Annals of African Medicine

ORIGINAL ARTICLE
Year
: 2021  |  Volume : 20  |  Issue : 3  |  Page : 169--177

Feeding behavior among health-care workers in a tertiary health institution Southeast Nigeria


Ugochukwu Uzodimma Nnadozie1, Nwabumma Cynthia Asouzu2, Nonso Christian Asouzu3, Emelie Moris Anekwu3, N Okwudiri K. Obayi4, Charles Chidiebele Maduba5, Adaobi Esther Anamazobi2, Christian Chidebe Anikwe6, Ikenna Bede Nnolim7, Adaobi Azuka Nnadozie8,  
1 Division of Plastic Surgery, Department of Surgery, Alex Ekwueme Federal University Teaching Hospital; Departments of Surgery, Ebonyi State University, Abakaliki, Ebonyi State, Nigeria
2 Department of Nutrition and Dietetics, Alex Ekwueme Federal University Teaching Hospital, Abakaliki, Ebonyi State, Nigeria
3 Department of Physiotherapy, Alex Ekwueme Federal University Teaching Hospital, Abakaliki, Ebonyi State, Nigeria
4 Department of Psychiatry, Ebonyi State University, Abakaliki, Ebonyi State, Nigeria
5 Division of Plastic Surgery, Department of Surgery, Alex Ekwueme Federal University Teaching Hospital, Abakaliki, Ebonyi State, Nigeria
6 Department of Obstetrics and Gynaecology, Alex Ekwueme Federal University Teaching Hospital, Abakaliki, Ebonyi State, Nigeria
7 Department of Medicine, Alex Ekwueme Federal University Teaching Hospital, Abakaliki, Ebonyi State, Nigeria
8 Department of Technology and Vocational Education, Ebonyi State University, Abakaliki, Ebonyi State, Nigeria

Correspondence Address:
Dr. Ugochukwu Uzodimma Nnadozie
Division of Plastic Surgery, Department of Surgery, Alex Ekwueme Federal University Teaching Hospital, Abakaliki, Ebonyi State
Nigeria

Abstract

Background: Feeding behavior is an important factor in the prevention and management of noncommunicable diseases, which are the leading cause of death globally. Objective: This study is aimed to investigate the feeding behaviors among health-care workers in a tertiary hospital in southeast Nigeria. Materials and Methods: The study was a cross-sectional survey. A total of 418 participants (186 males and 232 females) were involved in the study. The instrument is a sociodemographic questionnaire and a modified form of the British Heart Foundation's questions to assess the nutritional value of individuals. The participants were consecutively recruited from their workstations. Data were collected using self-administered questionnaires, which were hand distributed and collected back on the same day after completion. Results: The study showed that health workers in the teaching hospital had an overall “fair” feeding behavior (86.13 ± 8.52 out of 140). It also showed that females had a significant (P < 0.05) overall better feeding behavior (88.15 ± 9.00) compared to males (83.62 ± 7.18). The studied participants had poor feeding behavior in carbohydrates and fats and oil consumption and just fair behavior in fruits and vegetables, salt intake, and water consumption. The feeding behavior was inadequate, and there was no significant gender or profession-related differences in the overall behavior of the participants. Conclusion: The health-care workers in the tertiary health institution in southeast Nigeria have inadequate feeding behavior. They should join in the global call and awareness on healthy feeding behavior to prevent and reduce the burden of noncommunicable diseases.



How to cite this article:
Nnadozie UU, Asouzu NC, Asouzu NC, Anekwu EM, Obayi N O, Maduba CC, Anamazobi AE, Anikwe CC, Nnolim IB, Nnadozie AA. Feeding behavior among health-care workers in a tertiary health institution Southeast Nigeria.Ann Afr Med 2021;20:169-177


How to cite this URL:
Nnadozie UU, Asouzu NC, Asouzu NC, Anekwu EM, Obayi N O, Maduba CC, Anamazobi AE, Anikwe CC, Nnolim IB, Nnadozie AA. Feeding behavior among health-care workers in a tertiary health institution Southeast Nigeria. Ann Afr Med [serial online] 2021 [cited 2021 Dec 6 ];20:169-177
Available from: https://www.annalsafrmed.org/text.asp?2021/20/3/175/326191


