Double Burden of Malnutrition: Evidence from a Selected Nigerian Population

  • Journal of Nutrition and Metabolism, Volume 2020, Year 2020

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Study Justification:
– The study aimed to investigate the double burden of malnutrition in a selected population in Nigeria, as evidence on this issue in the country is limited.
– The study focused on mother-child pairs in Akwa Ibom State, providing valuable insights into the nutritional status of women of child-bearing age and children in the region.
– The study used standard procedures and anthropometric measures to assess malnutrition indicators, providing reliable data for analysis.
Study Highlights:
– The study found that 37.4% of the children in the sample were stunted, with 19.8% moderately stunted and 17.6% severely stunted.
– The prevalence of wasting was 13.1%, with 6.2% moderately wasted and 6.9% severely wasted.
– The mean maternal body mass index (BMI) was 23.54 ± 4.60 kg/m2, with 9.0% of mothers classified as underweight, 23.2% as overweight, and 9.3% as obese.
– The study revealed the co-existence of undernutrition among children and overnutrition in women of child-bearing age in the population.
Recommendations:
– The study recommends the implementation of active nutrition surveillance to accurately determine the prevalence of malnutrition and regularly assess priority challenges.
– Efforts should be made to address both undernutrition in children and overnutrition in women, focusing on interventions that improve dietary diversity and promote healthy lifestyles.
– Policy makers should prioritize nutrition interventions and allocate resources to address the double burden of malnutrition in the population.
Key Role Players:
– Researchers and scientists specializing in nutrition and public health.
– Government officials and policymakers responsible for health and nutrition programs.
– Non-governmental organizations (NGOs) working in the field of nutrition and community development.
– Health workers, including doctors, nurses, and nutritionists, who can implement and monitor interventions.
– Community leaders and volunteers who can raise awareness and mobilize communities for nutrition programs.
Cost Items for Planning Recommendations:
– Nutrition surveillance systems: funding for the establishment and maintenance of systems to monitor malnutrition prevalence and trends.
– Nutrition interventions: resources for implementing programs that address both undernutrition and overnutrition, including promotion of healthy diets and behavior change.
– Training and capacity building: investment in training programs for health workers and community volunteers to effectively implement and monitor nutrition interventions.
– Research and evaluation: funding for further research and evaluation to assess the impact of interventions and identify best practices.
– Advocacy and awareness campaigns: budget for communication and advocacy activities to raise awareness about the double burden of malnutrition and the importance of nutrition interventions.

The strength of evidence for this abstract is 7 out of 10.
The evidence in the abstract is moderately strong. The study provides descriptive data on anthropometric indices of women of child-bearing age and children in a selected Nigerian population. The sample size calculation and selection process are clearly described, which adds to the strength of the study. However, the study design is cross-sectional, which limits the ability to establish causality or determine temporal relationships. Additionally, the study relies on self-reported data and does not provide information on the representativeness of the sample. To improve the evidence, future studies could consider using a longitudinal design to examine changes in malnutrition over time and include a more representative sample to enhance generalizability.

Indices reflecting the double burden of malnutrition in sub-Saharan Africa are increasing. Evidence to support this claim in households of Africa’s most populous country – Nigeria – is scant. This study, therefore, presents results from a study of mother-child pairs sampled from Akwa Ibom State in the southern region of Nigeria. Anthropometric measures for 660 mother-child pairs were collected according to standard procedures. Indices were expressed as the standard deviation of units from the median for the reference group. Chi-square analysis was used to test significant differences in proportion, and p<0.05 was taken as significant. A total of 37.4% of the children were stunted out of which 19.8% were moderately stunted, and 17.6% were severely stunted. Prevalence of wasting was 13.1%, 6.2% were moderately wasted, and 6.9% were severely wasted. Mean maternal body mass index was (23.54 ± 4.60) kgm2. 9.0% were underweight mothers, 23.2% were overweight, and 9.3% were obese. The co-existence of undernutrition among children and overnutrition in women of child-bearing age is prevalent in this population. We recommend that more effort be placed on active nutrition surveillance to ascertain malnutrition prevalence and periodically reassess priority challenges.

