A Critical Examination Of The Benefit Of E-Naira Platform To Nigeria Citizens
The dietary supplements market is growing at an alarming rate despite dietary source being acknowledged as the primary and priority source of nutrients. Nigeria’s dietary supplements market has experienced a steady growth since 2009 owing to increasingly busy lifestyles, growing health consciousness and disposable income among the general population. Little has been documented about use of dietary supplements in Nigeria despite their increase in popularity. The purpose of this study was to determine the prevalence of dietary supplements use and dietary practices among students in tertiary institutions in Nsukka LGA, Enugu State. Students were chosen to represent the general population because it’s a homogeneous group, with average Nigerian income, evenly distributed across the country and hence opinion shapers in the community. The study adopted cross-sectional analytical study design with qualitative and quantitative methods in data collection, analysis and presentation. Researcher administered questionnaire and key informant interview guides were used to elicit information from the participants. Simple random sampling was used to select a sample of 178 students from tertiary institutions located in Nsukka LGA, Enugu State while purposive sampling was used to select a sample of the key informants. Data was analyzed using SPSS version 22. Data from the 24 hour dietary recall was analyzed using Nutri-survey to obtain specific nutrients consumed. A P-value of <0.05 was considered statistically significant. The mean age of the students was 38.53 ± 9.75 years with most being between the ages of 41-50 years. Majority of the participants were females (60.7%), married (65.7%) had an undergraduate university degree (67.4%), and earned an average household income of >N 50,000 (53.9%). Out of the possible 14 food groups, the mean DDS was 7.42 ± 1.40. The mean intakes for vitamin A, B6, iron and zinc (2300±4432, 1.43 ± 0.69; 28.39 ± 24.7; 14.40 ± 5.30 respectively) were found adequate as opposed to those of vitamin C, D and E as well as calcium (55.30 ± 27.09; 6.906 ± 4.59; 10.12 ± 5.697 and 703.04 ± 420.87 respectively) that fell below the RNIs. Consumption patterns showed high intake of starchy staples with rice and ugali having the highest intakes. There was moderate intake of proteins with high consumption of animal source foods while consumption of fruits and vegetables was low and moderate respectively. The prevalence of dietary supplements use was 28.7% with the most commonly consumed supplements being omega 3 and 6 (60.8%), calcium (56.9%) and multivitamins (19.6%). The main reasons for supplements use were medical reasons (59.6%), prevent deficiencies (29.8%) and to promote good health (25.5%). Key informants were used to give an insight on DS use. The main sources of information on dietary supplements use were health workers (68.6%) and internet (62.7%). Dietary supplements use was significantly associated with age (P<0.001), gender (P<0.000), marital status (P<0.006) and household income (P<0.049), with those above 40 years of age being 3.25 times more likely to use DS (AOR:3.2;C.I;1811-8.956; P value=0.023). Chi square test further showed that DDS was significantly associated with DS use (P<0.045). Furthermore, there was significant relationship (<0.05) between nutrient intake (vitamin A, C, iron and calcium) and dietary supplements use. Due to the increased number of people (28.7% prevalence) using dietary supplements among the general population, there is need for a solid foundation of regulatory framework to forestall consumer exploitation and promote their safety as well as prevent abuse of the products by consumers.
1.1 Background to the Study
The Global market for dietary supplements appear to be growing at an alarming rate (Valavanidis, 2016). Over the last decade, sales of dietary supplements have soared due to swelling demand and many new companies have now invested in the dietary supplements (DS) industry. More people appear to be appreciating the value of good health (Euro monitor International, 2017). It is reported that upsurge in lifestyle diseases, healthcare costs and the ever growing aging population are some of the factors driving the growth in the DS industry in different places across the world (Aryeetey & Tamakloe, 2015; Fransen et al., 2016; Ministry of Health, 2017).
Universally, the sales of dietary supplements are estimated to be $50 billion, with an annual forecast growth of up to 4% by the year 2018 with Singapore, Hong Kong and Norway leading in their usage and spending in household consumption and use (Euro monitor International, 2014). In the United States, The Council Responsible for Nutrition reports that 68% of US adults are taking supplements with multivitamins being the most commonly used (taken by 52% of DS users) followed by vitamin D (20%), omega 3 fish oil (19%), calcium (18%) and vitamin C (17%) (CRN, 2013). In South Africa, the dietary supplements market is estimated to be worth R7 billion, with main categories being fish oils, vitamins, minerals, herbs, fiber and probiotics (Euro monitor, 2014). Those who buy into the country’s health and fitness trends and those with large disposable income are the major consumers of healthcare products and dietary supplements (Gabriels et al., 2011).
