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This is to certify that the

thesis entitled

The role of nutrition education
on the factors influencing childhood

nutrition in Nigeria.
presented by

Maureen Menta Scott-Emuakpor

has been accepted towards fulfillment
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Ph.D. Education

 

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Hi Michigan State

 

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© Copyright by
MAUREEN MENTA SCOTT-EMUAKPOR
1978

ii

THE ROLE OF NUTRITION EDUCATION ON THE
FACTORS INFLUENCING CHILDHOOD NUTRITION
IN NIGERIA

BY

Maureen Menta Scott-Bmuakpor

A DISSERTATION

Submitted to
Michigan State University
in partial fulfillment of the requirements
for the degree of

DOCTOR OF PHILOSOPHY

Department of Administration and Higher Education

1978

ABSTRACT

THE ROLE OF NUTRITION EDUCATION ON THE
FACTORS INFLUENCING CHILDHOOD NUTRITION
IN NIGERIA

BY

Maureen Menta Scott-Emuakpor

A study of the factors that influence malnutrition in
Nigeria has been carried out. Emphasis was placed on the
possible role of educatiOn as well as on childhood mal-
nutrition. This study was conducted in Benin City by means
of well-tested questionnaires and, interviews with indivi-
dual subjects. The study group comprised of 1056 mothers
(15 to 45 years old) with two or more children, 7 primary
schools, 15 secondary schools, 3 nursing schools and 4
government ministries. This investigation was mostly an
effort aimed at providing apprOpriate baseline information
to aid the fight against childhood malnutrition in Nigeria.

The questionnaires were designed to highlight the role
that nutrition education can be made to play in the pre-
vention of undernutrition and diseases of malnutrition in
Nigeria. Several hypotheses were tested, the results of
which led to the conclusion that:

(a) the lower the education of the mother, the lower

her knowledge of nutrition.

(b) the older the mother, the lower her level of

(C)

Maureen Menta Scott—Emuakpor

nutrition knowledge.
the higher the educational level of the father,
the more involved and interested he is in the

total nutrition of his child.

Also concluded are:

(a) the major source of nutrition information for

(b)

(C)

the mothers is hospital nurses.

the curricula of primary and secondary schools
are grossly deficient in nutrition courses.
nursing schools nutrition programs are so trivial
that they do not adequately prepare the nurse

for the delivery of sound nutrition information

to the patients she serves.

An examination of government nutrition programs re-

vealed that:

(a)

(b)
(C)

there is a pathetic lack of good programs to

serve the masses.

the programs that exist lack proper publicity.
there is an enormous waste in terms of manpower
because of serious overlaps, resulting from poor
coordination in the functions of various govern-
ment agencies involved in nutrition. Thus, govern-
ment efforts to combat malnutrition are profoundly

handicapped.

This study concluded that with prOper education, both

Maureen Menta Scott-Emuakpor

at the adult level (non-formal) and at the level of
schools (formal), the most important cause of malnutrition
in Nigeria can be eliminated. Suggestions as to ways of
improving the quality of nutrition education, in general,
were made. Also, suggestions were made as to how govern-
ment can improve its programs so as to be effective in

combating childhood malnutrition in the country.

DEDICATION

To the memory of my father
KPEDE D. MBNTA
whose dogged refusal to yield to pressures,

not to give his daughters formal education,
made this possible.

and
To the memory of my son
MUDIAGA P. SCOTT-EMUAKPOR

who, in three short years of life, taught me
the true meaning of joy, love, sorrow and faith.

and
To the memory of my brother
TIVE H. MENTA

who taught me the meaning and joy of having a
united family with a sense of belongingness.

iii

ACKNOWLEDGMENTS

I have, in the preparation of this research, depended
upon the advice, encouragement, support and well-wishes
of a number of individuals and agencies, all of whom
deserve mention and an expression of gratitude. However,
ingratitude is not the case if any persons who deserve
thanks are not mentioned.

I am grateful to Professor Walter W. Scott and
Professor Melvin C. Buschman for serving as my academic
adviser and dissertation adviser respectively. Their
positive feedback serve as great incentive to me and,
their sound academic outlook was very helpful in the
design and pursuit of this research. To Professor John M.
Hunter and Professor Howard W. Hickey, I am specially
indebted. Apart from serving in my dissertation committee
where they helped immensely in the planning and execution
of this research, their critical academic outlook and
patience with my short-comings were sources of immense
inspiration to me.

Very special thanks are due to my husband, Dr. Ajovi
B. Scott-Emuakpor, who has been the primary motivator in
my educational pursuits, and who, throuth the years, has
taught me the value of continually striving to better
understand myself and the world at large with joy; and

iv

to my brother, Mr. C. A. Menta, who did not only encourage
my academic endeavors but provided the first financial
help that I needed to start my university education.

I am very grateful to several persons in the University
of Benin Teaching Hospital and the Ministry of Health,
notably, Professor L Ajabor and Mr. D. M. Egbikuadje,
respectively, for making it possible for me to gain access
to their patients. The Ministries of Health and Education
were very helpful by providing me with needed information
and data.

I am grateful to my mother, Mrs. Oboden Menta, for my
cherished upbringing and, to my mother-in-law, Mrs. Iroli
Scott-Emuakpor, for her moral support‘during this research
in Nigeria. I am also grateful to my sisters, Mrs. M. A.
Okungbowa (nee Menta) and Mrs. E. 0. Akaraiwe (nee Scott-
Emuakpor) for their support particularly during the data
collection, and to Miss Victory N. Menta for helping to
keep my household together and caring for my children
while I worked at school and did this research in Nigeria.

The agencies that have made my studies here in the
United States possible are:

(a) The Federal Government of Nigeria through the

award of a post-graduate scholarship.

(b) P. E. 0. International Peace Scholarship Fund

through the award of two grants over the sum of

$3,000 (three thousand dollars).

(c) Altrusa International Foundations, Inc. through
an» award of $1,000 (one thousand dollars) grant.
To these agencies and to the many P.E.O. members who
continue to send me presents, gifts and well-wishes,
particularly, Mrs. Eleanor Smith, I am grateful.
The bulk of this research was supported by a grant

from the African-American Scholars Council, Inc.

vi

 

TABLE OF CONTENTS

Chapter I

INTRODUCTION . . . . . . . . .
Objectives and Purpose of the Study. . . . .

Terminologies. . . . . . . . . . . . . .

Overview . . . . . . . . . . . . . . . . . .

Chapter II
REVIEW OF RELATED LITERATURE .

Extent of Childhood Malnutrition Especially in
Developing Countries . .

Related Studies on Nutrition and Education .

Income, Nutrition Education and Food and Nutrition
Policies as Related to Economic Development.

Nutrition Education in Medical and Nursing
Schools. .

Nutrition Education as a Means of Eliminating
Childhood Malnutrition . .

What is Childhood Malnutrition?. .

Extent of Childhood Malnutrition, Especially in
Developing Countries .

Prevention and Treatment of Childhood
Malnutrition

Chapter III
DESIGN OF THE STUDY.

Population and Sample Description.
Variables and Hypotheses
Instrumentation. .

Methods of Data Collection

Data Analysis. . . .

Chapter IV
ANALYSIS OF FINDINGS .

General Character of the Population.

Educational Levels of Mothers and their
Knowledge of Nutrition

Mothers Age and Knowledge of Nutrition

Fathers' Interest in their Children's Nutrition.

Reasons for Breast- -feeding .

From which Source do Mothers Learn most about
Nutrition.

Recognition of Malnutrition and Knowledge of the
Causes of Malnutrition . . . . . . .

Family Planning and Education.

Programs in Nutrition Education.

vii

“OOH

16
18"

19
21

22
26

28'
29,

42
42.

45
60
63
71
73
79

90

Chapter IV (Continued)

Primary and Secondary Schools. . . . . . . . . . 90

Nursing School Programs in Nutrition . . . . . . 96

Government Agencies. . . . . . . . . . . . . . . 97
Chapter V .

SUMMARY AND RECOMMENDATIONS. . . . . . . . . 102
The Importance of Education on Nutrition . . . . . 103
Breast- Feeding . . . . . . . . . 104
Sources of Information about Nutrition . . . . . . 105
Programs in Nutrition. . . . . . . . . . . . . . . 107
General Comments . . . . . . . . . . . . . . . . 108

What need to be done . . . . . . . 112
Other roles of the nutritionist in Nigeria . . . 123
Food and nutrition policies. . . . . . . . . . . 126
Need for future research . . . . . . . . . . . . 128
LIST OF REFERENCES . . . . . . . . . . . . . . . . . . 130
APPENDIX A '
DISSERTATION PROPOSAL. . . . . . . . . . . . . . . . 138
Appendix Al
BASIC PRINCIPLES OF NUTRITION EDUCATION. . . . . . . 149
APPENDIX B
QUESTIONNAIRE FOR MOTHERS. . . . . . . . . . . . . . 155
APPENDIX C
QUESTIONNAIRE FOR SCHOOLS. . . . . . . . . . . . . . 163
APPENDIX D
QUESTIONNAIRE FOR MINISTRIES . . . . . . . . . . . . 166
APPENDIX E

QUESTIONS ON BASIC NUTRITION ON MOTHERS'
QUESTIONNAIRE FOR WHICH ELEVEN POINTS WERE GIVEN . 167

viii

Table
Table
Table

Table

Table

Table

Table

Table

Table

Table

Table

Table

Table

Table

10:

ll:

12:

l3:

14:

LIST OF TABLES

Occupations of wives.

Occupations of husbands

Distribution of women according to
group and level of education.

Points score for women'

nutrition knowledge

Nutrition knowledge of
as compared to their

Nutrition knowledge of
as compared to their

Nutrition knowledge of
as compared to their

Nutrition knowledge of
as compared to their

Nutrition knowledge of
as compared to their

Nutrition knowledge of
as compared to their

Nutrition knowledge of

5 level of
women 15-20
educational

women 21-25
educational

women 26-30
educational

women 31-35
educational

women 36-40
educational

women 41-45
educational

age

years

level.

years

level.

years

level.

years

level.

years

level.

years

level.

mothers according

old
old
old
old

old

old

to

their educational level (pooled data from
Tables 5 through 10).

Average scores for nutrition knowledge of
mothers according to educational level.

The number of women who do not consider
high protein foods (meat, fish, shrimps,
eggs, etc.) as food and, their educational
level . . . . .

The educational levels of women who use
infant formulae and the educational
levels of those who have knowledge of
their nutrient content. . . . .

ix

43
44

46
4‘8
49
50‘
5‘1
52‘
53

S4

S6"

S7

59

61

Table

Table

Table

Table

Table

Table

Table
Table

Table

Table

Table

Table

Table

Table

Table

Table

Table

15:

16:

17:

18:

19:

20:

21:
22:

23:

24:

25:

26:

27:

28:

29:

30:

31:

Nutrition knowledge scores of women
according to their age group. . . . . .,. . 62

Average scores for nutrition knowledge of
mothers according to age group. . . . . . . 64

Father's interest in their children's
nutrition . . . . . . . . . . . . . . . . . 66

Relationship between father's educational
level and his interest in his child's

nutrition . . . . . . . . . . . . . . . . . 67
Reasons for breast-feeding. . . . . . . . . . 74
Source of information on general childhood

nutrition . . . . . . . . . . . . . . . . . 76
Source of infant formula information. . . . . 78

Decision makers of what foods the family
members should eat. . . . . . . . . . . . . 80

Recognition of childhood nutritional
deficiency symptoms by mothers compared
to their educational levels . . . . . . . . 82

Causes of malnutrition in children as seen
by the interviewees . . . . . . . . . . . . 84

Mothers' age groups and knowledge of the
existence of nutrition education
programs in the country . . . . . . . . . . 85

Mothers' educational levels and knowledge
of the existence of nutrition education
programs in the country . . . . . . . . . . 87

Number of children by mothers according
to age group. . . . . . . . . . . . . . . . 89

Number of children by mothers in age group
41-45 years and their educational level . . 91

Elementary (Primary) school responses to
questions on nutrition education courses. .1 94

Responses to questions on nutrition
curriculum by secondary (high) schools. . . 95

Health care facilities in Bendel State as
adapted from Ebie (24). . . . . . . . . . . 110

Table 32: Growth, in numbers, of major health
personnel in Bendel State as adapted ,
from Ebie (24). . . . . . . . . . . . . . . 111

xi

Figure

Figure

Figure

Figure

Figure

Figure

LIST OF FIGURES

Education as a fraction of causes of
malnutrition (adapted from Runyan,
Nutrition for Today, p. 134) (68). .

Educational level and proportion of
Fathers scoring 0 (no interest) in
Child's nutrition.

Educational level and proportion of
Fathers scoring 1 (little interest)
in Child's nutrition .

Educational level and proportion of
Fathers scoring 2 (very much interest)
in Child's nutrition . . . .

Educational level of mothers and ability
to recognize malnutrition.

Government programs in nutrition

xii

27

69

70

72

83
109

Chapter 1

INTRODUCTION

 

This study was carried out in Nigeria, which is the
most populous country in Black Africa. The population of
Nigeria by the 1963 Census was $5,670,000 and the pro-
jected population for 1976 at a 2%% rate of growth was
approximately 77,435,000 (59).. The population for Bendel
(then Mid—west) State by the 1963 Census was 2,535,839,
and for Benin City it was 100,694 but the estimated
pOpulation of this city in 1975 was 136,000 (1).

Benin City in Bendel State of Nigeria was an ideal
place for this study because its population comprised
individuals representing almost every cultural group in
Nigeria. Only few other Nigerian cities have this
uniqueness. Therefore, the data collected has general
applicability to Nigeria.

Nutrition has always been an "over-looked" subject
in many African countries. However, in Nigeria, concern
for the poor nutritional state of children has grown
tremendously in recent years. This is, probably, due to
an increase in the proportion of children with the

diseases of malnutrition. This increase is apparently

due to inflation, high population growth, and little or
no increase in food production. There might also be a
slight increase in public awareness because of the
activities of the few nutrition education programes which
currently exist in the country. For instance, some time
in 1976, a two week nutrition course was concluded in
Sokoto, Nigeria, during which time, the Chief Medical
Officer for Sokoto State, Dr. Shah, stressed the importance
of Nutrition Education (76). A day before the above
publication came out, the same paper (Nigerian Observer,
which is a local newspaper) published a statement by the
Oyo State Commissioner for Health, Dr. Atanda, which
sketchily outlined the causes of malnutrition (16). In
that statement, Dr. Atanda was quoted as saying that 70%
of the children between the ages of one and four years
old suffer from varying degrees of malnutrition in the
developing countries of the world.

It is apparent that no acceptable definite, or even
approximate figure of malnutrition exists for Bendel State
nor for the whole of Nigeria. Another newspaper, in an
article captioned, ”Alarm on Malnutrition" quoted the
Director of Food Science and Applied Nutrition Unit of
the University of Ibadan, Professor Omololu, as calling
for an increase in "personnel in the field of nutrition
to teach nutrition education especially in the (UPE)

universal primary education scheme" (6).

From the foregoing, there is little doubt that
Nigeria is prepared for a comprehensive study of the
factors that influence childhood nutrition and the ways
by which the nutritional status of all children can be
improved. With the introduction of the Universal Primary
Education (UPE) policy of the Federal Government which
commenced in September of 1976, the need to carry out
this study became more urgent. Nigeria can not afford to
have the UPE when 70% of all the children, for whom the
scheme is designed, have suffered from some malnutrition
early in life which, no doubt, affected proper mental
development. It will certainly be self-defeating if a
high proportion of these children are not educable.

In order to stress the importance of Nutrition
Education in an attempt to solve the enormous problem of
malnutrition in Nigeria, it is essential to define the
principles of Nutrition Education. In doing this, the
investigator chose to refer to the statement prepared by
a Study Group on Nutrition at the VIIth International
Conference on Health that met in Buenos Aires, Argentina
in 1969 (80). The statement is summarized below:

(a) Health education itself is incomplete without

nutrition education.

(b) For positive results, nutrition education

should be integrated into the government policy
plans. This will help to achieve higher economic

and social development

(c) There should be unified norms and concepts of
nutrition education in order to reduce the
state of confusion in nutrition education.
(d) Coordination of nutrition education programs
at the planning, implementation, and evaluation
levels, is essential.
(e) The educational techniques to be used must be
based on the cultural, socio-economic and
family meal patterns of the target population
as well as the available foods in the community.
For people in Nigeria to achieve a reasonably high
level of nutrition for their children through the efforts
of Nutrition Education, the masses must be made to be
aware of the importance of adequate nutrition to the family
and the means available for attaining it (63). There must
also be a clear knowledge of the various foods that are
available and their nutritional value. The population
must know the optimum conditions for storing foods under
local conditions. They must know what the contaminants
of foods are. The task must be a coordinated effort
between the different planning sectors concerned with food,
namely, Nutritionists, Health Personnel, Educators,
Economists, Agriculturists, Biochemists and Microbiolo-
gists, Politicians, and others.
For more than three decades now, there has been a
heart warming concern about the plight of the hungry the

world over. Well-meaning individuals and developed

countries have shifted their humanitarian concerns from
hunger occasioned by disasters to the general conditions
of perennial undernourishment with which a huge proportion
of mankind has had to contend. This has given impetus to
various people, countries and international and national
organizations to try to define the problems of under-
nutrition and malnutrition and, also, to find practical
solutions that would help alleviate the problems. This
research was conceived and designed as a form of practical
solution.

