ROCKVIEW UNIVERSITY

SCHOOL OF GRADUATE STUDIES AND RESEARCH

RESEARCH REPORT

AN ASSESSMENT OF THE FACTORS INFLUENCING FAMILY

NUTRITION. A CASE STUDY OF MULUNGUSHI WARD OF

LIVINGSTONE DISTRICT.

A Research report submitted to Rockview University in partial for the award

of Master of Science in Food Science and Nutrition

BY

Kaira Elivas

Student # 20180425

SUPERVISOR: PROFESSOR MALVERN KANYATI

LUSAKA DECEMBER 2020

 TABLE OF CONTENTS
DECLARATION......................................................................................................................v
APPROVAL............................................................................................................................vi
ABSTRACT............................................................................................................................vii
DEDICATION......................................................................................................................viii
TACKNOWLEDGEMENT.................................................................................................viii
CHAPTER ONE.......................................................................................................................1
1.0. INTRODUCTION..........................................................................................................................1
1.1 BACKGROUND..............................................................................................................................1
1.2. STATEMENT OF THE PROBLEM...................................................................................................2
1.3. PURPOSE OF THE STUDY.............................................................................................................3
1.4. GENERAL OBJECTIVE...................................................................................................................3
1.5. MAIN RESEARCH QUESTION.......................................................................................................3
1.6. SPECIFIC OBJECTIVES..................................................................................................................3
1.7. RESEARCH QUESTIONS...............................................................................................................3
1.8. SIGNIFICANCE OF THE STUDY.....................................................................................................4
1.9. LIMITATIONS OF THE STUDY.......................................................................................................4
1.10. DELIMITATION OF THE STUDY..................................................................................................5
1.11. DEFINITIONS OF TERMS............................................................................................................5
1.12. CHAPTER SUMARY....................................................................................................................7
CHAPTER TWO.....................................................................................................................8
LITERATURE REVIEW........................................................................................................8
2.1 Introduction.................................................................................................................................8
2.1. Theoretical frame work..............................................................................................................8
2.2.1 NUTRITIONAL KNOWLEDGE AND ATTITUDES AMONG FAMILIES..................................8
2.2.2 FACTORS INFLUENCING FAMILY NUTRITIONAL PRACTICES AMONG FAMILIES....................9
1. Impact of Hunger, Poverty, and Education on Nutrition........................................................9
2. Sanitation, Health Facilities and Water................................................................................10
3. Socioeconomic, Political Access and Inequalities.................................................................11
4. HIV / AIDS and Nutrition......................................................................................................11
5. Food Accessibility and Choices............................................................................................12
6. Culture, Taste and Food Classification.................................................................................14
7. Traditional Food Habits and Taboos....................................................................................15

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 8. Age.......................................................................................................................................16
9. Sex/Gender..........................................................................................................................16
10. Health promotion and education.....................................................................................17
11. Household Incomes.........................................................................................................17
2.2. 3 HEALTHY FAMILY NUTRITION INTERVENTIONS..................................................................17
2.4 Nutritional Food and Nutrition Policy........................................................................................19
2.5 CHAPTER SUMAMRY..................................................................................................................20
CHAPTER THREE...............................................................................................................21
RESEARCH METHODOLOGY.........................................................................................21
3.0. INTRODUCTION.........................................................................................................................21
3.1. RESEARCH DESIGN....................................................................................................................21
3.2 TARGET POPULATION................................................................................................................21
3.3 SAMPLE SIZE..............................................................................................................................22
3.4 SAMPLING METHOD..................................................................................................................22
3.5. RESEARCH INSTRUMENTS.........................................................................................................22
3.6. DATA COLLECTION PROCEDURE...............................................................................................22
3.7. DATA ANALYSIS.........................................................................................................................23
3.8. ETHICAL CONSIDERATIONS.......................................................................................................23
3.9. CHAPTER SUMMARY.................................................................................................................23
CHAPTER FOUR..................................................................................................................24
FINDINGS..............................................................................................................................24
4.1.0 INTRODUCTION.........................................................................................................24
4.1. PRESENTATION OF FINDINGS AS THEY COME IN THE STUDY...................................................24
4.1.1.1 Demographic data of respondents..................................................................................24
4.2. WHAT IS THE NUTRITIONAL KNOWLEDGE AND ATTITUDES AMONG FAMILIES OF
MULUNGUSHI WARD.......................................................................................................................27
4.2.1 Definition of food................................................................................................................27
4.2.2 Knowledge on Food and Nutrition......................................................................................28
.....................................................................................................................................................29
4.2.3 Impact of nutrition education.............................................................................................29
4.3. WHAT ARE THE FACTORS INFLUENCING FAMILY NUTRITIONAL PRACTICES AMONG FAMLIES
OF MULUNGUSHI WARD.................................................................................................................29
4.3.1 Religion of the respondents................................................................................................29
4.3.2 Perception of nutrition.......................................................................................................30

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 .....................................................................................................................................................30
4.3.3 Meaning of nutrients..........................................................................................................31
.....................................................................................................................................................31
a. Food preparation...................................................................................................................31
b. Food distribution and acquisition.........................................................................................31
4.3.4 Decision making on food availability and accessibility........................................................32
4.3.5. Food availability and accessibility......................................................................................32
4.3.6 Money for buying food.......................................................................................................32
.....................................................................................................................................................33
4.4. HOUSEHOLD EXPENDITURE......................................................................................................35
4.5. ARE THERE ANY POSSIBLE SOLUTIONS TO ALLEVIATE HEALTHY FAMILY NUTRITIONAL
PRACTICES AMONG THE FAMILIES OF MULUNGUSHI WARD..........................................................36
4.5.1 Better way of getting nutrients from food..........................................................................36
.....................................................................................................................................................36
4.5.2 Frequency of eating food in a day....................................................................................37
A high proportion (59.8%) of the respondents in the study areas reported a feeding frequency of
three times per day, and only 2.4% had a feeding frequency of four times per day.....................37
4.5.3 Relationship between eating food and health....................................................................37
4.6. CHAPTER SUMMARY.................................................................................................................38
CHAPTER FIVE....................................................................................................................39
DISCUSSION CONCLUSION AND RECOMMENDATIONS........................................39
5.0. INTRODUCTION.........................................................................................................................39
5.1. DISCUSSION OF FINDINGS........................................................................................................39
5.1.2 NUTRITIONAL KWOLEDGE AND ATTITUDES AMONG FAMILIES OF MULUNGUSHI WARD..39
5.1.3 FACTORS INFLUENCING FAMILY NUTRITIONAL PRACTICES AMONG FAMILIES OF
MULUNGUSHI WARD...................................................................................................................40
5.2. ARE THEY ANY POSSIBLE SOLUTIONS TO ALLEVIATE UNHEALTHY FAMILY PRACTICES AMONG
FAMILIES OF MULUNGUSHI WARD?................................................................................................43
5.2.1 Fruits and Vegetables Consumption...................................................................................43
5.2.2. Evaluation of Household Decision Making on Food Accessibility.......................................43
5.3. Conclusions...............................................................................................................................44
5.4. Recommendations....................................................................................................................44
5.5. Suggestions for Further Studies................................................................................................46
REFERENCES.......................................................................................................................47
APPENDICES........................................................................................................................53

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 APPENDIX 1 (QUESTIONNAIRE FOR RESPONDENTS)........................................................................53

LIST OF TABLES
Table 1: Number of Participants..............................................................................................15
Table 2: Distribution of participants by gender (n=126)....................................................34

LIST OF FIGURES
Figure 1: Distribution of respondents by age and sex........................................................36
Figure 2: Education level of respondents.............................................................................37
Figure 3: Occupation of respondents (N=126).....................................................................37
Figure 4: Family sizes of respondents (N= 126)...................................................................38
Figure 5: Definition of food (N=126)....................................................................................39
Figure 6: Source of knowledge (N=126)...............................................................................40
Figure 7: Perception of nutrition (N=126)...........................................................................41
Figure 8: Meaning of Nutrients............................................................................................42
Figure 9: Who prepares food for the family (N=126).........................................................44
Figure 10: Reason on who prepares food for the family (N=126)......................................45
Figure 11: Household expenditure (N=126).........................................................................46
Figure 12: Better way of getting nutrients from food.........................................................47
Figure 13: Frequency of eating food in a day......................................................................48
Figure 14: Reasons on how they relate food to their health (N=126)................................49

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 DECLARATION
I Kaira Elivas, do here by declare to the senate of Rockview University School of Post
Graduate Studies and Research that the work presented here in my own creation and has
not been submitted for degree in any other University.

Signed ___________________________________

Date: ______________________________

v
 APPROVAL

Examiners’ signature

_____________________________________

DATE:

_____________________________________

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 ABSTRACT
The study was undertaken to understand factors influencing attitudes and perceptions on food
and nutrition of adult families residing in Mulungushi ward of Livingstone District.
Specifically, the study aimed at determining the socio-cultural factors influencing attitudes
and perceptions on food and nutrition; to assess the influence of socio-cultural factors on
dietary pattern in the study area; to evaluate household decision making on food accessibility;
and to suggest how to resolve the nutritional status of families. A questionnaire, Face to face
interview and focus group discussion were used to explore the factors. Also, anthropometric
dimensions of the respondents were measured, and households were visited for direct
observation. A total of 126 respondents were involved. The main finding of the study
indicates that most of the people in the study area (88%) attained primary school education.
The majority of respondents (96%) were involved in odd jobs (manual work). A high
proportion (66%) of the respondent’s lack knowledge on food and nutrition. Moreover, socio-
cultural factors influenced the subjects’ attitudes and perception on food and nutrition. The
study concluded that there is an inverse relationship between socio-cultural influences and
eating behaviour of the people in Mulungushi ward. Through interaction, people adopt
different culture but they do not completely lose their culture, still adhere to their old traits
therefore interventions need to be geared towards different groups of the population focusing
more on factors influencing their attitudes and perception on food and mark the basis for
planning culturally sensitive interventions to promote healthy eating.

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 DEDICATION
This thesis is dedicated to the following people, my husband Katebe Christopher and my son
Peace N’gambi Kalasa, My Family and Friends for their reassurance and for the Almighty
God who diligently keeps on renewing my strength and breath each and every day.

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ACKNOWLEDGEMENT

Firstly, I would like to express my sincere and deepest appreciation and gratitude to Prof.
Kanyanti M for providing me with guidance, encouragement, wisdom and thoughtful
criticism throughout this academic journey. I was a novice along the path of research, and yet
as I journeyed with my supervisor, I began to realize that actually it was more about the
journey (learning) than the destination. I thank you for allowing me to stumble, and for
providing important road signs at the right time and for not giving up on me though my study
seemed to have been going on forever. My supervisor was indeed my light, helping me to see
in the dark tunnel of unknowing components of the research journey. He gave the strength to
stand to research challenges and showed that were no greater than the support he rendered to
me. In my humanity, I may not have lived up to his academic expectations, but I feel I am a
better person academically due to this experience.

I want to thank you my husband and my dear son for their patience rendered to through the
period I was doing my studies and for the help given through finances and emotionally.

Lastly I thank everyone who had been so supportive through my research. May God, bless
you all.

Above all I give glory to the almighty God for granting me this opportunity of studying at
Rockview university.

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 CHAPTER ONE

1.0. INTRODUCTION

In this chapter the researcher presented the background of the study, problem statement,
purpose of the study, objectives of the study, significance of the study, limitation and,
delimitations. The chapter further defined the operational terms within the study and eludes
on the participant’s bill of rights.

1.1 BACKGROUND

All humans eat to survive. They also eat to express appreciation, for a sense of belonging, as
part of family customs, and for self-realization. For example, someone who is not hungry
may eat a piece of cake that had been baked in his or her honour. The term eating habits
refers to why and how people eat, which food they eat as well as the way people obtain, store,
use, and discard food. Individual, social, cultural, religious, economic, environmental, and
political factor all influence people’s eating habits. Social factors and cultural practices in
most countries have a great influence on what people eat, how they prepare their food, their
feeding practices and the food they prefer (Baranowski et al., 2003). All people have their
likes and dislikes and their beliefs about food and many people were conservative to their
food habit. People eat according to learned behaviours regarding etiquette, meal, snack
pattern, acceptable foods, food combinations, and portion sizes. A common eating pattern
was three meals (breakfast, lunch, and dinner) per day with snacks between meals. The
components of a meal vary across cultures, but generally include grains, such as rice, or
maize, meat or meat substitute, such as fish, beans, soya beans and accompaniments, such as
vegetable, (Klimas-Zacas et al., 2001).

