PREVALENCEANDTHERISKFACTORSASSOCIATEDWITHMALNUTRITIO

NINCHILDRENUNDERFIVEYEARSOFAGEINPONGOVILLAGE,AKWOROS
UB-COUNTY,NEBBIDISTRICTANDUGANDA.

BY

BEDIJOWALTER

REG.NO……./……./….../……..

NATIONALCERTIFICATEINMEDICALRECORDSANDINFORMATIONMAN
AGEMENT

ARESEARCHPROPOSALSUBMITTEDTONATIONALINSTITUTEOFMEDIC
ALRECORDSANDINFORMATIONMANAGEMENT–
MULAGONEBBIBRANCHASPARTIALFULFILLMENTFORTHEAWARDOF
CERTIFICATEINRECORDS

DECEMBER2023.
DECLARATION
IJAGENBENEFITherebydeclarethatthisresearchreportismyoriginalworkandhasneverbeens
ubmittedtothisoranyotherinstitutionforanyacademicaward.

……………………………..…………………………………..

Signature Date
JAGENBENEFIT

APPROVAL
Thisistocertifythatthisresearchreporthasbeendoneundermysupervisionandhas,tothebestof
myknowledge,notbeenpresentedanywhereelseforanotherpurpose.Thisresearchhasbeende
velopedundermysupervisionandIapproveitforsubmission.

SUPERVISOR

MRWANOKPATRICK

(MasterofPublichealth,NCMR&IM)

……………………………..
Signature Date

ii

ACKNOWLEDGEMENTi

IthankGodforthishasbeenthesourceofmystrengthlifeandhehasprotectedme.
IwouldliketoacknowledgevariouspeoplewhocontributedtothedevelopmentofthisstudyandIsendmysincer
eregardtothem.

Thecompletionofthisundertakingcouldnothavebeenpossiblewithouttheparticipationandassistanceofsom
anypeoplewhosenamesmaynotallbeenumerated.However,Iwouldliketoexpressmydeepappreciationandi
nparticularlytothefollowing;-

MyfatherJagenDavidP’olangoandmymotherIwutungDoreenforthesocial,emotionalandfinancialsupport
duringprocess.

SpecialacknowledgementalsogoestoPikisaDerrickforthesupportandbearingwithmeallthebusytimes.

Lastlytoallmyfriendsandclassmate.

iii

DEDICATION

IdedicatethisresearchstudytomybelovedmumIwutungwhoneverleftmebehindincaseofanyneeds,MayGod
blessyouabundantlyforyourgreatcommitmentstowardsme.IcannotaffordtoforgetmydearBrothers,Sisters
andfriendswhohavebeenontheirtoestosupportmystudyfinancially,physicallyandspiritually.MayGodmee
tyourdesiresaccordingtohisrichesinglory.NotforgettingmysupervisorMr.WanokPatrick

iv

LISTOFABBREVIATION

CDC CentreforDiseasecontrol

DFID DepartmentforInternationalDevelopment
GAM GlobalAcuteMalnutrition

MAM ModerateAcuteMalnutrition

MOH MinistryofHealth

PCM Protein-caloricMalnutrition

SAM SevereAcuteMalnutrition

SPRING Strengtheningpartnership,ResultsandInnovationsinNutritionGlobally.

UNFP UgandaNutritionFoodPolicy

UDHS UgandaDemographisHealthSurvey

UBOS UgandaBureauofStatistic

USAID UnitedStatesAgencyforInternationalDevelopment

WEP WorldFoodProgramme

WHO WorldHealthOrganization

GOU GovernmentofUganda

UNICEF UnitedNationsInternationalChildrenEmergencyFund

NGO Non-GovernmentalOrganization

ICESCR InternalconvenantonEconomic,SocialandculturalRight

HIV/AID HumanImmuneVirus

MMR MaternalMortalityRatio

MUACMid-uppercircumference

HMISHealthManagementinformationsystem

PEMProteinenergyMalnutrition

HBMHealthBeliefModel

LISTOFFIGURES

Figure1;MapofUganda…………………………………………………………..2

Figure2;MapofNebbiDistrictshowingAtegosub-county……………………3
Figure3;ConceptofsocioecologicalModel………………………………………4

Figure4;ConceptoftheHealthbeliefModel……………………………………..4

vi

Tableofcontent

DECLARATION……………………………………………………………….i

APPROVAL……………………………………………………………………ii
ACKNOWLEDGEMENT……………………………………………………..iii

DEDICATION…………………………………………………………………iv

LISTOFABBREVIATION…………………………………………………...v

LISTOFFIGURE……………………………………………………………..vii

Tableofcontent……………………………………………………………..…ix

CHAPTERONE…………………………………………………………….…1

1.0INTRODUCTION………………………………………………………….1

1.1Background………………………………………………………………...1

1.2Problemstatement……………………………………………………….....1

1.3Researchquestions…………………………………………………………4

1.4.0Studyobjectives………………………………………………………….4

1.4.1Specificobjectives……………………………………………………….4

1.5Researchhypothesis……………………………………………………….4

1.6Conceptualframework…………………………………………………….4

1.7Significancyofthestudy…………………………………………………..4-5

1.8Studyjustification………………………………………………………….5

1.9Scopeofthestudy……………………………………………………….…5

10.0Operationaldefinitionofterm…………………………………………….5-7

CHAPTERTWOLITERATUREVIEW………………………………………8

2.0INTRODUCTION…………………………………………………………..8

2.1Theoraticalreview…………………………………………………………...8-10

2.2Prevalenceofmalnutrition…………………………………………………...10

vii

2.3Factorassociatedwithoccurrenceofmalnutrition………………………..10-11

2.4Immediatefactor…………………………………………………………..11

2.4.2Underlyingfactor……………………………………………………….11
2.4.3Educationalfactor………………………………………………………11

2.4.4Psychosocialsupport……………………………….................................11-12

2.4.5Poverty…………………………………………………………………..12

2.5Specificintervention………………………………………………………12

2.6Synopsisoftheliteraturereview………………………………………….15

2.7KeyinterventioninUganda……………………………………………….15

CHAPTERTHREE;METHODOLOGY……………………………………..16

3.0INTRODUCTION…………………………………………………………16

3.1Studydesign……………………………………………………………….16

3.2Studypopulation…………………………………………………………..16

3.3Localeofthestudy…………………………………………….………….17

3.4Samplesizedetermination…………………………………………………17

3.5Samplingtechniquesprocedure………………………………………….…17

3.6Datacollectioninstruments………………………………………………...17

3.7Datacollectionmethods……………………………………………………..17

3.8.1Studyquestion……………………………………………………………..17

3.8.2Clinicalexamination……………………………………………………….18

3.8.3.Weightmeasurement……………………………………………………...18

3.8.4.Length/heightmeasurement……………………………………………….18

3.8.5Mid-upperarmcircumference…………………………………………….18

3.9Dataanalysis………………………………………………………………...19

3.10Dataqualitycontrol…………………………………………………………19

Viii

3.11Ethicalconsideration………………………………………………………..19-20

3.12REFERENCES:……………………………………………………………..21-23
3.13APPENDICES………………………………………………………………24-31

Appendixi;Instrument1

Appendixii;Instrument2

Appendixiii;Instrument3

ix
CHEPTERONE

1.OINTRODUCTION;Thischapterwouldtalkaboutbackgroundofthestudy,problemstatement,generalobj
ective,specificobjective,researchquestion,researchhypothesis,conceptualframework,,significantofthestu
dy,studyjustification,scopeofthestudy,operationaldefinitionofterm.
1.1Backgroundofthestudy

Forover50yearstherehasbeenconcernedaboutthehighprevalenceofhungerandmalnutritionintheWorldthat
hascapacitytofeeditspeople.Populationsaffectedaremainlythosefrompoordevelopingcountries,whichdep
endonsubsistenceAgricultureandarepredominantlyrural.

