Poor nutritional status and growth retardation are associated with living in the orphanage: an observational cross-sectional study

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orphan, nutrition, growth, deficiency, malnutrition


Objective: Adequate and balanced nutrition is crucial for optimal growth and development. However, children living in orphanages without a family are at risk of malnutrition. In this study, we aimed to compare the nutritional status and growth process of orphans and non-orphans. Methods: We recruited 111 orphans and 116 non-orphans aged 3-6 years. We excluded children with any acute or chronic disease and physical or mental problems. We assessed dietary intakes via the 3 days food record form. We took anthropometric measurements and evaluated the growth level of children using the Z-score tables of the World Health Organization.  We analyzed the data using IBM SPSS. Results: Of the 227 children, the prevalence of undernutrition was as high as 54.8% among children in the orphans. According to Z-score of height for age values, 23.4% of orphans were only 4.3% of non-orphans were stunted. While the mean energy intake was significantly higher in orphans compared to non-orphans (1802.7±552.80 kcal vs. 1480.8±244.53 kcal, p<0.05), the proportion of energy from protein was lower (12.9±2.32% vs. 43.9±9.72%, p<0.05). The mean dietary vitamin C and calcium intakes were significantly lower in the orphans than non-orphans (p<0.05). Conclusion: The results of our study suggest that children living in the orphanages have a significant risk in terms of nutritional deficiencies and developmental delays compared to children living with their families.


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1. Rosenbloom AL. Physiology of growth. Annales Nestlé (English ed) 2007; 65(3): 97-108.
2. Michaelsen KF. Child growth. In: Koletzko B, Bhatia J, Bhutta ZA, Cooper P, Makrides M, Uauy R, eds. Pediatric nutrition in practice: Switzerland: Karger Medical and Scientific Publishers 2015 :1-5.
3. De Onis M, Blössner M, Borghi E. Global prevalence and trends of overweight and obesity among preschool children. Am J Clin Nutr 2010; 92(5): 1257-64.
4. Lloyd LJ, Langley-Evans SC, McMullen S. Childhood obesity and risk of the adult metabolic syndrome: a systematic review. Int J Obes (Lond) 2012; 36(1): 1-11.
5. Massad SG, Nieto FJ, Palta M, Smith M, Clark R, Thabet AA. Nutritional status of Palestinian preschoolers in the Gaza Strip: a cross-sectional study. BMC Public Health 2012; 12: 27
6. World Health Organization. World Health Statistics 2011. World Health Organization Web site. https://www.who.int/gho/publications/world_health_statistics/EN_WHS2011_Full.pdf. Published January 14, 2011. Accessed Janurary 23, 2021.
7. Hacettepe University Faculty of Health Sciences Department of Nutrition and Dietetics. Türkiye Beslenme ve Sağlık Araştırması 2010 Beslenme Durumu ve Alışkanlıklarının Değerlendirilmesi Sonuç Raporu. Ankara: T.C. Sağlık Bakanlığı Sağlık Araştırmaları Genel Müdürlüğü 2014.
8. Gupta N, Goel K, Shah P, Misra A. Childhood obesity in developing countries: epidemiology, determinants, and prevention. Endocr Rev 2012; 33(1): 48-70.
9. Yang XL, Ye RW, Zheng JC, Jin L, Liu JM, Ren AG. Analysis on influencing factors for stunting and underweight among children aged 3 - 6 years in 15 counties of Jiangsu and Zhejiang provinces. Zhonghua Liu Xing Bing Xue Za Zhi 2010; 31(5): 506-9.
10. Dybdahl R. Children and mothers in war: an outcome study of a psychosocial intervention program. Child Dev 2001; 72(4): 1214-30.
11. Anoop S, Saravanan B, Joseph A, Cherian A, Jacob KS. Maternal depression and low maternal intelligence as risk factors for malnutrition in children: a community based case-control study from South India. Arch Dis Child 2004; 89(4): 325-9.
12. Wang Y, Lim H. The global childhood obesity epidemic and the association between socio-economic status and childhood obesity. Int Rev Psychiatry 2012; 24(3): 176-88.
