FEEDING PRACTICES AND NUTRITIONAL STATUS OF UNDER-FIVE CHILDREN IN A PERI-URBAN SETTING IN IBADAN, SOUTHWEST NIGERIA: A COMPARATIVE CROSS-SECTIONAL STUDY

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A.A. Bakare^1,2,3, O.C. Uchendu^1,2, O.E. Omotayo⁴ , C. King³

1. Department of Community Medicine, University of Ibadan, Ibadan Oyo State Nigeria.
2. Department of Community Medicine, University College Hospital, Ibadan Oyo State Nigeria.
3. Department of Global Public Health, Karolinska Institutet, Sweden.
4. Department of Paediatrics, University College Hospital, Ibadan Oyo State Nigeria.

Abstract

Background: Existing literature suggests inequalities in nutritional and feeding practices for children in rural communities compared to their urban counterparts. However, with increasing urbanization and changing social norms, re-assessment of rural-urban differences in feeding practices for under-five children is essential. This study therefore aimed to assess the feeding practices and nutritional status of children in a peri-urban setting in Ibadan.

Methods: We conducted a community-based cross-sectional comparative study in peri-urban LGA (Lagelu) in Ibadan. Participants were 617 caregivers of underfive children identified, from wards typical of rural and urban settings, through a multistage sampling technique. Caregivers’ sociodemographic details, 24-hour dietary recall of the child’s feeding, and anthropometric measurements were obtained.

Results: Nearly half of the children were 2 years or older (rural: n=142, 47.2%; urban: n=147, 46.2%). There was significant difference between settings in terms of maternal age and education, father’s education, caregiver’s occupation and socioeconomic status. In total, 611 children (99.0%) were breastfed. Of those breastfed, 45% and 39% in rural and urban settings respectively were initiated within an hour of delivery. Children in rural setting had longer duration of breast feeding. However, they are less likely to be exclusively breast fed for 6 – months compared with children whose caregivers are urban dwellers. Dietary diversity was similar in both settings but higher among males. (20.3% male, 11.7% female in rural; 17.3% male and 15.5% female in urban). Overall, 108 (22.3%), 107 (21.9%), 152 (30.6%) and 34 (7.0%) of children aged 6-59 months were cachetic, underweight, stunted, and overweight respectively but commoner among children in rural settings.

Conclusion: Feeding and nutrition programmes need to apply a gender lens if sustained behavioural interventions on child nutrition are to reach equitable outcomes.

Keywords: Under-five nutritional status, Feeding practices, Dietary diversity, Peri-urban, Nigeria

Introduction

Adequate nutrition is essential for a child’s optimal wellbeing, growth, and development. It is also a cornerstone of poverty alleviation, good health and wellbeing, human capital, and economic development.^1,2 It is therefore an integral part of the United Nations Convention on the rights of the child – every infant and child must be allowed to grow, learn, play, develop and flourish with dignity and they have the right to the best health care possible, clean water to drink, healthy food and a clean and safe environment to live in.³ With the increasing burden of chronic noncommunicable diseases in low and middle-incomecountries, including Nigeria, a focus on nutrition in early childhood is crucial as many non-communicable diseases have links to nutrition and feeding practices in early childhood.^4,5 The global community has acknowledged the crucial role of nutrition: hence it is enshrined in the sustainable development goals (SDGs). Though SDG 2 is ‘Zero Hunger’, at least 12 of the 17 SDGs are related to nutrition.⁶

Malnutrition is characterized by either a deficiency (undernutrition) or an excess intake of nutrients (overnutrition). Undernutrition is a significant cause of morbidity and mortality among under-five children and is associated with 2.7 million child deaths annually.⁷ Globally, in 2020 an estimated 149 million under-five children suffered from stunting, and 45 million had wasting. Of these, 41% of those who were stunted and 27% of those with wasting were in Africa.8 Overnutrition is also a growing public health concern as 39 million under-five children were estimated to be overweight or obese in 2020, and 27% of these were in Africa.⁸ Therefore, Africa currently faces a dual burden of child malnutrition. The number of underfive children in Africa who are overweight has increased by 24% since 2020, and the continent has the highest burden of malnutrition after Asia.

In 2005, the National Policy on Infant and Young Child Feeding in Nigeria was formulated then reviewed in 2010 to ensure the optimal growth, protection and development of the Nigerian child from birth through the first 5 years of life largely through exclusive breastfeeding for the first 6months of life followed by adequate complementary feeding and breastfeeding for up to 24months.⁹ Also, the Home-Grown School Feeding and Health Program was initiated by Nigeria’s federal government to reduce child malnutrition and poverty while improving school enrolment. The program ensures a free meal for a child each school day that is adequate in quality and quantity.¹⁰ Despite these efforts, Nigeria has the second highest burden of stunted children in the world with an estimated 2 million children suffering from severe acute malnutrition (SAM), and 1 out of every 5 children with SAM has access to treatment¹¹ suggesting low policy impact. In fact, according to the 2018 National Demographic Health Survey (NDHS), 37% of children aged 6-59 months were stunted, 7% were wasted and 22% were underweight ¹² with wide variations in these indices across states and geopolitical zones. In Oyo state, 34.5% and 14.2% of children under-5 were stunted and severely stunted respectively:highest in southwest Nigeria. These children are unlikelyto reach their full intellectual, social and economic potentials.¹³

Nigeria is only on track to meet one of the 8 global targets on nutrition by the year 2025.8 While exclusive breastfeeding rate among children aged 0-6 months has increased from 17% in 2013 to 29% in 2018, it is still below the global target of 50% for the prevention of common childhood illnesses such as pneumonia and diarrhea.¹⁴ while 72% of children aged 6-8 months received timely complementary feeding.^12,15

Studies in Nigeria have identified factors such as child gender, parental education and socioeconomic status, maternal age and nutritional status to be associated with under-five nutrition.^16,17 Differences in the prevalence of childhood malnutrition across different geopolitical zones in Nigeria however suggests that these factors have heterogeneous effects, and may be mediated by other underlying factors such as cultural beliefs, environmental, economic, and political factors. Hence, there is a need for context specific local empirical data on child nutrition.¹² In the southwest of Nigeria, Oyo state has the highest burden of malnutrition, and rural-urban disparity in child nutrition has not been recently studied.¹² Therefore, this study assessed the feeding practices for children under-five in a peri-urban setting in Ibadan, Southwest Nigeria, and specifically to compared feeding practices between urban and rural contexts in this setting. Findings from this study can support local implementation of nutrition programmes in the region.