Culture was a major determinant of what people eat. Personal values, attitudes and beliefs
about food and food preferences were largely shaped during the early socialization period and
were thus already a product of culture. Food chosen, methods of cooking, eating pattern, food
preparation, number of meals per day, time and size of portion eaten make up human food
ways and were a part of coherent culture in which each custom and practices had a part to
play (Fieldhouse, 1982). Socio-cultural factors were transmitted from one generation to
another by the process of socialization. Furthermore, local knowledge and perception
concerning food were usually limited to socio-norms and other socio-cultural factors that
surround food.
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Undesirable dietary habits and nutrition related practices, attitudes, perceptions and socio-
cultural influences could affect nutritional status (Shetty, 1999). In every society, there were
rules (usually unwritten) which specify what food was and what was not food. What one
society regards as normal or even highly desirable however another society may consider
revolting or totally inedible (Fieldhouse, 1982) Food habits differ widely in regard to which
foods were liked, disliked, eaten or not eaten in the society. Cultural groups provide guideline
regarding acceptable foods, foods combination, eating pattern and eating behaviour
compliance with these guidelines creates sense of identity and belonging for the individual.

Someone who was repeatedly exposed to certain foods was less hesitant to eat them, for
example, lobster, traditionally was only available on the coasts and was much more likely to
be accepted as food by coastal dwellers (Onyango, 2003). Religion had an important role in
forbidding the consumption of certain foods for example the Muslim nor do the Jewish
people consume pork. Within Christianity, the Seventh Day Adventists discourage
stimulating beverage such as alcohol which was not forbidden among Catholics. Food habit
and custom do change and they were influenced in many different ways (Grivetti, 1980).

A number of food habits and practices were poor from a nutritional point of view; however,
some food practices were governed by taboos and beliefs, which in some societies may
contributed to nutritional deficiencies among particular groups of the population (Latham,
1997). The study aimed at contributing to improvement of the nutritional status of urban
communities by understanding the socio-cultural factors influencing attitudes and perceptions
on food and nutrition and sharing one knowledge with many different sectors including
agriculture, health, community development and other stakeholders whose aim was to ensure
provision, accessibility and improvement of nutrition services to both rural and urban district
in Zambia.

1.2. STATEMENT OF THE PROBLEM

Mulungushi ward was one of the compounds found in Livingstone district. It was home to a
cosmopolitan community of various ethnicity and interest. The nutritional status of adults and
children in the region was poor. Infant mortality rate for Mulungushi ward was 6 per 1000
live births. Maternal mortality rate was 7 per 1000. The prevalence of wasting in children
below five years of age was 1.5%, underweight 25%, and stunting 52.4% (Maramba Clinic,
2018). The prevalence of stunting was higher than the national average of 46%.

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This was evident that chronic under nutrition was prevalent in Mulungushi ward. The
prevalence of anaemia was 59% in children below five years of age and 47% in school going
children (Maramba Clinic, 2018). The nutritional status of adults was also of great concern;
about 31% of all males were underweight using the standard Body Mass Index (BMI) cut off
of 18. About 11% of adult females were underweight. Prevalence of anaemia among adult
males ranged between 29% and 71% respectively. Prevalence of anaemia of non-pregnant
women was 52%. In some villages, the prevalence was as high as 80%. (Maramba Clinic,
2018). Hence, the need to investigate factors influencing socio-cultural factors, attitudes and
perceptions on food and nutrition of Mulungushi ward.

1.3. PURPOSE OF THE STUDY

The purpose of this study was to assess the factors influencing family nutrition in Mulungushi
ward of Livingstone district in Southern Province.

1.4. GENERAL OBJECTIVE

The aim of the study was to find out the factors influencing healthy family nutrition among
families of Mulungushi ward.

1.5. MAIN RESEARCH QUESTION

What were the main factors influencing family nutrition in Mulungushi ward?

1.6. SPECIFIC OBJECTIVES

1. To determine the nutritional knowledge and attitudes among families of Mulungushi

ward.
2. To find the factors influencing family nutritional practices among families of
Mulungushi ward.
3. To establish possible solutions to alleviate healthy family nutritional practices among
the families of Mulungushi ward.

1.7. RESEARCH QUESTIONS

1. What is the nutritional knowledge and attitudes among families of Mulungushi ward?

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 2. What are the factors influencing family nutritional practices among families of
Mulungushi ward?
3. Are there any possible solutions to alleviate healthy family nutritional practices among
the families of Mulungushi ward?

1.8. SIGNIFICANCE OF THE STUDY

The result of this study would help the following beneficiaries. This work could help health
practitioners to effect chances at health care centres as well as household level. Whilst
parents and guardians at home also could have guidelines as to how best they could
implement proper nutritional family diets. Academic institutions world-wide could use the
research findings as reference point. Scholars (researchers world-wide) could use this piece
of work to increase their knowledge base in this phenomenon under study, it was essential in
increasing understanding in this area, it was fundamental in discovering new, currently un-
known parameters under this study and also to validate other researchers’ work. In
conclusion, this study seeks to unlock new ideas and increase our knowledge base and facts
on this research topic. Furthermore, the study would help solve nutritional problems within
our society. Lastly it promotes health and happiness amongst families through nutrition. A
better understanding of how the public perceives their diets would help in the design and
implementation of healthy eating behaviours. The present study provides information on the
socio-cultural factors surrounding food and nutrition and recommend appropriate
interventions to improve the situation.

1.9. LIMITATIONS OF THE STUDY

Difficulties or barriers/limitations are those factors which led to the inability of the system to
accommodate diversity, which lead to participant to give un-satisfactory feedback thereby
resulting in less accurate or detailed research work. Financial constraints would also hinder
the researcher to reach a broader population so as to reduce ‘bias’ or what is known a ‘noise’
in research cycles. Therefore, this study was only done at Mulungushi ward. Financial
resource constraint was a major challenge for this study since the researcher relies on mere
savings and no sponsorship/funding had been found. Due to financial challenges the
researcher was limited in selecting research assistance especially in data collection and could
only ask for help from well-wishers or volunteers. The study could have been conducted in a
large scale covering a large population but unfortunately financial constraints also limited the

4
study population. Time scarcity was also a huge challenge when it came to research work.
Due to the busy schedule of the research participants it was sometimes difficult to access
information. Hence the researcher had found a conducive time to reach out to the respondents
and carry out the desired research duties.

Time scarcity also limited the researcher on covering vast populations over a long period of
time. Therefore, the study focused on only the sampled size which could have been an
achievable goal.

1.10. DELIMITATION OF THE STUDY

The research work was confined only at Mulungushi ward, of Livingstone on the Southern
parts of Zambia. No other geographical area was studied for purposes of this research work.

In total this research comprised of 126 respondents categorized as:

Table 1: Number of Participants

Parents 56

Children 44

Nutritionist 10

Health workers 16

Total 126

1.11. DEFINITIONS OF TERMS

Nutrition refers to the process of providing or obtaining the food necessary for growth,
reproduction, catabolism, biosynthesis and health.

Food can be defined as any nutritious liquid, semi-solid or solid substance containing
carbohydrates, proteins and fats that human beings ingest in order to maintain life and
growth.

Food habits is the way some person or group eats, considered in terms of what types of food
are eaten, in what quantities, and when.

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Health according to WHO (2017) is a state of complete physical, mental and social well-
being and not merely the absence of disease or infirmity.

Balanced diet refers to meals consisting of all the food nutrients in their correct proportions
in order to maintain good health.

Diet refers to the sum total of foods or liquids regularly consumed or provided.

Underweight refers to a term given to an individual (human being) whose body weight is
considered very low to be in a state of good health.

Stunting according to WHO (2019) is a condition usually evident in children causing

impaired growth and development from poor nutrition, and is determined using the World
Health Organisation (WHO) Child Growth Standards median.

Maternal mortality also referred to as maternal death is defined as the death of a woman
while pregnant or within 6 weeks of termination of pregnancy, regardless of the duration and
site of the pregnancy, from any cause related to or aggravated by the pregnancy or its
management but not from accident or incidental causes.

Body Mass Index (BMI) is a measure of body fat calculated by a person’s weight in
kilograms divided by the square of height in meters,

Anaemia refers to condition in which there is a deficiency of red blood cells or the oxygen-
carrying capacity of RBC is inadequate to meet physiologic needs which vary by age, sex,
attitude, smoking and pregnancy status.

Malnutrition can be defined as the deficiencies, excesses or imbalances in human being’s

intake of energy and or nutrients.

Prevalence in epidemiology is the statistical concept referring to the proportion of a

particular population found to be affected by a medical condition.

Food security means that all people, at all times, have physical, social, and economic access
to sufficient, safe and nutritious food that meets their food preferences and dietary needs for
an active and healthy life.

Micronutrients are one of the major group of nutrients the body needs. These include
vitamins and minerals.

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Sanitation refers to the public health conditions related to clean drinking water and adequate
treatment and disposal of human excreta and sewage.

Morbidity the condition of suffering from a disease or medical condition.

Mortality rate is a measure of the number of deaths in a particular population, scaled to the
size of that population, per unit of time.

Taste is the sensation of flavour perceived in the mouth and throat on contact with a
substance.

1.12. CHAPTER SUMARY

The researcher undertook this study to assess factors influencing family nutrition in families
of Mulungushi ward. The next chapter will review the findings of other researchers who have
done the work in this field.

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 CHAPTER TWO

LITERATURE REVIEW
2.1 Introduction

Eating well is vital for a healthy and active life. Most people know that we need to eat in
order to have the strength to work. The problem of eating well with limited resources is a
particularly important one for developing countries. Poverty is a major cause of the
nutritional problems found in developing countries. Hence the study focused on the literature
related to the problem on factors influencing family nutrition, other scholarly views and
articles that may perhaps have different aspects of factors influencing family nutrition in a
community.

2.1. Theoretical frame work

A theory was a supposition or speculation about a phenomenon. This could have been looked
at as a collection of interconnected ideas based on theories (Kasonde, 2013). According to
Kombo and Tromp (2006) a theory explains a phenomenon and attempts to explain why
things were the way they were basing on the theories. It was a reasoned set of prepositions
which were derived from and supported by data or evidence. Imenda (2014:189) defined a
theoretical framework as, “the application of a theory or a set of concepts drawn from one
and the same theory to offer an explanation of an event, or shed some light on particular
phenomenon or research problem. On the other hand, conceptual framework can best be
understood by first defining the word concept. Kasonde (2013:23) defined concept as, “a
word that speaks for several coherent ideas”. Hornby (2010) defines a concept as an idea or
principle that is connected with something abstract”. He further defines conceptual
framework as a set of ideas or principles that is used as a basis for making judgments or
decisions. The researcher decided to use theoretical framework as opposed to conceptual
framework because of the nature of the study which needed a theory so as to help shed more
light on the study.

2.2.1 NUTRITIONAL KNOWLEDGE AND ATTITUDES AMONG FAMILIES

Eating attitudes were emotional, motivational, perceptive and cognitive beliefs that influence
the behaviour or practice of an individual whether or not they have knowledge. Attitudes
were measured to identify individual positive or negative disposition regarding a health
8
problem, dietary practises, nutritional recommendations, dietary guidelines or dietary
preferences, (Marias and Glauser, 2014). Knowledge was a complex scheme of beliefs,
information and skills gained through experience and education. In terms of nutrition and
eating knowledge could have been described as the familiarisation of the benefits of food and
nutrients on health and the ability to remember and recall specific terminology and
information subject, Marias et al (2014). Particularly parental nutritional knowledge had been
described as important factors for family’s healthy food knowledge. Mothers to be more
precise play a vital role since they prepare meals for the family, (Marias et al 2014).

