ABSTRACT
Stature is increasingly used as measure of the health and wellness(standard of living and quality) of population This work was done by taking measurements of height and weight of school children 6-11 years (n=1050) and adolescents 12-19 years (n=1440) of Hausa ethnic extraction of both sexesfrom Kano State using Stadiometer and estimation of leg length by calculating difference between stature and sitting height and comparing these data with parental level of education and birth order. A total of 2400 Students (1134 males and 1346 females) participated in the research. All the eight metropolitan local governments of the state and twelve outside local governments, three in each of the northern, southern, eastern and western parts of the State were randomly selected for the research. Information on Menarcheal age, Menstrual cycle and Menstrual blood flow of menstruating girls were collected by means of questionnaires. Data were analysed using SPSS 16.0 and statistical values acceptable at p<0.05. Children were observed to be under weight, (Male BMI; 17.61kg/m2 and Female BMI; 17.54 kg/m2), adolescents were observed to have normal weight (Male BMI; 21.67kg/m2 and Female BMI; 22.59kg/m2). Stature was observed to correlate positively with parental level of education and birth order. Height growth spurt was observed to be between the ages of 12 years and 13 years for both males and females. Correlations between stature, weight, birth order, birth weight, BMI, sitting height and leg length were established. Mean menarcheal age of menstruating Hausa girls was observed to be at the age of 14 years and linear equations for prediction of stature using age, weight, BMI, sitting height andleg length were established. It was also observed that the study population were observed to have normal progressive pattern of growth with female adolescents having higher values of the measured anthropometric parameters while male children were observed to have higher values of the measured anthropometric parameters.
TABLE OF CONTENTS
Title page ——————————————————————————- i Declaration ——————————————————————————- ii Certification ——————————————————————————- iii Dedication ——————————————————————————- iv Acknowledgements ———————————————————————- v Table of contents ———————————————————————- vi List of tables ——————————————————————————- viii List of figures ——————————————————————————- ix List of plates ——————————————————————————- x Abbreviations —————————————————————————– xi Abstract ——————————————————————————- vi 1.0 INTRODUCTION ————————————————————– 1 1.1 Background of Study ————————————————————– 1 1.2 Statement of Problem ————————————————————– 6 1.3 Significance of study —————————————————– 6 1.4 AIM AND OBJECTIVES OF STUDY ———————————– 7 1.4.1 Aim———————————————————————————— 7 1.4,2 Objectives of Study—————————————————————– 7 1.5 LIMITATIONS——————————————————————— 7
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2.0 LITERATURE REVIEW———————————————————– 8 2.1 Assessment of Growth————————————————————- 8 2.2 Growth Monitoring—————————————————————– 8 2.3 Importance of accurate measurement and plotting—————————– 9 2.4 Growth Spurt————————————————————————- 10 2.5 The WHO Reference 2007: 5-9 Years——————————————- 11 2.6 Undernutrition———————————————————————- 12 2.7 Prevalence of undernutrition and overnutrition——————————– 15 2.8 Underweight————————————————————————- 15 2.9 Stunting——————————————————————————- 16 2.10 Wasting——————————————————————————- 16 2.11 Growth Spurt———————————————————————— 16 2.12 Prepubertal growth—————————————————————– 17 2.13 Pubertal growth———————————————————————- 17 2.14 Correlations of some anthropometric parameters among Nigerians——— 18 2.15 Season of birth and anthropometric outcome———————————– 18 2.16 Season of birth and neurocognitive outcome———————————— 18 2.17 Birth order and growth————————————————————- 19 2.18 Weight-Height/Height-Age——————————————————– 19 2.19 Socioeconomic status and growth———————————————— 20 2.20 Skeletal muscle mass and ethnicity———————————————– 21 2.21 Body mass index (BMI)———————————————————— 21 2.22 Menarche—————————————————————————– 22
