As a

survey research design, the study required the collection of data from respondents in order to find

out their opinion on malnutrition and the factors affecting food choice of children in Obafemi

Owode Local Government Area of Ogun State through the use of questionnaire.

3.2 Research Design

This study examined adopted descriptive survey research design because it described the given

variables without manipulation and found suitable for studying large population. Research design

means structuring of investigation aimed at identifying variable and their relationship to one

another. This is use for the purpose of obtaining data to enable researcher test hypothesis or

answer research questions in relation to the malnutrition and the factors affecting food choice of

children in Obafemi Owode Local Government Area of Ogun State

3.3 Area of the Study

The study area for this research work was Obafemi owode Local Government Area of Ogun

State, headquarter in the town of Owode at 6°57′N 3°30′E, and has an area of 1,410 km². It is

bounded in the north by Odeda Local Government and Oyo State, in the east by Sagamu and

Ikenne Local Governments and in the south by Ifo Local Government and Lagos State.

3.4 Population of the Study

A sample is the subset of population selected for a study and the sample selected for this study

was purposive sampling technique where participants which are the children between 0 and 5

41
years of age were selected based on their nutritional status and with the help of their mother in

order to have quality and smooth process of data collection in Obafemi Owode local government

area of Mowe, Ogun State, Nigeria. The total population of Obafemi Owode local government is

estimated to be around 230,000 people, having a total population of children aged 0-14years to

be around 88,004 people. The total population of children between this age brackets (0-5)

according to google search was 9,722 and for the purpose of the study, 10% of the 9,722 for

sampled as the sample size for the study which make the final sampled to be 972.

3.5 Research Instruments

These are the tools or methods used in collecting data from respondents. Questionnaire was used

as research instrument for this study to gather necessary data from the sampled respondents

which was titled ‘Malnutrition and the Factors Affecting Food Choice of Children

Questionnaire’ (MFAFCCQ). The instrument contained research items prepared in line with the

research questions. In the questionnaires, the researcher made each item of the questionnaire

clear and understandable to encourage the respondents to answer all.

3.6 Validity of the Instrument

This refers to the degree to which an instrument actually measures what it was designed to

measure. In order to ensure that the instrument used for this study measures what they are

supposed to measure, face validity was adopted to allow experts in the field to examine the

questionnaire for adequacy.

3.7 Reliability of the Instrument

An instrument is reliable if it measures under the same circumstances consistently from one time

to another what is set out to measure. That is, reliability of a questionnaire may be estimated by a

42
second administration of the instrument comparing responses with those of the first

administration. For this study therefore, Test-Retest technique was used in determining the

reliability of the instrument, and the instrument was found reliable.

3.8 Administration of the Instrument

The instrument used was personally administered on the respondents by the researcher. A total

number of 972 questionnaire were administered on respondents.

3.9 Method of Data Collection

The data used for this study was collected by the researcher after the respondents have put down

their opinion on this study. A total number of 972 questionnaire was distributed while 300 were

retrieved and this was considered as population for the study.

3.10 Data Analysis

In order to analyze the collected data, simple percentage with frequency distribution table was

used for both Section A (demographic data) and Section B (analysis of research questions).

43
 CHAPTER FOUR

DATA PRESENTATION, ANALYSIS AND DISCUSSION

4.0 Introduction

This chapter presents the result of the study in order of the research questions raised as well as

the discussion of the result. Section A contains the demographic analysis and section B contains

the analysis of the research questions.

4.1 Demographic Data Analysis

SECTION A: Analysis of Demographic Characteristics

Table 4.1.1: Gender Distribution of Children between the age 0 and 5

Gender Frequency Percentage

Male 158 52.7

Female 142 47.3

Total 300 100

Table 4.1.1 above shows the gender of the studied participants which are the children between

the age of zero and five and out of the 100 participants who were studied, 52.7% were male

while 47.3% were female. The result proved that the number of male studied was a bit higher

than that of female.

