Summary

Introduction
A review of the 2018 Demographic and Health Survey in Cameroon, under-five Cameroonian children were 11% underweight,4% were wasted, and 29% were stunted. In 2015, Cameroon had an estimated under-five mortality rate of 88 per 1 000 live births. The burden of malnutrition in the South West Region of Cameroon is sparse.

Specifically, this study seeks to determine the prevalence of undernutrition in children, determine the prevalence of House Hold Food Insecurity Assess dietary diversity and risk factors associated to undernutrition in Kumba health district.
Methods: This study will be a community based study of 667 under-five children /carers who will be surveyed from their houses using a multistage randomized sampling technique.

The socio-demographic information will be collected using a well-structured questionnaire. Information on food insecurity will be captured using Household Food Insecurity Access Scale and quantified using the Household Food Insecurity Scale Score. A dietary diversity questionnaire will be used capture information on food diversity.

Risk factors of Malnutrition will be obtained using a multivariate logistic regression.
Expected results: We are expecting to see the prevalence of Household Food Insecurity, the prevalence of undernutrition ,determine dietary diversity and the factors associated to undernutrition
Key words: Undernutrition, prevalence, risk factors, Household food insecurity, Dietary diversity, under-five children in Kumba.

CHAPTERONE

1.1 Background of Study

Over the years malnutrition has been a public health problem affecting mainly the low and middle income countries [1] Malnutrition is made up of undernutrition and over nutrition .malnutrition is referred to as undernutrition in most developing countries[2].The sub Saharan region of Africa has still been having prevailing records of child malnutrition ,this can be seen with the increased rates of stunting 39 % ,wasting 10% and underweight 25%[2].In 2006 the World Health Organization(WHO) Child Growth standards determined that  underweight ,stunting and wasting occur in children less than 59 months with a standard deviation below 2 for  height-for-age, weight-for-height and weight-for-age[2].Stunting, wasting, underweight are the indicators of childhood undernutrition. Over the past decade there has been a decrease   prevalence of wasting, stunting though the percentages are still high with 38% stunted and 10 % wasted in under children [2].

 A study carried out in Ethiopia in 2000 shows that 55.7% of Ethiopian children were stunted and by 2011 the figure had decreased to 43.8% and 40% by 2014[2]. The prevalence of overweight was 41% in 2000 and in 2014 it decreased to 25% while wasting was higher than 10% in 2014. 45% of death in under five children is known to be associated to malnutrition [2].

Globally, undernutrition particularly amongst under- five children has been a public health problem, in 2020 about 149.2 million (22%) and 45.4 million (6.7%) under- five children were estimated to be stunted and wasted respectively[3].About 3.1(45%) million death in under-five children is accounted for by undernutrition[3].Undernutrition is known to be prevalent in South-East Asia and Africa, with Africa reported to account for 39.4% stunting ,24.9% underweight and 10.3 % wasted children under 5 years of age[1]. The African continent is known to bear the burden of malnutrition with two out of five (41% or 61.4 million children) stunted children and more than a quarter (27% or 12.1 million children) of all wasted children under-five live in the African continent[3]Suboptimal brain development is associated with poor nutrition which in turn affects the educational performance of children, cognitive development and economic productivity in adulthood[1].

The nutritional status of a child is used to determine the growth of that child. The first 1000days of a child’s life is very important because it is during this time that mental and physical development takes place thus undernutrition during this stage increases the risk of  morbidity and mortality in children[1]. Reports from the sustainable development goals records that one third of global undernourished children are found in Sub-Saharan Africa. This reports shows that malnutrition is still a major public health concern in Africa and needs interventions[1].

In Cameroon  prevalence of childhood stunting and underweight between 1991 and 1998   rose from 23% to 29% and 16% to 23% respectively[3].

In 1990, Cameroon was known to have the highest burden of malnutrition in Africa. In 2018 data from the Demographic and Health Survey in Cameroon ,under –five Cameroonian children were 11% underweight,4% were wasted, and 29% were stunted(3). In 2015, Cameroon had an estimated under-five mortality rate of 88 per 1 000 live births [4].

The rates of undernutrition in under five children have been trending upwards over the past two and half decades .The prevalence of stunting, wasting, and underweight increased from 24.4% to 32%, 3% to 5.2%, and 13.6 % to 14.8%, respectively from 1990 to 2014[5].

Over half a decade now the northwest and southwest region of Cameroon has been faced with socio-political conflicts  and this has affected the population negatively by limiting access to food ,medical care and water and sanitation amenities .The effects of the conflicts has predisposed the vulnerable groups especially under five children to health and nutrition related problems like undernutrition ,anaemia, malaria and diarrhea .Most malnutrition studies available have been carried out in different areas in Cameroon no study has been carried out in the kumba health district area and thus this research aims at determining the prevalence and risk factors of malnutrition in under 5 children in kumba health district

1.2. Problem Statement