Literature Review Alfa

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LITERATURE REVIEW

Child growth is internationally recognised as an important public health indicator for

monitoring nutritional status and health in population. Children who suffer from

growth retardation as a result of poor diet and recurrent infection tend to have more

frequent episodes of severe diarrhoea and are more susceptible to several infections

diseases such as malaria meningitis and pneumonia. The substantial contribution to

child mortality of all degree of malnutrition is now widely accepted. In addition, there

is strong evidence that impaired growth is associated with delayed mental

development , poor school performance and reduced intellectual capacity

(WFP,2005). This chapter, therefore, reviews the concept of malnutrition, influence

of mothers education, household total wealth and rural urban differential factors

affecting nutritional status of children less than five years (determining nutritional

status of under -5 children).

BRIEF CONCEPT OF MALNUTRITION AND CAUSES

Malnutrition literally means bad nutrition and it entails both over and under

nutrition. In relation to trend of malnutrition in nations, the latter is much prevalent in

developing countries including Nigeria. The world programme(WFP,2005) defines

malnutrition as a state in which the physical function of an individual is impaired to

the point where he or she can no longer maintain adequate bodily performance process

such as growth, pregnancy, lactation ,physical work or resting and recovering from

disease. It can result from a lack of macronutrients (carbohydrates, protein and fats)

,micronutrients (vitamins and minerals), your both. Consequently , malnourished

individuals can be shorter (reduced growth ever a prolonged period of time) and/or

thinner than their well nourished counterparts. hidden hunger, or micronutrient


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malnutrition, is widespread in developing countries. It occurs when essential vitamins

and (or mineral are not present in adequate amount in the diet.

Moreover, Phillips Foster, in his book The world Food Problem: tackling the cares of

causes of under-nutrition in the third world (1992), insists that nutrition programs treat

only the symptoms and do not treat the causes of hunger. Anand and Harris (1992)

add that in order to design polices that attempt to alleviate under-nutrition , it is

important to first understand the relationship between economic and social

characteristics and under-nutrition. Knowing which variable significantly affect

nutrition status would provide valuable practical leads for combating the causes of

under-nutrition in the community (Gopalan, 1992).

IMPORTANCE OF ADEQUATE NUTRITION ON CHILDS HEALTH

The nutritional status of children has impact on their health and development.

Therefore, the physical, mental, social and, nutritional status of children, as children,

as well as other characteristics related to malnutrition should be evaluated periodically

to monitor malnutrition, thereby enabling appropriate measure that can prevent it to

be implemented (Taguri et al., 2008) and Kariuki et al. 2002)

It is a known fact that our children are the greatest assets of a country. They are the

future leaders. Providing optimum health to children in terms of physical, social and

intellectual development should thus be a priority concern of everybody. Child

nutrition is important to stimulate the childs cognitive development during the first

five years through interaction and play. Nutrition in early childhood has a lasting

impact on health and well being in adulthood.

Good nutrition is critical to child health and development. Ensuring that children are

well nourished is essential to helping reach the millennium development goals

(MDGS), because sound nutrition is central in to health, learning and well being.


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investing in good nutrition for children would be a tremendous spur to global

development. Good nutrition, especially in the first five years of a childs life offers

massive return in health, education and productivity. Measuring the childs nutritional

status is important because of both the long term and short effort on the health,

education and cognitive abilities of the child. Nutrition has major effect on health.

Nutrition refers to the availability of energy and nutrient to the bodys cells in relation

to body requirements. Nutrition is concerned with social, economic, cultural and

psychological implication of food and eating, (council of food and nutrition, 1963).

Good nutrition helps protect natural immunity, which is particularly important for

wealth as resistance to drugs increase and new diseases emerge. It is essential for

normal organ development and function for normal reproduction growth and

maintenance for optimum activity and working efficiency. Food can be defined as any

edible substance that provides nourishment when (Dorothy and Barren, 1980). Food

contains ingredients known as nutrients which should have energy for activities to

grow and to maintain health.

INFLUENCE OF MOTHERS EDUCATION

Nutritionally educated mothers can bring up their children in a healthier ways.

