KNOWLEDGE AND ATTITUDE OF MOTHERS TOWARDS PREVENTION OF CHILDHOOD MALNUTRITION IN OWERRI MUNICIPAL COUNCIL, IMO STATE, NIGERIA

ABSTRACT

Background: Childhood malnutrition remains a significant public health challenge in sub-Saharan Africa, with Nigeria bearing one of the heaviest burdens globally. Mothers play a central role in children's nutritional outcomes through the feeding practices and health-seeking behaviours they adopt. However, inadequate knowledge and negative attitudes towards nutrition can perpetuate preventable malnutrition. Imo State, in southeastern Nigeria, continues to record high rates of stunting, wasting, and underweight among under-five children, making research in this area imperative.
Objective: This study assessed the knowledge and attitude of mothers towards the prevention of childhood malnutrition in Owerri Municipal Council, Imo State, Nigeria.
Methodology: A descriptive cross-sectional research design was employed. Two hundred (200) mothers of children aged 0–59 months attending selected primary healthcare centres in Owerri Municipal Council were recruited using systematic random sampling. Data were collected using a researcher-designed, pre-tested structured questionnaire. Data analysis was carried out using descriptive and inferential statistics. Chi-square test was used to determine associations at p ≤ 0.05 significance level.
Results: The mean age of respondents was 31.4 ± 6.8 years. Nearly half (49.0%) of the mothers had good knowledge of childhood malnutrition prevention, 36.0% had fair knowledge, and 15.0% had poor knowledge. The majority (59.0%) demonstrated positive attitudes towards malnutrition prevention. Significant associations were found between knowledge level and education (χ²=28.61, p<0.001), monthly income (χ²=24.33, p<0.001), and parity (χ²=9.76, p=0.002). Attitude was significantly associated with knowledge level (χ²=38.42, p<0.001) and source of health information (χ²=14.56, p<0.001).
Conclusion: While more than half of the mothers demonstrated good knowledge and positive attitudes, a substantial proportion still exhibited knowledge gaps and neutral or negative attitudes. Education level, income, and access to health facility-based information were key determinants of both knowledge and attitude. The study recommends intensified community-based nutrition education programmes, improved accessibility of primary healthcare services, and integration of nutritional counselling into routine maternal and child health visits.

Keywords: Childhood malnutrition, Knowledge, Attitude, Mothers, Prevention, Imo State, Nigeria.

