i 
 
SCHOOL OF PUBLIC HEALTH 
COLLEGE OF HEALTH SCIENCES 
UNIVERSITY OF GHANA 
 
 
COMMUNITY PERCEPTIONS AND MANAGEMENT OF MALNUTRITION IN 
CHILDREN UNDER FIVE YEARS IN THE CENTRAL TONGU DISTRICT 
 
BY 
 
PRECIOUS MENSAH 
(10269196) 
 
 
THIS DISSERTATION IS SUBMITTED TO THE UNIVERSITY OF GHANA, 
LEGON IN PARTIAL FULFULLMENT OF THE REQUIREMENT FOR THE 
AWARD OF THE MASTER OFPUBLIC HEALTH (MPH) DEGREE 
 
 
 
JULY, 2015
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DECLARATION 
I, Precious Mensah declare that except for other people’s investigation which have been 
duly acknowledged by means of referencing, this work is the result of my own original 
research, and that this dissertation, either in whole or in part has not been presented 
elsewhere for another degree.  
 
 
 
--------------------------------     …………………………….. 
Precious Mensah               Date 
(Student) 
 
 
 
-------------------------------------    ………………………….. 
Rev. Dr. Mercy Ackumey            Date 
(Academic Supervisor) 
 
 
 
 
 
 
 
 
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DEDICATION 
For their support, encouragement and prayers, this work is dedicated to:  
Madam Bernice Adorsu  
Noble Arden Kuadey  
Kwame Agbeshie 
           
      
 
 
 
 
 
 
 
 
 
 
 
  
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ACKNOWLEDGEMENT 
My deepest thanks goes to the almighty God for his protection and guidance throughout 
the study. I also express my sincere thanks to my supervisor Dr. Mercy M. Ackumey for 
her support, to Shelter Kuadey for his immerse contribution, the department of Social 
and Behavioral Science Department and to my family and friends for their support in 
diverse ways, and to Asesewa RCH staffs. 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
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ABSTRACT 
Introduction: Malnutrition remains one of the major problems confronting children in 
Sub - Saharan Africa (SSA). The nutritional status of children influences their health 
status, which is a key determinant of child survival. Therefore improvement of children’s 
nutritional status increases the chances of child survival and is considered as a 
precondition for their contribution to community as well as human development. The 
study was carried out to examine community perception and management of malnutrition 
in children under five years. 
Methods: Mixed methods approach was used. A semi structured questionnaire and a 
vignette was used to elicit information from 133 caregivers of children under five years. 
For qualitative one focus group discussion was also carried out with 12 caregivers. 
Results: From the study majority of respondents were able to mention causes of 
malnutrition. Causes cited included, poor feeding practices, which 85.7% caregivers 
agreed to, 85.7% also mentioned poor environmental and personal hygiene, 85.7% 
mentioned poor child care, and 86.9% mentioned poor birth spacing as a cause of 
malnutrition. Eighty seven percent of respondents agreed that cases of malnutrition can 
be managed by taking the child to the health centre, and majority (74.4%) of caregivers 
also disagreed that malnutrition was as a result of spiritual illness/curse and it can be 
prevented. 
Conclusion: Although, caregivers did exhibit some knowledge on malnutrition, it would 
be beneficial to reinforce their education with regards to the three categories of 
malnutrition. Especially stunting, explaining the consequences of long term malnutrition. 
This is very important given the fact that many cases of stunting go unnoticed to the 
untrained eye. Good nutrition in the first 1,000 days of a child lays the foundation for 
health. 
Key words: malnutrition, children under five, community perception, community 
management.  
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TABLE OF CONTENTS 
DECLARATION .............................................................................................................. i 
DEDICATION ................................................................................................................. ii 
ACKNOWLEDGEMENT ............................................................................................. iii 
ABSTRACT..................................................................................................................... iv 
TABLE OF CONTENTS ................................................................................................ v 
LIST TABLES .............................................................................................................. viii 
LIST OF FIGURES ........................................................................................................ ix 
LIST OF ACRONYMS ................................................................................................... x 
DEFINITION OF TERMS ............................................................................................ xi 
 
CHAPTER ONE .............................................................................................................. 1 
INTRODUCTION ........................................................................................................... 1 
1.1 BACKGROUND ..................................................................................................... 1 
1.2 PROBLEM STATEMENT ...................................................................................... 3 
1.3 CONCEPTUAL FRAMEWORK ON CHILD MALNUTRITION ........................ 5 
1.4 JUSTIFICATION..................................................................................................... 8 
1.5 RESEARCH QUESTIONS...................................................................................... 8 
1.6 RESEARCH OBJECTIVES .................................................................................... 8 
1.6.1 General Objectives ............................................................................................ 8 
1.6.2 Specific Objectives ............................................................................................ 8 
 
CHAPTER TWO ............................................................................................................. 9 
LITERATURE REVIEW ............................................................................................... 9 
2.1 INTRODUCTION ................................................................................................... 9 
2.2 COMMUNITY PERCEPTIONS OF MALNUTRITION ................................ 10 
2.3 MEANING OF MALNUTRITION AND COMMON INDICATORS ................. 11 
2.4 CAUSES OF MALNUTRITION........................................................................... 14 
2.5 CONSEQUENCIES OF MALNUTRITION ......................................................... 15 
2.6 HOUSEHOLD LEVEL AND SOCIO ECONOMIC DETERMINANTS OF CHILD 
MALNUTRITIONAL STATUS.................................................................................. 17 
2.7 HOUSEHOLD ECONOMIC STATUS ................................................................. 17 
2.7.1 Mother’s Educational Status ........................................................................... 17 
2.7.2 Women’s Status Relative to Men .................................................................... 18 
2.7.3 Mother’s Employment Status .......................................................................... 19 
2.7.4 Water and Sanitation ....................................................................................... 20 
2.8 COMMUNITY MANAGEMENT OF MALNUTRITION ................................... 21 
 
CHAPTER THREE ....................................................................................................... 23 
METHODOLOGY ........................................................................................................ 23 
3.1 TYPE OF STUDY ................................................................................................. 23 
3.2 STUDY LOCATION/ AREA ................................................................................ 23 
3.3 VARIABLES ......................................................................................................... 24 
3.3.1 Independent Variables ..................................................................................... 24 
3.3.2 Dependent Variables ....................................................................................... 24 
3.3.3 Study Population ............................................................................................. 24 
3.4 SAMPLING ........................................................................................................... 25 
3.4.1 Sample Size ..................................................................................................... 25 
3.4.2 Sampling Method ............................................................................................ 25 
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3.5 DATA COLLECTION TECHNIQUE/METHODS & TOOLS ............................ 26 
3.5.1 Quantitative Component .................................................................................. 26 
3.5.2 Qualitative Component .................................................................................... 27 
3.6 QUALITY CONTROL .......................................................................................... 27 
3.7 DATA PROCESSING AND ANALYSIS ............................................................. 27 
3.7.1 Statistical Analysis .......................................................................................... 28 
3.8 ETHICAL CONSIDERATION ............................................................................. 28 
3.8.1 Approval from study area ................................................................................ 28 
3.8.2 Description of respondents involved in the study ........................................... 28 
3.8.3 Potential risk /benefits ..................................................................................... 28 
3.8.4 Privacy / Confidentiality ................................................................................. 29 
3.8.5 Compensation .................................................................................................. 29 
3.8.6 Data Storage .................................................................................................... 29 
3.8.7 Voluntary Consent ........................................................................................... 29 
3.8.8 Conflict of Interest ........................................................................................... 29 
3.8.9 Proposal & funding information ...................................................................... 29 
3.9 PRETEST OR PILOT STUDY .............................................................................. 30 
 
CHAPTER FOUR ......................................................................................................... 31 
RESULTS ....................................................................................................................... 31 
4.0 INTRODUCTION ................................................................................................. 31 
4.1 SOCIO – DEMOGRAPHIC CHARACTERISTICS OF RESPONDENTS ......... 31 
4.2 PERCEIVED CAUSES OF MALNUTRITION.................................................... 33 
4.2.1 Perceived Causes of Wasting .......................................................................... 34 
4.2.2 Perceived Causes of Underweight ................................................................... 35 
4.2.3 Perceived Causes of Stunting .......................................................................... 36 
4.2.4 Sources of Water and Sanitation as a cause of malnutrition ........................... 39 
4. 3 COMMUNITY PERCEPTION FOR MANAGING MALNUTRITION ............. 41 
4.3.1Community Perception for Managing Wasting ................................................ 41 
4.3.2 Community Perception for Managing Underweight ....................................... 42 
4.3.3 Community Perception for Managing Stunting .............................................. 43 
4.3.4 Community Perceptions of Malnutrition ......................................................... 45 
4.6 CHI- SQUARED TEST BETWEEN DEMOGRAPHICS VARIABLES AND 
MANAGEMENT OF MALNUTRITION ................................................................... 47 
4.6.1 Association between socio-demographics variables and Perceptions of 
Malnutrition .............................................................................................................. 47 
4.6.2 Association between socio-demographics variables and Malnutrition can be 
managed with medical treatment only (N=133) ....................................................... 48 
4.6.3 Association between socio-demographics variables and Malnutrition can be 
managed with combination of other treatments (N=133) ........................................ 48 
4.7ASSOCIATION BETWEEN SOCIO-DEMOGRAPHICS VARIABLES AND 
MANAGEMENT OF MALNUTRITION (TAKING THE CHILD TO A HEALTH 
CENTRE FOR MEDICAL TREATMENT) (N=133) ................................................. 52 
 
CHAPTER FIVE ........................................................................................................... 54 
DISCUSSION ................................................................................................................. 54 
5.1 PERCEIVED CAUSES OF MALNUTRITION.................................................... 54 
5.2 COMMUNITY PERCEPTION OF MANAGING MALNUTRITION ................ 56 
5.3 COMMUNITY PERCEPTION OF MALNUTRITION........................................ 56 
  
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CHAPTER SIX .............................................................................................................. 58 
CONCLUSION AND RECOMMENDATION ........................................................... 58 
6.1 CONCLUSION ...................................................................................................... 58 
6.2 RECOMMENDATION ......................................................................................... 59 
 
REFERENCES .............................................................................................................. 60 
APPENDICES ................................................................................................................ 64 
INFORMED CONSENT ............................................................................................... 83 
VOLUNTEER AGREEMENT FORM........................................................................ 86 
 
 
  
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LIST TABLES 
Table 4.1 Background Characteristics of respondents  ................................ 32 
Table 4.2 Perceived Causes of malnutrition  .............................................. 38 
Table 4.3 Sources of Water and Sanitation  ............................................... 40 
Table 4.4 Community Perception for Managing Malnutrition  .................... 44 
Table 4.5 Community of Perceptions of Malnutrition  ................................ 46 
Table 4.6 Association between socio-demographics variables and Perceptions 
of Malnutrition ......................................................................... 49 
Table 4.7 Association between socio-demographics variables and Perceptions 
of Malnutrition ......................................................................... 50 
Table 4.8 Association between socio-demographics variables and Perceptions 
of Malnutrition ......................................................................... 51 
Table 4.9 Association between socio-demographics variables and 
Management of Malnutrition (Taking......................................... 53 
 
 
  
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LIST OF FIGURES 
Figure1 Conceptual Framework on Child Malnutrition (Adapted from 
UNICEF FRAMEWORK 1990) ..................................................... 5 
 
 
 
 
 
 
 
  
  
 
 
 
 
  
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LIST OF ACRONYMS 
FSAU   -          FOOD SECURITY ANALYSIT UNIT   
  GAIN       -  GLOBAL ALLIANCE FOR IMPROVED NUTRITION  
  GHS   - GHANA HEALTH SERVICE  
  GNA   - GHANA NEWS AGENCY  
  MDGs  - MILLENNIUM DEVELOPMENT GOALS  
  MIC   - MULTIPLE INDICATOR CLUSTER SURVEY  
  UNICEF  - UNITED NATIONS CHILDRENS FUND  
  USAID   - UNITED STATES AGENCY FOR INTERNATIONAL 
                                                 DEVELOPMENT 
   WHO             -           WORLD HEALTH ORGANIZATION  
 
 
 
 
 
 
 
 
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DEFINITION OF TERMS  
MALNUTRITION- Is all forms of bad nutrition which includes both 
under nutrition and over nutrition 
STUNTING- Occurs when a child suffers from a long term 
nutrient deficiency and or chronic illness, so there 
is only weight gain but height is affected  
UNDER NUTRITION- Insufficient food intake, inadequate care and 
infectious diseases or a combination of both factor 
UNDER WEIGHT- Is an effect of both wasting and stunting and is 
therefore a composite indicator of general 
malnutrition 
WASTING- Reflects a recent loss as highlighted by a small 
weight  
 
 
 
 
 
 
 
 
 
