ABSTRACT
A randomized iron and zinc supplementation trial was carried
out in Lafia Local Government, Nasarawa State, Nigeria with a total of 160
children below the age of five years. They were divided into 4 groups each
containing 40 respondents: the Fe-group received daily and for a 3-month period
10 mg of iron, the Zn-group 10 mg Zinc, the Fe-Zn group10mg iron + 10mg Zinc
and the control group, received no supplement. Serum iron (SFe) and serum Zinc
(SZn), with anthropometry were determined before and at the end of the
intervention. Socioeconomic characteristics of the respondents showed that the
female participants (52%) were more than male (48%), the highest number of
household heads were age 30-39 (50%) while 65.5% of the mothers were between
the age range of 21-30 years. Percentage changes in weight, mid upper arm
circumference, MUAC, iron and zinc status were higher in groups supplemented
than those that were not. There was a significant difference (P ˂ 0.05) in SFe
among the 36-47 months age group of Fe group. Horizontal pairs (baseline versus
endline) with different superscripts b and a(P < 0.05) while
pairs with similar superscripts a and a are not significantly different
(P > 0.05). Percentage change in SZn were higher in Zn-group (highest change:
19.10% in female group and 22.36% in male groups) than in Fe-Zn group (highest
% change: 8.45% in male group). However, there was no significant difference
(P ˂ 0.05) in serum concentration and weight in combined Fe & Zn
supplementation. Almost half of the respondents (49.38%) had no knowledge of
micronutrient supplements yet 57% caregivers who knew the importance of
micronutrient supplements do not give their children. There was significant
difference (P ˂ 0.05) in MUAC- for- age as a result of iron supplementation in
females of age group less than 11months while Zn supplementation recorded significant
difference (P ˂ 0.05) in males and females of age group 11 - 23 months. Iron and
zinc supplementation recovered 12.5% severely wasted respondents in Fe- group,
and reduce acute wasting by 10% in Zn- group. In conclusion, this study
revealed that iron and zinc supplementation recorded a significant difference
(P ˂ 0.05) in iron and zinc status and that single iron and zinc supplement
increased weight.
CHAPTER ONE
INTRODUCTION
1.1 Background
The prevalence of food insecurity in sub-Saharan Africa is
the highest in the world, with rates as high as 30% of the population being
undernourished (UNDP, 2011). The United Nations sub-committee on nutrition and
the World Health Organization estimated that about two-third of children in
developing countries show some degree of growth retardation due to
undernutrition. Micronutrients perform essential functions in normal growth and
development beginning in the earliest stages of life. About 40 nutrients which
are indispensable for the maintenance of vital processes, are required in only
very small amounts, for which reason they are called “micro” nutrients. The
child must consume small amounts of some 13 vitamins (Vitamins A, D, E, K, C, B12,
thiamine, riboflavin, niacin, pyridoxine, biotin, pantothenic acid and folate)
and 10 trace elements (zinc, selenium, chromium, cobalt, copper, fluorine,
iron, iodine, manganese and molybdenum). These essential micronutrients fulfill
a variety of special metabolic functions, some acting as cofactors in the
metabolism of proteins and amino acids, lipids and /or carbohydrates and in
energy production (Lander et al., 2008). Some others serve as the catalytic
centres or as structural elements of enzymes or other macromolecules.
Micronutrients cannot be synthesized by humans and must
therefore be obtained from the diet. Micronutrient malnutrition can result not
only from inadequate intake but also from inadequate digestion, and
absorption(Win,2015). According to Federal Ministry of Health (2013), 41% of
Nigerian children under the age of five years is stunted as a result of
malnutrition. Acute malnutrition level is as high as 53% in the North West, 49%
in North East, and 22% in South East (Omotola, 2012). UNICEF (2013) estimated
that 1.1 million children were threatened with severe
acute malnutrition in the Sahel region alone (comprising of 8 states in
Northern Nigeria) which is fueled by poverty, insecurity, insufficient access
to food, inadequate maternal and child caring practices, poor water and
sanitation, inadequate health services and flood. And that a total of 13,574
children with severe acute malnutrition (SAM) were admitted to 479 UNICEF
supported Community Management of Acute Malnutrition (CMAM) sites across
Northern Nigeria.
UNICEF conceptual framework (2009) shows that malnutrition
occurs as a result of two immediate causes: inadequate dietary intake and
diseases, but also recognizes that poverty, human and environmental resources,
economic systems and political and ideological factors are basic causes.
Malnutrition in developing countries has high social and economic costs, such
as increased mortality and morbidity, loss of human potential, decrease in
skills and qualifications, lower productivity and higher poverty rates (Ogbebo,
2014).
Pellertier et al., (1995) estimated the percentage of child
deaths (6-59months) which could be attributed to the potentiating effects of
malnutrition on infectious disease. The results from 53 developing countries
with nationally representative data on child weight-for-age indicate that 56%
of child deaths were attributable to malnutrition potentiating effects. Out of
about 31 widely known micronutrients, five are of public health significance in
Nigeria: vitamin A, iron, iodine, zinc and folate (Umunna, 2014), Micronutrient
deficiency also known as hidden hunger is a major threat to health, growth and
development of infants worldwide (UNICEF, 2011). According to Umunna (2014),
micronutrient deficiency has enormous consequences for economic growth and
human developmentin Nigeria as the connection between suffering, death and
malnutrition is manifested in poorly developed learning abilities, death from
childhood illness of children under the age of five and death of young mothers
at childbirth due to anaemia.
Iron deficiency is the most common
single nutrient deficiency in the whole world and the common cause of anaemia
(Wessling-Resnick, 2014). Preschool children and women of child bearing age are
at highest risk of iron deficiency (Mei et al., 2011). Also infants-especially
those born preterm or with low birthweight or whose mothers have iron
deficiency are at risk of iron deficiency because of their high iron
requirements due to their rapid growth (Aggett, 2012).
