effect of socio-economic and demographic factors on...
TRANSCRIPT
CHAPTER • VIII
EFFECT OF SOCIO-ECONOMIC AND DEMOGRAPHIC
FACTORS ON NUTRITIONAL STATUS
Vlll.1: Introduction
It is evident from several studies that many factors affect the level of
stunting, underweight and wasting. Socio economic and demographic
factors have a significant influence on nutritional status of children.
Likewise, maternal and child health factors have profound effect on
nutritional status of children. It is also apparent that compound effect of
anthropometric failures can affect a child, this effect can studied by using
CIAF. From many studies it can be understand that logistic regression is
reflective statistical tool to identify the effect of dependent variables on
stunting, underweight and wasting. This chapter gives more profound idea
on nutritional status of children.
Vlll.2: The Reference Value
From the study it is clear that only 13.5 percent children have height
for-age, equal or above the reference value and remaining 86.5 percent
(includes stunted and severely stunted) children fall below the reference
value or required height-for-age. Another heartening fact is that only 11.9
percent children have weight-for-age, equal or above the reference value
and remaining 88.1 percent (includes underweight and severely
underweight) children fall below the reference value or required weight-for
age. Again 33.4 percent children have weight-for-height, equal or above the
reference value and remaining 66.6 percent (includes wasted and severely
wasted) children fall below the reference value or required weight-for
height.
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V1I1.3: Socio Economic and Demographic Index
Using the selected socio economic and demographic factors such
as type of house, source of water, toilet facility, education of parents,
occupation of the father, monthly family income, exposure to mass media,
birth order of the child, preceding birth interval and succeeding birth
interval; an index is constructed and the values are classified in to low,
medium and high. The following table VII1.1 reveals the percentage
distribution of children by socio economic and demographic index.
Table VIII. 1: Percentage Distribution of Children by
Socio Economic and Demographic Index
Level Percentage
Low 48.4
Medium 36.9
High 14.7
Total 100.0 (1007)
The graph also shows the socio economic and demographic index.
Rg.VIII.1: Distribution of Children by Socio
Economic and Demographic Index
60 -,--------------'+Q.'!+----,IIICl~ 40 -r-----:-:--=-~--,--.'--r==;;;;;;_---j
~ 20 14.7~
~ 0
High Medium
Index Value
iSS
Low
From the graph and table it is clear that only 14. 7 percent children
belongs high level, 36.9 percent children belongs to medium level and 48.4
percent children belongs to low level. The table (Vlll.2) shows the
percentage distribution of children by anthropometric measurement and
Socio Economic and Demographic Index.
Table Vll/.2: Percentage Distribution of Children by Anthropometric
Measurement and Socio Economic and Demographic Index
Socio Economic Stunted Underweight Wasted
and Demographic
Index
Low 32.8 (487) 19.5 (487) 15.8 (487)
(54.0) (53.7) (51.3)
Medium 29.0 (372) 17.5(372) 14.2 (372)
(36.6) (36.7) (35.3)
High 21.6 (148) 14.2 (148) 13.5 (148)
(9.4) (9.6) (13.4)
29.3 (1007) 17.6 (1007) 14.9 (1007)
Total (100.0) (100.0) (100.0)
(295) (177) (150)
From the table it can be noted that 32.8 percent children belongs to
the low socio economic and demographic level are stunted, 29 percent
children belong to medium socio economic and demographic level are
stunted and 21.6 percent children belonging to high level are also stunted.
So this table shows that stunting is high among those children who have
low or medium socio economic and demographic status.
From the table it is also found that 19.5 percent children belong to
the low socio economic and demographic level are underweight, 17.5
percent children belong to medium socio economic and demographic level
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are underweight and 14.2 percent children belong to high level are
underweight. So the table shows that underweight is high among those
children who have low socio economic and demographic status. Again the
table shows that 15.8 percent children belong to low socio economic and
demographic level are wasted, 14.2 percent children belongs to medium
socio economic and demographic level are wasted and 13.5 percent
children belongs to high level are wasted. So this table shows that wasting
is high among those children who have low socio economic and
demographic level. From this table it can see that children belong to low
socio-economic and demographic status are more prone to stunted,
underweight and wasted.
