Assessment of sociodemographic predictors of iron deficiency among secondary school students in Misau LGA, Bauchi State, Northeastern Nigeria

Rufai A Dachi; Sani Awwalu; Falmata G Mustapha; Saleh Yuguda; Hassan Abdulaziz; Hassan A Odebiyi

doi:10.4103/ijmh.ijmh_26_22

ORIGINAL ARTICLE

Year : 2022 | Volume : 27 | Issue : 4 | Page : 392-396

Assessment of sociodemographic predictors of iron deficiency among secondary school students in Misau LGA, Bauchi State, Northeastern Nigeria

Rufai A Dachi¹, Sani Awwalu², Falmata G Mustapha¹, Saleh Yuguda³, Hassan Abdulaziz², Hassan A Odebiyi⁴
¹ Department of Haematology, Abubakar Tafawa Balewa University Teaching Hospital, Bauchi, Nigeria
² Department of Haematology, Ahmadu Bello University Teaching Hospital, Zaria, Nigeria
³ Federal Teaching Hospital, Gombe, Nigeria
⁴ Federal Medical Centre, Birnin Kudu, Nigeria

Date of Submission	14-Dec-2021
Date of Decision	03-May-2022
Date of Acceptance	20-Jun-2022
Date of Web Publication	22-Sep-2022

Correspondence Address:
Rufai A Dachi
Department of Haematology and Blood Transfusion, Abubakar Tafawa Balewa University Teaching Hospital, Bauchi
Nigeria

Source of Support: None, Conflict of Interest: None

DOI: 10.4103/ijmh.ijmh_26_22

Abstract

Background: Iron is an essential micronutrient found in red meat, vegetables, and dairy products. Iron deficiency (ID) is associated with poor growth and impaired cognitive development, lowered immunity with increased risk to infectious diseases, and reduced productivity. Objective: We determined some sociodemographic predictors of ID among secondary school students in Bauchi State, Northeastern Nigeria. Materials and Methods: This was a cross-sectional study of secondary school students in Bauchi State, Northeastern Nigeria. Four hundred and twenty (420) secondary school students were enrolled using stratified sampling with proportional allocation. Data on age, gender, and sociodemographic parameters were collated. Body mass indices (BMIs) were computed while blood was taken for hemoglobin concentration and iron status determination. Collated data were analyzed using JASP 0.11.1.0. Multiple logistic regression analyses were used to adjust for possible confounders in the observed significant relationships. Level of significance was set at P ≤ 0.05. Results: The mean age of the students was 16.5 ± 1.9 years with females constituting 210 (50.0%). Median (interquartile range) monthly incomes for fathers and mothers were 150 (100, 200) USD and 50 (30, 70) USD, respectively. Median BMI and hemoglobin concentration (Hb) were 17.9 (16.4, 19.6) kg/m² and 13.7 (12.7, 14.7) g/dL, respectively. Anemia was present in 62 (14.8%) participants, whereas ID was present in 213 (50.71%) participants. There was a statistically significant relationship between reduced intake of meat together with gender and iron status with females having a higher risk of having ID compared with males (P < 0.05). Conclusion: Female gender and decreased daily intake of meat are important predictors of ID among secondary school students in Bauchi State, Nigeria.

Keywords: Iron, predictors, sociodemographic, students

How to cite this article:
Dachi RA, Awwalu S, Mustapha FG, Yuguda S, Abdulaziz H, Odebiyi HA. Assessment of sociodemographic predictors of iron deficiency among secondary school students in Misau LGA, Bauchi State, Northeastern Nigeria. Int J Med Health Dev 2022;27:392-6

How to cite this URL:
Dachi RA, Awwalu S, Mustapha FG, Yuguda S, Abdulaziz H, Odebiyi HA. Assessment of sociodemographic predictors of iron deficiency among secondary school students in Misau LGA, Bauchi State, Northeastern Nigeria. Int J Med Health Dev [serial online] 2022 [cited 2023 Mar 29];27:392-6. Available from: https://www.ijmhdev.com/text.asp?2022/27/4/392/356627

Introduction

Iron is an essential micronutrient useful for many metabolic processes in the human body and one of the most abundant elements in the earth’s crust.^[1] It is found in red meat, vegetables, eggs, and dairy food.^[2] It has important roles in critical enzyme reactions concerned with oxygen and electron transport as well as cellular production of energy.^[1],[2] Its deficiency leads to iron deficiency anemia (IDA), which is the commonest form of anemia worldwide.^[2],[3]

