Effect Of Child Feeding Practice Counseling On Physical Development Among Under-Five Children In South-South, Nigeria

Nutrition of children is of paramount importance because the foundation for their lifetime health, strength, mental development and intellectual ability is laid during this period (Hurley, 2016). Nutritional status is an important determinant of the well-being of children specifically for the under-five children (Ergin et al., 2017). This is because of the influence it has on their growth and brain development which affects their ability to learn and perform appropriately in school (WHO (2018).

Physical Development is the growth and change of the body and brain, including the development of muscles, motor skills and senses (Aregaw, 2016), “It also includes health and wellness and plays a major role in living a healthy life. The age between birth and five years is the first stage of life, and it is an important stage in the physical development of the child (Aregaw, 2016). In Nigeria, under-five age children constitute 26% of the total population (Akani et al., 2021). Physical growth parameters, such as weight, height, and head circumference, are fundamental indicators of children’s health, (Hurley, 2016. Monitoring weight gain is crucial for detecting issues such as under nutrition or over nutrition, as sudden weight loss or failure to gain weight can indicate health problems that require further investigation and management as the case maybe. Tracking length or height helps assess skeletal growth and overall physical development, as abnormal growth patterns can signal underlying health conditions” (Hurley, 2016). Head Circumference: Measuring head circumference is important for monitoring brain growth. Deviations from normal head growth can indicate neurological issues or developmental disorders.

• 1. Research Question:
• How does child feeding practice counseling influence the physical development of under-five children in south-south, Nigeria?
• What are the social-demographic factors influencing Nutritional Status and Physical development among under-five children in Rivers State

1.2  Hypothesis

•  There is no significant association between feeding practices and nutritional status of under-fives in selected healthcare centers in Rivers.

2. Material and Methods

Research Design

This study design was a quasi-experimental research design (Non-equivalent)

The quasi-experimental approach of the study is demonstrated as given below.

EG =  Experimental Group; CG = Control Group

O₁ =  pre-assessment measurement for EG

O₃=  post-assessment measurement for EG

O₂ = pre-assessment measurement for CG

O₄ = post-assessment measurement for CG

X₁ = intervention (nutrition education counseling and intervention)

Xo = control group (nutrition education counseling only)

Xo = control group (nutrition education counseling only)

Xo = control group (nutrition education counseling only)

Xo = control group (nutrition education counseling only)

Study Area

The area for this study was South South, Nigeria which is made up of both upland and Riverine areas and is blessed with abundant natural resources like natural gas and crude oil. These features of the district make it a preferred destination for businessmen, tourist and expatriate from within and outside the Country. Their major occupation is farming, fishing and trading. 

Study Setting

Rivers State has a population of more than five million, one hundred and eighty-five thousand, four hundred (5,198,716) individuals (official 2006 Census), though more current estimate (around 2024) put the population of Rivers State at approximately 9,898,470 inhabitants, (Demographic Records and population estimates for Rivers State) making the State one of the sixth most populated States in Nigeria. The State is well known for its vast natural gas reserves, crude oil, and natural resources such as silica sand, clay, and glass and on the deposits of crude oil and natural gas with several oil mining corporations operating in the area which contribute to the economy. These features make it a preferred destination for business from tourist and expertrate from within and outside the country. The state is a hub for fishing with the rivers and tributaries that constitute the area's hydrosphere being rich in seafood. Other notable economic activities in the State include farming, trade, and crafts making. The State has over 500 health facilities in the three senatorial districts, including two tertiary health facilities (RSMOH, 2016) having personnel working in such facilities. 

Population of the Study

The population of the study consisted of 5,300 of all the under-five Management Board, children attending the Selected Healthcare Centers in Rivers State (Primary 2025).

Sample and Sampling Technique

Sample Size Determination

The sample size for the study was 372 which was calculated using the Taro Yamane (1967). Sample Size determination Formula to determine the sample size. The formula for the sample size determination is shown below:

n= N1+N(e)2

Where,

n =       Sample size

N =       Total Proportion of the study.

1 =       Constant

e =        0.05%i.e Confidence level

Therefore: n  = 5300

1+5300(0.05%)²

n= 53001+5300x0.0025

n= 53001+13.25

n= 530014.25

n = 371.9   = 372

Therefore, the sample size for this study is 372.

Thus the sample size for the study was 372 children for the study. The sample was recruited proportionately across the settings.

Sampling Technique

A multi stage sampling procedure was adopted for the study, which was done in three stages.

Stage one: Simple random sampling technique (tossing of coin) was used to select two LGAs in each district, making a total of six LGA for the study.

Stage two: simple random sampling technique (balloting without replacement) was also used to select two (2) Healthcare Centers from each of the LGAs selected.

Stage three: Purposive sampling technique (assigning respondents into experimental and control group) was done based on the anthropometric information obtained at the pre-intervention measurement stage. Hence all children observed with symptoms of malnourishment were assigned into intervention group (experimental group), while children that did not manifest symptoms of malnutrition were grouped into control.

