International Journal of Research in Business, Economics and Management Vol.2 Issue 5 September-October 2018

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1 Factors Influencing of Malnutrition Among Under 5 Year Children: A Case Study of Banadir Hospital, Hodan District, Mogadishu Somalia Abdullahi Abdi Hussein Master of public health ABSTRACT Introduction: the study was assessing of malnutrition. The major objectives were to assessment on the factors influencing malnutrition among under 5 year children: a case study of Banadir hospital, hodan district, and Mogadishu Somalia Therefore, this study was focused among under five children in Hodan district. Study Objectives Main Goal To assessment on the factors influencing malnutrition among under 5 year children: a case study of Banadir hospital, hodan district, Mogadishu Somalia Specific Objectives To determine the demographic factors influencing malnutrition among under five years children in Banadir hospital, Hodan district. (II)To identify the socio-economic factors influencing malnutrition among under five years children in Banadir Hospital, Hodan district. (III)To assess the health factors influencing malnutrition among under five years children Banadir Hospital, Hodan district. Methodology A descriptive case study approach was used in order to determine and report about the factors influencing prevalence of malnutrition among children under 5 years in Hodan district Mogadishu, Somalia. The study used a cross-sectional design which is both quantitative and qualitative. The findings of this study also revealed that more than 50% of the children under five years are looked after by other people other than their mothers. Among these, the study revealed that some children are left with neighbors, others in day care and some with grandmothers, when their parents have gone to work. For all these, the implication is that the child misses breast feeding, which is very important in child proper nutrition. According to Berdanieret al (2001) Introduction to the study 111

2 The study seeks to investigate the factors influencing malnutrition among under 5 year children in, Hodan district. According to the World Health Organization, malnutrition is the biggest contributor to child mortality, present in half of all cases. Six million children die of hunger every year. Underweight births and intrauterine growth restrictions cause 2.2 million child deaths a year. Alderman,et al., (2008) defines malnutrition is a condition that results from eating a diet in which nutrients are not enough or are too much such that it causes health problems. According to this study, malnutrition is a major health problem, especially in developing countries. Water supply, sanitation and hygiene, given their direct impact on infectious disease, especially diarrhea, are important for preventing malnutrition. Malnutrition and inadequate water supply as well as sanitation are linked to poverty. The impact of repeated or persistent diarrhea on nutrition related poverty and the effect of malnutrition on susceptibility to infectious diarrhea. Globally, more than 30 million children experience hunger regularly or are at risk of going hungry, according to the Child Welfare League of America. Some 8.5 million children, including nearly 3 million children, experience hunger on a daily basis. Many of them must rely on food banks and church-sponsored hot meals programs to get by. Of course, those who do not get enough to eat, run the risk of becoming malnourished. Some 13 million children live in homes with limited access to food, and an average one in three children receives food assistance via the food stamp program called the Supplemental Nutrition Assistance Program, according to the Louisiana State University Agricultural Center. Malnutrition leaves children vulnerable to illness and infection. It can also lead to higher levels of aggression, hyperactivity and anxiety. Malnutrition also affects a developing child's ability to learn (save the children, 2004). In Africa, malnutrition is responsible for about 5.6 million to10 million child deaths per year, with severe malnutrition contributing to about 1.5 million of these deaths (Heinkenset al., 2008). Therefore, understanding the factors contributing to malnutrition is not only required but also very important in looking for a solution to this problem (National Department of Health (NDoH), 2005). The United Nations Children s Emergency Fund (UNICEF) conceptual framework of child malnutrition shows multiple levels for interventions that can reduce morbidity and mortality related to malnutrition. To prevent or treat malnutrition, the factors causing the condition need to be evaluated. The different causes of malnutrition are interlinked and include immediate causes, underlying causes and basic causes (UNICEF, 2004). All these factors operate together and not independently (Williams, 2005). The government of Somalia recognizes good nutrition as being central to achieving the Millennium Development Goal 1 which advocates for the eradication of extreme poverty and hunger, and includes the target to reduce by half the number of underweight children by The aspect of nutrition is incorporated well in Vision 2016 and most of Somalia s existing national development plans, policies and programs (Save the Children, 2012). Specific Objectives 1) To determine the demographic factors influencing malnutrition among under five years children in Banadir hospital, Hodan district. 112

