CHAPTER 1-5

[Audio] WISCONSIN INTERNATIONAL UNIVERSITY COLLEGE, GHANA SCHOOL OF NURSING AND MIDWIFERY PREVALENCE OF MALNUTRITION AMONG CHILDREN UNDER FIVE YEARS: A STUDY AT TAIFA POLYCLINIC FELICITY MANKO SAKYI -1160153 GRACE BEMA -1160150 MAAME AKUA TENKORANG -1160194 JUNE, 2023.

[Audio] i WISCONSIN INTERNATIONAL UNIVERSITY COLLEGE, GHANA SCHOOL OF NURSING AND MIDWIFERY PREVALENCE OF MALNUTRITION AMONG CHILDREN UNDER FIVE YEARS: A STUDY AT TAIFA POLYCLINIC BY FELICITY MANKO SAKYI -1160153 GRACE BEMA -1160150 MAAME AKUA TENKORANG -1160194 Project work submitted to the School of Nursing and Midwifery, Wisconsin International University College, in partial fulfilment of the requirements for award of Bachelor of Science Degree in Midwifery JUNE, 2023.

[Audio] ii DECLARATION We hereby declare that this project work is the result of our own original research and that no part of it has been presented for another degree in this university of elsewhere. Name : ……………………………………… Candidates Signature : ……………… Date : …………………………………………... Name : …………………………………… Candidates Signature : ……………… Date : …………………………………………... Name : …………………………………… Candidates Signature : ……………… Date : …………………………………………... Supervisor's Declaration I hereby declare that the preparation and presentation of this project work were supervised in accordance with the guidelines on supervision of projects works laid down by the Wisconsin International University College. Supervisor's Signature: …………………… Date: ……………………………… Name: ……………………………………….

[Audio] iii DEDICATION We dedicate this research to all mothers with children under five years at Taifa Polyclinic..

[Audio] iv ABSTRACT Malnutrition often steals dreams from their young lives and hangs their future in the balance. Good nutrition is the basic need for children to thrive, grow, learn, play and participate. Access of every child to sufficient food may be the responsibility of parents and child to determine the fulfilment of this right. The purpose of the study was to assess the prevalence of malnutrition among children under five years at the Taifa Polyclinic and the factors associated with it. The descriptive quantitative research design was used in this study. A total of 91 mothers with children under five years were selected using the simple random sampling technique. A structured questionnaire was used to collect data for the study which was analysed using the SPSS (V. 23.0) data analysis software. Findings from the study showed a high prevalence of malnutrition among children under five years old (57.1%). This was mainly associated with having multiple children, history of fever, respiratory symptoms and being a female child. Socio-economically, lack of support from the father and short birth spacing of children, less than 2 years, were mainly associated with risk of malnutrition among children. It is recommended that religious leaders, opinion leaders, civil society organizations and the media to collaborate and champion the course of encouraging fathers to be responsible to their families and provide them with the needed support to ensure proper nutrition and upbringing of strong and healthy children, physically and mentally..

[Audio] v ACKNOWLEDGEMENTS We are thankful to God Almighty for giving us the strength to pull through. We are extremely grateful to our supervisor, Miss Elizabeth Antwiwaa, for her patience and guidance, throughout the duration of this work. Her constructive criticisms and suggestions were very helpful in improving the output of the study. We are thankful to the management and staff of Taifa Polyclinic for the permission and support to carry out this research. We acknowledge all mothers of children under five years students who took part in the study. We would also like to thank all our family, friends and colleagues who assisted us in one way or the other so far as this project work is concerned. God richly bless you all..

[Audio] vi TABLE OF CONTENTS Contents Page DECLARATION ......................................................................................................... ii DEDICATION ........................................................................................................... iii ABSTRACT ................................................................................................................ iv ACKNOWLEDGEMENTS ......................................................................................... v TABLE OF CONTENTS ............................................................................................ vi LIST OF TABLES ...................................................................................................... ix LIST OF FIGURES .................................................................................................... xi LIST OF ABBREVIATIONS .................................................................................... xii CHAPTER ONE .......................................................................................................... 1 INTRODUCTION .................................................................................................... 1 Background to the study ....................................................................................... 1 Problem statement................................................................................................. 3 Purpose of the study .............................................................................................. 4 Objectives of the study ......................................................................................... 4 Research questions ................................................................................................ 4 Significance of the study....................................................................................... 4 Delimitation of the Study ...................................................................................... 5 Operational Definition of terms ............................................................................ 5.

[Audio] vii Organization of the Rest of the Study ................................................................... 5 CHAPTER TWO ......................................................................................................... 7 LITERATURE REVIEW ......................................................................................... 7 Introduction ........................................................................................................... 7 Prevalence of malnutrition among children .......................................................... 7 Childhood factors associated with malnutrition among children ......................... 8 Socio-economic factors associated with malnutrition among children .............. 10 CHAPTER THREE .................................................................................................... 14 METHODOLOGY ................................................................................................. 14 Introduction ......................................................................................................... 14 Study Design ....................................................................................................... 14 Study Setting ....................................................................................................... 14 Study Population ................................................................................................. 15 Inclusion and exclusion criteria .......................................................................... 15 Sample size ......................................................................................................... 15 Sampling Technique ........................................................................................... 16 Tool for Data Collection ..................................................................................... 17 Validity and Reliability ....................................................................................... 17 Data Collection Procedure .................................................................................. 18 Data Analysis ...................................................................................................... 18.

