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A STUDY TO ASSESS THE PREVALENCE OF MALNUTRITION AMONG PRE-SCHOOL CHILDREN IN SLUM AREA OF PATNA

Dr. Rizwan Ahmar*, Mrs. Sangita Singh*, Ms Sushma Charly**, Ms. Nivedita Mishra***, Premshila Kumari***, Rashmi Kumari***, Ritu Kumari***, Ruby Kumari***, Rupa Kumari***

* Assistant Professor, IGIMS-College of Nursing, IGIMS, Patna, Bihar, India. **Tutor, IGIMS-College of Nursing, IGIMS, Patna, Bihar, India.

***Student, IGIMS-College of Nursing, IGIMS, Patna, Bihar, India.

ABSTRACT Introduction: Nearly half of all deaths in children under 5 are attributable to under nutrition, translating into the loss

of about 3 million young lives a year. Under nutrition puts children at greater risk of dying from common infections,

increases the frequency and severity of such infections, and delays recovery.1

Objectives: To assess the prevalence of

malnutrition among preschool children. The other objective was to assess the relationship of prevalence of

malnutrition with selected demographic variables. Material and methods: A non-experimental survey study was

conducted by using non-probability purposive sampling technique to select 200 preschool children from PWD Maidan

& Shastrinagar areas of Patna-23. Data was collected by using semi-structured interview schedule. The data obtained

was analysed in terms of objectives of the study, using descriptive and inferential statistics. Results: Findings of the

study revealed that out of 200 children, 51.5% were males and 48.5% females. Out of 200 children 20 (10%) were

severely malnourished, 33 (16.5%) were moderately malnourished, and 147 (73.5%) were normal. Study had found

certain socio-demographic factors like type of family as having significant association with malnutrition. Conclusion:

The study revealed that malnutrition is a major health problem in down-trodden and socioeconomically backward

classes. Its prevalence is significant irrespective of demographic variables.

Keywords: Malnutrition, Patna, Pre-School Students, Slum Area.

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INTRODUCTION

Growth and development of any country is reflected by the growth and development of its children. In our country,

children constitute a major bulk of the population. According to the 2011 census, 13.1% of the population in India is

between 0-6 years of age.1

The health of children and youth is of fundamental importance. Without ensuring optimal

child growth and development, efforts to accelerate economic development significantly, will be unsuccessful. Good

nutrition is a basic requirement for good health.2

Pre-school children (1-5 years) represent about 12% of the general population in children. A large majority of these

children live in rural and tribal areas and in urban slums. By virtue of their numbers, they are entitled to a larger share

of health and social services. Further, children are the human resources of the future. Their development is in the

interest of the total national development. Therefore, children need special attention. Unfortunately, Preschool age

children are comparatively less attended to. The pre-school age mortality rate in India is as high as 4% of all deaths.

The high mortality rate is largely due to infection and malnutrition which is characteristic of this age group in

underprivileged areas. Malnutrition was shown to be an underlying cause in 3.4% of all deaths in young children.3

Malnutrition is a silent emergency. Nutrition plays a key role in physical, mental and emotional development of

children and much emphasis has been given to provide good nutrition to growing populations, especially in the

formative years of life.4

Malnutrition is common in India, one in every three malnourished children in the world live in India. There are nearly

16 crore children in the country below the age of six years. The health of our economy and society lies in the health

of this generation. We cannot hope for a healthy future with a large number of malnourished children. The problem

of malnutrition is a matter of national shame. Malnutrition places a heavy burden on India; malnourished children

tend not to reach their potential, physically or mentally and they do worse at school than they otherwise would. It

has a direct impact on productivity.5

Early childhood (0-6 years) is a very critical period for a child’s physical and socio-psychological development. All

children need care and attention. Children below six years are particularly vulnerable to malnutrition, infections and

accidents. Therefore, there is a need of special care and health services for these children. All children in the

developed world have ready access to simple and affordable care that keeps them healthy to reach their full

potential, whereas children in the developing world do not have these facilities. World Health Organisation (WHO)

division of the Child Health Development (CHD) is at the forefront of a renewed effort to improve the health

prospects of the world’s children. Over the past five years, Child Health Organisation (CHO) and its international

partners have been devising and testing new strategies, new approaches to redress the imbalance of health equity.5

