NUTRITION KNOWLEDGE AND FACTORS ASSOCIATED WITH ANTHROPOMETRIC AND HAEMATOLOGICAL INDICES AMONG FEMALE UNDERGRADUATE STUDENTS IN UNIVERSITY OF NIGERIA , NSUKKA

Poor nutritional status among adolescents and young adults can have serious consequences on their health. This study assessed the nutrition knowledge, anthropometric, haematological indices and associated factors among female undergraduate students of University of Nigeria, Nsukka. Multistage sampling technique was used to select 500 respondents from four faculties of the University. Nutrition knowledge and food habit of the respondents were obtained using structured and validated questionnaire. Anthropometric measurements (weight and height), haemoglobin, haematocrit, malaria parasite and blood pressure were obtained. Statistical Package for Social Sciences version 18.0 was used for data analysis. Descriptive and inferential statistics were used for data analysis. Data were presented as frequencies, percentages, means and standard deviation. Relationships existing among variables at p < 0.05 were determined using Pearson’s correlation. Fair nutrition knowledge existed in 40.0% of the respondents. Anthropometric measurements revealed that 40.0% and 2.0% were overweight and severely obese, respectively. The prevalence of mild anaemia was 25.3% while 64% had for malaria parasite. Systolic and diastolic hypertension existed in 2.7% and 5.3%, respectively. Significant (p < 0.05) relationship existed between haemoglobin and monthly allowance; malaria parasite; body mass index (BMI) and nutrition knowledge. Poor nutrition knowledge, obesity, malaria and anaemia existed among the respondents. Nutrition education is required and should be promoted amongst University students.


INTRODUCTION
Nutrition knowledge is an important factor in promoting healthier eating habits and consequently maintaining an appropriate body weight, thus preventing overweight and obesity (Kruger et al., 2002).Poor eating habits and lack of nutrition knowledge are important public health issues that have serious health implications (Andere and Kyallo, 2013).In University campuses, lack of a central feeding facility for students has forced students to take responsibility of their feeding (Achinihu, 2009).As a result, most students in Nigerian Universities lack funds or divert their feeding money for other needs and so skip meals.This predisposes them to malnutrition.According to Estima et al. (2009) and Levy et al. (2010) the most prevalent habits accustomed in this age group include changing main meals for snacks, skipping breakfast, reducing the intake of fruits and vegetables and increasing consumption of sodas and high calorie foods.These habits can result in iron deficiency anaemia (IDA) and increase the risk of obesity (Zimmerman et al., 2008;Menzie et al., 2008).According to WHO (2011), anaemia is the most common intractable nutritional problem worldwide.Parasitic infections, inadequate iron intake and infectious diseases such as malaria are some predisposing factors that enhance the occurrence of anaemia.Adolescent girls are particularly prone to IDA because of increased demand of iron for haemoglobin, myoglobin and to make up for the loss of iron due to menstruation and poor dietary habits (Beard, 2000).Among young adults, IDA could be attributed to faulty feeding habits.Obesity, a leading cause of preventable death worldwide, is common among women than men (WHO, 2000).Arroyo et al. (2006)  students consume a lot of fast foods which is high in fats and has low intake of fruits and vegetables.High consumption of imported and processed foods which are highly refined, high in sugar, fats and salt coupled with less physical activity greatly contribute to rising chronic diseases even among young adults (Den Hartog, Stavereren & Brouwer, 2006).Female university students are of interest because they have increased nutrient (especially micronutrients) needs.The transition in living environment and the freedom to make food choices among them may translate to good or bad nutritional status.This study assessed the nutrition knowledge, anthropometric, haematological indices and associated factors among female undergraduate students of the University of Nigeria Nsukka campus.

MATERIALS AND METHODS
This cross-sectional study was carried out in the University of Nigeria, Nsukka (UNN) campus.Four faculties with a female population of 2407 were randomly selected out of the nine faculties (female population of 6638) in UNN.Twenty per cent of the total female population were used for the study (n=481 respondents).The sample population was further increased by 5% (24 respondents) to account for contingencies such as nonresponse or recording error (Yamane, 1967).The sample size was 24 + 481 = 505 respondents.Five hundred correctly filled questionnaires (representing 20.8% of the total female population) were, however, collected at the end of the study.Multi-stage sampling technique was employed where four (population -2407) out of nine (population -6638) faculties were randomly selected by balloting without replacement.Proportionate sampling was used to determine the number of respondents to be used in the selected faculties and their respective departments.Respondents were selected from their various departments and levels using random sampling by balloting without replacement.Fifteen per cent of the sample size was used for blood pressure, haematological parameters and malaria parasite assessment.

