INFLUENCE OF DIETARY PATTERN ON THE NUTRITIONAL STATUS OF URBAN ADOLESCENTS IN TASSIA NAIROBI COUNTY

NAME: OMONDI CRAIG

REG. NO: A90/4629/2017

A PROJECT SUBMITTED IN PARTIAL FULFILMENT FOR THE AWARD OF BACHELOR OF SCIENCE DEGREE IN FOOD NUTRITION AND DIETETICS IN THE UNIVERSITY OF NAIROBI                                                   

                                                                  MAY 2020

                                                       Declaration Form for Students

UNIVERSITY OF NAIROBI

Declaration of Originality Form

DECLARATION

1. I understand what Plagiarism is and I am aware of the University’s policy in this regard
2. I declare that this research proposal is my original work and has not been submitted elsewhere for examination. Where other people’s work or my work has been used, this has properly been acknowledged and referenced by the University of Nairobi’s requirements.
3. I have not sought or used the services of any professional agencies to produce this work.
4. I have not allowed, and shall not allow anyone to copy my work with the intention of passing

It off as his/her work.

5. I understand that any false claim in respect of this work shall result in disciplinary action, in accordance with University Plagiarism Policy.

Signature ______________________________________Date: _____________

ACKNOWLEDGEMENTS

I would like to thank my entire co researcher for the support and advice. I am deeply indebted to my supervisor Professor K. Makau, whose help, inflaming suggestions and encouragement helped me during the time of my research for writing this proposal. In addition I would like to express my gratitude to the department of FOOD SCIENCE, NUTRITION AND TECHNOLOGY who gave me the possibility to commence and complete this proposal and to do the necessary research work. I hope that my proposal will help you in some way about food and adolescents.

