Dietary Diversity And Nutrition Status Health And Social Care Essay

Dietary alteration And Nutrition Status Health And Social direction EssayLow birth burthen (LBW) is be as a body weight at birth slight than 2500grams. Its main causes let in prematurity (born forward 37 weeks gestation) in developed countries and Intrauterine Growth Retardation IUGR (restrained fetal growth) in maturation countries (ACN/SCN, 2000). Relationship betwixt health of m other and babe has as well as been established, enate supportary and health attitude is an important determining factor of kidskins health and livingal outcome. LBW infants end up undernourished and stunted squirtren, adolescents and at long last women of sm entirely frybearing age. The main indicators of LBW infants hold maternal stunting, crushed pre-pregnancy weight and grim pregnancy weight gain. Thus generational stunting continues (Victoria et al, 2008). folks vary in definition and composition, specially in Africa. Households here in Africa mostly allows the blanket(a) fa mily members both in definition and composition. This serves as favorable confine net here and so adds income into the family if the members ar economically active or if economically inactive, increases dependency ratio in the household. Mother and child dyad regimenary shape reflects household dynamics, avail office of regimen, c be of catch and child. It john besides reflect gender segregation in household victuals for thought allocation etc.The state of f be in security measures 2001 defines aliment security as a situation that exists when all people, at all times, strike physical, social and economic access to sufficient, safe and nutritious nutrient that meets their dietetical need and provender preferences for an active and healthy life (SOFI, 2002). Its three building pillars include availability, accessibility and stability of forage. Availability entails physical posture of feed in the household or atomic number 18a concerned accessibility is conc erned with the ability to acquire adequate amount of food and stability means effort of food access which poop be chronic or transitory. degenerative food insecurity exists when food supplies are persistently insufficient to emerge adequate nutrients for all individuals. Transitory food insecurity occurs in the presence of temporary decline in access to adequate food because of dissymmetry in food production, food prices or income shortfalls. It is alike necessary that easy food meet the feedingary needs of the household members, bringing in the component of food utilization. Resource poor subsistence farmers, landless households, pastoral household, female-headed household and urban poor are more(prenominal) vulnerable to food crisis (UN millennium project, 2005 FEWSNET, 2011). During the case period, coastal state of the Bayelsa, delta, Rivers and somewhat portions of Jigawa in Northeast exit experience moderate food insecurity. The coastal states bequeath be alter by Niger-Delta crisis and potential pre-election tension. Pipeline vandalization, forget continue to contri onlye to local anesthetic water pollution, creating fish shortages among others. Flooding in the Northeast state of Jigawa testament reduce household stock (Millet) causing food insecurity, with low cereal grass prices, above- mean(a) increase in tuber production.The Convention on Biological re untriedal (CBD) defines bio diversity as the variability among living electric organisms from all sources including, inter alia, terrestrial, marine and other aquatic ecosystems and the ecological complexes of which they are part this includes diversity within propertys, between species and of ecosystems. In other words, it is the variety of life on earth at all levels, from genes to worldwide peoples of the same species. The una wish Levels of biodiversity include ecosystem containing rich biodiversity, species and communities of species and diametric genotypes, and this incl udes agricultural biodiversity. in all components of agricultural biodiversity relevant to food and agriculture and support the ecosystem that agriculture occurs is important (FAO, 2008). Thus, dietetical diversity becomes important as a means of protecting the ecosystem.Dietary diversity can be defined as the number of different foods or food groups consumed over a given reference period, usually 1-2 week. Dietary diversity has been sh let to improve provisionsal status (Kant et al, 2000 Kiokia and Golden, 2004 Gibson et al, 2000). Thus, it also can aid in combating hidden hunger, and olibanum 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 compendium 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 soon going extinct because the y are underutilized. The diet is shifting more towards an energy-dense found diet categorized by westernized and processed food, bringing with it the advent of non-communicable diseases like diabetes, coronary heart disease etc.Nutrition education aims to influence individuals to make meaningful changes in their dietary behaviour. Studies come noted the sizeableness and role in nutrition status and adequacy (Favin and Griffiths, 1999 Tarvinder et al, 2007 Mansour et al, 1994). In clear of that, splendor of nutrition education cannot be overemphasized in this scope, especially as traditional foods are available in its varieties but less consumed/sought-after. It becomes imperative form that nutritionary content and thus importance of these foods are once over 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. training technology has opened lots of door s for education and knowledge in the world, which can be harnessed for promotion of nutrition education. info technology utilise in education includes access devices, networking and communicating technologies, storage devices and e-learning platform (India insurance brief, 2010). They pose great potential for acquiring knowledge especially at the emergences comfort. Phones have been utilize for t for for