Internaltreatiesandconventionsrecognizedthattherighttoadequatefoodisfundamentalhumanrights.Article
25[1]oftheuniversaldeclarationofhumanrightandArticle11[1]oftheinternationalcovenantoneconomic,so
cialandculturalrights[ICESCR]bothprovidesfortherightofeveryonetoanadequatestandardoflivingincludi
ngadequatefood.Article11[2]oftheICESCRrecognizestheneedformoreimmediateandurgentstepstoensur
ethefundamentalrighttofreedomfromhungerandmalnutrition.

Manyinternationalconferenceshavebeenconvenedtofindsolutiontopersistentfoodinsecurity,famineandun
der-
nutritioninpartsoftheWorld.OneofthefirstwastheUnitedNationsConferenceonfoodandAgricultureheldin
1943withtheobjectiveofachieving‘’anadequatedietforall‘’.OthersliketheUnitedNationConference[1992]
.Internationalconferenceonnutrition[1992]andWorldfoodSummits[1996and2002]werefollow-
upmeetingstoaddresstheprimaryproblemofinequitablefooddistributionandthereluctantmacro-andmicro-
nutrientmalnutritionespeciallyamongchildrenandwomen.TheWorldSummitsforchildren[1990],specific
allyconvenedtodiscussissuesofchilddevelopment,gaveaspecificcommitmenttoimprovethenutritionofchil
dren.

In1999,followingrequestsatthe1996Worldfoodsummits,theUnitedNationscommitteeoneconomic,social
andculturalrightsformulatedgeneralcommentNO.12togiveabetterdefinitionoftherightsrelatingtofoodinA
rticle11oftheICESCR.

1.2.Problemstatement

Malnutritioninchildrenisamajorpublichealthprobleminmostofthedevelopingcountriesandproteinenergy
malnutrition[PEM]ismorecommonamongchildrenunderfiveyears.Childhoodmalnutritionisamajorunderl
yingcause(50%)oftheunder-
fiveyear’schildrendeaths.Everyyear,7.6millionchildrendiesuchpreventablemalnutritionanditsrelatedcau
ses.

Similarly,nextprevalentcauseofinfantandchildmortalityisnowlowbirthweightwhichleadstointergeneratio
ncycleofmalnutrition

InUganda,malnutritioncontributestoabout60percentofchildmortality.The2011UgandaDemographicand
HealthSurveyfoundthat33percentofchildrenwerestuntedandthatonly6

1
Percentofchildrenaged6to23monthswerefedappropriately,basedontherecommendedinfantandyoungchil
dfeedingpractice.Onlyinthecountry,2.3millionchildrenundertheageoffivearechronicallymalnourished[G
overnmentofUganda,2011;UDHS,2011].
FIGURE1

MAPOFUGANDA

http:/www.researchgate/showingadministrativemapofUganda

TheburdenofmalnutritionamongchildrenunderfiveyearsinMawavillage,Zombodistrictandalsoinformatio
nregardingassociatedfactorsislacking.However,accordingtoproposalsfromZombohealthcenterIII,thenu
mberofcasesduetomalnutritionisincreasingandithasbeenrecognizedtobeamongtheleadingcausesofreferr
alsforfurthermanagement.Itrealburdenisnotknownsincenodataisavailable.Ithadneverbeenstudiedinthear
ea.However,withincreasingavailabilityofinterventionssuchasfoodprovisionsupplementslikeVitaminAto
childrenunderfive,theriskofsufferingfrommalnutritionhasbeensubstantiallyreduced,withallthatdone,the
number

2
Ofcasesofmalnutritionamongunderfiveisstillaproblem.

Despitethefactthatdifferentstudieshavebeenconductedontheprevalenceofmalnutritionamongfive
FIGURE2

MAPOFZOMBODISTRICTSHOWINGZOMBOTOWNCOUNCIL

http:/www.researchgate/showingZombodistrictsub-counties

1.3Generalobjectives.
Todetermineprevalenceandriskfactorassociatedwithmalnutritioninchildrenunderfiveyearssoastocomeup
withapracticumsolutiontoreducetherateofmalnutritioninMawavillage,Zombodistrict.

1.4Specificobjective
>TodetermineprevalenceofmalnutritioninMawavillageinchildrenunderfiveyear
>TodeterminetheriskfactorassociatedwithmalnutritioninchildrenunderfiveyearsinMawavillage,Nebbidi
strict.

>ToestablishtherelationshipbetweenprevalenceandtheriskfactorinchildrenunderfiveyearinMawavillage,
Nebbidistrict.

1.5Researchquestion
WhatistheprevalenceofmalnutritioninMawavillage,Nebbidistrictinchildrenunderfiveyear?

WhataretheriskfactorsassociatedwithmalnutritioninchildrenunderfiveyearsinMawavillage,Nebbidistrict
?

WhatistherelationshipbetweenprevalenceandtheriskfactorsinchildrenunderfiveyearsinMawavillage,Zo
mbodistrict?

1.6Researchhypothesis

OH;thereisnosignificantrelationshipbetweenriskfactorandprevalenceassociatedwithmalnutritioninchildr
enlessthanfiveyears.

1.7Conceptualframework

DEPENDENCEVARIABLEINDEPENDENCEVARIABLE

 Malnutrition in normal
children under five
 Food insecurity
years
 Poverty
 Low level of knowledge on
family nutrition
 Lack of psychosocial support

1.8Significantofthestudy

Thestudywouldhelptheresearchertogain/
getNationalcertificateinmedicalrecordsandinformationmanagement.

Theresultofthestudywillbeusedbythefronthealthworkers,Medicaladministratorsata

facilitiesandcommunitytoidentifythecontributingfactorofmalnutritionandidentifysolutiononhowtoaddre
sstheaboveprobleminMawavillage,Zombodistrict.
TheresultofthestudywillbeusedasreferencesbytheofficeofDistrictHealthOfficers(DHO)forprogrambase
dplanningandImplementationofappropriateproblembasedtoplanandimplementnutritionactivityinthedistr
ict.

Theresultoftheresearchwillbeusedbypolicymakers(councilsatsub-
county,District,Municipal,City,MOHandparliament)toreviewtheimplementationstrategythatareresearch
basedthatwouldhelptoaddressmalnutritionproblemintheregionatthecountryatlarge.

Theresultofthestudywillbeusedbyotherstudentsasreferencefortheirstudy.

1.9Justificationofthestudy

Thepreliminarystudiesbeforeresearchestablishthatmalnutritionisofhighdiseasesburdenthananyothercom
munityhealthprobleminMawavillage,Zombodistrict.

Governmentinterventionlikeintegratingnutritionactivityinantenatalandpostnatalvisitsoutreachesnutritio
nscreeningduringsickandhealthbothinfacilitiesandcommunityhaveyieldedlowimpacttomalnutritionredu
ctionduetolackofevidenceofmajorcontributingfactorofmalnutrition.