[Audio] viii Ethical considerations ......................................................................................... 18 CHAPTER FOUR ...................................................................................................... 20 RESULTS AND DISCUSSION ............................................................................ 20 Introduction ......................................................................................................... 20 Results ................................................................................................................. 20 Demographic characteristics of mother .............................................................. 20 Prevalence of malnutrition among children under five years old ....................... 23 Childhood factors associated with malnutrition among children under five years old ....................................................................................................................... 25 Socio-economic factors associated with malnutrition among children under five years old .............................................................................................................. 29 Discussion ........................................................................................................... 34 CHAPTER FIVE ........................................................................................................ 37 SUMMARY, CONCLUSION AND RECOMMENDATIONS ............................ 37 Introduction ......................................................................................................... 37 Summary ............................................................................................................. 37 Conclusion .......................................................................................................... 38 Recommendations ............................................................................................... 38 REFERENCES ........................................................................................................... 39 APPEINDIX A: QUESTIONNAIRE ........................................................................ 42 APPENDIX B: INTRODUCTORY LETTER ........................................................... 45.

[Audio] ix LIST OF TABLES Table Page Table 1: Marital status of respondents ....................................................................... 21 Table 2: Educational level of respondents ................................................................. 21 Table 3: Employment status of mother ...................................................................... 23 Table 4: Position does child fall among his/her siblings............................................ 25 Table 5: Illnesses child has experienced in the past one month ................................. 26 Table 6: Sex of Child and prevalence of Malnutrition ............................................... 26 Table 7: Position child falls among his/her siblings and prevalence of Malnutrition 27 Table 8: Diarrhoea (Watery stool for more than 3 days) and prevalence of Malnutrition ............................................................................................................... 28 Table 9: Fever (Temperature of 37.2°c and above) and prevalence of Malnutrition . 28 Table 10: Respiratory symptoms (cough/ cold) and prevalence of Malnutrition ...... 29 Table 11: Mother receiving any form of financial assistance .................................... 29 Table 12: Employment status of the child's father ..................................................... 30 Table 13: Fully attending antenatal clinic during pregnancy ..................................... 31 Table 14: Practice of exclusive breastfeeding ............................................................ 31 Table 15: Birth spacing of children ............................................................................ 31 Table 16: Receiving any form of financial assistance and prevalence of Malnutrition .................................................................................................................................... 32 Table 17: Father providing support for the family and prevalence of Malnutrition .. 32 Table 18: Fully attending antenatal clinic during pregnancy and prevalence of Malnutrition ............................................................................................................... 33.

[Audio] x Table 19: Practice of exclusive breastfeeding and prevalence of Malnutrition ......... 33 Table 20: Birth spacing and prevalence of Malnutrition ........................................... 34.

[Audio] xi LIST OF FIGURES Figure Page Figure 1: Age of respondents ..................................................................................... 20 Figure 2: Religion of respondents .............................................................................. 22 Figure 3: Body Mass Index Category of children ...................................................... 24 Figure 4: Sex of child ................................................................................................. 25 Figure 5: Father providing support for the family ..................................................... 30.

[Audio] xii LIST OF ABBREVIATIONS ANC: Antenatal Care BMI: Body Mass Index SADHS: South Africa Demographic and Health Survey SPSS: Statistical Package for Social Sciences WHO: World Health Organisation.

[Audio] 1 CHAPTER ONE INTRODUCTION Background to the study Malnutrition is a health condition resulting from eating food that contains either insufficient or too many calories, carbohydrates, vitamins, proteins or minerals (Davis et al., 2020). It is a state of under- or overnutrition, evidenced by a deficiency or an excess of essential nutrients. Good nutrition is the basic need for children to thrive, grow, learn, play and participate. Access of every child to sufficient food may be the responsibility of parents and child to determine the fulfilment of this right. Malnutrition often steals dreams from their young lives and hangs their future in the balance (Vollmer et al., 2017). It remains a major public health concern for children under the age of 5 years in many low- and middle-income countries because it is still the leading underlying cause of child mortality in these countries (Clark et al., 2020). Malnutrition in the form of undernutrition, namely underweight, stunting and wasting has been coined as the silent emergency (Shukla et al., 2018). According to the WHO 2020 report, about 144 million children under 5 years have stunted growth, 47 million children are wasted and 14.3 million are severely wasted, whilst 38.3 million are overweight or obese (Clark et al., 2020). According to the 2016 South Africa Demographic and Health Survey (SADHS), the prevalence rate of wasting was found to be 2.5% and underweight was 6%, whilst the stunting rate remained high at 27.0% amongst children under 5 years (May et al., 2020). Around 45% of deaths reported amongst children under the age of 5 years are linked to undernutrition (Clark et al., 2020)..

[Audio] 2 The causes of malnutrition are multifaceted and include diseases, inadequate diet, environmental, and socioeconomic factors (Boah et al., 2019). The age of the child, gender, birth weight, child's vaccination status, birth spacing, birth order, maternal education, mother's body mass index (BMI), antenatal care (ANC) use by mother, household wealth index, improved water, hygiene and sanitation, family structure, and family size have been identified as some of the determinants of children's nutritional status in sub-Saharan Africa (Sulaiman et al., 2018). The causes of childhood malnutrition can also be due to frequent infections, poor breastfeeding practices, delayed introduction of complementary foods, food taboos, growth and personal choice related to diet. Malnutrition can also develop due to neglect, abnormal mealtimes, and insufficient parental knowledge (Ansuya, 2018). In developing countries, the nutritional status of children depends on socioeconomic status, awareness of diseases such as diarrhea and acute respiratory tract infection, educational status of mother and availability of safe drinking water (Mittal et al., 2017). Children are more vulnerable to macro- and micronutrient deficiencies caused by high demand for food during their years of growth (Clark et al., 2020). The effects of malnutrition in children under the age of 5 years include underweight, stunting, wasting with or without oedema (previously known as marasmus and kwashiorkor, respectively) and even death.8 Undernourished children are prone to infections. Statistically underweight children succumb to diseases such as diarrhea, measles, and malaria and lower respiratory tract infections. Undernutrition in young children has long-term negative effects on physical and cognitive development (Dhone, 2012)..

