Household hygiene, Sanitation and nutrition status of
under 5 year children
Kinigi Sector, Musanze-Rwanda
By HABIMANA Jean de Dieu
A55/70206/2013
A PROJECT PROPOSAL SUBMITTED IN PARTIAL FULFILLMENT OF THE REQUIREMENTS
FOR THE DEGREE OF MASTER OF SCIENCE IN APPLIED HUMAN NUTRITION OF THE
UNIVERSITY OF NAIROBI
Supervisor: ……………………………….
DEPARTMENT OF FOOD SCIENCES, NUTRITION AND TECHNOLOGY 2014
Declaration ...................................................................................................................................... ii
List of tables .................................................................................................................................. vii
List of figures ............................................................................................................................... viii
List of abbreviations ...................................................................................................................... ix
List of appendices .......................................................................................................................... xi
Operation definitions .................................................................................................................... xii
CHAPTER ONE: INTRODUCTION ............................................................................................. 1
1.1
Background of the study ................................................................................................. 1
1.2
Problem statement ........................................................................................................... 2
1.3
Justification ..................................................................................................................... 3
1.4
Aim ................................................................................................................................. 3
1.5
Purpose ............................................................................................................................ 3
1.6
OBJECTIVES ................................................................................................................. 3
1.6.1
Main Objective.......................................................................................................... 3
1.6.2
Specific objective ...................................................................................................... 4
1.7
Hypothesis....................................................................................................................... 4
1.8
Benefits ........................................................................................................................... 4
1.8.1.1
Community ........................................................................................................ 4
1.8.1.2
To the government ............................................................................................. 4
1.8.1.3
Researchers ........................................................................................................ 4
CHAPTER II LITTERATURE REVIEW ...................................................................................... 5
2.1
Malnutrition .................................................................................................................... 5
2.2
Indicators of children malnutrition ................................................................................. 5
2.2.1
Height/length for age ................................................................................................ 5
2.2.2
Weight for height ...................................................................................................... 6
2.2.3
Weight for age........................................................................................................... 6
2.2.4
MUAC....................................................................................................................... 6
2.2.5
Severe acute malnutrition ......................................................................................... 7
2.3
Hygiene and sanitation .................................................................................................... 7
2.3.1
Hand washing and personal hygiene......................................................................... 7
2.3.2
Food hygiene ............................................................................................................. 7
2
2.3.3
Food hygiene determinants and indicators ............................................................... 8
2.3.4
Sanitation .................................................................................................................. 9
2.4
Common water and sanitation-related diseases .............................................................. 9
2.4.1
Diarrhoea................................................................................................................... 9
2.4.2
Cholera ...................................................................................................................... 9
2.4.3
Intestinal worms ...................................................................................................... 10
2.4.4
Typhoid fever .......................................................................................................... 10
2.5
Gaps in knowledge ........................................................................................................ 10
CHAPTER THREE: STUDY DESIGN AND METHODOLOGY.............................................. 11
3.1
STUDY DESIGN.......................................................................................................... 11
3.2
Study site ...................................................................................................................... 11
3.2.1
Description of Kinigi Sector ................................................................................... 11
3.2.1.1
Climate............................................................................................................. 11
3.2.1.2
Geography ....................................................................................................... 12
3.2.1.3
Vegetation ........................................................................................................ 12
3.3
Study population ........................................................................................................... 14
3.4
Sampling ....................................................................................................................... 14
3.4.1 Sampling frame ............................................................................................................ 14
3.4.2
Sample size determination ...................................................................................... 14
3.4.3
Sampling procedure ................................................................................................ 15
3.5
Inclusion criteria ........................................................................................................... 15
3.6
Exclusion Criteria ......................................................................................................... 15
3.7
Data collection .............................................................................................................. 15
1.
Data collection tools and instruments ..................................................................... 15
2.
Recruiting and training research assistants ............................................................. 15
3.
Pretesting of questionnaires .................................................................................... 15
4.
Data collection process ........................................................................................... 16
4.1
Socio-demographic characteristics and socio economic information ................. 16
4.2
Questionnaire ...................................................................................................... 16
4.3
Anthropometric measurements ........................................................................... 16
3
4.4
Food frequency questionnaire .................................................................... 17
4.5
24 hours recall ............................................................................................ 17
4.6
Data from Health centers ........................................................................... 17
3.8
Data quality control and assurance ..................................................................... 17
3.9
Data handling and analyzing ............................................................................... 18
3.10
Ethical consideration ........................................................................................... 18
4
CHAPTER ONE: INTRODUCTION
Introduction
Each year 45% of total mortality of children under five
years worldwide is attributed to malnutrition (Dangour
et al. 2013). Undernutrition involves being
underweight for one’s age (wasting), too short for one’s
age
(stunting),
dangerously
thin
(acutely
undernourished) and deficient in vitamins and
minerals.(Black et al. 2010)
5
Worldwide
162 million under-five year olds
were stunted in 2012 and 56% of
them lived in Asia and 36% in
Africa, (WHO and UNICEF,
2009)
6
In developing countries
The prevalence rates is estimated to
be between 4% to 46% with 1% to
10% being severely malnourished
(Black, Allen, Bhutta, Caulfield, De
Onis, et al. 2008).