Table 4.1.2: Distribution of respondent According to Age Group

44
Age Frequency Percentage

Under 2 93 31

2-4 181 60.3

5 years 26 8.7

Total 300 100

Table 4.1.2 above data shows that 31% of the respondents fall between the ages of zero and two,

60.3% of the distribution was between the ages of 2 and 4 while 8.7% of the total population

represent children only for 5years. Therefore, from the data gathered it was evident that children

between the age of two and four were more than the other age (0-2 and 5years only) distribution

used for the study.

Table 4.1.3: Cultural Background of the respondent

Cultural Background Frequency Percentage

Ogodo 93 31

Egungun 181 60.3

Bolojo 26 8.7

Total 300 100

Table 4.1.3 above shows the different culture existing among the people of Obafemi Owode

which is related to the different types of dance practices, this is because only the dance was

mentioned as their culture. The findings gave an insight into the types of dance practices by the

respondents where 31% of Obafemi Owode family under research dances Ogodo, Egungun

dance was 60.3 and Bolojo 8.7%. This means that family under research that egungun is their

45
cultural dance take highest position out of the three cultural dances existing in the Obafemi

Owode.

Table 4.1.4: Parents Occupation of the Respondent

Occupation Frequency Percentage

Business 77 25.7

Civil Servants 61 20.3

Unemployed 40 13.3

Seasonal Trade 122 40.7

Total 300 100

The table 4.1.4 above shows the Occupation, of three hundred mothers where 25.7% mothers

were doing business (at whole sales and retails level), 20.3% worked as civil servants, 13.3 were

unemployed and 40.7% were seasonal trade such as selling of different type of fruit presently

available in the market and then jump to any other type of trade that is lucrative after that season.

Section B:

4.2 Research Questions and Analysis on Malnutrition and the Factors Affecting Food
Choices of Children
s/n Items Frequency Percentage
1 Is the child breastfeeding, bottle feeding or
mixed feeding?
breastfeeding 60 20.0
bottle feeding 116 38.7
mixed feeding 124 41.3
2 How frequent is the child feeding in 24
hours?
1-3 times 30 10
4-6 times 172 57.3

46
 7-10 times 80 26.7
11-14 times 18 6
3 Apart from breast milk is there any
supplementary foods?
Yes 282 94
No 18 6
4 When was the child weaned?
6 months 64 21.3
1 year 135 45
1 ½ years 68 22.7
2 years 33 11
5 When was the child introduced to
supplementary foods?
1-3 months 38 12.6
4-5 months 185 61.7
6 months 77 25.7
Others - -
6 What are the weaning foods?
Staples only 128 42.6
Staples, Legumes & Fruits 61 20.3
Staples, Fats, Oil & animal foods 43 14.3
Staples, Vegetables, Animal foods & Fruits 38 12.6
Staples, Vegetables, Fruits, Legumes, Fats & 24 8
oils
Staples, Legumes, Fruits, Vegetables, Fats & 6 2
oils and Animal foods
7 How frequent is the food given?
1-2 month 77 25.7
3-4 month 122 40.7
5-6 month 61 20.3
Above 6 months 40 13.3
8 What type of food does he/she takes?
Staples 128 42.6
Legumes 61 20.3
Fruits 43 14.3
Vegetables 38 12.6
Fats & oils 18 6
Animal foods 12 4
9 Staples (How many days in a month)

47
 1 – 7 days 67 22.3
8 – 14 days 42 14
15 – 21 days 103 34.3
22 – 30 days 88 29.4
10 Legumes (How many days in a month)
1 – 7 days 42 14
8 – 14 days 26 8.6
15 – 21 days 155 51.6
22 – 30 days 77 25.6
11 Fruits (How many days in a month)
1 – 7 days 187 62.3
8 – 14 days 58 19.3
15 – 21 days 32 10.6
22 – 30 days 23 7.6
12 Vegetables (How many days in a month)
1 – 7 days 155 51.6
8 – 14 days 69 23
15 – 21 days 48 16
22 – 30 days 28 9.3
13 Fat & Oil (How many days in a month)
1 – 7 days 179 59.6
8 – 14 days 82 27.3
15 – 21 days 29 9.6
22 – 30 days 10 3.3
14 Animal Food (How many days in a month)
1 – 7 days 155 51.6
8 – 14 days 69 23
15 – 21 days 48 16
22 – 30 days 28 9.3
15 He/She is frequently taken to hospital for
regular health check-ups?
Yes 118 39.3
No 182 60.6
16 Has the child experienced any significant
illness or health issues in the past year?
Yes 89 29.6
No 211 70.3
17 Has the child received all recommended
vaccinations for their age?

