Nutritional Status of Children Aged 3-6 Years in a Rural Area of Tamilnadu
Anuradha R1, Ranjit Sivanandham2, Sam Dashni Salome3, Roniya Francis4, Roopa D5, Sakthi Sampavi6, Sabu S R7, Ranjit Prasad8
1 Assistant Professor, Department of Community Medicine, Saveetha Medical College,Saveetha University, Thandalam, Kanchipuram District, Tamilnadu, India.
2 Student, Saveetha Medical Collegeand Hospital, Saveetha University, Thandalam, Kanchipuram District, Tamilnadu, India.
3 Student, Saveetha Medical Collegeand Hospital, Saveetha University, Thandalam, Kanchipuram District, Tamilnadu, India.
4 Student, Saveetha Medical Collegeand Hospital, Saveetha University, Thandalam, Kanchipuram District, Tamilnadu, India.
5 Student, Saveetha Medical College and Hospital, Saveetha University, Thandalam, Kanchipuram District, Tamilnadu, India.
6 Student, Saveetha Medical College and Hospital, Saveetha University, Thandalam, Kanchipuram District, Tamilnadu, India.
7 Student, Saveetha Medical College and Hospital, Saveetha University, Thandalam, Kanchipuram District, Tamilnadu, India.
8 Student, Saveetha Medical College and Hospital, Saveetha University, Thandalam, Kanchipuram District, Tamilnadu, India.
NAME, ADDRESS, E-MAIL ID OF THE CORRESPONDING AUTHOR: Dr. Anuradha R, Assistant Professor, Department of Community Medicine, Saveetha Medical College, Saveetha University, Thandalam, Kanchipuram District, Tamilnadu, India. Phone : 09884959653, E-mail : dr.anuhems@gmail.com
Background: A child’s entire life is determined in large measures by the food given to him during his first five years. Since childhood is the most vulnerable phase in the life of human being, nutritional inadequacies will result in the hampering of the development of the body. Future of the country is determined by the growing generation of the country.
Objectives: a) To assess the nutritional status of children aged 3-6 y in a rural area of TamilNadu.
b) To identify the factors associated with the nutritional status of the above study population.
Settings and Design: Kuthambakkam village in Tamilnadu, Cross divtional study.
Materials and Methods: Total number of children aged 3-6 y is 172 in Kuthambakkam village. The entire children aged 3-6 y was included in the study. Mothers of the children were interviewed using an interview schedule to collect information regarding the sociodemographic profile, feeding practices, and immunization status. Socio-economic status was assessed using modified BG Prasad’s classification. Weight of the children was measured using a portable weighing machine. Nutritional status among 3-6 y old children was assessed by computing weight for age (standard used - National Centre For Health Statistics (NCHS) standards for weight for age) and grading of nutritional status of the children was done using the Indian Academy of Paediatrics (IAP) classification. Grade I to Grade IV nutritional grade is taken as undernourished.
Statistical Analytical: Prevalence will be expressed in percentage and Chi-square test will be used to find association with factors.
Results: The prevalence of under-nutrition (≤ 80 percentage of standard weight for age) was 66.5%. The prevalence of grade 1 malnourishment was 46.2%.The prevalence of under nourishment increased with increasing age and the difference was found to be statistically significant (p< 0.05).Prevalence of under nourishment was higher among male children (76.9%)than female children (56.3%) and was statistically significant. As the socioeconomic status increased the prevalence of undernourishment decreased and the difference was found to be statistically significant(p<0.05). Duration of exclusive breast feeding had influence on the nutritional status.
Conclusion: Community based preventive measures should be taken to allievate malnutrition. Health education to the mothers on dietary practices like feeding their children with locally available low cost but healthy food should be given. Nutritional rehabilitation centres should be established. Improving the socioeconomic standards is mandatory.