In Nigeria, according to Euro monitor Nigeria, (2014), the consumption of various brands of dietary supplements in the country has increased since 2009 as individuals become more mindful of their health, coupled with rising disposable incomes. Besides, people seem to increasingly adopt busier lifestyles that militate against good dietary practices (Kearney, 2010; Berkum, Linderhoff, &Achterbosch, 2017).
For promotion of good health, it is important to ensure adequate intake of essential nutrients by having a variety of foods and increasing the number of food groups consumed (Ministry of Health, 2017). Dietary intake is correlated with a series of positive health outcomes of public health concerns. A diet that meets recommendations for both food groups (Melina et al., 2016) and nutrients (Institute of Medicine Food and Nutrition Board, 2000), and which is associated with disease prevention and promotion of optimal health, is considered a high-quality diet (Kranz, 2006).Further, nutrient dense diets have been linked to lower risk of obesity in children (Kranz, 2008; Tulchinsky, 2010) and other chronic diseases (Daaboul & Siverstein, 2004).
Access to good quality diet that is adequate in terms of nutrients is essential for human health, productivity and employment output (WHO, 2015). A non-diversified, low quality diet can impact negatively on an individual’s health and wellbeing since it may not meet his/her micronutrient requirements (FANTA, 2011; Habte &Krawinkel, 2016; Nithya & Bhavani, 2018). Dietary supplements can help bridge the gap between dietary intakes and the recommended nutrient intakes (RNIs) for various micronutrients in situations where the latter may not be easily attainable through normal diet (Shao et al., 2017). The use of dietary supplements, however, should not make up for poor food choices and inadequate diets (Burke et al., 2012). A wellchosen diet will promote an adequate intake of all nutrients.
1.2 Problem Statement
Increasing awareness about the functions of micronutrients in promotion of good health has resulted in a huge growth in the production, marketing and consumption of dietary supplements globally (Miller & Welch, 2013; Dickson & Mackay, 2014). In Nigeria, the last few years have witnessed a tremendous growth in the dietary supplements’ market (Euro monitor, 2013). Large multinational companies have engaged or contracted various local marketing and distribution agents who in turn have set up ‘health shops’ at strategic locations in major urban centers as well as using multilevel marketing to augment sales.
An uptake of 43.5% among Nigerian gym users (Wachira, 2011) and 15.5% among Nigeria league rugby players (Kimiywe and Simiyu, 2008), has been reported but it is uncertain whether the use of dietary supplements has increased due to self medication, aggressive marketing by producers, expensive health care or simply owing to inadequate diets. With the market unregulated and too many brands of the same product and unknown ingredients, there is a likelihood of business malpractice as well as consumer abuse of products through overuse (Euro monitor, 2013).
Although many studies have described the prevalence, trends and the dynamics in the use of dietary supplements in various populations (Archer and Boyle, 2008; Pouchieu et al., 2013; Kantor et al., 2016; Alfawaz et al,. 2017), they are mostly restricted to profiled groups or to medically challenged subjects who often use dietary supplements alongside drug prescriptions. There is limited information on the factors and outcomes surrounding their use in the general population. In Nigeria, there exist minimal empirical evidence regarding dietary supplements usage among the general adult population and its linkage to dietary practices. This study, therefore intends to fill in a gap in the literature on prevalence of supplements use on a general population.
1.3 Purpose of the Study
The purpose of this study was to determine the prevalence of dietary supplements use and dietary practices among students in public secondary school in Nsukka LGA, Enugu State.
1.4 Objectives of the Study
The objectives of this study were to:
- Establish the demographic and socio economic characteristics of the students in tertiary institutions in Nsukka LGA, Enugu State.
- Determine dietary practices among students in tertiary institutions in Nsukka LGA, Enugu State.
- Determine the prevalence of dietary supplements use among students in public secondary school in Nsukka LGA, Enugu State.
- Establish the relationship between demographic and socio-economic characteristics and use of dietary supplements among students in tertiary institutions in Nsukka LGA, Enugu State.
- Establish the relationship between dietary practices and use of dietary supplements among students in tertiary institutions in Nsukka LGA, Enugu State.
1.5 Hypotheses of the Study
- H01 There is no relationship between demographic and socio-economic characteristics of the students and use of dietary supplements among students in Nsukka LGA, Enugu State.
- H02 There is no relationship between dietary diversity and use of dietary supplements among students in Nsukka LGA, Enugu State.
- H03 There is no relationship between nutrient intake and use of dietary supplements among students in Nsukka LGA, Enugu State.
1.6 Significance of the Study
The findings of this study may be used by the Ministry of Health to inform policy initiatives regarding use of dietary supplements as an emerging trend in the dietary lifestyle of Nigerians. The findings will also provide evidence that can inform nutrition counseling interventions among specific sub-populations including students. The study may also avail information to the individual students and the general population so as to make informed choices on dietary practices and dietary supplements usage.
