2017 ILEX PUBLISHING HOUSE, Bucharest, Romania

http://www.jrdiabet.ro
Rom J Diabetes Nutr Metab Dis. 24(1):031-039
doi: 10.1515/rjdnmd-2017-0004

HIGH PREVALENCE OF ZINC DEFICIENCY IN RURAL

NIGERIAN PRESCHOOL CHILDREN: A COMMUNITY-BASED
CROSS-SECTIONAL STUDY

Amarabia N.E. Ibeawuchi 1, Alphonsus N. Onyiriuka 2, , Philip O. Abiodun 3

1
Department of Paediatrics, Faith Mediplex Hospital, GRA, Benin City, Nigeria
2
Endocrine and Metabolic Unit, Department of Child Health, University of Benin
Teaching Hospital, PMB 1111, Benin City, Nigeria
3
Gastroenterology and Nutrition Unit, Department of Child Health, University of Benin
Teaching Hospital, PMB 1111, Benin City, Nigeria

received: October 22, 2016 accepted: February 04, 2017

available online: March 15, 2017

Abstract
Background and Aims: In Nigeria, community-based epidemiological data related to the
prevalence of zinc deficiency in preschool children are scarce. We assessed the
prevalence of zinc deficiency and the associated socio-demographic variables in children
aged between 6 and 60 months, living in a Nigerian rural community. Materials and
Methods: In this cross-sectional study, the serum zinc concentrations of 252 children
aged between 6 and 60 months in a rural community in Nigeria were assessed, using
atomic absorption spectrophotometry. The study population was selected by multistage
random sampling and at least two children were selected from every household which
had children in the study age group. The socio-demographic characteristics of the
subjects were obtained, using an interviewer-administered questionnaire. Results: A total
of 252 children were studied, 134 (53.2%) males and 118 (46.8%) females. The mean age
was 32.717.0 months, similar for both sexes. Overall, 220 (87.3%) had low serum zinc
concentrations (less than 7.65mol/L). According to age, the highest mean serum zinc
concentration was 5.433.52mol/L in children aged between 6 and 12 months.
Correlation between serum zinc concentration and family size or socio-economic status
(SES) showed that the smaller the family size and the higher the SES, the higher the
serum zinc concentration. Conclusions: The high prevalence of low serum zinc
concentration indicates that zinc deficiency is a public health problem in our rural
communities, requiring public health intervention.
key words: Zinc deficiency, preschool children, rural community, Nigeria.
secretion and reproduction [1,2]. The main
Background and Aims sources of zinc are beef, pork, poultry, fish and
Zinc is a micronutrient that is integrated shellfish. Vegetables represent a good plant
with several enzyme systems. Important source of zinc. Some substances present in
biological functions of zinc include gene foods, such as phytic acid (present in maize,
expression, cell division, immunity, insulin millet, sorghum), dietary fibre, calcium and

