A community based cross sectional study was conducted in children of 3 months to 60 months of age living in the urban and rural field practice areas of Department of Community Medicine MMIMSR, Mullana, Ambala, during January 2012 to December 2012. NFHS 3 reports a prevalence of malnutrition to be 39.6% among children under 5 years of age in Haryana. The sample size was calculated assuming a prevalence of 38% among under five children.

The equation used for calculating sample size is as follows:

Where, Z = level of confidence - 95% (1.96), P= Prevalence of the disease, e = margin of error.

Taking relative error as 10% of the prevalence, the sample size came out to be 652. Assuming non-response rate to be 10%, minimum target sample size is 717. Finally we have taken up 750 children for this study. Simple random sampling technique was used for sample collection. As per census 2001, the ratio of rural to urban population in district Ambala was 3:1. Thus 530 children have been taken from rural area and 220 from urban area. In the selected households all the children of age 3-60 months have been included in the study.

The data was collected on a self designed and semi-structured questionnaire. We conducted house to house survey and data was collected by interviewing the mothers or the primary care giver of the child after taking an informed and written consent. This was followed by anthropometric assessment using standards methods as described in training manual of WHO Growth Standards.

The data collected during the survey have been entered in ms excel. Anthropometric data entered in WHO Anthro 2010 software (beta version) and Z scores for anthropometric measurements were computed for boys and girls separately by age groups. All the data were analysed in Statistical package for social sciences (SPSS) version 20 (IBM, Chicago, USA). Descriptive statistics as well as simple proportion were calculated for the data.

Study population included 410 (54.7%) male and 340 (45.3%) female children. Majority of children (23.6%) belonged to 36-47 month age group. Mean age of males was 28.58± SD 16.88 month, while of females 28.95± SD 16.89months. [Table/Fig-1] shows socio demographic details of children.

All children having weight for age Z score (WAZ) above – 2 SD were classified as normal, those with WAZ score < -2SD as underweight, and with WAZ score <-3 SD as severe underweight. Number of cases <-2 SD includes cases with <-3SD. In our study we found that out of 750 children 310 (41.3%) were underweight (WAZ < -2 SD) and 105(14%) were severe underweight (WAZ < -3 SD). Highest prevalence of underweight & severe underweight was found in 12-23 month age group. [Table/Fig-2] illustrates the prevalence of underweight in different age groups. Prevalence of underweight was higher in females compared to male children (42.9% Vs 40%, p value = 0.417) respectively. The prevalence of severe underweight among males and females were 13.4% and 14.7% respectively [Table/Fig-3]. We found that 44% of rural and 35% urban children were underweight and severe underweight was seen in 15.7% rural and 10% urban participants.

[Table/Fig-3]:

Sex wise distribution of children as per weight for age.

[Table/Fig-4] explains effect of maternal educational status on child’s nutritional status. We observed a declining trend of malnutrition with increase in educational qualification of the mothers. Less than half of the children (43.3%) of the illiterate mothers were having normal weight for age Z score. This observed difference was statistically highly significant (p=0.0001) while father’s educational status had less marked effect on child’s nutritional status. When mother is unemployed underweight prevalence was similar to total study population but if she is employed underweight and severe underweight prevalence was elevated (p=0. 002). On the contrary father’s occupation had modest effect on underweight prevalence (p= 0.135). We found that statistically highly significant (p=0.0001) number of children were underweight in lower socioeconomic status (52.5 and 55.4% respectively in class IV and V).

[Table/Fig-4]:

Association of maternal education with nutritional status of children.

Our study revealed that overall 41.3 % children under 60 months age were underweight and14 % were severe underweight. As per the NFHS 3 report, 43% of children below 5 years of age are underweight and 16% are severe underweight [6], while Ramchandran P et al., analysed the NFHS 3 data on new WHO standards and found 42.5% underweight prevalence [10]. [Table/Fig-5] depicts underweight prevalence reported by various researchers [11–18]. In our study underweight prevalence was higher in females compared to male children 42.9% and 40% respectively. Prevalence of severe underweight was 13.4% and 14.7% in males and females respectively, similar results were obtained by William R F et al., [19] on the contrary Ahmed et al., in his study demonstrated that female children had 20% to 21% less odds of being underweight than the male counterparts [20].

Among rural children overall prevalence of underweight was found to be 44%, while of severe underweight was 15.7%, similar results were obtained by 53 [21] urban children were privileged that only 35% children were underweight and 10% were found to be severe underweight, our findings are similar to earlier reported from slum children of Delhi by Bhadoria AS [22], while Narkhede V et al., [23] report higher (52.23%) prevalence among Nagpur children. while NFHS 3 reported that undernutrition is substantially higher in rural areas than in urban areas [6].

In present study, underweight was influenced by mother’s education status (p=0.0001) with increased prevalence of all forms of under nutrition among children of illiterate mothers. As observed in NFHS 3 report undernutrition has a strong negative relationship with the mother’s education. The percentage of children who are severely underweight is almost five times as high for children whose mothers have no education as for children whose mothers have 12 or more years of education [6]. According Menezes RCE et al., maternal schooling has been pointed out as a factor associated with child growth [24]. In our study effect of father’s education on child’s malnutrition status effect is not that much marked as that of maternal educational effect (p=0.007). According to Rijal P et al., education of mothers and fathers has significant effect on the nutritional status of their children [25]. Here, 41.6% mothers and 32.2% fathers were illiterate out of which 53.9% and 40.6% children had malnutrition. Similar to earlier study we observed that if mother is unemployed underweight prevalence was similar to total study population but when she is employed underweight and severe underweight prevalence was elevated (p=0. 002) [26]. On the contrary father’s occupation had modest effect on underweight prevalence (p= 0.135).

We found that statistically highly significant (p=0.0001) number of children were underweight in lower socioeconomic status (52.5 and 55.4% respectively in class IV andV). Our results are comparable to previous studies [27–29].

This study being a cross-sectional study cannot establish case and effect relationship between various socio-environmental factors and malnutrition. A follow-up study design is much better to assess the nutritional status of the children. Recall bias, and effect of both environmental and genetic factors is expected to have been obscured.

Although there is declining tendency of under-nutrition in the last years, yet malnutrition in preschool children ought to be considered as a community crisis. We found that almost half of our under five children are underweight, girl child being affected more. Malnutrition was more prevalent among children from rural families and from lower socioeconomic status. Maternal education and occupational status had significant effect on child’s nutritional status. To diminish the load of malnutrition in the children, a collective attempt by the government, non-governmental organizations and the community is crucial. Effective, efficient and equitable program should be designed to reduce child malnutrition. Indian government is having Integrated Child Development Services (ICDS), which At the national levels having high coverage, but utilization of ICDS services is low., For attainment of best possible nutrition and growth in children, targeted short-term strategies addressing underlying risk factors and more long-term poverty alleviation strategies may be needed.