|Year : 2017 | Volume
| Issue : 1 | Page : 49-55
A comparative study of nutritional status of adolescents from selected private and public boarding secondary schools in Ibadan, South Western Nigeria
Bolanle A Kola-Raji, Mobolanle R Balogun, Tinuola O Odugbemi
Department of Community Health and Primary Care, College of Medicine, University of Lagos, Lagos, Nigeria
|Date of Web Publication||7-Jun-2017|
Mobolanle R Balogun
Department of Community Health and Primary Care, College of Medicine, University of Lagos, Idi Araba Campus, Lagos
Source of Support: None, Conflict of Interest: None
Background: Adolescents form a part of the productive age group in Nigeria, and giving attention to their needs is essential in the development of the nation. Assessing the nutritional status of boarders in secondary schools could provide evidence-based information, which could be used for future nutritional interventions. This study compared the nutritional status of the adolescents in private and public boarding secondary schools in Ibadan, South Western Nigeria.
Materials and Methods: This was a descriptive cross-sectional study of 239 and 251 participants from both private and public boarding secondary schools, respectively, selected by multistage sampling technique. Socio-demographic characteristics and anthropometric measurements were analysed using Epi info version 3.5.1 software and the Statistical Package for the Social Sciences version 20 software.
Results: The mean age of the students in the private and public schools was 12.9 ± 2.05 years and 14.0 ± 1.49 years, respectively. The prevalence of stunting, underweight, normal weight, overweight and obesity among private school participants was 2.5, 39.3, 51.9, 8.0 and 0.8% respectively, whereas that of public school participants was 8.4, 37.1, 60.6, 2.4 and 0.0, respectively. These differences in the stunting and body mass index categories were statistically significant (P < 0.05). Higher proportion of the younger adolescents in both private and public schools were underweight (P < 0.001). In private schools, a higher proportion of male students were underweight (P = 0.001), whereas a higher proportion of the older adolescents were overweight (P = 0.033).
Conclusion: More private school boarders were underweight and overweight, whereas more public school boarders were stunted. Students, school administrators and parents should be enlightened on the nutrition problems of adolescents and their potential danger.
Keywords: Adolescents, anthropometry, boarding schools, Nigeria
|How to cite this article:|
Kola-Raji BA, Balogun MR, Odugbemi TO. A comparative study of nutritional status of adolescents from selected private and public boarding secondary schools in Ibadan, South Western Nigeria. J Med Trop 2017;19:49-55
|How to cite this URL:|
Kola-Raji BA, Balogun MR, Odugbemi TO. A comparative study of nutritional status of adolescents from selected private and public boarding secondary schools in Ibadan, South Western Nigeria. J Med Trop [serial online] 2017 [cited 2020 Aug 14];19:49-55. Available from: http://www.jmedtropics.org/text.asp?2017/19/1/49/207594
| Introduction|| |
Adolescence is a transitional phase from childhood to adulthood, and as defined by the World Health Organization, adolescents are a group of persons between the ages of 10 and 19 years. It is a phase characterized by physiological, psychological and social changes. Adolescents make up about one-fifth of the total world’s population and 22% of the population in Nigeria according to the 2006 census report, whereas young people of ages 10–24 years were approximately one-third of the total population.,
Adolescents in low- and middle-income countries such as Nigeria are at an increased risk of under-nutrition mainly because of poverty and inadequate food intake. There is also an increased incidence of overweight and obesity among the adolescents in developing countries; this is due to the adoption of nutrition transition lifestyle. It is established that over-nutrition and under-nutrition are most times simultaneous problems in the adolescents. A global data showed obesity among children and adolescents to be about one out of 10.
The active nutritional transition among the adolescents in the developing countries causing overweight or obesity pre-disposes them to health problems such as diabetes and cardiovascular diseases. The adolescence phase has been considered as a critical period to develop obesity, and prevention has been proposed as a public health priority. Obesity can predict compromising health issues later, as they get older, and this has a serious implication for public health.