Approximately 852 million people worldwide cannot obtain enough food to live health and
productive lives, (Food and Agriculture Organisation, 2004). ‘Hunger’ was a popular word
that resonates strongly with all people, even those who have experienced it only briefly. It
was common usage; it describes the subject's feeling of discomfort that follows a period
without eating. The term undernourishment defines insufficient food intake to continuously
meet dietary energy requirements (FAO, 2003). The term food insecurity relates to the
condition that exists when people do not have physical and economic access to sufficient,
safe, nutritious, and culturally acceptable food to meet their dietary needs and lead an active
and healthy life, (FAO, 1996).
Nutrition deals with the way body absorbs and uses food, while malnutrition leads to health
problems, growth retardation poor cognitive development, and in the worst cases death. It
may result from deficiencies, excesses, or imbalances in energy, protein, and other nutrients
(FAO, 2003).

2.2.2 FACTORS INFLUENCING FAMILY NUTRITIONAL PRACTICES AMONG

FAMILIES

Eating behaviours were shaped by both intrinsic and environmental factors. Environmental
factors also known as extrinsic factors include family, friends or neighbours and intrinsic
factors include genetics, sex and age, (FAO, 2014). A study conducted in Trinidad and
Tobago on factors influencing nutritional status of low-income rural elders concluded that the
chief factors were sex, age and level of aspiration, Vitolins et al (2007).

1. Impact of Hunger, Poverty, and Education on Nutrition

The results show that individuals who were malnourished have been failed by many different
sectors including agriculture, health, community development, education, social welfare,
finance, and employment. To address hunger effectively requires understanding many causes

9
of malnutrition at the household, community, and regional levels. It was also requiring multi-
sectoral approach to develop solutions, design and implement policies specifically targeted at
vulnerable populations. Previous research suggests that, a cross countries extreme poverty
accounts for close to half the variability in overall malnutrition rates. (Smith et al., 2002), in a
cross-country study of the causes of malnutrition, found that during 1970 – 95, re capita
income in developing countries increased significantly from USD 1 011 to USD 2 121. This
large increase was found to have facilitated an estimated 7.4 percent reduction in child
malnutrition. In a study of 42 developing countries, the UN standing committee on nutrition
(UN ACC/ SCN, 1994) found a statistically significant relationship between GDP per capital
growth and changes in underweight prevalence, with a 1 percent annual increase in the
growth rate of GDP per capita leading to a 0.4 percent increase in underweight prevalence. A
similar study of 18 Latin American Countries by the ECLAC in 2001 found that, in 3 percent
of the cases analysed, the percentage of people living on less than day was correlated with the
percentage of the population underweight. In effect, 49 percent of the cross-country
variability in the malnutrition rate (low weight- for- age) and 57 percent of the cross-country
variability in moderate to serious chronic malnutrition (low height – for- age) could be
attributed to differences in the percentage of people living in extreme poverty (ECLAC,
2004). The level of parents’ education especially mother’s level of education, had a
significant impact on child malnutrition. If the mother attains primary school education, the
child was less likely to be underweight. The correlation is even stronger if the mother also
received secondary education. (Smith et al., 2002).
In a similar study in 1993 the UN ACC/SCN found especially in South Asia, that female
enrolment in secondary school and government expenditures on social services (health,
education and social security), are negatively and significantly associated with underweight
prevalence.

2. Sanitation, Health Facilities and Water

Inadequate sanitation, poor health facilities, unsafe water sources, contribute significantly to
malnutrition by increasing the burden of illness for both children and adults. More than
1billion people, one - six of the world’s population, lack access to safe and drinking water.
Households dependent on well or surface water for drinking are more likely to have increased
prevalence of underweight children because the water is more likely to be contaminated and
the children living in households, with no toilets were more likely to be underweight (FAO,
2001a).
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 3. Socioeconomic, Political Access and Inequalities
The literature on malnutrition had drawn attention to various socioeconomic factors and the
functioning of markets in determining access to food. It was believed that the biggest
challenge throughout the developing world was to reduce the differences in access to food
across geographical areas and social strata. If people find it difficult to produce or purchase
enough food, the lack of functioning markets makes it doubly difficult. Access to food was
also limited by inefficient markets that were unable to supply sufficient quantities of seasonal
food in response to demand throughout the year. These market failures exacerbate
fluctuations in the price of food and affordability of food for the poor (Benson, 2004). Socio-
political Conditions affect Malnutrition through Inequality and exclusionary practices that dis
empower groups such as women, children (particularly girls), and ethnic minorities in many
countries. Social exclusion results in deprivation not just in food but in wide range of basic
services, Including education and health. At the intra household level, data from South Asia
demonstrate that when there was discrimination in food intake between boys and girls, it was
largely in favour boys (Haddad et al., 1995).
The inequalities in food intake for infants in South Asia reflect cultural values and the
different wages commanded by male and female adults in the labour market. This type of
gender specific exclusion from food consumption does not occur as frequently in sub –
Saharan Africa, in part because women were household heads in a large proportion of
households. But different forms of social and political exclusion in the region could have
similarly negative impacts on food security and nutrition status.

4. HIV / AIDS and Nutrition

It was well established that there were important two ways interactions between nutrition and
the spread of HIV/AIDS. Good nutrition was seen as an essential complement to the use of
anti-retroviral drugs to slow the progression of HIV into full blown AIDS (Kadiyala et, al.,
2003). Undernourished people infected with HIV/AIDS develop the full symptoms of the
disease more quickly than people who were well fed. People suffering from the disease need
good nutrition to fight it off. Yet one of the earliest effects of AIDS was reduced
consumption of food in affected households. HIV/AIDS have an especially devastating effect
on smallholders’ agriculture which remains the engine of economic development for the poor
in many developing countries. The main impacts of HIV/AIDS morbidity and mortality on
agriculture include reducing crop diversity and the area cropped, abandoning labour intensive
11
activities and selling livestock (Drimie, 2003). Other less direct factors also affect agriculture
performance. For example, pastoralist in Namibia Spend up to 25 percent of their time in
mourning and attending funerals. (Engh, et al., 2000). The support services to agriculture also
suffer. A study in Zambia found that 67 percent of extension workers interviewed had lost at
least one co-worker to AIDS over a three-year period (Alleyne et al., 2001).
5. Food Accessibility and Choices
Food security was linked to diet which was the food stuff available to people that the people
ate. In addition, food security was also about food preferences, another factor that influence
food choices. There was no doubt that the cost of food was a primary determinant of food
choices. Whether cost was prohibitive depends fundamentally on person’s income and
socioeconomic status. Low income groups have a greater tendency to consume unbalanced
diets and in particular have low intake of fruits and vegetables (De Irala-Estevez et al., 2000).
However, access to more money does not automatically equate to a better-quality diet but the
range of foods from which one can choose should increase.

Accessibility to shops was another important physical factor influencing food choice, which
was dependent on resources such as transport and geographical location. Healthy food tends
to be more expensive when available within towns and cities compared to supermarkets in the
outskirts (Donkin et al., 2000). However, improving access alone does not increase purchase
of additional fruit and vegetables, which were still regarded as prohibitively expensive
(Dibsdall et al., 2003).

Many Americans were concerned about nutrition and were aware that achieving a healthful
diet was important for health. Yet despite this awareness, many did not take up steps to
improve their diets (ADA, 2002). According to USDA’s most recent Healthy Eating Index,
the diets of most (74%) Americans needed to be improved (Basiotis etal, 2000). Furthermore,
information disseminated on nutrition comes from a variety of sources and is viewed as
conflicting or was mistrusted, which discourages motivation to change (De Almeida et al.,
1997).
Eating behaviour unlike many other biological functions was often subject to sophisticated
cognitive control. One of the most widely practiced forms of cognitive control over food
intake was dieting. Many individuals express a desire to lose weight or improve their body
shape and thus engaging in approaches to achieve their ideal body mass index (Mac Evilly &
Kelly 2001). Findings from a study of more than 34,000 Minnesota adolescents in grades 7 to

12
12 indicate that dieting and dissatisfaction with body weight were both strongly associated
with low intake of dairy foods (Neumark et al.,1999).
Research indicated that dairy foods could have been consumed without increasing calorie or
fat intake, body weight, or percent body fat (Miller et al., 2001). Furthermore, emerging
research findings suggest that calcium rich dairy foods such as milk, cheese, or yoghourt
played a role in reducing body weight and body fat in children and adults (Teegarden et al,
2003). Dietary quality and eating behaviour are influenced by where food was consumed, at
home, school, or away from home at restaurant and fast food establishments. (Miller etal,
2001). However, problems can arise when dieting and exercise were taken to extremes. The
ethology of eating disorders was usually a combination of factors including biological,
psychological, familial and socio-cultural. The occurrence of eating disorders was often
associated with a distorted self-image, low self-esteem, non-specific anxiety, obsession, stress
and unhappiness (MacEvilly & Kelly, 2001). There is a low level of perceived need among
European population to alter their eating habits for health reasons, 71% surveyed believed
that their diets are already adequately healthy (Kearney et al., 1997).
This high level of satisfaction with current diets had been reported in Australian (Worsley &
Crawford, 1985), American (Cotugna et al., 1992) and English subjects (Margetts et al.,
1998). The lack of need to make dietary changes, suggest a high level of optimistic bias,
which was a phenomenon where people believe that they were at less risk from a hazard
compared to other. This false optimism was also reflected in studies showing how people
underestimate their likelihood of having a high fat diet relative to others (Gatenby, 1996) and
how some consumers with low fruit and vegetable intake regard themselves as ‘high
consumers’ (Cox et al., 1998a).
If people believe that their diets were already healthy it may be unreasonable to alter their
diets, or to consider nutrition or healthy eating as a highly important factor when choosing
their food. Although these consumers have a higher probability of having a healthier diet than
those who recognize their diet is in need of improvement, they were still far short of the
generally accepted public health nutrition goals (Gibney, 2004).
Household income and the cost of food was an important factor influencing food choice,
especially for low-income consumers. The potential of food wastage leads to reluctance to try
‘new’ foods for fear the family rejected them. In addition, a lack of knowledge and the loss of
cooking skills can also inhibit buying and preparing meals from basic ingredients. Education
on how to increase fruit and vegetable consumption in affordable way such that no further

13
expense, in money or effort was incurred had been proposed as a solution (Dibsdall et al.,
2003).
Lack of time was frequently mentioned reason for not following nutritional advice,
particularly by the young and well educated (Lappalainen et al., 1997). However healthful
eating was perceived by some consumers to be convenient and costly (IFIC, 2002). People
living alone seek out convenience foods rather than cooking from basic ingredients.

6. Culture, Taste and Food Classification

Food was the organic substance that people ate to give the body energy. But people do not eat
everything that is eatable and prepare the meals differently. This has to do with culture.
Culture defines what was edible and what was not. Personal habits and preferences can
modify the cultural frame of reference (along with the biological). Food was like a language
allowing groups to be unique and different from other groups (Katz, 1982).
Palatability was proportional to the pleasure someone experience when eating a particular
food. It was dependent on the sensory properties of the food such as taste, smell, texture, and
appearance. The influence of palatability on appetite and food intake in humans had been
investigated in several studies. There was an increase in food intake as palatability increases,
but the effect of palatability on appetite in the period following consumption was unclear.
Increasing food variety could have increased food and energy intake and in the short term
alter energy balance (Sorensen et al., 2003).
What people ate was formed and constrained by circumstances that were essentially social
and cultural. Population studies showed that there were clear difference differences in social
classes with regard to food and nutrient intake. Poor diet can result in under nutrition and
over nutrition could have led to overweight and obesity. Also, culture leads to the difference
in habitual consumption of certain foods and in traditions of preparation, and in certain cases
could led to restrictions such as exclusion of meat and milk. Cultural influences were
however amenable to change, when moving to a new country individual often adopt
particular food habit of the local culture (Feunekes et al., 1998).
Attitudes and belief, many of which reflected cultural values, could have either positive or
negative effects on eating behaviours. A recent study of adolescent in California found that
those with positive attitudes about healthful eating (e.g. believed that healthful foods taste
good, that consuming a healthful diet would make them feel better about themselves)
intended to consume a healthful diet over the next month (Backman et al., 2002).

