ASSESSMENT OF THE FEEDING PRACTICES, VITAMIN A, IRON, ZINC AND ANTHROPOMETRICS STATUS OF UNDER-FIVE CHILDREN IN ORPHANAGES OF FEDERAL CAPITAL TERRITORY ABUJA, NIGERIA.

ABSTRACT

The study was undertaken to assess the feeding practices, anthropometric indices, vitamin A, zinc and iron status of under-five orphans living in Federal Capital Territory orphanages, Abuja. A cross sectional descriptive study was conducted using 200 orphans (96 males and 104 females) aged between 0-5 years living in ten orphanages. The subjects were purposively selected for the study and 20% of sub-sample was randomly selected for biochemical analysis and weighed food intake assessment. Haemoglobin (Hb) and serum ferritin were used to assess anaemia and iron status, respectively. Serum retinol was used to assess vitamin A status and serum zinc was used to assess zinc status. The subjects were screened for malaria parasites and worm infection to determine their possible impact on anaemia. C-reactive protein (CRP) was used as an indicator for inflammation. Anthropometric information was assessed using height, weight and mid upper arm circumference. Feeding practices and socioeconomic information were assessed using questionnaires. Dietary intake was determined using both food frequency questionnaire and weighed food intake techniques. The values obtained from nutrient intakes were compared with FAO/WHO recommended nutrients intake. Anaemia cut off was Hb < 11.0mg/dl, iron deficiency cut off was serum ferritin levels below 12ug/dl and serum retinol < 20µg/dl showed marginal vitamin A deficiency. Zinc deficiency was defined as a reading bellow 80µg/dl. There was high prevalence of zinc deficiency (60.0%) in relation to 30.0% of iron and 20.0% of vitamin A deficiencies among the under-five children. The prevalence of anaemia was 42.5%.  The children met the mean daily energy, protein, calcium, iron, thiamin and riboflavin intake. Zinc, vitamin A, niacin and ascorbate were below the recommended allowance. When dietary iron, zinc and vitamin A intake were correlated with the biochemical status of the children, adequate dietary iron intake significantly (P<0.05) correlated with good ferritin and zinc status of the children. Inadequate dietary zinc intake was significant (P<0.05) and correlated with inadequate zinc and ferritin status of the children. Adequate dietary zinc intake was significant (P<0.05) with serum zinc status. Adequate dietary vitamin A intake reflected significantly (P<0.05) with serum retinol. Inadequate vitamin A intake significantly (P<0.05) correlated with serum zinc. The study recorded a low prevalence (7.5%) of inflammatory disorders. Malaria parasite and worm infestations were also low in the children (12.5% and 10.0%, respectively). Anaemia was significantly associated with helminthes infestation as well as malaria parasite. The study showed that the caregivers practiced a faulty feeding practice. The under-five children were feed infrequently as against the recommended frequency of meal feeds across various age groups. The children were not fed “responsively”. About 45.5% of the children were underweight. About 63.5% of the children were stunted and 47.5% were wasted. These deficiencies were associated with poor feeding practices, low caregiver to child ratio (1:5) and low socio-economic status. The study shows that protein energy malnutrition and micronutrient deficiency are still of public health important in Nigeria.

 CHAPTER ONE

1.0 INTRODUCTION

1.1 Background to the study

‘Today’s children are tomorrow’s leaders’. This slogan is raising a massive wave of concern throughout the world. However, children all over the world are deprived of many facilities. Children need various types of support ranging from those things necessary for survival, such as food, adequate nutrition and health care, to those interventions that will provide a better quality of life in the future such as education, psychosocial care and economic self-sufficiency. Ideally, all children should have access to these high quality services. Realistically, this is not the case because most children residing in developing countries, especially orphans are malnourished, sick, without shelter and proper education.

Child malnutrition is the most widely spread disorder in Sub-Sahara Africa. Malnutrition is recognized as a consequence of poverty. It is viewed in the context of violation of child’s human rights.  Malnutrition is caused by inadequacy or over-consumption of one or more of the essential nutrients necessary for survival, growth and reproduction (Smith & Haddad, 2000). Under nutrition in all its forms is a significant public health concern. It is the underlying factor in over 50% of the deaths from under five preventable diseases annually (UNICEF, 2001). Poor nutrition severely hinders personal, social and national development^. Inmany regions of the world, the onset of stunting is within the first fewmonths of life. Wasting and under nutrition progressivelycontinue through the first two years of life. About one-third of the children less than five years of age are short and underweight for their ages (Jones, Steketee, Black, Bhutta & Morris, 2003). Studies have shown that, this is the peak age for growth faltering, deficiencies of most micronutrients, and common childhood illnesses such as diarrhoea (Martorell,Kettel & Schroeder, 1994). To grow, the children need to consume adequate amounts of energy, protein, calcium, iron, zinc and other nutrients. Failure to provide the extra nutrients precipitates deficiency of essential micronutrients prevalent among children in developing countries, including Nigeria. Under nourished under-fives are unable to learn and this is carried to adult life. The most devastating to under-fives is micronutrient deficiencies of vitamin A, iron and zinc. These combined can cause impaired growth, impaired mental development and learning capacity. The brain, central nervous system and immune systems are all affected when iron and zinc are deficient, other effects includes stunting wasting and underweight.