ThisstudyaimsatidentifyingthemajorcontributingfactorofmalnutritioninMawavillage,Zombodistrictsoas
toaddress/providesolutiontoreductionofmalnutritioninthearea

10.0Scopeofthestudy

Thestudywillonlycoverpongovillage,Nebbidistrictandchildrenunder5yearswillbeusedforthestudy

10.1OperationalDefinitionofterms

a)Malnutrition.

Thisreferredtowhenanindividuallacksfoodvaluesinthebody.ItwillbemeasuredusingMUACininfantsunde
r2yearsofageandweighusinga25kgsalterhangingscale(CMS)Weighingequipment,HighHilborn,London
UnitedKingdomwhilethoseabove2yearsofagewillbeweighwhilestandingonthemeasuringboard.Andwill
beadjustedtozerobeforeeachmeasurement.

Therefore,measurementwillbedoneatmidpointbetweenacromionandolecranonprocessbyTape

Measureontheleftarm.Thereadingwillberecordedtothenearest0.1cm.ChildrenwithMUACof12.5cm-
13.5cmwillbeconsideredmildacutemalnourish(MAM),11.0cmto12.5cmwillbeconsideredmoderateandle
ssthan11cmseverelyacutemalnourish(SAM).Andtodeterminenormal,wasting,stuntingandunderweightin
childrenasbelow;-

i)Normalinchildren.AccordingtoWHOstandardschildheightforageZ-scoreof1fornormalchild.

ii)Wastinginchildren.AccordingtoWHOstandardschildwithweightforheightZ-Scorebelow-
2standardDeviations(DV)ofthemedianofareferencestandard.

iii)Stuntinginchildren.AccordingtoWHOstandardschildwithlength/heightforagez-scorebelow-
2standards(SD)ofthemedianofareferencestandard.

iv)Underweightchildren.AccordingtoWHOstandardchildweightforagez-scorebelow-
2standarddeviations(SD)ofthemedianofareference.

b)Householdpoverty.

ThisreferredtothefactsthatwhenanindividualcannotaffordtospendlessthantUgsh5000inadaytoprovideade
quateincomeforthefamily.Itwillbemeasuredaccordingtosocio-
economicstatus.Amongthehousehold,therearethreetypesofrationcards,basedontheincomeofthefamily.A
ccordingly,familiesofwillbeclassifiedunderthreecategoriesdependingonincomeconsideringthecolorofth
ecardsasaproxyforincome.TheyellowrationcardrepresentslessthanoruptoUgshs10,500(3USD),anorange
rationcardrepresentsbetweenUgshs10500(3USD)toUgsh105000(30USD)andthewhiterationcardreprese
ntsmorethanUgshs105000(30USD)incomeperannumandthenrecordedonanominalscaleof1-yellow,2-
orangeand3-white.

c)Maternalpsychosocialsupport.Thesocialsupportprovidedbythehouseholdheadtothefamilyincaseofsi
cknessandonanyhouseholdneeds.

Socialsupportenhancespregnantwomen’sfeelingsofindividualabilityandcompetence,itprovidessenseofre
cognitionandbelonging,anditencouragessharedresponsibilityinthefamily.Weknowfromotherresearchtha
tanexpectantmotherwhoreceivesgoodsocialsupporthavebetterhealth,mentalandphysical.Examplesofpsy
chosocialfactorsincludesocialsupport,loneliness,marriagestatus,andsocialdisruption,bereavement,work
environment,socialstatusandsocialintegration.Financialsupportisimportanceformedicationandtransportf
orantenatalcare,maternalandchildnutrition,thiswillbeconsidersupportfromhusbandandimmediatefamily
memberswhichwillbemeasuredaslow,medium,high.

d)Householdfoodsecurity.
Thisreferstoavailabilityandaccesstofoodsuppliesbythehousehold.Thiswillbemeasuredinthreedimension,
ownershipofagriculturallandmeasuredonanominalscaleof1-yes,2-
NO,availabilityoffoodstocksforfutureconsumptionmeasuredonscaleof1-yes,2-
NO,lengthoftimethisfoodwasexpectedtolastasanumericalvaluemeasuredindaysandcategorizedas1-
insufficienttonextseason,2-sufficienttothenextseason,scaleoffarmproducecategorizedas1-
sustainableoffarmproduce2-
unsustainablesaleoffarmproduce.Thesewillbethentransformedintoasingleindexoffoodsecuritystatuscate
gorizedas1-foodsecure,2-foodinsecure.

e)Householdlevelofknowledgeonnutritionaleducation.

Thisalsoreferstothehighestlevelofeducationattainedbythemother/
fatherinthehousehold.Itwillbemeasuredonanordinalscalerangingfrom1-NOEducation,2-primary,3-
secondaryto3-tartiaryeducation.Thiswillbelatertransformedtotwocategories1-(<or=primary)andZ-
(>or=secondary)andalsospecificallymeasuredlevelofnutritionknowledgebyaskingthehouseholdwhether
he/shehassomeknowledgeonnutritionorwhatcompromisesofgoodfeedingandclassifiedas1-
hadknowledgeonnutrition,2-Noknowledgeonnutrition.

f)Predisposingdiseases.Arediseasesthechildhadsufferedfrominthelastpreviousdaysorweeks.Itwillbeme
asuredbyaskingmotherthatdoesthechildsufferedfromthefollowingdiseasesinthelastpreviousdays?:Malar
ia,Pneumonia,Diarrhea,Dysentery.andthebirthordercardandtheimmunizationstatus(forchildren12and23
months);-a)Fully

Immunizedchild.ThosewhohavereceivedallvaccinesrecommendedinNationalimmunization

scheduleininfancyi.e.BCG,OPVzerodoseandHepatitisBatbirth,DPT1andOPV1at6weeks,DPT2andOPV
2at10weeks,DPT3at14weeks,MeaslesandVitaminAat9Monthsb)Nonimmunizedchildren.Thosewhohav
enotreceivedasinglevaccinec)Partiallyimmunized;-
Allotherchildrenwhowillbeconsideredaspartiallyimmunized.Andchildrenwithimmunizationcardwillbec
onsideredfortheanalysis.Anothermeasurementwillbedonebyaskingthemotheronexclusivebreastfeeding.
Childfedonlybreastmilkexcepttakingvitamins,mineralsupplements,ormedicineuntil6monthsofagewillbe
consideredasexclusivefeedingandlatertransformasYes--Fullyimmunized,No-Notfullyimmunized.
 7
CHAPTERTWO;LITERATUREREVIEW.
2.0Introduction

Thischapterdiscussestheoreticalreviewframework,prevalenceofmalnutrition,factorassociatedwithoccurr
enceofmalnutrition,immediatefactors,underlyingfactor,educationfactor,psychosocialsupport,poverty,sp
ecificintervention,synopsisoftheliteraturereviewandthekeyinterventioninUganda.

2.1Theoreticalreviewframework.

Thetheoriesorbehaviouralmodelsthatgroundthisstudyincludedthesocioecologicalmodel(SEM)incombin
ationwiththehealthbeliefmodel(HBM).Inthe91970s,UrieBronfenbrennerfirstintroducedtheSEMmulti-
layeredandinteractiveeffectsofpersonalandenvironmentalfactorsinthe1980s(Kilanowski,2017).Thediagr
amofthemultileveloftheSEMisillustratedinFigure3below.

