PPT

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ASSESEMENT OF NUTRITIONAL STATUS OF CHILDREN IN
BIRNIN KEBBI ORPHANAGE HOME KEBBI STATE, NIGERIA
BY ABUBAKAR JUNAIDU 1410202025

• DEPARTMENT OF BIOCHEMISTRY AND MOLECULAR BIOLOGY
• FEDERAL UNIVERSITY BIRNIN KEBBI
• SUPERVISED
• BY
• MAL. YUSUF ABDURAHMAN BASHIR
• SEPTEMBER, 2018

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INTRODUCTION

• Malnutrition is a condition that is result from
  taking a diet that is deficient or excess in
  nutrients.
• The World Health Organization defined
  malnutrition as the cellular imbalance between
  the supply of nutrients and energy, and the
  bodys demand for them to ensure growth,
  maintenance, and specific functions (WHO, 2003).
• Malnutrition is often used to refer to
  undernutrition when there is inadequate supply of
  calories, proteins or micronutrients (Young,
  2012).

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MALNUTRITION
UNDERNUTRITION
OBESITY OVERNUTRITION
Micronutrient deficiency
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INTRODUCTION cont.

• JUSTIFICATION OF THE STUDY
• Malnutrition is a serious public health problem
  affecting so many children in Nigeria.
  Particularly Kebbi State, yet only little data
  are available on its prevalence in children of
  orphanages. This research aims at finding out
  whether children in the area of study are well
  nourished or not by providing available data, and
  how the community can assist in combating
  malnutrition and other diseases related to it.
• The national data by NNHS (2015), revealed 58
  of children in Kebbi State were stunted, 33.5
  were underweight and 12.8 were malnourish (NNHS,
  2015).
• Haleemath et al. (2017) stated that lack of
  reliable and comparable data on the incidence of
  nutritional deficiencies is prevalent throughout
  in the less developed countries.

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AIM AND OBJECTIVES

• The aim of this study is to assess the
  nutritional status of children in orphanage in
  Birnin Kebbi Metropolis.
• The specific objectives are
• Assess dietary pattern of the children
• Assess effect of dietary intake on anthropometric
  indices
• Screen the children for acute malnutrition using
  MUAC
• Assess effect of dietary intake on biochemical
  parameters
• Assess effect of dietary intake on skin folds

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Materials and Methods

• The following materials were used for data and
  blood sample collection for analysis.
• Questionnaire
• Seca weighing scale
• Flexible measuring tape and infantometer
• MUAC tape
• Skin fold Caliper
• Syringe
• Blood sample bottles

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Methodology

• Study participant
• A population of 40 children under-five years were
  used for the study.
• 27 were male and 13 were female.
• A sub sample consisting of 17 participants were
  used for biochemical and hematological analysis

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ANTHROPOMETRIC MEASUREMENTS

• Anthropometric data were collected by measuring
• weights,
• heights,
• mid upper arm circumference,
• skin folds thickness
• according to acceptable standard and in agreement
  with WHO recommendations (WHO, 2006).

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BIOCHEMICAL ANALYSIS

• Serum Albumin using bromocresol method (Doumasa
  et al., 1971)
• serum total protein using Biuret method (Gomall,
  1994)
• Serum globulin by the method of (Turnwald and
  Barta, 1989).
• Albumin/globulin ratio using method of
  (Rampengan et al., 2017)

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BIOCHEMICAL ANALYSIS

• Serum cholesterol using method of Roeschlau et
  al. (1974)
• Serum triaglyceride by method of Jacobs and
  Van-Dermark (1960)
• Serum HDL by method of Lopez-Virella et al.
  (1977).
• Serum LDL by Method of Friedwald et al. 1972)

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HAEMATOLOGICAL ANALYSIS

• Packed cell volume was determined by method of
  Linne and Ringsrud (1979)
• Hemoglobin using cynomethemoglobin method
  (Drabkin and Austin, 1932)

