SELENIUM, ZINC AND IRON STATUS OF PREGNANT WOMEN AND ZINC CONTENT OF SELECTED TRADITIONALFOODS IN OBIO-AKPOR L.G.A RIVERS STATE, NIGERIA

ABSTRACT

The study was designed to have both survey and biochemical  components.  Three  communities were  selected  randomly  from twelve  communities  in Obio-Akpor  local  government  area.  The sample  size was calculated  using the maternal  mortality  ratio  for  pregnant  women  in Nigeria which  was  30%.  Two  hundred  pregnant  women  were  purposively  selected  from  health  care centers, public and private clinics providing ante-natal care and from traditional birth attendants and local delivery homes. The survey component assessed the socio-economic  and demographic characteristics  of  the  respondents  using  a  structured  questionnaire  to  collect  information  on mothers’  age,  pregnancy  age,  number  of  deliveries,  education,  occupation,  food  frequency consumption, weighed food intake and clinical signs of malnutrition. Biochemical assessment was carried  out using  standard  procedures  in assessing  iron,  selenium  and zinc status  of pregnant women and zinc content of selected traditional foods consumed in Obio-Akpor LGA.  Serum iron, selenium,  and zinc were determined  using atomic absorption spectrometry  model number Buck 210/11.  The analytical  procedures  of the Association  of the Official  Analytical  Chemists  were used  for  proximate   composition,   and  mineral   composition   of  the  traditional   foods.   The questionnaire  were  coded  and  entered  into  computer  using  the  Statistical  Package  for  Social Sciences  (SPSS)  version  16.  The  data  were  analyzed  using  descriptive  statistics.  Chi-square analysis and Pearson’s  correlation  were used to identify variables that  had a significant  role in influencing  micronutrient  (iron,  selenium  and zinc) status.  The  study showed  that 40% of the pregnant  women  were  iron  deficient  and  97.3%  were  zinc  deficient.  No  case  of  selenium deficiency was identified in the present study. Occupation of women, pregnancy age and ‘‘who receives best portion of food” had a significant (P<0.05) association with the iron and zinc status of the pregnant women. There was a significant (P<0.05) association between iron status and signs and symptoms  of iron  deficiency namely weakness and reduced physical activity. There was a significant  (χ2  =  39.304;  P= 0.05)  association  between  education  and occupation.  Educational status  significantly  (χ2 =44.475;  P=0.05)  differed  with age at marriage.  Educational  status and number of children  was equally  highly significant  (χ2 =32.024;  P=0.05).  There was a  positive association  between income and availability  of money to purchase food (χ2  =17.240; P= 0.05). Occupation  and  availability  of  money  to  purchase  food  also  had  a  positive  relationship  (χ2 =16.808; P=0.05). There was a positive association between weakness and fatigue (r=0.355; P< 0.05);  weakness  and  reduced  physical  activity  (r=0.351;  P< 0.05)  in relation  to iron:  loss  of appetite and diarrhoea (r=0.157; P<0.05) in relation to zinc. The mineral composition of zinc in the foods  ranged  from  figures  4.37mg/100g  (shark  fish)  to 55.55mg/100g  (oysters). The iron contents of the foods ranged from shark fish (2.91mg/100g) to sardine fish (14.93mg/100g). When compared with FAO/WHO requirement values, the pregnant women had lower dietary intakes of nutrients  crucial  in  pregnancy  such  as  zinc  (72.9%),  niacin  (74.11%),  thiamin  (78.567%), riboflavin (87.85%) and calcium (96.99%). There were differences  in food consumption  pattern among the pregnant women, indicating that the foods consumed were determined by availability, affordability and seasonality.