Figure3ConceptofSocioecologicalModel

Note.Fromhttps://www.mdpi.com/1660-4601/16/19/3730/htm
Similarly,inthe1950s,agroupofsocialpsychologists,namely,Hochbaum,Rosenstock,andotherswithinthe
UnitedStatesPublicHealthService,developedtheHBMtodescribepeople’sfailureforparticipatinginprogra
mstopreventanddetectdisease(LaMorte,2019).Overtime,theapplicationoftheHBMexpansetostudypeople
'sbehaviouralresponsestohealth-
relatedconditions.Itsrelevancehasevolvedtoaddress10multipleP.H.concerns,awiderangeofpopulationsan
dhealthbehaviours(LaMorte,2019).TheHBM6containsseveralprimaryconstructsorconcepts,whichinclud
eperceivedsusceptibility,severity,benefit,barrier,andself-
efficacy.Theseperceptionspromptindividualstotakeactiontoprevent,screenfor,orcontrolillnessconditions
(Diddanaetal.,2018).
8
Figure4showsadiagrammaticrepresentationoftheHBMconstructsandconcepts.

Figure4ConceptoftheHealthBeliefModel

ModifyingfactorsLikelihoodofaction
Age
Gender
Perceivedbenefitsminusper
Ethnicity
ceivedbarriers
Personality
Socioeconomics
Knowledge
Individualperception

Perceivedsusceptibilityandp Perceivedthreat Likelihoodbehaviour

Cuestoaction
Note.Fromhttps://www.hindawi.com/journals/jnme/2018/6731815/

SEMisafour-
levelmodelthatshowcasestheinteractionbetweenindividual,relationship,community,andsocietalfactors(Centr
esforDiseaseControlandPrevention[CDC],2015b;Coreil,2010)asvitalcontributorstohealthproblems.TheSEM
approachisversatileforuseeitherinthepreventivephase,modificationoflifestyle,and11managementofmalnutriti
oninprioritypopulation(Glanzetal.,2015).UsingtheSEMpermitstherecognitionofthecomplexinteractionamon
gthedifferentlevels,thebroadersocialandculturallevelsofinfluenceonmalnutritioninchildhoodyears(Coreil,20
10),becausenosingleinterventionislikelytopreventmalnutrition.
Thepreventioneffortstargetanupstreamapproachthataimsatshapingthecircumstancesandconditionsthatarethe
underlyingdeterminantsofhealthandsocialequityinsociety(Baciuetal.,2017).Actionstargetthefoodenvironme
nts,thebroadersocioeconomicenvironments,andotherfactorsthatmayapply.Therefore,theSEMisarobustframe
workthathelpedmeidentifiesthefactorsthatinfluencemalnutritioninchildrenunder5aswellasexaminetheinterac
tionbetweenandwithinthemultiplelevelsofinfluence.
TheHBMisausefulconceptualframeworkonitsownandcanalsobecombinedwithothermodelsininterventionalpr
ograms.Coreil(2010)identifiedHBMasthemostusedtheoryinhealtheducation,healthpromotion,anddiseasepre
vention.Itsfourcomponentsareperceivedsusceptibility,perceivedseverity,perceivedbenefits,andperceivedbarr
iers(Glanzetal.,2015).TheHBMsuggeststhatpeoplecannothaveapositivehealthbehaviourchangeiftheydonotb
elievethattheyareatrisk.

TheunderlyingconceptoftheHBMisthatbehaviourisdeterminedbypersonalbeliefsorperceptionsaboutadisease
andthestrategiesavailabletodecreaseitsoccurrence.HBMpositsthatindividualsmust
9
Haveperceivedsusceptibilitytoadiseaseorillnesstotakeaction,haveperceivedthreatandperceived
severitytounderstandthedepthoftheriskandseriousnessofitseffects,haveperceivedbenefittoseeusefulness12an
dapplicabilityoftheprevention,havecuestoaction,andhaveperceivedbarriersasaresulttoacttothepreventiveacti
on(Khodaveisietal.,2018).

2.2Prevalenceofmalnutrition.

Malnutritionisamajor,globalhealthproblem.Childrenareparticularlyvulnerablesinceadequatenutritionise
ssentialtoensurehealthygrowthanddevelopment.Globallyare101million(%16)childrenunderfiveyearsofa
geestimatedbeingunderweight(UNICEF,WHO&WB,2012).Africaisseverelyaffectedandapproximately
48millionchildrenunderfiveyearsaremalnourishedinsub-
SaharanAfrica(UNICEF,2013b).ThemajorityofthecountriesinAfricaarestillstrugglingwiththeheavyburd
enofinfectiousdiseasesandpoormaternalandchildhealth.Thesecountriesneednutritionsolutionsthatareada
ptedtotheircircumstances,inordertoachieveimprovedpublichealth(Atinmoetal.,2009).

Prevalenceofstuntingindisadvantagedandvulnerablechildren(DVCs)rangeashighas64.2%.

Morethan70%ofchildrenwithprotein-
energymalnutritionliveinAsia,26%inAfrica,and4%inLatinAmericaandtheCaribbean(Erginetal.,2007).
WithintheSub-
SaharanAfrica35%and29%ofPreschoolchildrenarestuntedandunderweightrespectively(Leenstraetal.,20
05).

AccordingtoWHOBulletin(2002)thehighestlevelofstuntingisfoundinEastAfricawhereonaverageof48%o
fpre-schoolchildrenwereaffected.(Turyashemererwaetal.,2009).

InUganda,malnutritioncontributestoabout60percentofchildmortality.The2011UgandaDemographicand
HealthSurveyfoundthat33percentofchildrenwerestuntedandthatonly6percentofchildrenage6to23months
werefedappropriately,basedontherecommendedinfantsandyoungchildfeedingpractices.Onlyinthecountr
y,2.3millionchildrenundertheageoffivearechronicallymalnourished(GovernmentofUganda,2011;UDHS
),2011).

Regionally,accordingtotheresearchbyTuryashemererwaetal.,(2009)inPeri-
urbanKabarole,Ugandafoundoutthatstuntingwasbyfarthemostprevalentunder-
nutritionprobleminthestudyarea,withalmosthalf41.6%ofchildrenstunted.Theoverallprevalenceofunder-
weightandwastingwas15.7%and3.4%respectively.

2.2Factorsassociatedwithoccurrenceofmalnutrition

Thesubstantialreasonsforchildren’smalnutritionarecausedbythreeaspectsnamelyimmediateunderlyingan
dbasiccauses.Firstareimmediatecauseswhicharerelatedtopoordietanddiseases,exampleofdiseasesbeingH
IV,Measles,hookworms,diarrheaamongotherinfections.Secondlyareunderlyingcausesincludingfoodinse
curity,unhygieniclivingconditionsandinadequatehealthservicesandfinallythebasicsareasaresultsofwar,p
overty,lackofinformationandinadequacyofresourcesandfeedingpracticesandalsolimitedappreciationofde
vastatingimpacts(Lisa,
 10
Ramakrishman,Ndiaye,Haddad,&Martorell,2003;Prakash,2010).

