ABSTRACT
Childhood malnutrition continues to be a public health problem of school-aged children in resource-limited countries. Nutritional status which is an important index for measuring the quality of life especially in children is affected by food intake and incidence of childhood infections. The study so far assessed the dietary habits and anthropometric status of school-aged children in Enugu East L.G.A. The study employed the use of a cross-sectional study design. The population was made up of male and female primary school children in private and public schools in Enugu East L.G.A of Enugu State. The study used a multi-stage sampling technique to select 382 children from both public and private schools. Data for the study were gathered using a structured questionnaire, while the anthropometric data were obtained by taking various measurements of the children such as (weight and height), after which the data were analyzed using descriptive statistics. The result on personal data of the children showed that more than half (54%) of the children were girls, with 37% been the predominant age group between the ages of 6-8 years. The result on socio-economic characteristics of the parents showed that 49.7% of the parents had a secondary education while 31.4% had primary education. The result further showed that 31.7% were civil servants and 27.0% were artisans which was a reflection of their educational qualifications. The anthropometric status of the children showed that children in public schools were malnourished with 25.1% been severely underweight and 7.6% were underweight, 17.8% were stunted, and 7.3% were severely wasted while 17.8% were wasted. The result for the private school children showed that 7.0% were overweight while 8.0% were underweight. More so, 17.8% were stunted, 7.1% were severely wasted while 13.1% were wasted. Finally, on the result on the association between dietary habit and socioeconomic status, the study found that dietary habit had significant (P<0.05) relationship with the socio-economic status of the children. More so, the association between dietary habit and anthropometric status showed that dietary habit had significant (P<0.05) and positive association with anthropometric indices such as weight for age and height for age with weight for height. This result on feeding pattern and 24hour dietary recall suggest that the children consumed more of carbohydrate-rich foods such as starchy staples which may be as a result of the high cost of food as starchy staples are easily available in the study area. The significant association which exists between dietary habit and anthropometric status further buttresses the findings in previous studies, thus a good dietary habit will result in better anthropometric indices for school-aged children.
TABLE
OF CONTENTS
COVER PAGE
TITLE PAGE i
CERTIFICATION ii
DEDICATION iii
ACKNOWLEDGMENT iv
TABLE OF CONTENTS v
LIST OF TABLES
ix
ABSTRACT
CHAPTER 1
INTRODUCTION 1
1.1 Statement
of problem 3
1.2 Objectives 7
1.3 Significance
of study 7
CHAPTER
2
LITERATURE
REVIEW
2.1
Stages/Categories of School Aged Children 9
2.2
Key Nutrient Needs for School-Aged Children 11
2.3 Factors Affecting the Nutritional Status of
School- Aged Children 14
2.4
Review of Key Dietary Habit Variables among School- Aged
Children and Adolescents 18
2.4.1 Breakfast
consumption 18
2.4.2 Fruit
consumption 19
2.4.3 Soft
drink consumption 21
2.5 Methods for Assessing Food Consumption
Pattern of an Individual 22
2.5.1 Food records 22
2.5.2 24-
Hour dietary recall 23
2.5.3 Food frequency questionnaire 23
2.5.4 Diet history 25
2.5.5 Food habits questionnaire (FHQ) 25
2.6 Anthropometry 26
2.6.1 Weight 27
2.6.2 Height 27
2.6.3 Body Mass Index 28
2.6.4 Height-for-age 29
2.6.5 Weight-for-height 30
2.6.6 Body Mass
Index-for-age 31
2.6.7 Waist circumference
(WC) 31
2.6.8 Mid-Upper-Arm
circumference (MUAC) 32
2.6.9 Head circumference 32
CHAPTER 3
MATERIALS AND
METHODS
3.1 Study Design 33
3.2 Area of Study 33
3.3 Population of the Study 33
3.4 Sampling and Sampling Technique 34
3.4.1 Sample Size 34
3.4.2 Sampling Procedure 35
3.5 Preliminary Activities 35
3.5.1 Preliminary visit 35
3.5.2 Training of research assistant 36
3.5.3 Informed Consent 36
3.6 Data Collection 36
3.6.1 Questionnaire Administration 36
3.6.2 Anthropometric measurement 37
3.6.3 Dietary measurement 38
3.7 Data Analysis 38
3.8 Statistical Analysis 39
CHAPTER 4
RESULTS AND
DISCUSSION
4.1 Background characteristics of the
children and socio- economic
status
of their parents 40
4.2
Distribution of children according to their meal pattern 44
4.3 Twenty-four (24) hour dietary recall of the
children 48
4.4
Food frequency and consumption pattern of the children 51
4.5
Anthropometric status of the school aged children 57
4.6
Association between dietary habit and socio-economic status of the children 59
4.7
Association between dietary habits and the anthropometric status of the
children
61
CHAPTER 5
CONCLUSION AND
RECOMMENDATIONS
5.1 Conclusion 62
5.2 Recommendations 64
References 65
Appendix 79
LIST
OF TABLES
Tables Pages
4.1a Personal
characteristics of the children 42
4.1b
Socio-economic status of parents of
the children 43
4.2a Feeding
pattern of school aged children 46
4.2b Feeding
pattern of school children (Contd.) 47
4.3 Twenty-four
(24) hour dietary recall of children for breakfast,
lunch and dinner 50
4.4a Food
frequency and consumption per week of different fruits 53
4.4b Food
frequency and consumption per week of different food groups 54
4.4c
Food frequency and consumption per week of different food groups 55
4.4d Food
frequency and consumption per week of different food groups 56
4.5 Anthropometric status of the children 58
4.6 Association between dietary habit and
socio-economic status of parents
of
the children 60
4.7 Association between dietary habit and
anthropometric status of the children 61
CHAPTER 1
School
age is the active growing phase of childhood (NebGuide Series, 2002). Primary
school age is a dynamic period of physical growth as well as of mental
development of the child. Children and adolescent are considered to be the most
important natural resources and biggest human investment for development in
every community. The health and nutritional status of children is an index of
national investment in the development of its future manpower (Leger and Young,
2009).
