BAHIRDAR UNIVERSITY

COLLEGE OF MEDICINE AND HEALTH SCIENCE

SCHOOL OF PUBLIC HEALTH

THE IMPACT OF MATERNAL WORK STATUS OUTSIDE THE HOME ON

NUTRITIONAL STATUS OF 6-59 MONTH-OLD CHILDREN IN BAHIRDAR
CITY, AMHARA REGIONAL STATE, ETHIOPIA 2017.

BY: MESFIN TEGEGNE (BSC)

A PROPOSAL SUBMITTED TO THE SCHOOL OF GRADUATE STUDIES

OF BAHIR DAR UNIVERSITY IN PARTIAL FULFILMENT OF THE
REQUIREMENT FOR THE DEGREE OF THE MASTERS OF PUBLIC
HEALTH (EPIDEMIOLOGY)

AUGUST, 2017

BAHIR DAR, ETHIOPIA

i
THE IMPACT OF MATERNAL WORK STATUS OUTSIDE THE HOME ON
NUTRITIONAL STATUS OF 6-59 MONTH-OLD CHILDREN IN BAHIRDAR
CITY, AMHARA REGIONAL STATE, ETHIOPIA 2017.

BY: MESFIN TEGEGNE (BSC)

ADVISORS:

DEBERE NIGATU (MPH, Assistant Professor)

DERJE BIRHANU (MPH, Assistant Professor)

AUGUST, 2017
BAHIR DAR ETHIOPIA

ii
 BAHIRDAR UNIVERSITY
SCHOOL OF GRADUATE STUDIES

The impact of Maternal Employment on Nutritional Status of Children,

Bahir dar, tana kifleketema.

By:Mesfin Tegegne
Bahirdar University College of Medicine and Health Science school of
public health

Approved by

Mr.Dabere Nigatu(Advisor) _________________________

Mr.Dereje Birhanu(Advisor) _________________________

iii
ACKNOWLEDGEMENT

First of all, I would like to express my heartfelt thanks and appreciation to my advisors
Mr. Dabere Nigatu and Mr.Dereje Birhanu for their invaluable and constructive
comments in the preparation research proposal.

i
TABLE OF CONTENT

Contents
ACKNOWLEDGEMENT ............................................................................................................................. i
TABLE OF CONTENT ............................................................................................................................... ii
LIST OF FIGURES.................................................................................................................................... iv
LIST OF TABLES ....................................................................................................................................... v
LIST OF ABBREVIATION ........................................................................................................................ vi
LIST OF ANNEXES ................................................................................................................................. vii
SUMMARY ............................................................................................................................................... viii
1. INTRODUCTION ................................................................................................................................... 1
1.1 Background ......................................................................................................................................... 1
1.2 Statement of the Problem statement. ................................................................................................ 2
1.3 Justification of the research ................................................................................................................ 3
2. LITERATURE REVIEW ........................................................................................................................ 5
OPERATIONAL DEFINITION .................................................................................................................. 9
3. OBJECTIVES: ...................................................................................................................................... 10
3.1. General objective ............................................................................................................................. 10
3.2. Specific objective: ............................................................................................................................ 10
4. METHOD AND MATERIALS.............................................................................................................. 11
4.1. Study Area: ....................................................................................................................................... 11
4.2. Study Design and period: ................................................................................................................. 11
4.3. Source population: ........................................................................................................................... 11
4.4. Study Population: ............................................................................................................................. 11
4.5. Eligibility criteria............................................................................................................................... 11
4.6. Sample size calculation: ................................................................................................................... 11
4.7. Sampling Procedure: ........................................................................................................................ 12
4.9. Tools for data collection: ................................................................................................................. 14
4.10. Data quality .................................................................................................................................... 14
4.11. Data processing and analysis ......................................................................................................... 15
4.12. Ethical clearance ............................................................................................................................ 15
6. WORK PLAN ........................................................................................................................................ 16

ii
7. BUDGET BREAK DOWN ................................................................................................................... 18
8. REFERRENCES .................................................................................................................................. 20
9. ANNEX .................................................................................................................................................. 23

iii
LIST OF FIGURES

Fig 1: schematic presentation of conceptual framework…………………………7

Fig 2. Schematic presentation of sampling procedure…………………………..10

iv
LIST OF TABLES

1. Variables which are used to take samples………………………………11

2. Time allocation from data collection to analysis………………………..15
3. Budget breakdown for the field work……………………………………..17

v
LIST OF ABBREVIATION

EDHS: Ethiopia Demographic and Health Survey

(HAZ): Height for age Z score

NCHS: National Centers for Health Statistics

PEM: protein energy malnutrition

(WHZ): Weight for height Z score

(WAZ) – Weight for age Z-score

WHO: world health organization

vi
LIST OF ANNEXES

Annexe1: English version questionnaires

vii
SUMMARY

Back ground: Lack of proper nutrition, caused by not having enough to eat, not eating
enough of the right things, or being unable to use the food that one does eat.
Malnutrition accounts for 11% of the global burden of disease, leading to long-term poor
health and disability and poor educational and developmental outcomes.

