Studies on the Predisposing Factors of Protein Energy Malnutrition Among Pregnant Women in a Nigerian Community

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1 Peer Reviewed, Open Access, Free Pulished Qurterly Mnglore, South Indi ISSN Volume 6, Issue 3; Jul-Sep 007 Originl Article Studies on the Predisposing Fctors of Protein Energy Mlnutrition Among Pregnnt Women in Nigerin Community Authors Okwu GN, Ukoh AI, Nwchukwu N Agh NC Deprtment of Biochemistry, Federl University of Technology, Owerri Address For Correspondence Glori N. Okwu Deprtment of Biochemistry, Federl University of Technology, P.O. Box 57, Owerri, Imo Stte, Nigeri. E-mil: gnokwu@yhoo.com Cittion Okwu GN, Ukoh AI, Nwchukwu N, Agh NC. Studies on the Predisposing Fctors of Protein Energy Mlnutrition Among Pregnnt Women in Nigerin Community Online J Helth Allied Scs. 007;3:1 URL Open Access Archives Sumitted Aug 18, 007; Accepted Dec 17, 007; Pulished: Jn 4, 008 OJHAS Vol 6 Issue 3(1) - Okwu GN, Ukoh AI, Nwchukwu N, Agh NC. Studies on the Predisposing Fctors of Protein Energy Mlnutrition Among PregnntWomen in Nigerin Community 1

2 Astrct: Protein Energy Mlnutrition (PEM) continues to e mjor pulic helth prolem in developing countries nd ffects mostly infnts, young children, pregnnt nd lctting mothers. This study ws crried on some of the fctors tht predispose pregnnt women to PEM nd hence identify groups t greter risk. A totl of 1387 pregnnt women (910 in the urn re nd 477 in the rurl res) were recruited for the study. Anthropometric indices of weight, height nd Body Mss Index (BMI) of the pregnnt women were mesured nd semi structured questionnires were used to elicit informtion on possile predisposing fctors such s ge, level of eduction, prity, child spcing etc. Results otined showed tht the men weight nd height of the rurl pregnnt women, were significntly (p<0.0001) lower thn those of the urn pregnnt women. The men BMI of the rurl sujects, ws lso significntly (p< 0.007) lower thn tht of the urn sujects. Anlysis of the effect of ge showed tht the younger ge ctegory (4 yers nd elow) hd significntly (p<0.0001) lower men BMI nd higher prevlence of PEM while the effect of level of eduction showed significntly (p<0006) lower men BMI nd higher PEM prevlence mong the less educted (no forml nd primry eduction). Those with prity of two, one nd primipr showed significntly (p<0.0175) lower men BMI while child spcing did not hve ny significnt effect on oth men BMI nd prevlence of PEM. The implictions of these findings re discussed nd recommendtions mde on how to tckle the prolem. Key Words: Protein Energy Mlnutrition, Pregnnt Women, Predisposing Fctors, Owerri, Nigeri Introduction: Worldwide, n estimted 85 million people re undernourished with most (815 million), living in developing countries.(1,) Poverty is the min underlying cuse of mlnutrition nd its determinnts.(3) The degree nd distriution of Protein Energy Mlnutrition (PEM) in given popultion depends on mny fctors the politicl nd economic sitution, level of eduction nd snittion, the seson nd climte conditions, food production, culturl nd religious food customs, restfeeding hits, prevlence of infectious diseses, the existence nd effectiveness of nutrition progrmmes nd the vilility nd qulity of helth services..(,4) Mlnutrition continues to e mjor helth urden in developing countries. It is glolly the most importnt risk fctor for illness nd deth with hundreds of millions of pregnnt women nd young children prticulrly ffected.(5) Poor nutrition in pregnncy in comintion with infections is common cuse of mternl nd infnt mortlity nd moridity, low irth weight nd intruterine Growth Retrdtion (IUGR).(6) In Nigeri, mternl deth per 100,000 irths is put t 800 while percentge low irth weight stnds t twenty.(7) Low irth weight ies hve incresed risk of mortlity, moridity nd development of mlnutrition. Children who suffer from mlnutrition re more likely to hve slowed growth, delyed development, difficulty in school nd high rtes of illness nd they my remin mlnourished to dulthood.(8,9) IUGR is ssocited with poor cognitive nd neurologicl development for the infnt nd in dulthood, susceptiility to crdiovsculr disese, dietes nd renl disese.(10) Mlnutrition remins one of the world s highest priority helth issues not only ecuse its effects re so widespred nd long lsting ut lso ecuse it cn e erdicted. Erdiction is est crried out t the preventive stge. Hence the need to identify groups of pregnnt women t greter risk of developing PEM. Such high-risk groups cn e trgeted in ny plnned intervention progrmme. Mterils nd Methods: Sujects A totl of 1,387 pregnnt women took prt in the study, 910 in Owerri urn re nd 477 in the rurl re surrounding Owerri. The study ws crried out t the ntentl clinics of government hospitls nd privte clinics in Owerri urn re nd ntentl clinics of helth centres in rurl res surrounding Owerri nd covered period of 11 months. Approvl to crry out the study ws otined from the pproprite helth uthorities nd informed consent otined from the sujects efore the OJHAS Vol 6 Issue 3(1) - Okwu GN, Ukoh AI, Nwchukwu N, Agh NC. Studies on the Predisposing Fctors of Protein Energy Mlnutrition Among PregnntWomen in Nigerin Community

