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University of Nigeria Virtual Library

Serial No

Author 1

NGWU, E. K

Author 2

UZENDU, P. N.

Author 3

Title

Nutritional Status of Patients Attending Sickle-

Cell Disease (SCD) Clinic at a Nigerian University Teaching Hospital

Keywords

Sickle Cell Disease, Stunting, Underweight, Wasting, Hemoglobin

Description

Nutritional Status of Patients Attending Sickle-

Cell Disease (SCD) Clinic at a Nigerian University Teaching Hospital

Category

Agriculture

Publisher

Nigerian Journal of Nutritional Sciences

Publication Date

2007

Signature

NURITIONAL STATUS OF

The nutritional status of 200

Nigeria Teaching and 42% females. Their ages ranged between 2 years an with a mean age of 10.32*4.36 years for males and 10.07*3.34 years for females. There was no significant (p>O.OS) difference in the educational levels of males and females. A total of 38.5% of the children were pale. Malaria was the most common cause of crisis. Nutritional status indicators showed that 39.66% of the males and 13.09% of the females were stunted. Asmmany as 25.86% of the males and 11.9% of the females were .under weight. Wasting was prevalent in 20.69% of the males and 20.24% of the females. Wider varieties of foods .

were consumed by the children promoting dietary diversification. Intake of energy and protein were above 100% of FAO/WHO requirement f q over 90% of the children. The most limiting nutrients were riboflavin and folate. Intakes of other nutrients such as calcium, iron, vitamin A and thiamin were hlgh (over 70% FAO/WHO) requirement).

: r8 >

Key words: Sickle cell disease, stunting, underweight, wasting, hemoglobin.

globin. . gene, producing structurally nal viscosity o f the cell-

abhormal hemoglobins (1,

long ailment arising from

of sickle hemoglobin (Hb ry beds. This result in '

parents or of Hb S fro of blood flow (vaso--

may *also arise from t to lead to pain

another. variant of

hemoglobin such as Hb

tha1,aSemia '(Hb. S-thal) nemia which results from

par;$ (2, 3). In, ~b d life-span of

commonest, and most severe fo le cell, that survive in the circula

SCD, an amino acid, valine is subst

NIGERIAN JOURNAL OF NllTRiTIONAL SCIENCES VOL 28 (1) 2007

INTRODUCTION

Sickle cell disease (SCD) is a

general name for a group of inherited

blood disorders due to mutations in the

for glutamic acid at the sixth position of

the hemoglobin beta chain. This A

abnormality leads to polymerization of ..\

the Hb S molecule within the red cell , 4

120days for normal red blo

common feature in SCD (2,

sickle cell disease is the mos

genetic disorder affecting p

African ancestry (5, -6). I n

commonest type of sickle c

the homozygous . sickle

(SS), also known as sickle c

Less' common types include sickle

hemoglobin 'C disorder (SC) and t

much rarer sickle cell 'thalassemia

(S+thal). Persons with Hb SC and other

types have on the average similar but

milder syndromes (2).Those with sickle

cell trait (Hb AS) carry the sickle gene

but under normal circumstances are

completely asymptomatic (6).

Deficits in growth is common in children

with SCD including delayed skeletal and

sexual maturation suggesting inadequate

intake and/or increased requirements for

energy and possibly other nutrients (6).

This study was undertaken in order to

characterize the nature and severity of

(2 - 18 years) with

attending the clinic

e children usually

clinic on regular

and /or referrals with their

any adult. Education and'

are usually given topatients

families at the clinic. About 350

nts attended the clinic during the

period of this study (April 2006 - December, 2006).

Informed consent o f the children or

their parent /caregiver was obtained

before involvement in the study.

An approval for the study to be

carried out was obtained from the

chairman, ethical committee of UNTH.

Data collection

Instrument for data collection:

Questionnaire: Validated, semi-

structured questionnaire was used to

collect data on the socio-economic and

demographic characteristics of the

growth failure and nutrient

among children with SCD. ion: All the children

signs of malnutrition

MATERIALS AND METH , angular stomatitis,

Study area: The. study ce of co.mplications of

- a t the sickle cell clinic of

of Nigeria Teaching H etry: , Anthropometric

'Enugu. Highlights on UN ents of weights a'nd heights of

bcen . detailed elsewh n were done. Children were

,paediatric sickle cell clinic hed on a bathroom scale wearing a

.Institute of Child - Health (ICH) nimum of clothing. ~ ' e i ~ h t was

. . established in 1974. easured with a wooden height meter.

NIGERIAN JOURNAL OF NUTRITIONAL SCIENCES VOL 28 (1) 2007 119

Children were measured wit

Heads were erect and hand

their sides in a natural manne

were . taken to the neares

Height-for-age, weight-

weight-for-height of ea

compared with NCHS c

grouped according to WHO (

classification.

