Nutrition vulnerability and health risk factors of the older persons living in Southern Darfur. Case study: (Tulus Province).

Saad, Mariam ; Abdel Magied, Ahmed

Abstract

In the present investigation a population of 200 of older females and males from Fulani in Tulus, South Darfur, were investigated for their nutritional status, health status and risk factors and the impact of food security. The majority of the respondents were found affluent with high monthly income and ownership of cattle and cultivated land. Hence, their food is well secured. Although the majority of respondents were 65 years and up to over 85 years of age, a negligible percentage suffered from functional disabilities. Accordingly, the health risk factors were minimized among the studied Fulani population. That, at the age group above 85 years, none of the respondents was with poor mobility, is a phenomenon that should deserve further investigation. Results of the Body Mass Index (BMI) have shown their vast majority was normal and very few had the risk for. obesity or being obese. Therefore, the problem of malnutrition by under nourishment does not exist among the studied population.

In comparison to previous studies on Sudanese older persons, the fewer cases of hypertension and Diabetes that occurred among age groups 66-75 years and the complete absence of the disease among still older groups (76 to 85 and above 85 years) cannot be explained in. terms of nutrition. Hence, conclusions were made on this phenomenon as probably being genetically controlled among the Fulani ethnic group.

On screening the gender variations, the risk of tendency for obesity or obesity was highly significant for females (P = 0.000). Variations in dexterity and mobility have shown insignificant differences between females and males. Insignificant differences were also observed between the two sexes.

Accordingly, relevant recommendations were made in connection with the improvement of older people situation in general. Those included the participation of the government, Help Age International (HAI) and other relevant agencies.

Introduction

In both developing and developed countries, chronic diseases are significant and costly of disability and reduced quality of life. The likelihood of experiencing major disabilities dramatically increases in very old age and within the age of years and over (Second World Assembly on Ageing, 2002). Blindness or partial blindness is a significant physical disability that is observed among older men and women (HAI, 2002).

As a consequence of natural ageing, lower body dysfunction will affect mobility and would thus restrict mobility which would negatively affect other activities which are necessary for life.

In developing countries many people and forced to work at very old age; stopping only when hey are physically or mentally unable to continue (HAI, 2002.

According to the Ministry of Health and UNICEF (2003) malnutrition rate had been alarmingly and incredibly high (24.4%) in South Darfur.

It is also expected to be increasing among the affected population due to the current armed conflict and loss of any means of poor production, displacement and hence poor quality of life.

However, in natural disasters, political and civil conflicts, older persons in Sudan are the last to receive assistance (Save the Children, UK, 2004).

Although there is unpublished literature on older persons in Sudan, very little is found in the published form (Abdel Magied and El Refaie, 2006, Ali and Abdel Magied, 2005; Saad and Abdel Magied, 2005).

Methodology

The study was cross-sectional descriptive investigation. The study area was Tulus province in South Darfur State. The studied population were older persons (55 years and above). The sample size was 200 (50 males and 150 females) who were randomly selected.

Primary data was collected from the older persons through a pre-tested questionnaire and interviews. The nutritional status of the older persons was assessed by measuring their Body Mass Index (BMI) according to the following formula:

BMI = Weight in kg

Height in [(meter).sup.2]

The out- off points for determining the BMI were applied according to WHO (1993) recommendations and Ismail and Manandhar (1998):

If the BMI is

16: indicates server malnutrition.

< 18.5: indication risk to be malnourished.

Between 18.5-25 is normal.

Between 25 and 30: indicates risk to be come obese

Above 30: indicate obesity.

Quantitative data, that were collected for the older persons through questionnaire and interview, were analyzed using the computer package SPSS.

Results and Discussion

The majority (61.5%) of the respondent were 55-75 years of age, 24.5% between 76-85, and 14% over 85 years. Widowers were 54% and well correlates with the age groups and life expectancy of the male spouses. The overwhelming majority (81.5%) was either illiterate or only had basic Khalwa/Church education. Moreover, the overwhelming majority (88.5%) of unemployment among the respondents may be explained by the majority (75%) of the females in the sample and the general late age of the respondents.

Though the majority was unemployed (88.5%), yet affluent since 89% owned cattle; also 90.5% owned land for cultivation and 89.5% were not debited.

By the Sudanese standards of income, the majority (62.5%) had high income. This is in addition to the sufficiency in food items provided through the ownership of cattle and cultivated land. Therefore, by Sudanese standards, they enjoy high standards of living. The overwhelming majority (90%) did not live alone. This would, however, minimize the hazard of contracting depression.