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2.23 Age at menarche and height——————————————————- 23 2.24 Age at menarche and adult BMI————————————————– 24 2.25 Parental education and child growth——————————————— 26 2.26 Parental education and child health——=————————————— 26 2.27 Parental education and child nutrition——————————————– 27 2.28 Height estimation——————————————————————- 29 2.9 Anthropometry———————————————————————- 29 3.0 MATERIALS AND METHODS————————————————- 30 3.1 Study location/Duration———————————————————— 30 3.4 Subjects——————————————————————————- 33 3.5 Inclusion and Exclusion criteria————————————————— 33 3.6 Methodology————————————————————————- 33 3.7 Anthropometric Measurements—————————————————- 34 3.7.1 Height——————————————————————————— 34 3.7.2 Weight——————————————————————————– 34 3.7.4 Sitting Height———————————————————————— 35 3.7.5 Body Mass Index——————————————————————- 35 3.8 Ethical consideration————————————————————— 35 3.9 Statistical analysis—————————————————————— 40 4.0 RESULTS—————————————————————————- 41 4.1 Analysis of study population—————————————————— 41
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4.2 Descriptive statistics of study population————————————— 41 4.3 Growth pattern———————————————————————- 47 4.4 Influence of social status on growth of Hausa children and adolescents—– 55 4.5 Influence of parent’s level of education on menarcheal age and menstrual characteristics———————————————————————– 60 4.6 Influence of birth order on the measured anthropometric dimensions——- 63 4.7 Pearson’s correlation matrixes—————————————————- 66 4.8 Linear regression models———————————————————- 72 5.0 DISCUSSION———————————————————————– 96 6.0 SUMMARY, CONCLUSION AND RECOMMENDATIONS————– 100 6.1 Summary—————————————————————————– 100 6.2 Conclusion————————————————————————— 101 6.3 Recommendations—————————————————————— 102 REFERENCES——————————————————————— 103 APPENDIX 1———————————————————————– 116 APPENDIX 11———————————————————————- 117 APPENDIX III———————————————————————- 118 APPENDIX IV ——————————————————————— 119 APPENDIX V———————————————————————– 120
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CHAPTER ONE
1.0 INTRODUCTION 1.1 BACKGROUND OF STUDY Stature which means standing height (NHANES, 2007) is increasingly used as measure of the health and wellness(standard of living and quality) of population. Height, including leg length is a sensitive indicator of the socioeconomic or nutritional environment as was observed in the secular trend in Japanese children after World War II (Tanner et al., 1982;Ashizawa, 2002). Changes in body dimensions have attracted the attention of anthropologists(Ali et al., 2000) and in children of developed countries are well documented phenomenon (Jaeger 1998;Loeschet al.,2000, Adebisi, 2008). From an evolutionary perspective there are a number of different reasons why the leg to Body ratio (LBR) may be important in aesthetic judgment of men and women. One possibility is that the LBR is a signal or cue of both stable childhood development as well as current well-being. In terms of the former, the interruption of growth at any stage of the cycle results in a relatively long torso and short legs (Leitch,1951). If the rate of growth is sufficiently slowed down(e.g. due to nutritional deficiencies or psychological stress) the adult will have shorter legs relative to the trunk, indeed, studies suggest that leg length measured in childhood may be the component of stature most sensitive to environmental influences(Gunnellet al.,1998).
