Factors Militating Against Nutrition and Primary Health Services in Nigeria Volume 6 - Issue 4

Adaeze Oguegbu*

• Department of Public and Community Health, Liberty University, Lynchburg, VA, USA

Received: November 02, 2021   Published: November 22, 2021

Corresponding author: Adaeze Oguegbu, Department of Public and Community Health, Liberty University, Lynchburg, VA, USA

DOI: 10.32474/RRHOAJ.2021.07.000252

Abstract PDF

Abstract

All over the world, feeding has been and it is still one of the characteristics of every living thing which man is among sequel to this, food is one of the basic necessities of life. It does not just keep living things alive but also invigorates growth and development as well as builds up immunity for protection against diseases. In other to achieve all these benefits of feeding, one has to eat a right through making adequate choice of food. This is to state that there are various classes of food with its own distinct nutrient which requires certain amount of combination with others to produce that which the body requires for its metabolism. It is unfortunate that not everybody is aware of the ways one could eat food that contains all the food nutrients in the right proportion thus eats anything food which does more harm than good. There is need for sensitization of the rural dweller in particular on good nutrition practice, which should be carried out through the community health services. The community health services/primary health services are the grass root health workers who are rooted in the interior villages to oversee the health related cases of the community members. Stemming from the above expressions, this paper tries to x-ray the concept of nutrition, benefits of good nutrition, factors militating against good nutrition, reasons for nutrition education, the concept of Primary health services, primary health types, principles of community health services and the challenges facing them in the discharge of their duties. Suggestions were also made based on the findings.

Keywords: Factors; Militating; Nutrition; Community Health; Services

Introduction

Nigeria is one of the developing countries of the world that have many poverty stricken homes. This is evinced going by the massive unemployment that bedevilled the country over the years. Many Nigerian families cannot put food on their table on daily basis. Ugwu, Amadi [1] gave credence to the above declaration when the scholars submitted that many Nigerians could not afford good nutrition due to the amplified poverty level in the country. This has resulted to alarming increase in crime rate like armed robbery, kidnapping, internet fraud, child labour among others. It has also resulted to people being diseased of one ailment or the other resulting to high rate of maternal and infant mortality rate as this people are the most vulnerable when it comes to poor nutrition. Furthermore, many Nigerian parents are illiterate and do not know what and what makes for a balanced diet and as such make wrong choice of food thus eat imbalanced diet thus make their choice according to what they like and that which they can afford. Nutrition is basically the process of feeding or eating of food which may be in solid or liquid form. It is the way food substances are injected into the body by way of eating or drinking. That which is eaten or drank have different types of nutrients which reflects in the types of food. Then for one to know what food to eat for a particular nutrient requires some enlightenment. In support of the above claim, Sharma [2] succinctly put that nutrition is the study of how what is injected in the body as food or drink affects the entire body system bearing in mind the components of essential nutrients the body require for good functioning. This public awareness on nutrition education is basically provided by the community health services.
Community health services is a kind of health related aid given to people in the rural community to avail them the opportunity of being aware of certain ailments, causes, prevention and treatment. Food nutrition education is one of the essential training given to the rural dwellers as well as personal hygiene. Segen’s Medical Dictionary [3] laid weight to the above view point and lucidly put that community health service is a type of food which enables the recipients to obtain health related information from the health officials/professionals. The scholar stressed that these health professionals supply medical, dental, nursing and other related health care services at a designated place. They also give health care to people identified with physical and/or mental health conditions, pregnant mothers, nursing mothers, the aged and other people who needed community care services. Health services offered in the community include prevention services, intervention or health promotions as demanded by the community. In view of the above avowals, community health services are meant to oversee the overall wellbeing of the entire community members. In dealing with their health issues, the awareness of the appropriateness in the choice of food should be prioritized because good nutrition makes for good health while malnutrition is deficiency in human health. The health professionals educate the pregnant and nursing mothers on which food to feed on during that period for optimal health achievement among others. This is crucial because we are what we eat therefore, good nutrition translates to healthy individual who are more productive to promote the nations per capita income thus a boost in national growth and development.

