ASSESSMENT OF DIETARY PRACTICES AND NUTRITIONAL STATUS OF CHILDREN AGED 8 – 15 YEARS IN ETAM PRIMARY SCHOOL, AMOLATAR DISTRICT

LIST OF ACRONYMS

DLG                District Local Government

EFA                Education for All

GAIN              Global Alliance for Improved Nutrition

ICF                  International Classification of Functioning

KAP                Knowledge, Attitudes and Practices

MGLSD          Ministry of Gender, Labour and Social Development

NDPII             National Development Plan II

UBOS             Uganda Bureau of Statistics

UNICEF         United Nations International Children’s Emergency Fund

USAID           United States Agency for International Development

WASH            Water, Sanitation, and Hygiene

WFP                World Food Programme

WHO              World Health Organization

P.2                    Primary Two

P.7                    Primary Seven

MUAC             Middle Upper Arm Circumference

CHAPTER ONE: INTRODUCTION

1.1 Background

School age is the active growing phase of childhood. Primary school age is a dynamic period of physical growth as well as of mental development of the child (Finkelstein et al., 2015). Research indicates that health problems due to miserable nutritional status in primary school-age children are among the most common causes of low school enrolment, high absenteeism, early dropout and unsatisfactory classroom performance (UNICEF, World Health Organization, and The World Bank, 2018). The present scenario of Health and Nutritional status of the school-age children in India is very unsatisfactory, 53% of children in rural areas are underweight, and this varies across the country. (USAID, 2017).

In developing countries, malnutrition is a significant problem among school-going children. The World Health Organization’s Growth and Assessment Surveillance Unit reported stunting among children 5 to 14 years old in developing countries to be around 28 percent, with Eastern Africa experiencing 45 percent stunting (Chen and Chang 2010). Further, adolescents (ages 10–19) have some of the highest energy, protein, and micronutrient requirements of any age group, so micronutrient deficiencies particularly iron-deficiency anemia during adolescence due to poor diet can adversely affect health and productivity in adult life (WHO, 2018). Anemia, specifically, has been shown to diminish cognitive function, motor performance, and educational achievement by reducing overall learning ability and concentration as a result of poor diet (Agaba et al., 2016).

Of the world’s undernourished children, 80% live in 20 countries, Uganda being one of them (Vogt et al., 2016). It is estimated that malnutrition directly and indirectly contributes up to 60% of child mortality, making malnutrition one of the most significant contributors to childhood mortality in most countries (Comandini et al., 2016). Although rich in natural resources, favorable conditions for agriculture, and is realizing steady health, economic and social transformation, Uganda is still deeply affected by malnutrition, poor access to health care, poverty, and disease (Government of Uganda, 2011; UBOS and ICF, 2018; Vogt et al., 2016). According to the 2016 Uganda Demographic and Health Survey (UBOS and ICF, 2018), 28.9% of children under five are stunted, 3.5% are wasted, 10.5% are underweight, and 3.7% are overweight (based on weight for height). Further, a substantial percentage (14%) of Ugandan children is orphans, thus stretching the Ugandan child protection structures and hindering the improvement of children’s nutritional status (MGLSD, 2004; Vogt et al., 2016).

Improving the nutritional quality of meals served to school-age children has the potential to reduce anemia and under nutrition, and to support cognitive function (Chen and Chang 2010; Bellisle, 2004). School children and adolescents’ dietary intake in Eastern Africa and developing countries is generally limited in diversity and mainly comprises plant-based food sources. A review showed that providing food supplements and additional iron improved students’ academic performance notably (Vogt et al., 2016). Furthermore, recent evidence shows potential for “catch up” growth during adolescence for malnutrition experienced during infancy.

While school feeding programs have shown a consistently positive effect on students’ energy, enrollment, and attendance, their effect on growth, cognitive development, and educational achievement has been inconclusive (Jomaa et al., 2011). Studies show that meals served in schools should be of good nutritional quality and accompanied by other public health initiatives like deworming, water, sanitation, and hygiene (WASH), and malaria-control interventions.

