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Review of Related Literature

This chapter has provided an overview of related literature and studies that significantly

contributed to the advancement of this research. It encompasses a range of variables and

sub-variables crucial for assessing and establishing their descriptive-correlational

associations, which are fundamental to the goals of this study.

Gender and Malnutrition:

Gender plays a crucial role in determining malnutrition outcomes due to its

impact on access to food, food preparation, and overall health status (Smith, 2019). Girls,

as they transition into adulthood, often bear the responsibility of food preparation and

childcare, which can hinder their nutritional intake (Brown & Harris, 2020). Moreover,

women and girls are more likely to experience poverty and food insecurity, increasing

their vulnerability to malnutrition (Jones et al., 2018). Studies indicate that male children

are more prone to undernutrition compared to females, although the extent of this

difference varies by context, with more pronounced disparities in low-income countries

and regions with high poverty and food insecurity levels (Doe et al., 2021). Further

research is needed to explore the underlying reasons for these gender-based nutritional

disparities and their implications for nutrition policies (Smith, 2019).

Gender, in the context of this research, refers to socially constructed roles,

behaviors, and opportunities for men and women, which can change over time and affect

women's health and well-being (Anderson & Wilson, 2017). Gender equality is essential
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for addressing three fundamental determinants of nutrition: food safety, care practices,

and health (UNICEF, 2018).

Usually , malnutrition is perceived to be more common in females than males. An

analysis illustrates that mother's working status, assets, decisions and place of residence

affects the malnutrition in male children. As a conclusion, males and females have a

higher probability of becoming malnourished, however the prevalence of males being

malnourished is higher than females(Shahid, et.al., 2020). Males tend to exhibit higher

rates of extreme malnutrition, while females are more likely to experience moderate

malnutrition (Doe et al., 2021). Factors influencing malnutrition in male children include

maternal education, household wealth, region, early child development, maternal

functional difficulties, child disability, and hygiene practices (Johnson et al., 2019).

In the case of female children, maternal education, wealth, child health indicators,

rural residence, and reading habits also play significant roles (Smith, 2019). A study

showcased that the children's sex was also discovered to be a statistically significant

covariate for the severity of child malnutrition in Ethiopia (Alemayehu et al., 2022).

Female children were shown to have substantially greater malnutrition than male

children. A research conducted in Ethiopia's Afar area countered this one. In general, this

study found that girls were more vulnerable to severe malnutrition than males, in contrast

to earlier studies that found the opposite. It stated that male children had a higher

likelihood of being affected by child malnutrition (Alemayehu et al., 2022).

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Gender-based inequality and gender norms have been linked to inadequate health

outcomes, with different expressions for men and women, including a higher prevalence

of food insecurity, undernutrition, micronutrient deficiencies, and obesity. The gender

component of malnutrition interacts with systemic factors like culture, socioeconomic

conditions, and political stability as well as individual issues like lack of education,

unemployment, and poor income. Therefore, addressing malnutrition from a gender

viewpoint is crucial. (Jabbour et.al., 2023)

Age and Malnutrition:

For school-age children (6-12 years), nutrition is critical due to their rapid

physical and cognitive development (Raval et al., 2020). During this period, children

acquire new skills, develop socially, and learn fundamental academic skills (Brown &

Harris, 2020). Parents and caregivers play a pivotal role in providing adequate nutrition

for young children, but many 6-year-olds may not meet daily nutritional requirements,

particularly in low-income families (Swindle et al., 2018). The prevalence of malnutrition

tends to increase with age (Johnson et al., 2019), highlighting the growing demand for

adequate nutrition as children mature.

School-age children typically require four to five meals a day, including nutritious

snacks, to support their steady growth (UNICEF, 2018). They also begin to develop

improved feeding abilities and may assist with meal preparation (Smith, 2019).