Vlll.4: Maternal and Child Health Index
Using the indicators of maternal and child health such as first
antenatal checkup, frequency of antenatal checkup, mother's acceptance
of iron or folic acid tablets, premature birth, birthweight, initiation of breast
feeding, child immunization status and continuous disease an index is
created. The percentage distribution of children by maternal and child
health index is given in table VIII. 3.
Table V/11.3: Percentage Distribution of Children by
Maternal and Child Health Index
Level Percentage
Low 41.1
Medium 31.3
High 27.6
Total 100.0(1007)
The following graph shows the percentage distribution of maternal and
child health index.
157
Fig.VIII.2: Distribution of Children by Maternal andChild Health Index
31.3Gl 60 ,---....,,--.,.-----------------,
E 40 +--r:::~ 20~ 0
High Medium Low
Index Value
41.1 percent children belong to low level while 31.3 percent children
belong to medium level and there are 27.6 percent children falls in the high
level in the maternal and child health index.
The table (VillA) shows the percentage distribution of children by
anthropometric measurement and Maternal and Child Health Index. The
table shows that 32.6 percent children belong to low maternal and child
health level are stunted, 27.3 percent children belongs to medium level are
stunted and 26.6 percent children belongs to high level are stunted. So this
table shows that stunting is high among those children who have low
maternal and child health level. Again, 23.2 percent of the children who
falls in the low maternal and child health status are underweight, while 14.9
percent of the medium level children are underweight and among high
status it is only 12.2 percent. Further the table shows that 17.3 percent
children belong to low maternal and child health level are wasted, 15.5
percent children belongs to medium status are wasted and in the case of
high status group it is only 10.2 percent. So this table shows that wasting is
high among those children who have low maternal and child health level.
iS8
Table Vll/.4: Percentage Distribution of Children by Anthropometric
measurement and Maternal and Child Health Index
Maternal and Stunted Underweight Wasted
Child Health
Index
Low 32.6 (414) 23.2 (414) 17.3 (414)
(45.8) (54.2) (47.3)
Medium 27.3 (315) 14.9(315) 15.5(315)
(29.2) (26.6) (32.7)
High 26.6 (278) 12.2 (278) 10.2 (278)
(25.1) (19.2) (20.0)
29.3 (1007} 17.6 (1007} 14.9 (1007}
Total (100.0} (100.0} (100.0}
i (295} (177} (150} I
Again, the maternal and child health index also provides that
children belong to low category are more vulnerable with stunting,
undervveight and wasting compared to other group of children.
Vlll.5: CIAF (Composite Index for Anthropometric Failure}
CIAF permits desegregation of the undernourished children into
different subgroups as shown in the table Vlll.5.
From the table it is clear that overall only 57.6 percent children
studied are anthropometrically normal; remaining 42.4 percent children are
suffering from one or other form of anthropometric failure. There are 18
percent children with stunting alone, 1.6 percent children with underweight
only and 7 .1 percent children with wasting alone. It is also seen that 7 .8
percent children affected with both stunting and underweight, 0.1 percent
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i
children with stunting and wasting and 4.7 percent children with
underweight and wasting.
Table V/11.5: Percentage Distribution of Children by
Anthropometric failure
Anthropometric failure Percentage
No failure 57.6
Stunting Only 18.0
Underweight Only 1.6
Wasting Only 7.1
Stunting + Underweight 7.8
Stunting + Wasting 0.1
Underweight+ Wasting 4.7
Stunting + Underweight + Wasting 3.2
Total 100.0 (1007)
Again 3.2 percent children have all these anthropometric failures.
From this table it is clear that there are children who suffer from one or
other form of anthropometric failures. This is a very serious problem by any
scale. Under such conditions our intervention efforts need to be broader
than providing supplementary nutrition alone.
