CHAPTER ONE

INTRODUCTION

1.1 Background to the Study

Children from birth to one year of age are generally classified as infants. This period is characterized by very rapid growth and development, accompanied by nutritional requirements that differ considerably from those of other age groups. Infant nutrition is specifically designed to meet the unique needs of young children and provide them with a healthy foundation for life. Children below one year of age have organ systems that are not yet fully developed and therefore require foods and nutrients that can be easily digested and that provide adequate amounts of calories, vitamins, minerals, and other essential nutrients necessary for normal growth and development. Infants also require an appropriate quantity of fluids that their immature kidneys can effectively process. In addition, proper infant nutrition involves protecting infants from exposure to substances that may negatively affect their growth, development, and overall health.

Infancy represents a period of exceptionally rapid physical and developmental changes. Supplying infants with the appropriate types and quantities of nutrients, while preventing exposure to inappropriate or harmful substances, provides them with the best possible opportunity to achieve a healthy beginning in life. Parents and other primary caregivers therefore have an important responsibility to ensure that the nutritional requirements of their infants are adequately satisfied.

Adequate nutrition is fundamental to the rapid growth and development that takes place during the first year of a child's life. Giving babies appropriate foods supports good health while also providing opportunities for them to experience different tastes and textures as they gradually develop healthy eating patterns. Feeding also contributes to the development of affectionate and secure relationships between infants and their parents or caregivers. Positive, responsive, and supportive feeding methods are important because they encourage babies to feed adequately and develop healthy attitudes towards themselves and other people.

Throughout the first year of life, significant changes occur in the feeding abilities of babies. Their mouths develop from being capable primarily of sucking and swallowing to acquiring the ability to chew. Their digestive systems also mature from being able to process mainly liquids, such as breast milk or infant formula, to being capable of handling a broad variety of foods. At the same time, babies gradually move from depending entirely on others for feeding to developing the ability to feed themselves. As infants continue to grow and mature, their dietary needs, food choices, and feeding patterns must consequently be adjusted to correspond with their changing developmental stages.

The decision concerning how an infant should be fed is an important one because it can have long-term implications for both the child and the mother. The knowledge and experiences individuals acquire about infant feeding from family members, friends, teachers, and other people within their social environment are likely to influence their attitudes, beliefs, and perceptions concerning infant feeding.

Whether a mother has already decided to breastfeed exclusively or remains uncertain about the decision, it is important to recognize that breast milk is naturally suited to the nutritional requirements of the baby and represents the ideal first food during the early months of life.

Human breast milk is naturally designed specifically for human infants and possesses several advantages over artificial substitutes. It contains an appropriate balance of nutrients and provides these nutrients in forms that can be readily utilized by the immature body systems of the infant. Because breast milk is naturally produced for human babies, it is also generally gentle on the developing systems of the infant.

Infants who are exclusively breastfed should receive vitamin D supplementation within the first few days after birth. However, parents or caregivers should consult the infant's physician or healthcare provider concerning the appropriate supplementation requirements.

Where a mother chooses not to breastfeed or is unable to breastfeed, commercially prepared iron-fortified infant formulas can provide adequate nutritional support for the baby. Infant formulas contain appropriate quantities of protein, calories, fats, vitamins, and minerals required to support growth and development. However, unlike breast milk, infant formula does not contain the immune-protective factors naturally present in breast milk. These immune factors found in breast milk play an important role in helping to protect infants against infections and other illnesses.

Africa is remarkably the fastest-growing continent in the world despite facing numerous challenges, including poverty, civil conflicts, drought, famine, and the devastating effects of HIV and AIDS. This rapid population growth is largely associated with the high fertility rates recorded in the Sub-Saharan region, where the population is projected to double by the middle of the century according to estimates from the United Nations World Population Prospects. Despite the large number of children born across Africa, their chances of survival continue to be affected by inadequate neonatal healthcare services, exposure to communicable diseases, and the additional effects of malnutrition. Although infant mortality has declined considerably in many parts of the world, available evidence indicates that the rate remains highest in Sub-Saharan Africa. The region accounts for almost half of infant mortality worldwide, with an estimated rate of 98 deaths per 1,000 live births. Various interventions have been implemented in an effort to achieve the Millennium Development Goal of reducing infant mortality by two-thirds by 2015. One major area of intervention has been the reduction of malnutrition, which was associated with approximately 45% of deaths among children in this age group, according to the United Nations Interagency Group for Child Mortality Estimation in its 2013 report.