Education generally has an impact on survival both as a direct determinant of

behaviour and indirect as it affects cultural attitudes and gender relations. The higher

a womans level of education, the more likely it is that she will marry later, play a

greater role in decision making and exercise reproductive rights her children are also

more likely to enjoy better health and be well malnourished. Women education has

been found to be a key factor in reducing infant and child mortality (Martorell et al.,

1984)


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Evidence suggest that increasing level of maternal education is associated with

decline in poor infant nutrition and poor child health because education is associated

with many factors. It is understood that women who are educated break away from

traditional family method. The evidence of this break is seen in the way uneducated

women in rural area looks after their children as compared to their educated

counterpart in urban areas. Educated women would provide better and more valuable

nutrition for their children while their uneducated ones would feed their children

guided by traditional feeding habit, which is most circumstances deny children of

good and valuable nutrition food (Molt, 1983), illiterate women with little knowledge

of health needs of their children are less likely to take an adequate care of certain

dangers and are more likely to feed their children with unhygienic food, resulting in

malnutrition and various disease (Jellife, 1974)

Women who even receive a minimal education are generally more aware than

those who have no education of how to utilize available resources as for the

improvement of their own nutritional status and that of their families. Education may

enable women to make independent decisions to be accepted by others household

members, and to have greater access to household resources that are important to

nutritional status (ACC/SCN,1990). A comparative study on material malnutrition in

ten sub-saharan African countries (loalza, 1997) and a study in the SNNPR of

Ethiopia (Teller and Yimar, 2000) showed that the higher the level of education, the

lower the population of undernourished women.

Improving girls access to schooling and closing the gender gap in education

has received an enormous amount of affection in academic and policy dialogues.

Higher educational attainment yields a host of benefit for girls and women in terms of

their autonomy, rights labour market outcomes, and social status. These improvements


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occur due to acquisition of greater human capital in the form of knowledge and skills

that contribute to greater labour market productivity and greater empowerment for

women. Educating girls also has a functional importance in form benefits for the next

generation, as the socio-economic status, and choices of more educated mothers

during pregnancy and child rearing can have a large impact on childrens nutritional

status ,well-being, and survival(Frongillo et al., 1997, Pelletier 1998, Webb and Block

2004).

The benefits of mothers education for childrens health outcomes and

nutritional status commonly accrue through higher socio-economic status, which in

turn operates through a set of proximate determinants of health that directly

influence child health outcomes and nutritional status(Mosley and Chen 1984).The

proximate determinants include fertility factors, environmental hazards ,feeding

practices ,injury , and utilization of health services. Numerous empirical studies have

linked mothers education with such proximate determinants(Behrman and Wolfe

1987, Sandiford et al., 1995, Guilkey and Riphahn, 1998). Higher mothers education

and greater household wealth were associated with slightly greater preference for girls

, but that finding occurred only among people who had no living children.

Studies using house- level data have found mothers education to be positively

associated with a number of measures of infant and child health and nutritional status

(Wolfe and Behrman 1982, Thomas et al., 1991, Bicego and Boerma 1993, Hobcraft

1993 , Miller and Korenman 1994, Desail and Alva 1998, Waters et al., 2004, Boyle

et al., 2006). Empirical work has also shown that education can serve as a means of

adopting new health beliefs, gaining general knowledge, and applying specific

knowledge about health and nutritional practices that promote child health (Glewwe

1999). Furthermore, womens education can also affect child health because more


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education is linked with higher household income , which in turn strengthens families

abilities to handle adverse economic or environmental shocks, finance health care

needs and afford more nutritious food. Hence, families with more-educated mothers

are likely to have more income and assets than those with less-educated mothers

,giving them access to more and better food ,shelter, and protection from

environmental hazards. Socio-economic determinants thus affect child health and

nutritional status through a set of intermediary mechanism that encompass household

composition ,dietary intake, medical treatment, and environmental contaminants.

Greater education for mothers contributes to new skills, beliefs, and choices

about sound health and nutritional practices that directly influence the proximate

determinants of child health. For instance, knowledge obtained during a mothers

education can affect choices about antenatal care and about childrens nutrition,

hygiene, and health care. To the extent that more-educated mothers make healthier

choices for themselves during pregnancy ,education will have a direct effect on the

health of the health of the child at birth. Improved socio-economic status also involves

changes in norms and attitudes that influence the economic decisions and nutrition-

related behaviours of mothers and fathers. Stronger bargaining power for women

within the household can facilitate decision-making that improves child health

outcomes. Central to the social context in which mothers and fathers operate is

bargaining power, and an important change that comes with more education for

women in developing countries is increased empowerment and autonomy.

Numerous studies show that women literacy and schooling are associated with

improved child nutrition after controlling for the effect of education on income and

fertility. Women are often exhausted by the combination of reproductive demands,

work load and inadequate diet (UNESCO 1998).


