EFFECT OF IVERMECTIN INTAKE ON THE NUTRITIONAL AND HEALTH STATUS OF SCHOOL CHILDREN IN ONCHOCERCIASIS ENDEMIC COMMUNITIES OF EBONYI STATE, NIGERIA

Transcription

1 i EFFECT OF IVERMECTIN INTAKE ON THE NUTRITIONAL AND HEALTH STATUS OF SCHOOL CHILDREN IN ONCHOCERCIASIS ENDEMIC COMMUNITIES OF EBONYI STATE, NIGERIA BY EKWEAGWU, EBERE (MRS) REG NO: PG/M.Sc/03/34667 DEPARTMENT OF HOME SCIENCE, NUTRITION AND DIETETICS FACULTY OF AGRICULTURE UNIVERSITY OF NIGERIA, NSUKKA July 2012

2 ii TITLE PAGE EFFECT OF IVERMECTIN INTAKE ON THE NUTRITIONAL AND HEALTH STATUS OF SCHOOL CHILDREN IN ONCHOCERCIASIS ENDEMIC COMMUNITIES OF EBONYI STATE, NIGERIA BY EKWEAGWU, EBERE (MRS) REG NO: PG/M.Sc/03/34667 A DISSERTATION SUBMITTED IN PARTIAL FULFILLMENT OF THE REQUIREMENTS FOR THE AWARD OF THE DEGREE OF MASTER OF SCIENCE DEGREE IN HUMAN NUTRITION (COMMUNITY AND PUBLIC HEALTH NUTRITION) DEPARTMENT OF HOME SCIENCE, NUTRITION AND DIETETICS FACULTY OF AGRICULTURE UNIVERSITY OF NIGERIA, NSUKKA July 2012

3 iii APPROVAL PAGE This thesis has been approved for the Faculty of Agriculture, University of Nigeria, Nsukka By Prof. (Mrs.) H. N. Ene-Obong (Supervisor) Prof. (Mrs.) N. M. Nnam (Head of Department)

4 iv CERTIFICATION Ekweagwu, Ebere a postgraduate student in the Department of Home Science and Nutrition with Registration Number: PG/MS. Sc/ 03/34667, has satisfactorily completed the requirements for the Degree of Master of Science in Human Nutrition (Community and Public Health Nutrition). The work embodied in this dissertation is original and has not been submitted in part or full for any other diploma or degree of this or any other university Prof. (Mrs.) H. N. Ene-Obong (Supervisor) Dr. (Mrs.) N. Nnam (Head of Department)

5 v DEDICATION Dedicated to the Almighty God whose will is the best and should be appreciated at all times

6 vi ACKNOWLEDGEMENT I wish to acknowledge with appreciation the guidance and encouragement of my supervisor, Prof. H. N. Ene-Obong, in the execution of this work and all her efforts to make me a better academia. Iam also appreciative of the immense contribution made by Prof. E. C. Okeke, and Ms. Lizzy Udenta towards the successful completion of this project. My special thanks go to the Head of Department, Prof. N.M. Nnam, Prof. I.C Obizoba, Prof. Ngwu, Dr. (Mrs.) Madukwe, Dr. (Mrs.) Ola Onuoha, Dr. (Mrs.) Ibeanu, Dr. (Mrs.) Onyenchi, Dr (Mrs.) Nwamara and other staff of this Department for their time, patience and suggestions throughout the duration of this research work. To Prof. M. C. Madukwe and Prof. A. R. Ajayi (Late) of the Department of Agricultural Extension of this University who followed me bumper to bumper on the progress of this work, I owe my immense gratitude. Special thanks are due to the Coordinator and all the staff of Ebonyi state River Blindness Programme for their time, cooperation, assistance and hospitality during the period of data collection. Sincere thanks to Pharm. Obinna Udeogaranya (Mobix) for his patience and understanding during the data analysis. Special thanks also go to the Zonal Coordinator and all the staff of National Health Insurance Scheme, Enugu Zonal Office for the understanding and cooperation during the elongated period of this programme. Sincere thanks are also due to my friends and prayer group members, namely; Uju Mobix, Chizzy, Uju Laz and Ify. Their love and prayers influenced the successful completion of this study. I wish to extend my gratitude to my brothers and sister for their love and encouragement. My deep gratitude goes to my beloved parents, Ichie and Mrs. Lazarus Eze Mama for their parental love and academic concern.