In 1968 during a West African Conference on Nutrition
and Child Feeding, Johnson (43), while giving the report
on Nutrition in Nigeria, outlined six major problems
inhibiting programs to combat malnutrition. These include:

(a) Poverty.

(b) Inadequate food production due to a variety

of reasons.

(c) Poor storage.

(d) Inadequate food intake.

(e) Wrong choice of foods.

(f) Wrong preparation of foods.

An examination of these six reasons will show that more
than half of the obstacles could have been avoided had
there been adequate Nutrition Education programs.

Omololu (64), talking on Nutrition and Education during

the same conference, gave similar reasons for the

inadequacy of calories in Nigeria. In concluding his
views, he said,

"Improvement of nutrition in our countries is

not only the preserve of nutrition: all the

other disciplines...agriculture, education,

health, marketing, cooperatives, home economics,

and voluntary organizations...must be brought

in; and NUTRITION EDUCATION OF ALL OF THESE

GROUPS OF PEOPLE IS THE KEYNOTE OF SOUND

NUTRITION POLICY AND SOUND NUTRITION PRACTICE”

(added by the researcher).
What is most striking about the situation is that, inspite
of numerous and repeated strong statements such as that
quoted above, by individuals in positions to know the
importance of mass education on nutritional improvement,
no real scientific effort has been made to document the
fact that one of the most important tools for combating
undernutrition and malnutrition is adequate education.
Consequently, comments by well-meaning people in this
regard, have been looked at as mere untested opinions.
This research was, therefore, designed to provide a
scientific basis for understanding the role of Nutrition
Education in the pr0per nutrition of our people, particu-
larly the children upon whom the burden of our lack of

education is most profound (see Appendix A for copy of

proposal).

Objectives and Purpose of the Study
There are eight major objectives of this study.
(a) To examine the current state of understanding

that Nigerian mothers have about the proper

(b)

(C)

(d)

(e)

(f)

(z)

(11)

nutrition of their children; and how a child

is to be fed and nourished. .

To determine the sources from which mothers

get information regarding the proper feeding

of their children; and to determine the
relative role played by physicians, nurses,
relations, friends, booklet advertisements,

TV and radio, about infant nutrition.

To examine and evaluate the impressions that
Nigerian mothers have about breast-feeding
(factors that determine length of time of
breast-feeding and weaning).

To determine how many mothers feed their
children commercial formulae, and how many'
mothers have knowledge of their nutrient content.
To determine whether or not Nigerian mothers
consider protein foods as food, per se.

To determine what roles husbands play in

infant nutrition.

To postulate methods of improving public aware-
ness of the poor nutritional state of the masses
of the children; and also, to postulate methods
of improving public awareness of the nutrition_
education programs available in the country.

To postulate the role that adult education
programs can play in improving the nutritional

state of Nigerian children.

The purpose of this investigation can be said to be
four-fold: first, to find out the educational level of
mothers as related to their level of nutritional knowledge;
secondly, to find out the major sources of information on
infant nutrition and the mothers' attitudes toward breast-
feeding; thirdly, to find out the degree of the interest
fathers have on the nutrition of their children; and
fourthly, to find out how these three variables combine
to influence childhood nutrition in Bendel State and the
whole of Nigeria.

It was of interest to note that several research
efforts have been made in the area of applied nutrition
in Nigeria. In this regard, scientific papers exist,
published in learned journals on the nutritional values
and contents of various Nigerian foods, the factors that
influence proper nutrition, relationship between cultural
beliefs and proper nutrition, etc. A criticism often
levelled against academic people, which is not without
justification, is that communication of research results
are often confined to conferences, symposia and scientific
journals. Apart from serving the professional needs of
these researchers to further their academic progress and
to satisfy their intellectual curiousities, these studies
are worthless as far as the people are concerned. Because
of their awareness which was emphasized by Professor
Olayide (62), this study has also attempted to define the

role that extension services can play along with Adult

Education in finding meaningful solutions to the problem
of nutrition.

The material to be reported here, is in the broad area
of Nutrition Education, which has become an academic entity
by itself. Consequently, the language of Nutrition Educa-
tion has become rather specialized and, in some cases, tech-
nical. It would, therefore, be essential to define some of
the terms used in this dissertation at this stage to provide

the reader with a clear understanding of the subject matter.

Terminologies

 

Education: is "the process of equipping people with
certain attitudes and skills which can lead
to behavior or action... It is a life—
long process in any society" (32).

 

Adult Education: is the teaching of matured persons as

 

opposed to children. This can further be
defined in many ways. For the purpose of
this dissertation, the UNESCO definition will
be used:

"for a large num-er of adults in the
world today, it is a substitute for
the basic education they missed.

For the many individuals who received
only a very incomplete education,

it is the completement to elementary
or progressional education. For
those whom it helps respond to new
demands which their environment makes
on them, it is the prolongation of
education. It offers further educa-
tion to those who have already re-
ceive high level training” (85).

Also, adult education helps to improve defi—

ciencies of previous or earlier education in

10

order for the individual‘to be able to keep
pace with rapidly changing social order.

Adult Educator: is an adult who carries out the art of

 

teaching adults.

Basic Education: is primary school and/or secondary

 

school education.

Continuing Education: is the type of education that gives

 

"further direction in building a solid founda-
tion for future development, achievement and
advancement" (39). This type of education is
functional in that it becomes a tool by which
the individual who possesses it, advances
himself, his family, his country and the
world as a whole.

Non-formal Education: There are several learning activi-
ties outside the formal learning institutions.
These activities can be described as "non-
formal;" they are meant to provide education
to persons who, for several different reasons,
cannot be enrolled in formal educational
institutions. Hence, non-formal education
includes learning activities which lie outside
the primary, secondary, post-secondary and
higher educational institutions such as the
university.

Informal Education: is education in any non-formal

 

physical school setting.

Nutrition:

 

11

is the science of the function of food as
related to both healthy and sick bodies. This
science is highly related to the biochemistry

and physiology of the body.

Nutrition Education: involves any coordinated nutrition

 

activities between ministries of health,
education, agriculture and local government,
with schools and other related agencies for
the purpose of imparting nutrition knowledge
to all persons in the community and thereby
raising the levels of nutrition among family
members and the entire population of the
community. Also, according to Todhunter,
nutrition education:

"is the process by which beliefs,

attitudes and understandings about

food lead to habits that are nutri-

tionally sound, practical, and con-

sistent with individual needs and
available food resources" (82).

Nutrition Activities: involves any activities carried out

 

for the purpose of improving the nutritional

status of the people.

Extension Service: is a part of a major service or

 

activities given by a large institution or
organization such as the ministries. These
activities are directed toward a specific

group of individuals with the aim of delivering

some essential services or assistance. Such

12

services or assistance could be as a single
extension service program or a combination of
such services or assistance as educational,

financial, managerial, technical, etc.

Malnutrition: is a condition in which the diet may provide

 

the body's energy needs or excess of it, and
at the same time the diet does not provide the
other essential nutrients (protein, vitamins
and minerals) which the body requires for

proper development and growth.

 

Undernutrition: is a condition which occurs when there is

not enough food in terms of quantity to supply

the body's energy needs.

Protein-calorie Malnutrition (Kwashiorkor): is childhood

 

Marasmus:

Food Stamp:

 

malnutrition produced by a diet low in protein
and moderately high in calories.

is childhood malnutrition produced by a diet
low in both protein and calories, i.e., a
diet which does not provide for the body's
energy needs.

for this study, it is paper money of different
denominations of the Naira, which low income
families can buy from the government at reduced
rate, e.g., one hundred Naira worth of food
stamps could be bought for, say, seventy-five

Naira.

Educational

Nutritional

13

Level: is the number of years of schooling
beyond the primary school level. This refers
to the range of formal educational attainment
(i.e., from no formal schooling at all, to
university education).

Knowledge: is the knowledge of the nutrient
values of available foods and baby formula
nutrient content; also, whether or not protein
is considered food for better growth or just

a type of necessary "condiment" that makes

meals taste better.

Father's Interest in Feeding: involves interest in the

mere filling up of the child's stomach with

any food item (usually high carbohydrate foods).

Father's Interest in Nutrition: involves interest in the

 

types and combinations of foods fed to his
children for better nourishment to the child-

ren.

Overview

In Chapter I, the problem, its importance, defini-

tions of terminologies, and theory have been stated. In

Chapter II,

the pertinent literature covering aspects of

nutrition education in Africa and developing countries, as

well as aspects of the problem of malnutrition in these

areas are reviewed.

14

In Chapter III, the design of the study, the popula-
tion and sample, the variables, the hypotheses, and the
methods of analyses are presented. In Chapter IV, the
results are presented and analyzed. In Chapter V, the
conclusions derived from the study, discussion, and
implications are given. Also given in this Chapter, are
some suggestions for improving nutrition education in
Nigeria. The appendices include a copy of the research
proposal and questionnaires utilized during the data

gathering process.

Chapter II

REVIEW OF RELATED LITERATURE

 

Food and nutrition have always been part of mankind's
history. Whole populations and even civilizations have
been wiped out by famine. Battles are known to have been
postponed until after harvest and, in countless instances,
well-fed armies have prevailed over the under-fed ones
(65). Historians have written extensively on the effects
that nutrition had on the outcome of the Nigerian civil
war of 1967 to 1970 (5,22,72).

Some of the most significant accomplishments of man
in his struggle for survival have been closely associated
with nutrition. The discovery of fire is probably the
single most important event in man's history and this
discovery was to improve his food technology and hence,
his nutrition. The subject of nutrition education is,
therefore, as old as man himself.

Nutrition education is considered to be an art and
science which is expected to begin as soon as the child '
is born (48). But many parents themselves, who are

supposed to take up this role of nutrition education as

15

16

soon as the child is born, lack basic knowledge of
nutrition.

The existing literature on nutrition and education
is not particularly helpful in providing wider insight into
the question of the role of education on the factors

affecting childhood nutrition in Nigeria.

Extent of Childhood Malnutrition

Especially in Developing Countries

 

Studies have shown that contacts with foods early in
life, do influence food acceptance and selection later
in life (77,78). It, therefore, stands to reason that
poor childhood nutrition has an effect on adult nutrition-
al habits. Several studies have been carried out all over
the world which give different reasons as causes of
malnutrition. These reasons have cultural, social,
psychological, and economic base. For instance, in
Central America and in the Far East, the incidence of
malnutrition and death is high among preschool children
because high protein foods such as meat, fish, eggs and
also many fruits and vegetables are believed to be harmful
for young children; in Bantu families, girls of child-
bearing age are forbidden to drink milk because it is
believed to cause infertility in females; in Tunisia,
mothers exchange eggs laid by their hens for tea and sugar
for their children (29). Also, in many African cultures,

it is very common to find a system of priority within

17

families which gives the father the first chance on avail-
able food. The mother comes next and the children

last (57). The action comes not from any lack of affec-
tion or love for their children, but from lack of education.
Indeed, great importance is attached to bearing and rearing
large numbers of children. Therefore, fertility is of
great importance in African societies. Consequently,

most food taboos or habits have their origin in fertility
(73).

According to all indications from contemporary
research, inadequate nutrition can prevent a child from
reaching his full hereditary potential, not only in terms
of physical size and strength, but also in terms of
‘ cognitive development as well. The work of Mitchell (53)
showed clearly that when the nutritional needs of the
adolescent are not met, stature potential is not realized.
Thus, the food which provides nutrients required for
physical growth is a very essential factor for general
growth and development and the process of feeding a baby
does play a significant role in psychosocial development,
such as feeling of security, love, affection and attachment.

The problems of malnutrition are not restricted to a
particular group of people or to specific geographical
areas; they exist all over the world and even in such
developed or technologically advanced countries as the
United States of America (U.S.A.) for the same reasons

that they exist in developing countries. Mehren (51),

18'
referring to the U.S.A. said,

"Malnutrition in this country is due not
only to poverty. Poor choice of food due
to ignorance, faulty information and the
simple lack of appreciation of the
relationship existing between good nutri-
tion and the health and well-being of the
individual are general causes in all ages
and all geographical areas, and in
different...economic levels."

Related Studies on Nutrition and

 

Education_

 

Considerable attention has been given to child
nutrition as well as to nutrition education in several
developing countries, including Latin America and India
(17,18,30,40). This attention has led to investigative
efforts, only a few of which have been carried out in the
area of Nutrition Education. Many studies in Nigeria
have revealed that there is a decline in the nutritional
content, particularly protein of breast milk, with pro-
longed lactation. It is also known that solid foods
(usually comprised of low protein and high carbohydrate)
are introduced to the infant late. Thus, towards the end
of lactation (weaning period), the child experiences a
crucial shortage of essential nutrition, a situation
which could be avoided with adequate nutrition education

(4,37,42,54,60).

19

Income, Nutrition Education and Food
and Nutrition Policies as Related to Economic Development

Although poverty has been found to be a contributing
factor to malnutrition in general, several studies have
shown that increase in income to raise an individual from
the poverty level does not necessarily ensure better
nutrition (11,12).

Even in the so called developed countries such as the
U.S.A., it has been found that persons are malnourished
more because of nutritional ignorance than because of
poverty (50).

When talking of national development, education is a
factor that cannot be overlooked; it is an indispensable
factor in national development. Education has a very
important role to play in the biology of the individual
and the society as a whole. As explained by Griffin and
Light (35), "education can design and program the transfer
of knowledge and relevant behaviors required for the
continuing health and progress of society."

It is well known that:

"the quickest way to increase productivity in

Africa today, in any industry, is by on-the-

job training of adult workers. This form of

education is the most closely geared to economic

development, and yet the most neglected" (84).

Although, poorly appreciated, nutrition is one of the
key factors in national development. Economic growth is

development and it depends largely on the existence of

able human beings. If nutrition of the human being is not

20

considered a priority in national development, then such
development could become stunted.

In-service nutrition education for elementary
teachers has been found to be useful in the nutrition
education of elementary school children. Such in-service
training has been carried out in many parts of the world
including such developed countries as the U.S.A. (15,79),
and has been found to be useful and helpful in the
nutrition education of primary school children. This
aspect of nutrition education is found to be so important
in the U.S.A. that attempts are made to reach as many
elementary school teachers as possible. An example of
one attempt made to reach more teachers is the use of a
telephone circuit from Kansas State University, connecting
about seventeen sites throughout the entire state of
Kansas, to teach nutrition courses to elementary school
teachers (86).

Although, foods and nutrition courses have been
officially introduced into the curriculum of primary and
secondary schools for the whole of Nigeria, the subject
has not been adequately taught in the schools due to the
unavailability of teachers in nutrition. Experiences
gained from many other parts of the world showed that the
teaching of nutrition in elementary schools has been
found to improve nutritional habits of elementary school

children (10,19,38).

21

Nutrition Education in Medical and Nursing Schools

 

As recently as 1970, reports by the Food and Agricul-
ture Organization (FAO) and the World Health Organization
(WHO) experts revealed that nutrition is not adequately
taught in medical and paramedical schools (44). Nutrition
education in medical and nursing schools, especially in
developing countries, has been found to be deficient in
both content and method. Curriculum of these schools
lack nutrition as a component (45).

In disciplines as important and humanitarian as the
health professions, one would have expected that nutrition
would be given enormous emphasis in developing countries,
because a huge percentage of the diseases the profession
has to deal with are nutritional in origin. Because of
their special position in the society, their role in
educating their patients on the importance of proper
nutrition cannot be over-emphasized. Without an adequate
knowledge of basic nutrition, resulting from a deficient
school curriculum, their responsibilities to their patients
appear incomplete.

The disregard or lack of appreciation that medical
professions have for nutrition is not found only in
Nigeria; it is a world-wide practice. For instance, in g
the U.S.A. nutrition in nursing schools seem to be

receiving less attention (28,56).

22

Nutrition Education as a Means of

 

Eliminating Childhood Malnutrition

 

At the joint FAO/UNESCO/WHO meeting on the role of the
teacher in teaching food and nutrition (66), it was stated
that:

"although the solution of the problems of

nutrition depends to a large extent on the

solid economic and agricultural development

of the country and the quantity and quality

of the food available at reasonable prices,

it has been generally recognized that food

habits and cultural patterns also influence

nutrition. It has been shown that in many

places in the world, malnutrition is the

result of ignorance and prejudices rather

than of poverty and shortage of food."

