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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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