Objective: The objective of the study is to determine the effect of maternal work status
outside the home on nutritional status of 6-59 month-old children.
Method: community based comparative cross sectional study will be conducted to
measure the level of child malnutrition among children aged 6-59 months old age.
Multi-stage sampling procedure will be employed to select the required household a
total of 14628 households. Structured questionnaire will be used to obtain information
on demographic, social, economic factors and information on anthropometric indices
will be also collected using weighing scale and height measuring board. Which will be
analyzed by growth reference scale, EPI-INFO version 7.0 computer statistical
packages and multiple logistic regressions on SPSS
Expected result. The result will be expected that mother employment status outside
their home will have an impact of nutritional status of 6-59 month –old children

viii
1. INTRODUCTION

1.1 Background
Malnutrition means “badly nourished” but it is more than a measure of what we eat, or
fail to eat. Clinically, malnutrition is characterized by inadequate intake of protein,
energy, and micronutrients and by frequent infections or disease. Nutritional status is
the result of the complex interaction between the food we eat, our overall state of
health, and the environment in which we live – in short, food, health and caring, the
three “pillars of well-being.”(1)
Malnutrition is the basis of such human health at all ages. Children particularly, need
appropriate nutrition and protein to meet their needs for energy, cell growth and
development. One of the greatest threats of child survival and development in recent
years is malnutrition. Children in preschool stage requires most attention, at this is the
period of rapid growth and development, which makes them highly vulnerable to
malnutrition. Malnutrition in this stage has far reaching consequences on child’s future
by severely affecting child’s physical and mental development.(2)
It is a formidable challenge. Every country is facing a serious public health challenge
from malnutrition. One in three people is malnourished in one form or another.
Malnutrition manifests itself in many forms: as children who do not grow and develop to
their full potential, as people who are skin-and-bone or prone to infection, as people
who carry too much weight or whose blood contains too much sugar, salt, or
cholesterol. The consequences are literally devastating. An estimated 45 percent of
deaths of children under age 5 are linked to malnutrition. Malnutrition and diet are now
the largest risk factors responsible for the global burden of disease by far.(3)
In Nigeria, 37 per cent of children, or 6 million children, are stunted (chronically
malnourished or low height for age), more than half of them severely. In addition, 18
percent of children suffer from wasting (acutely malnourished or low weight for height),
half of them severely. Twenty-nine per cent of children are underweight (both acutely
and chronically mal nourished or low weight for age), almost half of them severely
affected.(4)
The 2016 EDHS estimated that 38 percent of children under 5 are considered short for
their age or stunted (below -2 SD), 10% are wasted, 24% are under weight and 18

1
percent are severely stunted (below -3 SD). after being fairly stable in the first 6-8
months of life, the prevalence of stunting increases steadily from age 9 months through
the first 4 years of life, before declining slightly in the fourth year of life. Children age 24-
35 months have the highest proportion of stunting (48 percent). Stunting is slightly
higher among male than female children (41 percent versus 35 percent).(5)
While women’s labor force participation tends to increase with economic development,
the relationship is not straightforward or consistent at the country level. There is
considerably more variation across developing countries in labor force participation by
women than by men. This variation is driven by a wide variety of economic and social
factors, which include economic growth, education, and social norms.(6)
African women, produce as much as 80% of the food, and supplement family income by
working in the formal and informal sectors as traders and producers. In Ethiopia, in the
rural area 85% of the women involved in agricultural work, while in the urban areas due
to various social crises as well as rural urban migration, about 35% of urban dwellers
are women. This huge work force was forced to engage in low skills, education and
inability to compete with their male counter parts.(7)
In this modern era, most mothers have become part of the labor force compared to
previous time. Maternal employment influence child feeding practices thus it reflects
child nutrition status. Mothers exert strong influence over child feeding practices.(8)
1.2 Statement of the Problem statement.
Stunting and other forms of under nutrition are clearly a major contributing factor to child
mortality, disease and disability. For example, a severely stunted child faces a four
times higher risk of dying, and a severely wasted child is at a nine times higher risk.
Specific nutritional deficiencies such as vitamin A, iron or zinc deficiency also increase
risk of death. Under nutrition can cause various diseases such as blindness due to
vitamin A deficiency and neural tube defects due to folic acid deficiency.(9)
Malnutrition in all its forms either directly or indirectly is responsible for approximately
half of all deaths worldwide. This applies to perinatal and infectious diseases as well as
chronic diseases. Malnutrition accounts for 11% of the global burden of disease, leading
to long-term poor health and disability and poor educational and developmental
outcomes. Worldwide, by 2010 it was found that about 104 million children under five

