Public Health

CONTEXTUAL ANALYSIS OF THE DELIVERY OF ESSENTIAL NUTRITION ACTIONS IN NIGERIA

Wed, 01 Dec 2021 00:00:00 GMT

CONTEXTUAL ANALYSIS OF THE DELIVERY OF ESSENTIAL NUTRITION ACTIONS IN NIGERIA OLUFOLAKEMI, Mercy Anjorin Maternal and child undernutrition persist in Nigeria. Essential Nutrition Actions (ENAs), including iron supplementation, exclusive breastfeeding (EBF), and vitamin A supplementation (VAS) were adopted nationally to reduce undernutrition, since 2004. However, there is paucity of literature on implementation of ENAs in Nigeria, thus, time-trends in coverage and determinants, and delivery context of ENAs in Nigeria were assessed in this study. Quantitative and qualitative methods were used. Data from 2003, 2008 and 2013 Nigeria Demographic and Health Surveys (NDHS) were analysed to establish time-trends and determinants of ENAs coverage. To account for NDHS cluster sampling method, estimates of time-trends and determinants were adjusted using sampling weights in respective datasets. Twenty-nine primary healthcare centers (PHCs), 21 in Ekiti (South) and 8 in Katsina (North) States, were assessed as case studies for delivery context of ENAs in Nigeria. Data from NDHS and case study PHCs were analysed using descriptive statistics, Chi-square tests and regression models. Among 21 nutrition policy/programme stakeholders from case-study states and federal level, perspectives about ENAs implementation were examined using Q-methodology. Coverage of ENAs was low and time-trends varied across ENAs. Iron supplementation prevalence among pregnant women and EBF rate did not change significantly (23.2%, 17.1%, 21.7% and 17.1%, 12.7%, 17.6% in 2003, 2008, 2013, respectively). VAS prevalence among children 6-59 months increased (33.7% to 40.6%) from 2003 to 2013. Utilisation of health system contact points was low; complete immunisation prevalence increased (6.8%, 17.2%, 21.5% in 2003, 2008, 2013, respectively) but was still low in 2013. Similarly, prevalence of skilled antenatal care, ANC (58.1%, 58.0%, 61.1%), delivery in health facilities (32.9%, 36.1%, 36.2%), and skilled delivery assistance (35.4%, 39.5%, 38.7%), was inadequate in 2003, 2008, 2013, respectively. Use of health system contacts was associated with ENAs. In 2008 and 2013, full immunisation increased adjusted odds of VAS 3 times (CI: 10.2–14.4). ANC increased odds of iron supplementation in pregnancy 11 times (CI: 7.9–15.9) in 2003, 12 times (CI: 10.2–14.4) in 2008, and 16 times (CI: 13.8–19.0) in 2013. In 2013, women who had skilled delivery assistance were 2 times (CI: 1.4–3.6) more likely to practice EBF. The poor were less likely than the rich to receive ENAs. Prevalence of skilled ANC was consistently lowest and decreased over time in the poorest quintiles, while richer quintiles had almost universal and increased coverage (p<0.001). In case study PHCs, ENAs were provided inconsistently and not integrated in routine service delivery. Weaknesses existed across health system building blocks assessed as only 3 (15.0%) and 8 (30.8%) of PHCs reported availability of ENAs routine supplies and nutritionists, respectively. Stakeholders identified weak leadership, governance and nutrition information systems, with inadequate funding, as challenges to ENAs delivery. Essential Nutrition Actions coverage was low in Nigeria and associated with inadequate utilisation of health system contact points. The delivery context in Ekiti and Katsina States had insufficient human, financial and material resources for nutrition service delivery. Systematic integration of nutrition interventions into health system services and system strengthening is required to improve coverage.

NUTRITIONAL CHARACTERISATION OF SELECTED YAM VARIETIES AND CONTRIBUTION OF YAM TO NUTRIENT INTAKE IN EKITI STATE, NIGERIA

