ABSTRACT
Endemic goiter and iodine deficiency is an important public health problem among women of reproductive age. This study examined the prevalence of goitre among adult females aged 20-35 years in Awgu Local Government Area in Enugu State. The study was a cross-sectional study. A multi-stage sampling technique was used to select a total of 343 respondents. Data on socio-demographic/economic characteristics, food habit and dietary pattern and food frequency of the women were collected using structured and validated questionnaire. The IBM SPSS version 23.0 computer programme was used to analyze the data. Significant relationship was judged at p ≤ 0.05. Data obtained were described using frequency and percentage. Pearson correlation was used to analyze the relationship between the socio-economic/demographic characteristics, dietary pattern and endemic goiter status of the respondents. Result from the study showed that most (43.1%) of the respondents were aged 20-24 years. Slightly more than half (51.6%) of the respondents are students. However, most (94.8%) of the respondents have heard of iodized salt while some (36.4%) heard it from the market. More than half (87.8%) of the respondents use salt packed in small packs in cooking while most (66.2%) of them choose their salt because of the health benefits. Additionally, majority (73.8%) of the respondents do not skip meals while some (30.6%) skip mostly breakfast. Majority (84.3% and 84.5%) of the respondents consume fruits and vegetables regularly. Prevalence of goiter through neck palpation and inspection revealed that most (83.4%) of the respondents do not have goiter while 16.6% had grade 1 goitre. Meanwhile, the iodine status of the women showed that majority (94.2%) of the respondents had optimal iodine status while few had more than adequate iodine status. There was a significant negative relationship (p=-0.043) between urinary concentration of the respondents and parity. There was also a significant negative relationship (p=-0.043) between urinary iodine status of the respondents and the type of salt they use in cooking. The goitre prevalence in this study was 16.6% which is still a public health problem in the study area. This indicates the need for further strengthening of the existing salt iodization program in order to avail homogenously and adequately iodized salt. Also it is necessary to find ways to provide iodine supplements as needed until universal salt iodization (USI) is fully established. Meanwhile, further studies of the association between iodine excretion and biochemical and physiological changes in women should be undertaken to better understand women’s needs for iodine and to develop criteria to monitor them in pregnancy because of the potential harm caused by iodine deficiency during pregnancy.
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 Statement of Problem 3
1.2.1 Objective of the Study 4
1.2.1 General Objective of the Study 4
1.2.2 Specific Objectives of the Study 4
1.3 Significance of the Study 5
CHAPTER 2
LITERATURE REVIEW
2.1 Middle Age Women 6
2.2 Nutrition and Nutritional Needs of Middle aged Women 7
2.2.1 Macronutrients Needs 7
2.2.2 Micronutrients during Pregnancy 9
2.3 Iodine 13
2.4 Importance of Iodine in Human Nutrition 14
2.4.1 Control of the thyroid by iodine14
2.4.2 The importance of iodine nutrition during pregnancy 15
2.4.3 Iodine and Brain Function 15
2.4.4 Fetal and infant development 16
2.4.5 Preventing Fibrocystic breast disease 17
2.4.6 Preventing radiation-induced thyroid cancer 17
2.5 Iodine Deficiency Disorders (IDDS) 18
2.5.1. Endemic Goiter 18
2.5.1.1 Pathophysiology of endemic goiter 19
2.5.2 Endemic cretinism 20
2.5.2.1. Neurological Cretinism 21
2.5.2.1.1 Pathophysiology of neurological cretinism 21
2.5.2.2 Myxedematous Cretinism 22
2.5.2.2.1 Etiology and Pathophysiology of myxedematous cretinism and
thyroid atrophy 23
2.6 Indices for Assessment of Iodine Status in Populations 25
2.6.1 Thyroid size through neck inspection and palpation 25
2.6.2 Urinary iodine concentration 26
2.6.3 Thyroid stimulating hormone 28
2.4.4 Serum Thyroglobulin28
2.7 Factors that Determine Adequate Intake or Availability of Iodine in the Body 29
2.7.1 Iodine content in water 29
2.7.2 Iodine content in Salt 29
2.7.3 Amount of iodine in Soils and Crops 30
2.7.4 Amount of iodine in Animals 30
