INSTITUTION: THIKA SCHOOL OF MEDICAL AND

HEALTH SCIENCES

TOPIC : A STUDY ON FACTORS CONTRIBUTING TO

MALNUTRITION AMONG CHILDREN UNDER THE AGE OF FIVE YEARS IN
MANDERA EAST HOSPITAL , MANDERA COUNTY

NAME MUHAMED ADEN

ADM :

COURSE : DIPLOMA IN COMMUNITY

NUTRITION AND DIETETICS

DEPARTMENT : HUMAN NUTRITION

SUPERVISOR :
DECLARATION

I hereby solemnly declare that this dissertation is the result of an independent investigation
except where literatures of records have been reviewed. Work and has not been presented
in the same or any other institution for academic purposes.

Name: MUHAMED ADEN

Sign :………………………………………

Date:………………………………………

Supervisor:

Signature:……………………………………..

Date:…………………………………………..
DEDICATION

I declare this project to my beloved parents, family members and friends for their support
during the time of carrying out the research work. Special thanks to my family members
for the financial support and encouragement.

This with great love and respect.

ACKNOWLEDGEMENT

First am humbled to thank the Almighty God for the strength, knowledge and wisdom he
granted me during the research proposal and project work. Special thanks to my
Supervisor madam for his timeless guidance and supervisor through the project.
ABSTRACT

A child's risk of dying is highest in the first 28 days of life (the neonatal period). Improving the
quality of antenatal care, care at the time of childbirth, and postnatal care for mothers and their
newborns are all essential to prevent these deaths. Globally 2.6 million children diet in the first
month of life in 2016. There are approximately 7 000 newborn deaths every day, amounting to
46% of all child deaths under the age of 5-years. Preterm birth, intrapartum-related
complications (birth asphyxia or lack of breathing at birth), and infections cause most neonatal
deaths. From the end of the ndo namalizia period and through the first 5 years of life, the main
causes of death are pneumonia,

diarrhoea and malaria. Malnutrition is the underlying contributing factor, making children

more vulnerable to severe diseases. The world has made substantial progress in child survival
since 1990. The global under-5 mortality rate has dropped by 56 per cent from

93 deaths per 1000 live births in 1990 to 41 in 2016. Nonetheless, accelerated progress will

be needed in more than a quarter of all countries, to achieve the Sustainable Development Goal
(SDG) target (1) on under- five mortality by 2030. Meeting the SDG target would reduce the
number of under-5 deaths by 10 million between 2017 and 2030. Focused efforts are still needed
in Sub- Saharan Africa and South East Asia to prevent 80 per cent of these deaths.(WHO, 2017).
ABBREVIATION

WHO - World Health Organization

MOH - Ministry of Health

AMREF - Africa Medical and Research Foundation

KDHS - Kenya Demographic of Health Survey

UN - United Nations

MDGS - Millennium Development Goals

Topic :- Factors contributing malnutrition among children under 5 years
in mandera east hospital in mandera county.

QUESTIONNAIRES

My name is Mohamed Aden a student at Thika School of Medical and Health Sciences , taking
Diploma in Nutrition And Ditectis , I am requesting you to be one of the participants in the study
on research project in which investigate on the A study on Factors contributing malnutrition
among children under 5 years in mandera east hospital in mandera county. This information will
be anonymous and confidential requesting you to give honest answers

Do you agree to be a participant/respondent?

Yes ( )

No ( )

INSTRUCTIONS

1. The information given will be private and confidential

2. Your name is not required

3. The questionnaire is meant for education purposes only

4. I shall only take 15 min of your time. I allow you to ask any question concerning the
study.

SECTION A: DEMOGRAPHIC AND SOCIO-ECONOMIC INFORMATION OF

THE RESPONDENTS

1. Gender of the respondents.

a) Male [ ]

b) Female [ ]

2. Age brackets of the respondents

a) 18-27 [ ]

b) 28-37 [ ]

c) 38-47 [ ]

d) 48 and above [ ]

3. Highest level of education of the respondents

a) None [ ]

b) Primary [ ]

c) Secondary [ ]

d) Tertiary [ ]

4. Marital status of the respondents

a) Single [ ]

b) Married [ ]

c) Separated/Divorced [ ]
d) Widowed [ ]

5. Religious affiliation of the respondents

a) Christian [ ]

b) Muslim [ ]

c) None [ ]

d) Others (specify)
………………………………….................................................................

