A randomized iron and zinc supplementation trial was carried out in Lafia Local Government, Nasarawa State, Nigeria with a total of 160 children below the age of five years. They were divided into 4 groups each containing 40 respondents: the Fe-group received daily and for a 3-month period 10 mg of iron, the Zn-group 10 mg Zinc, the Fe-Zn group10mg iron + 10mg Zinc and the control group, received no supplement. Serum iron (SFe) and serum Zinc (SZn), with anthropometry were determined before and at the end of the intervention. Socioeconomic characteristics of the respondents showed that the female participants (52%) were more than male (48%), the highest number of household heads were age 30-39 (50%) while 65.5% of the mothers were between the age range of 21-30 years. Percentage changes in weight, mid upper arm circumference, MUAC, iron and zinc status were higher in groups supplemented than those that were not. There was a significant difference (P ˂ 0.05) in SFe among the 36-47 months age group of Fe group. Horizontal pairs (baseline versus endline) with different superscripts b and a(P < 0.05) while pairs with similar superscripts a and a are not significantly different (P > 0.05). Percentage change in SZn were higher in Zn-group (highest change: 19.10% in female group and 22.36% in male groups) than in Fe-Zn group (highest % change: 8.45% in male group). However, there was no significant difference (P ˂ 0.05) in serum concentration and weight in combined Fe & Zn supplementation. Almost half of the respondents (49.38%) had no knowledge of micronutrient supplements yet 57% caregivers who knew the importance of micronutrient supplements do not give their children. There was significant difference (P ˂ 0.05) in MUAC- for- age as a result of iron supplementation in females of age group less than 11months while Zn supplementation recorded significant difference (P ˂ 0.05) in males and females of age group 11 - 23 months. Iron and zinc supplementation recovered 12.5% severely wasted respondents in Fe- group, and reduce acute wasting by 10% in Zn- group. In conclusion, this study revealed that iron and zinc supplementation recorded a significant difference (P ˂ 0.05) in iron and zinc status and that single iron and zinc supplement increased weight.

1.1 Background
The prevalence of food insecurity in sub-Saharan Africa is the highest in the world, with rates as high as 30% of the population being undernourished (UNDP, 2011). The United Nations sub-committee on nutrition and the World Health Organization estimated that about two-third of children in developing countries show some degree of growth retardation due to undernutrition. Micronutrients perform essential functions in normal growth and development beginning in the earliest stages of life. About 40 nutrients which are indispensable for the maintenance of vital processes, are required in only very small amounts, for which reason they are called “micro” nutrients. The child must consume small amounts of some 13 vitamins (Vitamins A, D, E, K, C, B12, thiamine, riboflavin, niacin, pyridoxine, biotin, pantothenic acid and folate) and 10 trace elements (zinc, selenium, chromium, cobalt, copper, fluorine, iron, iodine, manganese and molybdenum). These essential micronutrients fulfill a variety of special metabolic functions, some acting as cofactors in the metabolism of proteins and amino acids, lipids and /or carbohydrates and in energy production (Lander et al., 2008). Some others serve as the catalytic centres or as structural elements of enzymes or other macromolecules.

Micronutrients cannot be synthesized by humans and must therefore be obtained from the diet. Micronutrient malnutrition can result not only from inadequate intake but also from inadequate digestion, and absorption(Win,2015). According to Federal Ministry of Health (2013), 41% of Nigerian children under the age of five years is stunted as a result of malnutrition. Acute malnutrition level is as high as 53% in the North West, 49% in North East, and 22% in South East (Omotola, 2012). UNICEF (2013) estimated that 1.1 million children were threatened with severe acute malnutrition in the Sahel region alone (comprising of 8 states in Northern Nigeria) which is fueled by poverty, insecurity, insufficient access to food, inadequate maternal and child caring practices, poor water and sanitation, inadequate health services and flood. And that a total of 13,574 children with severe acute malnutrition (SAM) were admitted to 479 UNICEF supported Community Management of Acute Malnutrition (CMAM) sites across Northern Nigeria.

UNICEF conceptual framework (2009) shows that malnutrition occurs as a result of two immediate causes: inadequate dietary intake and diseases, but also recognizes that poverty, human and environmental resources, economic systems and political and ideological factors are basic causes. Malnutrition in developing countries has high social and economic costs, such as increased mortality and morbidity, loss of human potential, decrease in skills and qualifications, lower productivity and higher poverty rates (Ogbebo, 2014).

Pellertier et al., (1995) estimated the percentage of child deaths (6-59months) which could be attributed to the potentiating effects of malnutrition on infectious disease. The results from 53 developing countries with nationally representative data on child weight-for-age indicate that 56% of child deaths were attributable to malnutrition potentiating effects. Out of about 31 widely known micronutrients, five are of public health significance in Nigeria: vitamin A, iron, iodine, zinc and folate (Umunna, 2014), Micronutrient deficiency also known as hidden hunger is a major threat to health, growth and development of infants worldwide (UNICEF, 2011). According to Umunna (2014), micronutrient deficiency has enormous consequences for economic growth and human developmentin Nigeria as the connection between suffering, death and malnutrition is manifested in poorly developed learning abilities, death from childhood illness of children under the age of five and death of young mothers at childbirth due to anaemia.

Iron deficiency is the most common single nutrient deficiency in the whole world and the common cause of anaemia (Wessling-Resnick, 2014). Preschool children and women of child bearing age are at highest risk of iron deficiency (Mei et al., 2011). Also infants-especially those born preterm or with low birthweight or whose mothers have iron deficiency are at risk of iron deficiency because of their high iron requirements due to their rapid growth (Aggett, 2012).

