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Vol. 19 No. 2, June 2004Tanzania Medical Journal

NUTRITION STATUS OF THE ELDERLY IN PERI-URBAN DAR-ES-SALAAM, TANZANIA.

Liwayway Hussein and Asia K Hussein

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Vol. 19 No. 2, June 2004Tanzania Medical Journal

Summary

Objectives: To determine the nutrition status of elderly individuals and their associated factors in a periurban area.

Design: A cross sectional survey.

Setting: Chamanzi and Goba villages in periurban Dar-es-Salaam

Methods: A list of all elderly individuals (aged 60 years and older) residing in the study area was compiled with the help of village authorities. House to house visits were then made for interviews. Nutrition status was assessed using the anthropometric indicator of Body Mass Index (BMI) and the oral cavities of all study subjects were inspected.

Results: A total of 181 elderly individuals were included in the survey, with females constituting a higher proportion (64%). The prevalence of undernutrition was 34% with more males than females affected; 37% vs. 32% respectively. Nutrition status was found to be significantly associated with marital status (p<0.006). Possession of 20 or more natural teeth, a good appetite and consumption of three or more meals per 24 hours were more likely to be associated with nutritional status; however these associations were not statistically significant (P>0.05).

Conclusion: There is a high prevalence of undernutrition among the elderly living in periurban Dar-es-Salaam. There is need to focus more attention on this population sub group.

Key words: Elderly, body mass index, nutrition status,

Tanzania

Introduction

The World Health Organization (WHO) defines the elderly as people over the age of 60 years.(1) The proportion of the elderly in Tanzania was estimated to be 4.6% in 2000 and it is expected that it will reach 5.3% by the year 20302. In absolute numbers, the proportion of the elderly translate to 1.5 million in the year 2000 and 2.9 million in the year 2030.(2) The current high rate of ageing observed in Tanzania and other developing countries has been attributed to improved child survival rates, declining death rates and decreased fertility rates brought about by improved socioeconomic conditions, increased health care accessibility and wide application of general public health interventions.(1)

It has well been established that the elderly are a vulnerable group as far as malnutrition is concerned(3,4). They suffer from a wide range of nutrition disorders as well as chronic disease conditions, some of which have nutritional antecedents operating since early childhood.(1,4) The elderly are prone to suffer from malnutrition as they are usually on prolonged medication, have loss of appetite and poor oral condition, are depressed, inactive, live a solitary lifestyle and have decreased access to preferred foods.(5,6) Possession of less than 20 natural teeth has been associated with reduced chewing function and under nutrition in the elderly.(7) The elderly also face economic hardship, as they are no longer productive and do not have a regular income. They might also lack support from their children and relatives because of the younger generation moving to urban areas and breaking down of the traditional support systems.(4)

Under nutrition rather than obesity has been reported to be more common in the elderly in developing countries although in some urban areas the elderly are also experiencing nutrition problems similar to those of their counterparts in the developed countries.(3,4) If undernutrition in the elderly is not managed adequately, it may result in high rates of infection, poor quality of life and increased mortality rates.(4,5)

In Tanzania there is paucity of information with regards to the health and nutrition status of the elderly whose numbers and importance in society can no longer be ignored. This paper seeks to determine the nutrition status and some associated factors of the elderly in peri-urban Dar-Es-Salaam with the goal to contribute to the pool of existing information on the elderly in Tanzania. The study was carried out to fulfill the requirements for getting the MD degree of the University of Dar-Es-Salaam for the first author.

Methodology

Study area

A cross sectional study was carried out to describe the nutrition status of the elderly resident in the villages of Chamanzi and Goba which are situated in periurban Dar-Es-Salaam in September 2000. Dar-Es-Salaam is the largest city and business capital of Tanzania and it is subdivided into three administrative districts which are Ilala, Kinondoni and Temeke districts. Chamanzi village has a total population of 10,000 and is located in Temeke district while Goba village is in Kinondoni district and has a population of 17,000. The main tribes living in both villages are Wazaramo and Wandengereko. None of the villages have tap water or electricity. Farming is the main economic activity and crops cultivated include coconut, cassava, sweet potatoes and oranges.

Sample size and sampling

A convenient sample of 200 elderly was established i.e. 100 subjects from each village. All the elderly individuals in each village were enlisted with the help of village leaders. An elderly individual was defined as someone who was 60 years old or older. House to house visits were then made to get the elderly who were included in the study.