6. Residence of the respondents

a) Urban [ ]

b) Peri-urban [ ]

c) Rural [ ]

d) Others (specify)……………………………………

7. Is child malnutrition common in your community?

a) Yes [ ]

b) No [ ]

8. If yes to question 7 above, why?

a) Lack of proper feeding [ ]

b) open of enough food [ ]

c) Cultural practices [ ]

9. Is child malnutrition rate new case in your community?

a) Yes [ ]

b) No [ ]

10. If yes how dose it controlled ?

a) By educating cure gives on proper feeding [ ]

b) educating the care gives on balance diet [ ]

c) Others (specify)……………………………………………..

SECTION B: KNOWLEDGE ON EFFECT OF CHILD MALNUTRITION

11 Have you ever heard about child malnutrition?

a) Yes [ ]

b) No [ ]

12. If yes to question 11 above, what is it?

a) children poor growth [ ]

b) It is poor feeding habits [ ]

c) its a non commicable diseases [ ]

d) Others (specify)…………………………………………

13. Have you ever done child malnutrition control?

a) Yes [ ]

b) No [ ]

14. How can child malnutrition be prevented?

a) By empowering the care gives on the effect of child [ ]

b) By educating the children to eat fruits after every meal [ ]

c) By reporting to the country Government [ ]

d) Others (specify)………………………………………….

15. What are your views on the effect of child malnutrition. among children aged 5-10
years?

a) population decrese [ ]

b) mobidity [ ]

c) Others (specify)……………………………………………..

SECTION C: ATTITUDE OF PARENTS ON CHILD

MALNUTRITION
16). poor feeding practice is one thing that lead to child Malnutrition.

a) Strongly agree [ ]

b) Agree [ ]

c) Not sure [ ]

d) Disagree [ ]

e) Strongly disagree [ ]

17).Child malnutrition is common among children aged 5-10 years , do you agree?

a) Strongly agree

b) Agree ( )
c) Not sure ( )

d) Disagree ( )

e) Strongly disagree ( )

18. Is there Prevention for child malnutrition rate?

a) Strongly agree ( )

b) Agree ( )

c) Not sure ( )

d) Disagree ( )

e) Strongly Disagree ( )

19. All the survice for malnutrition prevention are found in Mandera east Hospital,
Mandera county?

a) Strongly agree ( )

b) Agree ( )

c) Not sure ( )

d) Disagree ( )

e) Strongly Disagree ( )

20. Deprevailing culture discourage child all Health Narok sub-county Hospital rate
among children aged 5-10 years ?

a) Strongly agre ( )

b) Agree ( )

c) Not sure ( )
d) Disagree ( )

e) Strongly Disagree ( )

SECTION D: CONTROLINGY OF CHILD MALNUTRITION RATE

AMONG WOMAN

21. Are you currently doing anything to prevent or avoid child mortality rate?

a) Yes [ ]

b) No [ ]

22. Are you doing eanythng to Prevent child mortality rate in your family?

a) Yes [ ]

b) No [ ]

23. Does child mortality rate affect your utilization of daily services?

A) YES ( )

b) NO ( )

24. Do you openly shary how you can prevent child mortality rate with your friends?

a) Yes ( )

b) NO ( )

25. Can child mortality rate lead to population decrese?

YES ( )

No ( )
CHAPTER FOUR:

STUDY FINDINGS

4.1 INTRODUCTION

The study investigated on the barriers to the study on factors that contributing the high
mortality rates among children under the age of five years in Mandera east Hospital in Mandera
county. The collected data was analyzed manually using scientific calculator and a computer. The
results were presented by use of frequency tables, pie charts, bar graphs and single statements.

4.2: DEMOGRAPHIC AND SOCIO-ECONOMIC INFORMATION

4.2.1 Gender of the.

The findings showed that, more than a half of the respondents 42(60%) were female and
28(40%) were male.

4.2.2 Age bracket of the respondents

The table below shows the age brackets of the respondents.

