DIATERY PATTERNS AND NUTRITION STATUS OF UNIVERSITY STUDENTS: A CASE STUDY OF KYAMBOGO UNIVERSITY
CHAPTER ONE: INTRODUCTION
- INTRODUCTION
- Background
Dietary patterns (DPs) are a set or group of foods, nutrients, consumed basing on usual eating habits of individuals or population. Dietary patterns are of increasing interest rather than individual foods or specific nutrients due to the relationship between biological interaction of food intake and nutrients. Analysis of dietary patterns is better at predicting diseases than isolated foods or nutrients. Dietary patterns of individuals develop and depend on factors like preferences, habits, availability, economic situation, religion, customs and nutrition needs (Fabian et al., 2013). Dietary patterns of young adults are highly associated with obesity, foods with high caloric density, frequent snacking and skipping meals especially breakfast (Hakim et al., 2012; Kabir, Miah, Islam, 2018). These increase the risk of developing many chronic diseases which are increasing in prevalence (Kapka-skrzypczak et al., 2012: World Health Organization, 2004).
Fruit consumption by young adults promotes optimal health, growth and intellectual development, lower levels of body fat and, in combination with vegetables, better bone density for boys. Eating fruit at younger ages appears to translate to adult patterns (Velde et al., 2017), with adult outcomes including decreased risks for coronary heart disease (Dauchet et al., 2010), stroke and cancer. Most of the official and governmental documents recommend the consumption of 5 servings of fruit and vegetables/day both to young adults and therefore having a good dietary practice by young adults like university students is essential in enabling them have a good nutritional status and promotion of good Health (USDA, 2010; WHO, 2010).
Having a good dietary is not only good for the body but also a pre-requisite for good Health. This is indicated by the fact that.One of the strategies for young adults in achieving good dietary practice is by limiting the energy intake from total fats and shifting fat consumption from saturated fats to unsaturated fats is avoiding or limiting snack consumption, which are very often high in saturated fats and it is usually consumed by young adults especially university students (Albers et al.,2018).
Good dietary patterns are recommended worldwide to enable the body fight against non-communicable diseases (Logue et al., 2018). The world health organization (2019) further indicates that due to poor dietary patterns, chronic diseases such as obesity, heart diseases, diabetes, blood pressure, tooth decay, anorexia nervosa, anemia and osteoporosis are on the rise. Having a good dietary pattern does not only benefit an individual but the country at large since the countries spend so much on Health care due to poor dietary patterns. According to WHO, (2008), of the 57 million deaths that occurred globally in 2008, 36 million almost two thirds were due to NCDs.
Poor dietary practices has risen across the globe and this is observed through the consumption of soft drinks, eating snacks and cakes this has risen across the globe, accompanied by an increase in the prevalence of overweight and obesity and generally poor health status of the citizens. Regular consumption has been associated with increased energy intake, weight gain, risk of overweight and obesity, and the development of obesity-related chronic metabolic diseases such as metabolic syndrome and type 2 diabetes (Malik et al., 2010). Though poor dietary patterns is a global challenge in Kyambogo university there has also been some challenge with informing students on the benefits of good dietary pattern as a result students make poor food choices and therefore this affects their general Health and productivity as young adults. This study therefore intends to investigate into the Diatery patterns and nutrition status of university students: a case study of Kyambogo University.
1.2 Problem statement.
University represents a key transition into adulthood for many adolescents, with many students having their dietary patterns shifting from traditional meal patterns to western life style due to socioeconomic status (Santos, 2016; Small, 2012; Kapka et al., 2012).
A worldwide study carried out in one of the universities in low- middle and high-income countries, showed that sub-Saharan Africa region has the lowest awareness of the health risks associated with poor nutrition (Pengpid & Peltzer, 2015). A bigger gap still exists amongst African university students regarding the effects of dietary patterns, food choices on the nutritional status. This study seeks to investigate the effects of, food choices on the nutritional status of University students . Similarly, issues surrounding the use of multivariate methods to analyze repeated measures of diet and how to characterize changes in dietary patterns haven’t thoroughly been investigated and are very few thus a need for this study to create more awareness about the need for correct food choices among university students for better transformation of their lives, entire country and the continent at large.
