Dietary Diversity And Nutrition Status Health And Social Care Essay

Dietary Diversity And Nutrition Status Health And Social C ar EssayLow birth slant (LBW) is delimitate as a body weight at birth less than 2500grams. Its main causes include prematurity (born before 37 weeks gestation) in developed countries and intrauterine Growth Retardation IUGR (restrained foetal growth) in developing countries (ACN/SCN, 2000). Relationship between health of mother and child has in addition been established, paternal comestibleal and health position is an important determinant of childs health and nutritional come outcome. LBW infants end up undernourished and stunted children, adolescents and fin completelyy women of childbearing age. The main indicators of LBW infants include maternal stunting, low pre-pregnancy weight and low pregnancy weight gain. Thus generational stunting continues (Victoria et al, 2008).Households vary in definition and composition, especially in Africa. Households here in Africa mostly includes the wide family members both in defi nition and composition. This serves as social support network here and so adds income into the abode if the members are economically active or if economically inactive, emergences dependency ratio in the kinsperson. Mother and child pair nutritional stance smooths household dynamics, availability of solid feed, care of mother and child. It can as well reflect gender segregation in household food for thought allocation etc.The state of food insecurity 2001 defines regimen security as a situation that exists when all people, at all times, have physical, social and economic access to sufficient, safe and nutritious food that meets their dietetic needs and food p quotes for an active and healthy spiritedness (SOFI, 2002). Its three building pillars include availability, handiness and stability of food. Availability entails physical front man of food in the household or area c erstrned accessibility is concerned with the ability to acquire adequate amount of food and stabili ty fashion constancy of food access which can be chronic or transitory. Chronic food insecurity exists when food supplies are persistently insufficient to supply adequate nutrients for all individuals. Transitory food insecurity occurs in the presence of temporary decline in access to adequate food because of instability in food production, food prices or income shortfalls. It is also necessary that operable food meet the nutritional needs of the household members, bringing in the component of food utilization. Resource paltry subsistence farmers, landless households, pastoral household, female-headed household and urban short are more vulnerable to food crisis (UN millennium project, 2005 FEWSNET, 2011). During the subscribe to period, coastal state of the Bayelsa, delta, Rivers and some portions of Jigawa in Northeast go forth experience moderate food insecurity. The coastal states bequeath be affected by Niger-Delta crisis and potential pre-election tension. Pipeline vand alization, go out continue to contribute to local water pollution, creating weight shortages among others. Flooding in the Northeast state of Jigawa go away reduce household stock (Millet) ca utilize food insecurity, with low cereal prices, above-average increase in tuber production.The Convention on Biological Diversity (CBD) defines bio novelty as the variability among living organisms from all sources including, inter alia, terrestrial, marine and other aquatic ecosystems and the ecological complexes of which they are part this includes variation indoors species, between species and of ecosystems. In other words, it is the variety of life on earth at all levels, from genes to worldwide populations of the same species. The contrary Levels of bio transition include ecosystem containing rich biodiversity, species and communities of species and unalike genotypes, and this includes agricultural biodiversity. All components of agricultural biodiversity relevant to food and agric ulture and support the ecosystem that agriculture occurs is important (FAO, 2008). Thus, dietary diversity becomes important as a means of protecting the ecosystem.Dietary diversity can be defined as the number of distinguishable foods or food groups consumed over a given reference period, usually 1-2 week. Dietary diversity has been shown to improve nutritional status (Kant et al, 2000 Kiokia and Golden, 2004 Gibson et al, 2000). Thus, it also can aid in combating hidden hunger, and thus double burden. Dietary diversity is a reflection of household food security because depicts accessibility, availability of foods and to some extent stability. Hoddinott and Yohannes analysis of evidence from 10 countries links dietary diversity to household access of calorie and by extension food security (2002). handed-down food systems abound, and are currently going extinct because they are underutilized. The diet is displacement more towards an energy-dense based diet