2
years of age were underweight and 171 million stunted. At the same time, it was found
that about 43 million children under five were overweight or obese. About 90% of
stunted children live in 36 countries and children under two years of age are most
affected by under nutrition.(10)
Trend in the proportion of children the prevalence of stunted and underweight over the
three EDHS surveys is decreased. The prevalence of wasting in Ethiopia has remained
constant over the last 11 years. Even though the prevalence was deceased; it continues
a major health problem yet.
There is a general consensus today that a complex set of causes determines
malnutrition. Inadequate and/or inappropriate dietary intake and infectious diseases are
the immediate/ direct causes, while these in turn are related to a number of socio-
economic and environmental factors, such as environmental sanitation, water supplies
and primary health care, and family factors such as the presence of other family
members, type of housing, availability of water, household hygiene, mother’s education,
infant-feeding practices, decision-making power and maternal work status.(11)
1.3 Justification of the research
It is widely accepted that the work status of the mother plays an important role in
determining the health and nutrition status of her child.
Malnutrition is still a neglected area and too little has been done to address its causes
and serious social and economic implications. However, recently there has been
growing interest in nutrition with stronger political involvement at national and
international level leading to significant financial pledges and policy commitments. It is
now crucial to turn this momentum into results by ensuring the delivery of pledges and
accelerating progress on addressing the challenge of under nutrition.(12)
Economic theory suggests that families in which mothers work outside the home must
trade off the advantages of greater income against the disadvantages of less time for
home food production and supervision of children’s activities. This trade off may result
in positive, negative, or no net impacts on children’s nutritional well-being.(13)
First, the mother’s increased income, and, second, the time taken away from child
cares, when she goes to work, will be associated with her employment. While one of the
effects is direct and positive, the other is inverse and negative. Maternal employment

3
usually results in a loss of childcare time; presumably the mother is therefore less
available for breast feeding and making frequent meals, etc., however, it is possible
those non-working mothers also spend relatively little time in child care, or that
important care giving behaviors continue to be performed if there are adequate
substitute care takers.
In this study, I will contribute some to find out whether the well-being of children is
affected more by the time constraints of women who perform the dual role of mother, or
by the increased income generated by the mother’s working. Also it is helpful in
producing applicable recommendations that will show more areas of intervention
programs to both governments and non-government organizations to improve the health
and nutritional status of children. And also used as a base line data for those who are
concerned with capacity development of nutritional status and may also serve as a start
for any other large scale study.

4
2. LITERATURE REVIEW

Nutrient deficiencies and malnutrition

Maintaining good health depends on the consumption of sufficient amounts of nutrients
and energy. Malnutrition can describe under nutrition or over nutrition. Under nutrition is
the result of not taking in enough energy or nutrients and if this continues over a length
of time, starvation and other deficiency disorders will occur. Most particularly, children
who suffer from under nutrition can suffer from physical stunting or mental retardation.
Over nutrition results from an excessive intake of energy of one or more nutrients and
can result in medical problems such as obesity, heart disease or diabetes.(14)
Magnitude of malnutrition
according to WHO study, The prevalence of worldwide stunting, underweight, wasting
and overweight in children under 5 years of age were 26 %, 16 % ,8% and 7 %,
respectively In Africa stunted (36% in 2011) and Asia (27% in 2011), Seventy percent of
the world’s wasted children live in Asia, most in South-Central Asia.In the study of
USAID, Prevalence of stunting, under weight and wasting in Ethiopia among children
under 5 (0-59 months) in 2011, 44%, 29% and 10% respectively.(15)
Impact of malnutrition
The worst damages of malnutrition happen during pregnancy and early childhood –
from conception to two years, i.e. the first 1000 days. Undernourished children have
weaker immune systems and are thus more susceptible to infections and illnesses.
Long-term insufficient nutrient intake and frequent infections can cause stunting, whose
effects in terms of delayed motor and cognitive development are largely irreversible.
Extreme food shortages, common childhood diseases such as diahorrea and
pneumonia, or both can lead to acute malnutrition or wasting, which can quickly lead to
death if left untreated.(16)
Factors Influencing Nutritional status of children
Employment status of mothers Although women’s employment enhances the
household's accessibility to income, it may also have negative effects on the nutritional
status of children, as it reduces a mother’s time for child care. Some studies have
revealed that mothers of the most malnourished children work outside their home.(17)

