Socio-demographic and immunization characteristics of siblings of children with severe acute malnutrition attending paediatric nutrition clinic of Ahmadu Bello University Teaching Hospital, Shika, Zaria

Abstract

Introduction
Severe acute malnutrition (SAM) is a disease of the developing world. Poverty and famine have escalated its prevalence. In Nigeria, the Boko Haram menace has resulted in an upsurge of internally displaced persons in need of food and shelter. It is estimated that about 16 million children are affected by malnutrition worldwide and accounts for two million deaths worldwide annually. Evidence suggests incomplete vaccination predisposes to malnutrition and its unwanted sequelae. Anecdotal findings show that most siblings of children with SAM were incompletely vaccinated and hence are at risk of SAM. The study thus aimed at assessing their socio demographic characteristics and immunization to document their vulnerability to development of SAM.

Materials and Methods
This was a cross-sectional study of socio-demographic characteristics and immunization status of siblings of children with SAM being rehabilitated in the Paediatric nutrition clinic of Ahmadu Bello University Teaching Hospital Shika Zaria, between March 2009 and September 2014. The information was directly obtained from the mothers of the children as they presented to the clinic and then recorded into a structured questionnaire.

Results
The socio-demographic characteristics of 229 parents and immunization status of siblings of children with SAM were reviewed. Most family settings were monogamous (54.2%) and the majority of the fathers were semi-skilled labourers (26.2%). Only 76 (33.2%) of the mothers had some form of formal education while 153 (66.8%) were not formally educated. The majority of the subjects received BCG vaccine but only 56% and 55.5% of the subjects completed their DPT3 and oral polio 3 vaccinations respectively.

Conclusion
The study showed that fathers of siblings of children with SAM were semi-skilled labourers while their mothers were predominantly stay at home and not formally educated with limited source of income. Furthermore, BCG vaccination was the most commonly received vaccine and it is recommended that concerted effort should be made towards improving vaccine delivery among siblings of children with SAM. Adult literacy and empowerment of mothers may help achieve improved immunization of siblings of children with SAM.