14
The Pan-European Survey of Consumer Attitudes to Food, Nutrition, and Health found that
the top five influences on food choice in 15 European member states are ‘quality/freshness’
(74%), ‘price’ (43%), ‘taste’ (38%), ‘trying to eat healthy’ (32%) and ‘what my family wants
to eat’ (29%). These are average figures obtained by grouping European member states
results which differed significantly from country to country. In USA, the following order of
factors affecting food choices has been reported; taste, cost, nutrition, convenience and
weight concerns (Glanz et al., 1998). In the Pan-European study, female’s older subjects, and
more educated subjects considered ‘health aspects’ to be particularly important. Males more
frequently selected ‘taste’ as a main determinant of their food choice. ‘Price’ seemed to be
most important in unemployed and retired subjects. Interventions targeted at these groups
should consider their perceived determinants of food choice (Glanz et al., 1998).
Social influences on food intake refer to the impact that one or more persons have on the
eating behaviour of the others, either direct (buying food) or indirect (learned from peer’s
behaviour) either conscious (transfer or belief) or sub conscious. Even when eating alone,
food choice is influenced by social factors because attitudes and habits develop through the
interaction with others (e.g. a young person at a basketball game may eat certain foods when
accompanied by friends and other foods when accompanied by his or her teacher (Feunekes
et al., 1998). However, quantifying the social influences on food intake is difficult because
the influences that people have on the eating behaviour of others are not limited to one type
and people are not necessarily aware of the social influences that are exerted on their eating
behaviour. Social support can have a beneficial effect on food choices and healthful dietary
change (Devine et al., 2003).
Taste is one of the most important influences on food choice (Story et al., 2002). In reality
taste is the sum of all sensory stimulation that is produced by the ingestion of a food. This
includes not only taste per say but also smell, appearance and texture of food. These sensory
aspects are thought to influence, in particular, spontaneous food choice. From early age, taste
and familiarity influence behaviour towards food. (Steiner, 1977). Taste preferences and
food aversions develop through experiences and are influenced by our attitudes, beliefs and
expectations (Clarke, 1980).
According to one survey, the belief that “healthy foods don’t taste as good” was cited by 19%
of respondents as the major reason they did not eat as healthfully as they should. Taste
preference for sweetness, which was inborn, was a significant determinant of food choices in
young children (ADA, 2002). These culturally influenced taste preferences should be
considered when developing interventions to increase calcium intakes.

15
 7. Traditional Food Habits and Taboos
The traditional diets of most societies in developing countries were good. Usually only minor
changes were needed to enable them to satisfy the nutrient requirements of all members of the
family. Many societies, for example in Indonesia and in parts of Africa, partly ferment foods
before consumption. Fermentation may both improve the nutritional quality and reduce
bacterial contamination of the food. The quantity of food eaten is a common problem than the
quality of traditional foods (Latham, 1997).
Some customs and taboos had known origins, and many were logical, although the original
reasons were no longer true. The custom may had become part of the religion of the people
involved the customs that prohibit consumption of certain nutritionally valuable foods may
not had an important overall nutritional impact, if only one or two food items are affected.
Some societies, however, for bided such a wide range of foods to women during pregnancy
that it is difficult for them to obtain a balanced diet. (Rozin et al., 1981). Foods may also be
classified according to a number of cultural factors, such as hot-cold, male female, and
dangerous for pregnant women, which were culturally constructed from sensory data and
other information (Manderson et al., 1981).
8. Age
According to (Vitolins et al 2007) vast majority of low-income socio-economic status older,
rural adults in the US were not meeting recommended nutrition guidelines; 98.4% consumed
diets that were poor or needed improvement.

This was supported by the USDA Centre for nutrition Policy and Promotion (2017) which
expounded that with an increase of age there was a slight, but constant increase in percentage
of elderly poor diets or pointer of poor nutritional status. Furthermore, some studies elude
that with age nutrient consumption and utilisation may be diminished, (Vitolins et al 2007).

9. Sex/Gender
Gender was amongst factors that influence family or individual nutrition. On the same study
conducted in Trinidad, results also showed that women tend to make better informed
decisions when it came to nutrition compared to men. Men diets were dominantly composed
of meat, fish, poultry products, beans, eggs and more servings of oils, sweets and snacks,
Vitolins et al 2007. However according to FAO (2019) suggests that women were in a unique
position to reduce malnutrition or nutrition related problems amongst communities as this
was one of the largest threats to public health in the world. The publication further expounds
that more often than not the face of malnutrition was female. In households that were
16
susceptible to food insecurity, women were at a greater risk of malnutrition than men.
Epidemiological reports by FAO (2019) further reveal that malnutrition in mothers,
especially those that were breast feeding or pregnant, can set up a cycle of deprivation that
increases the likelihood of low birth weight, child mortality, serious disease, poor classroom
performance and low work productivity

10. Health promotion and education

This department was usually found amongst health institutions like the ministry of health, or
private health care centres or municipal authorities under the Environmental health section.
The Environmental Health section deals with primary health care were health practitioners
offer preventative care to the citizens of any locality. They deal with health problems at their
infancy way before the involvement of nurses and general practitioners. Part and parcel of
their duties and responsibilities was to offer health promotion and education. The section
seeked to inform the public of life changing information on every other health related topic.
Examples include health and education on water and sanitation, food hygiene and safety,
diseases, occupational health and safety, nutrition, meat hygiene and many others. Some
people suffer different health problems simple because they lack information. According to
the World Health Organisation (2019) Nutrition, education and health support and enhance
each other. For instance, healthy nutrition improves educational potential. Unhealthy
nutrition and related infections can lead to diseases of malnutrition which in turn reduce the
educational potential. Increased integration and collaboration of health promotion and
nutrition education professionals to effectively engage consumers, debunk nutrition and
health information and mitigate the effects of chronic diseases is the vision presented for
success in the future.

11. Household Incomes

When economic shocks, climate-related challenges or health challenges strike a household,
families tend to cope with the resulting loss in income or purchasing power by changing the
quantity, quality and diversity of the food they consume, FAO (2019). Nutrition quality of
food purchases varies by household income. Lower household income had been consistently
associated with poorer diet quality, (Simone et al 2019). Compared to those with higher
income, lower income individuals consume fewer fruits and vegetables, more sugar-
sweetened beverages and had lower overall diet quality. A study conducted by Simone et al
(2019) concluded that low income households purchased less healthful foods compared with

17
higher income households. The study further concluded that food purchasing patterns may
mediate income differences in dietary intake quality.

2.2. 3 HEALTHY FAMILY NUTRITION INTERVENTIONS

At the most basic level, nutritional status depended on nutrition being available and on a
child’s ability to absorb it. Nutrition depends partly on household access to food, and on
caregivers’ awareness of nutrition and their ability to provide it to children. At the same time,
children’s ability to absorb nutrients was linked to their health status, which was, in part, a
function of environmental determinants of health such as access to clean water and developed
means of sanitation.
UNICEF’s conceptual framework, which had been used by the nutrition community for the
past 25 years, identified three levels of causes of under nutrition:
 Immediate causes: manifest at individual level, primarily addressed by nutrition-
specific interventions
 Underlying causes: manifest at household and community levels, primarily
addressed by nutrition-sensitive interventions.
 Basic causes: around the structure and processes of society, primarily addressed
through the enabling environment.
Nutrition-sensitive interventions had an impact on the underlying causes of nutrition. There
were three pathways:
1. Household food security refers to the accessibility of household resources to
consume sufficient food for all members in the household, either by food production,
cash income or food received as a gift.
2. Caring practices for women and children recognise pregnancy and lactation as
critical junctures for good-quality care and support. The quality of care for women
and children is determined by the caregiver’s:
 level of control over resources and autonomy
 mental and physical health (i.e., level of stress, maternal nutritional status)
 Knowledge (including literacy and educational attainment), preferences and
beliefs.
3. Health services and environment considered access to safe water and sanitation
facilities, healthcare and shelter.

18
The success of nutrition-sensitive programmes was often measured by their ability to
alleviate the incidence of chronic malnutrition (low height-for-age or stunting) and acute
malnutrition (low weight-for-height or wasting). It was also important to acknowledge that it
was difficult to attribute this to nutrition-sensitive interventions, given the complexity of most
social protection interventions and multi-causality of nutrition outcomes. Also, social
protection may address the underlying determinants of under nutrition without necessarily
hitting anthropometric outcomes, because of other limiting factors. For example, diets might
improve, but if there is no availability of clean water nutrition outcomes may not improve,
yet that was still a good thing to do for nutrition. This complexity of causality leads to a lack
of strong evidence.

2.4 Nutritional Food and Nutrition Policy

Nutrition was a cornerstone of human health and development. Good nutrition plays an
important role in people’s health and well-being; conversely, poor nutrition can lead to poor
health as well as impaired physical and mental development (Zambia Nutrition Advocacy
Plan 2017-2019).
Good nutrition was essential for healthy and active lives and had direct bearing on intellectual
capacity, which eventually impacts positively on social and economic development of a
country. Underlying this principle was the practical application of appropriate diet and
healthy lifestyles that were dependent on stable and sustainable food security, quality caring
practices, healthy environment and accessible quality health services. Therefore, in order to
maximise the health and economic benefits there should be in place sound food and nutrition
policies and strategies.
The Government recognises that malnutrition was a serious public health problem in Zambia.
Both acute and chronic Protein Energy Malnutrition exists in high proportions in both rural
and urban areas. Micronutrient malnutrition of Vitamin A, iron and iodine were also common
and affect all population groups especially women and children.
The situation was a reflection of the long-standing poverty that affected the majority of the
Zambian population, a situation that had been exacerbated by unfavourable climatic
conditions in many parts of the country in recent years. This in turn had led to inadequate
food intake and an increased disease burden eminent with malnutrition.
Malnutrition occurred and remained in a society due to a multiplicity of factors in the areas of
food security, and health services delivery. There were three main levels of malnutrition
19
causality:
 Immediate causes such as low food intake and the high disease burden Underlying
causes of inadequate food security, insufficient maternal and child care and poor health,
environmental and sanitary conditions.
 Basic causes including the socio-economic and cultural factors in society. The multi
sectoral nature of the causes call for a multi-sectoral approach to prevent or combat
malnutrition. Community capacity building and increasing nutrition awareness at
household and community level are seen as central to the establishment of local
capacities to prevent and combat malnutrition.
 The evolving National Food and Nutrition Policy is an outcome of a series of national
discussions facilitated by the National Food and Nutrition.

The situation was a reflection of the long-standing poverty that affects the majority of the
Zambian population, a situation that had been exacerbated by unfavourable climatic
conditions in many parts of the country in recent years. This in turn had led to inadequate
food intake and an increased disease burden eminent with malnutrition.
The nutritional status in Zambia had been affected by a myriad of factors dating as far back
as the early 1970s. A combination of factors including public policy choices, collapse of
world copper prices on which the export economy was very dependent, and the burden of
national debt have resulted in poor economic growth. This had been exacerbated by the
recurrent unfavourable climatic changes of the 1990s, thus reducing Zambia from one of the
richest countries in sub-Sahara Africa to one of the poorest countries in the World today.
(National nutrition policy 2006)
The first step towards improving the nutritional status of the population was the
establishment of the National Food and Nutrition Commission (NFNC) in 1967 by an Act of
Parliament as an advisory body with the broad objective of promoting and overseeing
nutrition activities in the country and specifically to:
 Assess and monitor nutritional status of the population.
 To support the improvement of nutritional status of the population of Zambia through
the health, agriculture, education, community development and other administrations,
and the non-profit sector, having a bearing on nutrition;
 Develop norms and implementation guidelines for various food and nutrition activities.
 Promote information, education and communication activities
 Promote and support in-service and pre-service training of staff whose activities affect

20
 nutrition.
 Promote and perform monitoring and evaluation of nutrition-related services and;
 Promote collaboration among the above administrations in the domain of nutrition
including the preparation and periodic review of a national food and nutrition policy.

