|Year : 2015 | Volume
| Issue : 2 | Page : 109-114
A survey of nutritional status of children 0-12 months in specialist hospital Gombe, Nigeria
Mela Danjin, Nasiba U Dawud
Department of Anatomy and Physiology, School of Nursing and Midwifery Gombe, Gombe State, Nigeria
|Date of Web Publication||16-Mar-2015|
School of Nursing and Midwifery Gombe, PMB 053, Gombe State
Source of Support: None, Conflict of Interest: None
Background: This study was a cross-sectional survey of children and their mothers in specialist Hospital Gombe, Nigeria. Objective: Anthropometric assessment of nutritional status of the children (0-12 months) and a survey of mothers' opinion on malnutrition. Population: Children and mothers attending immunization sessions in specialist hospital Gombe, Nigeria. Materials and Methods: Hundred children (0-12 months) attending immunization sessions were purposefully sampled and measured using sensitive anthropometric tools and techniques, while on the other arm of the study structured interviews were administered on the children's consenting mothers (100) who turned in for their wards' immunization. Only 97 out of 100 data collected on the children were used. Anthropometric indices used were height-for-age, weight-for-height, weight-for-age, and mid-upper arm circumference. Results: The study revealed a higher prevalence of moderate stunting in male (46.9%) than in female (33.3%) children (P < 0.05). All (100%) children within the age group of >11 exhibited both severe and moderate forms of underweight. Among infants 3-5 months, moderate wasting was found to be less prevalent (4.2%). And despite the fact that 90% of their mothers showed a positive attitude toward exclusive breastfeeding, only 44% of them breastfed their infants exclusively from birth to the 6 th month of life. Conclusion: In order to address the various forms of nutritional derangements detected among the children, mothers should be targeted for infant nutritional education and authorities should institute poverty alleviation measures so as to address underlying causes of malnutrition.
Keywords: Anthropometric, children, stunting, underweight, wasting
|How to cite this article:|
Danjin M, Dawud NU. A survey of nutritional status of children 0-12 months in specialist hospital Gombe, Nigeria. CHRISMED J Health Res 2015;2:109-14
|How to cite this URL:|
Danjin M, Dawud NU. A survey of nutritional status of children 0-12 months in specialist hospital Gombe, Nigeria. CHRISMED J Health Res [serial online] 2015 [cited 2020 Jan 25];2:109-14. Available from: http://www.cjhr.org/text.asp?2015/2/2/109/153253
| Introduction|| |
Anthropometric variables can be sensitive indicators of health, growth, and development in infants' and children. , Anthropometry is the single most universally applicable, inexpensive, noninvasive and accurate method available to assess the size, proportion, and composition of the human body. , According to World Health Organizati on (WHO), the ultimate intention of nutritional assessment is to improve human health.  Malnutrition which refers to an impairment of health either from a deficiency or excess or imbalance of nutrients is of public health significance among children all over the world.
Adequate food and nutrition are essential for proper growth and physical development so as, to ensure good health, mental performance, adequate immune reactions, and resistance to infection.  Inadequate immune reactions and resistance to infection and inadequate diet may produce severe forms of malnutrition in children such as vitamin A deficiency and iodine deficiency disorder. Three commonly used indicators of under-nutrition among children are stunting (low height-for-age [HFA]), thinness (low body mass index for age), and underweight (low weight-for-age [WFA]). Stunting is an indicator of chronic under-nutrition, the result of prolonged food deprivation and/or disease or illness; thinness is an indicator of acute under-nutrition, the result of more recent food deprivation or illness; underweight is used as a composite indicator to reflect both acute and chronic under-nutrition, although it cannot distinguish between them. ,
Breast feeding (0-6 months)
Breastfeeding has been in existence since the creation. It is the process by which a woman feeds an infant or young child with milk from her breast. It evolved over time to optimize the growth and development of the baby and young child. According to WHO, exclusive breastfeeding is defined as the practice of feeding with only breast milk (including expressed breast milk) and no other liquids or solids with the exception of drops or syrups consisting vitamins, mineral supplements, or medicine. , There is a relationship between having been breastfed as a child with stronger intellectual development and reduced risks of cancer, obesity, and several chronic diseases.  The 54 th world health assembly which met in Geneva in May 2001 affirmed the importance of exclusive breastfeeding (EBF) for 6 months. 