Over the last decade, childhood rates of stunting and underweight have declined in Uganda, although 33 percent of children under five years were stunted in 2011 (UBOS, 2012). In 2009, about 7 percent of school repetitions were associated with stunting in childhood and stunted children were expected to attain about 1.2 fewer years of education than their peers who were not stunted (AUC and WFP, 2014). Little data on adolescent nutrition status are available in Uganda but the few studies available indicate that micronutrient deficiencies are a big problem in this cohort of children and young adults. Various studies have reported stunting rates among adolescents in Uganda between 19 to 36 percent, (Lwanga et al., 2015; Brown and Kern, 2015) and anemia rates between 38 and 46 percent (Turyashemererwa et al., 2013; Barugahara, Kikafunda, and Gakenia 2013).

In Uganda today, free access to primary education has increased to over 7.3 million with the girl-child being the greatest beneficiary. Completion rates have also increased from more than 49.1% in 2012 to more than 62% (2014) (UBOS, 2015). However, limited information on nutrition and dietary practices is available on this age group despite the reported massive enrolments. In northern Uganda most of the primary school children majorly those in the rural areas mostly have one meal per day some of very poor diet. It is, therefore, important that data on dietary practices and nutritional status of this age group are documented, in order to create awareness to education and health planners, who can use this information to plan for these children so as to enable them get a better future as they engage in their learning. Thus, this study will assess the dietary practices and nutritional status of children aged 8 – 15 years in Etam Primary School, Amolatar District.

1.2 Statement of the problem

School-age children (ages 8 to 15) need healthy foods and nutritious snacks. They have a steady but slow rate of growth and usually eat 4 to 5 times a day (with snacks). Many food habits, likes, and dislikes are set during this time. Family, friends, and the media (chiefly TV) effect their food choices and eating habits. School-age children are often willing to eat a wider variety of foods than their younger siblings. Eating healthy after-school snacks is important, too, as these snacks may contribute up to one-fourth of the total calorie intake for the day. School-age children can also help with meal prep according to MyPlate icon (Dietary Guidelines for Americans 2015–2020).

The MyPlate icon is divided into 5 food group categories, emphasizing the nutritional intake of the following:

Grains. Foods that are made from wheat, rice, oats, cornmeal, barley, or another cereal grain are grain products. Examples include whole-wheat, brown rice, and oatmeal. Aim for mostly whole-grains.

Vegetables. Vary your vegetables. Choose a variety of colorful vegetables, including dark green, red, and orange vegetables, legumes (peas and beans), and starchy vegetables.

Fruits. Any fruit or 100% fruit juice counts as part of the fruit group. Fruits may be fresh, canned, frozen, or dried, and may be whole, cut up, or pureed. The American Academy of Pediatrics recommends children age 7 to 18 should limit juice to 8 ounces or 1 cup of juice per day.

Dairy. Milk products and many foods made from milk are considered part of this food group. Focus on fat-free or low-fat products, as well as those that are high in calcium.

Protein. Choose low-fat or lean meats and poultry. Vary your protein routine. Choose more fish, nuts, seeds, peas, and beans.

Oils are not a food group, yet some, like nut oils, have vital nutrients and can be included in the diet. Animal fats are solid fats and should be avoided.

Exercise and everyday physical activity should also be included with a healthy dietary plan.

In Uganda, scholars have estimated the prevalence rate of stunting among children under the age of 5 years old to be between 30-39.9% (Acham et al., 2012) with some estimates over 45% (Biondi et al., 2010) depending on the region. In 2006, USAID estimated the prevalence rate of wasting and underweight (both indicators of malnutrition) in Uganda to be 6% and 16% respectively. In addition to stunting, wasting, and underweight indicators, Uganda also has a high prevalence of micronutrient deficits, specifically Vitamin A and Iron deficiencies (Acham et al., 2012). Vitamin A deficiencies alone will result in over 160,000 child deaths from 2006-2015, according to USAID

(2017).

For the first time in 20 years, UNICEF’s annual State of the World’s Children report is focusing on nutrition, one of the most critical, if underappreciated, drivers of brain and body development in children. While 80% are iron-deficient and 38% have anemia, according to research compiled by Richard Bukenya, a Ugandan scholar in the Borlaug Higher Education for Agricultural Research and Development (BHEARD) program. Since nearly eight million (8 million) 8- to 15-year-old Ugandans, a quarter of the country’s population, are enrolled in primary education, schools are an ideal place for nutrition interventions.