Methods of data collection
A preliminary visit was made to the faculties that were selected and the students in each level were informed about the study at the end of a lecture offered by all.Time and date for the study was chosen with the students to ensure that the researchers had at least one hour for data collection.Their consent to participate in the study was sought using an informed consent form which was signed by the selected respondents.A structured and validated questionnaire was used to obtain information on respondents' nutrition knowledge and food habits.Basic nutrition questions on food groups, metabolism of nutrients, sources, functions and deficiencies of nutrients were used to assess respondents' nutrition knowledge.The questions had one correct and three incorrect answers (i.e.multiple choices) from which the respondents chose their answers.Questions were marked and scored in percentages at the end of the study.Nutrition knowledge grading scale was adapted from Essien et al. (2014).Anthropometric measurements of weight and height were obtained from each respondent.
Respondents were asked to stand in the centre of Hanson bathroom scale bare-footed with arms hanging at the sides and head, back and knees held comfortably erect.Weight was read and recorded to the nearest 0.1kg.Respondents stood bare-footed on the foot board of microtoise height metre with feet parallel to each other and back of feet, calves, buttocks, upper back and back of head touching the height metre.The head piece was lowered, crushing their hair and making contact with the top of their head.Height was read and recorded to the nearest 0.1cm.BMI of the respondents were calculated using the formula: Respondents were classified as underweight, normal weight, overweight and obesity using World Health Organization (WHO) standard (WHO, 2000).Blood pressure of the respondents was measured using a digital sphygmomanometer and was classified using WHO (1999) standard for adults.Five millilitres of blood samples were collected using the vein puncture technique and were used for biochemical determinations.Haemoglobin and haematocrit were determined using the cyanmethaemoglobin and microhaematocrit methods, respectively.Malaria parasite determination was done using microscopy method (thick blood smear).

Statistical analysis
Data obtained were analysed using Statistical Package for Social Sciences (SPSS) version 18.0.Data was presented as means, standard deviation, frequencies and percentages.Pearson's correlation was used to determine relationships existing among variables at p < 0.05.
Nutrition Knowledge and Anthropometric/Haematological Indices Among Female Undergraduates

RESULTS
The socio-economic characteristics of the respondents is presented in Table 1.Majority (97.0%) of the respondents were married and 63.0% were between 20 -29 years of age.
The Monthly allowance of 47.0% of the respondents was ₦5,500 -₦9,000.Table 2 shows the nutrition knowledge of the respondents.Excellent, fair and poor nutrition knowledge existed among 16.0%, 40.0% and 3.0% of the respondents, respectively.Food habits of the respondents is shown in Table 3.Most of the respondents (58.4%) ate twice a day and the source of food was mostly from food vendors (51.0%).Sixty-three per cent of the respondents skipped meals.Of those who skipped meals, majority (92.1%) skipped breakfast and the reason for skipping meals by most (58.7%) of the respondents was that there was not enough time to eat.Fruits and vegetables were occasionally consumed by 34.4% and 51.0% of the respondents, respectively.The anthropometric index, haemoglobin, haematocrit, blood pressure and malaria parasite infestation status of the respondents are shown in Table 5. Underweight (13.0%), overweight (40.0%), obesity class 1 (7.6%), mild anaemia (25.3%) and malaria parasite infestation (64.0%) existed among the respondents (Table 5).Significant (p < 0.05) relationship existed among haemoglobin and monthly allowance; BMI and nutrition knowledge (Table 6).Body mass index was not significantly (p > 0.05) associated with nutrition knowledge.