The Concept of Nutrition

Nutrition is the types of food and drink people take into the body system and the using up of those food elements to generate energy, repair worn out tissues, growth physically and develop psychologically in an appreciable level. Sharma [2] described nutrition as the way people select what they eat. The scholar emphasized that poor nutrition could result to a lack of energy, digestive problems, food allergies, weigh gain, depression and anxiety disorder as well as other chronic diseases like coronary heart disease, cancer, Attention Deficit Hyperactivity Disorder (ADHD). Continuing, she emphasized that nutrition education could assist in this direction by inducing people make informed decisions on the choice of food to eat thus attain optimal healthiness in one’s life time. Similarly, Stare and McWilliams (1977) in Ogwudire- Chukwudire [4] reiterated that nutrition is the process of learning about food types and the functions they perform in human body. This is imperative because different types of food substances have their discrete nutrients which perform distinct functions to the body for a healthier living and anything short of that amounts to malnutrition which could equally result to body malfunctioning.
In his own submission, Davis [5] posited that nutrition is a systematic way of eating food and making use of it to grow, metabolise and carry out body repairs. According to the scholar, nutrition under goes the following sequence; ingestion, absorption, transport, assimilation and excretion. In other to ascertain that all these phases of nutrition is functional, there is absolute need to have a broad knowledge of food types and their nutritional value, the proportion to be taken as well as the quality of the food. When all these are given adequate consideration, a healthy life is assured and the process of eating correctly is termed good nutrition. On the reverse side is malnutrition (poor nutrition) which is responsible for ill health conditions like loss of energy, anaemia, stomach cramp, illness and eventual death. Based on the heels of the above development, Biology Educare [6] observed that food is a necessity to every living organism for growth, maintenance of life, energy and so on and states that nutrition is a process through which food we eat are broken down from complex food materials to simple substances which the body requires for proper functioning. The nutrient which is contained in the food need to be consumed in specified proportion. Some are needed in large proportion while some are be consumed in small proportion. These gave rise to types of nutrients.

Types of Nutrients

Food nutrients are the substances contained in the food which results to good health and are of two types depending on the quantity required in human body thus.
a) Macro nutrients: these are those food substances that the body require in large quantities for proper maintenance of the body like carbohydrates, lipids or fats and protein. These nutrients give the body required energy to function.
b) Micro nutrients: these are those food substances the body require in small quantity for proper maintenance. These nutrients plays essential role in the protection, growth and development of the organism. Any deficiency in these micronutrients can result to sickness. Examples are vitamins, minerals, salt and water.
Owing to the different types of nutrient in the food, foods are categorized into two namely:
a) Proximate principles of food: these food substances are energy given food. They supple the energy for production, body maintenance, growth and development. Examples are carbohydrate, lipid or fat and protein.
b) Protective principles of food: they are so called because of their ability to fight disease and assist in the metabolism of food examples are vitamins, minerals, water and salt.

Types of Nutrition

There are two main types of nutrition viz.
a) Autotrophic nutrition: this is the process of using solar energy by green plants and some bacteria to produce their own food by themselves from simple organic substances such as water, mineral salts and water. This mode of nutrition is known as photosynthesis.
b) Heterotrophic nutrition: all non-autotrophic organisms depend on autotrophic organisms for food and are therefore referred to as heterotrophys. Heterotrophs are animals and non-photosynthesis plant which cannot produce food on their own.

Types of Heterotrophic Nutrition

There are four types of heterotrophic nutrition namely.
a) Holozoic nutrition: The term ‘holozoic’ is derived from the Latin word ‘holo’ which means whole and ‘zoikos’ meaning animals. It implies that the animals take their food whole. It is a type of heterotrophic nutrition which is characterized by the injection of the organic matter. It exhibited by most free-living animals and protozoa such as human and amoeba respectively. this implies feeding on organic matter procured from organisms and digestion takes place within the organism. The organism does not produce its food. It has five stages namely; feeding, digestion, absorption, assimilation and ejection.
b) Saprophytic nutrition: this feeding on dead or decomposing organic matter and digestion begins outside of their body which is referred to a chemoheterotrophic extracellular digestion. This mode of nutrition takes place in the presence of water, oxygen, neutral-acidic pH content and low to medium temperature optimally room temperature. Fungi, moulds, some bacteria and some protists obtain their food from dead and decaying organic matters,
c) Parasitic nutrition: they feed on other organism thereby causes harm to the organism they are feeding on. In other words, the organism does not in any way benefit from the relationship. It is a relationship whereby an organism lives on or inside an organism (the host) causing it a degree of harm and absorb nutrients from the host.
d) Symbiotic nutrition: This is when two organisms live in close association with each other for their mutual benefit in nutrition, then the type of nutrition is known as symbiotic nutrition. It is a type of close and long term interaction between two biological organisms be it mutualism or commensalism.
i. Commensalism: this is a type of symbiotic nutrition whereby one organism benefits and the other does not benefit nor is it harmed. This type of nutrition makes it possible for the two organisms to obtain their nutrition independently.
ii. Mutualism: in this mode of nutrition, the two organisms live closely together and benefit from each other in nutrition. The fungus protects the alga from drying up.

