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.
TABLE OF CONTENTS
Title page
List of tables
List of figures
Abstract
CHAPTER ONE
1.0 Introduction
1.1 Background to the study
1.2 Statement of the problem
1.2 Objectives of the study
1.3 Significance of the study
CHAPTER TWO
2.0 Literature review
2.1 Orphans and orphanages
2.2 Prevalence of Orphans and Vulnerable Children (OVC) in Nigeria
2.3 Causes of Orphans and Vulnerable Children (OVC) in Nigeria
2.4 Feeding practices
2.5 Breastfeeding
2.5.1 Composition of breastmilk
2.5.2 Mature milk
2.6 Replacement feeding
2.6.1 Nutrients composition of breastmilk and infant formula
2.6.1.1 Carbohydrates
2.6.1.2 Protein
2.6.1.3 Vitamins
2.6.1.4 Fat
2.6.1.5 Iron
2.7 Complementary feeding
2.7.1 Nutrient composition of complementary foods
2.7.1.1 Energy content of complementary foods
2.7.1.2 Protein content of complementary foods
2.7.1.3 Mineral content of complementary foods
2.7.2 How to introduce complementary feeding
2.8 Family food
2.9 Micronutrients
2.9.1 Iron
2.9.1.1 Metabolism, absorption and utilization of iron
2.9.1.2 Factors that influences iron absorption
2.9.1.3 Storage of iron
2.9.1.4 Interactions with other nutrients
2.9.1.5 Requirements
2.9.1.6 Dietary sources of iron
2.9.1.7 Deficiency
2.9.2 Zinc
2.9.2.1 Dietary sources of zinc
2.9.2.2 Zinc metabolism, absorption and utilization
2.9.2.3 Requirements of zinc
2.9.2.4 Deficiency
2.9.3 Vitamin A
2.9.3.1 Metabolism, absorption and utilization of vitamin A
2.9.3.2 Dietary sources of vitamin A
2.9.3.3 Requirements
2.9.3.4 Deficiency
2.10 Assessment of Nutritional Status
2.10.1 Anthropometry assessment method
2.10.1.2 Height and weight
2.10.1.3 Body Mass Index (BMI)
2.10.1.4 Mid upper arm circumference (MUAC)
2.10.2 Biochemical assessment method
2.10.3 Clinical assessment method
2.10.4 Dietary assessment method
2.10.4.1 Weighed food intake
2.10.4.2 24-hour dietary recall
2.10.4.3 Food frequency questionnaire (FFQ)
2.10.4.4 Diet History
2.11 Some factors that influence the nutritional status of children
2.11.1 Food Security
2.11.2 Socio-economic status
2.11.3 Care giver knowledge to feeing practices/psychosocial care
2.11.4 Infection and parasitic diseases
2.11.5 Caregiver-to-child ration
CHAPTER THREE
3.0 Materials and methods
3.2 Study design
3.3 Population of the study
3.4 Sample for the study
3.5 Ethical clearance
3.6.1 Data collection instruments and method
3.6.1 Questionnaires
3.6.2 Collection of blood sample and preparation
3.6.3 Biochemical analysis
3.6.3.1 Iron status analysis
3.6.3.2 Vitamin A status analysis
3.6.3.3 Zinc status analysis
3.6.3.4 Parasitological test
3.6.4 Anthropometric Measurement
3.6.5 Dietary assessment
3.7 Data analysis
CHAPTER FOUR
4.0 Results
4.1 Background Information of the Orphanages
4.2 Background Information of staff of the Orphanages
4.3 Feeding practices of the children
4.4 Nutrition interventions programmes and health care practices offered In the orphanages
4.5 Food frequency pattern of the children
4.6 Anthropometric assessment of children (0-5 years) in the orphanages
4.7 Energy and nutrient intakes of children (0-60 months)
4.8 Biochemical assessment result of children (0-60 months)
CHAPTER FIVE
5.0 Discussion
5.1.1 Background information of the orphanages
5.1.2 Nutrition intervention programmes, child health and morbidity pattern Of the children
5.1.3 Nutritional status of the children using anthropometrics indices
5.1.4 Feeding practices of the under-five children in the orphanages
5.1.5 Feeding pattern and energy nutrients of the under-five children
5.1.6 Vitamin A, iron and zinc status of the under-five children
5.1 Conclusion
5.2 Recommendation
REFERENCES
APPENDIX
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. In many regions of the world, the onset of stunting is within the first few months of life. Wasting and under nutrition progressively continue 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
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 analyses suggest that the challenge of achieving optimal feeding for infants and toddlers is often as much related to ignorance about feeding 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 cited as one of the most cost-effective strategies for improving health and reducing morbidity and mortality in young children (UNICEF, 2007). Studies indicated that, nearly one-third of child deaths could be prevented by a combination of exclusive breastfeeding for 6 months, optimal complementary feeding practices, iron, zinc and vitamin A 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....
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