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KWAME NKRUMAH UNIVERSITY OF SCIENCE AND TECHNOLOGY COLLEGE OF HEALTH SCIENCES SCHOOL OF MEDICAL SCIENCES DEPARTMENT OF COMMUNITY HEALTH DETERMINANTS OF MALNUTRITION IN CHILDREN LESS THAN FIVE YEARS IN THE BOSOMTWE DISTRICT, ASHANTI, GHANA BY NYARKO, LILY-VERSTA NOVEMBER, 2008 KWAME NKRUMAH UNIVERSITY OF SCIENCE AND TECHNOLOGY, KUMASI COLLEGE OF HEALTH SCIENCES SCHOOL OF MEDICAL SCIENCES DEPARTMENT OF COMMUNITY HEALTH A THESIS SUBMITTED TO THE SCHOOL OF GRADUATE STUDIES, KWAME NKRUMAH UNIVERSITY OF SCIENCE AND TECHNOLOGY IN PARTIAL FULFILLMENT OF THE REQUIREMENTS FOR THE DEGREE OF MASTER OF SCIENCE (M.SC) IN HEALTH SERVICE PLANNING AND MANAGEMENT BY LILY-VERSTA NYARKO NOVEMBER, 2008 DECLARATION I hereby declare that this submission is my own work towards the M.Sc and that, to the best of my knowledge, it contains no materials previously published by another person nor material which has been accepted for the award of any degree of the University, except where due acknowledgement has been made in the text. Lily-Versta Nyarko2006421 9…………………… …………………………………. (Student Name and ID) Signature Date Certified by …………………………….. ……………………………………. Peter Agyei-Baffour Signature Date (Supervisor) Certified by ……………………………… ………………………………………. Dr. E. Otupri ……………………………… ……………………………………….. (Head of Department) Signature Date I DEDICATION This thesis is dedicated to Nana Kofi Sarfo Adom. (M.Sc baby, my son). II ACKNOWLEDGEMENT I would like to express my sincere gratitude to the almighty God for seeing me through this M.Sc programme especially this thesis. My special thanks goes to Professor E. Addy and Peter Agyei Baffour my supervisors who were available to offer suggestions and for their patience and encouragement during the supervisor of this thesis. I am also grateful to all lecturers at the Department of Community Health College of the Health Sciences, as well as lecturers outside the department and the entire staff of the Department for their immense contribution and encouragement, which have brought me this far. Many thanks also go to the Bosomtwe District Health Workers especially the District Director, Dr. Mrs. Agartha Bonney, and Medical Superintendent Dr. Jeckey-Nyarko, the pharmacist, Mr.Timothy Mensah, for their criticisms and support. I wish to remember all those who have been of help, especially the Appiah-Adjei family, my Mother Mary Appiah, my cousins, my course mates, especially Sammy and Nana, the Addision family, the Dadzie-Bonney family and the entire staff of Kumasi Senior High Technical School, especially Miss Sandra Nkansah to these I am most grateful. I duly acknowledge here, the financial support from my husband, Daniel Appiah- Adjei and Hon. Dr. Richard W. Anane (Minister for Roads and Transport). III ABREVIATION AND ACRONYMS AK - Atwima Kwanwoma ANC - Antenatal Care DHA - District Health Administration GHS - Ghana Health Services GSS - Ghana Statistical Services GDHS - Ghana Demographic Health Survey KNUST - Kwame Nkrumah University of Science and Technology MDGs - Millennium Development Goals MOH - Ministry of Health SPSS - Statistical Package for Social Sciences UNICEF - United Nations Children Fund UN - United Nations WFP - World Food Programme WHO - World Health Organisation IV TABLE OF CONTENT Page Declaration…………………………………………………………………….i Dedication……………………………………………………………………..ii Acknowledgement…………………………………………………………….iii Abbreviations/Acronyms………………………………………………………iv Table of Content……………………………………………………………….v List of Tables…………………………………………………………….……..x List of Figures ……………………………………………………………..…xi Abstract………………………………………………………………………...xii CHAPTER ONE Introduction……………………………………….……..1 1.0 Background information………………………………………………1 1.1 Problem Statement……………………………………………………..3 1.2 Rationale of study……………………………..……………………....4 1.3 Research questions…………………………………………………..…4 1.4 Objectives………………………………………………………………5 1.4.1 General Objective....................................................................................5 1.4.2 Specific Objectives..................................................................................5 1.5 Conceptual Framework…………………………………………………6 1.6 Scope of the study………………………………………………….…....7 1.7 Organisation of work……………………………………………….…..8 V CHAPTER TWO LITERATURE REVIEW…………………………………………….9 2.0 Introduction …….………….………….………………………………………9 2.1 Brief concept of malnutrition and causes ………………………………...........9 2.2 Measuring nutritional status of children less than 5 year……………………10 2.3 Influence of socio-economic characteristics on children nutritional status….11 2.4 Maternal health care and child morbidity relationship with malnutrition …...12 2.5 Feeding practices, water and sanitation and malnutrition……………………12 2.6 Malnutrition rates among children less than 5 years…….……..