Full text

Socio-demographic and immunization characteristics of
siblings of children with severe acute malnutrition
attending paediatric nutrition clinic of Ahmadu Bello
University Teaching Hospital, Shika, Zaria
ABSTRACT
Introduction: Severe acute malnutrition (SAM) is a disease of the developing world. Poverty and famine have escalated its prevalence. In
Nigeria, the Boko Haram menace has resulted in an upsurge of internally displaced persons in need of food and shelter. It is estimated that
about 16 million children are affected by malnutrition worldwide and accounts for two million deaths worldwide annually. Evidence suggests
incomplete vaccination predisposes to malnutrition and its unwanted sequelae. Anecdotal findings show that most siblings of children with
SAM were incompletely vaccinated and hence are at risk of SAM. The study thus aimed at assessing their socio demographic characteristics
and immunization to document their vulnerability to development of SAM. Materials and Methods: This was a cross-sectional study of
socio-demographic characteristics and immunization status of siblings of children with SAM being rehabilitated in the Paediatric nutrition
clinic of Ahmadu Bello University Teaching Hospital Shika Zaria, between March 2009 and September 2014. The information was directly
obtained from the mothers of the children as they presented to the clinic and then recorded into a structured questionnaire. Results: The
socio-demographic characteristics of 229 parents and immunization status of siblings of children with SAM were reviewed. Most family
settings were monogamous (54.2%) and the majority of the fathers were semi-skilled labourers (26.2%). Only 76 (33.2%) of the mothers
had some form of formal education while 153 (66.8%) were not formally educated. The majority of the subjects received BCG vaccine but
only 56% and 55.5% of the subjects completed their DPT3 and oral polio 3 vaccinations respectively. Conclusion: The study showed that
fathers of siblings of children with SAM were semi-skilled labourers while their mothers were predominantly stay at home and not formally
educated with limited source of income. Furthermore, BCG vaccination was the most commonly received vaccine and it is recommended
that concerted effort should be made towards improving vaccine delivery among siblings of children with SAM. Adult literacy and
empowerment of mothers may help achieve improved immunization of siblings of children with SAM.
Keywords: Immunization, Nigeria, severe acute malnutrition, socio-demography
INTRODUCTION
Severe acute malnutrition (SAM) is a serious health menace
and accounts for up to two million under-five deaths
annually worldwide. Globally, It is estimated that about
16 million children are affected
[1,2]
with the highest
disease burdens in the African and South-East Asia World
Health Organization Regions.
[3]
It has been associated with
about 50–60% of under-five mortality in developing
countries.
[4,5]
Famine, conflicts/war resulting in human
displacements, loss of earnings are often contributory
factors. It was estimated that about nine million people
needed humanitarian aid in the Horn of Africa region due to
famine.
[6]
In Nigeria the conflict in North-east has resulted in
a huge economic, humanitarian and health burden; while
SANI M. MADO
1
, J.O. ALEGBEJO
2
,IBRAHIM ALIYU
3
1
Department of Paediatrics, ABU/ABUTH Zaria, Jos, Nigeria,
2
Department of Paediatrics, ABU Zaria, Jos, Nigeria,
3
Department of Paediatrics, BUK/AKTH Kano, Jos, Nigeria
Address for correspondence: Dr. SM Mado, FMC Paed,
Department of Paediatrics, ABU/ABUTH Zaria, Jos, Nigeria.
E-mail: sanimado@yahoo.co.uk
Submission: 6 June 2019 Revision: 28 November 2019
Acceptance: 18 December 2019 Published: 5 February 2020
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For reprints contact: reprints@medknow.com
How to cite this article: Mado SM, Alegbejo J, Aliyu I. Socio-demographic and
immunization characteristics of siblings of children with severe acute malnutrition
attending paediatric nutrition clinic of Ahmadu Bello University Teaching Hospital,
Shika, Zaria. Sub-Saharan Afr J Med 2019;6:129-33.
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the conflict in the middle belt between farmers/herders has
resulted in agricultural crisis, in the “food basket”of Nigeria.
The underlined poverty affecting many Nigerians
[7]
in
addition to the conflicts in both North-east, middle belt
and recently North-west of the country might have
contributed to food scarcity, hunger and overt severe
acute malnutrition.
Parental ignorance in contributing to SAM is
acknowledged. Their disposition towards childhood
immunization also contributes to under-five morbidity
and mortality. The relationship between measles and
SAM is intertwined. About 3–4% of children with measles
may develop SAM because of concomitant severe anorexia
and prolonged diarrhoeal diseases which can lead to
malnutrition
[8]
while SAM increases the fatality
associated with measles because inadequate vitamin A
store is a frequent finding in poor nutrition and studies
have shown an association between vitamin A deficiency
and increased mortality in children with acute measles