7 vii I recognize a debt of gratitude to my beloved husband Prof. A. E. Agwu of the Department of Agricultural Extension of this University for his time, patience, invaluable help and unflinching love throughout the duration of this study. My sincere appreciation goes to my God given beloved children namely Miracle, Destiny and Goodness for their patience and love even when I denied them my attention in order to concentrate and complete this work. Above all unfeigned and ceaseless praise and thanks are due to the faithful, most dependable and only wise God, my ever present Help for showing me His unfailing favour, journey mercies, love and support. I am indebted to Him. Ekweagwu, Ebere (Mrs.)

8 viii TABLE OF CONTENT Title page i Approval page iii Certification iv Dedication v Acknowledgement vi Table of content viii List of tables xiii List of figures xvi Abstract xvii CHAPTER ONE INTRODUCTION Background Problem statement Objectives of the study Significance of the study CHAPTER TWO LITERATURE REVIEW Onchocerciasis Causes of onchocerciasis Effect of onchocerciasis on people Clinical manifestation of onchocerciasis Skin disease Eye disease Treatment of onchocerciasis Role of Vitamin A in child health Role of iron in child health Indicators of nutritional status

9 ix CHAPTER THREE MATERIALS AND METHODS Area of study Study population Sample size and sampling procedure Data collection and measurement of variables Questionnaire method Anthropometric measurement Biochemical analysis Stool microscopy Data handling and analyses CHAPTER FOUR RESULTS General characteristics Children demographic characteristics Family characteristics of children aged 5 12 years Socio-economic characteristics of parents Parental estimated monthly income Housing / toilet facilities of children Sources of drinking water, water handling/ treatment and refuse disposal system Ivermectin consumption and de-worming of children Ivermectin intake Sources of Ivermectin and its perceived effects on children s well being De-worming frequency and drugs used for de-worming Food habits and dietary intake Types of food mostly eaten and meal pattern of chidren Hour dietary recall Fruit consumption pattern of children Frequently consumed roots/ tubers, cereals, legumes and vegetables

10 x Frequently consumed fruits and vegetables Frequently consumed fish / meat Nutritional status of children in onchocerciasis endemic communities of Ebonyi state Anthropometric measurement and BMI (Boys) Anthropometric measurement and BMI (Girls) BMI categorization of the children according to sex and age ranges using IOTF reference BMI for age Wasting, under weight and stunting (by gender) using ± 2SD of the NCHS standard as cut-off points Body Mass Index (BMI) of boys and girls using the 2007 WHO percentile ranking Health status of children in onchocerciasis endemic communities of Ebonyi state Level of parasitic infection in the children in onchocerciasis endemic communities of Ebonyi state Association of ivermectin intake with nutritional status, health status and parasitic load of children in the study area Ivermectin intake and body mass index Ivermectin intake and BMI percentile ranking of children Ivermectin intake and weight for height (Wasting), weight for age (Under weight) and height for age (Stunting) using ± 2SD Ivermectin intake and health status / parasitic load of the children Parasitic load with Hb level of children Relationship between socioeconomic characteristics of parents, children s age and sex on the nutritional status of the children Relationship between nutritional status of the children and father s socioeconomic status (using IOTF reference BMI for age) Relationship between nutritional status of the children and mother s socioeconomic status (using IOTF reference BMI for age) Relationship between nutritional status of the children and parental monthly

