FOOD CONSUMPTION PATTERN, ANTHROPOMETRIC INDICES AND MICRONUTRIENT STATUS OF CHILDREN AGED 6 – 59 MONTHS IN KADUNA STATE, NIGERIA

ABSTRACT

The study was undertaken to assess food consumption pattern, anthropometric and micronutrient status of children aged 6-59 months in Kaduna state.  A cross sectional survey design was used. A multi stage sampling technique was used to select the subjects for the study. In the first stage, two Local Government Areas were selected from each of the three senatorial districts using simple random sampling procedure. This gave a total of 6 Local Government Areas. In the second stage, purposive sampling was used in selecting two communities from each of the local government areas (a total of 12 communities). At the third stage, the subjects (420) aged 6 – 59 months were randomly selected for the study using proportionate sampling technique while 20% sub- sample was selected for biochemical analysis. Anthropometric information was determined using age, height and weight of the children. Haemoglobin (Hb) was used to determine anemia, serum retinol was used to determine vitamin A status and also iodine was determined using urinary iodine excretion level (UIE). Anemia was defined as Hb < 11.0mg/dl, Vitamin A deficiency was defined was defined as reading ≤ 10g/dl and marginal deficiency <20g/dl. Urinary iodine excretion (UIE) is defined as a reading <10mcg/dl. Socio-economic information and feeding practices were determined using questionnaire. The questionnaire was pretested and reliability index of 0.9 was obtained using Cronbach alpha. Dietary intake was determined using a combination of food frequency questionnaire and 24hour food recall. In determining the major staples in the area of study, the result showed that maize was the most frequent staple and rice (cereals) the least consumed in Kaduna State. Anthropometric results of the children showed high prevalence of different categories of malnutrition, 76.4% were too thin for their age (underweight), 70% were too short for their age (stunted) while (47.6)% were  too thin for their height (wasted).Biochemical results , revealed high prevalence of anaemia (53.6%) urinary iodine execration (29.2%) and vitamin A  as low as( 3.6%) of the children were deficient. Correlation between anthropometric, biochemical status and socioeconomic information revealed height-for-age of the children and their weight-for-age was highly significant (r = 0.666; P<0.001). The following variables also showed significant relationship: Iodine status with height – for – age was significant (r =0.353; P < 0.05). There was a significant (r = 0.664; P < 0.01) relationship between weight – for- height and weight- for –age. Iodine and weight- for- age was significant ( r =0.308; P < 0.005). Hemoglobin correlated with iodine (r = 0.226; P < 0.05). There was a significant(r =0.333; P < 0.02) relationship between Vitamin A and iodine. Vitamin A and hemoglobin was highly significant (r = 0.460; P < 0.01).Family income and weight- for -age was significant(r = 0.247; P< 0.05). There were more correlated values that were significant, fathers occupation with family income( r = 0.252; P<0.005), mother’s occupation with family income( r = 0.262; P < 0.005), fathers education with family income ( r = 0.340;P<0.005) and mothers occupation with fathers occupation (r =0.397;P<0.001).Equally fathers occupation and mothers education was significant(r=0.371;P< 0.005) and fathers education with mothers education (r =0.230;P< 0.005).These results were as a result of faulty feeding practices especially over-dependence on a particular crop(monotonous diets fed to the children) and low socio-economic status of the parents. The study established that there is malnutrition in under five children in Kaduna.

CHAPTER ONE

1.0    INTRODUCTION

1.1 Background to the Study

The World Development Report (WDR, 2007/2008) ranks Nigeria as the largest territorial unit in West Africa that has over one hundred and forty-seven million people (147,000.000). Approximately, 75% of the population is women and children.  Over 70% are residing and securing their livelihoods in the rural areas. Within this huge rural population, particularly among the urban poor, Nigeria infant and child mortality rates are alarming. The rate is 100 per 1,000 births and mortality of 1,100 per 100,000 live births.  Most of these deaths are due to lack of adequate intake of food or inappropriate combinations of food (Nigeria Demographic and Health Survey (NDHS) (2008). Akinyele (2009) reported a high level of malnutrition among children in rural Nigeria. The figures differed with geopolitical zones, 56 percent was reported in a rural area of South West and 84.3 percent in three rural communities in the northern part of Nigeria.