Importance of Nutrition

Nutrition is a necessity in every organism because of the benefits gotten there from by the organism in question. Specifically, this paper strives to consider the importance of nutrition to man. It has enormous benefits which include but not limited to.
a) It produces heat in the body of the animal.
b) It assists in beefing up the calories need in human body.
c) It produces energy and organic building blocks for the growth and repair of cells.
d) It facilitates the body metabolism.
e) It stores potential energy and transforms it to useable energy.
f) It controls various physiological functions of the living organism such as movement, reproduction, excretion.
g) It serves as protection unit of the body from diseases.
h) It helps to store future food matters within the living body.

Impact of Malnutrition

Nutrition is said to be deficient when the food that contains all the necessary nutrients are not eaten in the right proportion. According to World Health Organization (WHO [7]) malnutrition is all about deficiencies, excesses, or imbalances in a person’s intake of energy and /or nutrients. To them, there are three groups of malnutrition as follows;
a) Undernutrition: this embraces wasting (low weight-forheight), stunting (low height-for-age) and underweight (low weight-for-age).
b) Micronutrient-related malnutrition : which includes micronutrient deficiencies (a lack of important vitamins and minerals) or micronutrient excess; and
c) Overweight : obesity and diet-related noncommunicable diseases (such as heart disease, stroke, diabetes and some cancers).

This results to malnutrition which have adverse effect on the health of the individual as under listed:

a) The necessary nutrients and organic materials required to repair the body’s cells would be deficient. This would lead to susceptibility to health risks.
b) It could lead to loss of concentration, memory and focus, the aforementioned traits results in increased stress.
c) In younger children it could lead to poor neurological development. This could result in cognitive impairment, poor language development and low-problem solving skills.
d) It leads to long term growth implications resulting from deficiencies in necessary nutrients due to poor bone development and lack of proteins.
e) It could lead to emotional instability. Certain effects of malnutrition are behavioural and affect the mental stability of individuals. This could lead to emotional irregularities such as depression, self-neglect, irritability, etc.
f) It could lead to weight loss due to depletion of body mass. This often is accompanied by a decline in muscle function.
g) It could lead to increased risk of organ failure. This could lead to the corresponding illnesses associated with the damages.
h) It could lead to changes in body masses, over-nutrition leads to excess fats obstructing the proper flow of nutrients in the body whilst under-nutrition leads to a weakened immune system.
i) It leads to stress and anxiety disorder which could escalate to other serious mental disorder.
j) Malnourished children are more prone to die of respiratory infections and diarrhoea [8].
k) It impairs human function at all stages of life and reduces life expectancy.
l) Long term insufficient nutrient intake and frequent infections can cause stunting, whose effects in terms of delayed motor and cognitive development are largely unchangeable thus reduces affects their brains resulting in lower IQs (Mother and Child Health and Education Trust, [9])
m) Malnutrition increases health care costs, reduces productivity, slows economic growth which can transform to a generic poverty and ill-health.
n) It could result to eventual death.

Factors Militating Against Good Nutrition

There are lots of challenges facing the practice of good nutrition which include among others; Poverty; poverty has been pinpointed as one of the major factor that has aggravated malnutrition in many countries of the world with Nigeria inclusive (WHO, 2021).
Similarly, listed the following as the challenges of unhealthy eating; a) High availability of low-cost foods and beverages that are also high in calories, fat, salt and sugar.
b) Nutrition information that is ambiguous.
c) Non-accessibility of nutritious food due to class.
In the same vein, Anderson [10] recognized five barriers to good nutrition as listed below; lack of time, feeling overwhelmed, lackadaisical attitude, diet confusion, feeling deprived. The scholar asserted that people portray non-chalant attitude to ensuring they eat right, due to many types of nutrients and the sources, people seem confused on how to identify and access them thus falling prey to malnutrition. In consonance with the above observations, Anding [11] specified barriers to a healthy lifestyle to include:
a) Time: many people are so economic with time due to busy schedule and as such prefer junk food since home prepared food is time consuming. Yet others feel it is taking time to reduce their weight and due to impatience retire back to their normal eating habit.
b) Emotional eating: according to the scholar people like eating ‘comfort food’ this implies that people feed anyhow when they are unhappy to comfort themselves and positive emotion could also result to overeating which is not healthy when done on daily basis.
c) Health belief: some people have personal belief on what they eat and remain adamant to change irrespective of the nutritional values of what is eaten.
d) Poverty and unhealthy eating: socio-economic status and economy could dictate the mode of nutrition. Many people live below poverty level due to massive unemployment.
e) Food, religion and culture: in this regard many religious organization forbids eating of certain food irrespective of the nutritional value and members are expected to oblige. The same applies to some cultural setting where some food items are seen as a taboo and must be avoided at all cost.