48
 Yes 89 29.6
No 211 70.3
18 Has the child's weight and height been
regularly monitored by a healthcare
professional?
Yes 112 37.3
No 188 62.6
19 Have you noticed any signs of malnutrition in
the child, such as poor weight gain, lethargy,
or slow growth?
Yes 157 52.3
No 143 47.6
20 Does the child have any underlying medical
conditions that may affect their nutritional
status?
Yes 53 17.6
No 247 82.3

The table 4.2 above shows the response to each item of the research questions on malnutrition

and the factors affecting food choices among children under five years of age in Obafemi Owode

local government Mowe, Ogun State, Nigeria. The findings revealed how often the children

below six months breastfed from their mothers. Out of 300 children 20% were breastfed, 38.7%

were bottle-fed while 41.3% were mixed fed. However, 10% baby were breastfed only one to

three times a day, 57.3% babies were breastfed four to six times, 26.7% were fed seven to ten

times a day while 6% babies were fed eleven to fourteen times a day. This means that babies fed

between four to six times have the highest percentage, the reason was due to the fact that

majority of their parents were business men and traders. It was also noted that apart from the

breast milk, 94% of mothers do give their children supplementary foods while 6% continue

feeding them with only breast milk.

49
According to the results in the above table showing the period when the child was weaned, It

revealed that only 21.3% of children were weaned at six months, 45% of children were weaned

at age 1 year, 22.7% were weaned at age 1 and half year, another 11% were weaned at 2years.

However, there was requirement that each child is weaned at the age of 2 years old, but in this

case the findings shows that most of them were weaned at 1 year.

It was as well revealed from findings of the study from the table above that out of 300 under five

children who underwent research, 12.6% were introduced to supplementary foods between 1 to 3

months, 61.7% between 4 to 5 months and 25.7% were introduced to supplementary foods at

exactly 6 month. This shows a slight difference in the population of children who were

introduced to supplementary foods at right and wrong time. Meanwhile children between 4 to 6

months shows the highest percentage of 61.7%, this means that 61.7% children were introduced

to supplementary food between 4 to 5 months.

The table above also shows the weaning food and how frequent the food is served among the

children and family members in that family. The statistical data table showed that 34% of

children were served 2 times in a day, 42% of children were served 3 times in a day, 12% of

children were served 4 times in a day and another 12% of children were served more than 4

times in a day. Those who were almost served for four and more times were the babies from six

months of age.

According to the table above on food consumption, the food group of staples for 22.3% children

consumed it between 1-7 days, 34% consumed it between 8-14 days, 34.3% children consumed

it between 15-21 days while 29.4% consumed it between 22-30 days. This means that there was

high intake of staples almost every day. Such food include rice, cassava and potatoes etc. For

Legume consumption, most people eat beans, ground nuts and soya. According to the table

50
above 14% households eat legumes between 1 to 7 in 30 days, 8.6% households eat legumes 8 to

14 days in a month, 51.6% households eat legumes 15 to 21 days in a month and 25.6%

households eat legumes almost every day in a month. On fruit consumption, such as Mango,

Banana, Pawpaw, tangerines etc. Out of 300 households, 62% households eat fruits between 1 to

7 days, 19.3% households eat fruits 8 to 14 days, 10.6% households eat fruits 15 to 21 days while

7.6% eat fruits between 22 to 30 in a month.

