Prevalence and risk factors for malnutrition and effectiveness of need based intervention on nutritional status and cognitive development of preschool children in Anganawadi centers of Udupi District

Introduction

Child malnutrition is a wide spreadpublic health problem having international consequences because good nutritionis an essential determinant for their well-being. The most neglected form ofhuman deprivation is malnutrition, particularly among preschool children. Indiais one of the few countries in the world where poor nutritional status amongpreschool children is detrimental to their health outcome.

Malnutrition is a condition thatdevelops when the body does not get the proper amount of protein, energy,vitamins and other nutrients. Malnutrition is technically a category ofdiseases that includes: undernutriiton, over nutrition and micronutrientdeficiencies. Malnutrition occurs in children who are either undernourished orover nourished. In most of the world, malnutrition is present in the form ofundernutriiton, which is caused by a diet lacking adequate calories andprotein.

Under nutrition reflects a number ofintermediary processes such as household access to food, access to healthservices and caring practices. In India, since a large number of people arepoor, illiterate and ignorant of the importance of hygiene and sanitation, theyconsume inadequate amount of nutrients and suffer from infections that resultin poor utilization of nutrients which leads to under nutrition. This form ofmalnutrition is more common in our country.

UNICEF classifies the immediate causes ofchildhood malnutrition as insufficient diet as well as stress, trauma, frequentinfections and poor psychosocial care. Insufficient dietary intake may refer topoor breastfeeding practices, early weaning, delayed introduction ofcomplementary foods and insufficient protein in the diet.  Other factors that influence food intakeinclude health status, food taboos, growth and personal choice related to diet.Malnutrition can also develop due to neglect, abnormal mealtimes with a careror parent or insufficient quantities of food. Because of insufficient parentalknowledge, poor appetite in the child or neglect, physical or emotional abuse,sometimes the mother restricts the child’s food intake.

The effect of undernutriiton on youngchildren (ages 0-8) can be devastating and enduring. Delayed physical growthand motor development. It can impede behavioral and cognitive development,lower educational achievement, deficient social skills, decreased attention,deficient learning and reproductive health, thereby undermining future workproductivity. Malnutrition in early childhood has serious, long-termconsequences; it increases morbidity, greater risk of disease and early death.

Background of the study

Global scenario of Malnutrition:Globally it is estimated that under nutrition is responsible, directly orindirectly, for at least 35% of deaths in children less than five years of age.More than a quarter of World’s children are still malnourished – 26.7%(150million) children are underweight and 32.5% (182 million) stunted of whom70% are in Asia, 26% in Africa and 4% in Latin. An estimated 32% or 186million, children below five of age in developing countries are stunted andabout 10% or 55 million are wasted.

UNICEF states that the highest levelof underweight children are found in South Asia, involving 46% of allunder-fives in the region. There are more than 6 million preventable childdeaths every year in developing countries. Unfortunately, this is the tip ofthe iceberg. Estimated that, more than 200 million underfive children who failto reach their potential in cognitive development because of poor health andnutrition and deficient care.

Malnutrion in India:

More than half of World’smalnourished children live in India. Malnutrition is a major public healthemergency in India today. It is estimated that, 57 million children areunderweight (moderate and severe). India has a high prevalence of PEM about 50%of the population suffering from it in some form - protein-calorie deficitand/or micro-nutrient malnutrition. 46% of Indian children under 6 years areunderweight, and 38% are short for their age. It is the underlying cause of atleast 50% of deaths of under -five children in the country.

WHO world health statistics (2009)revealed 43.5% underweight underfive in India and 39.8% in Bangladesh amongSEAR which are high prevalence in the world also. In India the prevalence ofundernutriiton is the highest in Madhya Pradesh (55%), followed by Bihar (54%),Orissa (54%), Uttar Pradesh (52%) and Rajasthan (51%), while Karnataka (41%),Kerala (37%) and Tamil Nadu (27%).