infection.
[8,9]
MATERIALS AND METHODS
This was a cross-sectional study of socio-demographic
characteristics and immunization of siblings of children
with severe malnutrition being rehabilitated in the
Paediatric Nutrition clinic of Ahmadu Bello University
Teaching Hospital Shika Zaria, between March 2009
and September 2014. The socio-demographic
characteristics of parents included parental education,
occupation, religion, ethnicity and fathers’number of
wives. Data on immunization status of the children
and number of children delivered by the mothers were
also collected. The information was directly obtained
from the mothers of the children as they presented to
the clinic and then recorded into a structured
questionnaire.
DATA ANALYSIS Data were entered into statistical
software—Statistical Package for Social Sciences version
16 (SPSS Inc, Chicago Illinois USA). Categorical variables
were presented as frequencies and percentages.
RESULTS
The socio-demographic characteristics of 229 fathers of
siblings of children with SAM are shown in Table 1 and 124
(54.2%) of the fathers were into monogamous marriage
while 45.8% were into polygamy. The numbers of children
delivered by the mothers were grouped. The majority
(63.3%) had between 1 and 4 children while the rest
(36.7%) had between 5 and 15 children as in Tables 2
and 3.
Most of the fathers were unskilled or semi-skilled labourers
while only 2.2% of them had no monthly earnings.
A total of 122 (53.3%) of the mothers were stay at home
mothers while 107(46.7%) had some source of income.
Majority 197 (86.0%) of parents (mothers/fathers) are
predominantly Hausas and Fulani and Muslims. Other
tribes included Jaba, Kadara, Kaje, Igala, Idoma, Mada and
Yorubas who are predominantly Christians. The educational
level of both mothers and fathers are shown in Tables 4
and 5.
Table 1: Social characteristics of the fathers of children with
severe acute malnutrition
Number of wives Frequency Percent
1 124 54.2
2 76 33.2
3 12 5.2
4 17 7.4
Total 229 100.0
Table 2: Number of children delivered by the mothers of children
with severe acute malnutrition
Number of children delivered Frequency Percent
1-4 146 63.3
5–15 83 36.7
Total 229 100.0
Table 3: Occupational status of the fathers of children with
severe acute malnutrition
Occupation Frequency Percent
Teacher 15 6.6
Security 5 2.2
Businessman 28 12.2
Student/unemployed 5 2.2
Senior public servant 34 14.8
Semi-skilled labourer 60 26.2
Unskilled labourer 79 34.5
Junior public servant 3 1.3
Table 4: Educational level of mothers of siblings of children with
severe acute malnutrition
Level of education Frequency Percent
Tertiary 9 3.9
Secondary 13 5.7
Primary 54 23.6
None 153 66.8
Total 229 100.0
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Majority of the subjects received BCG vaccine and this was
followed by DPT and oral polio 1 respectively. Only 56% and
55.5% of the subjects completed their DPT3 and oral polio 3
vaccinations respectively
DISCUSSION
The proportion of fathers of siblings of children with SAM
engaged in a monogamous marital lifestyle is slightly higher
than those practicing polygamy. The possible reason for the
slightly higher monogamous marital lifestyle among the
fathers may be attributed to the level of education as
significant proportion of fathers had either secondary or
tertiary education. The practice of monogamous lifestyle
was also reported by Otite.
[10]
He documented a gradual
trend towards a westernized lifestyle of a nuclear family
setting with a reduction in the number of children among
Nigerians. The current study showed that most mothers
delivered between 1 and 4 children indicating a small family
size and the reason for this is not very clear as it could not be
attributed to their level of education because about 67% of
them were not formally educated. According to the 2006
census in Nigeria, about 72% of household had five persons
[11]
and the number of five persons per household however
is similar to that reported in the 1999 and 2003 Nigerian
Demographic and Health Survey. Orubuloye
[12]
in his
submission attributed some of these demographic
changes to the impact of improving maternal education
and societal urbanization. Educated mothers are more likely
to marry at a later age, and they may also be unwilling to
marry into a polygamous setting and more likely to practice
family planning and child spacing. The 2008 DHS data shows
that poor educational achievement and unemployment rate
are huge problems in Nigeria and north-west is the worst hit
region
[13]
and may possibly explain why the majority of the
fathers in our study were unskilled and semi-skilled. The
insurgency of the Boko Haram has further escalated the
already depreciating health indices.
About 46.7% of mothers in our study had some source of
income and this observation was higher than the 12%
reported by Igbedioh
[14]
in his study among women in
Benue state, North-central Nigeria.
It is estimated that immunization could save about two
million children from vaccine preventable diseases.
[15]
The
immunization pattern of the children in this study showed a
particular trend which was not different from those in the
