FACTORS ASSOCIATED WITH DEVELOPMENT OF ANAEMIA IN

CHILDREN BELOW 5 YEARS IN THIKA LEVEL 5 HOSPITAL

BY:

ROY MOBEGI NYABUTO

D/NURS/19005/3809

A RESEARCH SUBMITTED TO KENYA MEDICAL TRAINING

COLLEGE IN PARTIAL FULFILLMENT FOR THE AWARD OF
DIPLOMA IN KENYA REGISTERED COMMUNITY HEALTH NURSING

Kenya Medical Training College

Po Box 30195-00100

Thika.

July, 2022

i
DECLARATION
I hereby declare that all the work presented in this study is my own and has not been submitted
in partial fulfillment of a Diploma in Community Health Nursing in this or other institution of
higher Learning.

Roy Nyabuto Mobegi.

Signature……………………………….

Date……………………………………….

Supervisor: Mr. Shadrack Kirimi.

Signature………………………………….

Date…………………………………………

ii
DECLARATION
I hereby declare that all the work presented in this study is my own and has not been submitted
in partial fulfillment of a diploma in community health nursing in this or other institution of
higher learning.

iii
ACKNOWLEDGEMENT
I give thanks to almighty God for giving me good health and the will to undertake and
accomplish my research study.

Special thanks go to my course lecturers for their guidance and knowledge which they impacted
in me. Not forgetting my beloved parents who supported me financially through the course, May
almighty God bless them abundantly.

I wish to the management of Thika Level 5 hospital for allowing me to carry this study in their
facility.

I also thank the medical doctors, nurses in pediatric ward at Thika Level 5 hospital.

I also thank all my collogues for their moral support and encouragement throughout my study.
May the Almighty God bless them all.

iv
v
TABLE OF CONTENTS
DECLARATION.............................................................................................................................ii

DECLARATION............................................................................................................................iii

ACKNOWLEDGEMENT..............................................................................................................iv

ABSTRACT....................................................................................................................................x

CHAPTER ONE: INTRODUCTION OF THE STUDY................................................................1

1.1 Background of Study.................................................................................................................1

1.2 Problem Statement.....................................................................................................................2

1.3 Study Justification.....................................................................................................................2

1.4 Significance of Study.................................................................................................................2

1.5 Study Objectives........................................................................................................................3

1.5.1 Broad Objective......................................................................................................................3

1.5.2 Specific Objective...................................................................................................................3

1.6 Research Question.....................................................................................................................3

CHAPTER TWO: LITERATURE REVIEW..................................................................................4

2.1 Introduction................................................................................................................................4

2.2 Knowledge of care givers on anaemia among under fives........................................................4

2.3 Socio-demographic factors associated with anemia in under fives...........................................5

2.3.1 Age..........................................................................................................................................5

2.3.2 Gender.....................................................................................................................................6

2.4 Infections associated with anaemia in under-fives....................................................................7

CHAPTER THREE: STUDY METHODOLOGY..........................................................................8

3.1 Introduction................................................................................................................................8

3.2 Study area..................................................................................................................................8

3.3 Study design...............................................................................................................................8

vi
3.4 Study Population........................................................................................................................8

3.5 Study Criteria.............................................................................................................................8

3.5.1 Inclusion Criteria....................................................................................................................8

3.5.2 Exclusion Criteria...................................................................................................................8

3.6 Study Variables..........................................................................................................................9

3.6.1 Independent Variables............................................................................................................9

3.6.2 Dependent Variables...............................................................................................................9

3.7 Sampling Procedure...................................................................................................................9

3.8 Sampling interval.....................................................................................................................10

3.9 Data Collection Instruments....................................................................................................10

3.10 Data Collection Procedure.....................................................................................................10

3.11. Pre -Testing Questionnaire...................................................................................................11

3.12 Data analysis technique.........................................................................................................11

3.13 Limitation of The Study.........................................................................................................11

3.14 Ethical consideration.............................................................................................................11

CHAPTER FOUR: STUDY FINDINGS, DATA ANALYSIS AND PRESENTATION............12

4.1 Introduction..............................................................................................................................12

4.2 Socio-demographic data..........................................................................................................12

4.2.1 Age of the respondents.........................................................................................................12

4.2.2 Relationship of the care givers with the child......................................................................13

4.2.3 Marital Status of The Respondents.......................................................................................14

4.2.4 Occupation............................................................................................................................15

4.2.5 Number of children...............................................................................................................16

4.2.6 Age of the child....................................................................................................................16

4.2.7 Gender of the child...............................................................................................................17

vii
4.2.8 Gender of the child...............................................................................................................18

4.3 Knowledge of caregivers on anemia........................................................................................19