1.4 Objectives of the study
1.4.1 General objective
The main objective of the study is to determine the impact of dietary patterns, food choices on the nutritional status of University students at Kyambogo University.
1.4.2 Specific objectives
- To assess the influence of social economic status and nutritional status of the University students.
- To examine the influence of societal factors on nutritional status of university students.
- To examine the relationship between eating patterns and nutritional status of university students.
1.5 Research question
- What is the influence of social economic status and nutritional status of the University students?
- What is the influence of societal factors on nutritional status of university students?
- What is the relationship between eating patterns and nutritional status of university students?
1.6 Significance of the study
Dietary patterns and food choices of university students are of great importance since young adulthood is a productive and child bearing age and it sets the stage for lifestyles that influence later life. Young adults with poor dietary patterns are at a risk of nutrient inadequacies and dietary excesses of selected nutrients which affects their nutrition status. Through these research findings, a better understanding of changes in dietary patterns and diet-related behavior may provide an opportunity to explore appropriate intervention strategies. University students will be able to understand the trends of their dietary patterns, food choices and their nutrition status. The university management will be in position to design and initiate intervention programs regarding proper dietary patterns and food choices for the students. The research findings will also provide future scholars with information regarding this topic. Thus, this study will be to evaluate the impact of dietary patterns, food choices on the nutritional status of university students.
1.7 Justification
University students are young adults who have poor dietary patterns and food choices which are directly related to their nutritional status (Hakim, Muniandy, Danish, 2012). University students are solely responsible for their food choices, house and finance management. New university environment may change the students’ personality, behavior and attitude. During this transition period from adolescence to young adulthood, life style changes, new environments, lack of funds, psychosocial factors and high demand of academic work may contribute to adoption of unhealthy dietary patterns (Omega & Omuemu, 2018). University students have their dietary patterns shifting from traditional meal patterns to western life style and also make poor food choices which continue throughout their university life (Manwa, 2013), the issue of continuity has been confirmed by previous researchers (Soriano, Molto, Manes, 2000). Therefore, these poor dietary patterns and food choices may affect their nutrition status leading to long term health problems (Santos, 2016).
1.8 Conceptual framework
This study will focus on the effects of the dietary patterns, food choices on the nutritional status of university students. From FIVIMS nutritional status conceptual framework, poor nutritional status is the results of a complex set of elements as illustrated in the figure below
It is also evident that there are several studies which have assessed effects of dietary patterns among university students however majority employed cross-section study, and non-have used longitudinal study approach to assess effects of dietary patterns, food choices on the nutritional status of university students specifically at Kyambogo University. It’s therefore against this background that this study intends to investigate effects of dietary patterns, food choices on the nutritional status of university students.
Conceptual framework showing the relationship between dietary patterns, food choices and nutrition status
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Independent variables Dependent variable
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The conceptual frame work indicates that the independent variable of dietary status is measure by the following dimensions including; Social-economic factors, societal factors, Environmental factors and University related factors. The frame work also further indicates that
CHAPTER TWO: LITERATURE REVIEW
2.0 Introduction.
2.1 Dietary patterns and nutritional status of university students
Having good dietary pattern is something of universal benefit to everyone. Regular breakfast consumption is associated with higher intakes of micronutrients, a better diet that includes fruit and vegetables and less frequent use of soft drinks (Timlin et al., 2008).
The lifestyle of individuals is very vulnerable to negative influences during childhood and adolescence, which are crucial periods of life when both major physical and psychological changes occur. The risks associated with unhealthy behavior related to diet and physical activity begin in childhood and build up throughout life (WHO, 2010).