Nutritional status of adolescents is measured in terms of weight-for-height and expressed as body mass index (BMI), which is a direct reflection of the cumulative effects of health and nutrition from childhood. Adolescence, being a time of rapid growth and change, requires an increase in the intake of micronutrients. Nutritional problems of adolescents, whether under-nutrition, over-nutrition or nutrition-related diseases, are as a result of dietary inadequacies, which may be related to factors such as physiological, socio-economical and psychosocial factors.
Checking of BMI of adolescents is recommended whenever feasible, irrespective of the main type of nutrition problems to be expected, and without waiting for more specific reference data; when BMI is too low or too high among adolescents, it should trigger an adequate response from healthcare providers. Adolescents in boarding schools could be at a higher risk of developing nutritional deficiencies; this may be due to the financial constraints by either public or private owners in providing the nutrition essentials for the students in their boarding facilities. The aim of this study was to compare the prevalence of stunting, underweight, overweight and obesity among adolescents in private and public boarding secondary schools using anthropometric measurements and determine the factors influencing the nutritional status of these adolescents.
| Materials and methods|| |
Ibadan, which is the capital of Oyo state, is located approximately on longitude 3°5′ east of the Greenwich meridian and latitude 7°23′ north of the equator at a distance some 145 km North east of Lagos. Oyo state has 969 public and 57 private secondary schools, out of which 536 private and public schools are in Ibadan. There are eight public and 21 private secondary schools that have boarding facilities in Ibadan. This study was conducted among boarding students (live-in students) in public and private secondary schools within the ages of 10–19 years in Ibadan, Oyo state.
Study design and sample size determination
The design of this research was a descriptive cross-sectional study. A minimum sample size of 237 for each group was determined using n = (U + V)2 P1 (1−P1) + P2 (1−P2)/(P1−P2)2 with the standard normal deviate (U) as 1.96, power at 80% (V) of 0.84 and prevalence P1 and P2 of underweight from public and private schools, respectively, as 39 and 27%.
A multi-stage sampling method was used. In stage one, purposive numbers of four public and three private boarding schools were selected using simple random sampling (balloting). In stage two, stratified sampling was used to achieve a proportionate sample for each of the selected schools; respondents were then selected from the pre-existing hostel registers by a simple random sampling technique using a table of random numbers till the required numbers of students to be studied were selected.
Data collection and ethical consideration
An interviewer-administered questionnaire was used to collect socio-demographic data. For anthropometric measurements, weight was measured to the nearest 0.1 kg using a portable weighing device (Camry® scale, BR9015B). The machine was standardized about every 30 min by calibrating it to zero. Each student was informed to empty his/her pocket and remove the footwear and was lightly clothed before mounting the scale. The students’ heights were measured using a calibrated metre rule. Each student stood barefoot on the basal part of the measuring device with his/her feet together. His/her shoulders, buttocks and heels were touching the vertical measuring board for accurate reading.
Four research assistants, who are undergraduates, were trained on how to administer the questionnaires and take anthropometric measurements. A pilot of the questionnaire and measurements was conducted in a secondary school in Isolo, Lagos.
BMI was calculated using the standard equation: weight (kg)/height (m). Malnutrition was defined using the cut-offs: stunting (height for age Z-scores <−2 standard deviation (SD)); underweight: BMI <18.5; overweight: BMI 25–29.9 and obesity: BMI ≥ 30.
Ethical approval for this study (Ref. No: ADM/DCST/HREC/2061) was obtained from the Health Research and Ethics Committee of Lagos University Teaching Hospital, and written informed consent was obtained from the participants. Nutritional counselling was given to those with abnormal anthropometric findings.
Data entry was performed using Epi info version 3.5.1 software and statistical analysis was performed using the Statistical Package for the Social Sciences version 20 software (SPSS Inc., Chicago, IL, USA). Comparisons of categorical variables between the two groups as well as association between variables were determined using Chi-square test and Fisher’s exact test where applicable. The level of significance for all statistical analyses was set at 5%.
| Results|| |
About half, 124 (51.9%), of the respondents in the private schools were females, whereas 148 (59.0%) were males in the public schools (P = 0.021). Most of the participants, 112 (46.9%), in the private schools were younger and between the ages of 10 and 12 years, whereas majority of the participants, 180 (71.7%), from public schools were between the ages 13 and 15 years (P < 0.001). Majority in private, 201 (84.1%), and public, 236 (94%), schools were Yoruba; the Igbo and Hausa students were 6.3 and 0.4%, respectively, in the private schools and 2.4 and 0%, respectively, in the public schools [Table 1].
