الفهرس 
INTRODUCTIONOnly 14 pages are availabe for public view
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Abstract
Stunting affects majority of the African countriesespecially sub-Saharan region. Stunting does not only affect the health status of the children but also public health by creating excessive burden on the health sectors and economy. International organization likes UNICEF, WB and WHO they have outlined anumber of strategies to fight stunting. However, most of the strategies do not reach to the individuals and household level where much of the efforts in fighting stunting begin. Therefore, knowledge about feeding patterns among stunted children render significant efforts in fighting stunting both at the individual, household and national level.
The aim of this study was to identify the feeding patterns among stunted children under-five years in Dodoma city in Tanzania.
Research question
What are the feeding patterns among stunted children under-five years in Dodoma city in Tanzania?
A descriptive design was used to carry out this study. It wasconducted in the 7 central district hospitals’ outpatients’ clinics (one hospital from each district) at Dodoma city in Tanzania.A convenience sample of 175 under-five children and their mothers or caregivers (25 under five years stunted children and their mothers from each outpatient clinic in each district hospital) were selected to participate in the study. The study subjects were stunted children aged above two years and less than 5 years with their mother/caregiver who concerted (willing) to participate in the study. In addition, they should be notseriously ill children, or thosewho have severe end stage chronic disease, or those with the history of genetic short stature in their family.
Tools of the study:Three tools were used to collect data:
Tool 1: Feeding Pattern of Stunted Children Structured Interview Schedule
This tool was developed by the researcher after reviewingof the most recent and relevant literature to collect the required data from the mothers or caregivers.Data related to breast feeding, formula and complementary feeding practices, also data related to stunting.
Tool 2: A 24 hour’s diet recall Structured Interview Schedule
A 24-hour dietary intake list was developed by the researcher after reviewing the recent and relevant literaturesto record detailed information about all foods and beverages consumed by the children in the past 24 hours.
Tool 3:Anthropometric measurement
It was used to determine the stunted children. Height, weight, skinfold and bilateral mid-arm circumference of the child was measured then compared to the WHO growth chart of Height/Length for Age, Weight for age, Weight for Height which can be expressed in Percentile or Z-scores.
In addition to tools identified interview schedule for socio-demographic characteristics was added.
The main findings obtained from the study were as follow;
The first part includes caregivers/mothers’ socio-demographic characteristics related data.
Table (4.1):Socio demographic characteristics of the caregivers/mothers
The mean mother’s age was 26.5 years (26.49±5.300). While, 1.2 % of the mothers could just read and write and1.7% of them had university education. On theother hand, less than one fifth (17.0%) of the mothers were housewives.
The mean fathers’ age, 36.6 years (36.61 ±9.731). While, more than one third (39.5%) of them could just read and write, and 1.7 % of them had university education. On the other hand, the vast majority (93.7%) of them were working.
More than three quarters (81.7 %) of the families were livings in rural area, while, less than three quarters (74.3%) reported that their incomes were not enough, andless than two fifths (38.9 %) of the mothers/caregivers had a nuclear family.
Table (4.2):Mothers s’/Caregiver’shealthstatus
More than one quarter (29.1%) of the mothers/caregivers, experienced health problems, mainly acute health problems (84.3 %) and chronic health problems (15.7 %).
Table (4.3):Mothers s’/Caregiver’sobstetrical health status
The mothers’ mean age of marriagewas 18.43 years (18.43±2.823). While, the mean age of the first pregnancy was 18.55 years (18.55±2.610) and the mean age of the last pregnancy was 23.27 years (23.27±5.327).
Less than two thirds (60.0%) of the mothers had average birth interval of less than two years.While, less than three quarters (73.7 %) of the mothers had spontaneous vaginal delivery and less than one third (31.4 %) of the mothers experienced problems during delivery, mainly hemorrhages (65.5 %), infections (30.9 %) and hypertension as reported by 3.6 % of the mothers.
Less than one fifth (14.8 %) of the mothers reported occurrence of breast-feeding problems, and less than one third (30.9%) of them reported being pregnant during breast feeding. Furthermore, all mothers (100.0%) reported no familial history of the stunting.
Figure (4.1):Mothers s’/Caregiver’ssource of information about under five children nutrition and care
It was noticed that the first source of information about under five children feeding was doctors as reported by around one quarter (25.1 %) of the mothers, followed by the nurses as mentioned by 22.6 % of them. Moreover, friends and parents were mentioned by 19.1 % and 13.1 % of them respectively. On the other hand, 13.1 % of the mothers depend mainly on internet as their main sources of information about child nutrition and care.
The second part includes children’s related data.
Table (4.4):Socio demographic characteristics of the under five children
The mean age of the studied children was 3.53±1.61 years.
More than half (53.7%) of the children were males, while, the rest (46.3%) were females.
Around one fifth (20.6%) of the children were the first child within their families, while, about one tenth (9.7%) of them were ranked as the fifth child and more within the family.
Table (4.5): Under five children s’healthstatus
More than half (56.6%) of the children were illin the last one month.
Chronic illness was observed in less than one fifth (13.7%) of the children.
Approximately two thirds (35.4%) of the children were previously hospitalized.
More than one quarter (28.6%) of the children reported current intake of medications mainly conventional or synthetic medications (54.0%), while, 44.0% of them declared use of both synthetic and traditional medicine.
The vast majority (96.0%) of the children received all compulsory vaccination.
Table (4.6): Under five children s’developmental milestones
The mean age by which a child starts to sit was 6.72 months (6.72±1.453).
The mean age of walking was 11.07 months (11.07±1.632).
Teeth eruption occur at the mean age of 6.43 months (6.43±1.337).
The mean age at which a child starts to pronounce the first word was 9.94 months(9.94±1.711).