Full Text



 Introduction



Feeding behavior assessment is a part of many medical consultations, which is an important factor for the prevention and management of noncommunicable diseases (NCDs).[1] NCDs are the leading cause of death globally. In 2012, they caused 68% of all deaths (38 million) up from 60% in 2000.[2] The United Nations Department of Public information in 2011 estimated that with sustained growth trends, NCDs will attribute to 7 out of every ten deaths in developing countries like Nigeria by 2020, killing 52 million people annually worldwide by 2030.[3] With statistics such as these, it comes as no surprise that international entities such as the World Health Organization and World Bank Human Development Network have identified the prevention and control of NCDs as an increasingly important discussion item on the global health agenda. Alteration of feeding behavior is one of the main modifiable determinants of NCDs and good practice may result in a reduction of diet-related diseases.[4]

Feeding behavior, which influences energy intake and expenditure, is affected by some internal and external determinants.[5] These determinants are food knowledge, availability, attitudes, emotional state, experiences of the individual, and the socio-cultural environment in which the behavior occurs.[5],[6] According to a study,[7] Poor eating habits may result in emotional (irritation and frustration), physical (tiredness and hungriness), and cognitive (difficult concentrating and poor decision-making) challenges, which have a significant negative impact on personal health care, wellness, and professional performance. The nature of occupation, which is hinged on break time or fatigue after work, could affect eating habits, which may lead to malnutrition. Malnutrition can be under-nutrition or over-nutrition. Malnutrition may lead to the deficiency of many micro and macronutrients in the body. Over-nutrition involves the intake of nutrients in excess of body requirements. This may lead to overweight and obesity.[8] A Nigerian national survey reported a 20% increase in the prevalence of obesity from 2002 to 2014.[9] A 2010 study done among nurses in the Akwa Ibom State of Nigeria, reported that 62.6% of the nurses were obese.[10] This proportion was higher than the 2008 Nigerian Demographic Health Survey Data which assessed overweight and obesity among women in the general population, aged 15–49 years and resident in the same state, which was 34.8%.[10]

Health-care workers by their position and learning are considered role models in healthy practices, including adequate nutrition. They are the major source of nutritional information for the teeming population, particularly in developing countries.

However, studies have shown that in most developing nations health-care workers do not diligently put the information to practice. Kunene and Taukobong[11] reported poor eating habits among health professionals in a health facility in South Africa. A similar study in Jos, Nigeria, reported “largely fair” nutritional knowledge and practice among health professionals.[12] In the same study, Banwat reported that 35.2% of nurses in Jos, Nigeria, were obese.

The growing public health problem, especially nutrition-related risk factors of noncommunicable diseases (NCDs) amidst call for improved diet and exercise necessitated this study. This study, therefore, was designed to investigate the feeding behaviors among health-care workers in a tertiary hospital in southeast Nigeria as a way of assessing their risk profile of NCDs.

 Materials and Methods



Design

The study was a cross-sectional survey designed to study the feeding behavior of health workers in Alex Ekwueme Federal University Teaching Hospital, Abakaliki, a tertiary hospital in southeast Nigeria.

Setting

The study area, Abakaliki, is the capital city of Ebonyi State, Southeastern Nigeria. It is bounded by latitudes 6° 16' N and 6° 21'N and Longitudes 8° 05' E and 8° 10 E covering an area of about 83 square km.[13] This setting is geo-morphologically part of the cross-river plains. As a state capital, its population has been growing over the years since the creation of the state in 1996. The area is home to a tertiary health institution, the Alex Ekwueme Federal University Teaching Hospital, Abakaliki. The hospital with over 5000 staff is the only tertiary health facility that serves the entire state and the bordering states.

Study duration

The study was carried out from May 2019 to November 2019.

Material

The research instrument was a self-administered questionnaire [Appendix 1], which was made of two sections. The first section gathered information on the socio-demographics of the respondents, while the second on their feeding behaviors.

