Journal of Tropical Pediatrics, 2015, 61, 92–99 doi: 10.1093/tropej/fmu070 Advance Access Publication Date: 8 December 2014 Original paper
by Titilola B. Balogun1 and Alhassan M. Yakubu2 1
Division of Management, Policy and Community Health, University of Texas Health Science Center, Houston, TX, USA 2 Department of Paediatrics, Ahmadu Bello University Teaching Hospital, PMB 06 Shika Zaria – Nigeria Correspondence: Titilola Balogun, Division of Management, Policy and Community Health, University of Texas Health Science Center, 1200 Pressler Houston, TX, 77030 USA. E-mail: . Mailing address for corresponding author: Division of Management, Policy and Community Health 1200 Pressler Houston, TX 77005 USA
SU M MAR Y Good nutrition is necessary for the growth and development of preschool children. In sub-Saharan Africa, however, data on the determinants of their nutritional status are lacking. A cross-sectional survey of 366 preschool children was conducted in a rural community in northern Nigeria. Anthropometric measurements of the children were taken and information about feeding practices, immunization and parental education was obtained from their mothers. Fifty-two percent were stunted, 30% were underweight and 25% were wasted. Recent history of diarrhea was associated with wasting (OR ¼ 2.66, p < 0.001). Children whose fathers had postsecondary education were less likely to be stunted (OR ¼ 0.45, p ¼ 0.01) or underweight (OR ¼ 0.37, p ¼ 0.005). Promoting exclusive breastfeeding, preventing recurrent diarrhea and including fathers in community interventions will improve the health of children in this community. K E Y W O R D S : preschool children, malnutrition, anthropometry.
INTRODUCTION Nutrition is essential to normal growth, development and well-being of children [1]. It is of great importance in the development of the brain and other body tissues, especially in the first 5 years of life when this development is most rapid [2]. The national burden of undernutrition in Nigeria is difficult to estimate due to suboptimal data generation. Undernutrition encompasses underweight (measured as weightfor-age), wasting (measured as weight-for-height) and stunting (measured as height-for-age) and is
indirectly associated with more than 50% of all childhood mortality worldwide [3–4]. There is no recent information on the nutritional status of children aged less than 5 years in this rural community; the last nutritional survey was done more than 30 years ago [5]. National surveys conducted by the World Health Organization (WHO) in 1990 and 2003 showed the prevalence of wasting in preschool children to be 12.6 and 11.8%, respectively, in the rural areas [6]. These figures are, however, much lower
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Recent Illness, Feeding Practices and Father’s Education as Determinants of Nutritional Status among Preschool Children in a Rural Nigerian Community
Determinants of Nutritional Status among Preschool Children
than findings from local surveys carried out in midwestern Nigeria [7–8] within the same time period. Preschool children are a very vulnerable group, yet their nutritional status is the least studied, which makes it difficult to compare results and effect meaningful interventions. The objectives of this study were to compare anthropometric measurements of preschool children to the WHO reference [9] and to determine the impact of feeding practices, socio-economic status and immunization on nutritional status.
Study design A total of 374 children aged less than 5 years were selected by multistage cluster sampling. Of the eight communities that make up Shika village, four were selected by simple random sampling. In the selected communities, houses that were included into the study were again randomly selected. In each selected house, all children aged less than 5 years were included in the study. Children with obvious structural congenital defects and chromosomal anomalies were excluded. Surveys were conducted in the children’s homes. Interviewer-administered questionnaires were used to collect information about breastfeeding, immunization, father’s income, parental education, introduction of complementary foods and consumption of meat, fish, eggs and milk. Anthropometric measurements were then taken. Height (or length), weight and mid-upper-arm circumference (MUAC) were measured and body mass index (BMI) was calculated for each child. Data analysis Data were entered into the WHO Anthro version 2 software [10] and then exported to STATA 11.2 C [11] for further analysis. A final sample size of 366 was attained after data cleaning and editing were completed. The values of continuous variables like age and Z-scores of anthropometric measurements
93
were expressed as means and medians, and then analyzed using linear regression and Student’s t-test. Categorical variables were expressed as proportions and analyzed using logistic regression. Two-tailed estimation of significance was used, and the level of significance was set at p < 0.05. RESULTS Study participants were aged between 2 weeks and 59 months with a mean age of 25.6 months and standard deviation of 18.2. One hundred ninety (52%) were males and 176 (48%) were females (M: F ¼ 1.08:1). Each age-group was fairly equally represented as seen in Table 1. The median Z-scores for the anthropometric measurements by age-group are presented in Table 2.
