Abstract:
Reduction in the under-five morbidity and mortality rates as a result of improved nutrition and health care services has increased the number of school going children. Assessment of the school child’s nutritional status becomes imperative in ensuring that the gains are sustained so that they can benefit maximally from education. This work assessed the anthropometric, dietary pattern and micronutrient status of school children aged 6 – 15 years in a rural community of Enugu State, Nigeria. The methodology involved a descriptive cross sectional design. The respondents were 450 primary and secondary school children randomly selected out of 2366 school children from the ten schools in Ede-Oballa. Multistage random sampling technique was used in the selection of the study sample. Data were collected using questionnaire, clinical examination, anthropometry, 3-day weighed food intake, chemical analysis of commonly consumed local foods, blood and stool analyses. The questionnaire elicited information on the socio-economic background of the respondents, the children’s household and health characteristics/practices, their snacks and meal pattern and the consumption pattern/preference profile of micronutrient rich foods. Clinical examination was conducted to identify manifestations of nutritional problems in the children. Weight-for-age, height-for-age and body mass index (BMI)-for-age were anthropometric indices assessed. A 3-day weighed food intake was used to obtain data on the children’s daily energy and nutrient intakes. These were compared with FAO/WHO daily recommended energy and nutrient intakes (RNI). Aliquots of commonly consumed local foods were analysed chemically using standard analytical methods. Blood samples were collected using standard methods and preserved at – 200C prior to analysis. Haemoglobin was assessed using cyanmethaemoglobin method. Serum ferritin and serum zinc were analysed using atomic absorption spectroscopy. Creatine reactive protein and vitamin A were assessed by High Pressure Liquid Chromatography (HPLC). Thin film method was used for malaria whereas wet mount direct method was used for stool analysis. Data were analyzed using descriptive and inferential statistics of the Statistical Package for Social Sciences (SPSS, version 16.0). Duncan’s new multiple range tests were used to separate and compare group means. Pearson’s correlation coefficient, independent sample t-test and Chi square were used to detect associations between variables with P<0.05. The results showed that the school children had poor socio-economic background based on their parents’/guardians’ high illiteracy level (50.3%), low monthly income that ranged from N6,500 – N25,000 (41.8%) and the amount of money allocated to feeding per week which was less than N5,000 (45.5%). Clinical manifestations of malnutrition identified were pallor (35.6%), skin problems (34.6%) and hair changes (31.1%). School children who were underweight were 18.2%; 41.6% were stunted and 20.0% were thin. Underweight occurred more in children within 10 – 12 years (31.1 %). Stunting (45.9%) and thinness (28.6%) were found mostly among the 13 – 15 year old school children. Daily energy and protein intakes of the children aged 6 – 9 years (1878.0kcal:56.9g), 10 – 12 years (1775.6kcal:45.1g) and 13 – 15 years (1833.3kcal:37.7g) were below their daily RNI. Dietary assessment showed that while iron intake was inadequate, zinc and vitamin A intakes were adequate. Chemical analysis of commonly consumed local foods showed that iron content per 100g ranged from 0.23mg in Pterocarpus soyauxii (oha) soup to 13.5mg in Pentaclethra macrophylla (akpaka) sauce; zinc ranged from 0.17mg in Pterocarpus soyauxii soup to 4.97mg in Dioscorea spp + Cajanus cajan (ayaraya ji) dish and vitamin A ranged from 2.97RE in Irvingia gabonensis (ohoyi) soup to 44.0RE in Pentaclethra macrophylla sauce per 100g. Biochemical analysis showed that 96.7% and 85.5% of the school children had iron deficiency and anaemia, respectively. All the school children who were aged 13 – 15 years had mild (33.3%) and moderate (66.7%) anaemia. Zinc and vitamin A deficiencies were identified in 43.3% and 51.1% of the children, respectively. Children who were aged 10 – 12 years were mostly affected by zinc deficiency (48%) while children of 6 – 9 years had the highest prevalence of vitamin A deficiency (56.2%). Parasitic infections identified were malaria (58.9%), hookworm (36.7%), roundworm (27.9%), tapeworm (35.6%), whipworm (34.5%) and amoebiasis (42.2%). Malaria and amoebiasis caused significant (P<0.05) reductions in haemoglobin and serum zinc levels. Haemoglobin was significantly (P<0.05) reduced by hookworm infestation. Tapeworm and whipworm also caused significant (P<0.01) reductions in haemoglobin, serum zinc and serum retinol levels. There was no significant (P>0.05) relationship between anthropometric status and any of the nutritional biomarkers. The relationships of the nutritional biomarkers and daily dietary intakes of iron, zinc and vitamin A were not significant (P>0.05). Monthly income (r = 0.348), birth order (r = 0.207), household size (r = 0.264), weekly food expenditure (r = 0.290), household head (r = 0.210), malaria (r = 0.287) and tapeworm (r = 0.352) were factors that significantly (P<0.05) affected the nutritional status of the school children. Micronutrient deficiencies were found to be more prevalent than underweight, stunting and thinness. Strategies aimed at curbing the menace of micronutrient deficiencies are therefore, imperative to enable the children benefit maximally from their education and grow into healthy adults. A functionally effective school health programme with efficient school feeding programme is indispensable in this regard.
