Effects of Infectious Diseases and Malnutrition on the Nutritional Status of Pre-School Children in Selected Areas in Akwa Ibom State of Nigeria

Abstract

A research was conducted in some urban and rural areas of Akwa ibom State of Nigeria from August 1990 to July 1991. The objectives were to study the interactions of infectious diseases and malnutrition and their effects on the nutritional status of pre-school children (Study I). The occurrence and distribution of diarrhoeal disease and its relationship to infant feeding practices (Study II) and the influence of socio-economic and environmental factors on the prevalence and severity of infectious diseases (study III). Four hundred and sixty-six (466) pre-school children aged 6 months to 48 months were the subjects. Infant feeding practices were recorded. Follow-up visits involved fortnightly records of morbidity, and 3 monthly anthropometric measurements. The effects of infectious diseases and malnutrition on the growth pattern of the pre-school children were examined. For study I, a 2 x 2 factorial design was used in grouping the Sick/ Malnourished children and the Not Sick/Not Malnourished children into four groups as follows : (1 ) the “Not Sick Not Malnourished”(NSNM) (control group), (ii)The “Sick but Not Malnourished” (SNM), (iii) the “Not Sick but Malnourished” (NSM), (iv)The ’’Sick and Malnourished” (SM).Nutritional status of the children in each group was assessed and compared to that of their age control group. The results showed that the "Sick and Malnourished" (SM) group had low body weight, poor growth, low skinfold thickness, low head circumference, low upper arm circumference, low chest circumference, low muscle circumference, low body fat, low buttocks circumference, low upper thigh circumference, low lower thigh circumference, low calf circumference and low haemoglobin levels compared to other groups. Mean weights of the "Not Sick Not Malnourished" (NSNM) group were significantly (p<0.05) higher throughout all ages when compared to those of the other three groups (NSM, SNM and SM). Mean weight of the "Sick but Not Malnourished" (SNM) group was significantly (p<0.05) higher than those of the malnourished groups (NSM, SM). Subsequently, Mean weight of the "Not Sick but Malnourished" (NSM) group was significantly (p<0.05) higher than that of the "Sick and Malnourished" (SM) group. Increase in weight and length/height of children were measured as 3 monthly changes in body weights and lengths/heights. Mean values were based on NCHS/WHO standard. Mean increase in weights and lengths/ heights of the "Not Sick Not Malnourished" (NSNM) group exceeded that of the NCHS/WHO standard.. Mean increase in weights and lengths/heights of the "Sick but Not Malnourished" (SNM) group compared favourably with that of the NCHS/WHO standard. Mean increase in weights and lengths/heights of the "Not Sick but Malnourished" (NSM) and "Sick and Malnourished " (SM) groups were below the NCHS/WHO standard.This study demonstrates synergism between malnutrition and infectious disease, in which the combined effect was greater than the sum of the impact of each condition. It was found in Study II that the incidence of diarrhoea occurred among the children at the ages of 12 months and 24 months of life. There was a gradual increase in diarrhoeal prevalence in infancy. The observed first peak at 12 months coincides with the age of introduction of supplementary foods. The observed second peak at 24 months coincides with age at which children are left crawling on the floor. There is, in general, greater exposure to contamination in areas with poor hygiene and improper sanitation. Place of residence emerged as a strong predictor of diarrhoeal disease in children. The percentage of children who had diarrhoea was higher among the children from the rural areas compared to those from the urban area. During the \ season of high diarrhoeal incidence which is usually from September to January, the percentage of children who had diarrhoea was higher among children from the rural areas. In Study III factor analysis was used to group the children into social strata. The influence of socio-economic and environmental factors on the prevalence and severity of infectious diseases among the children were assessed. The results reveal high incidence of infectious diseases among the low socio-economic class followed by the middle socio-economic class with least occurrence among children from high socio-economic class. Severity of infectious diseases as it affects preschool children according to social strata was also assessed. It was found that severity was highest among children from low socio-economic class. A model was developed using variables used in factor analysis to predict outcome of nutrition and infections. The model reveals that the relative risk of being sick and malnourished were high among children from low socio- economic class and children from families with poor sanitary conditions.