ORIGINAL

Niger J Paed 2014; 41 (2): 99 –103

Abdulkarim AA

Otuneye AT

Ahmed P

Adolescent malnutrition: Prevalence

and pattern in Abuja Municipal

Area Council, Nigeria

Shattima DR

DOI:http://dx.doi.org/10.4314/njp.v41i2,4

Accepted: 23rd November 2013

2

Abstract Objective: To determine

the prevalence and pattern of mal-

nutrition among adolescents in

senior secondary schools in The

Abuja Municipal area council

formula: BMI= W/H , where W

=weight (in kilograms) and H=

height (in meters). The age and sex

specific height and BMI percentile

for each subject was determined

using the 2007 WHO Height and

BMI growth charts for age

Abdulkarim AA⁽

)

Department of Paediatrics,

University of Ilorin Teaching Hospital,

PMB 1459, Ilorin,

Kwara State, Nigeria.

Email: aishaakarim@yahoo.com

Methods: Study design: this is a

cross-sectional study conducted

among adolescents (10-19 years)

in secondary schools. A multi-

stage sampling technique was

employed to select a total of 1700

students from classes in selected

schools. All schools in the Abuja

Municipal Area council (AMAC)

were stratified into urban and ru-

ral schools. Eight schools were

selected by balloting from a list of

schools obtained from the Educa-

tion centre. A school was selected

from each of the four major dis-

tricts of AMAC and four schools

were selected from the rural mak-

ing a total of 8 schools. Although

the consent of the school authori-

ties was obtained, individual

subject also consented to the

study before being enrolled. The

study excluded those adolescents

who were physically challenged

thus limiting physical activity.

Information was obtained via the

use of questionnaires that were

administered by trained personnel.

Subject’s height and weight was

taken using the floor-type height

5-19years. The students were then

classified into one of the following

categories using previously used

standards: normal, stunted, wasted,

overweight or obese. Data was

analyzed using SPSS version 17

statistical package.

Results: The mean age was

14.43±1.94 years; male 688, fe-

male 862, M:F ratio 1.1.3. Mean

BMI, weight and height were

Otuneye AT, Ahmed P, Shattima DR

Department of Paediatrics,

National Hospital, Abuja, Nigeria.

2

20.31±3.07kg/m , 51.07± 10.80

kg, and 157.88±9.33 cm. The

prevalence of wasting, stunting,

overweight and obesity was docu-

mented as 1.7% (27/1550), 11.3%

(175/1550), 13.2% (205/1550),

and 2.6% (41/1550) respectively.

Those in urban schools had higher

mean BMI (20.91±3.22 kg/m2

versus 19.71±2.78 kg/m2) and

height (160.41±9.14 cm versus

155.32±8.81 cm) and p values

<0.05.

Conclusion: There is a double bur-

den of over-nutrition (overweight

and obesity) and under-nutrition

(stunting and wasting) among ado-

lescents in Nigeria.

(

H) and weight (W) measuring

scale model ZT-120 using Massa-

chusetts department of public

health protocol. The nutritional

status was determined using the

Key words: Adolescent, malnutri-

tion, school population

3

Introduction

rian population are adolescents (10-19 years).

Malnutrition is a group of pathological disorders result-

ing from imbalance between intake o₄f essential nutrients

and the body’s demand for them. Malnutrition is a

global problem but the prevalence and pattern differ

between nations and even within regions in the same

Globally there are about 1.2 billion adolescents and 85%

of these adolescents live in the developing countries.

According to the United Nations International Children

Education Fund (UNICEF) estimates, 23% of the Nige-

1

,2

1

00

4

,5

country. In the developed countries over-nutrition

obesity and overweight) is a major concern while in

Sampling technique: a multistage sampling was em-

ployed in this study. All schools in the Abuja Municipal

Area council (AMAC) were stratified into urban and

rural schools. Eight schools were selected by balloting

from a list of schools obtained from the Education cen-

tre. A school was selected from each of the four major

districts of AMAC and four schools were selected from

the rural making a total of eight schools.

(

6

most developing nations under-nutrition predominates.

Identified nutritional problems among adolescents

include wasting, stunting, o₆v_,₇erweight, obesity and

micronutrient deficiencies.

