DANIEL AYINE NYAABA

110 Pages·2015·1.29 MB·English

KWAME NKRUMAH UNIVERSITY OF SCIENCE AND TECHNOLOGY - KUMASI
COLLEGE OF SCIENCE
DEPARTMENT OF BIOCHEMISTRY AND BIOTECHNOLOGY

Assessing the Association between Nutritional Status and Asymptomatic Malaria
Parasitaemia in Children Under Five Years in Ghana

THIS DISSERTATION IS PRESENTED TO THE DEPARTMENT OF
BIOCHEMISTRY AND BIOTECHNOLOGY IN PARTIAL FULFILLMENT OF THE
REQUIREMENTS FOR THE AWARD OF MPHIL. (HONS) DEGREE IN HUMAN
NUTRITION AND DIETETICS
BY

DANIEL AYINE NYAABA
AUGUST, 2014
DECLARATION
I Daniel Ayine Nyaaba, hereby declare that this work submitted for a Master of Philosophy
degree in Human Nutrition and Dietetics, was entirely and exclusively produced by me under
the supervision of Dr. Patricia Brown and Dr. Jacob Agbenorhevi. The works of others which
served as sources of information have been duly acknowledged by making references to the
authors.
DANIEL AYINE NYAABA
(STUDENT)
SIGNATURE: …..………………............. DATE: …………………………...

DR. PATRICIA BROWN
(SUPERVISOR)
SIGNATURE: …………………………… DATE: ………………....................

DR. JACOB AGBENORHEVI
(SUPERVISOR)
SIGNATURE: …………………………… DATE: ………………....................

HEAD OF DEPARTMENT
NAME:......................................................
SIGNATURE:.…………………….......... DATE:…………………................

I
DEDICATION
I dedicate this thesis to my senior sister Mary Ayinpogbila Nyaaba, my senior brothers
Joseph Adugbire Nyaaba and Nuhu T. Akrugo Nyaaba and my father Mr. Stephen Nyaaba.
Thank you for your financial support and inspiration in the course of my studies and research
work.

II
ACKNOWLEDGEMENT
I am very grateful to the Almighty God for the gift of life, good health and divine providence
in the course of my studies and research. Thank you Lord for the opportunity.
My profound gratitude also goes to my affable project supervisors, Dr. Patricia Brown and
Dr. Jacob Agbenorhevi for your supervisory roles. I am indeed very grateful.
The Nyaaba family of Bolga-Tanzui is highly acknowledged for their prayers, pieces of
advice and financial assistance throughout my studies and in the course of this work.
The logistical support given me by the nutrition unit of Bongo district health directorate is
also very much appreciated. To the Assemblymen, health committee members and women
and children of Vea central, Vea Tangapore, Gowrie and Nyariga communities, I say thank
you very much for availing yourselves and facilitating my data collection. The sacrifice and
efforts of my research team; Mr. Emmanuel Adongo, Harold Anafo, Nicholas Atindama,
Hannah Atindana, Sandra Nabil, Anastasia A. Nsobila and Alphonsus Nyaaba, are highly
acknowledged. Thank you all.