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CHAPTER ONE 
INTRODUCTION 
1.1 BACKGROUND 
One of the most important potential resources of a community are the children in it and 
hence their survival and wellbeing is an essential prerequisite for sustainable community 
development. The early years of life of a child are crucial and when well nurtured, 
nourished and cared for, children are more likely to survive, to grow healthily, to have 
fewer illness, and to fully develop cognition, language, emotional, and social skills. 
Healthy child development sets the foundation for the resulting adult who has a greater 
chance of becoming creative and productive in society (UNICEF, 1998).   
Nutrition has increasingly been recognized as a pillar for social and economic 
development. The reduction of infant and young child malnutrition is essential to the 
achievement of the Millennium Development Goals (MDGs) particularly those related to 
the eradication of extreme poverty and hunger (MDG 1) and child survival (MDG 4) 
(WHO, WORLD BANK, UNICEF, 2012).  
The term malnutrition refers to both under nutrition and over nutrition. Under nutrition 
indicates lack of the necessary energy, proteins, and other micronutrients. (GAIN,2013). 
Under nutrition persist as a major threat to both physical development and health of 
millions of children below five years of age in developing countries (Pelletier, Frongillo, 
Schrveder, & Habicht, 1995, world health organization (WHO), 2005; UNICEF,2009). 
According to UNICEF (2009), failure to grow is easily observed through three forms of 
malnutrition. First, acute malnutrition or wasting, in which children remain thin with low 
weight for their height, second, chronic malnutrition or stunting, results in children 
remaining too short for their age and the third is either or both acute and chronic 
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malnutrition cause a condition of underweight. Assessment of underweight through 
weight for age analysis is a widely practiced method in evaluating growth patterns and 
body proportions because it reflects both acute and chronic malnutrition (De Onis, 
Monteiro, Akre &Glugston, 1993; Shetty, 2003; Nube, & Sonneveld, 2005; UNICEF, 
2009; Zavosshy, Noroozi, Jahanihashemi, & Kiamiri, 2012). 
 The factors that contribute to under nutrition among the children under the age of five in 
developing countries are complex. Immediate causes include diseases, inadequate intake 
of diet and substitute food in terms of quality, quantities, and frequency (Mahgoub, 
Nnyebi & Bandeke, UNICEF, 2009, 2012; Sungua et al, 2011). The underlying causes 
include, maternal education, household food insecurity, inadequate child care, inadequate 
social services (Black et al 2008, UNICEF, 2009, WHO, 2010).  
In 2011, stunting and wasting affected more than one hundred and sixty five million and 
fifty two million children under five respectively. 90% of stunted children were 
concentrated in 34 countries located mainly in Sub Saharan Africa and South Asia 
(Black et al, 2008). In Sub Saharan Africa, however, high malnutrition rates are often the 
outcomes of high child mortality and morbidity, and the low proportion of the population 
unable to meet their energy needs (Von Grebmer, 2008).  
Available statistics in Ghana, by the multiple indicator survey (MICS), 2011, indicates 
that almost one in seven children (13%), under the age of five years is moderately or 
severely underweight and 3% are classified as severely underweight. The results also 
reveal that nearly 1 in 4 children (23%) is moderately or severely stunted, and 7% are 
severely stunted. Six percent of the children are moderately or severely wasted and 1% 
can be considered severely wasted. Children in the Northern and Upper East regions are 
more likely to be underweight and stunted than children in other regions. In contrast the 
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percentage of wasting is highest in Upper West and Volta region 9% for each region 
(MICS, 2011).  
Individuals exposed to childhood under nutrition have been reported to face permanent 
socioeconomic and health consequences that have a potential to contribute to adverse 
impacts on their environment in the future. These consequences include prevalence of 
metabolic and cardiovascular diseases, reduced learning ability, lowered years of 
schooling, and intellectual performance in adulthood, reduced working ability, 
productivity and income, poor quality of life and overall poverty that mostly transferred 
to the future generations (Mc Gregor et al, 2007, Black et al, 2008, Walton & Allen, 
2011, UNICEF, 2012, Zavoshy et al, 2012). 
Under nutrition has also been associated with impaired cognitive development, poor 
social and emotional functioning, behavioral problems, reduced school achievement and 
low economic productivity (Abubakar, Hokling, Mwangome, Maitland, 2011). 
Studies have shown that community perceptions of malnutrition and of its causes 
influences health seeking behavior in terms of prevention and treatment (GFH, 2014). In 
order to reduce the cases of malnutrition in the community, it is imperative to understand 
caregiver’s comprehension of the illness (Kamara, Kimberly, 2013). And also to make a 
sustainable impact, interventions need to address direct causes and also the context of 
under nutrition. In any nutritional intervention, beliefs and behaviors of mothers is an 
important consideration (Abubakar, .Hokling, Mwangome, Maitland, 2011).  
1.2 PROBLEM STATEMENT 
Malnutrition is a major global public health problem and a contributing factor to 
mortality and morbidity. Its close association with perceptions has been observed in 
some studies carried out in Pakistan, Rwanda, and Ghana (UNICEF, 2013, Akparibo, 
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2013, Elsevier,2014). Globally an estimated one hundred and one million children 
constituting 16% of the world’s children under five years of age are under weight and 
this is associated with one million to two million preventable deaths each year (Collins et 
al, 2006). The current statistics for acute malnutrition presents a 36% decrease from an 
estimated 159million cases for 1990. However, the overall progress in management of 
malnutrition cases is insufficient and millions of children remain at risk (Global Alliance 
for Improved Nutrition, 2013). 
Recent UNICEF reports have estimated that 5% of the children younger than 5years 
(estimated 26million) are currently severely wasted most of whom are (<90%) live in 
South Asia and Sub Saharan Africa (Akaribo, 2013). Available statistics by the Ghana 
Health Service (GHS) indicates that 12,000 children die every year of underweight 
related ailment due to malnutrition. The statistics also indicates that under nutrition 
contributes to about half of all child deaths beyond early infancy, whilst one out of every 
thirteen children in Ghana die before their fifth birthday mostly as a result of under 
nutrition(GNA, 2012). 
A report on malnutrition trends in the Central Tongu District indicates that, from (2011- 
2013), there has been an increase in cases of malnutrition. That is from 17.1% to 23.1% 
(annual report, Central Tongu District Health Directorate). One might argue that the 
percentages are not high, but these rates continue to increase even in the years of project 
based and routine interventions. It was also observed that caregivers do not have much 
information on the three categories of malnutrition which are wasting, stunting, and 
underweight. This is especially important given the fact that many cases of stunting go 
unnoticed to the untrained eye and needs to be addressed explaining the consequences of 
long term malnutrition. It is therefore perceived that community perceptions have 
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influence on management of malnutrition and health seeking behavior because all illness 
which are not understood, are believed to be caused by the evil eye (FSAU, 2007).                                                                                               
Available statistics by the Multiple Indicator Survey (MICS) 2011, Indicated that the 
percentage of wasting is highest in the Volta and Upper West Regions 9% for each 
region. And in the Volta Region considering the districts that reports cases of 
malnutrition, Central Tongu District is considered the fourth district affected with 
malnutrition aside Krachi West and East District and Nkwanta District (Volta Regional 
Nutrition Department). 
It is in view of this that the study seeks to examine community perceptions, factors 
contributing to malnutrition and community management of cases of malnutrition. 
1.3 CONCEPTUAL FRAMEWORK ON CHILD MALNUTRITION 
 
Figure1 (Adapted from UNICEF FRAMEWORK 1990) 
 
 
 
 
 
 
 
Malnutrition 
in children 
under five
Immediate and 
underlying factors 
(diseases,inadequate 
dietatry intake,maternal 
& child care, inadequate 
health care services
Community 
management
Community 
perception
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Nutrition is directly related to food intake and infections such as diarrhea, acute 
respiratory infections, malaria and measles. Both food intake and infections reflect 
underlying social and economic conditions at the household level, community and 
national levels that are supported political, economic, and ideological structures within a 
country.  
The UNICEF conceptual framework for the causes of malnutrition, was developed to 
guide analysis of causes of malnutrition in a given context. The framework reflects 
relationships among factors contributing to, and their influences on children’s nutritional 
status. Understanding the many different factors on malnutrition allows the development 
of appropriate interventions to address malnutrition.  
The highlighted areas of the framework depicts selected factors for this study.  
These factors are:  
Immediate factors such as food intake (micronutrients status and supplementation) and 
infectious diseases (diarrhea and respiratory infections).  
Underlying biological and behavioral factors such as feeding patterns, child care, 
hygiene and community perception.  
Underlying social and Economic factors such as employment (mothers working status), 
water and sanitation (source of drinking water, type of toilet), education (maternal), and 
health service (community management).  
A child suffering from inadequate dietary intake is more susceptible to diseases. 
Inadequate dietary intake and illness interact in a negative synergy. Diseases depresses 
the child’s appetite and compete for limited energy resources from the child and also 
affect the digestion of food or absorption of nutrients from food. 
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 Influencing the immediate factors of nutritional status of a child are the underlying 
factors which include feeding patterns, child care, community perception, hygiene, 
maternal education, maternal employment, water and sanitation and health service 
(Gabriele & Schettino, 2008, UNICEF,2009, WHO,2010). Feeding patterns in terms of 
quality, quantity, and frequency of food intake by the child which can affect the child’s 
nutritional status. Care refers to caregiving behavior such as breastfeeding and 
complementary feeding practices, personal hygiene and care can also refer to the support 
that the family or community provides which in effect influences the child’s nutritional 
status. Maternal education is one of the most important resources that enable women to 
provide appropriate care for their children. Maternal employment enhances the 
household’s accessibility to income, it may also have negative effect on the nutritional 
status of the child as it reduces a mother’s time for child care. Access to and use of safe 
water, sanitation facilities and good hygiene have the potential to positively impact 
nutritional outcomes. Community perception and community management, also have 
influence on malnutrition, understanding the nature of malnutrition problem, affects in 
particular the choice of what is assessed, how it is analyzed and what actions are 
regarded as feasible in terms of community management of malnutrition, therefore 
having an effect on malnutrition outcome.  
Some of the problems causing malnutrition are amenable to effective actions at the 
household and community levels. If decision making at these levels are more supportive, 
more children would survive, and those surviving would be in better condition. 
  
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1.4 JUSTIFICATION 
The aim of this study is to enhance an understanding the role of community perceptions 
on management of malnutrition and the importance of caregivers identifying the three 
categories of malnutrition which will help in management and subsequently provide key 
recommendations for simple and effective public health programs. 
 
1.5 RESEARCH QUESTIONS 
1. What are community perceptions of malnutrition in children under five (5) years  
2. What factors contribute to malnutrition in children under five (5) years  
3. How are cases of malnutrition managed in the community? 
 
1.6 RESEARCH OBJECTIVES 
1.6.1 General Objectives 
To examine community perceptions and management of malnutrition in children under 
five years   
 
1.6.2 Specific Objectives 
1. To examine community perceptions of malnutrition in children under five years  
2. To determine factors that contribute to malnutrition in children under five years   
3. To examine how cases of malnutrition are managed in children under five years 
 
 
 
 
 
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CHAPTER TWO 
LITERATURE REVIEW 
2.1 INTRODUCTION 
This chapter gives a brief background of malnutrition and reviews Community 
Perception and Management of Malnutrition related literature. Literature were reviewed 
under themes following the objectives of the study.  
 Malnutrition remains a global problem affecting development particularly that of the 
under privileged and the poor. UNICEF, has coined malnutrition as a “silent emergency” 
that endangers children, women, society and the future of mankind (Biomedica, 2005). 
Poor nutrition contributes to approximately half of all the child deaths. Globally, under 
nutrition is a contributing cause for deaths from diarrhea (61%), malaria (57%), 
pneumonia (52%), and measles (45%) (Black et al, 2008). More than 90% of the worlds 
stunted children live on the continents of Africa and Asia.  
Under nutrition contributed to 3.1million (45%) of child deaths worldwide in 2011. 
Between 1990 and 2011, stunting (low weight for age), a measure of chronic under 
nutrition declined by 35%, while wasting a measure of acute underweight nutrition 
decline by 11%. However with population growth, the absolute number of children 
affected has remained unchanged. In 2011, stunting and wasting affected more than 
165million and 52million children under five respectively (USAID, 2013).  
Adequate nutrition is critical to child health and development. Growth during the first 
year of life is greater than any other time after birth. Good nutrition during this period of 
rapid growth is vital to ensure that the infant develops both physically and mentally to 
the fullest potential. Community perception is associated with malnutrition, hence forms 
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an essential first step for any need felt for intervention program designed to bring about 
positive behavioral change (Nohan, Sawsan...lily Kareema, 2009). 
 
2.2 COMMUNITY PERCEPTIONS OF MALNUTRITION 
Some studies have been carried out in some countries on how malnutrition is perceived 
by caregivers and community members. 
A study carried out by UNICEF, (2013), showed that in Ghana, especially in the northern 
part, many belief that symptoms and illness in their children signify a curse from the 
gods or a punishment from the ancestors and therefore children are taken to traditional 
healers for spiritual intervention rather than medical care.  
Another study carried out in the Upper East Region of Ghana, stated that most mothers 
believe that malnutrition comes about as a result of mother’s disregard of traditional 
norms and beliefs. To them, the treatment of malnutrition should also incorporate 
traditional medicine (Akpribo, 2013). 
A study was carried out in Pakistan on traditional perceptions of marasmus and most 
mothers interviewed said that the usual cause of malnutrition is the contact with a 
woman who had marasmic child or is otherwise in a state of ritual impurity. The 
mediating factor is said to be a saya (shadow, influence) emanating from such a person 
and ultimately linked with the spirit world. Some others associated the condition with 
fright and spirit possession. Mothers described various magico religious therapies that 
could be tried (Elsevier, 2014).  
A study carried out in Rwanda, Nyacyonya, on perceptions of malnutrition at the clinic 
where some mothers with malnourished children shared their experiences. One mother 
said she was shocked when she was told her child was malnourished and felt her 
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irresponsible behavior caused that, because that is the perception. Another mother said 
because of stigmatization and embarrassing questions she did not want to come out. 
(GFH, 2014).  
A study was also conducted in Dhaka Bangladesh in (2011), where it is perceived that 
having many brothers and sisters and also parents of large families were unable to 
provide adequate physical comfort. It is also perceived that neglect by sick or working 
mother’s leads to malnourishment in children. Sick mothers feel weak and exhausted and 
therefore lacked the physical energy and motivation to provide adequate care to their 
children which lead to poor health and malnutrition. All this boils down to inappropriate 
care (American Journal of Public Health, 2011).  
In a study carried out in Nepal, malnutrition is sometimes perceived as a natural 
phenomenon related to the “strength” of the body of the child at the time of delivery. It 
was explained as the result of God’s curse, a spirit threatening the child, or “a wizard 
eating the child slowly (Kolstern, Lefevre, Lerude, 1997). 
Considering the above studies carried out one thing stands out and that is the belief or 
perception of malnutrition is considered to be spiritual and not a natural cause and this 
influences health seeking behaviors. 
 