Table 4.1: Age of the respondents

Age bracket Frequency Percentage

18-27 15 21.5
28-37 30 42.9
 38-47 15 21.5
Above 48 10 14.1
Total 70 100

The above table shows that 15(21.5%) of the respondents were of the age bracket 18-27,
30(42.9) were of age bracket of 28-37, 15(21.5%) and 10(14.1%) were of age above 48

4.2.3: The highest level of education of the respondents

The figure below gives the highest level of education of the respondents

Figure 4.1: Highest level of education

The findings showed that 30(42.9%) of the respondents had attained secondary level of
education, 25(35.7%) had attained primary level education, 10(14.3%) had attained their tertiary
level of education and 5(7.1%) had not gone to school for formal education to be educated on
the barriers to the increase in prevelance of malnutrition among children under 5 years globaly
Mandera East Hospital, Mandera county.
 Object 1

Figure 4.1: Highest level of education

The findings showed that 30(42.9%) of the respondents had attained secondary level of
education, 25(35.7%) had attained primary level education, 10(14.3%) had attained their tertiary
level of education and 5(7.1%) had not gone to school for formal education on barriers to the
increase in the prevelance of high mortality rates among children under the age of five years in
mandera East hospital Mandera county.

Figure 4.2: Marital status of the respondents.

The above Pie chart shows that more than a half 36(51.4%) of the respondents were
married and as well as having children under 5 year. 15(21.5%) were single with poor
health sings, 10(14.2%) of the respondents were widowed and 9(12.9%) of the
respondents were women with children suffering from communicable diseases infection
such as marasmus among women in the area.

.4.2.5: Religious affiliation of the respondents

The study discovered that, most of the respondents 59(84.3%) were Muslims while few
11(15.7%) were Christians. With the women in factors contributing to the study on the
prevalence of factors that contributing to high mortality rates among children under the age of
five years in Mandera East Hospital, Mandera county.

4.2.6: The residence of the respond

The figure below shows the residence of the respondents as per the study

Object 3

Object 5

Figure 4.2: Marital status of the respondents.

The above shows that more than a half 36(51.4%) of the respondents were married and as
well as having children aged 5 year. 15(21.5%) were single with cholera sings, 10(14.2%)
of the respondents were widowed and 9(12.9%) of the respondents were women with
children suffering from communicable diseases such as cholera.
.4.2.5: Religious affiliation of the respondents

The study discovered that, most of the respondents 59(84.3%) were Muslims while few
11(15.7%) were Christians. Wich contributing to the barriers to the study on the prevalence of
high mortality rates among children under the age of five years in Mandera East Hospital,
Mandera county.

4.2.6: The residence of the respondents

The figure below shows the residence of the respondents as per the study findings.

Figure 4.3: Residence of the respondents.

From the above figure, it is clear that almost a half of the respondents 30(42.9%) are from
the Rural areas, . 2 25(35.7%) are peri-urbanites and 15(21.4%) are Urbanites.

4.2.7: pneumonia control practices

Malnutrition control practices were determined and the study revealed that, most of the
respondents 60(85.7%) of the female gender do not practice proper hand worsh while few
10(14.3%) of them contributing to the barriers to the study on prevelance of high mortality
rates among children under the age of five years in Mandera county.

4.2.8: Factors contributing to the study on prevalence of

high mortality rates among children under the age of
five years in Mandera east Hospital county

The study discovered that, most the respondents 50(71.4%) treat seawadges practices at there
chilaged while some 20(28.6%) as a sign of identity and recognition which contribute to high
mortality rates among children under the age of five years in Mandera east Hospital in Mandera
county.
 4.3: KNOWLEG ON HIGH MORTALITY RATES AMONG
CHILDREN UNDER THE AGE OF FIVE YEARS IN
MANDERA EAST HOSPITAL, MANDERA COUNTY.

The study indicated that majority 62(88.6%) of the respondents had heard about child
mortality rate while minority 8(11.4%) of the respondents had never heard control
Marasmus among women with infants under 5 years.

4.3.2 What is child mortality rate?

The table below shows how the respondents regarding cholera.

Table 4.2: what is child mortality rate?

Knowledge Frequency Percentage (%)

 Child population decrese 5 7.1

Killer disease 5 7.1

First moving disease 60 85.8

Total 70 100

4.3.3: children mortality rate control

It was discovered from the study that majority 65(92.9%) of the respondents had gone for
cholera control meeting while minority 5(7.1%) had never gone for body check up and
cholera.

4.3.4: Prevention of cholera and Malaria in the environment.

The figure below shows ways on which child mortality rate can be prevented as per the
study findings.
 Object 7

Figuring 4.4: Ways of child morbidity and mortality rate controle.