Contents

ACKNOWLEDGEMENTS. iii

CHAPTER ONE.. 1

1.1        INTRODUCTION.. 1

1.2 BACKGROUND.. 3

1.4 JUSTIFICATION.. 3

1.5 BENEFICIARY OF THE STUDY.. 4

1.6 AIM OF THE STUDY.. 5

1.6.1 PURPOSE OF THE STUDY.. 5

1.7 OBJECTIVES OF THE STUDY.. 5

1.7.1 General objectives. 5

1.7.2 Specific objectives. 5

1.8 ASSUMPTIONS. 5

1.9 HYPOTHESIS. 6

1.10 RESEARCH QUESTIONS. 6

CHAPTER TWO; LITERATURE REVIEW… 7

2.1 ADOLESCENCE IS ATIMELY PERIOD FOR THE ADOPTION AND CONSOLIDATION OF SOUND DIETARY HABITS. 7

2.2 ADOLESCENCE IS A PERIOD OF NUTRITIONAL VULNERABILITY.. 8

2.3 LIFESTYLE AND EATING PATTERNS, MAJOR THREATS TO ADOLESCENTS’ NTRITIONAL STATUS   8

2.3.1 Typical eating patterns and intakes of adolescents. 9

2.4 METHODOLOGY.. 11

2.5 SUMMARY.. 12

2.5.1 OPERATIONAL DEFINATIONS. 12

2.5.2 GAPS IN KNOWLEGDE.. 12

CHAPTER THREE: METHODOLOGY.. 14

3.1 STUDY SITE.. 14

3.2 GEOGRAPHICAL MAP. 14

3.3 STUDY POPULATION.. 14

3.4 SAMPLING PROCEDURE.. 15

3.4.1 Inclusion criteria. 15

3.4.2 Exclusion criteria. 15

3.5 DATA COLLECTION TOOLS. 15

3.5.1 Data collection tools. 15

3.5.2 Data collection process. 16

3.6 PERMISSION TO CONDUCT THE STUDY.. 16

3.7 RESEARCH ETHICS. 16

3.7.1 Data quality control 16

3.8 DATA HANDLING AND ANALYSIS. 17

RESEARCH CONSENT FORM. 28

ENUMERATOR RECRUITMENT CRITERIA. 30

APPENDIX IX; ENUMERATOR RESPONSIBILITIES. 30

ACRONOYMS AND ABREVIATIONS

W/L        Weight for Length

WFH      Weight for Height

BMI       Body Mass Index

CVD      Cardiovascular Disease

Kcal     Kilocalories

kg        Kilogram

CHAPTER ONE

1.1  INTRODUCTION

Dietary pattern is defined as the quantity, variety or combination of different foods and beverage in a diet and the frequency with which they are habitually consumed. (The prevention of cardiovascular disease through the Mediterranean diet, 2018).Nutrition status is the condition of the body in those respects influenced by the diet; the levels of nutrients in the body and the ability of those evils to maintain normal metabolic integrity.

This study is to assess the food habits, food preference, dietary pattern and nutrition status as well as the problem among urban adolescents in Tessie Nairobi County. Both quantitative and qualitative. Nutrition status is an essential component in improving dietary habits and food choices .Adolescent person is said to be between ages 13 and 19 according to WHO. Adolescence is also a period when development of the reproductive system, sexual maturation, formation of identity and gender roles set in and issues relating to identity and gender roles and related problems arise.

A study conducted by Kootchar et al. regarding the identification and rankings of problems among urban adolescents could identify problems broadly into the category of health and nutrition ,academic ,physical ,growth and development .The development of healthy eating habits is important as the rapid physical growth in adolescence is often associated with increased nutritional needs.

Various study on diet and nutrition intake of adolescents in the developing world especially urban settings have shown that their diets are often high in fats and refined carbohydrates. Some dietary pattern appear quite common among adolescents, to mention a few: snacking; usually on energy dense foods; meal skipping, particularly breakfast or irregular meals; wide use of fast food; and low consumption of fruits and vegetables. Consumption of diets high in sugar, saturated fat, salt, and calorie content in children can lead to early development of obesity, hypertension and impaired glucose tolerance. Adolescence is also a period of increased vulnerability to obesity.

Lack of physical activity and outdoor sports, along with the consumption of fat-rich foods is the cause of obesity among the affluent population. Nutrition status is assessed by measuring weight and height using BMI. It is an easy index of weight for height that is normally used to classify underweight, overweight.

1.2 BACKGROUND

Tassia is located in Nairobi county, Embankasi east constituency. It is situated along Outer Ring Road between Nairobi River and the North Airport Road roundabout.it mainly constitutes residential houses .Tassia is divided into phases: Tassia Phase 1 and Phase 2 are site and service residential development that was started in 1990s. The housing consist of a mixture of marionettes and two-three story apartments. Phase 1 has tarmac roads while Phase 2 has mural roads.Tassia Phase 3 is a more recent residential area that is largely under construction and development featuring a mixture of marionettes and residential flats .Tassia is 12.4 km and 36 minute drive from Nairobi city via Jogoo Road.

1.3 STATEMENT OF THE PROBLEM

Poor dietary practices and nutrition status is now developing among adolescents. Moreover, it is now an issue as it relates to some health problems such as CVD known to be the leading cause of mortality among world’s population.

The study research seeks to find out why it is developing and why the onset is related to dietary practices and nutrition status.

1.4 JUSTIFICATION

This topic is important because it provides information for example concerning their income, expenditure and amount of food distributed among households/community, how they feed, sources of food for different households. The problem is current as most adolescents have poor dietary pattern because they are in incomplete control of what food they eat that is most don’t have jobs which in turn influences their nutrition status. Money should be spent to make the research flexible and simple.

1.5 BENEFICIARY OF THE STUDY

1.6 AIM OF THE STUDY

To improve dietary intake and nutritional status of urban adolescents who consume foods high in fats and refined carbohydrates.

1.6.1 PURPOSE OF THE STUDY

Is to generate numerical data /results on how dietary pattern contributes towards the nutrition status of adolescents

Is to improved knowledge on new foods

Is to improve the utilization of new foods among adolescents as well as their nutrition status and dietary feeding practices.