Dietary Study: Data were obtained by '

dietary recall and weighing the items the

children consumed for three days (2

week days and one week-end day). All

ingredients used to prepare their meals

were weighed with dietary scales. Foods

eaten by each child during meals were

weighed. Leftovers and plate wastes

were recorded. All snacks and items

consumed outside their homes were

noted. Meat, fish and eggs were weighed

separately. Nutrients in foods consumed

were calculated using food composition

tables (10, 11). I-evels of nutrients

intake were compared with WHO (12)

and FAO/WHO/UNU . (13) requirement . .,, ,.,,... ,....,.

levels.

Statistical analysis:

analyzed using descriptive st

square, Student-t-test

variance were used to s

RESULTS

Table 1 show no significant (p>

) difference in the educational levels ,... .

of males and females (x2 = 6.13).

Table 2 shows results obtained by clinida~

examination of the subjects. A total of

77 children were pale. Only 2 children

had angular stomatitis, 4 xerosis and 5

' leg ulcer. The medical history (Table 3)

of the children showed that 38.0% of the

children were diagnosed with SCD before

age one and 16.5% after 6 years of age.

As many as 49.4% of the children had

brothers. with SCD and 48.3% sisters

with SCD. Only 1.2% had either parents

with SCD. Forty percent of the children

had crisis bi-monthly, 25% twice in a

year and 5.5% had crisis occasionally.

dren experienced bone -,

. .

ptom during crisis,

d only 16.0°/o- had.

s the major- cause: of

5% of the children,

in 12.5% .and others in l6%+

ws that the mean weights' of.

en. ranged from. 13.31 ZIZ 2.75kg . , '

47.60 * 6.22. ' ~ e i ~ h t ranged frdm .'

.95 i 8.25cm.to 158.20 * 6.09bm.

- NIGERIAN JOURNAL OF NUTRITIONAL SCIENCES VOL 28 (1) 2007 120

The mean weight (28.47 * the males was statistically

similar to the females (28.76

There was equally . no si

difference (p>0.05) in the

of males (128.1*2.12cm)

(130.0 * 2.5cm): .Assess

nutritional status of the c h ~

5) showed that 39.66% of the males

13.09% of the females were stunted.

total of 28.5% of the children were

stunted. As many as 25.86% of the

males and 11.9% of the females were

underweight. wasting was, prevalent in

20.69% and 20.24% of the males and

females respectively.. I n all the

anthropometric indicators used for

assessing malnutrition, males were

consistently more malnourished than,

females.

I n Table 6, a high proportion

(270%) of the children consumed bread,

rice, beans, okpa, moi-moi, bread fruit,

yam, cocoyam, semovita, . vita-rice,

pumpkin leaf, fish, egg, .b

ground nut and biscuit i

Observations of daily foo

indicated diversified dietary

families .living 'with SCD.

such as-corn, cassava, p

carrot, tomato.es, ice c

and cake were consume

of the children' in any

addition, supplements

FAO/WHO requirement levels.

ever, riboflavin and folate intakes

were low (570 %) for all children.

I n Figure 2, males 10 - 12 years

exceeded their energy and protein

requirements (106.47% and 109.65%

respectively) and had high (270%)

'intakes of other nutrients except

riboflavin and folate. Females ex eded

only their energy intake (107.31%) and

met over 70% of their requirements for

protein, calcium, iron, vitamin A, thiamin

and ascorbic acid.

Males and females 13 - 15 years

had 102.59% and 101.95%

(respectively) of their energy

requirements. Riboflavin and folate

(58.57%.and 68,32%.

ssessed the nutritional

ren with SCD using

try .and dietary studies. A

hildren aged- 2 - '1.8 years

lved in the'study. I n Nigeria,

a1 of relati"ely appreciable number /

of persons with SCD beyond childhood is

attributed to improvement in standard of

NIGERIAN JOURNAL OF NUTRITIONAL SCIENCES VOL 28 (1) 2007 12 1

care (2). Provision of sickl

positively influenced the 1 outcome o f SCD. Such clinics 'act as I

centers for education on the cll$gp3ar fay , d ,

both patients and their< families. "s:.h-s2~<.? . , , I

paleness and painful crisis experienced

by the children in th

observed signs and

associated with sickle cell a

resulting from excessive hemolysi

vaso-occlusion experienced by patients

(14). I n this study, malaria was the most

common cause of crisis. The distribution

of indigenous sickle cell disorder

coincides with the distribution of

plasmodium falciparum malaria (2).

Malaria is a common precipitating factor

for painful crisis and a major contributor

to morbidity and death (2, 3, 6, 15).

About 28% of the children were

stunted, 20°/o underweight and 21°/o

wasted. These are lower than reported

elsewhere (16). Growth in children with

SCD is important and should be part of

patients management, IncrcasOd calorie 1

. .

s a great energy cost in

fore raises nutrient

. The .high levels of

umed -in this study may.

arily meet requirements under

ase .condition. Standardized

re urgently needed to evaluate

y requirements in SCD.