5
Another study argued that there is no association between maternal working status
outside the home and children's nutritional status.(18)
Several studies have shown the association between women’s work and children’s
nutritional status controlling for potentially confounding variables. Earlier studies of this
type are reviewed that Dr Ritu Bhatia (2010) and Dr. Naheed Vaida (2013),these
researchers find a negative association of mother’s work and child nutrition, but for
others the correlation is positive.(19)
Results from the study at the Kindergartens in Selangor, Malaysia indicated that There
is a significant positive fair correlation (r=0.2, p=0.05) between child BMI and length of
working hours. However, the correlation of length of working hour and child’s height
(p=0.745) did not reach statistical significant which indicated.(8)
Results from in Shinille Woreda, Ethiopian Somali regional state, bivariate analysis
showed that family size, immunization status, maternal education, monthly income,
extra feeding during pregnancy/ lactation, ANC visit, continuation of breast feeding, birth
order, how long after birth did you first put the child to breast feed and availability of
latrine have significant association to wasting. Children from large family size were 2.0
times more likely to be wasted than children from small family size, children from
households having monthly income of less than 750 birr were 1.8 times more likely to
be wasted than children from households having monthly income of less than 750 birr,
non-immunized children were 7.6 times more likely to be wasted than their counter parts
and female were 1.5 times more wasted than boys.(20)
The result of study done at Babban-Dodo community Zaria city, Northwest Nigeria It
was found that there was significant difference, with regard to stunting, between the
children whose mothers were literate and had formal education and those whose
2
mothers had no formal education (x = 26.2, P < 0.05), but no significance was found
between the two groups as regards underweight and wasting.(21)
Findings from the 1992 Malawi DHS Survey ,Poor sanitation puts young children at risk
of increased illness, in particular diarrheal diseases, which adversely affect a child’s
nutritional status. Both inadequate food intake and poor environmental sanitation reflect
underlying social and economic conditions poor environmental sanitation reflect
underlying social and economic conditions.(22)

6
Studies show that as there is a strong relationship between a child’s age, family size,
birth interval and stunting. In communities with little access to and contact with health
care children are more vulnerable to malnutrition as a consequence of inadequate
treatment of common illness, low immunization rates, and poor antenatal care.
However, the factors associated with the problems malnutrition may differ among
regions, zones and communities, as well as over time.(23)
Results from the study of Guatemala, Characteristics of mother's income earning that
might be associated with anthropometric status where her income per month, the
percent of the family's income she earned, and the total number of hours she had
worked in the previous year. The woman's income per month was correlated with both
height for age and weight for age, whereas the mother's percent of family income
earned was related.(24)
Mother’s education seemed to play a protective role against child’s malnutrition. Overall
93% of the mothers literate though up to different levels..Prevalence was highest where
mothers were illiterate (52.94%) vs. value of 38.46% where mothers had education
more than secondary school. Similarly, stunting were 17.65% where mother was
illiterate and 7.69% where education level was more than secondary school. Differences
were statistically significant for both cases. Education of mothers significantly influenced
the nutritional status of under- five as the prevalence of under nutrition was 52.94%
where mothers was illiterate and it was 38.46% where education level was more than
secondary school.(25)

7
 Maternal work status and child nutritional status, Conceptual framework
Mothers’ employment status has potential implications for virtually all aspects of
children’s growth and development, and nutrition outcomes are no exception. The
quality of children’s diets and their subsequent physical health may depend significantly
on whether and how much their mothers work outside the home. On the one hand,
employed mothers may have less time available to supervise their children’s activities
and to prepare their meals. On the other hand, the additional income they bring into the
household may help to ensure a stable supply of high quality food.
.

