ANTHROPOMETRIC INDICES AND COGNITIVE PERFORMANCE OF PRESCHOOL CHILDREN IN NSUKKA RURAL AND URBAN AREAS OF ENUGU STATE, NIGERIA

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ABSTRACT

This study assessed the nutritional status and cognitive performance of preschool children aged 3-5 years in urban and rural areas of Nsukka in Enugu State, Nigeria. A total of 400 pre-school children aged 3 -5 years were involved. Four schools in Nsukka Local Government Area of Enugu State were selected by multistage sampling technique. Two schools each were randomly selected from the list of schools in the Nsukka rural and urban areas. The study collected data on child related factors, mother’s socioeconomic status, household size, environmental conditions, child health and nutritional status, using structured questionnaire. Anthropometric measurements of height, weight and arm circumference were taken using standardized procedures. Ziler’s “Draw a person test” was used to assess the cognitive performance of the children. Data were analysed using the Statistical Package for Social Sciences (SPSS) version 13 computer software. Analytical tools used included descriptive statistics (frequencies, percentages, means and standard deviation). Chi-square analysis was used to appraise the validity and reliability of the dependent variables. Anthropometric values were compared with World Health Organisation child growth reference standards. About 20.5% of the children in the study area were stunted, 16.5% were underweight, and 12.0% were wasted. The prevalence of stunting, underweight, and wasting were higher among rural children than their urban counterparts. Rural male children were significantly (P<0 .05="" 14.7="" 3.9="" 8.8="" a="" also="" among="" and="" association="" between="" children.="" children="" cognitive="" counterparts="" education="" female="" higher="" in="" male="" more="" mothers="" of="" performance="" prevalent="" respectively.="" rural="" significant="" significantly="" stunted="" sup="" than="" the="" their="" there="" underweight="" urban="" vs.="" vs="" was="" wasting="" were="">2
= 3.118; df = 2 P= 0.027) and urban (X2 = 2.891; df = 2; P= 0.029 ) areas. The study revealed the negative effect of malnutrition on cognitive performance of the children. The negative effect of malnutrition on cognitive performance of the children was more in the rural than in the urban area. Majority (81.9%) of the stunted children in the rural area and only 37.5%) in the urban area performed below average in the cognitive test. Stunting and cognitive performance of the children were significantly associated in the rural area (X2 = 1.247; df = 1; P=0.043) but not in the urban area (X2 = 0.849; df = 1; P= 0.238). The food consumption pattern varied largely between urban and rural areas. This study has provided evidence that pre-school children in Nsukka were under acute and chronic nutritional stress, especially in the rural area. Appropriate integrated public health nutrition intervention programmes, nutrition surveillance, and targeted nutrition education programmes to improve nutrition and cognitive performance of children are suggested.
TABLE OF CONTENTS

Title page
List of tables
ABSTRACT

CHAPTER ONE: INTRODUCTION
1.1       Background of the study
1.2       Statement of the problem
1.3       Objectives of the study
1.4       Significance of the study

CHAPTER TWO: LITERATURE REVIEW
2.1       Definitions of malnutrition
2.2       Definitions of cognition
2.3       The role of nutrition for proper cognitive development of children
2.3.1    Essential fatty
2.3.2    Carbohydrates
2.3.3    Proteins
2.3.4    Iron
2.3.5    Zinc
2.3.6    Iodine
2.3.7    Vitamins
2.4       Malnutrition in preschool children: The effects on cognitive development
2.4.1    Protein-energy malnutrition (PEM)
2.4.2    Micronutrient deficiency disorders
2.4.2.1 Iodine deficiency
2.4.2.2 Iron deficiency anemia
2.4.2.3 Vitamin A deficiency
2.4.2.4 Zinc acid deficiency
2.4.2.5 Fatty acid deficiency
2.5       Methods used in assessing the nutritional status of pre-school children
2.5.1    Anthropometry
2.5.2    Clinical Assessment
2.5.3    Dietary Assessment
2.5.4    Biochemical Assessment
2.6       Cognitive assessment of preschool children
2.7       Factors in child malnutrition
2.7.1    Socio-economic factors
2.7.2    Food insecurity
2.7.3    Poor availability and access to health services and unhealthy environment
2.7.4    Caring capacity
2.7.5    Maternal health
2.7.6    Mother’s education and status
2.7.7    Cultural factors
2.8       Consequences of childhood malnutrition
2.8.1    Childhood mortality
2.8.2    Childhood morbidity
2.8.3    Poor physical, mental development and school performance
2.8.4    Adult life consequences
2.9       Prevalence and number of pre-school (under five years old) children
            stunted, under weight and wasted
2.9.1    Prevalence of stunting
2.9.2    Prevalence of underweight
2.10  Millennium development goals (MDGs) and their relevance for
            reducing prevalence of malnutrition in children
2.10.1  Eradicate extreme poverty and hunger
2.10.2  Achieve universal primary education
2.10.3  Gender equality and the empowerment of women
2.10.4  Reduce child mortality
2.10.5  Combat HIV/AIDS, malaria and other diseases
2.10.6  Ensure environmental sustainability

CHAPTER THREE: MATERIALS AND METHODS
3.1       Study area
3.2       Survey design
3.3       Sample size and sample size calculation
3.4       Sampling procedure
3.5       Data collection
3.6       Tools for data collection
3.6.1    Questionnaire
3.6.2    Anthropometric measurement
3.6.2.1 Height
3.6.2.2 Weight
3.6.2.3 Arm circumference
3.6.3    Clinical observations
3.6.4    Food consumption pattern assessment
3.6.5    Measure of cognitive performance
3.7       Analysis of data