IDA is a worldwide problem that is prevalent in developing countries with highest incidence(s) reported in Africa and Asia.^[4] The prevalence is high in school-age children, particularly adolescents, due to physiological demand, adult females due to menstrual loss, and in pregnancy because of increased fetal demand.^[2],[3] Iron and other micronutrient deficiencies are associated with poor growth and cognitive development, lowered immunity with increased risk of infectious diseases, and reduced work productivity.^[5],[6] Large-scale fortification and supplementation programs are being carried out in many developed countries to combat micronutrients deficiencies among vulnerable groups including fortifying cereals and cereal products with iron for boarding schools as part of school health services.^[7]

The North-East (NE) geopolitical zone of Nigeria comprising Adamawa, Bauchi, Borno, Gombe, Taraba, and Yobe states is one of the zones with high poverty and low literacy rates due to negative cultural beliefs, droughts, and conflicts that result in displacements of persons from their places of abode.^[8],[9] The Federal Government of Nigeria and some state governments have instituted school feeding programs to encourage school enrollment and retention and to improve nutrition of pupils in the Northeast.^[10] However, for these programs to be effective, there is a need to be scientifically guided by baseline studies on the nutritional status of the students’ populations.

To the best of our knowledge, no such studies on anemia and ID have been conducted among secondary school students in Bauchi, Nigeria. Therefore, this study aimed to determine some sociodemographic predictors of ID among secondary school students in Misau Local Government Area (LGA), Bauchi State, Northeastern Nigeria, with a view to providing evidence-based information on the predictors of ID among secondary school students.

Materials and Methods

This was a cross-sectional study among secondary school students in Misau LGA of Bauchi State, Nigeria. The sample size was determined by estimating the odds ratio (OR) (2.762) of an adolescent female having anemia when compared with a male, using WinPepi 11.39. The prevalence of anemia among male and female adolescents, as described by Onabanjo and Balogun,^[11] in Ogun State Nigeria were 14.5% and 31.9%, respectively. Thereafter, using G*Power 3.1.9.4, it was estimated that a priori, a minimum of 305 participants will be required in order to have 95% power at an alpha error probability level of 0.05 of detecting at least an odds ratio of 2.762. This minimum sample size was adjusted to 366 to accommodate for a projected non-response rate of 20%.

After ethical approval from the Bauchi State Health Research Ethics Committee (BASHREC) was acquired, 420 boarding and day secondary school students were enrolled across 10 boarding and day secondary schools using stratified sampling with proportional allocation. Data on age, gender, present class, educational status of parents/guardians, average monthly income of parents/guardians, and number of siblings were collated. Body mass indices were computed while blood was taken for hemoglobin concentration determination using Swelab hematology analyzer and iron studies which include serum ferritin and serum soluble transferrin receptor assays using enzyme-linked immunosorbent assay. Anemia was defined as hemoglobin concentration (Hb) of <13 and <12 g/dL for males and females, respectively.^[12] ID was defined as the ratio of soluble transferrin receptor–log ferritin index >1.5.^[13] We have earlier reported the comparative performance of this ratio and other ID indices among subgroup of students’ population.^[14]

Data obtained were collated and analyzed using JASP 0.11.1.0. Qualitative variables were summarized as percentages. Distribution of quantitative variables was assessed using the Shapiro–Wilk test. Normally distributed variables were summarized as means±standard deviation, whereas medians and interquartile ranges (IQRs) were used to summarize non-normally distributed data. The χ² test was used to assess the relationship between anemia and gender. Spearman correlation analyses were done to assess relationships between ID and continuous variables. Multiple logistic regression analyses using the enter method were used to adjust for possible confounders in the observed significant relationships. Level of significance was set at P ≤ 0.05.

Results

The mean age of the participants was 16.5 ± 1.9 years with females constituting 210 (50.0%). Median (IQR) monthly incomes for fathers and mothers were 150 (100, 200) USD and 50 (30, 70) USD, respectively. The median number of siblings was 11 (8, 15). A summary of the class distribution is provided in [Table 1]. Educational status of the parents/guardians is summarized in [Figure 1]. The median (IQR) was 2 (2, 3) each for frequency of meat, tea, milk, and green vegetables intake. Median BMI and Hb were 17.9 (16.4, 19.6) kg/m² and 13.7 (12.7, 14.7) g/dL, respectively. Anemia was present in 62 (14.8%) participants. ID was present in 213 (50.71%) participants.

Table 1: Distribution of classes of the students

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Figure 1: Educational status of parents/guardians of the students

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There was a statistically significant relationship between gender and iron status with females having a higher risk of having ID when compared with males [χ²=6.944, OR=1.68, 95% confidence interval (CI) 1.14, 2.47, P = 0.008]. There were weak statistically significant correlations between iron status, on the one hand, and fathers’ monthly income, frequency of meat intake, and BMI, on the other hand [Table 2]. There was no statistically significant relationship between iron status, on the one hand, and educational status of father and mother, menstruation status, nature of secondary school (boarding vs. day), and present class, on the other hand [Table 3].

