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ORIGINAL ARTICLE
Year : 2018  |  Volume : 9  |  Issue : 1  |  Page : 7-11

Prevalence and risk factors associated with underweight among under-five children in a rural area of Puducherry


1 Department of Paediatrics, Azeezia Medical College, Kollam, Kerala, India
2 Department of Paediatrics, Pondicherry Institute of Medical Sciences, Kalapet, Puducherry, India

Date of Web Publication24-Jan-2018

Correspondence Address:
Dr. Jomol Sara John
Department of Paediatrics, Pondicherry Institute of Medical Sciences, Ganapathichettikulam, Kalapet - 605 014, Puducherry
India
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/mjmsr.mjmsr_16_17

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  Abstract 

Background: Nutrition has been recognized as a basic pillar for social and economic development. One in every three malnourished children in the world lives in India. The objective of this study was to measure the prevalence and to study the selected factors associated with underweight among the under-five children in a rural area of Puducherry. Aims: This study aims to study the prevalence of underweight among children under-five years of age and to study the associated risk factors. Methodology: This was a cross-sectional study conducted over a period of 13 months with a sample size of 500. The anthropometric assessments were taken and plotted on the Indian Academy of Pediatrics growth charts.Results: The prevalence of underweight was found to be 23.8%. The age of the child, gender, socioeconomic status, duration of exclusive breast feeds, birth order, and birth weight were found to have statistical significance in underweight. However, the maternal education did not show any significance in underweight. Conclusion: Nutritional status of under-five years children is one of the important indicators of overall development of community and thus country. Intervention to reduce the burden of underweight should be directed toward the education of the mothers regarding the importance of nutrition by community health workers.

Keywords: Indian Academy of Pediatrics chart, risk factors, under-five children, underweight


How to cite this article:
John JM, John JS. Prevalence and risk factors associated with underweight among under-five children in a rural area of Puducherry. Muller J Med Sci Res 2018;9:7-11

How to cite this URL:
John JM, John JS. Prevalence and risk factors associated with underweight among under-five children in a rural area of Puducherry. Muller J Med Sci Res [serial online] 2018 [cited 2018 Oct 22];9:7-11. Available from: http://www.mjmsr.net/text.asp?2018/9/1/7/223903


  Introduction Top


Malnutrition is the principal cause of deaths in the children under-five years of age. Malnutrition is more common in India than in Sub-Saharan Africa. One in every three malnourished children in the world lives in India. The National Family Health Survey (NFHS) in India reported the prevalence of underweight among children younger than 5 years in 2015–2016 to be nearly 35.7%, which has declined from the rates recorded in 2005–2006 (42.5%), 1992–1993 (51%), and 1998–1999 (47%).[1],[2] The NFHS in the Union Territory of Puducherry shows only a minor decline in underweight children below 5 years from 23.8% (2012–2013) to 22% (2015–2016).[3],[4]

Malnutrition is called invisible emergency because, much like an ice berg, its deadly menace lies mostly hidden from view. Each year malnutrition is implicated in about 40% of 11 million deaths of under-five children in developing countries and lack of exclusive breast feeding in infancy causes additional 1.5 million of these deaths. Data from UNICEF states that the highest level of underweight children is found in South Asia, involving 46% of all under-fives in the region.[5] It is often found to start in the womb and end in the tomb. The inadequate nutrition does not result from paucity of nutrients but largely due to ignorance, beliefs, lack of knowledge and unawareness about normal eating habits. Nutritional status is also influenced by factors such as household income, the skills and capacity of care givers especially mother, use of limited resources for better care of children, as well as local availability of health-care services.[6]

Growth is the key component of nutritional status and indicator of health and well-being for individual and in population, with every aspect of child's health being affected by his or her nutritional status. Nutrition has been recognized as a basic pillar for social and economic development. Adequate nutrition is necessary in early childhood to ensure healthy growth, proper functioning of organs, strong immune system, and neurological and cognitive development. Children are in a constant phase of development. 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. Undernutrition is a leading contributor to infant, child, and maternal morbidity and mortality playing a role in about half of all child deaths.[7],[8] Undernutrition directly affects many aspects of children's development such as retarding physical and mental development, increasing susceptibility to infections like sepsis, diarrhea, pneumonia, and so forth, and further enhancing the probability of undernutrition.[8],[9]

The present study was conducted to measure the prevalence of underweight and to study the selected factors associated with underweight among children under-five years of age residing in a rural area of Puducherry.


