A TERM PAPER WRITE-UP

AND PRESENTATION
ON

PERCEIVED SOCIO–CULTURAL FACTORS INFLUENCING

NUTRITIONAL STATUS OF CHILDREN BELOW 5 YEARS IN

SELECTED RURAL COMMUNITIES

BY

SAMA’ILA LAWAL
[email protected]

BSC. PUBLIC HEALTH

300 LEVEL

DEPARTMENT OF PUBLIC HEALTH

SUBMITTED
TO

JOIN PROFESSIONALS TRAINING AND SUPPORT

INTERNATIONAL
KANKIA STUDY CENTRE, KATSINA STATE

JULY, 2021
 ABSTRACT

Purpose: This study was carried out to assess the alleged socio-cultural
factors influencing nutritional status of children below 5 years. In order to
successfully carry out the study, objectives and corresponding
hypothesis'were1 formulated to guide the study. Literature was reviewed
based on the research variables, Methods and Results: the methods and The
results of this paper where gotten from a similar research paper adopted
which is “Perceived Socio-Cultural Factors Influencing Child Nutrition
below 5 years in Rural Areas” conducted by World Health Organization
(WHO, 2020); and the findings reveals that; The study reveal that majority
of the respondents believed that feeding children with egg, meat and fish
makes them thieves with mean value response of 3.48 and 3.53 respectively
while majority also disagreed with stopping breastfeeding in the advent of a
new pregnancy with mean value score of 2.03. majority also disagreed that
their cultural practices had influence on the nutritional status of their
children with a mean response value of 1.82 but the grand mean score of
2.77 and SD score of 0.64 which is greater than the criterion mean of 2.5
confirms that religious and cultural practices has an influence on the
nutritional status of children. Conclusion: Socio-economic status of the
family like the occupation of breadwinner, the person who controls the
finance, and poor living conditions (inadequate water supply, inadequate
sanitations), with a grand mean score of 2.91 has a negative influence on
the nutritional status of children.

KEYWORDS: socio-cultural, factors influencing, child nutrition, mothers..

1
INTRODUCTION

BACKGROUND TO THE STUDY

Child nutrition plays a key role in infant and child health or death. Young

children, pregnant women and lactating mothers are nutritionally the most

vulnerable group, especially in the developing countries of the world, and

yet relatively little is done to achieve their special nutritional needs. (Oyira,

Abua, Mgbekem & Okon, 2010).The importance of nutrition in childhood

for both immediate health and health in later life is a topic that has aroused a

considerable interest and argument over the past 15 – 20 years.

The depth of interest and the data that arouse the interest are new but the

concept that the way a child is fed has a long-term effect or consequences on

the child. In developed countries and many traditional societies today, early

feeding has been considered a determinant of later character as much as later

growth and health. Such considerations were not always well substantiated

although widely accepted. Thus, feeding on eggs made children thieves and

wet nurses (Mothers) transmitted their personalities to the children. (WHO,

2008) Current beliefs on the relation of childhood diet to later health and

development may seem more specific but are at present equally

unsubstantiated by hard clinical evidence.

Observation has shown that long term complications of childhood nutrition

that can be substantiated are well understood. For example, Rickets may be
2
responsible for long term bone problems, particularly pelvic deformity.

Energy deficiency may lead to poor physical abilities in adult life. One

dietary question that is of most concern to both the epidemiologists,

nutritionists and primary health care specialists today is whether diet of

nutritional inadequacy contain some long term risk?

Virtually all that we know about dietary excess in childhood leading to

health problems in adult life is circumstantial evidence derived from

population studies and unsubstantiated by individual correlation. Parameters

of nutrition in adult life can be correlated with risks for morbidity and

mortality. Childhood is implicated by association.

Thus, populations adopting Western high-fat, refined carbohydrate, low fiber

diets show increased prevalence of obesity, hypertension, coronary heart

disease, diabetes mellitus, large bowel/cancer and several other problems

(Shetty, 2008).

