1.1 BACKGROUND TO THE STUDY
Malnutrition in children also known as undernutrition is common globally and results in both short and long term irreversible negative health outcomes including stunted growth which may also be linked to cognitive development deficits, underweigt and wasting. The World Health Organization (WHO) estimates that malnutrition accounts for 54 percent of child mortality worldwide, about 1 million children. Another estimate also by WHO states that childhood underweight is the cause for about 35% of all deaths of children under the age of five years worldwide. The main causes are unsafe water, inadequate sanitation or insufficient hygiene, factors related to society and poverty, diseases, maternal factors, gender issues and overall poverty (Bhutta et al, 2008).
There are three commonly used measures for detecting malnutrition in children. They includes stunting (extremely low height for age), underweight (extremely low weight for age), and wasting (extremely low weight for height). These measures of malnutrition are interrelated, but studies for the World Bank found that only 9 percent of children exhibit stunting, underweight, and wasting. Children with severe acute malnutrition are very thin, but they often also have swollen hands and feet, making the internal problems more evident to health workers. Children with severe malnutrition are very susceptible to infections (World Bank, 2008).
Malnutrition in children causes direct structural damage to the brain and impairs infant motor development and exploratory behavior. Children who are undernourished before age two and gain weight quickly later in childhood and in adolescence are at high risk of chronic diseases related to nutrition. Studies have found a strong association between malnutrition and child mortality (Duggan et al, 2008). Once malnutrition is treated, adequate growth is an indication of health and recovery. Even after recovering from severe malnutrition, children often remain stunted for the rest of their lives. Even mild degrees of malnutrition double the risk of mortality for respiratory and diarrheal disease mortality and malaria. This risk is greatly increased in more severe cases of malnutrition. Undernourished girls tend to grow into short adults and are more likely to have small children.
Prenatal malnutrition and early life growth patterns can alter metabolism and physiological patterns and have lifelong effects on the risk of cardiovascular disease. Children who are undernourished are more likely to be short in adulthood, have lower educational achievement and economic status, and give birth to smaller infants (Bhutta et al, 2008). Children often face malnutrition during the age of rapid development, which can have long-lasting impacts on health.
The World Health Organisation estimated in 2008 that globally, half of all cases of malnutrition in children under five were caused by inadequate food intake, unsafe water, inadequate sanitation or insufficient hygiene. This link is often due to repeated diarrhoea and intestinal worm infections as a result of inadequate sanitation. However, the relative contribution of diarrhea to malnutrition and in turn stunting remains controversial. In almost all countries, the poorest quintile of children has the highest rate of malnutrition. However, inequalities in malnutrition between children of poor and rich families vary from country to country, with studies finding large gaps in Peru and very small gaps in Egypt. In 2000, rates of child malnutrition were much higher in low income countries (36 percent) compared to middle income countries (12 percent) and the United States (1 percent). Studies in Bangladesh in 2009 found that the mother’s literacy, low household income, higher number of siblings, less access to mass media, less supplementation of diets, unhygienic water and sanitation are associated with chronic and severe malnutrition in children.