Primary Health Services

Community health services is synonymous with primary health care which came on board to leverage the members of the community of the health relation matters like sanitation, proper hygiene, prevention of communicable diseases, immunization, good nutrition and a host of others. Primary health care is essential health care based on practical, scientifically sound and socially acceptable methods and technology, made universally accessible to individuals and families in the community through their full participation and at a cost that the community and the country can afford to maintain at every stage of their development in the spirit of self-reliance and self-determination (WHO & UNICEF 1978 in University of Cape Town 2021). In congruence with the above opinion, Pharmacy Practice in Developing Countries [12] opined that primary health care is the (PCH) is the first level of contact for individuals, the family, and the community with the national health system and addresses the main health problems in the community, providing health promotion, preventive, curative and rehabilitative services accordingly. Obviously this aspect of health services is meant to get to the interior villages and impact positively on their lives and entire wellbeing.

The Principles of Primary Health Care

Primary health care strives to improve health and wellbeing of the community members as well as curb undue illnesses that befell them from time to time. It goes beyond delivering health care services but covers ways of leading a healthy life and good nutritional practices. The following are the principles of health care services as stipulated by Victoria Order of Nurses for Canada [13]:
a) Accessibility: primary health care services are meant to be easily accessible by the rural dwellers, it should also be affordable and supplied to all that need it irrespective of family socio-economic status. To be precise, it has to be universal in approach.
b) Public or community participation: this is involvement of the communities resources in promoting health and addressing health issues at the grassroots level.
c) Health promotion: this is a way of helping the community reinforce the socioeconomic circumstances that contribute to good health.
d) Appropriate use of technology: this involves the use of modern technological facilities in health care delivery process to ensure effective and efficient service delivery.
e) Intersectoral collaboration: the outfit is expected to work in partnership with the community stakeholders so as to develop services that meet the unique needs of the individual communities.

Components of Primary Health Care

These components of primary health care was outlined in 1978 by World Health Organization (WHO) in Laverty [14] and made available to the member nations and espoused that these eight essential components should serve as a means of providing health care globally and they are.
a) Public Education: It is believed that by education the masses, the knowledge of prevention and control of health related problems are imbibed and utilized to avert transmissible diseases.
b) Proper Nutrition: This is another route to good public health. WHO works to prevent malnutrition and starvation thus prevents many diseases and afflictions.
c) Clean water and Sanitation: a supply of clean, safe drinking water, and basic sanitation measures regarding trash, sewage and water cleanliness can significantly improve the health of a population, reducing and eve eliminating many preventable disease.
d) Maternal and Child Health Care: Another essential element of primary health care is ensuring adequate health care to children and to mothers, both expecting and nursing. This requires adequate counselling on family planning and safe sex.
e) Immunization: Through the administration of global immunizations, infectious diseases are greatly tackled and the overall health improved globally.
f) Local Disease Control: to prevent and control local diseases measures should be put in place to fight them as they crop up while control measures must be explored and exhausted.
g) Accessible Treatment: this involves availability to handle immediate health challenges from the community without minding the cost thus reducing complications that might arise due to delayed treatment which costs more and devastating.
h) Drug Provision: there is need to make adequate provision of drugs both in quality and quantity to those who need them like antibiotics for infections. This helps to curb escalating of ailment thus makes the community safer for healthier living.

