ORIGINAL

Niger J Paed 2015; 42 (3):210 –213

Agbedeyi GO

Eke GK

Nte AR

Nutritional status of day care

attendees in Port Harcourt

metropolis

DOI:http://dx.doi.org/10.4314/njp.v42i3.7

Accepted: 29th July 2013

Abstract: Objective: To deter-

mine the nutritional status of chil-

dren aged 0-35 months attending

day care centres in Port Harcourt

metropolis.

sis were available for 1541 chil-

dren aged 5-34months (mean

23.78 ± 7.04 months, median 25

months and modal 24 months)

with 110(7.2%) children aged less

than 12 months and 283(18%) less

than 18 months. They consisted of

766 (49.7%) males and 775

(50.3%) females. Most children

had normal nutritional status using

the various indices but 46 (3%)

children were underweight, 85

(5.5%) stunted, 109 (7.1%) wasted

and 328 (21.3%) overweight. The

mean Mid Upper Arm Circumfer-

ence (MUAC) was 15.95 ± 1.698

cm with29 (2%) children having

MUAC below 115mm.

Conclusion: Majority of the day

care attendees were well nour-

ished. However, the high preva-

lence of overweight malnutrition is

of serious concern in view of its

associated long term morbidity and

the need for effective interventions

to reduce this risk.

(

)

Agbedeyi GO1

Department of Paediatric,

Ebony Hospitals, Rumuola,

Port Harcourt, Nigeria

Methodology: A cross-sectional

descriptive survey approved by

the University of Port Harcourt

Research Ethics Committee, the

parents, Authorities of Day care

centres and National Association

of Proprietors of Private Schools,

was carried out between Novem-

ber 2011 and July 2012 in 200

day care centres in Port Harcourt

metropolis. The centres were se-

lected using stratified multistage

random sampling technique. At

each day care 10 children (5

males and 5 females) selected

randomly from those who met the

inclusion criteria were recruited.

With parental cooperation, each

child's socio-demographic data,

nutritional history and anthropom-

etric measurements were ob-

tained. Data were analysed using

SPSS version 20. Statistical sig-

nificance was set at p<0.05.

Email: tagbedeyi@yahoo.com

Eke GK, Nte AR

Department of Paediatrics,

University of Port Harcourt Teaching

Hospital, Port Harcourt, Nigeria.

Key Words: day care centres,

under-fives, malnutrition, over-

weight, children.

Results: Complete data for analy-

Introduction

method of nutritional status assessment in under-fives,

involves the measurement of the length/height, weight

and mid (upper) arm circumference of a child. These are

compared with accepted national and international stan-

dards of their expression to determine a child’s status.

The z-score charts which were developed by the WHO

using children from different countries are the most

widely used in the assessment of a child’s nutritional

Malnutrition, as defined by the World Health Organiza-

tion (WHO), is a cellular imbalance between the supply

of nutrients and energy and the body’s demand for them

to ensure growth, maintenance and specific functions. In

childhood, malnutrition is an underlying factor in more

than half of under-five deaths worldwide and is the most

important risk factor for illness and death in children

2,3

status .

1

worldwide .

Although there is a dearth of literature on the nutritional

status of day care attendees in Nigeria, some available

reports have linked day care attendance with poor nutri-

tional status such_-a₉s underweight malnutrition or obesity

A child’s nutritional status is an indicator of his/her gen-

eral wellbeing and health. Influenced by food intake and

the quantity and quality of foods ingested and the child’s

physical health, it affects all aspects of the child’s health

i.e. growth and development, physical activity and

4

6

(over-nourished) . An Ibadan-basedstudy showed that

day care attendees were more likely to be moderately

underweight and wasted than those cared for at home

because they were breastfed less while in day care cen-

response to serious illness. The spectrum of nutritional

status spans from severe malnutrition to normal nutri-

2

7

tional status to obesity. Anthropometry ,the commonest

tres. On the other hand, in Irewole , Osun State, female

2

11

day care attendees were shown to be more wasted,

stunted or underweight than the males. In view of in-

creasing urbanisation, promotion of early child learning

and patronage of day care centres and the impact of mal-

nutrition on under-five morbidity and mortality in Nige-

ria, it is important to determine the nutritional status of

day care attendees and its determinants so as to guide

policy makers in adopting practices that will promote

optimal growth and development of under-fives. This

study was therefore conducted to determine the nutri-

tional status of children attending day care centres in

Port Harcourt metropolis so as to provide information

that will inform policies on child health, development

and education in the State.

up were done by the authors. The raw data were vetted

and entered into a Microsoft Excel spreadsheet and ana-

lysed using SPSS 20. A p value < 0.05 was considered

statistically significant.

Results

The 1541children with complete data comprised of 766

(49.7%) males and 775 (50.3%) females. They were

aged 5 to 34 months (mean 23.78 ± 7.04 months, median

- 25 months and mode- 24 months with 110(7.2%) chil-

dren aged less than 12 months and 283(18%) less than

18 months (Fig. 1).The weights of the children ranged

from 5.90 – 21kg (mean 13.69 ± 2.82 kg; median-14kg).

