Assessment Of Nutritional Status, Knowledge, Attitude And Practices Of .
OPEN ACCESSPakistan Journal of NutritionISSN 1680-5194DOI: 10.3923/pjn.2020.444.450Research ArticleAssessment of Nutritional Status, Knowledge, Attitude andPractices of Infant and Young Child Feeding in Kumbotso LocalGovernment Area, Kano State, Nigeria1Sa’adatu Sulaiman, 1A’isha Muhammad Gadanya, 1Amina Sa’id Muhammad, 1Hafiz Abubakar and1,2Salisu Maiwada Abubakar1Nutrition Research Group, Biochemistry Department, Bayero University Kano, P.M.B. 3011, Kano, NigeriaAfrican Centre of Excellence for Population Health and Policy, Bayero University, P.M.B. 3011, Nigeria2AbstractBackground and Objective: Optimal feeding practice for infants and young children is a prerequisite for good nutrition, health anddevelopment of children. Despite high burden of malnutrition, there is limited data on the nutritional status, knowledge, attitude andpractices for infant and young child feeding in Kano State, Nigeria. This study assessed caregiversʼ knowledge, attitude and practices forinfant and young child feeding and nutritional status of children 0-59 months. Materials and Methods: A descriptive cross-sectional studywas conducted which randomly sampled 270 children of 0-59 months and their caregivers. Data were collected using modifiedquestionnaire developed by the Food and Agricultural Organisation of the United Nations (FAO-UN). Results: Majority (51.1%) of thecaregivers were 25-34 years of age, 53.7% of caregivers have secondary school education as highest level of formal education. Only 23.7%of mothers initiated breastfeeding (BF) within one hour of birth. While only 15.4% practiced exclusive breastfeeding (EBF), 19.26% startedcomplementary feeding at the right time. In the current study 26.63% of children between 6-59 months of age had adequate dietarydiversity. Only 11.35% of children reported intake of meat/meat products and 15.7% of milk/milk products based on 24 h recall. Less thanhalf (48.7%) of the children (24-59 months of age) consumed fruits and vegetables. Only 11.4% of caregivers wash their hands beforefeeding their child. There was a significant positive relationship between knowledge of BF and BF initiation (r 0.288), practice of EBF(r 0.445) and place of child delivery (r 0.547). Conclusion: Results of this study suggests poor nutrition knowledge, attitude andpractices among caregivers of children under 5 years in Kano and call for more interventions towards behaviour change for improvedfeeding practices of infant and young child.Key words: Optimal feeding, nutritional status, knowledge attitude and practice (KAP), hand washing, caregivers, infants feedingCitation: Saʼadatu Sulaiman, Aʼisha Muhammad Gadanya, Amina Saʼid Muhammad, Hafiz Abubakar and Salisu Maiwada Abubakar, 2020. Assessmentof nutritional status, knowledge, attitude and practices of infant and young child feeding in Kumbotso local government area, Kano State, Nigeria.Pak. J. Nutr., 19: 444-450.Corresponding Author: Saʼlisu Maiwada Abubakar, Nutrition Research Group, Biochemistry Department, Bayero University Kano, P.M.B. 3011, Kano, NigeriaAfrican Centre of Excellence for Population Health and Policy, Bayero University, P.M.B. 3011, Nigeria Tel: 2348036190005Copyright: 2020 Saʼadatu Sulaiman et al. This is an open access article distributed under the terms of the creative commons attribution License, whichpermits unrestricted use, distribution and reproduction in any medium, provided the original author and source are credited.Competing Interest: The authors have declared that no competing interest exists.Data Availability: All relevant data are within the paper and its supporting information files.