Introduction
Malnutrition and Infection are the two most important factors that affect the growth of children. In most cases of childhood infections, the cause can be traced to insufficient food intake or absorption, which renders the human system vulnerable to infections. The magnitude of the problem of malnutrition among children under five years of age is high throughout in India [1]. More than 26,000 children under the age of 5 die around the world each day mostly conditions due to preventable causes. Nearly all of them live in developing countries or, more precisely in 60 developing countries [2]. A child’s entire life is determined in large measures by the food given to him during his first five years. Childhood is a period of rapid growth and development, and nutrition is one of the influencing factors in this period [3]. A number of anthropometric indices have been used successfully for many years to estimate the prevalence of under-nutrition among pre-school children. These include height-for-age, weight-for-age and weight-for-height. Height-for-age is an index of cumulative effect of under-nutrition during the life of the child. Weight-for-age is the combined effects of both, the recent and the long-term levels of nutrition, whereas weight-for-height reflects the recent nutritional experiences of the child. These indices are reasonably sensitive indicators of the immediate and underlying general causes of nutrition [4]. The risk of mortality is inversely related to children’s height-for-age and weight-for-height [5,6]. Freedom from hunger and malnutrition is a basic human right and their alleviation is a fundamental prerequisite for human and national development [7].
The present study was a community based cross sectional study carried out in Kuthambakkam village of Tamilnadu among children aged 3-6 y from September 2012-December 2012. Ethical clearance was obtained. The objectives of the study was to assess the nutritional status of children aged 3-6 y and to identify the factors associated with the nutritional status of the above study population.
Based on the prevalence rate of 52.23 % among under 5 children in a study conducted in Nagpur [8] minimum sample size required for this study, with allowable error of 15% and 95% CI, was 156.
Total number of Children aged 3-6 y was 172 in Kuthambakkam village. All the children aged 3-6 y were included in the study. Informed consent was obtained from mothers of the children. Mothers of the children were interviewed using an interview schedule to collect information regarding the sociodemographic profile, feeding practices and immunization status. Socio-economic status was assessed using modified BG Prasad’s classification [9].
Anthropometric data regarding weight of the children was recorded. Weight of the children was measured using a portable weighing machine and readings were taken to the nearest 0.1 kg. The individual was made to stand still on the platform of the weighing machine, with the body weight evenly distributed between both the feet. Light indoor clothing was allowed to be worn and footwear was removed when the weight was measured.
Evaluation of nutritional status- Nutritional status among 3-6 y old children was assessed by computing weight for age (standard used- National Center For Health Statistics (NCHS) standards for weight for age and grading of nutritional status of the children was done using the Indian Academy of Paediatrics (IAP) classification. Grade I to Grade IV nutritional grade is taken as undernourished [10].
IAP Classification
Nutritional grade Percentage of standard weight for age
Normal > 80%
Grade I 71-80%
Grade II 61-70%
Grade III 51-60%
Grade IV < 50%
Analytical strategy
Prevalence was expressed in percentage and Chi-square test was used to find association with factors.
Results
The prevalence of under-nutrition (≤ 80 percentage of standard weight for age) was 66.5%. The prevalence of grade 1 malnourishment was 46.2% [Table/Fig-1]. The prevalence of under nourishment increased with increasing age and the difference was found to be statistically significant (p < 0.05) [Table/Fig-2]. Prevalence of under nourishment was higher among male children (76.9%) than female children (56.3%) and was found to be statistically highly significant [Table/Fig-3]. Nutritional status of children of mothers who were unemployed was better than those whose mothers were working but not statistically significant [Table/Fig-4]. Father’s occupation and nourishment of the children were statistically associated [Table/Fig-5].