categorized by westerni zed and processed food, bringing with it the advent of non-communicable diseases like diabetes, coronary heart disease etc.Nutrition bringing up aims to persuade individuals to make meaningful channelizes in their dietary behaviour. Studies have check offd the importance and role in nutrition status and adequacy (Favin and Griffiths, 1999 Tarvinder et al, 2007 Mansour et al, 1994). In contemplate of that, importance of nutrition bringing up cannot be overemphasized in this scope, especially as traditional foods are available in its varieties but less consumed/sought-after. It becomes imperative that nutritional content and thus importance of these foods are once again extolled so that they can be consumed for optimum health. Biologically active substances have been found in traditional foods and functional foods include flavonoids etc.Information technology has opened lots of doors for education and knowledge in the world, which can be harnessed for forwarding of nutrition edu cation. Information technology utilise in education includes access devices, networking and communicating technologies, storage devices and e-learning platform (India policy brief, 2010). They pose great potential for getting knowledge especially at the defeats comfort. Phones have been utilise for t individuallyer training with positive results among other things, MMS examples of teaching, audio lectures, SMS for reminders, motivational messages and short taskment questions etc. were use (ADB/Pouezevara and Khan, 2007).STATEMENT OF PROBLEM on that lodge is a dearth of information on the relationship between dietary diversity and nutrition status in Nigeria. There is also little information on shift of food consumption from traditional to processed western foods together with a gap in the quantification of the force of nutrition education in enhancing dietary diversity.OBJECTIVESGOALOptimize nutrition status of mother and child done dietary diversity and nutrition educatio nSPECIFIC OBJECTIVESTo identify the available foods in the environ/environment/locality and crack the neglected and underutilized local foods/speciesTo identify the prevalence of malnutrition of mother and childTo assess the dietary diversity in the food consumed by the mother-child and factors affecting it.To Investigate association between dietary diversity and nutritional statusTo ascertain the charm of nutrition education on nutritional status of mother and child.JUSTIFICATIONPrevalence of malnutrition in Nigeria is currently high, especially in Under-Five. Currently, 41% of under-fives are stunted, 23% underweight and 14% wasted (NDHS, 2008).High Under-Five Mortality Rate propels continuous childbearing and with is accompanied maternal mortality due to nutrient depletion (El-Ghannam, 2005).Improved maternal health importantly pre-pregnancy status is vital for adequate growth and development of new foetus and to break intergenerational disease and poverty that can arise from poor health status during the first 1000 eld (ACC/SCN, 1992).Lack of adequate nutrition education has led to improper feeding techniques of growing child, especially the under-fives.Traditional food systems are gradually becoming extinct and non-existent. The bulk of foods consumed are shifting base to western-influenced and processed foods (Bioversity International, 2006).High incidence of NCDS in developing countries and increase of double burden has been linked to monopoly in consumption of food and lack of dietary diversity. At the beginning of the 1960s, nigh 40% of the developing countries were chronically undernourished. more developing countries have achieved 2700kcals. This high energy combined with an increasingly sedentary lifestyle has led to an increase in obesity and NCDS. The composition of the diet change to mainly high energy and fat etc. (Josef and Prakash, 2004).METHODOLOGY abbreviation OF OBJECTIVESObjectiveVariableType of analysisTo identify the available foo ds in the surround/environment/locality and determine the neglected and underutilized local foods/speciesFoods from Market survey, FGD and KII vs foods from DD QuestionnaireTo identify the prevalence of malnutrition of mother and childBMI, stunting, squander and underweightTo assess the dietary diversity of mother and childDDS of mother and childComputationTo Investigate association between dietary diversity and nutritional statusDDS and BMI/nutritional status indicesCross-tabulationTo determine factors affecting dietary diversityDDS and socio-demographic, economic and household factorsCross-tabulationTo ascertain the influence of nutrition education on dietary diversityDDS before and after nutrition educationPaired T-testSTUDY DESIGN The study will be a cross-sectional and descriptive study.STUDY LOCATIONThe study will be conducted in Anambra state. Anambra state is located in the south-east zone of Nigeria, with its state capital being Awka. On a longitude of 6 20 00N and latitu de of 7 