Components of Nutrition in the Clinical Exam a. Height, weight, BMI, waist circumference.
b. Body Composition, if applicable.
c. Review of Systems” with consideration of indices of nutritional adequacy or inadequacy for each system.
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CHAPTER THREE METHODOLOGY 3.1 Study Location
The study was carried out in Owerri North Local Government Area (LGA).
Owerri North LGA is one of the three LGAs in Owerri metropolis the capital city of Imo state in Nigeria. Imo State with a population of 3,927,563 (NPC 2006) is one of the 36 States that make up the Nigerian nation. It has an urban setting and located in the south – eastern part of the country.
The predominant occupation of the people is farming and closely followed by trading. However, significant percentages are in the public service and private sector while others are engaged in one form of self – employment or the other. It is bounded by Enugu State in the South, Abia State in the North, Anambra State in the East and Rivers State in the West. The Ibo ethnic group dominates the state predominantly; however, it has small proportion of non – Ibos from within and outside Nigeria. The state is divided into 27 administrative units‘ i.e. Local Government Area (LGA). The population is 70%
rural and 30% urban.
Owerri North has its headquarters in the town of Orie Uratta. It has an area of 198km2 and a population of 175,395 as at the 2006 Census.
The study was carried out in the following health facilities:
1. Federal Medical Centre, Orlu road, Uratta Amakohia Owerri North 2. Holy Rosary Catholic Hospital, Emekuku, Owerri North
3. Three primary health centers (Awaka, Egbu, Emii) all in Owerri North LGA.
All the government health facilities and the age long Catholic Hospital in the LGA are designated as ―Baby Friendly Hospitals.‖ These health facilities operate antenatal, postnatal and child welfare which take care of pregnant/lactating mothers and their infants living within and outside Owerri North Local Government Area.
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3.2 Study population
The populations were lactating women 15 – 49 years across the five communities in Owerri North LGA where the study was carried out.
3.3 Study Design
The study was a descriptive cross sectional in design carried out from September to December, 2010.
3.4 Sampling Method
In a systematic random sampling, 200 lactating mothers out of the total of 500 registered mothers as at the time of this studies attending immunization clinics every Thursday were proportionately selected from one of the health facility from the five major communities in Owerri North LGA. The five health facilities in each of the community and the number of mothers recruited are as follows: Emekuku (55), Emii (45), Egbu (40), Uratta Amakohia (40) and Awaka (30).
3.5 Sample Size Determination
The sample size of 200 was calculated by the use of the formula n = Z2 × p (100 – p)
X2
(Araoye M.O. 2003), where Z represents the standard normal deviate set at 1.96 which corresponds to 95% confidence level, X is 5% margin error and p is 12%
estimated prevalence of lactating mothers who do not meet their required dietary iron intake, (NFCN 20001--2003). Substituting in the values into the above formula,
n = 1.962 × 12 (100 – 12) 52
n = 162
The calculated size was 162. In order to make up for the attrition, an anticipated 81% (0.81) response rate was used. The estimated sample size was thusdetermined by dividing the originally calculated sample size by the anticipated response rate as
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162= 200 0.81
A total number of 200 lactating mothers were used for data collection.
3.6 Data collection procedure 3.6.1 Study Instrument
The main study instrument (questionnaire) had several sections;
Food Frequency Questionnaire (FFQ) 24 hour Dietary Recall
Anthropometric measurements.
The following procedures were employed:
Visits were carried out to the health facilities on the immunization day(s) till the complete 200 subjects were recruited.
Semi – structured questionnaire were administered to obtain data on: demographic and socio-economic characteristics, knowledge, attitude and practice on nutrition and Reproductive Health issues, food consumption pattern, coping skill strategy, food security health & sanitation, feeding practices.
Dietary Pattern and nutritional status assessment.
Food Frequency Questionnaire was administered
- The 24 hour dietary recall was conducted.
- Anthropometric measurement was carried out.
3.6.2 Demographic and Socio- Economic Characteristics
A pre-tested, interviewer-administered, semi-structured questionnaire was used to collect information on socio –demographic characteristics of the respondents (such as gender, age, house size, community, education, marital status, number of children, ethnic
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group and religion) and socio-economic characteristics (like occupation, primary sources of energy and water, income).
3.6.3 Dietary Iron Intake Assessment
Dietary iron intake was measured by the use of a qualitative food frequency questionnaire and 24 hour diet recall.
For the food frequency questionnaire, lactating mothers were asked to report their usual frequency of consumption of each food from food groups for a specific period of time. Information was collected on frequency (Thompson, F. E., and Subar, A. F. 2001).
For the 24 hour recall, the lactating mothers wereasked to remember and report all the foods and beverages consumed in the preceding 24 hours or in the preceding day. . The interview was conducted using a paper and pencil for recording. Also, common household utensils and models of portion sizes were used to aid the mothers‘ estimate the amount of food they consumed and these were converted to grams equivalent using household measures.
3.6.4 Anthropometric Measurement
Weight measurement was taken using a portable bathroom scale (Hanson model).
The mothers were asked to remove any clothing which might change body weight and remove their shoes while standing erect on the weighing scale. Readings were taken to the nearest 0.1kg. Height was measured using a portable Stadiometer with a movable head piece while subjects stood erect on bare foot. Also, a measuring tape was in centers where the stadiometer was not available. Measurement was taken to the nearest 0.1cm.
BMI was calculated by in computing the weight and height measurement of the lactating mothers in the computerized database system. (WHO, 1995)
The BMI of the lactating mothers as overweight (≥25.00 Kg/m2), normal (18.50 – 24.99 Kg/m2) and underweight (<18.50 Kg/m2).
3.6.6 Inclusion Criteria
Lactating mothers 15 – 49 years were included.
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3.7 DATA PROCESSING AND ANALYSIS
3.7.1 Data Processing
Steps taken in managing the data obtained included:
Questionnaire Sorting: this was done to identify and remove incorrectly and incompletely filled questionnaire. Care was taken at this stage to ensure that questions that were not responded tom were not mistaken for incomplete filling of questionnaire.
Data Entry: Following the coding guide, the data were entered into computer. The package used was Statistical Package for Social Sciences (SPSS) version 15.0. After cleaning the entered data (consistency checks and corrections), the data were analyzed.
Data Storage: Questionnaires were properly stored in a safe place after data entry. The electronic version of the data was saved in a retrievable format on the computer as well as on external storage devices
3.7.2 Data Analysis
Data were analyzed using descriptive statistics, Chi – square test and logistic regression analysis at 95% CI. The nutrient intake was analyzed using a computerized database system.
3.8 Ethical Considerations
Ethical clearance was sought for and obtained from UI/UCH Institutional Review Board. Consent was sought from the medical boards of the hospitals. Also, informed consent was obtained from each of the study participants. In view of this, a written informed consent was developed on the procedures, risks and discomfort, benefits and most importantly confidentiality steps of the research will be adhered to. Lactating women who had problems such as hypertension, infections, malaria, metabolic disorders (as indicated in their medical records) were excluded from the study. The details were given below:
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Procedures
The participants were invited to take part in this research project and participate in the questionnaire. On acceptance, they were asked to participate in the filling of the questionnaire in which the literate lactating women were given the questionnaire to fill while the illiterate were interviewed from the questionnaires and the answers recorded.
The participants were assured that the information recorded was confidential, and that no one else except the researcher and his colleagues would have access to the information documented during the research.
Again, the participants were given the option of moving to the next question if they did not want to answer any of the questions included in the survey. In total I recruited 300 participants into this study.