Vlll.6: Logistic Regression
In order to study the influence of various socio-economic and
demographic variables on anthropometric failures, logistic regression is
found to be a worthwhile statistical technique. Using logistic regression
technique Arshad Mahmood (2001) found that socio-economic factors have
significant impact on malnutrition. The logistic regression result revealed
that children of age 24-35 months are equally likely and the children of age
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36-47 months are likely to be severely underweight as that of the children
of age 12-23 months (Rajarethnam and Jyothi Hallad, 2000).They also
uncovered that the likelihood of children of SC/ST communities being
severely underweight is only slightly higher. Using logistic regression
Tharakan and Suchindran (1999) explained that the coefficients are
positive for age and month's breastfed, their odds ratios are greater than
one, indicating increased probability of stunting for unit increase in the
value of any of these variables. Again, age and months of breast fed have
positive coefficients with and odds ratios greater than one indicating
increase in their values is associated with increase in the probability of
underweight. And fathers education level has positive coefficient and an
odds ratio greater than one, indicating increased probability for wasting
when they increase in value. Mozumder et.al. (2000) used logistic
regression and found that short subsequent birth intervals emerge as a
significant predictor of malnutrition among children. The odds of being
stunted varied by fathers education in Goa and mothers education in
Kerala (Rajram.et.al, 2003). Again, Rohini Pande (2003) identified that girls
and boys no longer have significantly different odds for severe stunting. So
this technique is found to be appropriate for studying the relationship of
independent variables on nutritional status. The results of logistic
regression are discussed in the following paragraphs.
Vlll.6.1: Logistic regression - Stunting
The following table (Vlll.6) shows the result of logistic regression.
Here the dependent variable for logistic regression analysis is, children with
stunting, assign value one, otherwise zero.
The result clears that the children belonging age group 2-3 have 53
percent more chances of being stunted than children belong to 1-2 age
group. It is also noted that chances of getting stunted decreases with age.
There is no gender difference in the case of getting stunted.
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Table Vl//.6: Logistic Regression-Dependent Variable: Stunting-1, No-0
Name of the variable Exp(B)
Age of the child
1-2 (R)
2-3 1.532*
3-4 1.294*
4-5 1.173*
Sex of the child
Female (R)
Male 1.009*
Religion
Hindu (R)
Muslim 1.441 *
Christian 0.794*
Community
Others (R)
SC/ST 1.595*
Place of Residence
Rural (R)
Urban 0.693*
Coastal 1.534*
Type of House
Kutcha(R)
Pucca 0.0891 *
Source of water
Own pipe or well(R)
Other sources 1.421 **
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Toilet facility
Yes(R)
No 1.634**
Education of Father
Below Primary Level (R)
Middle Level 0.961 *
High School Level 0.835*
Higher secondary or above 0.621 *
Education of Mother
Below Primary Level (R)
Middle Level 0.824*
High School Level 0.805*
Higher secondary or above 0.643*
Occupation of father
Govt.Employees(R)
Coolie 1.396*
Others 1.447*
Occupation of Mother
Working(R)
Not Working 1.092*
Monthly Family Income
Below 5000Rs/-(R)
Above 5000 0.566**
Exposure to Mass media
No(R)
Yes 0.883*
Antenatal Checkup
Irregular (R)
Regular 0.784*
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Premature Birth
No (R)
Yes 1.927*
Birthweight
>2.5 Kg (R)
2.5 Kg-3.5 Kg 0.701**
>3.5 Kg 0.982*
Breast Feeding
Fed within hour(R)
Fed in the first day 1.122*
Fed after first day 2.034**
Birth order
First or Second(R)
Above 1.315*
Continuous Disease
No (R)
Yes 1.242*
Caring of child
Self (R)
With husband 0.821 *
With senior person 0.842*
Others 1.412*
* Significance Level 1 % level, * Significance Level 5% level
Muslim children have· 44 percent more chances of being stunted
than Hindu children, while Christian children have lesser chances than
Hindu children. Children belonging to SC/ST community have about 60
percent more chances of being stunted and children belongs to urban
areas have low chances of being stunted than rural children and the
coastal children have 53 percent higher chances than rural children.