3 2) To identify the socio-economic factors influencing malnutrition among under five years children in Banadir Hospital, Hodan district. 3) To assess the health factors influencing malnutrition among under five years children Banadir Hospital, Hodan district LITERATURE REVIEW Introduction Malnutrition is a condition that results from eating a diet in which nutrients are not enough or are too much such that it causes health problems. According to this study, malnutrition is a major health problem, especially in developing countries. Water supply, sanitation and hygiene, given their direct impact on infectious disease, especially diarrhea, are important for preventing malnutrition. Malnutrition and inadequate water supply as well as sanitation are linked to poverty. Malnutrition increases the risk and worsens the severity of infections. Somalia has one of the highest malnutrition rates in the world, with one in seven children below the age of five, are acutely malnourished and in need of specialized care. Since its start in 2009, our inventive program with local Somalia NGO SAACID has treated more than 136,000 malnourished children and their mothers (UNICEF, 2009). Malnutrition is a risk factor for death, with millions of young children being affected due to diseases, poor and inadequate diet. Malnutrition may increase or worse the severity of the diseases. The most vulnerable group for malnutrition are infants and young children because they have increased nutritional demands in this age for growth as well as development. Statiscs have shown that both undernourished children and severe malnutriton children have increased risk of death compared to children with good nutritional status(caulfield et al., 2004). This chapter comprises of the views and opinions of earlier authors which are related to the assessment on the factors influencing malnutrition among under five years children :Literature was discussed in relation to the major objectives of the study which are ; To determine the demographic factors influencing malnutrition among under five years children in Banadir Hospital, Hodan district,to identify the socio-economic factors influencing malnutrition among under five years children in Banadir Hospital, Hodan district Demographic Factors influencing Malnutrition in children under five years Household food security is seen as all people in the household having access to food at all times. The food must be safe and of high quality and the environment should be hygienic enough to use the food so that all members can lead healthy, productive lives. Food security concentrates on four aspects: availability of food, stability of food supply, access to food and utilization of food (Food & Agriculture Organization (Alderman et. al., 2008). The Health Related Factors Influencing Malnutrition among under 5 year children Malnutrition rates in the developing world are still high because of the lack of access to health services (Oyelami&Ogunlesi, 2007). Even though patients have little or no access to formal health services, 113

4 there is still the problem that patients do not make use of the services available. According to James et al. (2011) METHODOLOGY Research Design A descriptive case study approach was used in order to determine and report about the factors influencing prevalence of malnutrition among children under 5 years in Hodan district Mogadishu, Somalia. The study used a cross-sectional design which is both quantitative and qualitative in nature and which information was obtained from Banadir hospital in Hodan district Somalia. Study Population Based on the medical records from Banadir hospital, 420 children under 5 years have been recorded in the past one year (From January, 2014)from where the sample size was determined to obtain the respondents. Interviews were conducted on their caretakers or parents. Over 20 Key informants were interviewed and included district health officer, health inspectors, hospital staff and community members. Sampling Techniques/Procedures The simple random sampling was used to select 180 children under five years for the study while stratified random sampling and purposive sampling were used to select the 20 key informants FINDINGS Profile of Respondents Demographic factors influencing malnutrition among under5 year children Banadir Hospital, Hodan district Respondents in this study were the caretakers and/or parents of the children under five years in Banadir Hospital, Hodan district, Somalia. Through closed ended questions in the questionnaire, respondents were asked to provide their personal information, to ensure their easy categorization. Their responses were analyzed using frequencies and percentage distributions as shown in table1 Demographic factors influencing malnutrition by sex Categories of sex Frequency Percent Male Female Total According to the results in Table 4.1, most respondents (51.4%) were males as compared to females who were only 48.6%. This suggests that there were more male child caretakers in the 114