3 commencement of the study. Pregnnt women who hd complictions such s pregnncy induced hypertension, infections, mlri, metolic disorders etc (s indicted in their medicl records) were excluded from the study. All the pregnnt women in the study received routine prescriptions of iron, multivitmins, folic cid nd drprim (s ntimlri prophylxis). Dt on ge, eductionl level, prity, child spcing, etc were otined from the pregnnt women through semi-structured questionnire. Smpling Technique And Smple Size For the Owerri urn re, proportionte cluster smpling method ws used. Five clusters were identified nd one ws rndomly selected. All the hospitls nd clinics in the selected cluster were included in the study. For the rurl res surrounding Owerri totl of 1 helth centres were rndomly selected from the 55 helth centres elonging to 55 utonomous communities. Smple size n, for rndom smpling ws clculted using the reltionship 11 n = (Z 1 -α/δ) p(1-p) Prevlence, P ws tken to e 50, which gives the lrgest smple size. Smpling error, ws 5% Confidence coefficient 1- α = 95% (Z 1 - α = 1.96) Accordingly minimum smple size of 384 ws clculted for the rurl res. To tke into ccount the cluster design effect, the clculted rndom smpling size, n is multiplied y two.(1) Hence minimum smple size of 768 ws otined for the Owerri urn re. Anthropometric Indices Anthropometric mesurements of the pregnnt women were performed with the help of trined ssistnts. Body weights were mesured without shoes nd with light clothing to the nerest 0.1kg on weight scle. Stnding height ws mesured without hedger using stdiometer to the nerest 0.1cm. Body mss index (BMI) ws clculted s weight (kg) divided y height (m) squred (kg/m ). According to UN clssifiction, BMI < 18 is considered severely mlnourished, 18-0 is modertely mlnourished, 1-4 is norml, 5-7 is overweight nd > 7 is oese.(13) Sttisticl Anlysis Dt ws nlysed using the softwre pckge SAS version 8. (SAS Institute Inc, Cry, North Crolin). Person chi Squre, Anov nd post Hoc Duncn s multiple rnge test were used to identify sttisticlly significnt differences. Dt ws considered significnt for p <0.05 t 95% confidence limit. Results: A totl of 1,387 pregnnt women were included in the study (910 in the urn re nd 477 in the rurl res). The men weight nd height of the pregnnt women in the rurl res, ± 14.80kg nd 1.58 ± 0.07m respectively were significntly lower thn those of the urn sujects, 68.9 ± 10.3kg nd 1.67 ± 0.08m respectively, p< in ech cse. The men BMI of the rurl sujects, 5.8 ± 4.60kg/m ws lso significntly lower thn tht of the urn sujects, 6.41 ± 3.36kg/m, p< In the urn re, 35% of the pregnnt women were pulic servnts, 43% were involved in some usiness ctivity nd % were housewives/students not holding ny jos. In the rurl su smple, 8% were pulic servnts, % were involved in some usiness ctivity nd 70% were engged in susistence frming s mens of livelihood. OJHAS Vol 6 Issue 3(1) - Okwu GN, Ukoh AI, Nwchukwu N, Agh NC. Studies on the Predisposing Fctors of Protein Energy Mlnutrition Among PregnntWomen in Nigerin Community 3