  Methodology Top


This cross-sectional study was conducted from June 2012 to July 2013. Children under-five years attending various camps and those who had come to the outpatient department of our Medical College in Puducherry were included in this study by simple random sampling. The Institutional Ethical Committee had approved of the study and written informed consent from parents of all the children in the study were taken. Any children with chronic illness, those with a history of any acute illness that lead to departure from normal growth pattern, those with known or clinically recognizable endocrine or other system dysfunction or those on chronic drug usage known to impair growth, were excluded from this study. A pretested structured questionnaire was used to collect the data regarding age, gender, mother's education, socioeconomic status, natal history, feeding practices and birth order of the participant children from the parents.

The minimum sample calculated was 397 with the formulae n = 4 pq/d 2, with P taken as 46% and d taken as 0.05. Hence 500 children were included in this study, of which 271 were boys, and 229 were girls. Weight was recorded by using standard weighing machine to the accuracy nearest to 25 g with the child wearing minimum clothing. Children more than 2 years of age were made to stand with bare feet on a flat floor against a stadiometer, with feet parallel and with heels, buttocks, shoulder and occiput touching the wall. The head was held erect with eyes aligned horizontally and ears vertically without any tilt (Frankfurt plane). With the help of a wooden spatula or plastic ruler, the topmost point of the vertex was identified on the wall and height was recorded against the chart affixed. In children below 2 years of age, length was measured with the help of an infantometer. The footboard of the infantometer was moved to touch the feet to measure the length. Two readings were averaged for analysis.

After the anthropometric measurements, weight for age and height for age were plotted on the IAP growth charts. The data collected were coded and entered into Microsoft Excel. The relationship of nutritional status with various factors such as age, gender of the child, birth order, birth weight, duration of exclusive breast feeding, maternal education and socioeconomic status were compared. Chi square test for categorical data was used for statistical analysis. P < 0.05 was taken as statistically significant.


  Results Top


The study group included 500 children, of which 271 were boys, and 229 were girls [Table 1]. Underweight was seen in 119 children (23.80%) according to Indian Academy of Pediatrics (IAP) growth charts. [Table 2] shows the prevalence of underweight among under-five children in relation to the sociodemographic factors.
Table 1: General features of the study population

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Table 2: Sociodemographic features

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Our study showed the prevalence of underweight was higher in children <1 year of age (37.2%) compared with other age groups. Females were found to be more underweight (27.95%) compared to the males (20.29%). [Figure 1] shows that under-five children who received exclusive breast feeding for <3 months were found to have more prevalence of underweight (50%) compared to the other children. [Figure 2] shows that prevalence of underweight was found to be more in children with uneducated mothers (29.5%) compared to children whose mothers studied more than higher secondary school (20.93%). Children belonging to lower socioeconomic status, according to modified Kuppuswamy scale, were more underweight (74.33%). Children with birth weight of <2 kg were found to be more underweight (60%) compared to children with birth weight of more than 2 kg, as shown in [Figure 3]. Prevalence of underweight was found to increase with increase in birth order, as shown in [Figure 4].
Figure 1: Association between exclusive breastfeeding and underweight

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Figure 2: Association between education of mothers with number of children with underweight

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Figure 3: Association between birth weight and underweight

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Figure 4: Association between the order of birth with number of children with underweight

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  Discussion Top


In our study, the prevalence of underweight was 23.8%. The age of the child, gender, socioeconomic status, duration of exclusive breast feeds, birth order and birth weight were found to have statistical significance in underweight. However, the maternal education did not show any significance in underweight.

Limitation of this study was that it was conducted in a single rural area of South India and hence, the study population may not be representative of the entire Indian population. The details regarding the history of the child were based on the information furnished by the parents/caregivers and are subjected to recall bias.

The prevalence of underweight in this study was 23.8% according to IAP growth chart. According to the study done by Stalin et al. in Kancheepuram prevalence of underweight among under-five children was 52.9%.[10]

In our study, out of 271 male children 55 (20.29%) were malnourished; out of the total 229 female children, 64 (27.9%) were malnourished, which was statistically significant (odds ratio [OR]: 1.5233, 95% confidence interval [CI] 1.0075–2.3033). In a study done by Sharma had shown similar results with female being more underweight than males.[11] This in contrast with the study done by Ray et al. which reported statistically no significant difference between male (64.74%) and female (61.58%) underweight children.[12] Goel et al. conducted a cross-sectional study in the urban slums of Rohtak, a city in Haryana on 540 children aged 1–6 years. There was no significant association between nutritional status and sex of the child (P = 0.928).[13]

