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ASSESSMENT OF IRON, ZINC AND ANTHROPOMETRIC INDICES OF PRESCHOOL CHILDREN IN OZUBULU, ANAMBRA STATE, NIGERIA

CHAPTER ONE

INTRODUCTION

1.0.  Background of the Study

Malnutrition is one of the most important global health problems affecting large numbers  of  children  in developing  countries.  The  World  Health  Organization  defines malnutrition as “the cellular imbalance between supply of nutrient and energy  and body’s demand  for them  to ensure  growth,  maintenance  and specific  functions”  (Blecker  et al., 2000). Malnutrition is synonymous with protein- energy malnutrition (PEM) and signifies an imbalance  between the supply of protein and energy and the body’s demand for these to ensure  optimal  growth  and function.  A range of inadequacy  states  occurs  as  a result  of interaction  of  diet  and  nutritional  requirement.     Protein  energy  malnutrition  (PEM)  a consequence  of various factors, is often related to poor quality  of food, insufficient food intake, and severe and repeated infectious diseases, or, frequently, a combination of the three (de  Onis  and  Blossner,  1997).  The  major outcomes  of  PEM  during  childhood  may  be classified in terms of morbidity,  mortality, and psychological and intellectual development (Pollitt, Gorman, Engle, Martorell and Rivera, 1993) with important consequences in adult life.

Protein energy malnutrition (PEM) affects a large proportion of children under age 5 years  in  the developing  world.  In  children,  protein–energy  malnutrition  is  defined  by measurements that fall below minus 2 standard deviations under the normal weight for age (underweight), height for age (stunting) and weight for height (wasting)(Pinstrup-Anderson, Burger, Habicht and Peterson, 1993).  In developing countries, about 31% of children under 5 years of age are underweight,  38% have  stunted growth and 9% are wasted (Brabin and Coulter, 2003). Protein– energy malnutrition usually manifests early, in children between 6 months and 2 years of age  and is associated  with early weaning, delayed introduction  of complementary foods, a low-protein diet and severe or frequent infections (Muller, Garenne, Kouyaté,  and Becher, 2003;Kwena et al., 2003).

Pre-school children constitute the most vulnerable segment of any community. Their nutritional status is a sensitive indicator of community health and nutrition (Sachdev, 1995). Undernutrition  among  them  is one  of the  greatest  public  health  problems  in developing countries. Undernutrition raises the likelihood that a child will become sick and will then die from the disease. Children whose weight-for-age is less than -1 SD are also at increased risk of death, and undernutrition is responsible for 44  to 60 percent of the mortality caused by measles, malaria, pneumonia, and diarrhoea. Morbidity attributable to undernutrition depends on the nature of the illness. Susceptibility to a highly infectious disease such as measles is unlikely  to be affected  by nutritional  status: all individuals  are equally likely to become infected if they are unvaccinated and naive. However, 5 to 16 percent of pneumonia, diarrhea, and malaria  morbidity are attributable to moderate to severe underweight (Fishman et al., 2004).

Micronutrient deficiencies (iron, iodine, vitamin A and zinc) are also major public health  problems   in developing   countries,   however,   vitamins  C,  D  and  B-   complex deficiencies  have declined  considerably  in recent decades  (Diaz,  Cagigas  and  Rodriguez, 2003; Levin, Pollitt, Galloway and McGuire, 1993).  Iron and zinc deficiencies are common in  children  in  developing  countries  and  are  a  significant  contributor  to  morbidity  and mortality (Black, 2003). Iron and zinc deficiencies are likely to occur in the same population. Iron and zinc are essential micronutrients for human growth, development, and maintenance of the immune system. Iron is needed for psychomotor development, maintenance of physical activity and work capacity, and resistance to infection (Stoltzfus, 2001). Zinc is needed for growth and for maintenance of immune function, which enhances both the prevention of and recovery from infectious diseases (Black, 2003). Meat products are the best source of both iron and  zinc.  Consequently,  iron  and  zinc  deficiencies  may  coexist in  populations  that consume  diets  with  insufficient  amounts  of  animal  products.  The  intake  of   these  2 micronutrients  could  be  improved  through  dietary  diversification,  food  fortification  or supplementation. If iron and zinc are to be provided together, it is important to determine how they  interact  biologically.  This  is  because  they  have  chemically  similar  absorption  and transport mechanisms, iron and zinc have been thought to compete for absorptive pathways (Standstorm, 2001).