4 Tle 1: Men BMI And Prevlence Of PEM According To Age Of The Pregnnt Women. Overll Urn Rurl Age (yrs) Frequency < > Totl 1387 < > Totl 910 < > Totl 477 Vlues with different superscripts per column re sttisticlly significnt (p<0.05) BMI (kg/m ) Rnge Men s.d * % PEM: Overll p<0.0136, Urn p<0.4194, Rurl p< (Person X used) c 5.07 c %* PEM Tle 1 shows men BMI nd prevlence of PEM mongst the pregnnt women ccording to ge. Overll the pregnnt women elow 0yrs nd 0-4yrs ge groups showed significntly (p<0.0010) lower men BMI nd significntly (p<0.0136) higher percentge of PEM thn the older ge ctegories. In the urn su-smple, oth men BMI of the 4 yers nd elow ge ctegory ws significntly (p<0.041) lower thn tht of ove the 40 yers ge group while prevlence of PEM OJHAS Vol 6 Issue 3(1) - Okwu GN, Ukoh AI, Nwchukwu N, Agh NC. Studies on the Predisposing Fctors of Protein Energy Mlnutrition Among PregnntWomen in Nigerin Community 4

5 did not show sttisticl difference (p<0.4194) mong the vrious ge groups. In the rurl su-smple, men BMI of the 4 yers nd elow ge group ws significntly (p<0.0111) lower thn the older ge groups nd their proportion of PEM ws significntly (p<0.0001) higher. Tle : Men BMI nd Prevlence of PEM of the Pregnnt Women According to Eductionl Level Overll Level of eduction Frequency BMI (kg/m ) No Forml Eduction Primry Eduction Secondry Eduction Post Secondry Eduction Totl 1387 Urn No Forml Eduction Primry Eduction Secondry Eduction Post Secondry Eduction Totl 910 Rurl No Forml Eduction Primry Eduction Secondry Eduction Post Secondry Eduction Totl 477 Rnge Men s.d c 4.80 c Vlues with different superscripts per column re sttisticlly significnt (p<0.05) * % PEM: Overll p<0.0104, Urn p<0.0351, Rurl p< (Person X used) %* PEM Tle shows men BMI nd prevlence of PEM mongst the pregnnt women ccording to level of eduction. Overll, the pregnnt women with primry eduction nd no forml eduction hd significntly (p<0.0006) lower men BMI nd significntly (p<0.0104) higher prevlence of PEM. In the urn re, lthough there ws no sttisticl difference (p<0.687) in men BMI, there ws significnt difference (p<0.0351) in prevlence of PEM mongst the pregnnt women ccording to level of eduction. In the rurl su-smple the primry nd no forml eduction groups hd significntly (p<0.001) lower men BMI nd significntly (p<0.0476) higher prevlence of PEM. OJHAS Vol 6 Issue 3(1) - Okwu GN, Ukoh AI, Nwchukwu N, Agh NC. Studies on the Predisposing Fctors of Protein Energy Mlnutrition Among PregnntWomen in Nigerin Community 5

6 Tle 3: Men BMI And Prevlence Of PEM According To Prity Of The Pregnnt Women Prity Frequency BMI (kg/m ) Rnge Men s.d % PEM* Overll Primipr > Urn Totl 1387 Primipr c c c > Rurl Totl 910 Primipr > Totl 477 Vlues with different superscripts per column re sttisticlly significnt (p<0.05) * % PEM: Overll p<0.0136, Urn p<0.0166, Rurl p<0.194 (Person X used) Tle 3 shows men BMI nd prevlence of PEM ccording to prity. Overll the lower men BMI of prity of one, prity of two nd primipr showed significnt (p<0.0175) differences from the other groups lthough their prevlence of PEM ws not significntly (p<0.0638) different. In the urn su smple, the lower men BMI of prity of one, two nd primipr showed significnt (p<0.044) difference from those of the other groups. Their prevlence of PEM ws lso significntly (p<0.0166) different. In the rurl su-smple, lthough the men BMI nd prevlence of PEM did not show sttisticl differences, the pregnnt women with prity of one presented the highest prevlence of PEM of 31.8%. OJHAS Vol 6 Issue 3(1) - Okwu GN, Ukoh AI, Nwchukwu N, Agh NC. Studies on the Predisposing Fctors of Protein Energy Mlnutrition Among PregnntWomen in Nigerin Community 6

