assessment of different breastfeeding practices - kiu

ASSESSMENT OF DIFFERENT BREASTFEEDING PRACTICES

AND NUTRITIONALSTATUS OF CHILDREN BELOW THE AGE

OF FIVE YEARS IN SHEEMA DISTRICT, UGANDA

BY

MASIKO KASIGAIRE DENIS

BMS/0011/133/DU

A RESEARCH DISSERTATION SUBMITTED TO

FACULTYOFCLINICAL MEDICINE AND DENTISTRY IN

PARTIAL FULFILLMENT OF THE REQUIREMENT FOR

THE AWARD OF BACHELOR OF MEDICINE

AND SURGERY OF KAMPALA

INTERNATIONAL UNIVERSITY

NOVEMBER 2018

I Masiko Kasigaire Denis

dissertation is my original research

result of my hard work

knowledge and interpretation

the guidance of my supervisor.

been produced or submitted

learning for an academic

I hence present it for

Kampala international university western campus.

Signature……………….

Date 2ND November 2018.

Masiko Kasigaire Denis

Tell: 0773008226/0705316863.

Email: [email protected].

(Researcher)

i

DECLARATION

Kasigaire Denis do here by declare that, to the best of my

my original research work. Everything in this research

work through reading various literature including

interpretation of the contents of the topic in the field

supervisor. I am therefore certain that no work

submitted to this University or any other institution

academic qualification.

the award of Bachelors of medicine and Bachelor of surgery

Kampala international university western campus.

Signature……………….

November 2018.

Kasigaire Denis

: 0773008226/0705316863.

Email: [email protected].

do here by declare that, to the best of my knowledge, this

research paper is as a

including my personal

field of research under

work of this kind has

institution of higher

medicine and Bachelor of surgery

ii

APPROVAL

I hereby declare that the content of this research report has been done through my

supervision and has been submitted to faculty of clinical medicine and dentistry with

my approval as the candidate’s supervisor.

I certify that I have read this research report and that in my opinion it is fully

adequate, in scope and quality, as an undergraduate thesis for the award of a degree of

Bachelor of medicine and Bachelor of surgery Kampala international university

western campus.

2 Nov 2018

Atuheire Collins, PhDc (Supervisor)

iii

DEDICATION

This dissertation is dedicated to my Sponsors Mrs. Joan Rutaroh, my brothers and

sisters for theircontinuous support and encouragement.

iv

ACKNOWLEDGMENTS

All thanks and praises to my Almighty God for helping me through the difficult times,

fulfilling my needs and for keeping me alive to conduct this study, surely he will see

me through. I would like to appreciate and thank my supervisor Atuheire Collins for

his guidance and support for this study and his patience. Also my gratitude to my

colleagues who gave me all the good advice in regards to my proposal. Not forgetting

my dear colleagues in Jinja Regional Referral hospital for helping me with the

information I needed.

v

LIST OF TABLES

Table Page

Table 1: Showing anthropometric indicators for children 4

Table 2: Showing education level of respondents 27

Table 3: A table showing occupation of the respondents 28

Table 4: A table showing duration of each breastfeeding for exclusively

breastfed children 31

Table 5: Table showing foods for complementary feeding 34

Table 6: A table showing immunization status of the child 36

Table 7: A table showing child’s age in months and years 37

Table 8: A table showing Child’s height/lenght in centimeter 38

Table 9: A table showing nutritional status of the children 40

vi

LIST OF FIGURES

Figure Page

Figure 1: Conceptual Framework (Designed by researcher) 11

Figure 2: A Cylindrical graph showing the age distribution of Mothers in

Years 26

Figure 3: A cylindrical graph showing marital status of the Mothers 27

Figure 4: A pie chart showing the religion of the participants 28

Figure 5: Pie chart showing respondent’s source of income 29

Figure 6: A bar graph showing respondents monthly earning in uganda

Shillings 29

Figure 7: A cylindrical graph showing the participant’s number of children30

Figure 8: A pie chart showing exclusive breastfeeding of the respondent’s

Child 30

Figure 9: A cylindrical graph showing number of EBF per day 31

Figure 10: A pie chart showing the time of BF initiation from birth 32

Figure 11: A cylindrical graph showing respondent’s expenditure of time

with the child 32

Figure 12: A pie chart showing child’s complementary feeding 33

Figure 13: A cylindrical graph showing age at complementary 33

Figure 14: A cylindrical graph showing the number of complementary

feeding per 24 hours 34

Figure 15: A pie chart indicating wheather the child has been weaned or

not 35

Figure 16: A pie chart showing age at weaning in years 35

Figure 17: A pie chart showing the method of weaning 36

Figure 18: A cylindrical graph showing immunization status of the children37

Figure 19: A pie chart showing child’s sex 38

Figure 20: A bar graph showing child’s weight in kilograms 39

Figure 21: A pie chart showing degree of edema 39

Figure 22: A bar graph showing mid upper arm circumference 40

Figure 23: A bar graph showing degree of malnutrition 41

vii

ABSTRACT

Background

Globally, nearly half of all deaths in children below the age of 5 years are attributed to

under nutrition as a result of poor breastfeeding practices every year. Under nutrition

is a preventable cause of death among children below the age of 5 years (Sleive

Collins et al 2006). Worldwide the prevalence rate of admitted infants and children to

hospitals with both acute malnutrition and mixed diagnosis ranged from 6.1 to 40.9%

as stated by (Joosten et al., 2008).

Methods

The aim of this study was to assess the effects of the different breastfeeding practices

on the nutritional status of children between the ages of 0 to 5 years. The study was a

descriptive cross-sectional study using quantitative methods. The calculated sample

was 206.Data was collected from the breastfeeding mothers. Data was coded and

tabulated using SPSS program.

Results

The study showed that of the 203 children that were interviewed, 96% were healthy

and only 4% were malnourished this basically indicated that the mothers had adequate

knowledge and information about the different breastfeeding practices to enhance

proper growth and development of their children, the good available antenatal and

child health care services and programs like immunization provided at the health

facility also played a key role in increased prevalence rates of healthy children with a

few malnourished children. The 4% of the children that are malnourished is basically

because of the inadequate and improper breastfeeding practices among children, Poor

balanced diet for those that have started complementary feeding, busy working

schedule for those that are working and yet are mothers who need to breast feed their

children.

Conclusion

Maternal and child care services should be provided to both mothers and their

children at their own times of convenience to reduce on the rates of absenteeism from

these health care services provided like immunization which predispose and increase

the rates of malnutrition.

viii

TABLE OF CONTENTS

DECLARATION ........................................................................................................... I

APPROVAL ................................................................................................................. II

DEDICATION.............................................................................................................III

ACKNOWLEDGMENTS ...........................................................................................IV

LIST OF TABLES........................................................................................................V

LIST OF FIGURES .....................................................................................................VI

ABSTRACT............................................................................................................... VII

TABLE OF CONTENTS..........................................................................................VIII

LIST OF ACRONYMS ............................................................................................XIV

OPERATIONAL DEFINITIONS.............................................................................. XV

CHAPTER ONE ............................................................................................................1

1.0 INTRODUCTION ...................................................................................................1

1.1 BACKGROUND .....................................................................................................2

1.1.1 HISTORICAL BACKGROUND..........................................................................2

1.1.2 THEORETICAL BACKGROUND......…………………………………………3

1.1.3 CONCEPTUAL BACKGROUND...................................................……………3

1.1.4 CONTEXUALBACKGROUND………………………………………………………...7

1.2 PROBLEM STATEMENT......................................................................................8

ix

1.3 OBJECTIVE OF THE STUDY............................................................................8

1.3.1 GENERAL OBJECTIVE......................................................................................8

1.3.2SPECIFIC OBJECTIVES......................................................................................9

1.4 RESEARCH QUESTIONS .....................................................................................9

1.5 SIGNIFICANCE OF THE STUDY.........................................................................9

1.6 SCOPE OF THE STUDY......................................................................................10

1.6.1 TIME SCOPE .....................................................................................................10

1.6.2 CONTENT SCOPE ............................................................................................10

1.7 CONCEPTUAL FRAME WORK .........................................................................11

CHAPTER TWO .........................................................................................................12

LITERATURE REVIEW ............................................................................................12

2.0 INTRODUCTION .................................................................................................12

2.1 ANTHROPOMETRIC INDICATORS TO ASSESS NUTRITIONAL STATUS

OF CHILDREN ...........................................................................................................12

