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INFLUENCE OF SOCIO-ECONOMIC FACTORS ON NUTRITIONAL STATUS

OF CHILDREN IN A RURAL COMMUNITY OF OSUN STATE, NIGERIA

*Senbanjo IO (FWACP), **Adeodu OO (FWACP), ***Adejuyigbe EA (FMCPaed)

* Senior registrar, Department of Paediatrics & Child Health, Obafemi Awolowo

University Teaching Hospitals Complex, Ile-Ife, Osun State, Nigeria.

** Associate professor, Department of Paediatrics & Child Health, Obafemi Awolowo

University Teaching Hospitals Complex, Ile-Ife, Osun State, Nigeria.

*** Senior lecturer, Department of Paediatrics & Child Health, Obafemi Awolowo

University Teaching Hospitals Complex, Ile-Ife, Osun State, Nigeria

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ABSTRACT

Protein energy malnutrition (PEM) remains a major public health problem in

Nigeria to such extent that it is the second most common cause of childhood morbidity

and mortality. This was a questionnaire-based, cross sectional survey which relied on

anthropometry to assess the nutritional status of children aged one year to five years. It

was conducted using the multistage cluster sampling technique in Ifewara, a rural

community in Osun State, about 200 kilometers from Lagos, Nigeria in order to

determine the prevalence and types of malnutrition and the associated socio-economic

determinants in the population. A total of 420 children were recruited from 344

households.

By the modified Wellcome Classification, the prevalence of PEM was 20.5 percent, and

using the World Health Organization/ National Centre for Health Statistics (WHO/

NCHS) cut off points, the prevalence rates of underweight, wasting and stunting were

23.1 percent, 9 percent and 26.7 percent respectively. One hundred and twelve (26.7

percent) children had borderline malnutrition. However, severe forms of PEM were not

common. Only 4 (1 percent) children had marasmus while there were no cases of

kwashiorkor or marasmic-kwashiorkor. Of the 348 mothers, 336 (96.6 %) had secondary

education at best while 12 (3.4 %) had post secondary. The prevalence rate of

underweight children was three times as high in the former as in the later group. Also,

children of mothers who were not educated beyond secondary school level had one and a

half to two times the prevalence rate of stunting. On the other hand, children of mothers

with post secondary education were apparently more often affected by wasting than those

with less educated mothers. However, no statistically significant difference was found in

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all these comparisons (2

= 2.38, p = 0.667; 2

= 1.9, p = 0.754 and2

= 2.38, p = 0.666

respectively). Of the 344 fathers, 25 (7.3 %) were educated beyond secondary school

level. The others (92.7 %) had at least secondary school education at best. There was a

subtle inverse relationship between fathers educational qualification and prevalence of

underweight but the differences were not statistically significant (p = 0.568). There was

no consistent trend in the pattern of wasting or stunting with respect to paternal

educational level. Low maternal income and overcrowding were associated with higher

prevalence of wasting (2

= 4.63, p = 0.031 and 2

= 4.79, p = 0.029 respectively). No

association was found between the source of drinking water or social class and

malnutrition.

It is concluded from this study that PEM is a major childhood public health hazard in

Ifewara and the local government authorities need to plan and implement effective child

health promotion. However, the prevalence of PEM in Ifewara is low when compared

with reports from other parts of Nigeria and this has been ascribed to the availability of

social amenities and access to basic medical careprovided by a comprehensive health

centre and a Non Governmental Organization. To this end, it is recommended that

governments should support and collaborate with Non Governmental Agencies in the

provision of health care needs to the people. Empowerment of mothers with the aim of

augmenting family income and parental education on the need to limit family size may

also be key measures in reducing the incidence and expectedly mitigate the effect of PEM

among the children of this rural community.