Controversy continues to rage over the risks a particular dietary habit may

present even in adult life. Correlations between certain nutrients intakes and

particular disease are possible when comparing emulations, but the

calculation of the risks for individuals probably will never be possible.

Genetics and non-nutritional environmental factors affecting individuals are

risk factors as well (Shetty, 2008). The process of physiological growth in

children involves complex interaction of nutritional, genetics and

3
environmental factors. Nutritional requirements obviously vary with age and

diet must therefore be adjusted accordingly to achieve optimal health and

growth. Adequate nutrition ensures healthier children, who grow into more

productive adults while Poor nutrition on the other hand leads to

malnutrition. (United Nations Children’s Emergency Fund, 2008).

Factors that influence the nutritional status of children are many and varied.

These factors include inadequate dietary intake, poor household, food

security, diseases like diarrhea, infections e.t.c., inadequate maternal and

child care, unhealthy environment, lack of education and nutritional

information to mention but a few (Sullivan & Sheffrin, 2010). All these in

turn lead to malnutrition.

There is a relationship between socio-cultural factors, health and nutrition

(Noughani, Bagheri & Ramim, 2014). Socio-economic and socio-cultural

factors simultaneously influence both the children’s nutritional status and

their nutrition related roles.

Finally, relatively little has been written on factors influencing child

nutrition. Hence, the researcher hopes that this study will stimulate other

scholars, to conduct more in-depth studies on this topic.

4
PURPOSE OF THE STUDY

The purpose of this research is to assess socio-cultural factors influencing

the nutritional status of children below 5 years in selected some Local

Government Areas in Katsina State.

OBJECTIVES OF THE STUDY

The specific objectives of the study are:

1. To determine the influence of family structure on the nutritional status

of children.

2. To determine the influence of the socio-economic status of the family

on nutritional status of children.

3. To identify the religious and cultural practices that influence the

nutritional status of children.

HYPOTHESES

- There is no significant relationship between family’s socio-economic

status and nutritional status of their children.

SIGNIFICANCE OF THE STUDY

- This study is aimed at enlightening parents on the importance of adequate

nutrition especially during childhood, which promotes healthy growth of

children; and thus a healthy nation. This study may promote the use of

locally available food resources to prevent inadequate nutrition,

5
 occurring as a result of the superstitions and cultural practices held about

nutrition with regards to children.

- The result of this research might assist health workers to find out areas of

focus and emphasis when giving health talks to pregnant women and

nursing mothers during antenatal and postnatal clinics respectively.

SCOPE OF THE STUDY

The study will be delimited to mothers of young children under 5 years of

age at selected rural communities in Katsina State Local Government Area.

The study will cover the influence of family structure on the nutritional

status of children, the influence of the socio-economic status of the family

on nutritional status of children, religious and cultural practices that

influence the nutritional status of children and influence of maternal

education on nutritional status of the children.

LIMITATIONS OF STUDY

The researcher encountered certain difficulties in the cause of this research

and they include:- exaggerations. This has also been reported in similar

studies.

DEFINITION OF TERMS

- SOCIAL FACTORS: such as income, education, employment community

safety, and social support can significantly affect how well and how long we

6
live. These factors affect our ability to make healthy choices, afford medical

care and housing, manage stress, and more.

- CULTURAL FACTORS: This research include, encompasses the set of

beliefs, moral value tradition, language and law (or rules of behavior).

- NUTRITIONAL STATUS: Is a requirement of health of a person

convinced by the diet, the level of nutrient containing in the body and

normal metabolic integrity. Normal nutritional status is managed by balance

food consumption and normal utilization of nutrient.

Malnutrition is caused by 1m because food intake and faulty utilization, of

nutrient. Journal article is sometime called scientific article.

LITERATURE REVIEW

Influence of Family Structure on Malnutrition among Young Children

Separation of a child from his mother and his father occurs for a variety of

reasons, among these are broken homes, but it is usually a cultural practice

which eventually leads to the development of kwashiorkor in Uganda which

has been ascertained by Mccance and in Nigeria by Morley. Bicknell &

wood. Separation of a more temporary kind could be a major social factor in

the development of marasmus in Gambia in West Africa. (Guliano2009).