Pak. J. Nutr., 19 (9): 444-450, 2020children less than five years of age are attributable tomalnutrition, most of which is associated with inappropriatefeeding practices that occurs during the first year of life18.Malnutrition in girl child could lead to poor obstetricsoutcome when they are having children later in life. Otherconsequences include delayed sexual development, reducedmuscle mass and strength, weakened immune system andincreased lifetime risk of osteoporosis19.INTRODUCTIONThe first 1000 days (from conception to second birthdayof a child) is considered as a critical window of opportunity forsolid foundation of good nutrition, health and developmentwith long lasting beneficial effects throughout life1,2. TheWorld Health Organization (WHO) recommends exclusivebreastfeeding for the first six months of infantʼs life followedby the introduction of complementary foods at 6 monthswith continued breastfeeding until two years or beyond3.Breastfeeding protects child against infectious diseasesand increase intelligent quotient4. Growth faltering andmicronutrients deficiency are more prevalent during thecomplementary feeding period5, 6.Women and children are the most vulnerable tomalnutrition in population. Nutritional status of children is anindicator of the level of development and future potentialof the community. The World Health Organization (WHO)recognises the importance of good feeding practices of infantand young child in the survival, growth and development ofchildren. In 2003, WHO launched the global strategy for infantand young child feeding and issued the guiding principlesfor complementary feeding of breastfed and non-breastfedChildren3,7,8. In addition, appropriate feeding of infant andyoung child during and after illness is part of the WHO-ledGlobal Strategy for the Integrated Management of ChildhoodIllnesses9. Problems associated with complementary feedinginclude poor timing for the introduction of complementaryfoods (too early or too late), bottle-feeding, infrequentfeeding, unsupervised feeding, poor feeding methods, poorhygiene and child care practices 10.Malnutrition is a universal problem that affects all agegroups and sexes irrespective of social status11. The economiccost of malnutrition could be up to US 3.5 trillion per year,with overweight and obesity alone costing US 500 billion peryear12. Other consequences of malnutrition include increasein childhood death and future adult disability, diet-relatednon-communicable diseases (NCDs), as well as human capitalcosts13. Under nutrition explains around 45% of deathsamong children under five, mainly in low and middle-incomecountries14. Wasting and stunting are associated withincreased mortality, especially when both are present in thesame child15. It is becoming increasingly clear that childrenwho are wasted are more likely to become stunted andchildren who are stunted are more likely to become wasted16.There are about two billion children under five years andadults who are deficient of vitamins and minerals which canlead to greater susceptibility to many diseases resulting inhigher mortality rate17. Moreover, one third of deaths amongStatement of problem: One of the most critical factors forchildrenʼs health and development is their nutritionalstatus. The burden of malnutrition across the worldremains unacceptably high and progress unacceptably slow.According to Global Nutrition Report 2018, children underfive years of age face multiple burden of malnutrition with150.8 million stunted, 50.5 million wasted and 38.3 millionoverweight. Meanwhile 20 million babies are born with lowbirth weight each year. Children who are undernourished areless able to fight infections and more likely to die young.Malnutrition is the underlying cause of more than 50% ofunder-five deaths20. Infant and young child feeding is a keyarea toimprove child survival and promote healthygrowth and development. Although infant and young childfeeding policies recommended that infants be exclusivelybreastfed from birth to 6 months and continue breastfeedingto 24 months and beyond for optimal survival, growth anddevelopment, only 17% of infants fewer than six months ofage are exclusively breastfed in Nigeria21.Justification: Data gap in infant and young child feedingpractices in Kano appears to be one of the major problems forassessing progress of programs, interventions and policies onappropriate feeding practices of infant and young child.Therefore, the need and importance of this research andothers of its kind cannot be overemphasized.Aim of the study: The aim of this study was to assess thecaregiverʼs knowledge, attitude, practices of infant and youngchild feeding and nutritional status of children in KumbotsoLocal Government Area, Kano State, Nigeria.MATERIALS AND METHODSStudy area: The study was conducted in Kumbotso LocalGovernment Area (LGA) of Kano State, Nigeria. The localgovernment has an area of 158 km2 and a population of295,979 based on population census conducted by theNational Population Commission in the year 200622.445
