Study on Nutritional Problems in Preschool Aged Children of Kaski District of Nepal

Authors

  • J Acharya Faculty of Health & Social Sciences, Bournemouth university, Bournemouth, UK
  • E van Teijlingen Faculty of Health & Social Sciences, Bournemouth university, Bournemouth, UK; Visiting professor, Nobel College affiliated with Pokhara University, Nepal
  • J Murphy Faculty of Health & Social Sciences, Bournemouth university, Bournemouth, UK
  • M Hind Faculty of Health & Social Sciences, Bournemouth university, Bournemouth, UK

DOI:

https://doi.org/10.15415/jmrh.2015.12007

Keywords:

Malnutrition, Knowledge, attitudes and beliefs about nutritious food, poverty, health

Abstract

Undernutrition remains a key public health burden in Nepal. This study aimed to measure knowledge, attitudes, and beliefs about nutritious food amongst mothers of 3 – 5-year-olds from rural and urban areas. A cross-sectional mixed-methods approach comprised a quantitative survey and qualitative focus groups. The community-based survey included 524 mothers of children who are no longer breastfed. Open-ended and structured questions investigated knowledge, beliefs and attitudes about nutritious food, child feeding patterns, and major barriers, food insecurity, and health-seeking behaviours. Focus groups were held with key informants, a thematic analysis was applied to the qualitative data.
Results: Major barriers to recommending nutritious foods included: lack of knowledge (19%); cost (21%); and culture/beliefs (7%). Nearly 55% children were given fruit once a week. Almost 37% of mothers never gave meat, fish and egg regularly to their children and 34% did not choose healthy food from stores, and 12% lacked food. Most children (57%) had been taken at least once to a spiritual healer and 16% had been taken more than once. The qualitative analysis suggested that important factors of knowledge, attitudes, and beliefs about healthy diet are poverty, education, strong cultural beliefs, family size, household income, time and a growing preference for fast food.

Conclusion: Knowledge of and attitudes towards nutritious food is still poor. Beliefs about food practice are strongly embedded in Nepal. Thus, this study shows that policymakers should consider a public health intervention and approach based around changing these largely cultural beliefs and behaviours.

Downloads

Download data is not yet available.