4.3.1 Definition of anemia.............................................................................................................19

4.3.3 Cause of anemia....................................................................................................................20

4.4.0 Infections Associated with Anemia......................................................................................21

CHAPTER FIVE: DISCUSSION..................................................................................................23

5.1 Introduction..............................................................................................................................23

5.2 Socio-demographic factors......................................................................................................23

5.3 Knowledge of caregivers on anemia........................................................................................23

5.4 Infections associated with anaemia in under-fives..................................................................24

CHAPTER SIX: CONCLUSION AND DISCUSSION................................................................25

6.1 Conclusion...............................................................................................................................25

6.2 Recommendations....................................................................................................................25

REFERENCES..............................................................................................................................26

APPENDICES...............................................................................................................................27

Appendix II: Permission Letter.....................................................................................................28

Appendix 1: Questionnaire............................................................................................................29

Appendix II: Budget......................................................................................................................31

Appendix III: Work Plan...............................................................................................................32

Appendix IV: Maps.......................................................................................................................33

Map of Africa................................................................................................................................33

Map of Kenya................................................................................................................................34

Map of Kiambu County.................................................................................................................35

viii
LIST OF TABLES
Table 1: Age of the respondents....................................................................................................14
Table 2: Age of the child...............................................................................................................18

ix
LIST OF FIGURES
Figure 1: Relationship of the care givers with the child................................................................15
Figure 2: Marital Status of The Respondents................................................................................16
Figure 3: Occupation.....................................................................................................................17
Figure 4: Number of children........................................................................................................18
Figure 5: Gender of the child.........................................................................................................19
Figure 6: Gender of the child.........................................................................................................20
Figure 7: Definition of anemia......................................................................................................21
Figure 8: Definition of anemia......................................................................................................22
Figure 9: Infections Associated with Anemia...............................................................................23
Figure 10: Infections Associated with Anemia.............................................................................24

x
 ABSTRACT
Introduction: The purpose of this study was to determine the factors associated with
development of anemia among children under five years admitted in pediatric ward at Thika
Level 5 Hospital. Anemia is a major concern both globally and in the Africa continent. It is
ranked as the third leading cause of both morbidity and mortality to the under-five year’s
children. It is associated with many factors like, knowledge, social economic and infections.

Methodology: A descriptive a quantitative Cross-sectional research design was used. The tool
used was structured questionnaire. Simple sampling was to use on the large numbers of children
coming in at the same time. The researcher had to use the hospital randomly pick caregivers
whom were interviewed. The collected data was analyzed using Microsoft excel Microsoft word
and presented using tables, pie charts and bar graph.

Findings: According to the study, majority of children had anaemia are aged than one year
(38.5%) and between two years and three (38.5%). According to the findings most caregivers
(57.7%) they define anaemia as reduced blood supply in the body and remaining percentage
(42.3%) understood anemia as loss of blood. 40.4% of them said of anemia is causes of anemia is
poor diet, followed 25% to bleeding, and the rest 17.3% each believed that anaemia is caused by
infection such as helminthic and chronic diseases such as cancer respectively. According to the
study, most infections are associated with anemia in under-fives were worms (36.5%), followed
by sickle cell (23.1%) and cancer (23.1%) and (17.3%) malaria.

Conclusions: Children aged below 5 years, those living I low socio-economic status and those
who take a diet not enriched with iron are not at risks of developing anemia, thus improving
socio-economic status, prompt treatment infection and deworming under five years would
prevent the risk of anemia.

xi
 CHAPTER ONE: INTRODUCTION OF THE STUDY
1.1 Background of Study
Anaemia is defined as reduction of Red Blood cells (RBC) volume of hemoglobin concentration
below ranges of values occurring in healthy person

Table 1.1 shows ranges from hemoglobin and hematocrits values by age of well shed children

Age Haemoglobin range Haematocrit % range

Umbilical cord blood 13.7-20.1 45-65
2 weeks 13.0-20.0 42-66
3 months 9.5-14.5 31-34
6 months -6 years
Anaemia is not a single disease to but a condition like fever is with many possible causes and
many forms. Causes of anemia include nutritional deficiencies inherited genetic defects,
medication- related side effects and chronic diseases. It can occur because of blood loss from
injury or internal bleedings. The condition may be temporary or long term and can manifest in
mild or severe form. (Brutanek et al, 2015)

Anaemia is á highly frequent disease worldwide. It affects Individuals in all stages of life
although pre-school children and women are the most heavily affected. In pre-school children,
there is rapid growth which increase demand of iron, if micronutrients balance is negative, the
disease can develop. Various factors are associated with the occurrence of anaemia amongst
which are genetic causes; parasitic infections and other micronutrient deficiencies. in addition,
low consumption of iron-rich foods and high intake of iron absorption inhibitors iron chelating
substances (Horne et al, 2017)

Socio-economic factors such as poor housing, crowding and poor education level pre dispose to
illness in parts of Asia and Latin America. Other's socio-cultural beliefs may be important risk
factors of anaemia such as delayed treatment – seeking and inappropriate medication both which
are common among people of Africa (Tanzania) (Mwenesi et al 2016).