5 sample as compared to the females. This however surprises because it is usually expected that women are the care takers of children more especially when they are sick and are admitted to hospital. Table 4.2 shows distribution of respondents by age. Socio-economic factors influencing malnutrition among under 5 year children admitted in Banadir Hospital, Hodan district, Somalia The findings of this study revealed that members of the sample earned lower than $2 per day. This implies that poor people are not able to provide adequate nutritional requirements of their infants. In such poor families, other problems like child neglect are common. In most cases parents tend to leave the child at home to go and search for what to eat. They may comeback after long hours when a child has had little to eat. In some families both the parents go, while in others, either the father or the mother will go. The situation is even worse if the mother goes, taking even the naturally given food (breast milk). When both go, the child is left with young ones who know little about child care. FAO (1996), Table 2: Socio-economic factors influencing malnutrition Income levels per day Frequency Percent <$1 per day >$1 per day $1 per day Results from Table2 suggest that people s income levels are still very low and so, majority fall into the category of absolute poverty, since they earn less than two dollars a day. The findings indicate that almost 75% of the sampled respondents survive on either one or less than one dollar a day, which is so small for a person to survive in this highly monetized economy of today. Since majority, if not all are in absolute poverty (<$2 per day, according to international standards) their children are likely to be faced with a challenge of malnutrition, because their parents or care takers are too poor to buy nutrition supplements and also such people tend to lack knowledge of children nutrition and health. The results further suggest that most of children belonging to such poor families are likely to be not only malnourished but also experience many other problems as a result of poor nutrition and inadequate care due to inability of their parents to provide what is needed. Health related factors influencing malnutrition among under five year s children Immunization levels are still lower than WHO targets and there are low as well as poorly distributed breast feeding practices among the mothers, meaning inconsistence and so less effectiveness in the feeding arrangements. It is possible to reduce several diseases among children like diarrhea, measles and Marasmus through proper nutrition. Proper treatment and immunization can help boost the nutrition status of infants. The parents or mothers education about child 115

6 primary health care and nutrition seem to be inadequate, yet they are vital in reducing the malnutrition problem. Table3: Analysis of some child Birth related health factors Birth weight Frequency Percent Low birth weight (<2500g) Normal birth weight (>2500g) Nutritional diagnosis of the child (as indicated in patient file) Kwashiorkor Marasmus Marasmus and kwashiorkor Whether the child was born prematurely No Yes Where was the child born Clinic Community Centre Home Hospital Whether the child go to the health Centre for Checkups No Yes

7 According to the results of Table 4.13, 53% of the children investigated upon had normal birth weight, while 47% had a low birth weight. A low birth weight is an indication that the child has some malnutrition problems. The results also indicate a high rate of children with low birth weights. With regard to nutritional diagnosis, the findings indicated that majority of the children had the problem of kwashiorkor (59.7%) while 21.0% had a problem of Marasmus. These results imply that most of the children have signs of malnutrition indicate by the high rate of those with kwashiorkor. However, the fact that most of these children underwent a nutrition diagnosis, is a step ahead because, to diagnose the malnourished child, their nutritional status must be evaluated and ascertained first (Torún& Chew 2006). Another important finding in this table is that almost 49% of the children were prematurely born. Such children have more nutritional needs as compared to those born when they are completely mature. It is also very difficult to fulfil the nutritional requirements of such a baby, if is not advised by professional medical personnel, yet most people rarely medical professionals on such matters. This is further confirmed by the fact that majority (335.4%) of the parent s/care givers indicated that their children were born outside the hospital and another 33.7% revealed that theirs were born from either a clinic or a community centre, which are inadequate and tend to neglect issues related to children nutrition. Another important finding reveals that almost 67% of the children are not taken to health centers for medical checkups, which shows that their parents may not get the correct advice on how to feed their babies. Discussions of findings This study was intended to explore the health effects of malnutrition among under five years children in Banadir Hospital, Hodan district, Mogadishu, Somalia. It was based on three specific objectives, which included to; 1) determine the demographic factors influencing malnutrition among under five years children; 2) identify the socio-economic factors influencing malnutrition among under five years children; and 3) assess the health factors influencing malnutrition among under five years children Banadir Hospital, Hodan district. Demographic factors influencing malnutrition among under five year s children The findings of this study indicated that the most of the child caretakers were male in the sample as compared to the females. The findings also indicated that there were many young childcare takers, although on average most of the respondents were in the early adulthood age bracket. The justification was that young female children are more protected in going out so boys are usually sent out more than girls. Kvamme, et al. (2011). Socio-economic factors influencing malnutrition among under 5 year children admitted in Banadir Hospital, Hodan district, Somalia The findings of this study revealed that members of the sample earned lower than $2 per day. This implies that poor people are not able to provide adequate nutritional requirements of their infants. In such poor families, other problems like child neglect are common. In most cases parents tend to leave the child at home to go and search for what to eat. 117