References

[1] Acharya, J.R. (2012). The Barriers to uptake of eye care services for leprosy patients in Nepal. An article published in participation (National Journal), A Nepalese Journal of Participatory Development, 59-69. Available at: www.nepan.org.np/gallery/publication/pARTIcIpATION-13.pdf accessed 15 Jan. 2015
[2] Acharya, M. And Bennett, l.(1981). The rural women of Nepal: An aggregate analysis and summary of 8 village studies, Kathmandu: Centre for Economic Development and Administration, Tribhuvan University.
[3] Adhikari, J. (2010). Food insecurity, conflict and livelihood threats in Nepal in livelihood Insecurity and Social conflict in Nepal (eds.upreti, BR and MÛller-BÓker, U). South Asia Regional Coordination Office; Swiss National centre of competence in Research (NCCR) North-South; Kathmandu.
[4] Andersen, Ml., and Taylor, HF.(2007). The extended family may live together for many reasons, such as to help raise children, support for an ill relative, or help with financial problems. Sociology: understanding a diverse society. p. 396 ISBN 0-495-00742-0.
[5] Asres, G., and Eidelman, A.I.(2011). Nutritional assessment of Ethiopian Beta-Israel children: A cross-sectional survey. Breastfeed Med6: 171-176.http://dx.doi.org/10.1089/bfm.2011.0016. PMid:21770732
[6] Bandyopadhyay, M. (2009). Impact of ritual pollution on lactation and breastfeeding practices in rural West Bengal, India. International Breastfeeding Journal4, 2. http://www.internationalbreastfeedingjournal.com/content/4/1/2 accessed Dec.14, 2014.http://dx.doi.org/10.1186/1746-4358-4-2. PMid:19323839 PMCid:PMC2667394
[7] Babatunde, R.O., Olagunju, F.I., Fakayode, S.B., and Sola-Ojo, F.E.(2011). prevalence and determinants of Malnutrition among under-five children of Farming Households in Kwara State, Nigeria. Journal of Agricultural Science3: 173-181.http://dx.doi.org/10.5539/jas.v3n3p173
[8] Beardsworth, A., and Keil, T. (1997).Sociology on the menu: an invitation to the study of food and society Routledge, London.
[9] Bennett, l. (2005).gender, caste, and Ethnic Exclusion in Nepal: Following the policy process from Analysis to Action. paper presented at the conference New Frontiers of Social policy: Development in a Globalizing World, Arusha, Tanzania.
[10] Bishwakarma, R.(2009). Social Inequalities in child Nutrition in Nepal. Word Bank Internship project paper. Washington,D.c.
[11] Bishwakarma, R., and Vanneman, R.(2008). caste, gender, and location effect on child Stunting in Nepal. paper published in American Sociological Association Meetings, Boston. October 2008.
[12] Bouis, H. and Hunt,J. (1999). linking food and nutrition security: past lessons and future opportunities. Asian Development Review17 (1–2): 168–213.
[13] Bhattachan, K., Sunar, T. B., Bhattchan, Y. K. (2009). caste-based Discrimination in Nepal. Working Paper Series. (3). Indian Institute of Dalit Studies. New Delhi.http://dx.doi.org/10.1596/1813-9450-4866
[14] Bryant, C.A., Dewal, KM., Courtney, A., and Schwartz, J. (2003).The Cultural Feast: An Introduction to Food and Society, 2nd Ed. Belmont, CA: Thomson Wadsworth.
[15] Caulfield l.E, de Onis, M., Blössner, M., and Black, R.E.(2004). undernutrition as an underlying cause of child deaths associated with diarrhoea, pneumonia, malaria, and measles. Am J Clin Nutr80: 193-198. PMid:15213048
[16] Cox, D.N. & Anderson, A.S. (2004). "Food choice," in public Health Nutrition, Gibney MJ et al., eds., Blackwell Science, Oxford, pp. 146-166.
[17] Christakis, g. (1973). Nutritional assessment in health problems. Am. J. Public Health, 63(suppl): 1. PMid:4768543
[18] Darmstadt, G.l., Syed, U., Patel, Z., Kabir, N. (2006). Review of domiciliary newborn-care practices in Bangladesh. Journal of Health, population, and Nutrition 24(4), 380-393. PMid:17591335 pMcid:pMc3001142