On vegetable consumption, most family eat them almost every day (22 to 30) days while the

least household, that is out of 300 households only 51.6% household eat vegetables between 1 to

7 days in a month while 9.3% eat vegetables between 22-30 days . On fats and oils 59.6%

households eat them between 1 to 7days and only 3.3% households eat fat & oil between 22 to

30days. On animal foods, 51.6% households out of 300 households eat foods like pork, chicken

and meat between 1 to 7 days in a month while some other families eat less than previous

mentioned household but the least of the consuming household was 9.3% between 22 to 30days.

The results above show that there was equal proportionate of those who were sick for long time

and those who were not sick for long time. Sick children were 50%, and those who were not sick

were 50%. On the kind of diseases affecting the under five children, out of 50% children who

were affected by different kinds of diseases, children affected by Malaria were 18%, children

affected by Pneumonia representing 18%, children affected by diarrhea representing 10% and

children affected by Malnutrition representing 4% while 150 children which represent 50% were

not affected by any other disease. More than half of under-five children suffered from different

health status condition. Children affected having body rashes representing 16%, children affected

with diarrhea representing 10% , children affected with fever representing 2%, and the remaining

51
children were having breathing difficulty representing another 4%. However, 48% children were

not affected in any way on their health.

CHAPTER 5

SUMMARY, CONCLUSION AND RECOMMENDATIONS

52
5.0 Introduction
This chapter entails summary of findings drawn from the data presentation, conclusion and

recommendations made on the basis of these findings.

5.1 Summary of Findings

According to results explained above, they have greater meaning to the malnutrition issues in

health of all under five in Obafemi Owode Local Government Area of Ogun State. Looking at

the sample size there was almost equal proportion of male and female child. Males are relatively

more than females in the representation of true population. This however, has brought so much

pressure in caring of children, feeding them and even educating them due to increased number of

children in households.

According to WHO (2021), there has been almost 70% of under five children being affected by

malnutrition yearly, and almost five cases of malnutrition appear each month. During the study,

it was stipulated that almost 74 children were receiving malnutrition treatment at Ogo Oluwa

Clinic and Maternity and were mostly on diet like F75 and F100 milk, and Peanut butter

(Chiponde) in order to boost their health status to a better state. Most cases at the clinic had

increased due to poor feeding habits, food choices for the under-five children and eating

behavior of their households.

The 2021 WHO’s Survey showed that most nations are heavily affected by the under-five

malnutrition. 52% of families had shown challenge to nourish their children due to inadequate

nutritious food and as well as a result of present economy situation. This has been reason why

most families fail to nourish their children’s health with adequate nutritious food and most

families were into petty trade. There are many challenges for them to find adequate foods for

their families to feed themselves and children. More than half of millions of people in the

53
country are facing food shortage that is why most families have to look for food and then mind

about nutrition of children. Most families work very hard to buy food and necessities to sustain

the family needs which might not be enough to cater for the children.

Since three quarter of children who went under study were from two to three years old and their

pattern of eating was supposed to be at least three times main course meals because they were

still growing up. 36% of these children were eating only twice a day, putting them at even

greater risk of malnutrition. In relation to UNICEF 2007a; WHO 2001a, says malnutrition in

children is the consequence of much food insecurity, which stems from poor food quality and

quantity. Head of nutrition in the Ministry of Health, Janet Guta also seconded that Household

food insecurity is one of the contributing factors to malnutrition which leads to stunting and is a

bog challenge in Obafemi Owode.

It has been shown that most of the families in Obafemi Owode lack knowledge about child

health and nutritious meals. Most of them had expressed that, as long as they were not sick there

was no need to visit the hospital. Mothers in hospital are taught on the importance of exclusively

breastfeeding young babies below six months. The results showed that 2% were breastfeeding

less than 6 times per day since they opted to give babies water and porridge. The assessment

revealed that, their thinking is that the baby goes hungry if they are giving breast milk alone and

as well will not disturb their daily activities when fed with other supplements. Only 4 % of

children were breast feeding from 7 to 10 times giving us an equal proportionate of those who

are following exclusive breastfeeding and those who are not.