13. Lindblade KA, Odhiambo F, Rosen DH, DeCock KM. Health and nutritional status of orphans <6 years old cared for by relatives in western Kenya. Trop Med Int Health 2003; 8(1): 67-72.
14. Parikh A, Desilva MB, Cakwe M, Quinlan T, Simon JL, Skalicky A, et al. Exploring the Cinderella myth: intrahousehold differences in child wellbeing between orphans and non-orphans in Amajuba District, South Africa. Aids 2007; 21(7): 95-103.
15. World Health Organization. WHO Multicentre Growth Reference Study Group. WHO Child Growth Standards: Length/height-for-age, weight-for-age, weight-for-length, weight-for-height and body mass index-for-age: Methods and development. World Health Organization Web site. https://www.who.int/childgrowth/standards/technical_report/en/. Published 2006. Accessed January 23, 2021.
16. Rakıcıoğlu N, Tek Acar N, Ayaz A, Pekcan G. Food and Nutrition Photo Catalog: dimensions and quantities. Ankara: Ata Ofset Typography; 2016.
17. Merdol T. Standardized food recipes for Turkey Ankara: Hatipoglu Press; 2003.
18. Schmid M. Beslenme Bilgi Sistemi BeBIS 8.0 paket programı. Entwickelt an der Universital Hohenheim, Stuttgart; 2011.
19. Hacettepe University Department of Nutrition and Dietetics and The Ministry of Health of Turkey, The General Directorate of Primary Health Care. Dietary Guidelines for Turkey. Ankara: Onur Printing 2014.
20. UNICEF for every child. Orphans. UNICEF for every child Web cite. https://www.unicef.org/media/media_45279.html. Published January 16, 2017. Accessed January 23, 2021.
21. Özdemir N, Sefer N, Türkdoğan D. Bir Sosyal Sorumluluk Projesi Örneği:" Korunmaya Muhtaç Çocuklar. Sosyal Bilimler Dergisi/Journal of Social Sciences 2008; 32(2).
22. T.C. Ministry of Family, Labor and Social Services. Number of children under the maintenance in Turkey. T.C. Ministry of Family, Labor and Social Services. Web cite. https://www.ailevecalisma.gov.tr/chgm/istatistikler/. Published 2019, Accessed January 23,2021.
23. Johnson DE. Medical and developmental sequelae of early childhood institutionalization in Eastern European adoptees. In C. A. Nelson (Ed.), Minnesota symposia on child psychology; The effects of early adversity on neurobehavioral development. Lawrence Erlbaum Associates Publishers; 2000: 113–62.
24. Juffer F, van Ijzendoorn MH. Behavior problems and mental health referrals of international adoptees: a meta-analysis. Jama 2005; 293(20): 2501-15.
25. Cox A, Horii T, Granby B, Morgan B. The importance of early childhood development: Assessing the quality of care in Uganda. [Project]. Masters in International Development, Capstone Project GWU and CARE/HACI; 2006: 21-8.
26. Bundy D, Schaeffer S, Jukes M, Beegle K, Gillespie A, Drake L. Schoolbased health and nutrition programs. disease control priorities in developing countries. New York: Oxford University Press 2006; 1,091-1: 108.
27. Hearst MO, Himes JH, Johnson DE, Kroupina M, Syzdykova A, Aidjanov M, et al. Growth, nutritional, and developmental status of young children living in orphanages in Kazakhstan. Infant Ment Health J 2014; 35(2): 94-101.
28. Mwaniki EW, Makokha AN, Muttunga JN. Nutrition Status And Associated Morbidity Risk Factors Among Orphanage And Non-Orphanage Children in Selected Public Primary Schools Within Dagoretti, Nairobi, Kenya. East Afr Med J 2014; 91(9): 289-97.
29. Al-Adili N, Shaheen M, Bergstrom S, Johansson A. Survival, family conditions and nutritional status of motherless orphans in the West Bank, Palestine. Scand J Public Health. 2008; 36(3): 292-7.
