Ephraim-Emmanuel, B.C., Oghe A.P., Ugwoke, E.I., Odikeme, E.D.
College of Health Technology, Otuogidi, Ogbia, Bayelsa State.
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Background and Aim: Malnutrition in children is a major public health problem especially among underdeveloped countries. It is associated with over 41% of annual deaths in children in developing countries and is said to be responsible for childhood morbidities. This study thus aimed at determining the nutritional status of children between 0 to 12 months of age in Ogbia Local Government Area (LGA) of Bayelsa state, Nigeria as well as their mothers’ knowledge regarding child nutrition. Materials and methods: A descriptive cross-sectional design was used in this study conducted in selected Primary Health Care centres located within the Ogbia LGA of Bayelsa state.. The population of the study was all children aged between 0 to 12 months and their parents/caregivers. Sample size was 158 mothers/guardians and their children who attended 4 consecutive immunization clinics. A structured questionnaire was used to elicit the knowledge of the mothers/guardians regarding proper nutrition for children. The nutritional status of the children was assessed using anthropometric indicators including wasting, stunting and weight assessments. Ethical clearance to carry out this research was gotten from the Project Research and Ethics Committee of the Bayelsa State College of Health Technology. Data was analyzed using the Statistical Package for Social Sciences (SPSS) version 20. Results: In all, majority of the children had normal weight for age values (92.4%), weight for height values (81.0%) and height for age values (63.3%). However, considering the height for age values; quite a number of children were found to be chronically malnourished 44 (27.8%) and severely stunted 14 (8.9%). 151 (95.6%) of their mothers/guardians had good knowledge regarding child nutrition. Conclusion: This study showed that malnutrition is a source of public health concern among children of between 0 and 12 months in Bayelsa State. It was recommended that health education on exclusive breastfeeding practices and other sources of affordable nutrition be made available to mothers.
Keywords: Nutritional status, Children, 0 to 12 months, Knowledge, Nutrition.
Good nutrition for children especially in their formative years of life is important on both short and long term bases as it contributes to the physical, mental and emotional development of the children (Alamu, Atawodi, & Edokpayi, 2011; Dhungana, 2013; Roopadevi & Aravind, 2016). Optimal nutrition in children is achievable when there is adequate access to affordable, diverse, nutrient-rich food; appropriate maternal and child care, maternal education as well as availability of adequate health services and all components of a healthy environment (Akubugwo et al., 2014; Imo, Isiugo-Abanihe, & Chikezie, 2017; International Food Policy Research Institute, 2016).
Malnutrition in children is a major public health problem especially among underdeveloped countries (Chataut & Khanal, 2016; Zhang et al., 2011; Malmulwar et al., 2014). This pathological condition occurs in the event that a relative or absolute insufficiency or excess of one or more essential nutrients is present. It usually results from poor feeding practices such as inadequate breastfeeding, giving a child the wrong foods, lack of access to nutritious food, disease conditions such as malaria, frequent diarrhea among others (Adeola, Maccellina, Olatunji, Adedeji, & Olufemi, 2016; Chataut Khanal, 2016). Malnutrition could manifest as immediate and long-term consequences. On the immediate term, it could result in illness and disease, mortality as well as delayed mental and physical development. On the long term, malnutrition could result in impaired intellectual performance, impaired reproductive performance, reduced work capacity and an increased risk of chronic diseases (Alamu et al., 2011; Desalegne et al., 2015).
Malnutrition is associated with over 41% of annual deaths in children from 6 to 24 months of age in developing countries and is said to be responsible for childhood morbidities as well as more than a third of deaths due to preventable diseases (Akorede & Abiola, 2013; Adeola et al., 2016; Chataut & khanal, 2016; Desalegne et al., 2015; Olack et al., 2011). As at 2012, about 162 million under-five year children were stunted, 51 million were wasted and 99 million were underweight. Among these, 37% of all stunted children, 28% of all wasted children and 29% of all underweight children were reported to be in Africa (Ijarotimi, Adebiyi & Fatiregun, 2016). It remains a major public health issue in developing countries and its proper management is faced with a number of problems peculiar to the African continent (Awogbenja & Ugwuona, 2010; Imo et al., 2017). In Nigeria, reports have shown malnutrition prevalence among Nigerian children and its occurrence is associated with being in areas where basic essential needs of life such as food, shelter and clothing are often not within the reach of majority of the population (Adeola et al., 2016). Malnutrition has also been associated with poor maternal education which is a critical aspect in ensuring that mothers have the adequate knowledge of child nutritional needs and sources. (Babatunde, Olagunju, Fakayode & Sola-Ojo, 2011; International Food Policy Research Institute, 2016). Nigeria has also received low rankings with respect to indices of malnutrition and mortalities related with malnutrition. This is of public health importance as a result of the value placed on the lives of those affected. It is thus necessary to ensure the early detection of malnutrition in children in order to give way for relevant intervention strategies for its prompt reversal and management (Akorede & Abiola, 2013; Akubugwo, Okafor, Ezebuo, & Nwaka, 2016; Ijarotimi et al., 2016).