IAP classification of nutritional status
| Percentage of standard weight for age | Nutritional grade | Nutritional status | Frequency (n) | Percentage |
|---|
| > 80% | Normal | Normal | 53 | 33.5% |
| 71 – 80% | Grade 1 | Mild under-nutrition | 73 | 46.2% |
| 61 – 70% | Grade 2 | Moderate under-nutrition | 27 | 17.1% |
| 51 – 60% | Grade 3 | Severe under-nutrition | 4 | 2.5% |
| < 50 % | Grade 4 | Very severe under-nutrition | 1 | 0.6% |
| Total n(%) | | | 158 | 100.0% |
Age and nutritional status
| Age in months | Nutritional Status | Chi- square for linear trend | p-value |
|---|
| Normal | Underno-urished n(%) | Total n(%) |
|---|
| 36-48 | 31 (41.9) | 43 (58.1) | 74 (100.0) | 3.90 | 0.047 |
| 49-60 | 10 (26.3) | 28 (73.7) | 38 (100.0) |
| 61-72 | 12 (26.1) | 34 (73.9) | 46 (100.0) |
| Total n(%) | 53 (33.5) | 105 (66.5) | 158 (100.0) |
Sex and nutritional status
| Sex | Nutritional Status | Chi- square for linear trend | p-value |
|---|
| Normal | Undernourished n(%) | Total n(%) |
|---|
| Male | 18 (23.1) | 60 (76.9) | 78 (100.0) | 7.5716 | 0.005 |
| Female | 35 (43.8) | 45 (56.3) | 80 (100.0) |
| Total n(%) | 53 (33.5) | 105 (66.5) | 158 (100.0) |
Mother’s occupation and nutritional status
| Mother’s occupation | Nutritional Status | Chi square value | p-value |
|---|
| Normal | Undernourished n(%) | Total n(%) |
|---|
| semiskilled | 1(7.6) | 12 (92.3) | 13(100) | 5.3495 | 0.0689 |
| unskilled | 9(28.1) | 23(71.8) | 32(100) |
| unemployed | 43(38.0) | 70(61.9) | 113(100) |
| n(%) | 53(33.5) | 105(66.4) | 158(100) | | |
Father’s occupation and nutritional status
| Father’s Occupation | Nutritional Status | Chi square value | p-value |
|---|
| Normal | Undernourished n(%) | Total n(%) |
|---|
| Clerks | 14(63.6) | 8(36.4) | 22(100) | 11.24 | 0.02 |
| Skilled workers | 15(28.3) | 38(71.7) | 53(100) |
| Semi skilled workers | 11(31.4) | 24(68.5) | 35(100) |
| Unskilled workers | 13(28.2) | 33(71.74) | 46(100) |
| Un employed | 0(0) | 2(100) | 2(100) |
| Total n(%) | 53(33.5) | 105(66.5) | 158(100) |
The prevalence of under nutrition among children whose mothers were illiterate was 78.6% [Table/Fig-6]. No significant association was found between parents educational status [Table/Fig-6], type of family [Table/Fig-7], family size [Table/Fig-8] and the nutritional status of the children. As the socioeconomic status increased the prevalence of undernourishment decreased and the difference was found to be statistically significant (p<0.05 ) [Table/Fig-9]. The second order children were more undernourished than the first and third order but the difference was not statistically significant [Table/Fig-10].