2.3 MEANING OF MALNUTRITION AND COMMON INDICATORS 
The WHO defines malnutrition as “the cellular imbalance between the supply of 
nutrients and energy and the body’s demand for them to ensure growth.” Although this 
definition can be applied to excess and deficiency (World Bank, 2006). 
Malnutrition can also be defined as all forms of “bad” nutrition which includes both 
under nutrition and over nutrition. Under nutrition results from insufficient food intake, 
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inadequate care and infectious diseases, or a combination of these factors. This 
comprehensive term includes being underweight for one’s age, too short for one’s age 
(stunting), dangerously thin for one’s height (wasting ) and deficient in micronutrients 
(Benjon et al, 2008). According to UNICEF (2009), failure to grow is easily observed 
through the three forms mentioned. 
Acute malnutrition or wasting reflects weight loss as highlighted by a small weight for a 
given height. A child suffering from acute malnutrition can be categorized as being 
either moderately or severely thin or wasted. The consequences of acute malnutrition 
affect every organ and system. The presence of bilateral pitting edema is always a sign of 
severe acute malnutrition. Severe wasting, also referred to as severe acute malnutrition or 
SAM, is characterized by the following clinical manifestation. Marasmus, otherwise 
known as severe wasting. A child with marasmus is extremely thin, with wizard, old man 
appearance. Kwashiorkor, a manifestation of severe acute malnutrition is indicated by 
bilateral pitting edema. A child suffering from kwashiorkor may not appear to be 
undernourished, because the body swells as a result of edema. The additional water 
retained by the body increases the child’s weight so that it may be within limits. In its 
most severe form, kwashiorkor results in extremely tight, shining skin, skin lesions, and 
discolored hair (Benjon et al, 2008). 
Stunting is an adaptation to chronic malnutrition and reflects the negative effects of 
nutritional deprivation on a child’s potential growth over time.  Stunting can occur when 
a child suffers from long term nutrient deficiencies and or chronic illness, so, that only 
weight gain but height is affected. It can also be an outcome of repeated episodes of 
acute malnutrition. Stunting is classified by low height for age, indicating a restriction of 
potential linear growth in children, it negatively and often affects organ growth, stunting 
is strongly linked to cognitive impairment (Benjon et al, 2008). 
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Underweight is an effect of both wasting and stunting and is therefore a composite 
indicator of general malnutrition. It is measured by low weight for age in children or low 
weight for height in adults, and it’s an outcome of either past or present under nutrition. 
(Benjon, et al, 2008).  
There are three assessment methods that is used to assess malnutrition. Anthropometric 
measurement which is often used (such as height, weight, arm circumference, and skin 
fold). We have Analysis of biomedical content of blood and urine (such as iron 
deficiency and Vitamin A supplementation), and the last one is clinical assessment of 
physical signs of nutrient deficiencies (UNICEF, 2009, Zavosshy, Noroozi, 
Jahanihashemi & Kiamiri, 2012).  
 Among the three assessment methods, anthropometric measurement is a common and 
easy way to assess health and nutrition status. The other two methods are less practical 
because of the logistical difficulties involved and because data collection and analysis is 
expensive and time – consuming. Biochemical and clinical indicators are more useful 
when malnutrition is extreme. Due to their relative cost – effectiveness for wide – scale 
usage and relative sensitivity in detecting more moderate forms of malnutrition, 
anthropometric measurements are the most widely available in household surveys. 
Three common measurements include weight – for – age, height – for – age and weight 
for – height (often converted into Body Mass Index, or BMI). Each measurement is 
generally converted to a z – score, which indicates the number of standard deviations an 
individual is above or below the mean of a reference population. A z – score of two 
standard deviations or more below the mean indicates moderate malnutrition, while a z – 
score of three standard deviations or more below the mean indicates severe malnutrition. 
Weight – for – age, routinely collected in growth promotion programs, is the most 
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common assessment of child nutrition status. It is a measure of both short – and long – 
term insults to health. A child is considered underweight if his/her weight – for – age is 
two standard deviations or more below the mean for the reference population. Weight – 
for – height is a measure of acute or short – term nutritional deficiency. Wasting, a term 
applied when weight – for – height falls two standard deviations or more below the mean 
for the reference population, is a sensitive indicator often used for short – term program 
intervention such as providing nutritional supplementation in emergencies. Wasting can 
be calculated without knowing the age of a child and, therefore, is the best malnutrition 
indicator when it is difficult to determine the exact ages of the children being measured 
(such as in complex emergencies like famines). Height – for – age is a measure of linear 
growth and reflects the long term, cumulative effects of inadequate nutrition and poor 
health status. A child is considered stunted if his/her height – for – age is two standard 
deviations 
 
2.4 CAUSES OF MALNUTRITION 
Often, it is assumed that the primary cause of malnutrition is food security (Smith & 
Haddad, 2006). According to Shrimpton (2003), household food security refers to the 
adequacy of food availability at a household level in terms of both quantity and quality. 
The necessary resources for ensuring household food security include income for food 
purchases and in kind transfers (Smith &Haddad, 1999).  Studies suggest that food is not 
the only main cause of malnutrition (World Bank, 2006). Many children in food secured 
environment and those in poor families are malnourished because of insufficient energy 
and other nutrient intake combined with infectious diseases especially, diarrhea. Poor 
maternal knowledge, inappropriate caring practices, inadequate access to health services 
and water and sanitation (Ibid, 2006).   
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On the other hand, Shrimpton (2003) identified one drawback of the UNICEF conceptual 
framework. That is, it recognizes insufficiently the influence of maternal health and poor 
fetal growth on the occurrence of malnutrition. The most damaging effects of 
malnutrition occur during pregnancy and in the first two years of life (World Bank, 
2006). Thus, it is essential to incorporate maternal health and nutrition, and fetal growth 
that are temporally linked to child survival and growth (Shrimpton, 2003). In summary, 
the UNICEF nutritional framework facilitates assessment, analysis, and decision on 
actions to be taken in resolving nutritional problem at the broader level. 
A study was carried in Nepal and they believed the causes of malnutrition is direct and 
indirect. Example with “peso women”, or contact with another malnourished child. A” 
peso woman” is a woman who delivers and the child dies or have miscarriages. The 
contacts with another malnourished child were various and could take various forms, 
such as eye contact, wind, contact with a shadow, or heat of body, and also contact of a 
child with the weighing bag at the weighing center, and this belief has deferred some of 
the mothers from coming to the weighing center (Kolsteren, Lefevre, Lerude, 1977).  
 
2.5 CONSEQUENCIES OF MALNUTRITION 
Malnutrition has global repercussions, not only does it harm affected children but the 
societies they live in also suffer (Bhutta et al, 2008). Malnutrition also has dire 
consequences, causing critical health problems that lead to growth retardation and 
impaired cognitive development. Without treatment, individuals who are affected by 
moderate and severe acute malnutrition during the critical stage of life between 
conception and age two (2) may bear the scars for the remainder of their life’s (Victoria, 
2008). The 1,000 days from pregnancy to child’s second birthday is the most critical 
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time for positive impact on a child’s cognitive, intellectual, physical development, 
therefore good nutrition lays the foundation for good health, and even prosperity for the 
next generation (USAID, 2013). These adverse mental and physical developments in turn 
shape future market opportunities and earning prospects through reducing schooling and 
post – schooling productivity (Behrman and Hoddinot, 2001). Those surviving 
malnutrition as children are less productive both physically and intellectually, and suffer 
from chronic illness (UNICEF, 1998 cited in Smith and Haddad, 1999). These damaging 
effects of malnutrition on health, brain development, intelligence, educability, and 
productivity are largely irreversible (World Bank, 2006). 
According to World Bank (2006), malnutrition undermines economic growth and 
perpetuates poverty. Failures to deal with the problem have manifested themselves in 
terms of inadequate progress towards the achievement of the Millennium Development 
Goals (MDGs) which include not only reducing poverty and hunger by half by the year 
2015 but also goals on education, child and maternal health, and HIV/AIDS. Moreover, 
malnutrition poses a serious health problem. It causes more than half of all child deaths 
worldwide resulting in a major waste of human energy (Smith and Haddad, 2000). It is 
also a major contributor to the burden of diseases (mostly in developing countries) which 
subsequently has led to increased opportunity cost of health spending distorting 
economic resource allocation. 
With this in mind, it is, therefore, essential to direct timely interventions. Investments in 
people’s health and nutritional status play a key role in improving general welfare, 
promoting economic growth, and poverty reduction, for improved health and sanitation 
are preconditions to escape poverty and contribute to economic growth. 
 
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2.6 HOUSEHOLD LEVEL AND SOCIO ECONOMIC DETERMINANTS OF 
CHILD MALNUTRITIONAL STATUS 
The household level is the underlying factors, that causes malnutrition includes, 
household economic status, education of parents (particularly that of mothers), women’s 
status relative to men, employment status of mother, access to water and sanitation, 
health services and maternal and child care.  
 
2.7 HOUSEHOLD ECONOMIC STATUS 
The economic status of a household where a child lives has been identified as one of the 
key determinants of child nutritional status. It is also an indicator of access to adequate 
food supply, use of health services, availability of improved water sources and sanitation 
facilities which are prime determinants of child nutrition. Studies by Smith et al, (2005) 
stated that household economic status significantly affects access to food (a necessary 
condition for food security). It also indicates possession and utilization of child care 
resources on a sustainable basis. In addition, it allows a more diversified diet and 
effective child care arrangements. A study by (Yimer, 2000), also showed that the higher 
the level of economic status of the house hold, the lower the level of child stunting.  
Increase in household income at the community level leads to improved access to quality 
of health care, improved water and sanitation systems and access to information.  
 
2.7.1 Mother’s Educational Status 
In many developing countries particularly in Africa, tradition has laid the responsibility 
of child care on women saying the place for women is in the kitchen. Therefore women 
are the key players in the growth of and development of children (Oyekale & Oyekale, 
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2005). However it is not until recently that the role of mother’s education in enhancing 
the quality of care and nutritional status of children is being emphasized in empirical 
research (Smith et al, 2004). Maternal education is one of the most important resources 
that enable women to provide appropriate care for their children.   
Education improves the ability of mothers to implement simple health knowledge and 
facilitates their capacity to manipulate their environment including interaction with 
medical personnel. Furthermore, educated women have greater control over health 
choices for their children.  
Studies by Oyekale & Oyekale, (2005), showed that education of women also have 
positive effects on the quality of care rendered to children since women are the main 
caretakers of children. For instance educated mother’s may have good paid jobs, thus be 
able to earn higher income and take better care of their children, be resident in urban 
areas, where there are functioning social infrastructure, possess commendable culture of 
hygiene needed to protect children from diseases, be more likely to participate in child 
health enhancing programs like immunization and child care talks and be able to benefit 
maximally from nutrition and other health related programs. The mother’s ability to 
process information, acquire skills and positive behaviors improves with education.  
 
2.7.2 Women’s Status Relative to Men 
Conceptually, the status of women is multidimensional. Smith et al. (2005) define 
women’s status as the relative power of women in household, communities, and nations 
they live in. The status of women is an important determinant of two resources for care: 
their physical and mental health status, and control over household resources (Smith and 
Haddad, 2000). The physical conditions of women strongly affect the quality of care they 
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provide to their children even before they are born. Poor physical and mental status of 
women constrains the quality of care rendered to their children which includes the 
quality of breast feeding. 
On the other hand, women’s control over resources promotes household food security 
and nutrition because women show a tendency to spend resources on nutrition inputs 
such as food (Haddad, 1999). Improved control over resources gives women a better 
opportunity to provide good care which includes better food preparation and storage 
practices, hygienic practices, improved care for children during illness (including 
diagnosis of illness, care seeking and home treatment), and motivation for supporting 
child development. 
Weak control over household resources, tighter constraint on time, restricted access to 
information and health services, poor mental health, and lack of self confidence and self-
esteem typically characterize women with relatively lower status which in turn reflect on 
their children’s health and the quality of care provided. 
 
2.7.3 Mother’s Employment Status 
Although women’s employment enhances the household’s accessibility to income, it 
may also have negative effects on the nutritional status of children as it reduces a 
mother’s time for child care. Some studies have revealed that mothers of the most 
malnourished children work outside their home (Abbi et al, 1991). Another study argued 
that there is no association between maternal employment and children’s nutritional 
status. (Leslie 1988). 
The effect of maternal employment on the wellbeing of children has been controversial 
and it appears difficult to determine the net effect. Crepinsek & Burstein (2004), 
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underscored that employment of mothers can have both positive and negative implication 
on children’s dietary intake. On the one hand, the employment of mothers adds to family 
income and this may help to ensure stable supply of quality food through increased 
expenditure. On the other hand, mothers’ employment may leave them with lesser time 
for caring and supervision of the activities of their children, and preparation of food. This 
appears more apparent under the assumption that no care taker would be motivated as 
mothers. 
 