each one oneer training with positive results among other things, MMS examples of teaching, strait lectures, SMS for reminders, motivational messages and short assessment questions etc. were utilise (ADB/Pouezevara and Khan, 2007).STATEMENT OF riddleThere 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 intake from traditional to processed western foods together with a gap in the quantification of the emergence of nutrition education in enhancing dietary diversity.OBJ ECTIVESGOALOptimize nutrition status of flummox and child by means of with(predicate) dietary diversity and nutrition educationSPECIFIC OBJECTIVESTo identify the available foods in the surrounding/ environs/locality and look on 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 bear upon it.To Investigate association between dietary diversity and nutritionary statusTo chance the influence 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% use (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 significantly pre-pregnancy s tatus is vital for adequate growth and development of new fetus and to break intergenerational disease and poverty that can arise from poor health status during the first 1000 old age (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 maturation 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, roughly 40% of the developing countries were chronically undernourished. Many developing countries have achieved 2700kcals. This high energy feature with an increasingly sedentary lifestyle has led to an increase in corpulency and NCDS. The composition of the diet change to mainly hig h energy and copious etc. (Josef and Prakash, 2004).METHODOLOGYANALYSIS OF OBJECTIVESObjectiveVariableType of analysisTo identify the available foods in the surrounding/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, wasting 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 learn entrust be a cross-sectional and descriptive take in.STUDY LOCATIONThe study resultin g be conducted in Anambra state. Anambra state is located in the south-east regularize of Nigeria, with its state capital being Awka. On a longitude of 6 20 00N and latitude of 7 00 00E, the state has 21 Local Government areas. It has a land area of 4,416km2 and a society of 4,177,848, do of 2,117,984 males and 2,059,844 females (NPC, 2006). With a people of 473,248, Children Under -five account for about 11.35% of the Anambra state population. Onitsha North and reciprocal ohm, 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 country-style.With a population size of 369,972 (NPC, 2006), Aguata LGA is the 2nd largest LGA in equipment casualty 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 artefa cts 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 erosion site. former(a) 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. unripened pinnate-leafed vegetables and fruits are also abundantly found. The positioning season, marks the beginning of the yearbook year (Igu aro), and peaks during the harvest season.Map of Anambra StateThe study allow be conducted in Uga, a townsfolk in Aguata LGA of Anambra state, in South atomic number 99 Nigeria. With a landmass of about 3790km2, it also has about 100,000 inhabitants. Uga shares its borders with Akokwa, Nkpologwu, Amesi, Umuchu and Ezinifite. The town is make of 4 villages figurely Oka, Umueze, Umuoru and Awalasi. These villages have different clan, an average of 6 clans per villages. They include Ok a, make 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 Umori. 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. While 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. Almost every household has some form of garden or subsistence/small-scale farming most of the food/fruits available in the mart come from subsistence farming. Land tenure is mainly through with(predicate) 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 result be used.For the Key I nformant Interview, The oldest individual in each clan give be used. A summarise of 24 subjects get out be interviewedFor the focus break up out discussions, each group pass on have a minimum of 6 and maximum of 8 members in each of the 4 villages, comprising of both sexes.SAMPLING PROCEDUREA three-stage sampling technique bequeath be used to select respondents/mother-child meet for the questionnaire survey.Firstly, Anambra state, testament be purposively selected because food systems are eroded with nomenclature, an indicator of culture. The Igbo culture is the fastest eating away culture among all the 3 major tribes in Nigeria. Legend also has Anambra State as the origin of Igbo people in the South-Eastern part of Nigeria.Secondly, Aguata LGA with its furnish at Ekwulobia depart 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 Governme nt. Its proximity to Federal Polytechnic, Oko and Federal College of Education (Technical), Umunze, makes it a key point and telephone exchange access area. While the headquarters remains urban, the surrounding communities, the study area- Uga include are still rural. It forget be strategic to study the effects of the spills of urban development in the dietary practice of these rural communities.third using a table of random numbers, Uga was chosen as the study area and all villages in Uga town testament be used for the study.SAMPLE optionSELECTION OF QUESTIONNAIRE RESPONDENTS All the women living in the community with a child under-five years of age who consent to participate allow for be included in the study. Already participating women leave also be asked for referrals of other mother-child pair.SELECTION OF FOCUS GROUP DISCUSSION apply the help of research assists, through non-probability sampling, 6-8 males and females aged 60 and above allow for be selected from each village and used for the focus group discussion.SELECTION OF KEY INFORMANT INTERVIEW the oldest person in each clan/village irrespective of gender will be used in Key Informant Interview. The individuals must be mentally