III
LIST OF CONTENTS

Title Page
DECLARATION……………………………………………………..……………......….…..I
DEDICATION……………………………………………………….…....…….…….……...II
ACKNOWLEDGEMENT……………………...………………………………………....…III
LIST OF CONTENTS.............................................................................................................IV
LIST OF TABLES…………………………………………………………………….….…VII
LIST OF FIGURES...............................................................................................................VIII
LIST OF ABBREVIATIONS..................................................................................................IX
ABSTRACT…………………………………………………...………………………...........X
CHAPTER ONE: INTRODUCTION.......................................................................................1
1.1 Background………………………………………………………………………….….…1
1.2 Problem Statement………………………………………………………………….……..3
1.3 Research Objectives………...……………………….……………………………….……4
1.3.1 Main Objective..................................................................................................................4
1.3.2 Specific Objectives............................................................................................................4
1.4 Justification ……………………………………………………………….………………5
1.5 Research Hypothesis............................................................................................................5
CHAPTER TWO: LITERATURE REVIEW...........................................................................6
2.1 Child Undernutrition...........................................................................................................6
2.2 Undernutrition and Malaria.................................................................................................9
2.3 Micronutrient Deficiencies and Malaria.............................................................................15
2.3.1 Malaria, Anaemia and Iron Deficiency in Children........................................................15
IV
2.3.2 Vitamin A Status or Supplementation and Malaria in Children.....................................19
2.4 Asymptomatic Malaria.......................................................................................................22
CHAPTER THREE: METHODOLOGY................................................................................24
3.1 Study Design and Population.............................................................................................24
3.2 Study Site..........................................................................................................................25
3.3 Sample Size........................................................................................................................25
3.4 Sampling Strategy and Subject Recruitment.....................................................................25
3.5 Data Collection..................................................................................................................27
3.5.1 Anthropometry...............................................................................................................27
3.5.2 Blood Sample Collection and Transfer..........................................................................28
3.6 Data Analysis....................................................................................................................28
3.6.1 Haematological Tests (Full Blood Count).....................................................................28
3.6.2 Parasitological Tests for Asymptomatic Malaria...........................................................28
3.6.3 Statistical Analysis………………………………………………………….………....29
3.7 Ethical Issues....................................................................................................................30
CHAPTER FOUR: RESULTS..............................................................................................31
4.1 Descriptive Statistics……………………………………………………….…….….…..31
4.1.1: Socio-demographic Characteristics of Children...........................................................31
4.1.2: Socio-demographic Characteristics of Parents.............................................................34
4.1.3: Dietary Assessment of Children...................................................................................36
4.1.4: Factors that Influence Nutritional Status of Children..................................................38
4.1.5: Anemia and Associated Factors...................................................................................39
4.1.6: Malaria Transmission and Treatment...........................................................................41
4.1.7: Basic Statistics on Nutritional Status, Malaria and Haemoglobin Concentration........42
V
4.2 Inferential Statistics.........................................................................................................43
4.2.1: Prevalence of Undernutrition.......................................................................................43
4.2.2: Distributions of Undernutrition...................................................................................44
4.2.3: Distribution of Underweight and Statistical Test of Significance and Correlations...46
4.2.4: Distribution of Asymptomatic Malaria Parasitaemia and Statistical Test of
Significance and Correlations.................................................................................................50
4.2.5 Distribution of Anaemia and Statistical Test of Significance and Correlations...........52
4.2.6: Correlation between Nutritional Status and Asymptomatic Malaria............................54
4.2.7: Binomial Logistic Regression Analysis to Predict Association between Nutritional
Status Indicators to Asymptomatic Malaria............................................................................56
4.2.8: Binomial Logistic Regression Analysis for Predictor Variables of Anaemia and
their Statistical Significance...................................................................................................57
CHAPTER FIVE: DISCUSSION.........................................................................................60
CHAPTER SIX: CONCLUSION AND RECOMMENDATIONS……………………….67
6.1 Conclusion………………………………………………………………………………67
6.2 Limitations and Recommendations……………………………………………………..67
REFERENCES …………………………………………………………………………….68
APPENDIX………………………………………………………………………………...79
Appendix I: Field Work Plan………………………………………………………...…….79
Appendix II: Participant Information Leaflet and Consent Form..........................................80
Appendix III: Medical Assessment Forms............................................................................85
Appendix IV: Questionnaire…………………………………………………………...…..87
Appendix V: Research Referral From...................................................................................93
Appendix VI: ASMP and Haemoglobin (Hb) Concentration Test Results and Z-scores of
Anthropometric Measures.......................................................................................................94

VI
LIST OF TABLES
Table Page
Table 2.1: Summary of Finding of Cross-Sectional and Cohort Studies on Child
Undernutrition and Malaria......................................................................................................14
Table 2.2: Summary of Findings on Malaria, Anaemia and Iron Deficiency in
Children...................................................................................................................................18
Table 2.3: Summary of findings Vitamin A status or Supplementation and Malaria..............21
Table 4.1.1: Socio-demographic Characteristics of Children..................................................32
Table 4.1.2: Socio-demographic Characteristics of Parents....................................................34
Table 4.1.3: Dietary Assessment of Children..........................................................................36
Table 4.1.4: Factors that Influence Nutritional Status of Children.........................................38
Table 4.1.5: Anemia and Associate Factors............................................................................39
Table 4.1.6: Malaria Transmission and Treatment..................................................................41
Table 4.1.7: Basic statistics on Nutritional Status, Malaria and Haemoglobin
Concentration..........................................................................................................................42
Table 4.2.1: Prevalence of Undernutrition..............................................................................43
Table 4.2.2: Distributions of Undernutrition .........................................................................44
Table 4.2.3: Distribution of Underweight and Statistical Test of Significance and
correlations..............................................................................................................................46
Table 4.2.4: Distribution of Asymptomatic Malaria Parasitaemia and Statistical Test of
significance and Correlations..................................................................................................50
VII
Table 4.2.5 Distribution of Anaemia and Statistical Test of Significance and
Correlations............................................................................................................................52
Table 4.2.6: Correlation between Nutritional Status and Asymptomatic Malaria..................54
Table: 4.2.7 Binomial Logistic Regression Analysis to Predict Association between
Nutritional Status Indicators to Asymptomatic Malaria.........................................................56
Table: 4.2.8 Binomial Logistic Regression Analysis for Predictor Variables of
Anaemia and their Statistical Significance.............................................................................57

LIST OF FIGURES
Figure Page
Figure 3.1: Participant Recruitment Flow Chart 26

VIII
LIST OF ABBREVIATIOINS
ASMP Asymptomatic Malaria Parasitaemia
ATR African Traditional Religion
BMI Body Mass Index
CHRPE Committee on Human Research Publications and Ethics
GSS Ghana Statistical Service
H/A Height-for-Age
HAZ Height-for-Age Z-scores
Hb Haemoglobin
HIV Human Immunodeficiency Virus
IRS Indoor Residual Spraying
ITN Insecticide Treated Net
MICS Multiple Indicator Cluster Survey
MPs Malaria Parasites
MUAC Mid-Upper Arm Circumference
NMCP National Malaria Control Program
OR Odds Ratio
PCR Polymerase Chain Reaction
UNICEF United Nations Children’s Fund
W/A Weight-for-Age
WAZ Weight-for-Age Z-scores
W/H Weight-for-Height
WHZ Weight-for-Height Z-scores
WHO World Health Organisation
SPSS Statistical Package for the Social Science

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