DISCUSSION
Inadequate nutrition knowledge observed among the students was a thing of concern because lack of nutrition knowledge happens to be an important public health issue that has serious health implications (Andere & Kyallo, 2013).The occasional consumption of vegetables and rare consumption of fruits by the respondents is worrisome.Low intake of fruits and vegetables was observed by Adu et al. (2009) among students of Lagos state University, Ojo campus.Lack of adequate knowledge of the cumulative effects of eating habits may have caused the poor eating habits seen among the students.Breakfast, the most important meal for the day, was skipped by almost all the respondents with not having enough time to eat being a major reason.This is similar to earlier report among female undergraduate students in Osun state where 59% skipped breakfast (Olumakaiye et al., 2010).Skipping breakfast may lead to hunger in the morning and result in increased snacking or food consumption during the day leading to excessive consumption of food/snacks which may predispose them to overweight and obesity.More than half of the respondents were either overweight or obese.Olumakaiye et al. (2010) had a lower prevalence for overweight and obesity among female undergraduate students of Obafemi Awolowo University, Ile-Ife, Nigeria contrary to the findings of this study.High normal blood pressure and stage 1 hypertension existed among the respondents showing that the students could be at risk of developing hypertension in later life which may predispose them to other non-communicable diseases (NCDs).This is similar to the findings of Bimenya et al. (2005) who reported that undergraduate students in Uganda have systolic and diastolic blood pressure values of clinical pre-hypertension and hypertension.
Although it is commonly believed that essential hypertension usually begins between 35 and 45 years and worsens with age, our findings show imminent danger of hypertension in a young adult population of 18 -35 years.Mild anaemia seen in a quarter of the respondents is worrisome.The prevalence of iron deficiency anaemia in this population, however, may be higher than the prevalence reported because most individuals are likely to be iron deficient long before there is a detectable drop in blood haemoglobin levels (Kennedy, Nantel and Shetty, 2003).Malaria parasite infestation may have contributed to this.Young female adults are at increased risk of IDA due to consumption of energy-dense diets (Hendricks, Herbold and Fung, 2004), increased iron demand, menstrual losses, insufficient dietary iron intake (especially of animal origin), faulty dietary habits and limited financial resources and making the transition from home to independent living.Infections and parasitic diseases, in particular malaria, helminth infestations and urinary tract infections are also important factors contributing to the high prevalence of anaemia in sub-Saharan Africa (Asobayire et al., 2001).
Among undergraduate students in Nnamdi Azikiwe University Awka, Ezugbo-Nwobi et al .(2011)reported a 64% prevalence of malaria parasite infestation similar to the findings of this study.Findings of this study were higher than the 61.1% and 17% reported among undergraduates in Abuja (Mature, Azare and Ugbong, 2001) and Ibadan (Anumudu et al., 2006), respectively.The natural vegetation seen around students' hostels which probably serve as breeding ground for mosquitoes may have contributed to this high prevalence.Monthly allowance was significantly (p < 0.05) associated with BMI similar to earlier findings (Ibeanu, Onyechi & Onuoha, 2012).This has serious implication on the health of the respondents because those with high monthly allowance were more likely to eat out and their food selection may be based on food palatability, availability and convenience predisposing them to overweight and obesity.Those who had more monthly allowance were probably able to afford animal sources of protein such as meat which are known to be good sources of haem iron.This might be the reason for the positive correlation of haematocrit, haemoglobin and monthly allowance.BMI was positively correlated with haemoglobin and haematocrit.According to Paknahad et al. (2008) iron stores of obese women are higher than non-obese women.This is contrary to earlier report (Amato et al., 2010) that anaemia is found in obese individuals and could be attributed to the role of hepcidin (mediator of inflammation which is up-regulated in obesity) mediated inhibition of dietary iron absorption which in turn leads to anaemia.Nutrition knowledge was a factor that was positively correlated with haemoglobin and indicating that those with sufficient nutrition knowledge were probably able to combine foods from different food groups for optimum nutrition and good health.
Nutrition Knowledge and Anthropometric/Haematological Indices Among Female Undergraduates The significant (p < 0.05) but negative relationship which existed between malaria parasite infestation and haemoglobin is not surprising and may be due to increased extravascular haemolysis of red blood cells with a concomitant failure of the bone marrow to increase red cell production to compensate for these losses (Lamikanra et al., 2007).

CONCLUSION
Fair nutrition knowledge, anaemia, obesity and hypertension existed among this population.The findings of this study reveal a high prevalence of malaria parasite.Vegetables and fruits were occasionally and rarely consumed by the respondents.Significant (p < 0.05) relationships existed between nutrition knowledge, monthly allowance and BMI; and haemoglobin.Negative but significant (p < 0.05) relationship existed between haemoglobin and haematocrit; and malaria parasite.Nutrition education is imminent for University students to gain appropriate knowledge about nutrition and periodic screening of blood pressure is important.

Table 3 :
Food habits of the respondents

Table 1 :
Socio-economic characteristics of the respondents

Table 4 :
Mean anthropometric index, haemoglobin, haematocrit and blood pressure of the respondents

Table 5 :
Anthropometric and biochemical indices status of the respondents