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4.0. Introduction

This chapter presents the results of the study. There are four sections in this chapter. Section one

presents results on the socio-demographic characteristics of the respondents. Section two presents

analysis of results on the feeding practices by the caregivers. The third section present information

on the knowledge of caregivers in the control and management of Marasmus. The fourth section

present information on the perception of caregivers about the treatment/product in control and

management of malnutrition programs.

4.1 Socio-Demographic Characteristics of Respondents

Table 1; Sociodemographic Distribution of Respondent

Age of Caregiver (N) (%)

15-19 7 3.9%

20-29 78 42.9%

30-39 96 52.8%

40-49 1 0.6%

Marital Status (N) (%)

Single 2 1.1%

Married 180 98.9%

Educational Level (N) (%)

None 150 82.4

Primary 23 12.4
JHS 5 2.3

SHS 4 2.2

Number of Children by (N) (%)


1 13 7.1

2 34 18.7

3 49 26.9

4 46 25.3

5 40 22

Number of Caregivers children (N) (%)

under five

1 95 52.2

2 80 44.0

3 7 3.85

Ethnicity (N) (%)

Hausa 2 1.1

Yoruba 8 4.4

Igbo 171 94

Others 1 0.6

Religion (N) (%)

Christianity 173 95.1

Islam 6 3.3
Africa Traditional Religion 2 1.1

Others 1 0.6

Employment (N) (%)

Civil Servant 6 3.3

Farmer 91 50.3

Trader 59 32.6

Unemployed 20 11.1

Others 5 2.8

Source; Author’s Survey, 2019

A total of 182 questionnaires were administered. All questionnaires were appropriately completed.

Majority (53%) of the caregiver were within the age group of 30-39 years. Table 4.1 illustrates a

detailed distribution of the results on the socio-demographic characteristics of the respondents.

Out of the 182 caregivers, 180 (99%) indicated that they were married. Only 18% of the caregiver

interviewed have had some formal education with majority (72%) of those who had formal

education having just some form of primary education. Averagely each caregiver was caring for

about 3 children while majority (52%) of caregivers were taking care of only one child under five.

In terms of occupation or employment status, farming was the principal occupation (47%) while

34% reported that they were traders. Sixteen percent of caregivers were unemployed and only one

caregiver was a student. Also, many (59%) of the children were within the ages of 24-59 months

with majority of them (93%) receiving appropriate immunization for age. Only 9% of children

were restricted from certain foods. Of all the children whose caretakers were interviewed, 86% of

them were still in the program while 14% had exited the program prior to the time of the study.

4.2 Feeding Practices

Table 2; Distribution According to Feeding Practice of caregivers

First Introduction to water (N) (%)

From birth 3 1.7

After 3months 11 6.6

After 6months 163 89.6

Don’t know 5 2.8

First Introduction of HHF (N) (%)

After 3months 5 2.3

After 6months 166 91.2

One year 4 2.2

After One year 7 3.9

No of times child feed in a (N) (%)


Twice 1 0.6

Three 35 19.2

More 146 80.2

Caregivers Feeding Pattern (N) (%)

Caregivers feed children 157 86.3


Caregivers supervise child 12 6.6

feeding by others

Children with food restriction 16 8.8

Caregivers Food (N) (%)

Acquisition Processes

Difficult 69 37.9

Not Difficult 113 62.1

Kinds of Difficulty (N) (%)

Accessibility 10 6

Availability 86 47

Affordability 86 47

Source; Author’s Survey, 2019.

Feeding practices were found to be approximately generally the Marasmuse among the caregivers

interviewed. Out of the 182 caregivers interviewed, majority (90%) and (91%) of them practiced

timely introduction of water and household food respectively to child. Regarding information on

the number of times caregivers feed their children per a given day, most (80%) of the caregivers

responded that they feed their children more than three times a day with just one caregiver

reporting to feed the child only twice a day. Eighty-six percent of caregivers responded to feeding

their children personally while with 14% who do not feed their children personally, 73% of them

responded to supervising child’s feeding. In terms of caregiver’s difficulty in food acquisition,

38% claimed to have challenges with most of them ascribing the difficulty to availability and

affordability. Table 2 above shows results of the feeding practices carried out by caregivers.

Table 3; Knowledge on Marasmus and it control and Management

Health Condition of Child (N) (%)

Caregivers who knew 133 73.1

Time of discovery of illness (N) (%)

Before 6months 8 4.4

After 6months 88 48.4

Between 1-4 yrs. 88 48.4

After 4 yrs. 4 2.2

Perception about Causes of (N) (%)


Inadequate food intake 80 44.0

Curse 2 1.1

The sun 1 0.6

Born with condition 3 1.7

Others 96 52.8

Believe that Marasmus is (N) (%)


Curable 181 99.5

Not Curable 1 0.6

Caregivers effort to Curb (N) (%)


Clinic visit only 61 33.5

Clinic visit and good nutrition 116 62.1

Herbalist and good nutrition 4 2.2

Clinic visit, Herbalist and good 1 0.6

Source; Author’s Survey, 2019.