2.7.4 Water and Sanitation 
Access to and use of safe water, sanitation facilities and good hygiene have the potential 
to positively impact nutritional outcomes by addressing both direct and underlying 
causes of malnutrition. Washing of hands with soap, treatment and safe storage of 
drinking water, and sanitary disposal of human feces, have been shown to effectively 
reduce the prevalence of diarrhea, a major contributor of malnutrition. Lack of sanitation 
in particular is strongly correlated to stunting and even in absence of diarrhea. Essential 
food hygiene actions include maintenance of clean food preparation area, separation of 
raw and cooked food, cooking food thoroughly, strong food safety (time, temperature, 
covered container0 and use of safe water and fresh raw ingredients prevents infants and 
young children from infections.(USAID, 2013).  
Studies by the World Bank (2006), stated that improving access and quality of water 
source not only reduces transmission of water borne diseases but also saves women the 
extra time they spend on carrying water which can be allotted to child care and feeding 
or income generating activities.  
 
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2.8 COMMUNITY MANAGEMENT OF MALNUTRITION 
Considering management of malnutrition in the community, very little has been done in 
Ghana but however, this have been done in different countries. 
In Somalia, a study carried out by FSAU, (2007) showed that acute malnutrition, locally 
known as (nafagodoro), and is associated with poor food and sanitation. The two 
combine to cause malnutrition and treatment involves giving the child more food. No 
food is withheld during treatment of malnutrition. Medicine is used to treat 
accompanying diseases. In cases of kwashiorkor, the swollen limbs, stomach and face is 
burnt to remove the fluid. 
According to the same study the treatment of evil eye also involves the use of the 
following ingredients, feaces of elephant, hooves of donkey, hyena’s skin, garlic and 
ubuore leaves. These ingredients are burnt and the child is steamed with the smoke. In 
the process, the child sweats, sneezes with a lot of liquid coming out through the nose as 
a sign that the evil is being emitted from the head. During the process it is believed that 
the child becomes calm and recovers from the evil eye (FSAU, 2007).  
Another study carried out in Pakistan, by Elsevier, (2014), stated that mother’s described 
various magico religious therapies that is tried when their children are malnourished 
because the condition is associated with fright and spirit possession, and for some other’s 
the first response in health seeking is prayer or reading of Koran. 
In Rwanda, children are also taken to traditional healers for spiritual interventions rather 
than for medical care (GFH, 2014). 
In most cases malnutrition is a treatable condition that can be managed in the home. You 
may be given advice to use at home, or you may be treated at home under the 
supervision of qualified health professional. Children are also give additional nutrients to 
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increase their intake of energy and protein(Abubakar, Holding, Mwangome, & Maitland, 
2011) 
Aside these community management there are other interventions that can also be used 
in the community. The Government of Ghana, in collaboration with development 
partners, has taken a pragmatic steps towards addressing child malnutrition. One of such 
steps is the adaptation of the community based management of acute malnutrition 
(Akparibo, 2013). This intervention is to improve the lives of hundreds of thousands of 
children. Providing foods that are safe to use at home and ensure rapid weight gain in 
severely malnourished children.  
Linking community based management of acute malnutrition to other nutrition 
promotion services is important to prevent all forms of under nutrition and reduce the 
overall case load of malnutrition. 
 
  
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CHAPTER THREE 
METHODOLOGY 
This chapter discusses the research methodology including the type of study, variables, 
study population, sampling, data collection and analysis and ethical consideration. 
 
3.1 TYPE OF STUDY 
A descriptive mixed – methods approach was used. 
 
3.2 STUDY LOCATION/ AREA 
 The study was conducted in the Central Tongu District which was carved out from the 
former North Tongu District. It shares boundaries with North &South Tongu Districts, 
Akatsi North & South Districts, and Adaklu District, of the Volta Region. Ada West & 
East Districts, of the Greater Accra Region. The district has a total population of 68,374, 
projected from the 2010 census.  
The district has 13 health facilities made up of 1 hospital, 3 health centers, 1 private 
clinic, 7 CHPS, zones and 1 maternity home. It has 208 communities. The district is 
divided into two unequal halves by the Volta River stretching from the Titikofe in the 
North to Avadiokofe Island, located South of the lower Volta Bridge at Sogakofe. The 
district has 14 hard to reach communities, 3 are on the island, 3 inland and 8 that are 
seasonally to reach (raining season). 
The people are predominantly Ewes, with few other tribes. They are mainly farmers, 
fisher men and traders. Source of drinking water is pipe borne water, but few people use 
the Volta River and few manmade ponds. 
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Malnutrition trend in the district has been on the increase for the past three years. (2011- 
2013) That is from 17%   to 23%. Some intervention program on malnutrition has been 
carried out in the various communities and are still on going. Routine activities such as 
nutrition surveillance, counselling on feeding practices community based growth 
monitoring and project based interventions, which is mostly sponsored by international 
organizations and local organization, the district is currently implementing the 
community infant and young child feeding (IYCF), nutrition assessment, counselling & 
support (NACS), and nutrition and malaria control for child survival project, (NMCCS) 
to help reduce cases of malnutrition. All this interventions are community based 
programs.  
 
3.3 VARIABLES 
3.3.1 Independent Variables 
Socio demographic characteristics (age of mother, educational status, marital status, 
employment status, religion, ethnicity), perception of malnutrition  
 
3.3.2 Dependent Variables 
Community Management of malnutrition  
 
3.3.3 Study Population 
Mother’s and caregiver’s of children under five years will be the target population for 
this study 
  
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3.4 SAMPLING 
The sample size was determine by using the statistical formula of Fisher (Korlik & 
Higgins, 2001). 
 
3.4.1 Sample Size 
N = z2 pq/d2  
Z = 1.96, 95% confidence limit  
d= 0.05 as the acceptable margin of error  
p= the probability of the event occurring = 0.08 
q= 1-p = which is the probability of the event not occurring in this 1-p =0.92  
The sample size was determined as follows  
n=1.962 (pq)/d2 
n=1.962(0.08) (0.92)/ 0.0025  
0.228274/0.0025  
Minimum sample size required is 133  
Non respondent rate of 10% size to give a total of 124  
A sample size of 124 respondents will be required for the study 
 
3.4.2 Sampling Method 
The District Health Directorate initiated a malnutrition program in some selected 
communities scattered in 5 sub districts. A simple random sampling method was used to 
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recruit respondents from the communities. All 15 communities under the malnutrition 
program in the district were visited and an average of nine respondent were randomly 
sampled to be interviewed. Respondents were selected during child welfare clinic in the 
selected communities. Yes/No was written on a piece of paper and mothers who picked 
yes were selected for the study. 
Inclusion criteria includes: 
Mothers and caregivers with children under five (5) years  
Has to be resident of the study area 
Exclusion criteria: mothers and caregivers who do not have children under five (5) years. 
 
3.5 DATA COLLECTION TECHNIQUE/METHODS & TOOLS 
3.5.1 Quantitative Component 
A structured questionnaire was used to elicit information from respondents on 
background characteristics and other variables relevant to the study objectives and 
questions. Semi structured interview guide was more appropriate for the study because it 
elicited detailed information. 
A vignette was also designed to elicit information from respondents on each category of 
malnutrition. A vignette can be described as stories about individuals and situations 
which make references to important points in the study of perception, beliefs and 
attitude. They are stories generated from a range of sources including previous research 
findings. Participants are typically asked to respond to these stories with what they 
would do in a particular situation or how they think a third person will respond (Carlson, 
1996, Mckeganey, et al, 1995) 
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3.5.2 Qualitative Component 
One focus Group Discussion with 8 – 12 participants, was used to examine perceptions 
and practices about malnutrition among mother’s and caregivers. Participants for the 
Focus Group Discussion were representatives of the various stakeholders in the 
community. Selection was done with the help of the community volunteer. One 
executive of each group was selected. 
 
3.6 QUALITY CONTROL 
An interview and focus group discussion guide was created and revised based on 
reference materials and was reviewed by supervisor. All questionnaires that were 
returned by research assistants were checked for mistakes and completeness. The 
questionnaires which had unclear responses or many missing information that cannot be 
clarified were excluded. Double entry was done to reduce entry errors. Entering was 
done separately and reconciled.  
 
3.7 DATA PROCESSING AND ANALYSIS 
Numerical data was entered into SPSS version 15 and subsequently analyzed to generate 
frequency tables of selected variables.   
Community perception and management of malnutrition was measured by using the 
three variables. Agree, Disagree, Don’t know. This was measured based on the responses 
of participants to the three variables. 
  
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3.7.1 Statistical Analysis 
Chi square analysis was used to determine the association between independent and 
dependent variables. Interviews were transcribed into English and thematic analysis was 
used to analyze the data. 
 
3.8 ETHICAL CONSIDERATION 
The researcher ensured that all necessary measures needed to be followed was done. 
Approval to conduct this study will be obtained from the Ethical Board of the Ghana 
Health Service.  
 
3.8.1 Approval from study area 
Permission and approval was sought from the District Director of the District Health 
Directorate to have access to data and to conduct the study in some of their communities. 
Opinion leaders of the communities in which the study will be conducted will be 
informed before data will be collected.  
 
3.8.2 Description of respondents involved in the study 
The study population were caregivers of children under five years  
 
3.8.3 Potential risk /benefits 
The study is non evasive and did not cause any form of discomfort to respondents. The 
study is envisaged to be beneficial to the study population. Information obtained can be 
used to revise the health messages delivered to the communities in order to make them 
culturally more appropriate and relevant in the context of under nutrition.  
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3.8.4 Privacy / Confidentiality 
The identity and privacy of the respondents will be protected, a code was used to identify 
them instead of their names and objective of the study will be made known to them.  
 
3.8.5 Compensation 
No compensation will be given, however, their inputs will be recognized and appreciated  
 
3.8.6 Data Storage 
Hard copy and electronic data will be stored in locked file cabinets and access will be 
limited to PI and the supervisors of the study.  
 
3.8.7 Voluntary Consent 
Written consent was sought from study participants before data was collected from them. 
They were informed that their involvement in the study is voluntary. Respondents were 
given the opportunity to opt out of the study anytime they wish to without any 
consequence.  
 
3.8.8 Conflict of Interest 
Apart from academic and public health importance, there is no conflict of interest in this 
study.  
 
3.8.9 Proposal & funding information 
The study was self – financed from my own resources. 
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3.9 PRETEST OR PILOT STUDY 
Research instrument was piloted at Asesewa Reproductive Child Health Unit to know 
the sequence of the questions, time to complete the interview, difficult questions and the 
nature of responses. And also to determine the validity and reliability of the instrument. 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
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CHAPTER FOUR 
RESULTS 
4.0 INTRODUCTION 
This chapter presents results of the study on community perception and management of 
malnutrition in children under five years in the Central Tongu District, and focuses on 
the socio – demographic characteristics of respondents, causes of malnutrition, 
community perception of management of malnutrition and perceived perceptions of 
malnutrition. 
 
4.1 SOCIO – DEMOGRAPHIC CHARACTERISTICS OF RESPONDENTS  
One hundred and thirty three caregivers in 15 communities within the district were 
interviewed. Majority of the mothers interviewed were between 20 and 29 years of age 
(55.6%), while 5.3% were aged between 40 and 49 years. A display of respondents’ 
reported marital status as given in Table 4.1, indicates that the majority (97.7%) of 
mothers were married. None of the respondents reported being widowed, separated or 
divorced, and (2.3%) were single/never married. Most respondents had completed Junior 
High School (JHS), 
(50.4%) those with no educational level were (11.3%), while (1.5 %) reported having 
completed Tertiary education. Majority of respondents were Christians (96.2%) and a 
very small portion were traditionalist (3%), and Moslem (0.8%). Findings indicated that 
the majority (98.5%) of respondents were Ewe’s while (1.5%) were Northner’s. The 
majority of respondents, (39.9. %) were farmer’s, (18.8%) respondents were not 
working, (2.3%) of respondents were civil/public servants. This is because of the 
environment in which they find themselves, (49.1%) of respondents were earning 
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between GHS 100- 300, (35.2%) were earning below GHS 100, whilst (1.9%) were 
earning above GHS 700. (Table 4.1). 
 
Table 4.1 Background Characteristics of respondents  
Background Characteristics Frequency Percent 
Age 
  
15-19 13 9.8 
20-29 74 55.6 
30-39 39 29.3 
40-49 7 5.3 
Marital Status 
  
Married 130 97.7 
Single/Never Married 3 2.3 
Educational Background 
  
JHS 67 50.4 
Primary 46 34.6 
None 15 11.3 
SHS/Vocational 3 2.3 
Tertiary 2 1.5 
Ethnicity 
  
Ewe 131 98.5 
Northerner 2 1.5 
Religion 
  
Christian  128 96.2 
Traditionalist 4 3 
Moslem 1 0.8 
Occupation 
  
Farming 53 39.9 
Trading 37 27.8 
None 25 18.8 
Artisan 14 10.5 
Civil/Public Servant 3 2.3 
Fishing 1 0.8 
Average Income 
  
GHS100 - 300 53 49.1 
<GHS100< strong> 38 35.2 
GHS400 - 700 15 13.9 
Above 700 2 1.9 
No of Dependents   
Below 4 32 29.6 
4 to 7 69 63.9 
8 to 13 7 6.5 
Total 133 100 
Field Survey, 2015  
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4.2 PERCEIVED CAUSES OF MALNUTRITION. 
A vignette was used to elicit information from respondents on the categories of 
malnutrition. This were pictures with a brief story, that was shown to respondents to 
identified the three categories, wasting, underweight, and stunting, whether it is common 
in their communities and what they think causes malnutrition in the communities.  
Majority (86%) identified the condition in the first vignette, as Kwashiorkor while 1.5% 
said it was cholera. A little above 12% of the respondents have no idea what the first 
vignette represents. This could imply that 86% of the respondents within the South 
Tongu District perceived wasting in the vignette as Kwashiorkor, 81% of the respondents 
claim the second vignette presented showing underweight represents Kwashiorkor, 0.8% 
are of the view that the second vignette represents beriberi and 18% have no idea. The 
third vignette was on stunting, 4.5% of respondents identified it as “ siahor”, 2.3% said it 
is called “matsimatsi”, both literally in English means “the child has refused to grow”, 
60.2% said it was kwashiorkor and again 32.3% were not able to identify the third 
vignette. 86% of the respondents are of the view that the first vignette presented is not 
common in their community with 14% of them not responding to the question. It could 
therefore be said that, first vignette presented is not common in the South Tongu District. 
82% of the respondents are of the view that the second vignette presented is not common 
in their community with 18% of them not responding to the question. It could therefore 
be said that, the second vignette presented is also not common in the South Tongu 
District. With the third vignette, 80% of respondents said the condition is not common in 
the community, whilst 20% did not respond to the question. 
About 12% of respondents have seen these vignettes before but not in communities they 
live majority of respondents 74% have heard but not seen it before except in books that 
are shown to them by the nurses, and 14% of respondents have not heard about it before.     
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With respect to causes of malnutrition, generally responses were not very different when 
it came to quantitative analysis with regards to the three categories of malnutrition. 
However, narratives from the focus group discussion (FGD), showed differences in the 
causes of malnutrition with the three categories. People attributed wasting to always 
eating starchy foods without any nutrients, underweight to poor hygiene and stunting to 
caregivers failing to monitor the feeding habits of their children. Water and sanitation 
was mentioned as a component of malnutrition. Following are the causes of the three 
categories of malnutrition. 
 
