KNOWLEDGE OF MOTHERS ON HYGIENE PRACTICES AND NUTRITION AS PREDISPOSING FACTORS OF CHILDREN ILL-HEALTH

CHAPTER ONE

INTRODUCTION

1.1 Background of the study

The knowledge of hygiene practices and nutrition by people is of a great important and can be regarded as an important factor contribution to the health of the people. The Global  Monitoring  Report  (UNESCO  2011)  states  that  more  than  a quarter  of children below fifteen years of age in sub-Saharan Africa are underweight due to poor diet and malnutrition, making them more vulnerable to disease and less able to concentrate at school.  Malnutrition is generally defined as  a chronic  condition which is a  consequence of over- or under-consumption  of  any  or  several  essential  macro-  or  micronutrients  relative  to  the individual’s physiological and pathological requirements (Ecker & Nene,2012). Malnutrition is also a dangerous condition that develops when your body does not get enough nutrients to function properly. Poor nutrition can be caused by a lack of food or an unbalanced diet that's missing or insufficient in one or more nutrients (Chinyoka & Naidu, 2013). Children who do not consume adequate amounts of key nutrients, including calcium, potassium and vitamin C may be unable to work to their full potential at school (Nabarro, Menon, Ruel, & Yosef, 2012).

A study by Connell (2010) revealed that 34 percent of low birth weight children were either repeating grades or  placed  in  special  education  classrooms  while  only  14  percent  of  normal  birth-weight children experienced the same outcomes. Another research also reports elevated levels of grade repetition as a result of low birth weight due to poor nutrition (Bray, Gooskens, Khan, Moses, & Seekings; 2010, Duncan, Yeung, Brooks-Gunn, & Smith, 2008). Knowing more about what nutritional deficiencies can lead to, in terms of learning, will help families to feed their children adequately to succeed in class. Shrestha & Pathak (2012) as well as Brauw, Meenakshi,  &  Gilligan, (2012) concur that underfeeding in childhood was thought to hinder mental development solely by producing permanent structural damage to the brain. A child’s brain during the first three years of life is rapidly developing through generation of neurons, synaptogenesis, axonal and dendric growth, and synaptic pruning each of which build upon each other (Orazem, Glewwe, & Patrinos, 2007). Any interruption in this process, such as trauma, stress, under nutrition, or lack of nutrients can have long-term effects on the brain’s structure and on the child’s socio-emotional development and academic performance. Thus, research  has  established  that  poor  nutrition  in  early  life  can  limit  long  term  intellectual development (Lacour & Tissington 2011).    Implicit to the above, children should not be exposed to malnutrition even at an early age for  it has detrimental effects to their  academic performance and their holistic development.

Almost half of all under-five child deaths globally are attributed to undernutrition (Black, Victoria, & Walker, 2013). Outcome of insufficient food intake or nutrient absorption, and repeated infectious diseases, undernutrition manifests as stunting (low height-for-age), wasting (low weight-for-height) and deficiencies in micronutrients. In 2014, 159 million children around the world were stunted and 50 million were wasted while an estimated 2 billion people suffer from micronutrient deficiencies (Bailey, West & Black; 2015). The World Health Organization (WHO) estimates that 50% of undernutrition is associated with infections caused by unsafe water, inadequate sanitation or insufficient hygiene. Undernutrition accounts for 21 per cent of the global disease burden among children (Black, Victoria, & Walker, 2008), and manifests as stunting (low height-for-age scores), wasting (low weight-for-height scores), and underweight (low weight-for-age scores).

Impact on disease burden due to inadequate and unsafe water, lack of sanitation and poor hygiene behaviour is a complex issue. The occurrence and se verity of Hygiene related outbreaks in endemic area is greatly enhanced by human behaviour with regards to the practice of healthy hygiene. Poor hygiene behaviour is a major problem in developing countries (Van-Wijk and Tineke ,2003). Hygiene and sanitation related Diseases are a huge burden in developing countries; Causing many people to fall ill even to die (UNICEF,1998). Schools have repeatedly been implicated in the spread of gastrointestinal disease, High among primary school going children. Improvements in hygiene behaviour are the most important barrier to many infectious diseases, because with safe behaviour and appropriate facilities, people reduce their risk of becoming exposed to diseases. A study conducted by Feachem, (1984) stated that hygiene behaviour that influences the pattern of diarrhoeal spread. Water handling, latrine utilization behaviour, and hand-washing were the specific behaviour that received most attention.

Among children for whom mainly positive hygiene behaviour was recorded, the prevalence of diarrhoea was 6.4 days per child-year, while it was 14.2 days per child year in children with mainly negative scores (Strina, Barreto, Larrea and Prado; 2003).

As hands is an important mode of transmission of infectious disease among school-aged children. Simple hand washing with soap helps to protect children from the two common global paediatric killers (diarrhoea and lower respiratory infection), hand hygiene significantly reduce illness -related absences in elementary school students by 26% (Nandrup-Bus, 2009). Critical times for hand washing include after using the toilet, after cleaning a child, and before handling food. The mere provision of water supply and sanitation facilities is not enough to bring down morbidity and mortality rates. Water and sanitation facilities linked with hygiene behaviour have proven to be more effective in reducing diarrhoeal diseases and to support the improvements of sustained behavioural change. Attitudes, knowledge, and beliefs are some of the measures which are thought to be on the causal pathway to behaviour. Poor knowledge and practice of, and attitudes to personal hygiene has negative consequences for a child’s long term overall development. A study conducted in Ethiopia found that 60% of children surveyed did not know about the possible transmission of diseases through human waste. Awareness of health aspects of sanitary behaviour is important because it determines the degree of sustainability of an intervention in sanitation. Perception strongly influences one’s hand washing beliefs and practices.

