INFLUENCE OF MATERNAL NUTRITION ON NUTRITION STATUS OF
CHILDREN(0-23)MONTHS ATTENDING EMBU LEVEL FIVE HOSPITAL (20 TH
MARCH -20TH MAY) EMBU COUNTY
by
NAME: DOREEN MUKAMI
ADMISSION NO: CND/S-
0029/THI/19
DEPARTMENT: HUMAN NUTRITION
THIS IS SUBMITTED IN PARTIAL FULFILLMENT OF THE REQUIREMENT FOR
THE AWARD OF CERTIFICATE IN NUTRITION AND DIETETICS IN THIKA
SCHOOL OF MEDICAL AND HEALTH SCIENCE.
i
DECLARATION
I declare that this research proposal is my original work and has not been presented for award in
certificate in nutrition and dietetics in any other institute.
Doreen Mukami
CND/S-0029/THI/19
Signature............................... Date..................
Supervisor approval
This research proposal has been submitted for examination with our approval as the institution
supervisors
Mr. Benson Mathwel
Thika School of medical and health sciences
Department of Human Nutrition
Signature............................... Date........................
Mr. Patrick Muruingi
Thika school of medical and health sciences
Department of Human Nutrition
Signature...................................... Date.....................
ii
DEDICATION
This proposal is dedicated to Almighty God and MR and MRS Gedion and all my friends who
made this study easy.
iii
ACKNOWLEDGEMENT
My sincere acknowledgement goes to my supervisors Mr Benson Matthewel and Mr Partrick
Muriungi for their guidance and commitment throughout the study process.
iv
Operational definition of terms
Child- a person under the age of 0-23 months.
Nutritional status is the psychological state of an individual which result from relationship
between nutrient intake and requirements from the body‟s ability to digest ,absorb and use
nutrients.
Body mass index(BMI) IS the measure of fat based on heights and weight that applies to children
aged 0-23 months
Care giver - mothers providing direct care to children aged 0-23 months
Etiology - the investigation of the cause of maternal nutrition.
Maternal nutrition -the nutrition needs of women during antenatal and postnatal periods and the
period prior to conception‟
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List of abbreviation
BW -Birth Weight
FGR - Fetal Growth Restriction.
UNICEF - United Nations International Children‟s Emergency Fund
BMI - Basal Mass Index
vi
TABLE OF CONTENTS
DECLARATION........................................................................................... Error! Bookmark not defined.
DEDICATION............................................................................................................................................. iii
ACKNOWLEDGEMENT............................................................................................................................ iv
Operational definition of terms..................................................................................................................... v
List of abbreviation...................................................................................................................................... vi
CHAPTER ONE : INTRODUCTION.......................................................................................................... 1
1.1 Background of the Study..................................................................................................................... 1
1.2 Problem Statement.............................................................................................................................. 1
1.3 OBJECTIVES..................................................................................................................................... 2
1.3.1.General objective.......................................................................................................................... 2
1.3.2 Specific objective......................................................................................................................... 2
1.4 Research questions.............................................................................................................................. 3
1.5 Hypothesis........................................................................................................................................... 3
1.5.1Null hypothesis.............................................................................................................................. 3
1.5.2 Alternative hypothesis.................................................................................................................. 3
1.6 Significance of the study..................................................................................................................... 3
1.7 Limitation of the study........................................................................................................................ 4
1.8 Basic assumptions............................................................................................................................... 4
CHAPTER 2: LITERATURE REVIEW....................................................................................................... 5
2.0 INTRODUCTION TO LITERATURE REVIEW.................................................................................. 5
2.1 Maternal under nutrition in pregnancy............................................................................................. 6
2.2 Knowledge Gap................................................................................................................................. 7
2.3 Socio demographic characteristics.................................................................................................... 7
2.4 Conceptual frame work....................................................................................................................... 7
CHAPTER THREE : METHODOLOGY.................................................................................................... 8
3.1 Study design........................................................................................................................................ 8
3.1.1 Study location............................................................................................................................... 8
3.2 Target population................................................................................................................................. 8
3.1.1 Inclusion criteria........................................................................................................................... 8
3.1.2 Exclusion criteria.......................................................................................................................... 8
3.3 Research design................................................................................................................................... 8
3.4 POPULATION SAMPLE AND SAMPLING TECHNIQUES.......................................................... 9
vii
3.4.1 Methods of sampling................................................................................................................... 9
3.4.2 Dependent variables..................................................................................................................... 9
3.4.4 Sample size................................................................................................................................... 9
3.5 Sources of data.................................................................................................................................. 10
3.5 .1 Research instruments................................................................................................................. 11
3.5.2 Pretesting.................................................................................................................................... 11
3.6 Data collection techniques................................................................................................................. 11
3.7 Data analysis and presentation.......................................................................................................... 11
3.8 Logistics and ethical consideration................................................................................................... 12
REFERENCES............................................................................................................................................ 13
3.10 APPENDICES................................................................................................................................. 14
viii
CHAPTER ONE : INTRODUCTION
1.1 Background of the Study
Child morbidity and mortality is caused by under nutrition (Hien, N. N., & Kam, S., 2008).