The lifestyle of individuals is very vulnerable to negative influences during childhood and adolescence, which are crucial periods of life when both major physical and psychological changes occur. The risks associated with unhealthy behavior related to diet and physical activity begin in childhood and build up throughout life (WHO, 2010).
Poor dietary patter among young adults has led to malnutrition and it is affecting millions of people throughout the world. Malnutrition results from under and over consumption of different nutrients. Accordingly, for an individual to have an optimal nutritional status, one must be food and nutrition secure. However, being food secure does not mean nutrition secure, therefore an individual’s nutritional status depends on the interaction between food eaten, overall state of health and the physical environment (WHO, 2001), developed a conceptual frame work, which indicates that malnutrition is an outcome of immediate, underlying and basic causes in a hierarchal way.
In a study carried out CDC, (2012) It was discovered that Fruit and vegetable intake is below recommended levels f among university students, which is unfavorable for the energy density of the diet. The increased supplies in some countries may indicate a higher consumption of processed fruit or vegetable extracts, such as juices and syrup concentrates, which usually have a higher energy density than the less processed fresh alternatives. In addition, as fibre intake is also low throughout europe, consumption of more satiating foods –for example, wholegrain foods –should be encouraged as an additional measure to reduce the energy density of the diet. Sweetened beverages have become common beverages (Currie et al., 2008).
Based on WHO’s (2001), description, famine, starvation, fasting, economic instability, skipping meals can lead to under nutrition due to reduced amounts and number of times food is eaten. However, over nutrition might be due to over eating nutrient dense foods or physical inactivity levels.
According to Fabian et al., (2013); Racette, S. Deusinger, Strube, Highstein, H.Deusinger, (2015) students had reduced number of daily meals, less consumption of grains, vegetables, fruits, and dairy but fat consumption was adequate due to high consumption of fast and fried foods. According to Abraham et al., (2018) where they found that a large number of students consumed processed and fast foods but with high consumption of fresh fruits.
Regarding dietary patterns of university students in some developed countries it has been indicated 8% of students skip breakfast, 31% consume an inadequate breakfast (i.e. unbalanced carbohydrate/protein ratio), 52% consume a hyper-caloric morning snack, 25% of parents declare that their children do not eat fruit and vegetables every day and 41% of parents declare that their children regularly consume soft drinks (Spinelli et al., 2011).
Additionally, a number of authors noted that majority of the students had less healthy foods during examination period missing at least one main meal (Santos et al., 2015; Hernandez et al., 2016; Kabir et al., 2018). In fact, the majority of students preferred processed and high fat foods, a lot of snacking, consuming sugary beverages, sweets and other sweet products such as chocolates and cookies which increased their daily sugar intake (Kalkan, 2019). According to Abraham et al., (2018), students eating out in fast food restaurants consumed larger portion sizes, high saturated fats with high caloric values and low nutrient content. Moreso, it was also confirmed that many students consumed tea/coffee and milk on regular basis (Elneim, 2013, Kabir et al., 2018; Kalkan, 2019). However, Perera (2016) revealed that students had no milk tea and limited themselves to single plain tea a day.
Accordingly, dietary patterns common to young adults were snacking, high consumption of energy-dense foods, meal skipping with majority skipping breakfast and minority skipping lunch or supper resulting into two or three meals a day (Omage & Omueme,2018; Yun, Ahmad, Quee 2018) . The same study noted that majority consumed more cereals, roots and tubers, oils and fat groups, with less fruits, vegetables and eggs but with wide use of fast foods, and there was little or no consumption of alcohol and smoking. However, in contrast to the rate of drinking alcohol, Hernandez et al., (2016) noted that majority of students drank alcohol.
Manwa (2013) noted that most students took two meals during the week and three meals over weekends thus indicating that most students did not meet required daily intake.
Other studies carried out by Santos et al., (2015); Kabir et al., (2018) noted that during weekends there was increased consumption of better functioning meals and with better nutritional values. Though Perera (2016) concluded that students went back home during weekends to cut down meal expenses.