Wed, 01 Dec 2021 00:00:00 GMT

NUTRITIONAL CHARACTERISATION OF SELECTED YAM VARIETIES AND CONTRIBUTION OF YAM TO NUTRIENT INTAKE IN EKITI STATE, NIGERIA OLAWUYI, YETUNDE OLUKEMI Excessive consumption of staples plays a contributory role in the global upsurge of the prevalence of diet related chronic diseases. Yam is a multi-species and multi-variety staple food with pivotal role in ensuring food security in Nigeria. Intra and inter species diversity of foods are being promoted as part of means to tackle malnutrition. Ekiti State is one of the highest producers and consumers of yam, without well documented information on varieties commonly consumed and their dietary diversity. This study was conducted to assess the available and commonly consumed yam varieties, inter-varietal nutritional differences, evaluate dietary diversity and contribution of yam to nutrient intake in Ekiti State. Proximate, mineral and phytochemical analyses were carried out on 12 purposively selected yam varieties using standard methods. Cross-sectional study of 450 adults selected from six Local Government Areas (LGA) in Ekiti State was done using a four-stage sampling method. Interviewer-administered questionnaire was used to collect data on sociodemographic characteristics, commonly-consumed yam varieties, yam consumption pattern, and dietary intake. Dietary intake was assessed with multi-pass 24-hour dietary recall to calculate the Individual Dietary Diversity Score (IDDS), energy and nutrients intake. The IDDS was derived from nine (9) food groups and categorised into low (1-3), medium (4-6) and high (7-9). Contribution of yam to total energy and nutrient intake was determined using standard procedure. Data were analysed using descriptive statistics, Chi square test and ANOVA at α0.05. Nutritional composition per 100g of yam varieties was significantly different for moisture (50.1-69.8)g, carbohydrate (27.3-46.1)g, protein (1.8-3.0)g, ash (0.5-1.3)g, and metabolisable energy (119-194) kcal. Saponin, alkaloids, phenols, phytate and tannin content ranged from 19.38-33.19%, 1.11-4.29%, 6.11-10.11 GEmg/100g, 1.26-1.93%, and 0.06-3.00%, respectively. Twenty five yam varieties were identified in the state and the seven most commonly-consumed varieties were Gambari (29.2%), Olo (15.1%), Aro (7.8%), Ileusu (3.1%), Dagidagi (2.4%), Gbakumo (2.2%) and Odo (2.2%). Respondents’ age was 34.1±12.2 years, and 56.0% were females. About 61% of the respondents consumed yam or its products daily, including pounded yam (65.5%) and boiled yam (24.0%). Preference for yam varieties was largely determined by season/availability (53.3%) andvii organoleptic properties (30.6%). Mean IDDS was 3.6±0.9, 57.6% fell within medium and 42.0% had low IDDS. Daily energy, protein, carbohydrate, iron and magnesium intake were 1985.4±615.3 kcal, 55.1±27.3g, 422.5±117.3g, 15.3±5.8mg, and 251.9±86.0mg, respectively. Yam and its products contributed an average of 31.7%, 5.4%, 27.3% and 31.9% of total energy, protein, iron and magnesium intake, respectively. The choice of the most preferred yam varieties was significantly associated with LGA, age, educational qualification, occupation and household monthly income. Only marital status was significantly associated with IDDS. Yam varieties had disparate macro- and micronutrient contents, and largely contributed to energy, carbohydrate and magnesium intake. The diet of respondents was not diverse enough, hence the need to address dietary diversity in order to improve nutrient intake adequacy in Ekiti State.

CONTEXTUAL ASSESSMENT OF FOOD SYSTEM, SAFETY-NETS AND NUTRITIONAL STATUS OF PEOPLE LIVING WITH HIV/AIDS IN KADUNA CITY, NIGERIA

Wed, 01 Dec 2021 00:00:00 GMT

CONTEXTUAL ASSESSMENT OF FOOD SYSTEM, SAFETY-NETS AND NUTRITIONAL STATUS OF PEOPLE LIVING WITH HIV/AIDS IN KADUNA CITY, NIGERIA OHURUOGU, VICTOR UCHE HIV/AIDS status and food system interact in a vicious cycle which influence nutrition at individual and household levels. Safety nets are important mechanisms to promote health and nutrition among People Living with HIV/AIDS (PLWHA), however, these mechanisms are being weakened following dwindling resources among other factors. Understanding the food system and safety net types of PLWHA is important to promoting nutritional status and improved treatment outcomes. This study was designed to assess food system, safety nets and nutritional status of PLWHA in Kaduna city, Nigeria. Descriptive cross-sectional and a mixed-methods approach were used. A total sampling of consenting 532 PLWHA across 14 support groups in Kaduna was conducted. Three key informant interviews and three focus group discussion sessions were conducted among support group leaders and male/female members, respectively using structured guides. Intervieweradministered questionnaire was used to collect information on socio-demographic characteristics, CD4 cell count, safety net types, food system and dietary intake of PLWHA. A 24-hour recall was conducted to assess dietary intake and analysed using adapted Total Diet Assessment software and dietary diversity according to the FAO standard. Body weight and height were assessed to determine the Body Mass Index (BMI) and categorised using WHO standards. Qualitative data were analysed thematically. Quantitative data were analysed using descriptive statistics, and Chi-square tests at α0.05. There was declining involvement of PLWHA in food production following poor productive capacity. Respondents expressed understanding of the link between nutrition and treatment outcomes and identified poor income as a constraint to food access. Respondents’ age was 38.1±9.7 years, 78.0% were females, 44.9% were married, and 40.3% earned <₦5000 monthly. About 20.0%, 25.0% and 55.0% had CD4 cell count (cells/µl) of ≥500, 200-499 and <200, respectively. Safety net types included counselling (39.2%), treatment for opportunistic infections (27.5%), food and nutrition aid (15.7%), prayer (15.7%), and drug aid (1.9%). Majorly produced staple was cereals (93.7%), 40.3% raised livestock/poultry, and 27.4% had vegetable garden. Majority (58.1%) experienced hindrances to market access, 45.2% skipped meals and 59.7% consumed street foods. Rice (71.0%), beans (61.3%) and maize (50.0%); orange (61.3%), banana (25.8%) and watermelon (24.2%); and pumpkin leaves (ugwu) (41.9%) and okro (9.7%) constituted the widely consumed staples, fruits, and leafy vegetables. Intakes of energy, protein, vitamin A, zinc and iron were 1065.1±148.1Kcal, 50.3±42.7g, 10491.5±1510.6mcg, 6.7±6.1mg and 8.9±7.5mg, respectively. Mean dietary diversity was 4.8±1.12, reflecting a poor-quality diet. Prevalence of underweight, overweight and obesity was 5.1%, 28.9% and 12.4%, respectively. Among respondents with normal BMI, 80.0% had received financial empowerment, 64.5% received counselling /psychosocial support and 63.6% had food support. Body Mass Index was significantly associated with age, dietary diversity, income, and intakes of energy, protein and zinc. Access to food among people living with HIV/AIDS is constrained by poor income, reduced productive capacity and limited support mechanism and this reflect in form of poor diet quality, overweight and obesity. Household economic strengthening activities and food and nutrition support are hereby recommended for PLWHA in Nigeria.