CHAPTER ONE

1.0      INTRODUCTION

1.1      Background to the Study

Micronutrients   encompass   vitamins   and   minerals   which   are   essential   for   human development and functioning. They are needed in small amount. Micronutrients are well known to play an important role in the maintenance of health. Alterations in maternal – fetal disposition of some  essential  nutrients  could be a potential  health  risk for the  mothers  as well as the fetus. Micronutrient malnutrition is primarily related to inadequate dietary intake and pregnancy places women at risk of nutritional problems due to increased need for both macro and micronutrients during  pregnancy.  Deficiencies  of  micronutrients  (iron,  selenium  and  zinc)  during  pregnancy continue to be a problem of considerable magnitude in most developing countries of the world. Child  birth  remains  one  of  the  biggest  health  risks  for  women  especially  in  the  developing countries. Fifteen hundred women (1,500), die every day during delivery, which is a half a million mothers every year  (UNICEF,  2009). The WHO, (2007) estimated that about 80% of maternal deaths  are due  to direct  causes  which  are hemorrhage,  sepsis,  eclampsia  and unsafe  abortion. About 20% are due to indirect causes including anemia, malaria and heart disease (WHO, 2007). The micronutrient status of mothers can affect hemorrhage, anemia, eclampsia, sepsis and perhaps malaria. In addition,  micronutrients  can reduce morbidity.  Adequate  micronutrient  nutrition  for pregnant women is critical for the health and survival prospects of both mothers and newborns. Micronutrient deficiencies of mothers increase their health risks as well as that of their babies. The high incidence of micronutrient deficiencies in pregnant women predisposes them to high maternal mortality especially in the developing countries. In Africa maternal mortality is estimated at 820 per 100,000 births. In Nigeria, the maternal mortality ratio is 1,100 deaths per 100,000 live births and the lifetime risk of maternal death, at 1 in 8.  Approximately  1 in every 9 maternal deaths occurs in Nigeria alone (UNICEF, 2009).

Iron is an essential micronutrient which helps in normal human physiology. It is an integral part of many proteins and enzymes that maintain good health. Iron is essential for regulation of cellular growth and differentiation. It is also an essential component of protein involved in oxygen transport  (Dallman,  1986).  Iron deficiency  anemia  affects over 2  billion  people and the world health organization estimates that a disproportionate percentage of iron deficiency anemia occur in low income countries, accompanied  by adverse pregnancy outcomes such as preterm birth, low birth weight, and increased maternal mortality (UNICEF, 2009). It has been estimated that over half the pregnant women in the world have a hemoglobin level indicative of anemia. In Africa the prevalence ranges from 35% to 72% (UNICEF, 2009). The 2003 Nigeria Demographic and Health Survey conducted in Nigeria estimates that 35% of pregnant women were iron deficient (Maziya et al., 2003). Iron deficiency anemia, (especially severe form) has been shown to the associated with increased maternal mortality. The mild form of iron deficiency anemia may increase the rate of premature delivery and prenatal mortality (Carriaga, Skikne, Finley, Cutler and Cook, 1991).

Zinc is an essential micronutrient that participates in carbohydrate and protein metabolism. Zinc is required for cellular division and differentiation,  and is an essential nutrient for normal embryogenesis.   Zinc  plays  an  important  role  in  growth  and  development.  It  takes  part  in deoxyribonucleic  and ribonucleic  synthesis.  It also interacts  with hormones  important  in bone growth such as testosterone, insulin and the thyroid hormone. Through these functions, zinc plays an important role in intrauterine growth (Nishi, 1996). Several studies have shown an association between maternal plasma zinc levels and birth weight (Neggers et al., 1990). Studies have also shown how maternal serum zinc concentrations  are associated with increased incidence of foetal malformations   and  foeto-maternal   complication  (Scholl,  Hediger,  Schall,  and  Khoo,  1993). Maternal morbidities such as pregnancy induced hypertension, prolonged labour and pre-and post- term deliveries may be increased in zinc deficient pregnant women. However, zinc deficiency is one of the most common nutritional  problems  of pregnant  women especially in the  developing countries.  Caulfield,  Zavaleta,  Shankar,  and  Merialdi  (1998)  estimated  that  82%  of  pregnant women worldwide  have inadequate  intakes of zinc to meet the  normative  needs of pregnancy. Zinc deficiency  was reported  as 43% in pregnant  women  in  a food consumption  and nutrition survey in Nigeria (Maziya et al., 2003).