Dietary
Time for intake (Food
Cooking availability)

Nutritional
Maternal Maternal status of the
work status income child

Health
condition
Time for
(diarrhea,
child care
ARI)

Identify the specific variables described in the literature and figure out how these are
related and then generate the conceptual framework.
Fig 1. Conceptual framework

8
OPERATIONAL DEFINITION

1. Working mother - A mother is considered to be a “ working mother” if she reports

earning income at least for the last six months by working either in government, NGO,
public, private sector, or earnings is based on self – managed income-generating work
including, Street vending mothers, semiskilled mothers, informal occupation, fixed
market vending, technical and professional working mothers.(number of days mother
work per week, hours per day mother works, length of working station and generated
income will have to be considered.
2. Non – working mother - A mother is considered to be “non-working mother “if she
reports she is not working at least for the last six months and dependent on someone
else for earnings (these include, house-wives, and others, etc). (It is assumed that, a six
months gap in maternal working status is ideally to show any significant difference in
nutritional status of children).
3. Childcare substitute: - refers to a type of arrangements to care for child when the
mother is away for work.
4. Caregiver – is the most responsible person that provides child care when the mother
is out of home for work.
5. Standard reference- is the z-scores values used by National Centers for Health
Statistics (NCHS), recommended by WHO and internationally accepted anthropometrics
references, which make possible to compare the growth of children living in different
environments, and to compare these groups with each other.
6. Stunting (HAZ) – Height for age Z score < -2SD of the NCHS reference. It normally
measures long-term under nutrition.
7. Wasting (WHZ) – weight for height Z score < -2SD of the NCHS reference. It reflects
acute malnutrition.
8. Underweight (WAZ) – Weight for age Z-score < -2SD of the NCHS reference. It
tends to assess both chronic and acute malnutrition.

9
3. OBJECTIVES:

3.1. General objective

To determine the impact of maternal work status outside the home on nutritional status
of 6-59 month-old children.

3.2. Specific objective:

1. To compare the nutritional status of 6-59 month-old children of working outside the
home and nonworking mothers.
2. To identify factors influencing the nutritional status of children.

10
4. METHOD AND MATERIALS

4.1. Study Area: -The study will be conducted in Bahir Dar town, Tana
kifleketema.which contains 14,628 households and has a total population of 52,430 of
which 24,750 are males and 27,680 are females. Under-five children are estimated to
be 1681. In the kifleketema, three medium private clinic and one governmental health
center. 2% of the households use open defecation, while the remaining use shared pit
latrines and private toilet facility. (Health extension workers of Tana kifleketema)
4.2. Study Design and period: community based comparative cross sectional Study
will be conducted from October to November 2017
4.3. Source population: The source population will be all mothers lived in Bahir Dar
city
4.4. Study Population: working outside the home and non-working mothers with 6-59
month –old children living in Tana kifleketema

4.5. Eligibility criteria

4.5.1. Inclusion criteria:

.Only working and non-working mothers of children from 6-59 months old age
.Working women may be working either full time or part time.
.Working women should be working from at least past 6 months.
4.5.2 Exclusion criteria

.Child and mother lived separately will be excluded from the study.
4.6. Sample size calculation: The sample size is calculated based on the prevalence
of stunting child for working mother, Statistical power, ratio of unexposed to exposed,
percent of outcome in unexposed group, percent of outcome in exposed group, odds
ratio and 95 percent confidence interval (CI).a total sample of 652 will be selected using
simple random sampling technique. Accordingly, the calculated optimal sample 652
working and non working mothers who have child of 6 to 59 months old.
Using open epi version 7.1 statistical package. Among exposure variables, maternal
education and maternal work status of mothers are chosen as main exposure since it is
considered to give the larger sample size In this regard

11
 TABLE.4.1 variables which are used to take samples.

Assumptions Variable

Maternal work status

CI 95%

Power 80

Ratio 1:1

Odds ratio 0.63

% exposed 20.3

% unexposed 28.8

Sample size 652

4.7. Sampling Procedure: whole households will be enumerated to know total

population In order to identify working and non-working mothers, a total enumeration
(census) of each household of tana kifleketema will be undertaken. Therefore total non-
working mothers and working mothers with Under-five children will be identified. This
will be used as a sampling frame to identify the required sample size. Then mothers
with under five child will be selected using lottery method. For the family that will have
more than one child with in this age one child will be selected also as Lottery method.
Data will be collected between October, 28 2017, November 28, 2017.