Table 2: Relationship between iron status (ID/no ID) and quantitative variables

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Table 3: Relationship between iron status (ID/no ID) and qualitative variable

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The multiple logistic regression model created to predict iron status using gender, fathers’ monthly income, frequency of daily meat intake, and BMI as predictors was significant (H₀ deviance = 546.159 vs. H₁ deviance = 524.684, χ (389)=21.476, P < 0.001). It revealed that gender and frequency of meat intake were the only variables that remained statistically significant predictors of ID. When fathers’ monthly income, frequency of daily meat intake, and BMI were held constant, females were still at higher risk of ID when compared with males (OR=1.808, 95% CI 1.193, 2.739, P = 0.005). Controlling for gender, fathers’ monthly income, and BMI revealed an increased frequency of daily meat intake, which was protective for ID (OR=0.577, 95% CI 0.399, 0.835, P = 0.004) [Table 3].

Discussion

Micronutrient deficiencies among schoolchildren, especially iron and iodine, contribute to adverse educational and cognitive function as well as high rates of illnesses, which may culminate in poor school attendance and poor academic performance.^[6] Malnutrition is highly prevalent in developing countries like Nigeria, and the North-Eastern part of the country is most affected owing to low literacy and high poverty rates coupled with the Boko Haram terrorists’ insurgency currently ravaging the region.^[8],[9] This has led to the emergence of many internally displaced persons (IDP) camps and reduction in agricultural and economic activities.^[15] The physiologic demand of iron and other micronutrients in children is often difficult to meet under these circumstances.

This study reveals a high prevalence of anemia among the participants. Higher prevalence rates were reported by Gwetu et al. in Kwazulu-Natal, South Africa. Petry et al. reported in some low, medium, and high human development index countries across the globe and Wu et al. in Samoa island, a country in Ocaenia.^{[16],[17],[18]} The differences could be explained by some sociocultural diversities between the various geopolitical zones in the country and inter-country differences.

The prevalence of ID found in this study is higher than that demonstrated by Adebara et al.^[19] in Ilorin, North-Central, Nigeria and by Allen et al.^[20] in Sri Lanka. Higher prevalence rates were reported by Gwetu et al.^[16] in South Africa and Akodu et al.^[21] in Lagos, Southwestern Nigeria, respectively. The prevalence reported in this study and those with higher prevalence rates reported in South Africa and Lagos, Nigeria were mostly attributable to poor dietary intake and parasitic infestations. It is also important to note that this study reveals that the prevalence of ID far outstrips that of frank anemia among the study population. This suggests that many students may have latent ID as IDA occurs in phases from a latent phase in which the iron stores in macrophages are exhausted followed by a fall in red cell indices (mean corpuscular volume as well as mean corpuscular hemoglobin) to the final phase of frank ID.

The absence of a significant statistical relationship between iron status and mothers’ monthly income, number of siblings in the family, daily meal frequency, milk, and vegetables intake in this study is an unexpected finding. This contrasts with other reports which indicate that these factors significantly contribute to iron status.^[1],[2] It has been shown that socio-economic factors, especially parents’ education and family size, play particularly important roles in some health issues including IDA. Oyelese et al.^[22] in southwestern Nigerian study reported that the prevalence of anemia was found to be less in class mothers and their children.

Our findings indicate the absence of a statistically significant impact of level of parental education on iron status, suggesting that education alone is not adequate in addressing nutritional needs of children; rather, dietary and/or nutritional awareness may be more important. This is further buttressed by the absence of any effect of fathers’ income on iron status when other factors were controlled for. This suggests that apart from the economic sustainability, other factors such as dietary or nutritional awareness play vital roles. It may even be postulated that with increasing income and upward mobility in the society, some families are more likely to consume fast (junk) food which may be viewed as a status symbol.

The absence of any relationship between BMI and ID upon multivariate analyses implies that BMI cannot be relied on when predicting ID of students. Low BMI may suggest inadequate energy and nutrient intake, which may be associated with limited food resources, emotional stress, or lifestyle habits in adolescents.^[22],[23] It may not reflect adequacy or iron intake/loss.

The data from this study indicate that female gender and decreased meat intake are important predictors of ID among the study population. This suggests that for any intervention to succeed, female students and their parents need to be identified and educated on nutrition. An interesting finding in this study is the absence of any relationship between menstruation status and iron status. This may be because these are relatively young females. Additionally, this study did not assess frequency and volume of blood loss during menstruation.

Our study did not quantify the intake of meat, milk, tea, and vegetables; hence, it will not be possible to state amounts that will have such effects.

Conclusion

Female gender and low daily intake of meat are important predictors of ID among secondary school students in Misau LGA, Bauchi State, Nigeria.

Acknowledgements

We want to thank the Government of Bauchi State for approving this study and also want to sincerely thank and appreciate the students for participation in the study.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

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