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7/25/2019 Questionaire Eeeeeeeeeeee r

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FACTORS INFLUENCING NUTRITION AND FOOD INSECURITY IN KIROKA

VILLAGE MOROGORO, TANZANIA

BY

DOMINA ESTHER NKUBA MBELA

A DISSERTATION SUBMITTED IN PARTIAL FULFILMENT OF THE

REQUIREMENTS FOR THE DEGREE OF MASTER OF SCIENCE

IN HUMAN NUTRITION OF THE SOKOINE UNIVERSITY OF

AGRICULTURE MOROGORO, TANZANIA.

2009


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ABSTRACT

Nutritional status in children is an indicator of health and well-being at both the individual

and the population level. Malnutrition rates and incidences are still high in Kiroka village.

The aim of the study was to identify causes of recurrence of malnutrition among children

below five years of age in Kiroka village in Rural Morogoro, Tanania. !ace-to-face

interviews with the sampled mothers were conducted using a semi-structured

"uestionnaire. #nthropometric data were collected using standard procedures and analysed

using $mergency Nutrition #ssessment by %M#RT program where &-scores were

generated and imported into the %'%% software programme for further analysis.

#nthropometric indicators of weight-for-age, weight-for-height and height-for-age indices

were employed to assess the nutritional status of children below five years of age.The

prevalence rates of stunting, underweight, wasting, and morbidity were

43%, 13%, 3%, and 87%, respectively. 'revalence of underweight of children

reported in Kiroka village increased between ())* and ())+ from to ((

respectively. Nutritional status of children is affected by both inade"uate and "uality of

food, improper feeding practices, level of education of mother, household sie, marital

status and disease infections. /enerally, children were more susceptible to malnutrition as

age increased. #n educated mother was less likely to have malnourished children. #bout

01 of the mothers were able to breastfeed their children within one hour after delivery.

2owever, 3* of the infants in Kiroka village are given pre-lacteal foods such as thin

cerealbased porridgeand water. 4nly 5 of infants were e6clusively breastfed for

si6 months. #bout 5 of the children started complementary feeding when they were

two weeks old. 7uration of food shortage and household si!e had a negative

correlation with weightforheight !scores. 8ommunity nutrition education and

ii


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mobiliation of community members to adopt practices that favour good nutrition of

children are recommended.

iii


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DECLARATION

9, Dom!" E#$%&' N()*" M*&+", do hereby declare to the %enate of %okoine :niversity

of #griculture that this dissertation is my own original work, and that it has not been

submitted for a higher degree award in any other university.

7omina $sther Nkuba Mbela 7ate

;M%c 8andidateocational Training for granting me the study leave, and the ?elgium Technical

8ooperation who sponsored my study.

9 am very grateful to 'rof. =oyce Kinabo ;Mrs


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members of staff in the 7epartment of the !ood %cience and Technology for their tireless

support @ast but not the leastA 9 would like to thank the medical assistant and nurses at

Kiroka dispensary, all my respondents, village leadership and all others who in one way or

another made the study successful.

This study has benefited from innumerable sources and suggestions from many people.

Needless to say, for many of the errors, shortcomings and patches of ignorance that

remain, the ultimate responsibility rests with me.

vii


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DEDICATION

This work is dedicated to my 2usband, =ackson and daughtersA /race, /loria, !lora and

!aith and above all, the @ord #lmighty /od.

viii


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TABLE OF CONTENTS

i6


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LIST OF TABLES

TABLE - NUMBER OF HOUSEHOLDS SURVEYED BY HAMLET .................................................-/

TABLE 2 DEMOGRAPHIC CHARACTERISTICS OF SURVEYED HOUSEHOLDS IN KIROKAVILLAGE........................................................................................................................................................2

TABLE 1 NUTRITIONAL STATUS OF CHILDREN BY SE IN KIROKA VILLAGE.............. .....23

TABLE 4 NUTRITION STATUS OF CHILDREN BY AGE..................................................................29

TABLE PREVALENCE OF UNDEREIGHT FOR CHILDREN BELO FIVE YEARS AGE AS

RELATED TO THE GENERAL CHARACTERISTICS ........................................................................1-TABLE / PREVALENCE OF ASTING FOR CHILDREN BELO FIVE YEARS AGE ITHGENERAL CHARACTERISTICS...............................................................................................................1/

TABLE 5 PREVALENCE OF STUNTING FOR CHILDREN BELO FIVE YEARS AGE ITHGENERAL CHARACTERISTICS...............................................................................................................19

TABLE 3 PREVALENCE OF STUNTING FOR VARIOUS AGE CATEGORIES.............................42

TABLE 9 MID UPPER ARM CIRCUMFERENCE AND PERCENTAGE OF CHILDREN .............41

TABLE -0 PERCENTAGE OF CHILDREN SUFFERED FROM CHRONIC DISEASES BY AGEGROUP............................................................................................................................................................4/

TABLE -- Z6VALUES CATEGORIES BY HEALTH STATUS OF CHILD........................................43

TABLE -2 PROBIT REGRESSION OF DETERMINANTS OF CHILD NUTRITIONAL STATUS..........................................................................................................................................................................0