The prevalence of malnutrition throughout Uganda is a public health concern. Scholars attribute 60% of all deaths of children less than 5 years of age in Uganda either directly or indirectly to malnutrition (Francis et al., 2012). Studies conducted on nutrition status and dietary practices have focused mainly on children who are below the age of 5 years and there is paucity of data on school-age children between 8-15 years old in the study area which this study is intended to address. A significant literature gaps exist with regards to measuring school-age children’s’ malnutrition levels. A study estimates that 10%, 9%, and 13% of the school-age children in Uganda are underweight, thin, and stunted, respectively (WHO, 2012). In Amolatar District, the district statistics reveal that more than 22% of school-age children (10 – 15 years of age) were stunted, 5% were underweight, and approximately 19% suffered moderate acute malnutrition (Amolatar DLG, 2017).

1.3 Objectives

1.3.1 Main Objective

To assess the dietary practices and nutritional status of children aged 8 – 15 years in Etam Primary School, Amolatar District.

1.3.2 Specific Objectives

• To determine the dietary practices of primary school children aged 8 – 15 years.
• To establish nutritional status of selected respondents.
• To provide appropriate recommendations based on study findings.

1.4 Research Questions

• What are the dietary practices of primary school children age 8 – 15 years?
• What is the nutritional status of selected respondents?
• What is the implication of the relationship between nutrition status and dietary practices for this study?

1.5 Indicators

Weight, height, Mid-Upper Arm Circumference (MAUC) scores, food records and 24‐hour recalls of primary school children aged 8 – 15 years will be the indicators of this study.

1.6 Justifications

Stunting and wasting are wide spread among school age children in Northern Uganda. High levels of stunting among children suggest that there will also be a long term deficit in mental and physical development that leaves children unable to take maximum advantage of learning opportunities in schools (Agaba et al., 2016). Malnutrition is usually the result of a combination of inadequate dietary intake and infection. In children, malnutrition is synonymous with growth failure, mental retardation and impaired weak immune system to avert common illness. Malnourished children are shorter and lighter in weight than they should be for their age thus need for study on dietary practices and nutritional status of children aged 8 – 15 years.

1.7 Significance of the study

• The completion of this study will enable me fulfil a partial requirement to be awarded with a Degree of Bachelor of Vocational Studies in Home Economies of Kyambogo University since it is a requirement.
• The study will enable me acquire necessary skills of carrying out research and even writing research reports in addition to a deeper insight on dietary practices and nutritional status of children aged 8 – 15 years.

• The findings of this study are intended to benefit parents of Primary school children, particularly when making informed decisions on dietary practice for their children.

• The findings will be disseminated to the Department of Nutrition, Amolatar District Local Government to provide current existing nutrition status and dietary practices in the area. This will help to guide better implement of nutrition programs by the Local Government

CHAPTER TWO: LITERATURE REVIEW

This chapter presents the view and ideas of different scholars on the dietary practices and nutritional status of children aged 8 – 15 years. The literature is reviewed according to objectives of the study.

2.1 Dietary practices of primary school children aged 8 – 15 years

School-age children and adolescents have an increased need for nutrients. This dynamic period of growth and development forms a foundation for good adult health as children go through physical, emotional and social changes (Turyashemererwa et al., 2013). The health, physical growth, development and educational performance of school children aged 5 – 15 years depend largely on good dietary practices. Children with poor dietary practices are prone to poor health because of the synergism between malnutrition and infections (Turyashemererwa et al., 2013).

Dietary practices influences cognitive messages. There is scant research available on dietary intake of adolescents in developing countries. Snacking, skipping meals and intake of junk foods are common features of the diet of adolescents in developed countries, where most of the studies have been conducted. Some of these eating habits are increasingly being observed in developing countries (Goyle and Prakash, et al., 2011). This study will focus on assessing dietary practices of primary school children aged 8 – 15 years in Amolatar District with particular focus in Etam Primary School, this will help to draw solutions on the poor dietary practices by parents and even schools.