7 Tle 4: Men BMI And Prevlence Of PEM According To Child Spcing Of The Pregnnt Women Child spcing Frequency BMI (kg/m ) Rnge Men s.d % PEM* Overll Primipr <1yr yrs yrs yrs Aove.5yrs Urn Totl 1387 Primipr < 1yr yrs yrs yrs Aove.5yrs Rurl Totl 910 Primipr < 1yr yrs yrs yrs Aove.5yrs Totl 477 Vlues with different superscripts per column re sttisticlly significnt (p<0.05) * % PEM: Overll p<0.19, Urn p<0.1991, Rurl p< (Person X used) Tle 4 shows men BMI nd prevlence of PEM ccording to child spcing. Overll no sttisticl difference in men BMI nd prevlence of PEM ws found mong the pregnnt women ccording to child spcing. The sme ws the cse in oth the urn nd rurl su-smples. OJHAS Vol 6 Issue 3(1) - Okwu GN, Ukoh AI, Nwchukwu N, Agh NC. Studies on the Predisposing Fctors of Protein Energy Mlnutrition Among PregnntWomen in Nigerin Community 7

8 Discussion Mjority of the sujects in the rurl su smple were susistence frmers nd s is the cse in most su-shrn Africn countries lthough they spend long hours frming they still hve limited ccess to food since the men control the fmily resources. 14 The rurl women therefore consumes systemticlly elow their minimum dily clorie requirement. 15 This would explin the lower men weight, height nd BMI of the rurl sujects compred to the urn sujects. A previous study y the uthors showed prevlence of PEM to e 3-4 times higher in the rurl re compred with the urn re (unpulished finding). The effect of ge on the prevlence of PEM showed tht the ge groups, elow 0yers nd 0-4 yers, presented the higher prevlence of PEM of 5% nd 11.74% respectively. Their men BMIs were significntly lower thn those of the other ge group. The 4 yers nd elow ge group is pprently the group t greter risk for PEM especilly in the rurl res. The ge effect lthough not seen in the urn re ws quite prominent in the rurl res. The effect of level of eduction on the prevlence of PEM showed tht those with no forml eduction nd primry eduction hd significntly lower BMI nd higher percentges of PEM thn those of other groups. Hence it cn e concluded tht the less educted re t greter risk of developing PEM. Level of eduction did not show ny effect in the urn re ut ws significnt fctor in the rurl res. The more educted pregnnt women in the rurl res re the ones tht re likely to e engged in occuptions other thn frming which will fetch them more income nd hence greter food purchsing power. In the urn re on the other hnd, even the less educted pregnnt womn is likely to e engged in some economic ctivity which will ern her some income nd thus gurntee her resonle food purchsing power. Prity of two, one nd primipr recorded men BMIs tht were significntly lower thn those of the other groups. This effect ws more pronounced in the urn re thn the rurl res. This cn e explined y the fct tht weight gin increses with increse in prity. 16 Hence those with lower prity re likely to hve lower BMIs. However, in the rurl res, this might not necessrily e the cse since s hs een pointed out the rurl women live physiclly rduous lives 17 nd so the usul weight gin with increse in prity my not e oserved. Although the nutritionl demnds of frequent cycles of pregnncy nd lcttion (child spcing) hve lwys een known to impct negtively on the nutritionl sttus of women 17, results from the present study showed tht child spcing did not hve ny significnt effect on oth the men BMIs nd the prevlence of PEM mongst pregnnt women oth in the urn nd rurl res. The reson for this is not immeditely ovious ut it might e tht the eduction intervention progrmmes (usully common feture of ntentl clinics) on irth control mesures nd child spcing my e yielding dividends. In conclusion, Protein Energy Mlnutrition mong pregnnt women remins mjor pulic helth prolem in Nigeri especilly in the rurl res. Those who re t greter risk re the teenge nd young mothers, the less educted, the primigrvide nd those with prity of one or two especilly in the rurl res. In view of the dverse effects of PEM on oth mother nd child it is recommended tht pproprite intervention progrmmes e instituted to tckle the prolem nd the following recommendtions re herey mde: 1. Introduction of feeding progrmmes in ntentl clinics nd helth centers or in the lterntive, provision of food susidies to trgeted groups,. Counseling on dietry intke nd reduced energy expenditure efore nd during pregnncy. 3. Nutrition eduction nd efficient nutrition monitoring systems t ll levels of cre. 4. Susidized griculturl inputs nd lour sving devices for women. 5. Hygiene eduction, improved ccess to potle wter nd dequte snittion nd helth cre services 6. Providing opportunities for women s involvement in development through ccess to eduction, pid employment, ssets such s lnd nd credit fcilities. OJHAS Vol 6 Issue 3(1) - Okwu GN, Ukoh AI, Nwchukwu N, Agh NC. Studies on the Predisposing Fctors of Protein Energy Mlnutrition Among PregnntWomen in Nigerin Community 8

