ASSESSMENT OF NUTRITIONAL STATUS OF PUBLIC

PRIMARY SCHOOL PUPILS IN OKE-OYI COMMUNITY,

KWARA STATE, NIGERIA
BY
OJIAH, AHUOIZA ANAGWUREI
MBBS (ZARIA)
MATRIC NO 11/68LL!
(ARTICLE)
INTRO"UCTION The health of school children deserves special attention; in order to derive
the maximum benefit from the educational programme, the child must be healthy physically,
mentally and emotionally.
1

Nutrition can be defined as a branch of science that deals with food, the nutrients and other
substances therein, their action, interaction and balance in relation to health and disease, the
processes by which an organism ingests, digests and absorbs, transports, utilies and excretes
food substances.
!

The nutritional status of a child is influenced by the ade"uacy of food inta#e, both in terms of
"uantity and "uality and the physical health.
$
Thus, a well nourished child will have weight and
height measurement that compare well with the standard normal distribution of height and
weight of healthy children of same age and sex.
$

%nappropriate nutrition (abnormal nutrition or malnutrition) involves ! scenarios
!,&
under
nutrition and overnutrition.
&
'alnutrition continues to be a primary cause of ill health and
mortality among children in developing coutries,
(
especially under nutrition which leads to
growth failure, complication of other diseases, death and economic loss to the individual, family
and the nation.
&
) child*s growth is an indicator of health and society*s wellbeing. 'onitoring of growth and
relating it to health or nutrition related problems is an important tas# for health care providers.
(
Nutritional status is the best indicator of global wellbeing of children.
+

The ,orld -ealth .rganiation (,-.) believes that the ultimate ob/ective of nutritional
assessment is the improvement of human health.
0
The use of anthropometric indicators1
underweight (weight for age), stunting (height for age) and thinness (2ody 'ass %ndex for age)
allows for determining the extent of malnutrition in the community.
0
There are more school age
children in developing countries than ever before, due to population growth and the success of
child survival strategy. -owever, millions of school3age children in developing countries remain
at ris# due to poor health and nutrition.
4
Nigeria, li#e many developing countries has
malnutrition (especially undernutrition) as one of the main health problems.
+

5oor nutritional status has been found to be significantly higher in public primary schools
(
6ata will provide reliable basis for instituting appropriate strategies to identify and combat
factors associated with nutritional deficiency.
(
)lso the school platform offers more effective,
efficient and e"ual opportunity than any other setting to promote health and healthy eating and
conse"uently healthy adults in the community.
7
The study focused on the nutritional status of public primary school pupils aged +31&years in
.#e3oyi community in 8wara 9tate. The aim was to assess their nutritional status using
anthropometric measurement vi weight and height to determine the prevalence of malnutrition .
')T:;%)<9 )N6 ':T-.691 This study was conducted in .#e .yi community, %lorin east
local government area (<=)) of 8wara state. %t is a semi urban settlement located between
latitude 4
o
1(* >>
o
N and longitude &
o
(7* >>
o
: in the North ?entral geographical one of the
country with a population of 0,&+> inhabitants. The climate of .#e .yi is characteried by
tropical wet and dry seasons.
The people are @oruba and the main religions are ?hristianity and %slam. The main occupations
of the people are farming, weaving, blac#smithing, poultry and very few civil servants. The
ma/or staple foods are yam, rice and cassava. Aruits and vegetables are also grown and eaten in
small "uantities. 2eef and fish are the main sources of protein.There are $ public primary
schools, ! local government health centers and 1 private clinic within the community.
The study was a descriptive cross sectional survey on the nutritional status of public primary
school pupils in .#e .yi community, 8wara state. :thical approval for the study was obtained
from :pidemiology and ?ommunity health department, Bniversity of %lorin, the <ocal
=overnment :ducation )uthority (<.=.:.)) of 8wara 9tate () subsidiary of the 8wara 9tate
Bniversal 2asic :ducation 2oard39B2:2) and the individual school authorities and parents.
The study was conducted among public primary school pupils aged between + and 1& years
selected from the $ public schools in the community. The schools have a total population of (4+
pupils (males 3!47, females3!70).
Aischer*s formula was used to calculate the sample sie, assuming the prevalence stunting
among public primary school pupils in a previous study in Nigeria was put at (7.+C.
1>
The
calculated sample sie was !!+, this was increased to !(> to improve accuracy. The list of all the
$ public primary schools in the community obtained from the 8wara 9tate Bniversal 2asic
:ducation 2oard39B2:2 was used for the study. The schools are1 )nsaarul %slam <=. :.)
school ()%9) with a population of !40(males1&+, females 1&1), .#e3oyi <=. :.) 1school with a
population of 1!( (+& males and +1 females) and .#e3 oyi ! <=. :.) school with population of
10& (00 males and 7( females). )fter proportionately allocating the number of pupils to be
selected from each school and each class, simple random sampling was used to select
respondents. -owever, pupils who were absent or with chronic health conditions were excluded
from the study.
6)T) ?.<<:?T%.N1 9emi structured "uestionnaires administered by trained research
assistants based on ob/ectives were used to obtain information from each selected pupil. )lso, a
predesigned proforma was used to record the anthropometric measurements of each pupil; this
included the weight and height.
) standardied weighing scale (.mron
;
2A &>>) was used to measure the weight of each pupil
which was observed with each pupil wearing minimal clothing and no shoes, loo#ing straight
ahead. :ach respondent was made to stand still without any support. The reading was ta#en to
the nearest >.1 #g.
+