11 xi income (using IOTF reference BMI for age) Relationship between nutritional status of the children and father s socioeconomic status (using BMI percentile ranking of children) Relationship between nutritional status of the children and mother s educational status (using BMI percentile ranking of children) Relationship between nutritional status of the children and parental monthly incomes(using BMI percentile ranking of children) CHAPTER FIVE DISCUSSION Socio-demographic and economic characteristics of parents of the children Living conditions of children and their parents Food patterns and dietary intake of children Nutritional and health status of children and factors affecting them Ivermectin Intake Effect of ivermectin intake on nutritional and health statuses Relationship between socio-economic characteristics of parents and children s age and sex on nutritional status CHAPTER SIX SUMMARY, CONCLUSION AND RECOMMENDATIONS Summary Conclusion Recommendation REFERENCES APPENDIX A: INTERVIEW SCHEDULE APPENDIX B: Mean heights, weights and body mass index for boys aged 5 12 years old in Onchocerciasis endemic communities APPENDIX C: Mean heights, weights and body mass index for girls aged 5 12 years old in Onchocerciasis endemic communities

12 xii APPENDIX D: Health status of forty randomly selected children in onchocerciasis endemic communities APPENDIX C: Height measurement of children during the survey at Ohaukwu LGA of Ebonyi state

13 xiii LIST OF TABLES Table 3.1: Rapid assessment mapping of onchocerciasis in Ebonyi State Table 4.1: Age, sex and educational class distribution of children Table 4.2: Family characteristics of children aged 5 12 years Table 4.3: Socio-economic characteristics of parents Table 4.4: Parental estimated monthly income Table 4.5: Housing / toilet facilities of children Table 4.6: Distribution of respondents by reported source of drinking water source / handling and waste disposal practices Table 4.7: Knowledge and consumption of ivermectin Table 4.8: Source and perceived positive effects of Ivermectin on children s well being Table 4.9: De-worming frequency and types of drugs used for de-worming Table 4.10 Food and snack consumption pattern of the children Table 4.11: Table 4.12: Table 4.13: Table 4.14: Table 4.15: Table 4.16: Table4.17: 24 hour recall of breakfast, lunch, supper and snacks consumed by children aged 5 12 years old in onchocerciasis endemic communities Fruit consumption pattern of children aged 5 12 years old in onchocerciasis endemic communities Frequently consumed roots / tubers, cereals, legumes and oil / oil seeds and nuts by 5 12 years old children in onchocerciasis endemic communities Fruits and vegetables consumed by 5 12 years old children in onchocerciasis endemic communities Frequently consumed fish / meat by 5 12 years old children in onchocerciasis endemic communities BMI categorization of children aged 5 12 years in onchocerciasis endemic communities Haemoglobin concentration of children aged 5 12 years in onchocerciasis endemic communities

14 xiv Table 4.18: Table 4.19: Table 4.20: Table 4.21: Table 4.22: Table 4.23: Table 4.24a: Parasitic load of children aged 5 12 years in onchocerciasis endemic communities Two-way cross tabulation of ivermectin intake with body mass index (BMI) of children aged 5 12 years in onchocerciasis endemic communities Two-way cross tabulation of ivermectin intake with body mass index (BMI) percentile ranking of children aged 5 12 years in onchocerciasis endemic communities Effect of Ivermectin on nutritional wasting, stunting and general malnutrition of children aged 5 12 years in onchocerciasis endemic communities Two-way cross tabulation of Hb and parasitic load with ivermectin intake of children in onchocerciasis endemic communities Two-way cross tabulation of parasitic load with Hb levels of children aged 5-12 years in onchocerciasis endemic communities Two-way cross tabulation of father s educational status with BMI of children aged 5-12 years in onchocerciasis endemic communities Table 4.24b: Two-way cross tabulation of father s occupational status with BMI of children aged 5-12 years in onchocerciasis endemic communities Table 4.25a: Two-way cross tabulation of mother s educational status with BMI of children aged 5-12 years in onchocerciasis endemic communities Table 4.25b: Two-way cross tabulation of mother s occupational status with BMI of children aged 5-12 years in onchocerciasis endemic communities Table 4.26: Table 4.27a: Relationship between nutritional status of children and parental monthly Income (using IOTF reference BMI for age) Two-way cross tabulation of father s educational status with BMI percentile ranking of children aged 5-12 years in onchocerciasis endemic communities Table 4.27b: Two-way cross tabulation of father s occupational status with BMI percentile ranking of children aged 5-12 years in onchocerciasis endemic communities Table4.28a: Two-way cross tabulation of mother s educational status with BMI

