ABSTRACT
The aim of this study was to determine the nutritional status of children five years of age in Bagudo Local Government Area, using anthropometry. This was a cross sectional descriptive study involving Eguare and private children five years of age in Irrua local government area. Subjects were selected using multistage sampling technique over a 3 month period. A proforma was used to obtain information which included age, sex, parental education and occupation. Each child’s socioeconomic class was subsequently obtained using the classification proposed by Olusanya et al. Weight and height of the participants were measured using a digital scale and a wooden stadiometer. BMI, WAZ, HAZ and BMI for age z scores were then derived using the new WHO reference standards.
Three hundred and forty eight (40.4%) children were recruited from public schools while 512 (59.6%) were recruited from private schools. The mean age of the study subjects was 9.18 years with a male to female ratio of 1:1.7.
Normal nutritional status was observed in 691 (80.3%) subjects. Seven (0.8%) children were found to be stunted, 26 (3.3%) wasted and 28 (3.3%) underweight. Overweight was observed in 73 (8.5%) subjects, while 35 (4.1%) were obese. Wasting, stunting and underweight were found to be more prevalent in children aged 12 years (p = 0.001). Males were found to be more obese than females (p = 0.02). Underweight and wasting were significantly more prevalent in children of parents with secondary education and below (p < 0.05). On the other hand, overweight and obesity were more prevalent in children of parents with tertiary education (p < 0.001). Children of lower socioeconomic class were more stunted, underweight and wasted, while overweight and obesity were more prevalent in the upper socioeconomic class. Children attending private schools were more overweight and obese than those in public schools. (p < 0.001)
Majority of the children in Bagudo Local Government Area had normal nutritional status. Factors such as age and sex, parental education and socioeconomic class had a significant impact on nutritional status. Overweight and obesity were more prevalent among the children from the upper socioeconomic class, attending private schools, while stunting and wasting were more in children attending public schools. There is need for health promotion and nutrition education programmes for mothers and school children, which will aid in improvement of nutrition.
CHAPTER ONE
INTRODUCTION
1.1 Background of study
Nutritional status of children is an indicator of the level of development and future potential of the community. A well-nourished population has a capacity to be productive and to improve its standard of living through hard work. Furthermore, in children malnutrition adversely affects their cognitive and learning performance. Adults, who as children suffered malnutrition, suffer functional impairments including reduced intellectual performance and working capacity (Ola et al., 2011). Inadequate nutrition is one of a wide range of interlinked factors that form poverty syndrome – low income, large family size, poor education and limited access to food, water, sanitation and maternal and child health services (UNICEF, 2012). To address malnutrition, the type of malnutrition and nutrition related risk factors need to be identified and evidence based intervention and policies implemented.
Research estimates that the risks related to stunting, severe wasting and intrauterine growth retardation caused 2.2 million deaths and 21% of disability-adjusted life years worldwide for children under 5 years and in Nigeria, infant and under-five mortality rates are 77 and 115 per 1000 live births respectively (MMS /MPHS, 2009). The national figure for acute malnutrition of children under five years old is estimated at 6%, however there are huge variations in different regions of the country. In the Arid and Semi-Arid Areas (ASAL) where food insecurity and natural disasters have often afflicted the population, rates of acute malnutrition are between 15 and 20% of children under five years and sometimes substantially higher (MMS /MPHS, 2009). Prevalence of stunting in Eastern Region where Bagudo Local Government Area is located is estimated at 41.9% (NBS and ICF Macro, 2010).
Nutritional status has been defined as the extent to which the customary diet of any population group has been able to meet their nutritional requirements. It is an important determinant of growth and is the best indicator of the global wellbeing of children. The efficiency with which the body utilizes the food consumed is a key determinant of nutritional status. This can be affected by ill health and reduced significantly by specific disease conditions such as infections, helminthiasis and diarrhoea. When the nutritional status of children deteriorates, it leads to a vicious cycle of recurring sickness and growth failure. Therefore, an in-depth knowledge of the nutritional status of children has far reaching implications for promoting the health of future generations.
The World Health Organization (WHO) refers to malnutrition as “Failure of cells to perform their physical functions due to inability to receive and use the energy and nutrients needed in terms of amount, mix and timeliness. Waterlow and Insel (1995) described malnutrition as “Failing Health that results from long standing faulty nutrition that either fails to meet or greatly exceeds nutritional needs. This description could mean inappropriateness of the food taken. Again, Harrison and Waterlow (1990) defined malnutrition as “The effects of any nutrient deficiency including energy, protein and micronutrients.”
Under-nourished children have lowered resistance to infection; they are more likely to die from common childhood ailments like diarrhoeal diseases and respiratory infections, and for those who survive, frequent illness saps their nutritional status, locking them into a vicious cycle of recurring sickness and faltering growth. Their plight is largely invisible; three quarters of the children who die from causes related to malnutrition were only mildly or moderately undernourished, showing no outward sign of their vulnerability (UNICEF, 2006).