2.1.1 IMPORTANCE OF BIRTH WEIGHT ON NUTRITIONAL STATUS............12

2.1.2 DETERMINANTS OF UNDER NUTRITION IN CHILDREN .......................13

2.1.3 DIETARY PRACTICES AND NUTRITIONAL STATUS OF CHILDREN ...14

2.1.4 INDICATORS OF INFANT/CHILD FEEDING PRACTICES.........................17

2.2 EXCLUSIVE BREASTFEEDING AND COMPLEMENTARY

BREASTFEEDING .....................................................................................................17

x

2.2.1 EXCLUSIVE BREASTFEEDING.....................................................................17

2.2.2 COMPLEMENTARY BREASTFEEDING .......................................................19

2.3 SOCIOECONOMIC AND DEMOGRAPHIC FACTORS AFFECTING

BREASTFEEDING MOTHERS.................................................................................20

CHAPTER THREE .....................................................................................................22

METHODOLOGY ......................................................................................................22

3.0 STUDY DESIGN...................................................................................................22

3.1 STUDY POPULATION ........................................................................................22

3.2 SAMPLING TECHNIQUE ...................................................................................22

3.2.1 SAMPLE SIZE DETERMINATION .................................................................22

3.2.2 SAMPLING PROCEDURE ...............................................................................23

3.2.3 INCLUSION AND EXCLUSION CRITERIA ..................................................23

3.2.3.1 INCLUSION CRITERIA.................................................................................23

3.2.3.2 EXCLUSION CRITERIA ...............................................................................23

3.3 DATA COLLECTION ..........................................................................................23

3.3.1 QUESTIONNAIRE ............................................................................................23

3.3.2 ANTHROPOMETRIC MEASUREMENTS TECHNIQUE ..............................24

3.4 DATA ANALYSIS................................................................................................25

3.4.1 QUANTITATIVE DATA ANALYSIS..............................................................25

3.5 ETHICAL CONSIDERATIONS AND PROCEDURE ........................................25

xi

3.6 ANTICIPATED PROBLEMS...............................................................................25

4.0: DATA ANALYSIS AND INTERPRETATION..................................................26

4.1 THE AGE DISTRIBUTION OF MOTHERS IN YEARS....................................26

4.2: MARITAL STATUS OF THE MOTHERS .........................................................27

4.3 EDUCATION LEVEL OF RESPONDENTS .......................................................27

4.4 RELIGION OF RESPONDENTS .........................................................................28

4.5: OCCUPATION OF THE RESPONDENTS.........................................................28

4.6: RESPONDENT’S SOURCE OF INCOME .........................................................29

4.7: RESPONDENT’S MONTHLY EARNING.........................................................29

4.8: RESPONDENT’S NUMBER OF CHILDREN ...................................................30

4.9: EXCLUSIVE BREASTFEEDING OF THE CHILD...........................................30

4.10: NUMBER OF EXCLUSIVE BREASTFEEDING PER DAY...........................31

4.11: DURATION OF EACH BREASTFEEDING ....................................................31

4.12: TIME OF BF INTIATION FROM BIRTH........................................................32

4.13: RESPONDENT’S EXPENDITURE OF TIME WITH THE CHILD...............32

4.14: IS YOUR CHILD ON COMPLEMENTARY FEEDING?................................33

4.15: AGE AT COMPLEMENTARY FEEDING.......................................................33

4.16: FOODS FOR COMPLEMENATARY FEEDING.............................................34

4.17: NUMBER OF CF PER 24 HOURS ...................................................................34

4.18: IS YOUR CHILD WEANED? ...........................................................................35

xii

4.19: AGE OF WEANING..........................................................................................35

4.20: METHOD OF WEANING .................................................................................36

4.21: IS THE CHILD IMMUNISED...........................................................................36

4.22: IF YES, IMMUNIZATION AGAINST?............................................................37

4.23: CHILD’S AGE IN MONTHS AND YEARS.....................................................37

4.24: CHILD’S SEX ....................................................................................................38

4.25: CHILD’S HEIGHT/LENGTH IN CENTIMETER ............................................38

4.26: CHILD’S WEIGHT IN KILOGRAMS..............................................................39

4.27: EDEMA ASSESSEMENT .................................................................................39

4.28: MID UPPER ARM CIRCUMFERENCE...........................................................40

4.29: NUTRITIONAL STATUS OF THE CHILDREN .............................................40

4.30: DEGREE OF MALNUTRITION.......................................................................41

CHAPTER FIVE .........................................................................................................42

DISCUSSION CONCLUSION AND RECOMMENDATIONS................................42

5.0 INTRODUCTION .................................................................................................42

5.1 DISCUSSION........................................................................................................42

5.1.1 SOCIO-DEMOGRAPHIC CHARACTERISTICS OF THE RESPONDENTS..

......................................................................................................................................42

5.1.2. DIFFERENT BREASTFEEDING PRACTICES OF CHILDREN BELOW

THE AGE OF 5 YEARS. ............................................................................................43

xiii

5.1.3 NUTRITIONAL STATUS OF CHILDREN BELOW THE AGE OF 5 YEARS.

......................................................................................................................................44

5.2 CONCLUSION......................................................................................................44

5.3 RECOMMENDATIONS.......................................................................................45

REFERENCES ............................................................................................................46

APPENDICES .............................................................................................................48

APPENDIX I: CONSENT FORM ..............................................................................48

APPENDIX II: QUESTIONNAIRE............................................................................49

APPENDIX III: BUDGET ..........................................................................................53

APPENDIX IV: LETTER OF INTRODCUTION FROM KIU..................................54

APPENDIX V: LETTER FROM DISTRICT HEALTH OFFICER………………...55

APPENDIX VI: LETTER FROM KITAGATA HOSPITAL MANAGEMENT

AUTHORITIES. ..........................................................................................................56

APPENDIX VII: MAP OF KITAGATA.....................................................................57

APPENDIX VIII: MAP OF UGANDA.......................................................................58

xiv

LIST OF ACRONYMS

BMI: Body Mass Index

DHO: District Health Officer

DHS: Demographic and Health Surveys

EBF: Exclusive Breast Feeding

MOH: Ministry of Health

MUAC: Mid Upper Arm Circumference

NGOs: Non-Governmental Organizations

PEM: Protein Energy Malnutrition

UDHS: Uganda Demographic Health Survey

UNICEF: United Nations International Children’s Emergency Fund

USA: United States of America

VHTs: Village Health Teams

WHO: World Health Organization

xv

OPERATIONAL DEFINITIONS

Colostrum: Itis milk secreted for a few days after parturition and characterized by high

protein and antibody content

Exclusive breastfeeding: Mode of breastfeeding where by the infant only receives breast

milk without any additional food or drink, not even water.

Prelacteal feed: Any food except mother’s milk provided to a new born before initiating

breastfeeding.

Knowledge: Means information that mothers have acquired about the activities and benefits

of exclusive breastfeeding

Practice: Routine activities and actions of individual or group on exclusive breast feeding.

Attitudes: Beliefs on practices of exclusive breastfeeding

1

CHAPTER ONE

1.0 INTRODUCTION


under nutrition as a result of poor breastfeeding practices every year. This translates to

about 3 million unnecessary loss of young lives per year (UNICEF, Updated Feb

2016). Under nutrition is a preventable cause of death among children below the age

of 5 years (Sleive Collins et al 2006). Worldwide the prevalence rate of admitted

infants and children to hospitals with both acute malnutrition and mixed diagnosis

ranged from 6.1 to 40.9% as stated by (Joosten et al 2008). In the African continent,

children make up one quarter of the estimated 148 million underweight children

globally with the Sub Saharan region being the most affected with an increment of 43

million people being affected. In Uganda, the persistent high rates of malnutrition in

children below the age of 5 years are a result of inadequate access to food, poor infant

feeding practices, poor sanitation and health practices. 38% suffer from chronic

malnutrition, 16% are under weight and 6% suffer from acute malnutrition. Some of

the core nutrition interventions provided by government do include the following;

Encouraging mothers to exclusively breastfeed, improve maternal nutrition and health

and promotion of nutritional education (UFNP adopted in 2003). The institutional

framework for improving nutrition in Uganda is at different levels. At the National

level; the nutrition unit is based in the division of child health under the department of

community health; At Regional level; MOH staff structure includes a senior

nutritionist and a nutritionist at the referral hospitals with a focus on both curative and

rehabilitation services within the hospital. At District level; DHO coordinates health

and nutrition activities promoted by the government, NGOs and the private sector

partners. At the general hospital there is only one nutritionist. At Community level;

VHTs are used to interface between the community and the health facilities.

In conclusion, there are many related studies that have been done about the different

breastfeeding practices and the nutritional status of children below the age of 5 years

elsewhere in the world but none has been done within Sheema district. This study will

therefore help establish the different breastfeeding practices and the nutritional status

of children below the age of 5 years within Sheema district.

2

1.1 BACKGROUND

1.1.1 Historical background

The first recorded nutritional experiment was recorded in the book of Daniel in the

bible. Daniel objected eating from the king’s court and opted to eat both vegetables

and water. Ten days later along with his colleagues they were compared with the

king’s men and they appeared fitter and healthier hence they were allowed to continue

with their own foods. Hippocrates an Ancient Greek conjectured that since people

were the same, regardless of what they ate, there was one nutrient that everything was

made of. The one nutrient theory persisted for a very long time until almost the

modern era. In the late 1700’s a brilliant young French scientist called Antoine

Lavoisier became the father of nutrition as he designed a calorimeter which measured

the heat produced by the body from work and consumption of the varying amounts

and types of food. He is also famous for the statement “life is a chemical process.” In

1753, Dr James Lind published his treatise on scurvy which was credited with

recognition of the curative effects of fresh fruits on scurvy. Vitamins came from Funk

who erroneously thought all these new things being discovered contained amines

hence combined both vital and amine to form vitamin. Vitamin B12 was discovered in

1948 and reported in 1949. It was the essential animal protein factor. Prior to the

discovery, animal protein foods were essential in the diet to prevent pernicious

anemia. Discovery of the role of trace minerals in diet coincided with the discovery of

vitamins and elucidation of their essentiality, their rules and interactions continues

today. Zinc prevention of Para keratosis was discovered in the 1950’s and 1960’s,

Selenium’s essentiality was discovered in the 1970’s and chromium though

recognized as essential since its part of an enzyme is still controversial today.

3

1.1.2 Theoretical background

” The health belief model” stated by G. Hochbaum is the theory that was used to

conduct the study. The health belief model suggests that a person’s readiness to

change a specific health behavior is dependent on the following;

a) Perceived Susceptibility: Individual’s view of the likelihood of developing the

condition or disease.

b) Perceived Severity: Individual’s views of how serious the condition and its

consequences are.

c) Perceived Benefits: Individual’s view of what was gained by changing the specific

behavior

d) Perceived Barriers: Factors such as cost, inconvenience, time, that make it

difficult for the individual to change the behavior

e) Cues to Action: Events that “trigger” the individual to take action

f) Self Efficacy: Individual’s confidence in ability to take.

1.1.3 Conceptual background

Malnutrition and hunger remain among the most devastating problems facing the

world’s poor countries. Nearly 30 percent of humanity- infants and children suffer

from one or multiple forms of malnutrition from protein-energy malnutrition to

micronutrients deficiencies (WHO, 2003). The tragic consequences of malnutrition

include death, disability, stunted mental and physical growth and as a result, retarded

national socioeconomic development, some 49 percent of the 10million deaths among

children under-five years of age in the developing world are associated with

malnutrition (Pelletier, 1994). Recent research shows evidence that fetal malnutrition

has important immediate and long-term consequences.

4

Table 1: Showing anthropometric indicators for children

Indicators Definition Implication and use

Birth-weight The weight at which a baby is

born.

It is actually an indicator of

maternal nutrition

Weight Measured as weight in Kg Mainly affected by acute

infection and or acute food

shortage. If after the infection

the child is on an adequate diet

weight demonstrates a period

of rapid growth

Head

circumference

Measured around the head Useful in the first 2 years

mainly as a measure of brain

development

Mid upper arm

circumference

(MUAC)

Measured on the left arm. Is not

dependent on age.

MUAC is a measure of

adequacy in nutrition. A

useful measure for screening

acute malnutrition in the

community. Also used for

patients whose weight/height

cannot be taken

Weight for Age Is a measure of weight compared

to the weight of children of the

same age and sex from a

reference population.

It is an indicator of both acute

and chronic malnutrition.

Height for Age Is a measure for height

compared to the height of

children of the same age and sex

from a reference population

It is an indicator of chronic

malnutrition and is used to

identify stunted children.

Weight for

height

Is a measure of weight compared

to the weight of children of the

It is an indicator of acute,

malnutrition.

5

same height from a reference

population

Under weight Weight is below minus 2

standard deviation of expected

weight of children of the same

age from a reference population.

Stunting Height is below minus 2


height of children of the same

age from the reference

population.

Wasting Weight is below minus 3


weight of children of the same

height from a reference

population.

Classification of PEM:

Within the spectrum of PEM, three broad clinical types were recognized namely

kwashiorkor, marasmus and marasmic- kwashiorkor. This classification is based on

the presence or absence of edema. Waterloos (1972) recommended a classification of

PEM (Including kwashiorkor) based on weight and height that has special value to

determine whether the nutritional status of children in a community demands urgent

action in the form of food supplementation from external sources.