12
SCHEMATIC PRESENTATION OF SAMPLING PROCEDURE

Samples

13
4.9. Tools for data collection: Data will be collected using a structured
questionnaire for respondents (working and non-working mothers) and the sample will
be clinically assessed for visible symptoms of malnutrition, to take measurement of
children, weighing scale (Salter scale) for weight and a wooden measure for length and
height measurements will be used, after obtaining a written consent from the mothers
The questionnaire will contain different sections to obtain various types of
information.
I, General information: It includes the, age, sex and maternal history of the sample
and its variables (like age, qualification, occupation, monthly income, working hours
etc.). It also elicited information about the nutritional awareness of mothers.
II, Anthropometric measurements: It includes the weight, height, mid arm
circumference.
III, Clinical assessment: the sample will be clinically assessed for visible symptoms of
malnutrition. It includes the signs of malnutrition and deficiency diseases.
IV, Health status assessment: the mothers will be interviewed about the general
hygiene of their children, any recent illness, immunization status, taking of oral
supplements, frequency of skipping meals and medical checkups conducted.
V, Nutritional Assessment: Mothers will be asked to give dietary recall of the food
consumed by their children on the previous day in all the meals.
4.10. Data quality
Six data collectors, (three nurses and three assistants), two supervisors and the
principal investigator will be involved in data collection process. Before data collection,
the investigator will provide training and guideline for data collectors and supervisors on
how to interview mothers and how to take anthropometric measurements. The
instruments will be pre-tested on 10% of the samples in similar circumstances in order
to assure whether the instrument is efficient enough to meet the objective of the study
or not. Based on the feedback obtained from the pre-test, the questionnaire will be
reviewed. The pre-test questionnaire will be conducted on adjacent kifleketema the
principal investigators will regularly supervise data collector as the closing of each day
of data collection so as to check consistency, completeness and accuracy the filled
questioners.

14
4.11. Data processing and analysis

The weights and heights/lengths of children will be converted to z-scores of height-for-

age, weight-for-height and weight-for-age based on growth reference of National
Centers for Health Statistics (NCHS)
Data will be categorized and coded on prepared coding sheet by the principal
investigator. Then data will be entered and analyzed using EPI-INFO version 7.0
computer statistical package. Frequencies,P-values, odds ratios and confidence
intervals will be calculated to describe the occurrence and the association of selected
variables and stratification will be used to control confounding variable. Multiple Logistic
regression models will be applied by using SPSS 16.0 statistical package.

4.12. Ethical clearance

Before data collection, Ethical clearance will be obtained from school of public health,
college of medicine and health Sciences College of Bahir Dar University. The local
authorities will be informed about the purpose of the study and its objectives. Prior to
entry into the study, the mothers will be asked consent after explaining the benefits of
the study to them.

15
6. WORK PLAN

Table 1: time allocation from proposal preparation to analysis

Responsibili Octo Nov Dec Jan Feb Mar

ties (2017 2017 2017 2017 2018 2018

Proposal Principal
1 preparation investigator

Study tool Principal

2 preparation investigator

Prepare field Principal

3 work investigator

4 Travel to data Principal

collection site investigator

Select data Principal

5 collector and investigator
assistant
Providing Principal
6 training for investigator
data collector
Pre tested
7 period investigator,
data
collector
assistance
Data Datacollecto
8 collection r assistant

16
 and
supervisor
Data entry investigator,
9 and cleaning data
collector
assistance
Data analysis Principal
investigator
10

N.B One month has three divisions each division has ten days

17
7. BUDGET BREAK DOWN

Table 2: budget for the fieldwork component will include funds for personnel,
transport and supplies.

Budget category Unit cost Multiplying factor Total cost(Ethiopian

birr)
1 Personnel Daily wage Number of staff X
working days
Principal 200 200 X100 2,000
investigator
Supervisor 200 200 X30 6,000
Data collectors 140 140 X 30 4,200
Data entry clerk 100 100 X 20 2,000
Secretarial work 100 100 X 20 2,000
Personnel total 14,200
2 Transport Cost per K/M Number per KM

No. of vehicle X No.

days X No.KM
Car 2 birr 3X120X100=3,600 7,200
Sub total Transport total 7,200
3 Supplies Cost per item Number
Questionnaires 0.75 birr 1000 750
duplication
Pen 4 10 40
Pencil 1 15 15
Eraser 1 10 10
Marker 18 10 180
Printing 180 4 720
paper(pack)

18
 Photo copy cost 0.75 birr 500 375
Printing cost 1.5 birr 60 90
Binding cost 8 10 80
Supplies total 2,260

4 Training Cost per item Number of days

Hall rent 400 3 1,200
Tea/coffee and 80(multiply by 3 19,200
lunch No. of participant
Training total 20,400
GRAND TOTAL 29,860

19
8. REFERRENCES

1. Turning the tide of malnutrition - World Health Organization

http://www.who.int/mip2001/files/2232/NHDbrochure.pdf

2. UNICEF.Complementary foods for children between 6 and 36 months of age. September 2006,
Unilever Health Institute, ISBN-13: 978-92-806-3996-4
3. International Food Policy Research Institute. 2016. The new challenge: End all forms
of malnutrition by 2030. In Global Nutrition Report 2016: From Promise to Impact:
Ending Malnutrition by 2030. ISSN: 2380-644 Pp. 1-13.
4. Malnutrition rates in children under 5 years
https://www.unicef.org/nigeria/factsheets_NUTRITION_low.pdf
5. Central Statistical Agency. Ethiopia Demographic and Health Survey. Addis Ababa,
Ethiopia: 2016 pp 30
6. Verick, S. Female labor force participation in developing countries. IZA World of
Labor 2014: 87 doi: 10.15185/izawol.87
7. Federal ministry of health. National nutrition strategy, Addis Abeba, Ethiopia 2008