The assessment of dietary and nutrient intake is one of the most widely used indirect methods of establishing nutritional status. Estimating the true dietary and nutrient intake is extremely difficult. The main limitations of the common methods of assessing dietary intake centre on the accuracy of the data obtained by such methods in estimating an individual’s usual dietary intake (Onwuamaeze et al., 2017).

Childhood and adolescence are critical stages offering a window of opportunity for interventions to inculcate healthy eating habits to mitigate the occurrence of diet-related chronic diseases in later life associated with poor eating habits in earlier life (Motee et al., 2013). A discussion of the dietary intake of schoolchildren and adolescents in developing countries is suitable to point out data that are available for the formulation of food-based dietary models and guidelines to establish healthy dietary habits in these critical population groups (Turyashemererwa et al., 2013).

Indicators of educational performance show that Uganda has done remarkably well on education access related targets since the introduction of universal primary education (UPE) in 1997 (Finkelstein et al., 2015). There are currently over eight million children attending primary school, and the government requires that the parents and caretakers of these children take responsibility for feeding their children while at school. Many parents, however, particularly in the rural areas, cannot afford to pay even the minimal cost of a daily meal of maize porridge. Several factors including food insecurity, poverty, distance between home and school and lack of commitment make the parents involved unable to provide meals for their children (Mugabi, et al., 2012), which is a cause of irregular school attendance, particularly in rural areas.

Most pupils are unable to take a packed lunch and travel long distances to attend school; and those who stay on at school forge lunch. A participatory poverty assessment survey conducted in Uganda identified hunger and poor dietary practices as key causes of absenteeism and drop-out from school (Comandini et al., 2016). To alleviate this problem, interventions in the education sector, such as a national school feeding programme, is needed not only to help the disadvantaged children to access education but also to uplift educational standards, improve nutritional status, and in turn contribute to the realization of the Education for All (EFA) goals and the Millennium Development Goal 2, of ensuring that by 2015 all children, including Ugandan children, boys and girls alike, are able to complete a full course of primary schooling (Onwuamaeze et al., 2017).

2.2 Nutritional status of primary school children aged 8 – 15 years

Children of primary school age are responsive to health messages and behaviour changes which may be maintained into adolescence and adulthood. For this reason, nutrition interventions targeted at this age group are most likely to have long-term positive effects such as improved nutrition-related practices; reduced nutrition-related problems such as obesity, being overweight, under-nutrition; and nutrition-related chronic diseases. It is essential to assess children’s own nutrition knowledge, attitudes and practices (KAP) in order to plan meaningful nutrition interventions that will address gaps as well as factors that influence these aspects (Onwuamaeze et al., 2017).

An increasing prevalence of overweight and obese children in primary schools has been observed

Worldwide, including South Africa. Although it is highly prevalent in children from urban areas, this is also an increasing trend in children from the rural areas (Abrahams et al., 2011). According to Reddy et al. (2008) the national prevalence of overweight children is at 17% and obesity is at 5% among South African school children. Several factors contribute to being overweight and obese including dietary intake, urbanization, industrialization and socioeconomic status of the family. In most cases, dietary intake is directly linked to being overweight and obese among school children (Black et al., 2013) and, according to Sahota et al., dietary intake is greatly influenced by nutrition KAP. Stein et al. (2009) states that poor dietary behaviour, referring to high intake of unhealthy snacks, is a high-risk factor for the development of being overweight and obese in South African school children.

On the other hand, under-nutrition is also prevalent in some parts of South Africa. Stunting is the most prevalent form of under-nutrition, followed by being underweight and then wasting. The national prevalence of stunting among school children is at 13%; underweight at 8% and wasting at 4% (Black et al., 2013). While poverty is directly associated with stunting in South Africa it has also been reported that parents’ inadequate nutrition knowledge, children’s poor nutrition practices and infections contribute to the rate of stunting (Motee et al., 2013).