Maternal characteristics have also been associated to nutrition status of children under five years.
Present evidence indicates that a large proportion of women of reproductive age are
malnourished; many of them also have nursing babies or young children. There is clear lack of
full knowledge concerning the relationship between maternal malnutrition and infant health.
Besides it is clear that maternal nutrition is intimately intertwined with infant health and survival.
Thus, the problem of maternal malnutrition during pregnancy and lactation presents a potentially
and very serious obstacle to child nutrition and survival. Under nutrition disorders common in
children include, stunting, wasting and underweight (Lechtig A., Klein R. E.et al, 1982).
Studies have shown that, in malnourished populations, nutritional supplementation during
pregnancy increases birth weight. Supplementation provided in the third trimester of pregnancy
is important in terms of resultant decreases in the proportion of low birth-weight infants,
reductions in perinatal and infant mortality, and its effects on subsequent child development
(Dewey, K. G., & Cohen, R. J., 2007).
Under nutrition in children is highly prevalent and remains a major challenge. According to
United Nations Children‟s Fund (UNICEF) report, 25% of children under the age of five years
are stunted, 16% underweight and 8% wasted, and an estimated 6.3 million live born children
worldwide died before age 5 years, because of under nutrition. The highest prevalence of under-
five under nutrition is found in Africa (36%) followed by Asia (27%). Accordingly, the three
forms of malnutrition in Sub-Saharan Africa was 40, 21 and 9% stunting, underweight and
wasting, respectively (Mupunga I., Mngqawa P. et al,2017)
1.2 Problem Statement
Nutrition plays a significant role in maternal and child wellbeing. Poor maternal nutrition has
been correlated with poor fetal outcomes. In addition to poor maternal nutrition, biological,
socioeconomic, teenage pregnancy, short interpregnancy interval and demographic factors in
different populations play an important role on birth outcomes (Gemmill A. & Lindberg L. D.,
2013). Multiple nutrient deficiencies are generally observed in low socioeconomic status.
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In developing countries, improvement in maternal nutrition is associated with increased fetal
growth and decrease in adverse maternal and birth outcomes. There is significant reduction in
LBW babies among women receiving multi-micronutrient supplements compared with women
only receiving iron and folic acid supplements hence the need for multi-micronutrient
supplementation for pregnant women. Maternal nutritional deficiencies result from inadequate
dietary intake of energy, proteins, essential fatty acids (especially omega 3 fatty acids), iron,
folate, and other micronutrients during pregnancy (Purandare C. N., 2012). During pregnancy,
large amount of lysine and other amino acids obtained from cereals play an important role in the
synthesis of proteins
It is known that the production of milk and the act of breastfeeding requires more energy from
the body (Bentley, M. E., Dee, D. L., & Jensen, J. L., 2003). When the body is deprived daily of
a large amount of energy (at least 1500 calories per day), the production of breast milk should
diminish. Deficiency of certain vitamins in the mother would affect the nutritional quality of her
breast milk. These are the B vitamins (thiamin, riboflavin, B6 and B12) as well as vitamin A, C
and D found in breast milk that are mainly influenced by the mother‟s diet. These vitamins are of
concern since the breastfed child will also show a deficiency and accordingly, the child becomes
at risk for neurological and skeletal problems, as well as growth retardation (Pem, D. 2015).
1.3 OBJECTIVES
1.3.1.General objective
1.To investigate the efforts of maternal nutrition on nutrition status of children aged 0-23 months
attending Embu level 5 hospital.
1.3.2 Specific objective
1.To determine factors affecting nutrition status of mothers with children aged 0-23 months
attending Embu level 5 hospital.
2.To determine the nutritional status of children aged 0-23 months in Embu level 5 hospital .
3.To establish the relationship between maternal nutrition and nutritional status of children aged
0-23 months in Embu level 5 hospital .