9 Acknowledgements The uthors thnk Miss Dorothy Nwneri, Miss Mryjoe Keke nd Miss Chinemerem Anynwu for their ssistnce in dt collection. We lso thnk the numerous proprietors of the privte hospitls nd clinics in Owerri nd the nurses t the Government hospitls in Owerri nd helth centers in the rurl res for their co-opertion References 1. World Helth Orgniztion (00). World Helth Report, Genev: The Orgniztion, 00.. Food nd Agriculture Orgniztion of the United Ntions. Under Nourishment Around the World. In The Stte of Food Insecurity in the World, Rome, The Orgniztion, Schs JD, McArthur JW. The Millennium Project: A Pln for Meeting the Millennium Development Gols Lncet 005;365: Slm P, Spiegel P, Tlley L, Wldmn R. Lessons Lerned From Complex Emergencies Over Pst Decde. Lncet 004;364: Muller O, Krwinkel M. Mlnutrition nd Helth in Developing Countries. CMAJ 005;171(3): Pen M, Bclo J. Mlnutrition nd Poverty. Ann Rev Nutr 00;: Enwonwu CO, Phillips RS, Irhim CD, Dnfillo IS. Nutrition nd Orl Helth in Afric. Interntionl Dentl Journl 004;54: Scrimshw NS. Mlnutrition, Brin Development, Lerning nd Behviour. Nutrition Reserch 1998;18(): Aidoye RO, Eze DI. Comprtive School Performnce Through Better Helth nd Nutrition in Nsukk, Enugu, Nigeri. Nutrition Reserch 000;0(5): De Onis M, Blossner M, Villr J. Levels nd Ptterns of Intruterine Growth Retrdtion in Developing Countries. Europen Journl of Clinicl Nutrition 1998;5: World Helth Orgniztion Smple Size Determintion: A User s Mnul, Genev WHO 1986 (WHO/HST/EMS/86.1). 1. Lwng SK, Lemeshow S. Smple Size Determintion in Helth Studies: A Prcticl Mnul, Genev, WHO, United Ntions Administrtive Committee on Coordintion/Sucommittee on Nutrition. Second Report on the World Nutrition Sitution, vol. 1, 199. Glol nd Regionl Results. Genev; United Ntions Administrtive Committee on Co-ordintion/ Sucommittee on Nutrition. 14. Folre N. Herts nd Spdes: Prdigms of Household Economics. World development 1986;14: Food nd Agriculture Orgniztion (FAO). Food Requirements nd Popultion Growth. Technicl Pper No 1, World Food Sumit, FAO. 16. Ogeide O, Okojie O, Wgtsom V, Ish E. Nutritionl Sttus of Lctting Mothers in Benin City, Nigeri. Nig. J. Nutr. Sci. 1994;15(1&): Leslie J, Clemins E, Essm SB. Femle Nutritionl Sttus Across Life-Spn in Su-Shr Afric. I. Prevlence Ptterns. Food Nutr Bull 1997;18:0-43. OJHAS Vol 6 Issue 3(1) - Okwu GN, Ukoh AI, Nwchukwu N, Agh NC. Studies on the Predisposing Fctors of Protein Energy Mlnutrition Among PregnntWomen in Nigerin Community 9