1
1.2 Problem Statement

Up to 20% Of American children and 80%of children in developing countries become anemic at
same point during their childhood and adolescence. Iron deficiency is common cause in children
but other forms of anemia including hereditary blood disorders can also cause anemia in
population (Brutanek et al 2015).

The association of clinical, nutritional, demographic and socio-economic factors with

parasitaemia, anemia determined for children presenting at a hospital in holoendemic of
falciparum transmission in Western Kenya (Otieno et al 2018)

Under five years children hospitalized in Thika Level 5 Hospital, most of them suffer from
anaemia and some of the contributing factors are severe acute malnutrition and Iron deficiency.

1.3 Study Justification

Anaemia is an Important cause of pediatric hospital admission and deaths. The specific signs and
symptoms associated with anaemia to lead under-recognition of the anaemia related burden of
disease and death. This is supported by the observation that 20% of anaemia infants (Packed cell
volume) in one cohort study were only diagnosed at across sectional surveys (amendez et al
2014). This is important in to optimize effective anaemia control.

1.4 Significance of Study

This study is aiming to assess factors that are associated with development of anaemia in under
five years children. It will be useful to health practioners to know the factors that contribute
anaemia most in under five children admitted in Thika Level 5 Hospital.

Also, they will be able to curb those factors in order to reduce the number of admissions of those
children with anaemia in pediatric ward. Community also will be educated by the health worker
to get knowledge on the factors associated with anaemia to them under five children and improve
health status.

Under five children will be prevented and managed and reduce hospitalization and promote
developmental status.

2
1.5 Study Objectives
1.5.1 Broad Objective
To establish the factors associated with the development of anemia in children below five years
of age.

1.5.2 Specific Objective

1. To determine the level of knowledge of caregivers of children below five on anemia.
2. To determine the socio-economic factors associated with anemia.
3. To determine the infection associated with anemia.

1.6 Research Question

a) What is the knowledge of children below five on anemia?
b) What are the socio-economic factors associated with anemia?
c) What is the infection associated with anemia?

3
 CHAPTER TWO: LITERATURE REVIEW
2.1 Introduction
Anaemia refers to a condition that result from a decrease of blood cells or the normal quantity of
hemoglobin in the blood. However, it can include decreased oxygen- binding ability of each
haemoglobin molecule development in some other types of haemoglobin deficiency (sia et al
2013)

Anaemia is most common disorder of the blood. There are several on kinds of anaemia produced
by a variety underlying causes. Anaemia can be classified variety of ways, based on the
morphology of RBCs, underlying enological mechanisms and discernible clinical Spectra, to
mention a few.

The main classes of anaemia include, excessive blood loss (acutely such hemorrhage or
chronically thin low-volume loss), excessive blood destruction or deficient red blood cells
production effective haernetopoiesis) (Vinay et al 2015)

Anemia in under five is a public health problem worldwide data from World Health Organization
(WHO), shows that the anemia prevalence among children aged 16-59 years is 42.6% globally
and maximized in Africa (62.3%).

The cause of anemia is multi-functional, including the shortage of hematopoietic, material iron
deficiency is a common cause of anemia in children under five years (Juan Xiao et al, 2015)

Childhood anemia will adversely affect the health of children Including physical development,
and may cause eversible clamaqes to motion, cognitional and behavioral development. The age
from 0- 5years old critical period for children's growth and development and it is also a high
group for anaemia. There are factors that associated with development of anemia under fires
which are;

2.2 Knowledge of care givers on anaemia among under fives

caregivers are those who took care of the diets, living and personal security for children. A case
study was conducted at Mkuranga District Hospital in Tanzania. A cross sectional design was
used to recruit a convenience sample of 40 mothers whose children were male (52.5%) aged 6-29

4
months (87.5%) and had a diagnosis of severe anaemia (75.0%) according to the World Health
Organization definition: Maternal anemia reported by 67.500 of mothers.

Mother reported that maternal anemia (17.5%) and feeding practices (32.5%) are known
contributing factors to anaemia in children. Mother's reported anaemia could be prevented
(55.0%) and cured by herbal preparation (47.5%).