7
In Rwanda
According to National Institute of Statistics of
Rwanda (2012) stunting in children under
five years is at 44%, wasting at 3% and
underweight at 11%. Musanze District where
locate Kinigi Sector, stunting is above 61%,
underweight at 12% and wasting at 3.4%
8
Problem statement
According to National Institute of Statistics of
Rwanda (2012) stunting in children under five
years is at 44%, wasting at 3% and underweight at
11%. Musanze District where locate Kinigi Sector,
stunting is above 61%, underweight at 12% and
wasting at 3.4%
9
Despite the presences of several governmental and nongovernmental initiatives such as vitamin A distribution,
Growth monitoring, deworming programs, Programme
de Nutrition Basée sur la Communauté (PNBC), Water
Sanitation Hygiene (WASH), Community-Based Health
Promotion Program (CBHPP), and the natural richness of
the area, which have been contributing to the
improvement of nutrition status, hygiene and sanitation,
the high prevalence prevail. There might be other factor
influencing the nutrition status of children under five year
old.
10
Justification
This study will provide further understanding on
factors that contribute to prevailing level of
undernutrition which will help in development of
high effective strategies to combat malnutrition in
Rwanda, especially where stunting is highly
prevailing. and it will accelerate the progress to
achieve the Millennium Development goals at the
end increase the Economy of the country.
11
Aim
The aim is to establish the
association between malnutrition of
children under five year old and
associated factors in Kinigi Sector of
Musanze District
12
Purpose
The purpose of this study is to
contribute to the improvement
of nutrition status of children
under five years old through
identifying associated factors.
13
OBJECTIVES
14
Main Objective
To establish the prevalence of
malnutrition among children
under five years of age and its
associated factors.
15
Specific objective
1. To determine socio demographic and social economic
characteristics of the children under-five year old.
2. To evaluate the status of household hygiene and sanitation
among the households of the children under-five year old
3. To determine the food consumption practices of the
children under-five year old
4. To determine nutrition status of the children under-five
year old
5. To establish the factors associated with the nutritional
status of children under-five year old
16
Hypothesis
There is a high prevalence of malnutrition
among children under five year old in
Kinigi Sector which is associated with
poor hygiene and sanitation, Dietary
intake and morbidity.
17
Benefits
Community
The results from this study will help the community to improve their
knowledge and practices which can affect nutrition status of children
under five years old
To the government
The results from this study will provide to police makers some
information which will help them in better planning and decision
making based on scientific facts.
Researchers
The results from this research will provide additional literature to the
future researchers.
18
CHAPTER II LITTERATURE
REVIEW
19
Malnutrition
A health condition in which a diet does not provide
sufficient calories and protein for growth and
maintenance of the body or inability to fully utilize the
eaten food due to illness
Malnutrition exists in both undernutrition i.e. acute
malnutrition (wasting and/or nutritional oedema),
chronic malnutrition (and stunting), micronutrient
malnutrition and inter-uterine growth restriction (i.e.
poor nutrition in the womb) and overnutrition
(overweight and obesity)
20
Indicators of children malnutrition
• Height/length for age (stunting)
• Weight for height (wasting)
• Low weight for age (underweight)
• MUAC (severe acute malnutrition)
• Oedema (severe acute malnutrition)
severe acute malnutrition manifest as
• Marasmus
• Kwashiorkor
• Marasmic kwashiorkor
Common water and sanitation-related diseases
• Diarrhoea
• Cholera
• Intestinal worms
• Typhoid fever
21
Hygiene and sanitation
• Hygiene is a set of practices performed to keep yourself
and your surroundings clean for the promotion and
preservation of good health.
• Sanitation is the development of infrastructures and
equipment relating to the provision of safe water,
keeping places free from dirt, infection, disease and
adequate waste disposal.
• Globally, improvement of hygiene and sanitation can
prevent at least 9.1% of the disease burden or 6.3% of
all deaths
22
Hand washing and personal hygiene
Five critical times for hand washing include before handling of
food and eating, before feeding children, after sneezing and
coughing after cleaning babies’ bottoms and after visiting
toilets (Bourne, Pilime, and Behr 2013)
Food hygiene
The five key to food safety guidelines as described by Val
Hiller, Carolun Raab and Sandra Mc Curdy (2009) include to
stay clean, to separate cooked and uncooked foods, to cook
thoroughly, to keep food at appropriate and safe temperatures
and to use safe water and raw materials.