TABLE -1 PROBIT REGRESSION OF DETERMINANTS OF FOOD SECURITY ATHOUSEHOLD................................................................................................................................................2

TABLE -4 TYPES OF PRE6LACTEAL FOODS................................................................... .......... .......5

TABLE - ENERGY AND PROTEIN CONSUMED BY CHILDREN BELO FIVE YEARS OFAGE................................................................................................................................................................../4

TABLE -/ CROPS CULTIVATED AND PERCENTAGE OF GROERS IN KIROKA VILLAGE........................................................................................................................................................................../

TABLE -5 VEGETABLES7FRUITS AND PERCENTAGE OF GROERS IN KIROKA VILLAGE

..........................................................................................................................................................................//

TABLE -3 CROP HARVESTED SEASON 200572003 IN KIROKA VILLAGE................................../3

TABLE -9 FREQUENCY OF CONSUMPTION OF CARBOHYDRATE RICH FOODS................../9

TABLE 20 CONSUMPTION OF PROTEIN FOODS................................................................ .......... ....50

TABLE 2- FREQUENCY OF CONSUMPTION OF OIL FOODS .............................................. .........5-

TABLE 22 CONSUMPTION FREQUENCY OF VEGETABLE FOODS................................. ......... ...5-

TABLE 21 FREQUENCY OF CONSUMPTION OF FRUITS ...............................................................52

6


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LIST OF FIGURES

FIGURE - CONCEPTUAL FRAMEORK FOR FOOD AND NUTRITION SECURITY.............. .--

FIGURE 2 MEASUREMENT OF LENGTH ............................................................................................20

FIGURE 1 AGE S OF MOTHERS ............................................................................................................2/

FIGURE 4 DISTRIBUTION OF CHILDREN IN VARIOUS AGE GROUPS BELO AND ABOVE24 MONTHS OF AGE BY SE................................................................................................................. ...25

FIGURE LEVEL OF EDUCATION OF MOTHERS AND EIGHT6FOR6AGE Z6SCORE .... .. ..10

FIGURE / PREVALENCE OF UNDEREIGHT AMONG CHILDREN OF AGE BELO AND

ABOVE 2 OF AGE.........................................................................................................................................12

FIGURE 5 PREVALENCE OF UNDEREIGHT AMONG CHILDREN BELO FIVE YEARS BYSE..................................................................................................................................................................11

FIGURE 3 PREVALENCE OF UNDEREIGHT OF CHILDREN IN KIROKA VILLAGE FROM2001 TO 2005..................................................................................................................................................14

FIGURE 9 PREVALENCE OF ASTING AMONG CHILDREN BELO FIVE YEARS BY SE..........................................................................................................................................................................1

FIGURE -0 LEVEL OF EDUCATION OF MOTHERS AND PREVALENCE OF ASTING.........15

FIGURE -- PREVALENCE OF ASTING AMONG CHILDREN BELO AND ABOVE 2YEARS OF AGE............................................................................................................................................13

FIGURE -2 PREVALENCE OF STUNTING AMONG CHILDREN BELO FIVE YEARS BYSE..................................................................................................................................................................40

FIGURE -1 PREVALENCE OF STUNTING AMONG CHILDREN BELO AND ABOVE 2YEARS OF AGE............................................................................................................................................4-

FIGURE -4 LEVEL OF EDUCATION OF THE MOTHER AND PREVALENCE OF STUNTING 42

FIGURE - HEALTH CENTRES HICH ARE VISITED HEN CHILD FELL SICK .............. ...44

FIGURE -/ A FATHER HO HAS 8UST BROUGHT HIS CHILD BACK FROM CLINIC INMAHEMBE HAMLET................................................................................................................................. .4

FIGURE -5 TYPE OF DISEASES AFFECTING CHILDREN IN KIROKA VILLAGE.................. ..45

FIGURE -3 BREAST FEEDING STATUS VS DELIVERY ASSISTANCE .................................. ......1FIGURE -9 ASSISTANCE DURING DELIVERY VS LEVEL OF EDUCATION OF MOTHERS. .4

FIGURE 20 DURATION OF BREAST FEEDING :;.......................................................................... .

FIGURE 2- DURATION OF ECLUSIVE BREAST FEEDING OF INFANTS IN KIROKAVILLAGE......................................................................................................................................................../

FIGURE 22 AGE OF CHILD HEN STARTED FEEDING COMPLEMENTARY FOOD :;......3

FIGURE 21 BREAST FEEDING STATUS AND NUTRITIONAL STATUS AMONG CHILDRENBELO FIVE YEARS OF AGE..................................................................................................................9

FIGURE 24 NUMBER OF BREASTFEEDING PER DAY :;............................................................./0

FIGURE 2 AYS OF SERVING FOOD TO CHILDREN OF -2 MONTHS AGE AND ABOVE:; .................................................................................................................................................................../-

FIGURE 2/ AYS OF SERVING FOOD TO HOUSEHOLD MEMBERS........................................../-

FIGURE 25 NUMBER OF MEALS OF CHILDREN PER DAY FOR ALL CHILDREN :;.......... ./2

6i


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FIGURE 23 NUMBER OF MEALS OF CHILDREN PER DAY AND BREASTFEEDING STATUS:;..................................................................................................................................................................../1