To emphasize this point further, Marcel Autret indicated
in Ritchie's book that,

"Ignorance is the ally of hunger. Together

with poverty, which it often accompanies, it

is basically responsible for virtually every

case of malnutrition" (67).

From the investigator's experience, although most of the
world's hunger and malnutrition is caused by traditional
beliefs and practices, inefficient food production and dis-
tribution within individual nations and families, lack of
knowledge of nutrition appears to be a more direct cause in
a large percentage of cases. To be able to control malnutri-
tion, adults or parents must understand what the basic prin-
ciples of nutrition are and, the individual nutritional '
needs of the family members - the young child, the pregnant
and lactating mothers, etc.; also, they must know how to

make good food choices based on their limited family income.

23

Malnutrition is common in many African countries and,
in many of these countries, education has been proposed
as one important means of combating malnutrition. In
Tanzania, according to Semiti, "to combat malnutrition,
we are placing great reliance on education, and...it
should be possible to make much progress in this way" (75).
Giving a report on Nutrition in Gambia, Fuller remarked
(33), "the main aim for the future [to combat malnutrition]
would seem to be more education - in the schools, in
mixed farming centers, and at the clinics" brackets are
mine . Ofosu-Amaah, speaking for Ghana, identified
"ignorance, harmful beliefs, the general level of educa-
tion, and individual poverty” as major problems inhibiting
efforts to combat malnutrition and, among his four major
plans to solve the problem is "intensive Nutrition
Education" (61). Speaking for Uganda, Muyanga stated (55),
"The task ahead is to intensify our Nutrition Education to
reach that section of the people who need it most." There
is no question that nutrition education is considered a
very significant factor in the efforts to combat malnutri-
tion.

According to the United Nations Declaration of Human
Rights (87), every body has the right to sufficient and,
proper food. However, in order to attain this right,
nutrition education, by any means, is required to enable
any individual, any population or community to be

properly nourished.

24

Nutrition education is a need that has been relative-
ly newly recognized all over the world. In order for man
to make good choices of what he needs to eat, he has to
have some form of nutrition education; making good food
choices is not something in-born in man - it has to be
learned.

It has been shown that both fathers and mothers are
influential in food selection and meal planning for the

family (27). Therefore, their choices of foods which,

 

in the first place were made out of ignorance in most
cases, are passed on to their children and their children's
children; thus, perpetuating the same basic problem.

The success of nutrition education in improving the
nutritional status of individuals has been investigated
in several places. In the U.S.A. a study was carried
out among summer camp children during which time they were
given some nutrition education in order to increase their
vegetable consumption. It was noted that these children
had a significantly higher demand for vegetables than a
control group and thus had a higher vegetable consump-
tion (7).

It has been shown also that there is a direct
relationship between nutrition knowledge and the level of,
general education, not only in developing countries like
Nigeria (74), but also in developed ones like the U.S.A.
(27). Other studies have shown that mothers who have

knowledge of nutrition are more likely to serVe

25

nutritionally adequate diets to their families. For
instance, a study of homemakers in Richmond, Virginia

(in the U.S.A.) showed that 60% of the homemakers who

had some knowledge of nutrition were able to provide their
families with adequate diets (26,88).

In spite of the extensive public pronouncements and
the various academic articles that have been published on
the subject of nutrition education in Nigeria during the
past few years, there has been very little response in
the direction of improving the nutritional status of the
people of Nigeria. The reasons for this poor response
have been very well outlined by Professor Olayide of the
Department of Agricultural Economics and Extension of the
University of Ibadan (62). These reasons are:

(a) "The imprecise definition of the scope and
meaning of nutrition training and its
implications for accelerated economic
deve10pment.

(b) The inadequacy of the existing extension
organization to cope with demands of a
dynamic nutrition training in terms of
organization, personnel, material and
money.

(c) The lack of an articulated plan of programs
on nutrition training for which adequate
logistics have to be provided or mobilized
for meaningful implementation.”

These three points advanced by Professor Olayide, seem to

emphasize the degree of difficulty that nutritionists

have in Nigeria. How can one clearly define the scope and
meaning of nutrition training when there is no understand-

ing of what governs the food habits of the people in

Nigeria and what factors influence their choice of

26

available food resources! How can a country cope with the
immense extension facilities that a dynamic nutrition
training program demands, when the relative influence
which the various health personnel have on the Nigerian
mother is not known! An articulated nutrition education
program can only exist if methods are available for

improving the nutrition of children in Nigeria.

What is Childhood Malnutrition?

 

Kwashiorkor and marasmus are two major malnutrition
diseases of childhood well recognized all over the world,
especially in the tropical areas of the world (49).
Protein-calorie malnutrition (PCM), which is referred to
as kwashiorkor, is the most widespread childhood nutri-
tional disease found in developing countries. It is
found to be an important cause of child mortality and
morbidity, resulting in permanent damage to physical and
mental growth among children who survive (31).

In many developing countries, kwashiorkor seems to be
a disease of the infant that has been newly weaned from
breast milk (14). For this reason, the weaning period is
a very crucial one for Nigerian children. In fact, there
is evidence that the processes of malnutrition in these
children began much earlier in life. According to the
Ninth Report of the FAQ/WHO Expert Committee on Nutrition,

"at about 5 to 6 months of age, breast feeding

is no longer adequate to meet the infant's
nutritional needs. From this time until about

27

3 years of age, when the child can join the

family in eating the ordinary family diet,

special infant foods are required" (31).
In many developing countries, these special infant foods,
mentioned in the report above, are not readily available
to the people who need them most. Consequently, infants
are fed on available foods, which in most cases are wrong
foods for reasons described earlier.

Several factors have been said to be responsible for

malnutrition. This is presented graphically in Figure l.

 

 

Diseases ' ‘*Social factors:
education,
tradition,
economics,
religion.

 

 

 

 

 

 

Inefficient use1
of available
food

 

*Some social factors, traditions and religious beliefs
can be eliminated by adequate nutrition education.

Figure 1: Education as a fraction of causes
of malnutrition (adapted from Runyan,
Nutrition for Today, p. 134) (68)
Kwashiorkor is present mainly in places where
educational, socio-economic and cultural factors combine
to make sufficient protein unavailable to the child. From
an educational standpoint, studies have shown that
kwashiorkor is seen more among children of parents with

some elementary school education or less than secondary

(high) school education (74). From an economic

28

standpoint, this disease appears to be greater in rural
families with no steady income than in wage-earning.
families (14). From a cultural standpoint, Nicol showed
that in rural Nigeria, kwashiorkor is higher in areas
where the staple foods are starchy tubers, like yams and
cassava, than in areas where such cereals as sorghum and

millet constitute a major part of the diet (58).

Extent of Childhood Malnutrition,

 

Especially in Developing Countries

 

Childhood malnutrition is a world-wide problem
especially in developing countries; and studies in many
of these countries have shown that childhood malnutrition
is the greatest contributor to child mortality (13). In
India, children under five years old account for 65% of
all deaths; in Brazil it is 80% of all deaths; and in
Egypt it is 68% of all deaths (13). Also, in such
developing countries as in Asia, Africa, and Latin America,
a large number of children are malnourished (36); and
many of these children will die before they reach school
age; and those of them who survive may be handicapped
for life.

One hundred and one community surveys were carried
out among 59 developing countries in the period of ten
years (1961 to 1971); and results of these surveys show
that not less than 100 million children under the age of

5 years are affected by moderate to severe PCM (31).

29

Although precise quantitative information is lacking,
there is reason to believe that as much as 70% of all
children in Nigeria suffer from some form of malnutrition
at some time in their childhood. According to the Ninth
Report of the Joint FAO/WHO Expert Committee on Nutri-
tion (31),

"malnutrition is an especially important,
though often hidden, cause of mortality among
children. There is a high incidence of
infectious diseases among young children in
most developing countries and the resultant
high morbidity and mortality is largely due
to lowered body resistance because of
malnutrition... The existence of malnutri-
tion on any scale should be cause for concern.
The present and projected magnitude of the
problem calls for the most urgent considera-
tion of the means for its elimination."

Prevention and Treatment of

Childhood Malnutrition

 

Malnutrition is known to have existed even in pre-
historic times (35) but was not known to be associated
with food, hence, it could not be treated. Therefore, to
prevent malnutrition, we must have knowledge of how to
apply principles of nutrition to food selection in order
to be in good nutritional status.

For effective treatment of kwashiorkor, therefore,
it is important to know (apart from other information and
medical treatment given to the child) the educational
background of the parents in terms of how much nutrition
they know. This will help to outline how much nutrition

education to be given to the parents to prevent recurrence

30'-

of malnutrition in the child or subsequent children in the
family. This task of combating childhood malnutrition is
very important because early childhood malnutrition can
lead to permanent psychological and organic damage which
in turn will lead to negative social and emotional be-
havior as well as biological retardation. Many studies
have shown that kwashiorkor in early childhood does have
negative effect on the physical and physiological develop-
ment of the child; and inadequate nutrition in infancy

has been found to give rise to brain damage which may be
permanent (2,3,20,25,47,52,81).

Just as an individual with a hungry stomach will find
it difficult to function adequately, so also will a
malnourished child. His curiousity and ability to con-
centrate are impaired by malnutrition; he looks physically
and emotionally exhausted, and teachers who have no
knowledge of symptoms of malnutrition may feel that such a
child is not interested in coming to school. Such a child
may end up dropping out of school or spending more years
in school.

There is no doubt that a consensus of opinion that
poor or improper education is a major contributing factor
to the deplorable nutritional status of the children of
Nigeria. True, there are economic reasons as well as cul-
tural and social reasons (8,34,41,46,71,73,83) for poor
nutrition, but with proper education, the effects that

these factors have on nutrition could be reduced.

31

In summary, the literature has pointed out that:

(a)

(b)

(C)

(d)

(e)

(f)

C3)

Ch)

(1)

Nutrition has always been part of mankind's
history; and childhood malnutrition is recognized
all over the world.

Childhood malnutrition, especially in developing
countries, has been influenced by several

factors which have cultural, social, psychologi-
cal and economic basic factors.

Nutrition education is being recognized all over
the world.

Although poverty is a factor contributing to
malnutrition, increased income does not ensure
better nutrition; but that nutrition education
ensures better nutrition for the individual as
well as for the family.

There is direct relationship between nutrition
knowledge and the level of general education of
individuals.

Nutrition is a recognized key factor in national
development, even though it is poorly appreciated.
In-service nutrition education of teachers is
useful in nutrition education of school children.
Nutrition education in medical and nursing
schools is receiving less attention.

Nutrition education, in general, has been found
to be a major means of reducing childhood

malnutrition.

32

(j) Childhood malnutrition has negative effect
on the physical, physiological, and emotional

development of the child.

Chapter III

DESIGN OF THE STUDY

 

The study was designed to evaluate the relationship
between the level of formal education and knowledge of
nutrition on the one hand, and between knowledge of
nutrition and the prevention of malnutrition on the other.
This relationship was evaluated for the mother and; for
the father, the relationship between level of education
and concern for their children's nutrition was evaluated.
Thus, the relative influence that each parent has on the
nutrition of their children was examined. Also evaluated
were sources from which education about proper nutrition
was received by the population and the magnitude of influ-
ence that each of the sources has on nutrition. This
latter was with a view to finding out which educational
source is most effective in teaching the masses about
the meaning and usefulness of proper nutriton. Hence,
there are eight major hypotheses tested:

(a) The lower the educational level of the mother,

the lower the nutritional knowledge that she has.

(b) The older the mother, the lower the level of

nutritional knowledge that she has.

33

(C)

Cd)

(e)

Cf)

(8)

Ch)

34

The higher the educational level of the father,
the more interest he has in the nutrition of
his child as against the feeding of his child.
The major reason for breast-feeding is the
belief of the natural nourishment it provides
the child.

A major source of information on infant nutri-
tion is hospital nurses.

The curricula of both primary and secondary
schools in Nigeria have played no active role
in nutrition education and have thus, contri-
buted to childhood malnutrition.

There is little or no nutrition education in
nursing schools in Nigeria, thus, making the
nurse ill-equipped to help prevent childhood
malnutrition.

Lack of publicity and coordination of the
nutrition education programs presently in
existence are handicaps to the efforts of

government to combat malnutrition.

ngulation and Sample Description

The study was conducted in Benin City, Bendel State

of Nigeria. Because the population of Benin City (1)

represents almost every cultural group in Nigeria, the

findings are applicable to Nigeria as a whole. Benin

City, a major city in Nigeria (1) is also a cosmopolitan

35

area and the State's capital to which all nutrition and/or
medically related cases are referred. Thus, it serves as
the "Receiving Station" for Bendel State, and is very rich
in terms of an adequate and appropriate population for
this investigation.
The sample for this study was made up of three sets.
These are:
(a) One thousand and fifty six mothers who have
had, at least, two children and fed them
within the country during their infancy and
childhood period.
(b) Twenty five schools (seven primary, fifteen
secondary and three nursing).
(c) Four government ministries (Agriculture,
Education, Health, and Local government).
Mothers were randomly selected in hospitals, and in
the ministry of health nutrition unit and the health
center. These mothers are those who come to the hospital
for prenatal clinic or those who bring their children to
the hospital, nutrition unit and the health center either
for post-natal, well-baby clinic or for sick-baby clinic.
The schools were randomly selected but care was taken
to include all types in terms of composition of students
by sex; the three major nursing schools in Benin were
selected, by the help of the ministry of education. The
ministries considered to have nutrition related programs

were also selected by the help of the ministry of education.

36

Variables and Hypotheses

 

On the basis of the experimental design, four major

variables are identifiable. These are:

(a)
(b)

(C)

Cd)

Level of education of mothers and fathers.

Level of nutritional knowledge of mothers, and

their impressions of breast-feeding.

Degree of fathers' interest in their children's

nutrition.

Major sources of information on infant nutrition.

The first variable deals with the educational levels

attained by both husband and wife. For the purpose of

this study, there are seven possible levels of education

used. These

Level
Level
Level

Level

Level

Level

Level

1
2

are:

No schooling.

Did not complete primary school.
Completed primary school.

Had some post-primary school (e.g.,
modern school, grade III teacher, class
IV secondary school)

Completed high school (secondary school),
higher school certificate, or grade II
teacher.

Had some post-secondary schooling (e.g.,
advanced teachers college, university
undergraduate but did not graduate,
polytechnic or trade schools).

Had university first dgree and above.

37

The second variable concerns how much knowledge of

nutrition the mother has and how this knowledge relates

to her level of formal education. The questions asked to

evaluate knowledge of nutrition include:

(a)

(b)
(C)

(d)

(e)

Name ten to twenty things which you consider
food, per se;
What classes of foods do we have?
Why does the body need protein, carbohydrates,
fats, minerals, and vitamins?
What diseases do protein-deficient children
have?
Which Nigerian foods provide proteins, and
which provide carbohydrates? Under this was
also evaluated, impressions about breast-
feeding with questions such as:
(i) For how long breast-feeding was
provided each child?
(ii) Reasons for weaning the child from
breast-feeding.
(iii) Foods that were given in place of

breast milk.

The third variable deals with the degree of interest

that fathers have in the nutritional state of their child-

ren. To evaluate this, mothers were asked to label

fathers'

interests either as none, little interest, or

very much interest.

38

Four hypotheses were considered under the second and
the third variables. These are:

(a) The lower the educational level of the mother,

the lower the nutritional knowledge that she has.

(b) The older the mother, the lower the level of

nutritional knowledge that she has.

(c) The higher the educational level of the father,

the more interest he has in the nutrition of
his child as against the feeding of his child.

(d) The major reason for breast-feeding is the

belief of the natural nourishment it provides
the child. This is a major reason for prolonged
breast-feeding.

The fourth variable deals with the mothers' major
sources of information on infant nutrition. The hypothesis
for this variable is:

(a) A major source of information on infant nutrition

is hospital nurses.

Also considered in this study are the relative con-
tributions made by primary and secondary schools to
nutrition education. In this regard, some primary and
secondary school curricula were examined to see what, if
any, emphasis is placed on nutrition. The hypothesis
considered here is "curricula of both primary and secondary
schools in Nigeria have played no active role in nutrition
education and have thus contributed to childhood malnutri-

tion."

39

Another hypothesis considered was in relation to
nursing school programs in nutrition. The stated hypothe-
sis is that "there is little or no nutrition education in
Nursing Schools in Nigeria, thus making the nurse ill-
equipped to help prevent childhood malnutrition."

Also considered is the following hypothesis regarding
the role of government agencies in furthering the course
of proper nutrition - "lack of publicity and coordination
of the nutrition education programs presently in existence
are handicaps to the efforts of government to combat

malnutrition."

