Assessment of nutritional status of under five children in katagum local government, Bauchi state

CHAPTER ONE/Introduction

Background to the Study

The quality of nutrition throughout life determines the growth, development and disease susceptibility. Nutrition is a critical part of health and development.  World Health OrganizationWHO (2000) stated that nutrition improves children’s health, enhances stronger immune system, longevity and lower risk of non-communicable diseases. Healthy children learn better and children with adequate nutrition are more productive. Mandndhar, Krishna and Patowary (2008) opined that the nutritional status is an indicator of the level of the quality of life of school children. WHO (2009) maintained that children’s nutritional status is a reflection of their overall health, when children have access to  adequate food supply, they can reach their growth potential and are considered well nourished. Nutritional status is essential for identifying undernourished and over nourished states of children and in estimating the optimum intake of adequate nutrition to promote normal growth and well-being. Height and weight are the most commonly used indicators of the nutritional status of primary school children. (Himes, 2009).Hence the need for the anthropometric method.
The anthropometric method which involved the measurement of weight and height to determine the nutritional status of an individual is an easy-to-use method *because it requires weighing scale and a tape measure. The anticipated nutritional status of school children are as follows: < (-2)SD to<(-3)SD indicates weight-for-age(underweight) children, < (-2)SD to< (-3)SD indicates height-for-age (stunting) children,< (-2)SD to < (-3)SD indicates weight-for- height(wasting) and -1SD< X< +2SD of NCHS/CDC median indicates normal children while>+2SD indicates over-nourished children between the ages 6years to 12years (Odenigbo, Odenigbo & Oguejiofor, 2010).According to WHO (2000) appropriate height-for-age of children reflect linear growth and can measure long term growth or stunting (indicator of past or long term under- nutrition) while appropriate weight-for-height reflects proper body proportion or the harmony of growth. Weight-for-height is particularly sensitive to acute growth disturbances and is useful to detect the presence of wasting (indicator of present under nutrition). Weight-for-age represents a convenient synthesis of both linear growth and body proportion and thus can be used for the diagnosis of underweight (convenient synthesis of both present and past under nutrition) children. The presence of under nutrition in children was assessed using these anthropometric parameters thus; weight-for-age, height-for-age and weight-for-height and compared it with internationally accepted reference standards. The outcome showed that children that have a low height-for-age, a z-score below two standard deviations of the reference population mean (-2 Z-score) are categorized as “stunted”. Similarly, a low weight-for-age is diagnosed as “underweight” children, while a low weight-for-height is indicative of “wasting” children (WHO, 2009).
According to Suvama (2007) growth is the major characteristics of school children and this is dependent on adequate supply of nutrients.  Growth and development of the children is largely dependent on its nutritional status. Ijarotimi and Ijadunola (2007) asserted that nutritional status is very necessary to be determined because it helped in estimating the optimum intake of nutrition to promote good quality of life among primary school children. Hence, the present study used the anthropometrics parameters to determine the nutritional status of primary school children. The parameters are height- for-age which is the index used to compare children’s height with the expected value of children of the same age from a reference population. It is a measure of stunting. Secondly, weight -for-height, is the index used to compare children’s weight with the expected value of children of the same height. It is a measure of wasting. Thirdly, weight-for-age is the index used to compare children’s weight with the expected value of children of the same age. It is a measure of   underweight (Pullum, 2008). Davis (2001) maintained that it is vital to recall that the fundamental pillar of children’s life, health and development across their entire life span is nutrition.
Nutrition is the process by which living things receive the food necessary for them to grow and be healthy. Nutrition is the study of food in relation to the physiological processes that depends on its absorption by the body growth, energy production, repair of body tissues (Martin, 2003). Nutrition is basically the use of food by the body for the processes of growth, repair and work. (Akinsola, 2006). Basavanthappa (2008) defined nutrition as combination of dynamic process by which the consumed food is utilized for nourishment, structural and functional efficiency of every cell of the body.  Panebianco (2009) maintained that nutrition is also known as nourishment   from food in order to support life. Nutrition is the intake of nutrients and their subsequent absorption and assimilation by the tissue. Hence, in this study nutrition was referred to as a combination of dynamic processes by which the consumed food is utilized for nourishment, structural and functional efficiency of every cell of the body, adopted from Basavanthappa (2008) because the definition is easy and clearly articulated. Foods that contain the elements necessary to perform various functions in the body are nutrients.
Harper (1999) defined nutrients as a substance present in food and used by the body to promote normal growth, maintenance, and repair. Nutrients are defined as organic and inorganic complexes contained in food (Park, 2009). The present study referred to nutrients as a substance present in food and used by the body to promote normal growth, maintenance, and repair. Nutrients include carbohydrates, fats, proteins, minerals, vitamins and water (Martin, 2003).
Basavanthappa (2008) maintained that carbohydrates are the main sources of energy required by children to carry out daily activities and exercise. Any extra energy is stored in the body until it is needed. Fats are required in children’s diet to help them attain normal growth and development. Proteins are essential for children’s growth, repair and maintenance of body tissue. Minerals help the children to develop, grow and stay healthy. It is necessary to many mental and physical bodily functions, including emotional and cognitive functions. Vitamins are important in children’s diet for making red blood cells, formation of strong bones and teeth, and contribute to maintenance of their eyes, skin, liver and lungs. Water is the most important nutrient required by children because the function of cells depends on a fluid environment. Tanko (2006) observed that good nutrition is reflected not only in the growth and functions of the cell but in body appearance.  This implies that the eyes, skin, hair and teeth indicate whether body nourishment is good or poor. Poorly nourished children will fail to grow properly and deficiency diseases may occur.
