CHAPTER ONE
INTRODUCTION
- Background of the study
Malnutrition has an effect on children’s wellbeing and their ability to learn and play normally. Indeed, healthy food choices improve a child’s wellbeing and ability to learn and play normally (Kris-Etherton PM,2004). Dietary habits in childhood impact growth, development and the prevalence of disease throughout the life cycle. Healthy eating habits should thus be established during childhood (Sharma SV, 2008).
The youthful period mostly spent in tertiary institutions is a very critical period in an adolescent’s life. During this period, they do enjoy freedom and make decisions that can affect their nutrition and overall health. Although this period is considered as the period of optimal health and growth, but evidence has shown that students in tertiary institution nowadays have poor dietary habits which may be attributed to the independence they enjoy during this period. They tend to make poor dietary choices that can cause significant health problems (Achinihu 2009). They experience numerous health-related behavioral changes, which includes adoption of unhealthy dietary habits. They do eat with consciousness of their weight, appearance and beauty and which is likely to influence their food choices (Olumakaiyeet al., 2010). These adopted habits are mostly attributed to drastic changes in the environment and resources available, frequent exposure to unhealthy foods, poor food habits as well as poor nutritional knowledge among others (Haydaet al., 2007).
Furthermore, during this stage, the tendency to engage in unhealthy dieting, meal skipping, and fast food consumption is also very rampant. Minimal physical activity is also a regular attitude and this poor eating habits and limited physical activity can increase the risk for osteoporosis, obesity, hyperlipidemia, diabetes, and cancer later in life (Nzeaguet al., 2005). This unhealthy lifestyle has also been linked to health-related quality of life (HRQoL), which is related to an individual’s nutritional status. All of these associations suggest that it is important to establish good eating habits at an early age especially among female youth.
Health services in developing countries focus on children and pregnant women and therefore health needs of adolescents are not adequately investigated and addressed (Hamulka et al., 2018). However, the increased prevalence obesity worldwide has drawn attention to the diets of adolescents and children. It has been reported that adolescents are at a higher risk of becoming overweight and obese and prone to life style diseases and chronic diseases because of their unhealthy eating habits (Buxton et al., 2014). During adolescence nutritional care is key because there is increased physical growth, brain development, hormonal changes and increased nutrients requirement for growth and development (Faizi et al., 2017).
Diets consumed by adolescents in developing countries are inadequate in terms of micronutrients, diversity and meal patterns. Some adolescents consume more than adequate amounts of calories and high-energy-dense foods, which contributes to increased occurrence of overweight and obesity. Nutrition behaviors of concern among adolescents are fast food preference, frequent snacking, skipping meals, the risk of eating disorders, the omission of certain foods from diets and occasional dieting (Faizi et al., 2017). Adolescents health has not been a concern and they do not get care that children and adults get. They are believed not to be at risk of health issues but it has been proved that diseases of adulthood are linked to dietary behaviors and practices developed during adolescence (Usman et al., 2017).Under nutrition can start before birth and continue into adolescence, adult life and also continue for generations. Nutrition issues are not well addressed especially among the adolescents. There is a gap in knowledge on nutritional value of food, poor dietary practices and is affecting adolescents negatively (Buxton et al., 2014).
Health and education of adolescents is important in a country because developments, economic prospects future of a country depends on their health and education. At this stage in life adolescents are usually in a state of experimental, identity formation, and also lifelong behavior patterns which are established and mostly determine their future health state and productivity (Usman et al., 2017).
During adolescents there is a chance to teach and equip them with nutrition knowledge and develop positive healthy eating behaviors that can last for life time and hence mitigating the current trends of non-communicable diseases and intergenerational cycle of malnutrition (Miller et al., 2015).
Low and middle-income countries are the most affected by the current increase of non- communicable disease while malnutrition persist and therefore it is important to focus on addressing nutritional issues in adolescents to reverse and correct existing malnutrition through increasing their nutrition knowledge and practice of healthy eating (Abdullah et al., 2015).
- Statement of the problem
Adolescent’s nutrition is important for current, future and intergenerational health. Nigeria’s nutrition situation is characterized by stunting, micronutrients deficiencies and increased prevalence of obesity among adolescents. A formative research to inform Adolescent Programming in Kenya shows that there is prevalence of anemia (5-14 years 16.5%, 15-19 years 13.8%) and zinc deficiency 80% among adolescents ( MoH and WFP 2018). Currently the government is focusing on adolescent nutrition in order to achieve the Sustainable Development Goal 2; which advocates for zero hunger and ending malnutrition by 2030 ( MoH and WFP 2018). The influx of high dense foods in Nigerian market together with huge change in dietary habits of people has increased the incidence of overweight and obesity among adolescents. Healthy eating is not a priority and therefore there is increased habits of snacking, skipping meals and dieting among adolescents. Snacking interferes with regular meals which are healthier food choices and greater dietary diversity to meet the increased energy and nutrients requirement during this period (Faizi et al., 2017).