30. Börekçi G, Üzel A. Mersin ili Sosyal Hizmetler Çocuk Yuvası ve Yetiştirme Yurdundaki çocuklarda bağırsak parazitleri, fiziksel büyüme ve hijyen alışkanlıklarının belirlenmesi. Türkiye Parazitol Derg 2009; 33: 63-72.
31. Sarker M, Neckermann C, Müller O. Assessing the health status of young AIDS and other orphans in Kampala, Uganda. Trop Med Int Health 2005; 10(3): 210-5.
32. Crampin AC, Floyd S, Glynn JR, Madise N, Nyondo A, Khondowe MM, et al. The long-term impact of HIV and orphanhood on the mortality and physical well-being of children in rural Malawi. Aids 2003; 17(3): 389-97.
33. Kimani-Murage EW, Holding PA, Fotso JC, Ezeh AC, Madise NJ, Kahurani EN, et al. Food security and nutritional outcomes among urban poor orphans in Nairobi, Kenya. J Urban Health. 2011; 88(2): 282-97.
34. Hall A, Tuffrey V, Kassa T, Demissie T, Degefie T, Lee S. Case-control analysis of the health and nutrition of orphan schoolchildren in Ethiopia. Trop Med Int Health 2010; 15(3): 287-95.
35. Sadik A. Orphanage children in Ghana: are their dietary needs met? Pakistan Journal of Nutrition 2010; 9(9): 844-52.
36. Otieno PA, Nduati RW, Musoke RN, Wasunna AO. Growth and development of abandoned babies in institutional care in Nairobi. East Afr Med J 1999; 76(8): 430-5.
37. Vaida N. Nutritional status of children living in orphanages in district budgam, J&K. International Journal of Humanities and Social Science Invention 2013; 2(2): 36-41.
38. Gümüş H, Bulduk S, Akdevelioğlu Y. Yetiştirme yurtlarında kalan adolesanların beslenme ve fiziksel aktivite durumlarının vücut kompozisyonları ile ilişkisinin saptanması. Uluslararası İnsan Bilimleri Dergisi 2011; 8(1): 786-808.
39. Mahan L, Raymond J. Food and The Nutrition Care Process. Krause’s Food & The Nutrition Care Process. Elsevier; 2017.
40. Frank DA, Klass PE, Earls F, Eisenberg L. Infants and young children in orphanages: one view from pediatrics and child psychiatry. Pediatrics. 1996; 97(4): 569-78.
41. Shamah-Levy T, Rodríguez-Ramírez S, Gaona-Pineda EB, Cuevas-Nasu L, Carriquiry AL, Rivera JA. Three 24-Hour Recalls in Comparison with One Improve the Estimates of Energy and Nutrient Intakes in an Urban Mexican Population. J Nutr 2016; 146(5): 1043-50.
42. Ma Y, Olendzki BC, Pagoto SL, Hurley TG, Magner RP, Ockene IS, et al. Number of 24-hour diet recalls needed to estimate energy intake. Ann Epidemiol 2009; 19(8): 553-9.
43. Godoy-Matos AF, Guedes EP, Souza LL, Martins MF. Management of obesity in adolescents: state of art. Arq Bras Endocrinol Metabol 2009; 53(2): 252-61.
44. Cox R, Skouteris H., Rutherford L, Fuller-Tyszkiewicz M, Hardy LL. Television viewing, television content, food intake, physical activity and body mass index: A crosssectional study of preschool children aged 2-6 years. Health Promotion Journal of Australia 2012; 23(1): 58–62.
45. Mitchell J, Pate R, Beets M, Nader P. Time spent in sedentary behavior and changes in childhood BMI: A longitudinal study from ages 9 to 15 years. International Journal of Obesity 2013; 37(1): 54–60.
46. Dehghan M, Akhtar-Danesh N, Merchant AT. Childhood obesity, prevalence and prevention. Nutr J 2005; 4:24.
47. Ihmels MA, Welk GJ, Eisenmann JC, Nusser SM. Development and preliminary validation of a Family Nutrition and Physical Activity (FNPA) screening tool. International Journal of Behavioral Nutrition and Physical Activity 2009; 38: 60– 8.

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