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The result of logistic regression also shows that as education of
parents increases the chances being stunted decreases. Children whose
fathers are in the Govt.service have low chances being stunted compared
to children of coolie and other workers. Children whose mothers are not
working have low chances of being stunted. It is also noted that children
belongs to high monthly income families have low chances of being stunted
and children who belong to houses with media exposure have low chances
of being stunted.
Mothers who receive regular antenatal checkup have low chances of
being stunted children and premature babies have nearly 93 percent more
chances of being stunted than matured babies. Children with birth weight
ranging 2.5 Kg to 3.5 Kg have less chances of being stunted than others
and it is also noted that children who are breastfed within one hour after
delivery have low chances of being stunted and the result is found to be
signi ficant Again children, who are from higher birth order, have more
chances of being stunted and children with continuous disease have high
chances of being stunted. It can also apparent from table that children are
found to be more stunted if they are cared by others (servant etc.).
Vlll.6.2: Logistic regression - Underweight
The following table (Vlll.7) shows the result of logistic regression.
The dependent variable for logistic regression analysis is, children with
underweight, assign value one, otherwise zero.
The result shows that as age of the child increases the chances of
being underweight also increasing and female children have slightly less
chances of being underweight. Children belongs to Muslim religion have
high chances of being underweight than others and children who belongs
to SC/ST community have 36 percent high chances of being underweight
than others. Urban children have low chances of being underweighed and
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children who belong to pucca houses have about 21 percent less chance of
being underweighed. Also children belongs to those family with own source
of drinking water have low chances of being underweighed. The likelihood
of having underweight is low among houses with toilet facility.
Table Vlll. 7: Logistic Regression-Dependent Variable:
Underweight-1, No-0
Name of the variable Exp(B)
Age of the child
1-2 (R)
2-3 1.414*
3-4 1.495*
4-5 1.534*
Sex of the child
Female (R)
Male 1.017*
Religion
Hindu (R)
Muslim 1.011 *
Christian 0.934*
Community
Others (R)
SC/ST 1.365*
Place of Residence
Rural (R)
Urban 0.712*
Coastal 1.004*
Type of House
Kutcha(R)
Pucca 0.781*
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Source of water
Own pipe or well(R)
Other sources 1.371**
Toilet facility
Yes(R)
No 1.329**
Education of Father
Below Primary Level (R)
Middle Level 0.841*
High School Level 0.826*
Higher secondary or above 0.781*
Education of Mother
Below Primary Level (R)
Middle Level 0.824*
High School Level 0.775*
Higher secondary or above 0.723*
Occupation of father
Govt.Employees(R)
Coolie 1.416*
Others 1.436*
Occupation of Mother
Working(R)
Not Working 1.019*
Monthly Family Income
Below 5000Rs/-(R)
Above 5000 0.732**
Exposure to Mass media
No(R)
Yes 0.773*
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Antenatal Checkup
Irregular (R)
Regular 0.814*
Premature Birth
No (R)
Yes 1.757*
Birthweight
>2.5 Kg (R)
2.5 Kg-3.5 Kg 0.063**
>3.5 Kg 0.832*
Breast Feeding
Fed within hour(R)
Fed in the first day 1.322*
Fed after first day 1.884**
Birth order
First or Second(R)
Above 1.042*
Continuous Disease
No (R)
Yes 1.734*
Caring of child
Self (R)
With husband 0.773*
With senior person 0.845*
Others 1.312*
** Significance Level 1 % level, * Significance Level 5% level
As in the case of stunting the educational level of parent's increases,
the chances of being underweight children is decreases and children who
belong to the fathers working in Govt. service have low chances of being
stunted. It is also noted that children who belongs to nonworking mothers
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have low chances of being underweighed children. Children who belong to
low monthly income families have more chances of become underweight
and children who belongs household with mass media exposure have low
chances of being underweight.