Growth changes, which are one of the great 19th century discoveries in human growth research, were prominent in the 20th century, especially after World War II. It has been documented by scholars in many developed and developing countries (Eleveth and
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Tanner,1990). In the long run, growth trend is a product of continuous and often non additive interaction between genetic and environmental forces, However, this short time ranges involved (a few generations or a single generation) indicate that growth trends are likely to result not from alterations, but in the environment in which growth takes place (Castilho and Lahr 2001). From the 1980s, some studies reported that the acceleration of physical development had already ceased or reached a plateau in some developed countries, which suggest that they were possibly about to achieve their full genetic potential or that their socioeconomic conditions had ceased to improve (Lingren 1998;Krawczynskiet al.2003, Linsti and Kaarma, 2003). The most important environmental factors to influence growth changes are nutrition and health. Socioeconomic living conditions, control of infectious diseases through mass immunization, social and health care (preventive and curative), sanitary conditions, minimum income, level of education, industrialization and urbanization, as well as the psychological state appear also to be meaningful factors contributing to the secular trends through removing ingredients that had blocked full expression of the biological potential (Malinaet al., 1987; Tanner, 1992;Haupie et al., 1996; Bodzsar and Susanne 1998; Castilho and Lahr, 2001; Whitehead, 2003).
Adult height is influenced by nutrition and health throughout his or her growing years. Although final height is limited by a child genotype, environmental influences also affect his/her adult size (Silventoinen, 2003). Data from the Boyd Orr Cohort showed a significant positive association between childhood leg length and mortality from cancers unrelated to smoking .There were no significant associations in relation to trunk length, with weaker associations from overall height than for leg length (Gunnellet al., 1998). These data also showed that coronary heart diseases mortality increased with decreasing childhood leg
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length. Coronary heart disease was inversely associated with Leg length in another study (Smith et al., 2001). Some studies suggest that increase in height is due to increases in leg length rather than increased trunk length (Tanner et al., 1982; Gerver and De Bruin, 1995) and the Carnegie survey data support the view that leg length is the component of childhood height most sensitive to childhood circumstances (Gunnellet al., 1998).In addition, the effects of famine exposure were most marked on the leg length of women exposed to the Dutch Hunger winter during childhood (Van Noord, 2004). Data from 1946 British Birth Cohort showed that leg length was more sensitive to childhood environmental factors and diet while trunk length was more sensitive to serious illness and possibly to emotional disturbances (Wardsworthet al., 2002).
In a subset of the Carnegies children (Gunnellet al.,1998), for whom information at birth was available, similar correlation between birth weight and leg or trunk length were found, suggesting that differences in the component of stature were not related to growth during the gestational period. Results from the Avon longitudinal study showed that maternal diet in pregnancy was not associated with height or its components (Leary et al.,2005). Height is considered an important indicator of Nutrition and health of a population (Akachi and Canning 2007; Deaton, 2007). In the last Century, a consistent increase in height of adults has been found both in developed and developing Countries mirroring the improvements in nutritional (Hoppaand Garlie, 1998) and socioeconomic status (Li et al., 2004). In Europe, height has been increasing in most populations (Gracia and Quintanadomeque, 2007).
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However, recent studies have reported that the increase in height has reached a plateau in Germany (Zellneret al., 2004) and Poland (Krawczynskiet al., 2003). An increase in height has been reported from developing countries such as India (Virani, 2005) and Mexico (Malinaet al., 2004). BMI criteria are used to screen for weight categories: underweight (BMI values < 18.5), normal or desirable weight (BMI values 18.5-24.9), overweight (BMI values 25.0-29.9), obese-Class I (BMI values 30.0-34.9), obese-Class II (BMI values 35.0-39.9) and extremely obese (BMI values >40.0), (WHO, 1995). With obesity on the rise worldwide and at epidemic levels in the United States, it is critical to better understand its etiology. Obesity is commonly defined by BMI, which is calculated as weight (kg) divided by squared height (m2). The two components of BMI have different developmental trajectories. Whereas height is determined during childhood and adolescence, weight regulation can occur in all life stages (Li et al., 2008). Estrogens and Androgens are known to influence growth and weight. (Yang et al., 2006). Disruptions in any component of this biosynthetic pathway can have a number of health consequences, including obesity, (Long et al., 2007).On the molecular level, changes in the expression of the genes that code for the enzymes involved in the synthesis of estrogens and androgens may influence the onset of obesity, (Maffeiet al., 2007; Musatoyet al., 2007).