2.2.1Immediatefactors

AccordingtoastudydonebyEngebretsen,Wamani,Karamagi,Semiyaga,TuumwineandTylleskar(2007)ine
asternUgandaamong99%ofthemother’sbreastfed.By6monthnoneofthemotherspracticedexclusivebreastf
eedingpracticeandat3monthsonly7%exclusivelybreastfed.Breastfeedinghaspositiveimpactsonchild’ssur
vivalforchildrenlessthantwoyearsofage.Statisticsshowthatbreastfedchildrenhaveatleastsix-
timesgreaterchanceofsurvivalintheearlymonthsthanthosewhohavenotbeenbreastfed.Multiplestudiessho
wthatbreastfeedingdramaticallydecreasesdeathsfromdiarrheaandacuterespiratoryinfectionsaswellasfro
mothersinfectiousdiseases.Acuterespiratoryinfectionsanddiarrheaarethemajorchildkillersintheworld(W
HO,2010).

2.2.2Underlyingfactors

Theunderlyingfactorsforcausesofundernutritionincludefoodsecurity,resourcesforcare,andresourcesforh
ealthandallhaveaneffectontheimmediatecauses(Flax,2010).Inmanyhomeschildrenliveinunhealthyenviro
nment.Thereisnoaccesstopropertoiletsorothersanitationservices(GOU,2011).AccordingtotheUgandaNe
wspaper,Newvision(March16,2013)itisreportedthathalfoftheUgandapopulationhasnoaccesstocleanwate
randsanitation.InUgandapeopleneedmoreinformationontheimportanceofproperhandhygienelikewashin
ghandsafterusingtoilet.Themothershaspoorattitudeasregardsadmittingmalnourishedchildrenintohealthc
are,sinceinmanycommunitiesinUgandamothersdoalotinprovidingforthefamily,theyusuallyescapefromth
ehealthfacilitiesinordertocontinueworkingforhouseholdsurvival.Thesourceofincomeforthesemothersisb
rewinglocalbeer.Thereforethemothersabscondfromthehospitaleventhoughthechildrenhavenotcured.Ina
ddition,thetendencyforwomentodosmallbusinesssuchasbrewinglocalbeerleavesnotimesforfoodproducti
onandhencelimitedaccesstofoodvarieties(DFID,2011).

2.2.3Educationfactors

Educationstatusisrecognizedtobeassociatedwithhouseholdfoodinsecurity.Itisanessentialdeterminantoffo
odreductionaxesandutilization.(42)
(Amuigis.D.Aetal.,2016).Alongsideimprovinghouseholdincomeandaxestofood,educationalsoprovidean
employmentopportunity.Ahighlevelofeducationattainmentamongthehouseholdheldespeciallywomeninf
luencesproperfoodpreparationandgoodnutritionpractices.Thisimproveadequatefeedingpracticestopreve
ntmalnutrition.(TitusandAdetokubo.G.2007).

2.2.4Psychosocialsupport

Malnutritionremainsadominantscauseofmortality,mobilityandlossofpotentialintoday’schildren.In2017
morethanoneinfivedonotachievestheirgrowthpotentialandatriskoflongtermdeficitincognitivedevelopme
ntstatingafteralmost40%ofchildreninsouthAsiaandthenumberofstuntedchildreninAfricaisrisingassuchof
currentinterventiontopreventmalnutritionhavelimited

11
Impactsofmorepreventionandtreatmentofmalnutritionisneededurgently.Morethanoneinfourteenofalldea
thinunder5yearscontributedtomalnutrition.Managementofsevereacutemalnutrition(SAM)isthehugechall
engesinlowhealthcaresettingandmotartilityremainhighmoreburden.

2.2.5Poverty

Povertyisthemainunderlinedfactorsthathinderaxestoadequatefoodamonghouseholdwithlowincome.Duet
otheirlowsocialeconomicstatus,poorhouseholdarenotabletobefoodinsecureandacquiresufficientresource
s(DEMARCOandTHORBA,2009).Thisrendersthemtolimitedaxesoffood,whichcouldfurtherretireitdistri
butiontohouseholdmembersDEMARCOandTHORBA2009).InSub-
Saharanincomeisanadaptedlyoneoftheessentialdeterminantinfluencingfoodinsecurityandhungeramongp
opulation.Povertyandfoodinsecurityarecoleratedandtheyallleadtomalnutrition.
(Abo.TandIkuma.B.2015).Thepoorcannotaffordtopurchasefoodtoperformtheiractivityofprovidingadeq
uatehousing,qualityhealthcareandqualityservicesfortheireducation(Foken.s.wandOwor.s.o.,2008).Pove
rtyisperceivedtobedeterminantofacquiringaresourcestoobtainfood.SeveralstudiesconductedinNigeriaan
dGhanademonstratethatmonthlyhouseincomeincreaseshouseholdfoodsecurityandimproveonmalnutritio
nstatus.

2.2.5.1Infections;thesemayreduceappetite,increaseenergyandnutrientutilization(e.g.tofightinfection)an
dlimittheabilitytoabsorborretainnutrients(e.g.asaconsequenceofdiarrheaand/
orthisimportantissue(MOH,2011).

2.3Specificinterventionstocontrolmalnutrition

AccordingtoBachou(2014),someProven,EffectiveInterventionstoImproveNutritioninclude:
Promotionofoptimalbreastfeeding,promotionofappropriatecomplementaryfeeding,Improvedhygienicpr
actices,vitaminAsupplementation,de-worming,Iron-
folicacidandcalciumsupplementsforpregnantandlactatingwomen,familyplanningtopromotesmallerfamil
ysize,increasebirthspacing,anddelayfirstpregnancyuntilaftertheadolescentyears,promotionofgoodnutriti
onforadolescentgirlsandpregnantandlactatingwomen,saltiodization,industrialfortificationandbiofortific
ationofstaplefoods,multiplemicronutrientpowders,preventionofchronicmalnutrition,treatmentofseverea
cutemalnutritionwithspecialfoods,suchasready-to-usetherapeuticfoods.

2.3.1Competenceandcollaborationofcareworkers

Healthcareprofessionalsplaysignificantroleineveryone’slives.Theirimportanceisemphasizedonlivesofth
osewholiveindevelopingcountries;livinginpoverty,sufferingfromundernutritionandvariousdiseases,they
donothaveaccesstoinformationprovidedbyindependentsourcesduetoilliteracy.Thesearepeoplewhodepen
dtotallyontheskillsandknowledgeofhealthcareworkers
12
(MOH,2012).9Healthcareprofessionalssuchasnurses,midwivesanddoctorsandtheirnationalandinternatio
nalco-
workersplayaveryimportantroleinpromotingmaternalcare,newbornandchildhealth.Theyalsohaveauniqu
eroleofeducatingandtrainingpeople.Healthcareworkerscanalsoinfluenceinsomelevel,tonationalhealthcar
epolicy(ThePartnershipformaternal,newbornandchildhealth,2006).

2.3.2Reductionofchildmortalityrate

Therehasbeenreductionofinfantmortalityintheworld.However,therateofreductionislowinSub-
SaharanAfricaregion.Itisclearlyshownthatthereductionofinfantmortalityrateafterapproximatelytwentyy
earswasat20percent.ImprovinghealthisoneofthecentralgoalsoftheWorldBank2010.Manycountrieshavee
mphasizedonprimaryhealthcare,safemotherhoodinitiatives,includingimmunization,sanitationandaccesst
osafedrinkingwater.Ascanbeseen,thereductionofchildmortalityisaffectedbythesamekeyinterventionstha
tareinthecenterofpreventionofundernutrition.(WorldBank,2010).

