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 Table of Contents  
ORIGINAL ARTICLE
Year : 2019  |  Volume : 4  |  Issue : 1  |  Page : 7-10

An exploratory study to assess the prevalence and risk factors of malnutrition among under-five children residing in selected rural areas of district Sirmaur, Himachal Pradesh


1 Department of Child Health Nursing, Eternal University, Sirmaur, Himachal Pradesh, India
2 Department of Community Health Nursing, Akal College of Nursing, Eternal University, Sirmaur, Himachal Pradesh, India

Date of Submission29-Mar-2019
Date of Acceptance16-May-2019
Date of Web Publication20-Jun-2019

Correspondence Address:
Priyanka Devi
Department of Child Health Nursing, Akal College of Nursing, Eternal University, Baru Sahib, Via Rajgarh, Sirmaur - 177 001, Himachal Pradesh
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/bjhs.bjhs_14_19

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  Abstract 

INTRODUCTION: Nutrition is one of the most essential things of life, and it becomes an integral part for the growth and development of body and maintenance of health. In rural areas of India, there is widespread undernutrition.
AIM: This study aims to assess the prevalence and to explore the most probable risk factors influencing malnutrition among under-five children.
SETTING AND DESIGN: A quantitative nonexperimental exploratory study design was conducted in selected rural areas of district Sirmaur, Himachal Pradesh, India.
SUBJECTS AND METHODS: A total of 200 children and their mothers were selected by purposive sampling technique. Anthropometric assessment and semi-structured interview schedule was used as tool for data collection.
RESULTS: The prevalence of stunting was 40% and wasting was 19.5%. Maternal factors, birth characteristics, breastfeeding practices, environmental factors, and dietary practices affect malnutrition among under-five children.
CONCLUSION: The recapitalization of the study suggests that there was high prevalence of malnutrition, and various risk factors are responsible for malnutrition among under-five children.

Keywords: Malnutrition, prevalence, risk factors, under-five children


How to cite this article:
Devi P, Kaur S. An exploratory study to assess the prevalence and risk factors of malnutrition among under-five children residing in selected rural areas of district Sirmaur, Himachal Pradesh. BLDE Univ J Health Sci 2019;4:7-10

How to cite this URL:
Devi P, Kaur S. An exploratory study to assess the prevalence and risk factors of malnutrition among under-five children residing in selected rural areas of district Sirmaur, Himachal Pradesh. BLDE Univ J Health Sci [serial online] 2019 [cited 2019 Nov 19];4:7-10. Available from: http://www.bldeujournalhs.in/text.asp?2019/4/1/7/260729

Malnutrition is a silent emergency.[1] malnutrition includes both under nutrition and over nutrition ranging from severe nutrient deficiencies to extreme obesity.[2] Globally, undernutrition is responsible for more than 40% child deaths.[3]

About 80% of the world's undernourished children live in 20 countries, of them nearly 60 million children who are underweight, live in India. In India, majority (54%) of all deaths among under-five children are related to malnutrition. Because of the widespread prevalence in India, mild-to-moderate malnutrition cause more deaths (43%) than severe malnutrition (11%).[4]

The World Health Organization (WHO) has reported that malnutrition and hunger is the greatest single threat to the world's public health.[5] In India, according to National Health Family Survey 4 in 2014, 37% children under-five age are stunted, 42% are wasted, and 34% are underweight. In Himachal Pradesh, according to NFHS-4-National Family Health Survey (NFHS4), 21.6% under-five children are underweight, 16% were wasted, and 26.7% were stunted. Malnutrition is the underlying cause of at least 50% of deaths of children under-five. According to the district-level household and facility survey 4 in Himachal Pradesh 2012–2013, 31.6% under-five children were wasted, 50.5% were stunted, and 37.9% were under weight.[6]

In sustainable development goals (SDGs) (2016), emphasis of second goal of SDGs is zero hunger, i.e., improved nutrition till 2030. According to the latest Global Hunger Index (2017), of 119 countries, India is ranked 100th in the list but the malnutrition rate is 31.4%.[7]

During clinical postings, researcher screened few cases of severe malnutrition among under-five children, and the cases were from backward rural areas of district Sirmaur. Hence, there is a need to find the cases and contributing factors responsible for malnutrition to improve the health condition of children.


  Subjects and Methods Top


A quantitative nonexperimental exploratory study was conducted on 200 under-five children and their mothers through purposive sampling techniques residing in selected 10 rural areas of district Sirmaur. Data were collected through semi-structured interview and anthropometric measurement. Semi-structured interview comprised demographic variables, various risk factors such as maternal factors, birth characteristics, breastfeeding practices, environmental factors, health-care facilities, and dietary factors. The tool was constructed after extensive review of literature and discussion with the experts and with the investigator's personal and professional experience. Manual tools such as weighing machine and measuring tape were used for the anthropometric measurement.

Ethical permission was taken from the research committee of the concerned college and Panchayat Pradhan of selected villages. Written informed consent was taken from all the participants. Validity and reliability of tool was maintained. Each candidate was interviewed for 15–29 min. Data were analyzed using descriptive (frequency, percentage, mean, and standard deviation) and inferential statistics (Chi-square).