Malnutrition inKarnataka:

The findings of the third NationalFamily Health Survey (NFHS-3) reveals an unacceptable prevalence ofmalnutrition among children:42.5% of children under the age of ï¬ve years areunderweight (low weight for age), 48 % are stunted, 19.8%  are wasted. In poorer states the situation iseven worse with over 50 % of children underweight.

2.1 million children are mildlymalnourished, 1.13 million are moderately malnourished and 71,605 are severelymalnutrition children in Karnataka.8According to data provided by women andchild welfare department, 2,689 children have died due to malnutrition, ofwhich 811 died in 2009 and 1,233 in 2010. As many as 645 such deaths have beenrecorded till August 2011.Over 4,531 number of children suffering from severemalnutrition and 2,600 children died of malnutrition in Raichur District ofKarnataka.

A cross sectional study was conductedon prevalence of malnutrition among preschool children in Azad Nagar,Bangalore.  The prevalence ofmalnutrition among children was 68%. Among that, male children malnutrition was57.94% and females 42.06%.

 Malnutrition in Udupi :

A cross-sectional study was conductedin 11 villages of the field practice area of Community Medicine Department ofManipal in Udupi taluk among Anganawadi children.  Result showed that, 32.3% children aremalnourished. Proportionally girls (46.2%) were more malnourished than boys(33.6%).

A case control study was carried outamong under five children in Udupi taluk. Study found under-nutrition wasassociated with illness in the last one month , feeding diluted milk and havingmore than two children with a birth interval < 2 years.  Study concluded that, childhood illness,short birth interval, mothers negligence about diet and consumption of dilutedmilk were significant contributory factors.

On July 3rd 2012, as per DistrictHealth Officer, Udupi, 371 children who are less than 6years of age, in thedistrict are suffering of malnutrition. According to report from CDPO, Udupi(August 2012), a total 7859 underfive children were malnourished, 649 childrenwere severely malnourished in Udupi district.

Malnutrition andcognitive development:

Bhoomika R Kar (2007) conducted studyon malnourished children in NIMHANS, Banglore. Cognitive development wasassessed by using Gessell’s developmental schedule. Children with grade II andIII malnutrition had poor development in all areas of behaviour ie. motor,adaptive, language and social development.

Agarwal DK, Upadhyay SK, Agarwal KN(1989) conducted a study among rural children studying in primary school inBanglore between the age of 6-8 years were assessed on measures of socialmaturity. Study found, malnutrition was associated with deficits of socialcompetence, visuo-motor coordination and memory. IQ scores decreased with theseverity of malnutrition.

Thus present study intends to assessthe prevalence and identify the risk factors for malnutrition and provide needbased intervention such as education, food demonstration and counseling tomothers to improve nutritional status and cognitive development of preschoolchildren.

Problem statement:

“Prevalence and risk factors formalnutrition and effectiveness of need based intervention on nutritional statusand cognitive development of preschool children in Anganawadi centers of UdupiDistrictâ€.

Purpose of the study:

To identify the prevalence and riskfactors of malnutrition among preschool children. Study also aims to find outthe effect of need based intervention to mothers of malnourished preschooler onmodifying the various factors, which will further help to improve thenutritional status and cognitive development of preschool children.

Objectives:

The objectives of the study are to :

identify theprevalence of malnutrition among preschool children

Identify the riskfactors for  malnutrition among preschoolchildren.

determine theeffectiveness of need based intervention in terms of

·        changesin nutritional status of malnourished preschool children.

·        changesin cognitive development  of malnourishedpreschool children.

 Hypotheses:

Will be tested at 0.05 level ofsignificance

·        Therewill be a significant difference in the pre and posttest measurement ofnutritional status and cognitive development of malnourished preschool childrenin intervention group.

·        Theposttest measurement of nutritional status of malnourished preschool childrenin the intervention group will be significantly higher than control group.

·        Theposttest cognitive development of malnourished preschool children in theinterventional group will be significantly higher than the control group.