In addition, some mothers indicated that anemia was caused by witchcraft (2.5%) and eating
lemons (2.5%). Severe anaemia was high among the studied population which aligned with their
hospitalization status finding suggested that potential gaps in control and management of
anaemia in children possibly related to low awareness or incorrect knowledge on Information
about anaemia in children by me caregivers. There is also Imperative for culturally and
translation and exchange with mothers in order to impact on the prevention and control of
anaemia in children in Tanzania (Pammia Petruko et al 2014).

A study done at Sylvanus Olympia teaching hospital in Lomé shows that forty mothers had never
about any information about anaemia. Health personnel was the main source of mother's
Information (29%), mass media of mother’s information source (radio 5%, television 3%)

The decreased blood in the body is the most given definition from the mothers 44%. Malaria
(20%) and malnutrition (19%) were the main causes cited by the mothers. iron deficiency
mentioned by 36 of the mothers. Palmore plantar pallor 32% was the clinical sign best known by
the mothers. (B. Benoist, E, 2012)

Most of the mothers (90%) had never assist to an information education and communication
message about anaemia prevented. When their child had anaemia, 25 mothers (65.86%) took
their children to health facilities while fine mothers (13-2/2 had given a treatment. It concluded
that anaemia was not known by the mothers of under five children, that its causes and treatment
(Fidele Colman Dossou et al 2016)

2.3 Socio-demographic factors associated with anemia in under fives

Some of socio-demographic factors associated with development of anaemia children under five
years include:

5
2.3.1 Age
Infants are at high risk because milk diet contains very small amounts of Iron. Human breast
milk, for example iron, only about 0.3mg/l of iron. cow’s milk contains twice as much as human
breast milk bio availability. Children especially the early years of life, have incredible dietary
iron needs accompanying expansion of blood volume (Cartman et al 2013)

Infants’ boys may have ten times more risks than baby girls. In general, full term breastfed
infants have enough iron stores for their 6months of life. After that, they must rely on other
sources of iron stopping breast feeding too early or using formula that is not iron fortified is
associated with deficiency anaemia (Cartman et al 2013)

According to the results from the National Nutrition survey (NND in Mexico, carried m 2009
[NN-09), the highest prevalence was found in children between ages of 12 and 24 months
(Villalpando et al 2013)

In Mexico, as in other developing countries, micronutrient deficiency occurs mainly between 6

and 24 months of age and is significant public health problem (Zambrano 2014)

Children under 2 years have increased nutritional requirements because of their growth spurt,
which often leads to a negative nutrient balance. (Agostoni et al 2002)

2.3.2 Gender
Boys’ infants are affected more with severe anemic than girls’ infants. This is because of the
higher growth rate among boys during growth stages results in higher anaemia prevalence, as
their bodies demand higher amount of iron, which cannot be supplied by the diet as study results
done in Burma, Benin and Mali (Sankar Goseumai, Kishore k. Das et al 2015)

Even in the United States iron deficiency is the most prevalent nutritional deficiency. It is for
highly association with poverty. People in lower socio-economic groups having double the risk
of those who are middle upper class. In a study of low-income children six months was nearly
18% children two. It should be noted however, that children, group can develop deficiency
anaemia. (Britanek 2017).

A study carried out in Indian showed that low haemoglobin concentrations in rural Indian
children primarily result from micronutrient (especially on deficiencies attributable poor

6
nutritional intake compounded by adverse socio-economic conditions and food security,
Haemoglobin level was primarily associated with iron status in Indian toddler, how maternal
haemoglobin level, family health and food security also important factors. strategies for
childhood. anaemia must include optimized iron intake should simultaneously address material
analgia, poverty food insecurity (slenderer et al 2012)

2.4 Infections associated with anaemia in under-fives

Conditions associated with anaemia infection and chronic disease include such diverse disease as
chronic bacterial endocarditis, osteomyelitis, I wishenite rheumatoid arthritis, rheumatic fever,
Crohn’s disease and ulcerative colitis. Chronic renal failure may produce a similar anaemia
because of causes reduced levels of erythropoietin, the hormone that stimulated the protraction of
red blood cells in the marrow treatment of the underlying disease prevent or the anaemia chronic
bone can reverse the anemia chronic disease like Crohn’s disease are different to treat and
patients may exhibit intermittent anemia that varies with their conditions (Kumar et al, 2010)

Although the aetiology of anemia in tropical areas in multifunctional, plasmodium falciparum

malaria is commonly associated with anemia in children living in holoendemic malaria areas.
Stepwise transgression analysis showed that fever and parasternal were effective in predicting
anemia and that the anemia condition was age dependent. The majority of the children were iron
deficient, followed by normochromic macrocytic anemia. there was strong evidence in this age
group that the anemia was associated with malaria and geohelminth (Preminji et al, 2015)