Types of Primary Health Cares

There are different types of primary health cares depending on gravity of the ill health as outlined by Torrey (2020) namely.
a) Primary health care: this is the identification of the symptoms of the disease and minor treatments. Ailments such as sore muscles, broken bone, a skin rash etc.
b) Secondary health care: this is a situation whereby the primary care giver refers one to a secondary care in which case the patient is to be taken care of by a more specific expertise such as cardiologists, endocrinologists, oncologists etc. according to the affected illness.
c) Tertiary health care: this is where the patient is hospitalized and requires a higher degree of specialty care within the hospital, he may be referred to tertiary care. This requires highly specialized equipment and expertise. At this stage there is coronary artery bypass, renal or haemodialysis, plastic surgeries or neurosurgeries. Severe burn treatments and other complex treatment,
d) Quaternary health care: this is an extension of tertiary care which is on a higher level for uncommon ailments that require experimentation.
Factors Militating Against Primary Health Care Services Primary care services just like other sectors of the economy have so many challenges resulting to unattainable objectives. Some of these impediments are inadequate lack of community participation, culture and religion interference, inaccessible to safe and clean water National Academy of Sciences [15], unsteady electricity, ineffective communication, inadequate remuneration of the health officers. In support of the above declaration, Okere [16] reaffirmed that community conflict, poor administrative framework, attitude of community members towards self-help, financial constraint and insufficient supply of skilled and experienced field health workers are constraints to successful health care services. In like manner, Aregbeshola [17] opined that the barriers to adequate health care services could be attributed to political instability, corruption, limited institutional capacity and unstable economy are major factors responsible for the poor development of health services in Nigeria. The poor masses do bear the burden of dysfunctional and ill equipped health sector which is costly for the poor to afford. In alignment with Aregbeshola, National Academy of Sciences [15] expressed that its accessibility and affordability are some challenges facing the health services. Apparently, some are located too far from some of the recipients and in case of emergency, the worst is expected. Many others could not access the services as a result of high cost thus restricting the beneficiaries from getting the services as at when due. More often than not, some corrupt health officers do hoard and sell and/or divert the materials for personal use thereby depriving the community members the opportunity of being served better [18]. This was observed mainly during the sharing of medicated sleeping nets, people were caught selling them in the market in fact, it flooded the market and that is the case with other items meant for distribution to the masses [19]. Another challenge was on ignorance and fake speculations as some people do not believe in those free items shared by the health personnel, they feel it is fake or inferior or expired because people have lost confidence in the government [20].

Conclusion

Nutrition is the key to good and vibrant healthy life. This is imperative because an in-depth knowledge of the various aspects of nutrients and their sources equips the rural masses on what dictates good health and what deters good health thus better positioned to make wise choice and on time too. In the process of enlightening the masses on the good nutrition and other good health tips, the community/primary health care services come into play. For the health officers to attain great height, there is need for community participation which propels the sustainable health delivery services for the betterment of the community members thus ward off infectious diseases, infant and maternal mortality rate which has hitherto been a disaster in the interior villages.

Suggestions

From the above pronouncements, it is suggested as follows;
a) Government should through the appropriate agency endeavour to supply food supplements to the rural areas to assist those who out of poverty could not afford balanced diet.
b) The primary or community health workers should as a matter importance sensitize the masses especially in the interior villages on the need for proper nutrition and dangers of malnutrition exposed so as to compel them adhere to good nutrition habit.
c) Primary health centres should be located at every nook and cranny of the communities so as to make it accessible for people even in the middle of the night.
d) Health officers deserve good remuneration to make them committed, dedicated and devoted to their job.
e) Government should deem it fit to equip the centres adequately and more importantly make it affordable for the poor masses.

References

1. Ugwu CJ, Amadi GN (2011) Reducing the infant mortality rate through attitudinal change and preventive behaviours. Nigeria, TNDPRESS
2. Sharma M (2017) What is Nutrition?
3. Segen’s Medical Dictionary (2012) Community health services.
4. Ogwudire Chukwudire, HUC (2004) Educational psychology Human growth and development. Owerri, Udebiuwa press.
5. Davis CP (2021) Medical definition of nutrition.
6. Biology Educare (2021) Nutrient Nutrients, types of nutrition and importance of nutrition.
7. WHO (2021) Malnutrition.
8. (2019) Prevalence and socio-economic impacts of malnutrition among children. sage Publications.
9. The Mother and Child Health and Education Trust (2019) Impact of malnutrition.
10. Anderson MD (2020) Five barriers to diet change and how to overcome them.
11. Anding RH (2020) Why change is so hard Barriers to a healthy lifestyle In K Findley & A Shoemaker (Eds.).
12. Pharmacy Practice in Developing Countries (2016) Primary health care.
13. Victoria Order of Nurses for Canada (2021) Principles of Primary Health Care.
14. Laverty S (2017) 8 Components of primary health care.
15. National Academy of Sciences (2018) Factors that affect health-care utilization.
16. Okere GN (2005) Nigerian health policy in relation to WHO in JN Uchegbu (Ed.) Healthy living and national development. Owerri, Onii publishing house.
17. Aregbeshola B (2019) Health care in Nigeria Challenges and recommendations.
18. Torrey T (2020) Differences between primary, secondary, tertiary and quaternary care.
19. Biron Health Group (2021) Challenges of healthy nutrition.
20. University of Cape Town (2021) what is primary health care.