Indian J Pediatr DOI 10.1007/s12098-014-1358-y
ORIGINAL ARTICLE
Nutritional Status and its Correlates Among Tribal Children of Melghat, Central India Manoj Rajanna Talapalliwar & Bishan S. Garg
Received: 17 September 2013 / Accepted: 15 January 2014 # Dr. K C Chaudhuri Foundation 2014
Abstract Objective To find out the magnitude and epidemiological determinants of malnutrition among 0–6 y tribal children. Methods A community based cross sectional study was done in the villages of Melghat in central India. The information of 540 children in the age group 0–6 y was collected. The newly developed WHO growth standards were used to calculate conventional indices of malnutrition (underweight, stunting and wasting) and composite index of anthropometric failure (CIAF). Univariate and multiple logistic regression analysis were used to find out the correlates of malnutrition. Results The prevalence of malnutrition among these tribal children in terms of underweight, stunting, and wasting were 60.9 %, 66.4 % and 18.8 % respectively. Malnutrition in terms of composite index of anthropometric failure (CIAF) was 76.3 %. The important correlates of malnutrition that emerged out of this study were the age of child, age of mother less than 20 y at her first pregnancy, practice of not feeding colostrum, calorie deficit diet, anemia and morbidities like diarrhea and acute respiratory illnesses. Conclusions The prevalence of malnutrition was high in tribal children. The health care delivery at village level should be strengthened for early diagnosis and prompt treatment of anemia and other morbidities in children. The strategies are needed to delay the child bearing age in this community and improve breast feeding practices.
M. R. Talapalliwar (*) Department of Community Medicine, NKP Salve Institute of Medical Sciences & Research Centre, Nagpur 440019, Maharashtra, India e-mail: [email protected] B. S. Garg Department of Community Medicine, Mahatma Gandhi Institute of Medical Sciences, Sevagram, Wardha, India
Keywords Malnutrition . Melghat . Composite index of anthropometric failure . Underweight . Stunting . Severe acute malnutrition
Introduction There is an ongoing worldwide effort focused on the complete eradication of extreme poverty and hunger through achieving Millennium development goals [1]. However, the burden of undernutrition is still a major public health problem worldwide, especially in resource poor countries. Malnutrition contributes to more than half of all childhood deaths globally [2,3]. An analysis of longitudinal studies by World Health Organization (WHO) revealed a strong association between severity of underweight and mortality rates. Malnutrition in early childhood has serious, long-term consequences because it impedes motor, sensory, cognitive, social and emotional development [4]. The nutritional status of tribal children in India was explored on nationwide studies conducted by National Nutrition Monitoring Bureau (NNMB), National Family Health Surveys (NFHS) and also in some tribe specific studies [5–9]. The NNMB in its first repeat survey has reported the prevalence of 96 % underweight among tribal children studied [10] and as per India’s National Family Health Surveys-3, 54.3 % of tribal children were underweight [6]. The Korku tribe is an aboriginal inhabitant of Melghat in central part of India. The area has received huge media attention in the last decade for various claims of high prevalence of malnutrition and malnutrition deaths [11]. Somehow the epidemiological studies have not been conducted in this area to find out the actual situation. Hence, the present study was conducted to find out the magnitude of malnutrition and its determinants among 0–6 y children of Melghat.
Indian J Pediatr
Material and Methods The cross sectional study was carried out in the villages of Melghat block of Amravati district, Maharashtra, India. Study area had majority (75.5 %) of tribal population with 65 % literacy [12]. All the children in the age group 0–6 y from the study area formed the study population. The sample size was calculated by considering 15.6 % of wasting reported by NFHS-3 for Maharashtra [6] at 95 % confidence level, 5 % permissible error with design effect of 2.5. The sample size estimated was 526. The 30 cluster sampling method was used to select study subjects. The clusters were selected by probability proportionate to size of the population. It was decided to survey 18 children from each cluster to cover the desired sample size from 30 clusters, thus giving a total number of 540. Eighteen subjects from each cluster were selected by systematic random sampling method. The data was collected by interview method through house to house visit using a pre-designed and pre-tested questionnaire from November 2009 through January 2010. The information was collected from mothers (with children born between 1st April 2004 and 31st March 2010). The written informed consent was obtained from the mothers. If the mothers were illiterate then the nature and purpose of the study was explained to the mother and after agreeing for participation for study, they were included in study. A prior clearance from institutional ethical committee was obtained for this study. The data was collected on following variables. The mothers were asked for their age, education, occupation, income of the family, age at first pregnancy. The Anthropometric measurements i.e., weight and height of the mother were also taken using standard guidelines. The bathroom scale was used to measure weight of the mothers and height was measured by using a non-stretchable measuring tape [13,14]. Nutritional status of the mother was assessed by calculating body mass index (BMI) and categorized accordingly [15]. The socio-economic status was assessed by calculating per capita income in the family. Data was also collected on the infant feeding practices like the practice of feeding colostrum, the timing of initiation of breastfeeding, duration of exclusive breast feeding and the age of starting complementary feeding. The timely initiation of complementary feeding was defined as initiating complementary feeding in the age between 6-8 mo [6]. A 24 h dietary recall method was used to calculate calories and protein consumption of children. The Indian Council of Medical Research (ICMR) recommendations were followed to calculate recommended dietary allowance for children [16]. Hemoglobin estimation was done by WHO Hemoglobin Color Scale (HCS) methods. The cut off for diagnosing anemia was taken as the hemoglobin level less than 11 g/dL [17]. The weight of children were measured in kilograms (kg) to the nearest 100 g by using Salter’s weighing machine. For the children less than
2 y age, recumbent length was measured and for children aged 2 y or more, standing height was measured [13]. Three conventional standard indices of physical growth namely underweight (weight for age
ORIGINAL ARTICLE
Nutritional Status and its Correlates Among Tribal Children of Melghat, Central India Manoj Rajanna Talapalliwar & Bishan S. Garg
Received: 17 September 2013 / Accepted: 15 January 2014 # Dr. K C Chaudhuri Foundation 2014
Abstract Objective To find out the magnitude and epidemiological determinants of malnutrition among 0–6 y tribal children. Methods A community based cross sectional study was done in the villages of Melghat in central India. The information of 540 children in the age group 0–6 y was collected. The newly developed WHO growth standards were used to calculate conventional indices of malnutrition (underweight, stunting and wasting) and composite index of anthropometric failure (CIAF). Univariate and multiple logistic regression analysis were used to find out the correlates of malnutrition. Results The prevalence of malnutrition among these tribal children in terms of underweight, stunting, and wasting were 60.9 %, 66.4 % and 18.8 % respectively. Malnutrition in terms of composite index of anthropometric failure (CIAF) was 76.3 %. The important correlates of malnutrition that emerged out of this study were the age of child, age of mother less than 20 y at her first pregnancy, practice of not feeding colostrum, calorie deficit diet, anemia and morbidities like diarrhea and acute respiratory illnesses. Conclusions The prevalence of malnutrition was high in tribal children. The health care delivery at village level should be strengthened for early diagnosis and prompt treatment of anemia and other morbidities in children. The strategies are needed to delay the child bearing age in this community and improve breast feeding practices.