Nutritional  metals such as zinc do occur naturally  in foods as essential  trace  elements needed for good health, but they could be toxic when their concentrations  exceed  units of safe exposure  (Reilly,  1991).  Knowledge  of  heavy  metal  contents  in  crops  is  important  for  the identification  of adequate, sub adequate and marginal intake levels for  humans so that diseases related to trace elements deficiency can be overcome (Iyengar, 1974).   Presence of trace elements in foods has been ascribed to their absorption from the soil and sources such as type of fertilizer, agricultural chemicals and contaminating dirt’s (Banu, Preda and Vasu, 1985).  Other sources of heavy  metals  contamination  of  most  food  stuff  may  also  include  adaptation  of  mechanized farming, sprays and seed preservatives. Zinc can be absorbed orally from food. There have been some  reports  on the  zinc contents  of fruits and vegetables  consumed  in north-central  zone of Nigeria (Iyaka, 2007). But few have covered zinc content measured for a wide variety of foods consumed in Rivers State, Nigeria.

Selenium  has attracted particular  attention in recent years. Selenium is an essential  trace element  for  human  beings.  It  is  needed  for  the  activity  of  glutathione  peroxidase  and  other antioxidant  functions  (Combs and Combs, 1984). Selenium status during pregnancy  is of great importance because of the significance of selenium for fetus growth and antioxidant protection of neonates.  Many  factors  can influence  the selenium  contents  of  biological  fluids  and therefore values  can  vary  in a significant  way  from  one  person  to  another.  The  factors  that  influence selenium  content are: the geographical  location of  the population,  which affects the content of selenium in the soils; the availability of the element in soil and in vegetables; its chemical form and  its  bioavailability;  the  origin  of  the  foods  ingested;  eating  habits;  alcohol  and  tobacco consumption; the use of oral contraceptives; as well as the physiological conditions of the subject, e.g. age, sex,  pregnancy,  lactation  and other pathological  situations  can have   an effect on the metabolism  of  the  element.  The  selenium  requirements  of  women  seem  to  increase  during pregnancy. The prevalence of selenium deficiency in the world is not documented since there are a few  large  scale  surveys  that  have  been  conducted  in respect  to selenium.  This  study  was  an attempt  to  assess  the  mineral  status  (iron,  selenium  and  zinc)  of  pregnant  women  and  also determine the zinc contents of selected traditional foods in Rivers State, Nigeria.

1.2      Statement to the Problem

An understanding  and awareness  of the heavy  burden  of micronutrient  deficiencies (iron, selenium  and zinc) among pregnant  women  and women  of reproductive  age is growing rapidly owing to the high maternal mortality estimated in Nigeria. The maternal mortality ratio in Nigeria is estimated to be 1,100 deaths per 100,000 live births  (UNICEF,  2009; NDHS, 2008). Nigeria is a region with high rates of undernutrition among girls and women. A woman in Nigeria has one in eight chances of dying during the course  of her lifetime from complications  during pregnancy  and  delivery  (UNICEF,  2009).  Maternal  undernutrition  is  correlated  with  a  high incidence of low birth weight in infants, high maternal morbidity and mortality. The micronutrient status of women in developing countries affects their health during pregnancy,  the outcomes of their pregnancies, and the health of their infants (UNICEF, 2009).  There has been relatively Large scale survey that documents prevalence of micronutrient deficiency especially, selenium and zinc in pregnant women in Nigeria.