Marasmus:

Children who develop marasmus do so as a consequence of inadequate food intake.

The clinical picture of marasmus is characterized by the progressive wasting of

subcutaneous tissues and muscle until eventually the infant is a virtual skeleton,

covered by skin. As the tissue wastes, bones and joints become more prominent and

the head begins to appear disproportionately large for the body. The skin become

loose and may eventually hang in folds. The skin appearance over wasted buttocks

6

and thighs is similar to those of a trouser too large for the wearer. In young infants the

buccal pad of fat, which gives the cheeks their full rounded appearance, may persist

long after subcutaneous fat has disappeared from other areas. Disappearance of the

buccal pad of fat in a marasmic infant is a serious Prognostic sign which should never

be ignored. The abdomen may be scaphoid or distended. Wasting of the abdominal

wall is often so marked that the underlying pattern of bowel and peristalsis may be

observed. The liver may be palpable but it is not usually enlarged and structures like

the kidneys may be easily palpated. The skin shows no constant or characteristic

changes but tends to be wrinkled and dry and may be scaly. There are no constant or

characteristic biochemical derangement associated with marasmus. Electrolyte

derangements that may be observed are usually secondary to diarrhea. Plasma

proteins, lipids, enzymes and hormones are usually within the normal range in

nutritional marasmus. Marasmic children are usually unhappy and irritable.

Kwashiorkor:

It arises as a result of protein deficiency. Damage is expressed clinically as edema,

fatty liver and dermatitis. The peak-age incidence of kwashiorkor varies and can be

correlated with weaning practices. The onset is usually insidious with symptoms and

signs evolving over a period of several weeks, but rapid progression of symptoms

may occur over a period of days. Edema is invariable but may not be immediately

apparent in mild cases. It varies in degree and distribution from slight pitting over the

legs or feet to gross generalized edema. The mental state and behavior of these

children are among the most constant and characteristic feature of the disease, they

are objectively miserable, apathetic and desire to be left alone. The skin changes are

very variable and do not show a constant relationship to the degree of edema and

other features of the disease. A classical skin change is the appearance of patchy areas

of intense hyperpigmentation (often with clearly defined margins) that tend to occur

over the buttocks, the back of limb and the trunk They are sometimes referred to as

'black enamel' or 'black paint' dermatitis. The hyper pigmented skin frequently

desquamates leaving raw areas which may ulcerate.

Angular stomatitis, cheilosis and oral thrush are common. Typically, the hair become

sparse and thin, and in African children, loses its tight curliness and become

7

straightened. Some lightening of color is usual but not invariable. A moderate degree

of anemia is usual. When severe anemia occurs it is usually as a result of associated

iron and / or folate deficiency, complicated infections or due to parasites such as

malaria or hook worms. The liver is usually moderately enlarged but may not be

palpable or it may be greatly enlarged. It is typically smooth, non-tender and of a

normal consistency.

1.1.4 Contextual background


under nutrition as a result of poor breastfeeding practices every year. This translates to

about 3 million unnecessary loss of young lives per year (UNICEF, Updated Feb

2016). Under nutrition is a preventable cause of death among children below the age

of 5 years (Sleive Collins et al 2006). Worldwide the prevalence rate of admitted

infants and children to hospitals with both acute malnutrition and mixed diagnosis

ranged from 6.1 to 40.9% as stated by (Joosten et al., 2008).

In the African continent, children make up one quarter of the estimated 148 million

underweight children globally with the Sub Saharan region being the most affected

with an increment of 43 million people being affected.

In Uganda, the persistent high rates of malnutrition in children below the age of 5

years are a result of inadequate access to food, poor infant feeding practices, poor

sanitation and health practices. 38% suffer from chronic malnutrition, 16% are under

weight and 6% suffer from acute malnutrition. Some of the core nutrition

interventions provided by government do include the following; Encouraging mothers

to exclusively breastfeed, improve maternal nutrition and health and promotion of

nutritional education (UFNP adopted in 2003).

The institutional framework for improving nutrition in Uganda is at different levels.

At the National level; the nutrition unit is based in the division of child health under

the department of community health; At Regional level; MOH staff structure includes

8

a senior nutritionist and a nutritionist at the referral hospitals with a focus on both

curative and rehabilitation services within the hospital. At District level; DHO

coordinates health and nutrition activities promoted by the government, NGOs and the

private sector partners. At the general hospital there is only one nutritionist. At

Community level; VHTs are used to interface between the community and the health

facilities.

In conclusion, there are many related studies that have been done about the effects of

the different breastfeeding practices on the nutritional status of children below the age

of 5 years elsewhere in the world but none has been done within Sheema district. This

study will therefore help establish the effects of the different breastfeeding practices

on the nutritional status of children below the age of 5 years within Sheema district.

1.2 PROBLEM STATEMENT

In 2016 UDHS data collected on infant and young child feeding practices among

children below the age of 2 years showed that 66% of the children less than 6 months

were exclusively breastfed and the remaining 34% were on supplementary

breastfeeding. Overall 4% of the children are wasted and 1% are severely wasted (-

3SD) with the highest prevalence rate being in Karamoja sub regions and Teso being

the least. As a result of the increased prevalence rate in Uganda specifically in

Karamoja, there has also been an increase in the mortality rate of infants reported.

There has been no research conducted in Sheema district pertainingthe different

breastfeeding practices and the nutritional status of children below the age of 5 years.

1.3 OBJECTIVE OF THE STUDY

1.3.1 General objective

To assess the different breastfeeding practices and nutritional status of children below

the age of 5 years.

1.3.2 Specific Objectives

1. To determine the socioeconomic and demographic characteristics of the

mothers of children below the age of 5 years.

9

2. To determine the differentbreast feeding practices of children below the age of

5 years.

3. To determine the nutritional status of children below the age of 5 years.

1.4 RESEARCH QUESTIONS

1. What are the socioeconomic and demographic characteristics of the mothers of

children below the age of 5 years?

2. What are the different breast feeding practices of children below the age of 5

years?

3. What is the nutritional status of children below the age of 5 years?

1.5 SIGNIFICANCE OF THE STUDY

Due to malnutrition being the cause of mortality and morbidity below the age of 5

years along with the several policies that have been suggested to improve the

nutritional status but unfortunately have either not been well adopted or afforded by

the community has led to the need to conduct this study to assess the different

breastfeeding practices andthe nutritional status of children below the age of 5 years

and why the suggested policies have failed to be adopted and accepted by the

community. Information generated at the end of the research was of both benefit to

the institution and the community where the research was being conducted.

a) Institution

It is anticipated that once this research is completed successfully it will

generate more additional information and knowledge to the already existing

knowledge on issues relating to the different breastfeeding practices on the

nutritional status of children below the age of 5 years.

b) Community

The study could also help the policy makers have a better understanding of the

impact of the different breastfeeding practices on the nutritional status of

children below the age of 5 years and this will further enable them to make

more specific laws and policies concerning the different breastfeeding

practices in order to improve the nutritional status of children below the age of

5 years.

10

Currently in Uganda specifically Sheema district there is no information about

the impact of the different breastfeeding practices andthe nutritional status of

children below the age of 5 years hence the information collected and

analyzed could be kept and used in the future as reference for similar studies

to be conducted within the given region.

1.6 SCOPE OF THE STUDY

1.6.1 Time Scope

The research was done during August 2017 to March 2018 which involved data

collection, analysis and interpretation of the research findings.

1.6.2 Geographical scope

Kitagata General Hospital is located in the central business district of the town of

Kitagata, in Sheema district. The district is found in the Ankole sub region in western

Uganda and it’s about km from Kampala the capital city of Uganda by road. Sheema

is bordered by Buhweju district to the north, Mbarara district to the East, Ntungamo

district to the south, Mitooma district to the southwest and Bushenyi district to the

west. The district covers an area of 699.1km2 with an elevation of 1500m (4,900ft). Its

coordinates are 00 32S, 30 24E with a total population of 220,200 people as per 2012

and a density of 315km2. The hospital has a bed capacity of 120 beds.

1.6.3 Content scope

The study was basically centered on establishing the different breastfeeding practices

andthe nutritional status of children below the age of 5 years.

The study involved breastfeeding mothers of children below the age of 5 years

attending Kitagata general hospital.

11

1.7 CONCEPTUAL FRAME WORK

Independent Variables Dependent Variables

Intervening Variables

Figure 2: Conceptual Framework(Designed by researcher)

Breastfeeding Practices

1. Exclusive breastfeeding

2. Complementary

breastfeeding

Child Factors

1. Age

2. Weight

3. Height/Length

4. MUAC

Maternal Factors

1.Demorgraphics

-Name,

-Age

-Sex

2.Sociodemographic

-Marital status,

-Religion,

-Occupation,

-Education status.

Nutritional Status

1. Edematous Severe Acute

Malnutrition.

2. Non edematous Severe

Acute Malnutrition.

3. Healthy OR Normal

Health Factors

Government health policies like

1. Immunization,

2. Community health sensitization

3. Awareness programs.

12

CHAPTER TWO

LITERATURE REVIEW

2.0 INTRODUCTION

This section reviews previous research addressing the nutritional status of children

aged below 5 years and the various factors associated with it. This information is

required to identify and address these issues for improving the health and overall

nutritional status of these children.

2.1 ANTHROPOMETRIC INDICATORS TO ASSESS NUTRITIONAL

STATUS OF CHILDREN

The following section reviews the indicators used to assess the nutritional status of

children less than 5 years. Anthropometric measurements are the most common tool

used to assess the nutritional status of a population and to monitor growth in children.

The anthropometric indices commonly used are weight-for-height, height-for-age and

Weight-for-age expressed as percentiles or z-scores representing the overall

nutritional status of a child. Wasting, stunting and underweight is identified by the

weight-for height, height-for-age and weight-for-age < - 2.0 standard deviation (SD)

respectively, while weight-for-height and weight-for-age > 2.0 SD are also used to

assess overweight in children. The use of body mass index (BMI; weight/height2) is

used to assess overweight status in children 2 years and older with a cutoff > 95th

percentile or 2.0 SD. Longitudinal studies have indicated a significant correlation

between childhood BMI and adult adiposity.

