ASSESSMENT OF THE FEEDING PRACTICES, VITAMIN A, IRON, ZINC AND ANTHROPOMETRICS STATUS OF UNDER-FIVE CHILDREN IN ORPHANAGES OF FEDERAL CAPITAL TERRITORY ABUJA, NIGERIA

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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="" and="" children.="" correlated="" ferritin="" good="" of="" span="" status="" the="" with="" zinc="">

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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 eradication of extreme hunger and poverty. The prevalence of underweight in under-five children is an indicator for achieving this goal. MDG-4 talks about reduction of child mortality. Malnutrition which is preventable, accounts for up to 53% of all deaths in under-five children and remains the underlying cause of most child mortality. To achieve the Millennium Development Goals (MDG-1) for child survival and the prevention of malnutrition (MDG-4), adequate nutrition and health during the first few years of life is fundamental (United Nation, 2002). Poor feeding practices, coupled with high rates of infectious diseases, are the principal proximate causes of malnutrition during the first few years of life (WHO, 2005).

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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