Children’s growth and development do not occur in a linear fashion, but are influenced by each child’s environment,

nutrition and parental care. These factors play a critical role in a child reaching his/ her full potential. Recent evidence

indicates that good nutrition, particularly in early childhood is critical to the positive health outcome of children. In

fact children’s nutritional status can be viewed as a good proxy indicator of a community’s state of health.6

A child is precious and a beautiful source of joy and happiness, focus of love and care and subject of dreams for the

future. Children are an inheritance from God. They are like clay in a potter’s hand which when handled with love and

care become something beautiful or else they will break. So the child’s health is the cornerstone of national progress.

One cannot visualise good health without nutritious food and balanced diet. Children are the precious possession of

the family, community and a country.7

Malnutrition results from imbalance between the body’s needs and intake of nutrients, and leads to syndromes of

deficiency, dependency, toxicity or obesity. Malnutrition includes under-nutrition wherein nutrients are under

supplied.7 Malnutrition is an unbearable burden not only on the health system but the entire socio-cultural &

economic status of the society.8

Malnutrition is the principal cause of child deaths. Half of all child deaths in India could be prevented if this issue is tackled. Children die because malnutrition lowers a child’s resistance to infection.

9 Nutritional disorders may result

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from either deficiency or excess of the nutrients like carbohydrate, protein, fat, vitamins, minerals and salt. In India, majority of problems are related to deficiency status rather than profusion and the most important reasons are poverty, ignorance and illiteracy.

10

It has been estimated that nearly half of all child deaths are associated with under nutrition. Globally 5.9 million children under the age of 5 years died in 2015, about 45% of all child deaths are linked to under nutrition

11. The

malnutrition in India is very high. According to NFHS 3 data in urban Karnataka, stunting, wasting and underweight are 33.9%, 17% and 26.4% respectively.

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MATERIALS AND METHODS Research setting: The present study was conducted at P.W.D Maidan and Shastrinagar areas of Patna-23 Target Population: The target population for the present study was children of age group of 3 to 5 years. Sample & Sampling technique: The sample of the study was 200 children between the age group of 3 to 5 years. Non-probability purposive sampling technique was used to select the sample. RESULTS Sample Characteristics SECTION - I SOCIO-DEMOGRAPHIC CHARACTERISTICS OF STUDY SUBJECTS Table 1: Frequency and percentage distribution of preschool children as per their socio-demographic variables N=200

Sl. No. Socio-demographic variables Frequency Percentage 1. Gender of child Male 103 51.5

Female 97 48.5

2. Age of child 3-4 111 55.5

4-5 89 44.5

3. Religion of child Hindu 195 97.5

Muslim 5 2.5

4. Educational status of Mother of child Informal education 127 63.5

Primary education 32 16.0

Secondary education 23 11.5

Higher education 18 9.0

5. Educational status of Father of child Informal education 81 40.5

Primary education 49 24.5

Secondary education 47 23.5

Higher education 23 11.5

6. Occupation of mother of child Housewife 173 86.5

Employed 19 9.5

Others 8 4.0

7. Occupation of Father of child Farmer 2 1.0

Employed 143 71.5

Unemployed 19 9.5

Businessman 36 18.0

8. Monthly Family Income (`) Below 4000 36 18.0

4000-8000 154 77.0

Above 8000 10 5.0

9. Birth Order of child 1st 61 30.5

2nd 67 33.5

3rd 43 21.5

Others 29 14.5

10. Number of children in family One 12 6.0

Two 64 32.0

Three 62 31.0

More than 3 62 31.0

11. Type of Family Nuclear 119 59.5

Joint 80 40.5

Extended 1 0.5

12. Dietary pattern of child Vegetarian 7 3.5

Non-vegetarian 193 96.5

13. Immunization status of child Complete according to age 192 96.0

Incomplete according to age 6 3.0

Not done 2 1.0

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Table 1 reveals the frequency and percentage distribution of pre-school children as per their socio-demographic

variables.