Disease associated with ACD and information, the chronic disease that are associated with this
process include;

 autoimmune disease example includes systemic lupus, every thromatus, rheumatoid arthritis,
polymyalgia rheumatic and inflammatory bowel.
 Health failure. Many patients with a higher risk of death in patients with heart failure. It may
be caused by lack of nutrients from food. Heart failure can also cause a backup of fluid.
 Hepatitis C; the liver cirrhosis associated with hepatitis C can reduce the production of red
blood cells. Gastro intestinal bleeding, may also contribute to blood loss.
 Long term infections; examples include chronic or recurrent urinary tract infections and
osteomyelitis.
7
 HIV/AIDS; the inflammatory process associated with AIDS can adversely affect EDO levels
and red blood cells production.

CHAPTER THREE: STUDY METHODOLOGY

3.1 Introduction

This chapter deals with background of the study area, study design, definition of variables,
inclusion and exclusion criteria, study population, sampling procedure, sample size, data
collection tools, data collection procedure and study limitation.

3.2 Study area

The Study Will Be conducted in Paediatric unit of Thika Level 5 Hospital, located in Thika
town, Kiambu County Kenya. This the main county hospital in Thika with a well paedriatics
ward which offers all services concerning children but also medical and surgical services include
preventive, promotive and rehabilitation services are offered.

3.3 Study design

The study will be a cross-sectional study. It will be carried out to determine the associated
factors of anemia in children below 5 years.

3.4 Study Population

The study will include all children less than 5 years of age appropriately 200 who admitted in the
paedriatics ward at TL5H in July 2022.

3.5 Study Criteria

3.5.1 Inclusion Criteria
All children below 5 who are anemic will be included in the study.

3.5.2 Exclusion Criteria

All children above 5 years will be excluded from the study.

8
3.6 Study Variables
3.6.1 Independent Variables
Children below five years of age with anemia.

3.6.2 Dependent Variables.

Factors associated with development of anaemia

3.7 Sampling Procedure

This is the selected number of members from accessible population to be interviewed from target
population. Appropriate number will be determined by use of fisher at all times.

N= Z2PQ
d2
Where,

n= the desired sample size (if target population is more than 10,000)

Z= the standard normal deviation at required confidence level which is (1.96)

P= the population in the target population estimated to have characteristic being measured taken
as 0.5

Q= I-P

D =level of statistical significance set at 95% is confidence level with an error of 0.05

Therefore

n= (1.96)2(0.5) (0.5)
(0.0025)

n=384.16

9
If the target population is less than 10000, the required sample will be smaller. In such cases,
final sample estimates are calculated using the following formula:

Nf= n
(1+n)/N
Where nf=the desired sample size where the population is <10,000
n = the desired sample size when the population is > 10,000
N= The estimated number of populations is taken as 8,000
Nf= 384
(1+384)/200

Nf = 384/2.92=131.5
Therefore nf=132
Due to limitation of time the researcher will not be able to cover 132 subjects and thus only
40% of the sample size will be used to be the respondents
Hence:
40% of 132 respondents
40/100 x 132=52.4
Sample size = 52 respondents
3.8 Sampling interval
S1= total population/ sampling size
=200/132
=1.515
=2
So, every 2nd respondent will be selected

3.9 Data Collection Instruments

Questionnaires will be used in the =collection of data

3.10 Data Collection Procedure

Data will be collected by distributing questionnaires to those care takers who can read and write
and interviewing the others

10
3.11. Pre -Testing Questionnaire
This will be done using respondents from TL5H. The researcher will come up with 5
questionnaires for pre testing so as to achieve validity and detect any irrelevant sot that early
possible corrections may be made before actual survey is done pediatric ward.

3.12 Data analysis technique

The researcher will analyze data using sampling descriptive statistics e.g., mean, median, and
mode. The analyze will be presented in percentage using simple table graphs and pie charts.

3.13 Limitation of The Study

Shortage of time and limited funds, while carrying out the study.

3.14 Ethical consideration

The following ethical considerations will be adhered to. They include privacy, confidentiality,
anonymity, and present permission to carry out the research in the hospital will be obtained from
the nursing officer of TL5H.

The Questionnaire will contain clear instructions from the respondents in order to ensure that
each ethical consideration is observed.

11
 CHAPTER FOUR: STUDY FINDINGS, DATA ANALYSIS AND
PRESENTATION
4.1 Introduction
This chapter involves analysis and presentation of findings from data collection which are
presented in form of charts tables and graphs.

