ABSTRACT
Food related behaviours and other lifestyle practices are important determinants of health across all ages, but especially of food security status in older persons (60 years and above). Therefore the study was designed to assess what food related behaviours exist among older persons in Ukwa-East L.G.A of Abia State and to determine how they affect their food security status. A total of 398 respondents were purposively selected. A well structured questionnaire was used to determine their personal and socioeconomic characteristics, food related behaviours, dietary habits, food security status, 24-hour dietary recall, and food frequency, all of which were analyzed statistically with frequencies and percentages and chi-square tests using Statistical Product for Service Solution (SPSS v23). Results showed that (65.1%) of the respondents were females, occupational status of respondents reveal that 22.1% are traders, 23.4% retired civil servants, 24.6% artisans, 25.1% farmers, and 4.8% have other occupations, including fishing. Only a few have secondary (15.8%) and tertiary education (12.8%), others have just primary education (44.7%) or no formal education (26.6%) at all. Most of the older persons report to be Christians (96.7%). Most households were of the 5-7 (30.2) and 8-10 size ranges (33.9%) about 42.0% of which, have wives responsible for upkeep. Older married persons were 42.2% and 34.7% are widowed. Most of the older persons (54.5%) have their monthly incomes as less than N18.000, while about 71.1% spend less than N5,000 on food weekly. The study also revealed food related behaviours such as frequent food shortages (74.9%), lack of meal planning (80.1%), non-consideration of healthy foods in making food choices (64.2%) among the older persons. Results also showed that 50.8% of the older persons often skipped meals, mostly due to lack of appetite (56.0%) and 82.9% lacked scheduled meal times. The most preferred food group was starchy roots and tubers (51.0%) and the most preferred food preparation method was boiling (55.5%). Most older persons reported appetite loss during stress or bad mood (79.9%), most do not like eating (42.5%) or skip meals (44.5%) when alone, however, most reported to eat more (58.8%) when with family members showing the psychological aspects of food intake. Results also shows significant association between food related behaviours and age range (p<0.05), educational attainment, occupation, household size, household upkeep, marital status, monthly income and money spent on food weekly. However, sex and religion show no significant relationship with food related behavior (p>0.05). All of this showed that the food-related behaviours adopted by the older persons in these rural communities adversely affected their dietary patterns and in turn their food security status, as there is also significant relationship between food related behaviours and food security status of the older persons as results of the study show (p<0.05). Based on these findings, it is therefore necessary that Extensive nutrition education programmes should be planned and carried out by nutrition and health workers for older persons in Ukwa-East L.G.A, to enable them achieve all the above listed recommendations. Also, the technical and financial support of the government and related organisations is required to effectively plan, execute and especially monitor and evaluate the recommended intervention.
TABLE OF CONTENTS
TITLE PAGE i
CERTIFICATION ii
DEDICATION iii
ACKNOWLEDGEMENT iv
TABLE OF CONTENTS v
LIST OF TABLES viii
ABSTRACT ix
CHAPTER 1
INTRODUCTION 1
1.1 Statement of problem 4
1.2 Objectives of the study 6
1.3 Significance of the study 6
CHAPTER 2
LITERATURE REVIEW
2.1 Food security and food related behaviours 8
2.1.1 Meaning of food security 8
2.1.2 Food related behaviours 9
2.2 Older persons 10
2.3 Cause and effect relationships 11
2.3.1 Food insecurity, health and old age 11
2.3.2 Food related behaviours and health in old age 14
2.3.3 Physiological changes in old age and food security 17
2.4 Food security situation in Nigeria 18
CHAPTER 3
MATERIALS AND METHODS 20
3.1 Study design 20
3.2 Area of study 20
3.3 Population of study 20
3.4 Sampling and sampling techniques 20
3.4.1 Sample size 20
3.4.2 Sampling procedure 21
3.5 Preliminary activities 22
3.5.1 Preliminary visits 22
3.5.2 Training of research assistants 22
3.5.3 Informed consent 22
3.6 Data collection 23
3.6.1 Questionnaire administration 23
3.6.2 Interview 23
3.6.3 Dietary and Food related behavior 23
3.6.4 Assessment of food security status 24
3.7 Data analysis 24
3.8 Statistical analysis 24
CHAPTER 4
RESULTS AND DISCUSSION 26
4.1 Personal and socio-economic characteristics of older persons 26
4.2 Food related behaviours of older persons 29
4.3 Dietary habits of older persons 31
4.4 Food security status of older persons 34
4.5 24-hour dietary recall of older persons 36
4.6 Food frequency of older persons 38
4.7 Association between food related behaviours and personal/socioeconomic behaviours of the older persons 42
4.8 Association between food related behaviours and food security status of the older persons 45
CHAPTER 5
CONCLUSION AND RECOMMENDATIONS 47
5.1 Conclusion 47
5.2 Recommendations 47
REFERENCES 49
Appendix 1 56
Appendix 2 62
LIST OF TABLES
Table 4.1a Personal and socioeconomic characteristics of older persons 27
Table 4.1b Continuation of personal and socioeconomic characteristics of older persons 28
Table 4.2 Food related behaviours of older persons 30
Table 4.3a Dietary habits of older persons 32
Table 4.3b Continuation of dietary habits of older persons 33
Table 4.4 Food security status of older persons 35
Table 4.5 24-hour dietary recall of older persons 37