[19] de Onis, M.et al. (2004). Estimates of global prevalence of childhood underweight in 1990 and 2015. JAMA291: 2600-2606. http://dx.doi.org/10.1001/jama.291.21.2600pMid:15173151
[20] de Onis, M., Frongillo, E.A., and Blössner, M.(2000). Is malnutrition declining? An analysis of changes in levels of child malnutrition since 1980. Bull World Health Organ78: 1222-1233. PMid:11100617 PMCid:PMC2560621
[21] Deolalikar, A.B. (2005). poverty and child malnutrition in Bangladesh, Journal of Developing Societies: 21 (1-2): 55-9. http://dx.doi.org/10.1177/0169796X05053067
[22] Devkota, B., and Van Teijlingen, E. (2010). understanding effects of armed conflict on health outcomes: the case of Nepal. conflict & Health 4 (20) www.conflictandhealth.com/content /4/1/20. http://dx.doi.org/10.1186/1752-1505-4-20.pMid:21122098 PMCid:PMC3003631
[23] DFID. (2009). Nepal: maternal mortality and Morbidity Study, London, see: www.dfid.gov.uk/Documents/publications/nepal-maternal-mortality.pdf
[24] Dindyal, S., & Dindyal, S. (2004). "How personal Factors, Including culture And Ethnicity, Affect The choices And Selection Of Food We Make", The Internet Journal of Third World Medicine, 1, 2.
[25] Edris, M.(2006). Assessment of nutritional status of preschool children of gumbrit, Ethiop J Health Dev21: 125-129.
[26] Fieldhouse, p. (1995). Food and Nutrition: customs and culture., Second edn, Chapman & Hall, London. http://dx.doi.org/10.1007/978-1-4899-3256-3. PMid:7733023
[27] Ferro-Luzzi, g.(1980). Food avoidances during the puerperium and lactation in Tamilnad. In: J.K.R.Robson (Ed.), Food, Ecology and Culture, London: Gordon & Breach Science publishers, pp.109-117.
[28] Gittelsohn, J. Thapa, M. and landman, l.T.(1997). cultural factors, caloric intake and micronutrient sufficiency in rural Nepali households. Social Science & Medicine, 44, 1739-1749. http://dx.doi.org/10.1016/S0277-9536(96)00375-9
[29] Hill, S.E.(1990). More Than Rice and peas: guidelines to improve food provision for Black and Ethnic Minorities in Britain, The Food Commission, London. Journal of Current Research2: 103-108.
[30] James, p., Nelson, M., Ralph, A., and leather, S. (1997). "The contribution of nutrition to inequalities in health", British Medical Journal, 314, 24 May, pp. 1545-1549.http://dx.doi.org/10.1136/bmj.314.7093.1545. PMid:9183207 pMcid:pMc2126753
[31] Karim, R et al. (2003). Determinants of food consumption during pregnancy in rural Bangladesh: examination of evaluative data from the Bangladesh Integrated Nutrition project. Tufts University. Available from http://nutrition.tufts.edu/pdf/publications/fpan/wp11-food_consumption.pdf accessed Feb.17,2015.
[32] Khongsdier, R., and Mukherjee, N.(2003). Effects of heterosis on growth in height and its segments: a cross-sectional study of the Khasi girls in Northeast India. Ann HumBiol. 2003 Sep-Oct; 30(5): 605-21. http://dx.doi.org/10.1080/03014460310001592669.pMid:12959901
[33] Kwena, A.M., et al. (2003). prevalence and severity of malnutrition in pre-school children in a rural area of western Kenya. Am J Trop Med Hyg68: 94-99. PMid:12749491
[34] Reed, B.A., Habicht, J.p. and Niameogo, c.(1996). The effects of maternal education on child nutritional status depend on socio-environmental conditions. Int J Epidemiol25: 585-592. http://dx.doi.org/10.1093/ije/25.3.585. PMid:8671560
[35] Rocherson, Y. (1988). The Asian Mother and Baby campaign: The construction of Ethnic Minorities' Health Needs. Critical Social Policy8, 4-23.http://dx.doi.org/10.1177/026101838800802201
[36] Rome Declaration on Nutrition. (2014). WHY IT MATTERS & WHAT CAN BE DONE; Second International Conference on Nutrition (ICN2), 19-21, November
[37] Rustein, SO., and Johnson, K.(2004). The DHS wealth index: DHS comparative reports no 6. Calverton, MD: ORc Macro.
[38] Malla Pradhan, S. (2000). property Rights of Nepalese Women. FES Nepal. Available at http://www.nepaldemocracy.org/gender/property_rights.htm. Assessed on Jan. 2015