The gender wise distribution shows that 51.5% of pre-school children were males and 48.5% were females. Thus it can be interpreted that higher percentage of gender is male. The age wise distribution shows that 55.5% of pre-school children were in the age group of below 3-4 years and 44.5% were 4-5 years old. Thus it can be interpreted that highest percentage of age group is 3-4 years. The religion wise distribution of child shows that majority (97.5%) of pre-school children were Hindus and remaining 2.5% were Muslims. The educational status wise distribution of mothers of children shows that 63.5% of the mothers had informal education, 16% of the mothers had primary education and 11.5% of the mothers had secondary education and 9% of the mothers had higher education. The educational status wise distribution of fathers of children shows that 40.5% of the fathers had informal education, 24.5% of the fathers had primary education, 23.5% of the fathers had secondary education and 11.5% of the fathers had higher education. The occupation wise distribution of fathers of children shows that one percent was farmer, 71.5% were employed, 9.5% were unemployed and 18% were in business. The occupation wise distribution of mothers of children shows that 86.5% are housewife, 9.5% are employed and 4% are others.

The monthly income (`) wise distribution shows that 18% of the parents’ monthly income was below 4000, 77% of

the parents had monthly income of 4000-8000 and 5% of the parents’ monthly income was above 8000. The birth order wise distribution of child shows that in 30.5% it was 1

st order, in 33.5% is 2

nd order, 21.5% is 3

rd order

and 14.5% is others. The number of children in family wise distribution shows that 6% of the families had only one child, 32% of the families had two children, 31% had three children and the remaining 31% of the families had more than three children. Types of family wise distribution shows that 59.5% of the pre-school children were from nuclear families, 40% of the pre-school children were from joint families and 0.5% of the preschool children were from extended families. The dietary pattern wise distribution of children shows that majority (96.5%) of the children were non-vegetarians and 3.5% of the children were vegetarians. The immunisation status wise distribution of children shows that majority (96%) of the children were immunised according to age, 3% of the children were not immunised according to age and in 1% of the children, immunisation was not done. SECTION-2

Objective 1 - To assess the prevalence of malnutrition among pre-school children

Table 2: Frequency and percentage distribution of prevalence of malnutrition among preschool children

N=200

Prevalence of malnutrition N Mean SD Mean % ANOVA P

Normal 147 15.31 3.79 29.44

19.66 < 0.001** Moderate malnutrition 33 12.28 1.88 23.62

Severe malnutrition 20 11.46 0.68 22.03

Total 200 14.42 3.65 27.74

** Highly Significant

Table 2 & Figure 3 depict the frequency and percentage distribution of prevalence of malnutrition among pre-school

children. Out of 200 children 20 (10%) were severely malnourished, 33 (16.5%) were moderately malnourished and

147 (73.5%) were normal. Hence it is concluded that of the 200 pre-school children 33 (16.5%) had moderate

malnutrition and 20 (10%) had severe malnutrition.

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Figure 3: Pie-chart showing percentage distribution of prevalence of malnutrition among pre-school children

Objective 2 - To assess the relationship of prevalence of malnutrition with selected socio-demographic variables Table No 3: Association between the demographic variables and the level of prevalence of malnutrition

N=200

Demographic Variables

Prevalence of malnutrition Chi Square Df P Normal

Moderate malnutrition

Severe Malnutrition

N % N % N %

Age in years of child

3 – 4 79 71 21 19 11 10 1.071 2 0.585(NS) 4 – 5 68 76 12 14 9 10

Gender of child Male 77 75 16 16 10 10 0.184

2 0.912(NS) Female 70 72 17 18 10 10

Religion of child Hindu 143 73 33 17 19 10 1.386

2 0.499(NS) Muslim 4 80 1 20

Educational status of mother of child

Informal education 95 75 19 15 13 10 1.543 6 0.957(NS)