Poor dietary patterns causes Non communicable diseases later in life for example obesity is associated with high intake of energy-dense, nutrient poor foods such as soft drinks, savory crisps and sweet biscuits, and increased time spent in sedentary behavior (Carlsonet al., 2012). On the other hand, regular physical activity and a diet high in fruit, vegetables, legumes and whole-grain cereals have been shown to be protective (WHO, 2003).
2.1.2 Anthropometric measurements of malnutrition
Anthropometric measurements are used to indicate malnutrition. Anthropometry is the science of taking one’s size, weight and height (Dudek Suzan, 2010). Height and weight measurement depend on the person’s age and sex and these measurements are used to come up with indices like Body Mass Index (BMI), Weight- for- age, weight-for-height and Height-for-age, which index can be used to determine underweight, wasting and stunting respectively.
2.1.3 Body Mass Index
Body mass index is an index that categorizes an individual as underweight, normal weight overweight and obese. It is used to assess the nutritional status of children, adolescents and adults. BMI cut off points for adults remain the same regardless of sex and age. It is calculated by dividing weight in kilograms over height in meters squared. Cut offs according to WHO standards are <18.5 under weight, 18.50-24.99 normal, 25 > 29.99 over weight, ≥30 obese.
BMI and the prevalence of overweight are in general lower in young people who eat breakfast (Affenito, 2007), which is also advocated as a means of improving cognitive function and academic performance (Cooper et al., 2011). Moreover, breakfast consumption is also associated to the consumption of milk and yoghurt, which is promoted by USDA (2010) and other national guidelines.
2.1.4 Mid -upper arm circumference (MUAC)
MUAC is a measurement at the midpoint of the arm between shoulder and elbow. MUAC is commonly used to determine the nutritional status of adolescents and adults. However, there are no global standards to classify acute malnutrition among adolescents and adults (FANTA, 2018). MUAC is a useful indicator of malnutrition that can be used in ill patients.
2.1.5 Waist to hip ratio (WHR)
Waist to Hip Ratio is a dimensionless ratio of the circumference of the waist to that of the hips. According to (WHO) cut off points for Waist to Hip Ratio are 0.88 for males and 0.86 for female. Any value greater than 1.0 is indicative of a higher than normal risk for developing heart diseases (2019).
2.2 Effects of dietary patterns on health
WHO, (2018) recognizes that the increasing prevalence of obesity results from changes in society which has generally led to poor dietary patterns. The problem is linked not only to students’ behaviour but also, increasingly, to social and economic development and policies in the areas of agriculture, transport, urban planning, the environment, food processing, distribution and marketing, as well as education.
Health cannot be separated from nutrition. Nutrition can directly affect one’s health either through its improvement or deterioration likewise health can affect nutrition by improving one’s appetite or making it deteriorate. During young adulthood, there are high chances of nutrition deficiencies and poor eating habits hence being exposed to many risk factors leading to development of chronic diseases such as diabetes, osteoporosis, cancer, hypertension among others.
According to WHO (2010), out of total 57 million deaths in 2008, 36 million resulted from non-communicable diseases. The associated risk factors for non-communicable diseases are many but depends on the specific disease. For example, diabetes results from high blood glucose level in blood due to body’s inability to either make or utilize insulin. Diabetes has long been associated with obesity or overweight, it’s is believed that obesity accounts for 80-85% of the risk of developing type 2 diabetes, while obese people are up to 80 times more likely to develop type 2 diabetes than those with BMI of less than 22. According to WHO at least 2.8 million people die each year due to overweight or obesity. For instance, UK has the highest level of adult obesity with more than 1 in 4 (28.1%) obese or has a BMI of 30 or more.