Parent’s educational status and nutritional status
| Father’s Educational Status | Nutritional Status | Chi square value | p-value |
|---|
| Normal | Undernourished n(%) | Total n(%) |
|---|
| High school and above | 25 (33.8) | 49 (66.2) | 74 (100.0) | 0.022 | 0.883 |
| Middle School | 18 (32.7) | 37 (67.3) | 55 (100.0) |
| Primary School | 7 (31.8) | 15(68.2) | 22 (100.0) |
| Illiterate | 3 (42.9) | 4 (57.1) | 7 (100.0) |
| Total n(%) | 53 (33.5) | 105 (66.5) | 158 (100.0) |
| Mother’s Educational Status |
| High school and above | 11 (32.4) | 23 (67.6) | 34 (100.0) | 0.417 | 0.518 |
| Middle School | 25 (37.3) | 42 (62.7) | 67 (100.0) |
| Primary School | 14 (32.6) | 29 (67.4) | 43 (100.0) |
| Illiterate | 3 (21.4) | 11 (78.6) | 14 (100.0) |
| Total n(%) | 53 (33.5) | 105 (66.5) | 1 58 (100.0) |
Type of family and nutritional status
| Type of Family | Normal n(%) | Underno-urished n(%) | Total n(%) | Chi-square | p-value |
|---|
| Type of Family | Normal n(%) | Undernourished n(%) | Total n(%) | 0.091 | 0.762 |
| Nuclear | 49 (33.6) | 97 (66.4) | 146 (100.0) |
| Joint | 4 (33.3) | 8 (66.7) | 12 (100.0) |
| Total n(%) | 53 (33.5) | 105 (66.5) | 158 (100.0) |
Family size and nutritional status
| Family size | Normal n(%) | Underno-urished n(%) | Total n(%) | Chi-square | p-value |
|---|
| 3 | 15(32.6) | 31(67.3) | 46 (100) | 0.4865 | 0.7841 |
| 4 | 29(35.8) | 52(64.2) | 81 (100) |
| >5 | 9(29.0) | 22(70.9) | 31(100) |
| Total n(%) | 53(33.5) | 105 (66.4) | 158(100) |
Socio-economic status and nutritional status
| Socioeconomic Classification* | Normal n(%) | Underno-urished n(%) | Total n(%) | Chi-square | p-value |
|---|
| Class 1 | 2 (66.7) | 1 (33.3) | 3 (100.0) | 5.429 | 0.019 |
| Class 2 | 12 (46.2) | 14 (53.8) | 26 (100.0) |
| Class 3 | 25 (33.8) | 49 (66.2) | 74 (100.0) |
| Class 4 | 14 (27.5) | 37 (72.5) | 51 (100.0) |
| Class 5 | 0 (0.0) | 4 (100.0) | 4 (100.0) |
| Total n(%) | 53 (33.5) | 105 (66.5) | 158 (100.0) |
Birth order and nutritional status
| Birth Order | Normal n(%) | Underno-urished n(%) | Total n(%) | Chi- square for linear trend | p-value |
|---|
| 1 | 37 (35.6) | 67 (64.4) | 104 (100.0) | 0.304 | 0. 581 |
| 2 | 14 (28.6) | 35 (71.4) | 49 (100.0) |
| 3 | 2 (40.0) | 3 (60.0) | 5 (100.0) |
| Total n(%) | 53 (33.5) | 105 (66.5) | 158 (100.0) |
Time of initiation of breast feeding and nutritional status was not statistically associated. However there was a statistically significant association between duration of exclusive breast feeding and the nutritional status [Table/Fig-11]. No significant association between immunization and nutritional status of the children [Table/Fig-12].