Primary education 24 75 6 19 2 6

Secondary education 16 70 4 17 3 13

Higher education 12 67 4 22 2 11

Educational status of father of child

Informal education 65 80 10 12 6 7 3.692 6 0.718(NS)

Primary education 33 67 10 20 6 12

Secondary education 34 72 8 17 5 11

Higher education 15 65 5 22 3 13

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Demographic Variables

Prevalence of malnutrition Chi Square Df P Normal

Moderate malnutrition

Severe Malnutrition

Occupation of father of child

Farmer 1 50 1 50 7.014 6 0.320(NS)

Employed 102 71 27 19 14 10

Unemployed 17 90 1 5 1 5

Businessman 27 75 5 14 4 11

Occupation of mother of child

Housewife 126 73 28 16 19 11 1.85 4 0.763(NS)

Employed 15 79 3 16 1 5

Others 6 75 2 25

Monthly Family Income (Rs)

Below 4000 22 61 10 28 4 11 8.116 4 0.087(NS)

4000-8000 120 78 20 13 14 9

Above 8000 5 50 3 30 2 20

Birth order of child

1st

50 82 7 12 4 7 7.649 4 0.265(NS)

2nd

46 69 13 19 8 12

3rd

27 63 9 21 7 16

Others 24 83 4 14 1 3

Number of children in family

One 10 83 1 8 1 8 2.991 4 0.810(NS)

Two 48 75 10 16 6 9

Three 41 66 13 21 8 13

More than 3 48 77 9 15 5 8

Types of family of child

Nuclear 94 79 15 13 10 8 13.328 4

0.010(S) Joint 53 66 18 23 9 11

Extended 1 100

Dietary pattern of child

Vegetarian 5 71 2 29 1.37 2

0.504(NS) Non- vegetarian 142 74 31 16 20 10

Immunisation status of child

Complete according to age 139 72 33 17 20 10 3.005 2 0..557(NS)

Incomplete according to age 6 100

Not done 2 100

Table 3 depicts that calculated chi-square which was less than p˂0.05 is considered as significant for the variable, type of family. Association of prevalence of malnutrition with demographic variables like age, sex, religion, educational status of father and mother, occupation of father and mother, monthly family income, birth order of the child, number of children in the family and immunisation of the child was non-significant. SUMMARY This study dealt with the analysis and interpretation of data collected from 200 pre-school children. Descriptive and inferential statistics i.e. frequencies, percentage, mean, standard deviation, chi-square test were used for analysis. Bar-diagram was also used to depict findings of the study. DISCUSSION The analysis of the data regarding prevalence of malnutrition among children revealed that out of 200 children 20 (10%) were severely malnourished, 33 (16.5%) were moderately malnourished and 147 (73.5%) were normal. Another study by Gupta S et al (2013) found that prevalence of malnutrition was 28.87% and majority were having grade-I malnutrition.

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Demographic variables such as age, gender, religion, educational status of father and mother, monthly family income, birth order of the child, number of children in the family, and immunisation of the child were non-significant whereas there was significant association of prevalence of malnutrition with type of family. CONCLUSION To sum up, in the study, an effort was made to find and assess the prevalence of malnutrition among pre-school children in slum areas of Patna city. In this study, developmental cross sectional design was used by picking 200 samples using purposive sampling technique from the selected areas of P.W.D Maidan and Shastrinagar in Patna. The malnutrition is a preventable disease and it can be prevented by generating awareness among the mothers of young children by providing exclusive breast feeding and nutrition awareness programme. RECOMMENDATION On the basis of findings of the study, it is recommended that ― 1. The same study can be repeated in different regions of the state or nation for a more comprehensive study in

order to tackle the problem of malnutrition. 2. Similar kind of study can be conducted among different age-groups of children. 3. Same study can be conducted as experimental study i.e. Structured Teaching Plan. 4. Comparative study can be done on malnutrition among under-five children between urban and rural children. SUMMARY This chapter comprises the summary, problem statement, objectives of the study, major findings, conclusion, limitations, implications of the study and recommendations. REFERENCE 1. Ministry of Health and Family Welfare, GOI. Provisional Population Totals: India: Census 2011.Available from

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