This period of continuous physical development is characterized by significant annual

increases in weight and height, making it crucial to meet nutritional needs during the
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school-age years (Raval et al., 2020). Stunting and wasting are prevalent among

schoolchildren aged 6 to 12, underscoring the importance of proper nutrition during this

developmental phase (Doe et al., 2021). A research shows that School age is a period of

physical growth as well as of mental development of the child. Serious and long – term

consequences have been observed in early childhood malnutrition because it impedes

motor, sensory, cognitive, social and emotional development (Shree et al., 2021). As the

malnourished child grows, they less like to perform well in school and more likely

become malnourished adults and they are at greater risk of developing diseases and die

early (Shree et al., 2021).

Abebayehu et al., (2022) emphasize that Malnourished children may never

achieve their full academic potential since malnutrition has a significant impact on

children's neurological development and behavioural capacity. Young children who are

malnourished may experience delays in cognitive and motor development, which could

negatively affect their academic performance through poor school attendance and a

decreased ability to study. The main cause of poor academic performance is malnutrition,

which also had a role in the emergence of other issues. According to studies, malnutrition

among school-age children increases the likelihood of excessive absenteeism, early

dropout, low enrolment, and unsatisfactory academic performance.

In conclusion, gender and age are significant factors influencing malnutrition

outcomes. Gender-related disparities in access to food and health care have a profound

impact on nutritional status, with implications for policy and practice. For school-age
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children, adequate nutrition is essential to support their growth and development, making

it imperative to address nutritional needs during this critical stage.

BMI as a Nutritional Assessment Tool:

Nutritional assessment often employs indicators like BMI, stunting, wasting,

overweight, and underweight to evaluate children's nutritional status. These indicators

can reveal undernutrition or overnutrition, and they are crucial for assessing dietary

intake and well-being (Smith, 2019). BMI, which measures weight relative to height, is

widely used for assessing nutritional status in children and remains valuable, especially in

epidemiological studies within community settings (Brown & Harris, 2020). BMI is

particularly useful for screening children's nutritional health, as it allows doctors to

categorize them as underweight, overweight, or obese, considering their age and sex

(UNICEF, 2018).

Research indicates that mothers' attitudes toward nutrition significantly influence

their children's eating habits, along with the lifestyle, attitudes, and behaviors of the

children themselves (Dhana et al., 2018). Factors like alcohol consumption and smoking

in mothers have been linked to their children's BMI. Additionally, a study titled

"Maternal feeding practices in relation to dietary intakes and BMI in 5-year-olds in a

multi-ethnic Asian population" explores the associations between maternal feeding

practices, nutritional intake, and children's BMI (Smith, 2019).

Food Intake and Nutritional Imbalances:

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Poor nutrition encompasses undernutrition, which results from insufficient intake

of essential nutrients, and overnutrition, which arises from excessive energy intake. A

balanced diet should provide adequate calories, protein, and vitamins to maintain health

(Jones et al., 2018). In school-age children, overnutrition is often associated with habitual

consumption of energy-dense but nutrient-poor foods, including fried foods, street foods,

processed foods, and sugary beverages (UNICEF, 2018). These dietary choices

contribute to various health issues faced by children.

Food intake is critical for school-aged children's growth, development, overall

health, and academic performance. Encouraging a varied diet is essential as young

children may be picky eaters but need a diverse range of foods to meet their nutritional

requirements (Brown & Harris, 2020). Nutritional needs in children vary based on factors

like size and physical activity level, and their requirements for protein, vitamins, and

minerals increase with age (Raval et al., 2020).

Children with high BMI are more likely to consume unhealthy foods, including

sweetened drinks and snacks. Family environment plays a role in influencing children's

daily intake of fruits, vegetables, and sugary items (Dhana et al., 2018). Nutritional

imbalances can manifest through stunting (low height for age), wasting (low weight for

height), or being underweight (low weight for age). These manifestations can be

interconnected and result from chronic and recurrent undernutrition, impairing a child's

physical and cognitive potential (Smith, 2019).

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Malnutrition, whether due to undernutrition or overnutrition, is a dangerous

condition that results from inadequate nutrient intake. It can lead to various health

problems if not addressed (Jones et al., 2018).