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1.4 Research questions
1. What are the factors affecting nutrition status of children aged 0-23 months in Embu level 5
hospital Embu county?
2. What is the nutritional status of children aged 0-23 months in Embu Level 5 Hospita Embu
County?
3.What is the relationship between maternal nutrition and nutrition status of children aged 0-23
months in Embu level 5 hospital Embu County?
1.5 Hypothesis
1.5.1Null hypothesis
There is no significantrelationship between socio demographic characteristics and nutrition status
of children aged 0-23 months in Embu county.
There is no Significantbetween maternal knowledge and nutrition status of children aged 0-23
months in Embu level 5 hospital.
There is no Significant relationship between age and the nutrition status of children aged 0-23
months in Embu level 5 hospital.
1.5.2 Alternative hypothesis
There is a relationship between maternal knowledge and nutrition status of children aged 0-23
months in Embu county.
1.6 Significance of the study
It is important to study about maternal nutrition as it has a wide range of impact and influence
the nutrition status of children. This stud will be helpful in highlighting the problem of poor
maternal nutrition and the main contributing factor amongest lactating women or youth.The
study will act as a tool to reflect sanitary condition ,socio variables ,degree and influence of poor
maternal nutrition to nutrition status of the children .It will also help encourage pregnant women
to improve their nutrition care practices and feeding behaviour of pregnant and lactating
women.This will provide helpful information to both government and non-government
institutions about maternal nutrition and it's influence to nutrition status of children.
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1.7 Limitation of the study
Instrumental or personal errors may occur while measuring and recording anthropometric data of
the children .Correct age birth of the children may not be obtained in some individual lactating
mothers due to illetracy or tribal discrimination .Difficulties in assessing socio economic
information like family income ,family purchasing power,food consumption pattern as they are
considered as family prestige.
1.8 Basic assumptions
It is assumed that many lactating mothers in Embu level 5 hospital are under poor nutrition.The
causes of poor maternal nutrition are assumed to be socio economic and demographic factors.
Maternal nutrition knowledge. It is assumed that the response given by the target population in
this study are correct.
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CHAPTER 2: LITERATURE REVIEW
2.0 INTRODUCTION TO LITERATURE REVIEW
Maternal under nutrition, including stunting, wasting, and deficiencies of essential vitamins
and minerals, represents a global problem with important consequences for survival, incidence
of acute and chronic diseases, healthy development for mother and newborn, and the economic
productivity of individuals and societies . The impact of pre-pregnancy body mass index (BMI)
on obstetric outcomes, as well as subsequent disease (Guo X., 2013)
risk in the offspring, has attracted widespread attention due to the increased prevalence of its
abnormal value in women of childbearing age. In low-income and middle-income countries
maternal malnutrition encompasses both under nutrition and a growing problem with overweight
and obesity (De Onis, M. & Uauy, R., 2013). Overall, low body-mass index, indicative of
maternal under nutrition, has declined somewhat in the past two decades, but continues to be
prevalent in Asia and Africa. In contrast, prevalence of maternal overweight has had a steady
increase since 1980 and exceeds that of underweight in all regions.
After the global alert for overweight and obesity, an opposite extreme on the same spectrum of
malnutrition status has drawn attention in both developing and developed countries due to
different reasons.
Considering the malnutrition as “under nutrition,” it can be linked to longstanding food
deprivation in the first case and eating disorders (anorexia and bulimia nervosa) in the second,
respectively. Social, demographic, and obstetric factors, evaluated as independent variables, are
identified as aetiology of pre-pregnancy underweight. In these pregnancies, an increased risk of
fatal loss, preterm birth, anaemia, infections, fatal growth restriction (FGR), birth defects, low
BW, brain damage, admission to neonatal intensive care unit, and a
Longer duration of hospital stays, signs of the metabolic syndrome accompanied the catch-up in
body weight and central adiposity have been recognized. In addition, under nutrition has
profound effects on health throughout the human life course and is inextricably linked with
cognitive and social development, especially in early childhood (Triunfo, S., & Lanzone, A.
2015). In settings with insufficient material and social resources, children are not able to achieve
their full growth and developmental potential. Consequences range broadly from raised rates of
death from infectious diseases and decreased learning capacity in childhood to increased non -
communicable diseases in adulthood, in according to the „„fetal origins‟‟ hypothesis that
5
proposes that alterations in fetal nutrition results in developmental adaptations that permanently
change the structure, physiology, and metabolism, thereby predisposing to overweight/obesity in
adulthood.