Other factors responsible for diabetes are hypertension, sedentary lifestyle and family history. According to Erber (2010) fat and meat patterns were associated with diabetes whereas the vegetable pattern lowered diabetes risk. The same study findings concluded that the type of food consumed contributed to diabetes risk beyond its effects on body weight. In another study, consumption of healthy dietary patterns may prevent type 2 diabetes in general populations, it was also noted that healthy diets may retard progression of type 2 diabetes in both in general population and in persons at risk (Esposito, Maiorino, Ceriello, Giugliano, 2010). According to Beigrezaei, Ghiasvand, Iraj (2019), there was a direct association with western dietary patterns and the risk of type 2 diabetes, similarly processed foods were associated with greater risks of type 2 diabetes than whole grains and fruits, it was also found that a dietary score based on intake of 10 foods groups was less associated with type 2 diabetes risk (Block, 2008).
There is also good evidence that obesity is associated with high intake of energy-dense, nutrient poor foods such as soft drinks, savory crisps and sweet biscuits, and increased time spent in sedentary behaviour (Carlsonet al., 2012, WHO, 2003). On the other hand, regular physical activity and a diet high in fruit, vegetables, legumes and whole-grain cereals have been shown to be protective (Swinburn et al., 2004).
Hypertension results from extra effort needed to circulate blood due to excess fat built up in veins. The risk factors for hypertension include diet, physical inactivity, lifestyle, age, family history and stress. Dietary patterns associated with processing are likely to lead to obesity and overweight which result into high blood pressure, which is also a main risk for developing cardiovascular diseases. The study indicated that decrease in sodium intake and increase in potassium can both independently reduce blood pressure (Margerison, 2020). A study carried out by Ndanuko (2016), indicated that high consumption of whole grains, fish, dairy and low consumption of meat, sweets, and alcohol resulted in significant reductions in blood pressure.
Cardiovascular diseases (CVD) occurrence is due to malfunctioning of the heart, arteries and veins which carry oxygen to the brain. Obesity and overweight are independent risk factors for (CVD) (Carbone et al., 2019). Dietary patterns associated with processed foods and low whole grain intake is related to high risks of developing cardiovascular diseases (Mertens, 2017).
2.3 Basic knowledge on good nutrition
Among the so many factors that influence dietary choices, nutrition knowledge about foods and health is vital since food options change and dietary changes arise (Cooper et al., 2011). If college students are unaware of the nutritional requirements to maintain a healthy body weight, they can make poor nutritional decisions which can cause poor weight management and health problems (Abraham et al., 2018). Several studies have been conducted in this area. College students selected foods according to convenience, taste, time, price rather than healthy nutritional value, which is an indication of unhealthy eating (Abraham et al., 2018). Similarly, Perera (2016), showed that students did not consider nutritional value of the food but rather the quantity. Kabir et al., (2018) assert that student’s knowledge and perception about nutrition value of the food eaten was not considered but what was important was eating.
According to Abraham et al., (2018) students had knowledge on the effects of eating fast foods but college activities and schedules, peer pressure influence and accessibility played a great role in consuming them. In a different study carried out by Hernandez et al., (2016), students had knowledge about nutrition but they did not put it into practice because price was the major determinant of healthy food choices. However, contrary to those results, Manwa (2013) argues that students showed little or no knowledge of nutrition and diets.
Kalkan (2019) further states that eating behavior of individuals was affected by their nutrition literacy status. The same study noted that factors such as food and nutrition knowledge, preparation skills etc affected dietary behaviors positively whereas ambiguous nutrition knowledge through communication media can lead to confusion, anxiety and incorrect food choices by individuals.
2.4 Factors influencing choice of food
Young adults make independent choices including food choices. Though they choose what to eat, there are different factors that can influence their choices, many of which positively or negatively affect them. Individual, societal, environmental and factors related to university influence food choices made by university students (Manwa, 2013; Kabir et al., 2018; Omuemu & Omega, 2018; Lupi et al., 2015).
2.4.1 Social economic factors
Socio economic status determines health and nutritional status. Availability of food in terms of quantity and quality depends on social economic status, food practices, cultural traditions and physiological factors. College students chose their foods according to convenience, taste, time, and price (Abraham et al., 2018).