Data collection procedures

Data was collected using a pre-tested questionnaire by one of the authors with the help of a research assistant who had been trained on how to apply the study instrument. During the house-to-house visits, the age of the elderly individuals was determined by asking them to mention their ages and the year that they were born. In cases were they could not recall this, a local calendar of events was used to approximate their ages. When there was more than one elderly person living in a household, all were included in the study and each one was interviewed separately. Elderly individuals found to be absent during the initial visit were visited again the next day.

Data collected included socio-demographic characteristics, self reported morbidity, presence of mouth pain, frequency of eating in the past 24 hours, whether they were living alone or with family members and whether they received any social support. The anthropometric measurements of height and weight of each study subject were taken and recorded. A stadiometer was used to measure height and a bathroom scale for weight. The height measurements were recorded to the nearest 0.1 cm and weight to the nearest 0.1kg. The bathroom scales were adjusted to zero before weighing the next subject. The oral cavity of each subject was also inspected, the number of teeth counted and the condition of gums recorded.

Ethical considerations

Research clearance was obtained from the College Research and Publications Committee of the Muhimbili University College of Health Sciences. The importance of conducting the study was made known to the village authorities and their permission sought. All study respondents were also explained on the aims of the study and their consent obtained prior to being interviewed.

Data processing and analysis

The nutrition status of each individual was determined by calculating his/her Body Mass Index (BMI) by dividing their weight in kilograms by their height in metres squared. A subject was then classified to be normal (BMI between 18.5 and <30kg/metres squared), undernourished (BMI <18.5kg/metres squared) or overweight (BMI >30kg/metres squared) according to the World Health Organisation (WHO) classification of nutrition status for elderly individuals 8. Teeth numbering between 0 and 19 were considered inadequate, while 20 or more was considered adequate7. Data entry and analysis were done using EPI-Info version 6 computer software programme. To determine any association between nutrition status and some selected factors, p- values were calculated using the STATCALC calculator in the EPI-Info program. P-values less than 0.05 were considered to be significant.

Results

A total 181 elderly people were covered in the study. Table 1 shows that females (64%) were more compared to males (36%). Their ages ranged from 60 to 90 years. The mean age was 72 (SD=4.3) years for males and 74 (SD=4.9) years for females. The average BMI was 20.5 kg/metres squared for males and 21.2 kg/metres squared for females.

Table 1: Age And Sex Distribution Of Study Subjects

Table 2 shows that almost two thirds of the study population (65%) had normal nutrition status, about a third (34%) were undernourished and only 1% (2 subjects) were overweight. A larger percentage of females (67%) than males were found to have normal nutrition status but the results were not statistically significant (p>0.05). The highest proportion of elderly respondents who were undernourished were those in the age group 80 years and above (43%); while age group 60 to 69 years had the highest proportion of study subjects with normal nutrition status (71.3%).

Table 2:Nutrition Status Of The Study Subjects According To BMI By Sex And Age

Nutrition status

Normal

Sex

Age

Table 3 shows the relationship between nutrition status of the study subjects and some selected factors. Two subjects who were classified as being overweight have been excluded from this analysis. Most of the study subjects were either married i.e. 87 (49%) or widowed i.e. 55 (31%). Majority of the subjects 137 (77%) were found to have 20 or more natural teeth and however 19 (11%) reported to be experiencing mouth pain. When asked to assess their appetite, 33 (18%) study subjects reported that this was good. Table 3 also shows that a total of 116 (65%) subjects reported that they were suffering from some chronic illnesses. Most of the subjects, 128 (72%) reported that they received support from family and relatives and 34 (19%) reported that they lived alone.

Table 3.Association Of Nutrition Status And Some Selected

Factors

Variable

Number of Teeth

>3 times

Self Reported Morbidity

Marital status was significantly associated with nutritional status, with subjects who were separated or single being less undernourished compared to other marital status categories (p<0.006). Possession of 20 or more natural teeth was also found to be significantly associated with good nutritional status (p=0.03). While having a good appetite and eating three or more meals per day were also associated with good nutritional status, these findings were not statistically significant (p>0.05). Contrary to our expectations, a higher proportion of subjects with self reported chronic illness were well nourished (38.1%) compared to those not reporting any illness (31.9%), however this finding was not statistically significant. The results also showed that study subjects who reported that they were receiving support from relatives and friends and those who were not living alone tended to be better nourished.

