FACTORS INFLUENCING MALNUTRITION AMONG UNDER-FIVE CHILDREN IN OBIAKPOR HEALTH CENTER, PORT HARCOURT

TOPIC: FACTORS INFLUENCING MALNUTRITION AMONG UNDER-FIVE CHILDREN IN OBIAKPOR HEALTH CENTER, PORT HARCOURT

THIS TOPIC IS ALSO SUITABLE FOR:
1-Department of Public Health
2-Department of Nursing Science
3-Department of Community Health
4-Department of Human Nutrition and Dietetics
This research material contains:
1-Chapter One to Five
2-Recent References/citations
3-Tables in Chapter Four
4-Accurate Data Analysis
5-Table of Contents
6-Questionnare

ABSTRACT
This study was carried out to examine the factors influencing malnutrition among under-five children in Obiakpor Health Center, Port Harcourt. The study was specifically carried out to determine the prevalence of malnutrition among under-five children attending Obiakpor Health Center, Port Harcourt, examine the influence of child feeding practices on malnutrition among under-five children attending Obiakpor Health Center, Port Harcourt, assess the influence of household socioeconomic status on malnutrition among under-five children attending Obiakpor Health Center, Port Harcourt and evaluate the influence of childhood illnesses and infections on malnutrition among under-five children attending Obiakpor Health Center, Port Harcourt. The study employed the descriptive research design. Hence, the questionnaire was used for data collection, while the data collected were analyzed using frequency tables, percentages and Pearson Chi-square statistics. The population of the study comprised 1,248 respondents made up of mothers of under-five children and healthcare givers at Obiakpor Health Center, Port Harcourt. A total of 303 respondents were selected as the sample size using a multi-stage sampling technique involving stratified and convenience sampling, while 288 validated copies of the questionnaire were used for the final analysis. From the responses obtained and analyzed, the findings revealed that the prevalence of malnutrition among under-five children was moderate, with most respondents reporting normal nutritional status and average physical growth. The study also revealed that child feeding practices significantly influenced malnutrition among under-five children with r = 0.621, t = 13.36, P = 0.021. Furthermore, the findings showed that household socioeconomic status significantly influenced malnutrition among under-five children with r = 0.587, t = 12.27, P = 0.028. Likewise, the study further revealed that childhood illnesses and infections significantly influenced malnutrition among under-five children with r = 0.664, t = 15.01, P = 0.014. The study therefore recommends that healthcare providers should intensify nutrition education for caregivers, while government and relevant stakeholders should strengthen household economic support programmes and improve access to quality healthcare services to reduce the prevalence of malnutrition among under-five children.
Keywords: Malnutrition, Under-five Children, Child Feeding Practices, Household Socioeconomic Status, Childhood Illnesses and Infections.