Students from low income families tend either to choose less nutritious cheap food items or to forego certain meals to cope up with the situation (Mazzarella and Pizzuti, 2011). The less nutritious cheap foods cannot meet the daily requirements of the students from low income families. On the other hand students from rich families tend to eat out in restaurants where bigger portions of food are given and also they have high consumption of energy dense foods leading to obesity (Nardone et al., 2015).
Students choose healthy food products depending on price (Manwa 2013; Hernandez et al., 2016). Financial constraints led to students have their nutrient intake compromised through choice of inferior foods with low nutritive values and also at times missing meals whilst those with those with a lot of money chose junk foods which led to obesity.
At times individual stress especially due to examinations pressure impacted on food consumption either through reduction or over consumption (Santos et al., 2015; Kabir et al., 2018).
Female students chose more, raw vegetables, fruits and non-alcoholic drinks resulting into their high consumption (Lupi et al., 2015).
2.4.2 Societal factors
Peer pressure is an important determinant of food choice among young adults (Fabian et al., 2013). According to Abraham et al., (2018) peer pressure influence play a big role in consumption of fast foods. In fact, people are happier if they made similar choices to those sitting around them (Refs)
Social network such as social and personal interactions is reported to influence food choices and dietary intake as several dishes could be tasted due to pulling resources together (Kabir et al., 2018). However, according to (Refs), students tended to ignore the choice of nutritious needs in preference to acquiring non-food items like phones (Perera, 2016). Interventions like use of smart phones applications, text messaging proved to be beneficial in promoting healthy behavior such as exercises and eating healthy foods but few students used them (Abraham et al., 2018).
Social norms, culture and religious beliefs are also known to have both positive and negative influence on the kinds of food people eat. Accordingly, some students avoided taboo foods, due to the religious beliefs. For example, Jewish and moslems are forbidden from eating pork though it is a very good source of proteins (Kabir et al., 2018). The same study noted that female students were inclined to cook compare to their male cunterparts(Perera, 2016) s.Culturally, many students are used to frying or including rich sauces and gravies that might increase fat and caloric content of the meals but at the same time providing variety of nutrients (Refs).
2.4.3 Environmental factors
Availability and accessibility of food, presence of fast food restaurants within easy reach made access to fast foods easy (Abraham et al., 2018). Availability of seasonal vegetables during winter favored cooking in halls of residency (Fabian et al., 2013). According to Sogari et al.,(2018); Manwa, (2013) indicates that food choices are always restricted by the fact of availability and therefore when it is not available the diet is restricted and on the same note Omuemu & Omega (2018); Hakim et al., (2012) further indicated that most university students lacked access to healthy
Lupi et al., (2015) noted that students who stayed at home had a higher consumption of sweets, vegetables and sandwiches whereas those who resided at university had more milk and packaged foods.
Physical factors, students living off- campus reported a wide variety of foods from which to make choices, (Deshpande et al., 2009; Lupi et al., 2015). These students had a higher percentage of energy from protein, serum triglyceride level and the ratio of total cholesterol to high density protein among students living off-campus was observed, it was also noted that students living away from home had a high weekly consumption of alcohol could be because they had more freedom to interact with friends.
2.4.4 University related factors
According to Kabir et al (2018), the majority of the students chose low nutritive value foods from campus food vendors. New lifestyles at campus, led to a change in students’ behavior and attitude, resulting into lower consumption of fruits and vegetables with increased consumption of snacks and other junk foods (Sogari et al., 2018).
Academic activities are also known to negatively impacts on food choices. For example, improper lifestyles, characterized by high academic demands and physical inactivity lead to unhealthy dietary patterns. characterized by a lot of snacks and sweets and missing some main meals due to limited time and busy schedule (Santos et al, 2015; Abraham et al., 2018). According to Hernandez et al., (2016) .
The diet of students has been found to deteriorate during examination period Kabir et al., (2018) further noted that students eat less healthy foods during examinations could be they are busy preparing exams.