Nutrition is a vital component of health promotion and disease prevention (Mowe, Bosaeus, and Højgaard, 2008). The impacts of nutrition on health throughout the course of human life are very profound and are inextricably linked to cognitive and social development, more so in early childhood (Black et al., 2013). The major effects of under nutrition are believed to occur during the first 2 years of human life. This is because, at this stage, under nutrition causes irreversible damage to physical, mental, and social development of the child transcending into reduced intellectual potential at adulthood (Motee et al., 2013; Semahegn, Tesfaye and Bogale, 2014; WHO, 2010b). Despite the well-recognized importance of proper child nutrition to health well-being and human capital development, child under nutrition has remained one of the main public health problems in developing countries (Semahegn et al., 2014).

Nutritional knowledge, attitude, and practices of caregivers are critical elements that determine the outcomes of complementary feeding regime administered to children (Saha et al., 2008;

Turyashemererwa, 2009). It is classically believed that good knowledge should be associated with good attitude and proper nutritional practices (Azizi et al., 2011; Mowe et al., 2008). However, in some situations, good knowledge and attitude do not necessarily translate into good practices (Bukusuba, Kikafunda, and Whitehead, 2010). Nonetheless, in order to achieve proper outcome of complementary feeding, it is essential that nutritional knowledge, attitude, and practices should be appropriate. In the context of this study, knowledge is defined as the caregiver’s understanding of complementary feeding and nutrition, including the ability to remember and recall food, nutrition and specific pieces of information, and facts essential to complementary feeding.

Underachievement at school or failure to reach a satisfactory level of literacy and numeracy is a global problem, particularly in developing countries. The numerous causes of underachievement include the poor quality of teaching, the unavailability of text books, parental resistance to formal education and low attendance rates in the classroom. Nutrition, or the lack of it, has recently been recognized as an important additional factor because studies have identified under nutrition with poor school achievement (Rao et al., 2011).

School aged children deficient in iodine, for example, perform worse on intelligence and other tests of learning capacity than iodine replete children. Iron deficiency in school children reduces some aspects of their ability to learn and providing iron improves these capacities. Hook worm infection, one cause of iron deficiency anemia and malnutrition, is also linked to diminished learning capacity. A school feeding programme in Kenya found improvements in attendance as a result of the intervention of a cup of porridge for breakfast. School participation was 27.4% where meals were not provided and 35.9% where they were, an improvement in attendance of about one-third (Bukusuba, Kikafunda, and Whitehead, et al., 2010). The higher participation was believed to have resulted both from the attraction of new children to the school and by the greater attendance of children already enrolled.

2.3 Appropriate recommendation on dietary and nutritional practices of primary school children aged 8 – 15 years

Uganda’s policy and legislative environment promotes fortified foods in schools. School feeding is mentioned in a number of policy documents including the National Development Plan II (NDPII), Vision 2040, and the Education Act of 2008 (Barugahara, Kikafunda, and Gakenia, 2013). In NDPII, poor feeding of school children is stated as a major constraint on the quality of education at all levels. The Education Act of 2008 places the feeding of children in school as a role of parents and communities, who with the school determine the format of the feeding (Mugabi, 2012).

In 2013, the Ministry of Education and Sports (MOES) produced the Guidelines on School Feeding and Nutrition Interventions with clear direction on how to increase access to parent-led school feeding and improve food diversity by procurement and consumption of various nutritious foods, including fortified foods (Brown, Erika and Mark, et al., 2015). The 2013 Guidelines also recommend that schools implement complementary interventions like deworming and prevention of illnesses through WASH.

Maize flour is the main ingredient of most meals made in schools, however, the typical maize meal used in posho loses most of its vitamins and minerals during the milling process (WFP, 2013). In 2011, Uganda mandated fortification with folic acid or iron for multiple food vehicles for millers that have an installed production capacity of 20 metric tons or more per day. But a Fortification Assessment Coverage Tool study reported that only 6.5 percent of households consumed fortified maize flour (GAIN, 2015). Improving access to fortified food in school meals could mitigate various micronutrient deficiencies and have a positive effect on learning (Miglioranza et al., 2008; Finkelstein et al., 2015; Goyle and Prakash, 2011; Best et al., 2011).

