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Research Article
 

Infant Feeding Practices and Nutritional Status of Children in North Western Nigeria



Anigo Kola Matthew, Ameh Danladi Amodu, Ibrahim Sani and S. Danbauchi Solomon
 
ABSTRACT

Studies on infant feeding practices and nutritional status of children in North Western Nigeria were carried out. More than 50% of caregivers were full-time housewives while about 39% do not have any form of education. Main source of drinking water was from unprotected sources like river/lake (24%), private well (23.0%) and public well (13.5%) while the predominant source of energy for cooking and main type of toilet in the households were wood (85.7%) and pit latrines (67%) respectively. On the average, over 70% of mothers were still breastfeeding at the time of the survey and duration of breastfeeding was between 13-24 months (73.4%). Only 54.3% of mothers in North West practiced exclusive breastfeeding for the first six months but in addition to breastmilk over three-quarter of caregivers gave plain water while 50% of caregivers in Kaduna state ever bottlefed their child with infant formula mostly from the 6th month. Few caregivers (19%) that bottlefeeds always sterilizes them. Complementary foods were introduced to majority of the children much earlier at 3rd month (41.2%) than the 6th month recommended while some caregivers introduces complementary foods at 1-2 months (17.8%). This study revealed that on the average, 31.7% of the children sampled were severely stunted which was lower than the National average. More attention needs to be paid to the specific behaviours surrounding feeding and any constraints to childcare in North Western Nigeria.

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  How to cite this article:

Anigo Kola Matthew, Ameh Danladi Amodu, Ibrahim Sani and S. Danbauchi Solomon, 2009. Infant Feeding Practices and Nutritional Status of Children in North Western Nigeria. Asian Journal of Clinical Nutrition, 1: 12-22.

DOI: 10.3923/ajcn.2009.12.22

URL: https://scialert.net/abstract/?doi=ajcn.2009.12.22

INTRODUCTION

Malnutrition is one of the biggest health problems that the world currently faces and is associated with more than 41% of the deaths that occur annually in children from 6 to 24 months of age in developing countries which total approximately 2.3 million (Sandoval-Priego et al., 2002). WHO (2001) reported that 54% of all childhood mortality was attributable, directly or indirectly, to malnutrition. Sub-Saharan Africa has a high prevalence of stunting, low weight-for-age and acute malnutrition (Lutter and Rivera, 2003).

Feeding practices during infancy are critical for the growth, development and health of a child during the first two years of life (WHO, 1979) and of important for the early prevention of chronic degenerative diseases. Progress in improving infant and young child feeding practices in the developing world has been remarkably slow (Ruel, 2003) due to several factors. It is estimated that among children living in the 42 countries with 90% of global child deaths, a package of effective nutrition interventions could save 25% of childhood deaths each year (Jones et al., 2003).

The survival risks of early childhood in Nigeria remain considerable. A newborn Nigerian baby has a 30 times higher chance of dying before the age of 5 years than a baby born in the developed, industrialized countries. The data available on the regional prevalence of diarrhoea, undernutrition and under 5 mortality in Nigeria showed that each of them are far more prevalent in the northern than in the southern part of Nigeria (UNICEF, 2001).

Attention need to be refocused on the promotion of household level feeding practices that are beneficial to the survival of children and caregivers in this part of Nigeria in order to be able to meet the commitment of Nigeria to the United Nations Millennium Development Goals (MDGs) for reduction in childhood mortality by two-thirds and a reduction in the number of people who suffer from hunger by half by the year 2015 (Daelmans and Saadeh, 2003). Therefore, it is vital that a comprehensive study on the risk factors such as infant feeding practice is conducted which will help to identify current good practices to be supported for improving the feeding practices as effective strategies for solving childhood malnutrition. This present study is a contribution to knowledge on current infant feeding practices and nutritional status of children in North Western Nigeria.

MATERIALS AND METHODS

This study was carried out in North Western Nigeria during the 2005 using the Multiple Indicator Cluster Surveys (MICS) zones and Nigeria Demographic and Health Survey (NDHS) 1990 zones (UNICEF, 2001), which was based on agro-ecological zones of the country. Three States (Kaduna, Kebbi and Niger) were randomly selected based on principal food crop grown in the Northwest zone for the study. Mothers with children more than 6 but less than 24 months were eligible in a mother/child pair while in the absence of the biological mother, the person considered as the child`s primary caretaker (Father, Aunt, Grandmother) was eligible.

A cross-sectional descriptive study was carried out which incorporated quantitative and qualitative data collection techniques. Data collection was through random cluster sampling using assembly-type method wherein subjects were gathered in a centrally located place in the community. Preparation for field data collection includes training of local data interviewers and instruments that were used in this study includes pretested structured questionnaire, semi-structured interviews, observations and focus group discussion, key informant interview. Information on Demographic and social economic status and nutrition-related practices were obtained from caregivers.