Considering that malnutrition is a public health burden in Nigeria and that relevant published evidence about its prevalence among children is lacking in Ogbia Local Government Area of Bayelsa State, it necessitated the conduct of this study. It is worthy of note that conducting this research would apart from contributing to the existing literature on nutrition among under-five aged children, it would also provide lacking evidence useful for purposes of nutritional surveillance. In addition, evidence provided can be useful in health planning and development by relevant private and public stakeholders especially as it relates with child care. This study, thus determined the nutritional status of children between 0 to 12 months of age in Ogbia Local Government Area (LGA) of Bayelsa state, Nigeria as well as their mothers’ knowledge regarding child nutrition.
MATERIALS AND METHODS
A descriptive cross-sectional design was used to assess the nutritional status of children aged between 0 and 12 months as well as the knowledge of their mothers on child nutrition. The study was carried out in selected Primary Health Care centres located within the Ogbia LGA of Bayelsa state, Nigeria where the major occupation is fishing and farming and in which the Ogbia dialect serves as the main spoken language. The demonstration clinic of the Bayelsa State College of Health Technology, Otuogidi which renders primary health care services to the catchment area of Otuogidi and the Primary Health Centre, Otuasega, served as the study sites. Activities usually carried out by these health centres include: Routine treatment of patients with minor health conditions, referral of severe health problems, routine immunization of women of childbearing age and children, family planning, etc. The population of the study was all children aged between 0 to 12 months attending the immunization clinic with their parents/caregivers at the selected Primary Health Care Centres. Sample size of 158 mothers/guardians and their children aged between 0 to 12 months who attended 4 consecutive immunization clinics at the selected Primary Health Care Centres was used for the conduct of this study. Data collection was done using a weighing scale and a measuring board which were used for anthropometric measurements. A structured questionnaire was also used to elicit the knowledge of the mothers/guardians regarding proper nutrition for children. The nutritional status of the children was assessed using anthropometric indicators including wasting, stunting and weight assessments. This was done by the measurement of weight for height (wasting), height for age (stunting) and weight for age (underweight) indicators among the children. Measurement errors due to parallax were avoided by ensuring the reading of the weight measurements at the required angulation. Deviation of the anthropometric indices from the standard value was considered to be evidence of malnutrition (Akubugwo et al., 2016). Ethical clearance to carry out this research was gotten from the Project Research and Ethics Committee of the Bayelsa State College of Health Technology. Permission to carry out this study was also gotten from the head of the Primary Health Care facilities. Informed consent was also gotten from the mothers before questionnaire distribution and the decision to complete the questionnaire was completely made voluntary. The questionnaires were then distributed to the parents/guardians who provided information on their knowledge of nutrition for children. Also, after getting written or verbal consent from the parent/guardian, all required anthropometric data was collected. Data was analyzed using the Statistical Package for Social Sciences (SPSS) version 20, was presented on tables and charts and expressed as frequencies and percentages.
In all, 158 mothers and their children were involved in this study. 52.5% of the children were male and 47.5% were female. Majority of the children were aged between 9 and 12 months (38.6%) as well as between 1 and 4 months (38.0%). Regarding their mothers, majority were farmers (30.4%), married (86.7%) and had received secondary school education (62.0%). The demographic data of our study participants are shown in Tables 1 and 2.
Table 1: Demographic data of children
Regarding the nutritional status of the children, the weight for age, weight for height and height for age assessments were used. In all 3 assessments, majority of the children had normal weight for age values (92.4%), weight for height values (81.0%) and height for age values (63.3%). However, considering the height for age values; quite a number of children were found to be chronically malnourished 44 (27.8%) and severely stunted 14 (8.9%). The nutritional status of the children in this study is shown in Tables 3 to 5.