 High level Task Force on Global Food Crisis (HTFGFC, 2008) reported that inadequate diet and malnutrition are the major cause of death of over 3.5 million children, every year at a rate of more than 10,000 children per day. Inadequate dietary pattern is a threat to health and under-nutrition, mainly in young children. Inappropriate and inadequate dietary patterns have emerged as a major development crisis facing Nigeria today. Inadequate dietary patterns have serious implication on the growth and health of individuals and have a huge effect on the country’s productivity. The United Nations Development Programme Report (UNDP) (2007) states that adequate diet and health of the people are indicators of the country’s socio-economic situation. Apart from shelter and clothing as the basic needs of life, food remains the core or apex in the hierarchy of human needs. This is because of its importance not just to children but to the entire human existence. Over two thirds of child’s deaths are associated with inappropriate feeding practices that occur within the first year of life. Malnourished children who survive are more frequently sick and suffer the lifelong consequences of impaired development (Hatloy, Hallund, Diarra & Oshaug, 2000).

 Inadequate intake of food will continue to affect the nutritional status of households leading to malnutrition and consequently to poor health, poor livelihoods and poor productivity. This is very important and critical to life, adequate and appropriate dietary pattern should be the right of every individual. However, monotonous diet, inadequate food and poor feeding behavior have persisted.  These constitute a major threat to the health and wellbeing of children. Again, for any country to thrive and be productive, it must have a healthy population as a malnourished population leads to reduced productivity, hampering economic growth and the full realization of potential of citizens. Adequate nutrition is very crucial to the growth and the economic development of any country. Dietary pattern or habits become established in children from infancy and to a greater extent persist throughout life. Nutrition affects health throughout the life cycle and it is best to prevent malnutrition early in life. So it is very important to monitor the nutritional status of any country to determine the productive rate of that nation.

 The importance of good diet cannot be overlooked because food and eating well can make the difference between being alive or dead and being well or sick.  Some researchers have shown (Caulfield, de Onis, Blossner & Robert, 2004; Bryce, Coltinho, Darnton-Hill, Pelletier & Pinstrup-Anderson, 2008) that food or good diet can prolong life, well being and promote human development. This is because a healthy population means healthy productive force.

The Food and Agriculture Organization (FAO, 2000) reports that about 854 million people were under-nourished worldwide in 2001-2003 Nigeria inclusive and by 2008, the number had increased from 854 million to 925 million. The FAO report also shows clearly that a large percentage of this under-nourished number is located in Africa where one in three people are deprived of sufficient food.

 United Nations Children’s Fund (UNICEF, 2006) indicates that infant mortality rate is 75 deaths per 1,000 births. The under-five mortality rate is 157 per 1,000 live births. The neo-natal mortality rate is 40 per 1,000 live births. This translates to about one in every six children born in Nigeria dying before their fifth birthday. The report shows that almost half of childhood deaths occurred during infancy and first few months of life. There are variations in mortality levels across the country. Infant mortality and under-five mortality rates are higher in the northern areas of Nigeria. Child mortality rate in the north-west (which comprises of Kaduna, Sokoto, Kastina, Zamfara and Kebbi) according to NDHS (2008) is 109 deaths per 1,000 births compared to south-west which is 89 deaths per 1,000 births. All evidence points to the fact that almost all the deaths are dietary and nutrition related (NDHS, 2008).

Adequate dietary pattern is the fundamental challenge to children’s health status and welfare in Nigeria and Kaduna State in particular. Nutrition is not just eating and drinking but eating adequate food to get a good supply of all the key nutrients. Individual nutritional status is dependent on the interaction between food that is eaten, the state of health and the physical environment.