8. Dr. Naheed Vaida. Impact of Maternal Occupation on Health and Nutritional Status of
Pre schoolers. IOSR Journal Of Humanities And Social Science (IOSR-JHSS), e-ISSN:
2279-0837, p-ISSN: 2279-0845 Volume 7, Issue 1 (Jan. - Feb. 2013), PP 09-12

9.UNICEF. Improving child nutrition: The achievable imperative for global progress.
Unicef. April 2013 ISBN: 978-92-806-4686-3. P 124

10. The Basics of Under nutrition

http://www.who.int/nutrition/EB128_18_backgroundpaper2_A_reviewofhealthinterventio
nswithaneffectonnutrition.pdf

11.Mary Kay Crepinsek and Nancy R. Burstein, Abt Associates Inc.Maternal

Employment and Children’s Nutrition Volume II June 2004
12. The social and economic consequences of malnutrition
www.europarl.europa.eu/meetdocs/2009_2014/documents/..._/background_en.pdf.

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13. Michael C. Latham.Human nutrition in the developing world. Food and nutrition
series; 1997 (29): ISBN 925103818X P125-30

14. The Impact of Diet on Health

https://www.pearsonschoolsandfecolleges.co.uk/AssetsLibrary/.../PDFs/Unit9HSC.pdf

15.Mercedes de Onis, David Brown, MonikaBlössner and Elaine Borghi World Health
Organization. ISBN 978 92 4 150451 5.

16. The social and economic consequences of malnutrition in ACP countries

http://www.europarl.europa.eu/meetdocs/2009_2014/documents/acp/dv/background_/b
ackground_en.pdf.

17. United Nations Children’s Fund (UNICEF).Improving Child Nutrition. United Nations
Publications .April 2013 ISBN: 978-92-806-4686-3.

18. Hetal Damania and Dr. Perpetua Machado Nutritional Assessment of Working and
Non-Working Mothers: march 2014, ISSN 2278–0211 Vol 3 Issues 3

19. Dr Ritu Bhatia. influence of maternal occupation on family food pattern & eating
habits of preschool children. South -Asian Journal of Multidisciplinary Studies (SAJMS)
ISSN:2349-7858:SJIF:2.246:Volume 3 Issue 5

20. Dr. Naheed Vaida. Impact of Maternal Occupation on Health and Nutritional Status
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ISSN: 2279-0837, p-ISSN: 2279-0845 Volume 7, Issue 1 (Jan. - Feb. 2013), PP 09-12

21. Farhanah Shuhaimi and Naleena Devi Muniandy. The Association of Maternal
Employment Status on Nutritional Status among Children in Selected Kindergartens .
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malnutrition in children 6–59 months of age. BioMed Central .ISSN 2055-0928.2:44(20)

23. mu'awiyyah Babale Sufiyan, Sulaiman Saidu Bashir, Ahmad Ayuba Umar. Effect of

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maternal literacy on nutritional status of children under 5 years of age Year : 2012 |
Volume : 6 | Issue : 2 | Page : 61-6(20)

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9. ANNEX

Questionnaires

Section one: Identification

Kebele’s number

House number

Family size

Number of under five children

Who is the head of the house?

Name of the head of the household

Is mother working?

Section two: Respondents Background

1. What is your age?
(In completed year?)

3. What is your religion? 1. Orthodox

2. Muslim
3. Catholic
4. Protestant
5. Others
4. What is your education
status?
1 = Illiterate
2 = Read and write
3 = Primary (1-6)
4 = Secondary (7-12)
5 = Secondary+ (12+)

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5. What is your ethnicity?

1.Amhara
2. Oromo
3. Tigrie
4. Gurage
5. Others

6. What is your marital status?

1. Married and in union

2. Married lived separately
3. Divorced
4. Widow
5. Never married
6. No response

7. What is the ownership

of your house?

1. Owned
2. Rented
3. Dependent
4. Others

8. What is the main source of

Drinking water for members
Of your household?

1. Piped water
2. Well water
3. Surface water (river,spring )
4. Others
9. What kind of toilet facility
Does your household have?