) vertical standiometer (9eca
;
<eichester) was used to measure the height or stretch stature of
each pupil. The pupils* heights were ta#en as the maximum vertical distance from the floor to the
vertex of the head. %n this position, the head, shoulders, buttoc#s and calves were in contact with
the bac# of the standiometer. :ach sub/ect was made to loo# straight and ta#e a deep breath
while the head piece of the standiometer was then brought firmly down, Dcrushing* the hair and
ma#ing contact with the vertex. The reading was ta#en to the nearest >.1cm before the sub/ect
exhaled.
+

The readings for weights and heights were ta#en in pairs and the arithmetic mean of each pupil*s
reading was used for used for analysis.
NBT;%T%.N)< 9T)TB91 The anthropometric measurements obtained on each pupil were
converted into nutritional indices1 ,eight for )ge (,E)), ,eight for -eight (,E-) and -eight
for )ge (-E)) using the ,-. )nthro3plus
;
software. The 3scores of F 3 !.>96 was used to
classify children as stunted, underweight and wasted, while 3scores G!.>96 and G$.>96 was
used to classify overweight and obese children based on their -)H,,)H and ,-H values
respectively using the N?-9E,-. as reference population.
11,1!
"#$# A%#&'()(
6ata analysis was done using :5% %NA. version $.(.1 software pac#age. Are"uency distribution
tables, and cross tabulation of important variables were generated for categorical variables.
;elevant summary statistics were also generated for discrete variables1 the students* t3test to
compare means and the chi3s"uare test to compare proportions. <evel of significance was
predetermined at 5 value of less than >.>( at 7(C confidence level.
RESULTS
) total of !(> "uestionnaires were administered in the schools. These were duly completed and
returned giving a response rate of 1>>C. None of the three schools used in the study had a school
meal programme. The age of respondents ranged from +31& years with a mean age of 7.4!G!.(&.
(table 1) The modal age group was 7 to 11 years with a fre"uency of 7!($+.4C). The male to
female distribution was 11&11$+(111.1!). 'a/ority of respondents were 'uslims, !!&(47.+C)
while !+ (1>.&C) were ?hristians. The ma/or ethnic group of respondents was @oruba and other
ethnic groups represented the 7.+C. )mong respondents, 1!+((>.&C) came from monogamous
family while 1!&(&7.+C) from polygamous family and this could be attributed to the higher
proportion of 'uslims in the community. The grade levels of respondents were primary 13+ with
primaries ( and + pupils being the highest with a fre"uency of 1>1(&>.&C).
T#*&+ 1, S-.)-/+0-12#34). C4#2#.$+2)($).( O5 R+(3-%/+%$(
N678
9#2)#*&+( F2+:;+%.' <
S+=
'ale
Aemale
11&
1$+
&(.+
(&.&
A1+
+3 4
73 11
1!31&
'ean I 9.6
4$
7!
0(
7.4!I !.(&
$$.!
$+.4
$>.>
R+&)1)-%
?hristianity
%slam
!+
!!&
1>.&
47.+
E$4%).)$'
@oruba
%gbo
-ausa
Nupe
!!+
1>
&
1>
7>.&
&.>
1.+
&.>
F#0)&' T'3+
'onogamous
5olygamous
1!+
1!&
(>.&
&7.+
G2#/+ &+>+&
5rimary 13!
5rimary $3&
0$
0+
!7.!
$>.&
5rimary (3+ 1>1 &>.&
T#*&+ 7, C-03#2)(-% -5 M+#% A1+, W+)14$ #%/ H+)14$ -5 R+(3-%/+%$( *' S+=
PARAMETERS M#&+
% 6 11?
F+0#&+
% 6 1@6
$-$+($
A1+ (Y+#2()
J I
W+)14$
J I
H+)14$
J I