Anthropometric measurements were taken (Hossain et al., 2005). Children (in light clothing) were weighed by a Salter scale with a precision of 100 g and recumbent length was measured in centimeters to the nearest 0.1 cm using an infantometer. The Z-scores outcome was used as children nutritional status according to WHO criterion on basis of height-for-age, weight-for-height and weight-for-age for stunted, wasted and underweight, respectively.

The questionnaires were coded and analyzed and frequencies for various responses were generated to describe the care practices/behaviours of mothers and caregivers using the Microsoft Excel data analysis package for windows.

RESULTS

Table 1 presents the data on some demographic characteristics of the caregivers studied, over 50% of caregivers were full-time housewives and 39.0% had no form of education and about double that proportion was obtained in Niger state (70.5%) while average annual income of most caregivers in the states studied fell below fifteen thousand naira ($115) per annum. The most common source of drinking water to households was the river/lake (24.0%) while private well was 23.0% followed by water obtained from Tap inside the house which was 18.66% and that from borehole (14.1%). Clay pot was the main means of storing drinking water (51.3%) while wood (85.7%) was the predominant source of energy and 67% of caregivers household used pit latrines, with 25% using the bush as main toilets (Table 2).

Table 1: Demographic characteristics of caregivers in North Western Nigeria (%)
N represent sample size average for North West

Table 2: Socioeconomic characteristics of caregivers in North Western Nigeria (%)
N represent sample size average for North west

Table 3: Hygienic practices in food preparation by caregivers in North Western Nigeria
N represent sample size average for North west

Table 4: Percentage of children 6-24 months old by feeding practice and state

Table 5: Breastfeeding initiation, giving of colostrum, frequency and duration (%)
N represent sample size average for North west

Data on the practice of hand washing before preparing foods was 61% for those that wash sometimes, followed by 28% which does it always while 11% never (Table 3) and the proportion of caregivers who sterilized feeding bottles in North West was 19% always, 53% sometimes and 28% never. The use of boiled water for drinking as well as in the preparation of milk was not a popular practice among the caregivers while 52% sometimes practiced hand feeding. Table 4 shows that breast-feeding was a universal practice and feeding colostrums. Table 5 presented practiced among mothers in North Western Nigeria (81.8%). Reasons given by caregivers who did not feed their children with colostrums includes tradition (67.5%) which was passed on by elders in the communities without knowing the actual reason, this was followed by those that believed that the first milk is dirty (16.6%) while 4.4% were due to lack of breast-milk (Table 6). Reasons given by majority of caregivers for stopping breastfeeding before the 24th month (Table 7) was that the child can eat on his/her own (41.4%) and At the time of the survey, only 54.3% of the caregivers practiced exclusive breastfeeding (Table 8) but 85.5% of the children were giving water in addition to breastmilk. Over 60% of caregivers introduced bottlefeeding from the 5th to 6th month with worst situation recorded in Niger state (Table 9). 41.9% of caregivers gave something to their children before initiation of breastfeeding while majority of the respondents disclosed that the reason for giving it was that, it makes the children healthy (33.5%) while some simply said it reduces thirst (27%) (Table 10).

Table 6: Reasons for not giving colostrums (%)
N represent sample size average for North west

Table 7: Reasons for stopping breast feeding before 24 months (%)
N represent sample size average for North west

Table 8: Exclusive breastfeeding and duration (%)

Table 9: Bottlefeeding practices in North western Nigeria (%)
N represent sample size average for North west

Based on Fig. 1, complementary foods in the North west were introduced to children at age 3-4 months (41.2%) and 5-6 months (38.9%) while 17.7% introduced it at an earlier age 1-2 months. Continuous feeding of children during an episode of illness were practiced by caregivers (Fig. 2).

Table 10: Pre-lacteal feeding (%)
N represent sample size average for North west

Fig. 1: Age of introduction of other foods

The nutritional status of children in North West which showed that 31.7% of children in North west were severely stunted with Kebbi state recording the highest prevalence rate of 51.9% among states studied (Fig. 3).

DISCUSSION

As depicted in the extended (UNICEF, 1990) model of care, child survival, growth and development depend not only on food intake and health, but also on the amount and quality of care given by the caregiver. Lack of education by many of the caregivers (Table 1) may hinder their ability to give care to their child since according to Sandoval-Priego et al. (2002) a more educated mother/caregiver raises a better quality child than a less educated mother, which also enhances efficient use of time of mother or caregiver. Ruel et al. (1999) reported that care practices are strong determinants of children`s nutritional status, particularly for children with mothers having less than a secondary school education.