Childhood
malnutrition continues to be a public health problem of school-aged children in
resource limited countries. Nutritional
status which is an important index for measuring quality of life especially in
children is affected by food intake and incidence of childhood infections. Of
the 7.6 million deaths reported by the World Health Organization (WHO) in 2010,
64% were attributable to infectious causes including pneumonia, diarrhea and
malaria which claimed the most lives (Liu et
al., 2002). But their severity is greater when confounded by chronic
malnutrition especially in children who are unable to mount an effective immune
response. Chronic under-nutrition in childhood is linked to slower cognitive
development and serious health impairments later in life that reduce the
quality of life of individuals (Rice et
al., 2000; Rayhan and Khan, 2006).
Research indicates that health problems due to miserable nutritional
status in primary school-age children are among the most common causes of low
school enrolment, high absenteeism, early dropout and unsatisfactory classroom
performance (Panda et al., 2000).
Adequate
dietary intake is of vital importance for children’s growth and development,
not only in physiological terms, but also in mental and behavioral aspects
(Merkiel and Chalcarz, 2007; Institute for Health Metrics and Evaluation, 2008;
Anatoszczuk, 2002). Therefore, it is important that early interventions focused
on enabling children acquire healthy eating habits which will continue through
adulthood be carried out (Krawczynski and Kliniczna, 2005). Both excessive and
inadequate intake of energy or nutrients may have a detrimental influence on
children’s health, and predispose to childhood obesity, dental caries,
underachievement at school and lower self-esteem (Lobstein et al., 2004; McCrindle, 2015; Maunder et al., 2015) and also to diseases like hypertension,
atherosclerosis, obesity, osteoporosis and type 2 diabetes later in life. This
means that the prevention of these diseases should start as early on as
childhood (Institute for Health Metrics and Evaluation, 2008).
Adequate
micronutrient status is critical for good health and development during
childhood. Severe anemia, which can result from iron, folate, or vitamin B12
deficiency, among other causes, negatively impacts work capacity, intellectual
performance, and child cognitive development (De Benoist, 2008). Vitamin A
plays a critical role in eye health and immune function (Sommer and Davidson,
2002) and also plays a role in the etiology of anemia. Sufficient iodine is
crucial to the growing child to optimize mental development and prevent goiter
and its complications (Allen et al.,
2006), while zinc is essential for many biologic processes and zinc deficiency
can also affect brain development and cognition (Golub et al., 2005).
Not
much is being done to ensure good health and nutritional status of the
school-aged child, particularly in developing countries. This probably is a
consequence of dearth of data on the factors associated with under-nutrition
among school children (Armecin et al.,
2006; Wolde et al., 2015). The
school-aged child who is a survivor in an environment of high under-five
morbidity and mortality is often not regarded as vulnerable and therefore not
targeted for many nutrition and health programmes. WHO developed 10
recommendations for school health, and initiated a global school health
initiative in ten countries, of which 8 were developing countries (Kolbe,
2001). Despite such initiatives, school health has not been focused in Nigeria
for many years and donor initiated school health projects have come and gone
sporadically over the decades. Absence of functional school health programme
further increases the vulnerability of these children to various nutrition and
health problems that jeopardize their health and educational potentials (Wolde et al., 2015).
Therefore,
understanding the nutritional status of children has far reaching implications
on better development of future generations as well as future development
of humanity (Leger and young, 2009). Schools are considered as perfect
settings for health promotion among children and school staffs (Rezaeian et al., 2014), hence they are a
practical platform to deliver an integrated package of interventions, such as
nutritious meals or snacks, micronutrient supplements or on-site fortification,
infection control, health promotion, and life-skills education, to improve the
health and nutrition of schoolchildren.
Based
on these issues highlighted above, this study is designed to explore the
dietary habits and anthropometric status of school age children in Enugu East
L.G.A, Enugu State.
Despite
advocacy for health and nutrition services in primary schools, there is a clear
lack of data on the actual nutritional status of children in this age group in
developing countries and countries in transition. Most research focuses on
malnutrition in young children under 5 years of age, whereas school-aged
children are often omitted from health and nutrition surveys or surveillance.
