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University of Nigeria Virtual Library
Serial No
Author 1
NGWU, E. K
Author 2
UZENDU, P. N.
Author 3
Title
Nutritional Status of Patients Attending Sickle-
Cell Disease (SCD) Clinic at a Nigerian University Teaching Hospital
Keywords
Sickle Cell Disease, Stunting, Underweight, Wasting, Hemoglobin
Description
Nutritional Status of Patients Attending Sickle-
Cell Disease (SCD) Clinic at a Nigerian University Teaching Hospital
Category
Agriculture
Publisher
Nigerian Journal of Nutritional Sciences
Publication Date
2007
Signature
NURITIONAL STATUS OF
The nutritional status of 200
Nigeria Teaching and 42% females. Their ages ranged between 2 years an with a mean age of 10.32*4.36 years for males and 10.07*3.34 years for females. There was no significant (p>O.OS) difference in the educational levels of males and females. A total of 38.5% of the children were pale. Malaria was the most common cause of crisis. Nutritional status indicators showed that 39.66% of the males and 13.09% of the females were stunted. Asmmany as 25.86% of the males and 11.9% of the females were .under weight. Wasting was prevalent in 20.69% of the males and 20.24% of the females. Wider varieties of foods .
were consumed by the children promoting dietary diversification. Intake of energy and protein were above 100% of FAO/WHO requirement f q over 90% of the children. The most limiting nutrients were riboflavin and folate. Intakes of other nutrients such as calcium, iron, vitamin A and thiamin were hlgh (over 70% FAO/WHO) requirement).
: r8 >
Key words: Sickle cell disease, stunting, underweight, wasting, hemoglobin.
globin. . gene, producing structurally nal viscosity o f the cell-
abhormal hemoglobins (1,
long ailment arising from
of sickle hemoglobin (Hb ry beds. This result in '
parents or of Hb S fro of blood flow (vaso--
may *also arise from t to lead to pain
another. variant of
hemoglobin such as Hb
tha1,aSemia '(Hb. S-thal) nemia which results from
par;$ (2, 3). In, ~b d life-span of
commonest, and most severe fo le cell, that survive in the circula
SCD, an amino acid, valine is subst
NIGERIAN JOURNAL OF NllTRiTIONAL SCIENCES VOL 28 (1) 2007
INTRODUCTION
Sickle cell disease (SCD) is a
general name for a group of inherited
blood disorders due to mutations in the
for glutamic acid at the sixth position of
the hemoglobin beta chain. This A
abnormality leads to polymerization of ..\
the Hb S molecule within the red cell , 4
120days for normal red blo
common feature in SCD (2,
sickle cell disease is the mos
genetic disorder affecting p
African ancestry (5, -6). I n
commonest type of sickle c
the homozygous . sickle
(SS), also known as sickle c
Less' common types include sickle
hemoglobin 'C disorder (SC) and t
much rarer sickle cell 'thalassemia
(S+thal). Persons with Hb SC and other
types have on the average similar but
milder syndromes (2).Those with sickle
cell trait (Hb AS) carry the sickle gene
but under normal circumstances are
completely asymptomatic (6).
Deficits in growth is common in children
with SCD including delayed skeletal and
sexual maturation suggesting inadequate
intake and/or increased requirements for
energy and possibly other nutrients (6).
This study was undertaken in order to
characterize the nature and severity of
(2 - 18 years) with
attending the clinic
e children usually
clinic on regular
and /or referrals with their
any adult. Education and'
are usually given topatients
families at the clinic. About 350
nts attended the clinic during the
period of this study (April 2006 - December, 2006).
Informed consent o f the children or
their parent /caregiver was obtained
before involvement in the study.
An approval for the study to be
carried out was obtained from the
chairman, ethical committee of UNTH.
Data collection
Instrument for data collection:
Questionnaire: Validated, semi-
structured questionnaire was used to
collect data on the socio-economic and
demographic characteristics of the
growth failure and nutrient
among children with SCD. ion: All the children
signs of malnutrition
MATERIALS AND METH , angular stomatitis,
Study area: The. study ce of co.mplications of
- a t the sickle cell clinic of
of Nigeria Teaching H etry: , Anthropometric
'Enugu. Highlights on UN ents of weights a'nd heights of
bcen . detailed elsewh n were done. Children were
,paediatric sickle cell clinic hed on a bathroom scale wearing a
.Institute of Child - Health (ICH) nimum of clothing. ~ ' e i ~ h t was
. . established in 1974. easured with a wooden height meter.
NIGERIAN JOURNAL OF NUTRITIONAL SCIENCES VOL 28 (1) 2007 119
Children were measured wit
Heads were erect and hand
their sides in a natural manne
were . taken to the neares
Height-for-age, weight-
weight-for-height of ea
compared with NCHS c
grouped according to WHO (
classification.