Although 27 (58.7%) of the 46(3%) underweight chil-

dren were aged 24-35 months, underweight malnutrition

was not statistically significantly associated with the

ages of the children (p = 0.226) (Table 1).

Materials and Methods

This cross-sectional descriptive survey was carried out

in Port Harcourt, the capital of Rivers State located in

the South-South geopolitical zone of Nigeria, from No-

vember 2011 to July 2012. By legislation, Day Care

Centres in Rivers State are expected to be registered

with the Department of Child Care in the State Ministry

of Social Rehabilitation as well as with the National

Association of Proprietors of Private Schools (NAPPS).

However less than 10% of the 500 centres registered

with NAPPS were registered by the State government.

These centres were spread across the metropolis and

clustered in the 20 zones- 10 zones in each of the 2 Lo-

cal Government Areas (LGA) that made up Port Har-

court metropolis-Obio/Akpor and Port Harcourt LGAs.

Sadly the Rivers State Government did not run any day

care centre.

Fig 1: Age

Distribution of

the 1541 day

care attendees

studied

Table 1: Age distribution of the mean weight and weight

forage z scores of the day care attendees

WAZ scores

Underweight

-2 SD

N (%)

Normal weight

≥ -2 SD

N (%)

Total

<

Age range

months)

Mean weight

(kg)± SD

N (%)

(

0

6

1

2

-5

-11

2-17

8-23

4-29

7.25 ± 0.80

10.27 ± 2.90

11.74 ± 2.40

13.42 ± 2.31

14.43 ± 2.29

14.85 ± 2.58

13.69 ± 2.82

0 (0.0)

4 (0.3)

7 (0.5)

8 (0.5)

12 (0.8)

15 (1.0)

46 (3.0)

21 (1.4)

85 (5.5)

21 (1.4)

89 (5.8)

With the assistance of the NAPPS, 200 schools were

selected using a stratified multistage random sampling

technique, based on the location of the school. In each

LGA, 5 out of 10 zones were selected and 20 schools

from each of the 5 selected zones. At each school 10

children -5 from each gender- aged between 0-35

months who had been attending the day care centre for

at least 3 months were recruited with the consent of their

parents. Socio-demographic data and anthropometric

measures – weight, length/height, mid upper arm cir-

cumference- were obtained from the children using a pre

166 (10.8)

277 (18.0)

619 (40.2)

327 (21.2)

1495 (97.0)

173 (11.2)

285 (18.5)

631 (40.9)

342 (22.2)

1541 (100)

30-35

Total (%)

The children’s supine lengths/heights ranged from 56.90

– 112.0 cm (mean 89.54 ± 8.60 cm, median 90.80 cm).

Of the 85 (5.5%) stunted children, 45 (52.9%) were aged

24-35 months with a modal age of 24-29 months. The

differences in the age distribution of stunting was statis-

tically significant (p = 0.005) (Table 2).

-tested questionnaire approved for the study by the Re-

search Ethics Committee of the University of Port Har-

court Teaching Hospital and the West African College

of Physicians. Additionally, NAPPS Port Harcourt

Chapter, Proprietors of each day care centre and Parents

of children recruited approved the study. Standards

methods and equipment were used for anthropometric

measurements. The anthropometric indicators used were

the weight-for-age z-score, the length/height-for-age z-

score and the weight-for-length/height z-score. The

WHO’s z-scores for various nutritional indices were

calculated and the WHO definitions of various forms of

malnutrition were adopted for this study. Data were ob-

tained by one of the researchers with the assistance of

trained field workers. Data handling, analyses and write

Table 2: Age distribution of the mean length/height and

height-for-age z scores of the day care attendees

HAZ score

Mean length/

height (cm) ±

SD

Normal

Stunted

Total

Age range

months)

(≥ -2 S.D)

N (%)

(<-2 S.D)

N (%)

(

0

6

-5

-11

12-17

8-23

4-29

0-35

65.25 ± 4.21

76.13± 10.92

82.26 ± 6.37

88.03± 6.47

92.10 ± 5.78

94.75 ± 5.76

89.54 ± 8.60

21 (1.4)

77 (5.0)

0 (0.0)

21 (1.4)

89 (5.8)

12(0.8)

15 (1.0)

13 (0.8)

27 (1.8)

18 (1.2)

85 (5.5)

158 (10.3)

272 (17.7)

604 (39.2)

324 (21.0)

1456 (94.5)

173 (11.2)

285 (18.5)

631 (40.9)

342 (22.2)

1541 (100)

1

2

3

Total (%)

2

χ = 17.762, df = 5, p = 0.005

2

12

Three hundred and twenty eight (21.3%)children were

overweight and 109 (7.1%) were wasted with children in

the age group 24-29 months being more affected by

these forms of malnutrition. The weight-for-height/

length z scores (Table 3) were statistically significantly

different between the age groups (p = 0.049).

