ABSTRACT
Background: Poor nutrition can hinder adolescents from achieving good educational performance at school because they are either hungry or malnourished and are unable to concentrate and perform well in academic activities. This study compared the dietary diversity, nutritional status and academic performance of adolescents in public and private secondary schools. It also identified factors influencing their nutritional status and dietary diversity.
Methodology: This study utilized a comparative cross-sectional survey. A multi-stage sampling technique was used to select adolescents from public and private secondary schools. Data was collected using interviewer-administered questionnaire. Nutritional status was assessed using anthropometric measures and dietary diversity scores. Educational performance was assessed using the end of term examination results for Mathematics and English in the selected schools. WHO Anthroplus software version 1.0.4 was used to classify adolescents as underweight, stunted, overweight or normal. Data was analysed using Statistical Package for the Social Sciences (SPSS) version 21.0.
Results: A total of 1694 adolescents aged 6-11years participated in this study with 847 adolescents in the public and private schools respectively. Adolescents in the private schools had a significantly higher mean dietary diversity score of 4.74±1.05, while adolescents in the public schools had a mean dietary diversity score of 3.67±0.71 (p=0.001; 95%CI: -1.16, -0.99).
Adolescents in the public schools were significantly more underweight with a lower mean WAZ of -0.72 ± 1.04 compared to adolescents in private secondary schools (WAZ = 0.24 ± 0.72), [p=0.001; 95%CI: -1.05, -0.87]. Adolescents in public schools were also significantly more stunted (HAZ = -1.24 ± 0.86), [p=0.000; 95%CI: -1.07, -0.92] compared to adolescents in the private schools (HAZ = -0.24 ± 0.73), while the mean BMI-for-age was significantly higher among adolescents in private schools (0.50 ± 0.79), [p=0.001; 95%CI: -0.48, -0.31] compared to adolescents in the public schools (0.10 ± 0.98).
The mean academic performance of adolescents in the private secondary schools was significantly higher compared to adolescents in the public secondary schools. Low dietary diversity score, being underweight or being overweight were significant predictors of poor academic performance. Father’s income was a significant predictor of dietary diversity among public and private secondary school adolescents. Hours watching TV was a significant predictor of overweight and obesity among adolescents in private secondary schools.
Conclusion: Adolescents in the private schools had significantly higher dietary diversity scores, good nutritional status and educational performance compared to adolescents in the public schools.
CHAPTER ONE
INTRODUCTION
1.1. Background of study
Educational performance at school has been significantly related to dietary diversity, dietary quality and malnutrition along with other factors among adolescents.1 Education and good performance at school is a necessity for the development of communities and societies. They play a major role in influencing and leveling differences of social class, racism and traditions as well as elevating individuals and communities above poverty.2 Education is a central factor for achieving the millennium development goals.3 With education there are greater opportunities for employment and one year of schooling can increase a person's earnings by 10%, thus eradicating poverty and hunger.4 When there are equal opportunities for schooling across gender, females have increased educational opportunities and this creates a multiplier effect on female education, women’s employment, improvement in child and family health, increased maternal life expectancy, reduction in fertility rates and delayed marriages.4
Globally, Dietary Diversity (DD) has been identified as a vital element of high quality diets. DD is a measure of the number of individual foods or food groups consumed in a given time period. Dietary diversity is related to the pillars of food security (accessibility, availability and utilization).8 It can reflect household access to a variety of foods and can also act as a proxy for individual nutrient adequacy.6, 7 Increasing dietary diversity is also the preferred way of improving the nutrition of a population because it has the potential to improve the intake of many food constituents, not just micronutrients simultaneously. 7 Poor dietary intakes such as monotonous diets are related to increased risk of malnutrition and other diseases and therefore local and international dietary guidelines have suggested an improvement on the variety of foods consumed by individuals and families. 8 For growing students who are at risk of being malnourished, they need more energy and nutrient-dense foods to grow and develop both physically and mentally and to live a healthy life. Therefore, consumption of wide variety of food items and food groups can improve nutritional adequacy of their diet.9