4.2 Socio-demographic data

4.2.1 Age of the respondents

Table 1: Age of the respondents

Age in years Frequency Percentage

26-30 Ears 18 34.6%
>30 years 12 23.1%
21-25 years 10 19.2%
16-20 years 10 19.2%
<15 2 3.8%
Total 52 100%

From the above table, 34.6% of the respondents were aged between 26-+30 years, 23.1% above
30 years. 21-25 (19.2%), 16-20 years and 3.8% before 15 years. This shows that majority of the
respondents were between 26-30 years

12
4.2.2 Relationship of the care givers with the child

Figure 1: Relationship of the care givers with the child

9.60%

13.50%

76.90%

Mothers Guardian Father

The above pie chart (76.9%) 40 respondents are mothers, 13.5% (7 respondents) guardians and
9.36% (5 respondents) are fathers.

13
4.2.3 Marital Status of The Respondents

Figure 2: Marital Status of The Respondents

13.50%

7.70%

50.00%

28.80%

Married single Widowed Divorced

From the chart above 50% (26 respondents) were married, 28.8% were single, 13.5% (7
respondents) were divorced and 7.7% (4 respondents) were widowed. From the above shows that
majority of the respondents were married 50% (26 respondents) clients.

14
4.2.4 Occupation

Figure 3: Occupation

60.00%

50.00% 48.10%

40.00%

30.00% 28.80%

23.10%
20.00%

10.00%

0.00%
Occupation

government employed business farmers

From the figure above showed that majority (48.10%) of the respondent were business while the
least (23.10%) of the respondents were farmers.

15
4.2.5 Number of children

Figure 4: Number of children

5.80%

11.50%
32.70%

9.60%

40.40%

one two three four five or more

From the above chart, it shows that majority of the respondents have two children (40.4%),
followed by one (32.7%), four (11.5%) three (9.6%) and five or more.

4.2.6 Age of the child

Table 2: Age of the child

Age in years Frequency Percentage (%)

< I year 20 38.5%
2-3 years 20 38.5%
3-5 years 12 23.1%
Total 52 100%

From the above table 38.5% of the age of the children are < 1 years, 38.5% between 2-3 years
and 2.3% between 3-5 years.

16
4.2.7 Gender of the child

Figure 5: Gender of the child

40.40%

59.60%

Female Male

From the chart above majority of the children are male (59.6%) and 40.4% are female.

17
4.2.8 Gender of the child

Figure 6: Gender of the child

13.50%

53.80%
32.70%

Breastfeeding Balanced Diet Ugali and Vegetable /

From the above chart 53.8% of the children are breastfeeding, 32.7% eat balanced diet and
(13.5%) eat ugali and vegetables.

18
4.3 Knowledge of caregivers on anemia
4.3.1 Definition of anemia

Figure 7: Definition of anemia

42.30%

57.70%

Reduced blood supply Loss of blood

The study revealed that (59.7%), most of the caregivers understand anemia as having reduced
blood in the body and the rest (42.3%) understood it as loss of blood.

19
4.3.3 Cause of anemia

Figure 8: Definition of anemia

45%
40.40%
40%

35%

30%

25% 23%

20%
17.30% 17.30%

15%

10%

5%

0%

Bleeding Poor diet (Causes) Infection (Helminthic) chronic disease ( cancer)

From the above graph, 40.4% of the caretakers knew causes of anemia as poor diet, 25% who
said bleeding, 17.8% infection such as helminthic and 17.3% chronic diseases such as cancer.

4.2.4 Source of information about anemia from the above chart majority of the caretakers got
information about anemia from health workers (36.5%), followed by mass media CTV, radio and
newspapers.23.1%, then social media such as Facebook, WhatsApp) 21.2% and lastly
community health volunteers.

20
4.4.0 Infections Associated with Anemia

Figure 9: Infections Associated with Anemia

19.20%

36.50%

21.20%

23.10%

Health Worker Mass Media

social media community health volumteer

Infections associated of anemia majority of them are worms 36.5%, followed by sickle cell
(23.1%) cancer (23.1%) and malaria (17.3%)

21
Figure 10: Infections Associated with Anemia

17.30%

36.50%

23.10%

Worms 23.10% Sickle Cell

Cancer

The study revealed that majority of the respondent (36.50%) cancer while the least (17.30%)
were worms.