According  to  World  Health  Organization  (2011),  it  is  important  to  make  sure  that information  about  health and nutrition is  accessible in  public  places and especially parents.  Such information should be made available in an  eye-catching,  uncomplicated  and  accurate  fashion.  Where appropriate, large posters, containing bright colours and well-chosen messages pertaining to health and hygiene, should be displayed in public places for the education of the mothers.  parents could be involved in preparing  educational  posters  and  notices  for  display  in  public  places.  Poster messages should include the promotion of: Hand washing, use of refuse bins, care of toilet facilities, Protection of water supplies.

 WHO (2011)  further  stated  that,  about  2.4  billion  people  globally  live  under  highly unsanitary conditions. Poor hygienic behaviour and exposure to the risks of infection are very serious issues.  The WHO has been at the forefront  of  environmental sanitation  and  hygienic  initiatives  during  recent  years  and  has developed  key materials  directed  at  policy  makers  and  technical  people  dealing  with  these  issues. These materials  include:  guidelines;  “best  practice”  documents  and  promotional materials on sanitation and hygiene. Around 1.1 billion people globally do not have access to adequate sources of water and about 2 million people die every year due to diarrheal diseases; most of them children under five years of age. The most affected people are those living in developing  countries,  those  living  under  conditions  of extreme poverty, and peri-urban dwellers. Providing access to sufficient supplies of safe  water,  the  provision  of  facilities  for  the  sanitary  disposal  of  excreta  and the introduction  of  sound  hygienic  behaviour,  are  of  the  utmost  importance  in  the reduction of disease caused by these risks.

The importance of mothers knowledge in the production of child health is well-established (Behrman & Deolalikar, 1988;   Strauss & Thomas, 1995 ) . The association of parental knowledge on nutrition with child health may arise because parents with such knowledge are more efficient ‘producers’ of child health   (‘productive efficiency’) through adopting   better child- care practices or superior  hygiene standards. Alternatively, it may be because  they   choose health input mixes  that generate  more health  output (‘allocative efficiency’ ) than  selected by   mothers without such knowledge . This may be because education instils greater knowledge of the health production function or the ability to respond to new knowledge more rapidly (Grossman, 2005).

1.2 Statement of Problem

Poor sanitation results in morbidity which may later lead to death. It is important for an individual to live in a healthful environment so as to have maximum enjoyment of life. The hygiene condition of environment has become an issue of serious concern to Nigerians, especially with the migration of people from rural to urban centers. It should be noted that poor or dirty environment has adverse effect on our health which has nothing to do with age or status.

The local government of Ijebu North is an agrarian area with heavy waste generated which requires attention to keep the environment healthy. Personal hygiene too is poorly observed by parents and other local food handlers. The filthiness of the environment calls for concern in the major terms of the local government which can easily predispose to a number of ill health conditions.

This study is carried out to investigate the knowledge of the mothers on the correlation between unhealthy environment/personal hygiene and poor nutrition and ill health

 Diseases peculiar to Ijebu North Local Government Area of Ogun state which is the area of study are Lassa fever, malaria, diarrhea (Direct Observation,2011 till date). The primary cause of the above listed diseases in Ijebu North Local Government Area of Ogun State is poor environmental hygiene.

1.3 Research questions

·        Do mothers know that nutrition is part of what make a child healthy?

·        Are mothers aware that poor hygiene practices predisposes to diarrhoea diseases?

·        Are mothers aware that good personal hygiene will prevent several ill health conditions?

1.4 Hypotheses

H01: There will be no significant relationship between the effect of malnutrition and the health of children as perceived by mothers in Ijebu north local government of Ogun State.

H02: There will be no significant correlation between the knowledge of mothers and the prevention of diseases through personal hygiene.

H03: There will be no significant correlation between the knowledge of mothers and the prevention of diseases through nutrition.

H04: Good environmental sanitation may not significantly lead to a healthy life

1.5 Significance of the Study

This study is relevant in the sense that it might help mothers on their role and responsibility towards improving the health of their children through personal hygiene and proper nutrition.

It shall also be of benefits to the government of the state to take the issue of educating the people of the state on personal hygiene and proper nutritional practice. It shall be to help to the entire people of Ijebu North on the issue of proper nutrition and also improve their knowledge on personal hygiene.

 Finally, this study shall also serve as a useful material for the government, health educator, and public health workers on resolving the causes of poor sanitary condition and causes of malnutrition. Thus provides government with the insight on how to give lectures on health talk and how people can maintain balanced diet.

1.6 Purpose of the Study

The main purpose of this study is to find out knowledge of mothers on hygiene practices and nutrition as predisposing factors of children ill-health in Ijebu North Local Government Area of Ogun state.

1.7 Delimitation of the Study

The study would be delimited to:

The mothers who live in Ijebu North Local Government Area of Ogun state.

The use of descriptive research design.

The use of self structured questionnaire as instrument for data collection

The use of frequency counts and percentage to analyze the demographic data and the use of regression and correlation analysis to determine the acceptance and non-acceptance.

1.8 Limitation of the Study

The limitations that the researcher might experience in the quest of finding the truth in this study are as follows:

The responses that would be provided by the people to some of the questionnaire form may be incomplete. Efforts would be made by the researcher in guiding respondents to fill the questionnaire appropriately. Other limitations in the course of this study would be adequately taken care of by the researcher.

1.9 Operational definition of terms

Malnutrition: A state of poor nutrition or lack of adequate nourishment

Poor Sanitation: Inadequate care of the environment.

Ill Health: All health condition that may arise due to poor environmental sanitation and nutrition.

Environmental sanitation: The control of all those factors in man’s environment which may exert a negative effect on his physical development, health and survival.

Poor Environment: Unhygienic Environment or Unclean Environment.