Posted on 27th Sep 2024 12:59:07 AM Medicine
1.1 INTRODUCTION
The primary causes of morbidity and mortality among children aged less than 5 years are pneumonia, diarrhoea diseases, low birth weight, asphyxia and in some parts of the world, human immunodeficiency virus ( HIV) infection and malaria. One out of every two such deaths has malnutrition as the underlying cause (Murray and Lopez, 1997). However malnutrition is rarely cited as being among the leading cause of death even through it is prevalent in developing countries (WHO, 2000b).
Malnutrition is currently the leading cause of global burden of disease (Ezzati et al.,2002) and has identified as the underlying factor in about 50% of deaths of children under 5 years of age in developing countries (Black et al., 2003). The condition may result from lack of food or from infections that cause loss of appetite while increasing the body’s nutrient requirements and losses. Children between 12 and 36 months old are especially at risk since they are the most vulnerable to infections such as gastroenteritis and measles (WHO, 2000b). It is estimated that, in developing countries, more than one-quarter of all children younger than 5 years of age are malnourished (UNACC, 2000).
A nationwide survey in Côte d‟Ivoire indicated that chronic malnutrition affects an estimated 34% of children under five years, while an estimated 20.2% are underweight. In many countries in the Sahel region, notably Burkina Faso, Mali and Niger, the prevalence of acute malnutrition is between 10.6% and 18.6% (UNICEF, 2006a).
Protein energy malnutrition (PEM) is a potentially fatal body depletion disorder (Dulger et al., 2002). The term protein energy malnutrition applies to a group of related disorders that include marasmus, kwashiorkor and intermediate states of marasmic kwashiorkor. Marasmus involves inadequate intake of protein and calories and is termed “the sickness of the weaning” with no oedema (de Onis et al., 1993). Kwashiorkor including marasmic kwashiorkor is characterized by massive oedema of the hands and feet, profound irritability, anorexia and desquamative rash, hair discolouration and a large fatty liver (Manary and Brewster, 1997).
1.2 Child malnutrition
Even though it has long been recognized that malnutrition is associated with mortality among children (Trowell, 1948; Gomez et al., 1956), a formal assessment of the impact of malnutrition as a risk factor was only recently carried out. In the early 1990s, results of the first epidemiological study on malnutrition showed that malnutrition potentiated the effects of infectious diseases on child mortality at population level (Pelletier, Frongillo & Habicht, 1993), a result that up until then had only been observed clinically. The methodology was based on the results of eight community-based prospective studies that looked at the relationship between anthropometry and child mortality in developing countries (Pelletier et al., 1994). The literature review used to select the eight studies was published separately (Pelletier, 1994). The results of the eight studies were consistent in showing that the risk of mortality was inversely related to weight-for-age, and that there was an elevated risk even at mild-to-moderate levels of malnutrition. In fact, most
Malnutrition-related deaths were associated with mild-to-moderate, rather than severe, malnutrition, because the mild-to-moderately malnourished population was much bigger than the severely malnourished population. The study also confirmed that malnutrition has a multiplicative effect on mortality. Taking into account all underlying causes of death, the results suggested that malnutrition was an associated cause in about one half of all child deaths in developing countries.
From a national policy perspective, however, the epidemiological study had a limitation: the global estimate of malnutrition-associated mortality could not be applied to countries with distinct disease profiles. To fill this gap, a joint WHO/Johns Hopkins University working group was set up to estimate the contribution of malnutrition to cause-specific mortality in children. The first step was a literature review to collect data for estimating the relationship between malnutrition and mortality from diarrhea, acute respiratory infections, malaria and measles (Rice et al., 2000). Cause-specific mortality was estimated by applying the method of Pelletier et al. (1994) to the data of 10 cohort studies that contained weight-for-age categories and cause-of-death information. The weight for- age categories were based on the number of standard deviations (SDs) from the
Median value of the National Centre for Health Statistics (NCHS)/WHO international reference population (< -3 SD; -3 SD to < -2 SD; -2 SD to < -1 SD; and > -1 SD). All the included studies contributed information on weight-for-age and risk of diarrhea, malaria, measles, acute respiratory infections and all-cause mortality (comprising other remaining infectious diseases besides HIV). These other infectious diseases include: tuberculosis, sexually transmitted disease excluding HIV, pertussis, poliomyelitis, diphtheria, tetanus, meningitis, hepatitis B and C, tropical-cluster diseases, leprosy, dengue, Japanese encephalitis, trachoma, intestinal nematode infections, upper respiratory infections and otitis media.
By including these other infectious diseases, the burden estimates take into account, for example, malnutrition associated effects on immune system and consequent worsened prognosis of disease development. The relationship between weight-for-age and risk of death was estimated by calculating the logarithms of the mortality rates by cause and by anthropometric status for each country, and using weighted random effects models. Using these models, the working group derived the relative risks of dying for each cause and all causes.
1.3 STATEMENT OF PROBLEM
Malnutrition is associated with abnormalities in the specific immune response and with susceptibility to infection. From early childhood it is associated with significant functionally increased impairment in adult life, reduced work capacity and decreasing economic productivity (Pelletier et al., 1995).
Children who are malnourished not only tend to have increased morbidity and mortality but are also more prone to suffer from delayed mental development, poor school performance and reduced intellectual achievement (Pelletier et al., 1995).