4.2.1 Perceived Causes of Wasting 
 Majority of respondents mentioned poor birth spacing (86.9%), eating too many starchy 
foods (85.7%), eating foods deficient with fruits and vegetables (85.7%), frequent 
absence of mother at home (85.7%), poor personal/environmental hygiene (85.7%) as 
some of the causes of wasting as presented in the first vignette except for mothers with 
low educational status.   
Narratives from the FGDs further gave more weight on the causes of wasting. Main 
causes cited included feeding practices. Feeding practices refers to the quantity, quality 
of foods eaten and varieties of foods:  
“When the child is always eating starchy foods without any nutrient. And giving 
complementary food at the wrong time and also the child one type of food 
everyday (akple kple atadi gbesiagbe) eating banku and pepper everyday.”  
                                                                                      (26 – year old female respondent) 
Narratives also suggests that the absence of caregivers due to work, poor food choices 
been made where biscuits of lower nutritional value were bought for the children instead 
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of feeding them with protein rich foods. Respondent also considered the multi task of 
caregivers makes most of them not able to cook regularly for the children. 
“Sometimes you wake up and because you are busy doing something, you give 
money to the child/children to buy biscuits or buy food from food venders at 
popular joints. (Rice and beans popularly called wakye, rice, or kenkey, 
preparation from fermented corn dough eaten with fresh tomatoes, pepper and 
onion sauce with fried fish). 
(28 – year old female respondent) 
4.2.2 Perceived Causes of Underweight 
Results from Table 4.2 on the causes of underweight, shows that majority of respondents 
(82%) agreed that eating too many starchy foods; child experiencing diarrhea; frequent 
absence of mother at home are causes presented in the second vignette. Furthermore 
81.2% of the respondents agreed eating foods deficient with fruits and vegetables is also 
a cause presented in the second vignette except for Presence of other infections and 
Mother’s low educational status which appears to be evenly spread. 
Narrative from FGD highlighted poor hygiene as one of the causes of malnutrition, this 
was linked to drinking dirty water, poor environment, i.e. general untidiness of the home, 
using dirty cooking utensils to prepare food and children playing in the sand and dirty 
environment and also children   not washing their hands before eating, and birth spacing. 
The following narratives are typical 
“Sometimes we don’t wash the child hands with soap and water after use oftoilet 
and before eating, and if the cooking utensils we use to cook are dirty, and the 
water children drink is dirty, the child will be malnourished. 
  (20 – year old female respondent)   
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“If our surroundings are dirty, our children play in it, they can fall sick, and if the 
child is being fed with a lot of food at a time, the child can become 
malnourished.”  
(22 – year old female respondent)  
“Getting pregnant when the other child is still very young and you do not give 
attention to the other child. The child lacks care and in the end the end the 
stomach and the cheeks become big”.  
                                                                                       (30 – year old female respondent)  
4.2.3 Perceived Causes of Stunting 
From Table (4.2), we could say in general that majority of respondents agreed to the 
causes of stunting presented in the third vignette, such as eating too many starchy foods 
(79.7%), eating foods deficient with fruits and vegetables (79.7%), and sub optimal 
breastfeeding (79.7%), except for Malaria, Diarrhoea and Mothers low 
employment/socio economic status which appears to be evenly spread.    
During the FGD, mother’s explained that sometimes they felt overwhelmed by their 
daily chores, which include going to the farm, fetching water and firewood, therefore, 
neglecting the needs of their children and failing to monitor their feeding habits.   
“Sometimes you wake up early in the morning and go to farm till evening, so you 
give money for the children to buy food or eat gari, therefore feeding is not good, 
they don’t get the nutrients they are supposed to get. Because you the mother you 
are not around to monitor the child’s feeding” 
                                                                                              (26 – year old female 
respondent)      
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“If you don’t practice exclusive breastfeeding as the nurses have been Saying, 
your child can become malnourished” 
(19 – year old female respondent) 
  
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Table 4.2 Perceived Causes of malnutrition 
Perceived Causes 
Wasting Underweight Stunting 
       F (%) 
 
F (%) 
 
F (%) 
 
Eating too many starchy foods 114(85.7) 
 
109(82) 
 
106(79.7) 
 
 
Eating foods deficient with fruits and 
vegetables 
114(85.7) 
 
108(81.2) 
 
106(79.7) 
 
 
Sub-optimal breast feeding 
113(85) 
 
83(62.4) 
 
106(79.7) 
 
 
Having Malaria attack 
86(64.7) 
 
98(73.7) 
 
78(58.6) 
 
 
Experiencing Diarrhoea 
102(76.7) 
 
109(82) 
 
80(60.2) 
 
 
Frequent absence of mother from the 
home 
114(85.7) 
 
109(82) 
 
105(78.9) 
 
 
Poor birth spacing 
123(86.9) 
 
104(78.2) 
 
106(79.7) 
 
 
Mother dying at birth  
109(82) 
 
104(78.2) 
 
101(75.9) 
 
 
Mother dying during her child 
infancy(0-1) 
110(82.7) 
 
105(78.9) 
 
101(75.9) 
 
 
Child growing up and often playing in 
dirty surroundings 
109(82) 
 
103(77.4) 
 
103(77.4) 
 
 
Presence of other infections 
102(76.7) 
 
62(46.6) 
 
98(73.7) 
 
 
Mothers low educational status 
64(48.1) 
 
79(59.4) 
 
64(48.1) 
 
 
Mothers employment/socio economic 
status 
84(63.2) 
 
108(81.2) 
 
81(60.9) 
 
 
Lack of food in the house 
113(85) 
 
107(80.5) 
 
105(78.9) 
 
 
Poor personal/environmental hygiene 
114(85.7) 
 
     0 
 
0 
 
 
Genetic/Heredity 
0 
 
     0 
 
28(21.1) 
 
Field Survey, 2015 
 
 
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4.2.4 Sources of Water and Sanitation as a cause of malnutrition 
 Results from (Table 4.3) indicated that the major source of water use in most of the 
communities visited, is pipe borne water. Whilst few of the communities, used the 
river/stream as their source of water. Seventy two percent of respondents were using pit 
latrine as household toilet, (12.0%) of respondents do not have household toilets, 
therefore turn to go the free range way. With regards to refuse disposal (77.4%) of the 
respondents burn their refuse and (3.0%) of respondents either bury or controlled crude 
dumping.   
 
 
 
 
  
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Table 4.3 Sources of Water and Sanitation 
Water and sanitation Frequency Percent 
Bathing water 
  Pipe borne 76 57.1 
River/stream 50 37.6 
Borehole 7 5.3 
Washing water 
  
Pipe borne 69 51.9 
River/stream 56 42.1 
Borehole 7 5.3 
Hand dug well 1 0.8 
Drinking water 
  
Pipe borne 79 59.4 
River/stream 47 35.3 
Borehole 7 5.3 
Cooking water 
  
Pipe borne 79 59.4 
River/stream 47 35.3 
Borehole 7 5.3 
Household toilet 
  
Pit latrine 97 72.9 
KVIP 20 15.0 
Free range 16 12.0 
Method of refuse disposal 
  
Burning 103 77.4 
Backyard dumping 22 16.5 
Burying 4 3.0 
Controlled crude dumping 4 3.0 
   
Total 133 100 
Field Survey, 2015  
 
 
 
 
 
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4. 3 COMMUNITY PERCEPTION FOR MANAGING MALNUTRITION 
This section talks of management of the three categories of malnutrition. The responses 
for the management of the three categories were not different based on the quantitative 
analysis. However, narratives on the management of the three categories during FGD 
were linked to the causes, such as feeding children with food rich in protein, practicing 
good hygiene and attending child welfare clinic. 
 
4.3.1Community Perception for Managing Wasting 
From Table 4.4, we could say that overwhelming majority of respondents (87.2%) 
agreed to take the child to a health center for a medical treatment as a means of 
managing the condition for wasting. Furthermore, 85.7 % of the respondents agreed that 
feeding the child with less starchy foods; feed the child with fruits and vegetables are 
other means of managing the condition for wasting. However 90.2 % of respondents 
disagree that offering of prayers for the child whether at home or away from home is one 
way of managing wasting.  
In order to manage malnutrition in the community respondents during FGD 
recommended giving a balance diet, attending child welfare clinic/ health center and 
seeking spiritual treatment.   
“We should feed our children with vegetables, fish and fruits, reduce starch foods 
start complementary feeding at the right time.”  
(25 – year old female respondent)                                                                                    
It was recognized that management of malnutrition could be obtained at the hospital.  
“We have to send our children to weighing for the nurses to tell us what is wrong 
with them or where there is a clinic.   
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        (26 – year old female 
respondent)                  
Most of them nodded in agreement and some saying yes, that is what we should 
do.   
For some they felt there is the need to seek spiritual treatment. Going for prayers at 
prayer camps. 
“Well for me I think sometimes you need to seek spiritual treatment (prayers) 
because sometimes is not all sickness that are physical. And where necessary you 
use herbs.”  
(29 – year old female respondent)  
 
4.3.2 Community Perception for Managing Underweight 
From the results in Table 4.4 , majority of the respondents (82%) agreed that taking the 
child to a health center for a medical treatment; feed the child with less starchy foods; 
feed the child with fruits and vegetables; give the child more water or fluids to drink and 
allow the child to rest frequently are factors for managing underweight . Furthermore 
92.2% of the respondents agreed that giving other food supplements to children who are 
severely malnourished is a means for managing underweight. However 91% of the 
respondent disagree that offering of prayers for the child whether at home or away from 
home is one of the means of managing underweight. This overwhelming response from 
the respondents who are predominantly Christians indicates that they do not perceive 
spirituality can be considered as a factor for managing underweight. 
Narratives from the FGD suggests 
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“We need to practice proper personal and environmental hygiene, by making 
sure that our surroundings are clean and the cooking utensils we use are also 
clean. Washing our hands with soap and water is very important for both mother 
and child.”   
(21 – year old female respondent)                                                                
“Fruits should be given to the children at least three times in the week, and we 
should cook our children’s food separately from the adult’s food.” 
       (19 – year old female respondent) 
4.3.3 Community Perception for Managing Stunting 
From Table 4.4, majority of the respondents (79.7%) agreed that taking the child to a 
health center for a medical treatment; feed the child with less starchy foods; and feed the 
child with fruits and vegetables are means of managing stunting.  
During the FGD respondents suggested that:   
“We should practice exclusive breastfeeding for six months and continue to Two 
years, and also we should feed the children with kontomire and other Green 
leaves and monitor their feeding.”                                                
                                                   (21 – year old female respondent)  
 
 
 
 
 
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Table 4.4 Community Perception for Managing Malnutrition  
Field Survey, 20154.4 Community Perceptions of Malnutrition 
 
 
 
 
 
 
 
Community Perception and 
Management 
Wasting Underweight Stunting 
      
F (%) 
 
F (%) 
 
F (%) 
 
Taking the child to a health centre for 
medical treatment 
116(87.2) 
 
109(82) 
 
106(79.7) 
 
 
Offer prayers for the child whether at 
home or away from home  
13(9.8) 
 
12(9) 
 
14(10.5) 
 
 
Provide traditional treatment 
(spiritual or herbal care) 
30(22.6) 
 
26(19.5) 
 
24(18) 
 
 
Feed the child with less starchy foods 
114(85.7) 
 
109(82) 
 
106(79.7) 
 
 
Feed the child with fruits and 
vegetables 
114(85.7) 
 
109(82) 
 
106(79.7) 
 
 
Give the child more water or fluids to 
drink 
113(85) 
 
109(82) 
 
103(77.4) 
 
 
Allow the child  to rest frequently 
113(85) 
 
109(82) 
 
102(76.7) 
 
 
Do nothing 
0(0.0) 
 0(0.0)  0(0.0)  
 
Giving other food supplements to 
children who are severely 
malnourished 
109(82) 
 
132(99.2) 
 
130(97.7) 
 
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4.3.4 Community Perceptions of Malnutrition 
Perceptions about malnutrition was examined based on perceived causes, treatment and 
prevention. Table 4.5 shows the description of respondents’ response on the perception 
of malnutrition. Majority of the respondents (74%) disagreed that malnutrition is a result 
of a spiritual illness/curse. This response from the respondents who are predominantly 
Christians indicates that they do not perceive spirituality can be the cause of 
malnutrition. However about 87% of the respondents agreed that very little to eat for 
children born into a large family; mothers inability to afford a nutritious diet; and 
children who are not exclusively breastfed can be causes of malnutrition. Furthermore 
about 86% of the respondents agreed that improper weaning and introduction of family 
foods to child causes malnutrition.  Nevertheless 62 % of the respondents agreed that 
only medical treatment can manage malnutrition whilst 26.3 % agreed that malnutrition 
can only be managed with a combination of other treatments. They are of the view that 
medical treatment alone is not enough for managing malnutrition. Eighty seven percent 
of the respondents agreed that malnutrition can be prevented. 
 