2.1 Maternal under nutrition in pregnancy
Malnutrition in the mother has direct effects on the body size of the offspring, and may
contribute to the health risks in childhood, persisting throughout life. Considering that one of the
goals of prenatal care is the early identification of risk factors for unfavourable pregnancy
outcomes, early prenatal care should focus greater attention on pregnant women with important
nutritional deviations. An adequate referral may favour
timely and pertinent measures for each case, thereby minimizing the effects of inadequate pre-
gestational weight (Villar, J. $ Bergsjø, P., 1997)
Maternal under nutrition, including stunting, wasting, and deficiencies of essential vitamins and
minerals, represents a global problem with important consequences for survival, incidence of
acute and chronic diseases, healthy development for mother and newborn, and the economic
productivity of individuals and societies. The impact of pre-pregnancy body mass index (BMI)
on obstetric outcomes, as well as subsequent disease
risk in the offspring, has attracted widespread attention due to the increased prevalence of its
abnormal value in women childbearing age.
In Kenya “under nutrition,” can be linked to longstanding food deprivation in the first case and
eating disorders (anorexia and bulimia nervosa) in the second, respectively. Social, demographic,
and obstetric factors, evaluated as independent variables, are identified as aetiology of pre-
pregnancy underweight. In these pregnancies, an increased risk of fetal loss, preterm birth,
anaemia, infections, fetal growth restriction (FGR), birth defects, low BW, brain damage,
admission to neonatal intensive care unit, and a longer duration of hospital stay, signs of the
metabolic syndrome accompanied the catch-up in body weight
and central adiposity have been recognized in Kenya. Nnutrition has profound effects on
health throughout the human life course and is inextricably linked with cognitive and social
development,
In Embu County, 26.8% of children under five years are moderately stunted, 6.5% severely
stunted, 3% moderately wasted while and 0.2% are severely wasted.
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2.2 Knowledge Gap
Despite extensive research on nutrition, maternal nutrition and the nutrition status of children,
there is little data for the same in developing countries such as Kenya. The study therefore shall
aim at filling the knowledge gap as far as nutrition care practices and the link between maternal
and child nutrition is concerned (Alderman, H, 2013)
2.3 Socio demographic characteristics
Gender
Age
Income
Maternal knowledge
2.4 Conceptual frame work
Nutrition status
Poverty
Sociol economic
Age Maternal And
knowledge demographic
factors
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CHAPTER THREE : METHODOLOGY
3.1 Study design
The previous chapter presented the literature review and conceptual framework this chapter will
delinate the research methodology.This chapter consists of study area , research desighn
andTarget population sampling techniques data collection methods and procedure will also be
inclusive
3.1.1 Study location
The study will be conducted at Embu level 5 hospital Embu county.The county boarders
Kirinyaga to the west, kitui to the east,120 km from Nairobi. It is a metropolitan area with a
population of 608,599 persons with 81,040 children under the of 0-23 months.(Muchuka N.M
2018)
3.2 Target population
The target population will be mothers or caregivers and their children aged 0-23 months old
living in Embu county level 5 hospital. Study population will be children under age of 0-23
months age randomly selected and included in the study .
3.1.1 Inclusion criteria
Mothers and their children aged 0-23 months old who are residents of Embu County for past 6
months and who will be willing to participate in the study.
3.1.2 Exclusion criteria
The study participants who are seriously ill or who will not be available during the time of study
will be excluded in the study.
3.3 Research design
A community based cross sectional survey will be conducted to assess the nutritional status and
associated factors among children aged 0-23 months
a) Anthropometric measurements of 0-23 months children at household level.
b) General household survey by the application of questionnaire to the parents to find out the
situation of the household.
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3.4 POPULATION SAMPLE AND SAMPLING TECHNIQUES
3.4.1 Methods of sampling.
Cluster sampling techniques followed by random sampling will be used to select children from
households and from wards of Embu level 5 hospital will be selected by simple random
sampling. A household containing atleast one child of 0-23 months of age will be included in the
study.
3.4.2 Dependent variables
The dependent variable of the study will be nutrition status.
3.4.3Independent variable
The independent variable will be maternal nutrition, socio economic and demographic variables,
head of household ethnicity, poverty, maternal knowledge on maternal nutrition
3.4.4 Sample size
The sample will be determined using a single proportional formula assuming the influence rate
of maternal nutritional 50% in the study area, 80% confident interval (CI) 8% margin error (d)
and non- response rate added to the total calculated sample size.