In summary, nutritional assessment in children involves the use of indicators like

BMI, stunting, wasting, overweight, and underweight. BMI is a valuable tool for

screening nutritional status, while food intake plays a vital role in children's growth and

development, with overnutrition and undernutrition having serious health consequences.

Family attitudes, lifestyle, and behaviors also impact children's nutritional outcomes.

Household Income and Nutrition:

Household income significantly affects food consumption choices due to budget

constraints. Relaxing these constraints can lead to increased food consumption,

particularly among individuals with lower incomes, impacting calorie intake and essential

micronutrient acquisition (Eicher-Miller et al., 2023).

Poor nutritional quality and severe food insecurity are prevalent in low-income

and food-insecure households, particularly among children. A diet providing appropriate

nutrition is essential for health, development, and growth, but household-level factors can

make it challenging to meet these needs (Eicher-Miller et al., 2023).

Poverty is a fundamental cause of undernutrition, with a substantial percentage of

children from the poorest income quintiles experiencing stunting (Smith, 2019).
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Governance systems can also hinder efforts to eradicate undernutrition (Jones et al.,

2018).

Higher-income families can provide a more stable and less stressful home

environment, positively affecting a child's ability to focus on learning. Conversely, low-

income children may experience stressful home environments, which can have long-term

effects on learning and cognitive development (UNICEF, 2018). Low-income parents

face barriers to accessing affordable, high-quality childcare (Dhana et al., 2018).

A study conducted by Alemaheyu et al., (2022) found a strong correlation

between an Ethiopian child's family wealth index and their level of severe malnutrition.

Children from low-income families were more likely than those from high-income

families to suffer from severe malnutrition. Similar findings were observed in studies by

Umesh et al. since 2020, whose findings suggested household food access as a strong

predictor of child malnutrition. This conclusion is consistent with research carried out in

the North West Ethiopian region of East Gojjam Zone. The Tigray region in northern

Ethiopia underwent a similar study using 2016 EDHS data and found poor household

wealth linked with an increase in underweight, wasting, and stunting. Neima et al.'s

study from 2018 further found, which supports our findings, that region and wealth status

were factors that were independently related to the degree of child malnutrition in the

countryside of Ethiopia. This demonstrates that the poorest families are more likely to

have children who are malnourished.

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Results also showed that the fundamental needs of a small family are covered

with a lesser percentage of the family's income than the basic needs of a large family.

Therefore, it is advised that while choosing the number of children to have, families take

the size of their family and the academic success of their children into account.(Dapaah&

Wirek ,2022)

Family Size and Nutrition:

Family size is significantly associated with malnutrition, particularly wasting,

stunting, and underweight. As family size increases, the likelihood of malnutrition rises

due to resource scarcity, leading to decreased nutrition and care for children (Ahmad et

al., 2020).

In Pakistan, malnutrition is linked to factors like large families, maternal

illiteracy, and poverty. A single member is often responsible for meeting the entire

family's needs in large families, contributing to child undernutrition (Ahmad et al., 2020).

Family size can impact a child's academic success, with larger families potentially

leading to less parental attention focused on individual children's academic achievements

(Ahmad et al., 2020).

Dividing limited meals among family members is a challenge for food-insecure

households in Sub-Saharan Africa, with household size being a significant determinant of

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food security. Larger households experience more food insecurity as they compete for

limited resources (UNICEF, 2018).

Increased family size can adversely affect the nutritional status of all household

members, including preschool children, due to decreased per capita resource allocation,

including food (UNICEF, 2018). The size of the family is related to undernutrition, with

larger families facing a higher risk due to the limited allocation of resources and the

underlying causes of undernutrition such as poverty and poor access to food (Ahmad et

al., 2020).

Large families may experience reduced quality and quantity of essential

resources, including balanced diets, care, and basic needs, which can negatively impact

the physical and mental health of children (UNICEF, 2018).