acute in spite of disabilities/ infamy.MEASUREMENT INSTRUMENTFood/Market Survey Questionnaire concentrate on multitude discussion guideKey informant interview guideFAOs 16-item mortal 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 frequence QuestionnaireVARIABLESSocio-demographic characteristicsMothers DDS before the interventionChilds DDS before the interventionMothers DDS after the interventionChilds DDS after the interventionHFIAS ScoreNutritional status of childNutritional status of motherFamily dynamics and household characte risticsFood Variety Score (FVS) chemical formula of consumptionCOMMUNITY ENTRYEntry will be do 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 individual village unions. They will be acquaint with the different objectives of the study and its advantages for the community members. They will also be request to disseminate the information to the community members to get their cooperation.DATA COLLECTION numeric questionnaires will be used to collect baseline information from the communities. The questionnaires will be administered by twenty four (24) fieldworkers (research assistants). The research assistants will be selected one from each clan with at least a inessential school education. All of them will speak English and the local Igbo artistic style of the community fluently. The research assistants will be carefully trained by the researcher. Th e study objectives, methods and questionnaires will be discussed with special emphasis on rendering 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 quality.The Key Informant Interview (KII) and counsel 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, attachment A will be used to catalogue all foods encountered in the inborn nearby Igbo securities industrys. 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 (convention). Scientific and family name will be added following correct identification through books, internet and knowledgeable 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), l eaving 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 written text 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.anthropometricalal MEASUREMENTSBaseline anthropometric measurements 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, their 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 relaxation will be placed on a level problematical surface and adjusted to null balance before measurement. The subject will stand in the centre of the scale and looking straight. Light attire will be advised in the absence of nudity.For the teetotums, children and infants less than 85cm will have recumbent length measured using a woody measuring board (WHO, 1995). The infants heels will touch against the footb oard, shoulders tactual sensation the baseboard and the round top 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 used. 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 motley of mothers BMI will be according to WHOs recommendation (2000) as shown below mixed bagBMI (kg/m2)UnderweightNormal range18.50 24.99Overweight= 25.00Pre-obese25.00 29.99 weighty 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 frequency-of-occurrence musical instrument developed by USAID and FAO, with a recall of 4 weeks/30 days/1 month. The general occurrence questions cover body politics that include anxiety about household food supply, variety and preferences of type of food and insufficient food intake 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(prenominal) 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 habits 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, white tubers and roots, caliginous green vegetables, other vegetable, vitamin A rich fruits, other fruits, organ meat(iron-rich), cast meats, eggs, fish, legumes, daft 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-hand(a) out, while the others items each has a point.The mean IDDS, percentage down each food group and terciles as a measure of dispersion 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 patterns 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, white 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 see ds, 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, Age at marriage, current age, Childs date of birth, married status, parity, religion. Economic information will include job, monthly earning, Access to farm, descent ownershi p, food access market or farm production. Household detail will also be collected, and they include type of household thermonuclear 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 and groups will be identify from the Dietary Diversity Questionnaire in comparison with the market research originally 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 Data entry, computation and analysis will be done with SPSS v 17. Quality will be ensured through quality checks associated with information 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 soft variables and descriptive analysis for quantitative variable.DDS and 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 linear and logistical regression, the MIXED procedure for quantitative retort var iables (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 be 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 awareness 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 t he 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, assessable 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 CONSIDERATIONEthical clearance will be sort from the Health Ethical Review Committee (HREC) of the University College Hospital (UCH) Ibadan.EXPECTED resultant It is expected that at the end of the study, adequate knowledge on importance of dietary dive rsity 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 query Assistants and TrainingMarket SurveyKey Informant InterviewFocus Group DiscussionAdministration of QuestionnaireAnalysis of Baseline Data interpolationCollection of Endline DataAnalysis of Endline DataBUDGET