Human milk is the ideal nourishment for infant survival, growth, and development. Exclusive breastfeeding in the first 6 months of life stimulates the baby's immune system and protects them from diarrhea and acute respiratory infections, which are the two major causes of infant mortality in the developing world. It improves their responses to vaccination. 
Breast milk not only provides all nutrients a baby needs but also passes along antibodies, which help protect them from infections that cause diarrhea and pneumonia-two leading causes of mortality worldwide. According to WHO if more babies are exclusively breastfed for 6 months it will reduce mortality rate. 
Complementary feeding (6-12 months)
Complementary feeds are feeds given after breastfeeding. Complementary feeds of breast milk substitutes (formula milk) should be given as a last resort, not as a quick fix, as any formula used is enough to sensitize susceptible infants. Early weaning is necessary to provide a well-balanced feeding, a baby needs later in life. Because breast milk diminishes in quality and quantity after 6 months to the infant's need. 
According to United Nation Children Emergency Fund (UNICEF), founder of baby friendly initiative, complementary feeding should start after the first 6 months of life. At 6 months, the first solid food should be iron-fortified cereals, pap with soya bean powder, vegetable, egg, meat. At end of 1 st year of life, most children can eat suitable family meals and snacks. 
Anthropometric indicators in Nigeria
Anthropometric measurements carried out during the Nigeria Demographic and Health Survey (NDHS), 2008 indicate that overall, 41% of Nigerian children are stunted (short for their age), 14% are wasted (thin for their height), and 23% are underweight.  The indices show that malnutrition in young children increases with age, starting with wasting, which peaks among children age 6-8 months, underweight peaks among children age 12-17 months, and stunting is highest among children age 18-23 months. The highest rates of all the three major anthropometric indicators of nutritional status were reported in the North-East region, where Gombe state is located-Stunting, 48.6%; wasting, 22.2% and underweight, 34.5%.  Danjin et al. assessed the nutritional status of school children aged 5-15 in Gombe metropolis and reported lower rates-stunting, 18.4%; wasting, 17.7% and underweight, 26.6%.  In Ondo State, South-West Nigeria, Ijarotimi working among infants, classified 22.5%, 9.5% and 5.0% of them as exhibiting first, second and third degree of malnutrition, respectively. 
In providing what seems to be a possible explanation for the above seemingly high rates of malnutrition, in a systematic comparative review of health demographic and multi-cluster indicator surveys from 76 countries Lopriore et al. observed overestimations in especially Asia and Sub-Saharan Africa.  In related findings, Harries et al. and Toriola drew attention to the fact that cutoff points for nutritional depletion in the Jellife (1966) reference standard, may not be applicable to Nigerian or African children as large proportion of their healthy subjects (Adults and Children) would be classified as malnourished. ,, Despite the foregoing argument, in large population assessments, anthropometric measurement still remains the most reliable and sensitive indicators of nutritional status. ,
The incidence of malnutrition among children (0-12 months) is increasing drastically in developing countries.  Thus this study was designed to evaluate the overall prevalence and degree of undernutrition as well as assess the perceived causes of nutritional deficit among this vulnerable population group (0-12 months) and provide a baseline data for further research.
| Materials and methods|| |
A total number of 100 children 0-12 months was purposefully sampled from 621 of them who were immunized in March 2011 at Gombe Specialist Hospital. Their selections were based on the consent of their mothers to have their wards measured and also consent to being interviewed. Those mothers who declined were not interviewed and neither their children measured. A pretested structured questionnaire was used to collect information on their opinions on the possible causes of child malnutrition.
Anthropometric data collected include age, height; weight and mid-upper-arm-circumference (MUAC). A proforma (data collection sheet) carrying all these was developed and used for documentation as the data were generated. The women freely supplied information on the age of their children. Heights of children were measured by taking the recumbent length, that is, using meter rule while they lied face up on the table.  The weights of subjects were measured using the UNICEF SECA digital infant weighing scale. Heights and weights were measured to the nearest 0.5 cm and 0.1 kg, respectively. All extra clothing that could add to the weight measurement were removed. MUAC of the children were measured by means of Shakir strip. The service of one data collection clerk was engaged and together with one of the co-authors, the data for this study were generated. Mothers' were then interviewed in order to obtain their personal opinions on child malnutrition.