Many childhood deaths can be prevented if there is timely intervention for example; ensuring appropriate dietary pattern from birth, immunizing children against preventable diseases and making sure that children receive prompt and appropriate treatment when they become ill. A child that is born without any abnormalities and given the best environment including adequate care and protection against infection will grow well and develop to his or her full potential.  Nutrition plays a major role in shaping a child’s life towards attaining or the attainment of his potential. The nutritional assessment of an individual or community is very important because it could be used to identify populations or population segments at risk for nutrition-related diseases and provide critical information for intervention.

Malnutrition is associated with an inadequate diet, poor health and sanitation services as well as inadequate care given to children. Malnutrition (poor nutritional status) constitutes a major public health problem in most developing countries including Nigeria.  A lot of the population cannot afford enough to eat and most of them live in very poor environment. Vulnerable children with high nutritional needs and weak immune systems fall victims to diseases and subsequently to malnutrition.

Eliminating hunger and malnutrition is one of the most fundamental challenges facing humanity. Malnutrition and its associated disease conditions can be caused by eating too little, eating too much or eating inadequate diet that lacks necessary nutrients. Malnutrition is one of the most devastating problems worldwide.  It is inextricably linked with ignorance, illiteracy, poverty and lack of development.

  Creating awareness and appropriate knowledge of food combination (adequate diet) will contribute to reducing the incidence of malnutrition. Dietary pattern becomes established in children from infancy and to a greater extent persist throughout life. Nutrition affects health throughout the life cycle and it is best to prevent malnutrition early in life.

For  any country to thrive and be productive, it must have a healthy population as a malnourished population leads to reduced productivity, hampered economic growth and inability of citizen to realize their potentials. A healthy population with adequate nutritional status is very crucial to the growth and the economic development of any country.  It is very important to monitor the nutritional status of any country because this will determine the productive rate of that nation.

 The importance of good diet cannot be overlooked.  Some researchers (Behrman, Alderman & Hoddinott, 2004; Brown, 1990) have shown that food or good diet can prolong life, well being and promote human development, because a healthy population means healthy productive force.

1.2. Statement of the Problem 

Every year, children die as a result of complications from different illnesses and malnutrition. In the rural areas, it is mainly inadequate nutrition and over dependency on particular kinds of food that may contribute to child mortality. If the child is lucky to survive, the result is a depleted, malnourished and under-weight child. Malnutrition has been responsible, directly or indirectly, for 60% of the 10.9 million deaths annually among children under five (WHO, 2003). About 160 million children under five years of age (almost one-third of the developing world’s children) are still malnourished (WHO, 1999; Smith & Haddad, 2000a).It has been projected that under the most likely circumstances, about 135 million children under the age of five in developing countries will be malnourished by 2020 (Pinstrup-Andersen , 2000 ). All people particularly children need a variety of foods to meet the requirements for essential nutrients and the value of diverse diet is of great importance to children’s nutritional status.

 Eating is usually an enjoyable experience with a social as well as a nutritional dimension but for many children in the rural areas, it is a monotonous exercise. Most parents believe in having one particular type of food on the table instead of having variety of adequate diet because that is what they know and were brought up with.

Mono-dieting or lack of diverse diet is a particularly severe problem among the rural populations. The diets are based predominantly on what the family produces or farm and what is available seasonally in the environment. For vulnerable children, the problem is critical because they need energy and nutrient dense foods to grow and develop physically and live a healthy life. Beyond meeting needs for essential nutrients, dietary diversifications are increasingly recognized as playing a role in the prevention of some chronic diseases.  Incidentally, most of the rural populations are on mono-diet revolving round a single crop for their dietary pattern (WHO/FAO, 1998; Pan American Health Organization / World Health Organization (PAHO/WHO), 2003).

Dietary patterns are critical issues in Kaduna State where the NDHS, (2013) and other reports have indicated high prevalent rate of child mortality.