2.5 CHAPTER SUMAMRY

This chapter has provided an overview on the factors influencing family nutrition end with at
children and elderly people has the mean focus of the study.

CHAPTER THREE

RESEARCH METHODOLOGY

3.0. INTRODUCTION

This chapter outlined the research methodology taken for the study and further discussed the
research design, population and sampling strategy. It also included data collection
instruments and techniques. The chapter eluded on the choice of research design to be
employed and further outlines the data collection procedure. This section would also set
ground on the participants’ bill of rights and it would further expound on the data analysis
and presentation process.

3.1. RESEARCH DESIGN

This study made use of both the qualitative and quantitative research method. Qualitative
research was the collection, analysis of non-numerical data for the purpose of gaining insights
into a particular phenomenon of interest. The quantitative research was the collection of
numerical data for the purpose of explaining, predicting and/or controlling a phenomenon of
interest. This approach was adopted to ensure that information obtained by one design was
complimented by the other and quantitative design aimed at collecting data on how feeding in
the community actively contribute to the poor family nutrition. In terms of resources, the
research will aim at collecting quality data that can be obtained from a small sample size than
a larger one that might be expensive.

Dercket and Vicker (2011) identified a case study as not only useful for fact finding but also
in the formation of vital principles of knowledge and solutions to current problems regarding
the teaching of practical skills.
21
3.2 TARGET POPULATION

A population was an entire group of persons or elements that have at least one thing in
common (Kombo, 2013). The population for the purpose of this research work was the
residents of Mulungushi ward. According to the Census statistics Zambia (2016) Mulungushi
ward had approximately 8263 residents. Hence this was the target population for this research
work. The target population which included new born to adults under the age of 100 years.

3.3 SAMPLE SIZE

A sample was a subset of the population with same characteristics as the population. A
sample was a small group which was actually studied (Punch, 2014).A sample was also
defined as part of the targeted population, carefully selected to represent that population
(Bluemberg, 2014). The researcher had a sample size of at least 10% respondents from the
population of Mulungushi ward.

3.4 SAMPLING METHOD

The researcher adopted the purposive sampling technique. This sampling technique involved
selecting a group with specific qualities. Therefore, the specific group in this research work
was families with nutritional challenges. The technique was cost effective and saved time.
The chosen participants will a variety of stakeholders, the teachers, health care practitioners
and the community members.

3.5. RESEARCH INSTRUMENTS

The study employed the use of a structured questionnaire. A questionnaire was defined as the
research instrument consisting of a series of questions for the purpose of gathering
information from respondents. A questionnaire was advantageous because it saved time on
the part of the researcher and heightens the independence and accuracy of responses from
respondents Van Dalen (2012). It was set in a way that it aided the researcher to gain in-depth
insights on this phenomenon of interest under study.

Part A of the questionnaire looked into the demographic data of respondents; part B will
further had asked questions that aided in answering the study objectives or research questions
and lastly part C will attempt to establish any possible solutions to alleviate this amid
stupendous health concern in Mulungushi ward.

22
3.6. DATA COLLECTION PROCEDURE

The data collection instruments were on the influence of nutrition on families, questionnaires
and the interview guides. The questionnaires were administered to the selected members of
house-holds in the community, healthy workers and the interview guides will be used on key
informants. The questions contained in these data collection instruments were both open-
ended and closed-ended questions. Such a design will make it possible for the collection of
both types of data that was qualitative and quantitative data. The open-ended questions
allowed respondents to express their views on how food influence family nutrition. The
questions had the capacity to allow diverse views from various respondents and because of
this, the tools were of great importance in coming up with valid findings which would reflect
the true picture of the situations. These data instruments were able to cover a large number of
people within the shortest possible time and they were also a cheaper way of collecting data.

3.7. DATA ANALYSIS

The research attempted to gain insights on the factors influencing family nutrition at
Mulungushi ward. Data analysis was done using text analysis and Statistical Packages for
Social Sciences (SPSS) version 23 was used to analysis quantitative data. This was because
the study employed both the quantitative and qualitative method.

3.8. ETHICAL CONSIDERATIONS

The researcher observed the participants’ bill of rights in this research work. The
respondents’ identity was confidential meaning no names were to be written on questionnaire
when responding. This was obeying their right to anonymity. Other rights include right to be
briefed about the research, right to gain something for participating, right to withdraw from
any point of the study and the right to know the chief purpose of the research study and any
possible social consequences.

3.9. CHAPTER SUMMARY

This chapter outlined the methodologies used in this study. It outlined the research design and
discussed data collection methods and instruments. The purpose of a research design is to
maximise valid answers to research questions. This was achieved by using both qualitative
and descriptive approach that was contextual. Data was collected by means of questionnaires.

23
The chapter ended with an overview of ethical aspects of the study. The next chapter presents
the findings of the study.

24
 CHAPTER FOUR

FINDINGS
4.1.0 INTRODUCTION
The preceding chapter presented the research design and methodologies used in this study.
This chapter focuses on information of respondents on factors influencing family nutrition at
Mulungushi ward. Data was presented on frequency tables, bar charts and pie charts with
objectives of the study.

The study made use of the questionnaire survey and assessment of nutritional status, the study
involved 126 respondents of which 54.2% were males and 45.8% females.

4.1. PRESENTATION OF FINDINGS AS THEY COME IN THE STUDY

4.1.1.1 Demographic data of respondents

Table 2: Distribution of participants by gender (n=126)

Frequency %

Female 86 68

Male 40 32

Total 126 100

The study sought to establish the participant’s gender. From the findings, the study
established that the majority of the participants were female as shown by 68%, while males
were 32%.

25
Figure 1: Distribution of respondents by age and sex

Age and sex of respondents (N=126)

PERCENT TOTAL 51-65 41-50 31-40 20-30

100
126
52
TOTAL 20
25
29

45.2
57
31
MALE 6
9
11

54.6
69
21
FEMALE 14
16
18

About the age of females, the study found that the majority of the females were between 51-
56 years, and indicated that the last was below 41-50 years. For males, the majority of males
were between 51-65 and the last was between 41-50. The graph shows that 54.8% were
females and 45.2% males.

26
Figure 2: Education level of respondents

Education level of respondents (N=126)

Percent Total Female% Female Male% Male
100
126
Total 31
69
68.8
57
7.1
9
No formal education 7.3
5
7
4
25.4
32
Senior Secondary 26.4
17
26.3
15
52.4
66
Junior Secondary 50.7
35
54.4
31
15.1
19
Primary school 17.4
12
12.3
7

The study also sought to establish the highest level of education of the community.
According to the findings, 52.4% had attained junior secondary school education, 25.4%
were senior secondary, and 15.4% were primary school level. While only 7.1% had no
formal education. This information shows that the respondents were knowledgeable enough
and could give valid and reliable information based on level of education.

Figure 3: Occupation of respondents (N=126)

The respondents mentioned their occupation, and it varied from farming to employment.
Ninety six percent (96%) of the respondents were involved in Labour (odd jobs) activities
others were employed and were in different business as shown in figure 4.

The respondent’s family sizes were listed in order of seniority. Each respondent was required
to
Family sizes of respondents (N= 126)
140

120

100

80
Figure 4: Family sizes of respondents (N= 126)
60

40

20

0 27
Number of 1 2 3 4 ABOVE 4 TOTAL
people

N PERCENT
mention members of the family. It shows that the family size of the respondents ranged
between 2 and 4 people. The family size of most of the respondents (33%) was 3 people in a
family, only 8.6% of the respondents had family size of 4 people or more.
OBJECTIVE 2: To find the factors influencing family nutritional practices among families of
Mulungushi ward.

4.2. WHAT IS THE NUTRITIONAL KNOWLEDGE AND ATTITUDES

AMONG FAMILIES OF MULUNGUSHI WARD

4.2.1 Definition of food

28
Figure 5: Definition of food (N=126)

Definition of food (N=126)

29%
Anything edible
Anything which when eaten supplies
energy and materials for body build-
100% ing.
Anything that satisfies hunger
63%
I don’t know
Total
42%

According to the findings majority of the respondents were able to define food as anything
which when eaten supplies energy and nutrients in the body, this was represented by 63%,
about 29% of the respondents were able to define food as anything edible. Other two
responses were shown by 4% each.

4.2.2 Knowledge on Food and Nutrition

Respondents were asked to respond on whether they had knowledge on food and nutrition or
not. The majority of the respondents (66%) lacked knowledge on food and nutrition. Only
34% of the respondents had knowledge on food and nutrition, this shows that only a few did
food and nutrition at school on those who attended school.

29
Figure 6: Source of knowledge (N=126)

Source of knowledge (N=126)

250
100
200

150 PERCENT
126 N
50
100
32.3
63
50
40 14.7
19
0 3
4
At school Hospital Mass media Neighbour Total

Schools were the most important source and 50% of the respondents acquired knowledge
through trainings conducted at schools. Other sources are from neighbours, 32.3% required
knowledge on instructions given by health workers at the hospitals, 14.7% shows those who
learnt through mass media and 3% learnt through the neighbours.

4.2.3 Impact of nutrition education

The respondents were asked to respond on whether the nutrition education had an impact to
their daily lives. The results showed that 50% of the respondents admitted that there were
impacts, 44.1% said that there were no impacts and 5.9% were not sure if nutrition education
had an impact or not.

4.3. WHAT ARE THE FACTORS INFLUENCING FAMILY NUTRITIONAL

PRACTICES AMONG FAMLIES OF MULUNGUSHI WARD.

4.3.1 Religion of the respondents

The respondents were asked to mention their religion in order to understand the influence of
religion on food attitude and perception. Results show that a high proportion (80%) of the
residents were Christians specifically Seventh Day Adventist, 20% were Muslims.

30
4.3.2 Perception of nutrition
Figure 7: Perception of nutrition (N=126)

Perception of nutrition (N=126)

Total

Activity of eating food to meet nutritional requirement

PERCENT
RESPONSE

Knowledge of choosing food

N
To eat sweet foods

Different food that are good

0 20 40 60 80 100 120 140

PERCENT

Sixty one percent of the respondents perceived nutrition as an activity of eating enough food
to meet nutritional requirements of the body. However, 3.2% perceived nutrition as
knowledge of choosing food (Table 7).

31
4.3.3 Meaning of nutrients

Figure 8: Meaning of Nutrients

Table 8: Meaning of a nutrient (N=126)

Total
I don’t know
Is delicious food
Chemical substance that is available in different varieties of foods with specific functions in the body when eaten
0 20
40 60 80
100 120 140

Percent N

About 46% of the respondents could not define nutrient properly and 11% could not define it
at all.
a. Food preparation
In the ten households visited, only four households own back house gardens. Two households
had planted food production and four households depended on food they bought from the
market. The cereal foods eaten were milled maize Nshima and rice. Roots and tubers
included; rape, cassava, sweet potato and wild roots. Fruits commonly eaten were ripe
mangoes, bananas and a variety of wild fruits in season. Vegetables included are cabbage,
Chinese cabbage, pumpkin leaf, amaranth, okra and tomato. Pulse foods included beans,
pigeon pea, chick pea. They also consume beef and fish.
b. Food distribution and acquisition
Most of the families ate two to three times in a day. They prepared Nshima from decorticated
maize with a relish prepared using fish, kapenta, meat or vegetable for lunch and rice or samp
with beans or sliced mixed roots and tubers with beans for dinner. Black tea or milk tea with
boiled sweet potato or samp for breakfast. They also ate white breads and fritters. This
observation was made in six households Mulungushi Ward, two of the visited households
prepare tea and left-over food for breakfast (rice with Sugar). They normally skip eating
lunch. Another two households do not take breakfast. The common cooking methods were
boiling, shallow frying and stewing. Vegetable cooking oil, tomato, onion and salt was added
in relishes for flavour. Charcoal and fire wood stoves were used to cook food. Aluminium

32
pan and lid, plastic bowls, ceramic plates, and glass utensils were used for handling and
serving food. Normally adults ate separately. Nshima in plastic plate with fish relish in the
plastic bowls. Most of households visited depended on food they bought from the market.