2.5 Research gap
A worldwide study in universities in low, middle and high income countries, showed that sub-Saharan Africa region have the lowest knowledge regarding healthy risks associated with poor dietary patterns and food choices while Caribbean, South America and Southeast Asia had the highest knowledge (Pengpid & Peltzer, 2015). Therefore, there is a bigger gap between African university students regarding effects of dietary patterns, food choices on their nutritional status. This study aims at bridging this gap by creating more nutritional awareness about the need for proper dietary patterns and food choices for the university students for better transformation of their lives and the entire country.
CHAPTER THREE: METHODOLOGY
3.1 Research Design
The study will adopt a longitudinal survey research design because of the nature of the variables that are at hand; to produce data required for quantitative and qualitative analysis and to allow simultaneous description of views, perceptions and opinions at any single point in time (White, 2000). The study will also use qualitative and quantitative methodologies for data analysis. Quantitative and qualitative methodologies. Quantitative research will consist of those studies in which the data concerned will be analyzed in terms of numbers while qualitative described events, persons and so forth scientifically without the use of numerical data. Quantitative research is based more directly on its original plans and its results are more readily analyzed and interpreted. Qualitative research is more open and responsive to its subject. (Christina Hughes, 2006).
3.2 Target population
The target population will include all students from different faculties at Kyambogo University.
3.3 Selection criteria
A multiple-stage, systematic sampling procedure will be used to draw samples from the different faculties. A detailed description of the cohort composition, are in the original study, where students were enrolled in the 2018 academic year, and a follow up made for the progressing semesters.
3.4 Sample size determination
It is impossible to study the whole targeted population of the study and therefore the researcher Take sample of the population this is also further supported by Mugenda and Mugenda (2003) who notes that a research should choose a sample out of the whole targeted population. A sample is a subset of the population that comprises members selected from the population.
Using the formula below the sample size will be determined
The sample size will be determined using the formula
N =(Z)2p(1-o.5)
e2
Where:N=Sample size
Z= confidence level =1.96
P= standard deviation =0.5
e= margin of error=5%=0.05
N.B confidence level corresponds to a Z-score.
N= (1.96)2.5(1-0.5)
(0.5)2
(3.841 ×0.25)
0.0025
N=384.14
N=384 respondents.
3.5 Data Sources
Source of data will be from both primary and secondary sources.
- Primary data
Primary data will be obtained from the questionnaires administered on the target respondents to gain opinions and practices on food choices and nutrition status of university students: a case study of Kyambogo University.
- Secondary sources
Secondary data is data which has been collected by individuals or agencies for purposes other than those of a particular research study. It is data developed for some purpose other than for helping to solve the research problem at hand (Bell, 1997). This will comprise of literature related to food choices and nutrition status of university students: a case study of Kyambogo University. Secondary data will be sourced because it yields more accurate information than obtained through primary data, and it is also cheaper
3.6 Data analysis
Mugenda and Mugenda (1999) and Mbaaga (2000) both defined data analysis as a process of bringing order, structure and meaning to the data gathered to create information out of it. Data analysis will therefore, done with quantitative and qualitative methods. The quantitative (Questionnaires) and qualitative (interviews) will be analyzed separately and then combined during discussion of the findings.
3.6.1Quantitative Data Analysis
Data processing will be done by entering the data into a statistics package for social sciences (SPSS) version 24.0 in line with the research questions. Data analysis will be done by also using this statistics package for social sciences (SPSS) to formulate frequency tables where the percentages, frequency, mean, variance and standard deviation will be obtained.
Under quantitative analysis, process will include editing, classification, coding and presentation. Data will be summarized in frequency tables, percentage; data will be analyzed with the use of statistical package for social scientist (SPSS). Quantitative data will be collected through structured questionnaires and it was cantered into a computer, tabulated and analyzed.