Adolescence, characterised by rapid growth and devel-

opment, is therefore accompanied by increase require-

ments for nutrients. When t₈h_,₉ese increase needs are not

met under-nutrition results. A previous (WHO) report

showed that under-nutrition was widespread among Ni-

gerian adolescents. Sixteen percent (16%) of adoles-

cents in rural area were reported to be wasted compared

to 8% in the urban area. Stunting was also reported to be

Study population: only students who were verified

(using school records and/or birth certificate) to be be-

tween the ages of 10 and 19 years were selected. Al-

though the consent of the school authorities was ob-

tained, individual subject also consented to the study

before being enrolled. The study excluded those adoles-

cents who were physically challenged thus limiting

physical activity.

9

more frequent in rural area. Significantly higher preva-

lence of under-nutrition was reported in many other de-

veloping countries, 23% in Benin, 36% in Nepal and

9

5

6% in India. Globally there are reports of increasing

Sample size determination₃was done using the approach

1

prevalence of obesity and overweight and the associa-

tion with non-commu₆n_,₇icable disease especially cardiac

deaths and morbidity.

described by Araoye et al. The study assumed a preva-

lence of 50% among adolescents in the population.

Eight hundred and fifty students were selected from the

four urban schools and an equal number were selected

from the rural schools. The total number of study

subjects was 1,700.

Some determinants of malnutrition include area (rural

versus urban), socioeconomic status, lifestyle including

alcohol and tobacco use, eating₆_-h₁a₁ bits and level of

physical activity in an individual.

The association of

Multistage random sampling was employed for the se-

lection of students from the classes in each school. In-

formation was obtained via the use of questionnaires

that were administered by trained personnel. Subject’s

height and weight were taken in the presence of a chap-

eron assigned by the school. The floor-type height (H)

and weight (W) measuring scale model ZT-120 was

used for measurement using Massachusetts department

of public health protocol. The nutritional status was de-

malnutrition with increased m_,₁o₂rtality and morbidity in

5

childhood is well understood. In adulthood, there is a

higher burden of Type II Diabetes Mellitus (DM), hy-

pertensive heart diseases, coronary heart diseases, colo-

nic cancers a_-₉nd other disorders in obese and overweight

6

individuals. Malnutrition in childhood through adoles-

cence may progress to adult life. More importantly there

may be factors that influence malnutrition e.g. eating

habits and low physical activities that start in adoles-

cence and persist into adulthood, thus increasing the

burden of non-communicable diseases (NCDs) among

the population.

2

termined using the formula: BMI= W/H , where W

=weight (in kilograms) and H= height (in meters). The

age and sex specific height and BMI percentile for each

subject was determined using the 2007 WHO Height

and BMI growth charts for age 5-19years. The students

were then classified into one of the following categories

using previously used standards: normal, stunted,

wasted, overweight or obese. The socioeconomic status

of the students was determined by a method described

by Olusanya et al based on the educa₁t₄ional attainment of

There is a dearth of data on nutritional status in Nigerian

adolescents. The global economic recession, adoption of

sedentary lifestyle, the advancement in technological

development and changing eating habits are some of the

reasons to believe that there are changes in the nutri-

tional status of Nigerian adolescents and their current

status may be very different from the findings more than

the mother and father’s occupation.

Data was ana-

lyzed using SPSS version 17 statistical package.

9

a decade ago. This cross-sectional study was therefore

designed and conducted to determine the prevalence and

pattern of malnutrition among Nigerian adolescents us-

ing in-school adolescents as the target population.

Results

Sociodemographic parameters

The overall sample size was 1,700 but 1550 (91.2%)

questionnaires were analyzed because of withdrawal of

consent in 150 (8.8%). There were 688 (44.4%) males

and 862 (55.6%) females and the Male: Female of 1:1.3.

The mean age of the study population was 14.43±1.94

years. The students in middle adolescence (14-16 years)

were 818 (52.7%) of the sample; early adolescence (10-

13 years), 500 (32.3%) and 232 (15.0%) late adoles-

cence. Seven hundred and eighty (50.3%) were from

Materials and Methods

Study design: this study is a cross-sectional study con-

ducted among adolescents in secondary schools

Study area: the study was conducted in the Abuja Mu-

nicipal area council in the Federal capital territory of

Nigeria.