From August–September, 2017, the Strengthening Partnerships, Results, and Innovations in Nutrition Globally (SPRING) project conducted mixed-methods research to explore the dynamics of teenage students’ diets in four sub-regions of Uganda, and the potential for using micronutrient-fortified foods, in particular maize four, in boarding schools that already provide at least two meals per day to children. Since boarding schools uniformly provide meals to their students, they are an easy entry point to reaching schoolchildren in Uganda. Absent large-scale iron supplementation and deworming interventions through schools, increased consumption of fortified maize flour would be the most cost-effective way to increase micronutrient intake and reduce widespread iron deficiency (WHO, 2018).

An appropriate diet is critical especially in the first 2 years of a child’s life (Rao, Swathi, Unnikrishnan, and Hegde, 2011). This period is considered the most crucial time due to the increased nutritional needs to support rapid growth and development (Semahegn et al., 2014). Infants and young children in developing countries are at an increased risk of under nutrition from 6 months of age onwards when complementary foods are introduced (Memon, Shaikh, Kousar, and Rubina, 2010; Muhimbula and Issa-zacharia, 2010; Rao et al., 2011). The susceptibility of young children to under nutrition becomes apparent if complementary foods are of low nutrient density and bioavailability (WHO, 2013). On the other hand, if complementary feeding is not carried out properly, it can lead to problems such as diarrhea, growth retardation leading to kwashiorkor, marasmus, and immunodeficiency marked by recurrent and persistent infections which may be fatal (Rao et al., 2011).

CHAPTER THREE: METHODOLOGY

3.1 Research Design

The study will use cross sectional design involving both quantitative and qualitative methods of data collection. This design takes a ‘slice’ of target population and bases its overall finding on the views or behaviours of those targeted, assuming them to be typical of the whole population.

3.2 Study Area

The study will be carried out in Etam Primary School located in Amolatar District. The district is located in Northern Uganda and is bordered by the districts of Dokolo in the North-East, Kaberamaido in the East, Kayunga, Kamuli and Nakasongola in the South; and Apac in the North-West. The district lies between: Latitudes 1o 21’N, 2o 42”N, Longitudes 320 51”E, 34015”E. Poverty levels are high in Amolatar; over 67% of the populations are living below the poverty line, (hard core poor). Average household income is Ush. 170,000= per annum. The main sources of household livelihood in Amolatar are subsistence farming, fishing, petty trading, formal trading, employment income and family support (UBOS, 2017). This area is characterized by malnourished children (Amolatar DLG, 2017).

3.3 Target Population

The target population will be students of Etam Primary School in Amolatar district. This school is a mixed day and boarding primary school offering subjects such as Mathematics, Social studies, English, Science among others.

3.4 Sample size determination

On the assumption that the total population of pupils in primary seven and primary two within Etam Primary school is 160, the sample size will be calculated using Krejcie and Morgan formula of determining sample size (Krejcie and Morgan, 1970. Determining Sample Size for Research Activities. Educational and Psychological Measurement, 30, 607-610) which gives a sample size of 113 respondents at 95% confidence interval.

That is; s = X²NP (1-P) d² (N-1) + X² P (1-P)

Where; s= required sample size

X² = the table value of chi-square for 1 degree of freedom at the desired confidence level

(1.96 x 1.96 =3.8416)

N = the population size.

P = the population proportion (assumed to be .50 since this would provide the maximum sample size).

d = the degree of accuracy expressed as a proportion (.05).

3.5 Sampling techniques

Simple random sampling technique will be adopted and used for this study. Using a class registers of Primary seven (P.7) and Primary Two (P.2) as a sampling frame, computer generated random numbers shall assigned to select the required number respondents for the study. 56 respondents will be selected from P.2 and 57 respondents from Primary seven (P.7)

3.6 Sample Population.

The study will consider boys and girls of school going age in the range of 8 – 15 years who are physically fit not disabled in Etam Primary School. Most of the children within Primary two and primary seven in Etam Primary School are aged between 8 –to 15 years (Amolatar DLG, 2016) For purposes of achieving a better age range (8-15 years) students of Primary two (P.2 ) and Primary seven (P.7) only will be considered for the study.

3.7 Data collection methods

3.7.1 Quantitative data collection

3.7.1.1 Assessment of dietary practices of target population

The dietary practices of respondents will be determined in particular using a semi-structured closed ended food frequency questionnaire to capture an individual’s usual food consumption by querying the frequency at which the respondent consumed food items based on a predefined food list to elucidate frequency of food consumption a particular food group by a student. The questionnaire will be administered to the responded and respective views will be captured and recorded after receiving the respondent’s consent. The questionnaire will be arranged on a 5 – point alikert scale, consisting of mainly closed items to facilitate quick data collection and analysis, questionnaire will be self-administered.