8 Health factors influencing malnutrition among under five year s children Banadir Hospital, Hodan district The findings of this study showed that more than 50% of the children surveyed are not immunized, over 26% are not breast fed and over 45% are breast feed less than four times a day. Of those children surveyed, only 37% are directly breast fed, the rest are given milk using a spoon, cup or bottle. All these factors are key in influencing the nutritional status of children. Several other researchers have investigated on these factors; for example, Ayayaet al. (2004) found that incomplete immunization was a risk factor for the development of malnutrition among children. Conclusion The purpose of this study was to investigate the factors influencing of malnutrition among under 5 year children: a case study of banadir hospital, hodan district, mogadishu somalia. An empirical investigation was undertaken, using the simple correlation analytical technique, specificallythe Pearson product movement correlation coefficient. Immunization levels are still lower than WHO targets and there are low as well as poorly distributed breast feeding practices among the mothers, meaning inconsistence and so less effectiveness in the feeding arrangements. It is possible to reduce several diseases among children like diarrhea, measles and Marasmus through proper nutrition. Proper treatment and immunization can help boost the nutrition status of infants. The parents or mothers education about child primary health care and nutrition seem to be inadequate, yet they are vital in reducing the malnutrition problem. REFERENCES Alderman H &Linnemayr S. (2008) Reducing child malnutrition through community intervention programmes: Evidence from a large scale randomized trial in rural Senegal. 5 March. Amsalu, S &Tigabu, Z Risk factors for severe acute malnutrition in children under the age of five: a case control study.: University of Gondar. Ayaya, S.O., Esamai, F.O., Rotich, J. And Olwambula, A.R Socio-economic factors predisposing under five-year-old children to severe protein energy malnutrition.referral Hospital, Eldoret, Kenya. Eastern African Medical Journal. August, Boon, AN, Colledge, NR & Walker, BR Davidson s principles and practice of medicine; 20th edition. Philadelphia: Bhutta Z, Ahmed T, Black R, Cousens S, Dewey K, Giugliani E, Haider B, Kirkwood B, Morris S, Sachdev H, Shekar M. (2008) Maternal and Child Undernutrition Interventions for maternal and child undernutrition and survival in Lancet Bhutta Z, Ali S, Cousens S, Ali T, Haider B, Rizvi A, Okong P, Bhutta S, Black R. Almaata. (2008). Rebirth and Revision 6 Interventions to address maternal, newborn, and child survival: what difference can integrate primary health care strategies make? in Lancet 2008: Collins, S., Dent, N., Binns, P., Bahwere, P., Sadler, K. and Hallam, A Management of severe acute malnutrition in children. Duggan, M and Golden, B Deficiency diseases, in Human Nutrition. 11th ed. pp. 118

9 United Kingdom: Elsevier Churchill Livingstone. Fuchs, GJ, Ausayakhun, S, Ruckphaopunt, S, Tansuhaj, A &Suskind, R Relationship between vitamin A deficiency, malnutrition and conjunctival impression on cytology. American Journal of Clinical Nutrition. Heinkens, G.T., Bunn, J., Amadi, B., Manary, M., Chhagan, M., Berkley, J.A., Rollins, N.,Kelly, P., Adamczick, C., Maitland, K. and Tomkins, A Case management of HIV infected severely malnourished children: challenges in the area of highest prevalence. 119