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Some socioeconomic factors of malnutrition in Benin city, Nigeria
PubL H/th, Lond. (1982) 96, 288-291
Some Socioeconomic Factors of M a l n u t r i t i o n in Benin City, Nigeria P. C. O s u h o r F NM,C. PH. F,I S.CD, F.W.A C P. F R,S.H, and Osafu Ogbeide MSc., F.R.SH.
Department of Community Health, College of Medical Sciences, University of Benin, Benin City, Nigeria
This paper describes a study of the socioeconomic status of families of 570 protein energy malnourished (PEM) babies who attended the Nutrition Unit of the Ministry of Health, Owina Street, Benin City, Nigeria, over a period of two years (1971-3). The results showed that PEM was highly associated with poor education, poor environment and poor income. A high percentage of the babies came from unstable and dysmorphic families, living in known slum areas of Benin City. Emphasis should therefore be laid on various measures to raise the socioeconomic status of the population, e.g. through basic education, better nutritional programmes and family spacing and planning education. Introduction
The relevance o f socioeconomic factors in the study of epidemiotogy of proteinjenergy malnutrition (PEM) is documented. Such knowledge helps in the planning 9f.'effective nutritional rehabilitation programmes in the community. This study forms part o f a series of papers on PEM in Benin City, Nigeria. ~ Materials and Methods
The confirmation o f PEM is as outlined elsewhere. ~,'-' The mothers of the malnourished children who came to the Nutrition Unit, Ministry o f Health, Owina Street, Benin City, Nigeria, were interviewed by one of the authors '(O.O.), using the following parameters as measures o f the socioeconomic status o f their families: ethnic group, marital status, residence, occupation and therefore probable income, education and religion. Results
The age and sex distributions o f the 570 malnourished children have been reported in an earlier paper, where it was ;found that there were 297 (52-t %) males and 273 (47.9~) females, x As expected, the Binis formed the largest ethnic group in this study (391 ; 68-6~). It can be seen from Table 1 that the parents o f these malnourished children had little or no formal education, Of these predominantly non-working mothers, who spend a lot o f time with their children in this society, 346 (60.7~) had no formal education at all. 0033-3506/$2/050288+04 $02.00/0
~) 1982 The Society,of Community Medicine
Socioeconomic Factors in Mabmtrition in Nigeria
289
TAatE !. Formal educational level of parents of 570 malnourished children in Benin City, 1971-73
Father
Mother
Formal educational level*"
No.
70
No.
,°/o
None Primary education Secondary education Post-secondata, education
209 201 119 41
36.7 35-2 20-9 7.2
346 205 15 4
60.7 36.0 2-6 0.7
Total
570
i 00.0
570
100.0
* Primary, 6 years; secondary, 5 years post-primary; post-secondary, varies according to profession or vocation.
TABLE 2. Occupations of parents of malnourished children
Father Occupation Unemployed/irregular income earners; income ¢ ~768 per year from odd jobs, petty trading, etc. Unskilled and semi-skilled workers; income N768-1452 per year Skilled workers, for example carpenters, masons, typists, professional drivers, etc., income i~1476--3252 per year Total
Mother
No.
7,
No.
%
33
5-8
3~
65-3
399
70.0
177
31-0
138
24.2
21
3.7
570
100.0
570
I00,0
One naira (N) is approximately £0-85 sierling or US$1-5.
Table 2 indicates that 33 fathers (5"870) had no regular income while 399 (70-070) were unskilled o r semi-skilled workers on low annual income. Table 3 shows that 270 children (47.470) were from dysmorphic families, where the status of the mothers could be divided into unmarried girls 41 (7-2 7o), widows 38 (6.7 7o), married but living apart 191 (33.5~). Table 4 summarizes the various reasons given for separation by the married mothers. It can be seen that separation had occurred at the wish of one o r o t h e r parent 41.9~ of the time: husbands 27-770; wives 14-270. Table 5 shows that the children from traditional religious families were in a majority (301 ; 52-870). This is in contrast with the findings in Lagos, Nigeria, where children from Moslem families contributed the highest percentage, a In all, 368 families (64-9~) lived in known slums. Some 125 families (21 "970) lived in the new Ugbekun and East Circular slum areas of the city, while 243 (42-770) were in the old slums of the Ogboka quarters. It should also be noted that none of these cases came from
290
P. C. Osuhor and O. Osafii T,XaLE3. Marital status of the mothers of malnourished children
Marital status
No.