Six (2.5%) participants in private boarding schools and 21 (8.4%) in public boarding schools were stunted. There was a statistically significant difference in the prevalence of stunting in the two groups (P = 0.005) [Table 2].
One-third of the participants from private schools 94 (39.3%) and public schools 93 (37.1/%) were found to be underweight, whereas 8.0 and 2.4% in private and public boarding schools, respectively, were overweight. Obesity was found in 2 (0.4%) participants in private school and none in public schools. Malnutrition was more common among the adolescents in private than that in public boarding schools (P = 0.004) [Table 3].
In bivariate analyses, there was no statistically significant association between sex, age group, class and stunting in both private and public schools (P > 0.05) [Table 4]. There was a statistically significant association between sex and underweight in public schools, with a higher proportion (45.3%) of male students being underweight compared to 25.2% of the female students (P = 0.001) There were statistically significant associations between age group, class and underweight status in both private and public schools. In private schools, higher proportions of students in age group 10–12 years (52.7%) and in junior secondary school (JSS) (52.2%) were underweight. Similarly, in public schools, higher proportions of participants in age group 10–12 (65.6%) and in JSS were underweight (48.0%) [Table 5].
|Table 4: Association between demographic characteristics and stunting among students|
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|Table 5: Association between demographic characteristics and underweight among students|
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Only an association between age group and overweight was found to be statistically significant in private schools. A higher proportion of students in age group 16–18 years (19.2%) were overweight compared to 9.8 and 4% in the 10–12 years and 13–15 years range, respectively (P = 0.033) [Table 6].
|Table 6: Association between demographic characteristics and overweight among students|
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| Discussion|| |
Adolescent malnutrition in the developing countries is currently receiving attention. Data available suggest high prevalence of under-nutrition in South and South East Asia and Sub-Saharan Africa. From the results of this study, the percentage of stunting in private boarding schools was found to be 2.5%, whereas that of public schools was 8.4%, and the overall average percentage of stunting of all participants was 5.5%. This prevalence of stunting is much lower than that reported in among the adolescents in Port Harcourt (36.3%) but higher when compared to 3% prevalence reported in a study among the adolescents age of 11–12 years in Jamaica.
The higher prevalence of stunting in public schools suggests chronic under-nutrition, which might result in slowing the metabolic process of maturation. A study in Abeokuta also showed higher prevalence of stunting in public schools than that in private schools. Another similarity with our study was the lack of significant associations among sex, age group and stunting in both type of schools.
The existence of higher prevalence of underweight among private schools participants in this study was a surprise. However, the prevalence of underweight was high in both school types, and a possible reason for this could be the poor social and health services in the developing countries as mentioned by other authors.
Findings from this study further revealed that there was a statistically significant association between age group and underweight in both private and public boarding schools. Higher proportion of age group 10–12 years in both schools were underweight; this may be because of putting a kid in boarding schools at an early age which may make them more difficult to adjust to the food types and feeding system of the boarding schools, although a study among school children and adolescents in another part of Nigeria showed that there was no statistically significance association between age group and underweight.
In addition, there was a statistically significant association between class and underweight in both private and public boarding schools. This could also be linked to the age group, because a high proportion of the participants in age group 10–12 were in JSS class.
Using BMI, the results showed that prevalence of overweight and obesity among private boarding school participants was 8.0 and 0.8%, respectively, whereas respondents from public boarding schools had a prevalence of overweight and obesity at 2.4 and 0.0%, respectively. This prevalence for public schools was similar to a study conducted in Osun, being 4.0% and 1.2% and 2.3% and 0.0% for prevalence of overweight and obesity in private and public schools, respectively, whereas the prevalence of overweight for private schools was higher than that of the study conducted in Osun. This prevalence was also similar to those that had reported in different parts of Nigeria., The study conducted in Lagos state reported a prevalence of overweight as 3.1 and 3.0% for both urban and rural areas and 0.4 and 0.0% for prevalence of obesity in both urban and rural areas. The findings in this study also showed a higher prevalence of overweight for private schools than that for public schools (i.e. 8.0% vs 3.1%), whereas the results of a study in Lagos were closer to the prevalence of overweight in public boarding schools, that is, 2.4% vs 3.1%.