The same views hold in Nigeria and Northern, Cross River State in

particular.

7
During the planting and harvesting season, which coincides with the rains

and the greatest incidence of infection, mothers are always in the field from

dawn to dusk and young children are looked after by 5 – 14years old “nurse

maid”. Thus at the time when the child most likely to be ill and most in need

of motherly care and attention, both nutritionally and other help is least

available. Malnutrition is due to multiple socioeconomic problems and is

associated with the level of development of a country.

Although the simple etiological factor is insufficient food, it is not as straight

forward as this, since there are many related problems of supply and

demand, level of income, social status and education as well as health care

services availability (Obionu, 2007).

Malnutrition can be associated with occupation of the head of the family or

the breadwinner. The person who controls the family’s finances influences

(intentionally or unintentionally) both the food fed to the children and their

nutritional status. In general, when mothers rather than fathers have some

control over finances, the family diet is likely to be better. When the mother

has little or no control over family funds, dietary arrangements may become

haphazard or even dangerous. The result is usually malnutrition (Di Censo,

2010). According to Adebayo (2009) an exponential rise in birth rate

especially in the developing countries is well documented and now this

exceeds annual increase in world food production. Moreover, food

8
production and distribution are uneven and in general, the countries with

greatest population increase are those with the least improved agricultural

production. Inevitably, this is producing an increase in shortage of food and

a rise in the incidence of malnutrition. In recent years, the overriding role of

poverty in the etiology of malnutrition has been receiving increased

attention.

Many childhood diseases achieve their worse effect in poverty, socially

deprived homes and it would be surprising if protein energy malnutrition

were an exception (Center for Disease Control & Prevention, 2008). It is not

necessarily the poorest children who become the most malnourished. Some

families do manage by ingenious self-help schemes and economies to stave

off malnutrition but in general; it is the case that malnutrition is primarily a

problem of poor countries and of the poorest sections of the community

within these countries (Levison, 2011). Lucas & Gilles (2010) noted that

poverty is the main determinant of energy and nutrient malnutrition. Many

surveys undertaken in rural areas of developing countries have emphasized

that poor families are more likely to have malnourished children. In their

study in rural Bangladesh household, wealth was estimated from the size of

the dwelling. Children from poor households who do not live in convenient

and decent houses were more likely to be severely stunted than those from

wealthy households who live in very comfortable and decent houses. Such
9
association between nutritional status and household wealth has led many

investigators to examine links between poverty, the domestic environment,

child illness and food intake in more detail (Ali & Haider, 2005). In many

cases where the knowledge about nutrition exists, there is insufficient money

to purchase enough quantity of the required food. Wage earners are forced to

buy cheap food in order to make ends meet, leading to over reliance on few

high yielding staples that are usually cheap to procure. Everywhere, protein

energy malnutrition is clearly more common in the less affluent members of

the population (Obionu, 2007).

According to the study by Adebami, Oyedeji & Aderinsola, (2009),

nutritional status is compromised where people are exposed to high levels of

infection due to unsafe and or insufficient water supply and inadequate

sanitation. The public health challenges of unsafe water and inadequate

sanitation have plagued humanity for centuries and may continue to do so

unless government makes water and sanitation infrastructural improvement

one of the first priorities. The poor in most of the developing countries like

Nigeria either pay more for their access to water or have to travel far

distances to obtain water, thus exposing them to water borne diseases like

diarrhea which could predispose to malnutrition. (Neiederhauser, 2007).

Mere economic development or even the adequacy of food at household

levels is no guarantee for a stable and satisfactory nutritional status. At the

10
same time nutrition has to be tackled independently along with other

developmental issues like education of the people. (Mother and Child

Nutrition, 2007). Majority of the people are not aware of the concept of

balanced diet and significance of health and hygiene. Across the developing

world, women play key roles in maintaining household food security and in

caring for children on a day-to-day basis, both of which are extremely

important factors influencing a child’s nutritional status.

