Abstract
Background: According to W.H.O, malnutrition refers to deficiencies, excesses or
imbalances in a person’s intake of energy and/or nutrients.

Malnutrition is the underlying cause of more than 45% mortality in children under 5 in sub-Saharan Africa. Sub-Saharan Africa is one of the most affected regions by malnutrition with 31.2% of children under 5 years of age suffering from stunting, 5.2% of overweight and 7.4% of wasting, a third of all deaths among children under 5 years in resource limited settings.
Objectives: The main objective of this study was to assess the nutritional status of children between 6 months to 5 years seeking health care in some major facilities in Buea.
Methods: The study was an analytical cross-sectional study.

Well-structured questionnaires were used to collect socio-demographic, and anthropometric data from participants.

Data was analyzed using SPSS version 25.
Results: The overall prevalence of malnutrition in the study population was 48.9% (138/282). Most of the children were stunted (35.5%, 181/282) followed by wasting (14.5% (67/282), and underweight (8.9 %, 25/282).

Malnutrition was higher among children whose mothers were less than 25 years of age (58.1%).
Children from single parents also had a significantly higher prevalence of malnutrition (62.8%) and children from parents with primary level of education had the highest level of malnutrition (64.1%).

The overall prevalence of anemia in the study population was 60.3%.

In addition, the prevalence of underweight was significantly lower (P = 0.035) among anaemic children (11.8%) when compared with non-anemic children (4.5%).
CHAPTER ONE
INTRODUCTION
1.1 Background
According to W.H.O, malnutrition refers to deficiencies, excesses or imbalances in a person’s intake of energy and/or nutrients.

The term malnutrition can be grouped into two. One is ‘under nutrition’ which includes stunting (low height for age), wasting (low weight for height), underweight (low weight for age) and micronutrient deficiencies or insufficiencies (a lack of important vitamins and minerals).

The other is ‘overweight’, obesity and diet-related non communicable diseases (such as heart disease, stroke, diabetes and cancer).
Focusing on under nutrition, many factors can cause malnutrition, most of which relate to poor diet, conflict, and severe or repeated infections particularly in underprivileged populations [1].

There are 4 broad sub-forms of under nutrition: wasting, stunting, underweight, and deficiencies in vitamins and minerals.

Under nutrition makes children in particular much more vulnerable to disease and death.
Low weight for height is known as wasting: It usually indicates recent and severe weight loss, because a person has not had enough food to eat and/or they might have had an infectious disease, which could be diarrhea, causing them to lose weight.

A young child who is moderately or severely wasted has an increased risk of death, though treatment is possible.
Low height for age is known as stunting: It is the result of chronic or recurrent under nutrition, usually associated with poor socioeconomic conditions, poor maternal health and nutrition, frequent illness, and/or inappropriate infant and young child feeding and care in early life.

Stunting holds children back from reaching their physical and cognitive potential.

Low weight for age is known as underweight: A child who is underweight may be stunted, wasted, or both.
Inadequacies/deficiencies in intake of vitamins and minerals, often referred to as micronutrients, can also be grouped together.

Micronutrients enable the body to produce enzymes, hormones, and other substances that are essential for proper growth and development.
Overweight and obesity is when a person is too heavy for his or her height. Abnormal or excessive fat accumulation can impair health.

Body mass index (BMI) is an index of weight for height commonly used to classify overweight and obesity.

It is defined as a person’s weight in kilogram divided by the square of his/her height in meters(kg/m2).
Overweight and obesity results from an imbalance between energy consumed (too much) and energy expended (too little).