Pak. J. Nutr., 19 (9): 444-450, 2020Study population: The study population is made up ofRESULTSchildren less than five years of age and their care givers whoThe results obtained in the study are summarised inTable 1-10 and divided into demographical characteristics;infant and young children feeding practices; hygiene andsanitation; and nutritional status.Table 1 shows that most of the mothers (51.1%) werein the age group of 25-34 years. The modal level of educationof mothers studied was secondary school education.Table 2 shows a total of 270 children between the agesof 0-59 months (58.5% boys and 41.5% girls), with theircaregivers which comprised of mothers and grandmothersliving in Kumbotso local government Kano state during theperiod of data collection were sampled and their data wasanalysed. Majority of the children were between the ages of6-24 months. Table 3 shows the breastfeeding practices ofthe caregivers studied. Majority of the mothers did notpractice early initiation of breastfeeding; only few initiatedbreastfeeding within one hour of birth. The major reason fornot initiating breastfeeding early was that the infant does notdemand for it or there was no breast milk supply during thefirst few days after birth.Based on the results obtained from this study, only few ofthe infants and children assessed were exclusively breastfed.Majority of infants and children were fed with other fluidsare permanent residents of the study area.Sample size determination: Considering a precision of 5and 95% confidence interval and based on 51.9% estimatedprevalence of stunting in Kano state as reported in the year2015 National Nutrition and Health Survey (NNHS)23 report onthe Nutrition and Health situation of Nigeria, sample size wascalculated using Cochran24 formula (N pqZ2/d2).Ethical considerations: All caregivers of the children gaveinformed consent for participation of their children prior toadministration of the questionnaire. All the informationcollected during the survey is treated as confidential and usedfor the study purpose only.Data collection methods: Modified questionnaire on nutritionknowledge, attitude and practices of FAO was used in datacollection. Data was collected on the social, demographic andhousehold characteristics, infant and young children feeding,hygiene and sanitation practices.Anthropometric measurements: Length/Height of childrenTable 1: Characteristics of the caregiverswas measured using meter ruler (for those that can stand) andVariablestadiometer (for children less than 24 months). A StandardizedFrequency (N 270)PercentageCaregiversscale was used to weigh the children in their underpants. Forchildren who could not stand, their caregivers were weighedtogether with them, then the caregiverʼs weight alone wasmeasured and the difference was recorded as the child'sweight in kilogram. The scale was calibrated before eachweighing to ensure that the mark returned to zero. The midupper arm circumference of the children (6-59 months) wastaken at the level of the left upper arm midpoint between thetip of the scapula (acromion process) and the olecranonprocess using Shaker's strip.Urine sample collection: Urine samples were collected toMothersGrandmothersOthersAge (years)2682099.260.740.0015-2425-3435-44 45Level of education64138422623.7051.1015.609.60No formal educationPrimarySecondaryTertiaryPlace of 019029.6070.40detect biomarkers of protein and calorie intake (Urea nitrogenTable 2: Characteristics of the infant/childand Creatinine) and were analyzed using Urease-BerthelotVariablesmethod and Jaffe/colorimetric methods respectively.FrequencyPercentage0-6 months6-24 months24-59 541.5Age of the childData analysis: Data was analysed using Statistical Packagefor Social Sciences (SPSS) version 20. The anthropometricindices of the children were interpreted using anthropometricsoftware developed by World Health Organization.446