Dietary pattern describes the regular or habitual foods consumed by an individual. It includes the eating patterns for breakfast, lunch and dinner separately. A healthy eating habit promotes growth and reduces many risks associated with both immediate and long-term health problems.10 Students who do not eat breakfast can have lower grades in Mathematics, shorter attention spans and school performance that is worse than students who have regular breakfast.11 Nutrition experts have indicated that students should eat a variety of foods, have three meals daily, eat plenty of grains, and fruits to meet up with their growing body's needs.12
Nutrition is the ingestion of food, considered in relation to the body’s dietary needs and implies; an adequate, well balanced diet combined with regular physical activity.13 Therefore, students who are well-nourished with balanced diets are more likely to be healthy, productive and able to learn.14 They attain better academic performance, develop to adults in a good state of health and consequently give their students a healthier beginning in life.15
Malnutrition is a pathological condition resulting from abnormal nutrition. It is broadly classified as under-nutrition, as a result of inadequate consumption of energy and other nutrients, and over-nutrition occurring as a result of excess intake of energy giving foods and other nutrients essential for survival, growth, reproduction and capacity to learn and function in society.16 Malnutrition has been described as a significant public health problem in most developing countries and has affected more than 30% of students below the age of five years.17 This may be the reason why most available studies done have focused on students below the age of five.18, 19 However, problems with nutrition in students below the age of five may progress as they attain the secondary school age if early corrective intervention or measures are not done and this may lead to harmful effects on the child’s health and school performance.20
The nutritional and health status of adolescents has been on the global agenda. A joint review with the World Health Organization (WHO) and World Bank stated that early child development programs are the most cost-effective interventions in developing countries, not only with regard to improving child health and academic performance, but also considering the potential long-term societal impact of the intervention, such as reducing poverty and diminishing disparities between socioeconomic groups.21 In addition, the united nations standing committee on nutrition (UNSCN) in the year 2000 resolved to encourage more research and operational work on the nutritional status of this age group. The focus resources on effective school health, nutrition and hygiene (FRESH) partnership emphasized on the importance of hunger, malnutrition and ill health as constraints on both ‘Education for All’ and the second and third Millennium Goals of achieving universal secondary education and gender equality in education access.22
Addressing both the quality and quantity of food intake by adolescents, including dietary diversity is therefore necessary to prevent malnutrition over a long term period and subsequently improve performance at school. Long term negative consequences on the individual and country can occur if malnutrition and DD are not addressed; such as a 2-3% decrease in national wealth, 23low labour productivity on the part of the individual and poor competence in the labour market.
1.2. Statement of problem
Educational achievements of students all over the world are restrained due to malnutrition amongst other factors. 24 Adolescents may also be unable to learn, because some are already malnourished, are currently hungry, or have some infections that affect their state of health and nutritional status.
Globally, malnutrition among adolescents is becoming a major public health concern. More than 200 million adolescents are stunted and underweight.25 If appropriate measures are not taken and at this rate, approximately one billion school students will be growing up by 2020 with impaired physical and mental development.26-28 The poor nutritional status of students in secondary schools impacts their health, cognition, and subsequently their educational achievement.29, 30
Diets of school students in developing countries are restricted in diversity, with minimum intake of animal foods and fruits and vegetables and increased intake of highly refined foods.31 As a result, many students are deficient in micronutrients and this can have negative consequences for attainment of good health and achievement of educational objectives.