1.7 OBJECTIVES OF THE STUDY

1.7.1 General objectives

To determine the nutrition status of adolescents and the associated dietary habits and patterns

1.7.2 Specific objectives

To determine the adolescents dietary intake

To determine the nutritional status of adolescents

1.8 ASSUMPTIONS

The study will give indicators of health status in relation to tools used to collect data for example BMI

1.9 HYPOTHESIS

Imbalanced dietary pattern and restrictions observed during menstruation in adolescent girls and puberty in adolescent boys is responsible for poor nutrition status among adolescents.

1.10 RESEARCH QUESTIONS

• What is the nutritional status of urban adolescents in tassia Nairobi county
• What are some of the dietary practices adolescents in tassia engage in

CHAPTER TWO; LITERATURE REVIEW

2.1 ADOLESCENCE IS ATIMELY PERIOD FOR THE ADOPTION AND CONSOLIDATION OF SOUND DIETARY HABITS.

Diet plays a very important role in the growth and development of adolescents during which the development of healthy eating habits is of supreme importance. There is dual burden of under nutrition and over nutrition in this age group as well as chronic diseases manifestation as a result of poor eating habits. The study will assess food habits, dietary pattern and nutritional status of adolescents.

Adolescents are far from being a homogenous group in terms of development, maturity and lifestyle. Many eating habits acquired during adolescence will let a lifetime , furthermore , with increasing age , adolescents personal choices and preferences gain priority over eating habits acquired in the family and they have progressively more control over what they eat , where and when( Thomas 1991;Shepherd and Dennison ,1996 ;Spear 1996)

Changes in lifestyle, including food habits, are often more obvious among urban adolescents, (Ahmedet al, 1998), as they are typically the ‘early adopters’ owing, among other things to their attraction for novelty and high exposure to commercial marketing in cities. Indeed, looking into adolescents’ living and eating patterns may give an idea of the changes taking place in a society. They may act as role models for others in the community, in particular if they are from higher socioeconomic status groups.

In this sense, the patterns seen in urban well-off adolescents anticipate the patterns of the future. Since these privileged youth are a reference group for other adolescents they should also be targeted by health and nutrition promotion activities.

2.2 ADOLESCENCE IS A PERIOD OF NUTRITIONAL VULNERABILITY

IT may be said that adolescents are a nutritionally vulnerable group for a number of specific reasons, including their high requirements for growth, their eating patterns and lifestyles, their risk-taking behaviors and their susceptibility to environmental influences. Inadequate nutrition in adolescence can potentially retard growth and sexual maturation, although these are likely consequences of chronic

Malnutrition in early infancy and childhood. It can affect adolescents’ current health and put them at high risk of chronic disease as well, particularly if combined with IT other adverse lifestyle patterns, even if the detrimental effects may take long to show.

2.3 LIFESTYLE AND EATING PATTERNS, MAJOR THREATS TO ADOLESCENTS’ NTRITIONAL STATUS

Nutritional problems of adolescents, whether under nutrition or nutrition-related chronic diseases, are mainly the result of dietary inadequacies, which may be related to a number of factors that can be grouped under physiological, socioeconomic, and psychosocial factors. Growth imposes additional nutritional requirements in adolescence, and these requirements are further increased in pregnancy. Such high requirements mean that adolescents are exposed to not meeting them.

Socioeconomic factors have a pervasive influence on quantity and quality of diets, irrespective of lifecycle groups; adolescents are not different in this respect, perhaps with the exception of the great influence upon their eating habits by the commercial environment, particularly mass media. Psychosocial factors are probably those with particular importance during adolescence. The search for identity, the struggle for independence and acceptance, and concern about appearance, are changes that may have a great impact on lifestyle, eating patterns and intakes of adolescents (Spear 1996), as discussed below.

2.3.1 Typical eating patterns and intakes of adolescents

How do intakes of adolescents compare with those of adults? It may be hypothesized that in most settings, the diet of adolescents is likely less adequate than that of adults, to begin with because of their eating patterns. However, the bulk of the information comes from high-income countries, and particularly the USA, where several surveys have been conducted on adolescents’ health, nutritional status, dietary behaviors and intakes.

