Background to the study
Child nutrition plays a key role in infant and child health or death. Young children, pregnant women and lactating mothers are nutritionally the most vulnerable group, especially in the developing countries of the world, and yet relatively little is done to achieve their special nutritional needs. (Oyira, Abua, Mgbekem&Okon, 2010).
The importance of nutrition in childhood for both immediate health and health in later life is a topic that has aroused a considerable interest and argument over the past 15 – 20 years. The depth of interest and the data t hat arouse the interest are new but the concept that the way a child is fed has a long-term effect or consequences are not new. In developed countries and many traditional societies today, early feeding has been considered a determinant of later character as much as later growth and health. Correct nutrition ensures healthier children, who grow into more productive adults while Poor nutrition on the other hand leads to malnutrition.
Malnutrition continues to be a significant public health and development concern around the world with about one-third of the world’s children malnourished and an estimated 150 to 200 million pre-school children (< 5-years) in developing countries being underweight and stunted, respectively (WHO, 2006).
Malnutrition is the condition that results from taking inadequate diet in which certain nutrients are lacking, in excess, or in the wrong proportions (Sullivan & Sheffrin, 2010).
The effects of malnutrition on human performance, health and survival have been the subject of extensive research for several decades and studies show that malnutrition affects physical growth, morbidity, mortality, cognitive development, reproduction, and physical work capacity (Pettetier & Frangillo, 2008). Malnutrition is particularly prevalent in developing countries, where it affects one out of every three preschool-age children (United Nations Sub-Committee on Nutrition, 2012). Nigeria contributes 5.7% of hunger problems in the world and 40% of Nigerian children under five are stunted, 9% are wasted while 25% are underweight. Micronutrient deficiencies in vitamin A, iron and iodine are widespread, while 2 out of 5 children in Nigeria are chronically undernourished (Global Hunger Index Report, 2011).
Factors that influence the nutritional status of children are many and varied. These factors include inadequate dietary intake, poor household food security, diseases like diarrhea, infections e.t.c., inadequate maternal and child care, unhealthy environment
, lack of education and nutritional information to mention but a few (Sullivan & Sheffrin, 2010). All these in turn lead to malnutrition.
There is a relationship between socio-cultural factors, health and nutrition (Noughani, 2010). Socio-economic and socio-cultural factors simultaneously influence both the children’s nutritional status and their nutrition related roles. Cultural practices like breastfeeding, food taboos and feeding patterns can affect a child’s welfare and nutrition (Noughani, 2010).
Therefore, social and cultural factors related to health and nutrition assist in answering some of the practical problems involved in implementing health programs. The socio-cultural perspective enables us to understand the existing habits of the people, and the linkages between these habits, thus identifying major barriers in the implementation of health programs. Socio-cultural factors influence individuals directly and very likely change the course of conduct that an individual may be compelled to take (Noughani, 2010). A society’s customs and ideas have a great impact on the nutritional status of its indigenes.
These factors in combination with other factors such as family structure, ignorance, illiteracy and poverty can lead to severe malnutrition in children.
It is therefore important to identify and understand factors that put children from rural or farming communities at a greater risk of malnutrition in early childhood compared to their urban counterparts.
The present study thus aims to identify the socio-cultural factors influencing malnutrition in children under age 5 in rural communities in Enugu East L.G.A, Enugu State.
Statement of the Problem
Malnutrition has for a long time been recognized as a consequence of poverty since most of the world’s malnourished children live in the developing nations of Asia, Africa and Latin America, where those mostly affected are from low income families (Unicef, 2004) especially those living in the rural areas and urban slums.
When income decreases, the quality and quantity of food also decreases. Evidence shows that when unemployment and low wages are presenting factors, families eat cheaper food, which is less nutritious leading to weight loss and malnutrition (Unicef, 2009).
The scourge of under-five malnutrition is on the increase globally and in Nigeria, with the attendant child mortality facing our society. Studies have pointed out that malnutrition is high in communities with low income group, (Ene-Obong, 2007; Maziya-Dixon., 2011). They are of the opinion that this low income group have heavy workload, poor education and poor nutrient intake. And even the traditional breast feeding practices that suppose to be exclusively practiced have been substituted with food complements.