CHAPTER ONE
INTRODUCTION (Preview)
1.1 Background to the Study
Health, as an essential driver in human capital development, social progress and economic growth, is universally recognised as a major determinant of productivity, educational outcomes and quality of life. Appropriate nutrition, providing the protein, carbohydrates and fat (macronutrients) and vitamins and minerals (micronutrients) needed for normal physiological functions, tissue growth, metabolic regulation and immune competence during the human life cycle is central to optimal health. Nutritional adequacy is especially critical in the early years of life, during the rapid growth of biological and cognitive development, when adequate dietary intake is essential for healthy growth and development. Ahmed et al (2022) indicates that proper nutrition is a key prerequisite for better health outcomes and sustainable development of a nation. Moreover, Francis et al. (2020) claimed that the proper nutrition practices helped to promote normal development of physical growth, cognitive functions, and immunological resistance among the population. Likewise, Adeyonu et al. (2022) noted that a great deal of nutrition practices positively affected the health status and wellbeing of the vulnerable population groups. Moreover, Imam et al. (2020) also emphasized that nutrition is an integral part of primary health care as it helped to achieve healthy childhood development and therefore healthy lifelong outcomes. The wider importance of nutrition therefore will underpin the knowledge of the nutritional wellbeing of children especially during the under-five period where developmental processes are most evident.
The under-five stage is the critical period of human development during which rapid physical growth, neurological maturation and cognitive acquisition are at play, with a high reliance on nutrition. Children have needs for balanced diets during this time to ensure they get enough protein, vitamins, minerals and energy to enable them to grow and progress through development. Malnutrition is a pathological condition arising from a deficiency, excess or imbalance in the energy and essential nutrient intake which includes undernutrition, micronutrient deficiencies, overweight and obesity (Fagbamigbe et al., 2020). However, undernutrition is still the most common form of malnutrition in many developing countries among under fives. According to Obasohan et al. (2020), the anthropometric indicators are used commonly to assess undernutrition which include stunting, wasting and underweight which are indicators of chronic and acute undernutrition respectively. Sumon et al. (2023) further mentioned that proper nutrition during the initial 5 years of life set the physiological and cognitive base for positive health effects throughout life. Similarly, Ekholuenetale et al., (2020) revealed that good nutrition in early childhood increased the developmental potential, readiness for learning, and overall health of children. The perspectives show that malnutrition cannot only be interpreted as a lack of food consumption but as a multidimensional nutritional condition, which is affected by various biological and environmental situations.
Malnutrition among under five children is determined by a combination of factors including demography, socioeconomics, environment, behaviour, and health system determinants, all of which play a role in children's nutritional status. These determinants include infant and young child feeding practices, maternal education levels, household income, food security, health care services, sanitation, environmental hygiene, caregiver knowledge, and health care utilization. Tesfaye et al. (2024) found that the nutritional status of children was a result of biological, household and community factors. In the same vein, Sanni et al. (2024) noted that the knowledge of the mothers regarding nutritional and proper complementary feeding practices played a significant role in nutrition status of young children. Obasohan et al. (2024) also noted that the nutritional wellbeing of children is influenced by household socioeconomic factors, maternal healthcare utilization and community level health interventions. Ahmed et al. (2022) pointed out that providing access to preventive health care services such as growth monitoring, immunization, nutrition counseling and health education encouraged proper childcare and improved the nutrition status of the children. Moreover, Francis et al. (2020) revealed that good household conditions and quality parenting were significantly associated with adequate food consumption and healthy development of under-fives. These interdependent determinants reflect that childhood malnutrition is a multifactorial phenomenon, in which factors at individual, household and community levels influence it.
Primary Healthcare facilities play an integral part in the health care delivery system in Nigeria and offer vital services to children and women of reproductive age such as growth monitoring, immunization, breastfeeding support, nutrition education and routine child welfare services. These facilities are used as strategic places for tracking children's nutrition status and for encouraging proper infant and young child feeding practices by caregivers. Obiakpor Health Center, Port Harcourt, is one of the main healthcare providers that serve essential health services to families living in the catchment population. The characteristics of the population reached, along with the existing household, environmental and healthcare-related situations, offers a proper context for analysing the factors affecting malnutrition among under 5 children seeking health care services in the health facility. The interaction between household characteristics, care giving practices and access to health services in the assessment of childhood nutritional status was emphasized by Fagbamigbe et al. (2020). Similarly, Obasohan et al. (2024) reported the different effect of context on childhood nutritional outcomes, in terms of family contexts and service use. Therefore, an understanding of the context specific factors influencing malnutrition in under-five children attending Obiakpor Health Center, Port Harcourt, will be provided which in turn will add to the existing literature on childhood nutrition in Nigeria in a primary healthcare setting.

1.2 Statement of  the Problem    
Health and nutrition in the first five years of life are important markers of children's survival, healthy growth and national sustainable development. Eating well helps children have healthy growth and development, think clearly, stay healthy and be happy. Therefore, nutrition of under-five children is a key priority for maternal and child health programmes as it helps to obtain good health outcomes and improve children's developmental potential. Ahmed et al., (2022) stated that proper nutrition in early childhood led to healthy growth and better health outcomes throughout life. Thus, the importance of nutrition in childhood was reiterated in Obasohan et al. (2024) as part of the interventions of primary healthcare aimed at improving child health and development. Although attempts have been made to improve child nutrition services with health education, growth monitoring and caregiver support, there is an ongoing need to gain a deeper understanding of the contextual factors affecting under-five children's nutritional status in specific healthcare contexts.
The prevalence of malnutrition among children under five remains a major public health problem in many regions of Nigeria despite the provision of nutrition interventions and child welfare services. Under-5 children should achieve optimal nutrition through good infant and young child feeding practices, adequate food and nutrition intakes, good care in the home and the proper use of primary health services. But, current conditions suggest that there are still numerous children who are suffering from poor nutritional outcomes due to the combination of socioeconomic, environmental, maternal and healthcare-related factors. Fagbamigbe et al. (2020) found that multiple household and community factors affecting childhood malnutrition were different across settings. Similarly, Sumon et al., (2023) found caregivers' practices and economies status to be influencing factors for disparities in nutrition outcomes in under five children. This gap between the expected nutritional wellbeing of children and the actual nutritional realities suggests the need for more empirical research.
While past studies have explored the issue of childhood malnutrition in Nigeria and other developing nations, a large number of these studies have focused on wide geographical zones or the nation as a whole, and thus failed to offer sufficient evidence of factors that affect malnutrition in primary healthcare centres like Obiakpor Health Center, Port Harcourt(Obasohan et al., 2020). Thus, the evidence of the combined effect of these factors at the local level on the nutritional status of under-5 children seeking care at this health facility is still limited(Tesfaye et al., 2024). This contextual knowledge gap reduces the evidence to inform nutritional interventions and child health programmes at a location level. Hence, the aim of this study is to investigate the factors that affect the malnutrition of under five children in Obiakpor Health Center of Port Harcourt with a view of giving empirical evidence that would guide informed decisions, support nutrition related interventions and improve child health outcomes.
1.3 Objectives of the Study
The study's main goal is to assess the factors influencing malnutrition among under-five children in Obiakpor Health Center, Port Harcourte. The study specifically attempted to: 
1.Determine the prevalence of malnutrition among under-five children attending Obiakpor Health Center, Port Harcourt.
2.Examine the influence of child feeding practices on malnutrition among under-five children attending Obiakpor Health Center, Port Harcourt.
3.Assess the influence of household socioeconomic status on malnutrition among under-five children attending Obiakpor Health Center, Port Harcourt.
4.Evaluate the influence of childhood illnesses and infections on malnutrition among under-five children attending Obiakpor Health Center, Port Harcourt.
Other parts of chapter one include:
1.4 Research Questions: 
1.5 Hypotheses
1.6 Significance of the Study
1.7  Scope of the Study
1.8 Operational Definition of Terms