1

01

urban schools while the rest were selected from rural

schools. The ethnic groups represented in the sample

were Igbo (29.7%), Yoruba (19.7%), Hausa (6.6%) and

others (Gbagyis, Fulanis, Nupes, Ebiras) 44%. The up-

per social class represented 708 (45.7%) of the study

population; 542 (35.0%) were in the middle class and

Table 3: Pattern of malnutrition among adolescents studied

Malnutri-

tion type

Total

No (%)

Male

No (%)

Female

No (%)

Odds

ratio

X2

Df

p-

value

Stunting

Wasting

175

127

(18.5)

18 (2.6)

48

(5.6)

9 (1.0)

3.839

2.545

0.379

0.797

63.4

82

5.52

6

34.6

27

0.49

1

0.000

0.019

0.000

0.484

(11.3)

27 (1.7)

Over-

weight

Obesity

205

(13.2)

41 (2.6)

52 (7.6)

16 (2.3)

153

(17.7)

25

3

00 (19.3%) in the lower class. In the urban area, 502

64.4%) belong in the upper class and 68 (8.7%) in the

lower class. In the rural area 206 (26.8%) and 232

30.1%) belong in upper and lower class respectively.

(

(2.9)

Total

448

213

235

(

(28.8%)

(31.0)

(27.2)

These differences were statistically significant p<.05.

Nutritional status of the adolescents

Discussion

The mean weight, height and BMI of the adolescent₂s are

5

1.07±10.80 kg, 157.88±9.33 cm, 20.30±3.07 kg/m .

Adolescent malnutri₁t_-i₆o_,₁n₅_,₁h₆as been reported from several

parts of the world. An earlier report by WHO

Table 1 below shows the distribution of the anthropome-

try among the study population.

from this country documented essentially under-

nutrition which was more frequent among adolescents in

rural areas than those in urban area. In that report 10%

of rural adolescents girls were stunted and 5% in urban

areas were stunted. The prevalence of wasting was 8%

and 16% in urban and rural areas respectively in the

Table 1: Distribution of mean weight, height and BMI

for the study population

Age

years)

No

Mean weight Mean Height Mean₂BMI

(kg) (cm) (kg/m

143.00±7.72 16.97±1.36

147±7.78 18.34±2.74

150.64±7.15 18.70±2.64

(

1

0

1

2

3

4

5

23

83

170

224

290

287

34.87±5.05

40.35±8.31

42.82±8.22

47.55±9.56

same report. The current findings are different from the

earlier reports in that it documented a double burden of

malnutrition: a high prevalence of overweight (13.2%)

and stunting of 11.3%. Indeed, overweight is the most

prevalent form of malnutrition among the adolescents

studied. The mean BMI and weight for adolescent fe-

males is higher than those for males while the height of

adolescent males is higher than that of females. These

differences were statistically significant. The observed

higher BMI in females may be because of the effect of

oestrogen which leads to more accumulation of adipose

tissue. Furthermore, females are less likely to engage in

outdoor physical activities compared to their female

counterparts in this part of the world. With respect to the

males, they have a longer duration of growth spurt than

the females hence likelihood to have a higher final

height as observed in this study.

155.10±7.93 19.62±2.84

50.26±10.23 156.94±7.98 20.30±3.12

53.76±9.21

160.56±7.45 20.81±2.90

1

6

241

56.18±9.53

163.00±8.37 21.09±2.87

1

7

8

9

138

84

10

57.65±7.89

59.52±8.81

57.60±6.42

163.05±8.22 21.71±2.97

164.29±7.82 21.95±2.86

163.70±5.24 21.73±1.87

Total

1550 51.07±10.80 157.88±9.33 20.31±3.07

The mean BMI, weight and height for males were

2

9.60±2.71 kg/m , 50.81±11.85kg and 160±11.14 cm

1

respectively. The mean BMI, weight₂and height in

females were 20.89±3.22 kg/m , 51.28±9.87 kg,

1

56.19±7.16 cm respectively (p 0.000). The parameters

show statistically significant differences p<0.05 and also

statistically significant differences when disaggregated

for the urban and rural schools as shown in Tables 2

below.