"" O
Unmarried Widowed Married and not staying with husbands Married and staying with husband
41 38 191
7-2 6.7 33.5
300
52.6
570
100.0
Total
T,xaL~ 4. Various reasons given by the married mothers for not staying with their husband
Reason
No.
%
Husband's wish, whether in same or different towns Husband -working-in another town Divorced Mother's wish Mothe~ ill Husband disowns child Don't know
53
27.7
40
20-9
28 27 12 9 22
14.7 14.2 6.3 4-7 11.5
191
100-0
Total
T^BLE 5. Religion of parents
Religion
No.
%
Traditional Christian Moslem
301 185 84
52.8 32.5 14.7
Total
570
I00.0
the Government Reservation Area (GRA) of Benin City, where the higher socioeconomic classes of thecommunity, live. With such a low income, the number of children per family was high. For example, 362 mothers (63"5~o) had one to three children, 178 (31-2~) had four to eight children and 30 (5-3~) had more than eight children.
Socioeconomic Factors in ~tabmtrition in Nigeria
291
Discussion
Some 301 families in the study population (52-8~) practised traditional religion. This is not surprising since Berlin City, as an ancient city, still adheres to her strong cultural beliefs and, therefore, traditions. 4 Some of these beliefs play important roles in the aetio]ogy of PEM.=~.~ PEM is seen to be highly associated with poor education and therfore poor income and also poor environment in this study, as was indeed found elsewhere. T M Poor education and low income go hand-in-hand with poor housing conditions a~d poor nutrition, a view also confirmed in this study. 1° The incidence of PEM from slu m areas in Benin City was quite high. Poor environmental conditions contribute to infections and infestations which in turn aggravate PEM. Migration from the rural to the urban areas, with its resultant difficulties in adaptation, may also be a factor in the ePidemiology of PEM in Benin City.~.L Family stability and a healthy environment are essential for the optimal growth of the child. Unstable and dysmorphic homes due to divorces, separations a n d unmarried pregnancies are among the social factors predisposing to PEM in the study. Some 191 children (33-5%) came from unstable homes and this confirms observations from Lagos, Nigeria) Uganda H and West Africa.: The problem seems to be increasing with industrialization and urbanization in Nigeria, where society no longer frowns on temporary and or permanent separation ofcouples. In this study. 53 husbands (27~7%) and 27 wives (14-2%) had voluntarily decided to live apart from their spouses. The problem of the large family with low income in developing countries must be tackled in various ways, including the devlopment of basic education through such methods as the Universal Primary Education (UPE) programme in Nigeria, better nutritional provision (for example the Nigerian agrarian drive to grow more food for domestic consumption) and family spacing and planning education. These could contribute to an eventual rise in the general socioeconomic status of the population. References
I. Ogbeide, O., & Osuhor, P. C. (1981). Malnutrition in children in Benin City, Nigeria (unpublished paper). 2. Jelliffe, D.B. (1966). The Assessment of the Nutritional Status of the Community. WHO Monograph Series No. 53. Geneva: WHO. 3. Ransome Kuti, O., Gbajumo, W. O., & Olaniyan, W. O. (1972). Some socioeconomic conditions predisposing to malnutrition in Lagos. Nigerian AIedical Journal 2, 11. 4. Ogbeide, O. (1974). Nutritional hazards of food taboos and preferences in mid-west Nigeria. American Journal of Clinical Nutrition, 27, 213. 5. Osuhor, P. C., & Osuhor, A. (1978). Factors of culture and change in health education for adults in Nigeria. Conrergence, The International Journal of Comparative Adult Education 11, 63-8. 6. Osuhor, P. C., & Essien, E. S. (1978). Urbanisation and its effects on environmental sanitation. Public Health, London 92, 69-75. 7. Gans, B. (1963). Some socioeconomic and cultural factors in West African paediatfies. Archives of/he Diseases of Child Health 38, 197. 8. Gupta, B. M. (1976). Study of malnourished children in Tanga, Tanzania; socio economic and cultural aspects. Journal of Tropical Paediatrics and Environmental Health 22, 268. 9. Osuhor, P.C. (1981). The socioeconomic aspects of protein energy malnutrition (PEM) in Kaduna, Northern Nigeria (unpublished paper.) 10. Osuhor, P. C. (1979). Stillbirths in a savannah district of northern Nigeria; the socioeconomic and sociocultural factors. Nigerian A[edical Journal 9, 681-5. 11. Wellbourne, H. R. (1959). Background and follow-up of children with kwashiorkor. Journal of Tropical Paediatrics 5, 84.
