KIBOGORA POLYTECHNIC
FACULTY OF HEALTH SCIENCE
DEPARTMENT OF GENERAL NURSING

ASSESSMENT OF MOTHER’S KNOWLEDGE ATITTUDE AND PRACTICES TOWARD THE PREVENTION OF MALNUTRITION AMONG UNDER-FIVE CHILDREN
CASE STUDY: Kibogora health center
PERIOD: August to september 2023
The undergraduate thesis presented in partial fulfillment of the requirements for the bachelor's degree with honor in Science of Nursing
RESEARCH PROJECTED BY:

 MUTESI Belyse
 Reg : 2000436
 UWONAKUNZE Thabitha
 Reg: 2000076
SUPERVISOR:
Mrs. TUYISENGE Francine (RN&CC&T)

Kibogora, September, 2023

DECLARATION
Declaration by the candidate
I, MUTESI Belyse and UWONAKUNZE Thabitha, hereby declare that this is my own original work and not a duplication of any similar academic work. It has therefore not been submitted to any other institution of higher learning all materials cited in this paper which are not my own have been duly acknowledge

MUTESI Belyse
Signed…………………………………………….
Date………………………………………………

UWONAKUNZE Thabitha
Signed……………………………………………
Date……………………………………………..
.DECLARATION BY THE SUPERVISOR
I declare that this work has been submitted for examination with my approval as KP supervisor
Mrs. TUYISENGE Francine (Ms)
SUPERVISOR’S NAME: TUYISENGE Francine (RN&CC&T)
SIGNED………………………………………………
DATE…………………………………………………

ABSTRACT

Malnutrition is a public health concern. In 2022, 2063 children under the age of five were screened in Kibogora district hospital’s catchment area and revealed that 3% of children were malnourished. Acute and moderate malnutrition was at 82% and acute severe malnutrition was at 18%. (Kibogora DH, 2022). 
This study aimed for assessing mother’s knowledge, attitude, and practices toward the prevention of malnutrition among under-five children attending kibogora health center. with objectives including assessing level of mother’s knowledge and attitude toward the prevention of malnutrition, to identify the mother’s practices toward the prevention of malnutrition and to evaluate measures employed by mothers in prevention of malnutrition among under-five children. The study adopted a cross sectional study design with a quantitative approach where 100 mothers with under-five children were enrolled in the study.
According to mother’s knowledge. Some mothers (78%) agreed that it is necessary to provide the antenatal care for the health of the fetus, including prevention of intrauterine growth retardation (IUGR) whereas 10% had no idea about this matter. 63% of those mothers knew that child can catch an under-diagnosed malnutrition due to lack of routine growth monitoring by a skilled provider. Access to food security and balanced diet was quite present to mothers with children below five at 63% rate at Kibogora health center whereas 37% of them did not at a level of getting adequate balanced diet for their children
As conclusion according to the findings show that the crucial problem are belongs food accessibility and balanced diet where there is low percentage comparing to the other findings. According to the recommendation kibogora health center should support mothers to participate in income generating activities to help them access food and develop themselves.
Key concepts: Knowledge, practice, malnutrition and prevention measures

DEDICATION

To:
almighty God
our parents
our sisters and brothers
Colleagues and supervisor
MUTESI Belyse
UWONAKUNZE Thabitha

ACKNOWLEDGEMENTS
This work would not have been successfully complete if it had not gain guidance, moral and financial support from different people. we would like to extent our sincere gratitude and heart left appreciation firstly to the almighty God, for his guidance, protection and daily care, love and blessings.

Let's express our gratitude to the Kibogora Polytechnic, the Faculty of Health Sciences, and the Department of General Nursing for the initiatives they took to motivate final students to conduct research and write memoirs in order to receive a Bachelor's degree.

We are deeply indebted or thankfully to our supervisor, TUYISENGE Francine (Ms), who supervised our research and guided us from the beginning to the end.
We would like to express our profound gratitude to our parents, brothers, and sisters for their moral, material, and financial support during our academic endeavor, which helped to make our academic careers successful. We want to thank them from the bottom of our hearts, especially for their support, encouragement, and patience.

Last but not least, we would like to express our sincere thanks to our colleagues and friends in the specialized team, who have always been a source of encouragement, luck and great resources for us in the future. 

May the Almighty GOD richly blesses all of you!

MUTESI Belyse & UWONAKUNZE THABITHA

LIST OF TABLES
Table 1:Assessment of knowledge of respondents on prevention of malnutrition In kibogora health center
Table 2:Assessment of attitude toward the prevention of malnutrition among mothers with children under-five
Table 3:Levels of mother’s practice toward the prevention of malnutrition among under-five children
Table 4:Measures employed by mother’s in prevention malnutrition of the under-five children

LIST OF GRAPGS AND CHARTS
Figure 1:Conceptual Framework
Figure 2:Age-group distribution of the participants
Figure 3:Marital status of participants
Figure 4:Educational background of all participants
Figure 5:Occupation in daily life
Figure 6:Mother’s practice toward the prevention of malnutrition among under-five children
Figure 7:Attitude employed by mothers in prevention of the under-five children
Figure 8: Food accessibility and adequate balanced diet to children. Series1 balanced diet adequacy. Series 2: food accessibility.

LIST OF APPENDICES
APPENDICES 1:INFORMED ONSENT
APPENDICES 2:QUESTIONNAIRE (ENGLISH)
APPENDICES 3:CONSENT FORM (KINYARWANDA)
APPENDICES 4:QUESTIONNAIRE (KINYARWANDA)
APPENDICES 5:MAP TO THE STUDY
APPENDICES 6:PLAGIARISM
APPENDICES 7:RESEARCH LETTER

ACKNOWLEDGEMENTS

HAZ: Height for age z-score
IYCF: Infant and Young Child feeding
KAP: Knowledge, Attitude, And Practices
KHC: Kibogora health center
KP: Kibogora polytechnic
MINISANTE: Rwanda Ministry of Health
SDGs: Sustainable development Goals
SSA: Sub-Saharan Africa
WHO: World health organization
WHZ: Weight for height z-score

TABLE OF CONTENTS
Contents
DECLARATION
ABSTRACT
DEDICATION
AKNOWLEDGE
LIST OF TABLES
LIST OF GRAPGS AND CHARTS
ACRONYMS
CHAPTER ON2: INTRODUCTION
1.0. INTRODUCTION
1.1 BACKGROUND
1.2. PROBLEM STATEMENT
1.3. PURPOSE OF THE STUDY.
1.4. RESEARCH QUESTIONS
1.5. OBJECTIVES OF THE STUDY
1.6. SIGNIFICANCE OF THE STUDY
1.7. Limitation of the study
1.8. SCOPE OF THE STUDY
CHAPTER TWO: LITERATURE REVIEW
2.0. Introduction
2.1. Definition of key concepts
2.2. Knowledge of mothers toward the preventive of malnutrition among under-five years old
2.3. Mothers’ attitude toward malnutrition prevention
2.4. Mothers’ practices toward malnutrition prevention
2.5. Measures employed by mothers in prevention of malnutrition among under-five children
2.6. Other relevant and related literature to support the study causes of malnutrition
2.6.1. CAUSES OF MALNUTRITION
2.6.2. MEASURES OF MALNUTRITION PREVENTION
2.7. RESEARCH GAP
2.8. CONCEPTUAL FRAMEWORK
CHAPTER THREE: RESEARCH DESIGN AND METHODOLOGY
3.0. INTRODUCTION
3.1. RESEARCH APPROACH AND DESIGN
3.2. TARGET POPULATION
3.4. SAMPLE PROCEDURES
3.5 .SAMPLE SIZE
3.5. RESEARCH INSTRUMENTS FOR DATA COLLECTION
3.6. DATA COLLECTION PROCEDURES
3.7. ETHICAL CONSIDERATIONS
3.8. DATA ANALYSIS
3.9.1. Validity
3.9.2. Reliability
CHAPTER FOUR: DATA PRESENTION, ANALYSIS, INTERPRESENTATION AND SUMMARY
4.0. INTRODUCTION
4.1. PRESENTATION OF FINDINGS AND INTERPRETATION
4.1.1. IDENTIFICATION OF RESPONDENTS
4.1.1.1. AGE OF RESPONDENTS
4.1.1.2.  MARITAL STATUS
4.1.1.3. EDUCATION LEVEL OF RESPONDENTS
4.1.1.4.  OCCUPATION IN DAILY LIFE
4.1.2. Assessment of knowledge of mothers toward the prevention of malnutrition among under five children
4.2. DISCUSSION OF FINDINGS
4.3. SUMMARY OF FINDINGS
CHAPTER FIVE: GENERAL CONCLUSION AND RECOMMANDATION
5.0. INTRODUCTION
5.1. CONCLUSION
5.2. RECOMMANDATION
5.3. SUGGESTION FOR FURTHER STUDY
REFERENCE
APPENDIX

 

CHAPTER ONE: INTRODUCTION
1.0. INTRODUCTION 
Malnutrition is the leading global problem in developing countries (Edith et al. 2016). This causes mortality and morbidity among children and can impair physical and cognitive development of the children. The study aimed at assessing the Knowledge, Attitude, and Practice (KAP) regarding dietary practices in prevention of malnutrition among mothers of under - five children). ( sangra et al,, 2019)
The aims of chapter one is discuss the background of the study, the statement of the problem, the purpose of the study, the objectives of the study, the ones to benefit from the study, the significance of the study, and the scope of the study.
1.1 BACKGROUND  
Worldwide malnutrition is a public health concern. Globally 462 million adults are malnourished (dukhi, 2020). Globally around under-five in 2020, 149million were stunted,45 million were wasted, it was estimated that globally around 45%of death in under-five children are corresponding to malnutrition (WHO,2021) about 230million under-five children in developing countries are experiencing chronic malnutrition and it was indicated that about 54% of under-five deaths in developing countries are associated with malnutrition (Yisak et al,2020). 
Protein energy malnutrition is a leading nutritional problem in India. This cause mortality and morbidity among children under-five years old and can impair physical and cognitive development of children. the study aimed at assessing the knowledge, attitude and practice regarding dietary practices in prevention of malnutrition among mothers of under five years old with sample size 200 mothers of under five years the study shows that (Lakshmi et al,, 2016) majority 112(56%) of mothers had moderately adequate knowledge’s and moderately adequate practices 116(58%) regarding dietary practices in prevention of malnutrition. Favorable attitude towards dietary practices in prevention of malnutrition was found among majority 112(56%) of the mothers the research concludes that adequate knowledge of mothers regarding dietary pattern of under-five children will enhance the attitude and practice to prevent malnutrition. (Lakshmi et al,, 2016)
According to the WHO 2020 report, about 144 million children under 5 years have stunted growth, 47 million children are wasted, whilst 38.3 million are overweight or obese. According to the 2016 south Africa demographic and health survey (SADHS), the prevalence of rate of wasting was found to be 2.5% and stunting remained high at 27% among under-five children. Around 45% of deaths reported amongst under-five children are linked to malnutrition. (Selvandran et al,, 2021)

45.4 million Children under the age of five were wasted globally in 2020, of which 13.6 million were seriously wasted. This is 6.7 percent and 2.0 percent prevalence, respectively. In Kenya, the study done at Nairobi hospital found that malnutrition mothers knew that there is malnutrition but not all. This was due to lack of sufficient knowledge on appropriate feeding and negative cultural beliefs towards certain foods (Josephine, 2018). Mothers’ knowledge about malnutrition enhanced its prevention among under five year’s children (Edith, 2016). It is very needed that all mothers as primary caretakers get knowledgeable about dietary practices and choices in preventing malnutrition (Edith et al. 2016). This will help them to change their behavior and harmful practices towards dietary habits. Training and making sure mothers are aware on good dietary practices will lower rates of malnutrition and henceforth get to the SDGs.