Indices of malnutrition are still higher in Kaduna state than in Nassarawa, Niger and the national average report (NDHS, 2013).  Severe Acute Malnutrition (SAM) prevalence among children from zero to 59 months of age is 8.7 percent nationally.  According to the Nigeria Demographic and Health Surveys (NDHS, 2013), malnutrition has declined from 41 percent in 2008 to 37 percent in 2013. What that shows is that within the span of five years, Nigeria was able to reduce malnutrition by four percent which is still not encouraging. It is something that calls for every Nigerian to rise up to see that nutritional status of children and mothers are improved. The report concluded that malnutrition problem is more in the North West (Kaduna) and the North East, and
 the north (Kaduna State inclusive) generally has more malnutrition problem compared to other part of the country.

  In Kaduna, farming is the commonest occupation.  The climate permits the cultivation of cereals (maize, sorghum, wheat and millet), roots and tubers (cassava, cocoyam, yam and sweet potatoes), legumes, (Bambara nut, groundnut and different varieties of beans) and vegetables (onions, lettuce, peppers, tomatoes, spinach and amaranths).

 During dry season, a considerable number of farmers in the state engage in irrigation farming along some major rivers, streams and dams. Another important aspect of agriculture engaged by the people is the rearing of cattle, sheep, goats, pigs and poultry. Petty trading, sale of raw and cooked farm produce is a major trade for men, young male and females of school age.  The dietary habit of the Kaduna State peoples is dominated by one particular diet. Maize can be converted into tuwo (paste for swallowing) pate (maize portage) and ko-ko (akamu). These foods are consumed three times daily . The nutritional status of an individual to a large extent is determined by the type of diet and frequency of the food consumed. Knowledge on dietary pattern of Kaduna State and its effect on nutritional status is important. This is because poor dietary pattern, sanitation, feeding practices and drinking water are the major causes of under-nutrition, particularly in the rural areas.  The country’s poor healthy environment is a contributory factor to child malnutrition. Only 42% of the Nigerian population has access to health services, safe water and sanitation(WHO,2003).

The millennium Development Goals (MDGs) adopts nutritional status as one of the key indicators of poverty and hunger.   Improved nutrition is critical to good health. It is imperative to conduct study that will provide basis for intervention. Dietary and nutritional assessment of a community is very important for proper diet planning and implementation of intervention programmes to reduce cases of child mortality related to under nutrition.

1.         Objectives of the Study

The general objective of the study was to assess food consumption pattern, anthropometric micronutrient status of children aged 6 – 59 months in Kaduna State, Nigeria

The specific objectives were to:

1. document the major food crops produced in Kaduna State.
2. determine the  food consumption  pattern of under-five children in Kaduna State.
3.  assess the feeding practices of the under five children in Kaduna State.
4. assess the anthropometric indices of the under five children in Kaduna State.
5.  assess the vitamin A, iron and iodine status of the under five children in Kaduna State.
6.  ascertain the relationship between the feeding practices of under five children and their nutritional status.
7. determine the relationship between socio-economic status of the parent and their nutritional status(children).

1.4 Significance of the Study

There is high prevalence rate of malnutrition and infant mortality in northern states of Nigeria.

There are less extensive research to document dietary pattern and anthropometric status of children in Kaduna State. The study would highlight the consumption pattern and the nutritional status of under- five children in Kaduna State.

The result of the study would x-ray the relationship between the consumption pattern of the children and their anthropometric status. The documented results when published would serve as a guide to both senatorial district, local government, CBOs, TBAS, nongovernmental organization etc to institute proper nutrition intervention. It would also be useful tool to Kaduna State Government, Ministry of Health to plan nutrition intervention and implement for under- five children in the State.

 It would provide much more detailed nutritional guide for use to educate women or mothers who attend ante-natal’s on major food crops in Kaduna State as well as relationship between dietary patterns of children and their anthropometric status.  Nutritionists, Home Economic Teachers, Extension workers and other health workers in the state would benefit from the study because it would provided a tool for knowledge in the class rooms and in the field. The food and agricultural sectors will be spurred to focus attention in producing and promoting high quality food crops to reduce the global burden of malnutrition. The result would provide data for regional food policy change as well as spur research work on the vulnerable groups (women and children).