Some Socioeconomic Factors of M a l n u t r i t i o n in Benin City, Nigeria P. C. O s u h o r F NM,C. PH. F,I S.CD, F.W.A C P. F R,S.H, and Osafu Ogbeide MSc., F.R.SH.
Department of Community Health, College of Medical Sciences, University of Benin, Benin City, Nigeria
This paper describes a study of the socioeconomic status of families of 570 protein energy malnourished (PEM) babies who attended the Nutrition Unit of the Ministry of Health, Owina Street, Benin City, Nigeria, over a period of two years (1971-3). The results showed that PEM was highly associated with poor education, poor environment and poor income. A high percentage of the babies came from unstable and dysmorphic families, living in known slum areas of Benin City. Emphasis should therefore be laid on various measures to raise the socioeconomic status of the population, e.g. through basic education, better nutritional programmes and family spacing and planning education. Introduction
The relevance o f socioeconomic factors in the study of epidemiotogy of proteinjenergy malnutrition (PEM) is documented. Such knowledge helps in the planning 9f.'effective nutritional rehabilitation programmes in the community. This study forms part o f a series of papers on PEM in Benin City, Nigeria. ~ Materials and Methods
The confirmation o f PEM is as outlined elsewhere. ~,'-' The mothers of the malnourished children who came to the Nutrition Unit, Ministry o f Health, Owina Street, Benin City, Nigeria, were interviewed by one of the authors '(O.O.), using the following parameters as measures o f the socioeconomic status o f their families: ethnic group, marital status, residence, occupation and therefore probable income, education and religion. Results
The age and sex distributions o f the 570 malnourished children have been reported in an earlier paper, where it was ;found that there were 297 (52-t %) males and 273 (47.9~) females, x As expected, the Binis formed the largest ethnic group in this study (391 ; 68-6~). It can be seen from Table 1 that the parents o f these malnourished children had little or no formal education, Of these predominantly non-working mothers, who spend a lot o f time with their children in this society, 346 (60.7~) had no formal education at all. 0033-3506/$2/050288+04 $02.00/0
~) 1982 The Society,of Community Medicine
Socioeconomic Factors in Mabmtrition in Nigeria
289
TAatE !. Formal educational level of parents of 570 malnourished children in Benin City, 1971-73
Father
Mother
Formal educational level*"
No.
70
No.
,°/o
None Primary education Secondary education Post-secondata, education
209 201 119 41
36.7 35-2 20-9 7.2
346 205 15 4
60.7 36.0 2-6 0.7
Total
570
i 00.0
570
100.0
* Primary, 6 years; secondary, 5 years post-primary; post-secondary, varies according to profession or vocation.
TABLE 2. Occupations of parents of malnourished children
Father Occupation Unemployed/irregular income earners; income ¢ ~768 per year from odd jobs, petty trading, etc. Unskilled and semi-skilled workers; income N768-1452 per year Skilled workers, for example carpenters, masons, typists, professional drivers, etc., income i~1476--3252 per year Total
Mother
No.
7,
No.
%
33
5-8
3~
65-3
399
70.0
177
31-0
138
24.2
21
3.7
570
100.0
570
I00,0
One naira (N) is approximately £0-85 sierling or US$1-5.
Table 2 indicates that 33 fathers (5"870) had no regular income while 399 (70-070) were unskilled o r semi-skilled workers on low annual income. Table 3 shows that 270 children (47.470) were from dysmorphic families, where the status of the mothers could be divided into unmarried girls 41 (7-2 7o), widows 38 (6.7 7o), married but living apart 191 (33.5~). Table 4 summarizes the various reasons given for separation by the married mothers. It can be seen that separation had occurred at the wish of one o r o t h e r parent 41.9~ of the time: husbands 27-770; wives 14-270. Table 5 shows that the children from traditional religious families were in a majority (301 ; 52-870). This is in contrast with the findings in Lagos, Nigeria, where children from Moslem families contributed the highest percentage, a In all, 368 families (64-9~) lived in known slums. Some 125 families (21 "970) lived in the new Ugbekun and East Circular slum areas of the city, while 243 (42-770) were in the old slums of the Ogboka quarters. It should also be noted that none of these cases came from
290
P. C. Osuhor and O. Osafii T,XaLE3. Marital status of the mothers of malnourished children
Marital status
No.