23
Some water and sanitationrelated diseases
•Diarrhoea
•Cholera
•Intestinal worms
•Typhoid fever
24
Gaps in knowledge
Huan Wang et al (2013) shown that even if
populations’ attitudes were positive, some gaps
are still existing in knowledge and practice. A part
from knowledge and practice; decision makers,
researches, and the population itself need to
know and to understand factors associated either
directly or indirectly to the nutrition status.
25
Chapter III
STUDY DESIGN
AND
METHODOLOGY
26
Study site
The study will be
carried out in Kinigi
Sector,
Musanze
District/Northern
province Rwanda
27
Study design
A cross sectional study
design will be used to
address the research
objectives of this study.
Study population
The study population is
composed by households within
there are at least one under five
year child in Kinigi Sector
Musanze District/ Rwanda.
29
Sample size determination
The formula to calculate sample size is
adapted from (Israel, 1992) but developed by
Cochran (1963)
30
Where
Z2 is the abscissa of the normal curve that cuts off an area α at
the tails (1 – α equals the desired confidence level). Our case,
95%)
e is the desired level of precision. In our case , 5%
p is the estimated proportion of an attribute that is present in
the population (61%)
q is 1-p
31
32
Sampling procedure
From a list of all household having at least one
children under five year old in Kinigi Sector, the
systematic sampling will be applied where every
13th household will be taken after selecting
randomly a starting point between 1st and 12th
household . in households with more than one
child under five years old, simple random will be
used to select only one
33
Recruiting and training research assistants
We shall recruit 4 students of Human
Nutrition and Dietetics Year 4 of
University of Rwanda as research
assistants and 4 community Health
workers as field guides.
34
Training of research assistants
The main objective is to be able to collect data
addressing to the study objectives.
At the end of training, the learners should be able to:
• Demonstrate the capacity to address people with a consent
• Carry out a household hygiene inspection
• Take anthropometric measurements of children
• To read information figured on vaccination card of children
• Fill the questionnaire and checklist addressing to the study objectives
35
Methodology of training
• Lecture
• Demonstration
• Field trip
• Exercises
The training will take 2 days
36
Pretesting of questionnaires
Pretest will be carried out
with 30 household of one
village in Kinigi Sector and the
information will help to rectify
and to update the used tool.
37
Data collection tools and instruments
Data shall be collect using a structured
questionnaire, combined with anthropometric
data sheet and an observation checklist, Food
frequency
questionnaire,
24
hours
measurement for food intake, measurement
instruments and materials to be used are Scale,
MUAC, and length board, weighing pants.
38
Data quality control and assurance
• Calibration of scales will be done daily.
• The scale must be checked for accuracy and verified using a
2Kg at the beginning of every session.
• For all measurements taken, the average shall be calculated
from two taken measurements.
• The completed questionnaire will be examined in the field to
check on the completeness of data, consistency of answers
and measurements taken.
39
Data handling and analyzing
• Descriptive analysis will help to generate information to the
characteristics of the population.
• Data collected from the questionnaire will be checked,
verified and entered into computer database of SPSS
statistics 17 which will used for analysis of data.
• The analysis of anthropometric data will done on the basis of
SPSS statistics 17.
• Data concerned food intake and food frequency will help to
obtain information about food quantity and frequency of
consumption.
40
Ethical consideration
We shall look for Ethical clearance from the
University of Rwanda College of Medicine
and Health Sciences Research and Ethics
committee, Permission from local leaders
where the research will be conducted and an
informed consent from participants to the
study.
41
Gantt diagram
No Activities
1.
2.
3
4
5
7
8
9
10
12
13
14
Prepare the research
Develop the research tools
Pre-test and revise research tools
Contact with local leaders
Train the research team
Prepare for the survey
Hold meetings with locals
Identify local human resources
Conduct the survey
Enter data in computer, validating and
correcting data
Analyze the data
Write Research report
Present the draft report to Kinigi
community and Musanze Hospital and
District
Write final report and submission
1st month
Period in weeks
Responsible
2ndmonth 3rd month 4th month 5th month
Researcher
Researcher
Researcher
Researcher
Researcher
Researcher
Researcher
Research
assistants
Researcher and
Research
assistants
Researcher
Researcher
Researcher
42
Researcher
Budget
Total cost
Item/Person
Rwa Fr
KE S
Sub total
3274497
414493
Contingency 10%
327450
41449
Total
3601946
455943
43
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