2. SEQUENCES
2.6 OPEN SETS, CLOSED SETS, COMPACT SETS, AND LIMIT POINTS
From previous studies, it has been indicated that socio-economic factor were associated with stunting, underweight and overweight among under five children.
Some maternal factors ( occupation and education) and household factors (income and lower socio-economic status) were associated with coexisting stunting and overweight.
Household factors such as size and composition also have an impact in that large household size may suggest that there is more competition for available food.
Maternal education was cited as important in improving nutritional status of children (Gewa, 2010; Steyn et al., 2005; Mostert et al.,2005; Mamabolo et al., 2004; Said
Mohamed et al., 2009; Ayoola et al., 2009).
Maternal education is also often associated with maternal employment and higher income (Gewa, 2010). Having a mother as a student increased the risk of stunting at 3 years, whereas having a working mother'increased the risk of overweight (Mamabolo et al., 2005). A working mother in most cases would mean increased income for the household and consequently more access to food.
2.4.2 Environmental factors associated with stunting and ovenveight
Research studies found that in the stunting and overweight were dependent of environmental factors. Rural and urban differentials were the most common factors among the reviewed studies to affect stunting and overweight (Gewa, 201 O;
Omigbodun et al., 2010; Kimani-Murage et al., 2010; Steyn et al., 2005; Jinabhai et al., 2003; Bosman et al., 2011; Ayoola et al., 2009).
ln a study in Nigeria, adolescents in rural schools were much more likely to be stunted than those in urban private schools (Omigbodun et al., 20 l 0). Stunting and underweight were most severe in the rural adolescents, where they were 16 times
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more likely to be stunted and 4 times more likely to be underweight than adolescents in urban private schools (Omigbodun et al., 2010). Rural and urban settlements vary in terms of poverty levels and socio-economic status.
A study in South Africa by Kruger (Kruger et al., 2010) reported no significant association between stunting and overweight; however, there was a tendency to gain subcutaneous fat after the age of 14 year�, especially in urban girls. Living conditions such as housing, sanitation etc. were also cited in some studies as important factors in determining malnutrition ((Kruger et al., 2010; Steyn et al., 2005; Dapi et al., 2009;
Bosman et al., 2011). Sanitation and access to health care was reported as a factor in the differences in nutritional status between urban and rural children (Kabubo
Mariaraet al, 2008).
In as much as there was an increase in overweight in the urban settlements as reported in many studies, the rural areas are also not spared, as seen in Equatorial Guinea (Custodio et al., 2010) and South Africa (Kimani-Murage et al., 2010).
2.4.3 Nutritional factors and their effects on stunting, wasting and underweight in children
It was also found out that stunting and overweight of children wru-e independent of nutritional factors. A study by Oliveria et al on the association between parental and children's dietary practices was shown to be stronger for the mother-child comparison than that for the father-child comparison ·(Oliveria et al., 1992). Studies have reported maternal nutritional status to be positively associated with child nutritional status (Gewa, 2010, Thuita et al., 2005). In a study in Kenya it was found that maternal nutritional status was significantly associated with overweight as well as with obesity among pre-school children (Gewa, 2010). Therefore the health and wellbeing of the mother is necessary to ensure healthy children. However this is not always the case as seen in some studies that report stunting as well as underweight in households with overweight mothers (Garret and Ruel,2003; Jehn and Brewis, 2009). Inadequate dietary intake was reported to contribute to stunting and underweight among children in many studies (Gewa, 201 O; Mamaboloet a/., 2004; Said-Mohamed et al., 2009;
Bosman et al., 2011 ), while formula feeding and early weaning contributed to overweight (Mostert et al., 2005).
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2.4.4 Cultural Norms and Beliefs related to nutrition
In rural areas in Low and Middle income countries where modern communication media has not yet fully penetrated, traditional socio-cultural praqtices still prevail Many of these practices contribute to maternal and early child under-nutrition. For example, gender-related cultural practices are largely determined by cultural nonns and encompass many factors that influence the nutritional status of the child, including age of first pregnancy (and thereby fetal growth) and parity. Age at marriage is highly correlated with age at first birth. Adolescent and child marriage continues to be a strong social norm in the developing world, particularly in Central and West Africa, and South and Southeast Asia. As mentioned earlier, in many Low and Middle Income Countries, 40 percent of first pregnancies occur whilst the mother herself is still a child (<I 8y) (Shrirnpton, 2010). Increased median age at marriage is associated with lower incidence of low birth weight in Africa and Asia and overall (UNSCN 2010).
Moreover, the development of maternal obesity in mothers over twenty years of age seems to be related to teenage pregnancy and parity.
Without recognizing the associated problems of low birth weight babies, women in some cultures are so worried with surviving the ordeal of childbirth that they eat very
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little food during pregnancy on purpose (Blaffer, 1999). This practice by pregnant women is called "eating down." By eating less, they hope to have a smaller baby that will be easier to deliver. This practice has been observed around the world. In Bangladesh, pregnant women are encouraged not to eat too much so that their baby will be small and more likely to be born without difficulty. Other cultures across the world (the Enga of Papua New Guinea, the rural Malays, the Ainu of Japan, and the Maya from Guatemala) try to achieve the same objective through enc01..1ra0oing pregnant women to work hard and do lots of heavy physical exercise in the last few months of pregnancy, rather than by eating less. Similarly, in Nepal, women are aware that smoking stunts a baby's growth, so some women intentionally continue to smoke during pregnancy in the hope of producing a smaller baby.
There are also cultures where pregnant women are given extra food. There are many examples of cultural believes and practices that have serious negative consequences for exclusive breastfeeding and its subsequent negative impact on nutritional status of the new-born. It may have made sense in the past when it was probably "normal" for young girls to get pregnant as soon as they menstruated and before their hips properly
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broadened. This is still the custom in many places, such as South Asia (India;
Bangladesh, Nepa]) and West Africa (Niger) for examples. Young girls don't reach full maturity (fully become women) until at least after 18 years of age.
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broadened. This is still the custom in many places, such as South Asia (India;
Ban gladesh, Nepal) and West Africa (Niger) for examples. Young girls don't reach full maturity (fully become women) until at least after 18 years of age.
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