Mothers who received irregular antenatal checkup have more
chance of having underweight children. Premature babies have 75 percent
more chances of being underweight than others and children who have
birthweight ranging from 2.5Kg to 3 Kg have low chances of being
underweight and this relationship is found to be more significant. Likewise
children who were early breastfed have low chances of being underweight.
Children who have high birth order have slightly more chances of being
underweighed and children who have continuous disease have about 73
percent more chances of being underweight and this result is found to be
highly significant. Children who got care from others have more chances of
underweight.
Vlll.6.3 Logistic regression - Wasting
The following table (Vlll.8) shows the result of logistic regression.
The dependent variable here used for logistic regression analysis is,
children with wasting, assign value one, otherwise zero.
The chances of wasting are found to have increases as the age of
the child increases and males have slightly more chances (12 percent) of
being wasted than females. Children belong to Muslim and Christian has
low chances of being wasted than reference category and the children
belong to SC/ST category have more chance of being wasted. Again the
children who belong to urban and coastal areas have low chances of being
wasted and the children belong to pucca houses have low chances of
being wasted. It is also noted that children who belongs to families with
common or other source of drinking water have 6 percent more chances of
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wasted and the children belongs to household with toilet facility have less
chance of being wasted.
Table Vl//.8: Logistic Regression-Dependent Variable: Wasting-1, No-0
Name of the variable Exp(B)
Age of the child
1-2 (R)
2-3 1.355*
3-4 1.513*
4-5 1.604*
Sex of the child
Female (R)
Male 1.124*
Religion
Hindu (R)
Muslim 0.984
Christian 0.892*
Community
Others (R)
SC/ST 1.006*
Place of Residence
Rural (R)
Urban 0.934*
Coastal 0.904*
Type of House
Kutcha(R)
Pucca 0.936*
Source of water
Own pipe or well(R)
Other sources 1.064*
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Toilet facility
Yes(R)
No 1.140*
Education of Father
Below Primary Level (R)
Middle Level 0.948*
High School Level 0.876*
Higher secondary or above 0.711*
Education of Mother
Below Primary Level (R)
Middle Level 0.914*
High School Level 0.843*
Higher secondary or above 0.656*
Occupation of father
Govt.Employees(R)
Coolie 1.546*
Others 1.606*
Occupation of Mother
Working(R)
Not Working 0.916*
Monthly Family Income
Below 5000Rs/-(R)
Above 5000 0.942*
Exposure to Mass media
No(R)
Yes 1.014*
Antenatal Checkup
Irregular (R)
Regular 0.973*
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Premature Birth
No (R)
Yes 1.014*
Birthweight
>2.5 Kg (R)
2.5 Kg-3.5 Kg 0.917**
>3.5 Kg 0.784*
Breast Feeding
Fed within hour(R)
Fed in the first day 1.321 **
Fed after first day 2.106*
Birth order
First or Second(R)
Above 1.637*
Continuous Disease
No (R)
Yes 1.012*
Caring of child
Self (R)
With husband 0.962*
With senior person 1.013*
Others 1.143*
** Significance Level 1 % level, * Significance Level 5% level
As education of parents increases the chances of having wasted
children becomes low. Govt.employed fathers have low chances of getting
wasted children and working mothers has low chances of getting wasted
children. Children belong to low income families have more chance of
wasting than others. Children who belong to family with mass media
exposure have low chances of being wasted.
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Mothers who received regular antenatal checkup have low chances
of getting wasted children and premature babies are more chances of
being wasted. Children whose birthweight above reference category have
low chances of being wasted and children who are early breastfed have
low chances of being wasted and are found to be more significant. Children
with higher birth order have 63 percent more chances of being wasted and
this relationship is also highly significant. Again children with continuous
disease have more chances of being wasted and children who cared by
respondent or with the help of their husband have low chances of being
wasted.
Vlll.6.4: Logistic regression - Anthropometric failure
The following table (Vlll.9) shows the result of logistic regression.
The dependent variable for logistic regression analysis is, if the child
suffering any one of the anthropometric failure, assign value one, otherwise
zero.