Adolescent girls may be even more at risk of inadequate intakes for various reasons: dieting, discrimination, early pregnancy, lower energy intake than boys. And yet, girls usually have better eating habits than boys and they are more concerned about healthy eating (Dennison and Shepherd, 1995), when they can exert their choice, and provided dieting does not interfere. According to a large body of dietary survey data collected in the USA, it appears that some dietary patterns are consistently observed among adolescents, and put them at risk of unhealthy eating: the consequence of snacking, usually on energy-dense but otherwise nutrient-poor items; meal skipping; irregular eating patterns; and a wide use of fast food for meals and snacks.

These food habits may also apply in varying degrees to adolescents in other parts of the world. Other eating behaviors generally recognized as common among adolescents are eating away from home, low intake of fruits and vegetables and in some instances, of dairy products as well; and weight concerns leading to faulty dieting practices, particularly in girls (Frothing 1991; Perry-Hummicuft and Newman, 1993; Gutierrez and King, 1993). Adolescents may also try unconventional dietary practices, such as vegetarian diets, which may reflect their propensity to adopt social causes and explore different philosophies (Johnston and Haddad, 1996).

Breakfast is often missed: more than 50% of respondents in the National Adolescent School Health Survey (US Dept. Health and Human Services, 1989). Snacking was reported by 90% in the same survey. Only 39% reported eating nutritious snacks, the others describing snacks of “junk” food: chips, soda, sweets and cake (Porto and Christensen, 1989). Wisely chosen snacks are important, however, as energy

Requirements of adolescents are high. Indeed, it was reported in the USDA Nationwide Food Consumption Survey that snacks provided up to one third of adolescents’ daily energy intake, and a significant amount of micronutrients (Bigler-Doughten and Jenkins, 1987). Fast foods are popular choices among adolescents, and this can contribute to high intakes of saturated fat. In developing-country adolescents, eating “on the go” may also be common, and street foods represent a major dietary contributor.

In Nigeria, for example, it was reported that street foods contributed 21% (boys) and 29% (girls) of adolescents’ energy intake, 50% of dietary protein, 64% of calcium, and almost 60% of vitamin A (Oguntona and Kanye, 1995). In contrast with western snack foods, however, street foods often provide nutrient-dense traditional dishes in developing countries.

2.4 METHODOLOGY

2.5 SUMMARY

2.5.1 OPERATIONAL DEFINATIONS

Dietary attitude, Dietary knowledge, dietary practices, over nutrition, under nutrition.

2.5.2 GAPS IN KNOWLEGDE

No studies has been done in TASSIA on the nutritional status and dietary pattern of urban adolescents.

CHAPTER THREE: METHODOLOGY

3.1 STUDY SITE

Tessie is located in Embanks east constituency, east of the central business district. A residential area of middle income earners and accommodates lots of industrial factories. It is one of the fast developing estates in Kenya.

3.2 GEOGRAPHICAL MAP

3.3 STUDY POPULATION

The study is to be conducted among urban adolescents aged between 13-19 in cassia Nairobi county especially school going adolescents

3.4 SAMPLING PROCEDURE

Purposive sampling will be used in the four wards present in embaksai east constituency. Random sampling will be used in the households present in these four wards. The sampling frame will be 68 for the adolescents as per the Fischer’s formula.

3.4.1 Inclusion criteria

Teenagers between 10-19 years within Tassia (school going).

3.4.2 Exclusion criteria

Teenagers with chronic diseases such as hypertension, pregnant adolescents

3.5 DATA COLLECTION TOOLS

3.5.1 Data collection tools

WHO Model Care Questionnaire will be used to collect the data

1) Anthropometric assessment data sheet will be used for height/ Weight measurement for calculating the BMI

2) A structured questionnaire for socio-economic information egg age, sex, level of study and area of residence

3) To assess the dietary intake, a food frequency questionnaire will be included, food frequency of choice which targets specific food and frequency of consumption.

3.5.2 Data collection process

The questionnaires will be administered to the respondents and anthropometric measurements taken and recorded in the anthropometric data sheet to ensure eligibility.