Instrumentation

 

For this study there were three sets of questionnaires
used (Appendices B, C, and D). These three sets of
questionnaires are:

(a) An 3 page questionnaire for multiparous

mothers (mothers with two or more children) -

to find out how much nutrition knowledge they
have as compared to their educational back-
ground; whether or not protein foods are con-
sidered as foods or just mere condiments, and the
functions of food as related to the body;

whether or not they are involved in or know of,
any nutrition education programs in the country;
to find the sources from which they receive

information concerning child nutrition; to find

40

out whether or not fathers are interested in the
nutrition of their children; to find out whether
or not they are interested in nutrition educa-
tion programs if made available; to find out
what they consider to be the major cause of
childhood malnutrition in the country.

(b) A three page_questionnaire for primary, secondary
and nursing schools. This is to help find out
whether or not nutrition related subjects are
taught in the schools as well as the reasons
for or for not teaching these subjects.

(c) A one page questionnaire for the ministries.
This is to help identify the types of nutrition
education programs which the State runs for the

benefit of the public and child health.

Methods of Data Collection

 

For this study, data were collected through direct
interviews with mothers in hospitals and in the ministry
of health nutrition unit and the health center. All
interviews were conducted by the investigator who, using
the questionnaire as a guide, recorded all answers
personally to ensure that information collected is com-
parable between mothers.

The same method was used for information gathered
from schools as well as from government agencies. Thus,

all of the questionnaires were completed on the basis of

41

person-to-person interviews. In schools, teachers of
nutrition or principals were interviewed. In Nursing
Schools, matrons or principals were interviewed and, in
government ministries, commissioners and/or individuals

in charge of nutrition related activities were interviewed.

Data Analysis

 

The information gathered through the use of the
questionnaires were analyzed by use of the computer in an
attempt to find answers to the various hypotheses stated
earlier. The computer data were then produced in the
form of tables and figures which better portrayed the
statistical outcome of the study.

In one instance, where correlation between variables
was sought, Pearson Correlation Coefficient analysis was
employed. This was also done with the help of the com-
puter. Significance level was established at 0.001.

Some of the information obtained from schools and
Government agencies did not lend itself to tabulation;
but these results were, nonetheless, described and

critically appraised.

Chapter IV

ANALYSIS OF FINDINGS

In this chapter, all of the major hypotheses are re-
stated and presented in terms of their statistical out-

comes .

General Character of the Population

All of the women interviewed were of child-bearing
age (TS to 45 years old). The income levels of the families
could be assessed from a combined evaluation of the
occupations of bOth husbands and their wives. From the
information collected, the families, on the average, could
be said to be of low to middle income (Tables 1 and 2). It
will be observed from Table 1 that more than half of the
women have no income and 18.6% of them are petty traders.
Petty traders bring very little income to the family.
However, a combination of husband and wife (or wives)
petty trading provides adequate income for maintainance of
the family needs. The husbands as shown in Table 2, vary
in their occupations and money earning interests as one
would expect for a cosmopolitan city.

As pointed out earlier, all of the women interviewed
are those with at least two living children. These women

42

43

Table l: Occupations of wives.

 

 

 

 

Occupations of Number of % of women
housewives women

None 700 66.3
Secretary/ 88 8.3
Clerical

School teacher 72 6.8
*Petty trader 196 18.6

Total 1056 100.0

 

* A petty trader, as used in this study, is one who buys and sells
in small stalls in or out of the market places. Also, according
to Bauer (9), petty traders are "small traders"; they are retail

sellers who sell their commodities in small quantities.

44

Table 2: Occupations of husbands.

 

 

 

 

*Occupations of NUmber of % of husbands
husbands husbands

Land lords/Private 152 14.4
business

Secretary/ 288 27.3
Clerical

School teacher 72 6.8
Petty trader 152 14.4
Taxi driver 136 12.9
Laborer 256 24.2
Total 1056 100.0

 

* The occupation stated here is what was considered the mainnmoney
earning venture by the wives. It is worth noting that a number

of these husnands are engaged in more than.one occupation.

45

have been divided into six different age groups as

follows:
(a) 15-20
(b) 21-25
(c) 26-30
(d) 31-35
(e) 36-40
(f) 41-45

The distribution of these women according to their level
of formal educational attainment is presented in Table 3.
It will be observed that as much as 42.4% of the women
either have no formal schooling at all or did not even
complete elementary (primary) education, while only about
9.1% completed secondary (high) school. Considering the
fact that this study is in a large cosmopolitan city, the
figure 42.4% appears to be a very high rate of

illiteracy.

Educational Levels of Mothers and their

 

Knowledge of Nutrition

 

Regarding the hypothesis that the lower the education-
al level of the mother, the lower her knowledge about
nutrition, one point score each was given to a series of
eleven basic questions about nutrition (See Appendix E)..
Thus, a maximum score of eleven for level of nutrition
knowledge was given and the lowest score was zero. About

one third (30.3%) of the 1056 women interviewed scored

46’

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47

"zero", meaning that they have no idea what nutrition is
all about. Ninety two of the 1056 women (8.8%) did, how-
ever, show adequate understanding of what nutrition means,
scoring between 9 and 11. Table 4 shows a detailed break-
down of the number of women with the different scores.
One can infer from this table that about 78.3% of the
women (scored 4 or less) have much less than adequate
knowledge of nutrition.

In order to illustrate the relationship between this
knowledge of nutrition and the educational level of the
mothers, the next six Tables (Tables 5 through 10) were
produced. In each of these Tables, the relationship
between nutrition knowledge and level of education of the
six different age groups of mothers was presented.

In Table 5, it will be observed that 12 women in the
age group 15-20 who never went to school had no nutrition
knowledge at all. Of the 32 women who either did not
complete or completed primary school, 16 of them had no
knowledge of nutrition, while 12 of them had some idea
about the principles of nutrition; and only 4 had a fair
knowledge of nutrition. Almost half (28) of the 60 women
in this group scored zero, indicating no nutrition know-
ledge at all.

In Table 6, almost one third (120) of the 408 women'
in this group have no nutrition knowledge at all. For
the 368 women in the age group 26-30, 88 (about 24.0%)

scored zero as shown in Table 7. For the age groups 31-35,

48'

Table 4: Points score for women's level of nutrition knowledge.

 

 

 

Points Number of % of women
women

0 320 30.3
264 25.0
2 144 13.6
3 48 4.5
4 52 4.9
40 3.8
6 16 1.5
7 40 3.8
8 40 3.8
9 28 2 7
10 20 1.9
11 44 4.2

 

Total ' 1056 100.0

 

49

 

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54

 

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SS

zero scores were reported for 44 out of 132 (33.3% women
(Table 8)); 28 out of 64 women (43.8%) in age group 36-40
scored zero (Table 9); and 12 of the 24 women (50.0%
group 41-45 scored zero (Table 10)).

An examination of these six Tables reveals that, for
every age group, there is a consistent direct relationship
between the levels of education and nutrition knowledge
scores. In order to determine the statistical significance
of this relationship, Pearson Correlation Coefficients'
analysis was employed. Using this method, r was found to
be 0.6690 which is significant at the 0.001 level. To
prove this further, Tables 11 showing the score distribu-
tion according to educational level, and 12 showing the
average score of each educational level were computed. For
instance, in Table 11, 112 women in the no schooling
educational level scored zero (total score = 0); 68 scored
1 (total score = 68); 24 scored 2 (total score = 48);

8 scored 3 (total score = 24); 4 scored 4 (total score =
16). All the scores in this education level added up to
156 (0+68+48+24+l6). Therefore, the average score was 156
divided by 216 which is 0.72. In this way, all of the
average scores for the different educational levels are
computed as shown in Table 12.

If there were no relationship between educational
level and knowledge of nutrition, then the mean score for
each educational level would be expected to be about the

same as for the grand average. Table 12 shows that the

S6

 

 

 

 

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57

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58.

grand average of the group averages (calculated by adding
all the educational level average scores and dividing by
six) is 4.19. The standard deviation of the various educa-
tional level average scores from the grand average of the
group averages is calculated to be 3.5. It will be observed
that the average score increased with increasing educational
level. The measured standard deviation of 3.5 is an indica-
tion of the extent to which the various group averages
deviated from the grand average. As pointed out earlier,
Pearson Correlation Coefficient analysis showed r value to
be 0.6690 which is significant at the 0.001 level.

When the women were asked to name 10 to 20 things which
they considered to be food, most of them did not consider
high protein foods as food per se but as condiments or
spices or something that makes food taste better. When
specifically asked if they considered high protein foods
(such as meat, fish, shrimps, eggs, etc.).as food, 56.8%
(600) of the women did not think that these foods are
really necessary for the human body, but do make the food
more palatable and hence improve appetite. When these
women are separated according to their educational level,
it is again seen that their answers bear a direct relation-
ship to their level of education as shown in Table 13.

No statistical analysis is necessary to see the correla4
tion.

Feeding children with infant formulae has grown in

popularity in Nigeria over the last 20 years. Yet, most

59

Table 13: The number of women who do not consider high protein
foods (meat, fish, shrimps, eggs, etc.) as food and,
their educational level.

 

 

 

 

Educational Number of Protein is food
level (1-7) women

NO % N0
No schooling 216 152 70.4
Incomplete primary 232 156 67.2
Complete primary 324 196 60.5 ‘
Some post primary 188 80 42.6
Complete secondary 72 16 22.2
Some post secondary 24 0 0.0
University degree 0 0 0.0

 

Total 1056 600 S6 . 8

 

60

women who give their children infant formula have no

idea of the origin of such formula or of their nutritional
values. Questions were asked the women in an attempt to
find out how many of them used these infant formulae.

An astonishing 93.6% (988 out of 1056) use infant formulae
as a supplement to breast-feeding. None of the women used
infant formulae exclusively or before the child was three
months old. When asked about the origin of these formulae
and/or their nutritional values, only 18.2% (192 out of
1056) of them gave correct answers. Once again, correct
answers in this case are directly related to the level of
education - ranging from 0.0% for the no schooling educa-
tional level to 83.3% for those with some post secondary

educational level (See Table 14).

Mothers Age and Knowledge of Nutrition

 

The stated hypothesis here is that the older the
mother, the lower her level of nutritional knowledge.

To test this, the average score of mothers belonging
to the different age groups was computed. For instance,
in Table 15, 28 women in the age group 15-20 scored zero
(total score = 0); 8 scored 1 (total score = 8); 4 scored
3 (total score = 12); 4 scored 4 (total score = 16);

12 scored 5 (total score = 60); and 4 scored 10 (total N
score = 40). All the scores in this age group added up to

136 (0+8+12+l6+60+40). Therefore, the average score was

61

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62

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63

136 divided by 60 which is 2.27. In this way, all of the
average scores were computed as shown in Table 16. '

If there were no relationship between age and know-
ledge of nutrition, then the mean score for each age group
would be expected to be about the same as for the grand
average. It will be observed in Table 16 that the grand
average of the group averages (calculated by adding all the
age group average scores and dividing by six) is 2.32. The
standard deviation of the various age group average scores
from the grand average of the group averages is calculated
to be 0.4866. There is no one of the average scores that
is more than 2 standard deviations from the population
average. The mothers in age group 41-45 had an average
score of 1.50 which is 1.6 standard deviations from that
of the grand average. This does indicate a fairly low
level of nutritonal knowledge, but it is difficult to
accept the hypothesis in the face of the values presented

in the Table.

Fathers' Interest in their Children's

Nutrition

 

The hypothesis here is that the level of the father's
education bears a direct relationship with his interest in
his child's nutrition.

In order to test this hypothesis, the women in this
study were asked to evaluate their husband's interest in

their children's nutrition. There were three main

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64

 

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65

categories of evaluation: no interest (scored as 0),
little interest (scored as 1), and very interested (scored
as 2). Those who scored 1 and 2 were further subdivided
into the type of interest they showed: whether the
interest is just on food consumption (labelled b) or
whether it also involves balanced nutrition (labelled a).

Table 17 shows the results. It will be observed from
the Table that 37.5% of the husbands show no interest in
their children's feeding or nutrition, while 62.5% show
varying degrees of interest. This latter group is divided
evenly into two main groups, those that scored 1 and those
that scored 2. Of those that scored 1, the interest is
overwhelmingly on the consumption of food, rather than on
balanced nutrition (21.6% to 9.8%). Of particular signi-
ficance is the fact that of those fathers who were judged
by their wives to show a great deal of interest in their
children's nutrition (scoring 2), their interest is over-
whelmingly on balanced nutrition rather than mere food
consumption (25.0% as against 6.1% for a ratio greater than
4:1).

Another important finding is the relationship that the
father's level of education has on his interest in his
child's nutrition. In Table 18, the results are tabulated.
It will be observed that among those parents who scored 0,
their relative proportions decreased as the educational
level increased, in such a way that by the time they get

to parents with university degrees and above, there was no

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67

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68

0 score. This trend is even more clearly illustrated in
Figure 2. It will be observed in this figure that the
graph dips down at educational level 2 (incomplete primary).
This is most likely because of the immense difficulty in
placing fathers in this group. Some of the fathers in

this group may have had informal education that could be
equivalent to educational level 3 (complete primary) or
higher, but because formal education was used as the
criterion, they could not be classified higher. In addi-
tion, information was derived from the wives, most of whom
themselves did not have any formal education, were not
certain of the educational level of their husbands. As

a result, they used criteria such as reading of newspapers,
writing of letters, and signing of names in assessing their
husbands' educational level, which makes level 2 fairly
inaccurate.

There were 332 fathers who scored 1 for degree of
interest. For these fathers, there does not seem to be any
relationship to educational level. However, all of those
with university degrees and above showed interest in proper
nutriton rather than in mere food consumption (See Figure
3). As a matter of fact, this trend was evident among
those with some post secondary education, where the ratio
of those fathers showing interest in proper nutrition to.
those showing interest in mere food consumption was about

3:1 (11.5% to 3.9%) as shown in both Table 18 and Figure 3.

69

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71

The distribution of the 328 fathers that scored 2 for
degree of interest according to their educational level,
was very impressive (See Figure 4). The percentage of
fathers showing "type a" interest seemed to increase signi-
ficantly with increase in educational level. The propor-
tion of fathers showing ”type b" interest, however, remained
relatively the same at all educational level except among
those with university degrees and above, when all fathers
showed only "type a" interest.

The general trend, therefore, seem to be that the
father's educational level bears a direct relationship with
the degree of interest he shows in his child's nutrition.
The data also seemed to relate educational level positively

to the type of interest the father showed.

Reasons for Breast-feeding

 

The hypothesis tested is that mothers breast-feed
their babies because they consider it the natural way of
nourishing the babies.

To test this, mothers were asked to give reasons why
they breast-fed their children. Interestingly, all 1056
women used breast-feeding as the only mode of feeding their
-children at the time of birth. The least length of time
that breast-feeding was used exclusively was 3 months.

All of the answers given by the mothers fall into

three main categories only. These are:

72

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73

(a) Economic - can not afford the extra expenses
of buying baby formula. ‘

(b) Biological - nature's desire that breast milk be
fed to babies and that is why every nursing
mother is gifted with instantly available breast
milk. There is no great fear of contamination.

(c) Traditional - our mothers fed us this way, their
mothers fed them the same way, and we cannot stop
it now.

A small number of these women gave more than one reason,
hence, the total showed in Table 19 is that of total number
of reasons given rather than the total number of women
giving those reasons. It will be observed from the Table
that 3/4 of the time, mothers gave a biological reason and
the other 1/4 of the time, the reason given is a tradition-
al one. Less than one-half percent of the time, an
economic reason was given.

It is worth noting that no one of the mothers gave as

a reason the excuse that breast-feeding cause breasts to

droop.

From which Source do Mothers Learn
most about Nutrition?
It is hypothesized here that hospital or clinic nurses
provide mothers with the most information about infant

nutrition. This is an important factor to know since plans

74

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75

to improve nutrition education can be centered around
existing sources of disseminating such information.'

Answers given by mothers fell under 4 general cat-
egories:

(a) Doctors.

(b) Nurses.

(c) Friends and relatives.

(d) Books and mass media.
The results are tabulated in Table 20. Again, it will be
observed that some of the women named more than one source
and that is why the total is greater than 1056. More than
87.0% of the women named hospital nurses as the main source
of information about nutrition. About 9.0% named friends
and relatives, 2.7% named books and mass media, while the
remaining 1.0% named doctors. The relative unimportance
of physicians in the education of patients most likely
extends beyond nutrition to other areas of health education.

As mentioned earlier, infant formulae were used by
988 of the 1056 mothers (93.6%). No one of these women
used these formulae exclusively or before the child was 3
months old. When asked about their source of information

about the formulae, their answers fell under 5 main

categories:
(a) None.
(b) Doctor.

(c) Hospital nurse.