In Asia, the prevalence of stunting (32.8-43.7%) is high, particularly in south and central Asia, although rates of stunting continue to improve throughout this region. In a review of mortality and morbidity trends in Bangladesh between 1970 and 1975 by Hussain (1987) it was found that the crude mortality rate, the infant mortality and the childhood malnutrition rate fell and rose with improvement and deteriorations in food supply that were largely determined by political, economic, climate and social factors.
The importance of addressing childhood malnutrition is a prerequisite for achieving internationally agreed goals to reduce malnutrition and child mortality. Child growth is therefore internationally recognized as an important public health indicator hence growth monitory centers are established in all communities.
Pre school age is a period of dynamic physical growth and mental development.11 Research has shown that poor nutritional status results in low school enrolment, high absenteeism, early dropout and unsatisfactory classroom performance. Well-nourished children perform better in school and achieve their full physical and mental potential.
Nutritional assessment is a detailed evaluation of objective and subjective data relating to an individual’s food intake, lifestyle and medical history. The results of this assessment then leads to either a plan of care or intervention designed to help the individual maintain the assessed status or attain a healthier status. In any community, nutritional assessment is essential for accurate planning and implementation of intervention programmes which are designed to reduce the morbidity and mortality associated with malnutrition. The most frequently used quantitative method for assessment of the nutritional status of individuals or population groups is anthropometry.
1.2 STATEMENT OF PROBLEM
Malnutrition situation in Nigeria is a serious public health problem among pre-school children. About 3 out of every 10 young children are undernourished. Nearly 2 out of every 10 babies born die before their 5th birth day. Undernutrition is an important cause of death (MoH 1995)
According to the Reproductive and Child Health (RCH) annual report, (2005) among children registered at Child Welfare Clinics, malnutrition rates have been increasing over the years. In children 0-11months, about 4.1% of children were found to be malnourished. This shows an increase when compared with 2.6% in 2004.Among children 12-23 months, 7.5% were malnourished as compared to 5.4 in 2004.
The 1998 Nigeria Demographic and Health Survey (NDHS) shows that under-nutrition is significant in Nigeria with one in four Nigerian children less than five years of age being stunted (short for their age) 10 % wasted and 25% underweight. The Survey revealed that, in general children residing in the three northern regions of Nigeria and children of uneducated mothers are more likely to be malnourished.
It is on this backdrop that this study seeks to examine the nutrional status of Bagudo Local Government Area in Bagudo Local Government AreaKebbi state.
1.4 OBJECTIVES OF STUDY
To determine the nutritional status of children aged 6-12 years who are attending pre schools in Irrua Local Government Area (LGA) of Kebbi State.
Specific Objectives
To determine:
1. the prevalence of malnutrition (under nutrition, stunting, wasting, obesity, overweight) in children five years of age in Bagudo Local Government Area using WAZ, HAZ scores, BMI.
2. the factors which influence the nutritional status of this age group.
3. the differences in the aforementioned anthropometric indices between children in private and public schools in Bagudo Local Government Area.
1.4 Research Questions
1. What is the prevalence of malnutrition (under nutrition, stunting, wasting, obesity, overweight) in children five years of age in Bagudo Local Government Area using WAZ, HAZ scores, BMI ?
2. What are the factors which influence the nutritional status of Bagudo Local Government Area?
3. What are the differences in the aforementioned anthropometric indices between children in private and Eguarepre school in Bagudo Local Government Area.
1.5 Significance of study
Sub-Saharan Africa is still struggling with high rates of underweight and stunting in children under five, with the proportion of stunted children being 41%. These figures are only estimates, since no direct data are actually available to assess the magnitude of these problems, identify their causal factors, or describe the nutritional status of the poor.
School age children constitute about 24% of the total population in developing countries and about 15% in industrialized countries. In Nigeria, school age children constitute 23% of the total population. As today’s children are the citizens of tomorrow’s world, their survival, development and protection are requirements for the future development of humanity. People who survive a malnourished childhood are less physically and intellectually productive, and suffer from more chronic illness and disability. Until recently, overnutrition, obesity and its attendant complications had been perceived as problems of developed countries only. However, overnutrition is increasing even in countries where hunger is endemic.Recent reviews have reported significant increase in overweight and obesity in developing countries.
The ultimate objective of nutritional assessment is to improve human health.31 Nutritional assessment is recommended to map out the magnitude and geographical distribution of malnutrition as a public health problem. This will aid in determining the factors which may be responsible for the nutritional status of a community, and where possible, suggest appropriate corrective interventions which can be applied, with continuing community participation.
The Nigeria National Demographic Health Survey (NDHS) measures children’s nutritional status by comparing height and weight measurements against an international reference standard. These surveys, carried out in 2003 and 2008 did not capture the important issue of malnutrition among school aged children, as only children under 5years were surveyed.
1.7 Scope of the Study
The study was limited to mothers of pupils in EguarePre school. The respondents for the study include women of child bearing age. The study focused on nutritional status and mothers. The study used questionnaires, interview schedule and observation checklist to collect data from the respondents The findings of the study cannot be generalized to other parts of the country unless a similar study is done in areas with similar characteristics.
1.7 LIMITATION
The researcher was handicapped by both time and finances. The time was too short for a study of this magnitude. Also the non-availability of finance to enable the researcher move around was another limitation.
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