W.U. Adenuga1, T.A. Obembe2, 3, K.O. Odebunmi4, and M.C. Asuzu1
1. Dept. of Community Medicine, Faculty of Clinical Sciences, College of Medicine, University of Ibadan
2. Dept. of Health Policy and Management, Faculty of Public Health, College of Medicine, University of Ibadan.
3. University of Witwatersrand, School of Public Health, Wits Education Campus, Johannesburg, South Africa.
4. Department of Palliative Medicine, University College Hospital, Ibadan, Ibadan.
Background: Studies on stunting in children have largely focused on the underfive, establishing it as a strong predictor of mortality in these children. Few studies have documented the prevalence or determinants of stunting among school children in southwestern Nigeria. The aim of the study was to determine the prevalence and predictors of stunting among selected primary school children in rural and urban communities of Obafemi Owode Local Government Area, Ogun State.
Methods: A cross-sectional study of rural and urban primary school children was conducted. An interviewer-administered questionnaire was used to collect information on respondents’ and parents’ socio-demographic characteristics. Stunting was defined as height-for-age less than two standard deviations from the median height-for-age of the standard World Health Organization reference population. Using EPI-INFO version 6.03, children were classified as stunted if zscores of height-for-age were less than 2 standard deviations below the National Centre for Health statistics (NCHS)/WHO median. Height and weight were taken using a stadiometer and weighing scale respectively. Data were analyzed using the Statistical Package for the Social Sciences (SPSS) Version 16.0 while predictors were determined using logistic regression at 95% level of significance.
Results: A total of 1,160 primary school children were studied with 52.2% from rural schools. Males constituted 57.1% and 51.8% in the rural and urban school respectively. Prevalence of stunting among rural school children was 46.2%, and was significantly higher (p<0.001) than among urban children at 33.8%. Younger children <10 years (OR: 0.088; 95CI: 0.052 - 0.150) and children between 11-12 years (OR: 0.534; 95CI: 0.322 - 0.886) were at a significantly lower risk of stunting both in rural schools compared to children >13 years.
Conclusion: The prevalence of stunting was high especially among pupils from schools in the rural communities. This underscores the need for urgent feasible and effective nutrition programs for primary school children especially those in rural schools within the study area.
Keywords: Stunting, School children, Under-nutrition, Millennium development goals, Sustainable development goals
Malnutrition has continued to persist in both developed and developing countries.1,2 Stunting is an indicator of chronic malnutrition which may lead to poor mental development later in life.3 Stunting typically represents a cumulative process of reduced growth that predominantly occurs before three years of age and persists into school age.4 Globally, prevalence of stunting amongst school age children typically varies from place to place ranging from 9.3-24.0% in Latin America and Caribbean to as high as 20.2-48.1% in Africa.5 In South Africa the prevalence for stunting is 18.0%, whereas it is as high as 42.0% and 50.0% in mid and Eastern Africa respectively.6 Nationally, prevalence of stunting among primary school children ranges from 11.5% in Anambra, 11.8 % in Onitsha to as high as 60% in Kebbi State.7,8 In Nigeria, the progress towards halving the proportion of people suffering from hunger under the Millennium Development Goals (MDGs)9 has hitherto been slow and daunting.
Stunting has profound effects on the health of children. It predisposes to heightened risks of severe infections as a result of immune-compromised responses.10 Stunting has also been implicated in increased morbidity and mortality, reduced physical, neurodevelopmental and economic capacity and an elevated risk of metabolic disease into adulthood.11 Under-nutrition significantly interferes with a number of bodily functions such as immunity (cell-mediated immune responses)12 antibody responses and cytokine production13, that as a result provoke poor health outcomes in early infancy and childhood.14,15. Most importantly, the high prevalence of bacterial and parasitic diseases in poor and developing countries have continued to exacerbate the effect of stunting in children.16
Risks of stunting are high in children as a result of heightened vulnerabilities to “low dietary intake, inaccessibility to food, inequitable distribution of food within the household, improper food storage and preparation, dietary taboos and infectious diseases”16. Significant associations have been established between early childhood stunting and late onset adulthood depression with elevated self-reported conduct problems. 17 The consequences of stunting iterated above demonstrate the need to investigate and implement interventions to address the problem amongst school children. Furthermore, the ‘double burden of malnutrition’, (in which households have a stunted child and an overweight mother) makes stunting as a form of under-nutrition quite worrisome.18-20
Numerous studies have investigated and provided broader national estimates of stunting8, even though key health-related targets in the Millennium Development Goals and the Sustainable Development Goals supports concerted calls to eradicate poverty and hunger whilst also bridging inequities in health.21 Bearing this in mind, there is a dire need for comparative statistics across wealth quintiles and vulnerable populations that can inform formulation and adoption of feasible policies at the strategic and operational levels of government in order to curtail the effects of stunting in Nigeria and sub-Saharan Africa. The objective of this study was to document the prevalence of stunting and its determinants amongst rural and urban students in selected primary school pupils of South-Western Nigeria.