 
 
 
 
 
 
 
 
 
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Table 4.5 Community Perceptions of Malnutrition 
Community Perceptions of malnutrition 
Agree Disagree 
Don’t 
know 
F (%) F (%) F (%) 
Malnutrition is a result of a Spiritual illness/curse 18(13.5) 99(74.4) 16(12) 
    
Malnutrition can be managed with Medical 
treatment only 82(61.7) 33(24.8) 18(13.5) 
    
Malnutrition can only be managed with a 
combination of other treatments. Medical treatment 
alone is not enough.  35(26.3) 80(60.2) 18(13.5) 
    
Malnutrition can be prevented 115(86.5) 0(0) 18(13.5) 
    
Malnutrition is a result of very little to eat for 
Children born into large family 115(86.5) 0(0) 18(13.5) 
    
Malnutrition is a result of Mother’s poor 
understanding of nutritious diet 115(86.5) 0(0) 18(13.5) 
    
Malnutrition is a result of Mothers inability to afford 
a nutritious diet  115(86.5) 0(0) 18(13.5) 
    
Children who are  not exclusively breastfed 115(86.5) 0(0) 18(13.5) 
    
Improper weaning and introduction of family foods 
to the child causes malnutrition 114(86.4) 0(0) 18(13.6) 
    
Poor hygiene and sanitation practices makes the 
child malnourished 114(86.4) 0(0) 18(13.6) 
    
Malnutrition is caused by the Presence of disease 
and other infections like diarrhoea  113(86.3) 0(0) 18(13.7) 
Field Survey, 2015  
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4.6 CHI- SQUARED TEST BETWEEN DEMOGRAPHICS VARIABLES AND 
MANAGEMENT OF MALNUTRITION 
Findings from the analysis (Table 4.9) also depict a Chi-Squared test between 
demographics variables (Age, Occupation and Education) and management of 
Malnutrition (Taking the child to a health centre for medical treatment). Based on the 
fact that taking the child to a health centre for medical treatment had the highest 
frequency of responses. This analysis was done to see whether there is an association 
between the variables. It is clear from the table that none of the variables are significant 
at a (p value) of less than 0.05.  This implies that there is no significant relationship 
between the socio-demographic variable and management of malnutrition (Taking the 
child to a health centre for medical treatment).  
 
4.6.1 Association between socio-demographics variables and Perceptions of 
Malnutrition 
4.6.1.1 Association between socio-demographics variables and Malnutrition is a 
spiritual illness (N=133) 
Table 4.6 presents a relationship test between socio-demographics variables (Age, 
Occupation and Education) and Perceptions of Malnutrition (Malnutrition is a spiritual 
illness). It is clear from the table that none of the variables are significant at an 
asymptotic significance (p value) of less than 0.05.  This implies that there is no 
significant relationship between the socio-demographic variable and perception of 
malnutrition (Malnutrition is a spiritual illness).    
 
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4.6.2 Association between socio-demographics variables and Malnutrition can be 
managed with medical treatment only (N=133) 
Table 4.7 also depict a Chi-Squared test between socio-demographics variables (Age, 
Occupation and Education) and Perceptions of Malnutrition (Malnutrition can be 
managed with medical treatment only). It is clear from the table that none of the 
variables are significant at an asymptotic significance (p value) of less than 0.05.  This 
implies that there is no significant relationship between the socio-demographic variable 
and perception of malnutrition (Malnutrition can be managed with medical treatment 
only). 
 
4.6.3 Association between socio-demographics variables and Malnutrition can be 
managed with combination of other treatments (N=133) 
At a significance level of 0.05, none of the variables are related as shown in Table 
4.8.This implies that there is no significant relationship between the socio-demographic 
variables and perception of malnutrition (Malnutrition can only be managed with 
combination of other treatments).   
  
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Table 4.6 Association between socio-demographics variables and 
Perceptions of Malnutrition (Malnutrition is a spiritual illness)  (N=133) 
Variables  Malnutrition is a spiritual 
illness/Curse N (%) 
 
χ2 p-value 
Agree Disagree Don't Know 
    Age       
15-19 0(0) 9(69) 4(31)  8.582 0.199 
20-29 8(11) 55(74) 11(15)    
30-39 6(15) 30(77) 3(8)    
40-49 2(29) 5(71) 0(0)    
       
Occupation       
Missing 2(8) 18(72) 5(20)  8.472 0.583 
Artisan 3(21) 11(79) 0(0)    
Farming 4(8) 41(79) 8(13)    
Fishing 0(0) 1(100) 0(0)    
Trading 7(19) 26(70) 4(11)    
Civil/Public 
Servant 
0(0) 2(67) 1(33)    
       
Education       
None 2(13) 10(67) 3(20)  3.532 0.897 
Primary 5(11) 33(72) 8(17)    
JHS 9(13) 51(76) 7(11)    
SHS/Vocation 0(0) 3(100) 0(0)    
Tertiary 0(0) 2(100) 0(0)    
Data are presented in frequency (N) and proportions (%); χ2, Pearson’s chi-square value; 
p-value˂ 0.05 
 
 
 
  
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Table 4.7 Association between socio-demographics variables and 
Perceptions of Malnutrition (Malnutrition can be managed with medical 
treatment only) (N=133) 
Variables  Malnutrition can be managed with 
medical treatment only N (%)  
 
 
χ2 
 
p-
value 
Agree Disagree Don't 
Know 
    Age       
15-19 6(46) 3(23) 4(31)  5.87
5 
0.437 
20-29 46(62) 17(23) 11(15)    
30-39 25(64) 11(28) 3(8)    
40-49 5(71) 2(29) 0(0)    
       
Occupation       
Un employed 15(60) 5(20) 5(20)  9.97
3 
0.443 
Artisan 11(79) 3(21) 0(0)    
Farming 29(55) 16(30) 8(15)    
Fishing 0(0) 1(100) 0(0)    
Trading 25(67) 8(22) 4(11)    
Civil/Public Servant 2(67) 0(0) 1(33)    
       
Education       
None 8(53) 4(27) 3(20)  5.55
7 
0.697 
Primary 25(54) 13(28) 8(18)    
JHS 44(66) 16(24) 7(10)    
SHS/Vocation 3(100) 0(0) 0(0)    
Tertiary 2(100) 0(0) 0(0)    
Data are presented in frequency (N) and proportions (%); χ2, Pearson’s chi-square value; 
p-value˂ 0.05 
 
 
 
 
 
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Table 4.8 Association between socio-demographics variables and 
Perceptions of Malnutrition (Malnutrition can be managed with 
combination of other treatments (N=133) 
Variables  Malnutrition can only be managed 
with 
 
 
 
 
 
p-value 
combination of other treatments N 
(%) 
Agree Disagree Don't 
Know 
    Age    
   15-19 3(23) 6(46) 4(31)  5.941 0.43 
20-29 18(24) 45(61) 11(15)    
30-39 12(31) 2462) 3(7)    
40-49 2(29) 5(71) 0(0)    
       
Occupation       
Missing 5(20) 15(60) 5(20)  9.935 0.446 
Artisan 4(29) 10(71) 0(0)    
Farming 17(32) 28(53) 8(15)    
Fishing 1(100) 0(0) 0(0)    
Trading 8(22) 25(68) 4(10)    
Civil/Public 
Servant 
0(0) 2(67) 1(33)    
       
Education 
   
   
None 5(33) 7(47) 3(20)  6.014 0.646 
Primary 13(28) 25(54) 8(18)    
JHS 17(25) 43(64) 7(11)    
SHS/Vocation 0(0) 3(100) 0(0)    
Tertiary 0(0) 2(100) 0(0)    
Data are presented in frequency (N) and proportions (%); χ2, Pearson’s chi-square value; 
p-value˂ 0.05 
 
 
 
 
 
 
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4.7ASSOCIATION BETWEEN SOCIO-DEMOGRAPHICS VARIABLES AND 
MANAGEMENT OF MALNUTRITION (TAKING THE CHILD TO A HEALTH 
CENTRE FOR MEDICAL TREATMENT) (N=133) 
Table 4.9 also depict a Chi-Squared test between socio-demographics variables (Age, 
Occupation and Education) and management of Malnutrition (Taking the child to a 
health centre for medical treatment). It is clear from the table that none of the variables 
are significant at an asymptotic significance (p value) of less than 0.05.  This implies that 
there is no significant relationship between the socio-demographic variable and 
management of malnutrition (Taking the child to a health centre for medical treatment)   
 
 
 
 
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Table 4.9 Association between socio-demographics variables and 
Management of Malnutrition (Takingthe child to a health centre for 
medical treatment)  (N=133) 
Variables  Taking the child to a health centre  
 
 
χ2 
 
p-value for medical treatment N (%) 
Yes  
    Age   
   15-19 9(69)   5.74 0.125 
20-29 64(86)     
30-39 36(92)     
40-49 7(100)     
      
Occupation      
Un employed 20(80)   5.482 0.362 
Artisan 14(100)     
Farming 45(85)     
Fishing 0(0)     
Trading 34(92)     
Civil/Public 
Servant 
2(67)     
      
Education 
  
   
None 12(80)  3.191 0.526 
Primary 38(83)     
JHS 61(91)     
SHS/Vocation 3(100)     
Tertiary 2(100)     
Data are presented in frequency (N) and proportions (%); χ2, Pearson’s chi-square value; 
p-value˂ 0.05 
 
 
 
 
 
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CHAPTER FIVE 
DISCUSSION 
The primary goal of the study was to examine community perceptions and management 
of malnutrition in children under five years, using a mixed method approach to elicit 
information from caregivers.  The study findings suggests that majority of respondents 
agreed that malnutrition was a multifaceted problem with a complex sequence of 
causation, but were not able to identify the categories of malnutrition. And again 
majority of respondent agreed that cases of malnutrition can be managed medically by 
taking the child to the health centre. Majority of respondents also disagreed that 
malnutrition is a result of spiritual illness/curse and therefore can be prevented. This 
response from the respondents who are predominantly Christians indicates that they do 
not perceive spirituality can be the cause of malnutrition. .  The Central themes and 
categories that resulted from the data analysis and interpretation process were discussed 
and evaluated as they correlate with and/or contribute to existing literature. 
 
5.1 PERCEIVED CAUSES OF MALNUTRITION 
The study findings indicated that majority of respondents observed that malnutrition was 
a multifaceted problem with a complex sequence of causation. This is consistent with the 
UNICEF Frame work on malnutrition. The causes of malnutrition given by the mothers 
in this study can be categorized into the three strata of the UNICEF framework. The first 
stratum is made up of the immediate causes that manifest themselves at an individual 
level. Immediate causes identified included disease such as malaria and diarrhoea, 
inadequate food intake, child personality and behavior. The second stratum are the 
underlying causes that manifest at the household level and impact on quality of care (e.g. 
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inadequate child supervision because of the multi task of caregivers, and maternal 
attitude and behaviors), and access to resources (e.g. income, food supply).The third and 
last stratum, basic causes which includes  potential resources (financial). From this last 
stratum the mothers identified constraints on potential resources related to the 
availability of farmland and the means to develop alternative income sources. The 
presence of these strata suggest that the mothers recognize individual differences in 
needs among children, households and communities, while also acknowledging the 
influence of expectations at the societal level.     
The sentiments expressed by the mothers in the FGD concerning the heavy burden of 
household and farm chores concur with findings from other parts of Africa where  
maternal work load (i.e. many household duties and long working hours outside the 
house) has been observed to contribute to poor nutritional outcomes (American Journal 
of Public Health, 2011).  
 Research from Africa and other parts of the world provide evidence of the contributing 
effects of infectious diseases to malnutrition, (Ibid, 2006). Interestingly, none of the 
participants during the focus group discussion, raised the relationship of ill-health and 
malnutrition, except for the quantitative analysis. 
 Some studies have reported a significant relationship between maternal education and 
child's nutritional status, (Onyekale & Onyekale, 2005). However, the findings in this 
study revealed, some respondents think mother’s educational background do not have 
any effect on malnutrition. Reason being that as far as that mother attends child welfare 
clinic, and implement what is taught by the nurses, she can be able to care for the child. 
  
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5.2 COMMUNITY PERCEPTION OF MANAGING MALNUTRITION 
 Studies carried out in Pakistan, by Elsevier, (2014), stated that mother’s described 
various magico religious therapies that is tried when their children are malnourished 
because the condition is associated with fright and spirit possession, and for some other’s 
the first response in health seeking is prayer or reading of Koran. 
In Rwanda, children are also taken to traditional healers for spiritual interventions rather 
than for medical care (GFH, 2014). In Somalia, in cases of kwashiorkor, the swollen 
limbs, stomach and face is burnt to remove the fluid (FSAU, 2007). 
 However, this study showed the contrary, majority of respondents agreed that cases of 
malnutrition can be managed medically by taking the child to the health centre and given 
other supplements to increase their protein level. This is in accordance with studies by 
Abubakar, Holdings, Mwangome, & Maitland,( 2011), that showed that cases of 
malnutrition is a treatable condition that can be managed under the supervision of 
qualified health professional and children are also given additional nutrients to increase 
their intake of energy and protein. 
 