Common causes of iron deficiency include inadequate dietary ingestion or absorption of dietary iron to meet iron losses or iron requirements imposed by growth or pregnancy. According to Lee and Nieman (2013) a good amount of iron is lost from heavy menstruation, frequent blood donations, early feeding of cow‟s milk to infants, frequent aspirin use, or disorders characterized by gastrointestinal bleeding. The tendency of iron deficiency increases during periods of rapid growth particularly at infancy (and the risk is greater in premature infants), adolescence and pregnancy (Gibson, 2011). Iron deficiency has a number of consequences which include impaired body temperature regulation, impairments in behavior and intellectual performance, reduced work capacity, increased susceptibility to lead poisoning, and decreased resistance to infections (Beard, 2001). During pregnancy, iron deficiency increases risk of maternal death, prematurity, low birth weight, and neonatal mortality. During early childhood iron deficiency adversely affects cognitive, motor, and emotional development that may be only partially reversible (Lynch, 2011).

Anaemia is a haemoglobin level below the normal reference range for individuals of the same sex and age, or a haemoglobin level that is lower than two standard deviations from the mean distribution in a healthy population of the same gender and age living at the same altitude (Thomas, 2014).

Zincis found in all parts of the body and plays an important physiologic function as a component of more than 300 enzymes also influencing hormones (King, 2011). Consequently, zinc is involved in many metabolic processes, including protein synthesis, wound healing, immune function and tissue growth and maintenance. It canreduce the duration and severity of a common cold and halt diarrhoea. Severe zinc deficiency characterized by hypogonadism and dwarfism has been observed in the Middle East. Cousins (2006) has shown that reduction or cessation of growth in humans and laboratory animals is an early indication of zinc deficiency and supplementation in growth-retarded infants and children who are mildly zinc deficient can result in improved growth response.

1.2 Statement of Research Problem
Nasarawa State is generally regarded as a rural state with rate of acute malnutrition (19.9%) higher than North Central average (14.3%) (CS-SUNN, 2015). This has been made worse by the recent ethnic crisis that engulfed the senatorial district.

Micronutrient undernutrition is generally correlated with overall malnutrition, since poverty limits both the quality as well as quantity food in the diet (Horton et al.,2008)

Existing beliefs and practices in infant feeding, like: early introduction of sweetened palp to infants before 4-6 months; cow‟s milk given to children before 1 year of age; infants fed using bottle; inappropriate timing of introduction of weaning foods (either too early or too late), and the amount of weaning foods (caloric content, nutritional value) contribute to micronutrient deficiencies.

Poverty, lack of access to a variety of foods, lack of knowledge of optimal dietary practices and high incidence of infectious diseases are prevalent in children below 5 years(Chiejina,2012; NDHS, 2013)

Micronutrients deficiencies are not always clinically apparent or dependent on food supply and consumption patterns. They are associated with physiologic effects that can be life-threatening or more commonly damaging to optimal health and functioning (Tulchinsky, 2010).

Uchendu (2011) reiterated that micronutrient malnutrition is a serious childhood dietary problem in developing nations citing vitamins A and B12, iron, folic acid and zinc as preventable causes of poor childhood growth and school performance.

1.3 Justification
Childhood mortality data indicates that underfive mortality rate was higher in Nasarawa State than both North Central average and nationally (HMIS, 2014). Micronutrient deficiencies in early childhood can lower a country‟s Gross Domestic Product (Win, 2015).

Evidences (Bhutta et al., 1999; Berti et al., 2014) have shown that the most cost-effective approaches to address symptoms of micronutrient malnutrition are targeted supplementation and fortification with iron, iodine, zinc, folic acid, vitamin A, and multi-micronutrients with adequate monitoring.

In 2008, a group of internationally acclaimed economists, including five Nobel Laureates, concluded that combating the world‟s malnutrition problem through the provision of vitamin A and zinc ranked high among the various cost-effective solutions to the world‟s pressing problems (IZA, 2010). They calculated that for every dollar invested in zinc supplements, there would be a return of US $17.

Iron deficiency affects more people than any other condition, constituting a public health condition of epidemic proportions (WHO, 2003) with a devastating health consequence.

The National Food and Nutrition Policy in Nigeria which is a step in addressing the malnutrition problems of the country in its plan of action sets strategies for improving the nutritional status of all Nigerians with specific emphasis on the most vulnerable groups (NFNP, 2005). These include the reduction of undernutrition, especially among children underfive, in particular, severe and moderate malnutrition by 30% and reduction of micronutrient deficiencies, particularly which includes among others Iron deficiency Anaemia by 50%. Zinc supplementation has been associated with motor development in very low birth weight infants and more vigorous and functional activity in infants and toddlers (Black, 1998).

Scanty or no data exist on micronutrient malnutrition in children under five years in Lafia Local Government Area of Nasarawa State.

1.4 Aim and Objectives
1.4.1 Aim
To investigate the effect of iron and zinc supplementation on the nutritional status of children under five years in Lafia Local Government of Nasarawa State

1.4.2 Specific Objectives
The objectives of this study includes

i. To determine socio-economic characteristics of caregivers of children under five years in Lafia Local Government Area of Nasarawa State.

ii. To determine the caregiver knowledge, attitudes and practices on micronutrient supplementation.

iii. To examine the effect of supplementation (Iron and Zinc) on some anthropometric parameters of the children under five years in Lafia Local Government Area of Nasarawa State.

iv. To evaluate the effect of Iron and Zinc supplementation on children under five years in Lafia Local Government Area of Nasarawa State.

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