Dietary Study: Data were obtained by '
dietary recall and weighing the items the
children consumed for three days (2
week days and one week-end day). All
ingredients used to prepare their meals
were weighed with dietary scales. Foods
eaten by each child during meals were
weighed. Leftovers and plate wastes
were recorded. All snacks and items
consumed outside their homes were
noted. Meat, fish and eggs were weighed
separately. Nutrients in foods consumed
were calculated using food composition
tables (10, 11). I-evels of nutrients
intake were compared with WHO (12)
and FAO/WHO/UNU . (13) requirement . .,, ,.,,... ,....,.
levels.
Statistical analysis:
analyzed using descriptive st
square, Student-t-test
variance were used to s
RESULTS
Table 1 show no significant (p>
) difference in the educational levels ,... .
of males and females (x2 = 6.13).
Table 2 shows results obtained by clinida~
examination of the subjects. A total of
77 children were pale. Only 2 children
had angular stomatitis, 4 xerosis and 5
' leg ulcer. The medical history (Table 3)
of the children showed that 38.0% of the
children were diagnosed with SCD before
age one and 16.5% after 6 years of age.
As many as 49.4% of the children had
brothers. with SCD and 48.3% sisters
with SCD. Only 1.2% had either parents
with SCD. Forty percent of the children
had crisis bi-monthly, 25% twice in a
year and 5.5% had crisis occasionally.
dren experienced bone -,
. .
ptom during crisis,
d only 16.0°/o- had.
s the major- cause: of
5% of the children,
in 12.5% .and others in l6%+
ws that the mean weights' of.
en. ranged from. 13.31 ZIZ 2.75kg . , '
47.60 * 6.22. ' ~ e i ~ h t ranged frdm .'
.95 i 8.25cm.to 158.20 * 6.09bm.
- NIGERIAN JOURNAL OF NUTRITIONAL SCIENCES VOL 28 (1) 2007 120
The mean weight (28.47 * the males was statistically
similar to the females (28.76
There was equally . no si
difference (p>0.05) in the
of males (128.1*2.12cm)
(130.0 * 2.5cm): .Assess
nutritional status of the c h ~
5) showed that 39.66% of the males
13.09% of the females were stunted.
total of 28.5% of the children were
stunted. As many as 25.86% of the
males and 11.9% of the females were
underweight. wasting was, prevalent in
20.69% and 20.24% of the males and
females respectively.. I n all the
anthropometric indicators used for
assessing malnutrition, males were
consistently more malnourished than,
females.
I n Table 6, a high proportion
(270%) of the children consumed bread,
rice, beans, okpa, moi-moi, bread fruit,
yam, cocoyam, semovita, . vita-rice,
pumpkin leaf, fish, egg, .b
ground nut and biscuit i
Observations of daily foo
indicated diversified dietary
families .living 'with SCD.
such as-corn, cassava, p
carrot, tomato.es, ice c
and cake were consume
of the children' in any
addition, supplements
FAO/WHO requirement levels.
ever, riboflavin and folate intakes
were low (570 %) for all children.
I n Figure 2, males 10 - 12 years
exceeded their energy and protein
requirements (106.47% and 109.65%
respectively) and had high (270%)
'intakes of other nutrients except
riboflavin and folate. Females ex eded
only their energy intake (107.31%) and
met over 70% of their requirements for
protein, calcium, iron, vitamin A, thiamin
and ascorbic acid.
Males and females 13 - 15 years
had 102.59% and 101.95%
(respectively) of their energy
requirements. Riboflavin and folate
(58.57%.and 68,32%.
ssessed the nutritional
ren with SCD using
try .and dietary studies. A
hildren aged- 2 - '1.8 years
lved in the'study. I n Nigeria,
a1 of relati"ely appreciable number /
of persons with SCD beyond childhood is
attributed to improvement in standard of
NIGERIAN JOURNAL OF NUTRITIONAL SCIENCES VOL 28 (1) 2007 12 1
care (2). Provision of sickl
positively influenced the 1 outcome o f SCD. Such clinics 'act as I
centers for education on the cll$gp3ar fay , d ,
both patients and their< families. "s:.h-s2~<.? . , , I
paleness and painful crisis experienced
by the children in th
observed signs and
associated with sickle cell a
resulting from excessive hemolysi
vaso-occlusion experienced by patients
(14). I n this study, malaria was the most
common cause of crisis. The distribution
of indigenous sickle cell disorder
coincides with the distribution of
plasmodium falciparum malaria (2).
Malaria is a common precipitating factor
for painful crisis and a major contributor
to morbidity and death (2, 3, 6, 15).
About 28% of the children were
stunted, 20°/o underweight and 21°/o
wasted. These are lower than reported
elsewhere (16). Growth in children with
SCD is important and should be part of
patients management, IncrcasOd calorie 1
. .
s a great energy cost in
fore raises nutrient
. The .high levels of
umed -in this study may.
arily meet requirements under
ase .condition. Standardized
re urgently needed to evaluate
y requirements in SCD.
REFERENCES
1. El-Hazmi, M.A.F. (1986). Infections in sickle cell disease. Annals of Saudi Medicine. 6(1), 33 - 40.
2. Akinyanju, 0. (2001). Issues in the management and control of sickle cell disorder. Archives of Ibadan Medicine. 69: 37 - 41.