2.1.1 Importance of birth weight on nutritional status

The nutritional status of children is known to be influenced by several factors, of them

birth weight is an important component. As defined by the World Health

Organization, birth weight is the first weight of the newborn obtained within the first

hour of life. A birth weight less than 2500 grams is defined as low birth weight and is

a universally accepted classification. The relationship between birth weight and

nutritional status of children at the end of their first year of life was investigated by

Motta et al. (2015), who reported the significant influence of low birth weight on the

13

incidence of underweight among children, compared to those who had birth weight

above 2500 grams. More recent studies confirmed the importance of birth weight as a

determinant of a child’s nutritional status. A study conducted in Vietnam, to assess

the nutritional status and factors contributing to malnutrition in children less than five

years of age also reported similar findings. Of the 650 children included in the study,

31.8% were underweight, 44.3% were stunted and 11.9% were wasted. Interestingly,

children born low birth weight had higher risks of being malnourished compared to

their normal birth weight counterparts. The odds ratio for underweight, stunting and

wasting were as high as 7.7, 5.6 and ee5.2 respectively in low birth weight children

thereby indicating the negative impact of low birth weight on future weight gain and

linear growth pattern of a child.

2.1.2 Determinants of under nutrition in children

Epidemiological studies conducted in developing countries have identified several

causes of under nutrition in children. The most prominent cause is poverty, followed

by low levels of parental education, poor dietary intake by children and rural

residence. For example, children < 5 years from low socio-economic households were

found to have twice the risk of being stunted than children from rich households in

Ghana.

The association between poverty and under nutrition is mainly due to lack of adequate

and nutritionally balanced diet, health care and poor living conditions. As reported by

JalanandRavallion (2013), children living in households without piped water system

were more susceptible to diarrhea that influenced their overall health status compared

to those with access to piped water. Underweight among these children were also

strongly associated with maternal education, as children of mothers with no formal

education were more likely to be underweight than children of mothers with at least

secondary school education. An examination of the Bangladesh Demographic Health

Survey reported children from households with low socio-economic status and

illiterate mothers were at a greater risk of being undernourished. Other studies have

shown the influence of place of residence on the nutritional status of children. A study

by (Shenet al.2012) revealed that despite economic reforms in both rural and urban

China, higher percentage of rural children aged 2 to 5 years (38.0%) were stunted as

14

compared to urban children (10.0%) this evidence clearly indicates the increased risk

of poor nutritional status for rural children compared to their urban Counterparts. In

addition to the anthropometric indices that reflect optimal growth or growth faltering,

iron supplementation is also indicative of overall nutritional status. Iron deficiency

adversely affects the immune system and increases the onset of diseases in children.

Children from both developing (Kenya and Bangladesh) and industrialized countries

(United Kingdom and United States) were found to benefit from iron supplementation

with respect to growth and reduced incidence of diarrhea and other infections. Among

the various socio-demographic causes, maternal illiteracy and poverty remained

primary causes. A more recent study by (Pasrichaet al.2010) reported low ferritin and

hemoglobin levels in children from households with low socio-economic status.

Maternal and household characteristics are directly associated with feeding and health

care practices received by the child. Poor dietary intakes, lack of health care and

incomplete immunization are immediate causes of under nutrition and have been

identified as potential modifiable risk factors. Several epidemiological studies have

confirmed the importance of dietary pattern and immunization coverage for optimum

growth and nutritional status in children.

2.1.3 Dietary practices and nutritional status of children

On the 16th of November 2011 at about 1: 17pm, New vision released a report that

was organized and presented by BRAC Uganda an NGO offering different services

aimed at creating awareness on the availability of the nutrient rich food crops in

Uganda. The report was indicating over 2 million children in Uganda below the age of

5 years were chronically malnourished. Malnutrition was the underlying cause of

death in nearly 60% of the infants and 25% of mothers especially in the rural areas

where there were high incidences of poverty and malnutrition as compared to their

urban counterparts. It was also revealed that children below the age of 5 years

affected by malnutrition accounted for 38% of which 16% were underweight while

6% were wasted.

The World Health Organization (WHO) has issued guidelines regarding infant and

child feeding practices. These guidelines encourage the promotion of exclusive

15

breastfeeding for the first six months and initiation of complementary feeding

thereafter. The guidelines also promote continued breastfeeding till the child’s second

birthday. Notzon (2011) studied the changing pattern of breastfeeding in 7 developing

countries using data from cross-sectional surveys. His study revealed a notable

decline in average duration of breastfeeding in these countries, by ethnicity and

modernization. More recently, the changing pattern of infant feeding practices in

developing countries was reviewed by King and Ashworth (2012). While extended

breastfeeding and early introduction of complementary feeding were traditional norms

among low-income mothers in Malaysia and the Caribbean, a notable decrease in the

duration of breastfeeding was observed in these countries. Early introduction of

complementary feeding, that is before the age of 6 months is significantly associated

with poorer growth patterns among infants. A longitudinal study of 4 cohorts of

infants in Vietnam examined this association and reported growth faltering in infants

receiving premature complementary feeding compared to exclusive breastfeeding at 3

months. Not only were weight and length gain delayed among infants who were

partially breast-fed or weaned compared to exclusive breastfed infants at 1 to 3

months of age, a similar trend was also observed among infants aged 3 to 6 months,

thereby confirming the negative consequences of early weaning. Additionally,

morbidity from diarrhea and acute respiratory infections was significantly lower in

infants who were exclusively breastfed compared to their weaned counterparts. In

spite of the global guidelines on infant feeding practices, adherence to these

recommendations is limited in developing countries. A longitudinal study of

newborns in Malawi, Africa, highlighted this notion. Although universal

breastfeeding was practiced for 18 months, rates of exclusive breastfeeding were only

19.0%, 8.0%, 2.0% and 0.0% at ages 1, 2, 3 and 4 months, respectively. Moreover,

the average age range of introduction of complementary foods varied from 2.5 to 6.3

months, indicating premature initiation of weaning. Evidence suggests that maternal

characteristics such as age, education, employment and marital status impact infant

feeding practices. Adherence to the feeding recommendations varied with respect to

the mother’s education level and SES. Previous studies have established the impact of

household and community characteristics on infant feeding practices and overall

nutritional status.

16

A cross-cultural study by (Abel et al 2011) in New-Zealand showed the existence of

inter-ethnic similarities and differences in infant care and feeding practices. Kannan

and group (2010) compared American mothers and Asian-Indian-American mothers

residing in the United States for a median duration of 6 years with respect to infant

feeding practices. Their study revealed that beliefs about prelacteals, introduction of

solid foods and feeding carbonated beverages differed significantly between

American and immigrant Asian-Indian-American mothers. This study thus

accentuates the influence of culture on infant feeding practices. The influence of

cultural beliefs and traditions on infant feeding practices and its effect on child’s

nutritional status in Puerto Rico was studied by Higgins in 2012. This again revealed

that culture was an important predictor of infant feeding practice. Infant feeding

practice is also influenced by other household factors such as presence of a

grandparent and place of residence. Feeding practices in households with a

grandmother present were significantly influenced with respect to the time of

introduction and type of solid foods received by the infant. In a low socio-economic

rural African community, although breastfeeding was initiated in 99.0% of the study

sample, more than 60.0% of the infants included in the study had been introduced to

water during their first month of life. Moreover, nearly 95.0% of the infants were

introduced to solid foods at 2-4 months of age. This study therefore highlights that

although the rate of breast feeding initiation is relatively high in developing countries,

exclusive breastfeeding is rarely practiced. Similarly, while breastfeeding was

initiated by 97.0% mothers in a cross-sectional study in Brazil, early introduction of

complementary feeding was the usual norm. Moreover, the dietary pattern of the

infants/children aged 0 – 24 months mainly comprised of a higher intake of

carbohydrate rich foods, cow’s milk and lower intake of animal protein. Failing to

initiate breastfeeding 6 hours after birth, lack of colostrum and improper

complementary foods were all significant predictors of poor nutritional status of

Indian children under 5 years of age.

17

2.1.4 Indicators of infant/child feeding practices

This section reviews the indicators in use for assessing infant and child feeding

practices. For the purpose of this research proposal, feeding practices include

breastfeeding for infants < 6 months and dietary diversity for older children (> 6

months). Feeding practices are based on a 24-hour dietary recall by the

mother/caretaker. Researchers have identified differences in the assessment of

exclusive breastfeeding with variability in the methods and breastfeeding definitions.

(Aarts et al, 2012) examined the underlying differences between data pertaining to the

‘current 20 status of breastfeeding’ (based on 24-hour recall) and ‘exclusive

breastfeeding since birth’ (based on daily recording) and reported a discrepancy

between the results. However, epidemiological studies have employed food records

and dietary recall by the infants’/children’s caretakers to assess exclusive

breastfeeding and dietary practices. Information obtained retrospectively by Launer

and group (2012) examined the accuracy of maternal recall regarding infant feeding

practices and reported positive results. Although levels of accuracy were lower for

formula feeding compared to other feeding practices, accuracy rates were

significantly higher for breastfeeding and complementary feeding. The review by (Li

et al., 2015) also documents evidence of validity and reliability of maternal recall for

infant feeding practices. Additionally, WHO has developed indicators for assessing

breastfeeding practices for household surveys using the 24-hour dietary recall? Other

studies have successfully utilized this approach to estimate the duration of exclusive

breastfeeding. The national level Demographic and Health Surveys (DHS) have

therefore incorporated the 24-hour feeding recall method to obtain information on

infant and child feeding practices.

2.2EXCLUSIVE BREASTFEEDING AND COMPLEMENTARY

BREASTFEEDING

2.2.1 Exclusive breastfeeding

Determinants of EBF are the factors or conditions that might lead to some changes in

the practice by for instance encouraging or impeding it. The extent to which these

determinants or factors affect EBF is fairly complex and varies from one country to

another and/or between different groups in the same country. Some are biological and

18

beyond women’s control (e.g. Breast engorgement, nipple problems etc.) while others

are combinations of economic, environmental, cultural, social etc. Albeit with

quantitative approaches, several of these determinants have been extensively studied

and documented in recent years. In a research to examine the perceive, incentives and

barriers to EBF among pre-urban Ghanaian women, Otoo,Larty and Perez-Escamilla

(2011) found supposed milk insufficiency, family pressure, breast and nipple

problems, and maternal employment as barriers to EBF. The risk of diseases resulting

from poor sanitation, ready availability of breast milk after birth and the high cost of

infant formula were also inter alia identified as motivations to EBF. An earlier study

by Perez-Escamillia, et al. (2015) in three Latin American countries (Brazil, Honduras

and Mexico) also revealed that lower socioeconomic status (in Honduras and

Mexico), prior planning on EBF duration (in all the 3 countries), maternal

unemployment (in Brazil and Honduras), hospital delivery facilities that had

breastfeeding promotion services, and having a baby girl (in Brazil and Honduras)

were all positively associated with EBF. In a similar study to assess factors associated

with EBF in Accra, Ghana, Aidam and colleagues (2015) too reported delivery at

hospital/polyclinic, prior intention or planned EBF at birth, higher education,

socioeconomic status, and positive attitudes towards EBF as the most essential

support factors for EBF (P.793). Further research in Mazabuka of Southern Zambia

by Fjeld et al. (2011) similarly found feelings of breast milk inadequacy, perception

of ‘bad milk’, limited knowledge about EBF, and conventional family expectations as

obstructions to EBF. Indeed, several other researchers (Senerath, Dibley and Agho,

2010; Arora, Mcjunkin, Wehrer and Kuhn, 2014; Alemayehu, Haidar and Habte,

2011) have also linked the practice of EBF to factors similar to the aforesaid. Whereas

some of the aforementioned determinants have been consistently recognized as

barriers to EBF (e.g. perception of milk insufficiency, maternal employment,

inadequate knowledge etc.), others have been less straight forward. For instance, the

connection between breastfeeding mothers’ level of education and desirable or

undesirable breastfeeding practices has been wavering from one study to another and

in some cases from one form of behavior to another in the same study. Educated

mothers in Western Uganda for example were on one hand, more inclined to use

prelacteal feeds; and yet on the other hand were also likely to prepare nutritionally

19

good complementary food for their children (Wamaniet al. 2015). The difficulty in

relation to education’s role in this instance is whether education enhances one’s

cooking abilities or it is increased incomes resulting from education that occasions

one’s ability to prepare good complementary foods.