Research Instrument

The instruments for data collection were a researcher-structured questionnaire and unstructured questionnaire titled: ‘Nutritional Status Questionnaire (NSQ)’ and anthropometric tools such as height rule measured in meters for measuring the height of the participants, and a weighing scale (HANSON Mechanical Bathroom Scale) for measuring the weight of the children. The socio-demographic information of the participants and the measurement of the height and weight of the children were recorded in the researcher-structured questionnaires. The instrument consist of three sections A, B,C and D. Section A used 5 items to elicit information on social demographic data of participants, Section B with 12 items on child feeding practices, Section C with 9 items on physical development while Section D with 4 items focused on anthropometric measures for the nutritional status and physical development – weight, height, and mid upper arm circumference.

Validity of Instrument

Validity of the instrument is the ability of the instrument to measure what it was designed to measure

Reliability of the Instrument

The reliability of the instrument was determined using the test-retest method, the instruments were administered and re-administered to 37(10% of sample size) participants in another district which was not part of study population but shared similar characteristics with study setting. Data generated from the two sets of administered instruments were analyzed using Pearson Product moment correlation coefficient of 0.70 same was reliable for the instrument.

Procedure for Data Collection

Data were collected by (i) researcher administered questionnaire with the help of research assistant recruited and trained by the researcher / (ii) WHO Anthropometric measurement tools. Data collection were done in stages and it lasted for 24 weeks.

Stage one:  Pre-intervention stage- 1 -6weeks.

Activities: First contact with participants for introduction and other formalities,,(explaining to the participants on what the research is about, things to do among others) and recruiting participants. Baseline information was collected such as child characteristics data, anthropometric data (weight, height, mid-upper arm measurements, head circumference), and child physical development measurement were taken, mothers data (maternal and socio-demographic characteristics of the children), assessing nutrition practices of the under-five children as well as assigning participants to either control group or intervention group were done , this lasted for 6weeks.

Stage two: Intervention stage -7-12 weeks

 Researcher visited the facilities and administered nutrition practices education counseling to mothers/caregivers also food items (eggs and fortified soya beans) were given to them. Stage three: Follow-up stage - 13-18weeks

 Two weekly visitation to the healthcare facilities to assess participants as well as reinforcing the nutrition education counseling and give nutritional food items to the participant.

Stage four: Post intervention stage- 19-24weeks

At this stage (participants were visited and child characteristics data, anthropometric data (weight, height, mid-upper arm measurements, head circumference), and child physical development measurement were taken again for data analysis. At the end of the experimental process the researcher gave gift items both to the intervention and control groups to appreciate them for their time and patience in course of the study

3. Results

The results of the study are shown below:

The data in Table 2 shows a paired sample t test analysis of the effects of feeding practices on the nutritional status of under-fives in Rivers State. Across all feeding practice indicators, the post intervention mean scores were higher than the pre intervention scores, indicating improvements after the intervention. The mean differences reflect varying degrees of change across practices. The results show that all feeding practice variables recorded statistically significant differences at the .000 level. This indicates that the observed changes are unlikely to have occurred by chance. The t values further reveal the strength of these changes. Moderate t values were observed for breast-feeding start time (t = 4.28), prelacteal feeding (t = 4.43), and colostrum feeding (t = 5.45), suggesting meaningful improvements in early feeding behaviors.” “Exclusive breastfeeding (t = 5.36) and breastfeeding duration (t = 3.20) also showed significant progress, though with comparatively smaller magnitudes. Stronger effects were recorded in practices related to continued feeding and dietary intake. Complementary feeding (t = 7.59), bottle use reduction (t = 8.91), diet diversity (t = 8.94), snacks (t = 8.28), and meal intake (t = 8.91) demonstrated large and statistically significant improvements. This suggests that the intervention had its greatest influence on practices involving food intake patterns and feeding frequency. The paired sample correlations indicate moderate to very strong relationships between pre and post intervention scores.

Discussion of Finding

Socio-Demographic Factors influencing Physical Development among under-five Children in South-South.

