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ASSESSMENT OF KNOWLEDGE OF GROWTH MONITORING CHART OF MOTHERS/CAREGIVERS OF UNDER-FIVE CHILDREN ATTENDING UNDER-FIVE CLINIC AT GWAMNA AWAN GENERAL HOSPITAL KAKURI, KADUNA

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ABSTRACT
BACKGROUND Recent data shows that Nigeria has the 12th (with Niger) highest under- five mortality rate of 143 per 1,000 live births. It is estimated that 60% of under-five deaths in developing countries are attributable to malnutrition and it is a threat to the achievement of the Millennium Development Goal (MDG). In sub-Saharan Africa under nutrition poses a major challenge for child survival and development in the region. In developing countries, knowledge of growth monitoring among mothers/caregivers is generally poor and the extent of practice and attitude to its use among them varies from one community to another. In Nigeria, child mortality and malnutrition rates are far higher in the North East and North West geopolitical zones than in other parts of the country. To address this, it is important for mothers‘/caregivers‘ of under-fives to be aware of early and regular monitoring of growth using growth chart (also known as ―road-to-health‖).

METHODOLOGY
A descriptive cross-sectional study of 360 mothers of under-fives, who presented in Dr Gwamna Awan General Hospital Kakuri, Kaduna in October 2012 was done. The mothers were selected using ballot sampling and interviewed using interviewer-administered pre-tested questionnaires and four (4) growth charts showing different growth curve situations were used: overweight above the upper reference curve, normal ascending within the reference curves, static within the reference curves, and dangerous below the lower reference curve.

CHAPTER ONE
INTRODUCTION
1.1 Background Information
In developing countries, knowledge of growth monitoring among mothers/caregivers is generally poor and the extent of practice and attitude to its use among them varies from one community to another.1 Early possession, regular use, interpretation of the chart (also known as ―road-to-health‖), and quick communication with health workers to take prompt action is a major barrier to attaining child nutrition and child under-nutrition remains a major public health concern.1 Malnutrition, especially under-nutrition continues to be a serious problem and a major threat to the achievement of the Millennium Development Goal (MDG) and it is estimated that 60% of under-five deaths in developing countries are attributable to it.2 Worldwide, 5 million children die every year, that is to say one child in every 6 seconds.5Malnutrition accounts for over 50% of death in children in Nigeria7. To address these major health problems caused by malnutrition, monitoring of growth using growth chart becomes of great importance among health workers in general and mothers/caregivers in particular.

1.2 Types of Malnutrition
There are three types of malnutrition which are under-nutrition, over-nutrition, and nutrient deficiency.8 Over nutrition occurs when nutrients are oversupplied relative to the amounts required for normal growth, development, and metabolism. The term can refer to obesity, brought on by general overeating of foods high in caloric content, as well as the oversupply of a specific nutrient or categories of nutrients, such as mineral or vitamin poisoning, due to excessive intake of dietary supplements or foods high in nutrients (such as liver), or nutritional imbalances caused by various fad diets.

34 Micronutrient deficiencies are when a child is lacking essential vitamins or minerals such as Vitamin A, iron, and zinc. Micronutrient deficiencies in children are associated with 10% of all children’s deaths.35 Under-nutrition is not getting enough protein, calories, vitamins and minerals which the body needs to function. This results in stunting, underweight and wasting. Stunting refers to low height-for-age (also known as chronic malnutrition), under-weight is measured by low weight-for-age and refers to a child whose weight is too low for its age and wasting is described as low weight-for-height which can be acute, moderate or severe. Under nutrition could also be due to specific nutrient deficiencies.9 The different types are Marasmus, Kwashiorkor, Marasmic-kwashiokor and Micronutrient malnutrition. Marasmus occurs when children do not get enough energy-giving food and this either result in stunting, under- weight or wasting. In Kwashiorkor, the child does not get enough variety of the right kind of food, for example if they eat only cereal-based meals, it results in stunting, under- weight, wasting and oedema. Marasmic-kwashiokor is a combination of Marasmus and kwashiorkor symptoms. Finally, in micronutrient malnutrition, the child lacks micronutrients such as vitamins A, B and C, folate, zinc, calcium, iodine and iron.7

1.2.1 Malnutrition among children in Nigeria
It is estimated that about 16% of the world children are moderately under-weight, 9% severely under-weight, 10% are suffering from wasting and 27% from stunting. The worst cases are recorded in sub-Saharan region as shown in Figure 1 where 20%, 9% and 39% of under-fives are suffering from under-weight, wasting and stunting respectively. Between 2006 and 2010 alone, it was estimated that one child in every three under-five children in West and Central Africa was likely to be stunted at 5 years of age.8

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