FIGURE 29 PERIOD OF FOOD SHORTAGE IN THE LAST -2 MONTHS :;.......................... ...../5

6ii


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LIST OF APPENDICES

APPENDI - QUESTIONNAIRE FOR MOTHERS AND CHILDREN........................................ .......9/

APPENDI 2 CHECK LIST FOR FOCUSED GROUP DISCUSSION........................................... ....-03

APPENDI 1 CHECK LIST FOR DIRECT OBSERVATION ............................................................--0

6iii


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LIST OF ABBREVIATIONS

##!' The #merican #cademy of !amily 'hysicians

?T8 ?elgium Technical 8ooperation

8%'7 8hild %urvival 'rotection and 7evelopment

$N# $mergency Nutritional #ssessment

!#4 !ood #gricultural 4rganiation

/7' /ross 7omestic 'roduction

!/7s !ocused /roup 7iscussions

!$B%N$T !amine $arly Barning %ystems Network

!%9T !ood %ecurity 9nformation Team

h 2our;sulnerability #ssessment

%7 %tandard deviation

:N98$! :nited Nation 8hildren !und

>#7 >itamin # 7eficiency

BC# Beight-for-age

BC2 Beight-for-height

B24 Borld 2ealth 4rganiation

B!' Borld !ood 'rogramme

6v


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CHAPTER ONE

INTRODUCTION

-.- B"


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period is often marked by growth faltering, micronutrient deficiencies, and common

childhood diseases like diarrhoea, as children transit from e6clusive breastfeeding to solid

foods in addition to breast milk ;Mukuria et al.,())0


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to be malnourished and among them ( were from Kiroka village ;Morogoro 2ospital

Records, ())3


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-.1.1 H?o$%#

i. 'revalence of malnutrition in Kiroka village is low.

ii. The current feeding practices of children below five years of age have no effect on

their nutrition status in Kiroka village.

1


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CHAPTER TO

LITERATURE REVIE

2.- I!$'o>)


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have impaired immune systems which increase their risk of sickness and death.

Malnutrition certainly creates a huge human and economic waste ;B24, ())*A

Nyaruhucha et al., ())0


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survival "#ahgoub et al.,())0!=

I!$"$o! o *'&"#$&&>!= "!> '&6+"


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E


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2.1.2 Com+&m&!$"'? &&>!=

#ppropriate complementary foods can be readily consumed and digested by the young

child from si6 months onwards and provide nutrients ;energy, protein, fat and vitamins

and minerals< to help meet the growing childHs needs in addition to breast milk ;:N98$!,

())3


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is necessary for households to have access to food, but it is not a sufficient condition for

nutrition security. 'eople also need ade"uate care and a healthy living environment to be

able to absorb the nutrients available in food and thus use it in their everyday lives ;%mith

et al.,())0


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G+o*"+oo>""+"*+$?

N"$o!"+ !&$mo'$# ooo>

N"$o!"+ oo>'o>)""+"*+$?

666666666666666666666666666666666666666666666666666666666666666666666666666666666666666666666666666HOUSEHOLD ANDINDIVIDUAL

Foo># "!>!o!!& !)$'$o! #&


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2.4.- Foo> #&


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2. N)$'$o!"+ P'o='"mm

eoples- participation approach in reducing malnutrition in the

community is of prime importance. The 8hild %urvival, 'rotection and

7evelopment ;8%'7< is a community-based programme whose main strategy is to

empower communities to assess, analyse and take appropriate actions on development

issues, especially those which are pertinent to health and nutrition situation of children and

women ;Nyaruhucha et a., ())0


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# study done by Nyaruhucha et al. ;())0< in Morogoro Rural and Morogoro :rban found

that the e6tent of community participation in the 8%'7 proEect is generally low. 'eople

were not aware of the programme and its activities making 8%'7 lose its effectiveness.

2./ So


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CHAPTER THREE

METHODOLOGY

1.- D


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Taking into account the attrition rate of ), the reasonable sample sie for this study was

(0 ;i.e., (1* (1? D=! "!> S"m+!= P'o)'&

# cross sectional study was conducted in the selected households in Kiroka village. # list

of households with children below-five years of age was obtained from the Reproductive

and 8hild 2ealth 8linics ;R828< ;assumption was that all children below five years

attend R828


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1.4 M&$%o># "!> M"$&'"+# o' D"$" Co++&


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and female focus group discussions were conducted separately, and then the two groups

were brought together for plenary discussions ;#ppendi6 ( )$o!!"'

!ace-to-face interviews with the mothers or fathers Ccaregivers were administered to all

selected households. The information collected using this survey instrument included

socio-demographic factors, (1-hours dietary recall, food security information, utiliation

of health services, breast and complementary feeding practices, and diseases and

infections ;#ppendi6


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;@ukmanE et al., ())3< and each child was classified as normal, below or above R7#

following this procedure.

1.4.1.2 A!$%'oom&$'< m&"#)'&m&!$# "!> >&$&'m!"$o! o !)$'$o! #$"$)#

#nthropometric variables such as weight, heightClength, age and se6 were collected.