Similar studies, according to kleges, 1991 says that parental attitudes certainly affect children’s

eating habits, dietary surveys show that young children are not eating recommended amount of

nutritious foods. Most women weaned their children at the age of one year representing 36% of

54
children weaned at that age. It is recommended that children be weaned at the age of two years,

so that they do not lack nutrients for body development. Under-five children who were weaned at

two years were 2%. Careless, weaning will put children at risk of malnutrition and opportunistic

infections since in the breast milk they lack major nutrients that can nourishment their system.

46% of under-five children were introduced to supplementary foods at four to five months, with

foods such as yoghurt, cow milk, porridge and freezes. This practice may make it easy for babies

to develop complications of the gastrointestinal since at that age the baby’s gastrointestinal

system is not well developed. 52% of children under study had history of malnutrition,

pneumonia, fevers, and Diarrhea. This is similar to the study of Brian J, 2004, saying that poor

diet result in many diseases affecting physical development of under-five children.

Poverty is one of the contributors to the food choices at household level. 42% of parents were not

employed, this showed income challenges as the least were civil servants. This affected their

meal patterns and most of families ate twice a day with their children. This is similar to the

statement of Timothy Bonyonga a Motherhood specialist which opined that most women get

pregnant at early stage since they failed school and because of influence from parents, for they

would want to attain some money through marriage. Most of them who are married below 20

years of age are not prepared for food, care and support for their children. The end result is child

malnutrition, less thinking and poor brain development. According to the results of this study

more than half of children were affected with different kinds of diseases which include; malaria,

pneumonia, severe respiratory diseases, diarrhea and malnutrition. According to a report by UN

World Food Program (WFP), almost half of all children 1under five in some part of Africa were

affected by stunting in 2012 and 350,715 children were underweight.

55
5.2 Conclusion

Poverty is the leading cause of food insecurity which has led to poor food choices for the

underfive children. However, parental attitude, lack of knowledge, meal patterns, food

availability are the contributing factors to food choices. Most children have developed

pneumonia, malaria, diarrhea and malnutrition as main effects of poor sanitation, lack of health

nutritious foods, and improper caring for children.

5.3 Recommendations

The government and non-governmental organizations such as USAID, WHO, Save the Children,

WFP etc. need to work continually in close partnership in dealing with malnutrition. Resources

such as drugs, food porridge, peanut butter and Milk for children with malnutrition need to be

adequate for all affected children. This is why government must continually involve the

nongovernmental health organization to increase the funds in order to have quality health

outcome in children’s status.

Empowering of all health professionals like Doctors, Nurses, and Disease Control Assistants

through continuation of training in child health and health care. This later improves the skills of

professionals in promotion of improved food choices through health education. It will also help

in the prevention of malnutrition cases and diseases such as Malaria, Pneumonia, and Diarrhea

which commonly leads to death of most under-five children.

The government should also invest considerable amounts of money in the Maternal Child Health

sector (MCH) since nutritional issues affect a lot of women, pregnant mothers and under five

children. If more funding and support is given to this sector, there will be improved health of

both mothers and their children.

56
There is need of non-governmental health organization in collaboration with the government to

develop research based programs that will contribute in the alleviation of malnutrition issues and

poverty reduction which has heavily affected the local government under study and the nation at

large. About 10.7 percent of those who would now be aged between 15 and 64 died as children

because of under nourishment. Such people would have helped the country in different fields of

Agriculture, Health, Environment and Nutrition, hence promoting development of a country.

Research based work shall help in depicting levels and effects of food choices. It will also help in

finding possible means on balancing and control the rate of malnutrition in the country and attain

a free nation of malnutrition cases in under-five children.

57
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APPENDIX
DEPARTMENT OF PUBLIC HEALTH
FACULTY OF SCIENCE
HILLCITY UNIVERSITY, LIBERIA.

…………………………………………

60
…………………………………………

…………………………………………

Dear Respondent,

I am a final year student of the above mentioned school and department conducting a research on

the topic: "Malnutrition and the Factors Affecting Food Choice of Children".