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INTRODUCTION

Malnutrition has for a long time been recognized as a consequence ofpoverty

since most of the worlds malnourished children live in the developing nations of Asia,

Africa and Latin America where those mostly affected are from low income families.1It

is conceivable that most of the resources of these developing countries are spent servicing

external debts at the expense of health and other social welfare services. The heavy

depletion of state funds by corrupt political leaders as well as the ravaging effects of wars

and strife result in economic instability and low purchasing power of the currencies.2

This

translates to low standard of living of the people.2

Therefore, this study, aimed at determining the current nutritional status of under-

five children in a rural Nigerian community and the socio economic determinants can be

used to canvass for nutrition surveillance and appropriate nutritional intervention

programme particularly in a times of depressed economy.

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SUBJECTS AND METHODS

The study was carried out in Ifewara, a rural community located in Atakunmosa

West Local Government Area, of Osun State, south-western Nigeria. Ifewara with the

estimated population of 3, 927 and household count of 1,849 is located 18 kilometers

from Osu, the headquarters of the local government area, 36 kilometers from Osogbo, the

capital of Osun State and 200 kilomaters from Lagos, a former federal capital city.3, 4

The multistage cluster and random sampling techniques were used to select

households and subjects. All under-five children in the entire households of the selected

houses were studied. For the purpose of this study, the housing system was classified into

flats or self contained apartments and individual rooms. A flat/self contained apartment

refers to residence whereby a family is able to carry out some of its major functions

without sharing with another family while individual room refers to sleeping room.

In each household, information was obtained on demographic, socio-economic and

environmental characteristics and the families were assigned a socio-economic class

using the method recommended by Oyedeji.5

The anthropometric parameters of every

child were recorded and each child was clinically examined for gross evidences of

malnutrition. Standardization checks on the tools for anthropometric measurements were

done periodically. Children with evidences of chronic diseases were excluded.

Malnutrition was diagnosed clinically using the modified Wellcome System of

Classification.6

The National Centre for Health Statistics/World Health Organization

(NCHS/WHO) guidelines and cut off points7, 8, 9, 10

were also used to determine the

degree of stunting, underweight and wasting. Underweight, wasting and stunting were

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diagnosed when the Weight-for-Age (WA), Weight-for-Height (WH) and Height-for-Age

(HA) were equal to minus two Standard Deviation (-2 SD) or below the mean of this

reference international standards respectively.7

Using the Mid Arm Circumference

(MAC), the subjects with values less than 12.5cm, between 12.5cm and 13.5cm and

above 13.5cm were deemed to have severe malnutrition, borderline malnutrition and

normal nutritional status respectively as suggested by Shakir.10

Data analysis was done using the Epi info 2002 and the SPSS for windows version 11

softwares.11, 12 Personal and family data were separately analyzed to avoid data

duplication. Proportions and rates were compared using the Pearson Chi squared (2

) test.

p values less than 0.05 were accepted as statistically significant.

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RESULTS

Demography

A total of 420 children were studied from 344 households consisting of 348

mothers and 344 fathers. The mean age of the study population was 35.4 + 14 months.

There were 218 (51.9 %) females and 202 (48.1 %) males giving a female: male ratio of

1.1: 1. The means ( SD) of the weight-for-age Z-scores (WAZ), height-for-age Z-scores

(HAZ) and weight-for-height Z-scores (WHZ) were -1.25 + 1.36, - 1.30 + 1.30 and

0.402 + 1.12 respectively. The prevalence of underweight, wasting and stunting are 23.1

%, 9.0 % and 26.7 % respectively (Table II).

Socioeconomic Characteristics of Parents and Nutritional Status

Tables III and IV shows the level of education of the parents in relation to the

nutritional status of their children. Of the 348 mothers, 336 (96.6 %) had secondary

education at best while 12 (3.4 %) had post secondary education. Underweight and

stunting were more common among the former than the latter while wasting was found

more among the latter. These differences, however, lack statistical significance.

Of the 344 fathers, 319 (92.7%) had at most secondary education while 25 (7.3

%) were educated beyond secondary school level. There w