Prevalence of and Risk Factors for Stunting among School Children and Adolescents in Abeokuta, Southwest Nigeria

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INTRODUCTION

Stunting is defined as height-for-age z-score (HAZ) of equal to or less than minus two standard deviation (-2 SD) below the mean of a reference standard (1). It is a well-established child-health indicator of chronic malnutrition which reliably gives a picture of the past nutritional history and the prevailing environmental and socioeconomic circumstances (2). Worldwide, 178 million children aged less than five years (under-five children) are stunted with the vast majority in South-central Asia and sub-Saharan Africa (3). In Nigeria, the national prevalence of stunting among under-five children between 2000 and 2006 was 38% (4).

Stunting is a major public-health problem in low- and middle-income countries because of its association with increased risk of mortality during childhood (3,5). Apart from causing significant childhood mortality, stunting also leads to significant physical and functional deficits among survivors (1,3,5). According to the latest reports, stunting contributes to 14.5% of annual deaths and 12.6% of disability-adjusted life-years (DALYs) in under-five children (3). Children who are stunted complete fewer years of schooling. This may be due to the fact that stunted children are known to enroll late in school (6), perhaps because they are not grown enough to enroll. It may also be because they drop out earlier. This may lead to fewer years of education of stunted children when compared with tall children. Stunting hinders cognitive growth, thereby leading to reduced economic potential. In a study on the effects of nutritional status on primary school achievement score in Kenya, undernourished girls were more likely to score less on achievement tests (7). Stunting is known to be highly prevalent in environments that are characterized by a high prevalence of infectious diseases (8). On the other hand, stunting impairs host immunity, thereby increasing the incidence, severity, and duration of many infectious diseases (9). In countries where malaria infection is endemic, stunting increases the degree to which malaria is associated with severe anaemia causing considerably higher likelihood of mortality due to malaria (9).

The long-term consequences of stunting include short stature, reduced capacity of work, and increased risk of poor reproductive performance (1,3). There is a positive association among stunting, central obesity, and cardio-metabolic disorders (10). The burden of these chronic diseases is daunting as they remain significant causes of morbidity and mortality even in the tropics and subtropics. This could stretch health facilities which are either non-existent or ill-equipped to cope with the yet-to-be resolved problems of undernutrition and infections.

In developing countries, most deaths in children are among the under-five children. As a result, there is extensive literature on under-five children compared to dearth of information on the health of school children. Moreover, children who are stunted are likely to remain stunted into adulthood (11). The objectives of this study were, therefore, to determine the prevalence of and risk factors associated with stunting among school children and adolescents in Abeokuta, southwestern part of Nigeria.

MATERIALS AND METHODS

Location

This questionnaire-based, cross-sectional study was carried out in randomly-selected primary and secondary (both public and private) schools in Abeokuta. Abeokuta, located on longitude 7'10'N and latitude 3'26'E and is about 100 km north of Lagos, the capital of Ogun State in southwestern part of Nigeria. It has an estimated population of four million. Abeokuta is predominantly made up of people of the Yoruba tribe but urbanization and industrialization have brought in many other ethnic groups.

Method of sampling

At the time of the survey, there were 322 schools in Abeokuta (the ratio of public to private primary schools was 1:1 while the ratio of public to private secondary schools was 3:1). …