A study conducted in Nepal revealed that there is a great association education level and knowledge which later improved malnutrition prevention among mothers having under five children (Dahal,2020). Assefa et al in their study in rural Ethiopia, found that Overall mothers had good knowledge and a positive attitude about IYCF practices. To support infant and young child feeding practices, behavior change communications intervention strategies should be introduced in mothers to bridge the gap between knowledge and practices (Assefa et al,2021)). 

The Economic Commission for Latin America estimated the cost of malnutrition for Costa Rica, El Salvador, Guatemala, Honduras, Nicaragua, Panama. Approximately, 1 million children have dropped out of school because of malnutrition, and as a result, malnourished children have 2 years less schooling, which brings social and economic losses not only to those affected but to society at large. ( weisstaub et al,, 2014)

In south africa , the demographic and health survery (SADHS) has reported stunting (27%) As the most common manifestation of malnutrition affecting children under five years, with substantially low prevalence of underweight (5.9%) and wasting (2.5%) . major determinants of child  malnutrition in  sub-saharan africa (SSA) are poverty and socioeconomic inequality, to those who live in South Africa . Children in the poorest wealth group had triple prevalence of stunting (36.3%) compared to those in the wealthiest group (12.5%) . Additionally, factors associated with malnutrition among children under five years in African countries include the age of the child, gender, birth weight, birth order, maternal education, mother’s body mass index, clean water availability, hygiene and sanitation, family structure and family size (modjadji et al,, 2020)
This study looked at risk factors for emaciation and stunting in children aged 6–59 months in the Ugandan general population. Secondary data from the 2011 Uganda Demographic and Health Survey were used. A sample of 2214 children was studied. Two-variable analysis and multivariable conditional logistic regression were used to determine the association of risk factors with childhood wasting and stunting. 5% and 33.5% of malnourished children are stunted. (Odjidja et al,, 2022) Burundi, a small, low-income and densely populated country in East Africa, has one of the highest rates of malnutrition in the world. According to the Burundi Demographic and Health Survey 2016-2017, 55.9% of children under 5 years of age are chronically malnourished, the highest rate in the world, with 5% suffering from various forms of acute malnutrition.

In Rwanda, mothers training about nutrition, Kitchen Garden and regular growth and malnutrition monitoring was a central core value that empowered malnutrition rates reduction in rural areas (UNICEF, 2017). In 2022, 2063 children under the age of five were screened in Kibogora district hospital’s catchment area and revealed that 3% of children were malnourished. Acute and moderate malnutrition was at 82% and acute severe malnutrition was at 18%. (Kibogora DH, 2022) Also this screening indicated that among 660 children screened in the catchment area of Kibogora health center 1% has malnutrition. (Kibogora District Hospital, 2022).
The Rwanda Demographic and Habitation Census of 2015 revealed that 2% of children younger than five were wasted (down from 3% since 2010) whereas 38% of children younger than five were stunted (down from 44% since 2010) (UNICEF, 2017). The Rwandan government worked on women’s empowerment was built into the UNICEF nutrition programme and has taken place through mechanisms such as savings and loan groups for mothers, many partners found they had to proactively manage gender dynamics in ways that went beyond what was originally expected (MoH, 2017).
Sufficient understanding of mothers regarding dietary practices of under-five children is very important as it enhances change their attitude and harmful practices in solving the nutritional health problems in our settings (Sangra, 2019).

The Rwandan government launched a sustained drive in 2013 to improve family nutrition circumstances, focusing on expectant and nursing women, infants in their first 1000 days, and children (Rwandan ministry of health, 2014). This initiative comprises neighborhood-based activities that are aimed at the aforementioned disadvantaged population, such as cooking demonstrations, model kitchen gardens, and feeding demonstration. According to the Rwandan Ministry of Health (2014), this was intended to improve the growth of appropriate mother's knowledge, attitude, and behaviors for better feeding. (Rwandan ministry of health, 2014). (Nsengiyumva, 2016) The study was conducted in 12 health centers supervised by kibogora hospital. the structured questionnaire was addressed to 24 health care providers in charge of nutritional program at selected health centers to explore the predictors of nutritional management failures for acute malnutrition and chronic malnutrition among children below 5years old. the study included 169 children, out of which 78 were boys and the remaining 91 were girls. The study included 36.6% of 12-18 months old children of which boys were 38.5% while girls were 55.2%. unexpected, girls were breastfeeding for long period than boys. More than 50% of the children had childhood illness. 20.2% exhibited stunting include both moderate and severe ,42.6% were underweight and 10.1% were wasting. The overall prevalence of malnutrition was 72.8%nutritional management intervention by social works revealed 70.8% of them educated mothers on the role of breastfeeding and balanced diet. (Nsengiyumva, 2016) Health system predictors such as poor knowledge of mothers and low family income linked malnutrition.
1.2. PROBLEM STATEMENT
The World Health Organization (2014) established global nutrition targets for 2025 with the intention of supplying frameworks and assisting policymakers in taking appropriate action to prevent malnutrition and associated complications. 
Poor knowledge of primary care givers is among the factors contributing to malnutrition as a study conducted in India revealed that mothers need appropriate knowledge which should affect their attitudes and practices in prevention of malnutrition (Edith et al, 2016). 
(Mawa et al,, 2018) Malnutrition remains a major cause of morbidity and mortality in children under 5 years of age, especially in developing countries. The burden of malnutrition in children under 5 years of age is a great concern to policymakers and public health professionals in globally. Preventing and treating malnutrition is a top priority in the United Nations Development Program to 2030. 
The government of Rwanda began a sustained campaign in 2013 to improve family nutritional conditions, with a particular emphasis on pregnant and breastfeeding mothers, as well as children in their first 1000 days. This program includes community-based activities like cooking demonstrations, model kitchens, and feeding demonstrations that are targeted at pregnant and breastfeeding mothers, as well as children under two years old, with the goal of enhancing the development of appropriate eating habits.
 Even if this were done, 33% of children in Rwanda are stunted (short for their age), 1% are wasted (thin for their height), and 8% are underweight (thin for their age); 36% of these children come from rural areas, 20% come from urban areas, and 40% come from the western province (National Institute of Statistics of Rwanda, 2020). a cross-sectional study from the Rwanda Demographic and Health Survey from 2010 revealed that 42% of under-five children with stunting are of mothers with no education (Nzayirambaho,, 2018) elaborating on the strong correlation between the high prevalence of malnutrition and the lack of knowledge of mothers as primary caregivers for children under-five years old. In the Nyamasheke district, 34% of all children under the age of five were stunted in 2018 (Nyamasheke District, 2018). ). In 2022, 2063 children under the age of five were screened in Kibogora district hospital’s catchment area and revealed that 3% of children were malnourished. Acute and moderate malnutrition was at 82% and acute severe malnutrition was at 18%. (Kibogora DH, 2022) Also this screening indicated that among 660 children screened in the catchment area of Kibogora health center 1% has malnutrition. (Kibogora District Hospital, 2022).
1.3. PURPOSE OF THE STUDY.
The aim of this study is to determine mother’s knowledge, attitude and practices toward the prevention of malnutrition among under-five children attending kibogora health center.
1.4. RESEARCH QUESTIONS 
•	What is the mother’s knowledge and attitude toward the prevention of malnutrition?
•	What are the mothers’ practices toward the prevention of malnutrition? 
•	What are the measures employed by mothers in prevention of malnutrition among under-five children?
1.5. OBJECTIVES OF THE STUDY 
•	To assess mother’s knowledge and attitude toward the prevention of malnutrition 
•	To identify the mother’s practices toward the prevention of malnutrition.
•	To evaluate measures employed by mothers in prevention of malnutrition among under-five children

1.6. SIGNIFICANCE OF THE STUDY
This research offers data on moms of children under five years old's understanding of preventative strategies for malnutrition. Our knowledge and abilities will be improved, allowing us to put this experience to use and take part in activities that involve problem-solving while helping the community. The mothers of children under the age of five will get new knowledge in accordance with the suggestions in order to assess their capabilities in putting the prevention of malnutrition measures into practice.

The findings of this study will be useful to KHC as they will identify areas for improvement on malnutrition preventive measures in the catchment area. These efforts will benefit the community the health center serves. The Nyamasheke District Health Directorate will make use of the information and promote malnutrition prevention strategies. The results of this study will be made available to the university library, where they will be used by nursing educators as references and to advance new information. For the benefit of the larger community, we anticipate publishing this work in regional publication.

1.7. Limitation of the study
1. Some respondents failed to understand the purpose of the study clearly and give wrong answers. They also thought that the information given was affecting their future in their endeavors and business dealings.

2.  This research required financial resources and need to be financed ourselves but due to unsatisfactory resources like money and time, it required to us to even work in extra time for achieving the output as expected.
1.8. SCOPE OF THE STUDY
The study was conducted on mothers with under-five year’s children attending Kibogora health center catchment area. The health center is located in Nyamasheke district, Western province, Republic of Rwanda. During the period of June and august 2023.

CHAPTER TWO: LITERATURE REVIEW
2.0. Introduction
Malnutrition among children under five is among the most common global burden. Malnutrition contributes to childhood short- or long-term complications like increased morbidity, mortality, impaired intellectual development, and increased risk of diseases in adulthood, with lack of knowledge and proper feeding practice by their mothers being the leading cause. (MINISITRY OF HEALTH, 2018).

This chapter outlines the literatures related to the mothers with under-five year’s children in the presentation of malnutrition, the various measures employed by mothers in prevention of malnutrition in the under-five; the problems faced by mothers in the prevention of malnutrition. The chapter ends with any other relevant and related literature to support the study.
2.1. Definition of key concepts
Knowledge: refers to familiarity, awareness or understanding gained through experience study. ( Imera, 2016)
Attitude: refers to a learned tendency to evaluate certain behaviors, it can either be positive or negative judgement towards a given behavior. (Imera, 2016)
Practices: something that is done regularly or habitually. (Imera, 2016)
Malnutrition: in this study stands for deficiencies or imbalances in person’s intake of energy and /or nutrients. (WHO, 2019)
Malnutrition is a condition that results from eating a diet in which nutrients are not enough or are too much such that it causes health problems especially a common pediatric, where the nutrients involved are, calories, vitamins, proteins, carbohydrates and mineral. (Fonyuy, 2015).
Malnutrition in this study might be interpreted as an insufficient supply of nutrients in a person's daily meal preparation. Stunting and other effects are caused by undernutrition, over nutrition, and illnesses caused by micronutrient deficiencies, including as vitamin A insufficiency, iron deficiency anemia, iodine deficiency disorders, and scurvy.
Prevention measures: defined as any reasonable measures taken by any person, public or private entity or organization, in response to an incident, to prevent, minimize, or mitigate loss or damage or to effect environmental clean-up (Insider, 2022).
Preventive measures in this study might be interpreted as any activity intended to hinder, anticipate, inhibit, or avoid any behavior that would result in unhealthful living situations for children.
Children under the age of five: According to the United Nations Convention on the Rights of the Child, a child is a person who is younger than the age of 18 (UNICEF, 2020). A child under the age of five is a person who has not yet turned five. 