CHAPTER ONE
INTRODUCTION

1.1 Background to the Study
Childhood malnutrition remains one of the most devastating public health challenges confronting low- and middle-income countries in the twenty-first century. The World Health Organization (WHO) defines malnutrition as deficiencies, excesses, or imbalances in a person's intake of energy and/or nutrients, with the term broadly encompassing undernutrition (including stunting, wasting, and underweight), micronutrient deficiencies, and overnutrition (WHO, 2021). Among children under five years of age, undernutrition continues to be a leading cause of morbidity and mortality across sub-Saharan Africa and South Asia, undermining the physical and cognitive development of millions of children each year.
Globally, the United Nations Children's Fund (UNICEF), WHO, and the World Bank Group (2023) estimated that approximately 148.1 million children under five years of age were stunted, 45 million were wasted, and 37.0 million were overweight in 2022. Wasting, which reflects acute nutritional deprivation, is directly responsible for an estimated 1.0 to 1.5 million child deaths annually (Black et al., 2013; UNICEF/WHO/World Bank Group, 2023). Sub-Saharan Africa bears a disproportionate burden, accounting for nearly half of all stunted children worldwide, with persistent stagnation in the rate of progress (Victora et al., 2021).
Nigeria, as the most populous country in Africa, contributes significantly to the global burden of childhood malnutrition. The 2021 Nigeria Demographic and Health Survey (NDHS, 2022) reported that 36.8% of children under five were stunted, 6.4% were wasted, and 21.8% were underweight. These figures underscore Nigeria's status as one of the countries with the highest absolute numbers of malnourished children globally. Regional disparities are pronounced, with the North West and North East geopolitical zones recording the highest rates; however, the South East and South South zones, including Imo State, also register significant and clinically concerning prevalence rates (National Bureau of Statistics [NBS] & UNICEF, 2021).
Imo State, located in the southeastern part of Nigeria, is one of the most densely populated states in the country. Despite its relatively higher educational attainment compared to many northern states, childhood malnutrition persists as a significant health problem. The Imo State Nutrition Profile (Federal Ministry of Health [FMoH], 2022) indicates that approximately 22.5% of children under five in the state are stunted, 4.9% are wasted, and 15.3% are underweight. The burden is exacerbated by poverty, inadequate healthcare infrastructure, poor dietary practices, and persistent cultural beliefs that influence child feeding. Owerri Municipal Council, the state capital of Imo State, as an urban setting, faces unique challenges including rising food prices, urban poverty, and inadequate time for childcare among working mothers.
The role of mothers in determining children's nutritional status cannot be overemphasised. Research consistently identifies maternal feeding practices, health-seeking behaviours, and nutritional knowledge as key determinants of child nutrition (Abuya et al., 2012; Ayele et al., 2022). Mothers are primary caregivers responsible for food preparation, initiating breastfeeding, introducing complementary foods, and ensuring timely health consultations. When mothers possess adequate knowledge of child nutrition and positive attitudes towards preventive measures, children are more likely to receive adequate care and appropriate diets (Imdad & Bhutta, 2012; Nti & Lartey, 2019).
Knowledge, in the context of nutrition, refers to the awareness and understanding of facts related to nutritional requirements, feeding practices, and preventive strategies (Onyeka et al., 2023). Attitude, on the other hand, reflects the evaluative disposition or predisposition that influences mothers' intentions and actual behaviours regarding child nutrition (Agho et al., 2011). Studies have consistently shown that inadequate maternal nutritional knowledge and negative attitudes toward breastfeeding, dietary diversity, and healthcare-seeking are associated with higher rates of childhood malnutrition (Dang et al., 2020; Beyene et al., 2019).
Despite the well-established link between maternal knowledge, attitude, and childhood nutrition outcomes, there remains a dearth of studies specifically examining these relationships within the urban local government areas of Imo State. The available literature is largely drawn from northern Nigerian states or national-level surveys, with limited evidence from the South East. This study, therefore, sought to fill this gap by providing current, locally relevant data that can inform targeted interventions. The findings are expected to guide healthcare policymakers, nursing practitioners, and community health educators in developing contextually appropriate nutrition promotion strategies in Owerri Municipal Council and similar settings across Imo State.

1.2 Statement of the Problem
Despite significant national and international efforts to combat childhood malnutrition in Nigeria, the condition persists at alarming rates in many states, including Imo State. The 2021 NDHS data indicate that approximately one in three Nigerian children under five years of age is stunted, and the proportion of underweight children remains high at over 21%. In Imo State specifically, rates of stunting and underweight remain above globally acceptable thresholds, placing thousands of children at increased risk of impaired cognitive development, susceptibility to infections, and premature death.
Malnutrition is widely acknowledged to be largely preventable through evidence-based interventions such as exclusive breastfeeding for the first six months of life, timely introduction of nutritionally appropriate complementary foods, dietary diversification, micronutrient supplementation, access to clean water and sanitation, and regular growth monitoring. The successful adoption of these interventions depends heavily on the knowledge and attitudes of primary caregivers, particularly mothers.
Preliminary observations at primary healthcare centres in Owerri Municipal Council reveal that a significant number of mothers present with children showing signs of malnutrition, yet many are unaware of the early warning signs, appropriate feeding practices, or available interventions. Anecdotal evidence from healthcare workers suggests that harmful cultural practices, misconceptions about child feeding, and negative attitudes towards exclusive breastfeeding continue to contribute to poor nutritional outcomes in the area. However, there is a paucity of quantitative data that precisely documents the levels of knowledge and attitudes of mothers in this specific local government area.
Without an accurate understanding of the current knowledge and attitudinal gaps among mothers in Owerri Municipal Council, it is difficult for healthcare professionals, including nurses, to design and implement effective, targeted nutrition education interventions. This study was therefore designed to provide empirical evidence on the knowledge and attitude of mothers toward childhood malnutrition prevention in this setting, with a view to informing context-specific public health and nursing practice responses.

