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Table of Contents
ORIGINAL ARTICLE
Year : 2021  |  Volume : 12  |  Issue : 3  |  Page : 127-131

Prevalence of undernutrition among preschool children (3–6 years) attending anganwadi centers in urban Mysuru


1 Department of Community Medicine, JSS Academy of Higher Education and Research Centre, Mysore, Karnataka, India
2 Department of Community Medicine, JSS Medical College, JSS Academy of Higher Education and Research, Mysore, Karnataka, India

Date of Submission28-Jan-2021
Date of Decision17-Feb-2021
Date of Acceptance17-Feb-2021
Date of Web Publication20-Jul-2021

Correspondence Address:
Dr. Preetha Susan George
Department of Community Medicine, JSS Medical College, Mysore, Karnataka
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/injms.injms_11_21

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  Abstract 


Introduction: For balanced growth and childhood development, adequate nutrition is very necessary. The health and nutritional status of children is an indicator of the health and nutrition of the community and the nutritional profile of the entire country. Undernutrition is not only a significant cause of childhood morbidity and mortality, but it jeopardizes physical as well as mental development of children. The Public Distribution Scheme's bias toward calories and subsidies continued on rice and wheat and did not include more diverse and nutritious foods. Aims and Objectives: This study aims to determine the prevalence of undernutrition among preschool children (3–6 years) attending Anganwadi in Urban Mysuru. Materials and Methods: This community-based cross-sectional study was carried out in the field practice area of Bannimantap Urban Primary Health Centre for a period of 1 year. A total of 365 children (3–6 years) were included in the study. Required total sample size of 365 children in the age group of 3–6 years was selected from each Anganwadi as per population proportionate to size sampling technique. A pretested, semi-structured proforma was used to collect data pertaining to sociodemographic variables, maternal-related variables, and child-related variables. Data were coded and entered into MS Excel 2016 and analyzed using SPSS Version 22. Results: Among the total 365 children aged 3–6 years, 54.7% were males and 45.3% were females. Majority (60.8%) of the children hailed from nuclear family and 50% belonged to upper lower socioeconomic class. The prevalence of undernutrition which constitutes underweight, stunting, and wasting was 25.4%, 23.5%, and 10.2%, respectively. Prevalence of severe acute malnutrition was 0.3%. Conclusion: Lack of socioeconomic development along with ignorance of cost-effective nutritional diet intake contributed to undernutrition in our study area.

Keywords: Anganwadi, preschool children, undernutrition, Urban Mysuru


How to cite this article:
George PS, Murthy M R. Prevalence of undernutrition among preschool children (3–6 years) attending anganwadi centers in urban Mysuru. Indian J Med Spec 2021;12:127-31

How to cite this URL:
George PS, Murthy M R. Prevalence of undernutrition among preschool children (3–6 years) attending anganwadi centers in urban Mysuru. Indian J Med Spec [serial online] 2021 [cited 2021 Sep 19];12:127-31. Available from: http://www.ijms.in/text.asp?2021/12/3/127/321976




  Introduction Top


Adequate nutrition is very crucial for balanced and healthy growth and early childhood development. Economic growth and human development need well-nourished communities that are able to learn new skills, think critically, and contribute to their society. Children between 1 and 6 years constitute 15% of total population. Nutritional status of preschool children is considered to be the most sensitive indicator of community health, owing to their rapid growth.[1] Undernutrition also includes “hidden hunger,” which is due to the deficiency of micronutrients such as iron, iodine, and other trace elements.[2] Hidden hunger affects more than 2 billion people globally, which is more than twice the 805 million people who do not have enough calories to eat (FAO, IFAD, and WFP 2014).[3]

Globally, in 2019, 47 million (6.9%) under five children were wasted among which 14.3 million (2.1%) had severe wasting. The deaths that were linked with undernutrition, among children under the age of 5 years, were around 45%, mainly in low- and middle-income countries.[4],[5] The Joint Malnutrition Estimates' (UNICEF) 2020 edition shows that 144 million children under the age of 5 years were stunted in 2019, and 47 million suffered from wasting.[6],[7] In India, the child population (0–6 years), according to the Census of India (2011), was 13.94%. As per National Family Health Survey (NFHS) IV data, in India, 31% of under 5 were stunted, 20% were wasted, 21.1% were underweight, and 7.5% were severely wasted.[8] In the 2019 Global Hunger Index, India ranks 102nd out of the 117 qualifying countries, making India a home to the highest number of malnourished people in the world, which is about one-quarter of the global total.[9]

The term undernutrition encompasses stunting, i.e., low height-for-age (chronic malnutrition), wasting, i.e., low weight-for-height (acute malnutrition), and underweight, i.e., low-weight-for-age. As per the World Health Organization (WHO), underweight, stunting, and wasting are defined as Z-scores <2 standard deviations of weight for age, height for age, and weight for height, respectively. Wasting and stunting reflect acute and chronic nutritional deficiency exposures, respectively. In addition, underweight reflects both acute and chronic exposure to nutritional deficiency.[2] With this background, this study was undertaken to estimate the prevalence of undernutrition among preschool children (3–6 years) attending Urban Anganwadi.