3.7.1.2 Assessment of nutrition status of respondents

The nutrition status of respondents will be established by taking measurements of children’s weight using an adult weighing scale and a hanging scale will be used for minor cases of students who will not be able to stand, such as those who will be sick.  Levels of malnutrition will be assessed using a range of Mid-Upper Arm Circumference (MUAC) measuring tape to measure the upper arm circumference of respondents. Using this tool, the child will not be wearing any clothing on his or her left arm, the child will stand straight and sideways to the researcher. The child’s left arm will be bended at 90 degrees to the body. The mid-point of the upper arm (The mid-point is between the tip of the shoulder and the elbow) will be identified and marked with a pen. Then the child will be asked to relax the arm so it hangs by his or her side. Using both hands, MUAC tape window (0 cm) will be placed on the mid-point. While keeping the left hand steady, MUAC tape will be wrapped around the outside of the arm with the right hand. Then the MUAC tape will be fed through the hole in the tape while keeping the right hand planted on the arm. Pulling the tape until it fits securely around the arm while keeping the right hand steady on the child’s arm. The measurement in the window of the MUAC tape will be read and recorded at to the nearest millimeter (mm)

In order to determine the weight of the individual, the weighing scale will be hanged up where the children can reach, after adjusting the pointer of the scale to zero level, the child will be asked to take off heavy clothes and shoes. Then the child will be asked to hang freely on the weighing scale and the kilo grams (kg) will be recorded the child will be removed slowly and safely.

In order to determine the height of the individual, the measuring board will be set vertically on a stable level surface, child’s shoes and any head-covering will be removed then the child will be placed on the measuring board, standing upright in the middle of the board. The child’s heels and knees will be ensured that is firmly pressed against the board by the assistant of the researcher while the researcher positions the head and the cursor. The child’s head, shoulders, buttocks, knees and heels will be touching the board. The measurement will be read to the nearest 0.1cm and record and the measurement will be repeated to make sure it has been correctly measured.

3.7.2 Qualitative data collection

A 24-Hours (24HR) dietary recalls structured interviews will be used to increase the precision of estimation of usual dietary intakes 24 hours while looking at dietary practices of the selected respondents.

First an interview guide will be developed so that a set of same questions are asked in the same manner.

Secondly an ethical guide to keep my participants at ease and maintain trust of the safety of the information provided

A leading question set to direct participants basically to get a right answer as the question links to the research question.

With the guide and other logistics set, participants are recruited ready to start interviews

Using this method, a face to face interview with each individual respondent at a time will be conducted which will take approximately a duration of 15 to 20 minutes. The respondents will be asked to recall and mention the foods eaten in the past 24 hours and this will be captured and recorded

3.7 Data collection tools       

3.7.1 Questionnaire

A semi-structured closed ended questionnaire will be employed in quantitative data collection. Before administering the tool, it will be pre-tested, standardized and validated. Questionnaires will be administered to children in upper primary such that first-hand information can easily be got and this will help to avoid any form of bias in the case of any.

3.7.2 Middle Upper Arm Circumference (MUAC) tape

A tape will be used to measure the upper arm circumference of children to help identify malnutrition.

The MUAC tape has three colours of identifying malnutrition namely green, yellow and red

• Green represents normal
• Yellow represents Moderate malnutrition
• Red represents acute malnutrition

3.7.3 Weighing scale

Standard weighing scale, hanging and adult will be well calibrated to start at zero and reading taken in kilogram units. They will be validated and tested okay before data collection in the field.

3.7.4 Height board

A height board will be used to measure child’s height. Before measuring the height of the individual, it will be tested and standardized to give accurate results.

3.7.5 Structured interviews

The tool will be pretested and standardized before actual data collection in the field.

3.8 Data analysis

3.8.1 Quantitative data

The raw data from the questionnaires will be coded cleaned, sorted and then exported into SPSS (Version 20) data analysis package which will be analyzed quantitatively using descriptive statistics like frequency counts and then presented in comprehensive tables and charts showing the responses.