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Assessment of dietary intake

• Information on dietary pattern was obtained using
• 24hour dietary recall,
• Three days recall and
• Food frequency questionnaire

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DATA ANALYSIS

• Data obtained during the study was imported to
  IBM SPSS software version 20 for analysis.
• Descriptive statistics were used to get the
  frequencies.
• Ena for SMART package, 2011 was used to analyze
  the data of anthropometric measurements for the
  children.
• WHO (2006) cut offs was used to interpret the
  nutritional status.
• A Z-score of 2 SD for stunting (HA),
  underweight (W/A) and wasting (W/H) without edema
  was used to indicate nutritional status.
• Z-score of -2SDto-3SD indicate moderately
  malnourish, lt-3SD indicate severely malnourish.
• MUAC cut off 13.5 reflect normal, 11.5 to 12.5
  moderately malnourish and lt11.5 as severely
  malnourished.

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Results

• Table 1 Demographic
  and Anthropometric characteristics of children
• Values with superscript µ are means of
  triplicate measurements. N represent total number
  of participants

Factor Frequency Percentage
Gender (N40) Male Female 27 13 67.5 32.5
Age in years 7.32µ  
Height 106.015 µ  
Weight 17.22 µ  
Middle Upper arm Circumference (MUAC) 15.01 µ  
Skinfold Triceps Subscapula Supraliac 12.18 µ 12.05 µ 15.01 µ
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Figure 1.0 Mean results of some Biochemical
parameters of the children TP
(5.73 g/dl), Alb (3.34 g/dl) Glbn (2.37 g/dl) and
Alb/Glbn ratio 1.38.
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Figure 2.0 Mean results of Lipid profile of the
participants T Chol (137.37 mg/dl), TAG (54.87
mg/dl), HDL (29.56 mg/dl) and LDL 96.83 mg/dl.
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Figure 3.0 Mean results of Hematological
parameters of the children (change this to a bar
chart)
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Table 2 Prevalence of Hypoproteinamia in the
children
Frequency Percentage
Hypoproteinamia 10 58.82
Normal 7 41.18
Total 17 100
Key Hypoproteinamia low level of serum total
protein
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Figure 4.0 Albumin levels of the children
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Table 3 Lipid profile of the children
Frequency Percentage
Total cholesterol Low level Total 17 17 100 100
Triacylglyceride Low Normal Total 3 14 17 17.64 82.36 100
HDL Low Normal Total 9 8 17 52.94 47.6 100
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Figure 5 Prevalence of anemia in the children
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Table 4 Skinfolds results of the children
according Percentile Categories Distributions
lt10th Percentile n() 10 to 90th Percentile n () gt90th Percentile n() Total N40
Triceps skinfold 9 (22.5) 31(77.5) 0(0) 40 (100)
Subscapular 0(0) 40(100) 0(0) 40 (100)
Supraliac 0(0) 40(100) 0(0) 40 (100)
Key n indicate the number participants in a
group and N total number of participants
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Table 5.0 Physical examination for nutritional
deficiency
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Table 6.0 Anthropometric indices of the children
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• Figure 6 Prevalence of PEM among the children in
  the orphanage
• stunting 60, 37.50 underweight and 25
  wasting.

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Table 7 Prevalence of malnutrition by gender
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Figure 7.0 Food Consumption pattern of the
participants
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Discussion of the findings

• The result of this finding (table 1) this is in
  line with the finding in southwest part of the
  country by Adejugbagbe et al (2012), on
  assessment of Nutritional status of under-fives
  in rural and urban communities of Southwest,
  Nigeria where 61.0 were male and 39.0 were
  female (Adejugbagbe et al., 2012).
• The current study also differ with findings on
  assessment of Childhood Nutritional Status in
  Zamfara State, Nigeria where females were the
  majority of the participants (51.4) and males
  were 48.6 (Alabi et al., 2016).
• Comparatively, the result of table 2 is similar
  to the findings in Kussada Local Government Area
  of Katsina State where more than half of the
  participants have low level serum total protein
  (Adegbusi and Sule 2011).