  Discussion Top


Findings of study had shown that of the total sample, 40% of under-five children were stunted followed by 19.5% were wasted, 10.48% were stunted and wasted, respectively [Figure 1]. The rate of stunting was high. As per mid-upper arm circumference [MUAC], 25% of them were moderately malnourished followed by 18% at risk and 3% has severe malnutrition and 54% were normal [Figure 2]. Of the total sample, 64% were boys and 36% were girls. Of 64% boys, 10.5% boys were wasted and 19.5% boys were stunted. Of 36% girls, 9% were wasted and 20.5% were stunted. It is shown that the rate of stunting was more as compared to the wasting in both the genders.
Figure 1: Percentage distribution of the prevalence of stunting and wasting among under five children

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Figure 2: Pie diagram showing distribution of prevalence of malnutrition as per mid-upper arm circumference

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A similar study was conducted in the community area of Medical College Pune, India, during 2008–2009. They have selected 336 under-five children through enumerated sampling technique by house-to-house survey. Anthropometric measurements of the children were carried out as per WHO guidelines. The study results revealed that of total, only 319 children have participated in the study; among them, majority (65.2%) of children were undernourished. Undernutrition was significantly more among boys than among girls. The overall prevalence of morbidities was 43.4%.[8]

This study finding has shown that malnutrition was associated with the occupation of father, type of house, source of information, number of rooms, child's eating habits, gender of child, and education of mothers. Other than this, the less antenatal visits, inadequate breastfeeding practices, unsafe drinking water, lack of transport facilities, lack of awareness regarding educational programs, and inadequate dietary practices were found as responsible factors for malnutrition among under-five children [Table 1].
Table 1: Association between the prevalence of mid-upper arm circumference with risk factors of malnutrition

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Similar study was conducted in a slum community area of Gurgaon, Haryana, among 500 randomly selected households of <6-year-old children. Physical examination and anthropometric measurement were done to assess nutritional status. The study revealed that the prevalence of protein-energy malnutrition (PEM) was found to be 43.86% (37.73% among males, 50% among females). Nearly 31.48% of children have clinical signs of nutritional deficiency. The major factors responsible for PEM were poor literacy of parents, low socioeconomic status and recurrent diarrhea, prolonged breastfeeding, and poor quality of supplements. These factors are not due to the lack of awareness but because of their home conditions.[9]

In the present study, anthropometric assessment was done by checking the height, weight, and MUAC. After the analysis, the prevalence of malnutrition as per height and weight was more in comparison to the MUAC. The prevalence as per height was 40%, and as per weight, it was 19.5%, and stunting and wasting common cases were 10.94%. However, as per MUAC, the prevalence of malnutrition was only 28%, i.e. moderate and severe category. The present study identified that only MUAC cannot detect all the cases of malnutrition [Table 2].
Table 2: Comparison between the prevalence findings of height, weight, and mid-upper arm circumference

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A study was conducted to assess the prevalence of malnutrition among 256 children of rural areas who attended Anganwadi Centres of Karnataka in South India. The study findings revealed that the presence of wasting, stunting, and wasting and stunting were 31.2%, 9.4%, and 29.2%, respectively. The wasting was more prevalent among children. The study results revealed that MUAC should be used with caution as a method to assess the malnutrition because it is not reliable for screening of malnutrition.[10]


  Conclusion Top


The findings of the study showed that the prevalence of malnutrition was high. There was presence of various risk factors such as less antenatal visits, inadequate breastfeeding practices, unsafe drinking water, lack of transport facilities, lack of awareness regarding educational programs, and inadequate dietary practices responsible for malnutrition among under-five children. Health education and awareness program will enhance the mother's knowledge regarding contributing risk factors and can also help to decrease the prevalence of malnutrition.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
  References Top

1.
Pulfrey S. Malnutrition: A silent emergency. CMAJ 2006;174:1837.  Back to cited text no. 1
    
2.
Kandala NB, Madungu TP, Emina JB, Nzita KP, Cappuccio FP. Malnutrition among children under the age of five in the democratic republic of Congo (DRC): Does geographic location matter? BMC Public Health 2011;11:261.  Back to cited text no. 2
    
3.
Kumar A, Kamath VG, Kamath A, Rao CR, Pattanshetty S, Sagir A. Nutritional status assessment of under-five beneficiaries of integrated child development services program in rural Karnataka. Australas Med J 2010;3:495-8.  Back to cited text no. 3
    
4.
Edith M, Priya L. Knowledge, attitude and practice (KAP) survey on dietary practices in prevention of malnutrition among mothers of under-five children. Manipal J Nurs Health Sci 2016;2:19-24.  Back to cited text no. 4
    
5.
Levels and Trends in Child Mortality Report 2011. Estimates Developed by the UN Inter-Agency Group for Child Mortality Estimation. Available from: http://www.unicef.org/media/files/Child_Mortality_Report_2011. [Last accessed on 2019 Feb 14].  Back to cited text no. 5
    
6.
Available from: https://data.gov.in/catalog/district-level-household-and-facility-survey-dlhs-4. [Last accessed on 2019 Jan 16].  Back to cited text no. 6
    
7.
UNICEF India. The Children – Nutrition. Available from: http://www.unicef.org/India/children_2356.htm. [Last accessed on 2019 Feb 18].  Back to cited text no. 7
    
8.
Dhone AB, Chitnis UB, Bhawalkar JS, Jadhav SL. Epidemiological study of under nutrition among under five years children in an urban slum. Med J Dr DY Patil Vidyapeeth 2012;5:110. Available from: http://www.mjdrdypu.org/article.asp?issn=0975-2870. [Last accessed on 2019 Feb 27].  Back to cited text no. 8
    
9.
Kumar T, Balbir S. An epidemiological study of protein energy malnutrition among children below six years' age in an urban slum of Gurgaon, Haryana, India. Int J Community Med Public Health 2016;3:2431-6.  Back to cited text no. 9
    
10.
Joseph B, Rebello A, Kullu P, Raj VD. Prevalence of malnutrition in rural Karnataka, South India: A comparison of anthropometric indicators. J Health Popul Nutr 2002;20:239-44.  Back to cited text no. 10
    


    Figures

  [Figure 1], [Figure 2]
 
 
    Tables

  [Table 1], [Table 2]



 

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