Only 0.5% had physical disability, despite the majority (65.5%) were over 65 years age. Despite the generally late age of the respondents, only 34% were suffering from poor eyesight or blindness. Also only 2% had poor mobility. They had sound functional ability were only 0.5% need help in feeding, only 4 percent were with poor manual dexterity, 4% with slow response to questions and only 5% had loss of memory. Of the respondents, 14% recently lost a loved one and 25% had traumatic events and this might explain that 27.5% of the respondents were depressed.

The majority (82.5%) of the respondents had good nutrition knowledge, hence the eaten quantity was adequate, none drunk, alcohol or smoked; a situation that avoid impairment of absorption or loss of appetite. The frequency of eating varied from three to more meals per day. Moreover, the majority (70%) was self-dependent in preparing their own food.

Their general health status seemed better off compared to other studies on older Sudanese persons. Despite the advanced age of the majority of respondents, only 14% had repetitive sickness, but 70% did not have back pain. Those with good appetite for foods were 88% and good chewing ability were 89%. Therefore, generally the respondents enjoyed a healthy life compared to those in the other studies carried out in Sudan. Nonetheless, the overwhelming majority (91%) of the respondents suffered from gout. This is because their diet is more than rich in protein. None of the respondents was undernourished and the majority (60.5%) was normal. The risk to obesity by 18% and obesity for 21.5% can be explained by the very rich food eaten and perhaps personal bad eating habits.

The majority of respondents from 55 years up to 85 years of age had normal eyesight and it was only after passing the age 85 that the picture is reversed (Fig 1).

[FIGURE 1 OMITTED]

In all age groups within 55-85 years, a negligible minority had problems of poor mobility. That, at the age group above 85 years none of the respondents was with poor mobility poses a phenomenon that deserves further investigation (Fig 2).

[FIGURE 2 OMITTED]

The picture of not being repetitively sick (Fig 3) exactly overlaps with that of figure 2 with the same comment of presenting also a phenomenon that deserves further study.

[FIGURE 3 OMITTED]

Although very few of the respondents within the age groups between 5585% years had poor appetite (Fig 4), none of the respondents above 85 years of age had poor appetite.

[FIGURE 4 OMITTED]

Only few respondents of age groups falling between 55-85 years of age had poor chewing ability (Fig 5). It is, however, phenomenal that all respondents within the age group above 85 years had normal chewing ability.

[FIGURE 5 OMITTED]

It is here worth mentioning that one of the female respondents, aged 125 years, when smiling was observed to have a complete natural set of teeth. On the other hand, her daughter who aged 85 years lost her complete natural set of teeth. This would represent a most rare phenomenon that is worth of in-depth investigation. Having few or no cases of Gout among the respondents with ages falling between 55-85 years despite the very rich food in proteins and the relatively more cases of Gout among respondents of over 85 years may be explained by the sedentary lifestyle of the latter age group (Fig 6).

[FIGURE 6 OMITTED]

Body Mass Index results have shown that almost all respondents at the age group 55-65 were normal (Fig 7). Being the youngest group compared to others, they seem to be the more active and hence burning most of the energy producing food that they eat. The dominating obesity in age group 66-75, its scarcity among the age 76-85 years and the complete absence among those above 85, is difficult to explain unless more screening research is conducted.

[FIGURE 7 OMITTED]

The very few cases of contracting Hypertension among age groups 55-65 and 66-75 and the complete absence of the disease among older groups (76-85 and above 85) cannot be explained in terms of nutrition reasons (Fig 8).

[FIGURE 8 OMITTED]

Most probable this phenomenon is genetically controlled. The situation of eases of Diabetes among the respondents (Fig 9) in close to that of Hypertension and hence, cannot be explained in terms of nutrition. As well, the genetic control of Diabetes cannot be excluded.

[FIGURE 9 OMITTED]

Rheumatism is known to be of higher prevalence among older groups. In contrast, this investigation has shown (Fig 10) that varying cases of contraction of Rheumatism were found amongst all the studied age groups. Phenomenally the pattern of prevalence declines from the older towards the oldest groups (Fig 10).

[FIGURE 10 OMITTED]

After T-testing, looking into the gender variations, those for sex and age were insignificant (P= 0.30). Regarding the nutritional knowledge, that of males was poorer with high significance (P= 0.001). The relative distribution of monthly income has shown highly significant (P= 0.00) value for higher male income. This is quite understandable on cultural grounds where normally males are the main income generating sources for the family.

The appetite of females was poorer than the males wit high significance (P= 0.004). On the other hand, in connection with the number of meals eaten, females intake of meals was highly significant (P= 0.001) when compared with males. A high significant value (P= 0.002) was observed for males having Gout. Risk for obesity or obesity was highly significant (P= 0.000) for female.