22
 CHAPTER FIVE: DISCUSSION
5.1 Introduction
This chapter discusses conclusively the study findings in line with the study objectives data
collected.
5.2 Socio-demographic factors
According to the study, majority of children had anaemia are aged than one year (38.5%) and
between two years and three (38.5%). This concurs with 2013 study carried out in Mexico by
Villalpando and showed that the highest prevalence of anemia was found in children aged
between 12 and 24 months and most of them boys. This indicates that less aged male children are
at a higher risk of developing anaemia. (Villalpando 2012)
The findings of the study show that the usually children were (53.8%) breastfeeding. This shows
that infants are at high risk because milk diet contains very little amounts of iron, hence
predisposed to anaemia. This corresponds a study of 2013 done by cartman suggested that
infants to stop breastfeeding early and provided supplements to increase iron in the circulation
(cartman et al 2013),
majority of caregivers were mothers (34.6%) aged between 26 and 30 years. Most of them were
business people followed by (28.1%) government employment. The highest were (50%) married
and had two children (40.4%). This explains that the care givers' families in middle class living,
hence concentrate in more to their businesses rather than spending enough Time children, and
providing with required nutrients
5.3 Knowledge of caregivers on anemia
According to the findings most caregivers (57.7%) they define anaemia as reduced blood supply
in the body and remaining percentage (42.3%) understood anemia as loss of blood. 40.4% of
them said of anemia is causes of anemia is poor diet, followed 25% to bleeding, and the rest
17.3% each believed that anaemia is caused by infection such as helminthic and chronic diseases
such as cancer respectively.

There sources of information about anemia were led by health workers (36.5%), followed by
mass media (TV, Radio, Newspaper) (23. 1%), social media (Facebook, WhatsApp) 21.1%) and
least from community health volunteers (19.2%).

23
These findings concur with a study carried out by whenter in 2012 shows that causes of anemia
were poor diet intake of Iron and worms’ infestation in under five years.
5.4 Infections associated with anaemia in under-fives
According to the study, most infections are associated with anemia in under-fives were worms
(36.5%), followed by sickle cell (23.1%) and cancer (23.1%) and (17.3%) malaria.

24
 CHAPTER SIX: CONCLUSION AND DISCUSSION
6.1 Conclusion
Children aged below 5 years, those living I low socio-economic status and those who take a diet
not enriched with iron are not at risks of developing anemia, thus improving socio-economic
status, prompt treatment infection and deworming under five years would prevent the risk of
anemia.

6.2 Recommendations
Deworming od children after every three months should be encouraged to the caregivers by
health workers. health talks should be arranged by health workers to advice caretakers on
prompt treatment of disease like malaria to avoid complications.
More emphasis should be put on parents/guardians bringing their children to hospital to
improve feeding practices on their children by giving them iron rich foods, such as meat,
fortified cereals, eggs, green vegetables and beans.

25
REFERENCES
1. Siamak T. Nabili et al 2013, Harrison’s principles of internal medicine 17 th edition, United
States.
2. Juan Xiao Et al 2015.
3. Zul Promji et al 2015: Anemia and plasmodium falciparum infections Among young
children in an holoendemic area, Bagamoyo, Tanzania.
4. Villalpando s et al 2013: prevalence of anemia in 1-2 years of age results from nationwide
probabilities survey.
5. Kumar, et al 2017, Robbins Basic Pathology page 432, 8th edition, Saunders Elsevier.
6. S. Bharati, M. Pal, S. Chakrabarty, and P. Bharati, “Socioeconomic determinants of iron-
deficiency anemia among children aged 6 to 59 months in India,” Asia-Pacific Journal of
Public Health, vol. 6, 2013.

7. S. Pasricha, J. Black, S. Muthayya et al., “Determinants of anemia among young children in

rural India,” Pediatrics, vol. 126, no. 1 2010.

8. B. Benoist, E. McLean, I. Egli, and M. Cogswell, Worldwide Prevalence of Anaemia 2011–

2015: WHO Global Database on Anaemia, WHO, Geneva, Switzerland, 2015.

9. International Institute for Population Sciences and Macro International (IIPS and Macro
Int.), National Family Health Survey (NFHS-3), 2005-06, Key Findings, International
Institute for Population Sciences, Mumbai, India, 2007.

10. T. Walter, I. de Andraca, P. Chadud, and C. G. Perales, “Iron deficiency anemia: adverse
effects on infant psychomotor development,” Pediatrics, vol. 84, no. 1, pp. 7–17, 1989.

11. Freedman, D.S, Thornton, J.C., Mei, Z., Wang, J., Dietz, W.H., Pierson, R.N. and Horlick,
M. (2004). Height and Adiposity among Children. Obese Res, 12: 846–853.

12. Frohlich, K.L., Potvin, L., Gauvin, L. and Chabot, P. (2002). Youth smoking initiation:
disentangling context from composition. Health & Place 8, 155–166.

