Introduction
It is estimated that at least 1,500 people in developing countries die every twenty minutes from one or more of a litany of ailments referred to as neglected diseases, most of which are closely related to poor diet, poverty and poor hygiene practices (Wamanji, 2006). Madamombe (2006) stated that every year, about 5,500 children across Africa alone continue to die before they reach their fifth birthday as a result of poor diet and hygiene practice.
Nigeria is among the African countries where malnutrition and poor hygiene practices remain widespread with one in every three children aged less than five years being stunted. The country experiences intermittent scarcity of food in both rural and in slums of urban areas. In both cases, women and children suffer most and children are usually the first to die (Ubong, 2010).
Apart from the hard reality of poor dietary intake, poor hygiene has greatly contributed to the woes which had befallen the African continent. A study conducted in Onitsha, Anambra found that children living in unhygienic environments indicated by poor drainage systems, inadequate or non-existent toilets and piles of uncollected garbage suffer higher levels of morbidity and mortality (Njoku, 2012). The study further reveals that only 24% of all households within Onitsha have access to piped water in form of public water taps and 75% purchase water for domestic use. In terms of child health the rate of diarrhoea was 31% for children under five years while the infant mortality rate (IMR) was 91/1000 compared to 39/1000 in non-slum parts of Onitsha. Malnutrition also a major cause of child morbidity and mortality can, therefore, be related to environmental degradation. The study linked child malnutrition, morbidity, hygienic practices, food and/or water safety.
Conceptual framework
United Nations Children’s Fund (UNICEF) (2009) stated that poor nutritional status has become a serious public health problem that requires urgent attention. In their opinion, despite the economic growth observed in developing countries, poor nutritional status especially under-nutrition is still highly prevalent. Poor nutritional status according to the World Health Organisation (WHO) (2010) is usually the result of a combination of inadequate dietary intake and infection resulting from poor hygiene practices. In children, poor nutritional status is synonymous with growth failure. Children with poor nutritional status are shorter and lighter in weight than they should be for their age.
WHO (2010) recognized that high incidence of poverty and poor hygiene practice are the leading factors of poor nutritional status. Poor health status and malnutrition may impair both the growth and cognitive development of children. Some children are dramatically affected by anaemia, vitamin A deficiency and parasitic infections with adverse impact on their nutritional status as well as on their cognitive development and school performance also.
There is growing evidence of considerable burden of morbidity and mortality due to infectious diseases and poor nutritional status among children in developing countries. Studies in different countries identified the following health effects of poor nutritional status among children: respiratory problems, diarrheal disease, nutritional disorders, anaemia, parasitic infestations, pediculosis, caries teeth, refractive errors, skin diseases, ear and throat problems, tic disorders, sleeping disorders etc. Stunting and wasting are widespread among children in developing countries (Gupta, Bhat, Khajuria & Bhat, 2007).
Definition of nutritional status
According to David (2005), nutritional status is the condition of the body in those respects influenced by the diet; the levels of nutrients in the body and the ability of those levels to maintain normal metabolic integrity. Srihari, Eilander and Muthayya (2007) opined that nutritional status of an individual refers to whether or not the individual is eating the correct amounts and types of nutrients that he or she ought to eat. They added that nutritional status can be determined by assessing several factors, including body composition and appearance, blood levels, existing conditions, and issues that may impact access to or ability to consume and absorb food and also influenced by the amount of each essential nutrient that an individual consumes.
For children, weight and height for age are compared with standard data for adequately nourished children. The increase in the circumference of the head and the development of bones may also be measured (David, 2005).
Nutritional status and dietary intake
Basically, under consumption and over consumption of calories tend to result in poor nutritional status. For one to have a very good and optimum nutritional status, one must be both food and nutrition secures, however most people are on borderline nutrition because nutrition security is difficult to achieve (Williams & Schlenker, 2013). Therefore even though a person may be food secured, he or she may not necessarily be nutrition secured. Individual nutritional status depends on the interaction between food that is eaten, the overall state of health and the physical environment (WHO, 2010).
A model developed by UNICEF (2009) provides a widely accepted framework that shows the most likely causes of poor nutritional status. This framework indicates that poor nutritional status is an outcome as a result of immediate, underlying and basic causes in a hierarchical manner. Food, health can care are major requirements for nutritional well-being. However, food preferences that are developed in childhood influence adult food preference. Furthermore, it is during this period that they experiment and start developing dietary habits. Poor dietary patterns once developed eventually become permanent dietary habits (Chopdar & Mishra, 2011).
As described by WHO (2010), poor nutritional status essentially means bad nourishment. It concerns not enough, as well as too much food, the wrong types of food and body’s response to a wide range of infections that result in malnutrition is in two forms: over nutrition and under nutrition. Most people however associate poor nutritional status to under nutrition only.
