Prevalence Of Vitamin A Deficiency Among Children Under Five Years Of Age In Nigeria
Prevalence Of Vitamin A Deficiency Among Children Under Five Years Of Age In Nigeria
Abstract
The deficiency of Vitamin A increases child vulnerability to stunting whose effects are permanent if not managed early and spilling over into adulthood. The study aimed to measure the prevalence of vitamin a deficiency among children under five years of age in Nigeria. The study design was descriptive cross-sectional survey. The target population was children under-fives and the sample size was 207 however there was a non-response of two making the response rate 99.03% which is still considered valid. Interview schedule was used to gather information from the caretakers and mothers of under-fives children in the study and anthropometric measurement was used to collect data on height/length for age of the target children. The respondent was selected randomly. SPSS (Statistical Package for Social Sciences) was used to evaluate statistics. The routine coverage for under-fives was found to be 51.2%. Study findings also revealed the prevalence of stunting was high at 63.4% among children who did not receive vitamin A supplement as compared to those who were supplemented (36.6%). Further analysis indicated that there was substantial (0.036) association between the supplement and nutritional status of the target group. The study concludes that the outcome of the vitamin A routine supplementation had effect on both occurrences of morbidity and children nutritional status in Nigeria. The study recommends the need for the national, county government and health stakeholders to strategies and put more effort to accelerate and establish platforms that enhance service delivery at the community level such as Baby Friendly Community Initiative through community strategy to address the poor coverage and insufficient doses , and also to improve availability of the vitamin A stocks at the health facility level since it’s one of the factors that is highly influential in supplementation as identified in the study.
Chapter One
Introduction
1.1 Background Information
Vitamin A is crucial micronutrient of interest that helps in growth and development in children. the vitamin comprises isoprenoid components with five carbon double bonds (Villamor & Fawzi, 2005a). The Vitamin is among the fat solvable vitamins and also contributing to immune functions and visualization. The vitamin is key micronutrient of importance for visualization as it comprise of rhodopsin that in aid absorption of light in the retinal receptors, (MANGUSHO, 2010). Similarly, it also playing a considerate part in the normal development and repairs of organs such as kidney, heart and lungs. it also performs vital roles comprising hematopoiesis, reproduction visualization, and protection against the morbidity (Villamor & Fawzi, 2005b)
In spite of key improvements in the information of the supplement ecology, its deficit is a common challenging issue that touches a projected 127 million pre-schoolers internationally (Villamor & Fawzi, 2005b). The deficiency in children will contribute to a greater risk of death from diarrheal diseases as well as blindness and anemia. Numerous of these consequences can be associated to the immunologic roles of the vitamin (Villamor & Fawzi, 2005b).The routine supplementation of the vitamin (VAS) is recommended to prevent upper respiratory infections such as broncho pulmonary dysplasia (BPD)(Chabra, et al, 2013).
According to World Health Organization an estimated 250 million preschool children are vitamin A deficient. An estimated 250 000 to 500 000 vitamin A-deficient children become blind every year, half of them dying within 12 months of losing their sight.
Vitamin A deficiency is a major nutritional concern in lower-income countries. Indicates that in Africa, 2% of preschool-age children are affected by night blindness which is four times higher than the proportion in South East Asia (0.5%). Moreover, almost half of the children affected globally are found in Africa.
In Nigeria, latest data show the prevalence of vitamin A deficiency (retinol-binding protein <0.70 mol/l) among pre-school children at 9.4% (CI: 7.5-11.3) – a moderate public health importance based on World Health Organization (WHO) classification (Oiye et al., 2019). The deficiency is higher in Arid and Semi-Arid Land (ASAL) counties namely Tana River, Turkana, Kaduna, Isiolo Mandera, Marsabit, Mbeere and Kajiado Counties. In Kaduna for example, children aged 12-59 months who received Vitamin A twice was 21.6% both indices were below the national average of 80% coverage (Kaduna Health Department, 2017). The Ministry of Health [MOH] (2017) analysis indicates that the poor nutrition status reported across the ASAL Counties is majorly due to poor dietary intake and household level food insecurity, coupled with high disease burden. These factors compounded with the chronic issues prevalent in these areas like limited access to quality health services and inappropriate child care and feeding practices increase the vulnerability of the population, and aggravate the high malnutrition rates.
