NUTRITIONAL STATUS OF UNDER-FIVE CHILDREN IN URBAN AND RURAL COMMUNITIES OF EDO STATE, NIGERIA

CONTEXT Adequate nutrition is essential for strong immunological, neurological and cognitive development of children. OBJECTIVE To assess nutritional status of under-five children in urban and rural communities in Edo State. METHODOLOGY A Community based descriptive cross-sectional study was conducted between August 2017 and February 2018, involving administration of pretested structured questionnaires to caregivers of 800 under-five children selected by multistage sampling technique. Data collected was analyzed using WHO Anthro® version (1.06) and IBM SPSS version 22.0 statistical software with statistical significance set at p<0.050.

children in addition to reduced capacity of 3,[5][6][7] economic productivity in adulthood.According to the World Health Organization, 45% of deaths among children under 5 years of age was linked to malnutrition, an estimated 5.6 million children under five years of age died in 2016, with Africa accounting for majority of these deaths 4 attributed to malnutrition.The magnitude is so alarming that 9 children/minute die as a result of malnutrition, the World Health Organization has identified childhood malnutrition as the most lethal form of 3,4 malnutrition.Globally, it is estimated that nearly 20 million children have severe acute malnutrition, most of which live in south Asia 8 and in sub-Saharan Africa.Children with malnutrition especially acute malnutrition face a higher risk of morbidity and mortality from infectious disease, than their 9-10 counterparts with sufficient nutrition.Research finding reveal that more than 400,000 child deaths can be prevented each year by adequate identification and proper 11,12 management of acute malnutrition.In May 2017, UNICEF, WHO and World Bank Group released the 2017 edition of the joint child malnutrition estimates for the 1990-2016 period, representing the most recent global and regional figures.This document places the global prevalence of stunting, wasting and overweight at 22.9%, .7.7% and 6.0% respectively with an estimated corresponding population of underfive affected put at 154.8, 51.7 and 40.6 million under five children respectively globally.In Africa 31.2%,7.4% and 5.2% of total under-five children are stunted, wasted and overweight respectively with an estimated corresponding population affected put at 59.0, 14.0 and 9.8 million 13 respectively.In Nigeria, 37 per cent of children (i.e 6 million children) are stunted (chronically malnourished or low height for age), more than half of them severely.In addition, 18 per cent of children suffer from wasting (acutely malnourished or low weight for height), half of them severely.Furthermore, 29  LGA selected and Stage 4 using cluster sampling technique all eligible respondents in the selected communities were recruited for study till the calculated sample size was achieved.The questionnaire was divided into sections on socio-demographic data, feeding practices and general Inspection and Anthropometric measurements.The anthropometric measurements of each underfive was assessed using weight, height and mid-upper arm circumference.Weight measurement: The weights were measured in Kilogram (kg) using a bathroom scale (Hana model) with a capacity of 120kg.The scale was set at zero point before each measurement.The scale was placed on an even floor with the child standing in the center of the scale with hands by the sides.For children who could not stand, the mother was asked to carry the child and stand on the scale with the reading on the scale recorded.The mother was then asked to stand alone on the scale, and the reading on the scale recorded.Then her weight was subtracted from the combined weight of her and her child to get the weight of the child.Height Measurement: The height of each child was measured in centimeters (cm) using a stadiometer.The measurements were taken with the child barefooted, standing erect on the stadiometer and looking straight ahead.Children that were unable to stand erect without support were laid on flat platforms and their length measured from the vertex to the heel of the feet.

M i d U p p e r A r m C i r c u m f e r e n c e
Measurement: This was measured in centimeters using a measuring tape, from the mid-point between the acromion process of the scapula and the olecranon process of the ulna, for under-fives who were between the ages of 12-59 months.The occupation of caregivers was according to modified ILO classification.Relevant data collected was imported into the WHO Anthro® Software version (1.06) to compute the weight-for -age, height-for-age and weight-for-height, MUAC for age and BMI for age.The nutritional status was analyzed accordingly: Currently, the WHO recommended the use Z-Score or SD system to grade under-nutrition.This method measures all the three indices and expresses the results in terms of Z scores or standard deviation units.Children who are less than 2 SD below the reference median (i.e. a Z-Score of less than -2) are considered to be undernourished i.e. to be stunted, wasted or to be underweight.Children with measurements below 3 SD (a Z-Score of less than-3) are considered to be severely undernourished.Stunting (Low height-for-Age) is an indicator of chronic undernutrition due to prolonged food deprivation and/or illness; Wasting (Low weight for height) is an indicator of acute undernutrition, the result of more recent food deprivation and/or illness; Underweight (Low weight-for-age) is used as a composite measure to reflect both acute and chronic under-nutrition UPPER ARM CIRCUMFERENCE: This was measured using shakir strip and categorized as follows Under-nourished: Less than 12.5cm; Borderline: Between 12.5 and 13.5cm; Normal: Greater than 13.5cm.Data collected was subsequently analyzed and prose and tabular format with quantitative variables expressed as mean (with standard deviation).Bivariate analysis was carried out to determine the association between socio-demographic variables and various outcomes using Chi square.A p-value of < 0.050 was considered statistically significant.