Malnutrition in children can be a consequence of unfavorable family

structure. Ten (10) children die every minute as a result of malnutrition.

More than a quarter of children in developing countries are underweight,

stunted, wasted and suffer from certain diseases because of the separation of

a child from his mother and or his father. This separation could be as a result

of variety of reasons. Among these are broken homes, death or even the

presence of a new pregnancy (Tarrant, 2010 and Ojofeitimi, Owolabi,

Aderomi, Esimai & Olasami, 2003).

Influence of Socio-Economic Status of Family, Maternal Education and

Malnutrition among Young Children

In many cases where the knowledge about nutrition exists, there is

insufficient money to purchase enough quantity of the required food. Wage

earners are forced to buy cheap food in order to make ends meet, leading to

over reliance on few high yielding staples that are usually cheap to procure.
11
Everywhere, protein energy malnutrition is clearly more common in the less

affluent members of the population (Obionu, 2007).

According to the study by Osibegun (2008) nutritional status is

compromised where people are exposed to high levels of infection due to

unsafe and or insufficient water supply and inadequate sanitation. The public

health challenges of unsafe water and inadequate sanitation have plagued

humanity for centuries and may continue to do so unless government makes

water and sanitation infrastructural improvement one of the first priorities.

The poor in most of the developing countries like Nigeria either pay more

for their access to water or have to travel far distances to obtain water, thus

exposing them to water borne diseases like diarrhea which could predispose

to malnutrition.

Since child-birth and breast-feeding can only be carried out by women, they

are naturally the primary caregivers at the beginning of a child’s life. And

women are most often the people who feed and bathe children, seek health

care when they are sick, protect them from exposure to danger, and support

their cognitive and social development (UNICEF,

2009). Given these key roles, women’s knowledge and abilities and their

own physical well-being and decision-making power are crucial to

children’s nutrition.

12
It is not surprising, that women’s education and status relative to men’s is

strongly associated with child malnutrition in developing countries.

Improvements in female secondary school enrolment rates are estimated to

be responsible for 43 percent of the total 15.5 percent reduction in the child

underweight rate of developing countries during the period 1970–2005. The

estimated contribution of improvements in women’s status relative to men’s

is only 12 percent, mainly because there has been little progress in this area

during the period in spite of its strong influence (Smith & Haddad, 2007). If

a mother knows that consumption of green leafy vegetables prevents anemia,

she would certainly include it in her own and her children’s diet. Our

countryside is rich in green leafy vegetables. Mothers are ignorant about the

right age of weaning the child, how to supplement his diet and proper way of

cooking foods. It is because of this ignorance that the available resources are

improperly used.

Maternal education has a lot of role to play. An educated mother not only

could take better care of child nutrition but also help prevent infant

morbidity and mortality to a large extent. Indeed self-sufficiency in food

production will not address the problem even of hunger or the calorie gap,

unless accompanied by adequate knowledge and purchasing power.

Experience shows that malnutrition and ill-health are traceable partly to

economic causes and partly to educational factors. For, even while living in
13
poverty, the health and nutrition status would be appreciably better, if people

know what to do about it. Malnutrition is due to multiple socio-economic

problems and is associated with the level of development of a country.

Although the simple etiological factor is insufficient food, it is not as straight

forward as this, since there are many related problems of supply and

demand, level of income, social status and education as well as health care

services availability (Obionu, 2007).

Malnutrition can be associated with occupation of the head of the family or

the breadwinner. The person who controls the family’s finances influences

(intentionally or unintentionally) both the food fed to the children and their

nutritional status. In general, when mothers rather than fathers have some

control over finances, the family diet is likely to be better. When the mother

has little or no control over family funds, dietary arrangements may become

haphazard or even dangerous. The result is usually malnutrition (Di Censo,

2010).

According to Adebayo (2009) an exponential rise in birth rate especially in

the developing countries is well documented and now this exceeds annual

increase in world food production. Moreover, food production and

distribution are uneven and in general, the countries with greatest population

increase are those with the least improved agricultural production.

14
Inevitably, this is producing an increase in shortage of food and a rise in the

incidence of malnutrition.

