LITERATURE REVIEW Child growth is internationally recognised as an important public health indicator for monitoring nutritional status and

health in population. Children who suffer from growth retardation as a result of poor diet and recurrent infection tend to have more frequent episodes of severe diarrhoea and are more susceptible to several infections diseases such as malaria meningitis and pneumonia. The substantial contribution to child mortality of all degree of malnutrition is now widely accepted. In addition, there is strong evidence that impaired growth is associated with delayed mental development , poor school performance and reduced intellectual capacity (WFP,2005). This chapter, therefore, reviews the concept of malnutrition, influence of mothers education, household total wealth and rural urban differential factors affecting nutritional status of children less than five years (determining nutritional status of under -5 children). BRIEF CONCEPT OF MALNUTRITION AND CAUSES Malnutrition literally means bad nutrition and it entails both over and under nutrition. In relation to trend of malnutrition in nations, the latter is much prevalent in developing countries including Nigeria. The world programme(WFP,2005) defines malnutrition as a state in which the physical function of an individual is impaired to the point where he or she can no longer maintain adequate bodily performance process such as growth, pregnancy, lactation ,physical work or resting and recovering from disease. It can result from a lack of macronutrients (carbohydrates, protein and fats) ,micronutrients (vitamins and minerals), your both. Consequently , malnourished individuals can be shorter (reduced growth ever a prolonged period of time) and/or thinner than their well nourished counterparts. hidden hunger, or micronutrient

malnutrition, is widespread in developing countries. It occurs when essential vitamins and (or mineral are not present in adequate amount in the diet. Moreover, Phillips Foster, in his book The world Food Problem: tackling the cares of causes of under-nutrition in the third world (1992), insists that nutrition programs treat only the symptoms and do not treat the causes of hunger. Anand and Harris (1992) add that in order to design polices that attempt to alleviate under-nutrition , it is important to first understand the relationship between economic and social characteristics and under-nutrition. Knowing which variable significantly affect nutrition status would provide valuable practical leads for combating the causes of under-nutrition in the community (Gopalan, 1992). IMPORTANCE OF ADEQUATE NUTRITION ON CHILDS HEALTH The nutritional status of children has impact on their health and development. Therefore, the physical, mental, social and, nutritional status of children, as children, as well as other characteristics related to malnutrition should be evaluated periodically to monitor malnutrition, thereby enabling appropriate measure that can prevent it to be implemented (Taguri et al., 2008) and Kariuki et al. 2002) It is a known fact that our children are the greatest assets of a country. They are the future leaders. Providing optimum health to children in terms of physical, social and intellectual development should thus be a priority concern of everybody. Child nutrition is important to stimulate the childs cognitive development during the first five years through interaction and play. Nutrition in early childhood has a lasting impact on health and well being in adulthood. Good nutrition is critical to child health and development. Ensuring that children are well nourished is essential to helping reach the millennium development goals (MDGS), because sound nutrition is central in to health, learning and well being.

investing in good nutrition for children would be a tremendous spur to global development. Good nutrition, especially in the first five years of a childs life offers massive return in health, education and productivity. Measuring the childs nutritional status is important because of both the long term and short effort on the health, education and cognitive abilities of the child. Nutrition has major effect on health. Nutrition refers to the availability of energy and nutrient to the bodys cells in relation to body requirements. Nutrition is concerned with social, economic, cultural and psychological implication of food and eating, (council of food and nutrition, 1963). Good nutrition helps protect natural immunity, which is particularly important for wealth as resistance to drugs increase and new diseases emerge. It is essential for normal organ development and function for normal reproduction growth and maintenance for optimum activity and working efficiency. Food can be defined as any edible substance that provides nourishment when (Dorothy and Barren, 1980). Food contains ingredients known as nutrients which should have energy for activities to grow and to maintain health. INFLUENCE OF MOTHERS EDUCATION

Nutritionally educated mothers can bring up their children in a healthier ways. Education generally has an impact on survival both as a direct determinant of

behaviour and indirect as it affects cultural attitudes and gender relations. The higher a womans level of education, the more likely it is that she will marry later, play a greater role in decision making and exercise reproductive rights her children are also more likely to enjoy better health and be well malnourished. Women education has been found to be a key factor in reducing infant and child mortality (Martorell et al., 1984)