 Nutrition is linked to most of, if not all the Millennium Development Goals (MDG), which are closely interlinked. The right to food and good nutrition for all is fundamental to achieving the MDGs (United Nations, 2002). The first goal (MDG-1) is emphatic on the eradication of extreme hunger and poverty. The prevalence of underweight in under-five children is an indicator for achieving this goal. MDG-4 talks about reduction of child mortality. Malnutrition which is preventable, accounts for up to 53% of all deaths in under-five children and remains the underlying cause of most child mortality. To achieve the Millennium Development Goals (MDG-1) for child survival and the prevention of malnutrition (MDG-4), adequate nutrition and health during the first few years of life is fundamental (United Nation, 2002). Poor feeding practices, coupled with high rates of infectious diseases, are the principal proximate causes of malnutrition during the first few years of life (WHO, 2005).

Infant feeding is a critical aspect of caring for infants and young children. An appropriate feeding practice during infancy and early childhood is fundamental to the development of each child’s full human potential. Economic analysessuggest that the challenge of achieving optimal feeding forinfants and toddlers is often as much related to ignorance aboutfeeding and food choices as to scarcity of food (Global Health Council, 2006). Infant and young child’s feeding practices such as breastfeeding and complementary feeding are major child survival strategies especially in developing world. Improving the quality of infant feeding practices was citedas one of the most cost-effective strategies for improving healthand reducing morbidity and mortality in young children (UNICEF, 2007). Studies indicated that, nearly one-third of child deaths could beprevented by a combination of exclusive breastfeeding for 6months, optimal complementary feeding practices, iron, zinc and vitaminA supplementation (Shrimpton, et al., 2006).

Micronutrients are nutrients required by the body in small amount for proper body functions (Sandstrom, 2001). Micronutrients which include vitamins and minerals play vital roles in body growth and development, reproduction, brain functions and resistance to diseases among others. Vitamin A, iron, iodine and recently zinc are the major micronutrients of public health importance especially in developing country like Nigeria (UNICEF, 2007). This is because of the magnitude and seriousness of their deficiencies and consequences on health, learning capacities and productivity of affected people. Micronutrient deficiencies increase morbidity and mortality rates not only in children under-five years, pregnant and lactating mothers, who are more vulnerable but also to the general populace including vibrant adolescents (Bryce, Boschi-Pinto, Shibuya & Black, 2005). It is generally known that the prevalence of malnutrition and micronutrients deficiency increases rapidly in under-five children because of rapid growth and development, therefore deficiency of these nutrients jeopardises the normal health, growth and development of the child. Children may look healthy and their diets may provide adequate energy and protein but are lacking in micronutrients. This is referred to as “hidden hunger”.

Iron is one of the trace mineral that play a vital role in the body. It is an integral part of many proteins and enzymes that maintain good health. It is an essential component of protein responsible for distributing oxygen throughout the body. It plays a central role in metabolic processes involving oxygen transport and storage as well as oxidative metabolism and cellular growth (Serene, Jack, & James, 2003). Iron deficiency most commonly manifest as anaemia. In Africa iron deficiency occurs more often amongst premature infants, growing children and pregnant women. Studies have shown iron deficiency anaemia to be associated with increased morbidity and mortality rates (UNICEF, 2009).

Anaemia prevalence is high in children and its cause is frequently multifactorial. It has been estimated that about 40% of the world’s population (more than 2 billion individuals) suffer from anaemia with a prevalence of 48% in school-aged children (Shell-Duncan & Mcdade,2005). Anaemia occurs as a result of abnormally low haemoglobin due to pathological conditions. Iron deficiency is one of the most common causes of anaemia, other causes include chronic infections such as malaria, worm infestation, hereditary haemoglobinopathies and other micronutrient deficiency particularly folic acid and vitamin C (WHO, 1999).

Vitamin A is a fat soluble vitamin that is of great significance to the body especially its role as immune booster and for health eye sight. Vitamin A deficiency (VAD) is a major public health problem. The most vulnerable group for VAD includes under-five children and pregnant women in low-income countries. In children, VAD is the leading cause of preventable visual impairment and blindness. Twenty six percent of vitamin A–deficient children live in Africa, with the largest number in Ethiopia (UNICEF, 2009). VAD affects almost 1 in every 3 children in Nigeria (WHO, 2007). World Health Organization has classified Nigeria among 34 countries in the world with serious problem of VAD related nutritional blindness and xerophathalmia (WHO, 2007). VAD significantly increases the risk of severe illness and death from common childhood infections, particularly diarrheal diseases and measles (FAO/WHO, 1992). Zinc is a trace mineral needed by human body in small quantity but of great importance for child survival. Zinc deficiency is wide spread in developing countries and the most vulnerable groups are infant, children, pregnant women and lactating mothers (ACC/SCN, 2000). It is marked by growth retardation or stunting. In period of rapid growth zinc requirement is normally high and where this demand is not met, problems like growth retardation may arise (Micronutrient Initiative, 1998). Zinc enhances the transport of vitamin A in and out of the cells and its deficiency is thought to have a close link with iron deficiency. Zinc participates in carbohydrate and protein metabolism, DNA and RNA synthesis among other functions (FAO/WHO, 1992).