7.&1 I !.+(
!0.+0 I 1>.$4
1!7.1$ I1!.+$
1>.!$ I !.!(
!4.+! I (.7>
1$>.7& I 14.!1
t K (.+0
p K F>.>>1
t K !.70&
p K >.>>&
t K1.74
p K >.>(
The mean age of the males was 7.&1G!.+4 while that of the females was 1>.!$G!.!( and this was
statistically significant. There was also a statistically significant difference between the weight of
the male and female respondents. -owever the difference in the mean height of both sexes was
not statistically significant.
T#*&+ @, ")($2)*;$)-% -5 R+(3-%/+%$( N;$2)$)-%#& I%/).+(
9#2)#*&+( F2+:;+%.'
N6 78
<
W+)14$ 5-2 A1+
F3!(Bnderweight)
3! to G!(Normal)
LG! (.verweight)
0
!$$
1>
!.4
7$.!
&.>
H+)14$ 5-2 A1+
F3!(9tunted)
3! to G!(Normal)
LG!
(7
1++
!(
!$.+
++.&
1>.>
W+)14$ 5-2 H+)14$
F3!(,asted)
3! to G!(Normal)
LG!
+$
10&
1$
!(.!
+7.+
(.!
)mong the respondents, 0 (!.4C) were underweight, 1> (&C) were overweight, (7 (!$.+C)
stunted and +$ (!(.!C) wasted respectively. The result also showed that !$$(7$.!C) of
respondents were of normal weight for age, 1++(++.&C) were within normal range of height for
age and 10&(+7.+C) were of within normal range of weight for height.
T#*&+ ?, C-03#2)(-% -5 M+#% N;$2)$)-%#& I%/).+( -5 R+(3-%/+%$( B' S+=
P#2#0+$+2( M#&+
% 6 11?
F+0#&+
% 6 1@6
$-$+($
WAZ
J I
HAZ
J I
WHZ
J I
>.>7I 1.!$
3>.&1 I !.(0
3>.44 I1.10
3>.$7 I >.4>
3>.77 I 1.+&
3>.7> I 1.17
t K >.&7
p K >.+!>
t K >.0(
p K >.0&4
t K>.&>
p K >.+7>
?omparison of the mean nutritional indices showed that there was no significant statistical
difference between the mean nutritional indices of the male and female pupils.(pL >.>()
T#*&+ 8, N;$2)$)-%#& )%/).+( -5 R+(3-%/+%$( B' A1+ B#(+/ -% Z-(.-2+(
N 6 78
WAZ
A1+(Y+#2() T-$#& F3! 3! to G! LG!
+34
7311
1!31&
! (!.!)
( ((.&)
> (>.>)
01 (4(.()
40 (7&.+)
0( (1>>.>)
1>(1!.1C)
> (>.>)
> (>.>)
4$ (1>>.>)
7! (1>>.>)
0( (1>>)
@ates
!
K !(.&+ dfK & p3valueK F>.>>1
HAZ
+34
7311
1!31&
1(1.!)
1((1+.$)
&$((0.$)
+>(0!.$)
0&(4>.&)
$!(&!.0)
!!(!+.()
$($.$)
>(>.>
4$(1>>.>)
7!(1>>.>)
0((1>>.>)
@ates
!
K 77.+7 df K & p3value K >.>>1
WHZ
+34
7311
1!31&
((+.>)
1((1+.$)
&$((0.$)
+4(41.7)
0&(4>.&)
$!(&!.0)
1>(1!.>)
$($.$)
>(>.>)
4$(1>>.>)
7!(1>>.>)
0((1>>.>)
@ates
!
K +4.7+ df K & p3value K >.>>1
The result showed that among the underweight, pupils age group 7 to 11 years had the highest
fre"uency of ( ((.&C) and among the overweight pupils, age group + to 4 years pupils had all the
1> overweight respondents. 5upils aged 1! to 1& years had 1>>C of them being within the
normal range of weight for age. The result showed that across the different age groups of
respondents, there is a statistically significant relationship between their ages and the height for
age H3scores (pK >.>>1). ,hile the youngest respondents had more of normal or taller height for
age, the older pupils from age 7 had a higher rate of stunting1 1((1+.$C and &$ ((0.$C))
respectively.
T#*&+ 6, N;$2)$)-%#& )%/).+( -5 R+(3-%/+%$( *' S+= B#(+/ -% Z-S.-2+(
N 6 78
S+=
WAZ
T-$#&
F3! 3! to G! LG!
'ale
Aemale
& ($.()
$ (!.!)
1>! (47.()
1$1 (7+.$)
4 (0.>)
! (1.()
11&(1>>.>)
1$+(1>>.>)
@ates
!
K (.&+ df K ! p3valueK F>.>+(
HAZ
'ale
Aemale
!7(!(.&)
$>(!!.1)
+4((7.+)
74(0!.1)
10(1(.>)
4((.4)
11&(1>>.>)
1$+(1>>.>)