00 00E, the state has 21 topical anesthetic Government areas. It has a land area of 4,416km2 and a population of 4,177,848, made of 2,117,984 males and 2,059,844 females (NPC, 2006). With a population of 473,248, Children Under -five account for close to 11.35% of the Anambra state population. Onitsha North and South, Awka North and South and Nnewi North and South are all urban area in the state. Idemili, Oyi, Anaocha, Ogabru and Dunkofia are peri-urban, while the remaining Local governments are agricultural.With a population size of 369,972 (NPC, 2006), Aguata LGA is the 2nd largest LGA in terms of size and the largest LGA in terms of number of constituting communities 15 communities. The local government has the presence of a prison in Ekwulobia and the renowned Igbo-ukwu museum that houses artefacts and monuments from pre-colonial era. Like all other LGA in Anambra state, Aguata has its own share of ecological disasters, the most prominent being the Ekwulobia Oko we aring site. Other small-sized erosion sites abound in different communities in the LGA. The Staple food consumed here is mostly cassava and yam, eaten as fufu, garri, abacha etc. green ivied vegetables and fruits are also abundantly found. The planting season, marks the beginning of the annual year (Igu aro), and peaks during the harvest season.Map of Anambra StateThe study will be conducted in Uga, a town in Aguata LGA of Anambra state, in South East Nigeria. With a landmass of astir(predicate) 3790km2, it also has about 100,000 inhabitants. Uga shares its borders with Akokwa, Nkpologwu, Amesi, Umuchu and Ezinifite. The town is made of 4 villages to wit Oka, Umueze, Umuoru and Awalasi. These villages have different clan, an average of 6 clans per villages. They include Oka, made up of Okwuowerre, Umuikpa, Umueziama, Amaeke, Okohia and Umucheke. Umueze is made of Umucheke, Ezihe, Umu-umeonye, Umudim and Umuonyike. Umoru village is made of Imishii, Umudieleke, Umuezekpoko and Umor i. Awalasi village is made of Umunocha, Umuchiaku, Umuakabo, Umudim, Umuosu, Okwu, Agbako and Umuoweri. The community Uga, has 2 streams/waterbodies, namely, Obizi and Agwazi. eyepatch the former is potable and serves as a tourist site, its a taboo to fetch from the latter or visit. The population is predominantly Igbos with few settlers from other tribes. to the highest degree every household has some form of garden or subsistence/small-scale farming most of the food/fruits available in the market place come from subsistence farming. reason tenure is mainly through inheritance and few by purchase.STUDY POPULATION Mothers with under-5 children in the study community.SAMPLE SIZEFor the main study, all mothers with their youngest under-5 children in the town will be use.For the Key Informant Interview, The oldest individual in each clan will be use. A total of 24 subjects will be referenceedFor the focus Group discussions, each group will have a minimum of 6 and maximum of 8 mem bers in each of the 4 villages, comprising of both sexes.SAMPLING PROCEDUREA three-stage sampling technique will be apply to select respondents/mother-child pair for the questionnaire survey.Firstly, Anambra state, will be purposively selected because food systems are eroded with language, an indicator of culture. The Igbo culture is the fastest eroding culture among all the 3 major tribes in Nigeria. Legend also has Anambra State as the simple eye of Igbo people in the South-Eastern part of Nigeria.Secondly, Aguata LGA with its headquarters at Ekwulobia will be purposively selected because in the local government, urban and rural communities are found. Its headquarters, Ekwulobia, serves as the entry point to numerous communities and Local Government. Its proximity to Federal Polytechnic, Oko and Federal College of Education (Technical), Umunze, makes it a key point and central access area. While the headquarters remains urban, the surrounding communities, the study area- Uga inc luded are still rural. It will be strategic to study the effects of the spills of urban development in the dietary practice of these rural communities.Thirdly employ a table of random numbers, Uga was chosen as the study area and all villages in Uga town will be used for the study.SAMPLE SELECTIONSELECTION OF QUESTIONNAIRE RESPONDENTS All the women living in the community with a child under-five years of age who con move to participate will be included in the study. Already participating women will also be asked for referrals of other mother-child pair.SELECTION OF FOCUS GROUP DISCUSSION Using the help of query assistants, through non-probability sampling, 6-8 males and females aged 60 and above will be selected from each village and used for the focus group discussion.SELECTION OF KEY INFORMANT query the oldest person in each clan/village irrespective of gender will be used in Key Informant Interview. The individuals must be mentally acute despite disabilities/ infamy.MEASURE MENT INSTRUMENTFood/Market Survey