ABSTRACT

A review of the 2018 Demographic and Health Survey in Cameroon, under-five Cameroonian children were 11% underweight,4% were wasted, and 29% were stunted. In 2015, Cameroon had an estimated under-five mortality rate of 88 per 1 000 live births. The burden of malnutrition in the South West Region of Cameroon is sparse.  Specifically, this study seeks to determine the prevalence of undernutrition in children, determine the prevalence of House Hold Food Insecurity Assess dietary diversity and risk factors associated to undernutrition in Kumba health district.

Methods: This study will be a community based study of 667 under-five children /carers who will be surveyed from their houses using a multistage randomized sampling technique. The socio-demographic information will be collected using a well-structured questionnaire. Information on food insecurity will be captured using Household Food Insecurity Access Scale and quantified using the Household Food Insecurity Scale Score.  A dietary diversity questionnaire will be used capture information on food diversity. Risk factors of Malnutrition will be obtained using a multivariate logistic regression.

Expected results: We are expecting to see the prevalence of  Household Food Insecurity, the prevalence of undernutrition ,determine dietary diversity and the factors associated to undernutrition

Key words: Undernutrition, prevalence, risk factors, Household food insecurity, Dietary diversity, under-five children in Kumba.

CHAPTER ONE

1.1 Background of Study

Over the years malnutrition has been a public health problem affecting mainly the low and middle income countries [1] Malnutrition is made up of undernutrition and over nutrition .malnutrition is referred to as undernutrition in most developing countries[2].The sub Saharan region of Africa has still been having prevailing records of child malnutrition ,this can be seen with the increased rates of stunting 39 % ,wasting 10% and underweight 25%[2].In 2006 the World Health Organization(WHO) Child Growth standards determined that  underweight ,stunting and wasting occur in children less than 59 months with a standard deviation below 2 for  height-for-age, weight-for-height and weight-for-age[2].Stunting, wasting, underweight are the indicators of childhood undernutrition. Over the past decade there has been a decrease   prevalence of wasting, stunting though the percentages are still high with 38% stunted and 10 % wasted in under children [2].

 A study carried out in Ethiopia in 2000 shows that 55.7% of Ethiopian children were stunted and by 2011 the figure had decreased to 43.8% and 40% by 2014[2]. The prevalence of overweight was 41% in 2000 and in 2014 it decreased to 25% while wasting was higher than 10% in 2014. 45% of death in under five children is known to be associated to malnutrition [2].

Globally, undernutrition particularly amongst under- five children has been a public health problem, in 2020 about 149.2 million (22%) and 45.4 million (6.7%) under- five children were estimated to be stunted and wasted respectively[3].About 3.1(45%) million death in under-five children is accounted for by undernutrition[3].Undernutrition is known to be prevalent in South-East Asia and Africa, with Africa reported to account for 39.4% stunting ,24.9% underweight and 10.3 % wasted children under 5 years of age[1]. The African continent is known to bear the burden of malnutrition with two out of five (41% or 61.4 million children) stunted children and more than a quarter (27% or 12.1 million children) of all wasted children under-five live in the African continent[3]Suboptimal brain development is associated with poor nutrition which in turn affects the educational performance of children, cognitive development and economic productivity in adulthood[1].

The nutritional status of a child is used to determine the growth of that child. The first 1000days of a child’s life is very important because it is during this time that mental and physical development takes place thus undernutrition during this stage increases the risk of  morbidity and mortality in children[1]. Reports from the sustainable development goals records that one third of global undernourished children are found in Sub-Saharan Africa. This reports shows that malnutrition is still a major public health concern in Africa and needs interventions[1].

In Cameroon  prevalence of childhood stunting and underweight between 1991 and 1998   rose from 23% to 29% and 16% to 23% respectively[3].

In 1990, Cameroon was known to have the highest burden of malnutrition in Africa. In 2018 data from the Demographic and Health Survey in Cameroon ,under –five Cameroonian children were 11% underweight,4% were wasted, and 29% were stunted(3). In 2015, Cameroon had an estimated under-five mortality rate of 88 per 1 000 live births [4].

The rates of undernutrition in under five children have been trending upwards over the past two and half decades .The prevalence of stunting, wasting, and underweight increased from 24.4% to 32%, 3% to 5.2%, and 13.6 % to 14.8%, respectively from 1990 to 2014[5].

Over half a decade now the northwest and southwest region of Cameroon has been faced with socio-political conflicts  and this has affected the population negatively by limiting access to food ,medical care and water and sanitation amenities .The effects of the conflicts has predisposed the vulnerable groups especially under five children to health and nutrition related problems like undernutrition ,anaemia, malaria and diarrhea .Most malnutrition studies available have been carried out in different areas in Cameroon no study has been carried out in the kumba health district area and thus this research aims at determining the prevalence and risk factors of malnutrition in under 5 children in kumba health district

1.2. Problem Statement

Malnutrition has been over the years a call for concern especially in the developing countries and Africa. With this concern, there’s still a lot that needs to be done so as to bring the situation to a halt. Despite the health care system witnessed to bring in a lot of services to help prevent malnutrition among children less than five years of age, it has also been noticed by the researcher that the parents may have inadequate knowledge on diet, hygiene and other factors that leads to malnutrition. Though the main cause of malnutrition in children could be due to lack of adequate nutrient for growth and immune development, it is still being investigated to identify other factors that may lead to malnutrition.

From observation, the recent socio-political crisis in the Anglophone region in Cameroon has caused many families to move out of their home towns and villages to nearby cities in search of refuge. This movement may have caused most families to be dependent on other people for food, affected their incomes and causing insufficient funds since they no longer live in their homes where they have their source of livelihood; also, it may have affected the transportation of food products to these areas thereby causing increase in food prices and scarcity of some essential food supplies for children. These factors may be some of the attributes to the prevalence of malnutrition in the area of study Kumba which is found within the Anglophone region of Cameroon.

Despite these suspected factors identified above, the presence of the health care delivery system in Cameroon should be able to provide means for early identification of malnourished children, proper preventive measures (such as community and parental education on nutrition in children, sensitization and encouragement of effective hygiene measures etc.) and treatment management for malnutrition in children less than five years. However, malnutrition is still witnessed and identified among some children in the Kumba health district of Cameroon. It is for this reason this study seeks to investigate the prevalence and risk factors of malnutrition in children less than 5 years of age at the KHD of the Meme Division of Cameroon.

1.4 Research questions

1. What is the prevalence of adequate dietary diversity among children aged 6-59 months in KHD
2. What is the prevalence of household food insecurity among children aged 6-59 months in KHD
3. What is the prevalence of malnutrition among children aged 6-59months in KHD
4. What are the factors associated to malnutrition among children aged 6-59 months in KHD

1.5. Research hypotheses

1. The prevalence of adequate dietary diversity among children aged 6-59 months in the KHD is poor
2. The prevalence of food insecurity among children aged 6-59 months is high

• The prevalence of malnutrition among children aged 6-59 months in KHD is high

1. Socio-economic factors, dietary diversity  and food insecurity are associated with increased risk of malnutrition in children aged 6-59 months

1.6 Objectives of the study

1.6.1 General objective

 To determine the prevalence and the risk factors of malnutrition in children between 6 months to 59 months in the kumba health district