1.0 Introduction
1.1 Background of Study
The interconnection between malnutrition and diarrheal diseases has long been recognized in global health discourse. Historically, malnutrition has been a persistent issue in many developing regions, particularly in sub-Saharan Africa, where poverty, food insecurity, and limited access to healthcare converge to compromise the nutritional status of vulnerable populations especially children (Black et al., 2008). The prevalence of diarrhea as a leading cause of child morbidity and mortality has similarly been well documented, with significant attention paid to its disproportionate impact in low-income settings where water, sanitation, and hygiene (WASH) infrastructure is inadequate (WHO, 2017). Malnutrition and diarrhea are two of the most significant public health concerns affecting children under five years of age, especially in low- and middle-income countries. Malnutrition, defined as a deficiency, excess, or imbalance in a person's intake of energy and nutrients, directly impairs the body's ability to fight infections and recover from illnesses (World Health Organization [WHO], 2021). Among children, undernutrition manifesting as wasting, stunting, or underweight has been consistently linked with increased susceptibility to infectious diseases, with diarrhea being one of the most common and deadly.
In Nigeria, and particularly in conflict-affected regions like Borno State, the impact of malnutrition and diarrheal diseases is more pronounced due to the displacement of populations and the breakdown of essential services. Internally Displaced Persons (IDPs) in Borno State, displaced by the prolonged Boko Haram insurgency, live in camps with limited access to nutritious food, clean water, and adequate healthcare (International Organization for Migration [IOM], 2023).
Diarrhea, which is characterized by the passage of three or more loose or liquid stools per day, contributes significantly to childhood mortality worldwide. According to UNICEF (2020), it remains a leading cause of death among children under five, particularly in settings with poor sanitation, unsafe water, and inadequate hygiene (UNICEF, 2020). Children suffering from malnutrition are more vulnerable to repeated episodes of diarrhea, creating a vicious cycle of poor nutrient absorption and persistent infection (Black et al., 2013). Internally Displaced Persons (IDPs) in conflict-ridden regions like Borno State, Nigeria, face multiple health challenges due to overcrowded living conditions, limited access to safe water and sanitation, inadequate healthcare, and food insecurity. These factors converge to increase the risk of both malnutrition and diarrheal diseases among children living in IDP camps (Owoaje et al., 2016).
Owoaje, Uchendu, Ajayi, & Cadmus (2016) stated that, the fragile living conditions in IDP camps characterized by overcrowding, inadequate sanitation, and food insecurity create a high-risk environment for both malnutrition and diarrheal diseases. Reports have shown that malnutrition rates among displaced children in northeastern Nigeria remain alarming, with many children experiencing multiple episodes of diarrhea, further exacerbating their nutritional deficiencies (Owoaje, Uchendu, Ajayi, & Cadmus, 2016).
Malnutrition according to World Health Organization (2021) is defined as a condition that results from an imbalanced or insufficient intake of nutrients essential for growth and health. It includes undernutrition (wasting, stunting, and underweight), insufficient vitamins or minerals, overweight, and obesity (World Health Organization [WHO], 2021). In children, undernutrition is particularly devastating as it weakens the immune system, hinders physical and cognitive development, and increases susceptibility to infectious diseases such as diarrhea.
The situation in Borno State has been exacerbated by the Boko Haram insurgency, which has displaced over two million people and significantly disrupted agricultural activities, health services, and social structures (International Organization for Migration [IOM], 2023). As a result, thousands of children in IDP camps suffer from acute malnutrition and are repeatedly exposed to pathogens responsible for diarrhea. Therefore, this study aims to assess the extent to which malnutrition contributes to diarrheal diseases among children in selected IDP camps in Borno State, Nigeria.
1.2 Statement of Problems
Investigation revealed that the growing burden of malnutrition among children living in Internally Displaced Persons (IDP) camps in Borno State is a public health concern that continues to threaten child survival. Malnutrition is not only undermining the physical growth and cognitive development of children but is also directly increasing their vulnerability to infections such as diarrhea. Diarrhea remains one of the leading causes of morbidity and mortality in children under five years, especially in low-resource settings where access to clean water, and adequate nutrition is limited (UNICEF, 2020).
In the fragile environment of IDP camps, children are frequently exposed to unsanitary conditions, limited access to nutritious food, and poor healthcare services. This combination of factors is resulting in a high incidence of diarrheal diseases, particularly among children already weakened by undernutrition (WHO, 2021). The recurrent nature of diarrheal infections among these children is further deteriorating their nutritional status, creating a vicious cycle that is difficult to break (Owoaje et al., 2016). It is against the backdrop that this study seeks to address these problems by exploring the extent to which nutritional deficiencies contribute to the prevalence of diarrhea among children in these vulnerable settings.