The Feeding behavior section of the questionnaire was adapted from the British Heart Foundation's questions to assess the nutritional value of individuals. The adaptation was based on the objectives of the present study. The questionnaire was designed in a 5 scale Likert format to quantitatively assess the feeding behavior of the respondents. The 28 item Feeding behavior questionnaire was categorized into seven, which include: Eating habit, fruits and vegetable consumption, fats and oil consumption, carbohydrate consumption, refined sugar consumption, salt consumption, and water and alcohol intake.

Eating habit

This section assessed how often one skips various meals and also how often one takes junks as meals. The maximum score on this category is 20, while the minimum score is 4.

Fruits and vegetable consumption

This section assessed how often one eats fruits and vegetables. The maximum score on this category is 15, while the minimum score is 3.

Fats and oil consumption

This section assessed how often one avoids unhealthy fats and oil and how often one chooses healthy ones such as fish oil. The maximum score on this category is 25, while the minimum score is 5.

Carbohydrate consumption

This section assessed the frequency of carbohydrate sources as the main base in meals, how often one chooses cereals, and the inclusion of pulses such as beans, okpa, fio-fio, and lentils as carbohydrate sources in meals. The maximum score on this category is 20, while the minimum score is 4.

Refined sugar consumption

This section assessed one's consumption of refined sugar in foods, fizzy drinks, and confectionaries. The maximum score on this category is 20, while the minimum score is 4.

Salt consumption

This section assessed the quantity of salts one consumes and the healthy practices associated with it. The maximum score on this category is 25, while the minimum score is 5.

Fluid intake

This section assessed the consumption of water, sugary drinks consumption, and the rate of consumption of alcoholic beverages. The maximum score on this category is 15, while the minimum score is 3.

The maximum score on the general feeding behavior questionnaire is 140, while the minimum score is 28. The 5 scale ranking which ranged from “never” to “always” was interpreted to represent three levels of feeding behavior, which is “poor,” “fair,” and “good.” The maximum score shows an ideal feeding behavior, which is required to maintain optimum health and avoid the nutritional risk of metabolic diseases. “Poor” feeding behavior marks a score in the range from 28 to 83; “Fair” feeding behavior marks a score in the range 84–111; while “good” feeding behavior is marked by a score from the range 112–140 points on the scale.

Validation of instrument

The face validity of the instrument was determined by three expert scholars. Its reliability was also tested with a test-retest method. Copies of the questionnaire were first administered to 25 health workers (who did not participate in the main study) and were re-administered after 7 days. Its test-retest reliability yielded correlation coefficients of r = 0.960 (P = 0.001).

Data collection

Health-care workers from Alex Ekwueme Federal University Teaching Hospital Abakaliki were recruited as participants using a convenience sampling method. The Questionnaires were hand distributed to participants at their workstations in the hospital and collected back on the same day after completion.

Sample size calculation

The sample size in the study was determined using the formula[14] for the sample size n:

n = N × X/(X + N– 1),

where,

X = Zα/22 P (1-p)/MOE2, and Zα/2 is the critical value of the Normal distribution at α/2 (e.g., for a confidence level of 95%, α is 0.05 and the critical value is 1.96), MOE is the margin of error, P is the sample proportion, and N is the population size.[14] Accordingly, a minimum sample size of 357 participants was determined in population size of 5000, with an estimated sample proportion of 50%. However, 418 participants participated in the study.

Statistical analysis

Descriptive statistics of mean, standard deviation, frequency, and percentage were used to summarize data. Inferential statistics of independent t-test and analysis of variance (ANOVA) were used to test for statistical differences between variables at alpha level P < 0.05. Data were analyzed using the Statistical Package for the Social Sciences (SPSS) version 25 (IBM, New York, USA).