The prevalence of overweight and obesity found in this

study was higher compared with previous reports from

1

7

Nigeria. This may be related to the higher socioeco-

nomic class of the adolescents in this study because half

to two-third of the adolescents were in the upper social

class. The study by Owa et al documented a higher

prevalence of obesity and overweight among chil₁d₈ren 5-

Table 2: Mean BMI, weight and height for male and

female adolescents by school setting

Mean

Males

Females

Rural

Urban

Rural

Urban

1

5 years in an essentially affluent population. These

BMI (kg/

m2)

20.20±2.90 19.10±2.40 21.30±3.30 20.30±3.00

findings of rising obesity and overweight among adoles-

cents and children are in keeping with findings from

Weight

50.60±12.0 47.10±10.3 53.20±9.90 48.90±9.30

(

Kg)

Height (cm) 165.10±10. 156.10±10. 157.50±6.8 154.60±7.3

00

0

other developing countries as well as_,₁₅w_,₁₆hat has been

6

documented for developed countries.

The higher

4

0

prevalence of overweight and obesity among the females

in this study is in agreement with previous studies from

The overall prevalence of any type of malnutrition in the

sample population was 28.8% i.e. 448 adolescents. The

type of malnutrition and prevalence in the population is

shown in table 3 below.

1

7,18

This may be because female adolescents are

Nigeria.

less likely to engage in outdoor physical activities in our

setting compared to the males. They may also have more

access to food and snacks as they are more likely to be

involved in the preparation and serving of food in the

household in our setting. Female adolescents may also

skip meals and therefore end up snacking and

1

02

consuming high calorie drinks more than their male

counterparts. Overall overweight and obesity were more

prevalent among adolescents in urban schools from up-

per social class. This translates to probability of higher

access to food and snacks and likely due to less physical

activities including household chores. The fast food

revolution (as both parents work leaving little room for

home cooking), easy access to cheap sweetened drinks,

and sedentary activities like watching television, playing

video games may have all contributed to the increasing

levels of over-nutrition. These factors more likely affect

adolescents in urban areas compared to those in rural

areas where there is limited access to fast food and even

internet.

quences. These effects are likely to add on to the in-

creasing burden of NCDs in developing countries if ef-

forts are not made to control malnutrition among adoles-

cents. There is a need for more broad-based research

into adolescent malnutrition including associated factors

- causal and related- and consequences both short and

long term. This information will help in the design of

preventive and interventional programmes on individual,

family and community levels.

Conclusion

The double burden of under-nutrition and over-nutrition

exists in an epidemic proportion among the adolescent

population. Overweight among females is the most

prevalent form of malnutrition documented.

Stunting was commoner among those from rural schools

and among males. This may be due to lower socioeco-

nomic status of the students in the rural schools com-

pared to those in the urban schools. Poor nutritional

knowledge, low maternal education, and higher physical

burden like hawking may all contribute to the higher

levels of stunting in rural areas though were not investi-

gated in this study.

Authors’ contributions

AAA and OAT: Developed the conceptual frame work

for the study, prepared the study questionnaire, and

participated in data analysis and preparation of

final draft.

OAT: Data collection from the schools.

AP and SDR : Reviewed the questionnaire, data collec-

tion and data analysis.

When factors that affect nutrition are persistent, the ef-

fects are best seen in the final height of individuals.

Male adolescents, who have a longer period of growth

spurt, compared to the females are more likely to mani-

fest stunting more frequently compared to females in the

event of chronic malnutrition, hence the current observa-

tion.

Conflict of interest: None

Funding: None

The association between malnutrition in childhood and

increased₂_,₁₉mortality and morbidity is well docu-

Acknowledgement

1

mented.

The association between over-nutrition and

metabolic syndromes and increased mortality and mor-

The following study would not have been possible with-

out the consent of the adolescents in the various schools,

their parents and the management of Federal capital ter-

ritory Universal education board and the management of

the schools involved in the study.

bidity from non-communicable di_,₂s₀eases (NCDs) in

6

adulthood is also well documented. The effect of mal-

nutrition among adolescents is less well studied. It is

plausible to assume that over-nutrition in adolescents

may progress into adulthood with similar health conse-

References

5

.