Discussion

The prevalence of undernutrition among the studied elderly in peri urban Dar-Es-Salaam was 34% with more males affected compared to females (i.e. 37% v.s. 32% respectively). According to WHO8, this indicates that there is high prevalence of undernutrition among 0the elderly in the study area. The magnitude of undernutrition obtained in this study is much higher compared to findings from previous studies in Tanzania i.e. that of 26% established amongst elderly patients admitted in Morogoro regional hospital or 20% and 13% for elderly men and women living in Rwandan refugee camps in Kigoma region respectively3,9. It is likely that the difference in study settings contributed to the observed difference. Morogoro regional hospital is situated in an urban area and the observed low rate of undernutrition could be a result of better socio-economic status enjoyed by the elderly respondents in that area together with better access to health care. It is not clear for how long the study respondents from the refugee camps were resident in Kigoma. Their much better nutrition situation is most likely due to improved food security as food rations are regularly distributed in the camps.

Findings of the study reveal that several of the variables analysed were found to be associated with nutritional status, however the association was significant (p<0.05) for only two variables i.e. marital status and number of teeth present. This could be attributed to the small sample size studied. Age was found to be associated with nutritional status with individuals in more advanced age groups being more likely to suffer from undernutrition. About a quarter of the study subjects had inadequate dentition and this was also found to be associated with undernutrition. It should also be noted that the majority of study respondents reported having poor appetite and suffering from chronic illness. These findings concur with what has been established by other researchers who have shown that physiological changes associated with ageing influence food intake of the elderly both in terms of amount and quality4,5,6. Changes in taste and ability to smell influences appetite while the decrease in gastrointestinal motility associated with ageing creates a sense of fullness4. Impaired mastication due to teeth loss has been associated with food selection and unbalanced diets amongst edentulous elderly with a resultant poor nutrition status7.

We established that the majority of the elderly studied were living together with other family members and were receiving social support from them. This is a positive finding as care is an important contributory factor to the health and nutrition status of vulnerable groups, the elderly not excluded. Living with family and relatives ensures that older citizens get help with psychological stimulation, physical assistance like fetching water, cooking and other domestic chores.

The welfare of the elderly has not yet been accorded adequate emphasis in Tanzania, evidence for this being the existence of minimal literature on this age group. In the past attention has been focused mainly on nutrition and health status of underfive year old children and maternal health. The elderly population is however increasing rapidly, making it difficult to ignore their presence. It is now the right time for this population segment to receive the attention it deserves from policy makers, health and social researchers so that their health and nutrition needs can be identified and addressed.

Conclusion and Recommendations

There is a high prevalence of undernutrition and self reported morbidity amongst the elderly residing in per-urban Dar-Es Salaam. This situation underlines the need for a further review of the health and nutrition status of the elderly followed by the application of appropriate interventions. The existing good traditional practices of living together and providing support to older family members should be maintained.

References

1. World Health Organization. Nutrition for health and development. A global agenda for combating malnutrition, WHO/NHD/00.6, France 2000.
2. US Census Bureau. International Data Base (IDB): US Bureau of the Census’s International Program Center; 2000.
3. Charlton KE and Rose D. Nutrition among older adults in Africa: The situation at the beginning of the millennium. Journal of Nutrition 2001; 131:2424S-24428S.
4. Visvanathan R. Undernutrition in older people: A serious and growing global problem. Journal of Postgraduate Medicine 2003; 49:352-360.
5. Mojon P, Budtz-Jorgensen E and Rapin CH. Relationship between oral health and nutrition in very old people. Age and Ageing 1999; 28: 463-468.
6. Lauque S, Arnaud-Battander F, Mansourian R, Guigoz Y, Paintin M, Nourhashemi F and Vellas B. Protein-energy oral supplementation in malnourished nursing–home residents. A controlled trial. Age and Aging 2000; 29: 51-56.
7. Budtz-Jorgensen E, Chung JP and Rapin CH. Nutrition and oral health. Best Practice and Research Clinical Gastroenterology. 2001; 15(6):885-896.
8. World Health Organization. Physical status: The use and interpretation of anthropometry. Report of WHO expert committee. Technical report series No.854, Geneva; 1995; pp 375-407.
9. Nyaruhucha CN, Msuya JM and Agustino B. Health Status Of Hospitalised Elderly In Morogoro Regional Hospital. East African Medical Journal 2001; 78(9): 489-92.