DIETARY HABIT AND NUTRITIONAL STATUS OF SICKLE CELL PATIENT IN UNIVERSITY OF BENIN TEACHING HOSPITAL (UBTH) EDO STATE NIGERIA

ABSTRACT

Sickle cell disease (SCD) is a group of disorder that affect hemoglobin, the molecule in red blood cells that delivers oxygen to cell throughout the body. People with this disorders have a typical hemoglobin molecule called hemoglobin S, which can distort red blood cells into sickle or crescent shape. Characteristic features of this disorder include a low number of red blood cells (Anemia), repeated infections and periodic episodes of pain.

The aim of this study is to understand how the eating habit of people with SCD affect their nutritional status and how the micro nutrient contend in this food affect the severity and frequency of painful episode. A sample of 171 patients were gotten from the university of Benin teaching hospital by simple random sampling and their anthropometric measurements  were taken, each was given a questionnaire and data was collected using this questionnaire.

According to data collected, it was noted that their dietary habit  on the consumption of meals like poultry, rice, beans and beef did not affect their BMI and frame size but affected the severity and frequency of painful episodes. Those that always consume poultry,beans and rice experience lesser frequency and severity of pain than those that always consume beef.The fact that red meat has the highest concentration of zinc(stallings,1999), which in high concentration causes anemia,impaired immune system(Anderson,1998), thereby causing high frequency and severity of pain.In conclusion patients with SCD should reduce their intake of beef(red meat).

CHAPTER ONE

• INTRODUCTION

Sickle cell disease is a group disorders that affects heamoglobin, the molecule in red blood cells that delivers oxygen to cells throughout the body. People with this disorder have typical hemoglobin molecule called heamoglobin S, which can distort red blood cells into a sickle or crescent shape.

Signs and symptoms of sickle cell disease usually begin in early childhood. Characteristic feature of this disorder includes a low number of red blood cell(anemia), repeated infection and periodic episode of pain. The severity of the symptom varies from person to person, some people have mild symptoms while others are frequently hospitalized for more serious complications.

The signs and symptoms of sickle cell disease are caused by the sickling of red blood cells. When red bloods cell sickle, they break down prematurely which can lead to anemia. Anemia can cause shortness of breath, fatigue, and the delayed growth and development in children. The rapid breakdown of red blood cells may also cause yellowing of the eyes and skin which are signs of jaundice. Painful episode can occur when sickled red blood cells which are stiff and inflexible gets stuck in small blood vessels. These episode deprive tissues and organs of oxygen rich blood and can lead to organ damage, especially in the lungs, kidneys, spleen and brain. A particularly serious complication of sickle cell disease is high blood pressure in the blood vessels that supplies the lungs (pulmonary hypertension), pulmonary hypertension occurs in about 1/3 of adult with sickle cell disease and can lead to heart failure.

A problem in the hemoglobin-beta gene found in chromosome II the defects forms abnormal hemoglobin molecules. Both ones parents needs to pass the abnormal hemoglobin gene onto one in order for one to develop the disease. If both parents carry the defective gene, one has a 1over 4 chance of inheriting the disease and becoming sick with it. If a child is born with one defective hemoglobin –betagene he may become a carrier of the disease. Carriers usually don’t develop SCD symptoms but they can pass unto the future children if their partners also carry the sickle cell traits.

1.0.1 Types of Sickle cell Disease

There are several different forms of sickle cell disease. The type a parent or child inherits  depends on many things, including the specific type of hemoglobin one has ,Hemoglobin SS also called sickle cell anemia is usually the most severe type of this disorder, other common forms includes:

1. Hemoglobin SC (usually Mild)
2. Hemoglobin SB (Thalassemia)

Raretypes are:

1. Hemoglobin SD
2. Hemoglobin SE
3. Hemoglobin SO

In the U.S new born screening programme requires that all babies are tested for sickle cell disease shortly after birth.

1.0.2 Treatment of Sickle Disease

Finding a widely available cure of sickle cell Anemia (HbSS) still remains a challenge one hundred years after its discovery as a genetically inherited disease.However, growing interest in the nutritional needs of the disease has created a body of researchers seeking nutritional alternatives as a means of decreasing mobidiy and improving quality of life among HbSS patient. This review has been demonstrated the over past 30 yrs, the role of protein/Energy deficiency in HbSS has been more clearly defined via direct measurement, leading to the concept of a relative shortage of nutrients for growth and development, despite apparently adequate dietary intakes. Although there is still lack of data supporting the efficacy of macro nutrients supplementation, it is becoming clearer that recommended dietary allowances (RDAs) for the general population are insufficient for the sickle cell patients, a similar shortage is likely to be true for micro nutrients deficiencies including findings of vitamin D deficiency that might be associated with incomplete ossification and bone disease, which are well known complication of HbSS disease.

I theresay that there is need for more efforts and resources to be dedicated to research (including supplementation study of larger sample size) aimed at establishing specific RDAs for HbSS patients, much like specific RDAs developed for pregnancy and growth within the general population.

• Statement Of The Problem

Many raw conclusions have been made on the topic. While many see sickle disease as a death sentence others see it as incurable and many assumptions have been made and many fallacies adopted.

Many people do not understand that it can be totally cured or managed effectively and also can be avoided by taking major tests (genotype testing) before taking partners. Whereby those with sickle cell disease are seen as not worth living, many parents see such children as burden upon them. Many have ignored that before modern medicine came to lime light,  these disease have been managed using local foods and healthy eating habits. Therefore attention must be paid to the food the sickle cell anaemia patients consume.

• Objectives Of Study

At the end of this research the following objectives should be seen through:

1. To educate the public on the disease
2. To make them understand that more than the RDA included is needed for effective management of the disease
3. To identify micro nutrients that have been found essential in the disease condition and examine the extent to which they have been useful in the management of sickle cell disease.
4. To explore the metabolic function they carry out which alleviates the sickle cell disease state.
5. To gather information’s and document sources of these micro nutrients for the benefits of the generality of our society as a means of pointing out the need for more research into the important area that have received little attention, at least, in the Saharan African region.

• Significance Of Study

The study is important as it will bring about ideas that will correct abnormal nutritional status of patients with sickle cell disease and its dietary management and equally educate them on the benefits of maintaining good nutritional status.

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