Ulasi TO, Ebenebe J. Nutritional

disorders in Childhood. In:

Azubuike JC, Nkanginieme KEO

8. Blake K, Davis V. Adolescent

medicine. In: Kliegman RM, Mar-

cdante KJ, Jenson HB, Behrman

RE (eds) Nelson Essentials of Pae-

diatrics: Saunders (Publishers),

2006. 342-356

9. WHO discussion paper on adoles-

cent nutrition: Nutrition in adoles-

cence: Issues and challenges for

the Health sector 2005; accessed

7/7/2008. www.who.int/child-

adolescent-health/

1

.

United Nations Food and Popula-

tion Agency: State of the World

population. 2005; Accessed

(ed) Paediatrics and Child Health

4

/07/2008. www.unfpa.org/

in a tropical region: African Edu-

cational services (publishers), Ow-

erri, 2007: 250-67

Prentice AM. The emerging epi-

demic of obesity in developing

countries. Int. J. Epidemiol. 2006;

swp/2005

2

3

.

Federal Republic of Nigeria offi-

cial gazette. January,2007

UNICEF- at a glance: Nigeria

statistics, 2006; Accessed

6

.

2

0/5/2008. www.unicef.org/

3

5(1): 93-9

infobycountry/

nigeria_statistics.html

Grisby DG, Shashidhar HR. Mal-

nutrition. 2006; accessed 7/7/2008.

www.emedecine.medscape.cim/

article/985140-overview

7

.

Olumakaiye MF. Prevalence of

underweight: a matter of concern

among adolescents in Osun state,

Nigeria. Pak J Nutr 2008; 7(3):503

New_publications/

10. Doustmohammadian A, Dorosty-

motlagh AR, Keshavarz A,

4

.

-508

Sadrzadehyeganeh H, Mohammad-

pour-Ahrangani B. Socidemo-

graphic factors and BMI of female

adolescent students in Semnan City,

Iran Mal J Nutr 2009; 15(1):27-35

1

03

1

1. Shepherd R, Dennison CM. Influ-

ences on adolescent food choices.

Proceedings of the Nutrition Soci-

ety 1996; 55: 345-57

2. Akinbami FO, Hamzat TK, Ori-

madegun AE, Tongo O, Oyeyemi

L, Okafor O et al. Body mass

composition: a predictor of admis-

sion outcomes among hospitalized

Nigerian under-five children. Asia

Pacific J Clin Nutr 2010; 19(3):

15. Jugesh C, Manorama V, Sandeep

KR. Obesity among preadolescents

and adolescents of developing

country (India). Asia Pacific J Clin

Nutr 2004; 13(3): 231-5

16. Lissau I, Overpeck MD, Ruan WJ,

Due P, Holstein BE, Hediger ML.

The Health behaviour in school-

aged children obesity working

group: body mass index and over-

weight in adolescents in 13 Euro-

pean countries, Israel and The

18. Owa JA, Adejuyigbe O. Fat mass,

fat mass percentage, body mass

index and mid-upper arm circum-

ference in a healthy population of

Nigerian children. J Trop Paed

1997; 43:13-9

19. Heird WC. Nutritional Needs. In:

Behrman RE, Kleigman RM,

Jenson BH (eds) Nelson Textbook

of Paediatrics: Saunders

(publishers) 2007. 153.

2

95-300

20. Non-communicable disease mor-

tality/morbidity data and analysis.

www.who.int/research/en accessed

7/10/2013.

1

3. Araoye MO. Subject selection. In :

Research methodology with statis-

tics for health and social sciences,

Nathadex (Publishers), 2004.115-

United States. Arch Pediatr Ado-

lesc Med 2004; 158(1):27-33

17. Ben-Bassey VP, Oduwole OA,

Ogundipe OO. Prevalence of over-

weight and obesity in Eti-Osa Lo-

cal government area, Lagos, Nige-

ria. Obes Rev 2007; 8(6):475-9

2

9.

1

4. Olusanya O, Okpere E, Ezimokhai

M. The importance of social class

in voluntary fertility control in a

developing country. West Afr J

Med 1985; 4:205-12