2.2.2 Complementary breastfeeding

When breast milk is no longer enough to meet the nutritional needs of the infant,

complementary foods should be added to the diet of the child. The transition from

EBF to family foods, referred to as complementary feeding, typically covers the

period from 6 to 18-24 months of ages, and is a very vulnerable period. It is the time

when malnutrition starts in many infants, contributing significantly to the high

prevalence of malnutrition in children less than 5 years of age worldwide. WHO

estimates that 2 out of 5 children are stunted in low income countries. Complementary

feeding should be timely, meaning that all infants should start receiving foods in

addition to breast milk from 6 months onwards. It should be adequate, meaning that

complementary foods should be given in amounts, frequency, and consistency and

using a variety of foods to cover the nutritional needs of the growing child while

maintaining breastfeeding. Foods should be prepared and given in a safe manner,

meaning that measures are taken to minimize the risk of contamination with

pathogens. And they should be given in a way that is appropriate. The adequacy of

complementary feeding (adequacy in short for timely, adequate, safe and appropriate)

not only depends on the availability of a variety of foods in the household, but also on

the feeding practices of caregivers. Feeding young infants requires active care and

stimulation, where the caregiver is responsive to the child clues for hunger and also

encourages the child to eat. This is also referred to as active or responsive feeding.

WHO recommends that infants start receiving complementary foods at the age 6

months in addition to breast milk, initially 2-3 times a day between 6-8 months,

increasing to 3-4 times daily between 9-11 months and 12-24 months with additional

nutritious snacks offered 1-2 times per day, as desired. Inappropriate feeding practices

are often a greater determinant of inadequate intakes than the availability of foods in

the households. WHO has developed a protocol for adapting feeding

recommendations that enables program managers to identify local feeding practices,

20

common problems associated with feeding and adequate complementary foods. The

protocol builds upon available information and proposes household trials to test

improved feeding recommendations. WHO recommends that the protocol be used to

design interventions for improved complementary feeding, and is included as part of

adaption process of the integrated management of childhood illness strategy. Research

has shown that caregivers require skilled support to adequately feed their infants.

2.3 SOCIOECONOMIC AND DEMOGRAPHIC FACTORS AFFECTING

BREASTFEEDING MOTHERS

Extensive breastfeeding research has been done to identify factors that influence

breastfeeding initiation and duration. The literature however suggests that predictors

of breastfeeding may vary in the different parts of the world. For instance, studies in

Australia, Iceland, Ireland and Scotland as well as the USA have found that the

breastfeeding rates are higher among women who are older and have high levels of

education (Baghurst et al…2013, Cairney and Barbour 2015, Tarrant and Kearney

2012). Additionally, high incomes have also been associated with increased

breastfeeding rates in areas such as Sweden (Wallby and Hjern 2011) and rural

Jamaica (Chatman et al…2014). A study by Qui Zhao, Binas, Lee and Xie (2011) in

Zhejiang China, which looked at initiation and prevalence of breastfeeding, however

suggested that younger mothers with lower educational levels and family income are

more likely to breastfeed. In Brazil, a mother’s daily contact with their own mother

had a negative impact on breastfeeding (Susin, Giugliani and Kummer 2015) while

the study performed by Grassley and Eschiti (2014) on mother’s in Texas USA

suggested that grandmother’s value regarding breastfeeding was considered to

positively influence their daughter’s breastfeeding practices. In South Asia, an

intervention which involved a leaflet with information on health benefits of

breastfeeding as well as the good practices to educate both mothers and grandmothers

increased the likelihood of breastfeeding (Ingram, Johnson and Hamid 2015.

Meanwhile while/when computing urban versus rural areas, the results of the studies

comparing breastfeeding initiation are not consistent. For example, (Kamudoni,

Maleta, Shi and Halmboe, Ottesen 2011) used the cross-sectional household study

that consisted of 157 rural and 192 Semi Urban mother infant pairs in Malawi and

21

found that the Semi Urban mothers were more likely to engage in exclusive

breastfeeding however, the other studies found that women in the rural areas were

most likely to practice breastfeeding (Qui et al…2013). Economically, China has

undergone a rapid surge and transition. The economic growth may have affected the

practice of breastfeeding and the increased marketing of the breast milk substitutes

could have contributed to the decrease in the breastfeeding (Xul et al…2012). The life

style and socioeconomic levels of individuals in China have also greatly contributed

to the decrease in the breastfeeding of the children.

22

CHAPTER THREE

METHODOLOGY

3.0 STUDY DESIGN

The study was a descriptive cross-sectional study using quantitative methods. The

design aimed at obtaining data about the different breastfeeding practices

andnutritional status of children below the age of 5years in Sheema district, Uganda.

3.1 STUDY POPULATION

The study focused on the sample population of children below the age of 5 years.

3.2 SAMPLING TECHNIQUE

Simple random sampling technique was used.

3.2.1 Sample size determination

From the medical reports in the district of Sheema, % of the breastfeeding mothers do

have children between the ages of 0 to 5 years. Assuming a standard error of

5%(0.05) at 95% confidence interval the sample required was determined as follows.

n= Z2Pq

d2

Where: n- Is the sample size

Z-It’s the normal deviate (Confidence limit) which is taken as 1.96 at 95%

confidence level.

P- I the proportion of the breastfeeding mothers with children below the age

of 5 years in the study population.

q- Is the proportion of the population of non- breastfeeding mothers with the

children greater or equal to 5 years in the study population.

d- It’s the acceptable margin of error desired.

The calculated sample was 206. This was calculated based on fisher et al…. 1998

formula of n= Z2Pq Where Z=1.96, P=0.16 and d=0.05

d2

n=1.962 X 0.16(1-0.16) =206

0.052

23

3.2.2 Sampling procedure

Simple random sampling was used. The procedure allowed for convenience of the

patients. All children below the age of 5 years attending Kitagata general hospital and

meet the inclusion criteria were recruited for the study. Simple random sampling was

then being applied to establish the actual sample cases. A number was assigned to

every subject of the study population. These numbers were written on the small pieces

of paper. All the papers were then being put in a box after which the box was shaken

vigorously to ensure randomization. The papers were picked at random from the box

and the numbers recorded. The subjects responding to the numbers picked were also

recruited. The area considered for study wasKitagata general hospital.

3.2.3 Inclusion and exclusion criteria

3.2.3.1 Inclusion criteria

All children below the age of 5years in Kitagata general hospital who

are still breastfeeding.

3.2.3.2 Exclusion criteria

Children above the age of 5 years in Kitagata general hospital.

All children within the age bracket of 0 to 5 years but with congenital

abnormalities or Deformity

Refusal of parents to have their children between the ages of 0 to 5

years to be included in the study.

3.3 DATA COLLECTION

The study applied only quantitative analysis by the use of structured questionnaires

3.3.1 Questionnaire

Data was collected from the breastfeeding mothers with children below the age of 5

years and the questionnaire comprised of the structured questions having both the

closed ended and open ended questions. The questionnaires were used to collect the

following information from the key respondents;

1. Different breastfeeding practices of children below the ages of 5 years.

24

2. Nutritional status of children below the age of 5 years.

3. Socioeconomic and demographic factors affecting breastfeeding mothers.

3.3.2Anthropometric measurements technique

Height, weight and head circumference were obtained for all children

participating in the study by using standard anthropometricprocedures.

a) Weight

Body weight with minimum clothes was obtained and recorded. The children below

5 years were put on a single beam scale.

.

b) Length-

The length for those less than 5 yearswas measured using an infantometer

c) Height

The height for children less than 5 years was obtained in bare footed children using

height anthropometer (standiometer). The anthropometer consist of a measuring tape

attached to a movable plastic triangle comprising the head piece, the measuring tape

stretched to its maximum and placed on a flat wall. The child was made to stand on

the floor with the feet in the parallel position and with the heel, buttocks, shoulders

and back of the head touching the wall while the head in the erect position and the

arms hanging loosely at the side. The head piece of the scale was brought down

perpendicular to the wall and parallel to the top of the head. The measuring scales was

adjusted and checked before each measuring section.

d) Head circumference

This was measured using flexible non-stretch tape which was made to encircle the

child's head at the occipito-frontal diameter.

e) Mid upper arm circumference

The subject was positioned as for the measurements of head circumference with the

left arm completely relaxed and extended by the side. A mark was drawn on the

lateral side of the upper arm midway between the acromion and the olecranon. The

25

tape was then passed around the arm, so that it does touch the skin but not

compressing the tissue, and the measurement read to the last completed unit.

3.4 DATA ANALYSIS

3.4.1 Quantitative Data Analysis

The data was edited before, during and after leaving the respondents. The researcher

checked for uniformity, accuracy, consistency, legibility and comprehensibility. It

was coded and tabulated using SPSS program. Chi-square tests was calculated using

independent variables such as age, sex, level of education and income and the

dependent variable like the nutritional status and consistent deployment of ITNs.

3.5 ETHICAL CONSIDERATIONS AND PROCEDURE

The researcher got an introductory letter from Kampala international University

Teaching Hospital Western campus. The letter was presented to the hospital

administration to seek permission to conduct research within the hospital. The

interviews were conducted at Kitagata general hospital. Each interview lasted about

20 minutes.

In regard to ethical considerations, the rights of individuals and institution were

respected. The researcher first asked consent from of all the respondents prior to the

interviews and respondents was assured of confidentiality of their responses and that

information would not be used for anything else other than that of the study

3.6 ANTICIPATED PROBLEMS

The delimitations of the study included the following; the small geographical area,

one hospital may not be a representation of the nutritional status of breastfeeding

children below the age of 5 years in Sheema district and the other limitation of the

study may include; failure of key informants to fulfill appointments made with them.

