Project Description

CHAPTER ONE

INTRODUCTION

Malnutrition is one of the most important global health problems affecting large numbers of children in developing countries. The World Health Organization defines malnutrition as “the cellular imbalance between supply of nutrient and energy and body’s demand for them to ensure growth, maintenance and specific functions” (Blecker et al., 2000). Malnutrition is synonymous with protein- energy malnutrition (PEM) and signifies an imbalance between the supply of protein and energy and the body’s demand for these to ensure optimal growth and function. A range of inadequacy states occurs as a result of interaction of diet and nutritional requirement.  Protein energy malnutrition (PEM) a consequence of various factors, is often related to poor quality of food, insufficient food intake, and severe and repeated infectious diseases, or, frequently, a combination of the three (de Onis and Blossner, 1997). The major outcomes of PEM during childhood may be classified in terms of morbidity, mortality, and psychological and intellectual development (Pollitt, Gorman, Engle, Martorell and Rivera, 1993) with important consequences in adult life.

Protein energy malnutrition (PEM) affects a large proportion of children under age 5 years in the developing world. In children, protein–energy malnutrition is defined by measurements that fall below minus 2 standard deviations under the normal weight for age (underweight), height for age (stunting) and weight for height (wasting)(Pinstrup-Anderson, Burger, Habicht and Peterson, 1993).  In developing countries, about 31% of children under 5 years of age are underweight, 38% have stunted growth and 9% are wasted (Brabin and Coulter, 2003). Protein– energy malnutrition usually manifests early, in children between 6 months and 2 years of age and is associated with early weaning, delayed introduction of complementary foods, a low-protein diet and severe or frequent infections (Muller, Garenne, Kouyaté,  and Becher, 2003;Kwena et al., 2003).

Pre-school children constitute the most vulnerable segment of any community. Their nutritional status is a sensitive indicator of community health and nutrition (Sachdev, 1995). Undernutrition among them is one of the greatest public health problems in developing countries. Undernutrition raises the likelihood that a child will become sick and will then die from the disease. Children whose weight-for-age is less than -1 SD are also at increased risk of death, and undernutrition is responsible for 44 to 60 percent of the mortality caused by measles, malaria, pneumonia, and diarrhoea. Morbidity attributable to undernutrition depends on the nature of the illness. Susceptibility to a highly infectious disease such as measles is unlikely to be affected by nutritional status: all individuals are equally likely to become infected if they are unvaccinated and naive. However, 5 to 16 percent of pneumonia, diarrhea, and malaria morbidity are attributable to moderate to severe underweight (Fishman et al., 2004).

Micronutrient deficiencies (iron, iodine, vitamin A and zinc) are also major public health problems in developing countries, however, vitamins C, D and B- complex deficiencies have declined considerably in recent decades (Diaz, Cagigas and Rodriguez, 2003; Levin, Pollitt, Galloway and McGuire, 1993).  Iron and zinc deficiencies are common in children in developing countries and are a significant contributor to morbidity and mortality (Black, 2003). Iron and zinc deficiencies are likely to occur in the same population. Iron and zinc are essential micronutrients for human growth, development, and maintenance of the immune system. Iron is needed for psychomotor development, maintenance of physical activity and work capacity, and resistance to infection (Stoltzfus, 2001). Zinc is needed for growth and for maintenance of immune function, which enhances both the prevention of and recovery from infectious diseases (Black, 2003). Meat products are the best source of both iron and zinc. Consequently, iron and zinc deficiencies may coexist in populations that consume diets with insufficient amounts of animal products. The intake of these 2 micronutrients could be improved through dietary diversification, food fortification or supplementation. If iron and zinc are to be provided together, it is important to determine how they interact biologically. This is because they have chemically similar absorption and transport mechanisms, iron and zinc have been thought to compete for absorptive pathways (Standstorm, 2001).

Nutritional status, especially in children, has been widely and successfully assessed by anthropometric measures in both developing and developed countries (WHO, 1995).  Height and weight are the most commonly used measures, not only because they are rapid and inexpensive to obtain, but also because they are easy to use. Once a childs height and weight have been correctly measured and their age known, a clinician or researcher can assess the childs growth and general nutritional status by using a standardized age- and sex-specific growth reference to calculate height-for-age Z-scores (HAZ), weight-for-age Z-scores (WAZ), weight-for-height Z-scores (WHZ) and body-mass-index-for-age Z-scores (BMIZ).

In April 2006, the World Health Organization released new global child growth standards for infants and children up to the age of 5 years. These new standards were developed in accordance with the idea that children, born in any region of the world and given an optimum start in life, all have the potential to grow and develop to within the same range of height and weight for age.

1.1    Statement of the problem

Child malnutrition is linked to poverty, low levels of education and poor access to health services.  Improved nutrition is assumed to be directly linked to expanded food production while increased income is a good proxy for improved nutrition. Growth disorders in children often go unrecognized, and therefore undiagnosed, for several reasons. Some infants and children are not routinely weighed and monitored at their regular health care visits. Some children see a health care professional only for acute care and may not be weighed at all. Measurements incorrectly taken, inaccurately plotted, or not plotted at all may lead to erroneous interpretation of growth patterns and unnecessary or missed referrals. Weight alone does not address linear growth and body shape and misses the opportunity to educate caregivers about a typical and normal pattern of growth.

Children aged less than 5 years are at high risk of iron and zinc deficiencies. Most children especially those from low income family do not consume iron rich complementary foods by 6 months of age. This is usually so because preschool children in developing countries and low socio economic status typically consume little meat or animal products, hence, iron and zinc deficiencies in this age group are common.  Recently it has been reported that about 48% of the world’s population may be at risk of inadequate zinc intakes (ACC/SCN, 2000) and zinc deficiency is widespread in developing countries.

The nutritional status of children under five years of age is of particular concern since the early years of life are crucial for optimal growth and development. Their nutritional well-being reflects household, community and national investments in family health thereby contributing both directly and indirectly to overall country development and in particular, development of human resource. However, most of the State Development programs (SDPs) in Anambra State do not have data on nutritional status of the under-fives in Ozubulu, and these data are used in the definition of health and nutritional status for purposes of programme planning, implementation and evaluation. Based on this, a nutritional assessment to determine the nutritional status of children 2 – 5 years in Ozubulu was conducted.

1.2 Objectives of study

The general objective of this study was to assess iron, zinc status and anthropometric indices of preschool children (2 – 5years) in Ozubulu community of Anambra State, Nigeria.

The specific objectives were to;

1. assess the anthropometric indices of preschool children in Ozubulu using WHO child growth standard and NCHS/WHO reference values.
2. assess the iron and zinc status of preschool children in Ozubulu; and
3. assess the dietary pattern and factors affecting the nutritional status of the preschool children in Ozubulu.

1.3   Significance of the study

Malnutrition and micronutrient deficiencies can be eliminated only when a given population is identified as affected, the causes known and the severity of the problems. Thus, this study will help to determine the growth and physical development among preschoolers. The data obtained will help in the definition of health and nutritional status for purposes of programme planning, implementation and evaluation in Ozubulu. The data will also be an important key in directing programme resources to the people of this community. The study will reveal whether or not the area it covers has problem(s) of zinc and iron deficiencies and possible causes. Also it will help to determine the dietary pattern of preschool children in Ozubulu.

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