13. Hien, N.N., Kam, S. (2008). Nutritional status and the characteristics related to
malnutrition in children under five years of age in Vietnam. J.
Public Health. 2008

14. Kabubo-Mariara, J. Ndenge, G.K. and Mwabu, D.K. (2009). Determinants of children’s
nutritional status in Kenya: evidence from demographic and health surveys.
.
15. Mamoun N. Homedia, S. Mabyou, M., Hussan, M., Muntasir, A., Salah, T and, Adam, I,
(2009). Prevalence, types and risk factors for malnutrition in displaced Sudanese

26
 APPENDICES
Appendix I: Consent Form

Name of researcher: Roy Mobegi Nyabuto

Name of Organization: Kenya Medical Training College

Title of Proposal: You will be given a copy of the full Informed Consent Form

Introduction: My name is Roy Mobegi Nyabuto. I am student undertaking a Diploma in Kenya

Registered Community Health Nursing health in KMTC, Thika Campus. As a requirement by
the college, for the completion and award of my diploma, I am conducting a study on factors

associated with development of anaemia in children below 5 years in Thika Level

5 Hospital.

Significance of Study
This study is aiming to assess factors that are associated with development of anaemia in under
five years children. It will be useful to health practioners to know the factors that contribute
anaemia most in under five children admitted in Thika Level 5 Hospital.

Also, they will be able to curb those factors in order to reduce the number of admissions of those
children with anaemia in pediatric ward. Community also will be educated by the health worker
to get knowledge on the factors associated with anaemia to them under five children and improve
health status.

Under five children will be prevented and managed and reduce hospitalization and promote
developmental status.

Participant selection: We are randomly selected for interview mother with under five
children with anaemia in TL5H.

Benefits and Risks: There are no direct benefits for you as an individual but your involvement
will help understand factors associated with anaemia in under five children.
Voluntary Participation: Your involvement in this research is completely voluntary. You

27
may change your mind later and discontinue taking part even if you had agreed earlier. I
will keep everything you tell me confidential and I will not show anyone that it came from
you.
Appendix II: Permission Letter

28
Appendix 1: Questionnaire
Instructions

1. Do no write your name

2. Mark the appropriate answer in the box provided
3. Give brief answer where stated specify.
4. Answer all questions.

SECTION A: PERSONAL DATA OF CARETAKERS

1. How old are you?

(a) < 15 years [ ]
(b) 16- 20years [ ]
(c) 21-25 years [ ]
(d) 26-30years [ ]
(e) >30years [ ]
2. What is your relationship with the child?
a) Mother [ ]
b) Father [ ]
c) Grandparent [ ]
d) Other specify_____________________
3. What is your marital status?
a) Single [ ]
b) Married [ ]
c) Separated/ divorced [ ]
d) Widowed [ ]
4. What is your occupation?
a) Government employed [ ]
b) Business [ ]
c) Farming [ ]
d) Others specify______________________
5. How many children do you have?
a) One [ ]
b) two [ ]
c) three [ ]
d) four [ ]
e) five or more [ ]

29
SECTION B: CHILD INFORMATION

6. What is the age of your child?

a) <1 year [ ]
b) 1-2 years [ ]
c) 2-3 years [ ]
d) 3-4 years [ ]
e) 4-5 years [ ]
7. What is the gender of the child?
a) Male [ ]
b) Female [ ]
8. What is the usual diet of the child?
a) Breastfeeding [ ]
b) Balanced diet [ ]
c) Ugali and vegetables [ ]
d) Others specify____________

SECTION C: KNOWLDEGE ON ANEMIA

9. What do you understand by the word anemia?

a) Loss of blood [ ]
b) Reduced blood in the body [ ]
c) Others specify [ ]
10. What are some of the causes of anemia you know?
a) Bleeding [ ]
b) Poor diet [ ]
c) Infection such as helminthic [ ]
d) Chronic diseases like cancer [ ]
11. What are some of the diseases associated with anemia?
a) Worms [ ]
b) Malaria [ ]
c) Sickle cell [ ]
d) Cancer [ ]
e) Others specify
12. What are the sources of information about anemia you know?
a) Health workers [ ]
b) Community health volunteers [ ]
c) Mass media (television, Radio, Newspaper, etc.) [ ]
d) Social media (Facebook, WhatsApp etc.) [ ]
e) Others specify____________

30
Appendix II: Budget

ITEMS QUALITY TOTAL(KSH)

Stationary

Pens 4 100

Pencils 2 20

Ream 1 500

Computer services

Typing proposals 24 pages 500

Printing proposals 1,800

Typing and printing research 2 100

questionnaires

Typing and printing research 2000

Binding research 3 copies 1,500

TOTAL 6520

31
Appendix III: Work Plan

2022 2022 2022 2022 2022 2022 2022 2022 2022

Activity APR MAY JUN JUL AUG SEP OCT NOV DEC

Topic
Selection

Proposal
Writing

Proposal
Submission

Proposal
approval

32
Appendix IV: Maps
Map of Africa

33
Map of Kenya

34
Map of Kiambu County

35