Nutritional status and hygiene practice
WHO (2010) estimates that 88% of diarrheal diseases worldwide are caused by poor water, sanitation and hygiene. Children are at risk for food and water-borne illness because they live in institutions, foster families or communities that lack access to a safe water source, and have poor sanitation and hygiene practices. For many children, illness and malnutrition occur as a never-ending cycle: illness increases the risk for malnutrition; and malnutrition increases the risk for illness.
Diarrhoea which usually occurs as a result of poor dietary practices combined with malnutrition can weaken a child’s immune system and put them at risk for other illnesses, such as acute respiratory infections (ARI). According to UNICEF (2009) ARI and diarrhoea combined account for two-thirds of child deaths worldwide. However, improved sanitation and food preparation practices can help to reduce the prevalence of poor nutritional status which can result from poor nutritional status.
Effects of dietary intake and hygiene practices on nutritional status of children
Hygiene practices means formulation and application of measures to promote quality of public health. Good hygiene practice and good food intake help to develop a healthy nutritional status among children. In contrast, poor hygiene practices and poor food intake can lead to poor nutritional status. Poor hygiene practices exposes children to poor immune system thereby predisposing them to diseases, such as diarrhoea, dysentery, cholera, etc. poor food intake coupled with poor hygiene practices lead to malnutrition in children. Poor dietary intake and poor hygiene ranked high in the causes of child morbidity and mortality in developing countries is diarrhoea. However, the presence of microorganisms in human food by itself may not imply direct infection to consumers. It has been established that the microbial load must reach some minimum threshold before disease symptoms can show in consumers. It is reported that at least 102 CFU of most salmonella species per ml (or per gm) is necessary to cause disease in consumers, both young and old (Kirkwood, 2011).
Microbiological qualities of foods and water consumed in crowded slums are very similar to those of street foods consumed in the same areas. They are purchased from the same sources, stored in similar premises, prepared by the same people in dusty environments and sold and consumed under completely similar conditions (Singh & West, 2014). Lack of basic sanitation, like in the unfavourable conditions that exist in slums in many developing countries, can lead to food contamination.
Food hygiene practices such as washing hands before handling food, washing vegetables before cooking and serving warm or hot food and use of properly cleaned utensils are healthy practices to prevent diseases and lead to healthy nutritional status. Good hygiene practices and adequate sanitation is associated with decreased morbidity, improved nutritional status and lower childhood mortality (Muller & Krawinkel, 2005). Malnutrition among children below five years in poor hygienic areas is influenced by many different factors in which sanitation is prevalent. The prevalence includes diarrhoeal diseases can result in poor growth through decreased absorption of nutrients and increased requirements thereby contributing to general protein energy malnutrition. Improved sanitation in the poor sanitation areas should therefore be central to all initiatives geared towards improvement of the health and nutritional status of children. The health and livelihood conditions of slum dwellers are diverse. The dwellers suffer from poverty, poor access to safe food and adequate drinking water, and poor sanitary facilities which pre-dispose them to illness.
Solution to poor nutritional status among children
According to Singh (2004), poor nutritional status can be managed through the following measures:
- Health education: The health education should start from the antenatal clinic where mothers should be advised on good nutritional status through the practice of good hygiene practices and health dietary practices. Mothers should be advised to take more protein less carbohydrates and small fat in order to produce a strong and small fat in order to produce a strong healthy and vigorous infants
- Utensils used by mothers for the preparation of food meant for children should be hygienically preserved to prevent contamination by disease causing pathogens.
- The importance of family planning will help space childbirth and provision of family planning services.
- Food demonstration: Teach mothers on adequate diet during welfare clinic and also weaning diet.
- Advice mothers on exclusive breastfeeding.
- Mothers should be advice to get protein from locally available foods in the community.
- The child should be de-wormed periodically
- Immunization of the child to protect him/her against the deadly disease so that the child can grow well.
According to Casey, Lubotsky and Paxsons (2010), healthy nutritional status of children can only be assured through a change in the living conditions of the child and the community. This must include the education of mothers and their caregivers provisions of balanced diet, improved hygiene, clean water, as well as prevention and treatment of repeated infections such as gastro-intestinal infections, measles, HIV/AIDS and tuberculosis.
Poor nutritional status can be prevented through the provision of a balanced diet, adequate housing, accessible clean, safe water and proper sanitation together with economic upliftment and prevention of infection. Public education to teach mothers on how to improve their children’s diets, apply basic hygiene and utilised monitoring and preventive programme made available by the department of health, is important to ensure that children do not develop poor nutritional status and subsequent stunting.
References
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