1. family and parenting
2. babies and toddlers

The Prevalence Rate and Determinant Factors of Protein
Energy Malnutrition among Children (Age 6 to 59 Months) in
Sinkat Locality, Red Sea State
Tahani Babiker Mohammed*
Abstract:
This a cross – sectional descriptive study was conducted in Sinkat locality,
Red Sea State during the period 2010 – 2012 to measure the prevalence rate
and to assess the determinant factors of protein energy malnutrition (PEM).
The sample of 768 child was selected using stratified sample techniques
and data were collected by questionnaire, anthropometric measurement
particularly weight for height and using WHO classification (85 – 80% mild,
79%- – 70 moderate and less the 70% are severe PEM and also data collected
by observation check list. The statistical package for social science was used
to analyzed the data. The study revealed that the prevalence rate was 62.7%
and there is significant association between PEM and some variables such as
age , mother educational level and family income. The study recommended
to state ministry of health to plan and implement nutritional program in
coordinated with NGOs, local community and the state government.
* Faculty of Medicine, Red Sea University, Sudan.
Red Sea University Journal, Refereed scientific biannual journal
Vol.(4) December -2013
7
The prevalence rate and determinant factors of Protein Energy Malnutrition
Among children age 6 to 59 months In Sinkat locality, Red Sea State
Introduction
36 – 37.2 East, with an altitude of 800
meters above sea level.
Pastoralism as the main economic
activity is a result of the nature of the
natural environment and the people
practice rainfed cultivation and they
grow sorghum which constitutes
their main staple food in the form of
thick porridge «assida» with milk.
According to the census of 2008, the
total population in Sinkat locality
was 172883 persons.
Sample size :
Was calculated by using a sample
formula
N = n2pq × def
d2
Where: N= sample size, Z: the
standard normal deviation (1.96)
which corresponds to the level of
the 95% confidence level, P : the
prevalence rate of (PEM) in Sinkat
locality (47.4%) (0.474), q : 1 – P
(0.526), d: the degree of accuracy
desired (0.05), def : design defect
= 2, according to above formula the
sample size was 768 child.
Materials and Methods
Study design
Sample technique
Nutrition status is often a result of
interrelated factors and is influenced
by the adequacy of food intake both in
terms of quantity and quality and also
by the physical health of the individual
(Park, 2007). Food scarcity and famines
tend to be the causes of growth failure
in children as a result of protein energy
malnutrition (UNICEF, 2002).
In 2009 the state ministry of health and
UNICEF jointly adopted a survey in Red
Sea State to assessment the nutritional
status and food security, the result revealed
that 17.8% and 4.4% were severely and
moderately protein energy malnutrition
consecutively (SMOH, 2009).
The continuous assessment of
nutritional status is very essential to
update data for decision makers and
program manager in the state. The
objectives of this study is to measure
the prevalence rate, to assess the
severity and types of PEM and
identified the association between
PEM and underlying causes affecting
the nutrition status.
Across– sectional , community based
descriptive study.
Study area:
The locality is bordered by Nile state
in the North,Gadami station in rail way
to the south, El Auleib locality to the
West and suakein & Toukar locality to
the East. It lies between the latitudes
18 . 3o – 19.1o North and longitudes
8
Tahani Babiker Mohammed
It was stratified random sample.
Population was divided into two strata
(urban 4266) and (Rural, 4262). The
sample was drown proportional of
population: Urban (384) Rural (384). The
Urban sample was drown from Sinkat
and Jabet twons proportional (220) (164)
consecutively – for rural villages 16 were
randomly selected,and from each village,
a sample of 24 houses was drawn.
Red Sea University Journal, Refereed scientific biannual journal
Vol.(4) December - 2013
The prevalence rate and determinant factors of Protein Energy Malnutrition
Among children age 6 to 59 months In Sinkat locality, Red Sea State
Data collection
The data were collected by using
questionnaire designed to obtain the
socio – economic data and knowledge,
practices of mothers regard the child
nutrition, also data were collected by
observation check list to gain information
about the housing conditions , sources of
water supply and solid waste and human
excreta disposal.
Also data collected by anthropometric
Tahani Babiker Mohammed
measurement using hanging scale and
portable measuring board to determine
weight and height.
Data analysis
Data on all components of questionnaire
were entered and analyzed using (SPSS)
software version 10. Descriptive
association statistics was performed
using x2 (chi square) test.
Results
Figure: (1) the prevalence rate of different grades of PEM.
n = 768
Red Sea University Journal, Refereed scientific biannual journal
Vol.(4) December -2013
9
The prevalence rate and determinant factors of Protein Energy Malnutrition
Among children age 6 to 59 months In Sinkat locality, Red Sea State
Tahani Babiker Mohammed
Figure (2): Distribution of the children aged 6 to 59 months according to the
types of severity.
n = 93
Figure : 1 and 2
Show that the prevalence rate of PEM
was 62.7% and about 20.5 was mild,
10
30.5% was moderated and 12.2 was server
PEM. Also the result revealed that 87.6%
of severe malnourished was marasmus.