PMB 1111, Benin City, Nigeria. Phone number: 08032529437

corresponding author e-mail: alpndiony@yahoo.com
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protein may impair absorption of zinc from the skin lesions) compatible with zinc deficiency,
intestine, potentially leading to zinc deficiency and low plasma/serum zinc levels [12].
[1,3]. Processing of certain foods may affect the Zinc deficiency is an important public-health
zinc available for absorption. In this regard, heat issue, particularly in resource-poor countries
treatment can cause food zinc to form complexes [13-15]. According to the report of the Joint
that are resistant to hydrolysis, thereby reducing WHO/UNICEF/IAEA/IZiNCG when the
zincs bioavailability [3]. Endogeneous sources proportion of individuals in a population with a
of zinc are pancreatic and biliary secretions that low serum zinc is greater than 20%, that
are released into the gastrointestinal tract [3]. population is considered to be at risk of zinc
Skeletal muscle and bone (calcified and bone deficiency, making it a public-health issue [16].
marrow) together account for approximately The Nigeria Food Consumption and Nutrition
90% of total body zinc [4]. No tissue acts as a Survey (NFCNS 200-2003) found that 20% of
zinc store but zinc released from muscle and children below 5 years age had zinc deficiency
bone during catabolism can, to some extent, be [17]. In one Nigerian study, involving children
reutilized [3]. Approximately 0.5% of the total between the age 4 and 60 months the prevalence
body zinc is found in circulating blood, of which of severe zinc deficiency was 37% [18]. In that
75% is found in erythrocytes and 10-20% in study, the total percentage of their subjects with
plasma [4,5]. The implication is that more than low serum zinc level was not stated. This shows
95% of body zinc content is intracellular. that even within the same country, there could be
Normal serum zinc concentrations range from variations in prevalence of zinc deficiency. To
7.65-22.5mol/L [6] and zinc deficiency has the best of our knowledge, there is no published
been defined as serum zinc below 7.65mol/L report of serum zinc status in preschool children
[7]. living in a rural community in Edo State,
Several indices have been used in the Nigeria.
assessment of zinc status but there is no Worldwide, it is estimated that in children
universally accepted measure suitable to aged between 6 months and 5 years, 450,000
accurately assess the zinc status of an individual deaths each year (representing, 4.4% of all
[8,9]. In this regard, measurements of leucocyte, mortalities) are attributable to zinc deficiency
erythrocyte, hair and saliva zinc have been used [19]. In the paediatric age group, various
as assessment measures but are not viewed as morbidities have been linked to zinc deficiency.
good indices of zinc status [10]. The most These include stunting, reduced capacity for
widely used index is the measurement of physical work, poor wound healing, dermatitis,
concentrations of serum zinc [11]. Zinc in the delayed sexual maturation, hypogeusia, night
plasma decreases only when the dietary intake is blindness, alopecia and increased susceptibility
so low that homeostasis cannot be maintained to infections [19,20]. The principal causes of
without use of zinc from the exchangeable pool zinc deficiency in developing countries include
that includes plasma zinc [12]. In clinical inadequate food intake, poor dietary quality,
practice, making a definitive diagnosis of zinc poor bioavailability, and/or the presence of
deficiency is difficult. However, such a parasitic infections of the gastrointestinal tract
diagnosis can be derived from the combination [21-23].
of a dietary history of chronic low zinc intake The present study aimed at determining the
and/or excessive intestinal losses, the presence prevalence of zinc deficiency and assessing the
of clinical signs (such as growth retardation or associated socio-demographic variables in

32 Romanian Journal of Diabetes Nutrition & Metabolic Diseases / Vol. 24 / no. 1 / 2017
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children aged between 6 and 60 months, living each household. Subsequently, those aged
in a rural community in Nigeria. between 6 and 60 months were counted and
recorded. Thus, a total of 1,028 children aged
Materials and Methods between 6 and 60 months were obtained by
This descriptive, community-based cross- direct counting in all the households within the
sectional study was conducted over a period of 3 Udo community. The minimum sample size for
months, from January to March, 2013. Ethical the study population was obtained, using the
approval for the study was sought and obtained minimum sample size determination table by
from the Ethics and Research Committee of the Bartlett et al [24]. The minimum sample size
University of Benin Teaching Hospital. The obtained was 213. To accommodate attrition due
details of the study were explained to the chief to losses of samples, haemolyzed blood samples
of Udo community (the Uwague) with his and unforeseen laboratory problems a high
subordinates (heads of the political wards) in attrition rate of 35% was built-in, making the
attendance and later to the various heads of final sample size to be 292. Fifty percent of the
households. Informed consent was also obtained 9 wards were selected by simple balloting to
from the parents of the children who participated represent the Udo community. This was
in the study. approximated to five political wards (quarters)
and they were selected using a table of random
Study area location numbers. Since the population of these political
The study was conducted in Udo, a rural wards were not even, appropriate random
community in Ovia South West Local sampling technique was used in selecting the
Government Area (LGA) of Edo State, Nigeria. subjects. The number of children between the
Udo community is made up of 9 political wards ages of 6 to 60 months in each of these political
(quarters). Each of these wards is headed by a wards was known and so, the number to be
chief who is a subordinate to the Uwague, the selected from each of the wards was allocated
overall chief of Udo community. The major proportionately, using percentages as follows:
occupation of the inhabitants is subsistence Efa 28% (82 children), Ogbe 36% (103
farming. Some of the men and women engage in children), Ihogbe 18% (53 children), Ikpema 5%
hunting and petty trading, respectively. In a (16 children) and Aragua 13% (38 children). By
nearby community (Okomu), there is Palm Oil combining the highest educational attainment of
Extracting Factory which processes palm nuts the mother and fathers occupation we analyzed
into palm oil and where some of the men are the socio-economic status (SES) of the parents in
employed as unskilled workers. keeping with the criteria previously suggested in
a Nigerian study [25]. Thus, the SES of the
Sampling and recruitment
subjects was categorized into high, middle and
of study population
low. Based on the number of children, the family
The study population consisted of children
size was classified as small size; one or two
aged 6 to 60 months who reside with their
children, medium size; three or four children,
parents in the Udo community. With some
and large size; five or more children.
research assistants, the houses in the community
were numbered and labeled. The members of
each of the households were interviewed to
determine the number and ages of persons in