76

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77

(d) Friends and relatives.

(e) Books and mass media.

These answers are tabulated in Table 21. Because some
women named more than one source, the total number of
responses is greater than the number of women who gave
answers. The nurses again provided these mothers with the
greatest access to information on infant formula (81.3% of
total responses). Friends and relatives were next (9.0%),
followed by books and mass media (5.0%), no source of
information at all (4.0%) and doctors (0.7%) in that order.
One cannot but be amazed by the lack of contribution that
Nigerian doctors have made to public health nutrition.

Although only 44 responses of no source of information
about infant formula were obtained (Table 21), as much as
392 individuals did not show any knowledge of the nutri-
tional value of these formulae (See Table 14). The reason
was that, most of the information received from the nurses
is about an alternative to breast-feeding, not about why
it is as good as breast milk wich would have included some
information about the nutritional value of formulae.

In a typical Nigerian home several decisions about
foods are made. What should be eaten; when to breast-
feed or give infant formula; when to add solid or table
foods; who eats what and in what amounts, etc. In order
to find out to whom general nutrition education should be
directed, it is essential that information be gained about

who makes these decisions. To this effect, mothers

78

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79

responses were classified into 4 groups:

(a) Nobody.

(b) Mothers only.

(c) Fathers only.

(d) Both father and mother.
These results are shown in Table 22. It will be observed
that slightly over 70.0% of the decisions made are by the
mothers only. In about 28.0% of the time, both fathers and
mothers take part in decision making. Thus, in 99.0% of
the time, the mother is actively involved in the decision
making. There was no instance in which the father alone
makes the decision. Only 4 individuals claimed that the
need for decision making does not exist in their households

since they eat any food that is available on a given day.

Recognition of Malnutrition and

 

Knowledge of the Causes of Malnutrition

 

Malnutrition is a major cause of infant mortality and
morbidity in Nigeria. As pointed out in Chapter II, this
is a well documented fact. Early detection of signs of
malnutrition is very important for effective management.
Questions were asked of mothers to determine their ability
to recognize signs of malnutrition in their children and
also to evaluate their opinions regarding the reasons why
malnutrition is so prevalent in Nigeria.

The question about recognition was asked in such a

way that the interviewer made the decision as to whether

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81

the answer constituted sufficient ability to recognize
malnutrition or not. Table 23 shows the proportion that
can recognize malnutrition and this is distributed accord-
ing to the educational level of the mothers. Not surpris-
ingly, this ability increased with increasing educational
level of the mother as shown in Figure 5.

Regarding causes of malnutrition, the answers given
fell into 3 classes:

(a) Those that thought it was exclusively because

of poverty.

(b) Those that thought it was exclusively due to

lack of education.

(c) Those that thought it is a combination of both.
In Table 24, the results are tabulated. It is encouraging
to note that about 74.0% of the women named lack of
education as all/or part of the cause. About one-half of
the women blamed lack of education as the only cause,
one-fourth blamed it on poverty as well as poor education
and the other one-fourth blamed it on poverty only.

There are a number of nutrition education programs in
Benin City that teach mothers such basic facts of nutri-
tion as recognition of malnutrition and proper food habits.
However, the existence of these programs is not sufficient-
ly publicized and their coverage is so limited that their
usefulness is in doubt. Mothers were asked if they knew
of the existence of nutriton education programs in the

country. Their answers are tabulated in Table 25. It is

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PERCENT OF ND'IHERS IN EACH LEVEL THAT CAN RECOGNIZE
MALNUTRITION

100

90

80

7O

60

50

40

30

20

10

83

 

 

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No Incomplete Complete Some Complete Some University
Schooling Primary Primary Post- Secondary Post- degree
Primary Secondary

EDUCATIONAL LEVEL

Figure 5: Educational level of mothers and ability to recognize
malnutrition

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86

shown in this Table that only 30.7% (less than one-third)
of the women know of the existence of such programs. When
this is distributed according to age group and educational
level as shown in Tables 25 and 26, no definite pattern
seemed to emerge. However, Table 25 shows that all of the
64 mothers in the 36-40 age group do not know of the
existence of any programs, those in 15-20 age group as
well as those in 41-45 age group showed less knowledge
(20.0% and 16.7% respectively) than any of the remaining
three groups. The most knowledge of existing programs was
demonstrated by the 31-35 age group where one-half of them'
know of the programs as opposed to one-third in each of the
21-25 and 26-30 age groups. Also, looking at this accord-
ing to the educational levels (See Table 26), over 40.0%
of the women, who had some post-primary education, completed
secondary school, or had some post-secondary education,
know of the existence of nutrition education programs;
whereas, of the other women who did not have more than
primary education, less than 30.0% of them knew of the
existence of nutriton education programs in the country.
The most knowledge of the existence of nutrition education
programs was demonstrated by those who completed secondary
school.education where, about two-thirds of them know of
the existence of nutrition education programs.

One important finding under this topic is the fact
that when the mothers were asked if they would be willing

to participate in nutrition education programs, only 48

87

 

 

 

 

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88

(4.5%) of the 1056 women were unwilling. The remaining
95.5% were not only willing to participate, but most were
enthusiastic about participating in any nutrition education

programs.

Family Planning and Education

 

Because of increased departure from traditional ways
of living due to the influences of Western life style,
considerable financial strain is imposed upon large
families with a lot of children. Although not specifically
investigated in this study, the indications throughout the
investigation were that there seemed to be a direct rela-
tionship between problems of malnutrition and number of
children. Therefore, the aspect of this study which tended
to correlate maternal level of education and the number of
children was thought to be useful. However, it is worth
mentioning that most of these mothers still have several
fertile years ahead of them and, as a result, valid con-
clusions can really not be made for most age groups. The
number of children according to age group distribution of
mothers is shown in Table 27.

It will be observed that no mothers in age group 15-20
have more than 3 children. But these women have better
than 20 years of fertile life ahead of them and no one can
predict at this time what their family sizes will ultimately
be. The same thing is true for the next three or four age

groups, only to a lesser extent with each succeeding age

 

 

89

 

 

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90

group. The only age group where conclusions can be made
is the 41-45 age group, where even then, it is with a
guarded degree of certainty. In Table 28, the number of
children as a function of the educational level of mothers
in the 41-45 age group is given. There does not seem to
be any relationship at all. It is recognized here that
several variables such as degree of fertility and environ—
mental factors have not been controlled. Whatever the
case, the impression is that educational level of mothers

bears no relationship to the desire to limit family size.

Programs in Nutrition Education

Education in nutrition can be found mainly in programs
of departments with nutrition related subjects at the
universities. To some degree, nutrition education is also
given through the adult education programs of the Minis-
tries of Agriculture, Education, Health, and Logal govern-
ment, as well as in a few primary and secondary schools.
Also, some instruction in nutrition is given in the medical
schools and in the nursing schools. Some medical schools
and nursing schools send their students to the Nutrition
Unit of the ministry of health, for about 10 to 20 hours

of instruction in nutrition.

Primary and Secondary Schools.
One of the perceived major functions of schools is to
promote the health of the community. It is hypothesized

here that curricula in these schools have not played an

91

 

 

 

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92

active role in nutrition education and have thus contri-
buted to problems of malnutrition. This study has revealed,
through answers by school principals that there has not
been an emphasis on nutrition education in schools, and

that schools' syllabi covering aspects of nutrition are

not mandatory, but optional for the students.

0f the seven primary schools examined, one does not
teach nutrition at all and the remaining six indicated
they do teach nutrition. However, on closer examination,
it was found that what is actually taught is techniques
of food preparation. Some of the responses of the princi-
pals are tabulated in Table 29. It will be observed that
6 of the 7 primary schools taught food preparation
techniques and 2 taught home management which includes,
among other things, when to eat breakfast, lunch and supper.
No other area of nutrition is taught.

In terms of reasons why nutrition is not taught, one
principal did not think it was part of the curriculum. The
other 6 felt that it was part of the curriculum, but not
required. In two schools it was felt that the students
were not interested in such subjects. All of the schools
felt that nutrition should be a woman's subject only. Even
then, they all agreed that they do not have trained teachers
to teach their girls nutrition.

When asked if they would like to see more emphasis on

nutrition, all schools were willing. However, when asked

93

if they would like to see their male students learn all
aspects of nutrition, only 4 out of 7 said they would like
it and, of these, 2 were women principals.

There were 15 Secondary (High) schools examined. Of
these, 5 were for boys only, 5 were for girls only, and
S were mixed. No one of the boys' schools taught nutrition
per se, except in such related subjects as Agriculture and
basic nutritional biochemistry under Biology courses.
Table 30 displays answers given to some basic questions
about nutrition courses in these schools. It is shown in
the Table that 3 of the 15 schools (20.0%) consider nutri-
tion a "girls only" subject; 2 of these 3 schools are boys
schools and l a mixed school with a male principal. One
male principal of an all girls school was not aware that
nutrition is an approved secondary school certificate
subject. The principals of 4 of the all boys schools deny
teaching nutrition as part of any subject, yet these
schools have in their Biology courses, topics such as
digestion, metabolism of carbohydrates, fats and proteins.
Apparently, these principals do not consider these to be
topics in nutrition. There was only one school in which
nutrition is taught as a separate subject titled "Foods
and Nutrition."

When asked if they would like to see nutrition taught
to male students in their schools, 2 principals of boys
only schools answered in the negative. These are the same

2 principals that claimed that nutrition is a "girls only"

94

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96

subject (Table 30). One male principal of a mixed school
also gave a negative answer for the same reason as his 2
other colleagues. No "boys only” schools would want to
teach Home Economics or Domestic Science to their students.
Three of the principals (all males) in mixed schools also
do not want their male students taught Domestic Science.
Some of these principals were appalled at the suggestion
of asking their male students to be involved in a feminine
subject such as Domestic Science. One of their responses
was, "we are here not only to help develop the minds of
these boys, but to make them think and act completely as

men, not half men and half women."

Nursing School Programs in Nutrition.

 

It was hypothesized that there is little or no nutri-
tion education in nursing schools, thus making the nurses
ill-equipped to help combat malnutrition.

It was found that most of the nursing schools do not
have established nutrition courses as part of their
curriculum. However, a few nursing schools send their
students to the Nutrition Unit of the Ministry of Health
to receive a few hours of lectures on nutrition for one
to two weeks. These courses are in the form of didactic
lectures to the nurses rather than field experience des
signed to expose nurses to the magnitude of the problem
of malnutrition and what community agencies are available

to the population for coping with these problems. Unlike

97

the Primary and Secondary schools, however, all of the
nursing schools visited indicated that male nurses should
not be excluded from nutrition courses taught in the

schools.

Government Agencies.

 

The function of the Ministry of Agriculture as related

 

to nutrition is in the following areas:

(a) Food production - this includes both crop and
animal production as well as fisheries.

(b) Food storage and consumption.

(c) Marketing of food produces and importation and
exportation of foods. Importation and exporta-
tion of foods is by the Federal ministry rather
than State ministry of Agriculture.

(d) Distribution of seeds for planting.

(e) Farming methods, soil fertility and land tenure
and use.

Most of the programs are directed toward producing more
foods. There was no program on nutrition education. The
type of nutrition education program which the ministry runs
is mainly agricultural extension services. For example,
disseminating government policy on agriculture and foods to
the people as in the recent Operation Feed the Nation (OFN),
a campaign designed to encourage individuals to grow their
own foods with the ministry helping to distribute seeds, at

low cost, to interested individuals.

98

The Ministry of Education's involvement in nutrition

 

education is in providing schools with course content on
nutrition in their curricula. In this way, uniform
standards are ensured in all schools under the jurisdiction
of the ministry.

It is under the Ministry of Education that the Home
Economics department is established. The function of the
Home Economics department includes nutrition curriculum
planning for primary, secondary and teachers training
schools. For secondary schools, it is in collaboration
with the West African Examination Council. In spite of
this effort, however, the subject is still not being taught
because of chronic unavailability of nutrition teachers.
Even the Home Economics department itself lacks a highly
trained nutritionist to guide their nutrition education
activities.

The major functions of the Ministry of Health as

 

related to nutrition are:

(a) To participate in coordinated nutrition surveys
and food consumption surveys.

(b) To participate in health programs that influence
nutritional status.

(c) To provide health criteria to be used in the
evaluation of nutrition related programs.

(d) To distribute supplementary food to children,

pregnant and lactating women.

(e)

(f)

99

To provide nutrition and health education for
the'public.
To import nutrition related drugs such as

vitamins.

This ministry also runs three major units dealing with

nutrition education for mothers. These units are:

(a)

(b)

(C)

The Health Center - This center functions as a

 

clinic for both well and sick (preschool) child-
ren. It does carry out nutrition education with
the mothers who take their children there either
for regular check ups or for illness. There is
no format as to how this nutrition education is
disseminated. It is at the discretion of the
nurse in charge.

The Health Education Center - This center, at the

 

moment, is not yet in full operation and its
goals do not seem to be well defined as yet.

The Nutrition Unit - This unit deals with the

 

prevention and treatment of malnutrition in
children as well as a nutritional rehabilitation
center. This unit was set up because of the
high prevalence of childhood malnutrition in the
country, and to provide, at little or no cost,

a level of nutritional care for children with
mild cases of malnutrition or during convales-
cence from severe malnutrition. In this unit,

mothers are also taught different types of diets

100

and feeding techniques. Therefore, this unit

is not only concerned with treatment of malnutri-
tion in children, but also with the prevention
of recurrent malnutrition.

This unit is also involved in providing
supplementary foods and feeding programs to the
most needy population groups with a view to help-
ing children attain their daily minimum nutrient
requirements. Generally speaking, this type of
program per se, does not correct the underlying
problems of childhood malnutrition but it pro-
vides a level of nutritional care for children
with less than severe malnutrition. The unit
refers severe malnutrition cases to the hospitals
for combined nutritional and drug treatment.

The Ministry of Local Government is mainly concerned

 

with social change of which nutrition is a part. This
ministry has a nutrition related section which is under the
umbrella of the Home Economics division. The duties of
this department of Home Economics are not well defined.
It is not certain if any relationship exist between this
Home Economics division and the Home Economics department
of the Ministry of Education.

This ministry also runs the Women Training Center in
Benin. This center trains women to be rural development
workers and organizers as well as volunteer workers. Food

and nutrition education is a major part of their training.

101

The Ministry of Education, and the Ministry of Health
are also jointly involved in an aspect of Adult Nutrition
Education for food vendors and school chefs (cooks). They
make it impossible for cooks to retain their jobs in the
schools or for food vendors to sell their foods unless
they undergo this training and get certified by the

Ministry of Health.

Chapter V

SUMMARY AND RECOMMENDATIONS

An analysis of the role of Adult Education on the
factors that influence malnutrition, especially that of
children, in Nigeria has been carried out. This study, as
clearly outlined in the previous chapter, involved 1056
women each of whom has had at least 2 children. Regarding
programs in Nutrition Education, 7 elementary (primary)
schools, 15 secondary (high) schools, 4 government minis-
tries and 3 nursing schools were examined. Among the 15
secondary schools were 5 that are mixed, 5 "boys only"
schools and 5 "girls only" schools.

Reviewing the character of the study population, it
was shown that almost every occupational group in Nigeria
was represented. The study was designed in such a way that
this variability in the background and economic standing
of individuals in the study group was essential in making
some of the comparisons that constitute some of the high-

lights of this research.

102

103

The Importance of Education

on Nutrition

 

The relationships that were established include
educational level and maternal knowledge of nutrition. It
was shown for each age group that the higher the level of
education, the greater the knowledge of nutrition. This
relationship was shown to be statistically significant
using Pearsons Correlation Coefficients analysis. The
implication of this is that formal education does improve
the awareness of mothers about the facts of good nutrition.
This is in spite of the fact that there is evidence to show
that school programs pathetically lack courses in nutrition
in their curricula, as will be discussed later. Almost
every aspect of nutrition showed this remarkable-direct
relationship to formal education of mothers. The age of
the mothers does not seem to have any relationship with
their nutrition knowledge. This, of course, means that the
direct relationship between nutritional knowledge and level
of formal education is true for each of the six different
age groups.

In another aspect of this study, fathers were evalu-
ated as to their interest in their children's nutrition.

A little over one-third of the fathers were stated, by
their wives, not to show any interest in their children's
nutrition. It was shown here again that the proportion of
fathers who show no interest in their children's nutrition

decreases markedly with increase in the educational level

104

of these fathers. Further, those who show interest in
their children's nutrition, the type of interest (whether
on proper nutrition or on mere food consumption) seem to
be dependent upon the level of father's education. The
more formally educated the father, the more likely the
interest is on proper nutrition.

