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

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) more  stunted (27.8%) than urban male children (7.1%). Underweight was more prevalent among the rural (20.8%) than urban male children (13.3%). Wasting was also  significantly (P<0.05) higher among rural (21.8%) than urban (8.2%) male children.  Rural female children were significantly more stunted than their urban counterparts (38.4% vs 8.8%), underweight (17.2% vs. 14.7%)  and wasting  (14.1%  vs  3.9%),    respectively.  There  was  a  significant  association    between mothers’ education and cognitive performance of their children in the rural      (X2 = 3.118; f = 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.

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

abound that malnutrition increases disease episodes and decreases the ability to respond and  impair  physical  and  intellectual  potential  of  functioning  and  hence  economic productivity (SCN, 2003).

The  consequences   of  nutritional  deficiencies   include  childhood   morbidity, mortality,  poor  physical  and  mental  development,  poor  social  performance,  reduced capacity to work, and delayed  psychomotor development  (World Health Organization (WHO), 1995). Early malnutrition which stunts growth has also clearly and repeatedly been shown in experimental animals to reduce subsequent learning ability, memory and behaviour, and evidence is already available to suggest that malnutrition  during the first few  years  of  life  does  have  adverse  effect  on  cognitive  behaviour  (Pollitt,  1993a). Malnutrition  reduces  resistance  to  infection  and  potentates  the  effects  of  infection (Pelletier, Frongillo, & Habicht,  1993) potentially creating a vicious cycle that can be extremely  dangerous  to  younger  children.  Malnourished  children  have  more  severe diarrhoeal episodes as measured by duration at risk of dehydration or hospital admission associated  with  growth  faltering  and  a  higher  risk  of  anemia.  This  was  based  on numerous studies on analysis of anthropometric data from children in various parts of Nigeria  (WHO,  1995).  Malnutrition  in children  acts synergistically  with diseases  by increasing fatality rate, progressively exposes the child to stunting and is associated with impaired mental development and poor school performance. Stunting in childhood leads to reduced adult size and reduced work capacity. Some of the dangers of early child malnutrition may be irreversible. Cretinism as a result of iodine deficiency can lead to severe mental retardation. Blindness and severe visual  impairment  following severe vitamin A deficiency in pre-school  children may handicap the child’s educational performance, affect cognitive  development, depresses the   immune   response,   increase   susceptibility   to   infection,   and   lower   scores   on intelligence (Pollitt, 1993b).

In the development of malnutrition among pre-school children, the role of socio- economic factors has been considered to be of greater importance than mere nutritional factors. Related problems, which influence nutritional status, have been shown to be due to  changes  in  environment,   socio-cultural  characteristics,   levels  of  education  and geographical  distribution  of  people  (Nnayelugo,  1981).       Poor  nutrition  hampers 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).

Studies have not been done on nutritional status and cognitive performance of  pre- school children in Nsukka Local Government Area of  Enugu State. Thus this study will assess the nutritional status and cognitive performance of preschool children in Nsukka rural and urban areas of Enugu State.

1.3        Objectives of the study

General objective

The  overall  objective  of  this  study  was  to  assess  the  nutritional  status  and cognitive performance of pre–school children in rural and urban areas of Nsukka Local Government Area of Enugu State, Nigeria.

Specific objectives

The specific objectives of this study were:

a.    to assess the prevalence of stunting, underweight and wasting   among   pre-school children in Nsukka  rural and urban   communities;

b.    to  assess cognitive performance of the pre-school children;

c.    to determine the association   between pre-school  children’s   nutritional status and mothers’ socioeconomic   characteristics

d.    to determine the association   between pre-school children’s cognitive performance and mothers’ socio-economic characteristics .

e.    to determine the association between pre-school children’s   nutritional status  and their  cognitive performance.

1.4         Significance of the study

Good  nutrition  is  important  during  the  whole  life  course.  It  is,  especially important during the first years of life, because these are the most important crucial years for normal physical and mental development.  Children  acquire many of the physical, social attributes and psychological structures for life and learning during the first year of life.

Thus, it is hoped that the findings of this study will generate data that is needed to improve the nutritional status and cognitive performance  of preschool children.   This findings will be accessed by beneficiaries through the University of Nigeria library. Such data will be useful to mothers and teachers in improving the nutritional status of children. Data generated will also help the ministries of health and education, health workers and nutrition  policy  makers  to  make  adjustments   and   modifications   in  planning  and implementation  of  appropriate  nutrition  interventions  and  surveillance  measures  to ensure  good  nutritional  status  of  pre-school  children.  The  study  will  highlight  the relationship between nutrition and cognitive performance in children.

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