ABSTRACT
Prevalence and determinants of nutritional disease among 499 under-five (U5) children and their mothers (496) in Unguwar Zango, Yauri Town was investigated through a cross- sectional survey using cluster sampling techniques based on probability proportion to size of Emergency Nutrition Assessment (ENA) for Standardized Monitoring and Assessment for Relief and Transitions (SMART) methodology. Malnutrition in the study area is unacceptably high with Global and Severe Acute Malnutrition at 12.8% and 5.4% respectively, stunting at 40.3% and underweight at 24.4%. For the mothers only 1.9% were underweight with about half (46%) overweight / obessed. Crude death rate was fifty-nine deaths per thousand live births (59/1000) with U5 years children mortality rate of 78/1000 and morbidity rate 17.2%. Majority of the children (79.5%) had fever, followed by cough (32.5%), malaria (29.8%), diarrhoea (27.3%). Mean U5 years children serum concentrations of Iron, Zinc, Calcium, Phosphorus, Vitamin A, Vitamin D and Haemoglobin levels respectively are 80.50±17.90µg/dl, 164.9±105.1mg/dl, 8.4±1.3mg/dl, 6.4±2.2mg/dl, 229.8±33.0 nmol/L, 89.1±82.1µg/L, 11.7±1.4g/dl, while that of their mothers are 85.69±30.69µg/dl, 153.76±97.28mg/dl, 8.54±0.98mg/dl, 5.82±1.90mg/dl, 131.76±130.98nmol/L, 118.11±115.28 µg/L, 12.55±1.03g/dl respectively. Feeding practices shows 30.6% initiated breastfeeding within 30 minutes of birth and 22.4% exclusively breastfed for up to 6 months. Determinants of nutritional disease at P< 0.05 include childcare, place of delivery, immunization status, early initiation to breastfeeding, exclusive breastfeeding practices, use of colostrum and age. There is high prevalence of double burden of nutritional disease among under-five children and their mothers in Unguwar Zango with multifactorial determinants.
CHAPTER ONE
1.0 INTRODUCTION
1.1 Background
Malnutrition is insufficient, excessive or imbalanced consumption of dietary energy and nutrients. It manifests in different forms, such as undernutrition, overnutrition and micronutrients malnutrition and results from either inadequate or excessive availability of energy and nutrients (Brown et al., 2011). Malnutrition can occur in two forms; Primary malnutrition which results when a poor nutritional state is dietary in origin and secondary malnutrition is precipitated by a diseased state, surgical procedure, or medication. Diarrheoa, alcoholism, AIDS, and gastrointestinal tract bleeding are examples of conditions that may cause secondary malnutrition (Brown et al., 2011).
Malnutrition in early childhood is associated with functional impairment in adult life as malnourished children are physically and intellectually less productive when they become adults. It decreases the educational achievement, labour productivity and economic growth of a country. Children that are malnourished tend to have increased risk of morbidity and mortality and often suffer delayed mental development, poor school performances and reduced intellectual achievement. Concurrent high levels of nutritional disease worsen the health status and development potential of a child (Smith and Haddad, 1999).
Globally, nutritional status is considered the best indicator of the well-being of an individual (Dasgupta et al., 2014). The nutritional status of a child is of particular concern because, early years of life are crucial for future growth and development. Under-five children represent the vulnerable and the most important target group where malnutrition plays a pivotal role in their mortality and morbidity along with delayed mental and motor development during these formative years (Dasgupta et al., 2014).
A widely used conceptual framework published by UNICEF in 1990 identifies three main underlying determinants of nutritional status: availability and access to food, the quality of feeding and care giving practices, and the health of the surrounding environment and access to health care services. Each of these determinants is a necessary but not sufficient condition on its own to good nutrition (ARDD World Bank, 2007)
1.2 Statement of Research Problem
The challenges of hunger and inadequate intake of food nutrients which hampers the nutritional status of children and women still remains an issue of concern in Nigeria. Worldwide, almost 7 million children die each year before they reach their fifth birthday, while India (24%) and Nigeria (11%) together account for more than one-third of all under- five deaths. Globally, undernutrition is responsible, directly or indirectly, for at least 35% of deaths in children less than 5 years of age (WHO, 2010; You et al., 2011; UNICEF, 2014). The under – 5 mortality rate in Nigeria is 128 deaths per 1000 live births, which implies that one in every eight children born die before reaching their fifth birthday (NDHS, 2013).