2eight-for-age, weight-for height and height-for-age indices were employed to assess the

nutritional status of children. 9nformation on birth-weight of the children was obtained

from their clinic cards. #nthropometric data were processed and analyed using a

computeried program $N# by %M#RT. 8hildren were classified as having mild,

moderate and severe malnutrition ;?ruce, ())5


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"; H&=%$7L&!=$% m&"#)'&m&!$ o' !"!$# 0621mo!$%#;

The measuring board ;%horr production, +3)( %hotley, ?ridge '@, 4lney, Maryland

()35(, :%#< was used to measure length of infants ;)-(5months


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*; H&=%$ o' '&! 24 mo!$%# "!> o+>&'

The measuring board was placed on a hard flat surface against a wall. The assistant placed

the childDs feet together in the centre of the flat surface of the board wall. The childDs legs

were placed straight and the heels and calves were pressed against the boardCwall. The

shoulders were level and rela6ed, the hands were placed at the childDs side, and the head,

shoulder blades and buttocks against the boardCwall. #fter the childDs position was

established, the measurement was recorded to the nearest ). cm ;?ruce, ())5


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1.4.4 M>6)&' "'m ersion 0.) for windows. #nthropometric data were analysed using $N# by

%M#RT software program where &-scores were generated and imported into %'%% for

further analysis. 7escriptive statistics was done to obtain means, fre"uencies, standard

((


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deviation, and link between variables through 8ross tabulation. T-test and #N4># was

used to test between means. 8hi-s"uare ;(< and t-test were used to test the significance of

various independent variables. 'earson 8orrelation coefficient and simple regression

analysis was used to determine the relationships that e6ist between variables and identify

important factors affecting food security in the study area. Multiple regression analysis

was needed to identify important factors and the interaction of factors. Therefore, probit

regression analysis was performed to identify the determinants of nutrition insecurity as

assessed by &-scores. The dependent variables considered was binary variable ;i.e., a child

health was normalI and )Imalnutrition


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CHAPTER FOUR

RESULTS

4.- I!$'o>)


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;Table (


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two types of households. #bout * of the women had no formal education and 1+ had

primary school education and was having secondary school education. The mean age

of mothers was (+.5( O 0.*0. Mothers with the age below () years were 5 ;!ig. 5


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4.1 P%?#


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underweight and stunting ;chronic malnutrition< was 5, 5, and 15, respectively

;Table 5


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of the boys were underweight and of the girls were underweight. 8hildren between

age group of (*-50 months are most affected by underweight ;0< ;Table 1&'"$&)!>&'&=%$;

61SD#&&'&+? )!>&'&=%$

n n n )-( ( ).

(

+ 0. 5 (.

5-(1 * 30.

1

0 ).

(

( 5.1

(*-50 *3 3*.

5

0 3.3 1 *.

5+-13 () 3).

)

1 0 1.)

1-0) 3(.0

1 0 ) ).)

The prevalence of moderate underweight was higher among children of mothers who had

not been through any formal education ;!ig. *


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10.6

3.5

9.2

3.8

0

2

4

6

8

10

12

Percen

tageofchildren

No o!mal e"#$at%on &!%ma!' e"#$at%on se$on"a!' e"#$at%on

Level of education of mothers

Mo"e!ate #n"e!we%(ht )eve!e #n"e!we%(ht

F=)'& L&&+ o &>) &=%$6o'6"=& Z6S


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T"*+& P'&"+&!&'&=%$ o' '&! *&+o & ?&"'# "=& "# '&+"$&> $o $%&

=&!&'"+ 62 6#&'&=%$61 6# o %o)#&%o+>

!emale 5 33.0 * .1 ) ).) * .1

Male () 30.5 (( .1 ) 1.5 (( 5.+

M"'$"+ #$"$)#

Married ()3 3+.) (( .( 5.3 5 5.)

%ingle ( 3+. 5 . 5.) 1 (.

7ivorced 5 0).) ( 1).) ).) ).) ( 1).)

L$o


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8.2

3.2

12.9

10.1

4.2

16.7

9

3.6

12.9

0

2

4

6

8

10

12

14

16

18

Percentageofchild

Below 2 'ea!s 2 'ea!s an"

above

*ve!all

Age of children

Mo"e!ate #n"e!we%(ht )eve!e #n"e!we%(ht *ve!!all +n"e!we%(ht

F=)'& / P'&"+&!&'&=%$ "mo!= '&! o "=& *&+o "!> "*o& 2 o "=&

There was a higher proportion of boys having &-scores of below -( compared to girls

;!ig. +


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F=)'& 5 P'&"+&!&'&=%$ "mo!= '&! *&+o & ?&"'# *? #&

T'&!> o !)$'$o!"+ #$"$)#

The prevalence of underweight in children showed increasing trend between ())* and

())+ ;!ig. 3


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0

5

10

15

20

25

2003 2005 2006 2007

Year

Proportio

nofchildren(

F=)'& 3 P'&"+&!&'&=%$ o '&! ! K'o(" ++"=& 'om 2001 $o 2005.