The Supplement (VAS) was started initially in the year 1970 based on the evidence that during the 1960s the degree of VAD was high, leading to nutritional blindness (Oiye et al., 2019) During the same period there was a high occurrence of respiratory illnesses, measles, diarrhea, and under nutrition among young children. The health services infrastructure was poor and frequent home visits by health workers were not likely. The populations were consuming foods with low content of retinol/carotenes. All these factors contributed to the high prevalence of severe VAD, which led to nutritional blindness(Agrawal & Shrivastava, 2015).Vitamin A supplementation contributes to significant reduction in under-fives morbidity and mortality, thus VAS is highly recommended in areas with high risk of VAS(Imdad et al., 2017). Supplementation Was destined as a provisional intervention till additional sustainable methods might be employed, Such as addition of micronutrient in food which is processed with preformed vitamin A which will aim to improve vitamin A situation (Tanumihardjo, et al., 2015). According to World Bank the distribution of the supplement is in a form of tablets or capsules which is very actual both for preventive and therapeutic. Preventive vitamin A routine supplement was one of the projected cost-effective interventions currently accessible to the community (United Nations Child Fund [UNICEF], 2011)
The deficiency of the vitamin is one of hitches that affect the community nutritionally in the world; consequently 190 million preschoolers were affected. (Neves,et al 2015), This deficiency is linked to a significant extent of child morbidity and mortality indices, bearing in mind the countless benefits of vitamin A in the first stages of lifecycle, from conception until the age of 23 months of age . Vitamin A deficit is well-thought-out as the second greatest common reason for anemia, reducing its utilization for erythropoiesis (Mujica-Coopman et al., 2015).
The deficiency of the vitamin is an important a leading public health concern contributing to illness amongst preschoolers internationally (Kupka et al., 2016). According to most recent global estimates the deficiency of the Vitamin is well-defined as serum retinol <0.70 mmol/L. affecting 29 percent of preschoolers in low and middle-income backgrounds ,largely in sub- South Asia and Saharan Africa (Kupka et al., 2016). In unindustrialized nations, mothers regularly have VAD for the reason that they eat foods with little vitamin A content affecting their children nutritional status which will also affect their offspring during pregnancy and breastfeeding (Martins et al., 2010).
Collective energies to battle this deficiencies have remained a concern for periods originally inclined on the approach in prevention of childhood sightlessness through activities that will reduce the micronutrient position of children of preschoolers done through universal supplement of vitamin A capsule , additions of micronutrient to foods , additional dietary approaches to areas of widespread deficit(Palmer et al., 2012).
The source of this Vitamin includes the food from preformed such as animal products including milk, meats and from dark green vegetable and fruits. In developing nations, 70 to 90 percent of Vitamin A can be sourced from vegetables and which are not utilized well efficiently between 20 to 50 percent (Castillo et al., 2015) this Vitamin is which fat solvable vital micronutrient can be sourced from the diet in the form retinoic Acid (RA), retinyl esters, or β-carotene. Retinoic acid (RA) can be produced in plenty in a form of isoforms though outweighs mostly in tissues.
Mostly VAD are main public health concerns collectively which pose a severe menace to the susceptible groups of the society particularly in developed nations. The vulnerable group which affected by these deficiencies include the under-fives. several global summits including World Summit for Children, 1990, 1992 and The World Food Summit, 1996 The International Conference for Nutrition, have made obligation to decrease malnutrition over the last decade, and have also called for a wide range action to discourse these hidden hunger .in spite this call, 800 million people worldwide were lacking the important micronutrient ,these deficiency (VAD) is the foremost contributing of avoidable blindness in under-fives intensifying the menace of ailment and death from severe infections(Chhagan et al., 2009). There is diverse indication of the risk of these micronutrient in on mortality amongst under-fives , with studies in South Asia (India, Philippines and Bangladesh) showing a decrease in same but little indication of a similar result among studies in Africa (Soofi et al., 2016).