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The women education has been found to be object to good household nutrition

and health. Women education tends to be positively correlated with birth interval that

in turn tends to improve birth outcome. On the other hand, educated women may

increasingly become involve in wage labour away from house , and child care has to

be provided to others(Schulfs et al.,1984).

HOUSEHOLD TOTAL WEALTH AND CHILDREN NUTRITIONAL STATUSIn poor families ,malnutrition may be inevitable. In developing countries, wide

disparities in income inequality has been shown to have high positive correlation with

child survival. The economic status of a household is an indicator of access to

adequate food supplies, use of health services, availability of improved water sources,

and sanitation facilities, which are prime determinants of child and maternal

nutritional status (UNICEF,1990).

At the household level, income and wealth are linked to child well-being

through the effects that purchased goods and services have on the proximate

determinants of child health. Greater household income and assets directly raise the

ability to purchase sufficient quantities of nutritious foods, clean water, clothing,

storage of food, personal hygiene items, and health services(Boyle et al., 2006 and

Hong et al., 2006).

Studies have identified poverty as the chief determinant of malnutrition in

developing countries that perpetuates into intergenerational transfer of poor nutritional

status among children and prevents social improvement and equity(Larrea and

Kawachi,2005 and Hong et al.,2006). Osmani, 1992 puts it that nutrition and poverty

are the very closely related themes. Many elemental aspects of being poor , such as

hunger, inadequate health-care, unhygienic living conditions, and the stress and strain

of precarious living, tend to impair a persons nutritional status. In consequence, being

poor almost always means being deprived of full nutritional capabilities. An


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understanding of the processes through which chronic malnutrition comes to afflict a

household or community can reveal a good deal about the process leading to endemic

poverty.

Assuming health is a normal good, economic theory would suggest that increases in

income would lead to increased use of health goods and services, presumably leading

to a mortality rate of under-five children. Indeed, there is strong micro-level evidences

that income affects health. In Brazil, Thomas(1990) estimated large effects of

mothers non-earned income on child health. While several studies have shown that

greater household income is associated with a lower likelihood of low birth weight or

stunting(Martoell and Scrimshaw 1995; Kramer 1987a; Kramer 1987b; Kramer 2000).

Studies of illness suggest some measure of social conditioning may result in a greater

likelihood of reporting of illness among wealthier households. Helman(2001),

suggested that non-poor households are more likely to report their child as ill than

poor households because their income makes illness management more affordable to

them.

In infancy, the children are rather too young, fragile, dependent and too weak to be

responsible for their own upkeep. Their proper upkeep medically, financially,

emotionally and nutritionally then lies in the hands of the parents or the guardians as

the case may be. The status of their parents or guardians (income) therefore, goes a

long way in determining what happens to the health of these children. Hence, it is

expected that when the parents are of a good socio-economic status , then their

children too would have good access to medical facilities and achieve a good medical

status , especially in terms of nutrition at the infant stage when they are most

dependent on others.


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RURAL-URBAN DIFFERENTIALS AND UNDER-FIVE NUTRITIONAL

STATUS .

Studies on child nutrition (Sommerfelt et al.,1994; Yimer, 2000) showed significantly

higher levels of stunting among rural than urban children. In almost all variables and

determinants associated with both child mortality and nutritional status a rural-urban

differential is apparent. Where womens status is concerned , the autonomy females

gain is central to exceptionally decrease child mortality levels ; but this is especially

true in poor societies and highly evident in rural areas. This increased level of female

autonomy, and its especially effect in rural areas makes it likely that educational

differences by sex will be narrow(Caldwell, 1986).

Sastray (1994) also found that life time urban residents have child mortality levels

62% lower than their rural counterparts , though Sastray says the reasons for this is

unknown, we have established that this may either be due to the passive reception of

information on child health and care that urban resident s receive. Similarly, to

Sastrays conclusion, though in India it was found that children living in rural areas

had a higher proportion of malnourished children than those in the urban areas(Som et

al.,2006). However, studies in rural India (Pal, 1999), Indonesia (Walters et al., 2004)

and Bolivia (Frost et al.,2005) found a specific correlation between mothers literacy

rate and the childs nutritional status, while male literacy was not significant to

childrens nutritional outcomes(Pal., 1999). Population of rural dwellers with limited

economic self sufficiency and housing are those most likely to be malnourished and

with these, disadvantage population children of less than five years are more likely to

suffer sickness, developmental retardation.

Urban communities present residents with a diverse amount of resources. The are the

hub of political and economic activities as well as an outlet for entertainment


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purposes. In general, cities are at the centre of health inventions and

advancements(Stephens,1995).

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