Evidence suggest that increasing level of maternal education is associated with decline in poor infant nutrition and poor child health because education is associated with many factors. It is understood that women who are educated break away from traditional family method. The evidence of this break is seen in the way uneducated women in rural area looks after their children as compared to their educated counterpart in urban areas. Educated women would provide better and more valuable nutrition for their children while their uneducated ones would feed their children guided by traditional feeding habit, which is most circumstances deny children of good and valuable nutrition food (Molt, 1983), illiterate women with little knowledge of health needs of their children are less likely to take an adequate care of certain dangers and are more likely to feed their children with unhygienic food, resulting in malnutrition and various disease (Jellife, 1974) Women who even receive a minimal education are generally more aware than those who have no education of how to utilize available resources as for the

improvement of their own nutritional status and that of their families. Education may enable women to make independent decisions to be accepted by others household members, and to have greater access to household resources that are important to nutritional status (ACC/SCN,1990). A comparative study on material malnutrition in ten sub-saharan African countries (loalza, 1997) and a study in the SNNPR of Ethiopia (Teller and Yimar, 2000) showed that the higher the level of education, the lower the population of undernourished women. Improving girls access to schooling and closing the gender gap in education has received an enormous amount of affection in academic and policy dialogues. Higher educational attainment yields a host of benefit for girls and women in terms of their autonomy, rights labour market outcomes, and social status. These improvements

occur due to acquisition of greater human capital in the form of knowledge and skills that contribute to greater labour market productivity and greater empowerment for women. Educating girls also has a functional importance in form benefits for the next generation, as the socio-economic status, and choices of more educated mothers during pregnancy and child rearing can have a large impact on childrens nutritional status ,well-being, and survival(Frongillo et al., 1997, Pelletier 1998, Webb and Block 2004). The benefits of mothers education for childrens health outcomes and nutritional status commonly accrue through higher socio-economic status, which in turn operates through a set of proximate determinants of health that directly influence child health outcomes and nutritional status(Mosley and Chen 1984).The proximate determinants include fertility factors, environmental hazards ,feeding practices ,injury , and utilization of health services. Numerous empirical studies have linked mothers education with such proximate determinants(Behrman and Wolfe 1987, Sandiford et al., 1995, Guilkey and Riphahn, 1998). Higher mothers education and greater household wealth were associated with slightly greater preference for girls , but that finding occurred only among people who had no living children. Studies using house- level data have found mothers education to be positively associated with a number of measures of infant and child health and nutritional status (Wolfe and Behrman 1982, Thomas et al., 1991, Bicego and Boerma 1993, Hobcraft 1993 , Miller and Korenman 1994, Desail and Alva 1998, Waters et al., 2004, Boyle et al., 2006). Empirical work has also shown that education can serve as a means of adopting new health beliefs, gaining general knowledge, and applying specific

knowledge about health and nutritional practices that promote child health (Glewwe 1999). Furthermore, womens education can also affect child health because more

education is linked with higher household income , which in turn strengthens families abilities to handle adverse economic or environmental shocks, finance health care needs and afford more nutritious food. Hence, families with more-educated mothers are likely to have more income and assets than those with less-educated mothers ,giving them access to more and better food ,shelter, and protection from environmental hazards. Socio-economic determinants thus affect child health and nutritional status through a set of intermediary mechanism that encompass household composition ,dietary intake, medical treatment, and environmental contaminants. Greater education for mothers contributes to new skills, beliefs, and choices about sound health and nutritional practices that directly influence the proximate determinants of child health. For instance, knowledge obtained during a mothers education can affect choices about antenatal care and about childrens nutrition, hygiene, and health care. To the extent that more-educated mothers make healthier choices for themselves during pregnancy ,education will have a direct effect on the health of the health of the child at birth. Improved socio-economic status also involves changes in norms and attitudes that influence the economic decisions and nutritionrelated behaviours of mothers and fathers. Stronger bargaining power for women within the household can facilitate decision-making that improves child health outcomes. Central to the social context in which mothers and fathers operate is bargaining power, and an important change that comes with more education for women in developing countries is increased empowerment and autonomy. Numerous studies show that women literacy and schooling are associated with improved child nutrition after controlling for the effect of education on income and fertility. Women are often exhausted by the combination of reproductive demands, work load and inadequate diet (UNESCO 1998).