2.8 Empirical Studies on Iodine Related Disorders 31
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 determination 34
3.4.2 Sampling Procedure 35
3.5 Preliminary Activities 35
3.5.1 Preliminary visits 35
3.5.2 Training of research assistants 35
3.5.3 Informed Consent 35
3.5.4 Ethical Clearance 36
3.6 Data Collection 36
3.6.1 Questionnaire Design 36
3.6.2 Questionnaire administration 36
3.6.3 Urinary Iodine Assessment 37
3.6.4 Neck Inspection and Palpation 37
3.6 Data Analysis 38
3.7 Statistical Analysis 39
CHAPTER 4
RESULT AND DISCUSSION
4.1 Socio-Demographic Characteristics of the Respondents 40
4.2 Awareness of Iodized Salt 43
4.3 Food Habit and Dietary Pattern of the Respondents 44
4.4 Food Frequency Table Showing Dietary Intake of Iodine Rich Food 49
4.5 Prevalence of Goiter Through Neck Inspection and Palpation 50
4.6 Urinary Iodine Status of the Women 51
4.7 Relationship between the Socio-Economic/Demographic
Characteristics, Dietary Pattern and Endemic Goiter Status of the Women 52
CHAPTER 5
CONCLUSION AND RECOMMENDATION
5.1 Conclusion 54
5.2 Recommendation 54
References 56
Appendix 68
LIST OF TABLES
Table 2.1 The spectrum of iodine deficiency disorders, IDD 24
Table 2.2 Criteria for assessing iodine nutrition in a population based on median and/or range of urinary iodine concentrations 27
Table 4.1a: Socio economic characteristics of the respondents 41
Table 4.1b: Socio economic characteristics of the respondents 43
Table 4.2: Awareness of iodized salt 44
Table 4.3a: Food Habit and Dietary Pattern of the Respondent 45
Table 4.3b: Food Habit and Dietary Pattern of the Respondent 47
Table 4.3c: Food Habit and Dietary Pattern of the Respondent 48
Table 4.4: Food Frequency Table Showing Dietary Pattern of Foods Rich in Iodine 50
Table 4.5: Prevalence of goiter through Neck Inspection and Palpation of the Respondents 51
Table 4.6: Urinary Iodine Status of the Respondent 52
Table 4.7: Relationship between the socio-economic/demographic characteristics, dietary pattern and endemic goiter status of the respondents 53
CHAPTER 1
INTRODUCTION
In Nigeria, under nutrition remains a public health problem. Globally, it is estimated that under nutrition is directly or indirectly responsible for at least 45% of all child deaths (World Health Organization WHO, 2018). Under nutrition is the major cause of disability, preventing surviving children from reaching their full physical and intellectual potentials (WHO, 2009). The immediate causes of malnutrition in Nigeria are many and complex. The immediate causes of malnutrition in the first two years of life are inappropriate breastfeeding and complementary practices, coupled with high rates of infections (Nigeria Demographics and Health Survey NDHS, 2008). The underlying factors to themselves are influenced by the socio- economic status of parents/caregivers (Muller and Krawinkel, 2005; Amsalu and Tigabu, 2008) poor knowledge on feeding practices and low education of mother's have also been implicated in malnutrition in children (Appoh and Klekling, 2005; Manga et al., 2014) infant feeding practices have a major role in determining the nutritional status of a child (Betran et al., 2001).
For proper physical and mental development infants should be breastfed within the first hour after birth, exclusively breastfed for the first six months of life and thereafter continue breastfeeding for two years or more, together with safe, nutritionally-adequate, age appropriate, responsive complementary feeding starting in the sixth month (WHO and United Nations International Children Emergency Fund UNICEF, 2018). According to WHO, (2018), breast milk is the natural first food for infants, which provides all the energy and nutrients that the infants needs for the first six months of life, and it continues to provide up to half or more of a child's nutritional needs during the second half of the first year, and up to one - third during the second year of life. It has nutritional and other benefits that improves the health of the child, prevent infant death, childhood illness and non-communicable diseases, while supporting brain development and protecting maternal health. However, around the age of 6 months, an infant's need for complementary foods along with breast milk are necessary to meet those needs and to prevent under nutrition (WHO, 2018).