Malnutrition is the underlying cause of more than 45% of deaths of under 5 children in Sub-Saharan Africa [2,3,4].
Updated anthropometric standards for the evaluation acute malnutrition in children has definitions as;
-Moderate acute malnutrition (MAM) defined by a weight for height Z score between -3 and -2 and
-Mid upper arm circumference (MUAC); between 11.5mm and 12.5mm and
-Severe acute malnutrition (SAM); defined by weight for height Z score less than -3 and MUAC less than 11.5mm [4].
Malnutrition increases a child’s susceptibility to infection while infection aggravates malnutrition by decreasing appetite and inducing catabolism and increasing demands on nutrients thus resulting in a vicious cycle of malnutrition-infection-malnutrition [3,4].

Although it is still debated whether malnutrition increases the incidence of infection or whether it only increases the severity of disease, solid data indicates that malnourished children are at greater risk of dying once infected [3,5].
The increased susceptibility to infection may be due to impaired immune function in malnourished children [3,4,5].

Other factors such as reduced muscle function may impair respiratory function and lead to lung infection while reduced electrolyte absorption from the gut and impaired renal concentration may increase susceptibility to dehydration from diarrhea [3].
1.2. Statement of the problem
According to UNICEF, up to 1.2 million of children are stunted, more than 190,000 children are wasted, 70,000 severely wasted. And also 45% of child deaths are linked to under nutrition.
Malnutrition is the underlying cause of more than 45% mortality in children under 5 in sub-Saharan Africa.

Sub-Saharan Africa is one of the most affected regions by malnutrition with 31.2% of children under 5 years of age suffering from stunting, 5.2% of overweight and 7.4% of wasting.

Severe forms occur in 2.2% of the population according to the UNICEF report of 2015.
According to UNICEF, in Cameroon, 31.5% of children under 5 years of age suffer from stunting, 5.2% from wasting and 14.8% from underweight. Another study by Chiabi et al. (2012) and Sobze et al. (2014) in Cameroon reported respectively that 66.6% and 31.5% of children under 5 years of age were malnourished.

Every year, malnutrition accounts for more than one third of all deaths among children under 5 years in resource-limited-settings.

It therefore increases susceptibility to infections and predisposes to poor physical and cognitive development.
It is therefore important to assess the nutritional status of children under 5 seeking healthcare in the Buea to determine the nutritional status and the health status of children 5 in Buea.
1.3. Scope
In 2016, an estimated 155 million children under the age of 5 years were suffering from stunting, while 41 million were overweight or obese.
Around 45% of deaths among children under 5 years of age are linked to under nutrition.

These mostly occur in low- and middle-income countries.

According to UNICEF in 2019, more than 190,000 children are wasted with 70,000 severely wasted.
Based on the 2013 United Nations Children’s Emergency Fund (UNICEF) report, 38% of children below the age of 5 years suffer from chronic malnutrition or stunting in sub-Saharan Africa, with under nutrition being the major cause of childhood mortality [7].
Anemia has also been reported as a significant determinant of stunting [6], which is the main type of malnutrition in young children [9].

While the global stunting prevalence fell from 39.6 per cent to 23.8 per cent between 1990 and 2014, the scenario is quite different in Africa, with an increase

[8]. The impact of anemia on nutritional status may differ due to the heterogeneity of the population under study.

Hence studies on anemia and malnutrition, as well as identifying the risk factors for these public health concerns among children living in Buea, is necessary.

1.4. Research Question
What is the prevalence of malnutrition among children under 5 seeking healthcare in Buea Regional Hospital and Muea Medical Centre?
Is the nutritional status of children associated to the displacement status of the family (IDP or host families)?
How is anaemia related to malnutrition?
1.5. Hypothesis
The massive displacement of families from their homes in the South West region has led to an increase in the prevalence of malnutrition in children from 6months to 5years in Buea Health District.
1.6. Objectives
1.6.1 General objective:
Assess the nutritional status of children from 6months to 5 years seeking healthcare in Buea.
1.6.2 Specific objectives:
Determine the prevalence of s malnutrition in children from 6 months to 5 years seeking healthcare in Buea.
Determine the background of children most likely to have malnutrition.
Determine an association between anemia and malnutrition