Children under five years old are defined in this study as those who are between the ages of 0 and 5, and whose mothers collaborate with other public, private, and humanitarian organizations to better the lives and living conditions of children in that age group by providing them with everything they need for a better and safer life.
2.2. Knowledge of mothers toward the preventive of malnutrition among under-five years old
In order to effectively manage this malnutrition among under five children, mothers' knowledge regarding the prevention of malnutrition is essential. As the primary caregivers for children, mothers have a crucial role in their growth and in maintaining their health, such as preventing malnutrition (Edith et al., 2016). One of the causes of malnutrition is inadequate awareness among primary caregivers, as evidenced by a study done in India that found that mothers require the right information to change their attitudes and behaviors in order to avoid malnutrition (Edith et al., 2016).

According to a study done on mothers of children under the age of five in a New Delhi slum, 40% of them had poor knowledge, 33.3% had average knowledge, and 26.7% had good knowledge about malnutrition and how to prevent it (Mishra et al., 2017). It was concluded that these mothers generally have poor knowledge.

Research done at the University of Nairobi on mothers of malnourished infants at Kitui County Hospital revealed that they had little understanding about breastfeeding as a means of preventing malnutrition. A high percentage of moms (80%) who attended high school, knew that breastfeeding initiated earlier (within the first hour) prevents malnutrition. His research found that although women have limited nutritional knowledge, education can have a significant impact on the proper time of breastfeeding beginning (Imera, 2016). According to a study carried out in Nigeria, young children's HAZ (height for age z-score) and WHZ (weight for height z- score) are independently and favorably related to their mothers' knowledge. Where mothers' HAZ and WHZ scores are significantly and favorably correlated with their degree of education—typically beyond primary—researchers have proposed that these moms should not be in-school mothers. To help them acquire the necessary skills, attitudes, and behaviors that will result in optimal child nutrition outcomes, nutritional education is necessary.

According to a demographic and health census carried out in Rwanda in 2019–2020, the percentage of kids who are stunted and underweight increases as the mother's education level declines. According to this study, 6% of children whose mothers have completed at least a secondary school suffer stunting, compared to 45% of children whose mothers have no formal education (National Institute of Statistics of Rwanda, 2020).
2.3. Mothers’ attitude toward malnutrition prevention
According to research from South Tarawa, Kiribati, women who are malnourished and have children under five have a moderate level of attitudes and practices around nursing, weaning, food, and vaccinations. Those factors are very crucial in preventing childhood malnutrition, as attitude and knowledge coupling with preventive measures showed a beneficial role ( Reiher et al., 2020).
Even though the majority of mothers had fair to good knowledge, attitudes, and behaviors about under-five nutrition and malnutrition prevention, a study of 300 women with children under the age of five who attended Miran Sahib's Primary Health Center in India revealed that mothers' education will improve mothers' attitudes and behaviors toward the prevention of malnutrition (Sangra et al, 2019).While the majority of mothers had fair to good knowledge, attitudes, and practices regarding malnutrition prevention and under-five nutrition, a study of 300 mothers with under-five children who visited the Primary Health Center of Sahib in India found that mothers' knowledge would improve their attitudes and practices toward the prevention of malnutrition.
According to a study done in the Department of Pediatrics at the Hindu Rao Hospital and North Medical College in Delhi, India, 65 mothers and caregivers of children under the age of five who were admitted to the hospital with severe malnutrition had a fair attitude toward the prevention of the condition through the requirement of antenatal visits, the use of medication during this time and at the time of delivery, immunization, and growth monitoring. 
According to a study done in the Department of Pediatrics at the Hindu Rao Hospital and North Medical College in Delhi, India, 65 mothers and caregivers of children under the age of five who were admitted to the hospital with severe malnutrition had a fair attitude toward the prevention of the condition through the requirement of antenatal visits, the use of medication during the antenatal and at the time of delivery, immunization, and growth monitoring (Tahilramani  et al., 2021). Programs for feeding children include a strong emphasis on educating mothers about this crucial component of child care and helping them adjust their attitudes while doing so (Tahilramani et al., 2021). A study conducted on mothers of malnourished children in Kitui County Hospital indicated that they feeding practices were influenced by some negative attitudes including negative cultural belief toward certain food (Imera, 2016).
2.4. Mothers’ practices toward malnutrition prevention
It has been demonstrated that mothers' practices to avoid malnutrition are strongly correlated with their knowledge, level of education, and socioeconomic standing. Research on mothers of preschoolers in the Indian district of Trivandrum found that only 19.1% of mothers had any formal education. 34.8% of 	mothers had less adequate knowledge about malnutrition prevention, whereas 33.2% had high knowledge. 36.6% of moms reported having poor practice, compared to 24.3% of mothers who reported having adequate practice (Ragab et al., 2021).
Research on parents of children under two years old in Ventaquemada ( orlando et al., 2019), Colombia Showed that despite the fact that the majority of parents and other adults who care for children had positive views and knowledge about baby feeding; the lack of application of information was a result of societal values, beliefs, and both individual and societal emotions (oscar et al., 2019).

Early supplemental feeding is crucial for preventing malnutrition in young infants under the age of two. According to a Nepalese study, only 64.4% of mothers are aware of the ideal time to start complementary feeding, but only 55.6% actually do it. Additionally, 9.6% of mothers postpone complementary feeding for longer than six months, which increases the likelihood that their children will become malnourished (sabina shrestha et al., 2021).
There is a gap in mothers' feeding practices, according to a study done on mothers of malnourished kids at the Kitui County Hospital. The study found that among mothers with kids older than 6 months, about 51.9% stop breastfeeding after starting complementary food (Imera, 2016). According to a study done on mothers of children under the age of two at the Kathmandu Medical College and Teaching Hospital, out of 250 mothers surveyed, even though 60.4% knew to start breastfeeding right away, 71.6% knew to exclusively breastfeed for six months, and 64.4% knew the right age to start complementary feeding, only 55.6% mothers actually did it (Sabina Shrestha et al., 2020).According to a cross-sectional study from the 2010 Rwandan Demographic and Health Survey, there is an increased risk of childhood stunting in children who are breastfed for only one year. There is also no correlation between child hood stunting and proper solid food initiation and early initiation to breastfeeding. These findings led researchers in Rwanda to conclude that proper breastfeeding practices and complementary food initiation are among the most preventive factors for malnutrition ( Nsereko et al., 2018)

2.5. Measures employed by mothers in prevention of malnutrition among under-five children

Though the majority of mothers have fair to good Knowledge, attitude, and practice toward malnutrition prevention in under-five child nutrition; mothers’ attitude and practice toward the prevention of malnutrition are enhanced by mothers‟ knowledge, so that those mothers become aware of malnutrition prevention measures set at their disposition (Sangra, et al, 2019).
The need for strong, locally-based infant and young child feeding programs, emphasizing mothers' knowledge of these crucial aspects of child care and helping mothers put their newfound knowledge of anti-malnutrition strategies into action is paramount (Tahilramani G, et al., 2021).

According to a study on mothers of malnourished children at the Kitui County Hospital in Kenya, 51.9% of mothers with babies older than 6 months stop breastfeeding them once complementary food is introduced (Imera, 2016). The study concluded that there is a gap in mothers' feeding practices. In Rwanda, a cross-sectional study from 2010 indicated that appropriate nursing practices and supplemental food introduction were among the most preventative factors for malnutrition:
A survey on demographics and health in Rwanda found that the risk of having children has risen. There is no correlation between childhood stunting and appropriate solid food introduction and early initiation to breastfeeding training (Nzayirambaho,, 2018). Stunting in children who are Breastfed for just 1 year. In Rwanda, a cross-sectional study from 2010 indicated that appropriate nursing practices and supplemental food introduction were among the most preventative factors for malnutrition:

As conclusion A survey on demographics and health in Rwanda found that the risk of having children has risen. However, none of the above-mentioned studies were conducted putting focus of the malnutrition prevention measures, by showing their effectiveness based on mothers‟ knowledge as the first care givers to their children still under five years, which explains the reasons why this study is very important and is going to bring solutions highlighting the role of boosting mothers‟ knowledge in prevention of malnutrition and its related consequences.
2.6. Other relevant and related literature to support the study causes of malnutrition
2.6.1. CAUSES OF MALNUTRITION 
The main categories of malnutrition are categorized into three: immediate, underlying, and root causes
Immediate causes: These factors are closely linked to inadequate dietary intake and infectious diseases, with diarrheal illnesses and HIV/AIDS being the most common infectious diseases that have been reported to hasten malnutrition due to the fact that they decrease nutritional absorption and utilization (UNICEF, 2016, 2007)
These problems include food insecurity, such as poor access to and availability of food. The underlying factors can include insufficient eating habits, such as incorrect breastfeeding and unsuitable care for children and women (Ministry of health, 2007).
Inadequate meal composition for newborns and/or children, in addition to supplemental feeding techniques. Inadequate primary healthcare is one of the root reasons of the rising rates of malnutrition, which results in children receiving inadequate growth and developmental opportunities. Nutritional surveillance, assistance, and treatment in cases of malnutrition (Joseline, 2023)
Root causes: These include economic inequalities and weak points, inadequate institutional support for nutrition interventions, unfavorable climate change, a lack of arable land, ownership and control over family resources, and low literacy rates particularly among women are a few (RDHS,2015).
2.6.2. MEASURES OF MALNUTRITION PREVENTION
According to Vollmer (2014), reported that poor practices of breastfeeding and complementary feeding and especially dietary habits among other factors can contribute to the high prevalence of undernutrition among children (Vollmer, 2014). In Rwanda a study conducted by Basinga (2013) showed that high prevalence of malnutrition maybe caused by the fact that the proportion of mothers capable of composing a balanced meal remains low (24-38%). Also, Basinga (2013) pointed out that being poor household was a documented risk to having (Rwandese wealth index 1and 2) undernutrition among children (Basinga,2014). The ministry of health recommend the following for the prevention of malnutrition: Regular monitoring of under five-years children for growth at health center and community levels; doing regular weight gain monitoring for pregnant women, through the ANC at health center and community levels; Promoting good and balanced nutrition among the population, especially in specific and vulnerable groups such as children under-five years, orphans and other vulnerable children, pregnant and lactating women, old people, refugees (Rwandan Ministry of Health,2007)
Additionally, the following activities were listed as being part of the prevention of malnutrition in children under the age of five: growth monitoring, oral rehydration, breastfeeding, vaccination, female education, family spacing, food supplements, and nutrition for children under the age of five and prevention of dietary deficits (Mohsen. et al., 2019).
2.7. RESEARCH GAP
Few information is known about the knowledge, attitude and practices of mothers with children under five on malnutrition prevention in rural areas of Rwanda in general and specifically at Kibogora health center in Nyamasheke district. We are conducting this study to assess those gaps among those mothers with children under five years at Kibogora health center. 
2.8. CONCEPTUAL FRAMEWORK

