Population and Individual-Level Double Burden of Malnutrition Among Adolescents in Two Emerging Cities in Northern and Southern Nigeria: A Comparative Cross-Sectional Study

Abstract

Background: Over the past three decades, double burden of malnutrition (DBM), a situation where high levels of undernutrition (stunting, thinness, or micronutrient deficiency) coexist with overnutrition (overweight and obesity), continues to rise in sub-Saharan Africa. Compared to other countries in the region, the evidence on DBM is limited in Nigeria. Objective: This paper aimed to determine the comparative prevalence of population-level and individual-level DBM among adolescents in two emerging cities in northern and southern Nigeria. Methods: This was a comparative cross-sectional study among apparently healthy secondary school adolescents aged 10–18 years in Gombe (northern Nigeria) and Uyo (southern Nigeria) between January 2015 and June 2017. A multistage random sampling technique was implemented to recruit adolescents from 24 secondary schools in both cities. Measures of general obesity (body mass index) and stature (height-for-age) were classified and Z-scores generated using the WHO AnthroPlus software, which is based on the WHO 2006 growth reference. Population-level DBM was defined as the occurrence of thinness and overweight/obesity within the population. Individual-level DBM was defined as the proportion of individuals who were concurrently stunted and had truncal obesity or stunted and were overweight/obese. Findings: Overall, at the population-level in both settings, 6.8% of adolescents had thinness, while 12.4% were overweight/obese signifying a high burden of population-level DBM. Comparatively, the population-level DBM was higher in Gombe compared to Uyo (thinness: 11.98% vs 5.3% and overweight/obesity: 16.08% vs 11.27% in Gombe vs Uyo respectively). Overall, at the individual level, 6.42% of stunted adolescents had coexisting truncal obesity, while 8.02% were stunted and had coexisting general overweight/obesity. Like the trend with population-level DBM, individual-level DBM was higher in Gombe (northern Nigeria) compared to Uyo (southern Nigeria). Conclusion: High levels of population-level and individual-level DBM exist in Gombe and Uyo. However, the level of DBM (under- and over-nutrition) is higher in Gombe located in northern Nigeria compared to Uyo in southern Nigeria.

Dual burden of individual malnutrition in children 1–4 years: Findings from the Colombian nutritional health survey ENSIN 2015

“…Some studies have reported that the prevalence of DBIM due to stunting can vary between 0.3% and 11% in children aged 0–5 years 12,28,37 . Another study used the ENSIN 2010 to calculate the prevalence of DBIM due to stunting in Colombia, which was 2.4% higher compared to our result 12 .…”

“…Although the prevalence of global DBIM is apparently low in the study population (4%, n = 272), considering that 5.3% of the children were overweight ( n = 361), it can be estimated that 75% of children who are overweight are also stunted and/or have one or more micronutrient deficiencies, which is an important result in public health given that the trend of overweight is increasing and is expected to continue to increase due to the nutritional transition 27 . Another reason for surveillance of DBIM is its apparent increase at later ages, an 8% prevalence has been estimated in a group of children aged 10–18 years in Nigeria 28 and in China a study found that 26.2% of children aged 6–17 years were overweight plus stunting, 29 their source was from a nationally representative survey. A similar study in Kenya even estimated 19% DBIM in adulthood 30 when the coexistence of overweight and micronutrient deficiencies was measured.…”

Double burden of malnutrition among school-aged children and adolescents: evidence from a community-based cross-sectional survey in two Nigerian States

“…After controlling for possible confounding variables using the multivariate analysis, older children from the minority tribes had 3 times higher likelihood of thinness compared to those from the Yoruba ethnic group. Regional and ethnic variation in malnutrition among Nigerian children has been reported by previous researchers 17,39 . Similarly, those whose mothers were unemployed had 2 times higher likelihood for thinness compared to those with employed mothers.…”

“…The DBM was also found at the individual level, with 4% of the children being stunted and overweight/obese at the same time. Although, much attention has not been given to DBM in Nigeria previously, recent studies have similarly reported the DBM at population and individual levels among different Nigerian populations [16][17][18] . This is important because most nutritional interventions for Nigerian children before now have focused on undernutrition alone, but with the current knowledge, attention must be paid to both under-and over-nutrition.…”

“…On the other hand, the United Nations Children Fund (UNICEF) estimates that 33% of Nigerian children are stunted, and this has been corroborated by other studies [12][13][14][15] . Few studies in Nigeria are already reporting the existence of the double burden of malnutrition [16][17][18] , but these studies are scattered, limited in geographical distriution and mainly school based. There is, to date, no nationally representative community-based data on the nutritional status of children 6 -14 years in Nigeria.…”