QuestionnaireFocus Group discussion guideKey informant audience guideFAOs 16-item Individual Dietary Diversity Questionnaire for mothers and children aged 36-59 monthsDemographic Health Surveys 21-item Dietary Diversity Questionnaire for children Under 36 monthsSocio-demographic characteristics questionnaire for the mother.USIAD/FAOs 3-item Household Hunger ScaleFood Frequency QuestionnaireVARIABLESSocio-demographic characteristicsMothers DDS before the interpositionChilds DDS before the interventionMothers DDS after the interventionChilds DDS after the interventionHFIAS mop upNutritional status of childNutritional status of motherFamily dynamics and household characteristicsFood Variety Score (FVS)Pattern of consumptionCOMMUNITY ENTRY first appearance will be done through the different religious bodies (Christianity and traditional) and the community leaders. The community leaders include Uga Town Union, the Igwe and his council and also the indi vidual village unions. They will be acquainted with the different objectives of the study and its advantages for the community members. They will also be requested to disseminate the information to the community members to get their cooperation.DATA COLLECTIONQuantitative questionnaires will be used to collect baseline information from the communities. The questionnaires will be administered by twenty four (24) fieldworkers ( explore assistants). The look into assistants will be selected one from each clan with at least a secondary school education. All of them will speak English and the local Igbo dialect of the community fluently. The research assistants will be cautiously trained by the researcher. The study objectives, methods and questionnaires will be discussed with special emphasis on interpretation of result, Dietary Diversity Score (DDS) and nutritional status. Proficiency of the research assistants will be verified through role play and pre-testing. The research assistant will be supervised by the lead researcher through field monitoring to check type.The Key Informant Interview (KII) and Focus Group Discussions will be conducted by the lead researcher and a note taker using the KII and FGD guides. The interview will be recorded, with the permission of the subjects.BASELINEAs a means of assessing the current situation, baseline information of the study communities will be conducted. For this phase of the study a short food identification questionnaire, cecal appendage A will be used to document all foods encountered in the immanent nearby Igbo markets. Any new food and fruit type (species) or variety will be photographed with a digital camera and information about it will be gathered. Information to be gathered include trade name, local name, name of market sold, source of food/fruit, type of buyers, season when available and (recipe). Scientific and family name will be added following correct identification through books, internet and knowledgeab le people in relevant departments of the University of Ibadan. All food items encountered will be classified into food groups. Since dietary diversity involves biodiversity food of plant and animal origin, aquatic and forest resources also found will be documented.MARKET SURVEY The market survey will be conducted on the 4 native Igbo market days Eke, Orie, Afor and Nkwo. Each communitys market operates on a given market day, example, Orie for Uga community, Nkwo for Umuchu community etc. A market survey of proximal markets to the study area will also be conducted. They include Orie-Uga, Nkwo-Uchu and Eke-Ekwulobia. These 3 markets fall on different Igbo market days (Orie, Nkwo, Eke), leaving out only one market day, Afor.Focus Group Discussions (FGD) and key-informant interviews (KII) will be carried out for foods not sold in the market, but consumed in the community.FOCUS GROUP DISCUSSIONFocus groups discussions will be facilitated in (different churches) each village to be used in the study by the lead researcher with a note-taker present. The use of FGD guide Appendix B will be employed and also a camcorder for recording and camera for photographs. Each FGD will have a minimum of 6 members and a maximum of 8 members. The purpose of the FGD is to learn about foods that are underutilised in the environment. The discussion will be conducted in native Igbo language dialect of the community.KEY INFORMANT INTERVIEWSThe KII guide Appendix C will be used to conduct the KII. Respondents will be asked foods, farming systems and varieties of foods that are currently underutilised. They will also be asked about the source, harvest season, recipe of those foods and use. The interview will be conducted in the native Igbo language dialect.ANTHROPOMETRIC MEASUREMENTSBaseline anthropometric cadencements will be taken of the mother (BMI) and child (Stunting, Wasting and Underweight). For the weights, electronic scales will be used.CHILDREN For children 0 to 23 months, th eir weights will be taken using the children weighing