Figure 1:Conceptual Framework
(Quamme, 2022) Based on this figure, the dependent variables are practices of mothers toward malnutrition prevention where it depends on independent variables such as Demographic factors, knowledge, and attitude. The intermediate variables are food availability and accessibility, and attendance in community-based nutritional education programs. This means that mothers’ practices can change or appear in a given way due to mothers’ Demographic factors, Knowledge, and attitudes without forgetting the effect of food availability and accessibility and government inputs. (UNICEF, 2017)
 (Nida et al,, 2019) This indicates that, in general, mothers' behaviors are affected by their demographics (i.e., their age, level of education, marital status, etc.), their level of knowledge, which may be low or high depending on how they perform on various assessments, and their socioeconomic situation. Attitudes that depend on how well they perform on the different tests, may be favorable or negative. However, mothers' behaviors could alter as a result of intermediary factors like government intervention, changes in food accessibility and availability, or both. (Sangra , et al. , 2019)
CHAPTER THREE: RESEARCH DESIGN AND METHODOLOGY
3.0. INTRODUCTION
This chapter is composed of the study area, study design and approach, study population and sampling procedures and sample size, data collection tool and procedure, ethical consideration, suspected data analysis procedures, reliability, and validity measures.
3.1. RESEARCH APPROACH AND DESIGN
1. Research approach
Research approach is the plan and procedure for research that span all the steps from broad assumptions to detailed methods of data collection, analysis and interpretation (Vijay Kumar Grover, 2015). This study was adopted quantitative also means collects numerical data and analyzes it using statistical methods. The aim is to produce objective, empirical data that can be measured and expressed in numerical terms
1.	Research design
A research design is the overall strategy and analytical approach that is used to integrate, in a coherent and logical way, the different components of the study. It includes settings, sampling, ethics, data collection and data analysis (Hssan,2022).
This study we used cross-sectional design means the investigator measures the outcome and the exposures in the study participants at the same time. 
3.2. TARGET POPULATION 
A study population is a group or a set of aspects that have something in common considered for a study or statistical reasoning (Majid, 2018). Targeted population attending kibogora health center in services including vaccination, family planning and antenatal care was 100 mothers.
Inclusion criteria
•	All mothers attending Kibogora health center in services including vaccination, outpatient and family planning who have under five children.
Exclusion criteria
•	All mothers attending kibogora health center who have children above five years old. 
•	3.4. SAMPLING PROCEDURES 
Sampling procedure is defined as a process by which a researcher selects the group that collectively represent a mass data on which data collection was done (Taherdoost, 2016). 
Non probability sampling including convenience where the sample is selected based on non-random criteria, and not every member of the population has a chance of being included. We used convenience sampling to split the population divide into small groups related to people who can answer the survey themselves and those who need help.
 3.5 .SAMPLE SIZE 
Sample size is a count the of individual samples or observations in any statistical setting, such as a scientific experiment or a public opinion survey ( Andrade, 2020)
The sample size corresponds to a total of 100 mothers attending KHC chosen by convenience sampling.
Sample calculation as the following formula
N: Total population
e: The level of precision
N= 10000Total population
n: sample size
e= 10% the level of precision
n= sample size
n=N/1+10000(0.1)2
n=100 people
According to solven’s formula (1967), the sample size of the population follows:
3.5. RESEARCH INSTRUMENTS FOR DATA COLLECTION
The tools used by researchers to actually collect data in the research process. The common data collection instruments in research include questionnaires, documentary analysis and observation (Bhandari, 2023).
A data collection questionnaire to collect raw data had been drafted and verified to make sure all needed data are covered to meet study objectives. We had used questions equal to 35. Questionnaire composed by demographic data, education level, occupation daily activities, marital status and question related to our objectives.
3.6. DATA COLLECTION PROCEDURES
After receiving authorizing letter for conducting research in Kibogora health center. We went in central administration leader for requesting permission to conduct data in different services including vaccination, family planning and antenatal care. We introduced to the chief of services and nurse on duty also they gave us permission to collect data.
At that time researchers had provide the responders with a clear and comprehensive explanation of the research aims and the questionnaire. The agreement to participate into research have been confirmed when a respondent accepts to fill questionnaire. The data collection has been done during day time from 8-17pm every day during working days also data was entered into Microsoft excel 
3.7. ETHICAL CONSIDERATIONS
Eligible participants who signed consent were the ones enrolled in this study. The right to privacy and confidentiality was respected through not filling the names on the questionnaires. The information provided in the questionnaire was highly confidential. 
3.8. DATA ANALYSIS
Data collection is the process of inspecting, cleansing, transforming, and modeling data with the goal of discovering useful information, informing conclusions, and supporting decision-making (Thompson, 2002). The statistical package for social sciences (SPSS) software version 26 was used to clean, check, and analyze the data. The data collected was interpreted using descriptive statistics.
3.9.1. Validity 
Validity refers to how accurately a method measures what it is intended to measure (Fiona Middleton, 2019).
All study objectives are covered by the questionnaire's items. To determine whether the questionnaire is comprehensive, it was reviewed. Under the supervision of the supervisor, adjustments was made as necessary to capture all the necessary information.
3.9.2. Reliability 	
Reliability tells you how consistently a method measure something. When you apply the same method to the same sample under the same conditions, you should get the same results. If not, the method of measurement may be unreliable or bias may have crept into your research. There are four main types of reliability ( Middleton, 2019). 
To evaluate the consistency of the replies supplied on the questionnaire across time in the same set of respondents, we used two respondents to pre-test it. In two sessions over two weeks, we used the questionnaire to gather data from the same member of the population.

CHAPTER FOUR: DATA PRESENTATION, ANALYSIS, INTERPRETATION AND SUMMARY
4.0. INTRODUCTION
This chapter is concerned with the presentation, analysis and interpretation of data collected with providing a summary of a findings.
4.1. PRESENTATION OF FINDINGS AND INTERPRETATION
4.1.1. IDENTIFICATION OF RESPONDENTS
4.1.1.1. AGE OF RESPONDENTS
The high percentage of participants (35%) were between 26-32 years, followed up by 18-25 years age group at a percentage of 27%. The age group with a low percent participation was below 18 years. A high percentage (65%) of the participants were married and the low percentage (10%) was single mothers. Fifty-five per cent of all mothers who were enrolled into the study attended at least primary school and 10 per cent got university training whereas 8% never went to school. Eighty-five per cent of all mothers who consented to participate into the study were living from agriculture whereas 1% were private employees. 

Source: primary data, august 2023

Figure 2:Age-group distribution of the participants
4.1.1.2. MARITAL STATUS
As presented the pie chart below, the marital status of respondents proves that 10% are single mothers, 65% are married, 12% widow while 13% of respondents were divorced.
Source: primary data, august 2023

 Figure 3:Marital status of participants
From the bar graph below show that 57% of the respondents had primary level ,10% had secondary level , university( bachelor and above) 10% , vocational studies 15% and the remaining never attended school 8%.
4.1.1.3. EDUCATION LEVEL OF RESPONDENTS 

Figure 4:Educational background of all participants
Source: primary data, august 2023
From the table below show that 85% of the respondents are farmers and breeders and 12% are in vocational and casual works, 2% are traders while 1% had public or private employees. 

4.1.1.4. OCCUPATION IN DAILY LIFE

Figure 5:Occupation in daily life
4.1.2. Assessment of knowledge of mothers toward the prevention of malnutrition among under five children
 The table below show that all mothers with children under five years old knew that lack of nutrients is the main cause of malnutrition. Is healthy fetal growth dependent on appropriate diet throughout pregnancy? Some mothers (78%) agreed that it is necessary to provide the antenatal care for the health of the fetus, including prevention of intrauterine growth retardation (IUGR) whereas 10% had no idea about this matter. Surprisingly 10% responded that it is not necessary to provide ongoing antenatal care for the health of the fetus, including prevention of intrauterine growth retardation (IUGR) in order to prevent maternal-fetal complications. 93% of the interviewed mothers with children under five responded that the exclusive breastfeeding in the first six months is crucial in preventing malnutrition and even mortality in children under five whereas 6% had no idea about the issue. 
99% of the mothers with children under five responded that it is necessary for every child and infant to undergo a routine post-natal growth checkup at a trained healthcare facility (such a nurse or community health worker) to prevent malnutrition in its early stages whereas 9% had no idea about routine post-natal growth monitoring. 2% of the mothers refuted the necessity of regular postnatal checks of anthropometric measures during childhood. Almost all mothers knew that mothers and children below five years should get a balanced diet and adequate initiation and performance of complementary food from 6 months to 2 years with continuity of breast feeding must be done for malnutrition prevention. 
Mothers with children under five knew the birth spacing practice at 62% with at least 2 years between one birth and the following pregnancy to gain enough time for first 1000 days care whereas 38% responded that there is no need of child-birth spacing practice and its importance.
Table 1:Assessment of knowledge of respondents on prevention of malnutrition In kibogora health center
Items	Range	 Number of respondents	Percentage	
It is clear that a lack of nutrients is the main cause of malnutrition. Is healthy fetal growth dependent on appropriate diet throughout pregnancy	True
	100	100.0	
	False	0	0.0	
	No idea	0	0.0	
To reduce postpartum issues for both mothers and children, is it necessary to provide ongoing antenatal care for the health of the fetus, including prevention of intrauterine growth retardation (IUGR)
	 True	78	78	
	False	105	10.0	
	No idea	12	12.0	
The first six months of nursing exclusive breastfeeding are crucial in preventing malnutrition and even mortality in children under five.
	True	93	93.0	
	False	1	1.0	
	No idea	6	6.0	
Is it necessary for every child and infant to undergo a routine post-natal growth checkup at a trained healthcare facility (such a nurse or community health worker) to prevent malnutrition in its early stages?
	True	89	89.0	
	False	2	2.0	
	No idea	9	9.0	
Adequate initiation and performance of complementary food from 6 months to 2 years with continuity of breast feeding must be done for malnutrition prevention?
	True	100	100.0	
	False	0	0.0	
	No idea	0	0.0	
Nursing mothers and children under five years of age need a balanced diet for the good growth and development of the child? 
	True	99	99.0	
	False	0	0.0	
	No idea	1	1.0	
Children need proper birth spacing with at least 2 years between one birth and the following pregnancy for to gain enough time for first 1000 days‟ care	True	62	62.0	
	False	38	38.0	
	No idea	0	0.0	

Table 2:Assessment of attitude toward the prevention of malnutrition among mothers with children under-five
22% of mothers with children under five strongly agreed that mothers must take adequate nutrition during their pregnancy life time for fetal growth retardation prevention whereas 20% were not sure adequate nutrition during pregnancy is paramount to prevent fetal growth retardation. Some mothers (71%) strongly agreed that intra-uterine malnutrition can be screened and managed early during routine antenatal care whereas 3% disagreed that one can’t screen intra-uterine malnutrition features. A high percentage (91%) of mothers with children under five strongly agreed that newborns can get some infectious diseases like rotavirus and cause malnutrition due to poor diet and possibly habitual rejection of vaccination. 45 of the mothers who responded were not sure that newborns can get some infectious diseases like rotavirus and cause malnutrition due to poor diet and possibly due to habitual rejection vaccination.