In recent years, the overriding role of poverty in the etiology of malnutrition

has been receiving increased attention. Many childhood diseases achieve

their worse effect in poverty, socially deprived homes and it would be

surprising if protein energy malnutrition were an exception. It is not

necessarily the poorest children who become the most malnourished. Some

families do manage by ingenious self-help schemes and economies to stave

off malnutrition but in general; it is the case that malnutrition is primarily a

problem of poor countries and of the poorest sections of the community

within these countries (Levison, 2011).

Lucas & Gilles (2010) noted that poverty is the main determinant of energy

and nutrient malnutrition. Many surveys undertaken in rural areas of

developing countries have emphasized that poor families are more likely to

have malnourished children. In their study in rural Bangladesh household,

wealth was estimated from the size of the dwelling.

Children from poor households who do not live in convenient and decent

houses were more likely to be severely stunted than those from wealthy

households who live in very comfortable and decent houses. Such

association between nutritional status and household wealth has led many

15
investigators to examine links between poverty, the domestic environment,

child illness and food intake in more detail.

Relationship between Superstitious/ Religious/ Cultural Beliefs on

Breastfeeding and Malnutrition among Young Children

Cultural beliefs and local tradition are important in determining health

behavior in general. Studies of feeding practices in different countries have

shown a large variety of beliefs and traditions related to breastfeeding

(Hizel, 2009). While some of these can encourage breastfeeding, others may

discourage it. Predominant among tribal practices in Africa and elsewhere is

the custom of ceasing breastfeeding once a new pregnancy has started. The

concept of the “Kabesh” is an example in which breastfeeding relates to

other people in society not only the mother’s milk as described in Egypt.

The belief that the entrance of a menstruating woman into the room can

harm a mother or a baby is referred to as (“Marandi, 2010).

In Anatolia, not allowing another lactating woman to enter the house is

believed to protect the mother and baby from evil forces. The perception of

the evil eye presents a barrier to women breastfeeding because a mother

might deny her child the benefits of her breast milk if she fears that she has

been subjected to evil eye (Hizel, 2009). Kuti (2012) studied the

breastfeeding practices among the Yorubas and found out that breastfeeding

is held in high esteem and practiced at ease. Problem arises when Yoruba
16
mothers have to work outside the home, formula feeding is usually used

during these periods while breastfeeding is done only in the evening when

they returned. A similar situation has been described among Zulus of South

Africa by Newton (2010) and the results in both cases are high incidence of

stunted growth; severe malnutrition, diarrhea and vomiting among the babies

of working class mothers and those influenced by their parents.

According to the study by Sabitu (2008) the prevalence of malnutrition is

higher among the children of women having the highest work load and it

tends to worsen among the children of women that are heavily engaged in

physically stressful agricultural activities.

This might be probably due to the inadequacy of breastfeeding pattern

observed among such mothers probably resulting from occupational stress.

This is likely to be the case in poor community, in Katsina Local

Government Area of Katsina State where the majority of mothers need to

struggle, maybe as farmers or petty traders to earn their daily living.

The early 1970s and second succeeding decades witnessed a universal

increase in feeding babies with infant formula and decline in duration of

breastfeeding, in many developing and developed countries. All these

findings informed the launching of Baby Friendly

Hospital Initiative (BFHI) by the United Nations Children’s Fund (UNICEF,

1998) and
17
World Health Organization in Ankara, Turkey in 1991 which is the latest

advance in decade’s long campaign to counter the world wide trends towards

breastfeeding. Despite the intervention by BFH and introduction of

Exclusive breastfeeding in 1991, there is still the recognition particularly in

African countries (Breastfeeding Newsletter, 2006).

Looking at the percentage of mothers practicing breastfeeding and for that

duration of time, malnutrition and its associated infant mortality should have

been a history in Nigeria. However, Nigeria and Enugu East in particular are

still saddled with the problem of malnutrition among young children, at a

time when infants are supposed to be fed alongside with complementary

feeds. For instance in Ghana, it was reported that water and glucose

solutions are widely given to infants beginning from the first few months of

life (Kwame, 2007).