Table 4.6a Food frequency of older persons 40
Table 4.6b Continuation of food frequency of older persons 41
Table 4.7a Association between food related behaviours and personal/socioeconomic behaviours of the older persons 41
Table 4.7b Continuation of association between food related behaviours and personal/socioeconomic behaviours of the older persons 44
Table 4.8 Association between food related behaviours and food security status of the older persons 47
CHAPTER 1
INTRODUCTION
At more than 160 million people, the population of Nigeria is the largest in Africa and accounts for 47% of West Africa’s total population (World Bank, 2012). Food is no doubt, the most basic of all human survival needs. Although, so many efforts have been sunk into improving the quality as well as production of world food supplies, food insecurity remains prevalent, particularly in the global southern nations of Asia and Africa, and in Nigeria, malnutrition has resulted in death of many of its citizens (World Food Programme (WFP), 2009). African Food Security Briefs (AFSB) estimated that approximately one out of every three persons in the sub-Saharan Africa is undernourished (Akerele et al., 2013). Achieving a sustainable economic development in Nigeria and Africa at large will continue to be a mirage without well-nourished and healthy people. In fact, failure to ensure food security has unavoidably resulted in many social problems including civil unrest and riots in many major cities of the world (Ogbonna et al., 2013). Behnassi et al. (2013) described food system and its governance as a process with a complex web which many times overlapped or even contradicted with formal policies and regulations, and is made even worse by the unwritten laws and practices which may not be susceptible to political subjugations. Food insecurity is therefore strongly linked with other global issues, such as population growth, surge in energy demand as well as competition for land and water and issues of climate change (Behnassi et al., 2013). Though Nigeria prides itself as the giant of Africa with its economy becoming the largest in 2014, the poverty rate in the country is alarming (Omorogiuwa et al., 2014). Not less than 70% of the Nigerian population is surviving on less than a dollar per day while food insecurity prevalence in the low income urban house-holds and rural areas respectively stands at 79% and 71% and these predispose them to high rates of food insecurity even at household levels and also cause them to adopt certain unfavourable food related behaviours (Akerele et al., 2013).
The agreed definition of Food Security at the 1996 World Food Summit, is that all people, at all times, have physical, social and economic access to sufficient, safe and nutritious food that meets their food preferences and dietary needs for an active and healthy life (Food and Agriculture Organisation, (FAO) 2008).
Although there are commonly used definitions of old age there is no general agreement on the age at which a person becomes old, the common use of calendar age to mark the threshold of old age assumes equivalence with biological age, yet at the same time, it is generally accepted that these two are not necessarily synonymous and the ageing process is of course a biological reality which has its own dynamics, largely beyond human control (Kallus et al., 2005). However, according to Gorman and Petersen (2000) it is also subject to the constructions by which each society makes sense of old age. In the developed world chronological time plays a paramount role, for instance, the age of 60 or 65, roughly equivalent to retirement ages in most developed countries, is said to be the beginning of old age. In many parts of the developing world, chronological time has no importance in the meaning of old age. Other socially constructed meanings of age are more significant in defining old age. Thus, in contrast to the chronological milestones which mark life stages in the developed world, old age in many developing countries is seen to begin at a point when active contribution is no longer possible (Gorman and Petersen, 2000). The aged population is the single largest demographic group at disproportionate risk of inadequate diet and malnutrition. Ageing is associated with a decline in a number of physiological functions that can influence nutritional status (Lintner et al., 2005). Thus, such changes in the oral cavity as lack of teeth and reduced saliva secretion make food consumption more difficult. Deficits in sensory function reduce the pleasure of eating and may provoke undernourishment. The reduced energy and nutrient consumption attacks the energy stores of the body and lowers body weight. As a consequence lean body mass can be reduced resulting in a decrease in basal metabolic rate (Hickson, 2006). These can be worsened by food insecurity which affects all population.
Lifestyle risk factors, of which dietary pattern is a part of, play an important role in people's health conditions (Kuulasmaa et al., 2000). Accordingly, the world views and ideological beliefs that people hold influence their dietary patterns (Eckersley, 2006). Perception is defined as "to become aware or conscious of", which enables the person to interact with the information perceived through behaviours (Sijtsema et al., 2002). A number of studies (Conner and Sparks, 2005; Povey et al., 2000) have demonstrated that attitudes can be strong predictors of health behaviours. Thus, perceptions and attitudes are among the many factors determining health behaviours. Furthermore, Body Mass Index (BMI) is related strongly to dietary behaviours such as consumption of different types and amounts of foods (Herrera et al., 2003).