Roughly high rates (77-83%) of mothers with children under five strongly agreed that untreated or undertreated infectious and non-infectious diseases like malaria and diarrhea which lead to malnutrition. 97% of the interviewed mothers with children under five strongly agreed that children can catch an under-diagnosed malnutrition due to lack of routine growth monitoring by a skilled provider whereas some of the mothers (3%) agreed that routine growth monitoring by a skilled provider prevents under-diagnosed malnutrition among children under five years of age. 
Seventy-nine mothers with children under five strongly agreed that a child can get malnutrition due to insufficient care resulting from being followed by another baby in a short-time mainly below two years whereas 15% of those were not sure if the practice of childbirth spacing may help prevent malnutrition.

Items	Range	Number of
respondents	Percentage	
Mothers must take adequate nutrition during their pregnancy life time for fetal growth retardation prevention
	 Strong Agree	72	72.0	
	Agree	3	3.0	
	Disagree	5	5.0	
	Not sure	20	20.0	
Intra-uterine malnutrition can be screened and managed early during routine antenatal care?	Strong Agree
	71	71.0	
	Agree	19	19.0	
	Disagree	3	3.0	
	 Not sure	7	7.0	
Your newborn can get some infectious diseases like rotavirus and cause malnutrition due to poor diet and possibly due to habitual rejection vaccination? 
	Strong agree	91	91.0	
	Agree	5	5.0	
	Disagree	0	0.0	
	Not sure	4	4.0	
Your children will develop malnutrition due to an untreated infectious disease such as malaria or diarrhea. 
	Strong agree	77	77.0	
	Agree	13	13.0	
	Disagree	6	6.0	
	Not sure	4	4.0	
Your children can catch an under-diagnosed malnutrition due to lack of routine growth monitoring by a skilled provider
	Strong agree	97	97.0	
	Agree	3	3.0	
	
Disagree	0	0.0	
	Not sure	0	0.0	

Your children will develop malnutrition due to undertreated contagious disease such as malaria or diarrhea diseases	Strong agree	83	83.0	
	Agree	7	7.0	
	Disagree	5	5.0	
	Not sure	5	5.0	
Your children can catch malnutrition due to not getting enough food every time he/she needs it.
	Strong agree	89	89.0	
	Agree	6	6.0	
	Disagree	4	4.0	
	Not sure	1	1.0	
Your child can get malnutrition due to insufficient care resulting from being followed by another baby in a short-time mainly below two years
	Strong agree	79	79.0	
	Agree	6	6.0	
	Disagree	0	0.0	
	Not sure	15	15.0	
Table 3:Levels of mother’s practice toward the prevention of malnutrition among under-five children

Mothers’ practice towards malnutrition prevention among mothers with children under five years was also looked at. A balanced diet taken on appropriate basis during pregnancy was observed in 97% of all mothers who participated into the study. On the other hand, 3% of those mothers responded that they don’t take it. All the mothers with children below five who participated into the study practiced appropriate breastfeeding.

With the reduced home-to-health facility distance in Rwanda, all participants except 9% agreed to have early access to health care. 94% all of the mothers with children below five responded that they can prepare to their children a balanced diet at every meal whereas 6 % were not able to do so. 98% all of the mothers with children below five responded that they can give to their children an adequate diet on every meal whereas 2% of them could not afford adequate diet on each meal.

Childbirth spacing was mostly practiced and all the mothers with children under five years who participated responded that they practice childbirth spacing to prevent malnutrition.

Figure 6:Mother’s practice toward the prevention of malnutrition among under-five children
TABLE 4. Measures employed by mothers in prevention malnutrition of the under-five children
Attitude of mothers with children below five years old in preventing malnutrition was assessed and analyzed too. All the participants agreed that during a routine antenatal checkup, this is a better time for screening and detect malnutrition in intra-uterine and initiation of early   treatment. Eighty per cent of mothers who participated said that they have proper nutrition during pregnancy to prevent fetal growth retardation whereas the remaining 20% were not sure of the attitude. All participants agreed that there are still mothers giving birth at home due to unqualified birth attendants and this is an obstacle to detect and diagnose if an infant is born with undiagnosed malnutrition and practiced steady child care giving, proper breastfeeding exercises, balanced diet and complementary food initiation, vaccination, antenatal and post-natal visits and follow ups among the measures employed by mothers in prevention of malnutrition that had effectively saved children under-five years old attending KHC. 
A great majority of mothers with children under five who consulted KHC during the study period knew that infants who are malnourished in the first 2 years are at risk of chronic malnutrition (88%), 63% of those mothers knew that child can catch an under-diagnosed malnutrition due to lack of routine growth monitoring by a skilled provider. On the side, 18% denied to have known that child can catch an under-diagnosed malnutrition due to lack of routine growth monitoring by a skilled provider. 92% of the participants knew that a child can catch malnutrition due to not getting enough food and balanced diet whenever he/she needs to eat whereas 3% did not even that.

Figure 7:Attitude employed by mothers in prevention of the under-five children

Table 4:Measures employed by mother’s in prevention malnutrition of the under-five children

Items	Range	Number of respondents	Percentage	
Do you agree with the statement that during a routine antenatal checkup, this is a better time for screening? and detect malnutrition in intra-uterine and treat it early? 
	Agree	100	100.0	
	Disagree	0	0.0	
	Not sure	0	0.0	
  Obviously, mothers have proper nutrition during pregnancy to prevent
fetal growth retardation. What is your position? 
	Agree	80	80.0	
	Disagree	0	0.0	
	Not sure	20	20.0	
There are still mothers giving birth at home due to unqualified birth attendants and this is an obstacle to detect and diagnose if an infant is born with undiagnosed malnutrition. Do you agree with this assertion? 	Agree	100	100.0	
	Disagree	0	0.0	
	Not sure	0	0.0	
Infants who are malnourished in the first 2 years are at risk of chronic malnutrition 	Agree	88	88.0	
	Disagree	3	3.0	
	Not sure	9	9.0	
A child can catch an under-diagnosed malnutrition due to lack of routine growth monitoring by a skilled provider	Agree	63	63.0	
	Disagree	18	18.0	
	Not sure	19	19.0	
A child can catch malnutrition due to not getting enough food and balanced diet whenever he/she needs to eat	Agree	92	92.0	
	Disagree	3	3.0	
	Not sure	5	5.0	
Steady child care giving, proper breastfeeding exercises, balanced diet and complementary food initiation, vaccination, antenatal and post-natal visits and follow ups are among the measures employed by mothers in prevention of malnutrition that had effectively saved children under-five years old attending KHC	Agree	100	100.0	
	Disagree	0	0.0	
	Not sure	0	0.0	

Food accessibility and adequate balanced diet to child
Access to food security and balanced diet was quite present to mothers with children below five at 63% rate at Kibogora health center whereas 37% of them did not at a level of getting adequate balanced diet for their children. Food security and accessibility was good among 71 mothers who responded whereas 29% had no full access to food security and availability as reported by respondents. 

Figure 8: Food accessibility and adequate balanced diet to children. Series1 balanced diet adequacy. Series 2: food accessibility.
4.2. DISCUSSION OF FINDINGS 
Majority of the respondents 35 (35%) were in the age range of 26–32 years, which showed that majority of respondents were mature and would thus appreciate the issue at hand and give good responses to the questions asked. The majority of the respondents 65 (65%) were married which implied that respondents would be able to receive support from their partners and ensure adequate and balanced diet to their children which help to prevent malnutrition among children under 5 years. The highest number of respondents 57 (57%) had attained primary level education and the highest number of them were living from agricultural activities; which in turn explained the lack of adequate information about steady child care giving, proper breastfeeding exercises, balanced diet and complementary food initiation, vaccination, antenatal and post-natal visits and follow ups are among the measures employed by mothers in prevention of malnutrition that had effectively saved children under-five years old attending KHC. This again may demonstrate that most respondents and their spouses had attained either little or no formal education and this could negatively influence their awareness about the importance of adequate balanced diet, childbirth spacing and practices in prevention of malnutrition among children under 5 years.