[Audio] 3 Problem statement Undernutrition among under five children is a major public health problem. Its prevalence is highest in the world and is almost double that of Sub-Saharan Africa (Sundari, 2017). Malnutrition amongst children under the age of 5 years is a result of a complex interaction of availability, accessibility, and utilization of food and healthcare services (Drammeh et al., 2019). Nutrition-specific factors include inadequate food intake, poor caregiving and parenting, improper food practices and infectious comorbidities. Nutrition-sensitive factors include food insecurity, inadequate economic resources at the individual, household, and community levels. Limited or poor access to education, healthcare services, infrastructure and poor hygienic environment are other nutritional sensitive factors that adversely affect the children under the age of 5-year nutritional status (Clark et al., 2020). The Taifa Polyclinic serves as the main public health facility for persons living in Taifa and surrounding towns. Most women access child welfare health care services from the facility where a lot of education is done on infant and young child feeding practices. However, the researchers have observed that some children are brought to the facility with underweight, wasting or stunting, an indication of malnutrition, however, no known study has been conducted to assess the situation. Therefore, this study assessed the prevalence of malnutrition and factors contributing to that at the Taifa Polyclinic..

[Audio] 4 Purpose of the study The purpose of the study was to assess the prevalence of malnutrition among children under five years at the Taifa Polyclinic and the factors associated with it. Objectives of the study The objectives of the study were to; 1. assess the prevalence of malnutrition among children under five years old. 2. describe the childhood factors associated with malnutrition among children under five years old. 3. identify the socio-economic factors associated with malnutrition among children under five years old. Research questions 1. What is the prevalence of malnutrition among children under five years old? 2. What are the childhood factors associated with malnutrition among children under five years old? 3. What are the socio-economic factors associated with malnutrition among children under five years old? Significance of the study The outcome of the study will provide evidence-based information on the prevalence of malnutrition among children under five years at the Taifa Polyclinic to help inform the nurses and midwives about the impact their health education has had on the mothers efforts to improve childhood nutrition. The findings would be useful in the formulation of policies in Ghana to tackle undernutrition and contribute to the literature by providing.

[Audio] 5 evidence on the common factors associated with childhood malnutrition among children under five years at the Taifa Polyclinic. Delimitation of the Study This study focused on the prevalence of childhood malnutrition and the factors accounting for this. The scope involved only children under five years and their mothers at the Taifa Polyclinic. Operational Definition of terms Malnutrition: Underweight, wasting or stunting among children under five years. Children: Male of females not more than five years of age whose mothers bring them to the Taifa Polyclinic for health care. Prevalence: The number of children suffering from malnutrition within a specific period. Individual factors: Personal circumstances relating to the child alone which are associated with malnutrition among children under five years. Socio-economic factors: Interpersonal and financial situations associated with malnutrition among children under five years. Organization of the Rest of the Study This study is reported in five (5) chapters. Chapter one encompasses the background to the study, problem statement, objectives of the study and research questions. This also contains the significance of the study, delimitations, and operational definition of terms..

[Audio] 6 The second chapter (Chapter two) comprises of the literature review for the study. Chapter three describes the research methodology and includes a description of the research design, population, sampling and sampling procedures, instruments, data collection process and data analysis. The fourth chapter is the presentation of results and discussion of the findings of the study. Finally, chapter five comprises a summary, conclusion and recommendations based on the findings of the study..

[Audio] 7 CHAPTER TWO LITERATURE REVIEW Introduction The literature review on the prevalence of malnutrition among children under five years is presented in this chapter. It includes an overview of previous studies on prevalence of malnutrition among children, childhood factors associated with malnutrition among children and childhood factors associated with malnutrition among children. Literature was accessed from articles and s from online databases including Google Scholar, PubMed and Science Direct. Prevalence of malnutrition among children The epidemiology of undernutrition and its determinants in children under five years in Ghana were assessed by Boah et al (2019). This study used data from the 2014 Ghana Demographic and Health Survey to estimate the prevalence of underweight, stunting, and wasting. They found that the prevalence of underweight, wasting and stunting was 10.43%, 5.31% and 18.37% respectively. There were significant differences between groups for all the three forms of undernutrition by child's age category. The highest prevalence of underweight (12.81%), wasting (11.44%) and stunting (28.60%) was found among children aged 12–23, 6–11 and 24–35 months, respectively. Female children (16.44%) were less prone to stunting than their male counterparts (20.15%). This shows that stunting remains the highest category of malnutrition among the children in their study. Although these were compared to their age group and gender to assess associations of malnutrition with age and gender, comparing the prevalence of underweight, wasting.

[Audio] 8 and stunting with variables such as mothers' occupation, monthly income, educational level, to mention but a few could provide more insight in the prevalence of malnutrition among the children. In a cross-sectional survey in North Sudan, Sulaiman et al. (2018) also assessed the prevalence and determinants of undernutrition among children under 5-year-old in rural areas. A total of 1635 children under 5 (0–60 months) years of age were enrolled in this study. Of them, 1081 (66.1%) were boys and 554 (33.9%) were girls. Anthropometric measurements were available for 1,447 of the 1,635 children surveyed. Stunting was found in 42.5% of the children while 32.7% were underweight, and 21% were wasted. Severe stunting was found in 28.2% of the children, severe underweight in 22.5% and severe wasting in 12.1% of the children. Although Sulaiman et al. (2018) used a cross sectional approach, the trend of their findings was not so different from that of Boah et al (2019) as stunting remains the leading category of malnutrition among children under five years. Childhood factors associated with malnutrition among children The causes of malnutrition are multifaceted and include diseases, inadequate diet, environmental, and socioeconomic factors (WHO, 2017). The age of the child, gender, birth weight, child's vaccination status, birth spacing, birth order have been identified as some of the determinants of children's nutritional status in sub-Saharan Africa (Chalashika et al., 2017). Associated factors of malnutrition among children under five years old was assessed by Fernandes et al. (2017) in Angola. Children of 24-35 months old had a lower prevalence of wasting when compared with the group of children younger than 12 months old. Children who are 12 months old or older, compared to those under.