Several factors have been identified as barriers to appropriate Infant and Young Child Feeding practices. Recommended practices include initiating breastfeeding within one hour of delivery, exclusively breastfeeding infants during the first six months of life, introducing appropriate complementary foods after six months, and continuing breastfeeding until two years of age and beyond. Although this strategy is ambitious and sometimes difficult to implement, it was endorsed by the World Health Assembly in May 2002.

The immediate causes of malnutrition include inadequate nutrient intake and poor absorption of nutrients by the body. These conditions are influenced by various underlying factors, including access to appropriate foods, educational levels, sanitation, and other environmental circumstances. Many of these causes are relatively well understood, and evidence-based interventions have been developed to address them. Examples include targeted food fortification programmes and other nutrition-specific interventions. However, these factors alone cannot explain every form of malnutrition. Feeding behaviour among children has increasingly become an important issue in discussions concerning malnutrition within international development, both as a contributing factor and as a possible means of addressing the problem.

The promotion of breastfeeding was identified as one of the most cost-effective interventions by the Copenhagen Consensus in both 2008 and 2012. Nevertheless, changing child-feeding behaviours remains one of the most difficult interventions to implement. This difficulty is partly due to the fact that food, dietary choices, and feeding behaviours are deeply influenced by culture. The way people eat, the foods they consume, and the timing of their meals are largely determined by practices, beliefs, ideas, and behaviours that are established from childhood. Consequently, infant-feeding practices are not solely based on rational decisions but are also deeply rooted in cultural norms, emotional relationships with food and nutrition, and subconscious motivations.

Reducing the prevalence of malnutrition is essential if the objective of achieving Millennium Development Goal 4 is to be realized. Numerous factors contribute to the high prevalence of malnutrition in Sub-Saharan Africa. Developing a clear understanding of the factors responsible for inappropriate infant and child feeding practices will contribute to the identification and resolution of these challenges. Such understanding is also important for ensuring that efforts towards child survival in one of the world's fastest-growing populations are successful.

Although nutrition policies and guidelines have been developed with good intentions, there is a need for stronger political commitment, social support, and community mobilization to promote their implementation, acceptance, and widespread adoption across Sub-Saharan African countries.

Several factors, including biological, economic, cultural, environmental, and disease-related factors, have been identified as influencing nutritional status. Inadequate food consumption, food insecurity, unequal distribution of available food within households, inappropriate storage practices, poor food handling, nutritional taboos, harmful traditional practices, and various forms of infection among infants can increase children's vulnerability to nutrition-related problems. These factors may operate at immediate, underlying biological and behavioural levels, as well as at broader social, economic, and basic structural levels (Degarege, Degarege & Animut, 2015). Understanding the causes and consequences associated with different nutritional conditions is therefore important in developing appropriate recommendations and interventions.

1.2 Statement of the Problem

Nutrition-related problems affect people across different population groups, but children under five years of age and women are particularly vulnerable to these conditions. The unique physiological characteristics of young children, socioeconomic circumstances, and other factors within the wider society may contribute to their vulnerability. Available evidence indicates that more than two billion people worldwide experience different forms and degrees of nutrition-related problems. Approximately 2.6 million children die annually as a result of nutrition-related problems, accounting for about one-third of deaths among children globally. Nigeria has one of the highest numbers of stunted children, making the country the nation with the highest stunting burden in Africa and the third highest globally, with more than 10 million people affected by stunting. During the first 1,000 days of life, malnutrition contributes to more than one-third of deaths among children under five years of age and approximately half of all child deaths globally (Malnutrition and Child Survival in Nigeria, 2016).

The North-Eastern and North-Western regions of Nigeria, where a substantial proportion of the food consumed in the country is produced, have recorded higher levels of nutritional deficiencies compared with other regions (Nigeria Demographic and Health Survey, 2016). This situation demonstrates that increased food production does not necessarily result in adequate food consumption or improved nutritional status. Many infants may develop micronutrient deficiencies before reaching two years of age, and these deficiencies may become severe enough to interfere with their normal growth and development. Children from households living below the poverty line have been shown to be approximately four times more likely to experience malnutrition than individuals living above the poverty line. Nevertheless, children from economically stable households may also become malnourished when their food intake is inadequate or when the available foods are not appropriately combined to provide a balanced diet. Food insecurity has also been closely associated with hunger and malnutrition. Approximately 39% of the Nigerian population is considered to be living below the poverty line.