Calculation of sample size for infinite population:-
n= Z² ×p[1-p]/d²
n = sample size
z = Normal deviation at desired confidence interval at 95% P
= Estimated interval of maternal nutrition
d= Margin error at 9%
Calculation of sample size for finite population from personal communication of the hospital was
found that the total number of children aged 0-23 months are 95%thus we apply finite
population.Sample formular to obtain new sample size to conduct survey will be
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N=z² p(1-p)
1²
N=z²pQ
1²
N=Sample size
Z=constant deviation at desired confined interval
P=Proportion of the population without desired characteristics
Q= proportion of the population without desired characteristics
I=degree of precision
EXAMPLE
N =( 1.96²)×0.5(1-0.5)
0.1²
N=3.8416×0.5(0.5)
0.1²
N=3.8416×0.25
0.01
N=0.9604
0.01
=96.04
=96
10/100×96
=9.6
=10
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3.5 Sources of data
The sources of data for materna nutrition will be online sources and offline sources. The primary
sources f data used will be books, journals and library and the online sources will be google,
google scholar, Wikipedia ,YouTube and Phoenix. This helped to obtain competitive edge
beyond click wins.
3.5 .1 Research instruments
Instruments and equipment necessary for the condition of the study are
a) Weighing machine - with a capacity of 100kg and having the least count of 0.1 kg.
b) Height measuring scale (standiometer)
c) MUAC tape- will be used to measure mid-upper arm circumference.
d) Questionnaire- designed and pretested questionnaire to collect household information.
3.5.2 Pretesting
The prepared sets of questionnaire and anthropometric instruments will be pretested among
parents of children aged 0-23 months, under the plan to maintain accuracy and clarity of the
questionnaire.
3.6 Data collection techniques
Data will be collected using structured questionnaire and also anthropometric measurements.
Interviews will be conducted to parented of the group under study to fill the questionnaires .In
wards with more than one child of 0-23 months age, one child will be collected by the use of
lottery method.
3.7 Data analysis and presentation
First the data will be checked if complete and for consistency. It will then be coded and entered
in the computer by use of statistical software. Qualititve data will be transcribed and coded by
assigning labels to various categories. Verified parameters will be used to determine the
variables and nutritional status of children.
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3.8 Logistics and ethical consideration
Ethical clearance will be obtained from Thika School of Medical and Health and Sciences,the
departmentof human nutrition and the office of the hospital.privacy and confidentiality of the
information collected will be considered.
12
REFERENCES
Black Robert E.(2013) Diarrheal diseases and child morbidity and mortality 'population and
development review 10 ' 2013: 141161.
Cheng T.L, Kotelchuk,M, $ Guyer B (2012) Preconception women's health and pediatrics : An
opportunity to address infant mortality and family health .Academic pediatrics, 12 (5)
357,359
Gemmil, A,& Lindberg, L.D(2013). Short inter pregnancy intervals in the United States.
Obsterics and gynecology 122(1)64.
Puradare C.N 'maternal nutrition deficiencies and interventions (2012):621 623.
13
3.10 APPENDICES
Respondent understanding of influence of maternal nutrition
Appendix 1. Questionnaire
1. When do you stop breast feeding you baby?
2. Do you have a kitchen garden?
Yes. No.
3. During pregnancy, what variety of food did eat?
4. Have you ever taken supplements before
Yes. No.
5. What food items do you feed your baby?
14
APPENDIX 2:
WORK PLAN
Actvity Months January February march April M
Acceptance of the
proposal
Research tool
organization and
presting
Selection of the
population under study:
lactating mothers
Data collection
Data analysis
Work Schedule
Action Responsibility Timeline
Revisiting Researcher May
Actual research Researcher March to may
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Appendix 4 Budget
ITEM QUANTITY UNIT TOTAL COST
COST
Writing proposal 25 20 5000
Typing 25 30 7500
Printing 25 10 2500
Binding 1 50 50
Photocopy 5 25 125
Allowance 300 300
Subtotal 81 435 25475
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Research instruments and data collection
ITEM QUANTITY UNIT COST TOTAL
Questionnaires 120 10 1200
Muac tape 1 500 500
Height measuring 1 2000 2000
scale
Transport to and from 150 200 30000
the area of study
Biro pens 2 25 50
Exercise books for 1 120 120
recording
measurements
Subtotal 2855 31850
275
17