1.3 Objectives of the Study
General Objective:
The general objective of this study was to assess the knowledge and attitude of mothers towards prevention of childhood malnutrition in Owerri Municipal Council, Imo State, Nigeria.

Specific Objectives:
1. To determine the level of knowledge of mothers regarding the prevention of childhood malnutrition in Owerri Municipal Council.
2. To assess the attitudes of mothers towards the prevention of childhood malnutrition in Owerri Municipal Council.
3. To determine the association between socio-demographic characteristics of mothers and their knowledge of childhood malnutrition prevention.
4. To determine the association between mothers' knowledge and their attitudes towards the prevention of childhood malnutrition.

1.4 Research Questions
1. What is the level of knowledge of mothers regarding the prevention of childhood malnutrition in Owerri Municipal Council, Imo State?
2. What are the attitudes of mothers towards the prevention of childhood malnutrition in Owerri Municipal Council, Imo State?
3. Is there a significant association between the socio-demographic characteristics of mothers and their knowledge of childhood malnutrition prevention?
4. Is there a significant association between mothers' knowledge and their attitudes towards the prevention of childhood malnutrition?

1.5 Research Hypotheses
H₁: There is a significant association between the educational level of mothers and their knowledge of childhood malnutrition prevention.
H₂: There is a significant association between mothers' knowledge and their attitudes towards childhood malnutrition prevention.

1.6 Significance of the Study
The findings of this study are significant for several stakeholders including nurses, public health practitioners, community health educators, policymakers, and the broader academic community. Specifically:
For nursing practice, the findings will enable nurses and midwives working in maternal and child health settings in Imo State to identify specific knowledge gaps and attitudinal barriers among mothers, thereby tailoring their counselling and health education interventions more effectively. Given the pivotal role of nurses in preventive healthcare, evidence-based guidance on what mothers know and believe about malnutrition prevention is essential for effective practice.
For public health programming, the study will provide evidence to support the development and scaling up of community nutrition education programmes in Owerri Municipal Council. It will also inform the nutrition component of routine antenatal, postnatal, and child welfare clinic services.
For policymakers at the state and local government levels, the findings will provide data to support resource allocation for nutrition promotion activities and the training of healthcare workers on nutrition counselling.
For academia, the study contributes to the body of literature on maternal determinants of childhood malnutrition in southeastern Nigeria, an area that is underrepresented in the existing literature.

1.7 Scope of the Study
This study was geographically limited to selected primary healthcare centres within Owerri Municipal Council Local Government Area, Imo State, Nigeria. It focused exclusively on mothers of children aged 0–59 months. The study assessed knowledge and attitude specifically in relation to the prevention of childhood malnutrition; it did not assess actual feeding practices or child nutritional status directly. The study was conducted between March and September 2024.

1.8 Operational Definition of Terms
Childhood malnutrition: For the purposes of this study, childhood malnutrition refers to a state of nutritional deficiency or imbalance in children below five years of age, including stunting, wasting, underweight, and micronutrient deficiencies.
Knowledge: The level of correct understanding and awareness demonstrated by mothers regarding the definition, causes, consequences, and preventive measures of childhood malnutrition, as assessed by their responses to structured knowledge questions.
Attitude: The overall orientation, disposition, or evaluative stance of mothers towards practices and measures known to prevent childhood malnutrition, as measured using a Likert scale.
Mothers: For this study, mothers refer to biological mothers or primary female caregivers of children aged 0–59 months residing in Owerri Municipal Council at the time of the study.
Prevention of childhood malnutrition: Measures and practices adopted to avert the occurrence or worsening of malnutrition in children under five, including exclusive breastfeeding, appropriate complementary feeding, micronutrient supplementation, dietary diversification, growth monitoring, and utilisation of healthcare services.