This study, “MATERNAL COMPREHENSION OF HOME-BASED GROWTH CHARTS AND ITS EFFECT ON GROWTH” contains concise information that will serve as a framework or guide for your project work. The project study is well-researched for academic purposes and are usually provided in complete chapters with adequate References.
Keywords: MATERNAL COMPREHENSION OF HOME-BASED GROWTH CHARTS AND ITS EFFECT ON GROWTH
In developing countries, knowledge of growth monitoring among mothers/caregivers is generally poor and the extent of practice and attitude to its use among them varies from one community to another.1 Early possession, regular use, interpretation of the chart (also known as ―road-to-health‖), and quick communication with health workers to take prompt action is a major barrier to attaining child nutrition and child under-nutrition remains a major public health concern. Malnutrition, especially under-nutrition continues to be a serious problem and a major threat to the achievement of the Millennium Development Goal (MDG) and it is estimated that 60% of under-five deaths in developing countries are attributable to it.2 Worldwide, 5 million children die every year, that is to say one child in every 6 seconds.5Malnutrition accounts for over 50% of death in children in Nigeria7.
To address these major health problems caused by malnutrition, monitoring of growth using growth chart becomes of great importance among health workers in general and mothers/caregivers in particular.
There are three types of malnutrition which are under-nutrition, over-nutrition, and nutrient deficiency.8 Over nutrition occurs when nutrients are oversupplied relative to the amounts required for normal growth, development, and metabolism. The term can refer to obesity, brought on by general overeating of foods high in caloric content, as well as the oversupply of a specific nutrient or categories of nutrients, such as mineral or vitamin poisoning, due to excessive intake of dietary supplements or foods high in nutrients (such as liver), or nutritional imbalances caused by various fad diets.34
Micronutrient deficiencies are when a child is lacking essential vitamins or minerals such as Vitamin A, iron, and zinc. Micronutrient deficiencies in children are associated with 10% of all children’s deaths.35 Under-nutrition is not getting enough protein, calories, vitamins and minerals which the body needs to function. This results in stunting, underweight and wasting. Stunting refers to low height-for-age (also known as chronic malnutrition), under-weight is measured by low weight-for-age and refers to a child whose weight is too low for its age and wasting is described as low weight-for- height which can be acute, moderate or severe. Under nutrition could also be due to specific nutrient deficiencies.9 The different types are Marasmus, Kwashiorkor, Marasmic-kwashiokor and Micronutrient malnutrition. Marasmus occurs when children do not get enough energy-giving food and this either result in stunting, under- weight or wasting. In Kwashiorkor, the child does not get enough variety of the right kind of food, for example if they eat only cereal-based meals, it results in stunting, under- weight, wasting and oedema. Marasmic-kwashiokor is a combination of Marasmus and kwashiorkor symptoms. Finally, in micronutrient malnutrition, the child lacks micronutrients such as vitamins A, B and C, folate, zinc, calcium, iodine and iron.7
It is estimated that about 16% of the world children are moderately under-weight, 9% severely under-weight, 10% are suffering from wasting and 27% from stunting. The worst cases are recorded in sub-Saharan region as shown in Figure 1 where 20%, 9% and 39% of under-fives are suffering from under-weight, wasting and stunting respectively. Between 2006 and 2010 alone, it was estimated that one child in every three under-five children in West and Central Africa was likely to be stunted at 5 years of age.8
In Nigeria, child mortality and malnutrition rates are far higher in the North East and North West geopolitical zones than in other parts of the country as compared and shown in Figure 2.18 Even though child mortality rate has declined slightly over the past five years, there are still about 16% of children in Nigeria who will die before they are five
(5) years old and above 25% of these deaths share direct link with malnutrition even
though most of the deaths will be from highly preventable causes such as malaria, respiratory infections, diarrhoea, and measles.2
Figure 2: Under-five Children Underweight by Geopolitical Zones
Source: The Nigerian Academy of Science, 2009
STRATEGY FOR OVERCOMING MALNUTRITION
Different communities have different strategies for addressing malnutrition and any prevention strategy may differ from one individual to another.2 Also, no one single strategy can stand alone and inter-sectorial collaboration is often required.10The key for effective malnutrition prevention is integrating health care, household food security and care as proposed by the model of Conceptual Framework of malnutrition by UNICEF.