2.3.3Improvingmother’shealth

Itisimportanttopayattentiontomothers’healthbyincreasingassistancefromskilledhealthpersonnelduringpr
egnancyanddelivery.Thisincludesadequatesupplyofequipment’sandaccesstoemergencyobstetriccare.Pr
egnantmothersshouldvisitatleastfourtimesantenatalcareduringtheirpregnancy.Manyunderagedmothersa
reexposedtounwantedpregnancieswhichrequireaccesstocounselingandinformationonbirthcontrolmetho
ds.Unwantedpregnanciesaffectsboththemother’sandthechild’shealthandtheirfutureprospects.Makingpre
gnancieswantedandchildbirthssafepreventsmaternaldeathsandsaveschildren’slives(UNICEF,2013).

2.3.4Emphasisontheimportanceofbreastfeeding
Breastfeedingduringthefirstsixmonthofthechild’slifeisoneofthemostcost-
effectivemeanstoreducetheriskofayounginfantdyingduetopneumoniaordiarrheaandhelpachildtosurvives
evereconditionsprevailingindevelopingcountries.Statisticsshowthatexclusivebreastfeedinghasincreased
inmanyhigh-
mortalitycountriesintheearly90’s.Despitethistrendlessthan40percentofchildrenlessthansixmonthofagear
eexclusivelybreastfedindevelopingcountries.Manystudieshaveshownthatexclusivebreastfeedingpractice
sarevitallyimportant10inreducingchildren’sundernutritionandmorbiditytoabovementionedpneumoniaan
ddiarrhea(UNICEF,2012).

AccordingtoWHOproperinfantfeedingpracticesarekeytochildsurvival,breastfeedingisthebest,easiest,an
dmostcost-
effectivemethodtoensureandmaintainchild’spropernutritionandhealth.Annuallymorethan1.4milliondeat
hsinchildrenunderfiveinthedevelopingworldcouldbepreventedwithoptimalbreastfeeding.Childrenundert
woyearsofagehavethegreatestpotentialforapositiveimpactofbreastfeedingonchildsurvival.Statisticsshow
thatbreastfedchildrenhaveatleast

14
six-timesgreaterchanceofsurvivalintheearlymonthsthanthosewhohavenotbeenbreastfed.

Multiplestudiesshowthatbreastfeedingdramaticallydecreasesdeathsfromdiarrheaandacuterespiratoryinf
ectionsaswellasfromotherinfectiousdiseases.Acuterespiratoryinfectionsanddiarrheaarethemajorchildkill
ersintheworld(WHO,2011)

2.3.5KeyinterventionsinUganda

InternationalNon-
GovernmentalOrganizations(NGOs)partnertostartlocalfoodproductionprojectsinpoorcommunitiesofUg
andathatsuffersfromchronicpoverty,malnutrition,foodshortagesandfrequentdroughtaswellasothernatura
ldisasters.SuchsmallvillagesprojectsincludetheKaramojaProductiveAssetsProgram(KPAP)whereDepar
tmentforInternationalDevelopment(DFID)WorldFoodProgram(WFP)partnerwiththegovernmentofUga
ndatoworkagainstfoodcrisistoensureconstantaccesstofoodinthecommunities(DFID,2011).
OtherinitiativefrominternationalNGOsuchasHarvestPlusincludeholdingtrainingworkshopswithfarmerst
alkingaboutfoodvarietiesandtheirbenefitssuchastheimportanceoffoodsrichinvitaminsAtoimprovehealth.
Inaddition,theydistributesuchfoodseedlingstofarmerstogrownutritiousfoodrichinvitamins,proteins,carb
ohydrates,mineralsandfatsforbothhouseholdconsumptionandincomegeneration(DFID,2012).

2.3.6SynopsisoftheLiteratureReview

ThisstudywillalsoprovideinsightsontheMalnutritionstatuschildrenunder5yearsintheDistrict.Theprojectc
ouldhelpimprovedonriskfactorsresponsibleforMalnutritionamongchildrenunderage5years.Theresultofth
estudycouldhelpshapeupNebbiDistrictHealthPolicyTeamwithappropriateinterventiontocurbincidencea
ndprevalenceofMalnutritionamongchildreninMawavillage,Zombotowncouncil.

15
CHAPTERTHREE:METHODOLOGY
3.0Introduction

Thischapterwilltalkaboutthestudydesign,studypopulation,samplesizedetermination,samplingtechniques
procedure,Datacollectionmethod,Datacollectioninstrument,qualitycontrol,Dataanalysis,measurementof
variables,Ethicalconsideration.

3.1Studydesign

Thestudywilladoptbothquantitativeandqualitativeresearchapproachandnon-
experimentalresearchdesignwithcrosssectionalanalyticalsurveyeddesign.Analyticalsurveyedistheproces
sofcollectingdatainordertotesthypothesistoanswerquestionconcerningstatusofthesubjectunderstudies(L
OBIONDOWOOD,2021)

AdescriptivecrosssectionalstudywillbeusedforchildrenunderfiveyearsinamonghouseholdsinMawavillag
e,inZombodistrictwheremothersofchildrenwillbeinterviewedontheriskfactorassociatedwithmalnutrition
.Thecrosssectionalanalyticalsurveydesignwillbeusedbecauseofitsabilitytomeasurebigrangeofun-
observabledata,likepreferences,attitude,behaviors,beliefs,andfactualinformatione.g.incomewhichwerer
equiredinthisstudy(Belbasis,2018).Itisalsosuitedforremedy.

3.2Samplesizedetermination

ThesamplesizewillbedeterminedusingMorganandKregcformula.Theformulawillbeusedtoestimatethesm
allestpossiblecategoricalsamplesizesincethepopulationforthehouseholdsinMawavillageisbig.Inthistable
148samplesizepopulationwillbeusedforthestudy

3.3Studypopulation

ThestudypopulationwillbeamongchildrenunderfiveyearsofageinMawavillage.Thehouseholdswithchildr
enunderfiveyearswillbeconsideredforthestudy.

Specificobjective1.Athrometricmeasurements/
weightforageinchildrenundertwoyearstodeterminewasting/moderateandacutemalnutrition.

Midupperarmcircumference(MUAC)forchildrenunderfiveyearsofagetodeterminewasting/
moderateacutemalnutritionandsevereacutemalnutrition,heightforagetodeterminestunting.Inhouseholds
wheretherearemorethantwochildrentheolderonewouldbeconsideredforthestudy.

Specificobjective2.Themother/caretakerwouldbeassessed/asked/
questionontheriskfactorassociatedwithmalnutrition.

16
3.4Localeofthestudy
ThestudywillbeconductedinMawavillage,AbiraEast,inZombotowncouncil,Zombodistrict,WestNileandi
nUganda.

3.5SamplingMethod

Samplerandomsamplingtechniquewillbeusedforthestudybecauseitallowpresentationofentirepopulationa
severymemberspopulationhasanequalchancetobeselectedtoavoidbias.

MappingofthevillagewillbedoneusingGooglemap,eachhouseholdwouldbegivenanumberandthisnumber
wouldbewrapanddropinabasket,thepaperwouldbeshapedandtheywouldbepickedrandomly.Theprocedur
ewouldberepeateduntilthetotalnumberofsamplesizeisreached.

3.6Studytools/instruments.

