Household Socioeconomic Determinants Of Nutritional Status Of Children Under-Five Years In Fishing Communities In Pangani District, Tanzania

EXTENDED ABSTRACT

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%) iii 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.