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

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ABSTRACT
This study was aimed at assessing the iron, zinc and anthropometric indices of pre-school children aged 2 – 5 years in Ozubulu. A total of two hundred and forty (240) preschool children were randomly selected. Questionnaire, anthropometric measurements, biochemical analysis and 3–day weighed food intake were used for data collection. Two hundred and forty (240) questionnaires were distributed to mothers and caregivers of the selected children. Out of the 240 samples, sub samples of thirty children were randomly selected for biochemical assessment of iron and zinc status and for 3-day weighed food intake analysis. Iron status was assessed in terms of transferrinemia (serum iron, total iron binding capacity and percentage transferrin saturation) while zinc status was assessed using serum zinc. WHO child growth standard and NCHS reference were used as standards. The result showed that prevalence of underweight and wasting for children 2 – 5 years was 1.7% and 11.8%, respectively using WHO standard. The overall prevalence of underweight and wasting was 3.3% and 10%, respectively by NCHS reference. Stunting affected only 0.8% using WHO Standard while none was stunted by NCHS reference. Sixty-seven percent (67%) of the pre-school children had low transferrinemia level (percentage transferring saturation <15 36.7="" 63.3="" and="" children="" had="" normal="" of="" result="" serum="" showed="" that="" the="" zinc="">65μg/dl) and deficient (<65 span=""> μg/dl) zinc status respectively. The children took ≥143.3% and ≥ 155.5% of their FAO/WHO iron and zinc requirement values, respectively. Their zinc intakes was high but were mainly from plant staples. Intensified nutrition education, improved food processing and handling techniques and diversification of diet would drastically reduce malnutrition.

TABLE OF CONTENT

Title page
ABSTRACT

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

CHAPTER TWO: LITERATURE REVIEW
2.1       Prevalence of child undernutrition
2.2       Causes and determinants of malnutrition
2.3       Consequences of undernutrition
2.4       Methods of assessing nutritional status
2.4.1    Anthropometric measurement
2.4.2    Biochemical assessment
2.4.3    Assessment of food intake
2.5       The new who child growth standard
2.6       Iron
2.7       Iron absorption
13 2.8  Iron deficiency
2.9       Zinc
3.0       Biological functions of zinc
3.1       Zinc metabolism
3.2       Requirements of zinc
3.3   Dietary sources of zinc and bioavailability
3.4       Zinc toxicity
3.5       Consequences of zinc deficiency
3.5.1    Risk of Infections
3.5.2    Mortality
3.5.3    Growth and development
3.6   Causes of zinc deficiency

CHAPTER THREE: MATERIALS AND METHODS
3.1       Research design
3.2       Study area
3.3       Target population
3.4       Sample size
3.5       Sampling
3.6       Methods of collection of data
3.6.1 Questionnaire
3.6.2    Anthropometry
3.6.3    Biochemical evaluation
3.6.4    Weighed food intake
3.7       Data analysis

CHAPTER FOUR: RESULTS
4.1       Background to the study
4.2  Anthropometric indices of the children
4.3  Iron and zinc status of the preschool children
4.4  Dietary pattern and factors affecting the nutritional status of the children

CHAPTER FIVE: DISCUSSION
5.1       General characteristics
5.2       Anthropometry
5.3       Biochemical Analysis
5.4       Weighedfood intake investigation
5.5  Limitations of the study
5.6       Conclusion
5.7       Recommendation
REFERENCES
APPENDICES


CHAPTER ONE

INTRODUCTION

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.....

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