Deficiencies of micronutrients (iron, selenium and zinc) during pregnancies are known to increase  the  risk  of  maternal  morbidity  and  mortality  and  also  cause  fetal  abnormalities, malformations  and  death  (ACC/SCN,  2000).  Iron  deficiency  is  the  most  common  nutritional deficiency  in  pregnancy  and  has  an  important  impact  on  maternal  and  fetal  morbidity  and mortality. Maternal anemia affects about half of all pregnant women. Anemia contributes to 20% of  the  maternal  deaths  in  Africa  (UNICEF,  2009).  Anemia  in  pregnancy  is  a  common  and worldwide problem that deserves more attention. Maziya et al. (2003) reported a prevalence rate of  35%  in  pregnant  women  in  Nigeria.  Zinc  deficiency  is  one  of  the  ten  biggest  factors contributing  to  burden  of disease  in  developing  countries  with  high  mortality  (WHO,  2002). Africa is at greatest  risk of zinc  deficiency,  zinc intake is inadequate  for about  a third of the population.  Mild  maternal  zinc  deficiency  has  been  related  to  complications  of  labour  and delivery, including placental abruption, prolonged labour and premature rupture of the membrane (Scheplyagina,  2005).  Selenium  status  is particularly  important  for pregnant  women  and their fetuses  (Kundu,  Parke,  Petersen,  Palmer  and  Olson,  1985).  However,  there  is no data on the prevalence  of selenium  deficiency  in pregnant  women  in Nigeria.  With  all these  emphasis,  it becomes important to assess the micronutrient status of pregnant women.

1.3      Objectives of the Study

The general objective of this study was to assess the iron, selenium and zinc status of pregnant women  and zinc content  of some  selected  traditional  foods  in Obio-Akpor  local  government, Rivers State.

The specific objectives were to:

1.        assess  iron,  selenium  and  zinc  status  in  pregnant  women  in  Obio–Akpor  LGA  using biochemical method;

2.        assess the dietary intake of pregnant  women  in Obio-Akpor  using weighed  food  intake study with emphasis on iron, selenium and zinc;

3.        determine the relationship between socioeconomic  and demographic variables on selected micronutrients (iron, selenium and zinc) status among the pregnant women in Obio-Akpor LGA;

4.         analyze the zinc content of some traditional foods consumed in Obio – Akpor LGA; and

5.        assess the frequency of consumption of traditional foods rich in the selected micronutrients (iron,  selenium  and  zinc)  in  pregnant  women  in  Obio-Akpor  using  a  food  frequency questionnaire.

1.4      Significance of the Study

There are relatively few large scale surveys that document levels of micronutrient (iron, selenium and  zinc)  in  pregnant  women  in  Nigeria.  Studies  have  documented  status  of  one  or  two micronutrients  amongst  pregnant  women  in  Nigeria.  However,  no  attempt  has been  made  to concurrently assess the prevalence of multiple micronutrient deficiencies, especially selenium and the factors associated with them amongst pregnant women. No survey has documented  level of selenium  deficiency  in  pregnant  women  in  Nigeria  hence  the  reason  for  the  scarce  data  on selenium status of pregnant women in Nigeria.

It is hoped that this study will generate the much needed data on the micronutrient status (iron,  selenium  and zinc) of pregnant  women  and also provide  the zinc content  in a  range  of traditional  foods  consumed  in Rivers  State,  Nigeria.  Such data will be useful  to  public health nutritionists, medical and health workers, and national policy makers in their future strategic plan to improve the health and nutrition status of pregnant women and women of reproductive age. The data could be a useful tool in providing the prevalence of micronutrient  deficiencies in pregnant women and also useful in lowering maternal mortality rate and improve birth outcomes in area under study. Data generated will help nutrition educators in developing intervention programmes to reduce maternal morbidity and mortality and improve a child’s prospects for survival.

The need to determine the zinc contents of some foods frequently consumed in Rivers State became imperative due to their principal role as essential or detrimental trace elements. A survey of the literature indicates that the study of zinc content of frequently consumed foods is scarce in Rivers State and Nigeria as a whole. Previous studies by Nwaedozie (2003) and Bonire, Jalil and Lori (1991) focused on the zinc content of fish and yam, respectively. Okeke et al. (2009) also focused on traditional foods consumed in Igbo land.

Women  are  an  important  segment  of our  population.  Poor  nutrition  and  high  maternal mortality continue to be a major problem in the developing world. The role of micronutrients  in undermining maternal well being cannot be over emphasized. The micronutrient status of pregnant women is of utmost significance and presents a general health status of a community and a nation as a whole and as such their welfare should not be compromised.

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