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 1. Flush toilet
2. Pit latrine, private
3. Pit latrine, shared
4. No facility / Bush / Field

10. Does your household have

Electricity?

1. Yes
2. No

11. What is your occupational status?

1. Government employee
2. Private Sector Employee
3. NGO employee
4. Self employee
5. Daily laborer
6. Vending
7. No work
8. Others, specify

12. What is the monthly income of

your husband/partner?

1. Less than Birr 500

2. Birr 500 - Birr 2000
3. Birr 2001- Birr 4500
4. More than Birr 4500
5. Don’t Know

25
13. While you are at home, what do you
do in your leisure time?

1. Do hand work (crafting)

2. Listen radio/Watch TV
3. Reading
4. Preparing/Cooking food
5. Care for my child
6. Do nothing
7. Others

14. The number of hours per day, days per week, months per year of work.
15. Distance from residence to work station in meter.
Section 3: Information on Characteristics of children aged 6-59 months

14. What is the age of your child?

(Index child)

In months

15. What is the sex of your

child? (Index child)

1.Male
2. Female

16.Place of delivery of your

index child

1.At health facility

2.At home

17. Who assisted you at delivery of

the index child?

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 1.Health professional
2.Trained Birth Attendant
3.Traditional Birth Attendant
4.Relatives/Friend/Neighbour
5.Others

18. Did you ever breast feed

Your child?

.Yes
2. No

19. If yes, for how many months did

you breastfeed?

2. 4 - 6 months
3. 7 – 9 months
4. 10 – 12 months
5. More than 12 months

20. For how long do you think should a

child exclusively breast feed?

In months

21. At what age do you think that a

child should start weaning?

In months

22. Has the child been ill with fever at

any time in the last two weeks?
1. Yes
2. No
3. Dont know

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23.If the answer for 22 is yes, did you
seek advice or treatment for the
Fever?

1. Yes
2. No

24. If the answer for question 23 is

yes, where did you seek
advice/treatment?
1. Public Sector
2.Private Medical Sector
3.Traditional Practitioner

25. Has the child been ill with cough at

any time in the last two weeks?

1. Yes
2. No

3. Don’t know

26. If the answer for question 25 is

yes, during a cough, did he/she
breathe faster than usual with short,
fast breaths?

1. Yes
2. No
3. Don’t know

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27. If the answer for 26 is yes, did you
seek advice or treatment for the
cough?

1. Yes
2. No
28. If the answer for question
number 27 is yes, where did
you seek advice/treatment?

1. Public Sector
2.Private Medical Sector
3.Traditional Practitioner
29. Is your child vaccinated?
(See card)

1. Yes
2. No
30.If the answer for question
number 29 is yes, what type of
vaccination does he/she take?
A) From Card ()
B) Mother’s Report ()

1. BCG only
2. BCG, DPT1, Polio1
3. BCG, DPT1 – 2, Polio1 – 2
4. BCG, DPT1 – 3, Polio1 – 3
5. BCG, DPT1-3, Polio1-3,Meseales

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Section 4: Information on Mother’s Work Characteristics

31. Have you taken any job

outside home in the last 6
months?

1. Yes
2. No
32. If the answer for question
number 31 is yes, how many
days do you work per week?

1. 1 day
2. 2 days
3. 3 days
4. 4 days
5. 5 days
6. The whole week

33.How much did you earn for

this work in Birr?

1. Per day
2. Per week
3. Per month

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34. If “No” for question No. 31
how do you get earnings?

1. From husband
2. From relatives
3. Help from others

35. (Only for working mothers)

Who usually takes care of your
child while you are at work /
working? or away from home?

1 ,Leaves with adult care giver

(husband, grand-mother,/father,
siblings, neighbors, friends)
2 ,Leaves with child <13 years
(Siblings, serevant/hierd help)
3 ,Leaves at child care institution
4 , Child is in school
5 ,Takes with mother to work

Section 5: Decision making in current relationship

36. In your household, who generally

decides in purchasing consumable
goods?

1. Respondent
2. Husband/partner
3. Both together
4. Others, specify
5. No response

37.When your child is sick, who

31
decides whether the child is sick
enough to be taken for treatment?

1. Respondent
2. Husband/partner
3. Both together
4. Others, specify
5. No response

38. Who in your household decides

whether your children will be
enrolled in school, or which school
they will attend?

1. Respondent
2. Husband/partner
3. Both together
4. Others, specify
5. No response

Section 6: Anthropometrics of 6 – 59 months old children

39. Child’s Weight in KG.

(to the nearest 100 gram)

40. Child’s Height in centimeters

(to the nearest 1cm)

32