In connection with dexterity, insignificant differences (P= 0.083) were observed between the two sexes and the same was observed (P= 0.159) for mobility. The dexterity ability for females, as compared to males was highly significant poor (P= 0.001). Contraction of back pain by males was highly significant (P= 0.000) when compared to females (Fig 22). This is quite expected since the males in the study area do the hard jobs. On the other hand, leg pain showed insignificant difference (P= 0.590) between the two sexes. Poor eyesight was of high significance (P= 0.000) among males compared to females. On the other hand, insignificant differences (P= 0.186 and P= 0.183) were observed in contraction of Hypertension and Diabetes.

Conclusion and Recommendations

The following conclusions were reached:

--The majority of respondents were affluent in the ownership of cattle, cultivated land and the enjoyment of high monthly income by Sudanese standards. Therefore, problems of food insecurity do not exist among the studied "Fulani" population in Tulus Province, South Dar Fur.

--The majority of respondents were over 65 years up to over 85 years. Negligible percentage suffers from functional disabilities. Accordingly, the health risk factors were minimized among the studied population. That at the age group above 85 years, none of the respondents was with poor mobility, presents a phenomenon that deserves further investigation.

--Despite the late age of the respondents, their overwhelming majority had good appetite and eat three or more meals highly rich in the required nutrients.

--Results of BMI have shown that almost all respondents of the age group 55-65 were normal. The dominating obesity among the age group 66-75 years, its scarcity among 76-85 years, and the complete absence of obesity among age group above 85 years could not be explained unless further screening is undertaken.

--The very few cases of contracting Hypertension and Diabetes among the age group 55-75 years and the complete absence of the diseases among the older age groups (76-85 and above 85) cannot be explained in terms of nutrition. Most probably this phenomenon is genetically controlled among the studied "Fulani" ethnic population.

--T-tested gender variations have shown high significant (P= 0.004) of poor appetite of females compared to males and risk of tendency for obesity or obesity was also or high significance (P= 0.000). In connection with dexterity and mobility, insignificant differences were observed (P= 0.083 and P= 0.159). Insignificant differences were also observed between the two sexes in the contraction of Hypertension and Diabetes (P= 0.186 and P= 0.183).

Accordingly, the following recommendations were thought pertinent:

1--To promote the already skills of the older persons so as to contribute to sustainable development.

2--Governmental strategies and policies should address older people's needs.

3--Help Age International, other agencies, and NGOs are requested to contribute to Sustainable Development issues connected with older people in addition to their relief efforts.

4--For effective Development, older people should participate to the formulation of strategies and policies connected with their welfare.

5--Help Age International and other relevant agencies are expected to contribute to older people issues under emergency situations in Dar Fur.

6--Since the study population was affluently rich, their nutritional awareness needs to be enhanced to avoid risks of obesity malnutrition.

7--The reasons for the sound functional ability of the older groups (above 85 years) of the Fulani tribe compared to other studies on Sudanese groups deserves further in-depth investigation.

8--The overall better off health situation compared to other studies on Sudanese groups also needs further investigation.

9--The very few cases of contraction of chronic disease, such as hypertension and diabetes and their complete absence in age groups over 85 years is a phenomenon that necessitates specialized reach to reveal our hypothesis for genetic and ethnic reasons.

References

(1-) Abdel Magied, Ahmed and E1 Rufaie, Hind (2006): Assessment of Nutritional Status and Health Risk Factors of Older Women in Khartoum "2". The Ahfad Journal. Vol. 23, No. 1 (Research Note).

(2-) Ali B.F, Samia and Abdel Magied, Ahmed (2005): Nutrition status, Health Risk Factors and Food Security of Older Persons Living in Kass Province (South Darfur State. The Ahfad University Journal. Vol. 22, No. 2. (Research Note).

(3-) HAI (2002): Ageing issues in Africa, HAI, Sudan.

(4-) Ismail, S. and Manandhar, M. (1998): Better Nutrition for Older People, Assessment and Action. UK: Help Age International and the London School of Hygiene and Tropical Medicine.

(5-) Ministry of Health and UNICEF (2003): Food Security Situation in South Darfur.

(6-) Saad, Mariam and Abdel Magied, Ahmed (2005): Nutrition Vulnerability and Health Risk Factors of Older Person Living in South Darfur State. Cas study: Tulus Province. The Ahfad Journal Vol.22, No. 2 (Research Note).

(7-) Save the Children Fund, UK (2004): Report of the Security Situation in South Darfur.

(8-) Second World Assembly on Ageing, Madrid, SWAA (2002): In: www.UN.org./Ageing/Logoda_en.gif,2008.

Saad, Mariam; Abdel Magied, Ahmed (Schools of Reed and Health Science, Ahfad University for Women)