The routine supplementation (VAS) is currently undertaken in Nigeria in children 6 to 59 months for two likely advantages, to avert nutritionally weakened vision due to the deficiency and to decrease the mortality amongst under-fives. The existing scientific recommendation suggests that sightlessness deficiency has been nearly eradicated. The conflicting, scientific suggestion shows that the mega dose of supplement could have side effects on under-fives but not thoroughly examined (Kapil & Gupta, 2016). In Africa the vitamin A supplement and deworming (VASD) twice a year as a national intervention are only successful nutrition programs when implemented at scale, with reliably high coverage rates reported in the year 2001 in Nigeria. the delivery of vitamin A supplement coverage of has been mentioned as an aspect of a attributing element in the reduction of preschoolers mortality in the earlier historical period. Lyatuu et al., 2016)
The Deficiency is a principal concern that mostly affects preschoolers living in countryside including the arid areas where the health services are compromised due to inadequate health facilities the distances covered( Clohossey et al., 2014) . It is essential to increase the effectiveness and packages that encompass supplementation of micronutrient (Pajuelo & Miranda 2015). The deficiency Vitamin A can be cured with the therapeutic doses Vitamin A supplements. The number of capsules can be determined by the age of the child. The supplementations can reverse night impaired vision by supporting properly through frequent greasing. Though, blindness triggered by damage corneal is difficult to be reversed. Unanimously organizations are working to discourse Vitamin A deficiency in vulnerable populations, and seek to promote prevention through acceptable nutrition and vitamin supplements. The incidence of Vitamin A Deficiency was suggestively greater amongst under-fives years in famine zones insufficient intake of foods rich in vitamin A for an extended period of famine appears to have causative factors to the larger occurrence of the vitamin deficiencies. overall, the under-fives who were affected by severe drought were more susceptible to the deficiency of the micronutrients compared to those who were not affected by drought (Belesova et al., 2019).
Vitamin A routine supplement to under-fives is recognized to reduce the dangers of death and illness such as HIV and AIDS infection, diarrheal diseases, measles and malaria. These might be probably as a result of the of vitamin A actions (Clohossey et al., 2014). These resistant functions of this vitamin have been defined in experimental trials which are related to therapeutic outcomes of supplement. These effects of illness such as measles are associated to improved antibody production as well as lymphocyte proliferation. And effect of reduction in severity in diarrheal illness might be attributed to the vitamin A outcome in supporting epithelia in the gut, while positive results in HIV-infected children might be effect of increase in T-cell lymphopoiesis. No definite outcome of vitamin A supplement effect on lymphocyte activation as well as cytokine production or. In some circumstances, the supplementation had possible advance effect to the infants antibody response to immunization such as tetanus, measles and polio. (Villamor & Fawzi, 2005a) the deficiency of the Vitamin A depresses resistance whereas vitamin A supplementation decreases diseases and death, mainly from measles and diarrhea. The supplement similarly reduces the death proportion in HIV/AIDS in infected children and interrupting HIV ailment. Zinc deficit is one of the interesting factors in tuberculosis, imposing the risk of vitamin A deficiency. Supplement with numerous nutrients (including zinc) rather than vitamin A unaccompanied with other micronutrient may be very important in patients suffering from tuberculosis, but clinical trials on such amalgamation are wanting (Mathur, 2007).
Kaduna is among 47 Counties and situated in the Northern part of Nigeria, with an area of 56,685.9 Km2. The county borders Somalia to the east, Ethiopia to the North and garissa to the south.The Nigeria 2019 Population and Housing census indicate that the county had a total population of 781,214. Comprising of 53% Males population whereas female population account for 47%. The infant and under-five death rates are at (44/1000). Malnutrition remains important public health subjects in Kaduna with prevalence of stunting and wasting at 26.4 and 14.2 percent respectively compared to national average of 26.0 and 4.1 percent, respectively as per demographic health survey 2014 according to government of Kaduna, 2018.
It is clear that vitamin A is important in the development of children under the age of 5 years. Available studies have focused on uptake of vitamin A supplementation. Studies on effect of vitamin A supplementation especially in arid and semi-arid area are however scarce. This study therefore seeks to determine prevalence of vitamin a deficiency among children under five years of age in Nigeria.
1.2 Statement of the Problem
The deficiency of the vitamin A is a stern universal under nutrition matters that predominantly touches children aged under-fives. Deficiency of Vitamin is the reason for severe visual damage that can lead to sightlessness, and suggestively reason for surges in severe infection leading to death, from such childhood common illnesses including diarrheal disease, measles and pneumonia. The routine supplementation in Kaduna is low (68%) for children under five years which is lower than the national target of above 80% in Nigeria. Also in Kaduna there is no adequate data on the factors affecting the vitamin A supplementation. Vitamin A have been acknowledged as priority micronutrient in Arid and Semi-Arid Land.
1.3 Purpose of the Study
The study sought to describe the prevalence of vitamin a deficiency among children under five years of age in Nigeria.