[Audio] 9 12 months old, had higher prevalence of stunting. The prevalence of stunting was higher in male children. In North Sudan, Sulaiman et al. (2018) in their cross-sectional study found that wasting was the lowest indicators of undernutrition among the under 5-year surveyed children. Moderate wasting was most common (33.3%) among children aged 0–6 months, and was the lowest (16.1%) in children aged 37–47 months. However, there was no statistical association between age and wasting. A similar proportion (21.2%) of boys was wasted as girls (20%). Severe stunting was found in 28.2% of the children. The moderate prevalence of underweight (low weight for age) was 32.7%. Among them, 22.5% of the children were severely underweight. Furthermore, Sulaiman et al. (2018) found that the prevalence of stunting among children aged 0–60 months was 42.5%, it was sustained high throughout all age groups and then reached the peak at the age of (48–60 months) (51.4%). The proportion (45.3%) of boys stunted was higher than girls (37.2%). Children aged 48–60 months had the greatest likelihood (50.5%) of being underweight. This difference was significant when compared with all other age groups. The household morbidity surveillance indicated that majority of the children had an illness 2 weeks before the interviews. The prevalence of the top four disease symptoms reported were respiratory symptoms (cough) (82.3%), symptoms of gastroenteritis (diarrhea) (71.2%), fever (34.6%), and symptoms of Measles (12.4%). There were statistical associations observed between wasting and report of recent illness mainly gastroenteritis and respiratory symptoms. In Ghana, Boah et al. (2019) also assessed childhood factors associated with malnutrition among children. The child's age, birthweight and mother's BMI category were significant.

[Audio] 10 determinants of underweight. Underweight was more prevalent among children aged 12– 23 months and 24–35 months compared to children aged 0–5 months. Relatively, low weight at birth was associated with a higher chance of being underweight. The child's age, sex and dietary diversity score were found to be significantly associated with wasting. Comparatively, wasting was less prevalent among children in the age groups of 24–35 months and 36 months and over. Independently, child's age, birth weight and the birth order of the child were identified as determinants of stunting. Stunting was more prevalent among children aged 12–23 months, 24-35 months and 36 months and over. Relatively, children born low birth weight were 3 times more likely to be stunted. Socio-economic factors associated with malnutrition among children Using data from Bangladesh Demographic and Health Survey, Talukder (2017) assessed the factors associated with malnutrition children under five. Based on estimates made in this study, it was concluded that nutritional status has a significant weak positive relationship with wealth index, mother's BMI, and birth interval. Therefore, with the increase in wealth index, mother's BMI, and birth interval, children tended to fall into the "nourished" category of child nutritional status. The percentage of severely malnourished and moderately malnourished children were found higher between the no or primary educated mother (10.9% and 28.7%, respectively), nor primary educated father (10.6% and 27.8%, respectively), rural area (8.3% and 26.1%, respectively), sylhet division (10.5% and 28.5%, respectively), and those who did not receive any antenatal care (ANC) service during pregnancy (13.2% and 25.4%, respectively)..

[Audio] 11 From the findings of Talukder (2017), it is evident that limited access to healthcare services is a significant barrier to addressing malnutrition in children under five. Inadequate antenatal care, limited immunization coverage, and lack of nutrition counseling contribute to maternal and child health problems (Black et al., 2013). The absence of skilled healthcare professionals in remote or marginalized areas exacerbates the issue. Timely diagnosis and treatment of infections, along with growth monitoring, are essential for early intervention to prevent malnutrition. Therefore, improving healthcare infrastructure and increasing the availability of nutrition services can help mitigate these factors. All these selected factors were found significantly related to the nutritional health status of children. Maternal education, mother's body mass index (BMI), antenatal care (ANC) use by mother, household wealth index, improved water, hygiene and sanitation, family structure, and family size have been identified as some of the determinants of children's nutritional status in sub-Saharan Africa (Chalashika et al., 2017). Sulaiman et al (2018) found that in North Sudan, the majority of children whose mothers did exclusive breastfeeding (62.1%) did not experience malnutrition. Most (64%) of the mothers continued breastfeeding up to 2 years of the child's age. When asked about mother's attitude when the child had diarrhoea as to whether they provide less or more amount of foods or drinks, a few number of mothers (3.6%) decreased the amount of food and drinks while a child had diarrhoea. The large majority (87.2%) of the mothers fed their children three or more meals per day. There were no significant differences in the feeding practices during illness and nutritional status. However, the prevalence of undernutrition was higher among infants weaned suddenly and those to whom bottle feeding was introduced..

[Audio] 12 Talukder (2017) also observed that the children with overweighted mother had a lower risk of having a poor nutritional status. The mothers receiving antenatal care service during pregnancy had a lower risk of having a malnourished child. Moreover, the children having birth interval 24−47 months had less chance of staying in the worst state of nutritional status compared with the children having less than 24 months birth interval. However, place of residence had no significant effect on the nutritional status of children. Socio-economic factors associated with malnutrition among children under five years old was also assessed by Fernandes et al. (2017) in Angola. In this cross-sectional study, the authors found that at the distal level a lower prevalence of wasting was observed among those whose fathers were not living at home and that the father had a smaller number of children. At the intermediate level a lower prevalence of wasting was observed among children with mothers aged 25 to 34 (compared to children with adolescent mothers) and higher prevalence of stunting was identified among children whose water supply came from the river or lake (compared to those supplied by fountain or pit). At the level proximal children presenting recent parasite expulsion or ear infection had a higher prevalence of stunting. Although Fernandes et al. (2017) in Angola compared fathers' presence and the availability of certain amenities at home to relate to malnutrition among children, further comparison with other socio-economic variables as demonstrated with Talukder (2017) could provide further detail and more meaning to the findings. However, this could be because Fernandes et al. (2017) directly engaged in primary cross-sectional data collection compared to Talukder (2017) who run their analysis based on Bangladesh Demographic and Health Survey data..