Nigeria Demographic and Health Survey (NDHS) revealed that under-5 mortality rate decreased from 201 deaths per 1,000 live births to 128 deaths per 1,000 live births from 2003 to 2013 (NDHS, 2003; NDHS, 2013). However, Nigeria did not achieve the millennium development goals (MDGs) target of reducing the under-5 mortality to 64 deaths per 1,000 live births and the infant mortality to 30 deaths per 1,000 live births (FMOH, 2014).
The estimated maternal mortality ratio in Nigeria of 545 deaths per 100,000 live births in 2008 has increased to 576 deaths per 100,000 live births in 2013 (NDHS, 2008; NDHS, 2013). The NDHS (2008) also reported that 12% of Nigerian women are too thin, but 22% are overweight or obese. The proportion of overweight women is almost twice as high in urban areas as in rural areas (31% compared with 17%) and increases with age, education, and wealth.
Micronutrients deficiencies in Nigeria has remained a great public health concern. The last national Food consumption and micronutrient survey conducted over a decade ago 2001- 2003, 29.5% of preschool children had Vitamin A deficiency, 24.8% of Nigerian children under 5 suffered from marginal vitamin A deficiency while 8% of pregnant women in Nigeria had night blindness. About 20% of the population were at risk of inadequate intake of zinc, 76.1% of pre-school children, 62% non-pregnant women and 66.7% of pregnant women were anaemic. One major cause of anaemia is iron deficiency (Maziya-Dixon et al., 2004; Aminu, 2010; FMOH, 2013). An increased visibility of the problem of "hidden hunger" arising from micronutrient deficiencies is noticed in communities of the Yauri Town. This calls for commitment of all stakeholders as a public health priority to undertake measures to make ending micronutrient deficiencies most especially, vitamin A, zinc, iodine, folate and iron deficiencies in Yauri Town.
The findings from MICS survey in 2011 indicated a high prevalence of nutritional disease amongst under-five children in the Yauri Town. It showed that the prevalence of vital nutrition assessment indicators in Yauri Town such as moderate (-2SD) stunting was 65.1%, moderate wasting 14.2%, and moderate underweight 46.8% (MICS, 2012). There is recently a reduction in these indices according to the report of NDHS (2013) which indicated overall stunting to be 29.6%, wasting 18.8%, underweight 16% in the Yauri Town. Concurrent high levels of nutritional disease worsen the health status and development potential of a child and makes every strategy for health, education and prosperity an uphill struggle.
1.3 Aim and Objectives of Study
1.4.1 Aim
The aim of the study was to determine the burden of nutritional disease, specific determinants causing it by assessing the nutritional status among under-five children and their mothers in Unguwar Zango of the Yauri Town.
1.4.2 Specific objectives;
The specific objectives of the study include;
i. Assessment of nutritional status and prevalence of nutritional disease among under-five children mother pair in Unguwar Zango of Yauri Town.
ii. Determine morbidity and crude death rate among under-five children and their mothers.
iii. Determine micronutrient (Vitamins A, Iron, Iodine, Zinc, Vitamin D, Calcium and Phosphorus) status of the under-five children and their mothers.
iv. Establish the determinants of nutritional disease in the study area.
1.5 Justification
The mortality indices for children in Nigeria are ranked among the worst in the world. Nigeria ranks 9th in global assessment of under-five mortality rate and approximately one million children die annually in Nigeria before their 5th birthday (UNICEF, 2014). The role of adequate and sustainable surveillance particularly for nutrition assessment of children in the community cannot be over-emphasized, considering the efforts in promoting optimal childhood nutrition, growth and development.
Although several studies and attempts to reduce child mortality in Nigeria have been conducted, yet progress on reaching the desired target is still limited. Many of the previous studies were descriptive in nature and lacked detailed analysis of socioeconomic and proximate determinants of child and maternal malnutrition (Ajieroh, 2009).
None or little effort has been devoted to examining the key determinants of nutritional disease among under-five children and their mothers in communities of Unguwar Zango of the Yauri Town that will effectively guide nutrition interventions.
MICS survey in 2011 indicated a high prevalence of nutritional disease amongst under-five children in the Yauri Town (Yauri Town). Hence, this study will provide information that can be used for nutritional surveillance and targeting programmes that would focus more on populations most affected. More importantly, the survey will be instrumental for generating information that will form the basis for developing interventions for nutrition and other health programmes in the Yauri Town as a whole.
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