Colostrum is seen as harmful in many cultures and discarding it is a common

practice in Hausa culture. They also have a belief that reflects that

breastfeeding is not only about transmission of nutrition from mother to

child but also about transmission of physical pain. Given that abdominal

cramping postpartum is essentially universal due to uterine involution, a

mother can deny her child of breast milk so as not to transmit the pain she is

feeling to him/her (Hossaini, 2008).

18
The health benefits of breastfeeding to both mother and infant have been

well established but early introduction of formula remains a common

practice in some developing countries where studies have shown that women

who receive encouragements to breastfeed from health care providers are

more likely to initiate and maintain breastfeeding than women who did not

receive any form of encouragement (Harrison, 2008 and Reyes, 2004).

The concern that poor maternal nutrition affects the infant has led to

widespread agreement on a policy of feed the nursing mother thereby the

baby. While the relationship may not be as direct as this policy implies, there

are several arguments for giving priority to women including lactating

women in supplementary feeding programmes. First, these women deserve

designation as a target group for the sake of their own nutritional status.

Second, most lactating women will later become pregnant again and

improving their nutritional status may reduce the level of low birth weight.

The lactating group may be important to reach in cultures where women

avoid eating more during pregnancy out of fear of birth complications

caused by large babies (Sosa, 2009 and Perez, 2007).

THEORETICAL REVIEW

Leininger’s Theory of Culture Care Diversity and Universality

Leininger (1978) introduced the concept of trans-cultural nursing and

developed the Culture Care Theory to explain cultural competency. It was

19
the first attempt in the nursing profession to highlight the need for culturally

competent nurses. Leininger (1978) explained that nurses had to acquire an

in-depth knowledge of different cultures in order to provide care to people of

various ethnicities. Moreover, it is the only theory that explicitly focused on

the relationship between culture and care on health and wellness.

She points out that the purpose and goal of her theory is for nurses to

understand diverse and universal culturally based care factors.

These factors include: (1) technological, (2) religious and philosophical, (3)

kinship and social, (4) cultural values and life ways, (5) political and legal,

(6) economic, and (7) educational, forming sunrays that influence

individuals, families, and groups in health and illness.

They influence the health, and well-being of others. An understanding of

these factors enables the nurses to provide care that is individualized and

meaningful to individuals of various cultural backgrounds. The major

concepts of Leininger (1991) theory include:

- Illness and wellness are shaped by various factors including perception

and copin skills, as well as the social level of the patient. Their

perception will influence the definition of such illness and determine

whether it should be taken seriously or not e.g. malnutrition in children.

This will in turn influence their pathway to health.

20
- Cultural competence is an component of nursing. Having knowledge of

patient’s cultural perspectives enables the nurse to provide more effective

and appropriate care. For example, understanding one’s religious or

cultural beliefs may be a deciding factor against giving a child eggs or

meat since these individuals are forbidden to receive this as they believe

that it will compel the child to steal in future. It is clear that having

specific knowledge about patient’s cultures ensures holistic and cultural

competent nursing care.

- Culture influences all spheres of human life. It defines health, illness and

the search for relief from disease or distress. The cultural belief that a

community may have well shape their own behavior all along and,

therefore, it will make it possible for medical treatment to be effected

when culture becomes an obstacle. For example, the diet therapy

encouraged or prescribed in order to prevent malnutrition in children may

be against the cultural beliefs in the community (the culture of the

community may be that proteinous foods e.g. meat should be reserved for

the elders instead of children who need them for growth and

development.

- Religious and cultural knowledge are an important ingredients in health

care. Nurses may encounter patients from numerous cultures in daily

practice as it is with mothers of young children living in Katsina Local

21
 Government Area. It is unlikely that nurses would know about the

culturally- based, health – related beliefs and practices of all persons.

However, nurses can gain knowledge and skills in cross – cultural

communication to help them provide individualized care that is based on

cultural practices.