Pak. J. Nutr., 19 (9): 444-450, 2020Table 3: Breastfeeding practicesPractice supporting exclusive 72830.647.68.313.6Have knowledgeNo knowledgePractice of exclusive breastfeeding for up-to 6months (N 228)12614446.753.3YesNoReasons for not practicing Exclusive breastfeeding (N ageInitiation of breastfeeding within 1 h of delivery (N 270)YesNoReasons for not initiating (N 206)No milkChild did not demandBaby was sickMother was sickMothers knowledge on exclusive breastfeeding (N 270)No milkBaby needs waterOthersTable 4: Complementary feeding practiceVariableKnowledge about appropriate complementary feedingHave knowledgeNo knowledgeAge when complementary foods are introduced (n 244)92613.3096.70 6 months6 months 6 monthsWeaning (n 82)178471972.9519.267.794436211.3013.800.60 24 months24 months 24 monthsTable 5: Dietary habit and diversity from 24 h recallVariablesChildren consumed cereal and grainsChildren consumed Milk and milk productsChildren consumed legumes and nutsChildren consumed meat and meat productChildren consumed other fruit and vegetablesChildren consumed vitamin A fruits and VegetablesDietary diversitybesides breast milk. More than half of the mothers interviewedhave no knowledge regarding exclusive breastfeedingwhere only 46.7% reported having knowledge on exclusivebreastfeeding. Majority of the mothers did not practiceexclusive breastfeeding because most of them think that thebreast milk is not enough to provide the required amount offluid an infant needs to prevent him/her from feeling thirsty.Table 4 shows that, majority of the mothers appearsto have no knowledge about appropriate complementaryfeeding practices. Majority of them started introducingcomplementary foods to their children before the age of6 months. Only 13.8% of children were weaned from breastmilk at the age of 24 months.According to the 24 h recall interview results summarisedin Table 5, less than half of children (6-59 months of age)Frequency (N 3548.4762.0026.63have adequate dietary diversity (four or more food groupsconsumed the previous day). Theresultrevealed thatchildren (6-59 months of age) were mainly fed with dietcontaining basic staples, legumes and vitamin A rich fruits andvegetables. Meat/meat products and milk/milk productsintake was inadequate among children (6-59 months of age).Table 6 shows that tap water is the major source of water fordrinking and cooking among the studied population. Majorityof the caregivers practiced hand washing before cookingalways, while only few practiced hand washing before feedingtheir children.Table 7 shows the anthropometric indices of the studiedchildren. The overall prevalence of wasting and stuntingamong the children was 10.4 and 16% respectively. Severe447
Pak. J. Nutr., 19 (9): 444-450, 2020( -3SD) and moderate (-3SD to -2SD) wasting in the childrenDISCUSSIONwas 6.3 and 4.1% respectively. Few of the children (9.1%) werefound to be overweight/obese. Table 8 shows that aboutFindings from this study suggest that mothers withhalf of the 100 children have abnormal urea and creatininehigh educational attainment (tertiary education) were morenitrogen. The results in Table 9 indicate that there is significantlikely to breastfeed exclusively. This observation (associationpositive correlation between knowledge of breastfeeding andbetween exclusive breastfeeding and education) agrees withplace of child delivery (r 0.547); knowledge of breastfeedingthe findings of a recent study in Nigeria25. Results from theand practice of exclusive breastfeeding (r 0.445) andstudy demonstrated that there is inappropriate child feedingbreastfeeding initiation (r 0.288).practices mostly due to lack of mother's knowledge aboutAs shown in Table 10, there was significant positiveinfant and young children feeding practices. More than half ofcorrelation between urine urea nitrogen level and MUACTable 7: Nutritional status(p 0.01). There was no significant correlation betweenVariablepractice of EBF, knowledge of complementary feeding, ageof starting complementaryFrequency (N 270)PercentageWeight-for-heightfeeding, consumption ofSeverely wasted20protein-rich foods and urine urea nitrogen status levelModerately wasted134.1(p 0.01) of the respondents. There was significant tween MUAC and the urine creatinine levels (p 0.01) of the6.3Height-for-agerespondents. However, there was no significant correlationSeverely stunted27between practice of EBF, knowledge of complementaryModerately stunted247.5feeding, age of starting complementary feeding, consumptionNormal21968.7134.1Tallof protein rich foods and urine creatinine level (p 0.01).Mid-upper arm circumferenceSeverely wastedTable 6: General hygiene practices of the respondentsVariablesModerately ter source for drinkingTap12539.2Borehole7623.8Well6921.6Table 8: Urea nitrogen and creatinine level of children between 6-59 months ofageVariableVessels use for