INTRODUCTION
Background
Malnutrition refers to deficiencies, excesses or imbalances in a person’s intake of energy and or nutrients. This means a condition which result from eating a diet in which one or more nutrients are either not enough or are too much to causes health problems. It is frequently part of a vicious cycle that includes poverty and disease. It usually refers to a number of diseases, each with a specific cause related to one or more nutrients. Examples are protein, iodine, vitamin A or iron 1.
Malnutrition is the greatest cause of the child death in the country, it contributes to over one third of the child death every year. Apart from the disease burden, micronutrient deficiencies severely affect economic and human development leading to an annual loss of 2.65% of Tanzania GDP 2.
Globally the impacts of malnutrition which are developmental, economic, social and medical burden are lasting among the affected individuals, their families and countries3. Malnutrition is closely linked to the overall standard of living and whether a population can meet its basic needs, such as access to food, housing and health care 3.
The condition is prevalent in many contexts, and the priority can be adopted in different approach to tackle the condition. Children from families with low quality of life when affected have worse outcome than those from higher quality of life. Understanding characteristics of the condition helps us to know how to prevent and control the condition 4.
Growth assessment in malnutrition does not only serves as a means for evaluating the health and nutritional status of children but also provides an indirect measurement of the quality of life of an entire population. The WHO Global Database on Child Growth and malnutrition illustrates malnutrition’s enormous challenge and provides decision makers and health workers alike with the baseline information necessary to plan, implement and monitor and evaluate nutrition and public health intervention programs aimed at promoting healthy growth and development5.
The state of food security and nutrition in the world 2018 tracks the rise of hunger worldwide over the past three years at it revealed levels were returning to those compiled a decade ago. The report warns that more must be done and urgently if sustainable development goal (SDG) of Zero Hunger is to be achieved by 20306.
By these reasons there must be intentional effort directed to our local health care providing areas so as to observe how far we have gone on reducing the burden of malnutrition to the under-fives, including the trouble they face being it morbidity and mortality to this age group.
Literature Review
A study done in 2012,show that about 171 million children less than 5 years of age are stunted globally, whereby 167 million children found in developing countries. It was estimated that childhood stunting will decrease from the prevalence of 39.7% in 2010 to 21.8% or 142 million in 2020. However in Africa the prevalence of malnutrition has persistently been high since 1990 at about 40% and little improvement was expected, as compared to Asia where the prevalence of malnutrition in children as dramatic decreased from49% in 1990 to 28% in 2010, nearly halved the number of stunted children from 190 million to 100 million. The conclusion was made that though there would be overall decrease in developing countries stunting remains a major public health problem in many countries14.
According to blessing et al, in 2017 conducted cross sectional study on 32 countries on the child malnutrition in Sub-Saharan Africa. A cross-sectional data from most recent Demographic and Health Surveys (from 2006 to 2016) of 32 countries were used, in subgroups of West Africa, East Africa, Southern and Central Africa. Generally the prevalence of malnutrition was highest within countries of East and West Africa by 52% and 39.2% of stunting respectively. The appropriate nutrition interventions are needed in East and West African countries if Sub-Saharan-Africa is to meet the WHO global nutrition target of improving maternal, infant and young child nutrition by 202515.
According to Cyprian Ouma, there are inequalities in the trend of malnutrition in East African countries. The study which was conducted on the malnutrition profile in East Africa in 2012 showed that stunting was highest in Burundi by the prevalence of 59.1%, lowest in Kenya by 26%. Wasting was higher in Burundi again, lowest in Rwanda. Underweight was higher in Tanzania by 22.5%, followed by the fellow Uganda by 14%. Generally the findings of the study show that malnutrition was highest in Burundi. About 45% of all child deaths were associated with poor nutrition in East Africa.16
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Maimuna M. Ahmed et al, conducted a cross sectional study on prevalence of under nutrition and risk factors associated with severe malnutrition among undernourished children aged 6-60 months admitted to Bugando Medical Centre (BMC) pediatric wards. Out of 720 screened children, 402 (55.8) were undernourished. Severe malnutrion was found in 24.7% children and among 54.5% had marasmus. Maimuna M.Ahmed then concluded that there is high prevalence of malnutrion in hospitalized children and majority ware marasmic17.