In our study, the prevalence of malnutrition decreases when the birth weight is above 2.5 kg. When the birth weight is below 2 kg, the prevalence of malnutrition is 60% whereas the prevalence for above 3 kg birth weight is 6.25% with P < 0.0001 which is statistically significant (OR: 3.276, 95% CI-2.093–5.127) there are various studies to show that the birth weight of more than 2.5 kg have more favourable relationship with nutrition.[14],[15]

Out of 500 children, 300 children were exclusively breastfed for 5–7 months. In our study, the prevalence of malnutrition in children who were exclusively breast fed for 3 months or less was 50%. P =0.0086 which is statistically significant (OR-3.2920). Suman et al. conducted a cross-sectional study among Shabar tribal community in the districts of Orissa found a similar result in the prevalence of underweight among children who were exclusive breastfeed for <6 months were significantly higher (P< 0.01) than those who were breastfed more than 6 months.[16]

Out of 224 first born babies, 33 (14.73%) were malnourished. Eighty percent of the fourth order children were malnourished showing a significant increase in the prevalence of malnutrition with increase in birth order with P < 0.05 which is statistically significant. Hence, the birth order <2 was found to be of lesser risk of underweight (OR-2.9130) This could be because the care given to the children by mothers would decrease as the birth order increases. This result is comparable with the study conducted by Verma et al. in Rohtak,[17] Dwivedi et al. in Bhopal slum children,[18] Bhavsar et al. in the urban slums of Mumbai [19] and Priyanka et al. in Thrissur, Kerala.[14]

In our study, total 61 mothers were uneducated, and 117 mothers were educated more than 12th grade. The prevalence of malnutrition was around 29.5% in mothers who were illiterate, and the prevalence in children whose mothers were more than 12th grade educated were 20.9%. There was no significant correlation observed between mother's education status and malnutrition in our study (OR-0.7138, 95% CI-0.3943–1.2922). Children born to the graduated parents were noted to have normal nutritional status. Similar results were observed by Mathad et al., in Karnataka which found that mother's literacy status was not significantly associated with underweight.[20] In contrast to this, a study conducted by Stalin et al. showed that children of mothers who had completed higher secondary/graduation were better nourished than other children compared to the uneducated.[10]

The prevalence of underweight in the lower socioeconomic status in this study was 74.33%, whereas the prevalence in the upper middle was 1.31% which was found to be statistically significant with P < 0.05. This is comparable with studies done by Bhanderi and Choudhary in Gujarat and Sengupta et al. in Ludhiana.[21],[22] Dwivedi et al. conducted a cross-sectional study in Bhopal slum children which showed inverse correlation was between socioeconomic status and the prevalence of malnutrition (P< 0.05).[18]


  Conclusion Top


Nutritional status of under-five years children is one of the important indicators of overall development of community and thus country. The gender preferences are still persisting in the community which can be clearly seen by the increased prevalence of the malnutrition among female children than male. Maternal education did not show a significant association as compared to the other studies. This may be due the increased awareness provided by the community health workers. Despite rapid economic development along with increase in food production in recent decades and several nutritional intervention programs in operation since the last three decades, childhood undernutrition remains an important public health problem in India. It is one of the important reasons for ill health and child mortality.[23] The proper awareness regarding the importance of nutrition for children, especially the nutritional education regarding the complementary feeds to mothers/caregivers is compulsory. By targeting children at an early age and by proper awareness for mothers, the burden of underweight can be further reduced.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
  References Top

1.
National Family Health Survey. Available from: http://www.nfhsindia.org/data/ka-pre.pdf. [Last accessed on 2017 Mar 20].  Back to cited text no. 1
    
2.
National Family Health Survey (NFHS-3) 2005-06. Ministry of Health and Family Welfare, Government of India. International Institute of population sciences, Deonar, Mumbai. Available at: http://dhsprogram.com/pubs/pdf/FRIND3/FRIND3-Vol1andVol2.pdf.[Last Cited on 2014 Oct 12].  Back to cited text no. 2
    
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National Family Health Survey for Union Territory of Puducherry. Available from: http://www.rchiips.org/NFHS/pdf/NFHS4/PY_FactSheet.pdf. [Last accessed on 2017 Mar 20].  Back to cited text no. 4
    