Common causes of iron deficiency include inadequate dietary
ingestion or absorption of dietary iron to meet iron losses or iron
requirements imposed by growth or pregnancy. According to Lee and Nieman (2013)
a good amount of iron is lost from heavy menstruation, frequent blood
donations, early feeding of cow‟s milk to infants, frequent aspirin use, or
disorders characterized by gastrointestinal bleeding. The tendency of iron
deficiency increases during periods of rapid growth particularly at infancy
(and the risk is greater in premature infants), adolescence and pregnancy
(Gibson, 2011). Iron deficiency has a number of consequences which include
impaired body temperature regulation, impairments in behavior and intellectual
performance, reduced work capacity, increased susceptibility to lead poisoning,
and decreased resistance to infections (Beard, 2001). During pregnancy, iron
deficiency increases risk of maternal death, prematurity, low birth weight, and
neonatal mortality. During early childhood iron deficiency adversely affects
cognitive, motor, and emotional development that may be only partially
reversible (Lynch, 2011).
Anaemia is a haemoglobin level below the normal reference
range for individuals of the same sex and age, or a haemoglobin level that is
lower than two standard deviations from the mean distribution in a healthy
population of the same gender and age living at the same altitude (Thomas,
2014).
Zincis found in all parts of the body
and plays an important physiologic function as a component of more than 300
enzymes also influencing hormones (King, 2011). Consequently, zinc is involved
in many metabolic processes, including protein synthesis, wound healing, immune
function and tissue growth and maintenance. It canreduce the duration and
severity of a common cold and halt diarrhoea. Severe zinc deficiency
characterized by hypogonadism and dwarfism has been observed in the Middle
East. Cousins (2006) has shown that reduction or cessation of growth in humans
and laboratory animals is an early indication of zinc deficiency and
supplementation in growth-retarded infants and children who are mildly zinc
deficient can result in improved growth response.
1.2 Statement of Research Problem
Nasarawa State is generally regarded as a rural state with
rate of acute malnutrition (19.9%) higher than North Central average (14.3%)
(CS-SUNN, 2015). This has been made worse by the recent ethnic crisis that
engulfed the senatorial district.
Micronutrient undernutrition is generally correlated with
overall malnutrition, since poverty limits both the quality as well as quantity food in the diet
(Horton et al.,2008)
Existing beliefs and practices in infant feeding, like: early
introduction of sweetened palp to infants before 4-6 months; cow‟s milk given
to children before 1 year of age; infants fed using bottle; inappropriate
timing of introduction of weaning foods (either too early or too late), and the
amount of weaning foods (caloric content, nutritional value) contribute to
micronutrient deficiencies.
Poverty, lack of access to a variety of foods, lack of
knowledge of optimal dietary practices and high incidence of infectious
diseases are prevalent in children below 5 years(Chiejina,2012; NDHS, 2013)
Micronutrients deficiencies are not
always clinically apparent or dependent on food supply and consumption
patterns. They are associated with physiologic effects that can be
life-threatening or more commonly damaging to optimal health and functioning
(Tulchinsky, 2010).
Uchendu (2011) reiterated that micronutrient malnutrition is
a serious childhood dietary problem in developing nations citing vitamins A and
B12, iron, folic acid and zinc as preventable causes of poor childhood growth
and school performance.
1.3 Justification
Childhood mortality data indicates that underfive mortality
rate was higher in Nasarawa State than both North Central average and
nationally (HMIS, 2014). Micronutrient deficiencies in early childhood can
lower a country‟s Gross Domestic Product (Win, 2015).
Evidences (Bhutta et al., 1999; Berti et al., 2014) have
shown that the most cost-effective approaches to address symptoms of
micronutrient malnutrition are targeted supplementation and fortification with
iron, iodine, zinc, folic acid, vitamin A, and multi-micronutrients with
adequate monitoring.
In 2008, a group of internationally acclaimed economists,
including five Nobel Laureates, concluded that combating the world‟s malnutrition
problem through the provision of vitamin A and zinc ranked high among the
various cost-effective solutions to the world‟s pressing problems (IZA, 2010).
They calculated that for every dollar invested in zinc supplements, there would
be a return of US $17.
Iron deficiency affects more people than any other condition,
constituting a public health condition of epidemic proportions (WHO, 2003) with
a devastating health consequence.
The National Food and Nutrition
Policy in Nigeria which is a step in addressing the malnutrition problems of
the country in its plan of action sets strategies for improving the nutritional
status of all Nigerians with specific emphasis on the most vulnerable groups
(NFNP, 2005). These include the reduction of undernutrition, especially among
children underfive, in particular, severe and moderate malnutrition by 30% and
reduction of micronutrient deficiencies, particularly which includes among
others Iron deficiency Anaemia by 50%. Zinc supplementation has been associated
with motor development in very low birth weight infants and more vigorous and
functional activity in infants and toddlers (Black, 1998).
Scanty or no data exist on micronutrient malnutrition in
children under five years in Lafia Local Government Area of Nasarawa State.
1.4 Aim and Objectives
1.4.1 Aim
To investigate the effect of iron and zinc supplementation on
the nutritional status of children under five years in Lafia Local Government
of Nasarawa State
1.4.2 Specific Objectives
The objectives of this study includes
i. To determine socio-economic characteristics of caregivers of
children under five years in Lafia Local Government Area of Nasarawa State.
ii. To determine the caregiver knowledge, attitudes and practices
on micronutrient supplementation.
iii. To examine the effect of supplementation (Iron and Zinc) on
some anthropometric parameters of the children under five years in Lafia Local
Government Area of Nasarawa State.
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