Red Sea University Journal, Refereed scientific biannual journal
Vol.(4) December - 2013
The prevalence rate and determinant factors of Protein Energy Malnutrition
Among children age 6 to 59 months In Sinkat locality, Red Sea State
Tahani Babiker Mohammed
Table (1)
Association between the PEM and some selected variables.
No
Independents variable
X2
Significant 0.05
1
Sex
3.632
0.304
2
Age
20.785
0.05
3
Educational level of mother
226.359
0.000
4
Family size
83.617
0.000
5
Income
181.772
0.000
6
Frequency of diarrhoea
616.449
0.000
7
Frequency of ARI
639.33
0.000
8
Frequency of malaria
378.121
0.000
In this part cross tabulation for
most important variables related to
PEM are presented: Table (1) shows
that, age of child, educational level
of mother, family size, income and
frequency of some disease are all
significant. On the other hand sex of
child turned out to be insignificant.
Table (2): Breast Feeding Practices:
Red Sea University Journal, Refereed scientific biannual journal
Vol.(4) December -2013
11
The prevalence rate and determinant factors of Protein Energy Malnutrition
Among children age 6 to 59 months In Sinkat locality, Red Sea State
Characteristics
Tahani Babiker Mohammed
Number
%
after one hour
250
33
Two to 23 hours
302
39
After one day
116
15
Before six months
473
62
After six months
295
38
After 2 years
300
39
Before 2 years
567
61
Used
152
20
Not used
616
80
Total
768
100
Initiation of breast feeding
Exclusive breast feeding
Time of weaning
Bottle usage
Breast feeding practices
All mothers were asked to assess
about their knowledge and practices
regarding breastfeeding. Table (2):
indicates that only 33% of mothers
initiated the breast feeding after one
12
hour, about 38% of them practices
exclusively breastfeeding and 61%
of mothers weaned their children
before two and only 20% of them
stated that they use bottle feeding
for their children.
Red Sea University Journal, Refereed scientific biannual journal
Vol.(4) December - 2013
The prevalence rate and determinant factors of Protein Energy Malnutrition
Among children age 6 to 59 months In Sinkat locality, Red Sea State
Tahani Babiker Mohammed
Figure (3): Show the reasons of mothers behind the early weaning
n = 567
figure (3) Illustrates the reasons of
mothers behind the early weaning,
(43%) weaned their children due
to the set of new pregnancy, 25%
insufficient milk, 15% working
mother, 14% mother illness and 3%
said due to child illness.
Discussion
By using an anthropometric
measurement, particularly weight
for height, the study revealed that the
prevalence rate of PEM was 62.7%,
this rate is high when compared with
the results of nutritional survey in
Red Sea State which found that the
prevalence rate in Sinkat locality was
(47.7% (SMOH,2009). This high
prevalence may be due to semi-arid
situation and also area subjected to
periodic drought and famine due to
poor rainfall, crop failure and animal
death due to disease out break or
consequences of draught. This result
agrees with (WHO, 2000) which
mentioned that the «increasing food
production and food scarcity are
responsible for the malnutrition at
the family level».
The statistics showed that there is a
significant relationship between PEM
and the age of child, mother education
and family income this result is similar
to (WHO,2006) «demographic and
socio-economic factors are under
lying causes of PEM» .
Breast feeding is a natural impulse
of all mothers as it allows them to
Red Sea University Journal, Refereed scientific biannual journal
Vol.(4) December -2013
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The prevalence rate and determinant factors of Protein Energy Malnutrition
Among children age 6 to 59 months In Sinkat locality, Red Sea State
express love, tenderness and protection
of their children. (WHO,1989) &
(Harmon,2006) have recommended
initiation of breast feeding with the
first hour of life, exclusive breast
feeding for six months and it should
be continued with appropriate
complementary food for two years.
This study indicated that only 33% of
mothers started breast feeding within
one hour, which is not similar to the
result of save motherhood survey
conducted in Sudan, where two third
of mother were initiate breast feeding
in the first hour of life (FMOH,1999),
also the study revealed that only 25%
of mother breast milk a lone is the
best food six months of life and this
is similar to UN region mentioned
the exclusive breast feeding rates are
25% in Africa, 45% in Asia and 31%
in Latin America. (Laure,et.al, 2004).
It is mentioned in Quran «Albagara
verse 233» mothers should breast
feed their infant for two complete
years in order to complete the term,
but 60.2% of them weaned their
children before 2 years and most of
mothers mentioned that the set of new
pregnancy is the main reason for early
weaning , this result is similar to SMS
and sub-Saharan Africa revealed that
«the mothers were stopping breast
feeding because they got pregnant
(FMOH,1999), (Net,2003).
The study showed that there was strong
relationship between PEM and repeated
attack of diarrhea, ARI and malaria.