  Materials and Methods Top


It is a community-based cross-sectional study, done over a period of 1 year (January 2019–December 2019) among 3–6-year-old Anganwadi children residing in the Urban field practice area of the Department of Community Medicine, JSSMC (Bannimantap PHC), Mysuru. Specially abled children were excluded and all children aged 3–6 years attending Anganwadi, residing in Urban area and whose parents consented were included in the study. The sample size of 365 was calculated based on the prevalence of undernutrition 31.5% (NFHS IV), with 5% absolute precision, 10% nonresponse rate, and 95% confidence level. Bannimantap Urban PHC area has a total population of 47,717. The area is divided into 5 subcenter areas, which includes: Metagalli, B. M. Shrinagara, Manjunathapura, Hanumantanagar, and H. U. D. C. O. Selection of Anganwadi center was done by taking a list of the Anganwadis from the Child Development Project Officer (CDPO). A total of 22 Anganwadis were selected based on population proportionate to size sampling technique. Required sample size of 365 children in the age group of 3- 6 years were selected from these 22 Anganwadis as shown in [Flow Chart 1].



Before commencing the study, necessary permission was obtained from CDPO of the study area, and ethical clearance was obtained from Institutional Ethics Committee of JSS Medical College, JSS Academy of Higher Education and Research, Mysuru.

A pretested semi-structured questionnaire was used to collect sociodemographic parameters such as age, gender, per capita income, educational status of parents, and occupational status of parents. Socioeconomic status was classified based on Modified Kuppuswamy's Classification. Anthropometric measurements were obtained according to the standard protocol. Body weight was measured without any footwear and with minimal clothing nearest to 0.1 kg using a standard Salter spring balance for children aged 1–5 years and by standard standing weighing machine for children aged 5–6 years. The scale was zeroed before each session. The study participants standing height was measured without foot wear to the nearest 0.1 cm using a standard calibrated bar. The children were made to stand straight with heels, buttocks, shoulders, and back of head touching the rod. Head was held comfortably erect with the lower border of orbit of the eye in the same horizontal plane as the external canal of the ear and the arms hanging loosely by the sides with palms facing the thigh. The headpiece was then lowered gently making contact with the top of head. Mid-upper arm circumference (MUAC) was measured using Shakir tape encircling the arm at the midpoint of the olecranon and acromion and recorded to the nearest 0.1 cm. The measurements were plotted on the WHO Growth Chart and classified as per the WHO Growth Chart for 3–5 years and 5–6 years.

The data collected were coded and transferred into Microsoft Excel worksheet 2016 and were later imported and analyzed using SPSS version 22 (IBM, Armonk, NY) (licensed to JSS AHER). Descriptive statistical measures such as percentages were used. Inferential statistics were applied as needed, such as Chi-square test to find out the association. Differences and associations were interpreted as statistically significant at P < 0.05.


  Results Top


Among the total 365 children, 199 (54.7%) were males and 166 (45.3%) were females. With regard to age distribution, it was observed that, in 3–4 year age group, male children were 155 (77.5%) and female children were 117 (71%); in 4–5-year-old children, 36 (18%) were male children and 35 (21.2%) were female children, and among 5–6-year-old children, male children were 9 (4.5%) and female children 13 (7.8%) as in [Table 1].
Table 1: Distribution of children in accordance with age and gender

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Majority (60.8%) of the children hailed from nuclear family, 38.9% from joint family system and a minor percentage, 0.5%, comes from a three-generation family. Half of the children (50%) belonged to upper lower class and one-third (34.7%) from lower middle class. Only 5.4% of the children were from upper middle class. Majority of the participant's mothers, i.e., 50% had completed high school education and above one-quarter of them had middle school education. 245 from the 365 mothers, constituting to 67.1%, were working in unskilled sectors, which makes it a huge number. 26.1% of the mothers were unemployed.

From the data collected for children age between 3 and 6 years, the variations in weight for age stands at 68.3%, 25.4%, and 6.3% for normal weight, underweight, and severely underweight, respectively, as shown in [Figure 1]. The prevalence of underweight and severely underweight was high among 5–6 years old children; with 59.1% and 9.1%, respectively. Females had a higher prevalence of underweight among 3–5 years and 5–6 years age group; at 26.3% and 69.2%, respectively.
Figure 1: Distribution of children according to weight for age

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Among the children aged between 3 and 6 years, the variations in height for age stands at 56.9% for normal height, 23.5% and 19.4% for underweight and severely underweight respectively, as shown in [Figure 2. Nearly 26.8% of 4–5-year old children were stunted with severely stunted (21.7%) among 3–4-year-old children. Nearly 21.5% of the male children among 3–5-year-old were severely stunted.
Figure 2: Distribution of children according to height for age

