Assessment of mothers and preschool-age children's food and nutrition security status: a cross-sectional case study of North central zone, Nigeria.
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Date
2023
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Abstract
Child and maternal nutrition are essential to any country's food and nutrition security,
encompassing all the components of maternal and child growth, well-being, development, and
productivity, as contained in the modified UNICEF 2020 conceptual framework on
determinants of maternal and child nutrition. According to the World Health Organization
(WHO) and Centers for Disease Control and Prevention (CDC), preschool children are
regarded as being between 3 and 5 years old. This period entails intensive cognitive
development in children, where developmental milestones that help shape their personality,
interpersonal relationships, and thinking patterns are fostered; hence, the need to consume
healthy meals following the recommended minimum dietary diversity requirements of at least
five to eight food groups per day for children is a bedrock for positive health outcomes. The
prevalence of nutrition-related maternal and child morbidity has continued to increase in recent
times across many low- and middle-income countries (LMICs) owing to several complex
multifactorial and interrelated determinants. The complexity and interconnectedness of the
determinants of maternal and child nutrition in developing countries, such as Nigeria, are yet
to be well conceptualised and have become a public health issue due to the emerging triple
burden of malnutrition (TBM) and the prevalence of diet-related non-communicable diseases
ravaging the nation. Therefore, this study assessed the food and nutrition security status of
mothers and their preschoolers in North Central Nigeria.
A cross-sectional descriptive design and a multi-stage sampling technique were used to recruit
450 mother-child pairs (preschool children aged 3-5 years) across the North South senatorial
district in Niger State, North Central Nigeria. Sociodemographic information and biodata of
mothers and their preschoolers were collected using semi-structured questionnaires. Feeding
patterns of mother-child pairs were assessed using a qualitative food frequency questionnaire
based on 24-hour and 7-day dietary recall. The dietary diversity of households, mothers, and
children was assessed using the Household Dietary Diversity Score (HDDS), Minimum
Dietary Diversity Score for Children (MDD_C), and Minimum Dietary Diversity Score for
women of reproductive age (MDD_W), respectively, as recommended by the Food and
Agriculture Organization (FAO), Family Health International (FHI) and World Health
Organization (WHO). The Household Food Insecurity Access Scale (HFIAS) was used to
assess the food insecurity status of the participants. Anthropometric indices of the preschoolers
were assessed based on weight-for-age, height-for-age, and weight-for-height indicators, while
maternal anthropometry was assessed using body mass index (BMI) and waist/hip ratio.
Maternal nutrition knowledge was assessed using a Likert-type scale. Retrieved information
was analysed using SPSS version 28. Descriptive statistics are presented in tables and charts,
while regression models were used for inferential statistics, with statistical significance being
considered at a 95% confidence interval with a p-value of < 0.05.
The study was conducted in two phases: the first phase considered an in-depth narrative
literature review that evaluated the food and nutrition security status of preschool children in
North Central, Nigeria, as well as the food insecurity and vulnerability of the food environment
among Nigerian mothers. This study explored the literature using a qualitative approach and
an overview of online sources, peer-reviewed articles, books, and other publications and
relevant reports from official websites to investigate the concept of the food environment, food
acquisition and utilisation complexities among Nigerian women, and the prevalence of food
and nutrition insecurity and its determinants among preschool children. This review found that
the global prevalence of the Triple Burden of Malnutrition (TBM) is alarming, especially
among developing nations, affecting more women than men. Food acquisition and utilisation
are important determinants of women’s food and nutritional security status. Full but empty
plates have continued to be a dilemma among women from countries undergoing urbanisation
and nutrition transitioning; hence, poor nutrient intake has been reported to account for the high
risk of maternal morbidity and mortality related to nutritional causes in most developing
countries, such as Nigeria. This revealed that the interconnectedness of the food environment
to food acquisition and utilisation in addressing food insecurity and malnutrition as an
innovative concept is yet to be well understood and explored in many studies across Nigeria.
It also elucidates the drivers of poor dietary diversity, meal quality, and food consumption
patterns among preschool children and possible health outcomes of compromised feeding
patterns and the risk of non-communicable diseases and malnutrition among the study
participants. In addition, the review also focused on the drivers of the food environment, food
acquisition, nutrient utilisation, and the prevalence of TBM among women across the six
geopolitical zones in the country. The high prevalence of malnutrition and diet-related noncommunicable
diseases in this study accounts for the high maternal and child morbidity and
mortality rates, especially in many rural and poor households across the nation, thus becoming
a significant public health concern. Some factors found to significantly impact food utilisation
among women were food literacy, poverty, insurgence, lack of support systems, seasonality,
and family size. To mitigate these challenges, efforts should be geared towards improving both
the community and consumer food environments, thus ensuring the consumption of nutrientdense
meals for optimal health outcomes and well-being, especially among women and
preschool children living in rural areas, urban slums, and low-income households across the
six geopolitical zones of the nation and among other developing nations experiencing food and
nutrition insecurity around the world.