The Theory of Planned Behaviour is essentially an extension of the Theory of Reasoned Action (Armitage and Conner, 2001). Both theories propose that individuals are more likely to intend to perform a behaviour if they hold favourable attitudes towards performing the behaviour (Conner and Sparks, 2005). Generally, behaviour is caused by attitudes and beliefs and attitudes are formed by evaluation of available information. Others have also found that, regardless of personal taste, a social context in which people eat in the presence of others can influence not only the volume (Wansink and Park, 2001) but also the variety (Pomerlau et al., 2008) of foods consumed. Among older people, having fewer social contacts or living alone is associated with consuming fewer calories, a less varied diet and fewer portions of fruits and vegetables (Lumbers and Raats, 2006). Food-related behaviours may be particularly influenced by these social factors in older persons with limited support, thus affecting their food consumption levels and defining how food secure they are in old age (Turrini et al., 2010). Therefore, though the strength and depth of the linkage between food security and food-related behaviours in older persons cannot be over-emphasized, yet it would be considered considerably in this paper.
1.1 STATEMENT OF PROBLEM
The researcher for this paper came to think of this research subject as a problem based on the views of Food Agriculture Organisation (2010) that refers to food insecurity as the consequences of inadequate consumption of nutritious food, considering the physiological use of food by the body as being within the domain of nutrition and health. Chronic diseases positively associated with food insecurity include hypertension, hyperlipidemia, and diabetes mellitus (Seligman, 2007, Seligman, 2010). Malnourishment also leads to poor health and if left unaddressed, reduced ability of adults to work and to give birth to healthy children and erode children‘s ability to learn and lead productive healthy and happy lives. This truncation of human development undermines a country‘s potential for economic development for generations to come (Idachaba, 2009).
Although food insecurity is a global phenomenon, it is more prevalent in the developing nations including Nigeria, where the study area is located (Nwajiuba, 2013). This age-related loss of muscle mass and function, or sarcopenia, has substantial health consequences and this decline in lean body mass is accompanied by reduced physical performance and loss of functional capacity. Reduced physical exercise accelerates the loss of muscle mass (Kallus et al., 2005). Furthermore, a decline in lean body mass is correlated with an increased risk of developing chronic metabolic diseases, like obesity and type 2 diabetes (Karakelides and Sreekumaran, 2005).
A balanced diet can slow down the ageing process. Unfortunately, many elderly do not maintain an adequate and balanced nutritional status which leads to either malnutrition or obesity, both of which strongly contribute to the ageing process (Mueller et al., 2006). Based on the evidence available, the prevalence of undernutrition is high in older African men (9.5-36.1%) and women (13.1-27%) (Charlton and Donald, 2001).
The problem of food security is one that needs to be treated with serious urgency, because despite the unprecedented efforts by international institutions, the population of the undernourished people in the world still constitutes a major problem in most parts of the world, even in the study area and according to the 2015 assessment of the Food and Agriculture Organization of the United Nations (FAO), around 795 million people in the world remained undernourished (Food and Agriculture Organisation, 2015) and an estimate of 9.6%, translating to about 33.7 million people in West Africa are food insecure (Food and Agriculture Organisation/International Fund for Agricultural Development/World Food Programme, (FAO/IFAD/WFP) 2012).
Over half of the population of older people in the world are not willing to change their eating behaviour as they consider their own diet to be healthy enough (Kearney et al., 2001) and ’eating types’ and ‘habits’ were only changed in the event of severe illnesses (Brombach, 2000).
The above-mentioned food-related behaviours can be seen in varying proportions in the selected study population. Though previous research has been done on the relationship between appetite, food intake and body composition among the apparently healthy elderly in Ukwa-East L.G.A (Erondu, 2012) yet the issues highlighted herein are yet to be addressed and the need to solve them are the essence of this research work.
1.2 OBJECTIVES OF THE STUDY
The general objective is to determine the food related behaviours and food security status of older persons (60 years and above) in Ukwa-East L.G.A of Abia State. The specific objectives are to;
i) assess the basic characteristics and socio-economic status of older persons in the location of study;
ii) determine the food related behaviours existing among older persons in that locality;
iii) assess food security levels among the study population;
iv) draw association between basic characteristics, socio-economic status and food related behaviours;
v) draw association between food security and food related behaviours.
1.3 SIGNIFICANCE OF THE STUDY
The results of this research will help to explain to a large extent the cause of deterioration in the health of older persons with relation to the kinds of food they consume, how they consume it and how much they consume as well. This research work will also raise awareness on the subject of study in the area which currently is not regarded as a matter of importance. The findings of this study will also improve the body of knowledge on other existing studies carried out on nutrition and health related issues on the selected study population and even in the selected study area.
In achieving the objectives of this research project, it is with prospects of enlightening the all concerned government authorities especially the local government of the area of study, non-governmental organizations and other interested agencies, but especially the public (with emphasis on older persons and their caregivers) on the food security issues that exist in the area, especially among the senior citizens, as well as bring to fore the need to tackle the highlighted issues. This research will also serve as a bedrock to other related research works in the future.
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