SOCIO-ECONOMIC DETERMINANTS OF MALNUTRITION AMONG URBANRURAL SCHOOL-AGE CHILDREN OF ENUGU STATE, NIGERIA

Abstract

Background: School feeding programs have been implemented in Nigeria to improve education outcomes and reduce hunger among school children. However, sustaining these programs remains a challenge. In Southeast Nigeria, urban–rural disparities in socioeconomic status, food security, and access to education affect caregivers’ ability and willingness to support school feeding programs. Malnutrition remains a pervasive and intractable public health challenge in Nigeria, particularly among school-age children. The phenomenon of malnutrition is complex and multifaceted, influenced by numerous socioeconomic factors that vary across geographic locations, including urban and rural areas. Enugu State, located in the southeastern region of Nigeria, is not exempt from these challenges. The state’s urban and rural communities exhibit distinct socioeconomic characteristics that influence the nutritional status of school-age children. Understanding the socioeconomic determinants of malnutrition among urban and rural school-age children is crucial for developing effective interventions aimed at mitigating the burden of malnutrition.

Methodology: This study was a comparative, cross-sectional descriptive study carried out in selected communities in Enugu State, South East Nigeria, involving households from four communities (two urban and two rural). The sample size was 422, and participants were selected using a multistage sampling technique. The questionnaire was adapted from the National Health Demographic Health Survey and was a pre-tested semi-structured interviewer-administered questionnaire in the English language. Data were collated, assembled, and analysed using the International Business Machine (IBM) Statistical Package for Social Science (SPSS) version 23. Descriptive statistics, including percentages and frequencies, were presented in tables. The mean and standard deviation of parameters in each community were obtained, and statistical tests of association between dependent and independent variables were conducted, with the level of statistical significance set at P ≤ 0.05. Ethical approval was obtained from the Ethics Review Committee of Nnamdi Azikiwe University Teaching Hospital. Consents were obtained from traditional rulers and village heads before commencement of the study. All participants had the right to withdraw from the study at any time without explanation, and confidentiality was maintained throughout the study.

Results: Most respondents were female 262 (62.4%), while 158 (37.6%) were males. The majority had formal education 401 (95.48%), with 194 (46.19%) having completed tertiary education. Most respondents were household representatives 254 (60.5%). Regarding marital status, 371 (88.3%) were married, followed by 34 (8.1%) single parents. A total of 159 (37.9%) respondents were government employees, 113 (37%) were self-employed, and 70 (16.7%) were unemployed. In urban areas, most caregivers fed their children at school daily, with 151 (72.25%) before health education and 146 (69.86%) after health education. The primary reason caregivers preferred enrolling their children in school feeding programs was the free provision of food, reported by 156 (74.64%) before health education and 143 (68.42%) after health education. Another major reason for enrolment was that children appeared very tired after school, as reported by 164 (78.47%) respondents. In rural areas, fewer caregivers fed their children at school daily, with 52 (24.64%) before health education and 4 (1.90%) after health education. Similarly, 66 (31.28%) rural caregivers indicated that children looking tired after school was a major reason for enrolment in school feeding programs. Most respondents believed that school authorities should be responsible for school feeding before health education 163 (77.99%), while parents were identified after health education 124 (59.33%). Regarding food preparation, 53 (25.36%) of respondents before and after health education felt it should be done within school premises. Most respondents 101 (48.33%) believed that food items should be sourced from locally available foods before and after health education, while after health education 28 (13.27%) felt sourcing should be within school premises. Socioeconomic grading showed that most respondents fell within the categories of most poor (Q1), very poor (Q2), poorer (Q3), poor (Q4), and least poor (Q5).

Conclusion: This study assessed the socioeconomic determinants of malnutrition among urban and rural school-age children in Enugu State, Nigeria. The findings revealed that poverty, low maternal education, inadequate access to healthcare, and poor sanitation and hygiene practices are significant factors influencing school feeding and contributing to adverse nutritional outcomes among school-age children in both urban and rural areas. Urban–rural disparities in the prevalence of malnutrition were also evident, with rural areas experiencing higher rates. The study underscores the need for the development and implementation of nutrition-sensitive policies, particularly targeting rural communities. Additionally, providing nutrition education to caregivers and school-age children is essential for promoting healthy eating habits and reducing the risk of malnutrition.