UNDERNUTRITION AND ASSOCIATED RISK FACTORS AMONG PRIMARY SCHOOL AGE CHILDREN IN A RURAL AREA IN THE THABA CHWEU SUB-DISTRICT, MPUMALANGA PROVINCE By Mosebusi Olga Hlahla MPH Faculty of Health Sciences School of Health Care Sciences Department of Public Health Supervisor Dr SEP Modjadji DECLARATION I declare that the dissertation “Undernutrition and associated risk factors among primary school age children in a rural area in the Thaba Chweu sub-district, Mpumalanga Province” hereby submitted to the University of Limpopo, for the degree of Master of Public Health has not previously been submitted by me for a degree at this or any other university; that it is my work in design and in execution, and that all material contained herein has been duly acknowledged. May 2019 Hlahla MO (Ms) Date ii DEDICATION I dedicate this dissertation to my beloved husband, Timothy Macharaga Moyo. He has been a great source of strength and encouragement throughout my academic walk. I also dedicate this study to my mother, Mapula Rose Hlahla, and my family and friends who never stopped believing in me even when I personally lost confidence in my own capabilities. iii ACKNOWLEDGEMENT First of all, I gloriously thank God for ushering and protecting me throughout my studies and blessing me with a beautiful life. Secondly, I give utmost thanks to my supervisor, Dr P Modjadji for her patience, understanding and mentoring throughout this study. I also use this opportunity to acknowledge the Matibidi hospital Allied department and management for their endless support. iv Table of contents DECLARATION ................................................................................................................ ii DEDICATION .................................................................................................................. iii ACKNOWLEDGEMENT .................................................................................................. iv LIST OF FIGURES .......................................................................................................... x LIST OF TABLES ............................................................................................................ xi DEFINITION OF CONCEPTS ....................................................................................... xiii ABBREVIATIONS ......................................................................................................... xiv ABSTRACT .................................................................................................................... xv CHAPTER 1 INTRODUCTION ....................................................................................... 1 1.1 Definition and overview of malnutrition ...................................................................... 1 1.2 Overview of stunting .................................................................................................. 2 1.2.1 Epidemiology of stunting in South Africa ................................................................ 3 1.3 Overview and epidemeiology of underweight ............................................................ 4 1.4 Overview and epidemiology of Wasting/Thinness .................................................... 5 1.5 Risk factors of undernutrition ..................................................................................... 6 1.6 Consequences of Undernutrition ............................................................................... 7 1.7 Problem Statement .................................................................................................... 8 1.8. Purpose of the study ................................................................................................ 9 1.8.1 Aim of the study ...................................................................................................... 9 1.8.2. Research questions ............................................................................................... 9 1.8.3. Objectives of the study .......................................................................................... 9 v 1.8.4. Significance of the study ....................................................................................... 9 CHAPTER 2 .................................................................................................................. 11 LITERATURE REVIEW ................................................................................................ 11 2.1. Introduction ............................................................................................................ 11 2.2 Immediate causes ................................................................................................... 12 2.2.1 Inadequate dietary intake ..................................................................................... 12 2.2.2 Health and diseases ............................................................................................. 14 2.2.3 Breastfeeding and other feeding practices ........................................................... 15 2.2.4 Poverty, unemployment and Socio-economic status ............................................ 15 2.2.5 Literacy of the parents and sanitation ................................................................... 16 2.3. Basic causes of undernutrition ............................................................................... 17 2.3.1 Household and family factors ............................................................................... 18 2.3.2 Inadequate complementary feeding ..................................................................... 19 2.3.3 Breastfeeding ....................................................................................................... 20 2.3.4 Infections .............................................................................................................. 20 2.4. Concurrent and short term consequences ............................................................. 21 2.5. Factors contributing to undernutrition amongst the school going children in rural areas ............................................................................................................................. 23 2.6 Consequences of malnutrition ................................................................................. 25 CHAPTER 3 .................................................................................................................. 26 INTRODUCTION TO METHODOLOGY ....................................................................... 26 3.1. Introduction ............................................................................................................ 26 3.2 Research design ..................................................................................................... 26 vi 3.3. Data collection ........................................................................................................ 26 3.3.1 Tool Piloting ......................................................................................................... 27 3.3.2 Tool translation ..................................................................................................... 27 3.4 Sampling ................................................................................................................. 27 3.4.1 Sample size .......................................................................................................... 28 3.5 Study recruitment .................................................................................................... 28 3.5.1 Inclusion criteria ................................................................................................... 29 3.5.2 Exclusion criteria .................................................................................................. 29 3.6 Study setting ........................................................................................................... 29 3.7Reliability and Validity .............................................................................................. 30 3.8 Data analysis ........................................................................................................... 30 3.9 Ethical clearance ..................................................................................................... 31 3.10 Bias ....................................................................................................................... 31 CHAPTER 4 .................................................................................................................. 33 RESULTS ..................................................................................................................... 33 4.1. Introduction ............................................................................................................ 33 4.2 Socio demographic characteristics of mothers/caregivers ...................................... 34 4.2.1 Describing parents/caregivers .............................................................................. 34 4.2.2 Relationship of parents/caregivers ....................................................................... 34 4.2.3 SOCIO-DEMOGRAPHIC STATUS OF THE PARENTS/CAREGIVERS .............. 34 SECTION B: ANTHROPOMETRY AND Z-SCORES OF CHILDREN ........................... 37 4.3 A DESCRIPTION OF THE SAMPLE USED IN THE STUDY .................................. 37 4.3.1. The distribution of the children ...........................................................................