5.3 COMMUNITY PERCEPTION OF MALNUTRITION 
Whereas in the northern parts of Ghana and other African countries such Pakistan, 
Rwanda and Nepal, many perceived that malnutrition comes about as a result of 
mother’s disregard of traditional norms and beliefs, some perceive the usual cause of 
malnutrition is the contact with a woman who had marasmic child or is otherwise in a 
state of ritual impurity. The mediating factor is said to be a saya (shadow, influence) 
emanating from such a person and ultimately linked with the spirit world, whilst some 
others associated the condition with fright and spirit possession. 
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Malnutrition is sometimes perceived as a natural phenomenon related to the “strength” of 
the body of the child at the time of delivery. It was explained as the result of God’s 
curse, a spirit threatening the child, or “a wizard eating the child slowly. (UNICEF, 2013, 
Akparibo, 2013, Elservier, 2014, Kolstern, Lefevre, Lerude, 1997). 
On the contrary key findings of the study revealed that majority of respondents disagreed 
that malnutrition is a result of spiritual illness/curse, and that malnutrition can be 
prevented.   
The study also pointed out that the association between maternal education, age, 
occupation and community perception. Likewise, the study did not find any associations 
between maternal education, age, occupation and community management of 
malnutrition. The insignificant association can be based on the fact that a number of 
respondents had some level of formal education, and education is generally known to 
have positive impact on respondents understanding of some health issues.  
Solutions to the problem of malnutrition includes more education by community health 
workers on the prevention of malnutrition. Because if people have the knowledge, their 
children will be healthy.  
 
 
 
 
 
 
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CHAPTER SIX 
CONCLUSION AND RECOMMENDATION 
6.1 CONCLUSION 
 The findings from the study shows that majority of participants were able to mention 
causes of malnutrition, but were not able to identify the three categories of malnutrition. 
They understood that it is a complex disease that has many determinants as stated by the 
UNICEF framework. Although, primary caregivers did exhibit some knowledge on 
malnutrition, it would be beneficial to reinforce their education. Additionally, the issue 
of the three categories of malnutrition, needs to be addressed, especially stunting, 
explaining the consequences of long term malnutrition. This is especially important 
given the fact that many cases of stunting go unnoticed to the untrained eye.  In spite of 
the fact that primary caregivers recognized the importance of a varied diet, due to their 
economic constraints, they believe the administration of a healthy diet to be more 
preventive than curative.  
 Study findings also revealed that majority of respondents disagreed that malnutrition is a 
result of spiritual illness/curse, and can be prevented. 
The study also pointed out that there is no association between age, education, 
occupation, and community perception and community management. In order to achieve 
the MDG 1& 4, the content and approach of any program must address the need for 
variability, determined by individual local needs, concerns, attitude and beliefs. 
Because the 1,000 days from pregnancy to child’s second birthday is the most critical 
time for positive impact on a child’s cognitive, intellectual, physical development. Good 
nutrition lays the foundation for health, development, and even prosperity for the next 
generation. 
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6.2 RECOMMENDATION 
Based on the findings of this study, I recommend:  
 To the district health directorate and health workers 
1: The District Health Directorate (DHD) and all health facilities in the district to 
encourage educational campaign that would focus on teaching community members how 
to use foods already available to them to prevent malnutrition in an economically 
feasible manner and the three categories of malnutrition. 
2: Film shows and drama should be encouraged as part of strategies to create awareness 
on malnutrition in the communities. Because it is believed that people believe in what 
they see than what they hear.   
3: The DHD, should encourage research to evaluate existing programs on prevention of 
malnutrition for its effectiveness. 
To mothers and caregivers 
1. Mothers and caregivers are encouraged to attend child welfare clinic for their 
children’s growth to be monitored.  
2. Mothers and caregivers are also encouraged to implement what they are taught by the 
health workers. 
 
 
 
  
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Abubakar, A., Holding, P., Mwangome, M., & Maitland, K. (2011). Maternal 
perceptions of factors contributing to severe under-nutrition among children in a 
rural African setting, 1–11. 
 Akparibo, R. (2013). Scaling up nutrition in Ghana. The lancet Global health Blog 
American Journal of Public Health, (2011). 101(7) 1225-1233 
Benjon P, Mohammed S,Mwangi I, et al, (2008). Fraction of all hospital admissions and 
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Biomedica, (2005). Perceptions and Practices of mothers regarding child feeding. vol 21, 
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Black, R.E. et al, (2008). Maternal and child undernutrition; global and regional 
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Bhutta, Z. A., Ahmed, T., Black, R. E., Cousens, S., Dewey, K., Giugliani, E., … 
Shekar, M. (2008). What works? Interventions for maternal and child 
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Carlson, B. E, (1995), Dating voilence student beliefs about consequences, Journal of 
interpersonal voilence 11, 3-18 
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Gabriele & Schettino, (2008). Child malnutrition and mortality in developing countries: 
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district of Uganda. 
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importance of the percption of malnutrition in the follow up of rehabilitated 
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improve nutrition in young children. 
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Kelantan, 13(1), 19–28. 
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medicine, V32 issue 2 1991, page 175-191 
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Erbil City. 
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Oyekale, A.S., Oyekale, T. O., (2005). Do mothers educational levels matter in child 
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APPENDICES 
INTERVIEW GUIDE 
I am Precious Mensah, a student of University of Ghana, School of Public Health, and 
Master of Public Health (MPH). I am conducting a research on the topic community 
perceptions and management of malnutrition in the South Tongu District. We are 
interviewing people here in order to provide data that would contribute to the 
formulation of pertinent programs in the district. 
This Interview Guide aims at examining community perception and management of 
malnutrition in children under five. The interview guide collects information on socio 
demographic, perceptions of malnutrition, factors contributing to malnutrition, and 
management of malnutrition.  
 
Unique code for respondent…………………………………………… 
Date of Interview…………………………………………………………………… 
District…………………………………………………………………………… 
Name of community/ locality……………………………………………………… 
Name of Interviewer………………………………………………………………. 
 
 
 
 
 
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SOCIO DEMOGRAPHIC CHARATERISTICS (Tick as appropriate) 
Question 
No 
Variable  Responses   
1 Age 
15 – 19   
20 – 29   
30 – 39   
40 – 49   
50 and above   
  
2 Marital Status 
Single/Never Married   
Married   
Widowed/Separated/Divorced   
  
3 Educational Background 
None   
Primary   
JHS   
SHS/Vocational   
Tertiary   
  
4 Ethnicity 
Ewe   
Akan   
Ga Adangbe   
Northerner   
Others (Specify)   
  
5 Religion 
Christian   
Muslim   
Traditionalist   
  
6 Occupation 
Fishing   
Farming   
Trading   
Artisans (seamstress, etc.)   
Civil/Public Servant   
None   
Others (Specify)   
  
7 
What is your average income 
GHC?  
<GHS100.00   
GHS100-300   
GHS400-700   
Above 700 GHC   
  
8 
How many people depend on this 
income?   
  
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WATER AND SANITATION 
Question No  Question Responses   
10 What is household source of water for bathing?   
River/Stream   
Hand dug well   
Bore hole   
Pipe-borne   
Harvested rainwater 
 Dam 
 Other (specify) 
   
11 
What is household source of water for 
washing?   
River/Stream   
Hand dug well   
Bore hole   
Pipe-borne   
Harvested rainwater 
 Dam 
 Other (specify) 
   
12 
What is household source of water for 
drinking?   
River/Stream   
Hand dug well   
Bore hole   
Pipe-borne   
Harvested rainwater 
 Sachet water 
 Dam 
 Other (specify) 
   
13 What is household source of water for cooking?   
River/Stream   
Hand dug well   
Bore hole   
Pipe-borne   
Dam 
 Other (specify) 
   
14 
What type of toilet facility does your household 
use?   
Pit Latrine   
Bucket latrine   
KVIP   
Water closet   
Free range   
Defecate in plastic rubber   
15 
How do you dispose of your refuse 
 
Burning   
Burying   
Backyard dumping   
controlled crude dumping   
    
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Presentation of vignette  
Preamble/Question Response 
Kofi is three is years old. Kofi’s mother noticed that 
Kofi had been losing weight over three weeks, and has 
become thin and skinny. Kofi looks like this (show 
picture to respondents to identify each category of 
malnutrition). 
16. How do you call Kofi’s condition?    
17. Is it common in this community?   Yes No 
   
   
18. What are the causes of kofi’s 
condition? 
Eating too many starchy foods 
 Eating foods deficient with fruits and 
vegetables 
 Sub-optimal breast feeding 
 Malaria 
 Diarrhea 
 Frequent absence of mother from the home 
 Poor birth spacing 
 Mother dying at birth   
Mother dying during her child infancy(0-1)  
Child growing up and often playing in dirty 
surroundings  
Presence of other infections  
Mothers low educational status  
Mothers employment/socio economic status  
Lack of food in the house  
Poor personal/environmental hygiene  
Don’t know 
 Others (Specify)  
   
19. How is Ama’s condition generally 
managed in the community 
Taking the child to a health centre for medical 
treatment 
 Offer prayers for the child whether at home or 
away from home  
 Provide traditional treatment (spiritual or 
 
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herbal care) 
Feed the child with less starchy foods 
 Feed the child with fruits and vegetables 
 Give the child more water or fluids to drink 
 Allow the child  to rest frequently 
 Do nothing 
 Others (Specify)  
Don’t know 
 Giving other food supplements to children who 
are severely malnourished  
Ama is two years old.Ama’s, mother noticed that Ama’s hair has changed, the stomach is 
becoming big and legs swollen (show picture to respondents to identify category of 
malnutrition). 
 
 
20. How do you call Ama’s condition?   
21. Is it common in this community? Yes No 
22. What are the causes of Ama’s 
condition? 
Eating too many starchy foods 
 Eating foods deficient with fruits and 
vegetables 
 Sub-optimal breast feeding 
 Malaria 
 Diarrhea 
 Frequent absence of mother from the home 
 Poor birth spacing 
 Mother dying at birth  
Mother dying during her child infancy(0-1)  
Child growing up and often playing in  dirty 
surrounding  
Presence of other infections  
Mother’s low educational status  
Mother’s low employment/ socio economic 
status  
Lack of food in the house  
Others (Specify)  
Don’t know 
 23. How is Ama’s condition generally 
managed in the community 
Taking the child to a health centre for medical 
treatment 
 Offer prayers for the child whether at home or 
 
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away from home  
Provide traditional treatment (spiritual or 
herbal care) 
 Feed the child with less starchy foods 
 Feed the child with fruits and vegetables 
 Give the child more water or fluids to drink 
 Allow the child  to rest frequently 
 Giving food supplements to children who are 
severely malnourished  
Do nothing 
 Others (Specify)  
Don’t know 
 Afua is four years old. When Afua is compared with 
/her age group, she is relatively shorter, Afua, in the 
yellow blouse, purple trousers and blue slippers is 
supposed to be above the green line. (Show picture to 
respondents to identify category of malnutrition.) 
24. How do you call Afua’s 
condition?   
25. Is it common in this community?   
26. What are the causes of Afua’s 
condition? 
Yes No 
Eating too many starchy foods 
 Eating foods deficient with fruits and 
vegetables 
 Sub-optimal breast feeding 
 Malaria 
 Diarrhea 
 Frequent absence of mother from the home 
 Poor birth spacing 
 Mother dying at birth  
 Mother dying during her child infancy(0-1)  
Child growing up and often playing in dirty 
surrounding  
Presence of other infections   
Mothers low educational status  
Mothers low employment/socio economic 
status  
Lack of food in the house  
Genetic/Heredity  
Others (Specify)…………………………….  
Don’t know 
 
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26. How is Afua’s condition generally 
managed in the community 
 
Taking the child to a health centre for medical 
treatment 
 Offer prayers for the child whether at home or 
away from home  
 Provide traditional treatment (spiritual or 
herbal care) 
 Feed the child with less starchy foods 
 Feed the child with fruits and vegetables 
 Give the child more water or fluids to drink 
 Allow the child  to rest frequently 
 Do nothing 
 Don’t know 
   
  
  
Giving other food supplements to children who 
are severely malnourished 
 Other (Speify)……………………………... 
  
 
 
 
 
 
 
 
 
 
 
 
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PERCEPTIONS OF MALNUTRITION  
No Question Responses   
27 Malnutrition is a result of a curse/Malnutrition is a spiritual 
illness 
Agree   
Disagree   
Don’t know   
  
28 Malnutrition can be managed with medical treatment only Agree   
Disagree   
Don’t know   
29 Malnutrition can only be managed with a combination of other 
treatments. Medical treatment alone is not enough.   
Agree  
Disagree  
Don’t know  
  
30 Malnutrition can be prevented Agree   
Disagree   
Don’t know   
  
31 Malnutrition is a result of very little to eat for  children born into 
large families 
Agree   
Disagree   
Don’t know   
  
32 Malnutrition is a result of mothers poor understanding of a 
nutritious diet 
Agree   
Disagree   
Don’t know   
  
33 Malnutrition is a result of the inability of mothers to afford a 
nutritious diet  
 
 
Agree   
Disagree   
Don’t know   
     
34 
Children who are not exclusively breastfed can be malnourished Agree  
Disagree  
Don’t know  
35 Improper introduction of complementary foods to children 
causes malnutrition 
Agree  
Disagree  
Don’t know  
36 Improper weaning and introduction of family foods to the child 
causes malnutrition. 
Agree  
Disagree  
Don’t know  
37 Poor hygiene and sanitation practices makes the child 
malnourished 
Agree  
Disagree  
Don’t know  
38 Malnutrition is caused by the presence of diseases and 
infections like diarrhea 
Agree  
Disagree  
Don’t know  
 
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FOCUS GROUP DISCUSSION GUIDE 
A Focus group discussion on Community Perception and Management of 
Malnutrition in children under five 
Good Morning, I am Precious Mensah working with Ghana Health Service, but currently 
a student at the School of Public Health. I am undertaking a study on malnutrition. The 
findings of the study will help to revise the health messages delivered to the communities 
in order to make them culturally more appropriate and relevant. 
I would therefore like to discuss a few issues on malnutrition with you. With me is 
…………………. To help me with the recording. 
 