Poor nutrition may result from excesses in the diet as well as deficiencies of certain vitamins or minerals which are capable of producing potentially lethal diseases.  Excess of carbohydrates or fats can result in obesity among primary school children. A diet deficient in protein causes a disease called kwashiorkor in children; a diet deficient in both protein and calories results in marasmus with lethargy and abdominal enlargement. Generally, deficiency diseases can be treated successfully and cured by ensuring that the nutritional needs of the primary school children are met on a daily basis (Harvey, 2011). Poor growth and development will result, unless the whole children’s health is good as well as their status.
Status is the situation at a particular time (Hornby, 2006). Merrian (2007) defined status as a particular state or condition. Specifically, Bourdieu (2011) identified that status are internalized at an early age and school children eat food which indicates their status as it relates to nutrition. For instance, children from the lower end of the social hierarchy are predicted to eat “heavy fatty foods which are cheap” than adequate diet and these bring about obesity, underweight, wasting and stunted growth among these children. In this study status was referred to as a particular state or condition.  The ability of children to be productive and grow can be hampered as a result of their nutritional status.
Nutritional status is the conditions of health of a person that is influenced by the intake and utilization of nutrients (Typpo, 2011). Winstead (2009) defined nutritional status as the state of a person’s health in terms of the nutrients in his or her diet. He further added that how well the body functions is a direct reflection of what the body takes as food and the balance between the two. When one or several of the body systems are malfunctioning, it most likely relates in some degree to nutritional status. David (1999) defined nutritional status as a state of the body in relation to the consumption and utilization of nutrients. The present study referred to nutritional status as the state of a person’s health in terms of the nutrients in his or her diet.  Odenigbo, Odenigbo and Oguejiofor (2010) affirmed that nutritional status can be determined using different methods such as Body Mass Index (BMI), clinical examination, biochemical examination, anthropometry, dietary assessment, questionnaires and checklist. The anthropometric method which involves the measurement of height and weight to determine the nutritional status of an individual is an easy-to-use method because it requires only tape and scale measure. Anthropometric method was used in this study to determine the nutritional status of primary school children because of changes in their body composition.  Frisancho (2011) maintained that nutritional status of children are determined with reference to height and weight using the standard from the National Center for  Health Statistics (NCHS) as a reference to determine the extent to which children are growing either normally, advanced, or delayed for their age.
Furthermore, the standard was also used to infer whether children are either obese, or undernourished for their height. Using height and weight standards, malnourished children can be classified as either stunted, if they have low height-for-age, or wasted, if they have low weight- for-height. Schlenker and Long (2007) asserted that  the conditions of the body  includes malnourished and well-nourished conditions,  nutritional levels which are optimal nutrition and under nutrition which may affect children’s ability to resist infectious diseases, ability to learn,  become productive, grow and develop properly. It is vital to identify the proportion of primary school children’s nutritional status.
Nutritional status ranges from nutrient levels in the body the products of their metabolism to the functional processes they regulate. Children’s low height-for-age is considered stunting, while low weight-for-height indicates wasting. (Himes, 1991).  In this study the proportion of stunted,   wasted and underweight   was determined among school children.
Skyes (2000) defined children as young males or females that have not reached the age of discretion. All over the world, children are seen as those who have to be provided for with such needs as food, shelter and protection until they are capable of looking after themselves. Children are young humans who are not yet an adult (Hornby, 2006).Whereas school children are children that attend school. Children are young humans between the ages of 0-13 years. Primary school children that were used in the present study are referred to as young human beings between the ages of 6-13 years. When a child reached primary school, he develops an eating style that becomes more and more independent of the influence and scrutiny of his parent (Suskind, 2009).  Moreover, children are in the period of rapid growth and development, and therefore total health cannot be attained without good nutrition. Adequate supply of food and proper nutritional habits are helpful for healthy living, normal growth and development of children (Onuzulike, 2005). Some children eat a lot due to affluence while other eats less due to poverty and ignorance. This may result to over nutrition or under nutrition  as  the case may be and they can be exposed to nutritional problem like obesity, stunting and wasting (Akinsola, 2006).The nutritional  status could be traced to some factors.
Some socio-demographic factors were capable of contributing to the nutritional status of primary school children. Such factors  includes location, age, gender, level of education and income.   Gender was identified as a factor that influences nutritional status. Usually prevalence of severe malnutrition is much more in young females as compared to young males of 5 years of age due to differential child rearing practices including feeding and health care seeking behaviour (Sunderlal, Adarsh & Penkay, 2010). Suskind (2009) observed that no gender distinction is made between the nutritional needs of male and female until the age of 11.  He added that males between the ages of 11 and 14, however, have a greater need for calories, vitamin A, thiamin, riboflavin, niacin, iodine and magnesium than to female of the same age and these differences reflect the greater muscle development and physical activity of boys in contrast to the slightly greater fatty deposits and lesser physical activity of girls. The greater need for some of the B vitamins is related to the greater quantity of food that was ingested by boys than was ingested by girls of the same age. Hence, there were differences in nutritional status, that higher percentage of stunting are more in female than male children. Another variable that can affect nutritional status is location.