4.4.2 &=%$6o'6%&=%$

The overall prevalence of wasting was 5. %evere wasting ;(< was observed among

children aged between ( and (1 months of age. The children in the age group of 50-13

months were more wasted ;3< followed by the children in the age group of (1-50 months

;1


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F=)'& 9 P'&"+&!


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T"*+& / P'&"+&! o %o)#&%o+>

!emale 15 +.+ ) ).) ) ).) (.5 ) ).) ) ).)

Male ()+ 33.3 + 5.) ).1 * 0.1 5 .5 3 5.1

M"'$"+ #$"$)#

Married (1 3.* + (. ).1 1 *. 5 .5 3 5.5

%ingle 5( +.) ) ).) ) ).) 5.) ) ).) ) ).)

7ivorced 1 ).5 ) ).) ) ).) ().) ) ).) ) ).)

L$o


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2.13.1

0.8

4.96.1

25

2.1

3.9

0

5

10

15

20

25

30

No o!mal e"#$at%on ,!%ma!' e"#$at%on )e$on"a!' e"#$at%on

Level of education of mothers

Percentageofmother

mo"e!ate wast%n( seve!e wast%n( ove!we%(ht obese

F=)'& -0 L&&+ o &>) '&"+&!


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1.3

4.2

2.5

0.60.4

5.75.9 5.8

1.3

0.8 1.1

1.9

4.2

2.9

0

1

2

3

4

5

6

7

Below 2 'ea!s 2 'ea!s an" above ove!all

Age group of children

Percentageofchildren

Moe"e!ate #n"e!we%(ht )eve!e #n"e!we%(ht *ve!we%(ht *bese *ve!all wast%n(

F=)'& -- P'&"+&!


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T"*+& 5 P'&"+&!


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F=)'& -2 P'&"+&!


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24.1

37

8.2

21

32.2

57.9

0

10

20

30

40

50

60

70

Below 2 'ea!s 2 'ea!s an" above

Age group of children

Percentage

ofchildre

Mo"e!ate st#nt%n( )eve!e st#nt%n( *ve!all st#nt%n(

F=)'& -1 P'&"+&! "*o& 2 ?&"'# o "=&

8hildren of age two years and above had high prevalence of stunting compared to children

of age below ( years ;!ig. 5


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29.6 29.8

25

16.9

10.7

0

5

10

15

20

25

30

35

No o!mal e"#$at%on ,!%ma!' e"#$at%on )e$on"a!' e"#$at%on

Education level of mothers

Percentageofmothe

Mo"e!ate st#nte" )eve!e st#nte"

F=)'& -4 L&&+ o &>) '&"+&!;

61SD #&&'&+? #$)!$&>;

! : ! : ! :

)-( +3 +0.* ( ().0 5 (.5-(1 5 *(.* 3 5).* ) 0.(*-50 ( 1(.0 (* 50.3 1 ().05+-13 11.) 3 5(.) 0 (1.)1-0) 3 51.3 ) 15.* * (.+

1(


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4.4.4 M> )&' "'m )&' "'m &'"$&m"+!o)'#%&>

A$ '#( om"+!)$'$o!

No'm"+

! : ! : ! :

(. G 3.) (* 1.) * ().) +0.)

3. - 5).) 0* * +.+ + ).3 *5 3.*

5). G 1(.) *( ) ).) 5 *.3 1 1.(

1(.- *1.) (5 ) ).) 1.5 (( *.+

*1.- 0).) ( ) ).) ) ).) ( )).)

4verall ++ 0 5.1 0 .) ** 3+.0

4.4. H&"+$% #&'


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2.9

87

9.4

0.7

0

10

20

30

40

50

60

70

80

90

Perce

ntageofrespond

Mo!o(o!o os&%tal %!o/a ealth $ent!e

,!%vate $l%n%$ T!a"%t%onal heale!

F=)'& - H&"+$% %&! &++ #


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F=)'& -/ A "$%&' %o %"# @)#$ *'o)=%$ %# *"$?

7uring the survey each mother was asked to list the type of disease;s< a child had suffered

during a period of one month prior to the survey. The results to this "uestion are

summarised in Table 3. Mothers who had no formal education ;*< had a high number

of children suffering from diseases ;Table )


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T"*+& -0 P&')


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74.7

46.9

19.5

0.7

14.4

0

10

20

30

40

50

60

70

80

Types of chronic diseases

Perc

entageofchildre

Mala!%a o#(h%n( %a!!hoea Feve! No "%seases

F=)'& -5 T?& o >#&"# "&


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T"*+& -- Z6"+) 'om >#&"# A++Pes No

&=%$ o' "=&Normal 31.3 +.* 30.0

Moderate underweight .) (.* .+

%evere underweight 1.( ).) 5.0

H&=%$ o' "=&

Normal *1.1 +).) *0.+

Moderate stunted 5).1 (*.) (.0

%everely stunted *.( *.) 5.+

&=%$ o' %&=%$

Normal (.) 3).) ).5

Moderate wasted 5.) ).) (.*

%everely wasted ).1 ).) ).1

4verweight 5.3 +.* *.3

4bese ).3 (.* .