According to mothers’ knowledge 99% of the mothers with children under five responded that it is necessary for every child and infant to undergo a routine post-natal growth checkup at a trained healthcare facility (such a nurse or community health worker) to prevent malnutrition in its early stages whereas 9% had no idea about routine post-natal growth monitoring. 2% of the mothers refuted the necessity of regular postnatal checks of anthropometric measures during childhood. This was contrary to the study of assessing the knowledge, attitudes and practices towards malnutrition prevention practices in Southern India, findings showed that most respondents interviewed had inadequate knowledge about the prevention of diarrhea among children under 5 years. This was attributed to lack of sensitization and health education of mothers about management of diarrhea as well as what could be done to prevent it (Banda et al, 2007). 
About attitude 99% mothers with children under five responded that it is necessary for every child and infant to undergo a routine post-natal growth checkup at a trained healthcare facility (such a nurse or community health worker) to prevent malnutrition in its early stages whereas 9% had no idea about routine post-natal growth monitoring. 2% of the mothers refuted the necessity of regular postnatal checks of anthropometric measures during childhood. This was supported by the study done in Rwanda which revealed that it is necessary to monitor children’s growth from conception till adult childhood to prevent malnutrition (Mujawimana et al, 2023). 
The attitude scores revealed that 100% of the mothers had good attitude towards routine antenatal check-up, as a better time for screening, detecting and treating malnutrition in intra-uterine milieu. This was different from a study in India by Soninka whereby 55.6% had fair attitude, and 14% had poor attitude. 80% of mothers who participated into this study showed a good attitude towards proper nutrition during pregnancy to prevent fetal growth retardation. The study done in Nepal by Dahal et al, also suggests, majority of the respondent, 60.9% strongly agreed with statement, “nutrition during pregnancy for mother is essential to achieve balance diet eating practice for their children (Dahal et al, 2020). 63% of respondents said strongly agreed that a child can get an under-diagnosed malnutrition due to lack of routine growth monitoring by a skilled provider while 18% disagreed that assertion. On the statement, a study by Srijat et al, 2020.revealed that there is a similar trend with 60% of the respondents strongly agreed that routine monitoring of child growth prevents malnutrition.  
According to the practice towards malnutrition prevention showed that 62% of the mothers had good practices, 5% had fair practices, and 20% were not sure about practices against malnutrition. The findings of this study are supported by a study conducted in South India among 200 mothers which had slightly higher good and fair scores.[13] Similar results regarding knowledge were reported by a previously conducted study on 30 mothers. A study conducted by Shettigar et al. reported a very low level of knowledge among mothers which is in contrast to our findings (Shettigar et al.2019). This may be due to differences in the levels of literacy and other sociodemographic factors among the respective study populations. 
Malnutrition is a very complex phenomenon with numerous causes, manifestations and is intergenerational. Like an iceberg, it affects the community both directly as nutritional deficiency diseases and indirectly by leading to high morbidity and mortality among young children (Mujawimana et al, 2023). Maternal knowledge, their attitude, and practices all can have an effect in changing the child’s nutritional pattern. It is very important that mothers show proper knowledge on dietary practices with malnutrition prevention aims, which can help them to have good attitude toward the dietary practices so that they can change their behavior and harmful practices.
4.3. SUMMARY OF FINDINGS
Access to food security and balanced diet was quite present to mothers with children below five at 63% rate at Kibogora health center whereas 37% of them did not at a level of getting adequate balanced diet for their children. Food security and accessibility was good among 71 mothers who responded whereas 29% had no full access to food security and availability as reported by respondents. 
Roughly high rates (77-83%) of mothers with children under five strongly agreed that untreated or undertreated infectious and non-infectious diseases like malaria and diarrhea which lead to malnutrition. 97% of the interviewed mothers with children under five strongly agreed that children can catch an under-diagnosed malnutrition due to lack of routine growth monitoring by a skilled provider whereas some of the mothers (3%) agreed that routine growth monitoring by a skilled provider prevents under-diagnosed malnutrition among children under five years of age
Attitude of mothers with children below five in preventing malnutrition was assessed and analyzed too. All the participants agreed that during a routine antenatal checkup, this is a better time for screening and detect malnutrition in intra-uterine and initiation of early   treatment. Eighty per cent of mothers who participated said that they have proper nutrition during pregnancy to prevent fetal growth retardation whereas the remaining 20% were not sure of the attitude. All participants agreed that there are still mothers giving birth at home due to unqualified birth attendants and this is an obstacle to detect and diagnose if an infant is born with undiagnosed malnutrition and practiced steady child care giving, proper breastfeeding exercises, balanced diet and complementary food initiation, vaccination, antenatal and post-natal visits and follow ups among the measures employed by mothers in prevention of malnutrition that had effectively saved children under-five years old attending 
CHAPTER FIVE: GENERAL CONCLUSION AND RECOMMANDATION
5.0. INTRODUCTION
This chapter provides, the general conclusion of the study, recommendation and suggestion for further studies
5.1. CONCLUSION
This study was chiefly aimed at assessing mothers’ knowledge, attitude and practice toward in prevention of malnutrition among under five children attending kibogora health center Majority mothers had good knowledge, attitude and practices with regards to prevention of malnutrition among mothers with children under-five years of age.  The study shows that all mothers with children under five years old knew that lack of nutrients is the main cause of malnutrition. Is healthy fetal growth dependent on appropriate diet throughout pregnancy? Some mothers (78%) agreed that it is necessary to provide the antenatal care for the health of the fetus, including prevention of intrauterine growth retardation (IUGR).
About Mothers’ practice towards malnutrition prevention among mothers with children under five years was also looked at. A balanced diet taken on appropriate basis during pregnancy was observed in 97% of all mothers who participated into the study. On the other hand, 3% of those mothers responded that they don’t take it means food accessibility and balanced diet is low among all 6 variables
5.2. RECOMMANDATION
TO GOVERNMENT AUTHORITIES AND NYAMASHEKE DISTRICT
- The government should support mothers to participate in income generating activities to help them access food and develop themselves.
- The government should help families find ways to help them access health care quickly, including helping them pay for public health insurance.
- The government needs to make sure that UMUDUGUDU Kitchen program is available to everyone.
- In order to avoid having a significant number of single mothers and divorced mothers, which would have negative effects on children, procedures should be put in place to manage and control divorce within families.
- In order to support the implementation of the existing programs to prevent malnutrition, they should take part in linking nutritional education with income-generating activities for mothers of children under five years old.

TO KIBOGORA HEALTH CENTER
- To ensure that corrective steps are taken, KHC should undertake more frequent home visits with families that have malnutrition cases.
- To assist the improvement of infant immunity, KHC should engage on changing the attitudes of local mothers toward vaccination.
- Health authorities should raise parents' awareness of how to care for their children during the first 1000 days of their lives.
- Health authorities should educate families about family planning as a measure
Ensure the appropriate birth spacing.
- KHC should continue to educate young single mothers about family planning so that family size does not match their economic ability.

TO THE MOTHERS WITH UNDER FIVE YEARS OLD ATTENDING KHC
- Mothers should also regularly visit the health center to receive nutrition education and other training related to better health for pregnant women and children under 5 years old.
- Mothers should continue to practice and implement all available measures to end malnutrition and its consequences, such as stunting, in the family in particular and in the community at large. 
5.3. SUGGESTION FOR FURTHER STUDY
- University and student colleagues should extend research in this field to detect risk factors of malnutrition among under-five years old.

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9.	Hiwot et al,. (2020). Prevalence of malnutrition and its associated factors among under five children at debretabor town north-west ethiopia. Archieves of Community Medicine and, 213.

10.	IMERA. (2016). KNOWLEDGE ATTITUDES AND PRACTICE OF MOTHERS WITH MALNURISHED CHILDREN LESS THAN THIRTY SIX MONTH REGARDING BREASTFEEDING AND COMPLEMENTARY FEEDING IN KITUI COUNTY HOSPITAL . Nairobi: University of Nairobi. 

11.	KIBOGORA DISTRICT HOSPITAL. (2022). malnutrition profile.KIBOGORA: DATA MANAGEMENT OFFICE.

12.	 Edith et al. (2016). knowledge,attitude,and practice(KAP)survey on dietary practices in prevention of malnutrition among of under-five children. semantic scholar,19. 

13.	Mawa et al,. (2018). Malnutrition Among Children Under Five Years in Uganda. 

14.	MINISITRY OF HEALTH. (2018). PTOTOCAL OF THE MANAGEMENT OF ACUTE MALNUTRITION. 

15.	MINISTRY OF HEALTH. ( dec,2013). 1000 DAYS CAMPAIGN IMPLEMENTATION PROGRESS REPORT.

16.	Mohsen et al. (2019). Prevention of malnutrtion of children under 5 old in Iran, A policy analysis. PLOS ONE Journal. 

17.	National Institute of Statistics of Rwanda. (2020). Rwanda Demographic and health Survey, Key indicators. 

18.	 dukhi(2020). global prevalence of malnutrition: evidence from literature. 82.

19.	Nowreen et al,. (2019). knowledge,attitude and practice of mothers regarding nutrition of under-five children: A cross -sectional study in rural settings. 
20.	Nyamasheke District. (2018). SUMMARY OF NYAMASHEKE DISTRICT DEVELOPMENT STRATEGY 2018-2024.

21.	Nzayirambaho,. (2018). Early feeding practices and stunting in Rwandan children: a cross-sectional study from the 2010 Rwanda demographic and health survey. The Pan African Medical Journal. 

22.	Nzayirambaho,. (2018). Early feeding practices and stunting in Rwandan children: a cross-sectional study from the 2010 Rwanda demographic and health survey. The Pan African Medical Journal.

23.	 orlando et al. (2019). knowledge,attitude and food practices in caregivers and nutritional status in infant from ventaquemada,boyaca,colombia. medical archieves of university of manizales.

24.	Quamme & Iversen ( (2022)). Prevalence of child stunting in Sub-Saharan Africa and its risk factors. Clinical Nutrition Open Science 42 (2022) 49e61 University of Oslo, Oslo,Norway. Contents lists available at ScienceDirect Clinical Nutrition Open Science atwww.clinicalnutritionopen. 

25.	RWANDAN MINISTER OF HEALTH. (2014). 1000 DAYS CAMPAIGN IMPLEMENTATION PROGRESS REPORT.

26.	RWANDAN MINISTER OF HEALYH. (2007). NATIONAL FOOD AND NUTRITION POLICY.

27.	 Shrestha et al. . (2020). Knowledge, Attitude and Practices among Mothers of Children 6 to 24 months of Age Regarding Complementary Feeding. Journal of Nepal Medical.

28.	shrestha et al. (2021). knowledge,attitude and practices among mothers of children 6 to 24 months of age regarding complemantary feeding. jouranal of nepal medical association.

29.	Sangra S, et al. . (2019). . Knowledge, attitude, and practice of mothers regarding nutrition of under-five children: A cross-sectional study in rural settings. . International Journal of Medical Science and Public Health, 392.

30.	Sangra, et al. (2019). Knowledge, attitude, and practice of mothers regarding nutrition of under-five children: A cross-sectional study in rural settings. s. International Journal of.

31.	 sangra et al,. (2019). knowledge,attitude,and practice of mothers regarding nutrition of under-five children . 

32.	Tahilramani , et al. (2021). To Study Knowledge, Attitude and Practices (KAP) of Mothers of Children (1-59 Months) Admitted with Severe Acute Malnutrition (SAM) Regarding Feeding and Prevention of Malnutrition. Indian Journal of Nutrition.

33.	UNICEF. (2017). MONITORING TRACKS MANY LEVELS OF CHANGE. 

34.	UNICEF. (2015). Rwanda has made significant progress in the fight against malnutrition.

35.	UNICEF. (2020). the state of world 's children 2017.available at:https://www.unicef.org/sowc/.
36.	USAID. (2020). Country profile:Rwanda.'' availabe at: https://feedthefuture.gov/country/rwanda.

37.	WHO. (2019). Malnutrition in India: status and government initiatives. 

 2019 | Vol 8 | Issue 5

APPENDICES 1:INFORMED ONSENT

Title of the study: Assessment of mother’s knowledge, attitude, and practices toward the prevention of malnutrition among under-five children.
We are UWONAKUNZE thabitha and MUTESI belyse, student at KIBOGORA POLYTECHNIC University, studying bachelor in science of nursing. we conducting this study in partial fulfilments of the requirements for the bachelor with honors in science of nursing. The purpose of the study is to determine the knowledge, attitudes and practices of mothers to prevent malnutrition in children the age of five in kibogora health center. Nyamasheke district, Rwanda. you have been selected to participate in this research effort. Your participation is voluntary and you have right to withdraw at any time.

Feedback from you and others participants informs knowledge. Attitudes and malnutrition in her children under the age of five in kibogora health center nyamasheke district, Rwanda. This survey only takes about 15 minutes. If you don’t want to participate, no problem. Please indicate if you agree to participate your name and signature/or fingerprint. The information you provide will be kept strictly confidential. Their names cannot be published in any way.

If you have concerned this research, you should ask the researcher to the following address:
_ UWONAKUNZE thabitha :(0786582575)
_MUTESI belyse:(0781401652)

Do you consent to participate                    yes                             No

If yes: code of participant………………………. signature………………………… Date……………………….Names of interview (write’s name) …………………. signature………………………date………………………………

APPENDICES 2:QUESTIONNAIRE (ENGLISH)
INSTRUCTIONS
Please answer each of the following questions Please tick the most appropriate
Answer using (V) sign in the corresponding box. This research aims to determine Knowledge,
Attitude and practice of mother toward the prevention of malnutrition in under-five children in kibogora health center of nyamasheke district, Rwanda.
 Read carefully and answer the questions below

SECTION A: IDENTIFICATION OF RESPONDENTS
1. Age in years
a) Under 18 years old……………………………………………………………
b) 18-25…………………………………………………………………………
c) 26-32…………………………………………………………………………...
d) 33-40…………………………………………………………………………..
e) Above 40….…………………………………………………………………  

2. Marital status of respondents
a) Single mother………….……………………………………………………...
b) Married……………. …..……………………. ………………………………..
c) Widow …………...…………………………………………………………...     
d) Divorced………………………………………………………………………...