Findings from this study suggest that the prevalence of both overweight and obesity is gradually increasing in Nigeria. This may probably be due to the increased rate of urbanization and industrialization, because these are major culprits for increase in prevalence of childhood obesity. The results from private school participants were also compared to a prevalence reported in a study conducted in South Africa, which showed 7.8% school children aged 10–15 years as overweight.
These overweight and obesity prevalence from this study were actually very low when compared to that of other parts of the world; for example, some studies conducted in Russia showed prevalence of overweight and obesity at 19.8 and 7.9%, respectively. Another survey made in New Zealand showed prevalence of overweight and obesity at 21 and 8% respectively. A similar study conducted in Cyprus also reported overall overweight prevalence among boys and girls to be 16.9 and 13%, respectively, and prevalence of obesity at 10.3 and 9.1% for both male and female, respectively.
There was no statistically significant association between sex and overweight, although results from this study showed prevalence of overweight in females in private school to be 11.3%, whereas their male counterparts had 5.2%. For public schools, percentage prevalence of overweight was 3.9% among females, whereas their male counterparts had 1.4%. This showed that females have higher tendency of being overweight or obese than their male peers. This was also noted in the study conducted in Lithuania, which reported prevalence of overweight to be 1.8% in 13-year-old boys and 2.6% in 13-year-old girls, although this is contrary to the same study in United states that reported the prevalence of overweight to be 12.6% in 13-year-old boys and 10.8% in 13-year-old girls.
Some other studies have also shown significant sex differences in the prevalence of underweight, overweight and obesity. This study showed higher prevalence of under-nutrition among males in public schools. This trend is similar to the study conducted in Jamaica, which reported that 10.6 and 7.1% of the male and female adolescents, respectively, were underweight, and 8.4 and 11.7% were the prevalence for overweight in males and females’, respectively.
This trend is also similar to that documented in studies among school-aged children in India, Benue and Ogun state. The study in Benue showed the prevalence of overweight to be 9.7%, but 20.3% of girls were overweight than 16.2% of boys. Similarly, in a study among school children aged 6–19 years in Abeokuta, 3.2% of males and 5.1% of females were obese using weight-for-age as criteria. The finding of higher prevalence of both overweight and obesity among girls than boys in this study may be partly due to genetic predisposition and some other preventable lifestyles. In contrast, boys of the same age group are more physically active in regular sporting activities such as football, and this reduces their risk of overweight and obesity.
Results observed from this study showed that more number of the older adolescents in private schools were overweight (P = 0.033); this is similar to the findings in Osun and could be as a result of adoption of the nutrition transition lifestyle alluded to earlier.
| Conclusion|| |
More private school boarders were underweight and overweight than their public school counterparts, whereas more public school boarders were stunted than their private school peers did. Factors associated with underweight status in both school types were younger age and junior class. It is recommended that students, school administrators and parents should be enlightened on the nutritional problems of the adolescents and their potential danger.
We thank Mrs. Folashade Oyeleye and Mr. Moshood Adebayo of Oyo State Universal Basic Education Board for their help in getting approval from the schools used in this study.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
World Health Organization. Nutrition in adolescence − issues and challenges for the Health Sector Issues in Adolescent Health and Development, CAH Nutr 2005;1-26:31-3.
WHO Multicentre Growth Reference Study Group. WHO Child Growth Standards based on length/height, weight and age. Acta Paediatr Suppl 2006;450:76-85.
Kurz KM. Health Consequences of Adolescent Childbearing in Developing Countries. ICRW Working Paper No. 4. Washington, D.C; 1997.
Onyiriuka AN, Egbagbe EE. Anthropometry and menarcheal status of adolescent Nigerian Urban Senior Secondary School girls. Int J Endocrinol Metabol 2013;11:71-5.
Schwartländer B, Stover J, Hallett T, Atun R, Avila C, Gouws E et al.