O&'"++ 3./ -4.4 -00

4.4.5 D&$&'m!"!$# o !)$'$o!"+ #$"$)# o '&!

The descriptive statistics discussed in the previous sections of this chapter assist in

understanding the factors important for children nutritional status in the study community.

2owever, further multiple regression analysis was needed to identify important factors and

the interaction of factors. Therefore, probit regression analysis was performed to identify

the determinants of nutrition insecurity ;or malnutrition status< as assessed by &-scores.

13


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The dependent variables considered was binary variable ;i.e., a child health was normalI

and )Imalnutrition


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T"*+& -2 P'o*$ '&='#o! o >&$&'m!"!$# o !)$'$o!"+ #$"$)#

D&$&'m!"!$# Co&


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Keeping livestock ;PesI< ).)+*5 ).5)+1 ).3)0

$6perienced food shortage ;PesI< -).*1++ ).5+*( ).11

Maie harvest -).)))5 ).)))* ).*3+

Rice harvest ).))) ).)))+ ).0+

2C# 8onstant -).(0)+ ).*+*( ).0*)

%e6 of child ;maleI< -).(0*3 ).()(( ).3

#ge group ;) G ( months I< ).+50 ).133* ).5)

#ge group ;( G (1 monthsI< -).(5 ).10) ).3(

#ge group ;(1 G 50 monthsI< -).))0( ).531 ).3+

#ge group ;50 G 13 monthsI< -).3 ).1+01 ).0

%e6 of household head ;maleI< -).)+0 ).(+)) ).++3

Mother education level ;!ormaleducationI #&"'>

&''o'

PJZ

!ood security ; !ood secureI&+&'? V# +&&+ o &>)


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1.5 4.3

36.1

1.4

56.7

ess than 1 'ea!

1 'ea!

2 'ea!s

Mo!e than 2 'ea!s

)t%ll #n"e! b!east ee"%n(

F=)'& 20 D)'"$o! o *'&"#$ &&>!= :;

4./.2 E


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60.7

24.5

3.2

11.6

0

10

20

30

40

50

60

70

Per

centageofinfants

1

Time of exclusive breastfeeding

Below 2 months 2 5 months Fo! 6 months om&lement not sta!te"

F=)'& 2- D)'"$o! o & oo># $o !"!$# 7'&!

8lose to 3* of the infants in Kiroka village was introduced to li"uids or semi-solid foods

after delivery before si6 months in which 0 of the children were given thin cereal

based gruels ;Table 1


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T"*+& -4 T? o '&6+" %&"> To$"+F&m"+& M"+&

Number 11 (55 (++

P'&6+"


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39

43.7

5.7

11.6

Two wee/s 1 3 months 4 6 months Not 'et sta!te" ee"%n(

F=)'& 22 A=& o %&! #$"'$&> &&>!= != #$"$)# o '&!

#t the time of the study, *+ ;*+ children< of the children surveyed were still

breastfeeding, and 15 ;()< had stopped breastfeeding. 2igher prevalence of

malnutrition was observed in children who were not breastfeeding compared to childrenwho were still on breastfeeding ;!ig. (5


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1.94.2

31.2

59.1

1720

0

10

20

30

40

50

60

70

B!easee"%n( )to&&e" b!easte"%n(

reastfeeding status

!verallprorportionofnutritionstatus

children(%)

*ve!all wast%n( *ve!all st#nt%n( *ve!all #n"e!we%(ht

F=)'& 21 B'&"#$ &&>!= #$"$)# "!> !)$'$o!"+ #$"$)# "mo!= '&! *&+o &

?&"'# o "=&

!or infantsCchildren who were still breast-feeding, about ** were being breastfed for

more than 0 times per day ;!ig. (1


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F=)'& 24 N)m*&' o *'&"#$&&>!= &' >"? :;

4././ Foo> '&"'"$o!

?oiling was the common method used for preparing food in Kiroka village. The

ingredients that are used for preparing porridge were maie flour, beans, groundnuts,

sorghum flour, vegetables, millet, rice and milk. /roundnuts were the most common used

ingredient. >egetables are e6posed under the sun to weather first before cooking. !or

e6ample, it was observed that one household sweat potato leaves were e6posed under the

sun for 5) minutes and then washed and boiled.

4./.5 M&$%o># o #&'!= oo> $o '&!

#bout (* of the children were served food on individual separate plates and were able to

feed without assistance. Twenty two percent of the children were sharing plates with

adults ;!ig. (*


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25.2

14.1

2.5

21.7

36.5

n he!h%s own &late

w%tho#t ass%stant !om

$a!e (%ve!

n he!h%s own &late w%th

ass%stant !om $a!e

(%ve!

)ha!e &late w%th othe!

$h%l"!en

)ha!e &late w%th a"#lts

Not sta!te" to eat am%l'

oo"s

F=)'& 2 "?# o #&'!= oo> $o '&! o -2 mo!$%# "=& "!> "*o& :;

The mother is the one who always prepares food for the family. #dults and children eat

together and use one plate. 7uring the survey, it was observed that in some families,

children eat with their mother outside the house while the father eats alone inside the

house ;!ig. (0 $o %o)#&%o+> m&m*&'#

0


77/125

4./.3 N)m*&' o m&"+# =&! $o !"!$# "!> '&!