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Progress for children, A Report Card on Nutrition, Number 4, Unicef (Online); 2006 May. Available at: https://www.unicef.org/publications/files/Progress_for_Children_-_No._4.pdf. [Last accessed on 2014 Oct 12].  Back to cited text no. 5
    
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Pongou R, Ezzati M, Salomon JA. Household and community socioeconomic and environmental determinants of child nutritional status in Cameroon. BMC Public Health 2006;6:98.  Back to cited text no. 6
    
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Levels and trends in child malnutrition: UNICEF-WHO-The World Bank joint child malnutrition estimates, http://www.who.int/nutgrowthdb/jme_unicef_who_wb.pdf. [Last cited on 2014 Oct 12].  Back to cited text no. 7
    
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Park K, editor. Preventive medicine in obstetrics, paediatrics and geriatrics. Park's Textbook of Preventive and Social Medicine. 23rd ed. Jabalpur, India: M/S Banarasidas Bhanot; 2013. p. 572-5.  Back to cited text no. 8
    
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Ghai OP, Paul VK, Bagga A. Nutrition. In:GhaiOP, Essential Pediatrics, 7th edition. New Delhi, CBS; 2009. p. 95-100.  Back to cited text no. 9
    
10.
Stalin P, Bazroy J, Dimri D, Singh Z, Senthilvel V, Sathyanarayanan S. Prevalence of underweight and its risk factors among under five children in a rural area of Kancheepuram District in Tamil Nadu, India. IOSR-JDMS 2013;3:71-4.  Back to cited text no. 10
    
11.
Sharma S. Child Health and Nutritional Status of Children: The Role of Sex Differentials. Population Research Center, Punjab University, Chandigarh, 2005. Retrieved from: http://www.iegindia.org/upload/publication/Workpa p/wp262.pdf. 2005.  Back to cited text no. 11
    
12.
Ray SK, Biswas AK, Gupta SB, Mukherjee D, Kumar S, Biswas B, et al. Rapid assessment of nutritional status and dietary pattern in a municipal area. IJCM 2000;25:14-8.  Back to cited text no. 12
    
13.
Goel MK, Mishra R, Gaur D, Das A. Nutrition surveillance in 1-6 years old children in urban slum of a city in Northern India. Int J Epidemiol 2007;5:1-5.  Back to cited text no. 13
    
14.
Priyanka R, Vincent V, Jini MP, Saju CR. An assessment of the nutritional status of under five children in a rural area of Thrissur district, Kerala, India. Int J Community Med Public Health 2016;3:3479-86.  Back to cited text no. 14
    
15.
Rodriguez-Llanes JM, Ranjan-Dash S, Degomme O, Mukhopadhyay A, Guha-Sapir D. Child malnutrition and recurrent flooding in rural Eastern India: A community-based survey. BMJ Open 2011;1:e000109.  Back to cited text no. 15
    
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Suman C, Rohini G, Premananda B. Breastfeeding Practices and Nutritional Status of Preschool Children among the Shabar Tribal Community in Orissa, India Proceeding of National Symposium on Tribal Health 2006. p. 227-34.  Back to cited text no. 16
    
17.
Verma R, Khanna P, Gaur D, Meena, Prinja S. Assessment of Nutritional Status and Dietary Intake of Pre-School Children in an urban pocket. The internet journal of nutrition and wellness 2008; 6(1).  Back to cited text no. 17
    
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Dwivedi SN, Banerjee N, Yadav OP. Malnutrition among children in an urban INDIAN slum and its associations. Indian J Matern Child Health 1992;3:79-81.  Back to cited text no. 18
    
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Bhavsar S, Hemant M, Kulkarni R, Maternal and Environmental Factors Affecting the Nutritional Status of Children in Mumbai Urban Slum. International Journal of Scientific and Research Publications 2012;(2):11.  Back to cited text no. 19
    
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Bhanderi D, Choudhary SK. An epidemiological study of health and nutritional status of under five children in semi-urban community of Gujarat. Indian J Public Health 2006;50:213-9.  Back to cited text no. 21
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22.
Sengupta P, Philip N, Benjamin AI. Epidemiological correlates of under-nutrition in under-5 years children in an urban slum of Ludhiana. Health Popul Perspect Issues 2010;33:1-9.  Back to cited text no. 22
    
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Nandy S, Irving M, Gordon D, Subramanian SV, Smith GD. Poverty, child undernutrition and morbidity: New evidence from India. Bull World Health Organ 2005;83:210-6.  Back to cited text no. 23
    


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