scale. Children 24 to 59 months and all mothers will be weighed using the electronic scale, after they have emptied their bladder. All weights will be measured to the nearest 0.1kg. For all weight measurements, the balance will be placed on a level hard surface and adjusted to zero balance before measurement. The subject will stand in the centre of the scale and looking for straight. Light clothing will be advised in the absence of nudity.For the heights, children and infants less than 85cm will have recumbent length measured using a wooden measuring board (WHO, 1995). The infants heels will touch against the footboard, raises touching the baseboard and the crown of head touching headboard. Stadiometer will be used for children longer than 85cm. The subject will stand straight, looking ahead with the head, shoulder blades, buttocks and heels touching the plane.For weight-for-age and height-for-age, exact date of birth will be u sed. WHO Anthro v3.2.2 will be used to calculate weight-for-age, height-for-age and weight-for-height. The WHO standard Z-scores will be used.MOTHERS Body Mass Index (BMI) also called Quetelets Index calculated as weight (kg)/height (m2) will be used to assess the nutritional status of the mothers. The weights will be measured using the electronic scale, after they have emptied their bladder with the scale on a hard surface and adjusted to zero balance.The mothers heights will be measured with a Stadiometer. The subject will stand straight, looking ahead with the head, shoulder blades, buttocks and heels touching the plane.The classification of mothers BMI will be according to WHOs recommendation (2000) as shown belowClassificationBMI (kg/m2)UnderweightNormal range18.50 24.99Overweight= 25.00Pre-obese25.00 29.99 grievous I30.00 34.99Obese II35.00 39.99Obese III= 40.00HOUSEHOLD HUNGER SCALE (HHS)Food Insecurity Score (FIS) will be found using the Household Food Insecurity Access Scale (HFIAS), Appendix G. The HFIAS is 9-item access and absolute frequency-of-occurrence instrument developed by USAID and FAO, with a recall of 4 weeks/30 days/1 month. The general occurrence questions cover domains that include anxiety about household food supply, variety and preferences of type of food and insufficient food inhalation and physical consequences. If the access question occurs, then the frequency of the domain question is asked and coded as often, sometimes and rarely. The maximum HFIAS for a household is 27, i.e., a situation where frequency of occurrence of all questions is often (3) and the least HFIAS is (0). The higher the HFIAS, the higher the food insecurity the lesser the HFIAS, the lesser the food insecurity.DIETARY DIVERSITYDietary diversity of mother and child will be assessed. The interview will be conducted on an Eke day, which is not preceded by a weekend. This is necessary as Eke day precedes an Orie day, which is the market day and dietary habit s are synonymous with festive day. Also, Eke day is the only day without a proximal market to the community.MOTHER The 16-item FAOs Dietary Diversity Questionnaire, Appendix D will be used from which Individual Dietary Diversity Score (IDDS) for the mothers will be calculated. The food groups include cereals, vitamin A rich vegetables and tubers, ovalbumin tubers and roots, dark green vegetables, other vegetable, vitamin A rich fruits, other fruits, organ meat(iron-rich), flesh meats, eggs, fish, legumes, nuts and seeds, milk and milk products, oils and fat, sweets and coffee/tea. To calculate Individual dietary diversity score (IDDS), the last two items sweets and coffee/tea are left out, while the others items each has a point.The mean IDDS, percentage consuming each food group and terciles as a measure of distribution of scores will be calculated.The Food Frequency Questionnaire (FFQ), Appendix H, will be used to calculate the Food Variety Score (FVS) and the consumption patte rns of the mothers. Different varieties of food will be listed and scored. Their consumption will be noted as never, once a month, more than once a month, once a week, more than once a week, everyday and more than once everyday.CHILDREN For children more than 3 years, as with the mothers, FAOs 16-item individual dietary diversity questionnaire, Appendix D will be used, for foods eaten in the last 24 hour. The food groups include cereals, vitamin A rich vegetables and tubers, snow-clad tubers and roots, dark green vegetables, other vegetable, vitamin A rich fruits, other fruits, organ meat(iron-rich), flesh meats, eggs, fish, legumes, nuts and seeds, milk and milk products, oils and fat, sweets and coffee/tea. To calculate Individual dietary diversity score (IDDS), the last two items sweets and coffee/tea are left out, while the others items each has a point.The 21-item dietary diversity questionnaire, Appendix E, used in Demographic Health Surveys (DHS) will be used for children less than 3 years. The items on the questionnaire range from water, breastmilk, infant