PEM impairs the linear growth of children, leading to a further reduction in food intake, nutrient absorption, direct or catabolic nutrient losses and increased metabolic requirements. It has been suggested that acute phase response and pro-inflammatory cytokines directly affect bone remodeling required for longitudinal growth (Stephensen, 1999). Malnutrition is responsible, directly or indirectly for 54% of the 10.8 million deaths per year in children under five and contributes to every second death (53%) associated with infectious diseases among children under five years of age in developing countries (WHO, 2005).
Early diagnosis of protein energy malnutrition will prevent complications from occurring in children who fall victim to the condition. However, there is very little knowledge on early and precise diagnosis of PEM in Ghana, thus the outcome of this study would provide remedy for early detection and precise diagnosis.
1.4 Background of the study
Globally, PEM continues to be a major health burden in developing countries and the most important risk factor for illnesses and death especially among young children (Muller and Krawinkel, 2011) . The World Health Organization estimates that about 60% of all deaths, occurring among children aged less than five years in developing countries, could be attributed to malnutrition (Faruque et al., 2011). The improvement of nutrition therefore, is the main prerequisite for the reduction of high infant and under five mortality rates, the assurance of physical growth, social and mental development of children as well as academic achievement (Anwar et al., 2011). Sub-Saharan Africa bears the brunt of PEM in the world. On the average, the PEM associated mortality in sub-Saharan Africa is between 25 and 35% (Gernaat et al., 2011). In Nigeria, 22 to 40% of under-five mortality has been attributed to PEM (Ibekwe VE and Ashworth 1994). PEM is also associated with a number of co morbidities such as lower respiratory tract infections including tuberculosis, diarrhoea diseases, malaria and anaemia (Ie Roux et al., 2012).These co-morbidities may prolong the duration of hospital stay and death among affected children.
1.5 JUSTIFICATION
Increased morbidity and mortality is found in children suffering from PEM and are also more prone to suffer from delayed mental development, poor school performance and reduced intellectual achievement (Pelletier et al., 1995). The consequences of these conditions may not end in childhood but can continue to adolescent stage where stunting and thinness is common (Leenstra et al., 2005). In West Africa, children under five and maternal mortality rates are amongst the highest in the world. One in three children under the age of five is undernourished and many are affected by acute and chronic malnutrition (UNICEF, 2006a). In Ghana PEM is common especially among those with poor living standards and most often in the rural areas. Found this study, we increase the quality of nursing care provided for the PEM children. So increase the children benefit.
1.6 Objectives
General objectives
The study will be carried out with a view to assess knowledge of mother’s of under five children regarding Protein-Energy Malnutrition in R.M.C.H.
Specific objectives
To assess knowledge of mothers regarding Protein-Energy Malnutrition.
To assess knowledge of mothers regarding cause of Protein-Energy Malnutrition.
To assess knowledge of mothers regarding type of Protein-Energy Malnutrition.
To assess knowledge of mothers regarding symptoms of Protein-Energy Malnutrition.
To assess knowledge regarding treatment of Protein-Energy Malnutrition.
To assess knowledge of mothers regarding prevention of Protein-Energy Malnutrition.
To assess knowledge regarding complication of Protein-Energy Malnutrition.
To find out socio demographic characteristics of the respondents.
1.7 Research question
What is level of Mothers having under five children regarding protein energy malnutrition?
1.8 Variable use in this study
Dependent variable: Knowledge on mother regarding Protein-Energy Malnutrition.
Independent variable: Age, Educational status, Occupation, Monthly family income, Housing condition etc.
CONTENTS
Abstract
CHAPTER 1: INTRODUCTION
1.1 Introduction
1.2 Child malnutrition
1.3 Statement of problem
1.4 Background of the study
1.5 Justification
1.6 Objectives
1.7 Research question
1.8 Variable use in this study
CHAPTER 2: REVIEW OF LITERATURE
2.1 Malnutrition
2.2 Protein Energy Malnutrition
CHAPTER 3: MATERIALS AND METHODS
3.1 Study design
3.2 Study place
3.3 Study duration
3.4 Study population
3.5 Sample size
3.6 Sample and sample technique
3.7 Research instrument for Data collection
3.8 Data collection procedure
3.9 Data analysis
3.10 Ethical consideration
CHAPTER 4: RESULTS
CHAPTER 5: DISCUSSION
CHAPTER 6: CONCLUSION
CHAPTER 7: REFERENCES
ANNEXURA
LIST OF TABLES
Table 1. Percentage Distribution of the mothers’ of under-five children by their age.
Table 2. Percentage Distribution of the mothers’ of under-five children by their educational status
Table 3. Percentage Distribution of the mothers’ of under-five children by their occupation.
Table 4. Percentage Distribution of the mothers’ of under-five children by their monthly family income.
Table 5. Percentage Distribution of the mothers’ of under-five children by their religion.
Table 6. Percentage Distribution of the mothers’ of under-five children by their housing condition
Table 7. Percentage Distribution of the mothers’ of under-five children by their Home location
Table 8. Percentage Distribution of the mothers’ of under-five children by their number of family members.
Table 9. Item wise analysis of knowledge of mothers regarding Protein-Energy Malnutrition.
Table 10. Item wise analysis of knowledge of mothers regarding Protein-Energy Malnutrition.
Table 11. Item wise analysis of knowledge of mothers regarding Protein-Energy Malnutrition.
Table 12. Item wise analysis of knowledge of mothers regarding Protein-Energy Malnutrition.
LIST OF FIGURES
Figure 1. Educational status of mother
Figure 2. Home location of mothers
Thesis, Nurses, Study, Knowledge, Mothers, Children, Regarding, Protein, Energy, Malnutrition, Attending, Rajshahi, Nursing, College, Medical, Hospital
Share on Facebook