1.3 Aim and Objectives of Study
The aim of this study is to examine the role of malnutrition in the prevalence and severity of diarrhea among children living in Internally Displaced Persons (IDP) camps in Borno State, Nigeria. The specific objectives of the study are:
- To evaluate the effectiveness of current nutrition and health interventions addressing diarrhea among children in the IDP camps.
- To identify environmental and hygiene-related factors that may influence both malnutrition and diarrhea prevalence in IDP settings.
- To investigate the relationship between malnutrition and the frequency or severity of diarrhea among children.
- To assess the nutritional status of children residing in selected IDP camps in Borno State.
- To determine the prevalence of diarrheal diseases among malnourished children in the camps.
- To recommend strategies for reducing diarrhea through improved nutritional support and public health practices in displaced populations.
1.4 Research Questions
Based on the objectives of the study, the following research questions have been formulated:
- What is the current nutritional status of children living in selected IDP camps in Borno State?
- What is the prevalence rate of diarrheal diseases among malnourished children in these IDP camps?
- How does malnutrition influence the frequency and severity of diarrhea in children residing in the camps?
- What environmental and hygiene-related factors are contributing to both malnutrition and diarrhea among children in the IDP camps?
- How effective are the existing nutritional and health interventions in reducing the incidence of diarrhea among children in the camps?
- What strategies can be implemented to minimize diarrhea prevalence through improved nutrition and public health practices in IDP settings?
1.5 Significance of Study
The outcome of this research will help to bridge the knowledge gap on the nutritional and health challenges faced by displaced children, offering empirical data that will support targeted health and nutrition interventions. The findings from this research will also inform policymakers, humanitarian organizations, and public health practitioners on the need to integrate nutritional support with disease prevention strategies.
Furthermore, caregivers and community health workers in the IDP camps will receive practical guidance from the study that will help improve child feeding practices and hygiene, thereby reducing the incidence of diarrhea and enhancing child health outcomes. It will also guide caregivers and camp managers on practical steps to improve child health through better feeding practices and hygiene management.
Lastly, researchers and academics will find this study valuable as it will fill existing gaps in literature regarding malnutrition and diarrhea in conflict-affected regions, providing a foundation for further research and innovations in child health and nutrition.
1.6 Scope of Study
This study focuses on investigating the role of malnutrition in the prevalence of diarrhea among children residing in selected Internally Displaced Persons (IDP) camps within Borno State, Nigeria. The research will be geographically limited to camps managed or supported by the National Emergency Management Agency (NEMA) in collaboration with local health authorities and humanitarian partners operating in the region. The study will concentrate on children under five years of age, as this group is most vulnerable to the combined effects of malnutrition and diarrheal diseases.
1.7 Limitations of the Study
Several limitations were encountered during the course of this study, which may have influenced the results and conclusions.
- Delay from Respondents: The questionnaire respondents delayed in providing unbiased information, as some caregivers was hesitant or unavailable at the time of data collection, impacting the timely completion of the study.
- Financial Constraints: Due to budget limitations, there was insufficient funding to expand the research to a larger sample size or to include more varied geographic locations, which might have provided a broader perspective.
- Time Constraints: The study was conducted within a limited period, restricting the ability to observe seasonal variations and conduct follow-up assessments.
1.8 Definition of Terms
Malnutrition:
Malnutrition refers to the condition that results from an imbalance in nutrient intake, either due to deficiency or excess, which affects the body's normal functioning and development. In children, it often manifests as wasting, stunting, or underweight, making them more vulnerable to infections such as diarrhea (WHO, 2021).
Diarrhea:
Diarrhea is defined as the passage of three or more loose or watery stools within 24 hours. It is a common illness among children, especially in vulnerable populations, and remains a leading cause of morbidity and mortality in children under five years old (UNICEF, 2020).
Internally Displaced Persons (IDPs):
IDPs are individuals or groups who have been forced to flee their homes due to conflict, violence, or natural disasters but have not crossed international borders. In the context of Borno State, many families live in camps established for protection and basic needs (Internal Displacement Monitoring Centre [IDMC], 2023).
IDP Camps:
These are temporary settlements set up to provide shelter, food, and basic services for internally displaced persons. Conditions in these camps often lead to challenges such as poor sanitation and inadequate nutrition, which contribute to health problems among children (NEMA, 2022).
…