Demographic Details  
  
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Name of community: 
Age: 
Occupation: 
Number of children under five years: 
Educational Background: 
Religion: 
Marital Status:  
Discussion Guide 
Welcome and thank you for volunteering to take part in this focus group. You have been 
asked to participate as your point of view is important. I realize you are busy and I 
appreciate your time. 
Introduction: This focus group discussion is designed to assess community perception 
and management of malnutrition in children under five. The focus group discussion will 
take not more than one hour. May I tape the discussion to facilitate its recollection?  
Anonymity:  Despite being taped, I would like to assure you that the discussion will be 
anonymous. The tapes will be kept safely in a locked facility until they are transcribed 
word for word, then they will be destroyed. The transcribed notes of the focus group will 
contain no information that would allow individual subjects to be linked to specific 
statements. You should try to answer and comment as accurately and truthfully as 
possible. I and the other focus group participants would appreciate it if you would refrain 
from discussing the comments of other group members outside the focus group. If there 
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are any questions or discussions that you do not wish to answer or participate in, you do 
not have to do so; however please try to answer and be as involved as possible. 
Ground rules 
 The most important rule is that only one person speaks at a time. There may be a 
temptation to jump in when someone is talking but please wait until they have 
finished. 
 There are no right or wrong answers 
 You do not have to speak in any particular order 
 When you do have something to say, please do so. There are many of you in the 
group and it is important that I obtain the views of each of you 
 You do not have to agree with the views of other people in the group 
 Does anyone have any questions?  (Answers).  
 OK, let’s begin 
Warm up 
 First, I’d like everyone to introduce themselves. Can you tell us your name? 
Introductory question 
I am just going to give you a couple of minutes to think about any experiences of 
malnutrition. Is anyone happy to share his or her experience? 
Guiding questions: 
1. What are the causes of malnutrition? (Show the different pictures of malnutrition) 
2. What are the signs & symptoms of malnutrition for each of the types of 
malnutrition? 
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3. How are these signs and symptoms for malnutrition managed in the community? 
(Ask for each of the three types, probe for home management, other options of 
management, prayers, herbs, medical treatment) 
4. What would you do if your child becomes malnourished? (Ask for each of the 
three types)  
5. At what stage of the malnutrition (ask for each of the types) would you seek 
treatment? 
6. What are the social and economic challenges to the family with respects to 
malnutrition? (Probe for socio – economic challenges and disruption of life).  
7. How do you think malnutrition can be prevented? (Probe for home remedies) 
Conclusion 
 Thank you for participating. This has been a very successful discussion 
 Your opinions will be a valuable asset to the study 
 We hope you have found the discussion interesting 
 If there is anything you are unhappy with or wish to complain about, please speak to 
me later 
 
 
 
 
 
 
 
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VOLUNTEER AGREEMENT FORM 
This questionnaire is designed to undertake a study on the topic Community Perception 
and Management of Malnutrition in Children under five (5) years in the Central Tongu 
District. Your assistance in this exercise in providing candid responses to each of the 
questions will go a long way to provide data that gives a true reflection of the situation 
on the ground and which will also contribute to the formulation of pertinent programs in 
the district. You are assured that your responses are completely confidential and be for 
only this study. If you have any questions during the course of the interview, you are free 
to ask and you want to opt out you are free to do so. Our interaction will take between 15 
– 30 minutes of your time 
 
I………………………………………………………………………………………… 
declare that the purpose, procedures as well as risks and benefits of the study have been 
thoroughly explained to me in English language and/or Twi and/or Ga /and/Ewe and I 
have understood. 
I hereby agree to answer the questionnaire provided below 
 
Signature/Thumbprint of Participant: ……………………………  
 Date……………. / …… / ……  
 
 
 
 
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Interviewer's statement: 
I, the undersigned, have explained this consent form to the subject in the English 
language (Twi, Ewe or Ga language) that He/she understands the purpose of this study, 
procedures to be followed as well as the risks and benefits involved. The subject has 
freely agreed to participate in this study. 
Signature of interviewer   ……………… 
Date   …………. / ………….. / ……………. 
Address   ………………………………………………… 
 
 
 
 
 
 
 
 
 
 
 
 
                              
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CURRICULUM VITAE 
 Dr Mercy M. Ackumey 
Contact: 
Department of Social and Behavioural Science  
School of Public Health 
College of Health Sciences 
University of Ghana 
P. O. Box LG 13 
Legon  
Accra, Ghana 
Tel: +233 24 78 77 681 
E – mail: jekammy@yahoo.com  or mackumey@ug.edu.gh 
 
Educational Background: 
Institution Qualification/Programme/Year 
University of Ghana (UG) B.A (Sociology, Psychology and Political Science),1989 
UG M.A (Population Studies),  1992 
UG MPH, (Master of Public Health), 2002 
 
Swiss Tropical and Public 
Health Institute, University 
of Basel, Switzerland. 
Ph.D. (Public Health) (2011) 
 
 
 
 
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Employment: 
Date Position 
2005 to date Lecturer, School of Public Health, UG 
1998-2005 Monitoring and Evaluation Officer, Centre for Social Policy Studies, 
UG. 
1992-1995 Sociologist/Demographer, Ghana Rural Water Programme (GRWP) of 
World Vision, Ghana 
1988-1991 National Service at the UG as a Teaching Assistant (TA) in Statistics 
and then as a research assistant 
 
Selected Publications 
1. Ackumey, M.M. (2002).Local Perceptions of Buruli ulcer in the Ga District, 
Greater Accra Region.Social Policy, Centre for Social Policy Studies, University 
of Ghana. 2(2), 44-57. 
2. Renzaho, A.M., Woods, P.V., Ackumey, M.M., Harvey, S.K., & Kotin, J. 
(2007).Community-based study on knowledge, attitude and practice on the mode 
of transmission, prevention and treatment of the Buruli ulcer in Ga West District, 
Ghana.Trop Med Int.Health, 12(3), 445-458. 
3. Ackumey, M.M., Gyapong, M., Pappoe, M., & Weiss, M.G. (2011).Help-
seeking for pre-ulcer and ulcer conditions of Mycobacterium ulcerans disease 
(Buruli ulcer) in Ghana. Am.J Trop Med Hyg, 85(6), 1106-1113. 
University of Ghana http://ugspace.ug.edu.gh
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4. Ackumey, M.M., Kwakye-Maclean, C., Ampadu, E.O., de Savigny, D., & 
Weiss, M.G. (2011).Health services for Buruli ulcer control: lessons from a field 
study in Ghana. PLoS.Negl.Trop Dis., 5(6), e1187. 
5. Ackumey, M.M., Yirenya-Tawiah, D.R., Amoah, C.M., Dade, M., & 
Bosompem, K.M. (2008).  Local Perceptions of Genital Schistosomiasis in the 
Afram Plains District of Ghana.New Developments on Health, Agricultural 
resources and Socio-economic activities in the Volta Basin 35-42. 
6. Yirenya-Tawiah, D., Amoah, C., Apea-Kubi, K.A., Dade, M., Ackumey, M., 
Annang, T., Mensah, D.Y., & Bosompem, K.M. (2011).A survey of female 
genital schistosomiasis of the lower reproductive tract in the Volta basin of 
Ghana.Ghana.Med J., 45(1), 16-21. 
7. Ackumey, M.M., Gyapong, M., Pappoe, M., Kwakye-Maclean, C., & Weiss, 
M.G. (2012).Socio-cultural determinants of timely and delayed treatment of 
Buruli ulcer: Implications for disease control.Infectious Diseases of Poverty, 1(6). 
8. Ackumey, M.M., Gyapong, M., Pappoe, M., Kwakye-Maclean, C., & Weiss, 
M.G. (2012).Illness meanings and experiences for pre-ulcer and ulcer conditions 
of Buruli ulcer in the Ga-West and Ga-South Municipalities of Ghana. 
BMC.Public Health, 12(1), 264. 
 
 
  
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CURRICULUM VITAE 
PERSONAL INFORMATION  
NAME     -     PRECIOUS MENSAH  
POSTAL ADDRESS    -    P.O.BOX 2, ASESEWA  
MOBILE NUMBER   -    0243503931  
EMAIL     -     ladypreciousmensah@gmail.com 
 
WORKING EXPERIENCE  
Working as a preventive nurse for the past 15 years. I am a proactive thinker, very 
confident when executing my duties and responsibilities. I possess influencing 
communication and interpersonal skills. I also possess organizational skills and a good 
facilitator. Very active and smart when on duty. 
 
EDUCATIONAL BACKGROUND  
UNIVERSITY OF GHANA       - 2008-2011 
COMMUNITY HEALTH NURSING TRAINING SCHOOL  - 1996 – 1998  
MAWUKO GIRL’S SECONDARY SCHOOL    -  1988 – 1993  
 
QUALIFICATIONS  
B.A. SOCIAL WORK WITH PSYCHOLOGY  
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CERTIFICATE IN COMMUNITY HEALTH NURSING  
G.C.E O LEVEL  
 
EMPLOYMENT HISTORY  
AKUSE GOVERNMENT HOSPITAL  -  1998 – 2001     
AKATENG CHPS     -  2001 – 2006   (FACILITY 
INCHARGE)  
ASESEWA RCH     -  2007 – 2014 (FACILITY 
INCHARGE AND  
                                                                                     SUB-DISTRICT LEADER) 
 
 
 
 
  
 
 
 
 
 
 
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INFORMED CONSENT 
 
 PROJECT TITLE 
COMMUNITY PERCEPTION AND MANAGEMENT OF MALNUTRITION IN 
CHILDREN UNDER FIVE IN THE CENTRAL TONGU DISTRICT. 
 
 INSTITUTIONAL AFFILIATION 
Department of Social and Behavioral Science (SOBS) School of Public Health, College 
of Health Sciences, University of Ghana, Legon.  
 
 BACKGROUND 
Dear Participants, My name is PRECIOUS MENSAH, a student of the School of Public 
Health, University of Ghana, Legon. The purpose of this study is to examine community 
perception and management of malnutrition in children under five. 
 
 PROCEDURE 
The study will involve answering of questions by respondents through an interview 
guide and focus group discussion on community perception and management of 
malnutrition in children under five. 
 
 RISK AND BENEFITS 
This study is non-invasive and will not cause any form of discomfort to respondents the 
result    will be used to revise the health messages delivered to the communities in order 
to make them culturally more appropriate and relevant and intervention  would be 
directed to address direct causes and also the context of under nutrition.  
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 RIGHT TO REFUSE 
Participation in this study is voluntary and you can choose not to answer any individual 
question or all the questions. You are at liberty to withdraw from the study at any time. 
However, I will encourage you to fully participate since your opinions are very important 
to us. Your opinions will enable us understand community perception having influence 
on health seeking behavior and management of cases of malnutrition and the effect on 
malnutrition outcome.  
 
 ANONYMITY AND CONFIDENTIALITY 
I would like to assure you that whatever information you will provide will be handled 
with strict confidentiality and will be used purely for research purposes. Your responses 
will not be shared with anybody who is not part of the study team. Data analysis will be 
done at the aggregate level to ensure anonymity. 
 
 DISSEMINATION OF RESULTS 
The final report of this study will be disseminated to the Volta Regional Nutrition 
Department, the Central Tongu District Health Directorate and communities that were 
involved in the study. 
 
 COSTS AND/OR PAYMENTS TO SUBJECT FOR PARTICIPATION IN 
RESEARCH 
There will be no costs for participating in this research and there will be no payments 
awarded for participating clients in this research. 
  
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For further questions, concerning the research, you may contact Ms Hannah Frimpong 
ERC, Administrator (+233 24 3235225, +233 50 704 1223) 
 Dr. Mercy Ackumey (PhD) (+233 247 877681),Precious Mensah (+233 24 3503931), 
all of the Department of Social and Behavioral Science (SOBS), School of Public Health, 
University of Ghana.  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
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VOLUNTEER AGREEMENT FORM 
This questionnaire is designed to undertake a study on the topic Community Perception 
and Management of Malnutrition in Children under five (5) years in the Central Tongu 
District. Your assistance in this exercise in providing candid responses to each of the 
questions will go a long way to provide data that gives a true reflection of the situation 
on the ground and which will also contribute to the formulation of pertinent programs in 
the district. You are assured that your responses are completely confidential and be for 
only this study. If you have any questions during the course of the interview, you are free 
to ask and you want to opt out you are free to do so. Our interaction will take between 15 
– 30 minutes of your time. 
 
I,………………………………………………………………………………………… 
declare that the purpose, procedures as well as risks and benefits of the study have been 
thoroughly explained to me in English language and/or Twi and/or Ga /and/Ewe and I 
have understood. 
 
I hereby agree to answer the questionnaire provided below 
Signature/Thumbprint of Participant: …………........................... 
Date: …………/……………/………………………. 
Interviewer's statement: 
  
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I, the undersigned, have explained this consent form to the subject in the English 
language (Twi, Ewe or Ga language) that He/she understands the purpose of this study, 
procedures to be followed as well as the risks and benefits involved. The subject has 
freely agreed to participate in this study.  
Signature of interviewer   ………………………………. 
Date   …………. / ………….. / ………………………. 
Address   ……………………………………………….. 
 
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