Spearman’s correlation coefficient and regression analysis as it is recommended by Amin (2005, P.378) will be used during data analysis. The formula will be used for this study because it is compatible with SPSS program in addition to being appreciated in analyzing data under which the data will be arranged.
3.6.2 Qualitative Analysis
Qualitative data will be analyzed using content analysis.it involves gathering and analyzing data based on the content, where by the raw data collected from the field will be read through to enable the researcher to get familiar with the data. At this process the study will use noted cards to organize the available data to accelerate further analysis. Data will then be evaluated and analyzed to determine its accuracy, credibility, usefulness and consistency.
In depth interviews will be conducted at follow ups to collect data on factors that determine the dietary patterns and food choices that affect the nutritional status to and to assess knowledge of the respondents on dietary patterns, food choices and nutrition in general.
3.7 Data quality control of instruments
The data collection tools will be pre-tested on a smaller number of respondents from each category of the population to ensure that the questions are accurate.
3.7.1 Validity
Validity is defined as the extent to which results can be accurately interpreted and generalized to other populations (Oso & Onen, 2008). While Borg & Gall, 1989 as cited in Onyinkwa, (2013) validity is defined as the degree to which results obtained by the research instrument correctly represented to the phenomenon understudy.
Amin, (2005) recommended minimum CVI of 0.7 to be used. Validity will be tested using content validity index which involves judges scoring the relevancy of the questions in the instruments in relation to the study variables.
The formula for Content Validity Index will be;
CVI =
Where CVI = content validity
n= number of items indicated relevant.
N = total no. of items in the instrument
In this study, validity will be achieved by establishing content validity. The researcher will achieve content validity by using the experts to assess the validity of the research instrument. The experts especially research supervisors will be given data collection tools to assess whether the items in the instruments are valid in relation to research topic, objectives, and questions. From the instruments they will declare some items valid and others invalid. Those declared invalid will be dropped, others adjusted, while the valid ones will be maintained. Then content validity index (CVI) will be computed by dividing the number of items declared valid by total number of items/questions in the data collection instrument.
3.7.2 Reliability
According to Mugenda and Mugenda, (2003) reliability is the measure of the extent to which research instruments are able to provide the same results upon being tested repeatedly. Crobach’s coefficient alpha (a) as recommended by Amin, (2005, P.302) will be used to test the reliability of the research instrument. The instrument is deemed reliable if reliable of 0.7 and above is obtained and therefore, it will be adopted for use in the data collection.
Formula for reliability is
= ()
Where = alpha reliability co efficiency.
K=Number of items included4 in the questionnaire
= sum of variance of individual items
= variance of all items in the instrument.
To ensure credibility and trust worthiness of qualitative data the researcher will ensure that only students of Kyambogo University are given questionnaires.
3.8 Data Quality control
All questionnaires filled per day will be checked to ensure all the questions are answered appropriately before leaving the study area.
3.9 Data management and analysis
Data will be entered into computer software, cleaned, sorted, coded and all errors will be corrected using original data collection tool. Raw data will be computed to nutritional status indices of BMI, WHR and MUAC. Statistical analysis will be conducted using SPSS version 21.. Dietary patterns will be determine using kappa concordance coefficient and be stratified by sex. Correlations between dietary scores at the different time points will be estimated using Spearman’s correlation, and the changes in dietary pattern scores within an individual will be assessed using the paired t test. In case of establishing the effect of the variables like effect of dietary patterns, food choices on the nutritional status over time of university students, Pearson correlation will be used to provide an in-depth analysis of the variables, the P-value will also be carried out in proving the hypothesis of the study.
3.10 Ethical consideration
This study is part of the ongoing study entitled “Dietary patterns, physical activity and body composition changes of Kyambogo University students during the academic semester Progression”. This study will be approved by Graduate school and Uganda National Council for Higher Education and a letter of Approval to conduct the research will be obtained from Graduate school Kyambogo University. Written informed consent for the participation in the study will be obtained from the participants at the time of follow –up. Information collected will be kept securely and confidentiality will be maintained.
