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Undernutrition among children under-five years old is still a public health problem in
Tanzania despite the global and national efforts in combating it. The Ministry of Health,
Community Development, Gender, Elderly and Children (MoHCDGEC) has initiated a
number of projects and programmes in order to curb the problem of undernutrition in
Tanzania. Despite the efforts, Tanzania has the highest rate of prevalence of
undernutrition in East and Southern Africa. This study was conducted in Pangani District
in Tanzania to examine the influence of household socioeconomic determinants of
undernutrition among children under-five years old in fishing communities. Data were
collected through a household survey of a sample of 340 mothers/care takers child-pairs in
which 355 children under-five were involved in anthropometric data collection. Key
Informant Interviews (KIIs) and Focus Group Discussions (FGDs) were also conducted.
Content analysis was used to analyse qualitative data. Quantitative data were analysed
using Statistical Package for Social Sciences (SPSS). The analysis employed Emergency
Nutrition Assessment (ENA) for SMART to generate indices for weight-for-height,
height-for-age and weight-for-age. A Composite Index of Anthropometric Failure (CIAF)
was established to measure the rate of undernutrition. Principal Component Analysis was
used to compute a wealth index based on household assets as the main indicators of
household socioeconomic status (SES). Descriptive statistics and binary logistic
regression were performed to estimate the influence of independent variables on the
dependent variable. The findings confirm that undernutrition is still a public health
problem in Pangani as indicated by higher level of stunting (27.9%) and wasting (5.1%).
When CIAF was performed, undernutrition rate was higher 36.7% compared to the rate
obtained in the anthropometric analysis. Further analysis based on area of residence
indicated that undernutrition was higher in households on the ocean side (20.6%) compared to those on the river side (16.1%). The difference in the level of undernutrition
between the river side and the ocean side was also portrayed in the concentration curve
which was then confirmed in the concentration value. Essential antenatal visits of the
mother during pregnancy and child immunization status were found to be the most
important predictors (p < 0.05) of a child wasting and underweight. Even when analysis
was performed based on CIAF, immunization status was among the strongest predictors
of undernutrition in Pangani. Similarly, education of the mother/child care-taker was one
of the most important maternal variables that significantly (β = 2.333, Wald = 30.356, OR
= 10.309, p = 0.000) influenced undernutrition as measured by CIAF. The availability of
health services near to the communities was linked to undernutrition. The study also
found more inclusiveness of undernourished children when CIAF is used in the place of
traditional anthropometric analysis. It is concluded that contradictions on the influence of
sex of the child on undernutrition still exist. The use of CIAF is more appropriate because
it provides a comprehensive analysis of the problem of undernutrition. Despite the
sensitivity of PCA in analyzing SES index, it is sufficient enough to differentiate SES
quintiles and health inequalities even when the communities are very homogeneous or
heterogeneous. Education of the mother is one among the important predictors of
nutritional status. Therefore, it is recommended to health and education providers to focus
on quality education geared at empowering mothers/caretakers. It is further recommended
to use CIAF because it provides the actual nutritional status of children under-five years.
Furthermore, it is recommended that the Government through the Ministry of Health,
Community Development, Gender, Elderly and Children; should work closely with the
service providers at district levels to ensure health services are available close to the
communities. Regular follow up visits by Local Government Authorities should be done
to the communities. |
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