formula, green leafy vegetables, organ meats, fish etc. The IDDS will be calculated over 21 items.The mean IDDS, percentage consuming each food group and terciles as a measure of distribution of scores will be calculated.SOCIO DEMOGRAPHY Socio-demographic characteristics of the household will be collected, using Appendix F. Demographic characteristics of the mother will include Education, get along at marriage, current age, Childs date of birth, marital status, parity, religion. Economic information will include job, monthly earning, Access to farm, livestock ownership, food access market or farm production. Household details will also be collected, and they include type of household nuclear or extended, number of dependents in the family, number of household members, source of income and total household income.CLASSIFICATION OF UNDERUTILIZED SPECIES Underutilized and neglected food species a nd groups will be identified from the Dietary Diversity Questionnaire in comparison with the market research earlier carried out.MAPPING The map of the town Uga, will be digitized, using the nutritional status and dietary diversity. This will help monitor trends in nutritional status and DDS.DATA PROCESSING information entry, computation and analysis will be done with SPSS v 17. Quality will be ensured through quality checks associated with data entry processes, double entry and further data cleaning through generation of descriptive analysis after data entry.DATA ANALYSISCharacteristics of the sample average mothers age, average childs age, mothers education, parity, occupation of mother, average household income, average DDS. Prevalence of malnutrition will also be assessed, stunting, wasting and underweight of the children and BMI of the mother. This will be done through Frequency distributions for qualitative variables and descriptive analysis for quantitative variable.DDS a nd nutritional status of mother (BMI) through cross-tabulationDDS and nutritional status of child (Stunting, wasting and underweight) through cross-tabulation with each indices.HFIAS and nutritional status of motherHFIAS and nutritional status of childNutritional status of mother and nutritional status of child through cross-tabulation of mothers status with each individual nutritional index.Effect of socio-demographic, household characteristics and economic differentials on DDS and anthropometric measurements.A model for interactions of quantitative will be generated analogue and logistic regression, the MIXED procedure for quantitative response variables (BMI and DDS) and the GLIMMIX procedure for dichotomous response variables.INTERVENTIONNutrition Education will be conducted in different ways to enhance the consumption of underutilised foods. Underutilized food/fruits/species that has been thus categorised will be promoted through nutrition education. A food/fruit/specie will b e said to be underutilized if it is readily available in the environment but its consumption is low.Firstly, food and nutrient information of underutilized foods will be sent to the phones of mothers as a daily SMS in the native Igbo dialect for 30 days. A single food/fruit will be highlighted each day, including the different ways in which it can be consumed. Recipes will also be included, to enable the mothers attempt otherwise new foods.Using mass media e.g. posters, handbills and stickers, general sensory faculty will be created on the underutilised foods in the town. The posters and stickers will be distributed on the towns market day Oye-Uga and at the different religious places in the town. Copies will also be made available to the participating women.Face -to -face nutrition discussion will be held for mothers in the clan with the lowest Dietary Diversity Score that correlates with low nutritional status of the Mother-Child pair. It will be held in the village hall, assess able to everybody. The discussion will seek to bring to the fore the underutilized food in the community, and the different recipes for preparation of the foods.ENDLINE/EVALUATIONThe IDDS of both mother child pair will be assessed again to calculate the post-intervention practise. This will help ascertain if the intervention impacted knowledge to the mother as evidenced by the post-intervention IDDS.ETHICAL CONSIDERATION ethical clearance will be sort from the Health Ethical Review Committee (HREC) of the University College Hospital (UCH) Ibadan.EXPECTED OUTCOME It is expected that at the end of the study, adequate knowledge on importance of dietary diversity will be garnered by the mothers and visible in their feeding practice, of both themselves and their children.TIMELINE FOR THE STUDYWeek123456789101112Activity/MonthMonth 1Month 2Month 3Community EntryRecruitment of Research Assistants and TrainingMarket SurveyKey Informant InterviewFocus Group DiscussionAdministration of Ques tionnaireAnalysis of Baseline DataInterventionCollection of Endline DataAnalysis of Endline DataBUDGET