1.1 BACKGROUND OF THE STUDY
Malnutrition in children also known as under nutrition or over-nutrition is common globally and result in both short and long term irreversible negative health outcomes including stunted growth which may also be linked to cognitive development deficit, underweight and wasting. The world health organization [who, 2008] estimates that malnutrition accounts for 54percent of child mortality worldwide about 1 million children. Another estimate also by [WHO, 2008] states that childhood underweight is the cause for about 35percent of all death of children under the age of five years worldwide. The main causes are unsafe water, inadequate sanitation or insufficient hygiene, factors related to society and poverty [Bhutta et al, 2008].
There are three commonly used measured for detecting malnutrition in children. They include stunting, underweight and wasting. These measurements of malnutrition are interrelated, but studies for the World Bank found that only 9percent of children exhibiting severe and acute malnutrition are very thin, but they often also have swollen hands and feet, making the internal problems more evident to health workers. Children with severe malnutrition are very susceptible to infections [World Bank, 2008].
Malnutrition in children causes direct structural damage to the brain and impairs infant motor development and exploratory behavior. Children who are undernourished before age two and gain weight quickly later in childhood and in adolescence are at high risk of chronic disease related to nutrition. Studies have found a strong association between malnutrition and child mortality.
Once malnutrition is treated, adequate growth is an indication of health and recovery. Even after recovering from severe malnutrition, children often remain stunted for the rest of their lives. Even mild degrees of malnutrition double the risk of mortality and malaria [Duggan et al, 2008]. He also state that the risk is greatly increased in more severe cases of malnutrition. Undernourished girls tend to grow into short adults and more likely to have small children.
Prenatal malnutrition and early life growth patterns can alter metabolism and physiological patterns and have lifelong effects on the risk of cardiovascular disease. Children who are undernourished are more likely to be short in adulthood, have lower educational achievement and economic status, and give birth to smaller infants [Bhutta et al, 2008].
The world health organization estimated in 2008 that globally, half of all cases of malnutrition in children under five were caused by inadequate food intake, unsafe water, inadequate sanitation or insufficient hygiene. This link is often due to repeated diarrhea and intestinal worm infections as a result of inadequate sanitation. However, the relative contribution of diarrhea to malnutrition and in turn stunting remains controversial. In almost all countries the poorest quintile of children has highest rate of malnutrition. However, inequalities in malnutrition between children of poor and rich families vary from country, with studies finding large gaps in Peru and small gaps in Egypt. In 2000, rates of child malnutrition were much higher in low income countries [36 percent] compared to middle income countries [12 percent] and the United States [1 percent]. Studies in Bangladesh in 2009, found that the mother’s literacy, low household income, higher number of sibling, less access to mass media, less supplementation of diets, unhygienic water and sanitation are associated with chronic and severe malnutrition in children [who, 2008]. Diarrhea and other infections can cause malnutrition through decreased nutrient absorption, decreased intake of food, increased metabolic requirements, and direct nutrient loss. Parasite infections, in particular intestinal worm infectious [Helminthiasis] can also lead to malnutrition. A leading cause of diarrhea and intestinal worm infectious in children in developing countries is lack of sanitation and hygiene. Children with chronic diseases like HIV have a higher risk of malnutrition. Since their bodies cannot absorb nutrients as well. Diseases such as measles are a major cause of malnutrition in children; this immunization presents a way to relieve the burden. The nutrition of children and younger depends strongly on the nutrition level of their mother during pregnancy and breastfeeding, world health organization [who, 2008].
Infants born to young mothers who are not fully developed are found to have low birth weight. The level of maternal nutrition during pregnancy can affect newborn body size and composition. Iodine deficiency in mother usually causes brain damage in their offspring and some cases cause extreme physical and mental retardation. This affects the children’s ability to achieve their full potential [Wag staff’s and Naoke, 1991]. In 2011 UNICEF reported that thirty percent of households in the developing world were not consuming iodine salt, which accounted for 41 million infant and newborns in which iodine deficiency could still be prevented. Maternal body size is strongly associated with the size of newborn children. Short stature of the mother and poor maternal nutrition stores increases the risk of intrauterine growth retardation [IUGR]. However, measurements of a child’s growth provide the key information for the presence of malnutrition, but weight and height measurements alone can lead to failure to recognize kwashiorkor and an underestimation of the severity of malnutrition on in children [UNICEF, 2011]