 Results



The total number of participants in the study was 418. There were 186 males and 232 females, representing 44.5% and 55.5% of the sample size, respectively. Various professions were represented in the sample. They include medical doctors, nurses, dietitians, physiotherapists, laboratory Scientists, Health information management officers, accountants, administration officers, and pharmacists. [Table 1] shows the sociodemographics participants.{Table 1}

The feeding behaviors of the respondents are shown in [Table 2] and [Table 3].{Table 2}{Table 3}

Eating habit

The minimum score was 4 out of 20, while maximum score was 20 out of 20. The mean score of the participants was 13.09 ± 2.72 out of 20. There was no significant difference (P > 0.05) between males and females in this category. The mean score based on the interpretation of the scoring format [Appendix 2] is fair. This means that the eating habit of the participants is suboptimal.

Fruits and vegetable consumption

The minimum score was 3 out of 15, while the maximum score was 15 out of 15. Females have better feeding behavior (P < 0.05) in fruits and vegetable consumption when compared with males. Males have poor behavior (8.26 ± 2.05) in this category. Females have a fair behavior (9.33 ± 2.59) in this category. The mean feeding behavior of the participants in the consumption of fruits and vegetables (8.85 ± 2.14) is fair.

Fats and oil consumption

The mean score of the participants was 13.72 ± 2.50 out of 25. The minimum score was 5, while the maximum score was 23. Although females have a significant (P < 0.05) better behavior in the consumption of fats and oil compare to males, the mean behavior for both gender (13.72 ± 2.50) was poor.

Carbohydrate consumption

The mean score of the participants was 10.03 ± 2.41 out of 20. The minimum score was 4, while the maximum score was 17. Although females have a significant (P < 0.05) better behavior in the consumption of carbohydrates compared to males, the mean behavior for both gender remained poor.

Refined sugar consumption

The mean score of the participants was 13.10 ± 2.81 out of 20. The minimum score was 4, while the maximum score was 19. There was no significant difference (P > 0.05) between males and females in this category. The mean behavior of the participants in the consumption of refined sugar is fair. This means that refined sugar consumption of the participants is suboptimal.

Salt consumption

The mean score of the participants was 17.00 ± 3.01 out of 20. The minimum score was 7, while the maximum score was 25. There was no significant difference (P > 0.05) between males and females in this category. The mean behavior of the participants in salt consumption is fair. This means that the salt consumption of the participants is also suboptimal.

Fluids intake

The mean score of the participants was 10.36 ± 2.13 out of 15. The minimum score was 5, while the maximum score was 15. There was no significant difference (P > 0.05) between males and females in this category. The mean behavior of the participants in the intake of fluids is fair. This means that the intake of fluids of the participants is equally suboptimal.

The mean score of the entire participants was 86.13 ± 8.52 out of 140. The minimum score of the participants was 65, while the maximum score was 115. Although females have a significant (P < 0.05) better overall feeding behavior (88.15 ± 9.00) compared to males (83.62 ± 7.18), the mean feeding behavior for both genders (86.13 ± 8.52) remained fair, which is suboptimal.

 Discussion



The study showed that health-care workers in the tertiary health institution in Southeast Nigeria had overall fair feeding behavior. It showed that the population was relatively at risk of NCDs. It also showed from the study that females had a statistically significant overall better feeding behaviour compared to males. However, none of the gender had good feeding behaviour. Each gender's score was within the “fair” range on the scale. There was no significant difference across various professions. Dietitians did not have any behavioral advantage over other professionals despite their wealth of knowledge in human nutrition.

The implication is that the studied population cannot be exempted from the global call and awareness on healthy feeding behavior to prevent NCDs. This study has a similar result with a study in South Africa, where Kunene and Taukobong reported poor eating habits among health professionals in a health facility in South Africa.[8] Similar study in Jos, Nigeria, reported “largely fair” nutritional knowledge and practice among health professionals.[9] Another study reported by Betancourt-Nuñez et al.,[15] stated that health-care workers in Mexico also reported unhealthy feeding behavior.

The score in the consumption of fruits and vegetables was actually approximated to the nearest whole number to meet the “fair” range. A significant gender-related difference was observed, where females reported to eat fruits and vegetables more frequently than males. This finding is similar to that of another study carried out in Finland and Baltic countries in which females have been found to eat healthier diets than males, including fruits and vegetables.[16] Furthermore, in a similar study in Saudi Arabia, females were observed to eat fruits and vegetables more than males.[17] The WHO, in 2003, recommends adequate consumption of fruits and vegetables (5 portions a day) to maintain optimum health.[6] It is shown that the recommendation may not have been met among health-care workers in the study population.