Method of data analysis and presentation
Data analysis was done using simple frequencies, percentage, charts, and Z-Scores. The EPI info software (CDC) was used to generate Z-scores (NHES) that were sensitive to various forms of malnutrition. Tables and Graphs were used to present the result of data from this study. The anthropometric measurement record for three out of the 100 children that were measured contained some ambiguities that rendered them unusable; hence, 97 instead of 100 children's data were used for relevant analysis and presentation.
Anthropometric indices used were HFA, weight-for-height, WFA, and MUAC. Z-score deviations from mean Compared with the National Centre for Health Statistics standard were used to categorize the children into different cases of malnutrition (protein-energy malnutrition). Those who fell below -2SD were categorized as moderate, while those who fell below -3SD were considered severe cases. These were used to characterize various degrees of stunting (height-for-age z-score [HAZ]), wasting (weight-for-height z-score) and under-weight (Weight-for-age z-score [WAZ]). All children with MUAC below-2SD were classified as having global acute malnutrition (GAM). 
Informed consent was obtained from the mothers of the children after full explanation on the research work and the anthropometric procedures to be carried out on their wards in addition to the few survey questions they were to answer. The approvals of the hospital management and that of research and Ethics Committee of the school of Nursing and Midwifery Gombe were secured. All necessary Ethical principles were highly respected throughout the study, and all the subjects (children and their mothers) were free from any harm that could have arisen from instruments used.
Limitations of the study
The sample size may be considered inadequate in view of the total number of attendees during the limited period of data collection. Hence, though very significant as an exploratory survey, the use of the result from this study for generalizations should be done with caution. The design of the study itself being cross-sectional imposes a limitation to the extent of causality association and absolute plausibility.
| Results|| |
[Table 1] presents sex-specific analysis of the levels of malnutrition among the children measured. The male segment indicates that most (44.9%) of the male children were moderately stunted while 14.3% were severely stunted. It also shows that 18.2% of them were moderately underweight whereas 12.7% exhibited severe underweight. Only 2.0% of them were moderately wasted, and none was severely wasted. By MUAC measurement GAM among the male children (GAM) was rated at 17.1%. The female segment of [Table 1] reveals the levels of malnutrition among female children, 0-12 months (n = 42). The level of stunting among them had the highest rate of 45.5%. Thirty-three point three percent (33.3%) of the female children were moderately stunted while 12.2% of them were severely stunted. The rate of wasting among the females was the lowest at 2.6% (moderate wasting). Using MUAC GAM among the female children was 4.3%.
|Table 1: Levels of malnutrition among male (n=55) and female (n=42) children aged 0-12 months|
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[Table 2] displays the combined rates of malnutrition among the subjects. Overall, the subjects exhibited moderate stunting rate of 40.9%, moderate underweight, 15.5% while the rate of moderate wasting was the lowest (2.3%). The overall means of height (57.02 cm), weight (6.47 kg), age (4.61 months), and MUAC (12.74 cm) of the subjects were also computed [Table 3].
|Table 2: Combined rates of malnutrition among children 1-12 months (n=97)|
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[Table 4] presents the degrees of stunting (HAZ) across age subgroups of the subjects. The age group of 9-11 months had the highest rate (37.5%) of moderate stunting (<−2 SD) while 3-5 months infants had the least rate (33.3%) while >11 months subjects exhibited neither moderate nor severe stunting. It was also found that for severe stunting (<−3 SD) infants within the age sub-group of 9-11 months had the highest rate of 25.0% while age group 6-8 months presented lowest rate (7.7%). The table also indicates the distribution of degrees of under-weight (WAZ) across age sub-groups. The prevalence of moderate under weights among the children were apparently higher than severe underweight. The age group 9-11 months had the highest (58.3%) rate of moderate underweight while 14.7% rate of severe underweight was recorded among the children. According to the table, only the age groups 3-5 months and 0-2 months exhibited some mild forms of moderate wasting, 4.2% and 2.9%, respectively, while none of the children presented with severe wasting.
|Table 4: Distribution of degrees of stunting HAZ, underweight WAZ, and wasting-WHZ across age sub-group of children|
1-12 months (n=97)
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[Table 5] shows that though there was a high (86%) level of awareness on EBF among respondent mothers and 90% of them indicated willingness to practice EBF, only 44% of them said they practiced EBF (from birth to 6 month of life). Only 19% of the mothers admitted the existence of child food taboos. And on the possible causes of malnutrition mothers' opinion indicated poverty which had the highest percentage of 36% followed by ignorance with 28%. Next to it was worm infestation comprising 19% and the least was ill health indicated by 17% of the mothers.