This information tends to emphasize the role that
formal education can play in the prevention of malnutrition.
In terms of fulfilment of research objectives, this section
examined the present state of knowledge that Nigerian
mothers have about nutrition. It also determined what
mothers know about the nutritional values of common
Nigerian foods. It also helped in fulfilling the objec-
tive whose aim was to determine what role husbands play in

their children's nutrition.

Breast-Feeding

An estimated 93.6% of the surveyed mothers use infant
formula in feeding their children. The 6.4% who do not
use it just do not consider it desirable. There was no
one woman who used it exclusively; it is always used to
supplement breast-feeding, meaning that quite a number of
Nigerian women use breast-feeding for varying periods of
time as the main mode of feeding their children. When.
asked the reasons for breast-feeding, three-fourths of
them thought it was nature's way of rearing a child.

Although not expressed in these terms, almost all of the

105

women alluded to the psychological satisfaction that
breast-feeding gives to them. A number of the women did
not think that they needed to give reasons for breast-
feeding, since that is the method of feeding babies that
was passed on to them from their ancestors. A handful of
the women did not think it is sound economics to buy the
same milk (infant formula) that one had been blessed with
(breast milk). Thus, contrary to the aesthetic rationale
in Western countries for not breast-feeding, the logic in
Nigeria is in favor of breast-feeding.

‘ This aspect of the study did examine the impressions
of Nigerian mothers about breast-feeding and did evaluate
the proportion of mothers in Nigeria that use commercial

infant formulae.

Sources of Information about

 

Nutrition

 

About 9 out of every 10 mothers identified the hospi-
tal nurse as the most important source of disseminating
general nutrition information. Only about 3 out of every
100 instances were newspaper, TV or radio commercials
indicated. Physicians provided little or no information
to their patients about nutrition. Relatives and friends
featured in providing nutrition information in about 9
instances out of 100.

Regarding specific information on infant formula, once

again the hospital nurse was mentioned 8 out of every 10

106

times as the main source, relatives and friends only 9 out
of 100 times, and mass media commercials only 5 out of
every 100 times. The physician was rarely mentioned as a
source of information on infant formula.

The implication here is very interesting. Programs
designed to improve public awareness of the facts of
nutrition should pay major attention to nurses, not only in
terms of emphasizing nutrition in their course content
but also in terms of involving them actively in efforts to
combat malnutrition.

The sources from which mothers get information regard-
ing proper feeding was determined in this aspect of the
study. Also determined was the impact of mass media adver-
tisements on infant feeding and the relative role played by
physicians, nurses, relatives and friends on nutrition.

Decisions about foods and feeding at home were shown
to be primarily the function of the mother. These deci-
sions include what is to be eaten, quantity to be eaten,
when to eat, who eats what and what the baby is fed on.

In this regard, this study showed that 99.0% of the time,
the mother is involved in the decision-making and 70.0% of
the time, she alone makes the decision. The implication of
this is that programs on nutrition directed at the mothers
are bound to yield more effective results. To a large~
extent, this fulfilled another of the objectives of the

study.

107

Programs in Nutrition Education

 

The sum total of the findings here is that nutrition
has never been emphasized in any school curriculum and that
attitudes towards nutrition are archaic. There is a
shameful shortage of teachers in Nutrition, which is not
surprising in the face of an implicit inferior status
accorded to the study of foods, nutrition and home economics
in general. The study of nutrition is considered so
derogatory that some school principals even denied that
they teach aspects of nutrition as part of other subjects.
Although willing to see nutrition courses taught to their
students on a more established and regular basis, some
school principals still do not think that their male
students need that kind of education. It does appear,
therefore, that in expanding on existing nutrition courses
and developing new ones for schools, it should be borne in
mind that they should be mandatory for all students rather
than optional as is the case at the present time.

Regarding government programs, four different minis‘
tries are involved in nutrition. The evidence is strong
that no one cares what the other's program is, yet there
are considerable overlaps in objectives. There is duplica-
tion of facilities in a country where need and economy
ought to dictate consolidation and pooling of efforts.~ It
stands to reason, therefore, that the government badly

needs a central agency to coordinate efforts in nutrition

108

and to synthesize a single effective unit from the frag-
ments of present governmental programs. Figure 6

demonstrates a conceptual paradigm for such coordination.

General Comments

 

It is significant to note that in the last decade
there has been a steady rise in health care facilities in
Nigeria. The situation is very clearly exemplified by the
figures of Ebie (24) reported in Table 31. As would be
expected, various categories of health personnel also
increased dramatically. However, conspicuously absent are
Health Educators and Nutritionists as shown in Table 32
(also adapted from Ebie (24)). No updated figures exist
beyond 1972, but it appears likely that the situation has
’not improved much since that time.

It is unfortunate that emphasis has not been placed
on Nutrition Education before now in Nigeria. It is impor-
tant not only in many aspects of food production but also
in the general health of the population. For instance, a
knowledgeable person is needed to tell the public facts to
improve food production, storage, processing, and consump-
tion; to educate society (with limited income) on food
choices, and food contamination. Malnutrition in children
can be prevented if parents know the causes and the correct
measures to be taken to prevent it. Thus, nutrition
education is very important for the physical, psychologi-

cal, emotional and the total well-being of the individual.

 

109

 

Hospitals:
pre- and
post-natal
Clinics
Health Education Health Clinics and
Unit Family Planning
Ministries

of Agriculture, Educa-
tion, Health, and Local

 

 

   

Government.

Nutrition Unit

School Health Unit

 

 

 

Figure 6: Government programs in nutrition

 

110

Table 31: Health care facilities in Bendel State as adapted from

Ebie (24).

 

 

Categories of health
facilities

Number available
in 1963

Number available
in 1972 -

 

Hbspitals
Health centers
Maternities
Dispensaries

Dressing stations

18
4
87
183

37
103
163
137

42

 

111

Table 32: Growth, in numbers, of major health personnel in Bendel

State as adapted from Ebie (24) .

 

 

 

Categories of personnel Number in Number in
1963 1972
Physicians 17 120
Dentists 2 3
Pharnncists in government service 9 14
Nurses 175 863
Radiographers in government service ? 7
Laboratory technologists ? 19
Physiotherapists in government service ? 1
Health educators ? 0
Nutritionists ? 0
Health superintendents and inspectors 31 80
Laboratory assistants ? 9
X-Ray technicians and attendants ? 6
Dispensing assistants ? 27

 

? = Figures are not available.

*a"

112

Recommendations

 

The remarks of Griffin and Light (35) are apprOpriate
in Opening this section:

"If it is agreed that a healthy nation is

potentially a more powerful and effective

member of the community of nations, it must

be agreed that the problems and issues of

nutrition are central to the advancement of

national interests. If this is the case,

there is a strong argument for the allocation

of necessary resources to nutrition education

and to the development of new curricula designed

to act directly upon the needs of the people."
It is with this kind of thought and feeling, so eloquently
stated above, that recommendations are being made here. It
should be pointed out at this stage that not all of the
recommendations directly emanate from the research results.
Some of them are personal opinions and others were adapted

from what is known to have worked in other countries.

What need to be done

 

What needs to be done, in a nutshell, is to improve
and expand the sum total of the nutrition services that
must be delivered to the population - children, adoles-
cents, adult men and women, and the aged. This, of course,
means that the components of such nutrition services have
to be identified and ways for improving and/or expanding
each component suggested. The components of a comprehen-
sive nutrition service are multiple and they include:

(a) Screeningand surveillance: This is probably the

 

very first essential service that needs effective

development. It is the service through which we

113

select the patients who are most likely to need nutri-
tion services. In a country like Nigeria where
malnutrition is widespread, where resources (both
manpower and financial) are limited, and where
attitudes towards nutrition are at best indifferent,
it is not realistic and practical to initially direct
programs in nutrition to everybody. That is why the
screening service is very necessary for the purposes
of identifying, in a general sense, the groups who
need nutritional help the most so that programs could
be directed more specifically at such groups.

It is, of course, obvious that the development of
screening tools would be a very difficult task because
the problems of nutrition are very complex due to the
mere fact that they stem from many causes. This study

showed that an adequate simple screening device could

 

be set up which considers:
(i) Level of education.

(ii) Economic status.

(iii) Culturally tied food habits.

(iv) Availability of food.
Through surveillance, a follow-up of these groups would
be ensured. It is essential to establish the extent
to which nutrition services have succeeded in provid-
ing for the needy. This can only be adequately

assessed by apprOpriate surveillance. Thus,

(b)

114

surveillance also will serve the purpose of evaluation
of the programs.

Nutrition education: In this study, an overwhelming

 

majority of those interviewed blamed poor education
as the major cause of nutritional problems. This is
why this service must be regarded as a priority in
efforts to prevent problems in nutrition. Different
individuals in Nigeria present different educational
needs in nutrition as portrayed by the examples below.
These needs have to be met differently.

(i) Attitudes of policy makers - during the
entire period of this investigation, one
glaring fact is the indifference of indivi-
duals in positions of authority towards
nutrition problems. Consequently, active
policies are not drawn up in this regard.
What is gratifying is that these individuals
appear to be willing to support programs in
nutrition as long as they do not have to take
the initiative. The education of this group
is relatively easy. What is mostly needed
for them is to be regularly confronted with
the magnitude of the problems of nutrition;
to be regularly reminded of their obligation
to the people to provide a better life for
them; and to be regularly informed that the

resources exist to make everyone nutritionally

115

self-sufficient if only they put in some
efforts. Formal or non-formal education
sessions do not need to be held. Their
education will come from results of investi—

gations such as is reported here.

(ii) Attitudes of school teachers - whereas every-

(iii)

one was enthusiastic about the problems of
nutrition, many still felt nutrition should
be a subject for females only. The reasons
given at best were chauvinistic. To these
individuals should be directed the same kind
of educational programs suggested for the
policy makers and, in addition, they need be
informed of the role male nutritionists have
played in the provision of nutrition services
in other parts of the world. During the
occasional continuing education seminars for
teachers, sessions should be included that
emphasize the Nigeria nutritional plight and
the role the country can play in finding
solutions to it. Mandatory nutrition or Home
Economics courses for all school children may
also be helpful in changing attitudes.

The masses who can not read nor write any
language - Education of this group is, per-
haps, the most difficult. Individuals who can

not read nor speak in the official language of

116

communication, English, have an enormous
problem of not understanding what government
policies are, what concerns are being expres-
sed by various experts and, what measures are
planned to help find solutions to problems.
To this group, the education should take the
form of government propaganda. Mobile nutri-
tion units, with film strips and slide shows,
all of which highlight nutrition programs and
the benefits of proper nutrition should be
available to reach remote rural places. This
type of technique has been employed in nutri-
tionally developed countries such as the
U.S.A. with enormous success (69).

In order to make programs in nutrition
more meaningful to these individuals, commun-
ity leaders must be convinced as to the
credibility of these programs. Some amount
of free food, no matter how meager, must be
available for distribution to the very needy.
Facilities should exist for demonstrations
of locally available food stuffs and how they
can be utilized in the provision of a balanced
diet. Efforts should be made to recognize
and respect the food habits of the people and,

where these habits do not adversely affect

(iV)

117

basic concepts of good nutrition, they should
not be discouraged no matter how irrational.
Education of mothers in general - This study
showed that mothers are the most important
individuals as far as childhood nutrition is
concerned. It showed that nutrition know-
ledge is dependent upon the general education
of the mothers and that most mothers gain
their knowledge of nutrition from hospital
nurses. With this kind of information,
programs should be centered in hospital
clinics, rural health centers and maternities,
and dispensaries (where drugs are dispensed to
the needy). With the increasing dependence
on these facilities for health care mainten-
ance, efforts should be made to expand their
functions. In-service or continuing educa-
tion training in nutrition should be made
available to all personnel working in these
health care facilities - nurses, midwives,
drug dispensers, sanitary inspectors, etc.

As a part of their routine patient care, it
should be mandatory for them to discuss with
their patients, important aspects of nutri-
tion in the community on a daily basis. This
should be supplemented by occasional visits

of a trained person in nutrition to these

(V)

118

areas for more detailed programs such as
demonstrations, film strips, slide shows,
group discussions as mentioned earlier.
Announcements as to when these demonstrations
are to take place could be done by the clinic
nurses or personnel to their patients. This
also underscores the great importance of a
strong nutrition program in nursing schools.
It would be very good to be able to
involve fathers in this educational process.
However, it is not easy to get men involved
in a program on nutrition in a male-dominated
society such as Nigeria. Nonetheless, it
is hoped that success in educating the mothers
will permeate somehow to the fathers. Be-
sides, in order to accomplish the mission of
helping to prevent malnutrition through
education, this study has shown the fathers
to be relatively unimportant since their
influence is comparatively minimal.
Education of children - This can best be
accomplished by the introduction of nutrition
or related courses into primary school curri-
culum. There are no aspects of development
plans that should be more important than this.
These courses should be mandatory for every

child. The introduction of nutrition into

119

the school curriculum must be done in such a
way that it is of relevance to the students.
According to Griffin and Light (35),

"the design of nutrition in the school
curriculum must reflect the real and
present needs and conditions of learners.
It must be problem-centered, enabling
learners to engage in guided exploration
so as to discover the role of nutrition
in the lives of people, the nutritional
environment, and the interplay between
the two... It must create in the
school-age child a desire to learn about
nutrition and develop the skills to
further this learning. It must be made
practical, allowing the child to become
familiar with the patterns of his own
food culture, to use available foods in
resourceful ways, and to acquire the
capacity to earn his livelihood and en-
joy life."

The purpose of nutrition education in the primary school
should be to help stimulate the child's interest in the
foods he eats and in the reason why it is essential to
have balanced nutrition. However, in setting up a curri-
culum for this level of education, it must always be
remembered that nutrition and health mean very little to
children. As eloquently stated by De Esquef of FAQ (21),
"the child has various interests, which may be
related to physical strength, skill in a certain
activity, appearance, or success in studies. These
aspects of the individual are closely tied to the
state of nutrition and health but, insofar as the
child is concerned, the words nutrition and health,
tend to be abstract and vague."
For nutrition to have any meaning to the child, he has to

identify his nutritional interests with something of con-

crete meaning and well defined to him. There is no doubt

120

the reason why food companies advertise their products
with famous athletes and heroes.

Therefore, nutrition teaching at this level should
incorporate the subject into other major primary school
subjects as has been done in many developing countries and
found to be successful (21). For instance, in teaching
the English language in the classroom, sentences such as,
"If I eat green vegetables, fruits, with meat or fish every
day, I will be a good soccer player as Pele" or "If I eat
plenty of fruits with meat or fish or snails every day, I
will be a pretty singer as Miriam Makeba," could be used
and this is likely to make the child modify his eating
habits for better nutrition. Also, in teaching addition
and subtraction in mathematics, examples with nutritional
implications could be used, e.g., "In my uncle's small
poultry, ten eggs were first laid and a day after, thirteen
eggs were laid. How many eggs are there all together; and
if my uncle's children ate six of the eggs for better
nourishment the following week, how many are left all to-
gether?" This type of teaching method has been shown to be
very effective in stimulating lot of nutritional interest
in the child. The child does not only learn his mathema-
tics, he also gets to know what a poultry is and knows that
eating eggs provides better nourishment. He may even begin
to develop interest in his parents having a poultry in
their backyard. This method could be used for all the

major subjects in the primary school. A curriculum as

121

simply stated above could arouse the nutritional interests
of both child and family, and it could help modify food
habits positively.

The theory of nutrition taught in the classroom should
be accompanied with practical experiences for the children,
such as visits to market places to show the children the
varieties of locally available food which many of them
may never have seen nor eaten before. Another way to give
the children practical experience is by food preparation.
Unfortunately, this has so far been limited to female
students only. The teachers in all of the primary and
secondary schools visited pointed out that food preparation
is a woman's subject. Hence, males have notoriously been
excluded from classes in food preparation by the teachers.
Food preparation classes are essential for teaching child-
ren, and probably, adults too, the effects of heat, cold,
and storage on the nutritional value of foods. It also
helps teach how methods of food preparation can improve the
taste of foods and how variations in preparation can
remove monotony from eating. Male students should be
encouraged, in fact mandated, to participate.

Another way to give the children good practical nutri-
tion experience is through school gardens and farms.
Several schools in years past had such facilities which,
for lack of encouragement, had to be abolished. The school
garden could be used to develop a school snack program for

the school. School feeding in itself is a very important

122

nutrition education activity in schools and has been suit-
ably referred to by Rees and Conafay (70) as "the nutrition
education laboratory" and "a place where theory and prac-
tice are combined." Feeding programs in schools provide
an opportunity for the children to learn and to know the
varieties of local foods, the knowledge of which they will
take back home to their parents. This will form a basis
for the promotion of good nutrition habits in terms of
production and consumption of food. Also, children in the
primary schools are in their formative years, and whatever
they experience in their youth tend to live long with them.
This applies to teaching nutrition to children. Once food
habits are formed in a child, it is difficult to change
them as the child grows older. This is why nutrition
education in the primary schOol is a very crucial and
urgent issue.