[Audio] 13 In addition, Boah et al. (2019) found that women in the normal and overweight BMI categories were less likely to have underweight children in Ghana. The authors indicated that the husband/partner's educational level, and wealth index were found to be significantly associated with wasting. Also, children from the middle-class of the household wealth index were less likely to be wasted. However, female sex, fourth birth order number of child, primary level husband/partner education were associated with a higher chance of wasting. Independently, a woman's autonomy and region were identified as determinants of stunting. Also, birth order of 5 or more was associated with 2 times the chances of stunting. A high woman's autonomy was associated with a lower chance of stunting in their children whereas children from the northern region of Ghana were about 3 times more likely to be stunted. Findings from the studies reviewed showed that socioeconomic status is a crucial factor influencing child malnutrition. These studies have consistently shown that children from low-income households are at higher risk of malnutrition (Smith & Haddad, 2015). This is because the limited financial resources restrict access to nutritious food, resulting in dietary deficiencies. Additionally, poverty is often accompanied by inadequate sanitation, unsafe drinking water, and overcrowded living conditions, leading to increased susceptibility to infections and poor health outcomes (Black et al., 2013; Boah et al., 2019). These adverse conditions contribute to malnutrition among children under five..

[Audio] 14 CHAPTER THREE METHODOLOGY Introduction This chapter presents the methodology of the study. This comprises a description of the research design and setting of the study, data collection technique and tool. The study population, sites and variables, sample size and sampling technique, validity and reliability, pre-testing of tool, data handling, data analysis, ethical considerations and limitations of the study are also presented in this chapter. Study Design The study employed the descriptive quantitative design to guide the study. This involved the use of a quantitative approach to transfer the data gathered numerically to reflect the properties of the subject under study. This helped the researchers to assess the prevalence of malnutrition among children under five years at the Taifa Polyclinic and the factors associated with it. Study Setting The study was carried out at the child welfare clinic of the Taifa Polyclinic. Taifa polyclinic is located at Taifa north in the Ga-East municipality. The facility was initially a CHPs compound which was built in 2005. It became a polyclinic in July 2013 and serves mainly the people Taifa Burkina and kwabenya sub- municipality. The Taifa Polyclinic is a 25-bed capacity facility and has a staff strength of 224 including 17 casual staffs..

[Audio] 15 The facility has male, female, surgical, maternity and infant wards. Units and departments in the facility include the reproductive and child health unit (RCH), out-patient department (OPD), Ear, Nose and Throat (ENT) clinic, Eye clinic, Antenatal clinic (ANC), records unit, accounts, administration, medical laboratory unit, dental, audit, nutrition, isolation, and anti-retroviral therapy (ART) unit. The facility also has a wellness clinic, pharmacy, procurement and stores unit. The child welfare clinic is one of the busiest clinics in the facility. The clinic is manned by 26 community health nurses and 2 public health offices. Services provided include growth monitoring, registration, immunisation, health education, counseling, home visit, family planning management of sexually transmitted infections. Clinic days and Mondays to Fridays with an average monthly attendance of 1,024. Study Population The population for the study was children under five years who attended Taifa Polyclinic with their mother. Inclusion and exclusion criteria Only children under five years of age accessing health care services at the child welfare clinic of the Taifa Polyclinic were included into the study. The mothers who did not accept the invitation for their children to take part in the study were all excluded. Sample size The sample size of the was determined using the Yamane (1967) formula….

[Audio] 16 Where n is the sample size, N is the population size, and e is the level of error allowed. (Using the average monthly attendance of children at the child welfare clinic (N=1.024), and 10% error margin (e= 0.1), the calculated sample size was as follows: n=1,024 [1+1,024 (0.1)2] n=1,024/ 11.24 n=91.103 Therefore, a total of 91 children under five years and their mothers were selected as the sample size for the study. Sampling Technique The simple random sampling technique was used to select respondents for the study. This is a form of probability sampling technique where each member of population is equally likely to be chosen as part of the sample (Saunders et al., 2012). In this method each of the mothers and their children at the child welfare clinic of the Taifa Polyclinic were numbered according to the times they report to the facility on a usual clinic day. The numbers were then written on separate pieces of paper. These pieces of papers were then folded and mixed into a box. Samples were taken randomly from the box by choosing folded pieces of papers in a random manner. This was done until the required number of subjects were selected for the study..

[Audio] 17 Tool for Data Collection A structured questionnaire was used to collect data for the study. The questionnaire mainly consisted of close ended questions which require specific answers. The questionnaire was organized in a systematic and sequential manner to satisfy the objectives of the study. The questionnaire was in three sections. Section A had items which cover socio-demographic data of the children and their mothers. Section B had questions on anthropometric data of children to determine the prevalence of malnutrition among children under five. Section C covered information on factors associated with malnutrition among children under five years old. Validity and Reliability Polit and Beck (2013) define the validity of a questionnaire as the degree to which the instrument measures what it is intended to measure. To ensure validity of this study, the questionnaire was designed according to the objectives of the study. It was presented to the supervisor to evaluate and approve before it was used to collect data. Reliability is the degree of consistency with which the instruments (tools) measures attitudes (Polit & Beck, 2013). To ensure reliability of the study, a pre-test of the questionnaire was carried out on six children and their mothers at the child welfare clinic of the Ghana Atomic Energy Commission (GAEC) Hospital. The responses from the completed questionnaires were assessed after which all necessary corrections were made before the questionnaire was administered to collect actual data for the study. This was to ensure that all the questions are clear and easily understood..