Obesity is an important risk factor for premature death (Allison et al., 1999; Flegalet al., 2005) and health problems like diabetes, gallbladder disease, coronary heart disease, high cholesterol, hypertension and asthma (Must et al., 1999). Excess weight reduces the quality of life, raises medical expenditures, places stress on the health care system and results in productivity losses due to disability, illnessand premature mortality (Andreyevaet al.,
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2004).Underweight status represents depleted body fat and/or lean tissue stores. Although there are expert guidelines for classifying underweight based on body mass index (BMI), the WorldHealth Organization defines underweight as a BMI below the 5th percentile for age and gender,(WHO,1995). Canadian and US studies have demonstrated higher rates of hospitalizations and mortality in underweight adults, compared to those with weights within normal ranges, (Katzmarzyket al.,2001). Higher rates of asthma, scoliosis, intestinal problems and emotional disorders were found in underweight 17 year olds (Luskkyet al., 1996), Abnormal menses and subfertility have been demonstrated in underweight females (Lake et al., 1997), amenorrhea may also occur, as a result of low leptin levels, decreased body fat, emotionalstress or anxiety (Kopp et al., 1997). The onset of puberty may be delayed in male and female adolescents with a low BMI, (He and Karlberg,2001). Anthropometry is a key component of nutrition status assessment in children and adults. The NHANES anthropometry data have been used to track growth and weight trends in the U.S. population for more than thirty years (Hedley, 2004). The anthropometric data for infants and children reflect general health status and dietary adequacy and are used to track trends in growth and development over time. The CDC has used NHANES data to produce national reference standards or “growth charts.” The CDC growth charts are used extensively by pediatricians and researchers in the U.S. and abroad (Kuczmarski et al., 2002).
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1.2 STATEMENT OF PROBLEM Anthropometric data is scarce not only in Kano State but in Nigeria as a whole. Obesity is an important risk factor for premature death (Allison et al., 1999; Fontaine et al., 2003; Flegalet al., 2005). Height was found to be associated with lower morbidity and mortality from ischaemic heart diseases. Coronary heart disease was found to be inversely associated with leg length (Smith et al., 2001). There is scarcity of the measured anthropometric data in Kano State and these data is significant health wise, therefore, the need to conduct a research of this kind so as to provide certain anthropometric information of Hausa Children and Adolescents residents in Kano state. 1.3SIGNIFICANCE OF STUDY Kano state is rapidly growing in population and densely populated but the growth pattern of the populace receives less or no attention. The findings of this research work will determine whether or not the children are experiencing normal or stunted growth, so as to sensitize the government of Kano State in particular to come up with programmes that would enhance the socioeconomic well-being of its people. Furthermore, the research outcome would provide a means of obtaining the BMI of Hausas with lower limb deformity by way of predicting their height using their sitting height and consequently, the outcome of this research work would serve as reference point to Scientists and clinicians for subsequent research programmes.
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1.4AIM AND OBJECTIVES OF STUDY 1.4.1Aim The Aim of this study was to describe the pattern of growth in Stature, weight and leg length of Hausa children and adolescents aged 6-19years and to describe menarcheal age pattern of menstruating girls from Kano State. 1.4.2Objectives of Study The objectives of the present study are as follows:
i. establish the age of Height growth spurt of Hausas 6-19 years from Kano State
ii. establish the age of leg (Subischial) length growth spurt of Hausas 6-19 years from Kano State
iii. investigate the relationship between growth in stature with sex and age
iv. establish the average BMI of Hausas 6-19 years from Kano States
v. establish commencement of menarche in Hausas
vi. investigate the relationship betweenmenarcheal age with height
vii. investigate the relationship between growth in stature with parental level of Education
viii. investigate the relationship between growth in stature with birth order
ix. establish an equation for prediction of height using sitting height measurement
1.5LIMITATIONS i. Non return of questionnaires ii. Very few records on birth weight of subjects
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