Structuredquestionnaires,observingchecklistandwritingmaterials(pencils,pensandbooks),examinationto
olssuchasshakirs,Tapemeasure

3.7Datacollectionmethod

3.7.1Studyquestionnaire

Thedatawillbecollectedusingbothopenandclosedendedstructuredquestionnaireaboutsocio-
demographic,characteristic(appendix1),thedatawillbecollectedbytheprincipleinvigilatorhimselfandthre
eresearchassistant.Thequestionnairewillbefilledbythechild’sguardian/
attendantbasingontherespondenttocollectprimarydataandwillbecompletedbytherespondersbasedonthere
sponseoftherespondent.

Forspecificobjective1.

Anthropometricmeasurementlikeheightforage(stunting),MUACtodeterminewastinginchildrenabovetwo
years.

Datacollectioninstrumentself-
administeredquestionnairewillbeusedasthetoolscollectionduringthestudy.Thisinstrumentswillcompriseo
fwrittenquestionnaireandwilladoptaninterviewformat.Theself-
administeredquestionnairewillbechosenfordatacollectionbecauseitiseffectiveformeasuringsubjectbehav
iors,preference,intentions,attitudeandopinions(pattern2016).

ForspecificobjectivethreeRankcorrelationwillbeusedtoexaminetherelationshipandtheriskfactorassociate
dwithMalnutritioninchildrenunder5years.

TheZ-scoreofindependentchildrenunderstudywillbeusedasindependentvariables(x-
axis)andthefactorthatcontributetoMalnutritionwillbeconvertedinpercentageandusedasDependentvariabl
es,scatteredwithlineofbestfitwouldbeusedtoshowthecorrelationbetweenriskfactorsandratetoMalnutritio
n.

17
3.7.2Clinicalexamination

Thoroughgeneralandsystemicexaminationwillbedone,andvitalsignswillbetaken.

Diagnoseofunder-nutritionwillbebasedonweight/heightorlengthandMUACasexplainedbelow;

3.7.2.1Weightmeasurement.

Infantsundertwoyearsofagewillbeweighedusinga25kgsalterhangingscale(CMS

3.7.2.2Length/heightmeasurement.

Inchildrenuptotheageof24months,lengthwillbemeasuredusingalengthboardintherecumbentpositionbytw
oexaminers.Forthoseabove24monthsandwhowereabletowalkheightwillbemeasuredwhilestandingusinga
heightmeter.Weightforheight/lengthandz-scoreoflessthan-1willbeformild–zasmoderateand-
3indicatedasseverelywasting.

3.7.2.3Midupperarmcircumference(MUAC)

Measurementwillbedoneatmidpointbetweenacromionandolecranonprocessbytapemeasureontheleftarm.
Thereadingwillberecordedtothenearest0.1cm.ChildrenwithMUACof12.5cm-
13.5cmwillbeconsideredmild,11.0cmto12.5cmwillbeconsideredmoderateandlessthan11cmwillbeconsid
eredseveremalnourished.

3.8Measurementofvariables

ValidityandLiability;

Thisreferstoextendtowhichinstrumentaccuratelymeasure(SEKARANandBOUGLES,2019).Thisstudyw
illinvolvetriangulationtoensurevalidityofresearchfindingpriortotheadministrationinstruments.

Theresearcherwillalsosharetheinstrumentwiththeresearchsupervisortoreviewandgivecommentsregardin
gtowhichinstrumentismeasureandwhatisintendtomeasure.Atotalofhealthexpectswillbeincludedinratingi
nstrumentwithmajoritybeingpracticinginstrument.Eachconceptwillberatedonascaleoffourwith1:1-
notclear,2-itemneedsomerevision,3-clearbutneedminorrevision,4-
veryclear.Ascoreof3or4ontheclarityofeachitemwillbeconsideredgood.Thereaftercontentvalidityratiowil
lbecomputedtodeterminethecontentofvalidityindexusingtheformulabelow;-

CVI=Totalnumberofitemsratedbyallrespondents/totalnumberofitemsintheinstrument.

18
Reliability.Thisreferstomeasurestheconsistencyofresearchinstrumentstocomeoutwiththesameresultseac
htimeitisusedunderthecondition(sekaran&Bougles.2017).

Thisisthedependability,stabilityandconsistencyofitemintheinstrumentindatacollection(Kerlinger,1986).
3.9Dataqualitycontrol

Toensurequalitycontrol,theresearcherpriortotheexercisewillconductonedaytrainingforthreeresearchassis
tantwhothereaftersetforfieldtestingofthestudytools.Atotalsixquestionnaireswillbedistributedforthepre-
test.Theresearchassistantswillsupervisecloselybytheprincipleinvigilatorhimself.

3.10Dataanalysis

Forobjective1,weightforagewillbeusedtodeterminewasting(MAMandSAM)inchildrenunder2yearsweret
heweightofthechildwillberecordedandplottedagainsttheageofthechildinmonths.

Thiscouldbeplottedonthegrowthmonitoringchart/childhealthcard,
(HMIS&EPI003)childrenwhowouldbefoundtohavez-
scorebelow0.003cmwillbeconsideredseverelyunderweight,between-2and-3z-
scorewillbeconsideredunderweightandthenbetween0and-2z-
scorewouldbeconsideredlowweightforageandthosewhohave0to2wouldbeconsiderednormaland3wouldb
econsideredoverweight/obesed.

Graphforweightforageforindexchildwillbeplotted.

Forwastinginchildren2to5yearsMUACtapewillbeusedtodeterminelevelofwastingintheindexchildmark(1
2.5cm)wouldbeconsideredasseverelymalnourishedwhilethosewhoseMUACfallinthefiguregreenmarkw
ouldbeconsiderednormal.

Forstuntingheightofthechildrenwouldberecordedincmanddateofbirthoftheindividualindexchildwillbere
cordedifthedateisnotatleastthemonthscanbeused.

Forz-scoreforheightforagewouldbecomputedandthosewithz-scorelessthan-2wouldbeconsideredstunted.

3.11Ethicalconsideration

Thestudywillbecarriedoutaftertheapprovaloftheproposalbytheinstitution.Anintroductionlaterfromthead
ministratorschoolofnationalinstituteofmedicalrecordsandinformationmanagement(NIMRIM)Nebbibran
chwillbeobtained.TheresearcherwillbeobtainedfrompermissionfromtheadministrationofMawavillage,c
ommunityleader,localelders,throughverbalinformedconsent.

Respondentwillberequestedfortheirconsentpriortotheinterviewer.Confidentialitywillbe

19
maintainedthroughtheresearchprocessandtheinterviewerwillcodethatwereonlyknownbyresponsibleparti
esotherthanuseofnameandensuringnottodisclosetheirinformationtothinkpartieswithouttheirconsent.
 20
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23
APPENDICES
APPENDIXI:STUDYQUESTIONARE
SectionA.Consent
IamOFOYRWOTHINNOCENT,asecondyearstudentdoingaCertificateinMedicalRecordsandInformation
ManagementatNationalInstituteofMedicalRecordsandInformationManagement-
MulagoNebbiBranchdoingastudyof“prevalenceofmalnutritionamongchildrenunderfiveinOkemoEastvilla
ge,Ategosub-county,Nebbidistrict.”
Yourparticipationsinthisstudyiscompletelyfreeandvoluntary.Youhavearighttosaynoorchangeyourmindandw
ithdrawatanytime.Whetheryouchoosetoparticipateornotitwillhavenoeffectontheservicestobegiventoyou.Alli
nformationthatistobeobtainedfromyouinthisstudywillremainconfidentialandwillonlybedisclosedwithyourpe
rmission.
Ihopethatthisinformationwillbeusedtodrawinterventiononprevalenceofmalnutritionamongunderfiveyearchil
dren.
THANKYOU.
Nameofinvestigator.
.............................Date............................
SectionB:Socio-demographiccharacteristics.
I.Forthemother

Age
a)<20years

b)20-30years

c)>40years

Educationlevel:
a)Primarylevel

b)Secondarylevel

c)Post-secondarylevel

d)Neverwenttoschool

e)Others(specify).............................................................................................................