DATA ANALYSIS AND INTERPRETATION

4.0: INTRODUCTION

This chapter deals with data analysis and results interpretation. The

conducted in Kitagata hospital of Sheema district in western Uganda

of determining the different breastfeeding practices

between the ages of 5 years

who were randomly selected.

4.1 THE AGE DISTRIBUTION OF MOTHERS IN Y

Figure 2: A Cylindrical graph showing the age distribution of Mothers in years

The age group 25-29 years was the

while the least age group was 15

0

10

20

30

40

50

60

70

80

15

Frequency

Fre

qu

ency

26

CHAPTER FOUR


4.0: INTRODUCTION

This chapter deals with data analysis and results interpretation. The

conducted in Kitagata hospital of Sheema district in western Uganda

of determining the different breastfeeding practices and nutritional status of children

between the ages of 5 years in Sheema district Uganda. There were 203 participants

who were randomly selected.

4.1 THE AGE DISTRIBUTION OF MOTHERS IN YEARS


29 years was the most73 (36%), followed by 20

while the least age group was 15-19 years old2 (1%).

15-19 20-24 25-29 30-34

2 48 73 45

2

48

73

45

Mother's age in years


This chapter deals with data analysis and results interpretation. The study was

conducted in Kitagata hospital of Sheema district in western Uganda for the purpose

nutritional status of children

. There were 203 participants


36%), followed by 20-24 years 48(24%)

>34

35

35

4.2: MARITAL STATUS OF THE

Figure 3: A cylindrical graph showing marital status of the Mothers

Most of the participants were Married

single 3(1%). No mother was widowed.

4.3 EDUCATION LEVEL OF RESPONDENTS

Table 2: Showing education

From the table above,

37(18%) attended secondary education,

9(5%) did not attended any level of education.

0

50

100

150

200

MarriedFrequency

Fre

qu

ency

Marital status of the Mothers

Education Level

primary

Secondary

Tertiary

None

Total

27

4.2: MARITAL STATUS OF THE MOTHERS

: A cylindrical graph showing marital status of the Mothers

Most of the participants were Married 196(97%) followed by divorced

(1%). No mother was widowed.

4.3 EDUCATION LEVEL OF RESPONDENTS

Showing education level of respondents

From the table above, 151(74%) of the participants attended primary education,

attended secondary education, 6(3%) attended tertiary education while

did not attended any level of education.

Married Divorced Single Widowed196 4 3 0

196

4 3 0

Marital status of the Mothers

Frequency Percentage

151 74%

37 18%

6 3%

9 5%

203 100%

: A cylindrical graph showing marital status of the Mothers

(97%) followed by divorced 4(2%) and

of the participants attended primary education,

attended tertiary education while

Widowed

0

28

4.4 RELIGION OF RESPONDENTS

Figure 4: A pie chart showing the religion of the participants

68% of the participants were Anglican, 28% were Catholics, 2% were muslim, and

2% were Adventist by religion.

4.5: OCCUPATION OF THE RESPONDENTS

Table 3: A table showing occupation of the respondents

OCCUPATION FREQUENCY PERCENTAGE

Peasant farmer 47 23%

Business woman 6 3%

House wife 125 62%

Others specify 25 12%

Total 203 100%

According to the findings, 125(62%) of the respondents were house wives, 47(23%)

were peasant and 6(3%) were business women. While 25(12%) were other

occupations like tailoring and teaching.

Catholic28%

Anglican68%

Adventist2%

Moslem2%

Religion of respondents

4.6: RESPONDENT’S SOURCE

Figure 5: Pie chart showing respondent’s source of income

79% of the participant’s source of income was farm

While17% of the income’s source were from other sources like tailoring and teaching.

4.7: RESPONDENT’S

Figure 6: A bar graph showing respondents monthly earning in uganda shillings

105(52%) of the respondents monthly earning was between 10,000

by 58(28%) respondents whose earning were < 10,000 while

monthly earning.

Business

Others specify17%

0

20

40

60

80

100

120

58

Fre

qu

ency

29

4.6: RESPONDENT’S SOURCE OF INCOME

ie chart showing respondent’s source of income

79% of the participant’s source of income was farming and 4% from business.

17% of the income’s source were from other sources like tailoring and teaching.

4.7: RESPONDENT’S MONTHLY EARNING

: A bar graph showing respondents monthly earning in uganda shillings

of the respondents monthly earning was between 10,000-

respondents whose earning were < 10,000 while 12(6%

Farming79%

Business4%

Others specify17%

Source of income

58

105

1810

Monthly earning

ing and 4% from business.

17% of the income’s source were from other sources like tailoring and teaching.

: A bar graph showing respondents monthly earning in uganda shillings

-50,000 followed

6%) didn’t have any

12

4.8: RESPONDENT’S NUMBER OF CHILDREN

Figure 7: A cylindrical graph showing the participant’s number of children

From the findings, 89(

3-4 children. Only 8(4

4.9: EXCLUSIVE BREASTFEEDING OF THE CHILD

Figure 8: A pie chart showing exclusive breastfeeding of the respondent’s child

96% of the children were not exclusively breastfed while only 4% were exclusively

breastfed

0

20

40

60

80

100

Frequency

Fre

qu

ency

30

4.8: RESPONDENT’S NUMBER OF CHILDREN

: A cylindrical graph showing the participant’s number of children

89(44%) of the participants have 1-2 children while

8(4%) of the participants have > 6 children

4.9: EXCLUSIVE BREASTFEEDING OF THE CHILD

: A pie chart showing exclusive breastfeeding of the respondent’s child


1-2children

3-4children

5-6children children

Frequency 89 74 32

8974

32

Number of children

Yes4%

No96%

EBF of the child

: A cylindrical graph showing the participant’s number of children

2 children while 74(36%) have

: A pie chart showing exclusive breastfeeding of the respondent’s child


> 6children

8

8

4.10: NUMBER OF EXCLUSIVE BREASTFEEDING PER DAY

Figure 9: A cylindrical graph showing number of EBF per day

Of the 4% children who were exclusively breastfed, 45% were breastfed > 9 times per

day, 33% were breastfed 7

day

4.11: DURATION OF EACH BREASTFEEDING

Table 4: A table showing duration of each breastfeeding for

children

DURATION OF EACH BF

<10 minutes

10-19 minutes

20-30 minutes

> 30 minutes

Total

Of those exclusively breastfed, 78% were breastfed for <10 minutes, while 11% were

breastfed for 10-19 minutes. None was breastfed for > 30 minutes.

0

0.5

1

1.5

2

2.5

3

3.5

4

1-3 times

0

Fre

qu

ency

Number of EBF per day

31


: A cylindrical graph showing number of EBF per day


day, 33% were breastfed 7-9 times per day while 22% were breastfed 4

4.11: DURATION OF EACH BREASTFEEDING

: A table showing duration of each breastfeeding for exclusively breastfed

DURATION OF EACH BF FREQUENCY PERCENTAGE

7 78%

1 11%

1 11%

0 0%

9 100%


19 minutes. None was breastfed for > 30 minutes.

3 times 4-6 times 7-9 times > 9 times

2

3

4

Number of EBF per day

Frequency



breastfed 4-6 times per

exclusively breastfed

PERCENTAGE

78%

11%

11%

0%

100%


Frequency

4.12: TIME OF BF INTIATION FROM BIRTH

Figure 10: A pie chart

51% of the children were first breastfed between 30 minutes

45% <30 minutes and only 4% >1 hour from birth.

4.13: RESPONDENT’S EXPENDITURE

Figure 11: A cylindrical graph showing respondent’s expenditure of time with

the child

196(97%) of the respondents stay with the child everytime while

with the child.

Time of BF intiation from birth

< 30 minutes

0

50

100

150

200

Everytime

Fre

qu

ency

32

TIME OF BF INTIATION FROM BIRTH

: A pie chart showing the time of BF initiation from birth

51% of the children were first breastfed between 30 minutes- 1 hour from birth while

45% <30 minutes and only 4% >1 hour from birth.

RESPONDENT’S EXPENDITURE OF TIME WITH THE CHILD

cylindrical graph showing respondent’s expenditure of time with

of the respondents stay with the child everytime while 7(

45%

51%

4%

Time of BF intiation from birth

< 30 minutes 30 minutes- 1 hour > 1 hour

Everytime Sometimes Does not

196

0 7

Staying with the child

showing the time of BF initiation from birth

1 hour from birth while

OF TIME WITH THE CHILD

cylindrical graph showing respondent’s expenditure of time with

7(3%) does not stay

4.14: IS YOUR CHILD ON COMPLEMENTARY FEEDING?

Figure 12: A pie chart showing

From the pie chart above, 33% of the children were on complementary feeding while

67% were not on complementary feeding.

3.15: AGE AT COMPLEMENTARY FEEDING

Figure 13: A cylindrical graph showing age at complementary

47(70%) of the children were introduced to complementary feeding at 6 months,

15(22%) at <6 months while

Complementary feeding

0

10

20

30

40

50

< 6 months

15

Fre

qu

ency

Age at complementary feeding

33


: A pie chart showing child’s complementary feeding


67% were not on complementary feeding.

AGE AT COMPLEMENTARY FEEDING

: A cylindrical graph showing age at complementary

of the children were introduced to complementary feeding at 6 months,

at <6 months while 5(8%) at > 6 months

Yes33%

No67%

Complementary feeding

< 6 months 6 months > 6 months

15

47

5

Age at complementary feeding



of the children were introduced to complementary feeding at 6 months,

3.16: FOODS FOR COMPLEMENATARY FEEDING

Table 5: Table showing

FOODS FOR CF

Powder milk

Porridge

Matooke, Beans soup and meat

Others specify

Total

From the table above,

soup. 52(25%) were fed on porridge and

4.17: NUMBER OF CF PER 24 HOURS

Figure 14: A cylindrical graph showing the number of complementary feeding

per 24 hours

From the figure above,

5% four times and 2(1%

0

50

100

150

200

Once

Frequency

Fre

qu

ency

Number of CF per 24 hours

34

: FOODS FOR COMPLEMENATARY FEEDING

able showing foods for complementary feeding

FREQUENCY PERCENTAGE

20 10%

52 25%

Matooke, Beans soup and meat 117 58%

14 7%

203 100%

From the table above, 117(58%) of the children were fed on matooke, beans and meat

were fed on porridge and 20(10%0 on powder milk.

NUMBER OF CF PER 24 HOURS

: A cylindrical graph showing the number of complementary feeding

From the figure above, 168(83%) of the children were fed thrice a day,

1%) once a day

Once Twice Thrice Fourtimes

> fourtimes

2 17 168 5 11217

168

5 11

Number of CF per 24 hours

PERCENTAGE

10%

25%

58%

100%

of the children were fed on matooke, beans and meat

on powder milk.

: A cylindrical graph showing the number of complementary feeding

of the children were fed thrice a day, 17(8%) twice,

4.18: IS YOUR CHILD WEANED?