The education for all (EFA) Global Monitoring Report by UNESCO in 2011 stated that more than a quarter of students below fifteen years of age in sub-Saharan Africa are underweight due to poor diet and malnutrition, making them more vulnerable to disease and less able to concentrate at school. 32, 33 In Nigeria, adolescents made up 39% of the population in 2010, 34 and 83.3% of students were enrolled (gross enrolment) in secondary schools with drop- out rates of approximately 32.4%.35 Malnutrition combined with a heavy disease burden especially among the adolescents (6-11 years) may be a reason for the high drop-out rates and poor learning achievement scores.36
Previous studies have shown that many Nigerian students are already malnourished by the time they are being enrolled into our secondary educational system, with a 49.9% - 52.7% prevalence of underweight and an 11.9% - 16% prevalence of overweight among Nigerian secondary school students. 37-41 While under-nutrition continues to be a major problem in many developing countries such as Nigeria, the problem of overweight and obesity has reached epidemic proportions globally, and both developed and developing countries are affected, creating a double-burden of nutrition-related ill health for students. 42
In Rivers State, results of the 2013 monitoring learning achievement (MLA) tests of secondary school adolescents indicated that greater than half (56.6%) of the adolescents selected underperformed in the numeracy test. 43 Nutritional problems may have contributed to this poor performance. This is supported by a study conducted in Rivers State by Anero, in 2011, who observed a higher completion rate of secondary education during the free feeding programme for secondary school adolescents in Rivers State sponsored by the Federal Government in 2007/2008, compared to the period when there was no free feeding programme.44
1.3. Research Questions
(a) What is the dietary diversity of students in public and private secondary schools in Port Harcourt?
(b) What are the differences in nutritional status of students in public and private secondary schools in Port Harcourt?
(c) How well are secondary school students performing academically in the study area?
(d) Is there any association between dietary diversity/nutritional status of the secondary school students and their school performance?
(e) What are the socio-demographic determinants of dietary diversity/nutritional status among adolescents in public and private secondary schools?
1.4. Hypothesis
1.4.1. Null Hypothesis
1. There is no difference in dietary diversity of students in public and private secondary schools in Port Harcourt metropolis using dietary diversity scores.
2. There is no difference in nutritional status of students in public and private secondary schools in Port Harcourt metropolis.
3. There is no difference in educational performance of students in public and private secondary schools in the study area.
4. There is no relationship between nutritional status and educational performance of students in public and private secondary schools in the study area.
5. There is no relationship between dietary diversity and educational performance of students in public and private secondary schools in Port Harcourt metropolis.
1.5. General Objective
To assess and compare the dietary diversity, nutritional status and academic performance of students in public and private secondary schools in Port Harcourt, Rivers State
1.5.1. Specific Objectives
1. To determine differences in the dietary diversity of students in public and private secondary schools in Port Harcourt metropolis.
2. To assess and compare the nutritional status of students in public and private secondary schools in Port Harcourt metropolis.
3. To determine and compare the educational performance of students in public and private secondary schools in Port Harcourt metropolis.
4. To identify and compare the determinants of dietary diversity and nutritional status of students in public and private secondary schools in the study area.
1.6 Justification of study
The population of students aged 6-11years enrolled in secondary school in Rivers State by 2012 was recorded as 508, 264 out of the 5, 185,400 population of Rivers State in 2006. 45, 46 This indicates that students in secondary schools constitute a sizeable number (one-tenth) of the population. There is paucity of data on the true nutritional status of secondary school students in Rivers state and how diet and nutrition influences their academic performance.
Rural communities have been regarded as priority areas for nutritional intervention due to the higher prevalence of under-nutrition in these areas.47 However there is an increasing prevalence of childhood nutritional problems in the urban areas which may be either under- nutrition or over-nutrition.48Students from impoverished, food-insecure homes have considerably lower energy, protein and fruit intake and stand a greater risk of becoming malnourished. These students are more likely to attend public schools, while researchers have indicated that students who are overweight or obese come from families of higher socioeconomic status and are more likely to attend private schools. 49, 50 There is also lack of evidence-based data about the differences in nutritional status and educational performance of students attending public and private secondary schools in urban Nigerian cities. The availability of quality data produced from this study on dietary diversity and nutrition among students in secondary schools in Rivers state is therefore necessary vital information. This study will determine the dietary diversity scores of students in public and private secondary schools and relate it to their school performance to provide evidence-based data for prioritizing nutrition and academic intervention programs that are of concern at the individual, family, community and national level.
1.7 Study limitation
The use of a 24 hour dietary recall to obtain information on dietary diversity scores may not fully represent the usual dietary intake of participants. This was reduced by use of a 2-day 24 hour dietary recall, and an average of the scores obtained from the two-day recall was used for analysis. Also, this research was a cross-sectional study; therefore associations could only be made and causation could not be established.
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