1.7 Limitation of the Study
The study focused only on commercial dietary supplements which included vitamins, minerals and essential oils and not traditional supplements that are not on the commercial market that are used for management and treatment of health conditions.
1.8 Delimitation of the Study
The study included only students in Nsukka LGA, Enugu State and hence the results can only be generalized to schools with same attributes.
Summary, Conclusion and Recommendations
5.1 Summary of the Findings
Majority (60.1%) of participants in this study were females and in the age category of 41-50 years. Most (65.5%) of the participants were married, had a university degree and came from households with an income of over N 50,000.
Dietary diversity of the participants was high with a mean of 7.42 ± 1.21SD. The majority of the participants had adequate intake of vitamin A, and B6 as well as iron and zinc but had insufficient intake of vitamin C, D, E, and calcium. The participants displayed varied consumption patterns with cereals being the most frequently consumed food group category while vegetables had modest consumption and fruits, low consumption. The consumption of animal foods was found to be moderate.
Almost a third of the participants (28.7%) took dietary supplements with most of the supplements users taking omega 3 and 6 and calcium tablets on prescription or as a prophylactic measure. Asked whether they had any nutrition information on the supplements they were using, most of the supplement users acknowledged having received advice on usage. Most participants said that they found DS important for maintaining bone density and general health. The main sources of information on dietary supplements were indicated to be doctors and the internet.
On associations, gender, age and household income were found to be predictors of dietary supplements use, with women, who were older, and with higher household income more likely to use supplements. Furthermore, dietary supplements usage was significantly associated with dietary diversity with users of dietary supplements tending to have a higher dietary diversity score than non-users. A significant association was also established between dietary supplement use and the intakes of certain nutrients including vitamin A, C and the minerals; iron and calcium. Those taking supplements were found to be more likely to fulfill their RNIs for these nutrients than non-users. Dietary supplements contribution to nutrient intake was not assessed.
Based on the study findings and objectives, the participants displayed varied consumption patterns with cereals being the most frequently consumed food group category with low consumption of dark green leafy vegetables and fruits. It was noted that there was inadequate intake of vitamins C, D, E and calcium among the
Almost a third of the students consumed dietary supplements on prescription or as a prophylactic measure with omega 3 and 6 and calcium being the most commonly consumed supplements. It was reported that the main source of information on dietary supplements use was health professionals and the internet.
Female students, those above 40 years and earning more than Ns 50,000 were more likely to take supplements. Those taking supplements were also more likely to have a higher dietary diversity. It was further noted that DS users were more likely to meet their fulfillments for their RNIs because they were more conscious about their health.
Marital status and education were not co related with DS use.
5.3. Conclusion on the Hypotheses.
The current study has established significant relationship in demographic characteristics (age, gender and household income) and socio economic of the study participants and dietary supplements use. Subsequently, the first null hypothesis
“There is no relationship between demographic characteristics and socio economic characteristics of the respondents and use of dietary supplements” is rejected.
Furthermore, a significant relationship has been established between dietary diversity of the participants and dietary supplements use, with users of DS tending to have a higher dietary diversity than non-users. The second null hypothesis which stated that “there is no relationship between dietary diversity and the use of dietary supplements among the subject population” is therefore rejected.
The findings of the current study have also revealed significant differences among DS users and non-users in the intakes (particularly the fulfillments of RNIs) of vitamins A, C, iron and Calcium. This therefore also leads to the rejection of the third null hypothesis: “there is no relationship between nutrient intake and the use of dietary supplements”
5.4 Recommendations of the Study
The following recommendations are made from this study
5.4.1 Recommendation for Policy
Due to the increased number of people (28.7% prevalence) using dietary supplements among the general population, there is need for a solid foundation of regulatory framework to forestall consumer exploitation and promote their safety as well as prevent abuse of the products by consumers by the Ministry of Health.
5.4.2 Recommendation for Practice
Since most people still rely on doctors and nurses as their primary sources of information on dietary supplements, information relating to dietary supplements should be incorporated in the relevant guidelines for delivery of healthcare. This may entail a clear system of referrals to department (e.g. nutrition department) which would best placed to offer counseling and advice on dietary supplements as a component of the medical nutrition therapy (MNT).
The internet is increasingly becoming appreciated by most people in the country as a platform for exchange of information including dietary information, it should thus be leveraged by information education and communication (IEC) interventions as it can prove more effective, efficient and cost-effective with certain categories of nutrition and health audience.
5.4.3 Recommendation for Further Research
Further research should be conducted in the following areas;
- The contribution of dietary supplements in achieving dietary adequacy.
- More studies should be done on other healthy population sub-groups to build the weight of evidence of DS use related factors.
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