Table 3: Weight for Age assessment of the children
|Weight for age assessment||Frequency||(%)|
|Underweight (-2 S.D.)||12||7.6|
|Severely underweight (-3 S.D.)||0||0.0|
Table 4: Weight for Height assessment of the children
|Weight for height assessment||Frequency||(%)|
|Severe acute malnutrition||1||0.6|
|(wasting) (-3 S.D.)|
|Overweight (+3 S.D.)||22||13.9|
|Table 5: Height for Age assessment of the children|
|Height for Age assessment||Frequency||(%)|
|Chronically malnourished (-2 S.D.)||44||27.8|
|Severely stunted (-3 S.D.)||14||8.9|
Regarding the knowledge of nutrition among the mothers involved in this study, 151 (95.6%) of them had cumulative knowledge scores greater than the median score for knowledge (12.5) showing that majority of respondents had good knowledge regarding child nutrition. Only 7 (4.4%) of the respondents had a knowledge score below the median knowledge score. This is shown in Figure 1.
Figure 1: Knowledge of mothers about child nutrition
The results of this study revealed that malnutrition is prevalent in the study area manifesting mainly as stunting, being underweight as well as being overweight. The prevalence of stunting in this study corroborates findings of stunted growth among children in South-Western Nigeria (Akorede & Abiola, 2013; Amosu et al., 2011), South-Eastern Nigeria (Ezeama et al., 2015; Nwabeuze et al., 2015) and in Nigeria as whole (NDHS, 2013; NNHS, 2015). Studies conducted in the North-Western and North-Central regions of Nigeria also corroborated the present study findings but with reports of much higher prevalence rates of stunting (Adeola et al., 2016; Awogbenja & Ugwuona, 2010). This finding could have occurred as a result of prolonged episodes of improper nutrition for young infants, such as poor exclusive breastfeeding practices and inadequate complementary feeding practices especially during the first 2 years of life (Ijarotimi et al., 2016).
The prevalence values of wasting as well as being underweight in the present study were found to be low. Comparison with other findings however, showed higher prevalence values in South-Eastern Nigeria (Akubugwo et al., 2014; Ezeama et al., 2015), South-Western Nigeria (Akorede & Abiola, 2013; Amosu et al., 2011; Ijarotimi et al., 2016) and Northern Nigeria (Adeola et al., 2016; Awogbenja & Ugwuona, 2010) with malnutrition values being highest in the Northern regions. This agrees with the NDHS (2013) report, that wasting as a sign of malnutrition is higher in Northern Nigeria as compared with the South (NDHS, 2013). This may be due to failure to receive adequate nutrition as well as the levels of maternal education available in the different geo-political zones in Nigeria (Ajao et al., 2010; International Food Policy Research Institute, 2016). The prevalence of malnutrition manifesting as being underweight, is however similar to the findings of other studies conducted in Nigeria (Akorede & Abiola, 2013) and beyond the shores of Nigeria (Zhang et al., 2011). Conversely, in this study, the proportion of the infants that were overweight was found to be higher than the national prevalence (NNHS, 2015), the prevalence in South-Eastern Nigeria (Nwabeuze et al., 2015) as well as the prevalence in Northern Nigeria which coincidentally recorded the lowest values (NNHS, 2015). The implication of this finding is the likelihood of the prevalence of non-communicable diseases including diabetes, coronary heart disease amongst others. This is because being overweight in childhood has been found to be a risk factor for adult obesity which is associated these non-communicable diseases (WHO, 2010).
This study also revealed that the knowledge of child nutrition among the mothers/guardians involved in this study was very high, with about 95.6% of them having cumulative knowledge scores which were greater than the median score for knowledge in this study. This shows that majority of them had good knowledge regarding child nutrition. This view was however, not shared by Berihu, Abera, Berhe & Kidanu, (2013) who reported moderate and slight knowledge levels in their study. This finding made in the present study, could possibly be attributed to the level of education which most of the respondents had received. Maternal education is an asset for a child’s proper growth and nutrition (Lawal & Samuel, 2010). Poor maternal education has been significantly associated with malnutrition in children (Babatunde, Olagunju, Fakayode Sola-Ojo, 2011). Maternal education has been identified to be critically important for child health, nutrition, growth, and development (International Food Policy Research Institute, 2016). It is also important to note that even though the mothers/guardians knew what to do to provide adequate nutrition, the unavailability of resources to provide the needed nutrition to the children could also be a factor that could inhibit provision of proper nutrition to the children (Imo et al., 2017; Ndukwu, Egbuonu, Ulasi & Ebenebe, 2013).
In this study, the inability to relate the mothers’/guardians’ demographics and the nutritional status of their children did not provide the opportunity to assess if demographic factors played a role in the occurrence of malnutrition among the children.
This study has shown that malnutrition remains a source of public health concern among children of between 0 and 12 months in Bayelsa State. Most of the mothers/Guardians of these children however had good knowledge of child nutrition. It was however recommended that health education on exclusive breastfeeding practices and other sources of affordable nutrition be made available to mothers. Food preparation demonstration should also be strengthened at the primary health level of care.
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