PREVALENCE, PATTERNS AND PERCEPTION OF EATING AND SLEEPING DISORDERS AMONG IN SCHOOL ADOLESCENTS IN ILORIN, NIGERIA

Abstract

BACKGROUND Adolescence is a period of transition in which there are unique nutritional and sleep requirements. Unhealthy dietary habits and inadequate sleep are common among adolescents around the world. Eating disorders are increasingly seen in non-western climes. However, there is a dearth of information about these behavioural patterns among adolescents in Nigeria. Therefore, this study aimed to determine the prevalence of eating and sleeping disorders among in-school adolescents in Ilorin East, the adolescents’ nutritional status and perception about their eating and sleeping habits. METHODOLOGY A cross-sectional study was conducted, with a mixed-methods approach, among 512 in-school adolescents in north-central Nigeria. A quantitative approach helped to determine the prevalence of eating and sleeping disorders and nutritional status, while the perception about their eating and sleeping habits was explored using qualitative methods. Data collection and focused group discussions were completed between February and April 2019. Screening and diagnoses of eating disorders was done using the Kiddies Schedule for Affective Disorders and Schizophrenia (K-SADS) and sleep quality was assessed with the Pittsburgh Sleep Quality Index (PSQI). The quantitative data were analyzed with the Statistical Package for Social Sciences (SPSS) version 22. The frequency distribution of variables was generated. The association between categorical variables was tested with Chi-square statistics, with the level of statistical significance set at less than 0.05. Binary logistic regression analysis determined the predictors of quality of sleep. Analysis of anthropometric data was done with the WHO Anthro software (Version 3.1.0), using the WHO growth reference for adolescents. Qualitative data was analyzed from audio recordings of focused group discussions, which were converted into text. Recurring ideas in the text were coded till a point of saturation was reached. Similar codes were organized into emerging themes. Refined themes provided a summary of the sleeping and eating habits of adolescents in the study. RESULTS A total of 512 students from eight public schools were interviewed. Six of the schools were mixed, while two were same-sex schools, namely one boys-only and one girls-only school, respectively. They were mostly late adolescents (62.7%) with 53.5% being female. Three out of every five adolescents were poor sleepers (PSQI global score > 5), even though they had mostly reported good subjective sleep quality. Only a few respondents (19%) had optimal sleep (≥ 9 hours), and more than half had inadequate sleep (< 7 hours). Poor sleep was associated with male gender, being the firstborn, residence at home, and being in a class with <40 pupils. Logistic regression analysis showed that living at home, as against hostel living, was predictive of poor sleep. Only 4.1% of respondents met the threshold for eating disorders and none fulfilled the diagnostic criteria. Of the adolescents, 21% were underweight while 20% were overweight. Only 0.1% were obese. The dietary pattern was starchy, with rice and yam being the common meals, and meat being rather uncommon (9.3%). One in five respondents was overweight. Being overweight was associated with early adolescence, Christianity, junior class, residence at home and a prior visit to the school counselor. Of all respondents, 21% were underweight. Being Underweight was significantly associated with older adolescence, Islam, senior class, living at home and having not gone to see the school counsellor before. Sixty-two adolescents (12.1%) of all adolescents were stunted. Stunting was significantly associated with being in the senior class, living in the hostel, late adolescence, being male, from a polygamous family and being raised by an unmarried parent. Being in the senior class and being raised in a polygamous family setting were predictive of stunting. Common dietary habits included meal skipping and snacking. These were perceived to be unavoidable, and indeed desirable. Negative perceptions about overweight were prevalent. Social media was perceived to be a major deterrent to sleep and chatting late into the night was perceived to affect academic performance. Despite these psychosocial challenges, some students (6.8%) did not know there was a guidance counsellor in their school. Even more disturbingly, one out of every four students was not willing to see the school guidance counsellor. CONCLUSION The two faces of malnutrition were common among adolescent students. Poor sleep was markedly prevalent but not perceived to be a problem. Eating disorders remain rare among adolescents in north-central Nigeria. There is a need for mental health promotion and effective school mental health policies in Nigeria and across Africa. Good nutrition and adequate sleep among adolescents have an impact on mental health and education–two promising pillars to support the demographic dividend of Africa’s youthful population.