Underweight Thirty-five percent of children were underweight (weight-for-age Z-score
by Titilola B. Balogun1 and Alhassan M. Yakubu2 1
Division of Management, Policy and Community Health, University of Texas Health Science Center, Houston, TX, USA 2 Department of Paediatrics, Ahmadu Bello University Teaching Hospital, PMB 06 Shika Zaria – Nigeria Correspondence: Titilola Balogun, Division of Management, Policy and Community Health, University of Texas Health Science Center, 1200 Pressler Houston, TX, 77030 USA. E-mail: . Mailing address for corresponding author: Division of Management, Policy and Community Health 1200 Pressler Houston, TX 77005 USA
SU M MAR Y Good nutrition is necessary for the growth and development of preschool children. In sub-Saharan Africa, however, data on the determinants of their nutritional status are lacking. A cross-sectional survey of 366 preschool children was conducted in a rural community in northern Nigeria. Anthropometric measurements of the children were taken and information about feeding practices, immunization and parental education was obtained from their mothers. Fifty-two percent were stunted, 30% were underweight and 25% were wasted. Recent history of diarrhea was associated with wasting (OR ¼ 2.66, p < 0.001). Children whose fathers had postsecondary education were less likely to be stunted (OR ¼ 0.45, p ¼ 0.01) or underweight (OR ¼ 0.37, p ¼ 0.005). Promoting exclusive breastfeeding, preventing recurrent diarrhea and including fathers in community interventions will improve the health of children in this community. K E Y W O R D S : preschool children, malnutrition, anthropometry.
INTRODUCTION Nutrition is essential to normal growth, development and well-being of children [1]. It is of great importance in the development of the brain and other body tissues, especially in the first 5 years of life when this development is most rapid [2]. The national burden of undernutrition in Nigeria is difficult to estimate due to suboptimal data generation. Undernutrition encompasses underweight (measured as weightfor-age), wasting (measured as weight-for-height) and stunting (measured as height-for-age) and is
indirectly associated with more than 50% of all childhood mortality worldwide [3–4]. There is no recent information on the nutritional status of children aged less than 5 years in this rural community; the last nutritional survey was done more than 30 years ago [5]. National surveys conducted by the World Health Organization (WHO) in 1990 and 2003 showed the prevalence of wasting in preschool children to be 12.6 and 11.8%, respectively, in the rural areas [6]. These figures are, however, much lower
C The Author [2014]. Published by Oxford University Press. All rights reserved. For Permissions, please email: [email protected] V
92
Downloaded from http://tropej.oxfordjournals.org/ at University of Birmingham on May 31, 2015
Recent Illness, Feeding Practices and Father’s Education as Determinants of Nutritional Status among Preschool Children in a Rural Nigerian Community
Determinants of Nutritional Status among Preschool Children
than findings from local surveys carried out in midwestern Nigeria [7–8] within the same time period. Preschool children are a very vulnerable group, yet their nutritional status is the least studied, which makes it difficult to compare results and effect meaningful interventions. The objectives of this study were to compare anthropometric measurements of preschool children to the WHO reference [9] and to determine the impact of feeding practices, socio-economic status and immunization on nutritional status.
Study design A total of 374 children aged less than 5 years were selected by multistage cluster sampling. Of the eight communities that make up Shika village, four were selected by simple random sampling. In the selected communities, houses that were included into the study were again randomly selected. In each selected house, all children aged less than 5 years were included in the study. Children with obvious structural congenital defects and chromosomal anomalies were excluded. Surveys were conducted in the children’s homes. Interviewer-administered questionnaires were used to collect information about breastfeeding, immunization, father’s income, parental education, introduction of complementary foods and consumption of meat, fish, eggs and milk. Anthropometric measurements were then taken. Height (or length), weight and mid-upper-arm circumference (MUAC) were measured and body mass index (BMI) was calculated for each child. Data analysis Data were entered into the WHO Anthro version 2 software [10] and then exported to STATA 11.2 C [11] for further analysis. A final sample size of 366 was attained after data cleaning and editing were completed. The values of continuous variables like age and Z-scores of anthropometric measurements
93
were expressed as means and medians, and then analyzed using linear regression and Student’s t-test. Categorical variables were expressed as proportions and analyzed using logistic regression. Two-tailed estimation of significance was used, and the level of significance was set at p < 0.05. RESULTS Study participants were aged between 2 weeks and 59 months with a mean age of 25.6 months and standard deviation of 18.2. One hundred ninety (52%) were males and 176 (48%) were females (M: F ¼ 1.08:1). Each age-group was fairly equally represented as seen in Table 1. The median Z-scores for the anthropometric measurements by age-group are presented in Table 2.
Underweight Thirty-five percent of children were underweight (weight-for-age Z-score