Adolescents are considered as low risk group for malnutrition and poor health but as they grow they engage in poor dietary habits and become adults with individual nutrition issues leading to poor health later in life. This translates into inter-generation cycle of malnutrition and development of non-communicable diseases. Under nutrition exposes adolescents to poor health, poor performance in school and over nutrition exposes them to life style diseases and can affect their self-esteem. Adolescents are more independent in their food choices and highly influenced by peer pressure and tend to ignore healthy eating (Tugault-Laflear et al., 2017)
1.3 Objective of the study
The main objective of this study will be to examine the Nutritional knowledge and status of secondary school students in Port Harcourt. Specifically, the study will aim to:
- To determine the socio-demographic characteristics of secondary school adolescents.
ii.To determine nutrition knowledge of secondary school adolescents.
iii. To assess dietary practices of the secondary school adolescents.
- To determine the nutritional status of the secondary school adolescents.
1.4 Research Hypothesis
The study will test the following null hypotheses in order to achieve the research objective.
Null Hypotheses
Hoi: There is no significant association between dietary practices and gender of secondary school adolescents.
Hoii: There is no significant association between socio-demographic (age and gender) and nutrition status of secondary school adolescents.
Hoiii: There is no significant association between nutrition knowledge and dietary practices of secondary school adolescents.
Hoiv: There is no significant association between dietary practice and nutrition status of secondary school adolescents.
1.5 Significance of the study
Addressing nutrition issues for adolescent is relevant for current, future and intergenerational health in order to reduce the triple burden of malnutrition and non-communicable diseases later in life. Good nutrition knowledge is one of the few modifiable determinants of dietary behaviors and contributes to strengthen the skills and abilities needed to resist the environmental influences leading to poor dietary habits. This will bring forth a healthy nation, break the tread of intergeneration malnutrition and prevent/delay development of non-communicable diseases in adulthood (Poskitt et al., 2014).
Through this study, gaps in nutrition knowledge, dietary practice and nutrition status of the adolescents will be identified. The respondents will benefit from the study by knowing their nutrition status, those with nutrition problems will be referred to a healthy facility for further management. The school will use research findings in promoting nutrition programs in school and planning healthy menu for the students. The research findings will be useful to the ministry of health in conjunction with ministry of education and non-governmental organizations in coming up with programs to address nutrition and health issues of adolescents.
1.6 Scope of the study
This study shall be restricted to secondary school in Port Harcourt, River State of Nigeria only in the realization of similar condition facing female students in other states of Nigeria. The survey shall be on Nutritional knowledge and status of secondary school students in Port Harcourt.
Nutrition education lectures shall be held for the subjects and pamphlets and handouts shall be used to facilitate the lectures.
1.7 Limitation of the study
This research work will specifically be on Nutritional knowledge and status of secondary school students in Port Harcourt. In the limitation on research work of this magnitude or nature will be carried out without limitation. Hence, during the course, certain constraints will be encountered.
- Cost: the cost of thorough research will not be what can be afforded by a student. The prices of materials needed for this work has gone up and transport fee has also gone up.
- Time: the time was one of the limitations in the process of carrying out this research work.
- Scarcity Of Literature: The research encountered some problems in collection of literature especially on the bank History and operations. This are hindered the smooth running of this work.
1.8 Definition of terms
Adolescent
Adolescents in this study are defined as being between 13 to 18 years of age attending secondary school. Adopted from World Health Organization (WHO), defining adolescent as any person between ages 10 and 19.
Dietary Practice
This study defined optimal dietary practices of Adolescents as those who did not skip meals, consumed three main meals and two healthy snacks per day.
Healthy eating
The study defined, Healthy eating as one where the adolescents achieved energy balance (for basal metabolic rate), while limiting intake of energy dense foods, free sugars, salt and highly processed foods. The diet should also have provided quality and adequate nutrients to meet the increased nutrients requirement among adolescents.
Nutrition knowledge
The nutrition knowledge of the student adolescents was determined by the level of knowledge on food groups, macronutrients, micronutrients, food preparation methods using multiple choices answers. The students got one mark each question for every correct response chosen. Using a marking scheme for nutrition knowledge tests the scores were rated on score percentage using five as the cut off points, the grading was categorized as: Excellent, very good, good, satisfactory and poor.
Nutritional status
Nutrition status of adolescents in the study was determined using Body Mass Index (BMI) in percentiles. Student adolescents with a cut-off of less than 5th percentile were classified as underweight, while normal or healthy between 5th percentile to less than 85th percentile, overweight 85th to less than 95th percentile and obese ≥ 95th percentiles.
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