!
K +.07 df K ! p3value K >.>$$
WHZ
'ale
Aemale
$!(!4.1)
$1(!!.0)
0$(+&.>)
1>1(0&.$)
7(0.4)
&(!.7)
11&(1>>.>)
1$+(1>>.>)
@ates
!
K +.07 df K ! p3value K >.>$$
The weight for age 3scores shows that 1>!(47.(C) and 1$1(7+.$C) of the males and females
had normal weight for age. %t was also shown that males were both underweight and overweight.
-owever, this difference seen was not statistically significant. )mong the respondents,
!7(!(.&C) and 10(1(C) of males and $>(!!.1C) and 4((.4C) of females are stunted and tall for
their ages respectively. This was found to be statistically significant, pK >.>$$. .ut of the +$
wasted respondents, $! ((>.4C) and $1(&7.!C) were males and females respectively. -owever
0$ (+&.>C) of males and 1>1 (0&.$C) of females were within the normal range of weight for
height and this difference was found to be statistically significant, pK>.>$$.
T#*&+ A, N;$2)$)-%#& )%/).+( O5 R+(3-%/+%$( B' G2#/+ L+>+& B#(+/ -% Z-S.-2+(
N 6 78
G2#/+ &+>+&
WAZ
N;$2)$)-%#& I%/).+(
T-$#&
F3! 3! to G! LG!
13!
$3&
(3+
( (+.4)
! ((.&)
> (>.>)
(4 (07.()
0& (70.&)
1>1 (1>>.>)
1>(1$.0C)
> (>.>)
> (>.>)
0$ (1>>.>)
0+ (1>>.>)
1>1 (1>>)
@ates
!
K $$.&4 dfK & p3valueK >.>>1
HAZ
13!
$3&
(3+
( (+.4)
!> (!+.$)
$&($$.0)
&4 (+(.4)
(& (01.1)
+& (+$.&)
!>(!0.&)
! (!.+)
$ ($.>)
0$ (1>>.>)
0+ (1>>.>)
1>1 (1>>)
@ates
!
K &4.4+ dfK & p3valueK >.>>1
WHZ
13!
$3&
(3+
7 (1!.$)
!> (!+.$)
$& ($$.0)
(+ (0+.0)
(& (01.1)
+& (+$.&)
4(11.>C)
! (!.+)
$ ($.)
0$ (1>>.>)
0+ (1>>.>)
1>1 (1>>)
@ates
!
K 1(.&1 dfK & p3valueK >.>>1
)mong respondents, those in primaries 1 and ! were more underweight than other class levels.
)lso this group of pupils had all the overweight pupils. There was a significant statistical
difference in the weight for age H3scores of the different class groups. The result showed that
among respondents class level, the proportion of stunting increased in the higher grades, with
primaries ( and + having the highest with $&($$.0C). This was found to be statistically
significant, pK >.>>1. The result showed that those pupils in primaries ( and + had the highest
proportion of wasted pupils with a fre"uency of $& ($$.0C) and this was found to be statistically
significant, pK >.>>1.
"ISCUSSION
Nutritional status has a great impact on the health systems and learning capacity of children, on
the productivity of adults; and on the "uality of life in general.
+,0
) total of !(> respondents were
recruited into the study. The mean age of the respondents was 7.4!I !.(& years (table 1), which
is similar to what was obtained in a previous study where the mean age of respondents was found
to be 1>.! I!.+ years.
1$
The male to female distribution in the study was 11&1 1$+, (11 1).
?hristianity and %slam were the only two religions represented and 'uslim pupils were
significantly more in numbers than the ?hristians. ,ith respect to the tribal distribution, pupils
of the @oruba tribe were significantly more and this could be attributed to the indigenous nature
of the community. The family types were polygamy and monogamy.
%n this study, the mean weight and height of the female pupils was more than males (table !) and
this could be attributed to the significantly higher ages of the females. This study found that
undernutrition was still a prevalent problem among the school children in .#e3oyi community in
%lorin :ast <ocal =overnment )rea of 8wara 9tate, Nigeria, /ust li#e in other developing
countries as found in previous studies.
1$,1&,1(,1+
.