With the introduction of universal free primary educa-
tion in Nigeria, every child is now destined, by law, to
pass through schooling in his path towards maturity and
independence. Thus, if nutrition education is introduced
into school curriculum at the level of primary schools,
every child in the country will leave school with a basic
knowledge of the principles of nutrition. Some of the same
reasons can be given for advocating the introduction of
nutrition into the curriculum of high schools, teacher

training colleges, nursing schools and medical schools.

123

However, nutrition at the level of primary schools is far
more important than at any other level. Hence, this plan

must be pursued vigorously and with enthusiasm.

Other roles of the nutritionist in Nigeria.

The nutrition profession in a developing country like
Nigeria must deal not only with disease problems of malnu-
trition (marasmus, kwashiorkor, vitamin deficiencies) but
also with several problems of living that these diseases
stem from. These include:

(a) Help with family size - There is evidence that
mothers who have short interconceptional periods
and those with high multiparity are likely to
need lengthy nutrition counselling and help (23).
Thus, in developing plans for the improvement of
child nutrition, family planning shOuld be a
major part of the services to be provided by the
nutritionist.

In developing countries where income per
capita is very low, it has been reported that
rapid population growth (because of increased
birth rate) contributes to further lowering of
the per capita income (31). In other words,
increased birth rate increases the number of.
mouths that a stable income feeds. Consequently,
there is less food for everyone and malnutrition

results. Informed curtailment of the family size

124

might, therefore, help in improving this aspect
of the problem. Several attempts at family
planning in the past have only been minimally
successful because of the enormous cultural
obstacles that are present. These obstacles
include:
(i) Cultural beliefs about what constitutes
a good family.
(ii) Cultural and religious beliefs about
birth control.
(iii) Cultural attitudes towards sexes of
children born into the family.

(iv) Acceptability of birth control methods.

The nutritionist must, therefore, have adequate training to

appreciate the societal structure and practices and to know

ways of adapting these for effective introduction of new

ways of life.

0))

Help with home and money management - This area
is probably one of the most neglected, yet it
contains part of the solution to health related
nutrition problems. The public has to be know-
ledgeable about what constitutes the best buys
from a nutritional standpoint. They must also be
knowledgeable about storage facilities and who
needs which foods most at home. All of the
counselling and education in the world about

nutrients may be less than effective if mothers

(C)

125

do not spend money on foods sensibly and if the
foods are not stored and distributed adequately
at home. This area of help may in fact be all
that some individuals need.

Good record keeping - In addition to the tasks of
screening and surveillance, nutrition counselling
and education, food assistance, family planning
help, and help with home and money management,
constant follow-up, coordination and evaluation
are essential. This is almost impractical with-
out good, complete and purposeful records. There-
fore, the nutritionist must learn to identify
areas that need documentation.

In essence, what is being suggested here is,
that a nutritionist working in Nigeria, must have
a wider area of coverage (in terms of academic
interests) than is usually the case. This
individual must be a good biologist, a good
educator, a good sociologist, a good social work-
er, a good economist, and a good psychologist.
This may sound like asking too much but it
probably takes no more than dedication to be
functionally good in a country in need of such
services. From the foregoing, the grave need for
training persons in nutrition programs in
Community Health services can not be over-empha-

sized.

126

Food and nutrition policies.

 

Advice to government on nutrition has always been by
persons from academic and research establishments with
nutrition-related interests such as nutritional biochemists
and physicians. These individuals are only peripherally
nutritionists and their advice has always been on technical
rather than policy issues of relevance to applied nutrition.
Good nutrition for infants, children, adolescents, and
pregnant women is essential to health, and programs for
providing it should be regarded as instruments of social
progress. Therefore, food and nutrition policies should
be National rather than State based. These policies should
call for the following, which appear to be the most urgent
areas where government policies need to be directed, at the
present time:

(a) Establishment of more nutrition units, either

independently or as part of comprehensive Health
Care Centers, in rural areas. Every Administra-
tive Division, at least, needs such a center.
Because most Divisions already have existing
Health Centers, it is suggested here that nutri-
tion programs be formally added as part of their
function.

(b) Establishment of food policies on the basis of

physiological needs. The problems of malnutri-
tion manifest themselves most profoundly among

infants and children. Consequently, they belong

(C)

(d)

127

to a very high priority group in terms of physio-
logical needs. Adolescents need nutritional
support for the attainment of maximum growth,
development and potentials. They too belong to

a high priority group. Pregnant women are often
faced with severe nutritional inadequacies
particularly iron deficiency. They also belong
to a high priority group. The nutritional
dilemma of the aged is, probably, universal and
they are usually placed in a high priority group
in terms of physiological needs. Thus, in
establishing food policies on the basis of
physiological needs, infants, children, adoles-
cents, pregnant women and the aged are placed in
high priority for special consideration in the
administration of food programs.

Massive education as the main tool for fighting
problems of malnutrition in the country. This
policy should address itself to several of the
issues on education that have previously been
described. The massive education of policy
makers, of teachers, of nurses and physicians, of
school children and of the masses of non-literate
Nigerians should be pursued vigorously. EaCh of
these have been discussed earlier.

The actual provision of food assistance to the

needy by the government. This policy should

128

adapt the same philosophy as that for ”Food
Stamps" and "WIC (Women, Infants, and Children's
Supplemental Food Program)" which are currently
being used in the U.S.A.

(e) An energetic training scheme for more workers in
the field of nutrition or allied subjects. In
this regard, nutrition programs need be expanded
in the universities to accomodate more students.
These students should vary in their professional
interests as possible - ranging from biochemists
to extension workers. They should also vary
in their training from full academic degrees to
professional diplomas. Summer in-service pro-
grams should be organized for the provision of
continuing education in this field. More scholar-
ships should be made available for specifically
training these workers. The training scheme
should aim at producing about 1000 nutritionists,
dieticians and allied workers in the next five

years.

fifleed for future research.

The hallmark of any investigative process is the
ixientification of areas within that field that need further
irrvestigative efforts. During the preparation for this
Stnady, in the execution of the investigation, in the

aJlalysis of the data from this study, and in the

129

preparation of this manuscript, areas which appear to be in

urgent need of investigation are:

(a)

(b)

(C)

(d)

Epidemiology of malnutrition or nutritional
disease in Nigeria. This should include
incidence of prevalence, distribution, etiologic
factors and possible seasonal variations.
Evaluation of presently existing nutrition
education programs. This should include:
(i) Adequacy of the teaching methods.

(ii) Content of the program.

(iii) The clientele served.

(iv) Successes or failures including reasons.
Income distribution and its implications on food
production and supply policies. This should
include aspects of price control, food export and
inport policies, and food distribution policies.
Investigation of food processing industries in
the light of types of foods processed, methods
for storage, additives and preservatives. This
area has been partially researched by the Niger-

ian Institute for Industrial Research.

There are, of course, many more areas of pure and

applied nutrition that need investigative efforts. This

research has only highlighted those areas in which laCk of

available information made the research efforts less than

optimum.

 

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10.

11.

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APPENDIX A

APPENDIX A

DISSERTATION PROPOSAL

 

The role of Nutrition Education on the factors

that influence childhood Nutrition in Nigeria.

 

Objectives:

 

1.

To examine the current state of understanding that
Nigerian mothers have about the prOper nutrition of
their children.

To determine what factors govern the decision as to

how a child is to be fed and nourished.

. To determine the sources from which mothers get

information regarding the prOper feeding of their
children and, to determine the relative role played
by physicians, nurses, relations, friends, booklet

advertisements, TV and radio, about infant nutrition.

. To examine and evaluate the impressions that Nigerian

mothers have about breast-feeding - factors that

determine length of time of breast-feeding and weaning.

. To determine how many mothers feed their children

commercial formulae.

To determine what Nigerian mothers know about the .
nutritional value of common foods present in Nigeria.

To determine what roles husbands play in infant nutrition,

and their impressions about breast-feeding.

138

139

8. To postulate methods of improving public awareness of
the poor nutritional state of the masses of the children
and, also, improving public awareness of the nutrition
education programs available in the country.

9. To postulate the role that adult education programs can
play in improving the nutritional state of Nigerian

children.

Theory and supportive researgh:

There are two main reasons why the act of feeding a child
is very important. First and foremost, it provides the
nutritive substances that the child needs for strength and
growth in every sense of the word. Secondly, the child
derives emotional and psychological benefits from being

fed - it is believed that the infant obtains from the
experiences of eating and drinking and from those who feed
him, many of his early ideas about the nature of life and
people (1). The later is very rarely lacking in traditional
Nigeria. Children are caressed and fed constantly by a
large number of people - parents, grand parents, siblings,
neighbors and friends. The former and most important
reason for feeding a child is what is lacking in Nigeria
(and indeed most developing countries of the world) for a
variety of reasons. These reasons range from poverty:
(inability to afford adequate amounts of food) to ignorance

about what actually constitutes prOper nutrition.

140

In Nigeria, concern for the poor nutritional state of
our children has grown tremendously in recent times. This
is partly because there is an apparent increase in the
proportion of children who have diseases of malnutrition.
This increase is due to inflation, high p0pulation growth,
and little or no increase in food production. There might
also be a slight increased public awareness because of the
activities of the few nutrition programs that currently
exist in Nigeria. For example, only recently a two-week
nutrition course was concluded in Sokoto, Nigeria (2)
during which time the Chief Medical Officer for Sokoto
State, Dr. Shah, stressed the importance of Nutrition
Education. A day before that publication appeared, the same
paper published a statement by the Oyo State Commissioner
for Health, Dr. Atanda, which sketchily outlined the causes
of malnutrition (3). In that statement, Dr. Atanda was
quoted as saying that 70% of the children between the ages
of one and four suffer from varying degrees of malnutrition
in the developing countries of the world. It is apparent
that no acceptable definite, or even approximate, figure
of malnutrition exist for the whole of Nigeria. Another
newspaper, in an article captioned "Alarm on Malnutrition"
quoted the Director of Food Science and Applied Nutrition
of the University of Ibadan, Professor Omololu, as calling
for an increase in "personnel in the field of nutrition to
teach nutrition education especially in the UPE (universal

primary education) scheme" (4).

141

From the foregoing, there is little question that
Nigeria is prepared for a comprehensive study of the
factors that influence childhood nutrition and the ways
by which the nutritional status of all children can be
improved. With the introduction of the Universal Primary
Education (UPE) policy of the Federal Government which
commenced in September of 1976, the need to carry out this
study has become more urgent. We can not afford to have
the UPE when 70% of all the children for whom the scheme
was designed have suffered from some malnutrition early in
life which, no doubt, affected prOper mental development.
It will certainly be self-defeating if a high proportion of
these children are not educable. It has been shown in well
controlled studies by Cabak and Najdanvic (5) that children
who had been undernourished in infancy were found, at
school age, to have "normal physical characteristics but
subnormal mental capacity". I have also observed previously
that certain practices resulting from ignorance could
severely affect good nutrition (6). Also, in a previous
observation, I reported that malnutrition seemed to be a
lot more prevailent among illiterates (people who can not
read or write any language) than among literates (7) which
of course, is a suggestion that education plays a very
important role in pr0per nutrition. Another major problem
which needs investigation is the massive availability of

infant formulae, the nutritional values of which are

142

sometimes coubtful. For example, in the issue of March
24, 1976, Nigeria's most popular newspaper, Daily Times,
published a full page advertisement which read, "When

milk alone is not enough, Formula 33 with honey, a
nutritionally complete food for babies from 3 months to
three years ..." (8). In this advertisement, no statement
was made concerning what the formula contained to make

it complete. From personal experience and that of many
mothers, there is little question as to the mis-leading
nature of these advertisements. What is not certain is
whether such advertisements do influence childhood feeding
and to what extent in Nigeria.

In spite of the extensive public pronouncements and
the various academic articles that have been published on
the subject, in Nigeria during the past few years, there
has been very little response in the direction of improving
the nutritional status of our people. The reasons for this
poor response have been very well outlined by Professor
5.0. Olayide of the Department of Agricultural Economics
and Extension of the University of Ibadan. These are
"(1) the imprecise definition of the sc0pe and meaning of
nutrition training and its implications for accelerated
economic deve10pment. (2) the inadequacy of the existing
extension organization to cope with demands of a dynamic
nutrition training in terms of organization, personnel,

material and money. (3) the lack of articulated plan of

 

143

programmes on nutrition training for which adequate
logistics have to be provided or mobilized for meaningful
implementation" (9). These three points advanced by
Professor Olayide, seem to emphasize the degree of dif-
ficulty that nutritionists have in Nigeria. How can we
clearly define the scope and meaning of nutrition training
when we do not understand what governs the food habits of
our peOple and what factors influence their choice of
available food resources! How can we cope with the emmense
extension facilities that a dynamic nutrition training
program demands, when we do not know the relative influence
that the various health personnel have on the Nigerian
mother! An articulated nutrition program can only exist
if we know what methods are available to us for improving
the nutrition of our children.

There is no doubt, a consensus of Opinion that poor
or improper education is the major contributing factor to
the deplorable nutritional status of our children. True,
there are economic reasons (10) as well as cultural and
social reasons (6, ll, 12, l3, l4, and 15) for poor
nutrition, but with prOper education, the effects that
these factors have on nutrition could be reduced to a bare
minimum.

In order to stress the importance of Nutrition Education
in our attempt to solve the enormous problem of malnutrition
in Nigeria, it is essential to define the principles of

Nutrition Education. In doing this, I choose to refer

 

144

to the statement prepared by a Study Group on Nutrition
at the VIIth International Conference on Health that met
in Buenos Aires, Argentina in 1969 (16, without reproducing
it here (The statement is attached as Appendix A1 of this
proposal). For us in Nigeria to achieve a reasonably high
level of nutrition for our children through the efforts of
Nutrition Education, the masses must be made to be aware
of the importance of adequate nutrition to the family and
the means available for attaining it (17). There must
also be a clear knowledge of the various foods that we have
available and their nutritional value. We must know the
optimum conditions for storing foods under local (or, as
some will like to call it, Primitive) conditions. We must
know what the contaminants of our foods are. In a nutshell,
the task must be a coordinated effort between the different
sectors concerned with food (Nutritionists, Health Personnel,
Educators, Economists, Agriculturists, Biochemists and
Microbiologists, Politicians, and others).

This work is, therefore, an effort to provide
apprOpriate baseline information that is so badly needed

in aspects of our fight against malnutrition in children.

145

METHOD OF INVESTIGATION

 

Review of literature:

 

(i) Nutritional status of Nigerian children.
(ii) Cultural influences on nutrition in Nigeria.
(iii) Current ideas about breast-feeding.
(iv) Adult or continuing education in Nigeria (Nutrition

Education in Nigeria).
Survey (Methodology):

(i) Sample selection:

(a) Survey will be carried out in the Benin City
area of Bendel State of Nigeria.

(b) It is anticipated that for this study, at
least, 2,000 multiparous mothers will be
included.

(ii) Method of data collection:

(a) For this study, data will be collected
through direct interviews with the mothers.
All interviews will be conducted by the
investigator.

(b) An interview guide (in the form of a
questionnaire) will be prepared for use by
the investigator. This way, one can be
reasonably sure that comparable data are

obtained from all mothers.

146

(c) The investigator will attempt to obtain
data that will help answer questions posed
in the objectives.

(d) From the State's ministries of Agriculture,
Education, Health and Local Government,
information about existing Nutrition
Programs and plans for future programs

will be collected.

 

(e) From a randomly selected sample of about
24 primary, secondary and nursing schools,
information will be gathered as to classes
on Nutrition.

(iii) Data analysis:

(a) Factual response data will be compiled and
analyzed separately for mothers, ministries
and, schools - as they relate to the
objectives.

(b) Opinions and recommendations, based on (a)
above, will be attempted to meet
objectives numbers 10 and 11.

(c) A critical analysis of existing nutrition
programs and plans for future programs will
be attempted. .

(d) Schools' syllabi, asthey relate to Nutrition,

will be reviewed and critically assessed.

10.

11.

12.

13.

147

REFERENCES

Silver, H.K., Kempe, C.H., Bruyn, H.B. Handbook of
pgdiatrics. Lange Medical Publications,Los
Altos, California, pp.41-53.

 

 

"Shah outlines importance of nutrition courses,"
Nigerian Observer, March 30, 1976, p.3.

 

. "Causes of malnutrition outlined," Nigerian Observer,

 

March 29, 1976, p.3.

"Alarm on malnutrition," Daily Times, March 29, 1976,
p.5.

Cabak, Vera and Najdanvic, R. "Effect of undernutrition
in early life on physical and mental development,"
Arch. Dis. Child., 40:532-534, 1965.