[39] Merrill, W.(1984). Report of Workshop on income and Nutrition effects of increasing commercialization of semi-subsistence Agriculture. Air lie House Virginia. December 1984: 3-5.
[40] Moestue, J., and Huttly, S.(2008). Adult Education and Child Nutrition: The Role of Family and community, Journal of Epidemiology and Community Health, 62:153-159. http://dx.doi.org/10.1136/jech.2006.058578. PMid:18192604
[41] Mulugeta, A et al. (2005). Factors contributing to child Malnutrition in Tigray, Northern Ethiopia. pMcid:pMc2715321
[42] Müller, O., and Krawinkel, M.(2005). Malnutrition and health in developing countries. CMAJ173: 279-286. http://dx.doi.org/10.1503/cmaj.050342.pMid:16076825 pMcid:pMc1180662
[43] Nagpal, N. (2003). "Health Matters: coping Indigenously", Nursing Journal of India, 94, 4, pp. 78-80. PMid:15315197
[44] NDHS.(2011). Nepal Demographic Health Survey, New ERA under the aegis of the Ministry of Health and population. ICF International provided technical assistance for the survey through the USAID Nepal.
[45] NDHS. (2006). Nepal Demographic Health Survey, CBS, Journal of Current Research2: 103-108.
[46] Nichter, M. (1989). Anthropology and International Health: South Asian case Studies Kluwer Academic publishers, London. http://dx.doi.org/10.1007/978-94-009-2231-0
[47] Nichter, M., Nichter, M.(1983).The ethnophysiology and fold dietetics of pregnancy. Human organization, 42, 234-246.
[48] Odent, Pl. G. (2010). Early infant feeding and neonatal survival in Nepal: Breastfeeding, colostrum and discarding of the first milk. university college London, u.K.
[49] Ola, E., Ahmed, and Mofida, y., et al. (2011). Nutritional status of the children under age of five in a decertified area of Sudan - Alrawakeeb valley. International
[50] Otgonjargal, D et al. (2012). Nutritional status of under-five children in Mongolia. Journal of Medicine and Medical Sciences3: 341-349. 15.
[51] Pandey, S et al. (2010). Determinants of infant and young child feeding practices of Nepal: Secondary data analysis of DHS 2006. Food and Nutrition Bulletin; 31(2):334-51.pMid:20707237
[52] Riordan, J. and Hoover, K. (2005). perinatal and Intrapartum care. In Riordan J (ed) Breastfeeding and Human Lactation. Jones and Bartlett: London. pp. 185-217.
[53] Rome Declaration. (2014). Rome Declaration on Nutrition, Why it matters & What can be done, Second Internal conference on Nutrition (IcN2), November, 17-21.
[54] Ross, D.A et al. (1995). child morbidity and mortality following vitamin A supplementation in Ghana: Time since dosing, number of doses, and time of year. American Journal of Public Health85, 1246-1251. http://dx.doi.org/10.2105/AJpH.85.9.1246pMid:7661232 pMcid:pMc1615567
[55] Rush, D.(2000). Nutrition and maternal mortality in the developing world. American Journal of Clinical Nutrition, 72 (suppl), 212S-240S. PMid:10871588
[56] Sapkota, V.P., and Gurung, C.K.(2009). prevalence and predictors of underweight, Stunting and Wasting in under-Five children. Nepal Health Res Counc7: 120126.
[57] Senbanjo, I.O., Adeodu, O.O., and Adejuyigbe, E.A.(2009). Influence of socio-economic factors on nutritional status of children in a rural community of Osun State, Nigeria.
[58] Siddiqui, N.A., Haque, N., and Goni, M.A.(2011).Malnutrition of under-Five children: Evidence from Bangladesh. Asian Journal of Medical Sciences2: 113-118. 14.
[59] Subba, S.H. et al. (2007). Infant feeding practices of mothers in an urban areas in Nepal, Kathmandu University Medical Journal; 5, 1, 42-47.
[60] Schoenbaum, M., Tulchinsky, T.H., and Abed, Y. (1995). gender differences in nutritional status and feeding patterns among infants in the gaza Strip. American Journal of public Health 85, 965-969. http://dx.doi.org/10.2105/AJpH.85.7.965. PMid:7604921 pMcid:pMc1615541