3. Education Qualification
a) Never attend school ……………………………………………………………
b) Primary………………………………………………………………………….
c) Secondary……………………………………………………………………….
d) Vocational studies ……………………………………………………………...
e) University (Bachelors and above) ………………………………………………

4. Occupation in daily life:
a) Farmer and/or Breeder…………………………………………………………  
b) Vocational and casual workers………………………………………………….
c) Traders ………………………………………………………………………… 
d) Public or private employees ……………………………………………………

SECTION B: KNOWLEDGE OF MOTHERS WITH UNDER-FIVE YEARS CHILDREN IN THE PREVENTION OF MALNUTRITION ATTENDING KHC.
5. It is clear that a lack of nutrients is the main cause of malnutrition. Is healthy fetal growth dependent on appropriate diet throughout pregnancy?

a) True….………………………………………………………………
b) False…………………………………………………………………
c) No idea…….………………………………………………………   

6.	To reduce postpartum issues for both mothers and children, is it necessary to provide ongoing antenatal care for the health of the fetus, including prevention of intrauterine growth retardation (IUGR)?

a) True….……………………………………………………………   
b) False………………………………………………………………
c) No idea…….………………………………………………………

7.	The first six months of nursing exclusive breastfeeding are crucial in preventing malnutrition and even mortality in children under five.

a) True….……………………………………………………………
b) False……………………………………………………………   
c) No idea…….…………………………………………………… 

8.	Is it necessary for every child and infant to undergo a routine post-natal growth checkup at a trained healthcare facility (such a nurse or community health worker) to prevent malnutrition in its early stages?

a) True….……………………………………………………………
b) False………………………………………………………………
c) No idea…….………………………………………………………

9.	Adequate initiation and performance of complementary food from 6 months to 2 years with continuity of breast feeding must be done for malnutrition prevention?

a) True….………………………………………………………………
b) False…………………………………………………………………
c) No idea…….………………………………………………………   

10.	Nursing mothers and children under five years of age need a balanced diet for
the good growth and development of the child? 

a) True….………………………………………………………………
b) False…………………………………………………………………
c) No idea…….…………………………………………………………

11.	Children need proper birth spacing with at least 2 years between one birth and the following pregnancy for to gain enough time for first 1000 days‟ care?

a) True….…………………………………………………………
b) False…………………………………………………………    
c) No idea…….……………………………………………………

SECTION C: MALNUTRITION PREVENTION ATTITUDE RELATED FACTORS OF DOMESTIC MOTHERS
12.	 Mothers must take adequate nutrition during their pregnancy life time for fetal growth retardation prevention
i.	Strongly agree …………………………
ii.	Agree……………………………………
iii.	 Disagree ………………………………
iv.	 Not sure…………………………………
13.	 Intra-uterine malnutrition can be screened and managed early during routine antenatal care?
v. Strongly agree …………………………………
vi. Agree………………………………………… 
vii. Disagree ……………………………………   
viii. Not sure………………………………………
14.	Your newborn can get some infectious diseases like rotavirus and cause malnutrition due to poor diet and possibly due to habitual rejection vaccination? 
 v. Strongly agree ………………………………….
vi. Agree…………………………………………...    
vii. Disagree ………………………………………...  
viii. Not sure………………………………………….

15.	Your children will develop malnutrition due to an untreated infectious disease such as malaria or diarrhea. 
  v. Strongly agree …………………………………….
vi. Agree………………………………………………...
vii. Disagree ……………………………………………
viii. Not sure…………………………………………….

16.	Infants who are poorly fed in their first 2 years are exposed to chronic malnutrition
i. Strongly agree………………………………………
ii. Agree………………………………………………
iii. Disagree……………………………………………
v.	Not sure…………………………………………

17.	Your children can catch an under-diagnosed malnutrition due to lack of routine growth monitoring by a skilled provider

v. Strongly agree………………………………………
vi. Agree………………………………………………
vii. Disagree……………………………………………
viii. Not sure…………………………………………  
18.	Your children will develop malnutrition due to undertreated contagious disease such as malaria or diarrhea diseases
ix. Strongly agree…………………………………………
x. Agree………………………………………………….
xi. Disagree………………………………………………
xii. Not sure……………………………………………   
19.	Your children can catch malnutrition due to not getting enough food every time he/she needs it.

xiii. Strongly agree…………………………………………..
xiv. Agree…………………………………………………….
xv. Disagree………………………………………………… 
xvi. Not sure…………………………………………………
20.	Your child can get malnutrition due to insufficient care resulting from being followed by another baby in a short-time mainly below two years
xvii. Strongly agree………………………………………………
xviii. Agree………………………………………………………
xix. Disagree……………………………………………………  
xx. Not sure………………………………………………………
SECTTION D: MALNUTRTION PREVENTION PRACTICES RELATED FACTORS AMONG DOMESTIC MOTHERS.

21.	Do you take a balanced diet and on appropriate basis while you are pregnant?
a.	Yes  
b.	No   

22.	Do you attend all recommended 8 routine antenatal care visits while you are pregnant?
c. Yes    
d. No    

23.	Do you have your baby immunized with all vaccines recommended by the Rwandan routine vaccination schedule?

a.	Yes   
b.	No    

24.	Do you exclusively breast feed your baby for the first 6 months and give him/her
Complementary food from 6 months to 2 years?
a.	Yes  
b.	No   

25.	Do you routinely monitor your baby’s growth parameters with help of a skilled provider?
a.	Yes  
b.	No
26.	Do you take your baby to a health facility in case of any disease mainly contagious diseases such as malaria and/or diarrhea?
a.	Yes  
b.	No   
27.	Do you every time prepare for your child a meal composed of body-building, energy giving, and body protecting food?
a.	Yes   
b.	No   

28.	 Is your birth spacing between the birth of one child and conception of another one at least not below 2 years?
a.	Yes 
b.	No  

SECTION C: VARIOUS MEASURES EMPLOYED BY MOTHERS IN PREVENTION
OF MALNUTRITION IN THE UNDER-FIVES

29.	Do you agree with the statement that during a routine antenatal checkup, this is a better time for screening? and detect malnutrition in intra-uterine and treat it early? 

a. Agree……………………………………………………………
b. Disagree…………………………………………………………
c. Not sure…………………………………………………………
30.  Obviously, mothers have proper nutrition during pregnancy to prevent
fetal growth retardation. What is your position? 
a. Agree……………………………………………………………
b. Disagree…………………………………………………………
c. Not sure…………………………………………………………
31. There are still mothers giving birth at home due to unqualified birth attendants and this is an obstacle to detect and diagnose if an infant is born with undiagnosed malnutrition. do you agree with this assertion? 
a. Agree…………………………………………………………… 
b. Disagree…………………………………………………………
c. Not sure…………………………………………………………  
32.  infants who are malnourished in the first 2 years are at risk of chronic malnutrition 
a. Likely………………………………………………………………
b. Not likely……………………………………………………………
c. Not sure………………………………………………………………
33. Is it possible that a child can catch an under-diagnosed malnutrition due to lack of routine
growth monitoring by a skilled provider?
a. Possible……………………………………………………………   
b. Not possible…………………………………………………………
c. Not sure………………………………………………………………
34. Children can be malnourished because of inadequate and unbalanced food. dieting whenever he needs to eat?
a. Agree…………………………………………………………………  
b. Disagree………………………………………………………………   
c. Not sure…………………………………………………………………
35.  Take care of your baby regularly, practice breastfeeding properly, eat a balanced and supplementary diet Start feeding, vaccinations, prenatal and postnatal visits and follow-up as part of Measures used by mothers to prevent malnutrition have actually saved children under five years old to attend KHC; Do we agree with that? 
a. Agree……………………………………………………………………
b. Disagree…………………………………………………………………  
c. Not sure……………………………………………………………………
If any other recommendation, please write it here:
………………………………………………………………………………………………………
THANK YOU SO MUCH FOR YOUR CONTRIBUTION!!!!
APPENDICES 3:CONSENT FORM (KINYARWANDA)

Ifishi itanga uburenganzira

Umutwe w’icyigwa (ubushakashatsi): ibyo ababyeyi b’abagore bitabira service zikigo nderabuzima cya Kibogora
bakora, baba bashaka gukora cg ubumenyi bafite mu gukumira imirire mibi mu bana bari munsiy’ imyaka itanu.
Twebwe UWONAKUNZE thabitha na MUTESI belyse, Abanyeshuli bo muri
kaminuza ya KIBORA POLYTECHNIC, biga mu cyiciro cya kabiri cya kaminuza (bachelor)
mu ishami ry igiforomo rusange, Turi gukora ubushakashatsi muri gahunda yo kugira ngo
twuzuze ibisabwa kugira ngo tubashe guhabwa impamyabumenyi yo mu cyiciro cya kabiri cya kaminuza mu ishami ry’ igiforomo rusange.
Intego nyamukuru y’ubu bushakashatsi ni ukureba ibyo ababyeyi b’abagore bitabira service zikigo nderabuzima cya 
Kibogora bakora, baba bashaka gukora cg ubumenyi bafite mugukumira imirire mibi mu bana bari munsi y’ imyaka itanu.
Mwatoranyijwe mu kugira uruhare muri ubu bushakashatsi. Uruhare rwanyu ni ubushake, kandi mufite uburenganzira bwo kuva muri iki gikorwa igihe cyose bibaye ngombwa. Amakuru uributange n’andi aributangwe nabandi kubijyanye n’ ibyo ababyeyi b’abagore bahabwa service kukigo nderabuzima cya Kibogora bakora, baba bashaka gukora cg ubumenyi bafite mu gukumira imirire mibi mu bana bari munsi y’ imyaka itanur. Iri bazwa rirabatwara iminota cumi n’itanu (15minutes). Udashaka kugira uruhare muri iri bazwa, ntacyo bitwaye. Niwemera kugira uruhare muri iri bazwa, uragaragaza amazina yawe, umukono cyangwa igikumwe byawe. Amakuru uributange aragirwa ibanga kandi amazina yawe ntazatangazwa mu buryo ubwo aribwo bwose.
 Uramutse ufite ibibazo kuri ubu bushakashatsi, wabaza Abashakashatsi kuri aderesi zikurikira:

Amazina: - UWONAKUNZE thabitha   Telefoni: (+250)789612009
                 - MUTSI belyse    Telefoni: (+250) 786582575
Wemeye kubazwa? Y ego                              Oya                   Niba ari yego,

code y’ubazwa………………………. Umukono…………………...itariki…………

Izina Ry’ubaza …………………………………itariki…………

APPENDICES 4:QUESTIONNAIRE (KINYARWANDA)