 

 

Scott-Emuakpor, Maureen M. "Carried-over African cultural
beliefs about food among selected Black American
women," West African J. Education, XVIII:167-l80,
1974.

Scott-Emuakpor, Maureen M. "Undernutrition - Kwashiorkor
and marasmus: With special reference to developing
countries," J. Society of Health in Nigeria, VIII:
21-25, 1973.

 

"Formula 33 advertisement," Daily Times, March 24, 1976,
p.7.

 

. Olayide, 8.0. "Role of extension workers in nutrition

training," Paper read at First African Nutrition
Congress, University of Ibadan, March 17-22, 1975.

Trant,H. "Food taboos in East Africa," Lancet, 267:
703-705, 1954.

Lee, D. "Cultural factors in dietary choices," Am.J.C1.
Nutrition, 5:166-170, 1957.

 

Jelliffe, D.B. "Culture, social change and infant
feeding: Current trends in tr0pica1 regions,"
Am.J.Cl.Nutrition, 10:19-45, 1962. .

 

Gift, H.H., Washbon, M.B., and Harrison, G.G. Nutrition,
behavior and changg. Prentice Hall, Inc., Englewood
Cliffs, New Jersey, 1972.

 

14.

15.
16.

17.

148

Bartholomew, M.J., and Poston, F.E. "Effects of food
taboos on prenatal nutrition," J.Nutr.Education,
Summer:15-l7, 1970.

 

Schult, G. "Food taboos," Todays Health, 42:28, 1964.

 

Study Group on Nutrition, VIIth International Conference
on Health, Buenos Aires, Argentina, 1969.

Olayide, 8.0., and Bocobo, D.L. ‘Food and nutrition

olic and lannin in En lish-speaking African
countries. FAO7DEN7TF 125, Rome,—l974.

 

 

Appendix A1

BASIC PRINCIPLES OF NUTRITION EDUCATION

The following statement, prepared by a Study Group on

Nutrition, during the Buenos Aires 1969, VIIth International

Conference on Health and Health Education, sums up the

basic principles of Nutrition Education.

1.

The process of health education cannot set aside nutrition
education as peOple are unable to achieve physical,

mental and social well-being without proper knowledge,
attitudes and behaviour with regard to food. In turn,

the process of nutrition education must be integrated

in global health education with the aim of improving

the state of nutrition of individuals, families and
communities. Both processes include synergic and
complementary action which cannot be planned separately

without jeopardizing end results.

. The precess of nutrition education would achieve more

positive results and in a shorter time if it were in-
tegrated with regional or national food policy plans,
which in turn should be included in national plans for
economic and social deve10pment.

Food policy covers a series of factors related to the
supply, demand and consumption of foods to meet the
needs of the population, but variations in food supply

and demand are, in turn, under the direct influence of

149

150

economic and demographic factors and conditioned by

the level of the population's education, particularly
by its level of nutrition education.

Government decisions regarding food policy plans and
programmes should include nutrition education which

is instructional in the effective implementation of
such a policy.

The planning of nutrition education programmes requires
that nutrition specialists have access to accurate
anthropological, social and economic data on the
geocultural target groups. '

The lack of unified norms and concepts in relation to
nutrition education leads to a state of confusion which
has a detrimental impact on the educational process.

To implement food policy plans, including nutrition
education, it is necessary to have a sufficient number
of trained technicians who can be active at all levels
in public as well as in private sectors, and to provide
the minimal structures indispensable to ensure the
development of plans and programmes.

The existence of a confused interpretation of the
processes of information and education has a negative
influence on the planning, implementation and evaluation
of nutrition education programmes and lessens their
educational value.

Co-ordination between the different sectors concerned

10.

11.

12.

13.

151

with food (health, agriculture, education and economy,
among others) must be ensured at all stages of pro-
gramme development, i.e. in the planning, the execution
and the evaluation phases.

The selection of educational techniques reflecting

the dynamic and active methodology which characterizes
the whole process of modern education must take into
account the characteristics of the target groups,
social and family structures, cultural patterns,
socio-economic standards, levels of instruction,
ecological conditions and speCific characteristics of.
the rural, peri-urban and urban populations.

Nutrition education must be directed to all levels of
the population, to the general public as well as
organized groups (in particular groups of mothers,
housewives, adolescents, parents, school children,
workers, etc.), and focus more specially on categories
of populations at risk.

Nutrition education must be directed as much to the
consumer as to the producer and to all those who, in
one way or another, are concerned with the handling

of food and need to become, for this very reason,
actively involved in the educational process.

The family unit constitutes the biological, social,
economic, cultural and affective base of the community;
nutrition education must therefore be channelled

through this basic unit and aim particularly at the

14.

15.

16.

17.

152

housewife or the person who decides on the family

meal pattern, utilizing all available means of mass
communication, among which women's journals can play

a very important role.

The evaluation of nutrition education programmes,
based on a preliminary diagnosis of the situation,
must be primarily concerned with the assessment of
behaviour change at the individual and community levels
and, at the same time, provide a measurement of the
progress toward goal achievement as well as of the
intrinsic usefulness of the indices selected for
evaluation.

So far, attempts at the evaluation of nutrition
education programmes have mainly focused on the volume
of activity and the level of knowledge - not on the
final objective of behaviour change.

Integrated programmes of applied nutrition (i.e. in-
volving a co-ordination between health, agriculture
and education services) have a definite impact on the
improvement of levels of nutrition, health and education
of the community, as well as the nutrition education
activities undertaken in primary schools.

The problem of gaining acceptance for new foods to
supplement traditional diets calls for the combined
efforts of specialists in nutrition education,
information and promotion in order to accelerate the

education process by providing a rational and scientific

 

18.

153

basis for promotion campaingns whose efficacy in

matters of community motivation cannot be ignored.

The promotion of new foods will be easier if these

are introduced to the whole population of‘a country,

without distinction of social category, and to all

countries of the world without distinction of state

of development.

In accordance with the proceeding conclusions, it

is recommended:

(a) that governments, principally those of developing

(b)

(C)

(d)

countries, give priority ot the establishment of
a food and nutrition policy, providing the human,
material and economic resources necessary for its
execution;

that each country try to unify food concepts and
norms, so that technical organizations concerned
with nutrition education can give a homogeneous
content to programmes;

that inter-disciplinary groups be formed to give
leadership to a co-ordinated and effective approach
to planning, implementation and evaluation of
nutrition education programmes;

that efforts be intensified towards establishing
a clear and concise evaluation methodology which
could be applied to present and future education

programmes;

 

154

(e) that the IUHE intensify its efforts to promote,

through official and private circles, nutrition

education plans which would effectively integrate

education techniques with mass promotion.

 

APPENDIX B

APPENDIX B

QUESTIONNAIRE FOR MOTHERS

 

GENERAL INFORMATION:

 

H

Name and address of hospital or location of mother at

time of interview

 

 

2. Name and address of subject (optional)

 

 

3. Age of subject (in years):
(a) 15-20___ (e) 36-40___ (i) 56-60___|
(b) 21-25___ (f) 41-4S___ (j) 61-65____
(c) 26-30___ (g) 46-50___ (k) 66+___
(d) 31-35___ (h) 51-55____

4. Marital status: Married Single Separated
Divorced
5. Are you living with your husband? Yes No

6. Profession of: (i) Subject

 

(ii) Husband

 

\’

Subject's number of children Ages

 

8. How many of your children did you have in/at:

 

(i) Hospital___ How old now?
(ii) Maternity homes with doctors___ How old now?___
(iii) Maternity homes without doctors____How old
now

 

155

(iV)
(V)
(vi)

EDUCATIONAL

156

Home How old now?

 

Church How old now?

 

Others (specify) How old now?

 

QUALIFICATION:

 

9. How much
(i)

(ii)

(iii)

(iV)

(V)

(vi)

(vii)

10. How much

formal education do you have?:

No schooling___

Did not complete primary school___

Completed primary school____

Had some post-primary school (e.g. modern school,
grade III teacher, class IV secondary school)____
Completed secondary (high) school, higher

school certificate, or grade II teacher___

Had some post-secondary schooling (e.g. advanced
teachers' college, university undergraduate but
did not graduate, polytechnic or trade schools)____
Had university first degree and above___

formal education does your husband have? (Please,

use sub-questions No. 9 and insert your answers bellow).

(i)
(ii)
(iii)
(iV)
(V)
(vi)

(vii)

 

 

157

BREAST-FEEDINGJ WEANING, AND CULTURAL BELIEFS ABOUT

 

INFANT FEEDING:

 

11.

12.

13.

14.

15.

16.

Did you breast-feed any of your children? Yes__ No

(i) If Yes, which ones did you breast-feed?

 

(ii) How long did you breast-feed each?:

(a) 0 to 3 months Present age(s)

 

(b) 3 to 6 months Present age(s)

 

(c) 6 to 9 months Present age(s)

 

(d) 9 to 12 months Present age(s)

 

(e) 12 months + Prensent age(s)

 

Why did you stop breast-feeding?

 

 

Did you think it is good to breast-feed your child/
children at the time you did? Yes No

Why?

 

 

What is your opinion now about breast-feeding?

 

 

What foods did you give your child after weaning?

 

From what sources did you receive information regarding
feeding your newborn child?:

(i) Physician How often?

 

(ii) Hospital nurse How often?

 

(iii) Friends How often?

 

17.

18.

19.

20.

 

 

 

158
(iv) Relatives (specify)___ How often?
(v) Booklets___ How often?
(vi) Magazines___ How often?
(vii) Newspapers advertisements___ How often?
(viii) Others (specify)___ How often?

 

Who plans the family meals?:

(i) Father (iv) Relative
(ii) Mother (v) Children
(iii) Grand parent (vi) Others (specify)__

Do any of your relations tell you anything about what

or how to feedi your children? Yes No

(i) If Yes, who?

 

(ii) What does he/she/they say?

 

 

 

Are there foods you would not like your children to

eat? Yes No

(i) If Yes, what are they and, why?

 

 

 

Who sees to it that your child/children do not eat
these foods?
(i) Father___
(ii) Mother____
(iii) Grand parent___
(iv) Relative___
(v) Friends____

(vI) Others (specify)

 

 

159
NUTRITIONAL KNOWLEDGE OF THE MOTHER AND HUSBAND'S

 

INTEREST IN THE NUTRITION OF HIS CHILDREN:

21. Name 10 to 15 things which you consider to be food

(Please, classify these):

 

(i) Carbohydrates (starchy foods)

 

(ii) Protein (body builders e.g. meat, fish, etc.)

 

(iii) Fats and oils

 

 

(iv) Vitamins (fruits)

 

(v) Minerals (vegetables)

 

(vi) None

 

22. What does the body need the following for?:

(i) Carbohydrates? Don't know___ Knows___
(ii) Protein? Don't know___ Knows___
(iii) Fats and oils? Don't know___ Knows___
(iv) Vitamins? Don't know___ Knows___
(v) Minerals? Don't know___ Knows___.

23. What type of disease do children without adequate
protein get? Don't know___ Knows___
24. From which food(s) do Nigerians get the greatest
amount of protein? Don't know___ Knows___
25. From which food(s) do Nigerians get the greatest
amount of carbohydrate? Don't know___ Knows___
26. When you see your doctor or when you are in the hospital,
who tells you anything about your child's nutrition?:
(i) Doctor___

(ii) Nurse

160

(iii) Neighbor patient___ \
(iv) Visiting relations___
(v) Visiting friends___
(vi) Others (specify)____
27. Has anyone ever spoken to you about what constitutes
a balanced diet? Yes No

(i) If Yes, who?

 

(ii) For how long (often)?

 

28. Have you ever fed your child ifant formula?

 

Yes No

(i) If Yes, which kind?

 

(ii) How did you know about it?

 

 

(iii) Do you know what it contains? Yes___ No___.
(iv) Do you have ways of storing the formula?
Ye s__ No__
(i) If Yes, is it by:
(a) Refregeration?___-
(b) Storing dry powder until ready for use?___
(c) Storing already mixed formula in the
cupboard?____
(d) Others (specify)?____
29. If there were programs that teach you how to care for
the nutritional needs of your child,
(i) will you participate? Yes___ No

(ii) Why?

 

 

161

30. If you have to pay to participate in this program,
would you still go? Yes No

31. What do you think is the main reason for malnutrition
in Nigeria?
(i) Poor education?___
(ii) Poverty3__
(iii) Inadequate food supply?___
(iv) Lack of appetite (secondary to disease)___.
(v) No malnutrition problem in Nigeria?___'
(vi) Others (specify)___.
32. Are there any foods that you will not eat because of
cultural taboos? Yes No

(i) If Yes, which one(s)?

 

(ii) What is the rationale for this taboo?

 

33. Does your husband show any interest in the nutrition
of the children?
(i) No interest____
(ii) Little interest____
(iii) Much interest____
34. Is your husband particular about what food his children

eat? Yes No

(i) If Yes, can you explain to me what he says
or does about the type of food(s) the

children eat?

 

 

 

 

 

162

35. What does your husband think about breast-feeding?
(i) does he like it?
(a) Yes__ No__.
(b) Neutral__
(c) Don't know_____ A
(ii) Why?

 

 

 

36. Do you know of any programs that currently exist in

Nigeria or in Bendel State that is aimed at solving

 

the problems of malnutrition? Yes No

(i) If Yes, what is the program(s)?

 

 

37. Can you recognize nutritional deficiency in your child?

Yes No

 

(i) If Yes, to whom do you complain?

 

(ii) Why would you complain to this person(s)?__

 

38. Do you weigh and measure your child's physical growth

regularly? Yes No

(i) Why?

 

39. When do you stop taking these measurements?
(i) O to 6 months____
(ii) 6 to 12 months____
(iii) 12 months +___
40. Why do you stop taking these measurements at the age

you do?

 

 

APPENDIX C

. Name and address of school

. Contact and position

. Type of school: Check one:

. Do you teach Health or Domestic Science in the school?

APPENDIX C

 

QUESTIONNAIRE FOR SCHOOLS

 

 

 

 

 

 

 

(a) Elementary

 

(b) Secondary

(c) Nursing

 

Yes No

If Yes, does this include Nutrition?

Yes No

If Yes, do your Nutrition classes include:

(a) Cookery (food preparation)?
Yes No Why?

 

(b) Food sanitation?

Yes No Why?

 

(c) Food storage?

Yes No Why?

 

(d) Principles of good nutrition?

Yes No Why?

 

(e) Infant feeding methods?

Yes No Why?

 

163

7.

164

(f) Nutritional deficiency diseases?

Yes No Why?

 

(g) Cultural influences on nutrition and food habits?

Yes No Why?

 

(h) Food values as related to body functions?

Yes No Why?

 

 

(i) Nutritional values of Nigerian foods?

Yes No Why?

 

(j) Nutritional requiremtnts of children?

Yes No Why?

 

(k) Nutritional requiremtnts in pregnancy?

Yes No Why?

 

(l) Nutritional requirements in old age?

Yes No Why?

 

(m) Nutritional requirements at all age levels?

Yes No Why?

 

(n) Home management?

Yes No Why?

 

Do you consider Nutrition a "girls' only" subject?

Yes No Why?

 

Would you like to see Nutrition taught in your school?

Yes No

If Yes, would you like to see it taught to male students
too?

Yes No Why?

 

 

 

 

165

9. Is Nutrition a required school certificate (or nursing

school) subject?

Yes No

10. Do you teach Nutrition as:

(a) A part of other subjects? Yes No

(b) A separate subject? Yes No

 

 

 

APPENDIX D

 

APPENDIX D

QUESTIONNAIRE FOR MINISTRIES

 

1. Ministry and location

 

 

2. Contact and position

 

 

3. What types of nutrition education programs do you

presently run?

 

 

 

 

 

 

 

 

4. Do you have plans for future programs in nutrition

education?

 

 

 

 

 

 

 

 

 

166

 

APPENDIX E

APPENDIX E

QUESTIONS ON BASIC NUTRITION ON MOTHERS'

 

QUESTIONNAIRE FOR WHICH ELEVEN

 

@POINTS WERE GIVEN

 

If a high protein food is named as a food, a point is

given (See Question No. 21 of Appendix B. Total point=l).

. A point each is given if the interviewee knows what the

body needs carbohydrates, protein, fats, vitamins, and
minerals for (See Question No.22 of Appendix B. Total

points = 5).

. A point is given if the interviewee knows the type of

disease children without adequate protein get (See Question

No.23 of Appendix B. Total point 8 l).

. A point each is given if the interviewee knows from which

foods Nigerians get the greatest amount of carbohydrate
and protein (See Questions Nos. 24 and 25 of Appendix B.
Total points = 2).

. A point is given if the interviewee knows the nutrient
content of the infant formula she ever used (See Question
No.28 of Appendix B. Total point = l).

. A point is given if the interviewee can recognize
nutritional deficiency in her child (See Question No.37

of Appendix B. Total point = l).

167