Location had influence on nutritional status. As opined by Florentino, Villavieja and Lana (2002) children from urban area tends to consume more total food, more animal foods,   fats and more beverages. According to SunderLal et al (2010) higher proportions of rural children are suffering from Protein Energy Malnutrition (PEM) compared to urban areas. Urban slum areas have as much prevalence of PEM as in rural areas and more often the situation of PEM in urban slum areas may be worse than rural areas because of poor living conditions and presence of all the risk factors for malnutrition. Higher intake of calories, protein, iron, and vitamins A, with less physical activities results in higher proportion of over nutrition and a lower proportion of under nutrition.
Children from rural area are of low-socio economic group (Suskind, 2009). This has effect on their diet which may be deficient in all nutrients except carbohydrate, iron and thiamine. The effect is that they suffer from malnutrition, sign of protein-calorie deficiency, vitamin A, vitamin D and essential fatty acid deficiency. Malnutrition has a dampening effect on their growth potential particularly during the spurt period (Adesola, 2006).Hence; urban children may be over nourished more than their rural compatriots. Another variable that can affect nutritional status is age.                           Age had influence on nutritional status. Evidence has shown that physical growth and cognitive development in children are faster during early years of life, and that by the age of five years, 50 per cent of adult intellectual capacity has been attained and before thirteen years 92 per cent of adult intellectual capacity is attained Sizer and Whitney (2000).
Christian and Greger (1998) reported that peer influence increases with age and extend to food attitude and choice, due to the sensory appeal of children. The children have strong influence in food choice and sensory characteristics that tastes sweet. Sizer and Whitney (2000) asserted that children of the same age group will prefer particular food choice despite the nutritional value. Another variable affecting nutritional status is level of education of the parents.
Level of education of parents had strong influence on nutritional status of primary school children. The information parents received about nutrition is capable of changing their child’s nutritional status. Additionally, the more knowledge about nutrition the parent, caregiver, and guardian have, the better the nutritional status of children (Mclaren, Burman, Belton &Williams, 1991).  Akinsola (2006) stated that the major problem was the insufficient knowledge and understanding of how to plan and choose good food.  When the diet is deficient in any food nutrient for a long period, illness such as kwashiorkor, marasmus can occur.
Income had influence on the nutritional status of primary school children.Lucas and Gill (2003) opined that household food shortages may be temporary, seasonal or persistent and have many causes including low income and low food production.Also middle income groups eat twice as much fat and have much more obesity, underlying causes are environmental and social factors such as sedentary lifestyles, availability of transport and fat-rich fast meals.
Number of children in the family (family size) was a contributing factor in the nutritional status of primary school children. It must be taken to mean that standard of living; naturally falls if the size of family increases and income remains constant. The ideal family size in Nigeria according to National population policy (1988) classification is six (parents and children). Any number less or equal to six is regarded as small family, while number greater than six constitutes larger family size in this study.  This study was anchored on a theory.
The theory that applied to explain the primary school children nutritional status is the precede model. Precede model is a participatory model for creating successful community health promotion and other public health interventions. It is based on the premise that behavior change is by and large voluntary; improving nutritional status of school children are more likely to be effective if adequate diet are planned and eaten with the active participation of children who will have to implement them. The precede model is aimed at understanding the factors that influence the individual’s health and develop interventions to promote total wellbeing. This was useful because the nutritional status of primary school children was associated with some demographic factors such as gender, location, age and level of education. Proper understanding of the effect of these factors and how to overcome them, will harmonize the nutritional status of primary school children in Enugu South Local Government Area.
The study was carried out in Enugu South Local Government Area of Enugu state. The Local Government covers 67 square kilometers away from the state capital in the Eastern part of the state. It shares boundary with Enugu North LGA to the North, it also shares boundaries with Enugu East LGA to the East, Nkanu West Local Government Area to the West, and its headquarters is located at Uwani in Enugu south. Enugu South Local Government Area is essentially inhabited by the Igbo people and among them are farmers and traders.
WHO (2000) estimated that between 48 per cent and 53 per cent of school age children   are stunted. In many cases, children do not know they have nutritional problem and fatigue, hence inability to concentrate is considered normal. Children who lack certain nutrients in their diet are more likely to be absent from school than healthy children, they also have a diminished capacity for learning, repeat grades and  may drop out of school(WHO,2000).
The primary school children in Enugu South may need adequate nutrition for good health and well-being. But it is likely that preferences to a particular food nutrient among some school children or the proportions of adequate diet given to the children by their parents/caregivers/guardians may prevent them from eating the quality food they need for their well-being. The tendency is that they may be prone to malnutrition, weight loss, stunted growth, underweight, fatigue, and lack concentration in learning