"" O
Unmarried Widowed Married and not staying with husbands Married and staying with husband
41 38 191
7-2 6.7 33.5
300
52.6
570
100.0
Total
T,xaL~ 4. Various reasons given by the married mothers for not staying with their husband
Reason
No.
%
Husband's wish, whether in same or different towns Husband -working-in another town Divorced Mother's wish Mothe~ ill Husband disowns child Don't know
53
27.7
40
20-9
28 27 12 9 22
14.7 14.2 6.3 4-7 11.5
191
100-0
Total
T^BLE 5. Religion of parents
Religion
No.
%
Traditional Christian Moslem
301 185 84
52.8 32.5 14.7
Total
570
I00.0
the Government Reservation Area (GRA) of Benin City, where the higher socioeconomic classes of thecommunity, live. With such a low income, the number of children per family was high. For example, 362 mothers (63"5~o) had one to three children, 178 (31-2~) had four to eight children and 30 (5-3~) had more than eight children.
Socioeconomic Factors in ~tabmtrition in Nigeria
291
Discussion
Some 301 families in the study population (52-8~) practised traditional religion. This is not surprising since Berlin City, as an ancient city, still adheres to her strong cultural beliefs and, therefore, traditions. 4 Some of these beliefs play important roles in the aetio]ogy of PEM.=~.~ PEM is seen to be highly associated with poor education and therfore poor income and also poor environment in this study, as was indeed found elsewhere. T M Poor education and low income go hand-in-hand with poor housing conditions a~d poor nutrition, a view also confirmed in this study. 1° The incidence of PEM from slu m areas in Benin City was quite high. Poor environmental conditions contribute to infections and infestations which in turn aggravate PEM. Migration from the rural to the urban areas, with its resultant difficulties in adaptation, may also be a factor in the ePidemiology of PEM in Benin City.~.L Family stability and a healthy environment are essential for the optimal growth of the child. Unstable and dysmorphic homes due to divorces, separations a n d unmarried pregnancies are among the social factors predisposing to PEM in the study. Some 191 children (33-5%) came from unstable homes and this confirms observations from Lagos, Nigeria) Uganda H and West Africa.: The problem seems to be increasing with industrialization and urbanization in Nigeria, where society no longer frowns on temporary and or permanent separation ofcouples. In this study. 53 husbands (27~7%) and 27 wives (14-2%) had voluntarily decided to live apart from their spouses. The problem of the large family with low income in developing countries must be tackled in various ways, including the devlopment of basic education through such methods as the Universal Primary Education (UPE) programme in Nigeria, better nutritional provision (for example the Nigerian agrarian drive to grow more food for domestic consumption) and family spacing and planning education. These could contribute to an eventual rise in the general socioeconomic status of the population. References
I. Ogbeide, O., & Osuhor, P. C. (1981). Malnutrition in children in Benin City, Nigeria (unpublished paper). 2. Jelliffe, D.B. (1966). The Assessment of the Nutritional Status of the Community. WHO Monograph Series No. 53. Geneva: WHO. 3. Ransome Kuti, O., Gbajumo, W. O., & Olaniyan, W. O. (1972). Some socioeconomic conditions predisposing to malnutrition in Lagos. Nigerian AIedical Journal 2, 11. 4. Ogbeide, O. (1974). Nutritional hazards of food taboos and preferences in mid-west Nigeria. American Journal of Clinical Nutrition, 27, 213. 5. Osuhor, P. C., & Osuhor, A. (1978). Factors of culture and change in health education for adults in Nigeria. Conrergence, The International Journal of Comparative Adult Education 11, 63-8. 6. Osuhor, P. C., & Essien, E. S. (1978). Urbanisation and its effects on environmental sanitation. Public Health, London 92, 69-75. 7. Gans, B. (1963). Some socioeconomic and cultural factors in West African paediatfies. Archives of/he Diseases of Child Health 38, 197. 8. Gupta, B. M. (1976). Study of malnourished children in Tanga, Tanzania; socio economic and cultural aspects. Journal of Tropical Paediatrics and Environmental Health 22, 268. 9. Osuhor, P.C. (1981). The socioeconomic aspects of protein energy malnutrition (PEM) in Kaduna, Northern Nigeria (unpublished paper.) 10. Osuhor, P. C. (1979). Stillbirths in a savannah district of northern Nigeria; the socioeconomic and sociocultural factors. Nigerian A[edical Journal 9, 681-5. 11. Wellbourne, H. R. (1959). Background and follow-up of children with kwashiorkor. Journal of Tropical Paediatrics 5, 84.