- The health concept held by many cultural groups may result in people

choosing not to seek modern medical treatment procedures. A concise

cultural assessment is an effective way to obtain pertinent information

about patient’s perspectives on important aspects of their care (Man K.

T., Uday, N. Y., Hassan, H., Bharat K., G. Paudel, S. K. & Varalakshmi

C. S. 2019). It is important for nurses to learn which foods are culturally

acceptable and if there are certain foods that are not tolerated. These

questions guide nurses in planning care. Most important, it gives nurses

better insight as to which foods are considered healthy and helpful.

Learning about patient’s family structures is important to understand

when performing a culturally assessment. Family is the basic social unit,

and it defines how persons of various cultures view health and illness. It

also gives nurses insight about the support systems for their patients.

These factors play a significant role in restoring and maintaining the

health of patients. Nurses should develop their plan of care with their

patients in order to derive mutual goals that are compatible with their
22
 cultural norms. Patients will develop trust with their nurses and be

comfortable with the nursing care plan because it is consistent with their

cultural values and practices. They will likely adhere to the plan of care

because they feel respected for their different cultural practices,

promoting a positive outcome.

SUMMARY OF LITERATURE REVIEW

Nutritional status of children has been extensively studied, particularly in

developing countries and several of these studies showed that socio-

economic situation of the family, mother’s educational level, age, parity,

types of family, child’s immunization status and age are some of the key

determinants of nutritional status of children under five years.

Malnutrition in children can be a consequence of unfavorable family

structure.

Separation of a child from his mother and or his father which can be as a

result broken homes, death or even the presence of a new pregnancy can

result in loss of appetite and nutritional deprivation leading to malnutrition.

Leaving children to the care of the older siblings or house maids while the

mother is away exposes children to risk of infection and malnutrition. Socio-

economic status of the family has a great influence on malnutrition.

Malnutrition can be associated with occupation of the head of the family or

the breadwinner. Poverty is a major determinant of energy and nutrient

23
malnutrition; poor families are more likely to have malnourished children.

Maternal education has been found also to have a great influence on

nutritional status of children. An educated mother not only could take better

care of child nutrition but also help prevent infant morbidity and mortality to

a large extent. Numerous theories proposed to explain the link between

beliefs and behavior, culture and social structure and their influences on

nutritional status of children include: Leininger’s theory of culture care,

diversity and universality.

Although, most of the studies were carried out in developing countries and

some parts of this country, none was found in the Eastern part of Enugu

State. Thus, a gap exists.

Therefore, the need to assess the socio-cultural factors influencing children’s

nutritional status in this part of the country especially in rural communities

in Katsina Local Government Area arises.

DISCUSSION

The findings of this paper where adopted from similar research paper by

World Health Organization (WHO, 2020) which is “Perceived Socio-

Cultural Factors Influencing Child Nutrition below 5 years in Rural Areas”;

and the findings reveals that:

- Influence of family structure on nutritional status of the children

24
The influence of family structure on nutritional status of children among the

study participants was relatively high. The study revealed that the grand

mean score of 3.29 which is greater than the criterion mean score of 2.5

confirms that separation of a child from his mother (3.50), neglect caused by

divorce (3.73), leaving care of children for older siblings (3.03), large

families (2.92), and single parent families (3.23) all have been identified as

factors that have a negative impact on the nutritional status of children

thereby leading to poor nutritional status. This finding is in consonance with

that of Tarrant, 2010 who found that more than a quarter of children in

developing countries are underweight, stunted, wasted and suffer from

certain diseases because of the separation of a child from his mother/his

father, which could be as a result of broken homes, death or even the

presence of a new pregnancy. It also coincided with the study of Oyira et al,

(2010) which showed that though divorce is not usually a cultural practice in

Africa, separation of a more temporary kind could be a major social factor in

the development of protein energy malnutrition in Nigeria and Northern

Cross River state in particular.

- Influence of Socio-Economic Status on Nutritional Status of the

children.

