Prevalence and Associated Factors for Protein Energy Malnutrition Among Children Below 5 Years Admitted at Jinja Regional Referral Hospital, Uganda


 Background Undernutrition immensely contribute to the death of almost half of the children under 5 years, translating into the loss of about 3 million young lives a year. In developing countries, penultimate to hunger that constitute to the death of most children, Protein Energy Malnutrition (PEM) amongst other factors account for the death of 49% of children below the age of five. Due to incessant increase in poverty level in Uganda, Jinja District five-year development plan of 2011 was designed to curb menace posed by malnutrition not only on children but also adults in this district. The objective of this study is to assess the prevalence and factors associated with PEM among under-fives admitted in the paediatric wards of Jinja Regional Referral Hospital (JRRH). Methods To carry out this study, a descriptive questionnaire-based and facility-based cross-sectional study design was used which will apply both qualitative and quantitative approaches. The study involved a sample size of 364 with the study population being under-fives admitted in the paediatric wards of JRRH between March and August 2019.Results Results of this study shows that 52 out of 364 admissions were due to PEM giving a prevalence of 14.29%, males being affected more than females, with suboptimal immunization history. Children aged between 12 – 24 months contributed the highest (34.62%) cases of PEM and most are living in rural areas with low family socio-economic status and poor breastfeeding and feeding practices. The under-five PEM case-fatality rate was 2% (1 out of 52). Conclusion In conclusion, both the prevalence and case fatality rates of under-five PEM were high, calling for appropriate interventions based on the associated factors.

45. between the supply of nutrients and energy and the body's demand for them to ensure 46.growth, maintenance, and specific functions" [1].Malnutrition is the condition that 47. develops when the body does not get the right amount of the vitamins, minerals, and other 48.nutrients it needs to maintain healthy tissues and organ function.Malnutrition remains a 49.major global public health challenge, especially among children under five years of age 50.[2].One form of malnutrition that affects children is Protein Energy Malnutrition (PEM).
51.The term protein-energy malnutrition applies to a group of related disorders that include 52.marasmus, kwashiorkor, and intermediate states of marasmic-kwashiorkor which arise 53.primarily as a result of a "food gap" between the intake and requirement [3].PEM is 54.considered the primary nutritional problem and is also known as the First National 55.Nutritional Disorder.Therefore, it is important for the health system to detect Protein 56.Energy Malnutrition at an early stage for planning and implementing timely interventions 57. at all the effective levels.58.Protein energy malnutrition (PEM) is a major public health problem in Uganda and other 59. developing countries especially in Sub -Saharan Africa.Sub -Saharan Africa has a 60. prevalence of under-nourished children second only to India [4].Every year, approximately 61. 2.3 million deaths among under 59 months aged children in developing countries are 85.Therefore, the aim of this study is to determining the case fatality rate and the various 86.predisposing factors to development of PEM among children under five years of age 87.admitted in the paediatric wards of Jinja Regional Referral Hospital.This will provide the 88.necessary information on the prevalence of PEM within the study area and help channel 89.towards finding the lasting solution to this problem.

Study design
92.A descriptive facility-based cross-sectional study design was used which applied both 93.qualitative and quantitative approaches.

Study area
95.The study was conducted at Jinja Regional Referral Hospital.Jinja Hospital is one of the 96.thirteen (13) Regional Referral Hospitals in Uganda.It is also one of the fifteen (15) 97.hospitals designated as Internship Hospitals, where graduates of Ugandan medical schools 98. may undergo a year of internship under the supervision of consultants and specialists in the 99.designated medical and surgical disciplines.

101.
The study population were all children below the age of five years admitted in the 102.paediatric wards of JRRH between March-August, 2019.

104.
All under-fives admitted in the Paediatric wards of JRRH within the time scope of 105.
the study and whose caretakers offered consent were included in the study.

106.
Meanwhile, all under-fives admitted in the Paediatric wards of JRRH within the 107.time scope of the study whose caretakers refused to offer consent were excluded.

109.
Consecutive sampling technique was used whereby study subjects were recruited 110.as they came and met the inclusion criteria.result may be attributed to the effectiveness of measures put in place to combat 174.malnutrition in the recent past [17].Otherwise, it may also vary as a result of 175.regional variation in economy, agricultural practice or food security within Uganda 176.

177.
The relationship between child sex of PEM in under-five children showed that 178.males (7.70%) under-five children suffer from PEM compared to females (6.59%).

179.
This sex difference was also reported by [19], they observed that Tanzanian under-180.five males were more affected by PEM than their female counterparts.Similarly, 181.[20] reported that males were worse hit by PEM in Egypt than females.This male 182.predilection could be due to the fact that male children take part in playful activities 183.that demand and expend more energy compared to female children [21].

184.
Poor immunization history was also found to be associated with increased rates of 185.
PEM.This was similar to the findings of [22]

217.
The caregivers of under-five children should strictly adhere to exclusive 218.breastfeeding for at least 6 months since its benefits have been scientifically proven 219.beyond doubt.Also, the administration and staff of Jinja Regional Referral 220.
Hospital should improve and/or scale-up existing community outreaches to educate 221. the community on the importance of exclusive breastfeeding, optimal child feeding 222.
practices and childhood immunization in the fight against childhood malnutrition, conclusion, both the prevalence and case fatality rates of under-five PEM were high, 41. calling for appropriate interventions based on the associated factors.42.Keywords: Protein-energy malnutrition; Case-fatality rate; Under-fives 43.BACKGROUND 44.The World Health Organization (WHO) defines Malnutrition as "the cellular imbalance

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