3. Okpala, I; Daniel, Y; Haynes, R; Odoemena, D. and Goldman, J. (2002). Relationship between . the manifestations o f SCD and expression o f adhesion molecules on WBCrs. Europ. J. Hematol. 69: 133- 144..
4. Ekvall, S.W. (1993). Paediatric nutrition in chronic diseases and developmental disorder. New York
and nutrient demand
physical activity and g
observed excess and
energy and other nut
children could be evidewt$ of compfiancr on the part of patients 8nd their farni l f~s j
I and dietary counseling in a Nigerian
patients management. I ity press, 289 - 2'92.
and nutrient demand .A, and Akinde, J.A.
physical activity and g atal diagnosis of sickle
observed excess and of sickle cell disorder. Ibadan Medicine. 2(2)
energy and other . . .
children could be evid nt, G.R. arid sergeant, B.E.
on the par t .of patieilt , The epidemiology of s'ickle
to education and co s.orcler: . A challen'ge for Africa es of ',1badan Medicine. 2(2) ..
the clinic. However, I
folate levels hav 7. Ngwu, E.K. (200,5). Characteristics of
implications. The rapid turnov patients receiving health education'
NIGERIAN JOURNAL OF NUTRITIONAL SCIENCES VOL 28 (1) 2007 122
Teaching Hospital. Ni dation Publication Series 26(1) 43-49. ventures, lbadan;
8. NCHS. United States ).. Handbook on human Services (1976). requirements. World administration.' Gr zation. Geneva,. : Rockville, Md, USA: for Health Statistics, WHO/UNU (1985). Energy and
rements. World Heath 9.. WHO (1983). Measo h Rept. Serles 724.
'Nutritional Status. Na health statistics ( .E. (1998). The Geneva. management o f crisis in sickle cell
disease. Eur, 3 . Haematol. 60: .I- 6. lO.Plalt, B.S. (19
representative v 15. Fleming, A.F. (1989). The commonly used in tropical countries. presentation, managem'ent and
-Med. Res. Counc. R : prevention of crisis in sickle cell (Seventh Impression) HMSO. London disease in ~ f r i c a . Blood Rev. 3: 18 - 'pp. 46.
Table 1 : Age distribution and educational level o f the children Male Frequencv Female Frequencv
l l.Oguntona, E.B. and Akinyele,' 1.0. (1981). Nutrient composition o f commonly eaten foods in Nigeria - raw, processed and prepared. Food
Age range
2 - 5 years 25.0 20.2
6 - 9 years 18.1 31.0
16. Phebus, C. Gloringer, M. and Maciak, '
B (1984). Growth patterns by age and sex in children with sickle cell disease. J. Paed. 2: 105-108.
Educational le
No, formal educatio
Senior seconda . .
NIGERIAN JOURNAL OF NU'TRITIONAL SCIENCES VOL 28 (1) 2007
Angular stomatitis
Xerosis
Leg ulcer
2 - 5 years 1 0.5
6 - 9 years - -
10 - 14 years "
15 - 18 years 1 0.5
Total . .
2 - 5 years
6 - 9 years - -
10 - 14 years 1 0.5
15 - 18 years 3 1.5
Total 4 2.0
2 - 5 years - -
NIGERIAN JOURNAL OF NUTRITIONAL SCIENCES VOL 28 (1) 2007 124
Mother 1
Sister 42
Brother 43
None 113
Total 200
Incidence Of Crisis
Monthly 43
Bi monthly 80
6 monthly 50
Yearly 16
Occasionally 11
Total 200
Major signs of SCD experienced during crisis
Bone pain (hand and foot) 142 c.
Chest pain 32
Abdominal pain 49
'Fever . , ,,.., . . :,:++ .. . .. . .. . .. :.... ..... .. ..%.
Usual cause of &i
Pneumonia
Bone infection . ,
Respiratory tra
NIGERIAN JOURNAL OF NUTRITIONAL SCIENCE5 VOC 28 (1) 2007 12
10-12
10-12
13-15 '
13-15
'16-18
16-18
Total
Table 5: Nutritional status of males and females compared with NCHS charts
Index Status , . Males. (010) Females (010) 'Total Heightlage Normal 60.34 86.91 71.50 (stunting)
...6..50 . .
Weightlheight No
15.50
. , ,
Moderate
. .
NIGERIAN JOURNAL OF NUTRITIONAL SCIENCES VOL 28 (1) 2007 126
Table
Cocoyam Cassava Gari Fruits Paw-paw Banana Apple Orange Vegetables Pumpkin bat Tomato Carrot Meat Fish Egg Beef Snall Chicken Milk and milk products Cow milk Soy milk Ice cream
96 -43 78.53 70.56 61.36 40.43 Percent (%) 92.83 73 S6 60.36
Snacks Percent ( O h )
Ground nut
. .
NIGERIAN JOURNAL OF NUTRITIONAL SCIENCES VOL 28 (1) 2007 12
NIGERIAN JOURNAL OF NUTRITIONAL SCIENCES VOL 28 (1) 2007 128
scorbic acid and
NIGERIANQOMNAL OF NUTRITIONAL SCIENCES VOL 28. (1) 2007,