Children of age 5-14 involved childhood and early adolescents that have special needs regarding nutrition. The growth and development during 5 to 14 years of age is fast and they require balanced diet. A diet that contains adequate amount of macro and micronutrients is needed for growing children. In Pakistan, there is insufficient evidence that indicates the nutritional status of orphans as well as adequacy of menus in orphanages.
In the current study 67% of orphans are male and 33% of orphans are female aged 5-14 years. Mean BMI of 318 participants aged 5 to 14 years was 16.4±2. From whole population 279 participants (88%) had Z -score between -2 to 2 SD that suggest normal weight-for-height Z-score. Only17 participants (5%) had Z-score less than -2 SD that suggest moderate mal-nutritional status of participants and 20 participants (6%) had Z-score less than -3 SD that suggest severe mal-nutritional status of orphans and only 2 participants (1%) had Z-score more than 3 SD that suggest severely obese nutritional status of orphans.
The study was cross sectional design. Participants of both gender aged 5 to 14 years were included in study. 67% male orphan and 33% female orphan were assessed through, 24 hour dietary recall at three alternative days, clinical assessment and anthropometric assessments including height, weight and weight-for-height (BMI) was recorded to assess nutritional status of orphans. Furthermore physical assessment was done to examine clinical sign and symptoms of iron deficiency anemia among orphan children by using questionnaire. Data were analyzed by using SPSS version 22. Descriptive statistic was used to describe the background characteristic profile of the respondents. Mean caloric and macronutrients intake of male and female orphans and comparison of mean caloric and nutrient intake among different male and female orphanages was calculated by using Excel.
There is great need of studies to be conducted in adjoining areas of Lahore as well as other cities especially small underdeveloped cities of Pakistan for accessing the nutritional status of orphan population and comparison must be done between orphan and non orphans groups. Nutrition interventional strategies must be followed to ensure better nutritional status of orphans.
6.1 Conclusion:
The nutritional requirement varies according to different age groups. Present study concluded that overall the nutritional status of male and female orphans and the dietary assessment of menus indicated that there is need of intervention in selected orphanages. Present study reported that inadequate composition of food according to age and sex is being provided in different orphanages. It is also reported that on average children derived 18% of calories from protein which is adequate intake for 5-8 years of both male and female orphans but mean caloric intake was inadequate foe all age groups and especially for male orphans as they need more proteins than female of same age. Menus of orphanages were also assessed which has been reported to imbalanced in regard to varieties of four food groups. Present study has also concluded that consumption of fruits and dairy product among all orphanages was very low and to meet protein requirement orphanages mostly used legumes especially gram pulse as it is cheap source of protein. It is also reported that majority 88% of population had Z score between -2 to 2 SD that is considered as normal but mean caloric and macronutrients intake of male orphan aged 14 years is very low only 65% of their calories meet their RDAs. It is also recorded that fat percentage had fluctuated that may affect the body composition of respondents. Mean caloric and macro nutrient intake of female orphans aged 5 to 9 years is adequate thus showing well nourished status. Physical assessment data showed that 55% of all respondents and pallor skin, 55% of population had sore slimy tongue and 47% of respondents had suffered from pica these three clinical sign and symptoms are considered very important in regard to iron deficiency. It is suggested from present study that more than half population is at risk of developing iron deficiency anemia.
6.2 Recommendations:
• There is need for orphanages’ management to ensure diet diversification and include more animal source foods and Fruits in menus to improve the nutritional status of the children
• Further studies must be conducted to compare nutritional status of orphans with non- orphan group
• Biochemical parameters specially testing of Hemoglobin level must be done to check and ensure iron deficiency anemia
• Efforts should also be directed towards increasing energy intake in the diets of children in orphanages. This could be through increasing frequency of meal intake per day specifically introduction of school breakfast and lunch programs to impact positively on the nutritional status of school children in the study area. There’s need for the government to set up support and enforce minimum hygiene.
• There is need for the government to provide proper system that ensures proper hygiene standards of the orphanage. Management of the orphanages must take important steps to maintain good personal hygiene practices among the children.