A number of components of malnutrition primary prevention programs have been developed and tested over past decades throughout the world in a variety of political and Social settings. Firstly, promotion of early contact between mother and infant to improve chance for successful breast feeding is important. It is good to establish hospital and other health routines that support breast feeding while in the maternity ward and later, successful early bonding and documented breast feeding is vital as well as supporting breast feeding by health team and by legal framework that promotes, protects, and sustains the right of working women to practice it.11
Secondly, monitoring of growth and development with adequate standards (present standards are being revised based on present recommended feeding modes) is proven to be effective and intervention is instituted only when appropriate to prevent malnutrition and specific micronutrient deficits.11 Mothers should be familiar with growth monitoring charts and be ready to take appropriate actions when growth faltering occurs.16 The degree of actions taken by the community will depend on the strength of the primary health care.1
Thirdly, it is important to introduce appropriate micronutrient rich complementary foods and supplements at 6 months of age.9 If complementary foods are needed earlier, consideration of the risks associated with interference of breast feeding should be made. Ideally these should be based on local foods that are accessible to the population.2 Micronutrient will be required in most cases and new developments include fortification at the household level either with tablets, sauces or sprinkles.13
Next is the identification of infants at risk for malnutrition and growth failure based on biological and social risk factors is a further strategy by providing adequate social and medical support for families with children at risk.11 Early identification should be based on community surveillance not only of growth but of caring practices and of critical food insecurity. Early interventions at this level are significantly more cost effective.17 This area is presently receiving insufficient attention despite being at the core of the problem.
A fifth strategy involves education of parents and adolescent girls (would be mothers) on how to promote growth and development through appropriate home environment, care, and stimulation.18 Verbal and cognitive stimulation for malnourished children results in higher growth rates than for children without such stimulation.21 Interactions with parents, caregivers, and other children are essential for the young child and these interactions can be improved by education of parents and other caregivers. Care initiatives should go beyond focusing on individual practices and behaviors to bring in dimensions of care for the family and the community.21
Finally, provision of universal coverage of children to basic health care services, full coverage for all children with immunizations to prevent infectious disease, and avoid their adverse effects on nutritional status and provide early diagnosis and treatment of diarrheal disease at the community level using oral rehydration is paramount.13 Linking this effort to the community based surveillance for effective prevention and control of mild and moderate Protein Energy Malnutrition (PEM) will compliment all other efforts.
Depending on what is available in the country the approach may not require expensive infrastructure but rather be community based and sustained. Treating hundreds or thousands of affected children will not solve the problem of malnutrition as a global public health problem.13 Unless society at large confronts this issue in its full dimension the problem will continue. Access to adequate amount and quality of food represent a basic human right and is a necessary precondition for health. In turn good nutrition and health are prerequisites for human, social, and economic development. Physicians and especially pediatricians should not be passive bystanders but rather be activists in this process.
Another good way to begin intervention strategies is to look up the UNICEF framework of the basic, underlying and immediate causes of malnutrition and seek to proffer solutions to these problems, so that the strategies can then focus on individuals, households, communities and the nation in general. Countries can save children‘s lives through these interventions by establishing adequate referral arrangements for children with complication and ensuring funding to provide free treatment and to integrate the management of severe acute malnutrition with other health activities such as the integrated Management of Childhood Illness.26
STATEMENT OF THE PROBLEM
Malnutrition accounts for over 50% of death in children in Nigeria.7Malnutrition leaves children more vulnerable to serious illness and early death.5 Globally, in 2011, an estimated 165 million children below 5 years of age were stunted and 101 million were underweight.6 Under-five deaths are increasingly concentrated in sub-Saharan Africa
and Southern Asia.7As high as 80% of the world‘s under-five deaths in 2011 occurred in only 25 countries, and about half in only five countries – including Nigeria.5According to (State of world children) SOWC 2012, 41% of under-five children in Nigeria are stunted and 23% are under-weight.14 Malnutrition, especially under-nutrition may continue to be a serious problem and a major threat to the achievement of the Millennium Development Goal (MDG) if early and regular monitoring of growth using growth chart (also known as ―road-to-health‖), is not taken as a thing of great importance among health workers in general and mothers/caregivers in particular. Without any intervention, severe acute malnutrition has up to 60% mortality risk and children with severe acute malnutrition are nine times likely to die from any causes than those who are not.7 One such intervention, which has proven to help improve the chances of survival of such children, is the growth monitoring program.18,19 The program presents a preventive approach to addressing malnutrition problems as it gives early warning sign; and the chart can serve as veritable diagnosing tool even in the hands of the mothers.
Role of mothers in growth monitoring
It is known that of all the major interventions stressed in the Child Survival Program, growth monitoring requires the highest level of participation and instruction. It will, and often does, function the most poorly of the four growth monitoring, oral rehydration, breastfeeding and immunization (GOBI) components.16 To buttress this, the success of,without the active involvement of mothers, health workers and the community, growth monitoring child survival projects and programs depend not only on
technical interventions themselves but on their being accepted and used by the millions of mothers and other child caretakers who determine in developing countries whether a child lives or dies.24
Keywords: MATERNAL COMPREHENSION OF HOME-BASED GROWTH CHARTS AND ITS EFFECT ON GROWTH