The women education has been found to be object to good household nutrition and health. Women education tends to be positively correlated with birth interval that in turn tends to improve birth outcome. On the other hand, educated women may increasingly become involve in wage labour away from house , and child care has to be provided to others(Schulfs et al.,1984). HOUSEHOLD TOTAL WEALTH AND CHILDREN NUTRITIONAL STATUS In poor families ,malnutrition may be inevitable. In developing countries, wide disparities in income inequality has been shown to have high positive correlation with child survival. The economic status of a household is an indicator of access to adequate food supplies, use of health services, availability of improved water sources, and sanitation facilities, which are prime determinants of child and maternal nutritional status (UNICEF,1990). At the household level, income and wealth are linked to child well-being through the effects that purchased goods and services have on the proximate determinants of child health. Greater household income and assets directly raise the ability to purchase sufficient quantities of nutritious foods, clean water, clothing, storage of food, personal hygiene items, and health services(Boyle et al., 2006 and Hong et al., 2006). Studies have identified poverty as the chief determinant of malnutrition in developing countries that perpetuates into intergenerational transfer of poor nutritional status among children and prevents social improvement and equity(Larrea and Kawachi,2005 and Hong et al.,2006). Osmani, 1992 puts it that nutrition and poverty are the very closely related themes. Many elemental aspects of being poor , such as hunger, inadequate health-care, unhygienic living conditions, and the stress and strain of precarious living, tend to impair a persons nutritional status. In consequence, being poor almost always means being deprived of full nutritional capabilities. An

understanding of the processes through which chronic malnutrition comes to afflict a household or community can reveal a good deal about the process leading to endemic poverty. Assuming health is a normal good, economic theory would suggest that increases in income would lead to increased use of health goods and services, presumably leading to a mortality rate of under-five children. Indeed, there is strong micro-level evidences that income affects health. In Brazil, Thomas(1990) estimated large effects of mothers non-earned income on child health. While several studies have shown that greater household income is associated with a lower likelihood of low birth weight or stunting(Martoell and Scrimshaw 1995; Kramer 1987a; Kramer 1987b; Kramer 2000). Studies of illness suggest some measure of social conditioning may result in a greater likelihood of reporting of illness among wealthier households. Helman(2001), suggested that non-poor households are more likely to report their child as ill than poor households because their income makes illness management more affordable to them. In infancy, the children are rather too young, fragile, dependent and too weak to be responsible for their own upkeep. Their proper upkeep medically, financially, emotionally and nutritionally then lies in the hands of the parents or the guardians as the case may be. The status of their parents or guardians (income) therefore, goes a long way in determining what happens to the health of these children. Hence, it is expected that when the parents are of a good socio-economic status , then their children too would have good access to medical facilities and achieve a good medical status , especially in terms of nutrition at the infant stage when they are most dependent on others.

RURAL-URBAN STATUS .

DIFFERENTIALS

AND

UNDER-FIVE

NUTRITIONAL

Studies on child nutrition (Sommerfelt et al.,1994; Yimer, 2000) showed significantly higher levels of stunting among rural than urban children. In almost all variables and determinants associated with both child mortality and nutritional status a rural-urban differential is apparent. Where womens status is concerned , the autonomy females gain is central to exceptionally decrease child mortality levels ; but this is especially true in poor societies and highly evident in rural areas. This increased level of female autonomy, and its especially effect in rural areas makes it likely that educational differences by sex will be narrow(Caldwell, 1986). Sastray (1994) also found that life time urban residents have child mortality levels 62% lower than their rural counterparts , though Sastray says the reasons for this is unknown, we have established that this may either be due to the passive reception of information on child health and care that urban resident s receive. Similarly, to Sastrays conclusion, though in India it was found that children living in rural areas had a higher proportion of malnourished children than those in the urban areas(Som et al.,2006). However, studies in rural India (Pal, 1999), Indonesia (Walters et al., 2004) and Bolivia (Frost et al.,2005) found a specific correlation between mothers literacy rate and the childs nutritional status, while male literacy was not significant to childrens nutritional outcomes(Pal., 1999). Population of rural dwellers with limited economic self sufficiency and housing are those most likely to be malnourished and with these, disadvantage population children of less than five years are more likely to suffer sickness, developmental retardation. Urban communities present residents with a diverse amount of resources. The are the hub of political and economic activities as well as an outlet for entertainment

purposes. In general, cities are at the centre of health inventions and advancements(Stephens,1995).