The result showed that nutritional status can be influenced by the occupation

of the breadwinner of the family with a mean score of 3.45, the person who
25
controls the family finances influences (intentionally or unintentionally)

both the food fed to the children and their nutritional status, the family diet

was agreed to be better when the mother is in controlling finances than when

the father does with mean score of 2.91. When the mother has little or no

control over family funds, dietary arrangements may become haphazard.

Poor wage and poor living conditions (inadequate water supply, inadequate

sanitation were also found to be associated with poor nutritional status with

a mean score of 3.34 and 3.66 respectively. This is in line with the study

done by Osibegun (2008) who found that nutritional status is compromised

where people are exposed to high levels of infection due to unsafe and or

insufficient water supply and inadequate sanitation. It is also in line with

Lucas & Gilles (2010) who noted that poverty is the main determinant of

energy and nutrient malnutrition as evidenced by study done in rural

Bangladesh household that emphasized that poor families are more likely to

have malnourished children.

- Religious and Cultural Practices that Influence the Nutritional

Status of the children.

The result of the study indicated that some religious and cultural practices

like the believe that mothers transmit pain to the child through breast milk

(3.07), discarding of colostrums (3.17), eating less during pregnancy in order

to prevent birth complications caused by large babies (2.49), denying

26
children some proteinous food like egg, meat and fish (3.48 and 3.53) are

held strongly by the majority of the respondents which can lead to poor

nutritional status although few of them with a mean score of 2.03 believe

that breast feeding should be stopped once a new pregnancy has started.

This situation corroborates the observation of Hossaini, 2008 who found that

colostrums is discarded in Ubanese culture and seen as being harmful, they

also have the believe that breast feeding is not only about transmission of

nutrition from mother to child but also about transmission of physical pain,

given that abdominal cramping postpartum is essentially universal due to

uterine involution, a mother can deny her child of breast milk so as not to

transmit the pain she is feeling to him/her. The practice of giving children

egg, meat and fish were being restricted because of the belief that it will

predispose them to stealing is widely believed by the respondents and this

can lead to protein- energy malnutrition.

IMPLICATION OF THE FINDINGS

Malnutrition is a major childhood killer disease and is responsible for over

60 percent of avoidable maternal and infant mortality. Therefore, the socio-

cultural factors influencing nutritional status like family structure, socio-

economic status religious and cultural practices and maternal education

should be addressed by the nurses through community health outreach

27
programmes in order to educate and encourage the mothers on the adequate

and affordable ways of meeting the nutritional needs of their children.

CONCLUSION

Based on the findings of this study, the following conclusions have been

made.

- Family structure has a great influence on nutritional status of children

with a grand mean score of 3.29. Separation of children from mother,

neglect caused by divorce, leaving care of children to older siblings, large

families and single parent families all have a negative impact on the

nutritional status of children.

- Socio-economic status of the family like the occupation of breadwinner,

the person who controls the finance, poor ways and poor living

conditions (inadequate water supply, inadequate sanitations), with a

grand mean score of 2.91 has a negative influence on the nutritional

status of children.

- Religious and cultural practices like believe that mothers transmit pain to

children through breast milk, discarding of colostrums, eating less during

pregnancy in order to prevent birth complications caused by large babies,

denying children of egg, meat and fish are held strongly by the mothers

and all can have a negative impact on the nutritional status of children.
28
- Maternal education has a strong influence on the nutritional status of

children. Educated mothers had less number of children malnourished

than uneducated ones.

RECOMMENDATIONS

Based on the findings, the following recommendations are made.

- Health care personnel should educate mothers on factors that lead to poor

nutritional status. Improvement on nutritional status of children can be

achieved through increasing client’s knowledge especially in the rural

areas to discourage those detrimental practices that lead to malnutrition.

- The importance of exclusive breast feeding and the use of locally

available, highly nutritious food resources as weaning diet should be

taught during antenatal period and community outreach programmes.

- Women empowerment should be encouraged as it promises improved

family finances, better food security and better childhood nutrition.

- Government should be involved to help improve the socio-economic

level of the people through the provision of employment opportunities,

provision of adequate water supply, affordable health facilities and other

social amenities.

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