|Table 5: Mother's awareness and attitude toward EBF and opinion on causes of child malnutrition (n=100)|
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| Discussion of findings|| |
It was observed in this study that 40.9% of the children were stunted, 15.5% underweight, and 2.3% wasted [Table 2]. These findings vary from another findings among school children in Gombe metropolis by Danjin et al.  where the prevalence of stunting was far lower (18.4%) while underweight (26.6%) and wasting (17.7%) rates were higher than those of the present study. The NDHS (2008) revealed 41% stunting, 23% underweight, and 14% wasting among Nigerian children.  The stunting rate (41%) is corroborated by that of this study (40.9%). And stunting being a proxy for chronic malnutrition ,, might by this findings be implying that nutritional deprivation in the 1 st year of life might be an issue for critical attention to concerned authorities in this part of Nigeria. The NDHS 2008 established that education and wealth are both inversely related to stunting levels. As also established by the NDHS 2008, this study also found a higher prevalence of stunting in male (44.9%) than in female (33.3%) children [Table 1]. None of the children is suffering from severe form of wasting as revealed in [Table 4]. Another trend that was also reported by National Population Commission and ICF Macro (2009) is a rapid rise in levels of malnutrition with age [Table 4].  Stunting increased from 37.5% among children aged 0-2 months to 75% among children aged 9-11 months; and underweight from 2.4% in age group 0-2 months to 58.3% among children aged 9-11 months. Children reported to be very small at birth are more likely to be wasted (20%) at the 3 rd year. North-East and North-West reported wasting levels that are above the National average (22% and 20%, respectively).  The rate of GAM among the male children (17.1%) is far in excess of acceptable proportion. The United Nations Standing Committee on Nutrition asserted that the prevalence of acute malnutrition between 5% and 8% indicates a worrying nutritional situation, and prevalence >10% corresponds to a serious situation. 
As earlier indicated anthropometric information is nonspecific and does not identify the cause of growth failure or faltering.  Hence, interview was employed in order to find out factors' responsible for the prevalence of malnutrition (undernutrition) based on the mothers' perception. According to [Table 5], 36% of the respondents indicated poverty as the main factor responsible for undernutrition while the rest of the respondents also indicated ignorance, worm infestation and ill health as other possible causes. As stated by Mamadou and Dwebel major causes of undernutrition include poverty, food prices, dietary practices, and agricultural productivity with many individual cases being a mixture of several factors. 
Moreover, the result shows that almost all (86%) the mothers interviewed are aware of exclusive breastfeeding as shown in [Table 5] while 90% of the respondents exhibited positive attitude toward EBF (for their infants from birth to 6 months of life). However, only 44% of them reported to have practiced EBF. This is by far in excess of the national rate (13%) at 2008 NDHS.  Ijarotimi, reported 20.4% rates in South-West Nigeria, while in Enugu State, Ene-Obong et al., reported that up to 74.4% of mothers with children 0-6 months of age exclusively breastfed their infants. , The 54 th world health assembly which met in Geneva in May 2001 affirmed the importance of EBF for 6 months. 
As stated by WHO (2001), if more babies are exclusively breastfeed for 6 months infant mortality will be reduced by 50%. Every year, it is estimated that undernutrition contributes to the death of about 5-6 million children under the age of 5 which include the infant.  And that 146 million children in the developing world are underweight for their age and at increased risk of early death. In this present study, stunting among the infants is unacceptably very high (40.9%).
| Conclusion|| |
The present study provides evidence that the children assessed were undernourished. Health education on weaning practice, EBF, infection prevention, and demonstration of dietary preparations should be strengthened in the ante-natal clinics so as to improve nutritional status of children. Food security measures should be put in place by relevant government organs and stakeholders. Further studies should be done in order to provide options and scientific basis for nutritional interventions. Prevailing feeding practices among children within the 1 st year of life should be further investigated. There should be particular attention to the kind of nutritional care being given to the male child.
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[Table 1], [Table 2], [Table 3], [Table 4], [Table 5]