CHAPTER TWO
REVIEW OF LITERATURE (Preview)
This chapter critically examines relevant literature that would assist in explaining the research problem and, furthermore, recognizes the efforts of scholars who had previously contributed immensely to similar research. The chapter intends to deepen the understanding of the study and close the perceived gaps. This chapter, therefore, focuses on the concept of malnutrition, types of malnutrition, prevalence of malnutrition among under-five children, causes and risk factors of malnutrition, effects of malnutrition on child growth and development, and factors influencing malnutrition among under-five children etc.The chapter is sub-grouped into the following major headings:
2.1 Conceptual Framework
2.2 Theoretical Framework
2.3 Empirical Review
2.4 Summary of Literature Review

CHAPTER THREE
METHODOLOGY (Preview)
Presented below is a snapshot of key areas of the study methodology, the full and detail chapter three methodology is contained in the instant download document.

Research Design: The study adopted a descriptive research design.
Population of the Study: The population of the study comprises respondents, including mothers of under-five children and healthcare givers at Obiakpor Health Center, Port Harcourt.
Sample Size Determination: The study adopted the Taro Yamane formula to determine a sample size of 303 participants.
Sampling Technique: The study employed a multi-stage sampling technique involving stratified and convenience sampling techniques to select the individual respondents.
Research Instrument: The study utilized a structured questionnaire titled “Factors Influencing Malnutrition among Under-five Children in Obiakpor Health Center, Port Harcourt” as the instrument for data collection.
Methods of Data Analysis: The collected data were analyzed using frequencies and percentages to summarize and present the demographic characteristics of the respondents and their responses. Inferential statistics, such as Pearson Chi-square, were used to test the hypotheses.
Full outline for chapter three;
3.1 Research Design
3.2 Research Setting
3.3 Target Population
3.4 Sample Size
3.5 Sampling Technique
3.6 Instruments For Data Collection
3.7 Validity and Reliability of Instrument
3.8 Pilot Study
3.9 Method of Data Collection
3.10 Method Of Data Analysis
3.11 Ethical considerations

CHAPTER FOUR: DATA PRESENTATION AND ANALYSIS
MAJOR FINDINGS (Preview)
The analysis results were presented in tables and charts. Based on the results obtained from the analysis, the following major findings were made:

i. The study found that malnutrition is prevalent among under-five children attending Obiakpor Health Center, Port Harcourt, as evidenced by the findings that 8.3% of the children had severe acute malnutrition, 18.1% had moderate acute malnutrition, and 27.8% had mild malnutrition, while only 38.9% had normal nutritional status. Furthermore, 26.4% of the respondents reported that their children's weight was slightly lower than that of children of the same age, while 36.1% indicated that their children occasionally appeared physically weak or lacked energy. This indicates that a considerable proportion of under-five children attending the health center experience varying degrees of malnutrition.

ii. The study found that child feeding practices significantly influence malnutrition among under-five children attending Obiakpor Health Center, Port Harcourt, as evidenced by the hypothesis test, which revealed a correlation coefficient (r) of 0.621, t-value of 13.36, and p-value of 0.021 (p < 0.05), leading to the rejection of the null hypothesis. This indicates that child feeding practices have a significant influence on malnutrition among under-five children.

iii. The study found that household socioeconomic status significantly influences malnutrition among under-five children attending Obiakpor Health Center, Port Harcourt, as evidenced by the hypothesis test, which revealed a correlation coefficient (r) of 0.587, t-value of 12.27, and p-value of 0.028 (p < 0.05), leading to the rejection of the null hypothesis. This indicates that household socioeconomic status has a significant influence on malnutrition among under-five children.

iv. The study found that childhood illnesses and infections significantly influence malnutrition among under-five children attending Obiakpor Health Center, Port Harcourt, as evidenced by the hypothesis test, which revealed a correlation coefficient (r) of 0.664, t-value of 15.01, and p-value of 0.014 (p < 0.05), leading to the rejection of the null hypothesis. This indicates that childhood illnesses and infections have a significant influence on malnutrition among under-five children.

CHAPTER FIVE: DISCUSSION OF FINDINGS
This chapter covers the following outline:
5.1 Discussion of Findings    
5.2 Implication of the Findings 
5.3 Limitations of the Study 
5.4 Summary 
5.5 Conclusion
5.6 Recommendations
5.7 Suggestions for Further Studies
Reference
Appendix

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