The number of meals given to infants and children per day ranged between one to five

meals with mode of three meals per day. Thus, about +1 of the children were taking

three meals per day ;!ig. (+


78/125

12.5

2.5

11.3

5

68.2

78.3

810.8

3.3

0

10

20

30

40

50

60

70

80

Pe

rcentageofchildre

*ne meal Two meals Th!ee

meals

Fo#!

meals

F%ve meals

"umber of meals of children

B!easte" )to&&e" b!easte"

F=)'& 23 N)m*&' o m&"+# o '&! &' >"? "!> *'&"#$&&>!= #$"$)# :;

4./.9 D&$"'? '&


79/125

T"*+& - E!&'=? "!> 'o$&! *? '&! *&+o & ?&"'# o "=&

E!&'=? 'om oo> *? '&! *&+o ?&"'# o "=&

! :

NC# 0 (1.Normal R7# 1) 1.1?elow R7# 03 0).0P'o$&! 'om oo> *? '&! *&+o ?&"'# o "=&Normal R7# 03.?elow R7# + 0.

N#F Not started to eat family food

4.5 Ho)#&%o+> Foo> S& 'o>)


80/125

T"*+& -/ C'o# &'


81/125

T"*+& -5 V&=&$"*+')$# "!> &'


82/125

12.7

2.7

1.50.7

14 "a's-1 month 1month -3 months

3months -5 months 5 months

F=)'& 29 P&'o> o oo> #%o'$"=& ! $%& +"#$ -2 mo!$%# :;

9n the ())+C())3 crop season, average maie and rice harvest was 55(.+) kg and (+.( kg

per household per year respectively ;Table 3


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households in Kiroka village these included in the order of importance maie, rice,

plantains, cassava, yams, sorghum and millet.

T"*+& -3 C'o %"'$&> #&"#o! 200572003 ! K'o(" ++"=&

C'o $?& N)m*&' o

%o)#&%o+>

'"$&


84/125

T"*+& -9 F'&)&!


85/125

T"*+& 20 Co!#)m$o! o 'o$&! oo>#

T?& o oo> F'&)&!


86/125

T"*+& 2- F'&)&!


87/125

&; F')$#


88/125

4.3 "$&' "!> S"!$"$o!

7istance from home to water sources ranged from a half to si6 kilometres. Ninety three

percent of the households get their water within a distance of half a kilometreA residents in

Kiroka village get their water from two main sourcesA water taps and wells. Bater for

home use is not treated and about 3 of the households surveyed were not boiling water

for drinking. The reserve tank of the pipe water is located at Mahembe hamlet. 9t has no

protection from human activities making it unsafe because people bath, wash utensils and

clothes in the catchmentDs area of this water reserve. #t the household level, the maEority

of the family members use the same cupCglass to take water from the bucket or a clay

water pot, which could also lead to disease transmission from one person to another.

#bout )-() of the households had no toilets in Kiroka village.

+5


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CHAPTER FIVE

DISCUSSION

.- D&mo='"%< F"'&!

The important demographic characteristics of the household investigated included ethnic

group, se6 and marital status of household head, age and education level of spouses, and

household sie. Kiroka village is homogenous and is mainly occupied by the @uguru tribe

;1< having minimal interaction with other tribes. 2owever other ( tribes from all over

Tanania live in Kiroka due to economic activities such as mining activities in Matombo,

employment opportunity in industries and farms. %ome have migrated to Kiroka in search

for new farm land. This implies that the nutritional status of children is mainly determined

by customs and beliefs of these tribes, particularly at low literacy level of its people. !or

e6ample, the @uguru tribe discourage children from eating green vegetables known as

MwiduU because they believe that it causes convulsion in children. They also, believe that

when an infant keeps crying it is a sign that sheChe is hungry and needs to be given

porridge to complement breastfeeding. Therefore, any intervention aiming at improving

nutritional status of children in Kiroka should consider the customs and beliefs of @uguru

tribe. There is a need of mobilising and creating awareness in communities on the

importance of appropriate caring practices of children. %imilarly, the homogeneity is

e6pressed by the fact that other demographic factors investigated did not vary among the

si6 hamlets implying that these factors have almost the same effect on the nutritional

status of children found in different households in Kiroka village.

!arming is the most common livelihood activity in Kiroka village whereby about of

the respondents were farmers and the rest were involved in petty business, wage

employment and casual labour. This depicts that the status of human nutrition is

+1


90/125

determined much by farming activity, which is the maEor source of food in this

community.

.2 N)$'$o!"+ S$"$)# o C%+>'&!

# well-nourished child is one whose weight and height measurements compare very well

with the standard normal distribution of heights and weights of healthy children of the

same age and se6 from a reference population. Measurements of heightClength and weight

are important indicators for health and nutritional well-being that indicate or show whether

an individualHs body measurements are appropriate for that individualDs chronological age.

The prevalence of stunting, wasting and underweight in Kiroka village was 15, 5 and

5 respectively.