From the figure above, it is noted that 40(57.1%) of the respondents impact knowledge on effect
of cholera control practices leading to protecting themselves from dihhorea disease , 20(28.6%)
and 10(14.3%) of the respondents were illiterate on contributing to the study on prevelance of
high mortality rates among children under the age of five years in Kedowa health county.

4.3.5: Views on how children under 5 years loose life.

The study established that more than a half 40(57.1%) of the women get adictet to poor
hygine leading to body infections due to illiteracy on effect of poor Health control by their
parents and 30(42.9%) due to harsh climatic condition that rampant in contributing to the
barriers to the increase in study on prevelance of high malnutrition rates among children under
the age of five years in Mandera East Hospital county.

4.4: ATTITUDE OF CHILD MALNUTRITION ON DEVELOPMENT

ACTIVITIES

4.4.1: Ways of conroling child morbidity reta.

The findings of the respondents on their attitude on morbidity rate can be contracted.

Table 4.3: Ways of priventing children mortality rate.

Response Frequency Percentage (%)

Strongly agree 25 35.7

Agree 25 35.7

Not sure 20 28.6

Total 70 100
From the table above, it is clear that 25(35.7%) of the respondents strongly agreed and
agreed in that order that poor liquid weast management contribute to cholera and
20(28.6%) of the respondents were not sure on the ways on how one can contribute to
barriers to the increase in study on prevelance of high malnutrition rates among children under
five years in Mandera East Hospital in Mandera county county .

4.4.2: Attitude of the respondents on poor hygine controlng

The following table shows the responses on the barriers to the increase in high mortality rates
among children under the age of five years in Mandera East Hospital in Mandera county.

Table 4.4: Attitude of respondents on ways of controling malnutrition reta among

children under 5 years rate.

Response Frequency Percentage (%)

Strongly agree 5 7.1

Agree 5 7.1

Not sure 15 21.5

Disagree 25 35.7

Strongly disagree 20 28.6

Total 70 100

From the table above, the study findings showed that 25(35.7%) of the respondents
disagree that poor hygine control services are not useful to children, 20(28.6%) strongly
disagree , 15(21.5%) were not sure if poor hygine control services are useful while
5(7.1%) strongly agree and disagree respectively that services are useful in conrling
Respondents .

4.4.3) : Cooperation of health service providers at the out

patients department in Mandera East Hospital,
Mandera county .

Object 9

Figure 4.5: Cooperation of service providers at out patient units

The findings in the figure above indicate that 35(50%) of the respondents strongly agreed
on cooperation of service providers at out patients department (OPD), 20(28.6%) agreed
and 15(21.4%) were not sure on the cooperation existing at out patients service units.
4.4.4: Availability of knowledge in treating complication on effect of child mortality
rate in the family.

The services availability at in patients department at the out patients units are represented
in the table as shown below

Table 4.5 Availability of Counseling services

Response Frequency Percentage (%)

Strongly agree 26 37.1

Agree 22 31.5

Not sure 15 21.4

Strongly disagree 5 7.1

Disagree 2 2.9

Total 70 100
The table above shows that 26(37.1%) of the respondents strongly agree on the
availability of mortality rate control Counseling services at the units, 22(31.5%) agree,
15(21.4%) were not sure on the availability of proper hygine practice, Counseling
services, 5(7.1%) strongly disagree on the availability of Counseling services among
women in prevention of children under 5 years mortality rate .
4.4.5: Deprevailing culture discouraging on mortality rate control
The figure bellows shows the response of the respondents on cultural factors hindering
home mobidity and Mortality control in contributing to high mortality rates among children
under the age of five years in Mandera East Hospital county.

Object 11

Figure 4.6: Deprevailing culture

The findings indicated that 22(31.4%) of the respondents disagree that deprevailing
culture hinders the infection treatment services by, 20(28.6%) were not sure, 16(22.9%)
strongly disagree, 7(10%) agree and 5(7.1%) strongly agree that deprevailing culture
discourages the use proper services.