AMABWIRIZA: Soma neza witonze usubize ibi ibibazo bikurikira
ICYICIRO A: UMWIRONDORO W’USUBIZA
1. Imyaka y’usubiza:
a) Munsi y‟imyaka 18……………………..………………………..
b) 18 – 25………………………………..………………………… 
c) 26 – 32…………………………………………………………  
d) 33 – 40…………………………………………………………  
e) Hejuru ya 40 …………………………………………………… 
2. Irangamimerere ry’usubiza:
a) Wabyaye imburagihe……………………………………………
b) Urubatse ………………………..………………………………
c) Umupfakazi …………………………………………………… 
d) Watandukanye n‟uwo mwashakanye ………………………… 

3. Amashuri usubiza yize:
a) Ntiyize …………………………………………………………
b) Abanza …………………………………………………………
c) Ayisumbuye ……………………………………………………
d) Imyuga ………….……………………………………………
e) Kaminuza n‟andi………………………………………………

4. Amashuri usubiza yize:
a) Umuhinzi cyangwa umworozi…………………………………
b) Akazi gashingiye ku muga cyangawa ibiraka …………………
c) Umucuruzi……………………………………………………  
d) Umukozi ukorera Leta cyangwa ubigo byigenga……………   
5. Ese ibyo kurya bihagije hano mutuye biraboneka?
a. Yego   
b. Oya    
6. Ese mushobora kubona ibyo ubushobozi bwo kugura ibiryo mukeneye
a. Yego   
b. Oya  

ICYICIRO B: AMAKURU YEREKEYE UBUMENYI
7.. Birazwi ko imirire mibi iterwa no kubura intungamubiri zihagije mu mubiri. Imirire iboneye igihe umugore atwite ni ngombwa mu mikurire y‟umwana utwitwe?
a) Ni ukuri……………………………………………………………
b) Si ukuri……………………………………………………………
c) Nta gitekerezo mbifiteho….………………………………………

8. Kwisuzumisha ku mugore utwite ni ngombwa ku buzima bw‟uwo atwite, kuko bifasha kumenya imikurire y‟umwana muri nyababyeyi, hirindwa ko hatabaho igwingira, nk‟uburyo bwo kugabanya ibibazo umwana agira nyuma yo kuvuka cyangwa umubyeyi nyuma yo kubyara?
a) Ni ukuri……………………………………………………………
b) Si ukuri……………………………………………………………
c) Nta gitekerezo mbifiteho….………………………………………

9. Konsa umwana gusa mu gihe cy‟amezi 6 ni kimwe mu by‟ingenzi bifasha kwirinda imfu z‟abana bari munsi y‟imyaka 5 no kubarinda kugira ibibazo bituruka ku mirire mibi?
a) Ni ukuri……………………………………………………………
b) Si ukuri……………………………………………………………
c) Nta gitekerezo mbifiteho….………………………………………

10. gusuzumwa kw‟umugore utwite bikowze n‟umuntu ubifitiye ububasha (urugero nk‟umuforomo cyangwa umujyanama w‟ubuzima wabihuguriwe) ni ingenzi mu kwirinda mbere imirire mibi n‟ingaruka zayo?
a) Ni ukuri……………………………………………………………
b) Si ukuri……………………………………………………………
c) Nta gitekerezo mbifiteho….………………………………………

11. Guha no kongerera umwana inyunganiramirire kuva ku mezi 6 kugera ku myaka 2 ari ko anakomeza kumwonsa ni ngombwa ko bikorwa hirindwa ko umwana yazagira ikibazo cy‟imirire mibi mu mikurire ye?
a) Ni ukuri…………………………………………………………… 
b) Si ukuri……………………………………………………………
c) Nta gitekerezo mbifiteho….……………………………………… 
12. Ari abagore bonsa nabana batarengeje imyaka 5 bakeneye kurya indyo yuzuye kugira ngo abana babashe gugira imikurire iboneye?
a) Ni byo ..……………………………………………………………
b) Si byo………………………………………………………………
c) Nta gitekerezo mbifiteho…………………………………………   

13. Umwana uvutse akeneye gukurikizwa byibuze agize imyaka 2 hagati ye no kongera gutwita kw‟umubyeyi we kugira ngo abone kwitabwaho muri ya minsi 1000 y‟ibanze?
a) Ni byo ..……………………………………………………………
b) Si byo……………………………………………………………  
c) Nta gitekerezo mbifiteho………………………………………     

ICYICIRO C: AMAKURU YEREKEYE IMYUMVIRE

(Subiza ibibazo bikurikira wemeza cg uhakana, kosora mukazu gahwanye nimyumvire yawe)

14. Ababyeyi bagomba gufata indyo yuzuye mu gihe batwite kugirango birinde igwingira ry’ umwana ukiri munda?

a. Ndabyemera cyane……………………………………………
b. Ndabyemera………………………………………………..    
c. Simbyemera…………………………………………………  
d. Simbizi/Simbyibuka………………………………………….

15. Igwingira ry’ umwana ukiri munda rishPobora kugaragara kandi rikavurwa hakiri kare igihe umuntu apimisha inda uko biteganyijwe.
a. Ndabyemera cyane…………………………………………..
b. Ndabyemera…………………………………………………
c. Simbyemera…………………………………………………
d. Simbizi/Simbyibuka………………………………………   

16. Umwana wawe ashobora kuvukana ikibazo cy’ imirire mibi kandi ntibimenyekane kuberako yavukiye mu rugo ahatari abakozi babihuguriwe?
a. Ndabyemera cyane…………………………………………
b. Ndabyemera………………………………………………. 
c. Simbyemera………………………………………………..
d. Simbizi/Simbyibuka………………………………………	

17. Umwana wawe ashobora kurwara indwara zikomeye nka Rotavirusi zishobora no kumuviramo imirire mibi kuberako utamukingije inkingo zisabwa?
a. Ndabyemera cyane…………………………………………
b. Ndabyemera………………………………………………  
c. Simbyemera………………………………………………  
d. Simbizi/Simbyibuka………………………………………

18. Umwana urya/ugaburirwa nabi mu gihe cy’ imyaka 2 ya mbere y’ ubuzima bwe bishobora kumuviramo kugira imirire mibi y’ akarande?
a. Ndabyemera cyane……………………………………….. 
b. Ndabyemera……………………………………………..   
c. Simbyemera…………………………………………….    
d. Simbizi/Simbyibuka………………………………………

19. Umwana wawe ashobora kuvukana ikibazo cy’ imirire mibi kandi ntibimenyekane kuberako yavukiye mu rugo ahatari abakozi babihuguriwe?

a. Ndabyemera cyane………………………………………..
b. Ndabyemera………………………………………………
c. Simbyemera………………………………………………
d. Simbizi/Simbyibuka……………………………………   

20. Umwana wawe ashobora kurwara indwara zikomeye nka Rotavirusi zishobora no kumuviramo imirire mibi kuberako utamukingije inkingo zisabwa?
a. Ndabyemera cyane……………………………………….
b. Ndabyemera……………………………………………...
c. Simbyemera……………………………………………   
d. Simbizi/Simbyibuka……………………………………..

21. Umwana urya/ugaburirwa nabi mu gihe cy’ imyaka 2 ya mbere y’ ubuzima bwe bishobora kumuviramo kugira imirire mibi y’ akarande?

a. Ndabyemera cyane………………………………………
b. Ndabyemera……………………………………………  
c. Simbyemera……………………………………………..
d. Simbizi/Simbyibuka…………………………………….

22. Umwana wawe ashobora kugira imirire mibi kandi ntibimenyekane kuber ko atigeze apimwa ngo anakurikirannwe mu mikurire ye?

a. Ndabyemera cyane………………………………………
b. Ndabyemera……………………………………………  
c. Simbyemera……………………………………………  
d. Simbizi/Simbyibuka…………………………………    

23. Umwana wawe ashobora kugira imirire mibi kubera kurwara kandi ntavurwe neza indwara zandura nka Malaria ndetse/cyangwa impiswi.?

a. Ndabyemera cyane……………………………………..
b. Ndabyemera………………………………………….  
c. Simbyemera……………………………………….      
d. Simbizi/Simbyibuka…………………………………. 

24. Umwana wawe ashobora kugira ikibazo cy’ imirire mibi kubera kutabona indyo ihagije mu gihe ayikeneye?
a. Ndabyemera cyane………………………………………….
b. Ndabyemera………………………………………………   
c. Simbyemera…………………………………………………
d. Simbizi/Simbyibuka………………………………………  

25. Umwana wawe ashobora kugira ikibazo cy’ imirire mibi kuberako atitaweho neza kuberako wamukurikije imburagihe (munsi y’ imyaka ibiri)?

a. Ndabyemera cyane…………………………………………
b. Ndabyemera………………………………………………...
c. Simbyemera………………………………………………...
d. Simbizi/Simbyibuka……………………………………….

26. Umwana wawe ashobora kugira ikibazo cy’ imirire mibi kubera kutabona indyo ihagije mu gihe ayikeneye?
a. Ndabyemera cyane………………………………………..
b. Ndabyemera………………………………………………
c. Simbyemera………………………………………………
d. Simbizi/Simbyibuka………………………………………

27. Umwana wawe ashobora kugira ikibazo cy’ imirire mibi kuberako atitaweho neza kuberako wamukurikije imburagihe (munsi y’ imyaka ibiri)
a. Ndabyemera cyane…………………………………………
b. Ndabyemera……………………………………………….
c. Simbyemera……………………………………………...   
d. Simbizi/Simbyibuka………………………………………

ICYICIRO CYA D: AMAKURU AJYANYE NIBYO ABABYEYI BAKORA KUGIRANGO BIRINDE IMIRIRE MIBI MU BANA BARI MUNSI Y’ IMYAKA ITANU
Subiza ibibazo bikurikira ukurikije imirimo ukora yaburimunsi. Kosora kuri yego niba ubikora nokuri oya niba utabikora.

28. Ese ufata indyo yuzuye ku kigero gikwiye igihe utwite?
a. Yego  
b. Oya  

29. Ese upimisha inda inshuro 8 zose zateganyijwe igihe utwite?
a. Yego  
b. Oya   

30. Ese wakingije cyangwa ukingiza umwana wawe inkingo zose zisabwa na gahunda y’ ikingira y’ igihugu?
a. Yego  
b. Oya  

31. Ese wonsa umwana wawe ntacyo umuvangiye mu gihe cy’ amezi 6 ukanamuha inyunganirabere kuva ku mezi 6 kugeza ku myaka 2?
a. Yego  
b. Oya   

32. Ese upimisha umwana wawe imikurire ku mukozi w’ubuzima nk uko bisabwa?
a. Yego  
b. Oya   

33. Ese ujya uvuza umwana wawe ku gihe igihe yagize indwara zandura nka Malariya cyangwa Impiswi?
a. Yego  
b. Oya  
34. Ese buri gihe utegurira umwana wawe indyo igizwe n’ ibiryo byubaka umubiri, ibitera imbaraga, ndetse n’ ibirinda indwara?
a. Yego  
b. Oya    
35. Ese ukurikiza umwana nyuma y uko agize imyaka 2?
a. Yego  
b. Oya
Hatri ikindi cyifuzo usigaranye?  Cyandike:   

NDABASHIMIYE KU RUHARE MUGIZE MURI UBU BUSHAKASHATSI!!!!

APPENDICES 5:MAP TO THE STUDY

APPENDICES 6:PLAGIARISM

APPENDICES 7:RESEARCH LETTER