This was a descriptive cross-sectional study to assess anthropometric indices of women of child-bearing age and children aged between 6 and 59 months. It was conducted alongside the study on vitamin A status of women of child-bearing age in Akwa Ibom State, Nigeria. Akwa Ibom State, which is located in the South-South geopolitical zone and the humid forest agroecological zone, was selected as the project state. Earlier surveys had established that the state has the highest consumption of cassava and a high prevalence of vitamin A deficiency. The estimation of sample size for this study was based on the prevalent data on vitamin A deficiency (VAD) and iron and zinc deficiencies obtained for the state from the National Nutrition survey [15]. The prevalence of wasting, stunting, and underweight obtained from the National Demographic and Health Survey [16] was included in the estimation of sample size. The sample size was calculated based on the following criteria and assumptions: Thus, a total of 660 households with women of child-bearing age and children of 6–59 months of age were selected for the study. The sample was selected using a multistage selection scheme consisting of three levels: selection of local government areas (LGAs), enumeration areas (EAs), and households. Akwa Ibom State has 31 LGAs, made up of 16 rural, 5 urban, and 10 periurban areas. In Nigeria, the current official designation of rural, urban, and periurban is based mainly on population. According to the National Population Commission of Nigeria, a community with less than 5,000 people is regarded as rural, between 5,000 and 20,000 people is regarded as periurban, and above 20,000 is regarded as urban. Since malnutrition is prevalent in both urban and rural centres and dietary habits cut across all sectors of urbanization, ten (10) LGAs were selected using the probability proportionate to size, such that the likelihood of an LGA being selected was proportionate to its size. This resulted in the selection of 5 rural, 1 urban, and 4 periurban areas. A random selection of three EAs within each LGA was made. Therefore, a total of 30 EAs were sampled. At least 22 households were sampled randomly at the community level from each EA totalling 660 households. Anthropometric indicators for women and children were collected in the study to provide outcome measures for nutritional status. Weight and height for both mothers and children were collected according to standard procedures, which included tared weighing procedure and length (recumbent) measurement for children under 24 months, while height measurement (standing) was carried out for children above 2 years and their mothers [16]. Data entry was done using MS Access and MS Excel. Data verification, screening, and editing were carried out to ensure that the entry errors were corrected. Double entered data were compared using the compare procedure of the Statistical Analysis System (SAS) to identify erroneously recorded data which usually cannot be easily verified or corrected. Weight and height values were used to calculate and classify body mass index (BMI) for mothers based on the World Health Organization classifications. Mothers within the teenage category were classified using WHO-Anthro Plus software, 2006, using the BMI-for-age classification [27]. Height-for-age, weight-for-age, and weight-for-height were determined using WHO-Anthro Plus software, 2006. The results obtained were compared with reference values from the population of well-nourished children. Indices were expressed as the standard deviation of units from the median for the reference group. Outlier values such as implausible values for anthropometric indices were excluded from the dataset. This accounts for variation in reported frequencies. Frequency of each variable was conducted to ensure that values are within the acceptable range. Essential basic descriptive statistics and plots on distribution were conducted using SAS version 9.2, Cary, NC, USA. The chi-square test tested the significance of differences in proportion, and p < 0.05 was taken as significant. Ethical clearance was obtained through the Nutrition Division in the National Health Research Ethics committee based in the Federal Ministry of Health, Abuja. Ethical approval was also obtained from Akwa Ibom State Research Ethics committee in the Ministry of Health. Written informed consent was obtained from the women who participated in the study after the study objectives had been explained.

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Based on the provided information, here are some potential innovations that can be used to improve access to maternal health:

1. Mobile Health (mHealth) Solutions: Develop mobile applications or SMS-based platforms that provide pregnant women and new mothers with access to vital health information, appointment reminders, and personalized care plans.

2. Telemedicine: Implement telemedicine services that allow pregnant women in remote or underserved areas to consult with healthcare professionals through video calls, reducing the need for travel and improving access to prenatal care.

3. Community Health Workers: Train and deploy community health workers who can provide basic prenatal and postnatal care, education, and support to pregnant women in their communities, especially in areas with limited healthcare infrastructure.

4. Maternal Health Vouchers: Introduce voucher programs that provide pregnant women with financial assistance to access essential maternal health services, such as antenatal care visits, skilled birth attendance, and postnatal care.

5. Maternal Waiting Homes: Establish maternal waiting homes near healthcare facilities, where pregnant women from remote areas can stay during the final weeks of pregnancy to ensure timely access to skilled birth attendance and emergency obstetric care.

6. Public-Private Partnerships: Foster collaborations between the public and private sectors to improve the availability and quality of maternal health services, leveraging the resources and expertise of both sectors.

7. Health Education Campaigns: Conduct targeted health education campaigns to raise awareness about the importance of maternal health and promote healthy behaviors during pregnancy, childbirth, and postpartum.

8. Transportation Support: Develop transportation initiatives, such as subsidized or free transportation services, to help pregnant women overcome geographical barriers and reach healthcare facilities for prenatal care and delivery.

9. Maternal Health Financing: Explore innovative financing mechanisms, such as microinsurance or community-based health financing schemes, to make maternal health services more affordable and accessible to low-income women.