4.3.4 Decision making on food availability and accessibility

a. Backyard Garden
Food production depended on availability of land in this study respondents were asked to give
information on whether they had backyard land or not. 71% of the respondents had land
while 29% either did not had land for food production.
b. Decision making on what to produce
On the question about who decides on what to produce the respondents admitted that it is
either the husband or wife or both who decides what to produce on their piece of land. It was
observed that in 59% of the households, husbands made decision on what to produce.
However, in 24% of the households both husband and wife were involved in decision making
for production. Only in 17% households that the wife made decision in production.

4.3.5. Food availability and accessibility

Food was available during the months of May to October. It was the time when food prices
fall. About 64% of the respondents indicated that they do not had enough food for six months
and 36% of respondents had enough food but only for the first three months (August to
October) after harvesting period. Food shortage months’ range from November to April. It is
also the time when food prices increase and remain elevated up to the next harvesting period
which normally starts in May up to August. During that time, most of the households
obtained foods from the markets. The type of food and quantity to be bought depends on
purchasing power of individual household. For example, during the month of November to
January people diverse from eating rice and maize (as price increases) cassava, fritters, and
sweet potatoes. It was also a time when whole maize flour (roller meal) was consumed.

4.3.6 Money for buying food

In 66. % of the households, said money for buying foods was provided by the fathers. In 21%
of the households, money was provided by the mothers. Father and mother contribution were
observed in 13% of households.

33
4.3.7 Preparation of food for the family
Figure 9: Who prepares food for the family (N=126)

Who prepares food for the family (N=126)

Total

Others

Sister

Father

Mother

0
20
40
60
80
100
120
140

PERCENT N

About (53%) acknowledged that mothers were responsible for preparing food for the family,
33% said fathers were responsible, 14% was represented by sisters as the ones responsible for
preparing meals for the family and 4% of the respondents mentioned other members of the
family.

34
Figure 10: Reason on who prepares food for the family (N=126)

reason on who prepares food for the family

100% Mother always cook food

I am not married
76% Mother is the head of household
6% My wife passed away
4% My wife and I separated
Total
12%
2%

About 76% of the respondents mentioned that mothers prepared food for the family. About
12% of the respondents agreed that mothers were the head of the family,6% of the
respondents were divorced, 4% were widowers, and 2% of respondents were not married.
The shows that the majority believes that, mothers were the ones who go to purchase food
and prepare it.

35
4.4. HOUSEHOLD EXPENDITURE

Figure 11: Household expenditure (N=126)

Household expenditure (N=126)

450

400

350

300

250

200

150

100

50

0
Buying food Education fee House rent Luxury Total

N PERCENT

The most important item of household expenditure was food. About 77.2% of the households
spend most of their money on buying food, while 14.4% goes to education fee, 7.8% was
used for house rent, and 0.6% was used on household expenditure.

36
4.5. ARE THERE ANY POSSIBLE SOLUTIONS TO ALLEVIATE HEALTHY
FAMILY NUTRITIONAL PRACTICES AMONG THE FAMILIES OF
MULUNGUSHI WARD.

4.5.1 Better way of getting nutrients from food

Figure 12: Better way of getting nutrients from food

Better way of getting nutrients from food

250
200
150
100
50
0

N PERCENT

About 55.6% of the respondents believed that better way of getting nutrients from the food
was through eating enough meals with different foods, 30.8% of the respondents believed in
eating sweet foods and 13.2 acknowledged eating foods containing the three nutrients as a
better way of getting nutrients from food. This shows that few people have proper knowledge
on nutrition.

37
4.5.2 Frequency of eating food in a day

Figure 13: Frequency of eating food in a day

Number of meals consumed in a day

(N=126)

Total

Four times

Three times

Two times

One time

0 20 40 60 80 100 120 140

PERCENT N
A
high proportion (59.8%) of the respondents in the study areas reported a feeding frequency of
three times per day, and only 2.4% had a feeding frequency of four times per day.

4.5.3 Relationship between eating food and health

About 79.2% of the respondents could relate food to their health but 20.8% could not due to
the fact that they lack nutrition knowledge.

38
Reasons on how they relate food to their health
Figure 14: Reasons on how they relate food to their health (N=126)

Reasons on how they relate food to their

health (N=126)
400
350
300
250
200
150
100
50
0
e t
di d
d f oo g
ce er tin si l
s
an ov ea en er
al e t at ge
r
l
tb eft or u w
un ta
ea at
l ef g ed To
I b vin il y h
te ds er bo tis
f
no an d
s k
sa
o y h
an rin
Id m g Id to
h in at
as ook Ie
Iw h
c
as
Iw

N PERCENT

Although 79.2% of the respondents agreed that they related food to their health only 14.7%
ate balanced diets and 6.1% of the respondents gave different reasons related to health but not
exactly to food and its function in the body.

4.6. CHAPTER SUMMARY

This chapter presented the findings of the study in the following: biographical Data of
respondents,

39
 CHAPTER FIVE

DISCUSSION CONCLUSION AND RECOMMENDATIONS

5.0. INTRODUCTION

This study sought to answer three research questions which are:

i. What is the nutritional knowledge and attitudes among families of Mulungushi ward?
ii. What are the factors influencing family nutritional practices among families of
Mulungushi ward?
iii. Are there any possible solutions to alleviate healthy family practices among the
families of Mulungushi ward?

5.1. DISCUSSION OF FINDINGS

The answers are as follows:

5.1.2 NUTRITIONAL KWOLEDGE AND ATTITUDES AMONG FAMILIES OF

MULUNGUSHI WARD.

To the research question-what is the nutrition knowledge and attitudes among families of
Mulungushi ward?
The study observed that they lack nutrition knowledge and few of them who had the
knowledge argued that it had no impact on their eating behaviour. Nutrition knowledge act as
a pathway through which food selection and preparation influence individual’s diet. Parents,
mothers in particular play an important role in shaping young children’s eating behaviours by
their own dietary behaviours, their attitudes towards food, and the availability of foods in the
home (Glewwe, 1999). Parents can also encourage more healthful dietary patterns among
adolescents (e.g. balanced diets through family meals). The quality of family meals is largely
dependent on their knowledge on nutrition and health practices.
Nutrition knowledge may be obtained from several sources including formal education,
families, friends, mass media, and community health service. (Glewwe, 1999). A study by
Kearney et al (2000) indicated that the level of education can influence dietary behaviour
during adulthood. In contrast, it has been shown that nutrition knowledge and good dietary
habit are not strongly correlated. This is because knowledge about health does not lead to
direct actions when individual is unsure on how to apply their knowledge (De Almeida et
al.,1997). Knowledge or health information also influences food choices. However,

40
knowledge alone does not necessarily translate into healthful eating behaviours. It may
provide information to implement a behavioural change, but it is the individual’s attitudes or
belief that ultimately determines whether or not to translate this knowledge into actual
behaviour (Katz, 1982). Behaviour must be understood within the context of the cultural
values in which they occur, reinforcing values which promote positive behaviours while
discouraging negative ones.
The study revealed that more education was needed with regard to social and cultural
acceptance of what food was. Furthermore, peoples’ attitudes and perception on food and
nutrition should be understood.

5.1.3 FACTORS INFLUENCING FAMILY NUTRITIONAL PRACTICES AMONG

FAMILIES OF MULUNGUSHI WARD

To the research question- what are the factors influencing family nutritional practices among
families of Mulungushi ward? The answers were:

5.1.3.1 Religion and cultural beliefs

In the study area, Religions such as Muslim and Seventh day Adventist restrict their followers
from eating pork. Other beliefs associated with culture also were found to influence their
food choice especially on fruits and vegetable consumption. For example, Tooth diseases are
associated with eating large quantities of sweets and without brushing teeth.

5.1.3.2 Pricing effect on food choices

The study observed that food prices increase when there is a shortage of food (November –
April). The price also determined the type and quantity of food to be bought. The respondents
alternate the foods they prefer (rice, maize) to available foods at low price (plantain, cassava,
taro, bread fruit etc.) The price reduction intervention targeting fruits and vegetables was
implemented in two secondary school cafeterias; one school was located in a primarily white
middle- income suburban area, where as the other school was located in an urban area of
California with a mixed ethnic and socioeconomic population. Price incentive can be an
effective intervention strategy to influence individual food purchase.

5.1.3.3 Attitudes and perception about food

The results indicated that many households do not consume balanced diet. Women would just
make sure the family members have something to eat and it does not matter whether the meal

41
compose a variety of food. In addition, lack of knowledge on nutrition and the loss of
cooking skills also inhibit buying and preparing meals from basic ingredients. Variation of
individual food choices depends on taste, perceived value (which include prices and portion
size) and perceived nutrition (Glanz et al., 1998). For example, individuals of lower
socioeconomic status may place greater importance on perceived value where as those who
are mainly concerned about health and nutrition may place greater importance on nutritional
quality of foods (Solheim et al., 1996). For example, decorticated maize mealie meal was
perceived having higher value than whole maize because of its bright white colour and
keeping quality (stored longer than whole maize flour).

5.1.3.4 Food intake in relation to health

Food intake was low; number of meals per day was between two to three meals and
frequency of eating different food stuffs varied from one to three times in a day. Almost half
of the interviewed people believed that eating meals three times in a day was enough but
some argued that the low food intake was due to either lack of enough resources to access
appropriate food for a balanced diet or low economic situation which limit them to prepare a
range of foods as that would require money for both foods and fuel. The study revealed that
there are variations of consumption of various foods between wards. The reason is that the
dietary pattern of households in each ward depended on the availability and accessibility of
the foods. However, respondents’ perceptions on food influenced their food choice. For
example, the respondents considered decorticated maize Nshima with relishes from animal
and poultry foods more nutritious than whole maize Nshima with relishes from pulse. This
indicates that although the foods consumed are the same but the influences of food choices
differ (in the wards and in households).
Most of the respondents agreed, disagreed or were undecided on the correct statement related
to food consumption. In focus group discussion, some of the participants agreed that they
lack nutrition knowledge. This indicates that they need more information about food and
health in relation to food consumption.
Basing on the fact that they prefer to eat rice and maize than sorghum and bulrush millet, the
preferences influenced their decision to produce the food crops they like. This is done
regardless of prevailing weather conditions that suit the growth of such crops, thus leading to
food shortage not only to poor food producers but also urban food consumers as prices tend
to increase. Moreover, their perceptions about food influenced their food choices enhancing
food aversion and avoidance. Social values attached to foods classifying some of food stuffs

42
as healthy, nutritious, highly valued, and inferior were the determinants of food choices
among many of the respondents. The way types of food are perceived significantly affect
purchasing behaviour of the households (Klesges et al., 1991). Consumption of protein foods
was also very low; pulses were frequently eaten than animal 6767
and poultry sources of foods which are of high protein quality. Perceptions about certain
foods contributed to low intake of available food stuffs; for example, on animal and poultry
sources of foods, beef was socially considered having higher value than other red meat, cow’s
milk than goat’s milk, chicken than duck’s meat, chicken’s eggs than duck’s eggs. These
foods are consumed only once or twice in a week. Fish was eaten at least twice in a week.
Therefore, increasing number of meals per day is necessary to ensure diversity and enhance
adequate intake of nutrients. It should be recognised that a perceived need to undertake
changes is a fundamental requirement for initiating dietary change to individuals and, or the
community.
Most interventions put emphasis on developing guidelines with the aim of encouraging all
population groups to adhere to appropriate nutrition intake. In developing these guidelines
little emphasis is placed on understanding what food means to certain individuals (De
Almeida et al., 1997). This therefore means that, general tool for behavioural modification
such as food-based guideline cannot be used in different cultures and produce similar desired
effect. Individuals have strong values that have been internalized early in life which may be
stronger than the guidelines which instruct them on new eating habits. Dietary interventions
should take this into consideration and plan interventions accordingly. It should be
acknowledged that each culture is unique with different norms and values, which also
determine eating habit.
Taste is one of the most important factors affecting food intake, knowledge of culturally
determined taste preferences can be used to help tailor interventions to specific ethnic
minority groups to increase their consumption of nutrient rich foods (Story et al., 2002).