[Audio] 18 Data Collection Procedure An introductory letter from the Nursing and Midwifery School, Wisconsin International University College, Ghana, was sent to Management of the Taifa Polyclinic to inform them about the study and to seek permission to collect data for the study. The nurse manager and staff at the child welfare clinic were also informed about the study. During the data collection period, the nurses helped introduce the researchers to the mothers and their children at the child welfare clinic. The researchers then informed the mothers about the study and seek their consent to recruit their children for the study. Those who agreed to take part in the study had the questionnaires administered to them and their children assessed. Those who could read and write English were given the questionnaires and were allowed enough time to complete the questionnaires after which it was collected from them. Those unable to read and write English had the questionnaires read out to them in languages that they understand for example "Ga" or "Twi" and their responses recorded. Data Analysis The data entry and analysis were done using the SPSS (version 23.0) software. This was done after coding the individual questions and entering the responses into the software. Data analysis was then done descriptively and the results were presented as mean scores, percentages and frequencies in tables, charts and graphs. Ethical considerations An introductory letter from the School of Nursing and Midwifery, Wisconsin International University College was sent to the management of the Taifa Polyclinic to seek permission to conduct the study. The researchers ensured that all the mothers and their children were informed about the purpose of the study. After that, verbal consent.

[Audio] 19 was sought from the mothers before the questionnaires are administered to them and the children assessed. The researchers explained to the mothers that participation in the study was non-obligatory. They were informed that all information provided would be treated as private and confidential. Names of the mothers and their children and other identifying information were not included in the questionnaire in order to ensure anonymity..

[Audio] 20 CHAPTER FOUR RESULTS AND DISCUSSION Introduction This chapter presents the results of the study. This has been analysed and presented descriptively in the form of frequency distribution tables, pie charts and bar graphs, and in accordance with the objectives of the study. The results have also been discussed by comparing it with findings from previous studies in existing literature. Results Demographic characteristics of mother Figure 1: Age of respondents Majority, 37 (40.7%) of the respondents were within the ages of 20-29 years, 30 (33.0%) were within the ages of 30-39 years, 20 (22.0%) were less than 20 years and 4 (4.4%) of them were within 40-49 years. 20 (22%) 37 (40.7%) 30 (33%) 4 (4.4%) 0 5 10 15 20 25 30 35 40 < 20 years 20-29 years 30-39 years 40-49 years.

[Audio] 21 Table 1: Marital status of respondents Status Frequency Percent Single 15 16.5 Married 36 39.6 Divorced Separated 4 4.4 Widowed 5 5.5 Cohabiting 31 34.1 Total 91 100.0 Table 1 shows that 36 (39.6%) of the respondents were married, 31 (34.1%) were cohabiting, 15 (16.5%) of them were single, 5 (5.5%) were widowed and 4 (4.4%) were separated. Table 2: Educational level of respondents Level Frequency Percent Primary 24 26.4 Secondary 31 34.1 Post-secondary 14 15.4 Tertiary 18 19.8 No Education 4 4.4 Total 91 100.0 Thirty-one (34.1%) of the respondents had secondary education, 24 (26.4%) of them had primary education, 18 (19.8%) had tertiary education and 14 (15.4%) had post secondary education. However, 4 (4.4%) of them had no education..

[Audio] 22 Figure 2: Religion of respondents Majority, 73 (80%) of the respondents were Christians and 18 (20%) were Muslims. 73, 80% 18, 20% Christian Muslim.

[Audio] 23 Table 3: Employment status of mother Status Frequency Percent Unemployed 10 11.0 Self-employed 41 45.1 Private employee 22 24.2 Government employee 18 19.8 Total 91 100.0 Close to half 41 (45.1%) of the respondents were self-employed, 22 (24.2%) were private employees and 18 (19.8%) were government employee. However, 10 (11.0) of them were unemployed. Prevalence of malnutrition among children under five years old The average age of the children is 11 months (SD=4.38) ranging from 2 to 18 months. The average weight of the children is 8.1kg (SD=1.42) ranging from 4 to 10 kg. The height range of the children is from 50 to 78cm. The average height is 67cm (SD=6.42). The average Body Mass Index (BMI) is 18.9kg/m2. This ranged from 13 to 26 kg/m2.

[Audio] 24 Figure 3: Body Mass Index Category of children Most, 52 (57.1%) of the children were underweight and 29 (31.9%) had normal healthy weight. However, 5 (5.5%) were overweight and 5 (5.5%) were obese. 52 (57.1%) 29 (31.9%) 5 (5.5%) 5 (5.5%) 0 10 20 30 40 50 60 Underweight Healthy Overweight Obese.

[Audio] 25 Childhood factors associated with malnutrition among children under five years old Figure 4: Sex of child Majority, 46 (51%) of the respondents were males and 45 (49%) were females. Table 4: Position does child fall among his/her siblings Position Frequency Percent 1st born 29 31.9 2nd born 26 28.6 3rd born 27 29.7 4th born 5 5.5 5th born 4 4.4 Total 91 100.0 Majority, 29 (31.9%) of the respondents had their children being the first born among their siblings, 27(29.7%) had their children being the third born, 26 (28.6%) had their 46, 51% 45, 49% Male Female.