DIET QUALITY, PHYSICAL ACTIVITY, OBESITY AND HYPERTENSION AMONG ADULTS IN AKWA IBOM AND CROSS RIVER STATES, NIGERIA

Wed, 01 Dec 2021 00:00:00 GMT

DIET QUALITY, PHYSICAL ACTIVITY, OBESITY AND HYPERTENSION AMONG ADULTS IN AKWA IBOM AND CROSS RIVER STATES, NIGERIA EKERETTE, NKEREUWEM NDAEYO Obesity and hypertension are risk factors for diet-related non-communicable diseases and are associated with poor quality of life, increased morbidity and mortality. There is a growing burden of obesity in Nigeria, especially the South South geopolitical zone. However, information on the interplay between diet quality, lifestyle factors, burden of obesity and hypertension in the zone is scarce. This study was designed to assess the associations between diet quality, physical activity, obesity and hypertension among adults in Akwa Ibom and Cross River states, Nigeria. This descriptive cross-sectional study adopted a three-stage random sampling technique to select 12 Local Government Areas, 36 communities and 1,320 adults from Akwa Ibom and Cross River states. Information on socio-demographic characteristics, dietary intakes and physical activity were obtained using interviewer-administered questionnaire. Dietary intake was assessed using multi-pass 24-hour dietary recall to determine diet quality (Diet Quality Index-International, DQI-I), categorised into terciles. Physical activity was assessed using International Physical Activity (PA) Questionnaire and analysed using standard procedures. Weight (kg) and height (m) were measured to calculate Body Mass Index (BMI) to define overweight and obesity as BMI 25.0-29.9kg/m2 and ≥30.0kg/m2 respectively. Waist Circumference (WC) was measured to define Abdominal Obesity (AO) as WC ≥102cm for men and WC ≥88cm for women. Blood Pressure (BP) measurements were taken and hypertension was defined as Systolic BP (SBP) ≥140mmHg and or Diastolic BP (DBP) ≥90mmHg. Data were analysed using descriptive statistics, Chi square test and logistic regressions at α0.05. Respondents’ age was 35.4±11.2 years, 50.4% were female and 54.1% were married. Total DQI-I score was 56.4±7.4 comprising variety (11.4±3.9), adequacy (24.8±4.9), moderation (19.6±6.0) and overall balance (0.7±1.5). Physical activity score was 4306.0 Metminutes/week, 29.7% and 60.7% had moderate and high PA patterns, respectively. Prevalence of overweight and obesity were 20.5% and 12.5%, respectively. Waist circumference scores were 82.7±11.3cm for men and 85.5±15.1cm for women andvii prevalence of AO was 37.6%. The SBP and DPB were 122.2±14.9 mmHg and 79.1±12.6 mmHg, respectively and prevalence of hypertension was 29.5%. There were non-significant increases in the risks of obesity (Adjusted Odds Ratio (AOR) = 1.1; CI: 0.8-1.4) and AO (AOR = 1.0; CI: 0.8-1.4) across DQI-I terciles. Risk of hypertension increased significantly across DQI-I terciles (AOR = 1.4; CI: 1.0-1.8). There was a significant decrease in the risk of obesity (AOR = 0.5; CI: 0.3-0.7) and a non-significant decrease in the risk of AO (AOR = 0.7; CI: 0.43-1.1) among adults with moderate-to-high PA patterns, compared to low PA patterns. There was a non-significant increase in the risk of hypertension among adults with moderate-to-high PA patterns (AOR = 1.14; CI: 0.7-1.8). The risk of hypertension increased significantly among adults with higher BMI values (AOR = 2.3; CI: 1.7-3.1). The risk of obesity was not related to high diet quality, but was inversely related to increased physical activity in Akwa Ibom and Cross River States, Nigeria. Increased physical activity should be promoted to reduce the burden of obesity.