5.1.3.5 Marriage

The families have an influence on dietary pattern especially when the couples are from
different culture. One of the reasons given was own schedule of eating. It was observed that,
husband or wife or both decides what to produce on their piece of land and that, husbands
make decision on what to produce. However, in some of the households both husband and
wife are involved in decision making for production and mothers prepare food for the family.
Initially the inhabitants of Mulungushi Ward were mainly from the various ethnic groups, but

43
the current population has a mixture of ethnic groups of different tribes (URT, 2002). A study
was done in 1995 and twenty-two heterosexual couples were recruited from Edinburgh and
Glasgow to examine the changes which took place in their eating habits and food related
activities when they began to live together. Both men and women felt that eating together
had a symbolic importance when they set up home together and most couples made efforts to
eat a main meal together most evenings, while shopping and eating patterns tended to become
more regular and formalized than they were at the pre-marriage/cohabitation stage (Kremmer
et al., 1998). This seems to be applicable to most couples and has an effect on eating habits
since each person tries to adapt the likes of his/her partner. It was mentioned by 76% of the
respondents that women were mainly responsible for preparing food and men (66%) provided
money for buying foods. This implies that cultural interactions within the family have an
influence on dietary pattern.

5.2. ARE THEY ANY POSSIBLE SOLUTIONS TO ALLEVIATE

UNHEALTHY FAMILY PRACTICES AMONG FAMILIES OF
MULUNGUSHI WARD?

The third question of this research- Are there any possible solutions to alleviate healthy
family practices among the families of Mulungushi ward? And the findings are as follows:

5.2.1 Fruits and Vegetables Consumption

It was observed that vegetables and fruits consumption was very low and it was not
considered important for the people to eat fruits every day. They just eat once to three times
in a week; this is a very low frequency as these are important foods rich of nutrients
responsible for protecting the body against diseases. However, through group discussion with
adult household members, it was disclosed that the cultural belief attached to consumption of
certain vegetables and fruits influence negative attitudes towards that particular foods leading
to consistent refusal and, or low intake. For example, men are not allowed to eat okra because
it is believed that okra reduces body strength. They believed that eating large quantities of
pineapple fruit is associated with tooth decay diseases.
According study findings all families of Mulungushi ward should consuming a wide variety
fruits and vegetables. These are rich in nutrients which are needed by the body for it to grow
well to avoid diet related diseases.

44
5.2.2. Evaluation of Household Decision Making on Food Accessibility

The main occupation of the people in the study area is odd jobs (Physical labour). The burden
is borne by the whole community, but more by women. Men and Women are the key
participants farming in odd jobs (Physical labour).
The study observed that men more aggressive to work and they keep the family money.
Although people in the study area were involved in odd jobs (Physical labour) activities, they
face food challenges from November to April each year. This indicates that many households
in the study area were food insecure. However, majority spent most of their money on buying
food.
About 9% of men prepared food themselves because they do not stay with their wives
(separated). This implies that some of the families’ happiness was robbed by different forms
of social, cultural and political exclusions which contributed to family chaos. The study also
found that in addition to nourishing the body, food plays central part in the culture, traditions
and daily life of the people. It is a sign of warmth, acceptance and friendship. Food is used
for celebrations, rituals, and for welcoming guests. Lack of enough resources to access
appropriate quantity and quality of food reduces social cohesion of married couples.

5.3. Conclusions

There was an inverse relationship between socio-cultural influences and eating behaviour of
the people in Mulungushi ward Municipality. The response given by some of the respondents
in the present study show the existence of certain negative beliefs and practices on food
which were rooted in the culture. Those beliefs had an impact on eating behaviours of the
people and the community in general. Women’s workload, lack of access to gender equality
and inadequate nutrition awareness also limit the food intake of the community although after
moving to the city, people adopt different culture, they do not completely lose their culture,
they still adhere to their old traits. Thus, more nutrition education is needed.
Furthermore, socially accepted norms and values surrounding peoples understanding of what
food was, revealed that food choices factors vary from one individual to another. Therefore,
one type of intervention to modify eating behaviour could not suit all population groups.
Rather dietary interventions should take this into consideration of these differences and
interventions could be planned accordingly. It was acknowledged that each culture was
unique with different norms and values. Therefore, interventions needed to be geared towards

45
different groups of the population with consideration of factors influencing attitudes and
perceptions on food and nutrition.

5.4. Recommendations

The study recommends that Nutritional and agricultural interventions were essential to
hunger reduction and could be more effective if designed and implemented in complementary
ways.
Yet all too often they were undertaken by separate institutions with little coordination
between them. Therefore, government should create institutional structures to integrate
agriculture and nutrition policy at all levels (from ministries to communities).
Price incentive can be an effective intervention strategy to influence individual food
purchases.
Meaning people should be encouraged to be involved in farming and the use of back yard
gardens. At population level, through policy changes, pricing strategies potentially could be
used to encourage fruit and vegetable consumption through government price subsidization
or to influence food choices among participants in Mulungushi ward, rewarding those
families which are doing well in the production of more crops at home. More research was
needed to better understand the potential effect of various pricing strategies on individual and
population food choices.
Because food was a cultural symbol and eating was a symbolic act through which people
communicated, perpetuated and develop their knowledge, beliefs, feelings and practices
towards life, an understanding of cultural influences on eating habit was essential for health
educators who wanted to provide realistic educational interventions which were designed to
modify dietary practices.
Call for further research was made on food processing, preparation and preservation to retain
nutrients, add taste and values to locally available foods socially considered not nutritious.
Vegetables and fruits consumption were highly encouraged. Orchards and homestead gardens
were encouraged to facilitate availability and accessibility of fruit and vegetables. Simple
improved vegetables preparation methods such as boiling for short time, avoiding drying
vegetables in the sun, washing before cutting and retaining of boiled stock or soup are highly
recommended.
Health educators (Nutritionist) needed to help people make healthy food and beverage
choices when eating both inside and outside the home. Efforts of government, public health

46
services, producers and retailers to promote fruit and vegetable dishes consumption as value
for money could also make a positive contribution to dietary change.
Since there was shortage of food before the harvesting season households could be thought
proper ways of preserving food for future use without losing nutrients.
A proper way of food preparation should be thought to households as well in order to have
nice balanced meals and hence to avoid nutrition related diseases.

5.5. Suggestions for Further Studies

Since this study explored to assess the factors influencing family nutrition status in
Mulungushi ward of Livingstone.in southern province.

Similar study should be done in other sub counties in Zambia for comparison purposes and to
allow for generalization of findings on the factors Influencing family nutrition in Zambia and
the whole world.

47
 REFERENCES
Alleyne, E.P. Kapungwe, A. and Kamona, R. (2001). The impact of HIV/AIDS on
agriculture extension Organization. Lusaka Research Institute, Zambia. 430pp.
Armelagos, G.A. (1996). Evolution of food choice: The Study of people. Harpers College
Press, New York. 141pp.
Backman, D. R., and Haddad, J. W. (2002). Consuming passion: The Anthropology of
eating, Journal of clinical Nutrition 34: 184-256.
Baranowski, T., and Cullen K. W. (2003). Dietary outcome, evaluation of multimedia
game. American Journal of Preventive Medicine 24:52-61.
Benson, T. (2004). Dietary aspect of Acculturation: The Anthropology of Foods and Food
habits. Morton Publishing, The Hague. 315 pp.
Collier, P. L., Elliott, H., and Nicholas, S. (2003). Breaking of conflict: Civil war and
Development policy. Oxford University Press, New York.120pp.
Drimie, S. (2003). HIV/AIDS and Land: Case Studies from Kenya, Lesotho, and South
Africa. Journal of Preventive Medicine.20 (5): 58-647.
Clarke, J. L. (1998). Taste and flavour: Their importance in food choice and acceptance.
Journal of Food Science 57: 639-643.
Cotugna, N., Subar, A. E. and Kahle, L. (1992). Nutrition and cancer prevention: Knowledge,
beliefs, attitudes, and practices. American Journal of Dietetic Association 92(8): 8-
96.
Cox, D. N., Anderson, A. S. Reynolds, L. (1998a). Nutrition education intervention to
increase fruit and vegetable intakes: Impact on consumer choice and nutrient intakes.
British Journal of Nutrition 80: 31-123.
De Almeida, M. D., Graca, P. and Lappalainen, R. (1997). Sources used and trusted by
nationally representative adults in the European Union for information on healthy
eating. European Journal of Clinical nutrition 51:58-159.
De Garine, L. (1970). The social and cultural Background of food habits in Developing
Countries (Traditional Societies). Herald Press, Scottsdale. 116pp.
De Irala- Estevez, J., Johansson, L. and Prattala R. (2000). A systematic review of
socioeconomic difference in food habits in Europe: Consumption of fruit and
vegetables, representative samples of adult from all member states of the European
Union. European Journal of clinical Nutrition 51: 30-55.

48
Devine, C. M., Connors, M. M. and Bisogni, C. A. (2003). Sandwiching it in: spillover of
work onto food choices and family roles in low- and moderate-income urban
households. Journal of Social Science and Medicine 56:617-630.
Dibsdall, L. A., Lambert, N. and Frewer, L. (2003). Low-income consumers’ attitudes and
behaviour towards access, availability and motivation to eat fruit and vegetables.
Journal of Public Health Nutrition 6(2): 68-159.
Donkin, A. J., Dowler, E, A. and Turner, S. A. (2000). Mapping access to food in a deprived
area: The development of price and availability indices. Journal of Public Health
Nutrition 3(1): 8- 31.
ECLAC (2004). Economic Commission for Latin America and Caribbean. Hunger in Latin
America and Caribbean: Its Scale, Characteristics and Livelihood. National
Academy of Sciences, Courtesy of the National Academy Press. Santiago.
[http://www.epi.umn.edu/let/pubs/adol.book.shtm] site visited on 14/03/2020.
Engh, J. (Ed.) (2000). HIV/AIDS in Namibia: The Impact on the Livestock Sector.
Proceedings of FAO Workshop, Windhoek, Namibia, 25 November 1989. 105pp.
FAO (1996). Rome Declaration on World Food Security and World Food Summit Plan of
Action. The report of FAO Expert Consultation. Technical Series No. 28. FAO
Publications. Rome. 102pp.
FAO (2000). The State of Food and Agriculture 2000: Lesson from the Past 50 years.
Proceedings of FAO Workshop, Rome, Italy, 15 March, 1986. 98pp.
FAO (2001a). The State Food Insecurity in the World: 2001.The report of FAO Expert
Consultation. Technical Series No. 342. FAO Publications. Geneva. 68pp.
FAO (2003). Codes Alimentarius: The State of Food Insecurity in the World. Monitoring
Progress towards the World Food Summit and Millennium Development
Goals. FAO Food Standards Program, Codes Alimentarius Commission, Vol.4. 2nd Edition.
FAO Publications, Rome. 122pp.
FAO (2004). The Nutrition Situation Analysis. The report of FAO Expert Consultation.
Technical Series No. 742. FAO publications. Geneva. 97pp.
Feunekes, G. J., de Graaf, C. and van Staveren, W. A. (1998). Food choice and fat intake of
adolescents and adults: Associations of intakes within social networks. Journal of
Preventive Medicine 27: 645-656.
Fieldhouse (Eds.) (1982). Food and its vicissitudes: A cross-cultural study of sharing and
Non-sharing, in social structure and Personality. The Free Press, New York. 513pp.