……………13 CHAPTER THREE METHODOLOGY……………………………...…………….….14 3.0 Study Design…………………………..……………………………….......14 3.1 Study Area……... …………………………….…………..….…………….14 3.2 Study Population....………………………………………………………..16 3.3 Study variable.....……………………………………………………….…...16 3.4 Sample size……...………………………….………………………………..17 3.5 Sampling Techniques…………………….……………………….………....17 3.6 Data Collection Techniques and Tools…………………………….………...18 3.6.1 Pre-testing of Tools.........................................................................................18 3.6.2 Structured Interviews......................................................................................18 3.6.3 Anthropometric Technique...........……………………………………………18 3.6.4 Key Informant Interview................................................................................19 VI 3.7 Data Analysis ………………………………………………………………..19 3.8 Ethical Consideration…..…………………………………………………….20 3.9 Study Assumptions…………………….…………………………………….20 3.10 Limitations..................…………………….………………………………..20 CHAPTER FOUR RESULTS…………………………………………………................................………….21 4.0 Introduction……………………………………….………………………. ............21 4.1 Socio-demographic characteristics.…….………………………….………………..21 4.2 Influence of socio-economic characteristics on malnutrition …….…………...........23 4.3 Influence of Maternal health seeking behaviour and child morbidity on the nutritional status of the child …………………………………………….………...25 4.4 Influence of feeding practices, water source and sanitation on child malnutrition ……………………………………………………………….............27 4.5 Malnutrition estimate among children in the district……………..……………..….29 CHAPTER FIVE DISCUSSION …………………………………………………………….........................32 5.0 Introduction ……………….……………………………………………………...32 5.1 Background characteristics ………………………………………………………..32 5.2. Influence of socio-economic characteristics on nutritional status of the child…...33 5.3 Influence of Maternal health seeking behaviour and child morbidity on nutritional status of the child………......................................................................35 VII 5.4 Influence of feeding practices, water source and sanitation on child Malnutrition………………………………………………………………………..36 5.5. Malnutrition estimate among children in the district.….…………………….……37 CHAPTER SIX CONCLUSION AND RECOMMENDATION………………………….. ....................39 6.0 Conclusion……..…………………………………………………………..………........39 6.1.1 Influence of socio-economic characteristics on nutritional status of the child………..39 6.1.2 Influence of Maternal and Child health seeking behaviour on nutritional status of the child.....................................................................................................................39 6.1.3 Influence of feeding practices, water source and sanitation on child malnutrition…...39 6.1.4 Malnutrition estimate among children in the district...................................................40 6.2 Recommendation……………..……………………………………………….…….40 6.2.1 Community and Opinion Leaders should....................................................................40 6.2.2 District Health Administration should ……...............................................................40 6.2.3 District Assembly should............................................................................................40 6.2.4 Parent should..............................................................................................................41 6.3 Concluding Remarks...............................................................................................41 REFERENCES ……………………………………………………………………………….………………………………...42 APPENDIX A: STRUCTURED INTERVIEW GUIDE FOR HOUSEHOLD......... …......45 APPENDIX B: STRUCTURED INTERVIEW FOR KEY INFORMANTS......................50 APPENDIX C: ANTHROPOMETRIC MEASUREMENTS..............................................52 VIII LIST OF TABLES Table No. Title Page 3.1 Population Distribution by Sub-districts and the number of 15 communities in the Bosomtwe district 3.2 Distribution of Health Facilities in the district 2007 15 3.3 Operational definition of Study Variables 16 4.1 Background characteristics of respondents 22 4.2 Relationship between socio-economic factors and malnutrition 24 4.3 Influence of Maternal health seeking behaviour and child 26 morbidity on nutritional status of the child 4.4 Influence of feeding practices, water source and sanitation on 29 child malnutrition 4.5 Descriptive statistics of background characteristics of respondents 30 4.6 Influence of characteristics on the malnutrition 31 X LIST OF FIGURES Figure Title Page No. 1.1 A conceptual frameworks showing the factors that influences 6 malnutrition directly or indirectly 4.1 Summary of background characteristics of respondents 21 4.2 Major meals
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