The result from Table 1“provide important insights into the socio demographic factors that shape the nutritional status and physical development of under five children in Rivers State. The distribution shows that almost half of the children were between 0 and 12 months, which suggests that many of the respondents were in the age group most vulnerable to malnutrition and growth faltering. The early months of life are critical for brain development, immune function and linear growth, making nutrition highly consequential at this stage. The sex distribution also shows more males than females, though both groups are well represented. The majority of children were delivered normally and most were born at full term, indicating a population with generally favorable birth conditions.” Birth weight distribution further supports this, with over 95 percent of the children weighing between 2 and 4 kilograms at birth. “Adequate birth weight is a known predictor of healthy growth trajectories during infancy and childhood. Immunization status also shows that most children had received vaccinations, which helps reduce infection related growth impairments. Birth spacing and birth order patterns reveal that more than half of the children were born less than two years apart, while a significant proportion were second or third born. These factors are important because short birth intervals and higher birth order have been associated with increased nutritional vulnerability due to reduced maternal recovery time and resource competition within households. The regression results in Table 1 further strengthen these interpretations.” The moderate positive “coefficient of relationship indicate that socio demographic factors jointly account 48.9 percent of the variation in the nutritional status of under five children in Rivers State. This demonstrates that socio demographic characteristics play an influential role in shaping nutritional and physical development outcomes. Among the individual predictors, age, birth weight, birth spacing and birth order were significant contributors. The significance of age suggests that developmental stage strongly influences nutritional vulnerability. The strong contribution of birth weight aligns with biological evidence that children born with adequate weight have better chances of achieving normal physical development. Similarly, the significance of birth spacing and birth order implies that family structure and maternal reproductive patterns affect both nutritional adequacy and growth outcomes. These findings are consistent with empirical studies.” In a similar study Adebisi et al. (2019) found that “birth weight and birth spacing significantly predicted growth outcomes among Nigerian children, concluding that children born with low birth weight or short birth intervals had higher risks of stunting and underweight conditions. This supports the results of this study, where birth weight and birth spacing were significant socio demographic predictors of nutritional status. Likewise, Akombi et al. (2017) reported that socio demographic factors such as maternal age, birth order and birth interval were consistently associated with childhood malnutrition in West Africa. Their study showed that higher birth order and narrower spacing between siblings increased the likelihood of poor nutritional outcomes because household resources and caregiver attention become increasingly stretched.” Taken together, the findings show that socio demographic characteristics are critical determinants of nutritional and physical developmental outcomes among under five children in Rivers State. “The significance of age, birth weight, birth spacing and birth order highlights the need for interventions that promote healthy pregnancy conditions, optimal child spacing, targeted support for high risk age groups and enhanced caregiver capacity. Strengthening maternal and child health services, promoting antenatal and postnatal care and encouraging exclusive breastfeeding and adequate complementary feeding can help mitigate the socio demographic risks identified in the study.

Effects of Feeding Practice counseling on physical development of under-five Children in Rivers State

The result from Table 2 provide clear evidence that the combined nutritional education counseling and nutritional intervention program produced measurable improvements in the physical development of under five children in Rivers State. The significant increase in mean weight from 13.29 kg to 13.95 kg indicates that the intervention supported healthy weight gain over the study period. The statistically significant p value confirms that this change did not occur by chance. “The moderate paired sample correlation (r = 0.532) further suggests that children who started with relatively low or high weights tended to respond consistently to the intervention. Similarly, the increase in mean height from 82.55 cm to 83.11 cm represents a positive linear growth response to improved nutrition and feeding practices. Height is a sensitive indicator of long-term nutritional adequacy, and the highly significant t value and p value (p < .001) show that the intervention contributed meaningfully to physical development. The strongest improvement was observed in MUAC which increased from 14.0 cm to 15.65 cm.” This 1.65 cm increase is substantial because MUAC directly reflects muscle mass and acute nutritional recovery. The significance of this change (p < .001) indicates that the intervention effectively addressed acute malnutrition and enhanced dietary intake quality. These findings are reinforced by the regression results in “Table 4.1.5 which show that nutritional counseling alone accounts for 27.5 percent of the variance in the nutritional status of under five children (R squared = 0.275). The regression coefficient reveals that for every unit increase in nutritional counseling, there is a corresponding improvement in nutritional status. The significant F statistic further confirms that nutritional counseling has a meaningful and statistically significant influence on child nutrition in Rivers State. These results align with empirical evidence in the literature. Leroy and Frongillo (2019) found that counseling interventions directed at caregivers significantly improved children’s weight, MUAC and dietary diversity, especially in low-income settings. Their study concluded that behavioral counseling improves caregiver knowledge and feeding practices, which ultimately enhances physical development among young children. In the same way, the present study shows that counseling contributed meaningfully to weight gain, height increases and MUAC improvements”. Similarly, Imdad et al. (2017) reported that “targeted nutrition education combined with supplementary feeding yielded significant improvements in both weight gain and linear growth among children under five. Their meta-analysis highlighted that counseling which focuses on appropriate feeding frequency, complementary feeding and early initiation of breastfeeding produces measurable gains in child growth indicators. This supports the findings from Rivers State where a combined intervention produced statistically significant improvements across all anthropometric indicators.” Taken together, these findings demonstrate that “nutritional counseling and structured feeding interventions are powerful tools for improving the physical development of under-five children. The results emphasis the importance of integrating nutritional education into routine child health services, scaling community based counseling programs and ensuring that caregivers are equipped with accurate feeding knowledge. Such interventions have the potential to substantially reduce malnutrition and improve developmental outcomes among under-five children in Rivers State.

CONCLUSION

The study revealed that feeding practices counselling is important in child physical development (statistics). The study concludes that improving nutrition knowledge of the mothers through feeding practices counselling, and paying attention to early life conditions are central to improving child physical development and reducing malnutrition and under development among under-five children in the studied setting.

RECOMMENDATIONS

Based on the findings of the study, the following recommendation was made:

Caregivers should be encouraged to adopt evidence-based feeding behaviors by eliminating increasing meal diversity, and adhering strictly to recommended feeding schedules to ensure sustained child development, generally.

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