The result shows that the children who belonging to age group 2-3
have 64 percent more chances of being failure than reference category and
male children have a little chances of being failure. Children belonging to
Muslim community have 28 percent more chances of being failure than
children belonging to Hindus and Christians have less chances of being
failure than Hindus. The likelihood of having failure is more for children
belong to SC/ST category.
The likelihood of having failure is more among coastal children and
less among urban children compared to rural children. Children who belong
to pucca houses have low chance of being anthropometrically normal than
others.
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Table V/11.9: Logistic Regression-Dependent Variable:
Anthropometric failure-1, No-0
Name of the variable Exp(B)
Age of the child
1-2 (R)
2-3 1.642*
3-4 1.244*
4-5 1.213*
Sex of the child
Female (R)
Male 1.016*
Religion
Hindu (R)
Muslim 1.281*
Christian 0.824*
Community
Others (R)
SC/ST 1.825*
Place of Residence
Rural (R)
Urban 0.743*
Coastal 1.414*
Type of House
Kutcha(R)
Pucca 0.842*
Source of water
Own pipe or well(R)
Other sources 1.323**
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Toilet facility
Yes(R)
No 1.525**
Education of Father
Below Primary Level (R)
Middle Level 0.932*
High School Level 0.874*
Higher secondary or above 0.732*
Education of Mother
Below Primary Level (R)
Middle Level 0.876*
High School Level 0.824*
Higher secondary or above 0.756*
Occupation of father
Govt.Employees(R)
Coolie 1.396*
Others 1.447*
Occupation of Mother
Working(R)
Not Working 1.074*
Monthly Family Income
Below 5000Rs/-(R)
Above 5000 0.637**
Exposure to Mass media
No(R)
Yes 0.845*
Antenatal Checkup
Irregular (R)
Regular 0.784*
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Premature Birth
No (R)
Yes 1.927*
Birthweight
>2.5 Kg (R)
2.5 Kg-3.5 Kg 0.071**
>3.5 Kg 0.982*
Breast Feeding
Fed within hour(R)
Fed in the first day 1.122*
Fed after first day 2.034**
Birth order
First or Second(R)
Above 1.334*
Continuous Disease
No (R)
Yes 1.242*
Caring of child
Self (R)
With husband 0.821 *
With senior person 0.842*
Others 1.412*
** Significance Level 1 % level, * Significance Level 5% level
Children who belong to household with other source of water have
32 percent more chances of being anthropometric failure than household
with own pipe or well. Children belong to houses without toilet facility has
53 percent higher chances of getting anthropometrically failure. As
education of parent's increases, the chance of being anthropometric failure
in children is found to be decreasing. Children of Government employees
and working mothers have less chances of being anthropometric failure.
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Children with high monthly income household have less chances of being
anthropometrically failure. Again children whose parents are exposed to
mass media have less chance of being anthropometric failure.
Children to mothers who had regular antenatal checkup have low
chances of being anthropometrically failure and premature babies have 93
percent more chances to become failure than matured babies and this
result is highly significant. The children with adequate birthweight have 28
percent low chance of being failure and this relation is also found to be
highly significant. The children who breastfed after first day have more than
double chances of being failure than others children who had fed within one
hour of delivery (Significance one percent level). The children with higher
birth order have more chances of being failure. Children who suffer
continuous diseases have 24 percent more chances of being failure than
other children. It is also noted that the chances of being failure is high
among to children whose daily care provided by others (servants etc.) than
with the help of husband or senior persons compared to reference
category.
Vlll.7: Conclusion
The socio-economic and demographic index and maternal and child
health index that divides the sample in to three classes (low, medium and
high) are given in this chapter. Again the influence of these three classes
on stunting, underweight and wasting were described. The children were
classified in to two groups using CIAF technique. The effect of various
socio-economic, demographic and health factors studied using statistical
technique, logistic regression. The next chapter presents the summary and
concluding remarks and suggestions and policies to improve the nutritional
status of children.
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