According to a study done by Omari Ali Juma et al, on the prevalence and assessment of malnutrition among children attending RCH at Bagamoyo district Hospital, Tanzania in 2016. A total of 63237 children under five were recruited and the prevalence of under nutrition was found to be 15.52%, stunting being 8.37%, underweight 5.74% and wasting 1.41%. In this study boys were more affected than girls. Also 50% of the under-five mortality rate were contributed by the underlying under nutrition18.
According to Tanzania National Nutritional Survey of 2014, under nutrition was found to be one of the world’s most serious but least addressed public health problem. Stunting has become an important target of nutrition and other development-related programs. Malnourished women or adolescent girls give birth to babies with low birth weight. If these children grow up in an environment of suboptimal feeding practices and a high burden of infectious diseases, these children do not experience much catch-up growth in subsequent years, leading to an intergenerational cycle of stunting. Stunting is a cumulative process that can begin in utero and continue until about 2 years after birth and it should be noted that environmental differences, rather than genetics, are the principal determinants of stunting because children from different settings worldwide are expected to grow similarly if they are brought up in healthy environments. Children who are stunted are more likely to get sick or die. If they survive they enter school late, do not learn well, and are less productive as adults. In later life, they are at an increased risk of chronic diseases. To illustrate, childhood stunting - even in its moderate form it increases mortality by 60%. It is related to a 2-3 year reduced school attendance and 22% lower income in adulthood. There is even evidence that poor nutritional status and childhood stunting may result in cognitive impairments which cannot be reversed in later life19, 20.
Problem Statement
Globally 1 in every 4 children was malnourished in 2017 making an estimation of 151 million children with malnutrition. The rates are still alarming and declining slowly. In Tanzania there is an estimation of Top of FormBottom of Form 43 % of children under 5 years old who were malnourished in 2016. Out of which 34% were stunted sign of chronic malnutrition, 5% were wasted i.e. too thin for their height which signify acute malnutrition and 4% are overweight or over nourished. In Dar es Salaam region (15%) of all under five children were malnourished, one in every sixth children is malnourished. All three nutritional status indicators are highest among children in the lowest wealth quintile and lowest in children in the highest wealth quintile7, 8.
Among the factors contributing to malnutrition in children in Tanzania were unbalanced diets eating, incomplete or lack of vaccination, children with single parent, low level of education in mother, early age of weaning before six month of age and interruption of breastfeeding before two years old of age. Stunting is attributed to a combination of factors, including maternal malnutrition, inadequate infant feeding practices, low quality of health care, and poor hygiene. Complementary feeding practices are inadequate, with only 10 percent of breastfed children 6–23 months receiving a minimum acceptable diet, which has a major impact on growth and development. The risk of stunting is 33 percent higher among first-born children of girls under 18 years in Sub-Saharan Africa, and as such, early motherhood is a key driver of malnutrition9.
The most consequence of malnutrition in children are vulnerability to illness, increased complications and in very extreme cases even death. About 50% of all childhood deaths are attributed to malnutrition. Their immune system have reduced ability to fight infection, have impaired wound healing, their kidneys have reduced ability to regulate salt and fluid which can lead to over hydration or dehydration. Children with malnutrition can develop apathy, depression, introversion, self-neglect and deterioration in social interaction. They have growth failure and stunting, delayed sexual development, impaired intellectual development and increased lifetime risk of osteoporosis. Consequences of specific nutrient deficient are many, such as anemia, skin rashes and inability to fight infection due to zinc deficiency, rickets and osteomalacia as deficiency of vitamin D and many more. Tanzania made significant progress in improving nutrition among children under 5 years of age. During 1992-2015 there was a significant reduction in number of underweight children and those suffering from chronic malnutrition10, 11, 12.