ETHICAL CONSIDERATION
Ethical Approval and permission to conduct study was sought and obtained from the Local Government Chairmen of Oredo LGA and Etsako West LGA respectively including the respective Community heads before commencement of study.Also individual verbal consent was obtained from caregivers of under-five children who were informed on the purpose of the study before being interviewed.

RESULTS
Table 1 shows that mean age (SD) of urban (n=400) and rural (n=400) under five children    (49.7%) than rural 170 (42.5%) practiced exclusive breast feeding.Also, a significantly higher proportion of caregivers in urban 180 (45.0%) than rural 202(50.5)initiated complementary feeding before 6months following child birth.Furthermore, fortified pap was the main complementary feed among urban 238(60.1%)caregivers compared to pap among rural 271 (68.4%) dwellers.Caregivers in both urban 70 (38.9%)and 88 (43.6%) identified insufficient breast milk to satisfy the nutritional health need of infants as main reason.In relation to nutritional assessment of underfive children table 5 shows that a greater proportion of under five children in the urban c o m m u n i t y w e r e s t u n t e d , w a s t e d , underweight, overweight, and malnourished than their rural counterparts.Finally, the nutritional assessment of respondents are depicted in the Anthro charts for urban and rural respondents' shown in Fig. 1-4 given below

DISCUSSION
The study identified that mean age of under five children was significant older in the urban than rural community studied.This finding may be due a high child birth, poor family planning and birth control measures among rural respondents compared to their 23 urban counterparts .The majority of care givers in both the urban and rural communities studied were Christians, 92.3% of the caregivers were married.This could stem from the fact that the culture and predominant religions in both communities hold marriage in high esteem.Marriage is known to foster family stability and has a positive influence on the psychological and mental development of the child.The practice of exclusive breastfeeding was noted to be higher in the urban community as compared to the rural community, although this was not statistically significant.This finding is in tandem to a comparative study done in 2011, in an urban and a rural setting in Imo State where exclusive breastfeeding was practiced more by mothers in the urban 25 community than the rural community.This finding could be attributed to a higher level of education of mothers in the urban community on the importance of exclusive breast feeding.

BMI FOR AGE OF UNDER FIVES IN URBAN AND RURAL COMMUNITIES FIGURE 5: MUAC FOR AGE OF UNDER FIVES IN URBAN AND RURAL COMMUNITY Nutritional Status Of Under-five Children In Urban And Rural Communities Of Edo State, Nigeria Ibom Medical Journal Vol.11 No.2 August, 2018
Majority of under-fives in the urban and rural communities had normal nutritional status based on weight for age, weight for height, height for age, mid upper arm circumference and body mass index.It was discovered that under five children in rural communities had lesser incidence of wasting, stunting, underweight and overweight, than their urban counterparts, which were all statistically significant except for the stunting which was not.Only about one-quarter of under-fives were stunted in the rural community as compared to one third of their urban counterparts.This finding is in contrast to a study done in Lagos in 2013 in Epe (rural) and Agbowa (urban) which showed a higher incidence of stunting in the rural area (43.3%) than the 30 urban area (12.6%)The low values seen in rural community is similar to a cross-sectional descriptive study done in 2012 in the rural community of Babban-Dodo, Zaria, North west Nigeria in which out of 300 children aged between 0 and 59 months studied, 87(29%) were found to have underweight, 21(7%) were wasted and 93(31%) were stunted .The finding in the urban community studied could be attributed to decreased intake of proteinous meals, increased intake of refined food as well as snacks and junk food, which have little or no nutritional value.Conversely, in the rural areas, children have more access to natural foods such as fruits, vegetables, meat, fish and other foods that are not refined, thus retaining their high calorific and nutritive values.An important long term consequence of chronic malnutrition is that children with stunting are prone to accumulation of body fat, especially central fat (obesity).This could increase the burden of non-communicable diseases such as diabetes mellitus (type 2) and hypertension in