Fig. 2: Distribution of feeding practice during childhood illnesses

Fig. 3: Nutritional status of children in North west and state

The income of the caregivers were very low (Table 1) hence, there may be inadequate resources for childcare and inability to utilize or contribute to the creation of resources for health in the household on a sustainable basis. Studies have shown that poor drinking water facilities, inadequate sanitary facilities and poor hygiene, particularly during food preparation are the main causes of many infections among the young children (WHO, 1993). And the best way to ensure that food and water are free from contamination is to heat them to a sufficiently high temperature (> 70°C) immediately prior to serving. Despite the simplicity of this recommendation, the limitations of available facilities in the household like distance from the source of water supply, refrigeration and sufficient fuel for cooking often makes this guideline impracticable to many mothers (Black et al., 1989). This was what obtained in this study as caregivers boiled drinking water sometimes (Table 3) and predominant source of energy and drinking water were wood and river/lake and unprotected well, respectively while most caregivers had no means of storing household foods (Table 2). Inadequate facilities in the household and the poor hygiene practices in the preparation of foods, results in infections due to contaminated foods and feeding utensils (Black et al., 1989). Lack of access to safe water and poor environmental sanitation due to unsanitary waste disposal are considered important causes of infectious diseases, especially diarrhea and intestinal parasites. Illness due to contaminated food is now regarded as one of the most widespread health problems (Mini and Reeta, 2006). The quality of household health environments is measured using indicators of type of water and latrine use but most caregivers that participated in this study uses pit latrines (Table 2).

Exclusive breast feeding is widely recognized as the optimal means of feeding and caring for the young infants during the first few months of life (Brown et al., 1995). The WHO (2002) recommends exclusive breast feeding for the first six months of life and continued breastfeeding until the age of two years and beyond. This study found that practices of exclusive breastfeeding in North west were not in full compliance with the International recommendation (Table 8). Only about half of mothers that participated in the study practiced exclusive breastfeeding from birth up to the age of six months but in addition to the breast milk over three-quarter of them gave water, most of start giving water to their children at birth (Table 8, 10). The main question arising from these data is why are so many children given something before initiation of breastfeeding, while some caregivers reasoned that it makes child healthy and also help to reduce thirst, others simply said it was a tradition passed on them by eders in their community. International consensus indicates that complementing breast milk even with water during the first six months of a child`s life is unnecessary and may increase the risk of diarrhoea as extra solids and liquids are often contaminated (Martines et al., 1992). Providing other liquid or food in addition to breast milk during the first six months could potentially be harmful that is, risk of infection, poorer stimulation of breast milk production and should only be done if medical reasons exist (De Pee et al., 2003). It was found that majority of the children (51.5%) were given plain water (Table 10) followed by those children given other things like cow butter (23.2%) before the initiation of breastfeeding. Additionally, because of the associated exposure to pathogens and interference with successful breastfeeding, current feeding recommendation strongly discourages use of baby bottles throughout childhood (PAHO/WHO, 2003). Over 50% of caregivers in Kaduna state bottlefeed their child at the 6th month with infant formula while some in Kebbi state (31.58%) start as early as less than one month of age.

Complementary foods were introduced to majority of the children much earlier at 3rd month than the 6th month recommended (Fig. 1) contrary to the recommendation of World Health Organization, that complementary feeding should be initiated on the 6th month (WHO, 1995). Studies in Malawi revealed that children who were given foods according to the timing set by the World Health Organisation were found well-nourished as compared with children who were introduced to solids too early (Madise and Mpoma, 1997). The high proportions of mothers in North Western Nigeria who sustained breastfeeding/bottle feeding/complementary feeding during child`s illness (Fig. 3) indicate that the practice of withholding foods during an episode of illness was uncommon.

In rural Africa the prevalence of linear growth retardation, also called stunting, among children is generally high (De Onis et al., 1993). This can lead to serious functional complications, such as lower mental development, reduced work capacity in adulthood and increased obstetric risk (Hautvast et al., 1999). In Nigeria, 42% of the children were stunted while 10% were wasted and underweight, 25% (NFCNS, 2004). This study revealed that North Western Nigeria average for severely stunted children was lower (31.7%) than the National average but that obtained for Kebbi state was higher (51.9%). This reflects the cumulative effects of numerous insults (chronic malnutrition) experienced by children during infancy and early childhood (Lutter, 2003). The region also had an almost equal proportion of moderately wasted children (10.38%) compared to the 10% National average reported (NFCNS, 2004).

In order to meet the Millennium Development Goals, there is the need to strengthen nutrition education among mothers/caregivers focusing on the importance of proper techniques of breastfeeding, proper timing of complementary foods, economic empowerment of caregivers and other intra-household factors.

The nutrient composition of the commonly used complementary foods in the region should be studied.

ACKNOWLEDGMENT

This study was funded by the University Board of Research, Ahmadu Bello University, Zaria-Nigeria.

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