Nutritional status, especially in children, has been widely and successfully assessed by anthropometric measures  in  both  developing  and  developed  countries  (WHO,  1995). Height and weight are the most commonly used measures, not only because they are rapid and inexpensive to obtain, but also because they are easy to use. Once a childs height and weight  have been correctly measured  and their age known,  a clinician  or researcher  can assess the childs growth and general nutritional status by using a standardized age- and sex- specific  growth  reference  to  calculate  height-for-age  Z-scores  (HAZ),  weight-for-age  Z– scores  (WAZ),  weight-for-height  Z-scores  (WHZ)  and  body-mass-index-for-age  Z-scores (BMIZ).

In April 2006, the World Health Organization  released  new global child  growth standards  for  infants  and children  up to the  age  of  5 years.  These  new  standards  were developed in accordance with the idea that children, born in any  region  of the world and given an optimum start in life, all have the potential to grow and develop to within the same range of height and weight for age.

1.1    Statement of the problem

Child malnutrition  is linked to poverty,  low levels of education  and poor access  to health  services.  Improved  nutrition  is assumed  to  be  directly  linked  to  expanded  food production while increased income is a good proxy for improved nutrition. Growth disorders in children  often go unrecognized,  and therefore  undiagnosed,  for several  reasons.  Some infants and children are not routinely weighed and monitored at their  regular health care visits.  Some children  see a health care professional  only for acute care and may not be weighed at all. Measurements incorrectly taken, inaccurately plotted, or not plotted at all may lead  to erroneous  interpretation  of  growth  patterns  and unnecessary  or  missed  referrals. Weight alone does not address linear growth and body shape and misses the opportunity to educate caregivers about a typical and normal pattern of growth.

Children aged less than 5 years are at high risk of iron and zinc deficiencies. Most children especially those from low income family do not consume iron rich complementary foods  by 6 months  of age.  This  is usually  so because  preschool  children  in developing countries and low socio economic status typically consume  little meat or animal products, hence,  iron  and zinc  deficiencies  in this  age  group  are  common.    Recently  it has  been reported that about 48% of the world’s population may be at risk of inadequate zinc intakes (ACC/SCN, 2000) and zinc deficiency is widespread in developing countries.

The nutritional status of children under five years of age is of particular concern since the early years of life are crucial for optimal growth and development. Their nutritional well- being  reflects  household, community  and  national  investments  in  family  health  thereby contributing both directly and indirectly to overall country  development and in particular, development of human resource. However, most of the State Development programs (SDPs) in Anambra State do not have data on nutritional status of the under-fives in Ozubulu, and these  data  are  used  in  the  definition  of  health  and  nutritional  status  for purposes  of programme planning, implementation and evaluation. Based on this, a nutritional assessment to determine the nutritional status of children 2 – 5 years in Ozubulu was conducted.

1.2 Objectives of study

The  general   objective   of  this  study  was  to  assess   iron,   zinc  status   and anthropometric  indices of preschool children (2 – 5years) in Ozubulu  community of Anambra State, Nigeria.

The specific objectives were to;

1.   assess the anthropometric indices of preschool children in Ozubulu using WHO

child growth standard and NCHS/WHO reference values.

2.   assess the iron and zinc status of preschool children in Ozubulu; and

3.    assess  the  dietary  pattern  and  factors  affecting  the  nutritional  status  of  the preschool children in Ozubulu.

1.3   Significance of the study

Malnutrition and micronutrient deficiencies can be eliminated only when a  given population is identified as affected, the causes known and the severity of the problems. Thus, this study will help to determine the growth and physical development among preschoolers. The data obtained will help in the definition of health and nutritional status for purposes of programme planning, implementation and evaluation  in Ozubulu. The data will also be an important key in directing programme resources to the people of this community. The study will reveal whether or not the area it covers has problem(s) of zinc and iron deficiencies and possible causes. Also it will help to  determine the dietary pattern of preschool children in Ozubulu.
Furthermore, the result of this study will help ministry of health and nutritionists to fashion appropriate nutrition education and other programmes to improve nutritional status and health of people of Ozubulu town.

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