3.8.2 Qualitative data

All collected data will be sorted by checking for any errors, grouped into themes and analyzed as postulated in the research objectives. Patterns and connections within and between categories will be identified and data will be interpreted by composing explanations and substantiating them using the respondents’ open responses.

3.9 Ethical consideration

After the approval of the proposal, an introductory letter will be acquired from the research coordinator of Department of Department of Human Nutrition And Home Economics for introduction to Etam Primary School administration. Permission then will be sought to carry out the study from the school. The tools will then be administered to the respondents. But before the interviews and administration of the questionnaires to the respondents is carried out, the researcher will ask for verbal permission from the respondents whether he/she is willing to be one of the respondents. The respondents will be assured that the information they give will be kept confidential and it is purely for academic purpose. The respondents will be told to sign consent form prior to their involvement in the study.

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APPENDICES

Appendix I: Work-Plan

Appendix II: Estimated Budget

Appendix III: Consent Form

Dear respondent,

RE: ASSESSMENT OF DIETARY PRACTICES AND NUTRITIONAL STATUS OF CHILDREN AGED 8 – 15 YEARS IN ETAM PRIMARY SCHOOL, AMOLATAR DISTRICT

I am, Angom Mercy a third year student of Kyambogo. As part of my course I am undertaking a study on dietary practices and nutritional status of children aged 8 – 15 years. This study seeks to assess dietary practices and nutritional status of children aged 8 – 15 years in Etam Primary School, Amolatar District. You have been identified as one of the respondent who can give the study information through filling this questionnaire. The questionnaire focuses on dietary practices and nutritional status of children aged 8 – 15 years. You will take your time in answering the questionnaire and you are free to withdraw during the study. There is no any benefit like monetary benefits from you participating in the study it is voluntarily.

I am, therefore humbly request you to spare some of your time and complete the questionnaire. The response obtained will be treated with utmost confidentiality and it’s purely for academic purpose. Your assistance is highly appreciated.

Yours faithfully,

……………………………………….

Angom Mercy

I ……………………………………. have understood the purpose of the study and I hereby consent to participate.

……………………………………………                                        …………………………..

Date                                                                                                                 Sign

Appendix IV: Questionnaires

Section A: Demographic Data

1) What is your gender?

Male              female

2) What is your age group?

8 to 10                        11 to 13                          13 to 15

3) What is your religion?

Anglican              Muslim          catholic                Adventists

Others ………………………………………………….

4) Where do you breakfast and lunch from when at school?

Dining hall             canteen            restaurant                   home

 Section B: Dietary Practices

1) Are you usually influenced by your peers in what you eat?

Yes                                  No

2) Do food advertisements on media influence what you eat?

Yes                             No

3) Do you prepare some meals for yourself in a day?

Yes                              No

4) Does your body size influence how much you eat and what you eat?

Yes   No

5) Do you find it trendy to eat snacks other than regular meals?

Yes                       No

6) How often do you take snacks?

More than 7times a week                2-6 times a week                  once a week

7) What is your favorite food?

Millet bread          posho           cassava         beans             meat              chicken

8) What do you think about your favorite food?

Healthy           unhealthy               don’t know             others (please specify)……………………

Section C: Anthropometry.

Height……………cm

Weight ………….kg

Arm length ……….cm

Section D:  Nutritional status

• What is the level of education of your parents?

Primary                        secondary                                tertiary                         university

• What is your parents’ occupation?

Mother   …………………………………     Father ………………………………….

• What is the minimum monthly income your parents get?

……………………………………………………………….

• How many are you in your family?

……………………………………………………………….

• How many times do you eat at home

Once                    twice                           thrice                           four times

• Which kind food do you usually eat at home

…………………………………………………..

Section D:  Food Frequency Questionnaire

Please estimate your average food use as best as you can, and please answer every question, do not leave any lines blank. PLEASE PUT A TICK (     ) EVERY LINE

Section D:  24-hour food recall

Please estimate your average food use as best as you can, and please answer every question, do not leave any lines blank. PLEASE PUT A TICK (     ) EVERY LINE