Complementary feeding as defined by World Health Organization is the process which starts when breast milk alone is no longer sufficient to meet the nutritional requirements of infants, and therefore other foods and liquids are needed, alongside with breast milk, Hence, the transition from exclusive breastfeeding to family foods is referred to as complementary feeding (WHO, 2019). It typically covers the period from 6-24 months of age even though breastfeeding may continue up to two years of age and beyond (WHO, 2018). As opined by WHO (2019), the period of complementary feeding is a critical period of growth faltering during which nutrients deficiencies and illness contribute globally to higher rates of under nutrition among children less than five years is age . The 2017 Nigeria Health Online reported an exclusive breastfeeding rate of 25% after six months of life. In Nigeria, it has been identified that over 50% of infants are inadequate in terms of energy, protein and micro nutrient such as iron, zinc, iodine and vitamin A, the frequency of feeding is usually low, while the quantities given are less than that required for the age of children (Federal Ministry of Health FMH, 2005). The direct consequences of these inappropriate feeding practices is the poor nutritional status of Nigeria under - fives as revealed in the Nigeria Demographics and Health Survey (National Population Commission NPC and NDHS, 2013). The data revealed that 37% of under- fives of Nigeria's are stunted, with 21% several stunted. The prevalence of stunting increases with age from 16% at age 6 months to 46% between 24 to 35 months. Additionally, 18% of Nigerian children are wasted peaking at age 9 to 11 months (NPC and NDHS 2013). Recognizing the role of infant and young child feeding practices on the nutritional status of children less than two years of age, the World Health Organization (WHO) developed and validated a set of care indicators to assess infant and young child feeding practices (WHO, 2008). These indicators encompass both breastfeeding and complementary feeding practices (WHO, 2008). These indicators encompass both breastfeeding and complementary feeding related practices. It is therefore important to ensure that caregivers are provided with appropriate support and guidance regarding optimal feeding of infants and young children to prevent malnutrition.
1.1 Statement of the problem
Globally, childhood under nutrition is one of the most important public health challenges. When considering all causes of under-fives mortality worldwide, it is estimated that 45% of these deaths are attributed to malnutrition (WHO, 2018). In Nigeria, malnutrition is widespread as reported by (UNICEF/WHO/ World Bank, 2016). The data revealed that 45% of Nigeria's under-five children are stunted, 11% are wasted, while 32% were underweight. The world Health Organization, UNICEF, and Nigeria National Breastfeeding policy recommend that children be exclusively breastfed from birth to six months and continued breastfeeding to twenty- four(24) months and beyond for optimal survival, growth and development (WHO, 2018). Unfortunately, only 25% of children under six months are exclusively breastfed in Nigeria (Nigeria Health Online, 2017). Furthermore malnutrition in Nigeria infants was found to be as a result of inappropriate feeding practices, for instance, 50% of Nigerian infants are given complementary foods which are sometimes made from traditional foods mainly of supplemented cereal porridge like maize, millet, etc. And are often introduced too early or too late and are often of poor nutritional value, mostly inadequate in terms of energy, protein and micronutrient such as Zinc, iron, iodine and vitamin A (FMH, 2005), the frequency of feeding is usually low, while the quantities are less than that required for the ages of children. However, the purpose of this study is to evaluate infants and complementary feeding practices of mothers and its relationship to nutritional status of infants.
1.2. Objectives of the study
General objective:
The general objective of this study is to determine the complementary feeding practices and anthropometric status of children in selected rural communities in Ekwusigo and Nnewi North Local Government Area in Anambra State.
Specific Objectives:
1. To determine the socio-demographics and economic characteristics of the mother's.
2. To determine the complementary feeding practices adopted by the mothers in feeding their children.
3. To assess the knowledge and attitude of mothers towards the recommended complementary feeding practices.
4. To assess the anthropometric status of the children.
1.3. Significance of the study
This study will provide an understanding of the complementary feeding practices for children ages (6 to 24months) among the communities and how they are related to the anthropometric status of children. It will also provide the information on mother’s knowledge and attitude towards complementary feeding practices. The finding of this research could serve as reference to students of health - related studies. It could also enable the Government and related authorities to form decision of health and nutritional policies to help them address the poor breastfeeding and complementary feeding practices. Information gotten from this study will help Nutritionist/dietitians in providing nutrition education and awareness for the mother's, caregivers and the entire population of the importance of adequate complementary feeding practices for adequate nutrition and better health outcome.
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