Under five children s’ feeding pattern across different age groups
Table (4.7): Children’s feeding patterns at the age less than 6 months (Breast feeding)
All children (100.0%) were breastfed during their first 6 months, despite that more than half (58.9%) of the children were not exclusively breast feed for six months.
The mean number of breast-feeding per day was 8.691 times (8.691±5.816).
The mean time for breast feeding for one session was 12.314 minutes (12.314±2.929).
Table (4.8): Feeding patterns of the children of age less than 6 months (Formula feeding)
Less than one third of the children (30.3%) used formula feeding during the age less than 6 months, of which the majority (88.7%) utilized homemade formula (cow or goat milk) whereas less than one tenth (11.3%) were using ready-made formula.
The majority of the children (83.0%) received their formula at the age between 3 to 6months.
The majority of the mothers/caregivers (86.8%) fed their children 3 to 5 times per day. While, the mean amount of 231.13ml (231.132±62.961).
Table (4.9): Distribution of the children according to their feeding patterns at the age of 6 months to 2 years (Complementary feeding)
More than half (56.6%) of the children had complementary food at the age of less than 6 months.
More than three quarters (75.4%) of the children received three meals a day, while, less than half (48.6%) of the children were given complementary food gradually and less than one third (32.6%) of the children were given only one type of food at a time during the introduction of complementary foods.
Table (4.10): Distribution of the studied under five children according to their feeding patterns at the age of 2 to 5 years (Complementary feeding)
The vast majority of the children (98.3%) received three main meals a day; however, approximately one quarter (25.1%) of the children received one or two snacks per day.
Table (4.11): Under five children s’life style pattern
Distribution of the children according to their life styles
The vast majority (95.5% and 97.1%) of the children consumed fast food and soft drinks respectively.
All children reported to have a daily intake of starches and sugary food, while, approximately half (50.9%) of the children had fat-related food. Furthermore, more than two fifths (44.6%) reported daily protein consumption, and the rest 39.4% and 33.7% reported to consume vitamins and salty food substances respectively.
The vast majority (93.7%) of the children had a daily participation in sports/exercise.
The vast majority of the child (98.3%) sleep for 6 hour or more during a night, whereas, 88.6% of them slept for less than 4 hours during a day.
Table (4.12, figure 4.2, 4.3, 4.4, 4.5): Under five children’s’anthropometric measurements
The children weight ranged from 9.0 to 19.0 kg with a mean of 13.34 kg (13.34±1.823), while the mean height was 87.21 cm (87.21±5.693).
The mean head circumference of the studied children was 47.84 cm (47.84±1.048), while the chest circumference and mid arm circumference mean scores were (50.37±1.122 and 14.58±0.795 respectively). On the other hand, the mean score of skin fold thickness was 6.957 cm (50.37±1.122).
Figure (4.6, 4.7, 4.8, 4.9): Under five children s’nutritional status
The vast majority (91.4%) of the children were stunted while less than one fifth (8.6%) were severely stunted.Less than one fifth (15.4%) of them were under-weight. Only 5.1% were wasted, while, 4.6 % were severely wasted. Moreover, about 2.3 % were over-weight.
With regard to MUAC, less than one tenth (8.6%) of the children were at the riskof suffering from acute malnutrition. Furthermore, 4.0% and 6.3% they were categorized as Severe Acute Malnutrition (SAM) and Moderate Acute Malnutrition (MAM) respectively.
The majority (81.7%) of the studied under five children had low dietary diversity (less than four food groups per day) and 18.3% of them had adequate dietary diversity (four food groups and more per day).
Based on the results of the current study, it can be concluded that the vast majority of the studied under five children were stunted while less than one tenth (8.6%) were severely stunted. Less than one fifth of them were under-weight. A minority of the studied children were wasted and severely wasted. Moreover, less than one tenth of the studied under five children were at the risk of suffering from acute malnutrition. Furthermore, a minority of them were categorized as Severe Acute Malnutrition (SAM) and Moderate Acute Malnutrition (MAM) respectively.
Additionally, the majority of the studied under five children had low dietary diversity (less than four food groups per day) and less than one fifth of them had adequate dietary diversity (four food groups and more per day).
It is apparent from the study that there are several risk factors for the occurrence of low dietary diversity whether related to the basic characteristics of the children and their families.
In light of the findings of the present study, the following recommendations are proposed:
Recommendation directed to different Ministries
Recommendations directed to Ministry of Health and Population:
• Improvement in interventional programs linked to health and nutrition to enhance quality practices of exclusive breastfeeding, and continued breastfeeding up to two years of age and beyond;
• Increase the scope of community-based programs for provision of professional services on appropriate and recommended feeding practices for infant and young children.
• Reproductive and child health units andoutpatient clinics should be more equipped with expertise to prevent and provide continuous education on the stunting.
• Discouraging the use of breast milk substitute like home-made and commercial formula.
• Discouraging the use of fast food and soft drinks through educational campaign and governmental policies that restrict uses in children.
Recommendations directed to families, and children:
• Provide health education programs to orient parents on proper child rearing and feeding practices.
• Maintain positive parenting controlling practices, responsive parenting style and mutual communication between parents and their children.
• Encourage parental guided and responsible supervision and support through proper monitoring of the children’s’ behaviors.
• Participate in dialogue, awareness -raising campaigns and initiatives addressing the stunting and dietary diversity.
Future researches:
• Study on exploration of the knowledge on the nutritional stunting among mothers or care givers in Dodoma city.
• Interventional studies on behavioral changes on the feeding styles among infants and young children in Dodoma city.
• Studies on each component of breast feeding, formula feeding and complementary feeding practices.
• Determinant of poor feeding patterns among the stunted children.