The study population had poor feeding behavior in the consumption of fats and oil. Females had better behavior in this category when compared to males. Dieticians had a fair, which put them on behavioral advantage over other health workers in terms of consumption of fats and oil. However, there is the unhealthy practice in the consumption of fats and oil, which shows a high risk of certain disease conditions, including cardiovascular diseases and metabolic diseases.[6]

There is unhealthy behavior in the consumption of carbohydrate sources of food among the study population. The recommendation of Republic of South African Department of Health 2013 official gazette on Guidelines for healthy eating stated that legumes (e.g., lentils and beans), nuts and whole grains (e.g., unprocessed maize, oats, wheat, and brown rice) should be focused on as the main source of carbohydrates because it a healthy source of carbohydrate in a healthy quantity.[18] This was noticed to be almost absent among the participants in this study.

On salt intake, the overall behavior of the health-care workers is fair, unlike a study reported by Bhattacharya et al. in 2018[19] among urban slum populations of North India. The same was reported in another study in a Chinese population by Lin et al.[20] Another study among Jordanian citizens confirms the same poor salt habit, adding that the citizens are mostly unaware of its negative impact on their health.[21] The implication is that the studied population cannot also be exempted from the global call and awareness of the healthy practice of salt consumption to prevent diseases.

It is recommended that adults should consume at least 3 L of water daily.[22] The study population had fair behavior in water consumption. A study by Douglass et al.,[23] among dietitians in the UK shows that the majority of dietitians rated their personal hydration practices as bad or average despite reporting the use of water dispensing facilities at their place of work.

The participants were assessed on the recommendation of the British Heart Foundation, which advocated that Men and women should not drink more than 14 units of alcohol each week.[22] Health-care workers studied had a fair behavior in alcohol consumption. This is also in line with the UK Department of Health recommendation in 2016.[24]

 Conclusion



The study showed that the health-care workers in the tertiary health institution in southeast Nigeria have inadequate feeding behavior. They are, therefore, relatively at risk of NCDs. Females have a significant overall better feeding behavior when compared to males in the study population. However, none of the genders had good feeding behavior. Each gender's score was within the “fair” range on the scale. There was no significant difference in feeding behavior across various professions. The implication is that health-care workers, who are publicly seen as custodians of nutritional health information, cannot be exempted from the global call and awareness on healthy feeding behavior to prevent and reduce the burden of NCDs.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 Appendixes



Appendix 1: Questionnaire

Dear Respondent,

We need your co-operation to carry out research on physical activity, feeding behavior, and anthropometric indices of metabolic disorders among civil health workers in Alex Ekwueme University Teaching Hospital Abakaliki. Your views on these questions are strictly confidential.

INSTRUCTION:

Please tick (✓) to answers that are most suitable to you and supply the appropriate answers where necessary.

SECTION A: DEMOGRAPHIC AND SOCIO-ECONOMIC DATA

1. Gender: □ Male □ Female □

2. Age : 20-29 □ 30-39 □ 40-49 □ 50 and above □

3. Marital Status: Single □ Married □ Separated □

Divorced □ widowed

4. What is your profession? ------------------------------

5. Monthly Income level:

Below 50,000 □ 50,000 – 99,000 □100,000 – 200,000 □

200,000-500,000 □ 500,000 and above □

6. What is your grade level? ____________________

7. Family type: Polygamous □ Monogamous □

8. How many children do you have? Not yet 1 -2

3-4 □ More than 4 □

9. Other dependents living with you apart from spouse and children?

None □ 1 □ 2 □ 3 □ More than 3 □

10. Do you have any children less than 18 years, living with you? Yes □ No □

SECTION B: HOW HEALTHY IS YOUR DIET? QUESTIONNAIRE

[INLINE:1]

[INLINE:2]

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