10. Data-driven Decision Making: Utilize data analytics and digital health technologies to collect, analyze, and utilize real-time data on maternal health indicators, enabling policymakers to make informed decisions and allocate resources effectively.

These innovations can help address the challenges of maternal health access and contribute to improving the health outcomes of pregnant women and their children.
AI Innovations Description
Based on the description provided, the recommendation to improve access to maternal health and address the double burden of malnutrition in Nigeria is to prioritize active nutrition surveillance and periodically reassess priority challenges. This recommendation is based on the findings of the study, which revealed a high prevalence of undernutrition among children and overnutrition in women of child-bearing age in Akwa Ibom State.

To implement this recommendation, the following steps can be taken:

1. Establish a comprehensive nutrition surveillance system: Develop a system to regularly collect and analyze data on malnutrition prevalence, dietary habits, and other relevant indicators. This will provide up-to-date information on the nutritional status of women and children in different regions of Nigeria.

2. Strengthen monitoring and evaluation: Implement a robust monitoring and evaluation framework to track the progress of interventions aimed at improving maternal health and addressing malnutrition. This will help identify gaps and areas for improvement.

3. Collaborate with relevant stakeholders: Engage with government agencies, non-governmental organizations, healthcare providers, and community leaders to coordinate efforts and share resources. This collaboration will ensure a holistic approach to addressing maternal health and malnutrition.

4. Conduct regular assessments of priority challenges: Periodically reassess the priority challenges related to maternal health and malnutrition. This can be done through surveys, research studies, and consultations with experts and community members. The findings will guide the development and implementation of targeted interventions.

5. Advocate for policy changes: Use the evidence from the surveillance system and assessments to advocate for policy changes that prioritize maternal health and address the double burden of malnutrition. This may include policies related to healthcare access, nutrition education, food security, and social protection.

By implementing these recommendations, Nigeria can improve access to maternal health services and effectively address the double burden of malnutrition, ultimately improving the health and well-being of women and children in the country.
AI Innovations Methodology
Based on the provided information, here are some potential recommendations to improve access to maternal health:

1. Strengthen Nutrition Surveillance: Implement an active and regular nutrition surveillance system to accurately assess the prevalence of malnutrition among women of child-bearing age and children. This will help identify priority challenges and inform targeted interventions.

2. Increase Awareness and Education: Develop and implement comprehensive awareness and education campaigns to raise awareness about the importance of maternal health and nutrition. This can include educating women and their families about proper nutrition during pregnancy and the early years of a child’s life.

3. Improve Access to Nutritious Food: Implement programs and policies that aim to improve access to nutritious food, especially in areas with high prevalence of malnutrition. This can include initiatives such as promoting local food production, improving agricultural practices, and supporting small-scale farmers.

4. Strengthen Healthcare Infrastructure: Invest in improving healthcare infrastructure, particularly in rural and periurban areas where access to quality maternal healthcare services may be limited. This can include building and equipping healthcare facilities, training healthcare providers, and ensuring the availability of essential maternal health services.

To simulate the impact of these recommendations on improving access to maternal health, a methodology could include the following steps:

1. Baseline Data Collection: Collect data on key indicators related to maternal health, such as maternal mortality rates, prevalence of malnutrition, access to healthcare services, and awareness levels among women.

2. Intervention Design: Design interventions based on the recommendations mentioned above. Define specific targets and objectives for each intervention.

3. Simulation Modeling: Use simulation modeling techniques to estimate the potential impact of the interventions on improving access to maternal health. This can involve creating a mathematical model that takes into account various factors such as population demographics, healthcare infrastructure, and behavior change.

4. Data Analysis: Analyze the simulated data to assess the projected impact of the interventions. This can include estimating changes in key indicators such as reduction in maternal mortality rates, improvement in nutritional status, and increase in access to healthcare services.

5. Sensitivity Analysis: Conduct sensitivity analysis to test the robustness of the simulation model and assess the potential variations in the projected impact under different scenarios.

6. Policy Recommendations: Based on the findings from the simulation analysis, provide policy recommendations on the most effective interventions to improve access to maternal health. Consider factors such as feasibility, cost-effectiveness, and scalability of the interventions.

7. Monitoring and Evaluation: Implement a monitoring and evaluation framework to track the progress of the interventions and make necessary adjustments based on the real-world outcomes.

It is important to note that the specific methodology for simulating the impact of these recommendations may vary depending on the available data, resources, and context of the study.


Statistics:
Citations: 4
Identifiers:
DOI: 10.1155/2020/5674279
ISSN: 20900724
Research Areas:
Community Interventions, Food Security, Health System and Policy, Maternal and Child Health, Quality of Care, Social Determinants
Study Countries:
Nigeria
Study Design:
Cross Sectional Study
Study Approach:
Quantitative
Participants Gender:
Female
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