CHAPTER FOUR: RESULTS
4.1       Background data of respondents
4.2       Anthropometric status of the respondents
4.3       Food consumption pattern of the respondents
4.4       Cognitive test scores of the respondents

CHAPTER FIVE:  DISCUSSION
5.1       Background data of the respondents
5.1.1    Mothers’ education levels
5.1.2    Mothers’ occupation and income
5.2       Anthropometric status of the respondents
5.3       Food consumption pattern of the respondents
5.4       Cognitive test scores of the respondents
5.4.1    Nutritional status and cognitive performance of the children studied
5.4.2    Relationship between socioeconomic variables on cognitive performance
            Conclusion
            Recommendations
            REFERENCES
            APPENDICES

CHAPTER ONE

1.0                                                               INTRODUCTION

1.1        Background to the study
A pre-schooler is a child that falls within the age range of 2–5 years. Preschool children are one of the most vulnerable groups that are at greater risk of malnutrition in the society. It is also during this period, the pre-school age, that most undernutrition in form of Kwashiorkor, Marasmus, anemia and xerophthalmia are common (Ene-Obong, 2001). Thus, Nutrition has a direct impact on their growth and development as well as their nutritional status. Health and nutritional status of children affect the capacity of learn. The higher the level of malnutrition, the lower the overall productivity.

Good nutrition during this period is very important since it is the cornerstone for survival, good health and development for current and succeeding generations (United Nations International Children’s Emergency Fund (UNICEF), 2006). Thus Children require balanced diet that will help them acquire many of the physical and social attributes, and psychological structures for life and learning. Well-nourished children perform better in school, grow into healthy adults, and in turn give their children a better start in life. Steady growth during childhood necessitates a gradual increase in intake of most nutrients (Shrimpton et al., 2001).


Childhood undernutrition has a negative influence on growth and cognitive development. Poorly nourished children have more problems fighting infection. Moderate undernutrition can have lasting effects and compromise cognitive development and school performance. Undernutrition results in decreased activity levels and decreased social interactions. Poor nutritional status and hunger interfere with cognitive function and are associated with lower academic achievement. Children who suffer from poor nutrition during the brain’s most formative years score much lower on tests of vocabulary, reading comprehension, arithmetic, and general knowledge (Brown &

Pollitt, 1996).

Every year it is estimated that undernutrition contributes to the death of about 5.6 million children under the age of five. One out of every four under five children in the developing world is under weight for his or her age and at increased risk of an early death (UNICEF, 2001). There is high under five mortality rate, stunting, and wasting sequel to food insecurity in many households (Food and Agricultural Organization (FAO), 2001). The risk and progression of diseases are increased by poor nutrition while disease exacerbates malnutrition such as protein-energy malnutrition (PEM), micro nutrient deficiencies, Human Immune-deficiency Virus (HIV) and acquired immune deficiency syndrome (AIDS). These forms of malnutrition are internationally recognized as important public health problems and their devastating effects on human performance, health and survival are well established (Martorell, Rivera, Kaplowitz & Politt, 1992.). The nutritional welfare of the Nigerian child is precarious. Child mortality rate is exceedingly high and Nigeria ranks fifteenth in the world among countries with high under five mortality rate (UNICEF, 2001). When under-five individuals are malnourished, they can no longer maintain natural body capacities, such as growth, resistance to infections and recovery from disease easily.

A wide range of factors result in malnutrition among pre-school children, including socio-economic factors, food insecurity, poor availability and access to health services, unhealthy environments, poor caring capacity, maternal health, mother’s educational status, and cultural factors. They usually appear in combination, reinforcing each other to cause morbidity, mortality and disability (UNICEF, 2006).

Good nutritional status therefore can be maintained by pre-school children by consuming adequate quantity and quality of micro and macronutrients such as carbohydrate, protein, fat, vitamins and minerals and water. Good breast feeding practices and adequate complementary feeding are pre-requisites for good nutritional status that significantly contribute to development of the brain and therefore cognitive development of children. Thus good nutrition in early life is crucial for optimal growth and mental development (Administrative Committee on Co-ordination and Sub-committee on Nutrition (ACC/SCN), 2004). As such, the increased recognition of the relevance of nutrition as a pillar for social and economic development has placed childhood undernutrition among the targets on the first Millennium Development Goal to “eradicate extreme poverty and hunger” (UNICEF, 2002). The target is to reduce by 50% the prevalence of underweight among children younger than 5 years between 1990 and 2015 (ACC/SCN, 2004).

1.2        Statement of the Problem
The underdeveloped regions of the world seem to be mostly affected by nutritional problems associated with food insecurity (Mayer, 1986). Within these underdeveloped countries, Africa’s share of the problems is great. Nnanyelugo (1981) observed that inadequate food situation has remained the greatest problem in Nigeria. Nutritional deficiencies such as are associated with protein, energy, iron, and iodine deficiency are recognized to have the potential for permanent adverse effects on learning and behavior (Scrimshaw, 1998).

Undernutrition results in decreased activity levels, decreased social interactions, decreased curiosity, and decreased cognitive functioning. Poorly nourished children have low resistance to infections. They may be sick more often, miss school often, and fail to keep up with classmate. Poor nutrition is associated with child morbidity and mortality.

Malnutrition in early childhood impairs functional performance in adulthood. This impairment may be physical as well as cognitive. Substantial and strong evidence....

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