The socio3economic standards and living
conditions in the country may have contributed to the persistent undernutrition especially
stunting which is an indication of low socio3economic status.
10
%n this community, the prevalence of underweight was found to be !.4C (table $). :arlier studies
in Nigeria found this to be higher with prevalence of &+.1C in %badan,
1&
+1.!C in %fe
&$
and
01.!C in Nsu##a.
14
-owever the prevalence of underweight was considerable lower in 'alaysia
and Tur#ey studies which were &.+C and +.$C respectively.
17, !>

The prevalence of stunting was found to be !$.+C (table $). 5revious studies in %badan, Byo,
=hana and 5a#istan found the prevalence of stunting to be &&.$C, !(.$C, (&.(C, and 1+.(C.
1&,
!1,!!,!$
The study also found !(.!C of the pupils to be wasted (table $). .ther studies found the
prevalence of wasting to be higher in =hana and %fe which were &&.$C
!$
and !0.+C
1$
respectively and lower in %badan and Tur#ey which were 1!.0C and 1C respectively.
1&,17
Arom this study, the prevalence of overnutrition (overweight) was found to be &.>C of pupils
(table (). No pupil was observed to be obese, a finding which is in conformity with earlier study
in Nigeria which reported low prevalence of obesity in primary school children; !.$C in
?alabar.
!&
-owever, some other studies in 2enin, Nigeria and 9outh )frica found higher
prevalence of overweight which were !>C and >.& to 1$.$C respectively.
1+,!(
The level of undernutrition (underweight, stunting and wasting) in this study is lower than in
earlier similar studies such as those cited above. )lthough there is a higher prevalence
overnutrition (overweight), the reduced prevalence of undernutrition might be attributable to
increased awareness of the public on the importance of good nutrition.
?omparison of nutritional indices between the male and female pupils showed that for weight for
age H scores, there was no significant difference, but for height for age H scores and weight for
height H scores, male pupils were significantly more stunted and wasted than the female
pupilsM( pK >.>+(, pK >.>$$, pK >.>$$) table &N. 2y sex, the mean nutritional indices of weight
for age H score, height for age and weight for height H scores were found not to be significant
(5K>.>+, pK>.>0, pK>.+7)Mtable & N.
The prevalent rates of wasting and stunting increased with age and class level of respondents.
They were generally higher in the older age groups. (Tables (,0). This finding also conforms to
those of similar studies on school children in Nigeria.
1$,1+,!+
%n one of such studies; it was shown
that children who were 7 years old and above were more stunted than those below the age of
eight years.

This may not be unconnected with deteriorations in the socioeconomic situation in
the country which has led to families concentrating meager resources to catering for the youngest
members of the families, to the detriment of older children.
C-%.&;()-%(
This study found that malnutrition especially undernutrition (underweight, stunting and wasting)
is still prevalent as a ma/or health problem among school children in .#e3oyi community in
%lorin :ast <ocal =overnment )rea of 8wara state, Nigeria. -owever the male pupils had poorer
nutritional indices and these were significant. Bndernutrition in all $ forms was more prevalent
in the older age groups and class while prevalence of overweight was higher among the younger
ages. The level of undernutrition in this study was though lower than in earlier studies; it has not
fallen to desirable levels. -owever, the prevalence of overnutrition was higher than other studies
in Nigeria.
The trend of malnutrition (especially undernutrition) observed in this study shows that there are
still unmet needs with respect to ma#ing sure that children are well fed. Thus, this calls for
comprehensive public health intervention measures with the necessary will of all sta#eholders at
all levels to ensure sustainability which will include 1 :stablishment of ade"uately financed and
well managed school mealE feeding programme. To this effect, selected teachers should be
trained on nutrition and these will be the supervisors in each school. %t is also recommended that
during 5arent Teachers )ssociation meeting, health education of parents on nutrition by the
assigned teachers should be given; 9ince udernutrition especially stunting is associated with low
socio3economic status,
10
there should be intersectoral collaboration to establish programmes that
will improve peoples* standard of living and there should be further research into the
determinants of malnutrition.