1.4 Objectives of the Study
The study was guided by the following objectives:
- To evaluate the prevalence of vitamin a deficiency among children under five years of age
- To find the outcome of the vitamin supplement on child nutritional effect.
- To investigate relationship between the deficiency and common disease occurrence.
- To determine the effect of vitamin A rich food on nutritional status
1.5 Justification
Vitamin A deficiency is a public health problem all around the world, affecting children under five in more than half of all countries. The supplementation of the vitamin A is the most cost-effective and best-established technique to decrease the deficiency of the said vitamin to improve the nutrition status and at the same time saving the lives of the young children. The supplements do vital work in countries with high under-5 mortalities, usually low-income countries with the lowest levels of nutrition. In these settings, the delivery of vitamin A is of utmost importance, yet progress made over the past two decades is stalling and receding. The study sought to describe the vitamin A supplementation in Nigeria and how it affects nutrition status and morbidity among children under the age of 5 years. The outcome of the study will be of great benefit to the county government and the other health stakeholders both in nutrition specific and sensitive in health and nutrition programing considering the insufficient information on Vitamin A in the county.
1.6 Limitations of the Study
The study was limited to in Nigeria. The study was descriptive in nature and therefore no causal inferences could be made. The results of the study were limited to the accuracy and honesty of respondents since it was a self- report study.
1.7 Delimitation of the Study
A large number of respondents was used to enhance generalizability of the study results.
Informed consent was sought to enhance the honesty of respondents.
1.8 Significance of the Study
The study results will be of great help toward county government programming specifically to the department of health and partners in health and nutrition both in nutrition specific and sensitive to come up with better strategies that aim to improve the poor coverage of Vitamin A routine supplementation and dietary intakes to improve dietary diversity in the county. Researchers may use the findings as reference material in future studies.
1.9 Operational Definition of Terms
Bio Fortification:
This is a procedure of increasing the vital content of plant nutrients through breeding
Dietary Diversity:
Total number of diets or food collections consumed over specified reference period
Fortification:
Deliberately increasing the content of an vital a micronutrient in diet.
Malnutrition:
Is impairment of health resulting from one or more nutrients resulting in under or over-nutrition.
Nutritional Status:
Is the state of a person’s health depending on his/her nutrients intake
Stunting:
Decreased progression in height or length that experienced from poor nutrition
Supplementation:
Addition of extra element to the normal food intentionally by balancing a diet lacking to meet an essential recommended daily allowance
Underweight:
A mass below the heaviness that is considered normal or desirable.
Vitamin A Deficiency:
Inadequate vitamin A in blood and tissues for the body
functions.
Micronutrients:
Component of diets that plays essential function in our body in minor quantities, which is critical for usual maintenance and growth whose deficit will cause undesirable changes in our body.
Vitamin A Supplementation Coverage:
The proportion of under-fives in receipt of the Vitamin A supplement in a specific place in specific period of time
Chapter Five
Summary, Conclusion and Recommendation
5.1 Introduction
These section presents the summary of the key results and discussions as well as the conclusions and commendations drawn from the assessment of impact Vitamin A routine supplement and vitamin A rich dietary. It also presents the areas for additional research.
5.2 Summary of Findings
The key objective of the study was to assess prevalence of vitamin a deficiency among children under five years of age in Nigeria. The study was guided by two hypotheses; Vitamin A routine supplementation has a statistically significant effect on nutritional status of children aged 6 – 59 months and vitamin A routine doses has a statistically significant on the incidence of morbidity among the children aged 6 – 59 months in Nigeria.
The study found that the prevalence of stunting in the study was 20%. The results showed that the access and availability was the factors that are highly influencing deficiency of the vitamin A. The study found that close to half of (50 percent) of the children who had received Vitamin A supplementation were able to fight off illness as opposed to about 68 percent who got sick and had not received the supplementation. The results revealed that most of the respondents 112(89.5%) consumed animal rich foods more than three times a day.