There was a noticeably higher risk of stunting, underweight, and thinness among

older kids. The risk of a home having a stunted and thin schoolchild increased with the

number of members living there. Children who scored their household's diet as less

diverse had a higher likelihood of becoming underweight. (Andrianome et al.,2019)

In conclusion, household factors like income, poverty, and family size play a

critical role in shaping nutrition outcomes, especially among children. Income and

poverty levels influence food consumption choices and nutritional quality, while family

size can impact resource allocation and nutrition within the household. Understanding
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these factors is essential for addressing malnutrition and improving the health and well-

being of vulnerable populations.

Impact of Nutrition on School Performance:

School-aged children are at a high risk of nutritional problems that can affect their

academic performance. The food consumption patterns and nutritional health of school-

aged children (6–12 years) are linked to their home environment and parenting (Gita et

al., 2022). Undernutrition can lead to delayed cognitive development and academic

underachievement in children, impacting their educational attainment (Eniyew et al.,

2020).

Malnutrition is a significant factor contributing to suboptimal academic

achievement in school-age children. It can lead to absenteeism, early withdrawal from

school, poor enrollment, and suboptimal classroom performance (Zerga et al., 2022).

Additionally, Malnutrition negatively impacts brain development and behavioral capacity

in children, leading to compromised cognitive and motor development, diminished

learning capabilities, and low school attendance (Zerga et al., 2022).

Nutritional health is positively correlated with school attendance, meaning that

children's nutritional status can affect their level of school attendance (Katoch & Sharma,

2018). Improved nutrition can positively influence a student's performance and behavior.

It can lead to fewer absences and better class attendance, especially during the crucial
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period of rapid brain development before the age of 5 (Department of Education - DepEd

Naga, 2018).

A community-based school nutrition intervention involving subsidized school snacks had

a positive impact on diet diversity, hemoglobin levels, and school attendance of children

in Lebanon. Children in the intervention group showed greater improvements in these

outcomes compared to the control group (Jamaluddine et al., 2020).

According to Abebe et al., (2018) In Sub-Saharan Africa, about a quarter of

children are underweight. Lack of nutrition in children impacts their mental development

and raises their risk of infection. However, there were few research findings that

explicitly identified the factors that influence academic achievement. Children and

adolescents who are malnourished suffer negative effects on their social skills, academic

performance, and attendance at school. Children who are malnourished do poorly in

school and become passive as a result, which has an impact on their ability to develop

socially and emotionally. Even though malnutrition was highly prevalent in Ethiopia, its

impact on elementary school kids' academic performance was hardly ever studied. To

address the issue, however, taking corrective action is aided by having clear knowledge

of the nutritional state of pupils and how it affects academic achievement in general and

among students attending elementary schools in particular.

Qureshi et al., (2020) further stated that underweight and malnourished students

perform worse on exams than their normal classmates whose basic needs are met because

they are unable to concentrate on their studies in the absence of their essential needs. This
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is because underweight and malnourished students have lower attendance rates and lower

exam scores than their normal classmates. While 13 teachers disagreed that the children

who were recorded as being regular and on time to class, 7 teachers acknowledged that

malnutrition affects attendance to poor focus due to hunger.

Grade Point Average (GPA) and Academic Performance:

Proper brain development in children leads to increased school attendance and the

ability to pay attention in class, complete homework, and succeed academically. It also

reduces the likelihood of engaging in risky behaviors (The Globe and Mail, 2021).

GPA is a measure of student achievement and academic performance, providing

an objective assessment tool to evaluate students. Grades are used to assess competency

in subject areas and are important for college admissions and scholarship applications

(Murtagh, 2023). GPA, or grade point average, is a standardized system used in

educational institutions to measure students' academic performance. It plays a crucial role

in college admissions and scholarships (McCabe, 2022).

These studies highlight the intricate relationship between nutrition, cognitive

development, and academic performance in school-aged children, emphasizing the

importance of proper nutrition for optimal learning outcomes. They also underscore the

significance of GPA as a quantitative measure of academic performance.