Table of Contents

• CHAPTER ONE: Introduction

• Background to the Study

• Statement of the Problem

• Purpose of the Study

• Research Questions

• Hypotheses

• Significance of the Study

• Scope of the Study

• CHAPTER TWO: Review of Related Literature

•   Conceptual Framework

• Nutrition and nutrients

•  Status and nutritional status                                                                   Children

• Socio-demographic factors associated with nutritional status

• Theoretical Framework

•       Precede model

•  Empirical studies of Nutritional Status

• Summary of Literature Review

•  CHAPTER THREE: Methods

• Research Design

• Area of Study

• Population for the Study

• Sample and Sampling Technique

• Instrument for Data Collection

• Validity of the instrument

• Reliability of the instrument

• Method of Data Collection

• Method of Data Analysis

• CHAPTER FOUR: Results and Discussion

• Results

• Summary of Major Findings

• Discussions of Findings

• Nutritional status of primary school children

• Nutritional status of PSC according to gender, location and age group

•  The proportion of food given to PSC according to gender,

• location and age group

• The proportion of food given to PSC according level of education, income of parents/guardian/caregiver and number of children in the family

• CHAPTER FIVE: Summary, Conclusions and Recommendations

• Summary

• Conclusions

• Recommendations

• Suggestions for Further Study

• Limitations of the Study

• References