REFERENCES

1. El-Hazmi, M.A.F. (1986). Infections in sickle cell disease. Annals of Saudi Medicine. 6(1), 33 - 40.

2. Akinyanju, 0. (2001). Issues in the management and control of sickle cell disorder. Archives of Ibadan Medicine. 69: 37 - 41.

3. Okpala, I; Daniel, Y; Haynes, R; Odoemena, D. and Goldman, J. (2002). Relationship between . the manifestations o f SCD and expression o f adhesion molecules on WBCrs. Europ. J. Hematol. 69: 133- 144..

4. Ekvall, S.W. (1993). Paediatric nutrition in chronic diseases and developmental disorder. New York

and nutrient demand

physical activity and g

observed excess and

energy and other nut

children could be evidewt$ of compfiancr on the part of patients 8nd their farni l f~s j

I and dietary counseling in a Nigerian

patients management. I ity press, 289 - 2'92.

and nutrient demand .A, and Akinde, J.A.

physical activity and g atal diagnosis of sickle

observed excess and of sickle cell disorder. Ibadan Medicine. 2(2)

energy and other . . .

children could be evid nt, G.R. arid sergeant, B.E.

on the par t .of patieilt , The epidemiology of s'ickle

to education and co s.orcler: . A challen'ge for Africa es of ',1badan Medicine. 2(2) ..

the clinic. However, I

folate levels hav 7. Ngwu, E.K. (200,5). Characteristics of

implications. The rapid turnov patients receiving health education'


Teaching Hospital. Ni dation Publication Series 26(1) 43-49. ventures, lbadan;

8. NCHS. United States ).. Handbook on human Services (1976). requirements. World administration.' Gr zation. Geneva,. : Rockville, Md, USA: for Health Statistics, WHO/UNU (1985). Energy and

rements. World Heath 9.. WHO (1983). Measo h Rept. Serles 724.

'Nutritional Status. Na health statistics ( .E. (1998). The Geneva. management o f crisis in sickle cell

disease. Eur, 3 . Haematol. 60: .I- 6. lO.Plalt, B.S. (19

representative v 15. Fleming, A.F. (1989). The commonly used in tropical countries. presentation, managem'ent and

-Med. Res. Counc. R : prevention of crisis in sickle cell (Seventh Impression) HMSO. London disease in ~ f r i c a . Blood Rev. 3: 18 - 'pp. 46.

Table 1 : Age distribution and educational level o f the children Male Frequencv Female Frequencv

l l.Oguntona, E.B. and Akinyele,' 1.0. (1981). Nutrient composition o f commonly eaten foods in Nigeria - raw, processed and prepared. Food

Age range

2 - 5 years 25.0 20.2

6 - 9 years 18.1 31.0

16. Phebus, C. Gloringer, M. and Maciak, '

B (1984). Growth patterns by age and sex in children with sickle cell disease. J. Paed. 2: 105-108.

Educational le

No, formal educatio

Senior seconda . .

NIGERIAN JOURNAL OF NU'TRITIONAL SCIENCES VOL 28 (1) 2007

Angular stomatitis

Xerosis

Leg ulcer

2 - 5 years 1 0.5

6 - 9 years - -

10 - 14 years "

15 - 18 years 1 0.5

Total . .

2 - 5 years

6 - 9 years - -

10 - 14 years 1 0.5

15 - 18 years 3 1.5

Total 4 2.0

2 - 5 years - -


Mother 1

Sister 42

Brother 43

None 113

Total 200

Incidence Of Crisis

Monthly 43

Bi monthly 80

6 monthly 50

Yearly 16

Occasionally 11

Total 200

Major signs of SCD experienced during crisis

Bone pain (hand and foot) 142 c.

Chest pain 32

Abdominal pain 49

'Fever . , ,,.., . . :,:++ .. . .. . .. . .. :.... ..... .. ..%.

Usual cause of &i

Pneumonia

Bone infection . ,

Respiratory tra

NIGERIAN JOURNAL OF NUTRITIONAL SCIENCE5 VOC 28 (1) 2007 12

10-12

10-12

13-15 '

13-15

'16-18

16-18

Total

Table 5: Nutritional status of males and females compared with NCHS charts

Index Status , . Males. (010) Females (010) 'Total Heightlage Normal 60.34 86.91 71.50 (stunting)

...6..50 . .

Weightlheight No

15.50

. , ,

Moderate

. .


Table

Cocoyam Cassava Gari Fruits Paw-paw Banana Apple Orange Vegetables Pumpkin bat Tomato Carrot Meat Fish Egg Beef Snall Chicken Milk and milk products Cow milk Soy milk Ice cream

96 -43 78.53 70.56 61.36 40.43 Percent (%) 92.83 73 S6 60.36

Snacks Percent ( O h )

Ground nut

. .


scorbic acid and

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