[Audio] 26 children being the second born, 5 (5.5%) of them had their children being the fourth born and 4 (4.4%) had their children being the fifth born. Table 5: Illnesses child has experienced in the past one month Illness Yes n (%) No n (%) Diarrhoea (Watery stool for more than 3 days). 52 (57.1%) 39 (42.9%) Fever (Temperature of 37.2°c and above) 41 (45.1%) 50 (54.9%) Respiratory symptoms (cough/ cold) 53 (58.2%) 38 (41.8%) Most, 53 (58.2%) of the respondents had respiratory symptoms such as cough and cold and 52 (57.1%) of them had diarrhoea all in the past one month. However, less than half, 41 (45.1%) of the respondents had fever in the past one month and 50 (54.9%) had no fever. Table 6: Sex of Child and prevalence of Malnutrition BMI Total Malnourished Normal/ Overweight Sex of child Male 22 24 46 47.8% 52.2% 100.0% Female 30 15 45 66.7% 33.3% 100.0% Table 6 shows that among the male children 22 (47.8%) were malnourished. However, among the females, 30 (66.7%) were malnourished..

[Audio] 27 Table 7: Position child falls among his/her siblings and prevalence of Malnutrition BMI Total Malnourished Normal/ Overweight What position does child fall among his/her siblings? 1st born 19 10 29 65.5% 34.5% 100.0% 2nd born 17 9 26 65.4% 34.6% 100.0% 3rd born 12 15 27 44.4% 55.6% 100.0% 4th born 0 5 5 0.0% 100.0% 100.0% 5th born 4 0 4 100.0% 0.0% 100.0% Table 7 shows that 19 (65.5%) of the first born children were malnourished and 17 (65.4%) of the second born children were malnourished. Twelve (44.4%) of the third born children were malnourished. All, 5 (100%) the forth born children had normal or overweight and all, 4 (100%) the fifth born children were malnourished..

[Audio] 28 Table 8: Diarrhoea (Watery stool for more than 3 days) and prevalence of Malnutrition BMI Total Malnourished Normal/ Overweight Diarrhoea (Watery stool for more than 3 days). Yes 27 25 52 51.9% 48.1% 100.0% No 25 14 39 64.1% 35.9% 100.0% It can be seen from Table 8 that 27 (51.9%) of children who had diarrhoea before the study were malnourished and 25 (64.1%) of the children who did not have diarrhoea were malnourished. Table 9: Fever (Temperature of 37.2°c and above) and prevalence of Malnutrition BMI Total Malnourished Normal/ Overweight Fever (Temperature of 37.2°c and above) Yes 32 9 41 78.0% 22.0% 100.0% No 20 30 50 40.0% 60.0% 100.0% Majority, 32 (78%) of the children with history of fever were malnourished and 20 (40%) of the children with no history of fever were malnourished..

[Audio] 29 Table 10: Respiratory symptoms (cough/ cold) and prevalence of Malnutrition BMI Total Malnourished Normal/ Overweight Respiratory symptoms (cough/ cold) Yes 38 15 53 71.7% 28.3% 100.0% No 14 24 38 36.8% 63.2% 100.0% Majority, 38 (71.7%) of the children with respiratory symptoms were malnourished and 14 (36.8%) of the children without respiratory symptoms were malnourished. Socio-economic factors associated with malnutrition among children under five years old Table 11: Mother receiving any form of financial assistance Received Frequency Percent Yes 45 49.5 No 46 50.5 Total 91 100.0 Majority, 46 (50.5%) of the respondents did not receive any form of financial support. However, 45 (49.5%) of the mothers received some form of financial assistance to cater for their child..

[Audio] 30 Table 12: Employment status of the child's father Status Frequency Percent Unemployed 4 4.4 Self-employed 27 29.7 Private employee 35 38.5 Government employee 25 27.5 Total 91 100.0 Majority, 35 (38.5%) of the respondents had their child's father being private employee, 27 (29.7%) were self-employed, 25 (27.5%) were government employee. However, 4 (4.4%) of them had their child's father being unemployed. Figure 5: Father providing support for the family Majority, 82 (90.1%) of the respondents had support from the fathers of their children. However, 9 (9.9%) of them had no support from the father. 82, 90% 9, 10% Yes No.

[Audio] 31 Table 13: Fully attending antenatal clinic during pregnancy Full attendance Frequency Percent Yes 59 64.8 No 32 35.2 Total 91 100.0 Majority, 59 (64.8%) of the respondents attended antenatal clinic during pregnancy. However, 32 (35.2%) did not attend antenatal clinic during pregnancy. Table 14: Practice of exclusive breastfeeding Practice Frequency Percent Yes 45 49.5 No 46 50.5 Total 91 100.0 Majority, 46 (50.5%) of the respondents do/are not practice(ing) exclusive breastfeeding. However, 45 (49.5%) of them practiced exclusive breastfeeding. Table 15: Birth spacing of children Spacing Frequency Percent Less than 1 year 5 5.5 1 year 8 8.8 1 and half years 28 30.8 2 years 35 38.5 3 years 15 16.5 Total 91 100.0 Majority, 35 (38.5%) of the respondents had a two-year birth spacing for their children, 28 (30.8%) had a one and half year birth spacing, 15 (16.5%) had a three-year birth.

[Audio] 32 spacing, 8(8.8%) had a year birth spacing and 5 (5.5%) had less than a year birth spacing. Table 16: Receiving any form of financial assistance and prevalence of Malnutrition BMI Total Malnourished Normal/ Overweight Do you receive any form of financial assistance? Yes 31 14 45 68.9% 31.1% 100.0% No 21 25 46 45.7% 54.3% 100.0% As shown in Table 16, 31 (68.9%) of mothers who received financial assistance had malnourished children and 21 (45.7%) mothers who did not receive financial assistance did not have malnourished children. Table 17: Father providing support for the family and prevalence of Malnutrition BMI Total Malnourished Normal/ Overweight Does the father provide any support for the family? Yes 43 39 82 52.4% 47.6% 100.0% No 9 0 9 100.0% 0.0% 100.0% Forty-three (52.3%) mothers with partners who provided some family support had malnourished children and all, 9 (100%) of mothers with partners did not provide family support had malnourished children..