Romanian Journal of Diabetes Nutrition & Metabolic Diseases / Vol. 24 / no. 1 / 2017 33
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 Blood sample collection and level of statistical significance was set at p <
serum zinc analysis 0.05.
Before collection of blood sample, the socio-
demographic data of the children and their Results
families were obtained from the Of the 292 eligible children, data for
parents/guardian, using an interviewer- 40(13.5%) were excluded from further analysis
administered questionnaire. The children were because they were incomplete. Thus, 252
also examined. The procedure for blood sample children, 134(53.2%) males and 118(46.8%)
collection was explained to each parent and females, were left for further analysis of their
consent obtained. Using standard aseptic data. The male-to-female ratio was 1.1:1. The
technique, 3 to 4 mls of blood was collected mean age of the study population was 32.71.7
from the child via any easily accessible vein on months. The mean age was similar for both
the forearm into a labelled plain specimen bottle sexes. Most of the subjects were aged 13 to 24
and kept aside for centrifuging later the same months (Table 1).
day. All the blood samples were collected in the
Table 1. Age and gender distribution of subjects.
morning, thereby minimizing effect of diurnal
variation. Six to 12 hours after collection, serum Parameter Frequency Percentage(%)

was separated from the blood following Age (months)

centrifugation. The serum was stored at -20oC 6-12 38 16.1

until analysis. The serum zinc was analysed by 13-24 68 27.0
atomic absorption spectrophotometer (Alpha 4- 25-36 57 22.6
model, S/No 4200 by Chemtech Analytical, 37-48 38 16.1
United Kingdom), utilizing flame for analysis. In 49-60 51 20.2
this study, serum zinc concentrations below Gender
7.65mol/L was defined as deficiency [6]. Male 134 53.2
Female 118 46.8
Statistical analysis
Total 252 100.0
The data were collated and entered into an
Excel spread sheet. The accuracy of the data As shown in Figure 1, a great majority of the
entered was double checked. Analysis of the data children came from families in the low social
was performed using Microsoft Excel and SPSS class.
(Statistical Package for Social Sciences) version The overall mean serum zinc level was
20.0 software. Measures of central tendency and 4.773.02mol/L (range of 1.0 -16.52mol/L).
dispersion involving the mean and standard Figure 2 shows that a vast majority (87.3%; 95%
deviation were computed for all quantitative CI = 83.2-91.4) of the subjects had low serum
data. Confidence intervals, frequency zinc levels (< 7.65mol/L).
distribution, percentages and ratios were According to age group, the highest mean
calculated. Correlation and multiple linear serum zinc concentration was 5.433.52mol/L
regression analysis were employed to evaluate and this was found in children aged between 6
the degree of relationships between variables. and 12 months as detailed in Table 2. The mean
Test for significant differences between means serum zinc progressively declined from the age
of variables was carried out, using the Single of 13 months up to 48 months (Table 2).
Factor Analysis of Variance (ANOVA). The

34 Romanian Journal of Diabetes Nutrition & Metabolic Diseases / Vol. 24 / no. 1 / 2017
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 Figure 1. Social class distribution of the subjects families.

Figure 2. Percentage distribution of serum zinc concentration.

Table 2. Mean serum zinc concentrations according to age, gender, social class and family size.

Parameters No of subjects Serum zinc 95% CI F p-

(N = 252) (MeanSD mol/L) value
Age (months) 0.248 0.29
6-12 38 5.433.52 4.30-6.56
13-24 68 5.033.14 4.27-5.79
25-36 57 4.782.92 4.02-5.54
37-48 38 4.052.44 3.29-4.81
49-60 51 4.482.95 3.68-5.28
Gender 0.997 0.33
Male 134 4.953.21 4.41-5.49

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 Table 2. Continued.

Parameters No of subjects Serum zinc 95% CI F p-

(N = 252) (MeanSD mol/L) value
Female 118 4.572.80 4.06-5.08
Social class 0.80 0.44
Low 207 4.662.91 4.26-5.06
Middle 42 5.303.48 4.25-6.35
High 3 5.053.97 0.56-9.53
Family size 1.55 0.21
Small 79 5.273.45 4.51-6.03
Medium 112 4.562.89 4.02-5.10
Large 61 4.532.64 3.87-5.19
CI = Confidence interval