The second phase was the experimental section and was divided into two parts: the first part
explored the socioeconomic status, household food security status using the HFIAS and the
feeding patterns of the preschool children using the qualitative 24 hour and 7-day dietary recall.
Dietary diversity was assessed using the MDD_C, while the anthropometric indicators for
under-five children were used to categorise the children into stunting, wasting, underweight,
and normal weight. The results showed that the majority (76.4%) of the preschool children
were from rural communities; more than half (51.8%) of the children were from mothers who
had only Islamic education (no formal education), and only a few (1.2%) of the children were
born to single mothers. Almost all (95.6%) of the children were from Islamic religious homes,
and the majority (71.6%) of the mothers were unemployed, while 83.8% of the monthly
household income was below N18,000 ($40), which is far below the national minimum income
range of N36,000. Most (73.6%) of the children were from male-headed households. The
predominant ethnic group was Nupe (68.4%), whereas the least dominant was Gwari (<1%).
Most (98.8%) of the preschool children were from food-insecure households, and almost half
(42.4% and 40.2%) of the preschool children were either moderately food insecure or severely
food insecure, respectively. The severity of food insecurity increased with parity, and its
prevalence was higher among children from multiparous and grand multiparous households.
The most consumed food group among preschoolers was cereal-based food products, while the
least consumed food groups were fruits and vegetables. This study also showed that over half
(60.0%) of the preschoolers did not meet the minimum dietary diversity score (MDD_C)
recommended for their age. The anthropometric indices of the preschool children showed that
half (50.0%) of the children were stunted (height-for-age), 21.0% had wasting (weight-forheight),
and 29.0% were underweight (22.2% were severely underweight) (weight-for-age).
The logistic regression model showed that the socioeconomic status of mothers, such as
education, income, religion, occupation, employment status, means of waste disposal, source
of potable water (water suitable for human consumption), and water treatment methods, were
associated with the household food insecurity status of the children and were associated with
inadequacy in children’s MDD (p < 0.05).
The second part of the experiment explored the contribution of maternal nutrition literacy to
the nutritional status of mothers in Niger State, North Central Nigeria. The results showed that
the majority (63.8%) of the mothers were between 26 and 35 years old. More than half (51.6%)
of the mothers did not know what a balanced diet was based on the definitions provided in the
questionnaire. Social media or online information was the most explored source of nutritional
information among mothers (36.4 %). Fifty-four per cent of the mothers indicated that their
nutrition literacy had no positive impact on their dietary quality. The food consumption pattern
showed that fruits/vegetables, and dairy products were the least consumed food groups among
the mothers (7.1% and 9.1%, respectively). More than half (57.6%) of the mothers were within
the normal BMI range, and the mean waist/hip ratio was 0.82 ± 0.08. The regression model
showed that place of residence, occupation, source of potable water, and method of waste
disposal were significantly associated with adequacy of maternal minimum dietary diversity.
Although nutrition knowledge has been reported to influence dietary quality among mothers,
this study showed that other intrinsic factors besides nutrition knowledge significantly
impacted the dietary quality and nutritional status of mothers in the study area. Therefore, to
optimise health outcomes among mothers, stakeholders at all levels must implement programs
and policies that address issues such as insurgence, inflation, climate change, disparity in
wealth distribution, and seasonal vulnerability.
In conclusion, the prevalence of food and nutrition insecurity was high among the participants
due to poor socioeconomic status and poor food environment, thereby compromising the meal
quality and consumption frequency of mothers and their preschoolers. Most mothers adopted
the consumption of ultra-processed foods and beverages as coping strategies to salvage the
impact of hunger and starvation, thereby predisposing them to the risk of TBM and NCDs
among mothers and their preschool children. To mitigate these challenges, efforts should be
geared towards addressing the determinants of food and nutrition insecurity with a
multidimensional approach at the grassroots level and involving all stakeholders and
policymakers, to enable a sustainable food system through nutrition-sensitive agriculture at the
household and community level. Draught resistant and improved variety crops should be used
to mitigate climate change impact on food access and affordability and thus, enhance adequate
consumption of nutrient-dense meals for optimal health outcomes among the participants and
across most food insecure developing nations.
Description
Doctoral Degree. University of KwaZulu-Natal, Pietermaritzburg.