4.Occupation
a)Student

b)Businesswoman

c)Housewife

24
d)Peasant

e)Civilservant

f)Others(specify).............................................................................................................
5.Maritalstatus
a)Single

b)Married

c)Widow

6.Tribe
a)Alur

b)Lugbara

c)Acholi

d)Banyoro

e)Others……………………………………………..

7.Religion
a)Catholic

b)Protestant

c)Muslim

d)Pentecostal

e)Others……………………………………………….

8.Whoisthechildcaregiver?
a)Aunt
b)Uncle
c)Mother
d)Father
e)MotherandFather

8.Numberofchildren
a)1
b)2-4
25
c)5-7
d)>7

II.Forthechildasgivenbymother
Agegroup
a)<12months
b)12months-23months

c)24-59months

Others………………………………………………………………
Gender
a)Male

b)Female

Birthweight
a)<2.5

b)2.5-3.5

c)>3.5
Immunizationstatus
a)Fullyimmunized

b)Partiallyimmunized

c)Notimmunized
Sectionc:Otherfactorsassociatedwithmalnutrition
Isyourchildbreastfeeding?
a)YES
b)NO

Afterhowlongdidyouinitiatethechildonbreastfeeding?
<1hour
>1hour
Forhowlongdidyoubreastfeedthechild?
a)Neverbreastfed

b)<3months

c)3-6months

d)>6months

26
Familystaplefood
a)Matooke

b)Posho

Typeoffoodchildfedon
a)Matooke
b)Posho

c)Vegetables

d)Fruits

e)Milk

Whatismajorsourceofincomeforthehousehold?
…………………………………………………………………………………………….
Doesthehouseholdsellfoodtogetmoneyforotherbasisneeds?
a)YES

b)NO

Doyoubuysomefoodtypes?
a)YES

b)NO
DoesthechildanOrphan?
a)YES
b)NO
Doesthechildtakefoodproperlythesedays?
a)Breakfast
b)Lunch
c)Supper
d)Onceaday
Others……………………………………………………………………………………
Doesthefathersupportthefamilywiththeresourceswhenthechildorthemotherissick?
a)YES
b)NO
Others……………………………………………………………………………………

Doesthemotherofthechildhasattendedantenatalvisitinallthefourvisits?
a)YES
b)NO
WhenyouwentforantenatalvisitattheHealthfacility,didyoureceivedanynutritionaleducation,andwhatdidyoule
arntfrom
27
a)Maternalfeeding
b)Infantyoungchildfeeding
c)Exclusivebreastfeeding
Didyourhusbandescortyouforanyoftheantenatalvisits?
a)YES didhereceivedanyofthebelownutritioneducation
i)Maternalfeeding
i)Complementaryfeeding
iii)Exclusivebreastfeeding
iv)Noneoftheabove
Inthelastthreemonthsdidthechildhadsufferedfromthefollowingdiseases?
a)Malaria
b)Pneumonia
c)Diarrhea
Didhereceiveanyofthefollowingnutritioneducationduringpostnatalvisits?
a)Maternalfeeding
b)Complementaryfeeding
c)Infantyoungchildfeeding
d)Noneoftheabove

Doyouknowwhatcomprisesofgoodfeeding?
a)YES
b)NO

Doyouthinkpoorfeedingmakesthechildunhealthy?
a)YES
b)NO

Doyouhaveanyfoodtaboosinthefamily?
a)YES
b)NO

Whichtypeoffamilydoyouhave?
a)Extendedfamily
b)Nuclearfamily

HasthechildreceivedanysupplementssuchasvitaminA?
a)YES
b)NO

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Hasthechildbeendewormed?
a)YES
b)NO

Hasthechildsufferedinfectionofrecent?
a)YES
b)NO
Howfarisitfromhometothehealthcenter?
a)<5km
b)5-10km
c)>10km

Sectiond:Specificinterventionstocontroloccurrenceofmalnutrition
Whathasbeendonetocontrolmalnutritionathouseholdlevel?
……………………………………………………………………………………………..
Whathasbeendonebyhealthcareproviderstocontrolmalnutrition?
……………………………………………………………………………………………..
Whathasthepolicydonetocontroltheoccurrenceofmalnutrition?
…………………………………………………………………………………………….

THANKYOU

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APPENDIXII;STUDENT’SAPPLICATIONLETTERFORACCESSOFDATASET

OCTOBER03,2023
Dearsir/Madam

RE:Requesttodataset

Mynameis…………………………
amedicalstudentinthecollegeofHealthsciencesatNationalInstituteofMedicalRecordsandInformationMan
agement-
MulagoNebbiBranch.Atpresent,IamintheprospectivestageofdissertationonMalnutritionamongchildrenu
nder5yearsoldinMawavillageNebbiDistrict,andUganda.MyResearchstudyistitled;Prevalenceandtherisk
factorsassociatedwithMalnutritioninchildrenunder5yearsinMawaEastvillageZomboDistrict.

IamrequestingDataformyResearchproject.Iwillbeworkingwithsecondaryorexistingdataforaretrospective
studyonMalnutrition.FormyClinicalareaofinterest,IamlookingintoHealthcenterfacilitiesandpossiblyaco
mmunitysetting(ifnecessary).

Iamusingprospectiveapproach,so,mystudywillneitherinvolvefieldwork,recruitmentofsubjects,interview
s,norwillIadministerQuestionnaires.MystudywillinvolvesecondaryDatawithtargetaudiencesthatarechild
renunder5years,theirparents/
guardians,andrelevantstakeholders.ThusIamrequestinganapprovalandEthicalclearance(Ifneeded).

Iappreciateyourcooperationassistanceinthismatter

Sincerely

……………………….

……………………….

……………………….

30
APPENDIXIII:letterofintroduction

Date:November07,2023
…………………………..
……………………….....
 ……………………………..
Dearsir/Madam

RE:LetterofIntroduction

Thebearer………………………….isastudentinthisSchoolofHealthScience,PursuingCertificateinmedic
alRecordsandInformationmanagementProgramatNationalInstituteofMedicalRecordsandInformationMa
nagement-
MulagoNebbibranch(NIMRIM).Andheispresentingintheprospectusstageofhisdissertationinchildrenund
er5yearsofage.HehasproposalconductinghisResearchprojectinMawavillage,ZomboDistrictandhehasind
icatedaninterestinaccessingexistingdatafromyourorganization.

Irecognizethatobtainingdatafromgovernmentagencycouldbequiteaprocess;hence,anyassistanceyourorga
nizationcanprovidetoassisthimtosecuredataasmoothlyaspossible,Iwillbegreatlyappreciated.

Iappreciateyourtimeandcooperation.PleaseletmeknowifyouhaveanyQuestionsconcerningthisletter.

Sincerely

…………………………………

………………………………..

…………………………………

………………………………..

………………………………..

31