[Audio] 33 Table 18: Fully attending antenatal clinic during pregnancy and prevalence of Malnutrition BMI Total Malnourished Normal/ Overweight Did you fully attend antenatal clinic during pregnancy? Yes 35 24 59 59.3% 40.7% 100.0% No 17 15 32 53.1% 46.9% 100.0% As shown in Table 18, 35 (59.3%) of the mothers who fully, attended antenatal clinic had malnourished children and 17 (53.1%) of the mothers who did not fully attend antenatal clinic had malnourished children. Table 19: Practice of exclusive breastfeeding and prevalence of Malnutrition BMICAT_RC Total Malnourished Normal/ Overweight Did you (are you) practice(ing) exclusive breastfeeding? Yes 26 19 45 57.8% 42.2% 100.0% No 26 20 46 56.5% 43.5% 100.0% Twenty-six (57.8%) of the mothers who practiced exclusive breastfeeding had malnourished children and 26 (56.5%) of the mothers who did not practice exclusive breastfeeding had malnourished children..

[Audio] 34 Table 20: Birth spacing and prevalence of Malnutrition BMI Total Malnourished Normal/ Overweight Birth Spacing < 2years 8 5 13 61.5% 38.5% 100.0% 2-4 years 44 34 78 56.4% 43.6% 100.0% Eight (61.5%) of the mothers who spaced their children malnourished children less than 2 years had malnourished children and 44 (56.4%) of the mothers who spaced their children 2-4 years had malnourished children. Discussion The purpose of the study was to assess the prevalence of malnutrition among children under five years at the Taifa Polyclinic and the factors associated with it. A total of 91 mothers with their children under five years took part in the study. The mothers were mostly young adults less than 40 years of age (95.6%). Most (39.6%) of them were married and they were mostly Christians (80%). Majority (95.6%) of the mothers have had some form of formal education indicating high level of literacy among the mothers. Majority (89%) of the mothers were employed. This suggests that they could make some money to cater for the nutrition of their children. The first objective of the study was to assess the prevalence of malnutrition among children under five years old. The findings from the study showed a 57.1% prevalence rate of malnutrition among the children under five years of age. However, in another study in Ghana, Boah et al (2019) found that the prevalence of underweight, wasting and.

[Audio] 35 stunting was 10.43%, 5.31% and 18.37% respectively. In North Sudan, Sulaiman et al. (2018) also found stunting in 42.5% of the children while 32.7% were underweight, and 21% were wasted. Thus, comparatively, the prevalence of malnutrition among children under five years in the current study is high. The second objective of the study was to assess childhood factors associated with malnutrition among children under five years old. Findings from the study showed that being a fifth born (100%) was the main childhood factors associated with malnutrition among children under five years. Thus, an indication that having many children deprives the younger ones of opportunity for good nutrition. In addition, being a female child (66.7%) was associated with malnutrition among children under five years. On the contrary, Fernandes et al. (2017) in Angola found that the prevalence of stunting was higher in male children, which is also an indication of malnutrition. In this current study, children with history of fever (78%), children with respiratory symptoms (71.7%) were childhood factors associated with malnutrition among children under five years. This confirms finding of Sulaiman et al. (2018) where statistical associations were observed between wasting and report of recent illness mainly gastroenteritis and respiratory symptoms among children under five years old. All this can be linked to the findings of Chalashika et al. (2017) that the gender, birth spacing, and birth order are some of the determinants of children's nutritional status in sub-Saharan Africa. The last objective of the study was to assess socio-economic factors associated with malnutrition among children under five years old. It was found that having a partner/.

[Audio] 36 husband who does not provide family support (100%) and spacing of child births for less than 2 years (61.5%) were the main socio-economic factors associated with malnutrition among children under five years old. Fernandes et al. (2017) in Angola. Also found that at the distal level a lower prevalence of wasting was observed among those whose fathers were not living at home to provide domestic support. This underscores the need for fathers to be actively involved in the care and support of their children. In addition, children under five years were more likely to be malnourished if their mothers were not practicing exclusive breastfeeding (56.5%) and mothers not fully attending antenatal clinic (53.1%). Similarly, in Bangladesh, Talukder (2017) found that mothers who did not receive any antenatal care (ANC) service during pregnancy were at risk of having malnourished children. Inadequate antenatal care, was also mentions by Black et al. (2013) as one risk factor for malnutrition among children under five years..

[Audio] 37 CHAPTER FIVE SUMMARY, CONCLUSION AND RECOMMENDATIONS Introduction This chapter presents a summary of the research report. Conclusions made from the study are also presented in the chapters. Recommendations based on the findings of the study have also been presented in this chapter. Summary This is a descriptive quantitative study that was conducted to assess the prevalence of malnutrition among children under five years at the Taifa Polyclinic and the factors associated with it. Nine-one mothers with their children under five years were recruited for the study. Findings from the study on the prevalence of malnutrition among children under five years old showed a 57.1% prevalence rate of malnutrition among the children under five years of age. Secondly, findings from the study on childhood factors associated with malnutrition among children under five years old showed that being a fifth born (100%), children with history of fever (78%), children with respiratory symptoms (71.7%) and being a female child (66.7%) were the main childhood factors associated with malnutrition among children under five years. With regard to the socio-economic factors associated with malnutrition among children under five years old, the study showed that having a partner/ husband who does not provide family support (100%) and spacing of child births for less than 2 years (61.5%).