49
Fisher, A. A., Lating, J. E., Stoeckel, J. E., Townsend, J.W. (1991). Hand book for family
planning operations: Research Design. Population council. New York. pp 45-235.
French, S. A., Story, D. and Neumark, J. (2003). Factors influencing eating behaviours.
American Journal of Clinical Nutrition 8: 133-641.
Gatenby, S. (1996). Healthy eating: consumer attitudes, beliefs and behaviour. Journal of
Human Nutrition and Dietetics 9: 84-165.
Gibney, M. J. (2004). European consumer’s attitudes and beliefs about safe and nutritious
foods: Concepts, barriers and benefits. Proceedings of the International Food
Conference, London, UK, 16 June 2003. 136pp.
Glanz, K., Basil, M. and Snyder, D, (1998). Why American eat what they do: taste, nutrition,
cost, convenience, and weight control concerns as influences on food consumption.
American Journal of Dietetic Association 99: 471-126.
Glewwe, P. (1999). Why does Mother's schooling raise child health in Developing countries:
Evidence from Morocco, Journal of Human Resources 34(1): 124 -159.
Grivetti, L. E. (1980). Dietary separation of meat and milk: A cultural Geographical
Inquiry. Journal of Food Science 9: 17-203.
Haddad, L., Westbook, D. and Weeks, M. (1995). Strengthening Policy Analysis:
Econometric Tests, using Microcomputer Software: Microcomputer in Policy Research.
International Food Policy Research Institute. Washington DC. 126pp.
Hansen, J.W., Goddad, L. and Ericksen, P. (2004). Climate Variability and the Millennium
Development Goal on Hunger. International Research Institute on Climate
Prediction. Technical Report Series No. 44 Columbia University Press. Palisades,
New York. 69pp.
IFIC (2002). International Food Information Council. The report of Expert consultation.
Technical Series No. 21. Courtesy of National Academic Press, Washington DC. 320pp.
Kadiyala, S., and S. Gillespie (Eds.) (2003). Rethinking Food Aid to Fight HIV/AIDS.
Proceedings of SADCC Workshop. Pretoria, South Africa, 12 March, 2000. 103pp.
Katz, S. (Eds.) (1982). Food Behavior and Biocultural Evolution: The psychobiology of
Human Food Selection, Van Gorgum Ltd., Amsterdam. 188pp.
Kearney, M., Jearney, J. and Gibney, M. J. (2000) Sociodemographic determinants of
perceived influences on food choice in a nationally representative sample of Irish
adults. Journal Public Health Nutrition 3(2): 219-226.

50
Kremmer, D. Anderson, A.S. and Marshall, D. (1998). Living Together and Eating Together:
Changes in Food Choice and Eating Habits during the Transition from Single to
Married/Cohabiting. Journal of Social Science 46: 18-72.
Kinabo J. L, Mkeni, A., Nyaruhucha, C., Msuya, J., Ishengoma, J., and Haug, A. (2004).
Dietary Guideline for Morogoro and Iringa Region. The Food security and
Household income for small holder farmers in Tanzania. Sokoine University of
Agriculture Project. Morogoro, Tanzania. 88pp.
Klimas-Zacas, A., and Dorothy, J. (Ed.) (2001). Influences on People's Eating Habits.
Proceedings of WFP Workshop, Lusaka, Zambia, 6 September, 2000. 47pp.
Lappalainen, R., Moles, A. and Gibney M. J. (1997). Difficulties in trying to eat healthier:
Descriptive analysis of perceived barriers for healthy eating. European Journal of
Clinical Nutrition 51: 36-40.
Latham, M.C. (1997). Human Nutrition in the Developing World. Food and Agriculture
Organization of the United Nations, Rome 120pp.
Mac Evilly, C. and Kelly, C. (2001). Mood and Food. Proceedings of FAO Workshop. Rome,
Italy, 17 January, 2000. 250pp.
Manderson, L. and Mathews, R. (1981). Vietnamese Behavioural and Dietary precaution
during pregnancy Journal of Ecological Food and Nutrition, 11:1-8.
Margetts, B. M., Thompson, R. L. and Speller, V. (1998). Factors which influence healthy
eating patterns: Results from the 1993 Health Education Authority and lifestyle
survey in England. British Journal of Clinical Nutrition 1(3): 193-198.
MM C (2006). Morogoro Municipal Council Social Economic Profile Annual Report.
Municipal Council Director's office, Morogoro, Tanzania. 49pp.
Miller, G.D., and Jarvis, J. K. (2001). Cultural influences on food choices: Why and how
people eat. American Journal of Clinical Nutrition 50: 249-253.
Messer, M. J., Cohen, S. and Marchione, T. (2001). A Cause and Effect of Hunger.
Proceedings of FAO Workshop. Rome, Italy, 2 December, 1998.112pp.
Neumark-Sztainer, D., Story, C. and Perry, M. (1999). Sensory perception of food:
Influences on eating behaviour. Journal of American Dietetic Association 99: 302-629.
Onyango A. W. (2003). Dietary diversity, Child nutrition in contemporary African
communities. Journal of Nutrition 136: 61-70.
Rozin, P. and Fallon, A. E. (1981). The acquisition of like and dislike for Food. Blackwell
Science Ltd., Oxford. 145pp.
Shetty, (1999). MALNUTRITION: Definition, Classification, and Epidemiology. London

51
School of Hygiene and Tropical Medicine, London, UK. Article No: DOI: 10. 1006/RWHN.
1999.0198.
Solheim, R., and Lawless, H.T. (1999). Consumer purchase probability, effect by attitudes
towards food liking, Journal of Food Science 7: 137-145.
Sorensen, L.B., Moller, P. and Flint A. (2003). Effect of sensory perception of foods on
appetite and food intake. European Journal of Clinical Nutrition 27:152-166.
Scherr, S. (2003). An association between supply of food and chronic undernutrition. Journal
of Social Science and Nutrition16: 82-210.
Smith, L., and Haddad, L. (2002). Economic Growth in Reducing Undernutrition. Journal of
Food Science 51: 55-76.
Steiner, J. E. (1977). Taste, the genesis of sweet preference. European Journal of Clinical
Nutrition 77: 106-240.
Stewart, F. (2002). Horizontal Inequalities. A Neglected Dimension of Development.
Foster Science Ltd, Zurich 110pp.
Story, M., Neumark-Sztainer, D. and French, S. (2002). Effect of Taste on Food Intake.
American Journal of Dietetic Association 10:40-60.
Teegarden, D., and Zemel, M. (2003). Food and Nutrition Anthropology. British Journal of
Nutrition 13: 243- 420.
ADA (2002). The American Dietetic Association. Position of Dietetic Association in Dietary
Guidance for Adult. Journal of American Dietetic Association 104: 660-680.
(URT) (2002). Population and Housing Census Volume VII. National Bureau of Statistics
and Government Printers, Dar-es-salaam, Tanzania. 430pp.
URT (2006) National Population Policy. Ministry of Planning, Economy and Empowerment.
Government Printers, Dar-es-salaam, Tanzania. 460pp.
(UN ACC/SCN) (1993). Nutrition Information in Crisis Situation. UN ACC/ SCN, Geneva.
120pp.
UN ACC/SCN (1994). Update on the Nutrition Situation. UN ACC/ SNC, Geneva. 137pp.
8383
WHO (2004). Expert consultation on Appropriate Body Mass Index for Asian population and
its implication for policy and Intervention Strategies. Lancaster, Pennsylvania.
163pp.
Worsley, A., and Crawford D. (1985). Awareness and compliance with the Australian dietary
guidelines: A descriptive study of Melbourne residents. Journal of Nutrition
Research 5:1291-1308.

52
Marias Y F and Glauser P (2014) “Guidelines for assessing nutrition-related knowledge,
attitudes and practices. Food and Agriculture Organisation (FAO) of the United
Nations
Santiago S, Zazpe I, Gea A, de la Rosa P A, Ruiz-Canela M, Martinez-Gonzalez M A (2017)
Healthy eating attitudes and the incidence of cardiovascular disease. The SUN
cohort. Int. J. Food Sc
Simeone A French, Christy C, Tangney, Bradley and M Appelhans (2019) “Nutrition quality
of food purchases varies by household income: The Shopper Study, Published 26
February 2019. BMC Public Health.
Food and Agriculture Organisation 2019 (FAO) “Nutrition, Education and Health; an
overview of nutrition at global level. FAO Publishers

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 APPENDICES

APPENDIX 1 (QUESTIONNAIRE FOR RESPONDENTS)

My name is Elivas Kira a Master of Science in Food Science and Nutrition student at
Rockview University. I am carrying out a research study titled: Factors influencing family
nutrition: A case study of Malota community (Mulungushi ward) of Livingstone district
in southern province. Kindly assist by filling in the questionnaire provided.

Instructions

1. All information shall be treated with the confidentiality it deserves

2. You are kindly requested to answer the questions as truthfully as possible
3. Indicate your response by putting a tick at your answer and for other questions spaces have
been provided.

Section A

Demographic Data

1. Gender
Male
Female

2. Respondents level of education

None
Primary level
Secondary level
Tertiary level

3. Respondents age
0-19
20-29
30-49
50-79
Above 80

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 4. Occupation status
Unemployed
Self employed
Employed

Section B - What is the nutritional knowledge and attitude amongst families of

Mulungushi ward?

5. Have you ever had a knowledge about food and nutrition?

(a) Yes (b) No (If the answer is no shift to question 5)
6. 2.Where did you get nutrition education
(a) School (b) Hospital (c) Neighbour/friends (d) Mass media
7. How many meals do you eat per day at your household?
………………………………………………………………………………………….
8. What type of food is eaten most at your household?
.
…………………………………………………………………………………………
…………………………………………………………………………………………
………………………………………………………………………………………….
9. Do you understand the meaning of ‘a balanced diet’? If your answer is YES, please
further elaborate?

(a) Yes (b) No

…………………………………………………………………………………………
…………………………………………………………………………………………
………………………………………………………………………………………….
Section C - What are the factors influencing family nutritional practices among families
of Mulungushi ward?

10. Does your household income meet your family daily needs including food? If your
answer is No, please further elaborate.

Yes No

55
 …………………………………………………………………………………………
…………………………………………………………………………………………
………………………………………………………………………………………….
11. Do you consider tastes and preferences priority when deciding what to purchase as
food for the family? If your answer is No, please further elaborate.

Yes No

…………………………………………………………………………………………
…………………………………………………………………………………………
………………………………………………………………………………………….
12. As a community member of Mulungushi ward how often do you access health
promotion and education officers in your locality?
…………………………………………………………………………………………
…………………………………………………………………………………………
………………………………………………………………………………………….
13. Do you have any access to Information Education Communication (IECs) materials
form local health institutions in Mulungushi ward on nutrition?
…………………………………………………………………………………………
…………………………………………………………………………………………
………………………………………………………………………………………….
14. Do you agree that lack of proper markets and land for gardening is a limiting factor in
accessing help on nutrition? If your answer is YES, please explain your answer.
…………………………………………………………………………………………
…………………………………………………………………………………………
………………………………………………………………………………………….
15. Do you think farming inputs are inadequate within the district?
…………………………………………………………………………………………
…………………………………………………………………………………………
………………………………………………………………………………………….
Drafted questions
1. Do you eat all the three (3) meals of the day?
Yes No
If your answer is No, please explain below

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…………………………………………………………………………………………………
…………………………………………………………………………………………………
………………………………………………………………………….
2. According to your assessment are the meals balanced
Yes No
State the type of diet eaten?
…………………………………………………………………………………………………
…………………………………………………………………………………………………
……………………………………………………………………………………………..
3. State the type of meal that is served frequently?
…………………………………………………………………………………………………
…………………………………………………………………………………………..
4. Are there days where you are served special meals?
Yes No
If the response is yes state, the type of meal served?
…………………………………………………………………………………………………
………………………………………………………………………………….
5. According to your own assessment what are the causes of poor diet within the home?
…………………………………………………………………………………………………
…………………………………………………………………………………………………
Section D – To establish possible solutions to alleviate healthy family nutritional
practices among the families of Mulungushi ward.
6. Do you feel the need of a dietician or nutritionist to plan and organise your meals?
…………………………………………………………………………………………………
…………………………………………………………………………………………………
7. What is the greatest challenge the Home is facing that might be adding to the poor
nutrition?
…………………………………………………………………………………………………
………………………………………………………………………………………………….
8. What do you think needs to be done to improve your meals or diet within the Home?
…………………………………………………………………………………………………
…………………………………………………………………………………………………

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