Recruitment and training of research assistance

Two enumerators will be needed. They should be fluent in English and Kiswahili. Form four graduates. A one day training session will be conducted to train them in questionnaires administering techniques and on the use of equipment and tools for anthropometric measurements.

3.6 PERMISSION TO CONDUCT THE STUDY

Permission to conduct the study will be obtained from study subjects.

3.7 RESEARCH ETHICS

Clearance to undertake my study is foreseen by lecturers, government administration officers and consents from the respondents (parents, guardians, adolescents).

 3.7.1 Data quality control

• Accuracy of the research tools to be used will be assessed before commencing data collection of data. Answers given by the respondents will be cross examined before exit of the household to ensure legibility of the information given.
• To achieve qualify of data, calibration of scales will be done every day to ensure accuracy of the measurements.
• The completed questionnaire will be cross-checked and examined in the field for completeness of data, consistency of answers in correlation with measurements to be obtained.
• Supervision of enumerators will be done frequently during data collection.
• Two to three measurements will be taken from an individual to avoid parallax on measurement readings.

3.8 DATA HANDLING AND ANALYSIS

Information from the questionnaire will be checked , verified  and entered into a computer database and Statistical Package for Social Sciences version 16 ( SPSS) used for analysis. Discourse Analysis will be done to provide general information on the characteristics of study population.

CHAPTER 4: RESULTS

4.1 INTRODUCTION

This section represents the results of the study of 68 respondents .the results will be presented as per the objective in the form of tables and narratives.

4.2 DEMOGRAPHIC FACTORS

4.2.1 Age, gender and type of school

The study was carried out to determine the influence of dietary pattern on the nutritional status of urban adolescents in Tassia Nairobi County. The study sample 68 out of a possible 120. Four questionnaires were used to pretest but they were incomplete: as such 50 adolescents were from public schools while 18 adolescents were from private school. Table 4 shows the distribution of adolescents by type of school and gender. There were females and males who took part in the study.

Table 4: Distribution of adolescents by type of school and gender

Table 5 shows the age distribution of the study adolescents by type of school. The highest percentage of children was aged ……… for both the private and public schools.

Table 5: distribution of adolescents by age and type of school

4.2.2 Religion

The study sought to determine religious beliefs of various respondents so as to determine whether this influenced their dietary pattern, habits and how they impacted on the nutritional status of these individuals.

Table 6: Religion of respondents

4.2.3 Education level

The study sought to determine the level of education of respondents.

Table 7: Education level of the respondents

4.3 SOCIOECONOMIC CHARACTERISTICS OF RESPONDENTS AND THEIR FAMILIES

The research sought to investigate the influence of socioeconomic characteristics of the respondents on their dietary pattern by studying the occupation of the household and its income .the results of the occupation level as well as its income is shown in table 8 and 9 respectively.

Table 8: occupation of the household

Table 9: household expenditure per month

table 10:distribution of dietary pattern and nutritional status

4.4 DISCUSSION

The discussion was based as per the objective.

General objective

This study used cross –sectional study to assess adolescents nutrition knowledge ,attitude ,practices and frequency of food consumption using questionnaire .results nearly 34.6% skipped meals every day ,13.5% did not skip meals while 51.9% were semi skippers. A significant but weak correlation between nutrition knowledge and attitude was observed (r = 0.258; p < 0.05). There was no significant relationship between dietary pattern and nutritional status  (p > 0.05).

Specific objective 1

This study assessed the nutritional status of adolescents. Weight and height were measured were 26.9% for undernutrition, normal 19.2% ,overweight 11.5% , obese 42.3 %.The study reveals not only a high incidence of under-nutrition  and obese casesbut also an inadequate energy/micronutrient intake among  adolescents. The consumption of breakfast outside the home, soft drinks and energy-dense fast foods were positively associated with overweight and obesity in adolescents.

Specific objective 3

Using weight for age as an indicator for obese 42.3% were found to be obese .59.6% were found to be primary students .The possibility that the obese  cadolescents came from poor families was not considered because majority of adolescents included in study, came from similar economic background that is their homestead had almost  the same income level.