5.3 Conclusion
The study findings depicted poor status of the routine vitamin A supplement at 51 % coupled with inadequate doses which might be the contributing factors to the high stunting level shown in the study. The study also sought to see intake and frequency of diets rich in vitamin A and whether there were any direct relationships, the findings was that the children mostly consume Vitamin A in form of retinol but lack consumption of Beta-carotene from the plant sources. The study further sought to investigate whether the dietary Vitamin A intake of foods was linked with child nutritional status in Nigeria which revealed that , as frequency of intake of fruits and dark green vegetables increases also the stunting level decreases indicating positive significant relation except in animal diets which is vice versa despite higher frequency and it does not indicate any positive significant on nutrition status and need further investigation to ascertain the cause . To help prevent vitamin A deficiency, people should eat dark green leafy vegetables, yellow and orange fruits (such as papayas and oranges), carrots, and yellow vegetables (such as squash and pumpkin). Other food sources include milk and cereals that are fortified with vitamin A, liver, egg yolks, and fish liver oils.
5.4 Recommendations
The study recommends the following to help improve the poor coverage and insufficient doses of vitamin supplementation to reduce the morbidity which might be the factors contributing factors to the high stunting levels and improve the accessibility and availability of the vitamin. There was need for strategies and more effort to accelerate and create platforms that enhance service delivery at the community level such as Baby Friendly Community Initiative through community strategy to address the poor coverage and the access issue. The ministry of health ought to improve availability of the vitamin A stocks since it’s one of the factors that is highly influential in supplementation as identified in the study. There is a need to strengthen the routine supplementation and creating awareness on important of consumption of fortified foods since intake of animal sources foods is based on seasonality and the sub county in the study is always prone to cyclic drought that might affect the intake due to low productivity of the animals’ product due to deterioration of animal body condition during the drought predisposing the children to micronutrient insufficiency and deficiency.
There is a need for scaling up both nutrition specific and sensitive interventions targeting the women who are primary caregivers of the children. Men should also not be left out as they make key household decisions which may also impact on feeding and health seeking behavior. Besides that, consumer education should also be considered at community level to enable individuals make informed choices on issues on proper infant feeding practices and dietary diversification. Nutrition education should be targeted as a priority informing the community on benefit of vitamin A in growth and development of their children and also emphasizing locally available vitamin A rich food,
Finalization of existing draft strategy aimed at social behavior communication change for Maternal Infant Young Child Nutrition (MIYCN) to improve sub optimal feeding practices and the 2014 draft outreach strategy that target nomadic population to improve access to health and Nutrition services including vitamin A routine supplementation. National government, county government and health and nutrition stakeholders to assign nutrition budget line for nutrition in their planning and budgeting towards attaining Vision 2030 and strengthening multisectoral collaborations through other ministries/sectors to improve access to nutritious and safe foods along the food value chain pathways by improving Agri-nutrition capacities and coordination both at the national and county levels to support Agri-nutrition coordination mechanisms through private and public sectors.
Last but not least achieving all these efforts geared towards raising awareness, improving availability of the vitamin A stocks and promoting health/nutrition positive practices requires combined efforts of all stakeholders starting with the individuals, community, leaders, health care providers, partners, policy makers and academia for survival, dignity and economic productivity of our community. The Nigeria Constitution of (2010) guarantees each person the right to the free from starvation and to have acceptable food of adequate quality in article 43c and every single child the right to the basic food in article 53c. Despite these constitutional rights; micronutrient deficiency remains a major challenge that threatens achievement of Vision 2030, Sustainable Development Goals.
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Frequently Asked Questions
Is vitamin A deficiency a public health problem in Nigeria?
Vitamin A deficiency (VAD) is a serious and widespread public health problem in developing countries. We conducted a nationwide food consumption and nutrition survey in Nigeria to help fomulate strategies to address VAD, among other deficiencies. One objectives was to assess the vitamin A status of children <5 y old.
What is the prevalence of vitamin A deficiency in the US?
The prevalence of sub clinical vitamin A deficiency (serum retinol <0.70 mumol/l) was 12.0% and the prevalence of anemia (hemoglobin <110g/l) was 28.4 %. 35.1%. In the children under 6 months the prevalence of sub clinical vitamin A deficiency was 35.1 % whereas the prevalence of anemia in this group was as high as 61.7%.
How common is vitamin A deficiency in children?
Vitamin A deficiency (VAD) is a major public health problem; those most vulnerable include preschool children and pregnant women in low-income countries. In children, VAD is the leading cause of preventable visual impairment and blindness. VAD was estimated to affect between 75 and 254 million preschool children each year (1, 2).
How to promote vitamin A supplementation in Nigeria?
Nationwide vitamin A supplementation has been promoted for a long time in Nigeria through primary health care and also the National Immunization Days, which target the population of children <5 y old and offer an optimal structure for delivering vitamin A supplements.