fetching waterVessel for that purposeFrequency (N 100)Percentage51Urine creatinine level15557.4Normal (1-1.5 g/24 h)51Bathing bucket9936.7Deficient ( 1 g/24 h)3939Washing basing165.9Above ( 1.5 g/24 h)1111Always10739.63Normal (20-35 g/24 h)6060Sometimes16159.63Deficient ( 20 g/24 h)202020.74Above ( 35 g/24 h)2020Table 9: Comparison between Knowledge of breastfeeding, breastfeedingWashing of hands before cookingNeverUrea nitrogen levelWashing of hands before child nitiation and practice of exclusive breastfeedingFrequency of child bathingOnce a day12947.78More than once12947.78Every other day124.4VariablesMean SDr-valuePlace of delivery1.70 0.4570.547**Breastfeeding initiation2.14 0.7550.288**Practice of EBF1.53 0.5000.445**SD: Standard deviation, r: Correlation, EBF: Exclusive breastfeedingTable 10: Association between nutritional status and related factorsVariablesPractice of EBFKnowledge of CFAge of introducing CFMUACConsumption of PRFsUrine urea nitrogen status level (p-value)Urine creatinine status level .0000.115**Correlation is significant at the 0.01 level (2-tailed). EBF: Exclusive breastfeeding, CF: Complementary feeding, MUAC: Mid-upper arm circumference, PRFs: Proteinrich foods448
Pak. J. Nutr., 19 (9): 444-450, 2020the mothers (53.3%) had no knowledge about exclusivebreastfeeding and 76.3% of the infants were not breastfedwithin one hour of birth.Studies have demonstrated that early introduction tosolid foods is a risk factor for infection, early cessation ofbreastfeeding and increased consumption of fatty or sugaryfoods at one year of age26. Results showed that more thanhalf of the children were introduced complementary foodsbefore the recommended age of 6 months. This highfrequency is similar with the studies in north western Nigeriawhere majority of the children (41.2%) were introduced tocomplementary foods much earlier at 3rd month27. Poorpractice of early introduction of complementary foods may bedue to the fact that mothers have wrong perception aboutfeeding breast milk alone for the recommended duration of sixmonths. In fact, this study indicates that majority of mothersand caregivers believed that their babies were not satisfiedwith breast milk as such they felt complementary feedingshould commence.Dietary diversity is an important element for dietadequacy. The poor diet diversity among children could bedue to the poor knowledge, attitude, infant and young childfeeding practices of the caregivers. Diets of children assessedin this study were: often poorly balanced; composed mainlyof staple foods, legumes, Vitamin A rich-fruits and vegetables;and poor in fruits and vegetables, meat and milk products.Findings of the present study revealed that only few(26.63%) of the children (aged 6-59 months) have adequatedietary diversity score. In contrast, a previous study reportedadequate dietary diversity in Moramanga (57.8%) andMorondava (52.3%.) districts28.The most important way to reduce the spread of infectionamong children is clean water, basic toilets and good hygienepractices. Finding from this study depicted that tap was themajor source of water for drinking and cooking food whichis similar to a study conducted in urban slum of Butwalsub-metropolitan city of Nepal29. However, the extensive useof dirty containers and improper water storage facilities andpractices are the main cause of waterborne illnesses in thepopulation studied.Similar study30 conducted in Adama town, CentralEthiopia suggested positive association between high level offormal education and employment status of mothers withnutritional status of children. The low level of formal educationand high level of unemployment among caregivers mayhave contributed to the poor feeding practices of infant andyoung child. A related study conducted among pastoralcommunity in Simanjiro District, Tanzania31 suggested theneed to promote appropriate multidisciplinary approach onnutrition education, environmental sanitation and hygienicpractices at family and community level in order to reducechildhood illnesses thereby increasing child health andnutritional status. A closely related primary health care facility-based study32 concluded that majority of mothers of childrenunder-five years in Indian rural settings had fair to goodknowledge, attitude and practices regarding under-fivenutrition and prevention of malnutrition.CONCLUSIONThe Research demonstrated that there is inappropriatefeeding practice among children under-five compared to therecommend standard, which is mostly due to lack of mother'sknowledge, attitude and practice about infant and youngchildren feeding. The