4.5CONCLUSION AND RECOMMENDATION

• This study revealed a high prevalence of malnutrition among adolescents.
• Further studies are required to accurately identify the effective factors for prevention and treatment of malnutrition in school age adolescents

REFERENCES

ACC/SCN. Nutrition and population links. Breastfeeding, family planning and child health. ACC/SCN

Symposium Report. Nutrition Policy Discussion Paper No.11, Geneva, 1992b

ACC/SCN. Controlling vitamin A deficiency. Nutrition Policy Discussion Paper No. 14, Geneva, 1994

Ahmed F, Barua S, Mohiduzaman M, et al. Interaction between growth and nutrient status in school-age

children of urban Bangladesh. Am J Clin Nutr 1993; 58:334-8

Ahmed F, Khan MR, Karim R, et al. Serum retinol and biochemical measures of iron

Ahmed F, Zareen M, Khan MR, et al. Dietary patterns, nutrient intake and growth of adolescent school

girls in urban Bangladesh. Pub Health Nutr 1998; 1:83-92

Ajzen I, Madden TJ. Prediction of goal-directed behavior: attitudes, intentions and perceived behavioral

control. J Exp Soc Psychol 1986; 22:453-74

Ali M, Delisle H. A participatory approach to assessing Malawi villagers’ perception of their own food

security. Ecol Food Nutr 1999; 38:101-21

APPENDICES

GANTT CHAT

 RESEARCH CONSENT FORM.

I am a student at the University of Nairobi pursuing food nutrition and dietetics. This course requires us to gain applied experience in designing and conducting a research. As such I have designed a research to study the nutrition status, dietary  patterns among adolescents in TASSIA Nairobi County

During this research you will be required to complete a number of brief questions concerning your children health status, socio economic background and economic status. Your participation will require approximately thirty minutes. There are no known harms in your participation in this research.

All your records will be kept strictly confidential such that only and my supervisor will have access to the information. Information about this research will not be made public in any way that identifies individual participants. Your participation is completely voluntarily, you may withdraw at any time for any reason without explanation and without penalty. You may choose not to answer any question for any reason.

I have read the above form, understand the information read, understand that I can ask questions or withdraw at any time.

Name……………………………………………………………………………………….

Signature……………………………………………..

ENUMERATOR CONTRACT

I …………………………………………………………….. agree to perform the following services and agree to the following terms.

1. Services to be performed- conduct an enumeration by issuing questionnaires, taking anthropometric measurements and recording.
2. Fees – the enumerator shall be paid shs.500 daily to cover the services offered. Enumerator shall not bill for any other disbursements such as travel costs, phone charges and meals. Payment of services will be at the end of this project
3. Insurance cover- throughout this time, we will not be required to provide liability insurance coverage and will not be covered under any of our insurance coverage.
4. Quality of work= the work covered here shall be of good quality.
5. Tools and data-we will not be responsible for any loss or destruction of tools. If enumerator mishandles any tools, he or she will be responsible for the damage.
6. Days of work- you will be required to work for five days. Monday to Friday.

IN WITNESS THEREOF, the parties have executed this agreement as of

Date…………………………………………………………………….

Name…………………………………………………………………

Signature…………………………………………….

Supervisor’s name………………………………………………………….

Signature…………………………………………………………………….

 ENUMERATOR RECRUITMENT CRITERIA.

1. Must be a Kenyan citizen.
2. Must have a national ID.
3. Must have good communication skills.
4. Must be a resident of Kibera slums.
5. Must be able to read and write.
6. Must be able to speak fluent English and Kiswahili.

APPENDIX IX; ENUMERATOR RESPONSIBILITIES.

1. The enumerator will be required to take anthropometric measurements.
2. The enumerators will be required to issue questionnaires and offer guidance in filling in the questionnaire
3. The enumerator will help in recruiting respondents into the study.
4. The enumerator will help respondents in understanding the consent form.
5. The enumerator will help in compiling  and storing the the data after the study