The high prevalence of overweight malnutrition found

in this study is of public health significance and further

buttresses the fact that overweight malnutrition is be-

coming an increasing problem in developing nations like

16

Nigeria . This can be deduced from the fact that previ-

ous Nigerian studies did no_,₇t document overweight mal-

6

nutrition in under-fives until the recent NDHS

10

2013 did so. However, our prevalence rate was five

10

Table 3: Age distribution of weight-for-height/length z- scores

of the day care attendees

times that reported in the NDHS 2013 and may be at-

tributed to the higher socioeconomic class of the study

WHZ (SD)

17

subjects and poor awareness of parents . Our preva-

18

Wasting

Age group < -2

Normal

Overweight Total

-2 to≤+2

>+2

N (%)

lence rate was comparable to that reported in Brazil

where the overweight prevalence was below

(months)

N (%)

0

6

1

2

3

-5

-11

2-17

8-23

4-29

0-35

1(0.1)

6 (0.4)

13 (0.8)

63 (4.1)

113 (7.3)

198 (12.8)

470 (30.5)

247 (16.0)

7 (0.5)

21 (1.4)

89 (5.8)

19

0%.However, in the Amazon region of Brazil , chil-

1

20 (1.3)

39 (2.5)

69 (4.5)

129 (8.4)

64 (4.2)

dren attending private day care centres were found to be

more overweight and obese compared with those at pub-

lic day care centres.

21 (1.4)

18 (1.2)

32 (2.1)

31 (2.0)

109(7.1)

173 (11.2)

285 (18.5)

631 (40.9)

342 (22.2)

1541(100)

Total (%)

1104 (71.6) 328 (21.3)

6

An Ibadan-basedstudy which compared the nutritional

2

χ = 18.377, df = 10, p = 0.049

status of day care attendees and those cared for at home

showed that day care attendees were more likely to be

moderately underweight and wasted. This was attributed

Discussion

^t^o^t^h^e^d^a^y^c^a^r^e^a^t^t^eⁿ^d^e^e^s^b^eⁱⁿ^g^b^r^e^a^s^t^f^e^d^l^e^s^s^t^h^aⁿ^t^h^e7

children who stayed at home. Another study in Irewole

Local Government Area of Osun State among children

aged 2 years and younger attending day care centres

showed no statistically significant gender differences in

their nutritional status with the prevalence rates of un-

derweight malnutrition, stunting and wasting being not

more than 5% in both sexes but more females than

males were wasted, stunted or underweight. These fig-

ures were lower than those reported among children in

The 97% children with normal weight-for-age z scores

obtained in the present study was higher than the na-

10

tional average of 71% . The prevalence of underweight

malnutrition found in this study compared to that found

at Ikire but was lower than was reported among day care

attendees in Ibadan and preschool children in Ethi₇o_,₁p₁_-i₁a₃,

Nigeria (Kano and Kaduna) and Western Kenya

.

The similarities in prevalence rates in this study and that

in Ikire may be due to the large sample sizes studied.

However, the five- fold prevalence rate reported in

8

day care centres in Rasht, northern Iran where 8.6%

were stunted, 8% wasted and 7.1% underweight. On the

contrary, among children at a day care centre in Sao

6

Ibadan compared to the current rate may be consequent

9

Paulo the initial prevalence rates for the different nutri-

on the inclusion of ill children in the Ibadan study con-

trary to the situation in this series.

tional status were 10.1% for wasting, 29.8% under-

weight and 50% stunting.

The 5.5% prevalence of stunting rate in the present

study is lower than the 37% national average in the Ni-

gerian 2013 National Demographic and Health Survey

Conclusion

10

NDHS) . It may be due to the fact that this study was

(

done in an urban population. However, it compared fa-

vourably with those reported amo₇_,n₈_,g₁₄day care attendees

Most day care attendees were either well-nourished or

overweight. The high prevalence of overweight malnu-

trition is of national health significance and requires an

evaluation of the feeding practices and exercise regi-

mens in the day care centres in order to adopt measures

to reduce the associated burden of non- communicable

diseases due to this form of malnutrition. It also calls

for awareness programmes and policies on food process-

ing and vending in schools and elsewhere.

in Iran, Osun State and Egypt

which reported a

stunting prevalence rate of less than 10%. These find-

ings are significant given the high prevalence of stunting

15

that had been previously reported in these areas . Simi-

larly, the lower (7.1%)wasting prevalence in this study

6

compared to the 12.1% reported at Ibadan may be at-

tributable to the fact that the subjects in the Ibadan study

were residents of a middle-high density area where per-

sons in the lower social classes resided. This contrasts

with the subjects of this study who belonged mostly to

the high-middle social classes who would be able to pay

the high fees for day care attendance. However, the cur-

rent prevalence of wasting was similar to that reported

Conflict of interest: None

Funding: None

8

amongst day care attendees in Iran . As reported by

Acknowledgement

7

Amosu et al , the prevalence of wasting in this study

was higher among females.

We acknowledge the research assistants who helped in

sample collection.

2

13

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