15 xv percentile ranking of children aged 5-12 years in onchocerciasis endemic communities Table 4.28b: Two-way cross tabulation of mother s occupational status with BMI percentile ranking of children aged 5-12 years in onchocerciasis endemic communities Table 4.29: Two-way cross tabulation of parental monthly earnings with BMI percentile ranking of children aged 5-12 years in onchocerciasis endemic communities

16 xvi LIST OF FIGURES Figure 1: Black fly Figure 2: O. volvulus Figure 3: Raised nodules under the skin Figure 4: Rapid epidemiological mapping of onchocerciasis in Ebonyi State, Nigeria Figure 5: Figure 6: Figure 7: BMI distribution of boys in onchocerciasis endemic communities compared with WHO (2007) reference BMI for boys 5 19 years BMI distribution of girls in onchocerciasis endemic communities compared with WHO (2007) reference BMI for girls 5 19 years Categories of boys and girls by wasting, under weight and stunting in onchocerciasis endemic communities using 2 SD of NCHS standards as cut offs Figure 8: BMI for age percentile ranking by sex

17 xvii ABSTRACT The study assessed the nutritional and health status of school-aged children (5-12 years) in onchocerciasis endemic communities of Ebonyi State and determined the effect of Ivermectin intake on haemoglobin and parasitic load of the children. The study was conducted in Ebonyi State of Nigeria. A multi stage random sampling technique was used in selecting respondents for the study. A total sample of 360 school aged children aged 5 12 years (made up of 194 males and 166 females) participated in the study. A structured, validated and pretested questionnaire was used to elicit vital information. The weight and height of the children were taken using standard procedures. Blood samples of the children were subjected to haematological analyses within 12 hours of collection. Haemoglobin levels were determined using cyanomethaemoglobin method. The WHO body mass index (BMI) for age z scores and the International Obesity Task Force (IOTF) were used to classify the children. Stool microscopy was carried out to detect parasitic infection. Secondary data were sourced from relevant documents of the Ebonyi State Ministry of Health, State Onchocerciasis Office and other relevant research materials. Data generated from this study were keyed into Excel spreadsheet and later summarized using SPSS 16.0 version. Frequency distribution, percentages, mean, charts and Chi - square were the statistical tools used for the analysis. The 24 hour dietary recall data showed that majority of the respondents ate cassava-based food for breakfast and dinner quite often. Less than 2.0% of the respondents frequently consumed chicken, egg and meat. Fruits were not frequently consumed by majority (73.6%) of the children. Irrespective of the standard used, the indicators of nutritional status showed high prevalence of malnutrition in these communities. The mean BMI of the boys and girls ranged from 14.77kg/m kg/m 2 and 14.14kg/m kg/m 2, respectively. These values were both below the standards. The IOTF classified 94.7% of the

18 xviii children as having various degrees of thinness and only 5.3% with normal BMI. The WHO percentile ranking showed that 11.4% of the children were underweight, 31.4% were at risk of underweight, 1.7% were overweight, 4.4% were at risk of overweight and 51.1% were probably normal. The haemoglobin concentrations of the children showed that 70% of the boys and girls were anaemic (haemoglobin concentration of 7>11gm/dl). Another, 12% of the boys and 16.7% of the girls were severely anaemic (haemoglobin concentration of < 7gm/dl) and about 18% and 13.3% of the boys and girls, respectively were normal. There was a significant positive association between ivermectin intake and nutritional status of the children (P <0.01). The association between haemoglobin level and ivermectin intake was not significant (P>0.05). However, there were more anaemic children among those who did not take ivermectin. Stool microscopy detected presence of intestinal helminth (Hookworm and Ascaris lumbricoides ova) in the faeces of 32.5% of the children. There was a significant association between ivermectin consumption and parasitic load. This confirmed the speculation that ivermectin has a deworming effect. Factors that affected the nutritional and health status of these children were their food habit, which was found to be very monotonous and mainly based on starchy staples and some other socio-demographic variables. These findings suggest the need for targeted health and nutrition intervention in these communities and also raise the question of appropriate anthropometric standards for the Nigerian population.