Figure 15: A pie chart indicating wheather the child has been weaned or not.

61% of the respondents reported that; their children have been weaned while 39% of

the children were not weaned.

4.19: AGE OF WEANING

Figure 16: A pie chart

Out of the 123 weaned children, 77% were weaned at age of 1

years while 10% at age <1 year.

>2 years

35

CHILD WEANED?

: A pie chart indicating wheather the child has been weaned or not.


the children were not weaned.

4.19: AGE OF WEANING

: A pie chart showing age at weaning in years

Out of the 123 weaned children, 77% were weaned at age of 1-2 years, 13% at age >2

years while 10% at age <1 year.

Yes61%

No39%

weaning

<1 year10%

1-2 years77%

>2 years13%

Age of weaning

: A pie chart indicating wheather the child has been weaned or not.


2 years, 13% at age >2

4.20: METHOD OF WEANING

Figure 17: A pie chart showing the method of weaning

Of 123 weaned children, 61%

gradually with introduction of foods

4.21: IS THE CHILD IMMUNISED

Table 6: A table showing im

Accordindg to the findings,

Is the child immunized?

Yes

No

36

4.20: METHOD OF WEANING

: A pie chart showing the method of weaning

Of 123 weaned children, 61% were weaned spontanously while 39% were weaned

gradually with introduction of foods

4.21: IS THE CHILD IMMUNISED

: A table showing immunization status of the child.

Accordindg to the findings, 203(100%) of the children were immunized.

Spontanously61%

Gradually withintroduction of

foods39%

method of weaning

Is the child immunized? Frequency Percentage

203

0

203

were weaned spontanously while 39% were weaned

of the children were immunized.

Percentage

100%

0%

100%

4.22: IF YES, IMMUNIZATION AGAINST?

Figure 18: A cylindrical graph showing immunization status of the children

99(49%) of the children were immunized against all disease and

children were immunized against some diseases.

4.23: CHILD’S AGE IN MONTHS AND YEARS

Table 7: A table showing

Age

<6 months

6 months-<1 year

1 year-2 years

3years- 4 years

> 4 years

Total

From the table above, majority of the children

years while the least 10

96

97

98

99

100

101

102

103

104

Frequency

Freq

uen

cy

37

4.22: IF YES, IMMUNIZATION AGAINST?

: A cylindrical graph showing immunization status of the children

of the children were immunized against all disease and 104(

children were immunized against some diseases.

4.23: CHILD’S AGE IN MONTHS AND YEARS

: A table showing child’s age in months and years

Frequency Percentage

10 5%

37 18%

82 40%

46 23%

28 14%

203 100%

From the table above, majority of the children 82(40%) were between the age of 1

10(5%) were <6 months

All diseases Some diseases99 104

99

104

Immunization Aganist

: A cylindrical graph showing immunization status of the children

104(51%) of the

(40%) were between the age of 1-2

38

4.24: CHILD’S SEX

Figure 19: A pie chart showing child’s sex

54% of the children were males while 46% were females

4.25: CHILD’S HEIGHT/LENGTH IN CENTIMETER

Table 8: A table showing Child’s height/lenght in centimeter

Height/Length in CM Frequency Frequency2

50-60cm 15 8%

61-70cm 47 23%

71-80cm 49 24%

81-90cm 26 13%

91-100cm 43 21%

>100cm 23 11%

Total 203 100%

49(24%) of the children were between 71-80 cm, 47(23%) between 61-70 cm,

43(21%) between 91-100c cm in length. Only 15(8%) were between 50-60 cm while

23(11%) were > 100 cm in height.

Male54%

Female46%

Child's Sex

39

4.26: CHILD’S WEIGHT IN KILOGRAMS

Figure 20: A bar graph showing child’s weight in kilograms

From the graph above, 90 children measured between 6-10kg, 58 children measured

between 11-15kg, 30 children measured between 16-20kg while only 14 children

measured between 1-5kg in weight.

4.27: EDEMA ASSESSEMENT

Figure 21: A pie chart showing degree of edema

From the findings above, 100% (203) of the children had no edema.

1-5kg 6-10kg 11-15kg 16-20kg >20kg

frequency 14 90 58 30 11

14

90

58

30

11

0

10

20

30

40

50

60

70

80

90

100

Freq

uen

cyweight in Kg

0%

100%

Edema

Present Absent

40

4.28: MID UPPER ARM CIRCUMFERENCE

Figure 22: A bar graph showing mid upper arm circumference

194 children had MUAC of >12.5 cm, 5 children had MUAC between 11.5-12.5 cm

while 4 children had MUAC < 11.5 cm

4.29: NUTRITIONAL STATUS OF THE CHILDREN

Table 9: A table showing nutritional status of the children

CHILD'S NUTRITIONAL STATUS FREQUENCY PERCENTAGE

Normal/healthy 194 96%

wasted 9 4%

From the findings, 194(96%) of the children had normal nutritional stus while 9(4%)

of the children were wasted.

<11.5 cm 11.5-12.5 cm >12.5 cm

Frequency 4 5 194

4 5

194

0

50

100

150

200

250F

req

uen

cy

Mid upper arm circumference

41

4.30: DEGREE OF MALNUTRITION

Figure 23: A bar graph showing degree of malnutrition

From the findings above, 96% of the children had >-1SD, 2% had - 3SD to - 2SD

while 2% had< -3SD

5 4

194

0

50

100

150

200

250

<-3SD (-3SD to -2SD) (> -1SD)

freq

uen

cy

Degree of malnutrition

42

CHAPTER FIVE

DISCUSSIONCONCLUSION AND RECOMMENDATIONS

5.0 INTRODUCTION

This chapter discusses result of the study. The purpose of the study was to determine

the different breastfeeding practices andthe nutritional status of children below the

age of 5 years in Kitagata general hospital in Sheema district. The information was

used to give a recommendation on how to improve and maintain the nutritional status

of children below the age of 5 years in rural areas and reduce the prevalence rates of

malnutrition among children in the rural settings. The objectives of the study were to;

determine the socioeconomic and demographic factors affecting the breastfeeding

mothers, determine the different breastfeeding practices of children below the age of 5

years, determine the nutritional status of children below the age of 5 years.

5.1 DISCUSSION

5.1.1: SOCIO-DEMOGRAPHIC CHARACTERISTICS OF THE

RESPONDENTS.

A structured questionnaire was administered to 203 participants of whom they were

all females and mothers. Most of the respondents were of the age group 25-29 years

(36%), followed by 20-24years (24%). 97% of the respondents were married with 2%

divorced and 1% widowed. Majority of the respondents attended primary education

with 74% and 5% not having attained any level of education. 98% of the mothers

were Christians with the majority being Anglicans 68% followed by Catholics 28%

and Adventists 2% while the Islam was the least denomination with 2% of the

Muslims. Majority of the respondents were housewives contributing to 62% of the

different occupations done with the least being 12% that catered for teaching and

tailoring. 44% of the mothers had 1 to 2 children and 8% had more than 6 children.

This information was in correspondence with two studies that were done and

contradicted by one. A study done by Xul et al in 2012 showed a decreased pattern of

breastfeeding among mothers in China because of the increased economic growth.

Another study which was in correspondence was one that was conducted by Qui

Zhao, Binas Lee and Xie 2011 in Zhejiang China which showed that young mothers

with a lower education level and income are more likely to breastfeed more often. The

43

above information collected from the study that was conducted in Kitagata general

hospital was contradicted by a study which was done Baghurst et al 2013 in USA,

Australia and Scotland which showed an increased prevalence rate of breastfeeding

among the older women with higher levels of education.

5.1.2. DIFFERENT BREASTFEEDING PRACTICES OF CHILDREN BELOW

THE AGE OF 5 YEARS.

Of the 203 children who were interviewed on their behalf by their mothers, 54% were

males and 46% were females. 95% of the children were more than 6months of age

while 5% were less than 6 months of age. 96% of the children were not exclusively

breastfed because they were above the age of 6months while the remaining 4% were

still exclusively breastfeeding because they were less than 6 months of age. Of those

that are exclusively breastfed, 45% were breastfed more than 9 times and 22% less

than 6 times per day. Majority of the breastfed children were breastfed for less than 10

minutes (78%) with none breastfed for more than 30 minutes (0%). Of the 96% that

were not exclusively breastfed, 33% were on complementary feeding and the

remaining 67% were not on complementary feeding. Majority of the children about

70% started complementary feeding at the age of 6 months with 22% before 6 months

and 8% after the age of 6 months. 58% of children were started on carbohydrate foods

with 10% on protein foods. 61% of the children were weaned and 39% were not

weaned. Of those that were weaned, 77% were weaned at the age of 1 to 2 years and

10% were weaned before the age of 1 year. The malnutrition prevalence rates in

Mitooma district are low because of the adequate exclusive breastfeeding practices

which are in correspondence to the study that was conducted by Perez Escamillia et al

which stated the different contributing factors to the increased prevalence rates of

exclusive breastfeeding namely; low socioeconomic status, maternal unemployment,

hospital delivery facilities with breastfeeding promotion and all these had contributed

to the low prevalence rates of malnutrition among children.

44

5.1.3 NUTRITIONAL STATUS OF CHILDREN BELOW THE AGE OF 5

YEARS.

Of the 203 children who were assessed for their nutritional status, 54% were males

and 46% were females. 95% of the children were more than 6months of age while 5%

were less than 6 months of age.194 children were healthy (96%) with the remaining

4% corresponding to 9 children were wasted although there was no edema. Of the 9

children that had non edematous malnutrition (4%), 2% had Moderate acute

malnutrition (MAM) as they were lying between -3SD to -2SD while the other

remaining 2%, they had severe acute malnutrition (SAM) as they were less than -3SD.

This basically implies that in relation to the research and study that were conducted,

the general nutritional status of children below the age of 5 years in Mitooma district

is good although this was contradicted by the study that was conducted by BRAC

Uganda and published in the New vision newspaper on the 16th November 2011

showing that 2 million children in Uganda below the age of 5 years were chronically

malnourished which accounted for 38% of which 16% were underweight while 6%

were wasted. Another study was done by Motta et al in 2015 which showed that

children who were born with a low birth weight had increased chances of becoming

underweight as compared to their counterparts who were born with a birth weight of

2500 grams and above also contraindicated the study which was conducted in

Kitagata general hospital in Mitooma district.

5.2 CONCLUSION

The study showed that of the 203 children that were interviewed, 96% were healthy

and only 4% were malnourished this basically indicated that the mothers had adequate

knowledge and information about the different breastfeeding practices to enhance

proper growth and development of their children, the good available antenatal and

child health care services and programs like immunization provided at the health

facility also played a key role in increased prevalence rates of healthy children with a

few malnourished children. The 4% of the children that are malnourished is basically

because of the inadequate and improper breastfeeding practices among children, Poor

balanced diet for those that have started complementary feeding, busy working

45

schedule for those that are working and yet are mothers who need to breast feed their

children.