Towards an improved investment approach for an effective response to HIV/AIDS. Lancet 2011;377:2031-41.
The National Health and Nutrition Examination Surveys (NHANES) Anthropometry Procedures Manual; 2007. p. 3-7.
Intiful FD, Ogyiri L, Asante M, Mensah AA, Steele-Dadzie RK, Boateng L. Nutritional status of boarding and non-boarding children in selected schools in the Accra Metropolis. J Biol Agric Healthc 2013;3:156-62.
Opara DC, Ikpeme EE, Ekanem US. Prevalence of stunting, underweight and obesity in school aged children in Uyo, Nigeria. Pak J Nutr 2010;9:459-66.
Cordeiro LS, Lamstein S, Mahmud Z, Levinson FJ. Adolescent malnutrition in developing countries: A close look at the problems and two National Experiences. SCN News 2006;31:6-13.
Esimai OA, Ojofeitimi EO. Nutrition and health status of adolescents in a private secondary school in Port Harcourt. Health Sci J 2015;9:1-5.
Jackson M, Samms-Vaughan M, Ashley D. Nutritional status of 11–12 years-old Jamaican children: Coexistence of under- and over-nutrition in early adolescence. Public Health Nutr 2002;5:281-8.
Senbanjo IO, Oshikoya KA, Odusanya OO, Njokanma FO. Prevalence of and risk factors for stunting among school children and adolescents in Abeokuta, Southwest Nigeria. J Health Popul Nutr 2011;29:364-70.
George OB, Ikiba PA, Mukoro DG, Ebiwari A, Fiateide A, McEteli DD et al.
Nutritional status of children in rural setting. IOSR-JDMS 2014;13:41-7.
Ojofeitimi EO, Olugbenga-Bello AO, Adekanle DO, Adeomi AA. Pattern and determinants of obesity among adolescent females in private and public schools in the Olorunda Local Government Area of Osun State, Nigeria: A comparative study. J Public Health Africa 2011;2:e11.
Omolola A, Kara E, Olayemi OO. Relative height and weight among children and adolescents of rural south-western Nigeria. Ann Hum Biol 2009;36:388-99.
Ben-Bassey UP, Oduwole AO, Ogundipe OO. Prevalence of overweight and obesity in Eti-Osa LGA, Lagos, Nigeria. Obesity Rev 2007;8:475-9.
Kruger R, Kruger HS, Macintyre UE. The determinants of overweight and obesity among 10-to-15 year-old schoolchildren in the North West Province, South Africa − the THUSA BANA (Transition and Health during Urbanization of South Africans; BANA, children) study. Public Health Nutr 2006;9:351-8.
Wang Y, Monteiro C, Popkin BM. Trends of obesity and underweight in older children and adolescents in the United States, Brazil, China, and Russia. Am J Clin Nutr 2002;75:971-7.
New Zealand Ministry of Health. Food and Nutrition Guidelines for Healthy Children and Young People (Aged 2–18 Years). A Background Paper. Wellington, New Zealand: Ministry of Health; 2012. p. 30-31, 72.
Savva SC, Kourides Y, Tornaritis M, Epiphaniou-Savva M, Chadjigeorgiou C, Kafatos A. Obesity in children and adolescents in Cyprus. Prevalence and predisposing factors. Int J Obes Relat Metab Disord 2002;26:036-45.
Lissau I, Overpeck MD, Ruan JW, Due P, Holstein BE, Hediger ML. Body mass index and overweight in Adolescents in 13 European Countries, Israel and the United states. Arch Pediatr Med 2004;158:27-33.
Takhor HG, Kumar P, Desai VK, Srivastara RK. Physical growth standards of urban adolescents (10-15) years from south Gujarat. Indian J Community Med 2000;25:86.
Musa DI, Toriola AL, Monyeki MA, Lawal B. Prevalence of childhood and adolescent overweight and obesity in Benue State, Nigeria. Trop Med Int Health 2012;17:1369-75.
Akesode FA, Ajibode HA. Prevalence of obesity among Nigerian school children. Soc Sci Med 1983;17:107-11.
[Table 1], [Table 2], [Table 3], [Table 4], [Table 5], [Table 6]