general population. BCG was the most received vaccine,
followed by the first dose of the polio vaccine, then the first
dose DPT, while measles was the least. This clearly showed
that there were fewer tendencies of caregivers to repeatedly
visit the vaccination centres for their children vaccination.
This may be attributed to burn-out on the part of the
caregivers, possibly due to prolonged waiting time,
repeated non availability of vaccines at the centres
(missed opportunities), or the practice of restriction of
vaccinations by health workers to specific days of the
week which may not be favourable to the caregivers.
Concerted efforts from donor agencies and government
in most developed countries have expanded their
immunization coverage to almost 90%
[16]
but the story is
different in most developing countries. The level of vaccine
effectiveness and acceptance in most developing nations
have exhibited a downward trend. In 2004, 80% DPT3
coverage was achieved in Nigeria, however we have
witnessed a progressive decline in vaccine coverage
falling down to 13–23%.
[17]
According to the World Health Organization, a child is
adjudged to be fully immunized if a dose of BCG, three
doses of oral polio vaccine, three doses of penta-valent DPT-
Hepatitis B vaccine-Hemophilus influenza type b vaccine;
and a dose of measles vaccine have been administered. This
should be given in the first year of life during five visits.
[18]
During the year under review, administration of Hepatitis B
and Haemophilus influenza type b vaccine was not routine
and therefore not analysed in this communication.
In the 2003 National survey the BCG acceptance was only
29.3%; while in 2011 this rose to 45%.
[17]
The BCG acceptance
in this study was slightly higher than the EPI policy average
of 80%;
[17]
however this figure was lower than the reported
99.55% from Enugu State but higher than 35.23% reported in
Kano. Lower BCG acceptance rate of 46% was also reported
by Orogade et al. from Zaria, Kaduna, Gusau, Abuja and Bida
both in Northern Nigeria. This difference may be related to
differences in the level of maternal education, and
awareness of the usefulness of vaccination. More-so our
study and that of Orogade et al.
[19]
were hospital based
studies.
The national DPT3 coverage stood at 67.73% with south
eastern Nigeria having a regional coverage of 91.18% while
the lowest of 46.16% was reported in the north-eastern
Nigeria;
[17]
however our study recorded 56% acceptance of
Table 5: Educational level of fathers of siblings of children with
severe acute malnutrition
Level of education Frequency Percent
Tertiary 49 21.4
Secondary 60 26.2
Primary 8 3.5
None 112 48.9
Total 229 100.0
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DPT3, this was similar to WHO-UNICEF estimate of 54% for
Nigeria but lower than the 81% reported by Odusanya
et al.
[20]
In their submission they attributed the influence
of health facilities readily making vaccines available as a
contributing factor to the increased acceptance rate.
Nigeria, India, Pakistan and Afghanistan were polio hot
zones however immense contribution from Bill and
Melinda; and Dangote Foundations have drastically
reduced its transmission in Nigeria to the point of
eradication. There had been tremendous increase in the
oral polio vaccine coverage in Nigeria; this progressively
increased from 55% in 1990 up to 73.95% in 2010.
[17]
However south-east Nigeria has a regional coverage of
86% while the north-eastern Nigeria has the lowest
coverage of 60.2%. However our study showed that 55.5%
of the children had received the third dose of oral polio.
Measles has a reciprocal relationship with malnutrition and
mortality is heightened in children with malnutrition that
contract measles.
[8,9]
The WHO-UNICEF estimate for
measles coverage stands at 66% for India, 85% for Ghana
while it is 62% for Nigeria;
[19]
our study recorded 44.1%
which was lower than the National average and the 74%
reported by Odusanya et al.,
[20]
but similar to the regional
average of 47.15% recorded in the south-southern part of
Nigeria but higher than the 16.48% reported in Kano in
north-western Nigeria.
[17]
LIMITATION OF THE STUDY
None of the findings among variables were statistically
significant possibly being a descriptive study.
CONCLUSION/RECOMMENDATION
This study showed that fathers of siblings of children with
SAM were semi-skilled labourers while the mothers were
predominantly stay at home and not formally educated
mothers with limited source of income. Furthermore,
BCG was the most commonly received vaccine and less
than half of the children received measles vaccine. It is
recommended that concerted effort should be made
towards improving vaccine delivery. Adult literacy and
empowerment of mothers may help achieve improved
immunization of siblings of children with SAM. There
should be a future study on the outcome of the siblings
of children with SAM to assess the impact of nutrition
counselling education on the mothers.
Acknowledgement
We will like to appreciate all the caregivers who participated
in this study.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
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