5.3 RECOMMENDATIONS

In accordance to the data collected, analyzed and discussed as shown above, this

study makes the following recommendations for the future planning and decision

making in relation to maternal and child health care delivery for children below the

age of 5 years.

1) Conducting more community outreaches to sensitize and educate the

community in particular mothers about the significance of good breastfeeding

practices and proper child health care immediately after birth and during

antenatal period.

2) Extension of child health care services away from the main district hospitals

to the peripheral health facilities like the health centers and the private health

facilities.

3) Intensifying training and support of the health care workers to broaden their

knowledge and skills pertaining good maternal and child health care in order

to properly communicate and educate society thereby reducing the prevalence

rates of malnutrition within the district.

4) Maternal and child care services should be provided to both mothers and their

children at their own times of convenience to reduce on the rates of

absenteeism from these health care services provided like immunization which

predispose and increase the rates of malnutrition.

46

REFERENCES

ACC/SCN (1997a).Nutrition and poverty-nutrition policy discussion paper

no.16.Geneva.24th session symposium. ACC/SCN (accessed at system.

Org/SCN

ACC/SCN (1997b).Third report on the world nutrition situation.Acc /SCN (accessed

at http://www.unsystem .org/scn/archive3s/rwns03/index.htm dated November

25th, 2006).

ACC/SCN (2000).Ending Malnutrition by 2020. An agenda for challenge in the

millennium final report to the acc/SCN by the commission on the nutrition

challenges of the 21st century (accessed at http://

www.unsystem.org/SCN/publications/UN report. PDF dated November 25th,

2006).

AIDS CAP/FHI/USAID (1996). USAID/ AIDSCAP Kenya Strategic and

implementation plan. AIDS Control and prevention programme / Family

Health International. September 1996.

Cogil B (2003).Anthropometric Indicators Measurement Guide.Food and Nutrition

Technical Assistance (FANTA) Project, Academy for Education Development

(AED), Washington DC (available at

http://www.fantaproject.org/downloads/pdfs/anthro2003.pdf).

Chlebowski RT (1985). Significance of Altered Nutritional status in Acquired

Immune Deficiency Syndrome (AIDS). Nutrition and Cancer 7: 85-91.

Cohen RJ, Brown KJ, Canahuati J, Rivera LL, Dewey KG (1994). Effects of age of

introduction of complementary foods on infant’s breast-milk intake, total

energy intake, and growth: A Randomized Intervention study in Honduras.

Eveleth PB. (1987). Population difference in growth: Environmental and genetic

factor. In: Falkner F, Tanner J Meds, editors. Human Growth Neurobiology

and Nutrition 3rd ed. London: Bailliere Tindal; 1987.p.373.

Park S, Park Y. (1997). Prevented medicine in obstetric, paediatrics and geriaterics.

In: Park K, editor. Park’s Text Book of Preventive Medicine, 15th ed. India:

M/S BandaridasBhan of publisher; p.210.

47

Tershakovec AM, Stallings VA (1998). Paediatrics nutrition and nutritional disorder.

In: Behrman RE, Kiliegman, editors. Nelson Essential of Paediatrics, 3rd ed.

London: W.B. Saunders Company; p. 312

Fomon SJ. Infant Nutrition (1974). Topical Paediatrics, 2nd ed. Philadelphia: W.B.

Saunders Company; p. 32.

Cameron M, Fofvander Y. (1976). Manual on Feeding and Young Children, 2nd ed.

New York: Saunders Company; p. 310.

Widdowson EM. Nutrition.(1981). In: Davis JA, Dobbing J, editors. Scientific

Foundation of Paediatrics, 2nd ed. London: William Heinemann Medical

Books Ltd; p. 41-43.

Laurence F. Feeding, the healthy child. In: Julia A, McMillan MD, Catherine D,

DeAnglis MD, Ralph D, Feigin MD, Joseph B,et al, (1999). editors.

Oski’sPaediatrics Principles and Practice, 3rd ed. Philadelphia: Lippincoh

Williams & Wilkins Company; p. 477-78.

Waterlow JC (1972). Classification and definition of protein calorie malnutrition. Br

Med J; 3: /archives/npp16/index.htm dated November 25th, 2006).

48

APPENDICES

APPENDIX I: CONSENT FORM

Good morning/Afternoon/Evening

1 am……………………………………………., a 5th year medical student of

Kampala International University Teaching Hospital Western campus, Ishaka,

Bushenyi district from the faculty of clinical medicine and dentistry. I am here to

conduct a study on the different breastfeeding practices and the nutritional status of

children below the age of 5 years in Sheema district. This will enable me to prepare

and submit a research report to the relevant authorities who will endeavor to employ

proper measures towards improving the nutritional status of children below the age of

5 years.

Since the child is too young to decide on his/her own, I would like to interview you on

his/her behalf. I have a few questions about the different breastfeeding practices and

related issues. Your answers will be written and then used for analysis. All

information you provide will be handled with confidentiality and your individual

answers will only be known to the interviewer and the coordinator of the study.

The results will beused to improve the nutritional status of children below the age of 5

years. We will need at least 20 minutes of your time to discuss and record the

information. You can withdraw from the interview at any stage without any

consequence if you do not wish to continue.

Do you have any question? (0705316863)

If you agree to participate in this study, may you please sign below here

Interviewee’s signature……………………………………

Interviewer’s signature……………………………………

Date……….………….

Thank you.

49

APPENDIX II: QUESTIONNAIRE

ASSESSMENT OF THE DIFFEENT BREASTFEEDING PRACTICES AND

NUTRITIONAL STATUS OF CHILDREN BELOW THE AGE OF 5 YEARS

IN SHEEMA DISTRICT, UGANDA

INTRODUCTION

This questionnaire is designed to obtain information from you regarding the different

breastfeeding practices andthe nutritional status of children below the age of 5 years.

The results of this study were used by the researcher (student) from Kampala

International University Teaching Hospital Western Campus to write his report. The

results will also be useful in designing the appropriate interventions aimed at reducing

the prevalence rates of malnutrition cases. This information was treated with

confidentiality that it deserves and will not be used for any purpose other than those

outlined here. Your participation in this survey was of great value to the researcher

and we appreciate your co-operation.

INSTRUCTIONS

The questionnaire is in four (4) sections. Please answer all questions in all the sections

by circling and filling in the most appropriate response. Some sections will have their

own set of instructions please follow these carefully.

A) SOCIOECONOMIC AND DEMORGRAPHIC FACTORS OF THE

MOTHER

1. Age………………………………………………………………….

2. Marital status

A) Married

B) Divorced

C) Widowed

D) Single

3. Education level

50

A) Primary school

B) Secondary school

C) University

D) Tertiary institution

E) None

4. Mother’s

Religion…………………………………………………………

5. Mother’s

occupation…………………………………………………………

6. What is the family source of income?

................................................................

7. About how much does the mother earn monthly?

..............................................

8. How many children do you have?

……………………………………………..

B) BREASTFEEDING PRACTISES

1. EXCLUSIVE BREASTFEEDING

9. Is the child exclusively breastfeeding?

A) Yes

B) No

10. If yes, how many times a day?

……………………………………………………

11. For how long was/Is the child breastfed?

…………………………………………………….

12. After how long did you introduce the child to breast milk on

delivery?

………………………………………………………

13. How often do you stay together (in the same room) with your new

baby?

…………………………………………….................

2. COMPLEMENTARY BREASTFEEDING

51

14. Is the child on complementary breastfeeding?

A) Yes

B) No

15. If yes in (14) above, then at what age were the complementary

foods started?

……………………………………………………………………

What foods where started on a child?

……………………………………………………………………

How many times is the child fed in 24 hours?

……………………………………………........................................................

3. WEANING

16. Is the child weaned?

A) Yes

B) No

17. At what age do you discontinue breastfeeding?

……………………………………………………

18. How did you discontinue the child from breastfeeding?

…………………………………………………….

C. HEALTH SERVICE

19. Is the child immunized?

A) Yes

B) No

20. If (Yes), what was he/she immunized against? (Look at the

immunization card)

…………………………………………………………….

21. If No as in (21) above, why?

……………………………………………………………..

D. NUTRITIONAL ASSESSMENT

1. CHILD’S DEMORGRAPHICS

a) Age………………………………….

b) Sex………………………………….

52

2. ANTHROPOMETRIC MEASUREMENTS

c) Height/Length………………………………. (cm)

d) Weight………………………………………. (Kg)

e) Edema (Present/Absent) …………………………

f) Mid Upper Arm Circumference………………(cm)

3. RESULT REFERENCE Z SCORE

g) Height for Age (H/A) ...……………………….

h) Weight for Age (W/A) ………………………….

i) Weight for Height (W/H) .……………………….

4. NUTRITIONAL STATUS

What is the nutritional status of the child? (Tick in the table provided below (a)

depending on the results obtained in part (3) respectively as shown above or choose

option (b) as shown below.

(a)

STATUS MODERATE SEVERE

UNDERWEIGHT (W/A)

STUNTED (H/A)

WASTED (W/H)

(b) Healthy/Normal………………………….

5 DEGREE OF MALNUTRITION

1 To what extent is the child malnourished?

A=Less than -3SD (Severe acute malnutrition)

B=between -3SD to -2SD (Moderate acute malnutrition)

C=Greater than -1SD (Normal)

D=None. Where SD-Standard Deviation.

THANK YOU VERY MUCH FOR PARTICIPATING IN THIS STUDY

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APPENDIX III: BUDGET

SN ACTIVITY/ ITEMS UNIT

COST

(ugshs)

QUANTITY TOTAL

COST

(ugshs)

JUSTIFICATION

1 Stationary and technical materials

Duplicating paper 15,000 1 Reams 15,000 Printing

questionnaires &

binding of research

write-ups (report

and summary).

Printing & Binding 50,000 3 Copies 150,000

Note books& pens 5,000 2 10,000

Internet subscription 25,000 1months 20,000 Information in

research writing

Sub Total 195,000

2 Data collection

Research assistant 50,000 1 50,000 To help in data

collection

Sub Total 50,000

3 Other Fees

Dissemination of

Research Results

100,000

Supervisor’s fee 55,000 For guidance and

recommendation.

Sub Total 155,000

GRAND TOTAL 400,000

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APPENDIX IV: LETTER OF INTRODCUTION FROM KIU

55

APPENIX V: LETTER FROM THE DISTRICT HEALTH OFFICER

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APPENDIX VI: LETTER FROMKITAGATA HOSPITAL MANAGEMENT

57

APPENDIX VII: MAP OF KITAGATA

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APPENDIX VIII: MAP OF UGANDA

assessment of different breastfeeding practices - kiu

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