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Discussion cont.

• The findings of figure 4 is in agreement with
  evaluation the findings on evaluation of
  Anthropometric and Biochemical status of children
  with nutrition deficiency, which reported low
  level of serum albumin among the studied children
  (Lidia et al., 2013).
• Low level of total serum protein and serum
  albumin reported in this study are indication of
  protein malnutrition. This could suggest that the
  children dietary intake of protein was lower than
  the acceptable range.
• However, this finding was not in agreement with
  the findings of Clerke et al (2006), which
  reported 85 of the studied children have serum
  albumin level within the normal.

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Discussion cont.

• The lipid profile status of the (table 3) showed
  low level of serum cholesterol, triacylglycerol
  and HDL. This is in line with the previous
  research on assessment of anthropometric and
  biochemical parameters of the under five children
  with nutritional deficiencies where level of
  lipid profile parameter were significantly low
  (Lidia et al., 2013).
• It imperative children with malnutrition have low
  level of serum triacylglycerides and cholesterol
  (Walker et al., 2002).
• The present study estimated the prevalence of
  anemia among the children to be 29.41 (figure 5)
  taking the cutoff hemoglobin level of 11g/dl.
  This is in line with the previous findings
  carried out in rural and urban southwest part of
  this country Nigeria by (Adejugbagbe et al.,
  2012).

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Discussion cont.

• However, the anaemia prevalence in this study is
  lower than what was observed in earlier work
  which recorded a higher (45.5) prevalence of
  anaemia among children in the orphanage of
  Federal Capital Territory Abuja (Chizoba, 2010).
• A different finding conducted among under-five
  children also reported a high prevalence (82.6)
  of anaemia (Onimawo et al., 2001). The prevalence
  of anaemia among under-five children nationally
  is 27.5 (Maziya Dixon et al., 2004).
• Anaemia prevalence (29.41) reported in this
  study signified that anaemia is still a major
  public health problem among under-five children
  as well as orphans. Conversely, low haemoglobin
  is a non-specific sign for anaemia because it is
  also affected by blood depletion, chronic
  infections, haematological condition, iron
  status, follate and vitamin B12 status among
  other nutrients (Leibel, 1977).

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Discussion cont.

• The presence of anaemia in this finding could be
  due to lack of dietary intake of iron source
  foods like fruits and vegetables (3.96), meat
  and poultry which are good sources of animals
  dietary iron. Reduce intake of animals foods can
  cause iron deficiency anaemia because animals
  source of iron more bioavailability than plant
  iron source (Giebel et al., 1998).
• The findings of anthropometric indices in this
  differ when compare to the findings of national
  survey on orphans and vulnerable children in
  Nigeria by NDHS (2008) this study reported more
  proportions of underweight (37.5 against 22.0),
  wasting (25.0 against 11.0) and stunting (60
  against 33.0).
• However, the anthropometric indices recorded were
  in line with findings of Chizoba (2011), where
  the prevalence of underweight, stunting and
  wasting were 45.5, 63.5 and 47.5.

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Discussion cont.

• Conversely, this study found the prevalence of
  wasting to be lower than stunting and
  underweight.
• Many studies have found the level of wasting to
  be lower than stunting in developing countries
  (WHO, 1995).
• In a recent released survey conducted among the
  under-five in Zamfara State Northan part of this
  country Nigeria, stunting (70) was higher than
  underweight (37) and wasting (15) among
  under-five children (Alabi, 2016).
• Another study conducted in southwest part of
  Nigeria to assess the nutritional status of
  under-five children in urban and rural
  communities reported high level of stunting
  (24.5) than underweight (16.9) and that of
  wasting were 0.3 (Adejugbagde et al., 2012)

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Discussion cont.