Tanzania is placing strong emphasis on decentralization to ensure that nutrition is on the agendas of those working closest to affected communities. There has been development of guidelines for planning and budgeting for inclusion in the council’s comprehensive plans, annual regional planning and budgeting sessions, and the training of the trainers on Mkoba wa siku 1000, influencing positive behaviors for better maternal and child nutrition13.
Rationale of the Study
Malnutrition is the global health problem by WHO, it affects mostly under five years children and in Tanzania there is the higher prevalence of stunting, wasting and a group of children who are overweighed. The findings from this study will be used to increase awareness and knowledge about malnutrition. Also the results will help to inform the policy makers how far we have reached concerning the problem, and simplify to know the way forward.
Study Area
The study is going to be conducted at Mwananyamala reginal referral hospital in the pediatric ward. It is located in a Mwananyamala administrative ward in the Kinondoni district in Dar es Salaam region in Tanzania. It is located between the latitude 6047’16’ and 6.78790 South of equator and longitude 39015’23 and 39.25630 to the east of Greenwich. Kinondoni District is a district in north west of Dar es Salaam's central business district, Tanzania, others being Temeke (to the far Southeast) and Ilala (downtown Dar es Salaam). To the east is the Indian Ocean, to the north and west the Pwani Region of Tanzania. The 2002 Tanzanian National Census showed that the population of Kinondoni was 1,083,913. The area of Kinondoni is 531 km².the latest population census of 2012 showed that population of Kinondoni was 1,775,049: 914,247 female and 860,802 male. There are 446,504 households in Kinondoni with the average of 4 person per household. The hospital has 6 departments, pediatric and child health department, medical department, surgical department, obstetric and gynecological department, TB and leprosy department and CTC department. Pediatric and child health department has reproductive and child health clinic which operates from Monday to Friday where children are given vaccines, and are weighed. Pediatric ward has more than 25 beds, and has some malnutrition cases.
Ethical Consideration
Before commencing of the study, ethical clearance will be requested from ethical clearance committee of St. Joseph College of Health Sciences. Also the permission to conduct study and collecting data will be obtained from district medical officer of Kinondoni district and medical officer in charge of Mwananyamala referral hospital. More over all ethical principles will be considered to ensure that the study respect human dignity.
The research findings would generate important information on the prevalence of malnutrition in Kinondoni district. The copy of the study will be disseminated to MOHCDGEC as the key decision makers in the responsible authorities which deals with health issues, District Medical Officer(DMO) of Kinondoni district and lastly the research findings will be given to St Joseph College of Health Sciences library to help further in updating the existing problem.
REFERRENCES
- WHO / What is malutritionen.
- Ochieng, J., Afari-Sefa, V., Karanja, D., Rajendran, S., Silvest, S. and Kessy, R., 2016. Promoting consumption of traditional African vegetables and its effect on food and nutrition security in Tanzania (No. 310-2016-5388). Tanzania food and nutrition journal, Volume 13. 2013; 1: 1-2.
- World Health Organization. Topic: malnutrition, 16th February 2018.
- Alan Jackson. Nutrition Journal 2018. 17:84. Identifying children at risk of malnutrition.
- WHO World Database on Child Growth and malnutrition, 2018.
- Stefan Jung curt PHD. Content editor for agriculture, climate change and sustainable energy (Germany) 18th September 2018, UN report.
- Chika Hayashi, Elaine Borghi, Espen Beer Prydz and Richard Kumapley. UNICEF, WHO, World Bank Group Joint Child Malnutrition Estimates, 2018, page 2.
- Tanzania demographic and health survey and malaria indicators survey. Topic: child nutrition. 2016: chapter 32 page 119.
- Tanzania nutrition profile journal by USAID, February 2018 edition, chapter 1, page
- Kyunki-JeenaIssiKaNaam Hal. The Mother and Child Health and Education Trust. Article: Malnutrition, impact of malnutrition. 16 December, 2017.
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