This result agrees with (Gammal,
14
Tahani Babiker Mohammed
2000) who mentioned that «persistent
diarrhea and repeated attacks of ARI
and malaria can lead to malnutrition
particularly in border line”.
observation techniques revealed that
most of the buildings had inadequate
ventilation and light which was
particularly an important factor for
the spread of PEM in the area, this
result agrees with (Brozek,1984)
who said that there are many ways
for the prevention of pneumonia
and other ARI, among which is the
prevention of over-crowding and
poor ventilation. Also observation
indicates that water was inadequate
and transported by water vendors
and these practices enhanced water
contamination. This agree with (Park,
2000) who stated that «improving
health services, sanitation, water
supplies and home environment help
prevent malnutrition»
Conclusion& Recommendation
This study shows that the protein energy
malnutrition is a sizable problem among
children aged less than five years.
Intensive health education programmes
for breast feeding promotion should be
addressed.
It is also recommended that the locality
should encourage the community to
participate actively in sanitation.
Acknowledgment
To our colleagues at Nutrition
department in Red Sea Ministry of
health and their staff in Sinkat and
Jabet for their assistance.
Red Sea University Journal, Refereed scientific biannual journal
Vol.(4) December - 2013
The prevalence rate and determinant factors of Protein Energy Malnutrition
Among children age 6 to 59 months In Sinkat locality, Red Sea State
Tahani Babiker Mohammed
References
1- Brozek. D. et al. (1984) Malnutrition and behavior. Critical assessment
of key issues. Lausance, Nestle foundation, 15 – 105 .
2- Cameron, M. Hofvander, y. (1991). A manual of feeding infants and
young children, 3rd ed. Nairobi : Oxford University press .
3- FMOH (1999) : primary health case , save mother hood survey.
Khartoum – Sudan.
4- Harmon – Jones C. (2006) , Duration , intensity and exclusivily of
breast feeding: Recent research confirms the importance of these
variables. Breast feeding abstracts; 25 (3) : 17 – 20
5- Lauer JA , Betrain AP , Victora CG , de onis M and Barros AJ , 2004.
Breast feeding patterns and exposure to suboptimal breast feeding
among children in developing countries: Review and analysis of
nationally representative survey ; 2 : 26.
6- LLLI center for breast feeding information. Breast feeding statistics ,
2003 (online) . available from
http://www.llli.org/cbi/bfstats03.htmsl .
7- Nasser Gammal, (2000). Manual of Paediatrics .
Khartoum, Sudan, P. 107 – 145 .
8- Park, K. (2000). Park>s textbook of preventive and social medicine.
16th ed. India , prem Nagar Jabalpur.
M/S Banarsidas Bhanot. India. 393 – 437
9- SMOH,(2009) . Nutritional Department Report . Red Sea State.
Sudan .
10- United Nation (1999). Anthropometric assessment, food and nutrition
bulletin. V(20), N(4) , 40 – 48 .
11- UNICEF, (1998). The state of the world children. New York :
UNICEF : P , 10 – 54 .
12- WHO, (2000) . The management of nutrition in major emergencies,
Geneva,9115- .
13- World health organization (1989) protecting, promoting and
supporting breast feeding : the special Role of maternally services. A
joint WHO / UNICEF statement. Genva : WHO.
Red Sea University Journal, Refereed scientific biannual journal
Vol.(4) December -2013
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‫‪Tahani Babiker Mohammed‬‬
‫‪The prevalence rate and determinant factors of Protein Energy Malnutrition‬‬
‫‪Among children age 6 to 59 months In Sinkat locality, Red Sea State‬‬
‫املستخلص‬
‫أجريت دراسة مقطعية وصفية يف حملية سنكات بوالية البحر األمحر ‪ ،‬بغرض قياس معدل إنتشار‬
‫نقص الربوتني والطاقة لألطفال من عمر ‪ 59 – 6‬شهر ‪ .‬مت إختيار عينة حتتوي على ‪ 768‬طفل ومت‬
‫توزيع الفرص عن طريق العينة العشوائية الطبقية ‪ .‬مت مجع البيانات عن طريق اإلستبيان واملالحظة‬
‫وأيضاً مت قياس وزن وطول األطفال حتت الدراسة وفقاً ملعيار منظمة الصحة العاملية الذي يوضح‬
‫أن (‪ )80 – 85‬سوء تغذية بسيط ‪ )70 – 79( ،‬سوء تغذية متوسط بينما أقل من (‪ )70‬عبارة‬
‫عن سوء تغذية حاد ‪ .‬ومت حتليل البيانات عن طريق برنامج التحليل اإلحصائي (‪ .)SPSS‬أوضحت‬
‫الدراسة أن معدل إنتشار سوء التغذية كانت ‪ %62.7‬وأن هنالك عالقة وثيقة بني سوء التغذية والعمر‬
‫وتعليم األمهات والدخل‪ .‬ومتت التوصية بأن تقوم وزارة الصحة بالوالية بعمل برنامج غذائي متكامل‬
‫وذلك بالتنسيق مع املنظمات الغري حكومية واللجان احمللية وحكومة الوالية‪.‬‬
‫‪Vol.(4) December - 2013‬‬
‫‪Red Sea University Journal, Refereed scientific biannual journal‬‬
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