The height-for-age reflects achieved linear growth. This inde6 is an indicator of past under

nutrition or chronic malnutrition. # child who is below -( %7 from the median of the

reference population in terms of height-for- age is considered stunted or short for hisCher

age. %tunting reflects failure to receive ade"uate nutrition over a number of years and is

fre"uently associated with poor overall economic conditions, chronic or repeated

infections, and consistently inade"uate nutrient intake ;N?%, ())*


91/125

development of the country. %tunted children have reduced cognitive development,

impaired immune function, poor school performance, and delayed attainment of walking,

diminished work capacity, increased risk of diseases and metabolic disturbances leading to

increased prospective risk of obesity and hypertension. %tunting is associated with a

developmental delay, with retarded achievement of the main child development

milestones, such as walking. %tunting is also associated with increased child mortality. #

very low height-for-age is the single strongest predictor of childhood mortality in the first

* years of life ;?ranca and !errari, ())(


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al. ;())+< in sub-%aharan #frica countries where it was found that male children under

five years of age were more likely to become stunted than females. The stunting rate in

Kiroka was observed to be very high, due to the long e6perienced food shortage and long

term illness of some children. This is also probably due to low household income, which

might reduce and limit the capability of families to afford and access food. This may in

turn lead to low weight of mothers before conception with conse"uent low birth weight.

%imilarly, the results of the inde6 of the weight-for-height of older children in Kiroka

village revealed that they were more severely stunted than the young ones. 7eterioration

of nutritional status after si6 months can be e6plained, in part, by the introduction of

complementary foods to young children ;N?%, ())*


93/125

underweight compared to girls ;


94/125

foods given to the children were of low nutritional "uality resulting into children loosing

or not gaining weight. Basting indicates deficit in tissue and fat mass resulted either from

failure to gain weight or from actual weight loss. !ailure to absorb nutrients and or recent

episodes of illness may cause loss of weight. 8hildren who have fre"uent illness may not

have time to regain the weight they loose during one illness before the ne6t illness reduces

their appetite again.

!re"uent illness such from malaria, lower respiratory infection, diarrhoea and fever are

likely to increase the problem of wasting. !urthermore, this situation occurs when almost

all children have stopped breastfeeding and therefore they depend on family meals for

their nutrient intake. 9n Kiroka village most of the children eat from the family meals,

which are prepared three times a day. 8hildren have low gastric capacity and therefore

they need to eat small amounts of foods but fre"uently to meet their nutritional

re"uirements. The most used component of these meals includes cereals ;maie, rice,., Ndossi /., !awi B., ;())3


107/125

Ministry of #griculture !ood %ecurity and 8ooperatives. ;())0


108/125

Nyaruhucha, 8.N.M., Msuya, =.M., Mamiro, '. % and Kerengi, #.=. ; ())0


109/125

%hah, M.%., %elwyn, ?.=., @uby, %., Merchant, # and ?ano, R. ;())5


110/125

>an de 'oel, $., 2osseinpoor, #. R., =ehu-#ppiah, 8., >ega, = and %peybroeck, N. ;())+


111/125

APPENDIES

A&!> - Q)$o!!"'& o' mo$%&'# "!> '&!

SOKOINE UNIVERSITY OF AGRICULTURE

DEPARTMENT OF FOOD SCIENCE AND TECHNOLOGY

%:# management is kindly re"uesting your assistance so as to assess !actors influencing

nutrition and food insecurity in Kiroka village, Morogoro Tanania. 'lease answer each

"uestion according to specific instruction given under each "uestion.

a< %e6 !\\\M\\ 7ate of birth \\\\\\\\\\\\\\

b< #NT2R4'4M$TR98 ]:$%T94NN#9R$F

RespondentNoF

2ousehold97

#geinmonth

Beight;kg98$% #N7 79%$#%$% #N7 9N!$8T94Ntick which is applicable

1.( 9f you oryour child issick wheredo you go fortreatmentfirstY

.hospital (. health center 5. private clinic 1. traditional healer *. community health worker 0. drug distributor +. 4thers ;indicate


119/125

your childsuffer frommost

1. coughing

*. 4ther ;specify


120/125

*.+ 2ow manytimes do youbreastfeedyour childper dayY

. 1 times

(. 0 times 5. 3 times 1. ) times *. 4thers specify\\..

*.3 2ow manytimes do youfeed yourbaby per dayapart frombreastfeedingY ;for

breastfedchild only9N/ !447 T4 T2$ ?R$#%T!$$79N/ 829@7Tick which is applicable0.( 2ow do you

serve food to

your child

. eat in herChis own plate without assistantfrom care giver (. eat in herChis own plate with assistant fromcare giver 5. share plate with other children 1. share plate with adults *. 4thers ;specify


121/125

5.0 FOOD FREQUENCY QUESTIONNAIRE FOR THE HOUSEHOLDS o' $%&+"#$ &&(

'lease let me know the fre"uency to which your family and the study child consume thelisted foods.

Tick the relevancetype of food 7aily

once perweek

(timesCweek

5 timesper week

1 timesper week

*timesper week

0 timesper week Never

MilletRiceugaliCmaie'lantainsweet potato?eans'eascowpeasTomatoMango4rangeavocadoripe banana'awpaw

8arrotwatermelon'assionapplepineappleother fruits;mention 1 C%&

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