[61] Storer, J. (1977). "Hot and cold food beliefs in an Indian community and their significance", Journal of Human Nutrition, 31, 1, pp 33-40. PMid:326951
[62] Tamang, A., and Broom, A.(2010). The practice and meanings of spiritual healing in Nepal. South Asian History and Culture, 1, 2:328 – 340.http://dx.doi.org/10.1080/19472491003593084
[63] Tesfaye, M.(2009). Bayesian approach to identify predictors of children Nutritional status in Ethiopia.
[64] Tierney, l.M., Mcphee, S.J., and Papadakis, M.A.(2004). Assessment of nutritional status: Current Medical Diagnosis and Treatment. Lange Medical Books/ Mcgraw-Hill, New York. pp 1210-3.
[65] UN/SCN. (2010). 6th report on the world nutrition situation: progress in nutrition. Geneva: Administrative committee on coordination-Standing committee on Nutrition, United Nations.
[66] UNICEF.(2014). UNICEF-WHO-The World Bank Joint Child Malnutrition Estimates, September. Available at http://www.who.int/nutgrowthdb/estimate accessed on November, 2014
[67] UNICEF REpORT.(2005).The State of the World's children; A UNICEF REpORT: childhood under threat.
[68] USAID.(2007). Nutritional status and its determinants in southern Sudan.
[69] Vijayaraghavan, K et al.(1990). Effect of massive dose vitamin A on morbidity and mortality in Indian children. Lancet336, 1342-1345.http://dx.doi.org/10.1016/0140-6736(90)92895-O
[70] Vella, V. at el. (1992).Determinants of child nutrition and mortality in north-west Uganda. Bulletin of the World Health Organization70, 637-643. PMid:1464151 PMCid: PMC2393364
[71] WFP.2013. Available at http://www.wfp.org/countries/nepal/overview accessed on 17 January 2015
[72] Willett, W.C. and Stampfer, M.J. (2013). current evidence on healthy eating. Annual Review of Public Health; 34, 77-95. http://dx.doi.org/10.1146/annurev-publhealth-031811-124646pMid:23297654
[73] WHO. (2014). UNICEF-WHO-The World Bank Joint Child Malnutrition Estimates, September. Available at http://www.who.int/nutgrowthdb/estimate accessed on November 2014
[74] WHO. (2014a). World Health Organization, Nutrition: Exclusive breastfeeding http://www.who.int/nutrition/topics/exclusive_breastfeeding/en/ Accessed 15 January 2015.
[75] WHO.(2006). The country co-operation strategy, 2006 – 11. Available at http://www.who.int/countryfocus/cooperation_strategy/ccs_npl_en.pdf, Accessed on 17 Jan. 2015
[76] WHO.(1989). WHO EMRO Technical Publication No 13. guidelines for the development of a food and nutrition surveillance system for the countries in the Eastern Mediterranean Region Based on the deliberations of a WHO/FAO Intercountry Meeting on Nutrition Surveillance Islamabad, Pakistan, October 1988.
[77] World Bank. (2015). global Economic prospects: A World Bank group Flagship Report, South Asia; chapter 2, pg. 89–100 Available at http://www.worldbank.org/content/dam/Worldbank/gEp/gEp2015a/pdfs/gEp15a_web_full.pdf Accessed on 24th January 2015.
[78] World Bank. (2014). UNICEF-WHO-The World Bank Joint Child Malnutrition Estimates, September. Available at http://www.who.int/nutgrowthdb/estimate accessed on November 2014
[79] World Bank. (2008). Nepal country Overview 2008, Available at http://www.worldbank.org.np/WBSITE/EXTERNAl/
[80] Yimer, G.(2000). Malnutrition among children in southern Ethiopia: levels and risk factors. Ethiopian Journal of Health Development14: 283-292.http://dx.doi.org/10.4314/ejhd.v14i3.9901
[81] Zewdu, S.(2012). Magnitude and Factors Associated with Malnutrition of children under Five years of Age in Rural Kebeles of Haramaya, Ethiopia. Harar Bulletin of Health Sciences4: 221-232.

Downloads

Published

2015-04-06

How to Cite

J Acharya, E van Teijlingen, J Murphy, & M Hind. (2015). Study on Nutritional Problems in Preschool Aged Children of Kaski District of Nepal. Journal of Multidisciplinary Research in Healthcare, 1(2), 97–118. https://doi.org/10.15415/jmrh.2015.12007

Issue

Section

Articles