The North-Eastern and North-Western regions of Nigeria have experienced considerable insurgency, while the Niger Delta region has also been affected by various forms of militancy. These situations contribute to increased rates of malnutrition because farming and other food-production activities are disrupted in affected communities. The consequences are particularly visible among internally displaced persons (IDPs) living in camps within the North-Eastern and North-Western regions of Nigeria. Many displaced persons have been forced to depend on IDP camps, where they struggle to access the limited quantities of food available for consumption. Agricultural activities and food production are consequently severely disrupted or completely halted. Infants, women, and elderly people constitute some of the groups that bear the greatest burden of these circumstances.

In addition to problems related to food availability, malnutrition may occur when parents or caregivers with limited nutritional knowledge are unable to properly combine available food sources or provide adequate diets for children under five years of age. Harmful traditional practices within communities can also negatively influence the nutritional status of young children and families and may eventually have implications for the wider society. Poor nutritional intake places the intellectual development of children at risk (UNICEF, 2016).

The management of recurrent illnesses among children places a considerable financial burden on families and government. Funds spent treating nutrition-related diseases, many of which could have been prevented, could otherwise be directed towards other developmental activities and projects (Kitinya, 2013). Poor nutritional status can also contribute to poor academic performance and reduced productivity within society. Considering the magnitude and seriousness of the identified problem, the researcher intends to assess the major determinants of nutritional status among under-five children attending Kawo General Hospital, Kaduna.

1.3 Objectives of the Study

The main objective of this study is to assess the nutritional status of infants and determine the factors associated with their nutritional status at Kawo General Hospital, Kaduna. The specific objectives are to:

1. Assess the nutritional status of infants using anthropometric measurements at Kawo General Hospital, Kaduna.

2. Determine the level of awareness of mothers concerning the nutritional status of their infants.

3. Assess the factors that influence the nutritional status of infants.

4. Determine the feeding practices adopted by mothers of infants.

1.4 Research Questions

1. What is the nutritional status of infants based on anthropometric measurements at Kawo General Hospital, Kaduna?

2. What is the level of awareness of mothers concerning the nutritional status of their infants?

3. What are the factors influencing the nutritional status of infants?

4. What feeding practices are adopted by mothers of infants?

1.5 Hypotheses

H01: There is no significant relationship between the nutritional status of under-five children and the socioeconomic factors of their primary caregivers.

H02: There is no significant difference between the nutritional status of male and female under-five children.

H03: There is no significant association between the nutritional status of children and their age groups.

1.6 Scope of the Study

The study was limited to infants between the ages of 6 and 59 months who attended the Infant Welfare Clinic at Kawo General Hospital, Kaduna. Anthropometric measurements were used as the only method for determining the nutritional status of the children. The researcher restricted the study population to children aged 6 to 59 months because the MUAC tape, also known as Shakir's tape, is commonly utilized for assessing children within this age range.

1.7 Significance of the Study

The findings of this study provided information reflecting the nutritional status of under-five children, which could be useful in decision-making and policy formulation. The study could contribute to the early identification of nutrition-related problems among under-five children. Early identification would make it possible to commend mothers whose children have satisfactory nutritional status while providing appropriate counselling and guidance to mothers whose children exhibit poor nutritional status.

The findings would also provide information concerning the pattern and prevalence of nutrition-related problems among under-five children as identified through anthropometric measurements. In addition, the results of the study would serve as useful reference and research material in the area of under-five nutrition by contributing to the existing body of knowledge.

The recommendations arising from this study would also provide useful assistance to government authorities in developing and implementing policies aimed at reducing the burden of nutrition-related problems within society, particularly among infants and young children.

1.8 Operational Definition of Terms

1. Nutritional Status: This refers to the health and nutritional condition of infants as determined through anthropometric measurements.

2. Associated Factors: These are the various factors or determinants that influence the nutritional status of under-five children attending Kawo General Hospital, Kaduna.

3. Infants: For the purpose of this study, infants refer to children between the ages of 6 and 59 months who are brought to Kawo General Hospital, Kaduna.

4. Anthropometric Measurements: These are standardized physical measurements used to determine the nutritional status of children. They include weight-for-age, which is used to determine underweight; height-for-age, which is used to determine stunting; and weight-for-height, which is used to determine wasting.

5. Primary Caregiver: This refers to any person who brings an under-five child to the Infant Welfare Clinic at Kawo General Hospital, Kaduna. Primary caregivers may include the child's mother, father, or guardian.