Most (73%) caregivers had fair idea of the condition of their children with majority (48%) of them

reporting to have discovered the situation after the six months and between the first one to four

years of the child. Forty-four percent of caregivers believe that the illness is caused by inadequate

food intake while 53% of them perceived it to be caused by inadequate breast milk. Almost all

(99%) of the care givers believed the condition can be cured. Sixty-two percent of the caregivers

have resorted to visiting the clinic and feeding their children well as a way to improve their child’s

condition. Thirty-three percent of the respondents have resorted only to the clinic with five of the

caregivers resorting to the help of an herbalist. But of all these figures, 14% of them had exited

the program and therefore where expected to have that level of knowledge. Table 4.6 shows results

of the knowledge on MARASMUS and its managements.

Table 4; Perception about the treatment/product given in the control and management

program of Malnutrition (CMAM).

Effectiveness of CMAM (N) (%)

Strongly Agree 65 34.6

Agree 118 64.8

Not certain 1 0.55

Usefulness of CMAM for (N) (%)


Strongly Agree 49 26.9

Agree 132 72.5

Not Certain 1 0.6

Availability of Feeding Items (N) (%)

Strongly Agree 17 9.3

Agree 92 50.6

Not Certain 42 23.1

Don’t Agree 31 17.0

CMAM awareness (N) (%)

Caregivers who are aware 181 99.5

Source; Author’s Survey, 2019.

Almost all (99%) of the caregivers interviewed held the view that the CMAM program has been

very effective and very useful for the recovery of their child. However, 23% of the caregivers were

not certain about the availability of the feeding items while (17%) of them didn’t agree that the

feeding items were even available. The general opinion of respondents regarding the CMAM

program’s ability to improve the condition of their children was positive. Almost all (99%) of them

reported that they have noticed improvement in the condition of their children ever since they

started coming to the CMAM clinic. In addition, 99% of them reported that it was necessary to

come for the CMAM program. This result were probably because participants were all either in or

had ever been in the program.

Chapter Five

Discussion of Findings

5.1 Introduction

This chapter discusses the findings of the study in relation to findings by other studies on the

subject matter under consideration. These discussions are done along the thematic areas outlined

in the results. It is presented in three sections. Section one presents the feeding practices by the

caregivers. Section two shows the knowledge of Marasmus and its control and management.

Section three presents perception about the treatment/products given in the CMAM program.

Feeding Practice

5.2 Discussion of Key Findings

5.1.2 Feeding practices

According to Amsalu (2008), there is a significant association between Marasmus and

inappropriate infant and young child feeding practices. This therefore necessitates the need to

improve the knowledge and practices of parents or caregivers on appropriate infant and young

child feeding practices. In this study, feeding practices among study respondents was found to be

generally uniform. It was observed that almost every caregiver reported to have timely introduction

of water and household foods in the feeding of their children and this may be due to the fact that

most (90%) of them have been taught in the CMAM program on food preparation and introduction

as regards management of their children’s conditions. The practice of exclusive breast feeding is

very important as the exclusively breast-fed child is used as the norm against which to asses

compliance to children’s right to achieve their full genetic growth potential (de Onis et al., 2012).

Majority (83%) of respondents reported that they fed their children more than three times in a day.
This practice is actually good for the children to be able to meet their daily nutrient requirements,

a necessary practice for the recovery of the child. Obviously, this might be true but only probably

because of the education given at the CMAM program. Quite a number (38%) of the respondents

admitted to have difficulty in food acquisition. This can be very true since 50% of the respondents

said they were farmers and 32% were traders.

5.1.3 Knowledge of Marasmus and its control and managements

Most of the respondents (99%) believe Marasmus is curable with (73%) now knowing a lot about

the condition of their children. Forty-three percent of this number was able to identify the condition

in children within the ages of above 6months to four years using the signs and symptoms. Although

the 43% appears to be less, these caregivers in their individual communities can serve as change

agents with the knowledge they have acquired through the CMAM program to compliment the

efforts of the community health workers in the district. These caregivers can be added to their

community’s mother-to-mother support groups under the IYCF after they have been discharged

to encourage and train other mothers on case identification. According to Collins et al., (2006b),

the standard practices of Marasmus managements has been to treat all children with Marasmus in

inpatient facilities. However there has been a paradigm shift to an approach that focuses on active

case finding and treatment of uncomplicated cases in community settings and the complicated ones

in the inpatient facilities (Collins et al., 2006).