I hereby solicit your assistance in all ways possible to enable me conduct a successful research.

You are required to complete with assurance that all information supplied will be treated as

confidential. For each of the statements below, indicate your level of agreement or disagreement

ticking (√) the appropriate column.

Thank you for your cooperation.

Section A: Demographic Characteristics:

Child’s gender: Male ( ) Female ( )

Age of child 0–2( ) 2–4( ) 5years only ( )
Cultural Background: Ogodo ( ) Egungun ( ) Bolojo ( )
Parents’ Occupational Status: Business ( ) Civil Servant ( ) Unemployed ( ) Seasonal Trade ( )

SECTION B: FEEDING HABITS

PART 1: Children from Birth to 24 Months
1. Is the child breastfeeding/ bottle feeding / mixed feeding?
Breastfeeding ( ) Bottle-feeding ( ) Mixed Feeding ( ) Others ( )
2. How frequent is the child feeding in 24 hours? 1-3 times ( ) 4-6 times ( ) 7-10 times ( ) 11-
14 times ( )

3. Apart from breast milk is there any supplementary foods? Yes ( ) No ( )

61
4. When was the child weaned? 6 months ( ) 1 year ( ) 1 ½ years ( ) 2 years ( )

5. When was the child introduced to supplementary foods? 1-3 months ( ) 4-5 months ( ) 6
months ( ) Others ( )

6. What are the weaning foods?

Staples only ( )
Staples, Legumes & Fruits ( )
Staples, Fats, Oil & animal foods ( )
Staples, Vegetables, Animal foods & Fruits ( )
Staples, Vegetables, Fruits, Legumes, Fats & oils ( )
Staples, Legumes, Fruits, Vegetables, Fats & oils and Animal foods ( )
7. How frequent is the food given? 1-2 month ( ) 3-4 month ( ) 5-6 month ( ) above 6 months ( )

PART 2: Food Intake Assessment for Children from 2 To 5 Years

8. What type of food does he/she takes?
FOOD GROUPS INTAKE
PER
MONTH
STAPPLES; Maize, rice, wheat, cassava, potatoes, banana
LEGUMES; soya, beans, beans, g/nuts, ground, beans, peas, cow peas, pigeon
peas
FRUITS; mango, banana, pawpaw, tangerines, lemon, guavas, peaches
VEGETABLES;,tomato, carrot,egg plants, pumpkins
FATS AND OILS; margarine, c/oil, milk, milk products, avocado pears,
poultry, soya beans, g/nuts, sunflower
ANIMAL FOODS; fish, pork, eggs, insects, chicken, meat

9. Staples 1-7 days ( ) 8-14 days ( ) 15-21 days ( ) 22-30 days ( )

10. Legumes 1-7 days ( ) 8-14 days ( ) 15-21 days ( ) 22-30 days ( )
11. Fruits 1-7 days ( ) 8-14 days ( ) 15-21 days ( ) 22-30 days ( )
12. Vegetables 1-7 days ( ) 8-14 days ( ) 15-21 days ( ) 22-30 days ( )
13. Fats & Oils 1-7 days ( ) 8-14 days ( ) 15-21 days ( ) 22-30 days ( )
14. Animal Foods 1-7 days ( ) 8-14 days ( ) 15-21 days ( ) 22-30 days ( )

PART 3: Healthcare Monitoring and Malnutrition Indicators

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15. I frequently take my child(ren) under five for regular health check-ups?
Yes ( ) No ( )
16. Has the child experienced any significant illnesses or health issues in the past year?
Yes ( ) No ( )
17. Has the child received all recommended vaccinations for their age?
Yes ( ) No ( )
18. Has the child's weight and height been regularly monitored by a healthcare professional?
Yes ( ) No ( )
19. Have you noticed any signs of malnutrition in the child, such as poor weight gain, lethargy,
or slow growth?
Yes ( ) No ( )
20. Does the child have any underlying medical conditions that may affect their nutritional
status?
Yes ( ) No ( )

Thank you for taking your time to fill this questionnaire. Your responses will remain
confidential.

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