INTRODUCTION
A wide range of factors, including underlying, immediate and basic factors, play a role in
the development of malnutrition. Globally, the prevalence of malnutrition is highest in
Sub-Saharan African, with the HIV pandemic further compromising the situation. Both
underweight and stunting are threatening the health of children younger than five years
old, with the Northern Cape having the highest percentage of stunted children in South
Africa. Malnutrition is still the leading cause of mortality and morbidity in children younger
than five years old.
The main aim of this study was to determine which of the underlying, immediate and
basic factors contributing to malnutrition are prevalent in the Northern Cape.
METHODS
Fifty-four malnourished children 0 to 60 months admitted to Kimberley Hospital Complex
and Upington Hospital were included in the study. Inclusion criteria included all
malnourished children 0 to 60 months admitted to paediatric or infant care units between
August 2007 and July 2008with a weight-for-age below 80% of expected weight, with an
RtHC and whose mother/ caregiver was present to sign the informed consent form. The
anthropometric measurements of both the child and mother/caregiver were taken. Blood
values of the child that were available in the files were consulted. Socio-demographic,
household, maternal information, medical history of the child, infant feeding information
and adherence to the FBDG were noted on a questionnaire during a structured interview
conducted with the mother/caregiver.
RESULTS
Factors contributing to malnutrition were categorized into the immediate, underlying and
basic factors as set out in the UNICEF conceptual framework of the causes of
malnutrition. Some of the socio-demographic findings associated with malnutrition
included rural households, male children, education level and marital status of the mother.
Educated and married mothers were less likely to have a malnourished child.
Anthropometric findings showed that low birth weight and the size of the childâs mother
were associated with malnutrition, with undernourished and obese mothers having a
higher chance of having a malnourished child. Household food insecurity and inadequate nutrition information received on care practices were often contributing factors. Most of
the malnourished children included in the study were marasmic. The medical history of
the child indicated that even though all the children had an RtHC, the cards were often
completed incorrectly. Clinic attendance was poor and the screening for HIV and TB was
insufficient as the childrenâs statuses were mostly unknown. Significantly more children
were up to date with their immunizations, but significantly fewer children were up to date
on their vitamin A supplementation. The NSP was not accessed effectively and even
children that did access the NSP were found to be malnourished after eight months on
the programme.
Some of the other household and maternal findings related to malnutrition included a big
household with more than five family members, a high birth order of more than four
children and if the child had any siblings that had died of malnutrition related illnesses.
The education levels of the mothers were generally low and health and feeding
information given at clinics did not have a significant impact. Information on infant feeding
showed that exclusive breastfeeding is still a challenge and mothers are not effectively
using milk alternatives when breastfeeding is ceased. Cup feeding was not practiced,
and the use of bottles can increase the risk of diarrhoea. Children are either introduced to
solid foods too early (before six months) or too late (after six months). When the
application of the FBDG was evaluated, the study found that children had high intakes of
fats, salt, sugar and sugary foods and tea and low intakes of animal proteins, fruit and
vegetables and milk (after breastfeeding was ceased).
CONCLUSIONS
Inadequate access of available interventions programmes such as the NSP,
immunizations, vitamin A supplementation, screening and treatment of diseases such as
HIV and TB was noted. Parents were generally uneducated, especially regarding infant
and young child feeding and the importance of correct food for the prevention of
malnutrition. Household factors were a major challenge, especially in rural areas. Low
levels of schooling and poverty are basic factors contributing to malnutrition that are
prevalent in the Northern Cape.
RECOMMENDATIONS
Maternal and community education are some of the most important interventions to
combat malnutrition in the Northern Cape. Intervention programmes at facilities should
be strengthened to empower health care professionals and the community they serve to
prevent and manage severe malnutrition. Detecting malnourished children earlier in the
communities by using the MUAC to screen children is recommended. The management
of severe malnutrition according to the 10 Steps of the WHO should be implemented at all
levels of care.
| Identifer | oai:union.ndltd.org:netd.ac.za/oai:union.ndltd.org:ufs/oai:etd.uovs.ac.za:etd-11192010-135204 |
| Date | 19 November 2010 |
| Creators | de Lange, Johanna Christina |
| Contributors | Prof CM Walsh |
| Publisher | University of the Free State |
| Source Sets | South African National ETD Portal |
| Language | en-uk |
| Detected Language | English |
| Type | text |
| Format | application/pdf |
| Source | http://etd.uovs.ac.za//theses/available/etd-11192010-135204/restricted/ |
| Rights | unrestricted, I hereby certify that, if appropriate, I have obtained and attached hereto a written permission statement from the owner(s) of each third party copyrighted matter to be included in my thesis, dissertation, or project report, allowing distribution as specified below. I certify that the version I submitted is the same as that approved by my advisory committee. I hereby grant to University Free State or its agents the non-exclusive license to archive and make accessible, under the conditions specified below, my thesis, dissertation, or project report in whole or in part in all forms of media, now or hereafter known. I retain all other ownership rights to the copyright of the thesis, dissertation or project report. I also retain the right to use in future works (such as articles or books) all or part of this thesis, dissertation, or project report. |
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