No correlation was found between the serum 9.9mol/L (65mg/dl) used in the study in
zinc level and the age of the subjects. Cameroon [26]. In a previous study by Wessells
Concerning the serum zinc concentration and et al, 7.65mol/L was also used as cut-off value
family size, our results showed that the smaller [7], justifying its use in our study. On the other
the family size, the higher the serum zinc hand, our prevalence rate was much higher than
concentration; r = minus 0.07; p = 0.25. the 63% reported in another Nigerian study,
Similarly, the higher the socio-economic status, involving urban preschool children [27].
the higher the mean serum zinc concentration; r Together, the lower cut-off value used in our
= 0.08; p = 0.21. However, these correlations study and the rural nature of the study population
were not statistically significant. may explain the observed higher prevalence rate
found in the present study. Zinc deficiency has
Discussion been shown to be commoner in rural compared
We found a high prevalence rate of zinc with urban children [28,29]. Again, the
deficiency in our rural community. Our prevalence rate found in our study was higher
prevalence rate is much higher than the 20% set than 65% found among Beninese rural preschool
by the Joint WHO/UNICEF/IAEA/IZiNCG children [15]. In that study, a higher cut-off
Interagency meeting for recognizing zinc value (9.9umol/L) was used in defining zinc
deficiency risk of public health importance, deficiency, probably accounting for the observed
needing intervention in a given population [16]. differences in prevalence rates.
This finding is a cause for concern, considering Poverty and illiteracy were notable findings
the various morbidities associated with zinc among the families of our subjects and this is
deficiency in the pediatric age group. Such evident in their low socio-economic status
morbidities include impaired cognitive function, (SES). We found that children from families in
growth failure, delayed sexual maturation and the low SES had the lowest mean serum zinc
increased risk of infections [1,3]. Despite concentration compared with their counterparts
differences in cut-off values used in defining from families in the middle or high SES,
zinc deficiency, the prevalence rate found among respectively. Our data revealed a slight negative
our subjects agrees with that reported among trend between serum zinc concentration and
preschool children from Cameroon [26]. Our family size and a slight positive trend between
cut-off value of 7.65mol/L was lower than the serum zinc concentration and SES. A similar

36 Romanian Journal of Diabetes Nutrition & Metabolic Diseases / Vol. 24 / no. 1 / 2017
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influence of SES on serum zinc concentrations One limitation of our study was that we
has been reported in some studies [30,31]. assessed zinc deficiency using only serum zinc
In developing countries, the major etiologic concentrations without assessing the intake of
factors for zinc deficiency are low intake of zinc- dietary zinc which would have provided
rich foods, poor bioavailability of zinc, and the information regarding etiology. On the other
presence of parasitic infections of the hand, our study had some strength. First, all the
gastrointestinal tract [21-23]. Together, these blood samples were collected in the morning,
factors which are known to be common in thereby minimizing effect of diurnal variation.
Nigeria, may account for our high prevalence Secondly, at least two children aged between 6
rate of zinc deficiency [27,28,30]. Our data and 60 months in every household within the
indicate that the lowest and highest mean serum study community were included in the study
zinc concentrations were found among children population, making our study sample more
aged 37 to 48 months and 6 to 12 months, representative of the whole community
respectively. This suggests that infants had compared with similar previous Nigerian studies
better zinc status than toddlers. This is not [18,27,28,30].
surprising as toddlers are transitioning to
complementary foods, making them vulnerable Conclusions
to micronutrient deficiencies, including zinc. In In conclusion, the high prevalence of severe
Nigeria, these complementary foods consist zinc deficiency in our rural communities is a
mainly of gruels from maize and millet which public-health problem, requiring public health
are poor not only in zinc content but also in its intervention strategies to improve the zinc
bioavailability. In addition, it is possible that nutritional status of these preschool children.
during the period of infancy, a fairly appropriate Zinc nutritional intervention strategies such as
breast feeding practices are observed in our nutrition education of the parents (e.g., dietary
community, leading to better zinc status among diversification by adding animal proteins,
children aged 6 to 12 months. In consonance improvement in food processing techniques to
with our finding regarding the influence of age, a ensure bioavailability of zinc), routine treatment
study in India reported a similar finding [32]. for intestinal parasites, using broad-spectrum
Although not statistically significant, we anti-helminthics (to reduce faecal zinc losses),
observed that boys had a slightly higher mean rotavirus vaccine immunization (to reduce zinc
serum zinc concentration than girls. In general, loss from diarrheal diseases), targeted
this finding is in keeping with the results of a supplementation, and fortification of staple foods
similar study among preschool children in India with zinc are suggested.
[32]. The reason for the better zinc status in Duality of interest: We have no competing
males than females is difficult to explain. Could interest with regard to the scope of this study.
it be due to preferential parental nutritive care
for boys over girls, as practiced in some cultures
[33-35] ?

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