However, the problem of adequate complementary food is still is enormous. Fermented cereal gruel-pap (ogi/akamu) continues to be the preferred complementary for infants in eastern Nigeria of which the study area is part of. This has been shown to be inadequate in term of nutrient density. It is bulky, viscose, and low in nutrients, (Ene-Obong, 2007). Many researchers have attributed the above cases to social or cultural affiliations. Since some communities in Enugu East L.G.A, Enugu State is more of the low income group, it’s assumed that the above scenario may be the applicable there and likely to contribute to under-five malnutrition. This has not been proved by research which this study is set to unravel.
Previous research studies on socio-cultural determinants of under-5 malnutrition in Enugu State particularly in Enugu East are few. Most of other Nigerian studies examined few determinants (either socioeconomic factors or environmental factors alone or individual factors); hence effects of confounding factors were not sufficiently looked into. As a result, under-five malnutrition has not always been seen as a complex process shaped by social and cultural forces in Enugu and environs.
In low-income communities the factors that generally seem to influence child malnutrition are associated with education, employment, and family. In these communities, it is common to see children below the age of five (5) years appearing stunted, wasted or underweight as observed by the researcher during community health outreach programmes.
In addition to the poor socio-economic status of most of the families, a good number of women of child bearing age are illiterates who still hold and value with utmost esteem their socio-cultural practices such as local weaning methods, naming rituals/rites “IguOgbo”. These practices encourage the separation of children from their parents which predispose such children to poor, unhygienic diets, loss of appetite and nutritional stress.
Thus, since studies have not yet unveil the determinants of under-five malnutrition in Enugu East, it is important to investigate if socio-cultural factors are the main factors influencing child malnutrition in the community.
Moreover, existing study on children’s nutritional status in Enugu was done with selected school children in Enugu town with little attention being paid to nearby communities like the ones in Enugu East L.G.A, Enugu State.
The children from rural communities in Enugu East L.G.A where chosen because of the researcher’s experience at community health outreach programmes and also in relation to the fact that this area is one of the socio-economically disadvantaged areas. Therefore, this study is aimed at determining the socio-cultural factors influencing the nutritional status of children in some rural communities in Enugu East L.G.A in Enugu State.
Purpose of the study
The purpose of the study is to assess the socio-cultural factors influencing the nutritional status of children below 5years in selected rural communities in Enugu East L.G.A in Enugu State.
The specific objectives of the study are to:
1. determine the influence of family structure on the nutritional status of children.
2. determine the influence of the socio-economic status of the family on nutritional status of children.
3. identify the religious and cultural practices that influence the nutritional status of children.
4. determine the influence of maternal education on the nutritional status of children.
There is no significant relationship between family’s socio-economic status and nutritional status of their children 2. There is no significant relationship between cultural practices and the nutritional status of children.
Significance of the Study
This study will unravel some of the superstitious and cultural practices that affect nutrition, especially with regards to children.
The information will be used by health workers to identify areas of concentration during health talk especially to mothers during ante-natal visits.
The result of the study will influence health education in promoting the use of locally available food resources to prevent malnutrition in children.
The result when used in health education will enable the community understand that malnutrition when prevented will result in high productivity ( when the children grow into adulthood), reduction in economic losses, reduction in health care costs of caring for those suffering from nutrition related illnesses thereby increasing returns on investment in education and other aspects of the economy.
The results obtained will help in informing and promoting woman’s role in providing nutritious food to her family and to herself in Nigeria. It will also enable policy makers to know that increased access to education and health services are vital, as well as a focus on increased gender equality in Nigeria.
It will also help to provide reliable and accurate information for policy making and programme design that aims at addressing nutritional deficiencies in under-five children.
Scope of the Study
The study will be delimited to mothers of young children under the age of five (5) living at selected rural communities in Enugu East L.G.A. The study will cover the influence of family structure on the nutritional status of children, the influence of the socio-economic status of the family on nutritional status of children, religious and cultural practices that influence the nutritional status of children and influence of maternal education on nutritional status of the children.
Operational definition of terms
Social factors: - this means family structure, family income, weaning practices including timing and type of food, food taboos.
Cultural factors: - this includes a broad range of factors, such as religious and spiritual practices, art, medical treatment and customs, diet, interpersonal relationships and child care.
Nutritional status: - the condition of the body in those respects influenced by the diet, the levels of nutrients in the body and the ability of those levels to maintain normal metabolic integrity. The general adequacy is assessed by measuring weight and height for age compared with standard data for adequately nourished children