Breastfeeding practices and nutritional status
| Time of Initiation of Breastfeeding | Normal n(%) | Underno-urished n(%) | Total | Chi-square value | p-value |
|---|
| No breastfeeding | 2 (100.0) | 0 (0.0) | 2 (100.0) | 4.025 | 0.258 |
| 0-1 hour | 44 (32.8) | 90 (67.2) | 134 (100.0) |
| >1 -4 hours | 6 (31.6) | 13 (68.4) | 19 (100.0) |
| >4 hours | 1 (33.3) | 2 (66.7) | 3 (100.0) |
| TOTAL | 53 (33.5) | 105 (66.5) | 158 (100.0) |
| Duration of Exclusive Breastfeeding |
| Noexclusive breastfeeding | 2(100.0) | 0 (0.0) | 2 (100.0) | 9.484 | 0.023 |
| 0-4 months | 13 (31.7) | 28 (68.3) | 41 (100.0) |
| >4-6months | 33 (39.3) | 51 (60.7) | 84 (100.0) |
| >6 months | 5 (16.1) | 26 (83.9) | 31 (100.0) |
| TOTAL | 53 (33.5) | 105 (66.5) | 158 (100.0) |
Immunisation Status and Nutritional Status
| Immunisation Status | Normal n(%) | Underno-urished n(%) | Total | Chi-square value | p-value |
|---|
| Adequately immunised | 44 (34.6) | 83 (65.4) | 127 (100.0) | 0.352 | 0.552 |
| Partially immunised | 9 (29.0) | 22 (71.0) | 31 (100.0) |
| TOTAL | 53 (33.5) | 105 (66.5) | 158 (100.0) |
Discussion
In this study the prevalence of under-nutrition (≤ 80 percentage of standard weight for age) was 66.5%. The prevalence of grade 1 malnourishment was 46.2%. In a study conducted in a rural area the prevalence of protein energy malnutrition among children aged 1-5 y was found to be 56.4% [11]. In a dietary survey conducted by Vinod et al., it was found that 52.23 %children were suffering from various grades of malnutrition among whom 32.18 % children were in grade I, 16.09 % in grade II, 3.46 % in grade III and 0.5 % in grade IV malnutrition [8].
Children in the age group 49-60 months were more undernourished than other age group children and the difference was found to be statistically significant (p < 0.05). Kavitha et al., [12] reported in her study the prevalence of protein energy malnutrition was higher in 3rd year age periods as compared to 4th and 5th year.
Prevalence of under nourishment was higher among male children (76.9%) than female children (56.3%) and the difference was found to be highly significant. This finding is unique in Indian context where females are prone to get neglected and sex wise prevalence of under nutrition was usually higher in females as compared to males [8,12].
Singh JP et al., in his study similarly found that prevalence of malnutrition was higher among male children (54.82%) than female children (45.18%) [13].
As the socioeconomic status increased the prevalence of undernourishment decreased and the difference was found to be statistically significant (p<0.05). Dhakal MM et al., [14] mentioned that the burden of malnourishment still haunts the poor with 82.75% children from low income group i.e. IV & V by Prasad Scale.
No significant association was found between educational status of parents and nutritional status of the children. Ahmed E et al., reported a higher proportion of children suffering from PEM belongs to illiterate parents and especially that of illiterate mothers [11]. Similarly in a study conducted by Verma et al., literacy of mother displayed a significant (p< 0.001) inverse relationship with malnutrition being highest (70%) among children whose mothers are illiterate [15].
No significant association was found between family size and nutritional status of the children. Mudkhedkar et al., found that relationship between family size and nutritional status was inversely proportionate when size of family was large (>8) [16]. In a study done in rural Hissar, it was found that majority of the cases of protein energy malnutrition had family size of 5 – 8 members [17].
The second order children were more undernourished than the first and third order but the difference was not statistically significant. Verma et al., found a significant association (p < 0.001) was observed between birth order and the nutritional status of the child. Highest prevalence of malnutrition (76.2%) was observed in children with birth order 4 and above [14].
Time of initiation of breast feeding and nutritional status was not statistically associated. However, there was a statistically significant association between duration of exclusive breast feeding and the nutritional status. Kavita et al., reported that Children deprived of colostrum and exclusive breastfeeding also showed significant difference in prevalence of PEM [12].
Conclusion
The nutritional status of a community particularly of its vulnerable groups comprising of children has been recognized as an important indicator of national development which in turn depends on social development indices. Nutritional inadequacies will result in the hampering of the development of the body. Future of the country is determined by the growing generation of the country. It is the health status of children of any country that represents the health status of people of that country. Since this growing generation is going to be the future productive citizens, they should be healthy enough to make use of the full potential of their productive age. Community based preventive measures should be taken to allievate malnutrition. Health education to the parents, especially to the mothers on dietary practices like feeding their children with healthy food in terms of quality and quantity should be given . Nutritional rehabilitation centres should be established. Improving the socioeconomic standards is mandatory.
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