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According to the data, 80% have a normal weight for height and 20% of the children fall into deviations of weight for height; 10.2% had wasting, 6.1% with severe wasting, overweight at 2.9%, and obese at 0.6%. The body mass index (5–6 years) also showed a similar pattern, where 86.4% (19/22) children were normal, 4.5% and 9.1% fall into thinness and severely thinness, respectively, as shown in [Figure 3]. The prevalence of wasting was higher among male children (11.5%) and 11.1% of 5–6-year-old males had severe thinness.
Figure 3: Distribution of children according to weight for height/body mass index

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MUAC for children between 3 and 5 years were collected, 91.3% (313/343) possess normal MUAC, 8.5% have moderate acute malnutrition, and 0.3% have severe acute malnutrition (SAM), [Figure 4].
Figure 4: Distribution of children according to mid-upper arm circumference

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  Discussion Top


In the present study, the prevalence of underweight, stunting, and wasting was 25.4%, 23.5%, and 10.2%, which was lower compared to the prevalence reported for Urban Karnataka.[8] This result was comparable to the research by Navya and Udayakiran in the coastal districts of Karnataka, where the prevalence of underweight, stunting, and wasting was 25.5%, 18%, and 15%, respectively.[20] Another study done by Roopadevi and Karinagannanavar, showed a higher prevalence of underweight, stunting, and wasting as 24.8%, 55%, and 23.1%, respectively.[17] Majority of the children, (74.5%) belonged to 3–4 years and 54.7% were males. The prevalence of underweight was higher among females (69.2%), but stunting and wasting were higher among males, 55.6% and 11.5%, respectively, which was similar to the study findings of Madhusudhan and Khargekar[16] but contrary to a study by Roopadevi and Karinagannanavar,[17] which showed a higher prevalence of underweight among boys.

According to the study, the prevalence of underweight (59.1%) and stunting (40.9%) was high among 5–6-year-old children, 10.7% of 3–4-year-old children being wasted, and 9.1% of 5–6 years old children being severely stunted in the current study. This finding was consistent with Payandeh et al., which showed that the rate of undernutrition increased with child's age with increased rate of stunting (4%) among 4–5 years.[19] Another study done by Shreyaswi et al.[20] showed higher undernutrition (68.9%) among the children belonging to 4–5-year age group.[21] The elevated prevalence of undernutrition, especially stunting in older children may be an indicator of failure of growth and development during the first 2 years of life. No significant association could be elicited between the age of the children and prevalence of undernutrition.

In the present study, females had a higher prevalence of underweight which was similar to other studies,[12],[13],[14],[15] A research carried out by Shankar et al.[21] and Ahmed et al., on the contrary showed a greater prevalence of underweight among boys when compared to girls.[18],[22] The prevalence of stunting and wasting was higher in male children than female children in the present study. It showed 55.5% stunting among 5–6-year-old boys and 11.5% wasting among 5–6-year old. This finding was consistent with Shankar et al.,[21] which showed a higher prevalence of stunting among boys (18.27%) when compared to girls.[18] Kavosi et al. reported an increased prevalence of stunting in male children, with an odds ratio of 1.41 times relative to girls.[10] One of the previous studies showed a similar proportion (21.2%) of boys and girls (20%) being wasted.[11] This difference in the prevalence can be due to different geographical area, different food habits, and different sociocultural factors. No significant association was found between the gender of the children and prevalence of under-nutrition.


  Conclusion Top


In the present study, the prevalence of undernutrition, which constitutes underweight, stunting, and wasting among 3–5-year-old preschool children was 25.4%, 23.5%, and 10.2%, respectively. Among 5–6-year-old children, the prevalence of thinness was 4.5%. Prevalence of SAM was very less (0.3%), which signifies improved nutritional status among the children in our study area.

Recommendations

Socioeconomic development, which is a distal determinant, needs to be ensured, which is the important factor not only to tackle undernutrition but also other diseases, thus breaking the vicious cycle of malnutrition. Nutrition education must be provided to the people in terms of consumption of cost-effective nutritious diet. People should be educated about vertical farming and kitchen gardening, in coordination with agricultural department. Conditional cash transfer programs can aid in consistent and reliable income to pay for nutritious food. Growth monitoring of children using only weight for age indicator is bound to ignore other forms of undernutrition. Hence, the feasibility of other criteria such as height for age and weight for height could therefore be implemented in the current ICDS project. Public Distribution System has to be strengthened with better transparency and governance. No doubt the nutritional status of the children is improving, hence all existing policies and steps for combating malnutrition needs to be continued in near future with full vigor and enthusiasm.

Acknowledgment

We would like to acknowledge the CDPO, Mysuru, for granting permission and necessary help to carry out this study.

Financial support and sponsorship

None.

Conflicts of interest

There are no conflicts of interest.



 
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