• In the south-south part of Nigeria a survey on
  orphanages practices in Benin City, Edo State
  also revealed high prevalence of children that
  are stunted than those that are underweight for
  their age (underweight) and those that were too
  short for their age that is stunting (Nwaneri and
  Sadoh, 2011).
• Somewhere else in Ethiopia, 38.8 of the
  under-five were underweight and 25.2 were
  stunted (Rajalakshmi and Getabalewendazenaw,
  2006).
• The level of malnutrition in this study can be
  explained as both chronic and acute. This is as a
  result of both short and long term dietary
  deficiency.
• Table 4 showed the result of three skinfold
  thickness, majority of the children were having
  have all the three skinfold within the normal
  range. This finding is in agreement with the
  study conducted in Canada where 68 of the
  children were having skinfold thickness within
  the acceptable range (Clerke et al., 2006).
• Lidia et al (2013), reported low level of Triceps
  skinfold (TSF) among the studied children.

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Discussion cont.

• On the basis of this finding we found that about
  60 (table 5) of the participants exhibited sign
  of one form of nutritional deficiency from the
  physical examination.
• Some of the children were having sign of iron
  deficiency anemia like pale coloration of sclera
  of eye, follow by sign of protein deficiency on
  hair like loss of pigment (melanin) and complete
  loss of hair in some part of head. These suggest
  that the children may be taking diet that is
  deficient in protein, iron.
• The findings of this study are similar to that
  of Haleemath et al (2017) which reported high
  sign of nutritional deficiency upon physical
  examination of the children.

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Discussion cont.

• Figure 7 show the food consumption pattern of the
  participants, majority of the foods mostly
  consumed by children were cereals group (rice,
  maize, indomie, spaghetti, garri, bread etc.).
• This concurred with the findings of NDHS (2008)
  survey where rice was reported to be the most
  obtainable and inexpensive staple foods providing
  main source of energy to households.
• The high rate of cereals food recorded could be
  because of their availability and acceptability
  to the children. It is also more suitable to
  prepare.
• It was observed that cereals (like indomie and
  rice) are among the food stuff donated regularly
  to the orphanage and such there would be low
  dietary diversification of the children food.

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Discussion cont.

• Animal foods contributed to 15.8 of the total
  diet consumed by the children recorded in this
  study. This was the major source of protein for
  the children.
• Vitamin A rich fruits and vegetables contributed
  to 9.96 of the children diet. This was the main
  source of vitamin A to the children.
• The dietary consumption pattern showed that
  legumes and nuts contributed to 11 of children
  dietary intake. This is comparable to the
  findings of (Chizoba, 2010).
• Diets which give adequate nutrients require by
  the body for its support and well functions are
  associated with good health (Krause and Mahan,
  1984).

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Discussion cont.

• It could therefore be suggested that for those
  children whose energy intake fell below the
  recommended, they were at risk of suffering from
  nutritional deficiencies and becoming malnourish.
  
• The key cause of undernutrition is inadequate
  consumption of energy and protein (FMOH, 2011).
• Low diversification of diet as observed in this
  study played a key role to most nutrient
  inadequacy.

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Conclusion

• Good nutrition is vital for children to reach
  their full developmental potential.
• The study revealed high prevalence of
  undernutrition among the children in the
  orphanage.
• This may be associated poor dietary diversity as
  revealed by food consumption pattern.
• Therefore, it is imperative initiate and sustain
  optimal feeding practices in the orphanage.

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Recommendations

• From the findings so far, the following
  recommendations were made
• Growth monitoring for early detection of
  malnutrition.
• Nutrition education
• Optimal feeding practices
• Proper hygiene
• Use of micronutrient powder
• Further study should be conducted to assess
  micronutrient deficiency (hidden hunger) among
  children in the orphanage.
• Finally, Government, NGOs and other stake holders
  in the community should help in providing
  adequate support to these children

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• Thank you