need for aggressive campaign for goodfeeding practices of infant and young child is necessary tomake required progress in tackling malnutrition in Kano,Nigeria.SIGNIFICANCE STATEMENTThis study discovered that poor knowledge, attitude andpractices of caregivers is a significant contributor to the poornutritional status of children under five. To the best of ourknowledge, this is the first study that assessed knowledge,attitude and practices among caregivers of children less than5 years in Kumbotso Local Government Area of Kano State,Nigeria. Findings of this study will guide appropriate policyformulation and encourage nutritional education interventionto address the poor knowledge, attitude and practices amongcaregivers of children in Kano State, Nigeria.REFERENCES1.2.Adu Afarwuah, S., A. Lartey and K.G. Dewey, 2017. Meetingnutritional needs in the first 1000 days: a place for smallquantity lipid based nutrient supplements. Ann. N.Y. Acad.Sci., 1392: 18-29.Bhutta, Z.A., J.K. Das, A. Rizvi, M.F. Gaffey and N. Walker et al.,2013. Evidence-based interventions for improvement ofmaternal and child nutrition: What can be done and at whatcost? Lancet, 382: 452-477.3.WHO., 2003. Global strategy for infant and young childfeeding. World Health Organization, Geneva, Switzerland,pp: 7-8. uments/9241562218/en/.4.Victora, C.G., R. Bahl, A.J.D. Barros, G.V. Franca andS. Horton et al., 2016. Breastfeeding in the 21st century:Epidemiology, mechanisms and lifelong effect. Lancet,387: 475-490.449
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recognises the importance of good feeding practices of infant and young child in the survival, growth and development of children. In 2003, WHO launched the global strategy for infant and young child feeding and issued the guiding principles for complementary feeding of breastfed and non-breastfed Children3,7,8. In addition, appropriate feeding .
Nutritional Status Assessment and Analysis Lesson: Nutritional Status Indicators Learner Notes 2 Learning objectives At the end of this lesson you will be able to: identify the most commonly used indicators of nutritional status and of causes of malnutrition; and apply criteria for selecting nutrition indicators in specific contexts.
Assessment of Food Consumption Pattern and Nutritional Status of Pre-school Children in a Rural Nigerian Population Henry-Unaeze, H.N. Abstract This study investigated the food consumptionpattern a nd nutritional status of three hundred (300) pre-school children in the rural area of Ikwuano Abia State, Nigeria.
might also have an impact on various nutritional out-comes [30, 31].Therefore, the aim of this study was to identify malnutrition in chronically ill patients, and to validate the patient's subjective nutritional assessment (SANS) by comparing it to an objective nutritional as-sessment (MNA), considered a gold standard nutrition assessment tool.
people. The effects of nutritional counseling and education on older people's nutritional status, nutrient intakes, diet quality, and QoL have not been rigorously studied. Objectives of the study: to determine nutritional status, nutrient intakes and associated factors in both home-dwelling and institutionalized older people at various stages of
Nutrition Assessment To determine an infant’s nutritional needs and develop a nutrition care plan, an accurate assessment of the infant’s nutritional status must be performed. The nutrition assessment provides the nutritionist or health counselor with important feeding practices and other information pertinent to an infant’s health.
the Nestlé Nutritional Foundation status and accordingly represents an appropriate choice when the consumer, children and/or adults, chooses to have it in the context of a balanced diet. A food or beverage product will only attain the Nestlé Nutritional Foundation when all of its nutritional factors meet the criteria for its category (Table 4).
Appropriate use of oral nutritional supplements Better nutrition after discharge Studies show that providing oral nutritional supplements (ONS) as part of care improves nutrition status and patient outcomes compared to standard care.7,8,10 By providing nutritional supplementation, you are helping patients meet their energy and protein
(HDIM) study focused at telemonitoring and improving nutritional status of community-dwelling elderly with the help of a television based platform and a website for health care professionals. The six-month intervention included telemonitoring of nutritional status, appetite, diet quality, and physical activity. Furthermore, participants received