Thus access to high-quality data on nutrition and health indicators in this age
group would aid in prioritizing and setting up deliberate, evidence-based
nutrition intervention programs, targeting the nutritional problems that are of
real concern (Armecin et al., 2006).
Despite
the lack of a compiled national data for school aged children, several studies
across the various region in Nigeria have individually reported the prevalence
of key micronutrient deficiencies amongst school aged children. In
Nigeria, the national prevalence of xerophthalmia was 1.1% while the national
prevalence of Vitamin A deficiency (VAD) using serum retinol < 20μg/dl (or
0.7 μmol/l) as cut-off was 28.1%; both values are indicative of a problem of public
health significance in children aged 0-71 months. This national data as
reported by Ajaiyeoba (2001) highlighted that children between the ages of
60-71 months were particularly vulnerable to Vitamin A deficiency. Using serum
retinol as indicator, highest prevalence of vitamin A deficiency was found in
the North East, 49.6%, and North West Zones (48.6%). In the South Eastern Zone,
the prevalence of vitamin A deficiency was lowest (Ajaiyeoba, 2001). To the
best of our knowledge, no recent study on the prevalence of Vitamin A
deficiency among school age children in Nigeria was found. Recent reports were
focused on under-5 children.
The prevalence of anemia amongst school age children
in several studies conducted in African countries are as follows; North Western
Nigerian as reported by Bello-Manga et al.
(2018) was 37.7%; Ibrahim et
al. (2017) reported 40.3% in Sokoto, Ngesa and Mwambi, (2014) reported
25.0% in Kenya; while Pullan et al.
(2013) report was 29.2%, Cape Verde was 23.8% by Semedo et
al. (2014), Sudan was 88.3% by
Eltayeb et al. ( 2016 ) and
Egypt had a prevalence of 59.3% (Salama
and Labib, 2016).
Goitre
prevalence amongst school age children was reported to be 42.2% and 8.3% in
studies conducted in Oyo (Sanusi and Ekerette, 2009) and Akwa Ibom State,
Nigeria (Alozie et al., 2014).
Nwamarah and Okeke (2012) found that the prevalence of Iodine deficiency was
58.3%.
Furthermore,
Malnutrition evident in stunting (21.4%, 34.9%, 11.1% 17.1%) and underweight/
thinness (41.6%, 36.9%, 10.3% 27.3%) prevalence was reported in Khartoum Sudan
(Nabag, 2009), Madagascar (Hirotsugu, 2019), Plateau (Akor et al., 2010) Uyo Nigeria (Opara, 2019), respectively. The high
burden of malnutrition and micro-nutrient deficiency of public health
significant in these studies reported suggests that school age children deserve
attention.
Estimates from National Bureau of Statistics revealed
that 61.2% of Nigerians live above the poverty line (NBS, 2012). Poverty is a
general condition that can limit people’s capacity to live a healthy life.
Studies in relation to poverty and health typically argue that people in
low-income countries lack financial, material or mental means to prevent
disease and do not have access to quality healthcare, education, and that this results
in reduced health and increased disease incidence among the poor (Ahmed et al., 2003).
Furthermore, childhood is the key step for
adopting and consolidating eating habits. This group has been one of the groups
most widely influenced by food globalization (Bogin et al., 2014) given the transformation of the current food model
with a wider range of industrial food, salty snacks, more soft drinks, skipping
breakfast, not eating plenty of fruit, vegetables, grains and drinking milk,
and abandoning traditional cuisine (St-Onge et
al., 2003; Bogin et al., 2014).
Thus their nutritionally inadequate diets make them more vulnerable (Miqueleiz et al., 2014) to health problems.
Children
for who nutrition is the most important element for their physical and mental
development rely on the knowledge of their parents/guardians. Overall, they
decide what food is available to their children and serve as role models by
providing a home. Unfortunately, according to related studies, parents / legal
guardians have poor knowledge of constituents of adequate diet and the
nutrition needs of school age children (Szczepańska et al., 2007).
Therefore
based on aforementioned evidences, this study is designed to determine the
dietary habits and anthropometric status of school aged children in Enugu East
L.G.A, Nigeria.
The
general objective of the study was to determine the dietary habits and
anthropometric status of school aged children in Enugu East L.G.A. The specific
objectives are to;
1. Assess
the personal data of the children and socio-economic status of their parents.
2. Determine
the dietary habits of the children.
3. Assess
the anthropometric status of the children.
4. Determine
the association between dietary habits of the children and socio-economic
characteristics of their parent.
5. Determine
the association between dietary habits and the anthropometric status of the
children.
This
study is expected to add to the limited studies available for school aged
children. Findings from the study will help expose the dietary habits and nutritional
status among the school-aged child within the study location.
The
findings from this study is expected to help to provide a baseline data for
nutritionist, public health workers, policy makers, advocates of nutrition, the
government, and other non-governmental organizations in planning
programs/interventions that will improve on the existing nutritional status and
dietary habits of school aged children.
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