CHAPTER 5

SAMMARY, CONCLUTION AND RECOMENTATION

5:1) INTRODUCTION

million babies die every year in their first month of life and a similar number are stillborn. Within
the first month, up to half of all deaths occur within the first 24 hours of life, and 75% occur in
the first week. The 48 hours immediately following birth is the most crucial period for newborn
survival. This is when the mother and child should receive quality follow-up care to prevent and
treatnillness. Globally, the number of neonatal deaths

declined from 5.1 million in 1990 to 2.6 million in 2016. However, the decline in ndo natal
mortality from 1990 to 2016 has been showed than that of post-neonatal under-5 mortality:

49% compared with 62% globally. The relative decline in the neonatal mortality rate was

slower in sub-Saharan Africa. The Modesta decline in neonatal mortality in this region was offset
by an increasing number of births so that the number of neonatal deaths remained

almost the same from 1990 to 2016. Moreover, 52 countries need to access rate progress to
reach the SDG target of a neonatal mortality rate of 12 deaths per 1000 live births by 2030.
(WHO, 2016).

Substantial global progress has been made in reducing child deaths since 1990. The total

number of under-5 deaths worldwide has declined from 12.6 million in 1990 to 5.6 million in
2016 – 15 000 every day compared with 35 000 in 1990. Since 1990, the global under-5 mortality
rate has dropped 56%, from 93 deaths per 1 000 live births in 1990 to 41 in

2016. Although the world as a whole has been accelerating progress in reducing the under-5
mortality rate, disparities exist in under-5 mortality across regions and countries. Sub-

Saharan Africa remains the region with the highest under-5 mortality rate in the world,

with 1 child in 13 dying before his or her fifths birthday. Inequity also persists within

countries geographically or by social-economic status. The latest mortality estimates by wealth

quintile show that in 99 low and Middle income countries (2) , under-5 mortality among children
born in the poorest households is on average twice that of children born in the wealthiest
households. Eliminating this gap between mortality in the poorest and wealthiest households
would have saved 2 million lives in 2016..(UNICEF, 2016) / (WHO; 2016)

5:2) SAMMARY OF FINDINGS

Congenital anomalies, injuries, and non- communicable diseases (chronic respiratory diseases,
acquired heart diseases, childhood cancers, diabetes, and obesity) are the emerging priorities in
the global child Health agenda. Congenital anomalies affect an

estimated 1 in 33 infants, resulting in 3.2 million children with disabilities related to birth defects
every year. The global disease burden due to non-communicable diseases affecting
children in childhood and later in life is rapidly increasing, even though many of the risk

factors can be prevented. Injuries (including road traffic injuries, drowning, burns, and falls) rank
among the top causes of death and lifelong disability among children aged 5-14 years. The
patterns of death in older children and adolescents reflect the underlying risk profiles of the age
groups, with a shift away from infectious diseases of childhood and towards accidents and
injuries, notably drowning and road traffic injuries for older children and adolescents. Similarly,
the worldwide number of overweight children increased from an estimated 31 million in 2000 to
42 million in 2015, including in countries with a high prevalence of childhood undernutrition. This
is Kenya Demographic Health Survey (KDHS; 2017 ).

5:3) CONCLUTION
Our analysis of determinants of under- five mortality in four selected regions of Ethiopia revealed
that preceding birth interval, family size, type of birth, breastfeeding status, source of drinking
water, and income of mothers were the significant determinants. However,

mothers’ education and mothers’ age at birth were found to be insignificant factors of under-five
morality in these regions, a result which is not in line with the literature. In this study, this could
be because the majority (77.01%) of mothers involved had no education.This is according to The
Kenya Demography of Health Survice (KDHs, 2017).

5:4) RECOMENTATION
In this study, the covariates, namely, preceding birth interval, family size,

birth type, breastfeeding status, source of drinking water, mother education, mother income,
area of residence, and father education, are significantly associated with under-five mortality in
univariable analysis but in multivariate analysis we obtained six factors, namely,

preceding birth interval, family size, type of birth, breastfeeding status,

source of drinking water, and income of mothers, to significantly affect the survival of under-five
children. There is a higher under-five death among children who were not breastfed than those
breastfed. A study conducted in Kenya showed that children who were breastfed for more than 6
months have significantly lower probability ( )

of mortality compared to children breastfed for less than 6 months [10 ]. Also, in Bangladesh, a
study revealed that the duration of breastfeeding was an important determinant of childhood
mortality [19 ]. This may be due to the fact that antimicrobial and anti- inflammatory factors in
breast milk provide protection from infection. (MOH, 2016).
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