M. R. Talapalliwar (*) Department of Community Medicine, NKP Salve Institute of Medical Sciences & Research Centre, Nagpur 440019, Maharashtra, India e-mail: [email protected] B. S. Garg Department of Community Medicine, Mahatma Gandhi Institute of Medical Sciences, Sevagram, Wardha, India
Keywords Malnutrition . Melghat . Composite index of anthropometric failure . Underweight . Stunting . Severe acute malnutrition
Introduction There is an ongoing worldwide effort focused on the complete eradication of extreme poverty and hunger through achieving Millennium development goals [1]. However, the burden of undernutrition is still a major public health problem worldwide, especially in resource poor countries. Malnutrition contributes to more than half of all childhood deaths globally [2,3]. An analysis of longitudinal studies by World Health Organization (WHO) revealed a strong association between severity of underweight and mortality rates. Malnutrition in early childhood has serious, long-term consequences because it impedes motor, sensory, cognitive, social and emotional development [4]. The nutritional status of tribal children in India was explored on nationwide studies conducted by National Nutrition Monitoring Bureau (NNMB), National Family Health Surveys (NFHS) and also in some tribe specific studies [5–9]. The NNMB in its first repeat survey has reported the prevalence of 96 % underweight among tribal children studied [10] and as per India’s National Family Health Surveys-3, 54.3 % of tribal children were underweight [6]. The Korku tribe is an aboriginal inhabitant of Melghat in central part of India. The area has received huge media attention in the last decade for various claims of high prevalence of malnutrition and malnutrition deaths [11]. Somehow the epidemiological studies have not been conducted in this area to find out the actual situation. Hence, the present study was conducted to find out the magnitude of malnutrition and its determinants among 0–6 y children of Melghat.
Indian J Pediatr
Material and Methods The cross sectional study was carried out in the villages of Melghat block of Amravati district, Maharashtra, India. Study area had majority (75.5 %) of tribal population with 65 % literacy [12]. All the children in the age group 0–6 y from the study area formed the study population. The sample size was calculated by considering 15.6 % of wasting reported by NFHS-3 for Maharashtra [6] at 95 % confidence level, 5 % permissible error with design effect of 2.5. The sample size estimated was 526. The 30 cluster sampling method was used to select study subjects. The clusters were selected by probability proportionate to size of the population. It was decided to survey 18 children from each cluster to cover the desired sample size from 30 clusters, thus giving a total number of 540. Eighteen subjects from each cluster were selected by systematic random sampling method. The data was collected by interview method through house to house visit using a pre-designed and pre-tested questionnaire from November 2009 through January 2010. The information was collected from mothers (with children born between 1st April 2004 and 31st March 2010). The written informed consent was obtained from the mothers. If the mothers were illiterate then the nature and purpose of the study was explained to the mother and after agreeing for participation for study, they were included in study. A prior clearance from institutional ethical committee was obtained for this study. The data was collected on following variables. The mothers were asked for their age, education, occupation, income of the family, age at first pregnancy. The Anthropometric measurements i.e., weight and height of the mother were also taken using standard guidelines. The bathroom scale was used to measure weight of the mothers and height was measured by using a non-stretchable measuring tape [13,14]. Nutritional status of the mother was assessed by calculating body mass index (BMI) and categorized accordingly [15]. The socio-economic status was assessed by calculating per capita income in the family. Data was also collected on the infant feeding practices like the practice of feeding colostrum, the timing of initiation of breastfeeding, duration of exclusive breast feeding and the age of starting complementary feeding. The timely initiation of complementary feeding was defined as initiating complementary feeding in the age between 6-8 mo [6]. A 24 h dietary recall method was used to calculate calories and protein consumption of children. The Indian Council of Medical Research (ICMR) recommendations were followed to calculate recommended dietary allowance for children [16]. Hemoglobin estimation was done by WHO Hemoglobin Color Scale (HCS) methods. The cut off for diagnosing anemia was taken as the hemoglobin level less than 11 g/dL [17]. The weight of children were measured in kilograms (kg) to the nearest 100 g by using Salter’s weighing machine. For the children less than
2 y age, recumbent length was measured and for children aged 2 y or more, standing height was measured [13]. Three conventional standard indices of physical growth namely underweight (weight for age