5.1.4 Perception about the treatment/products given in the CMAM program

Almost all, (99%) of respondents believed CMAM treatment/products has been very useful and

necessary for the recovering process of their children. The same number of respondents admitted

that, they have noticed an improvement since joining the program and as such agreed it was

necessary joining the CMAM program. This clearly proves the relevance of the CMAM program
in the recovery of children with Marasmus because of the quality health delivery by community

health workers. In accordance to this finding, a study done in southern Bangladesh reveals that

CMAM demonstrates a quality delivery by community health workers, when assessed against a

treatment algorithm, they achieved an average rate of 100% error-free case identification and

management (Sadler et al., 2011). Also, study by Shafiq et al., (2013), found that the CMAM

approach encompasses truly detection of Marasmus in children and ensures provision of treatment

for those without medical complication. CMAM can achieve success when mainstreamed within

the routine health and implement in a non-emergence context (Muller & Krawinkel, 2005).

5.2 Implication of the Findings to Nursing

Against the background of the findings were made which could be relied upon by the both

international and national Nursing bodies to review the current health system practice. There must

be an effective framework to guide integration of CMAM with the national health system. Also,

follow ups on referral should be recorded to ensure all children with Marasmus are admitted to

ensure all and that feeding and care practice for moderately malnourished children have improved

as in relation to the counseling. Provision must be made for group who might be migrating for

work or living long distances from health services in order to avoid relapses and defaulting.

5.3 Limitations to the study

A limitation to the study was that it was conducted only in Madonna University Teaching Hospital

(MUTH) with caregivers who are in the CMAM program or have ever been in the program without

taking into consideration all caregivers within the study area, due to financial constraints. Hence,

this may limit the generalization of the findings to the wider scope. The study could not uncover

reasons behind responses of the respondents as this was a purely quantitative study with closed
ended questions. This limited the responses of respondents to specific set of questions. This may

have obscured the responses of respondents relative to the questions asked on the subject matter.

The study was limited to Marasmus as the only protein-energy deficiency malnutrition , whereas,

they are several malnutrition disease that could be study on.

5.4 Summary of the Study

The study explored the Control and Management of Marasmus among children within the age 2-4

in the study area with the objectives of identifying the causes of malnutrition among children with

age 2-4 in MUTH, examining the knowledge of caregivers in the control and management of

Marasmus, and assessing the perception of caregivers about the treatment/products given in the

CMAM program. A descriptive or survey study design using quantitative study tools was used to

gather data from study participants. The data was analyzed using percentages and frequency and

the main conclusions of the study are presented below.

5.5 Conclusion

The following conclusion are made on the findings made in relation to the objective of the study.

5.5.1. Causes of Marasmus

Thirty-eight percent of caregivers admitted difficulty in food acquisition which mostly has to do

with issues of availability and affordability especially during the post-harvest season to the next

farming season. Thus, difficulty in food acquisition can be perceived as a cause of marasmus in

children receiving treatment in MUTH. This was similar to earlier studies (Aheto et al., 2015).

5.5.2. Knowledge of caregivers in the control and management of Marasmus

The general knowledge of respondents on the control and management of Marasmus was positive

because 99% of respondents knew malnutrition but not specifically Marasmus can be cured, 73%

knew the signs and symptoms. They were able to identify cases as 96% could identify children
with Marasmus after 6months and above, 62% knew that visiting the clinic and feeding children

well was necessary for their recovery and 53% of the caregivers knew that inadequate breast milk

intake could lead to the condition.

5.5.3. Perception of Caregivers about the treatment/products given in the CMAM program

Almost all (99%) of the respondents believe that the treatment/products given in the CMAM

program was very effective and useful for the recovery of their children. They agreed that they

have notice improvements in condition of their children since joining the program.

5.6 Recommendation

Based on the findings of the study, the following recommendations are made for consideration by

policy makers and health care practitioners.

5.6.1 Practice

To the effect that most of the caregivers believed in the services and products CMAM provides, it

is necessary to point out to these caregivers their role in the whole recovery. This is to blot from

their minds that only the CMAM services and products are needed for the recovery and

sustainability on the nutritional status of their children. This will enable the caregivers to

effectively adhere to treatment practices taught during the program in order to prevent relapse of

their children’s condition and their subsequent children from becoming severely malnourish.

5.6.2. Nutrition Education

Nutrition education at the community level should be intensified. This will ensure better

understanding of the need for the whole community involvement in creating a more supportive

environment in order to achieve a low CFR less than 10 percent, a recovery rate higher than 75

percent, and a defaulter rate less than 15 percent according to the Sphere’s guideline. The national

training curriculum for health workers should include necessary comprehension of nutrition
principles and in communities, nutrition issues require much greater sensitization especially for


5.7 Suggestion for Further Studies

In relation to the findings of the study, future studies could involve the management of subgroups

of children like those of HIV mothers. Future studies could also look at the program sustainability,

long-term survival and relapse rates. Increase the sample size above the current 182 and extend

the study to other caregivers not necessarily in the CMAM program to allow for the results to be

generalized to the wider community members. Future studies could investigate the barriers to

treatments program implementation. Apply qualitative research methods in order to identify as-

yet unidentified risk factors that might account for the unexplained house-level variation in

childhood nutrition outcome.


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