CHAPTER ONE
INTRODUCTION
Background of Study
    Reducing malnutrition among children under the age of five remains a huge challenge in developing countries of the World. An estimated 30 million under – five children are believed to be chronically malnourished in developing countries (Van de Poel, Hosseinpoor, Jehu – Appiah & Speybroeck, 2008). Similarly, about 54% of deaths among children of this age group are believed to be associated with malnutrition in developing countries (FAO, 2008). In Sub-Saharam Africa, 41% of under – five children are malnourished and deaths from malnutrition are increasing on daily basis in the region (FAO, 2008). Malnutrition is widespread in Nigeria, especially in the rural areas. This is partly due to inadequate food and nutrient supply. The 2003 Nigeria Demographic and Health Survey revealed that 38% of under – five children in Nigeria are stunted, 29% underweight and 9.2% wasted (Ajieroh, 2010). These surveys indicated significant variation between the rural and urban areas with children from rural areas worse affected by malnutrition.
    Most common form of malnutrition in Africa is protein energy deficiency affecting over 100 million people; especially 30-50 million children under 5 years of age (Maletnlema, 1992) and almost additional 200 in a retrospective semi – rural – community based study of million are at risk (Maletnlema, 1992). Up till now, children with PEM at Ile – Ife and Ilorin. Nigeria, we protein energy malnutrition (PEM), a known sequel of analyzed the demographics, weaning food insufficiency and poor social – economic conditions diets, weight – for – age deficits, family size as (Dulger et al., 2002) continues to be a major public well as parental socio – economic conditions, literacy health problem and a source of major concern in levels and annual per capita income. Employing the developing third world countries including Nigeria Modified, Welcome classification of PEM, based on various authors have identified the impact of a number weight – for – age (WA) deficits and presence or absence of risk factors underlying PEM. Involvement of the oedema, the children were categorized into the four nervous system by PEM is thought to result from the not only clinical syndromes of PEM including kwashiorkor, deficiencies of protein and energy alone but from marasmic – Kwashiorkor maramus and underweight.
    Simultaneous deficiency of micronutrient related to their parents was categorized into social classes’ brain growth and development. Malnutrition is one of the biggest health problems that the world currently faces and is associated with more than 41% of the deaths that occur annually in children from 6 to 24 months of age in developing countries which total approximately 2.3 million, (Sandoval – Priego, Reyes – Morals, Perez – Cuevas, Abrego – Blass & Orrico – Torres, 2002). World Health Organization in 2001 reported that 54% of all childhood mortality was attributable, directly or indirectly, to malnutrition. Sub-Saharam Africa has a high prevalence of the different types of malnutrition, namely stunting, wasting and underweight, (Lutter & Rivers, 2003).
    The United States is currently characterized by the coexistence of two forms of childhood malnutrition. On the one hand, the prevalence of overweight children has increased dramatically over the past two decades 1 (Hedley, Allison, Cynthia Ogben, Clifford L. Johnson, Margaret D. Carroll, Lester R. Curtin, and Katherine M. Flegal 2004). On the other hand, the degree of underweight among children has been unacceptably high for such a wealthy country (Polhamus, Delenius, Thompson, Scanlon, Borland, Smith, & Grummer – strawn 2003). Both forms of malnutrition create public health problems. For example, an overweight child is more likely to be obese as an adult and has a higher probability of suffering from Type 2 – diabetes, high cholesterol, high blood pressure, some types of cancer, and heart disease than is a child who is not overweight (Schwimmer, Jeffrey, Tasha, Burwinkle, James & Varni, 2003). Furthermore, the Surgeon General has linked childhood overweight to social discrimination and depression (U.S. Office of the Surgeon General 2001).
    Malnutrition in all its forms amounts to an intolerable burden not only on the health systems, but the entire socio – cultural and economic fabric of the society and is the greatest obstacle to the fulfillment of human potentials. Child malnutrition is a huge public health problem in Africa that is not properly given the priority that it deserves. Malnutrition is largely a preventable and treatable cause of childhood morbidity and mortality that can be dealt with for less that USD 20 per child per year (Chiabi et al., 2008). According to WHO malnutrition accounts for 6.6 million out of 12.2 million deaths among children under 5 (54% of child mortality) in developing countries. In Nigerian and elsewhere about 35.7% and 47.5% of children under 5 years of age are moderately to severely undernourished respectively (Solomon, 1985; Roy et al., 2007). It known that almost any illness will impair a child’s growth. However in practice in developing countries, growth deficits are caused by interplay of two preventable factors: adequate food and infections.