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CHAPTER ONE
INTRODUCTION
1.1   BACKGROUND TO THE STUDY
Malnutrition in children also known as malnutrition 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, under weight 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. Diarrhea and other infections can cause malnutrition through decreased nutrient absorption, decreased intake of food, increased metabolic requirements, and direct nutrient loss. Parasite infections, in particular intestinal worm infections (helminthiasis), can also lead to malnutrition.
A leading cause of diarrhea and intestinal worm infections in children in developing countries is lack of sanitation and hygiene. Children with chronic diseases like HIV have a higher risk of malnutrition, since their bodies cannot absorb nutrients as well. Diseases such as measles are a major cause of malnutrition in children; thus immunizations present a way to relieve the burden. The nutrition of children 5 years and younger depends strongly on the nutrition level of their mothers during pregnancy and breastfeeding. Infants born to young mothers who are not fully developed are found to have low birth weights. The level of maternal nutrition during pregnancy can affect newborn body size and composition. Iodine-deficiency in mothers usually causes brain damage in their offspring, and some cases cause extreme physical and mental retardation. This affects the children’s ability to achieve their full potential (Wagstaff & Naoke, 1999). In 2011 UNICEF reported that thirty percent of households in the developing world were not consuming iodized salt, which accounted for 41 million infants and newborns in whom iodine deficiency could still be prevented. Maternal body size is strongly associated with the size of newborn children. Short stature of the mother and poor maternal nutrition stores increase the risk of intrauterine growth retardation (IUGR). However, measurements of a child’s growth provide the key information for the presence of malnutrition, but weight and height measurements alone can lead to failure to recognize kwashiorkor and an underestimation of the severity of malnutrition in children
1.2   STATEMENT OF THE PROBLEM
Measures have been taken to reduce child malnutrition. Studies for the World Bank found that, from 1970 to 2000, the number of malnourished children decreased by 20 percent in developing countries. Iodine supplement trials in pregnant women have been shown to reduce offspring deaths during infancy and early childhood by 29 percent. However, universal salt iodization has largely replaced this intervention. Nutritional education and micronutrient-fortified food supplements has resulted in 10 percent reduction and the prevalence of stunting in children 12–36 months old. Milk fortified with zinc and iron reduced the incidence of diarrhea by 18 percent in children.
1.3   OBJECTIVES OF THE STUDY
The following are the objectives of this study:
1.  To examine the causes of malnutrition in children from zero to five years.
2.  To examine the prevalence of malnutrition in children from zero to five years.
3.  To identify the strategies for reducing malnutrition in children from zero to five years.
1.4   RESEARCH QUESTIONS
1.  What are the causes of malnutrition in children from zero to five years?
2.  What is the prevalence of malnutrition in children from zero to five years?
3.  What are the strategies for reducing malnutrition in children from zero to five years?
1.6   RESEARCH HYPOTHESIS
H0: There are no strategies for reducing malnutrition in children from zero to five years.
H1: There are strategies for reducing malnutrition in children from zero to five years.
1.7   SIGNIFICANCE OF THE STUDY
The following are the significance of this study:
1.  The outcome of this study will educate on the causes, prevalence and strategies for reducing malnutrition in children from zero to five years.
2.  This research will be a contribution to the body of literature in the area of the effect of personality trait on student’s academic performance, thereby constituting the empirical literature for future research in the subject area.
1.8   SCOPE/LIMITATIONS OF THE STUDY
This study will cover the causes and the prevalence of malnutrition in children. It will also cover the strategies for reducing malnutrition in children from zero to five years of age.
LIMITATION OF STUDY
Financial constraint- Insufficient fund tends to impede the efficiency of the researcher in sourcing for the relevant materials, literature or information and in the process of data collection (internet, questionnaire and interview).  
Time constraint- The researcher will simultaneously engage in this study with other academic work. This consequently will cut down on the time devoted for the research work.