Asian Journal of Modern and Ayurvedic Medical Science

Research Paper

Correlates Birth Order and Literacy with Nutritional Status under ‘6’ Children in Rural Area of Allahabad, India.

Author: Hari Shankar1, Dwivedi2,

1. Assistant Professor, Department of Community Medicine, Institute of Medical Sciences, Banaras Hindu University, Varanasi-221005, India 2. Professor and Head, Department of Community Medicine, MLN, Medical College Allahabad, India Email Id:dr_h_shankar@yahoo.co.in

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Birth order and under nutrition; p value 0.002

Birth order and stunting; p value 0.970

Birth order and wasting; p value 0.125

Results : Study showed that maximum prevalence of underweight children (weight for age Z-score below median – 2SD) was found to be (36.79%) in the age group 25-36 months, followed by (34.64%) in age group 37-72 months. It was (32.03%) and (28.37%) in age group 13-24 months and in age group 0-12 months respectively. Majority of the   severely underweight children (weight for age Z- score below median – 3SD) were belonged to the age group 37-72 months (13.07%)   , while only (9.45%) children weight were (weight for age below median-3SD) in age group 0-12 months. The maximum children whose height for age Z –score below median -2SD were reported in age group 25-36 months (40.56%) followed by (38.89%) in the age group 13-24 months. The minimum stunting (28.37%) was reported in age group 0-12 months. An increasing trend of severe stunting in children (height of age Z-score below median -3SD ) was observed with increasing  age up to 3 years  being (14.86%), (16.50%) and (22.64%) in age groups 0-12, 13-24 and 25-36 months respectively. Thereafter decreasing trend of stunting children was observed to be (17.64%) in the 37-72 months age. Similarly the proportion of wasted children (weight for height Z-score below median-2SD) was found to be (12.62%), (12.41%) and (12.26%) in age groups 13-24, 37-72 and 25-36 months respectively. A reverse pattern of severe stunting was observed in severely wasted children up to the age of 0-36 months i.e. severity of wasting (weight for height Z- score below median-3SD) decreases with increasing age (8.10%), (5.82%) and (2.83%) in age groups 0-12, 13-24 and 25-36 months respectively.

According to education of mothers: A decreasing trend of severe underweight (weight for age below median – 2SD) with increased education was observed. It was found to be  (12.21%) underweight children in illiterate mothers followed by  (12.0%) underweight in mothers educated up to primary school level. whereas  (11.42%) underweight in mothers educated up to High school level and (10.0%) underweight children were present in mothers educated up to intermediate level. No severely underweight child (weight for age Z-score below median-3SD) was observed where the mothers were educated up to graduate & above. A similar decreasing trend of stunting was also observed with education. The decreasing trend of wasting was also observed with increased education level as shown in Table2. No wasted child was present in mothers educated up to graduate & above. None of the severely wasted children (weight for age Z – score below median-3SD) were in mothers educated up to primary school level, Intermediate level &above.

According to birth orders: The maximum prevalence of underweight children (weight for age Z- score below median – 2SD) and severely underweight children (weight for age Z- score below median-3SD) was found to be (20.51%) and (16.67%) respectively in birth order three followed by (48.0%) and (11.11%) respectively in birth order one. The maximum prevalence of stunted whose height for age Z- score below median -2SD and severely stunted children (height of age Z- score below median -3SD was observed in birth order one being (42.22%) and (22.22%) respectively followed by (29.49%) and (14.10%) in birth order three respectively. Maximum severely wasted children (weight for height Z- score below median-3SD) were (8.97%) in birth order three followed by (3.78%) in birth order two and (3.5%) in birth order one. The proportion of underweight children among those having birth order one was found to be significantly higher as compared to those of higher birth order, however proportion of children having weight below median - 3 SD was significantly lower as compared to children of birth order three & above. Stunting as well as wasting was not found to be differing significantly in birth order categories. (P< 0.001).

Discussion: In developing countries, children and adults are vulnerable to malnutrition because of low dietary intakes, infectious diseases, lack of appropriate care, and inequitable distribution of food within the household. Evaluation of nutritional status is based on the rationale that in a well-nourished population, there is a statistically predictable distribution of children of a given age with respect to height and weight. The use of a reference population is based on the empirical finding that well-nourished children in all population groups for which data exist follow very similar growth patterns before puberty. Until 2006 the most commonly used reference population, which was used in NFHS-1 ( National Family Health Survey) and NFHS-2, was the U.S. National Centre for Health Statistics (NCHS) standard, which was recommended at that time by the World Health Organization (Dibley et al., 1987a; 1987b).^{6, 7} In this study table showed estimates based on a new international reference population released by WHO in April 2006 (WHO Multicenter Growth Reference Study Group, 2006) and accepted by the Government of India. Three standard indices of physical growth that describe the nutritional status of children are presented in this study. Height-for-age (stunting), Weight-for-height (wasting), Weight-for-age (underweight) .Each of the three nutritional status indicators is expressed in standard deviation units (Z-scores) from the median of the reference population. Each index provides different information about growth and body composition, which is used to assess nutritional status. The height-for-age index is an indicator of linear growth retardation and cumulative growth deficits. Children whose height-for-age Z-score is below minus two standard deviations (-2 SD) from the median of the reference population are considered short for their age (stunted) and are chronically malnourished. Children below minus three standard deviations (-3 SD) from the median of the reference population are considered to be severely stunted. Stunting reflects failure to receive adequate nutrition over a long period of time and is also affected by recurrent and chronic illness Height-for-age, therefore, represents the long-term effects of malnutrition in a population and does not vary according to recent dietary intake. The weight-for-height index measures body mass in relation to body length and describes current nutritional status. Children whose Z-score is below minus two standard deviations (-2 SD) from the median of the reference population are considered thin (wasted) for their height and are acutely malnourished. Wasting represents the failure to receive adequate nutrition in the period immediately preceding the survey and may be the result of inadequate food intake or a recent episode of illness causing loss of weight and the onset of malnutrition. Children whose weight-for-height is below minus three standard deviations (-3 SD) from the median of the reference population are considered to be severely wasted. Weight-for-age is a composite index of height-for-age and weight-for-height. It takes into account both acute and chronic malnutrition. Children whose weight-for-age is below minus two standard deviations from the median of the reference population are classified as underweight. Children whose weight-for-age is below minus three standard deviations (-3 SD) from the median of the reference population are considered to be severely underweight. Children of illiterate mothers are three times as likely to be severely undernourished as children of mothers with at least a high school education^{.8, 9} Present study revealed that maximum overall prevalence of mild underweight children was found to be33.48% The maximum overall prevalence of severely underweight children was 12% (weight for age Z- score below median-3SD) .The maximum 18% children were severely stunted. Only 4% children had severe wasting (weight for height Z- score below median-3SD)  NFHS-3 (2005-2006)¹⁰ reported similar findings butshowed that 16 percent children were severely undernourished (weight for age Z- score below median-3SD) and 24 percent children had short height according to height-for-age Wasting was also quite serious problem affected 20 percent of children under five years of age.  The study further stated that severity of under nutrition is closely related to birth orders, which was found to be statistically significant .Literacy did not show any statistical significant with nutritional status of a child , but it was observed that overall prevalence of both mild n and severe malnutrition was more in illiterate as compared to literate. Nutritional status of child is directly related to educational status of the mother. This may be because of an educated mother will follow better child care practices like exclusive breast feeding, timely complementary feeding, care of child during sickness and better hygiene practices which in turn enhance the chances of child survival.

Conclusion:  Study showed that under nutrition was more prevalent in early age of life hence detection should be started as early as possible, so that the mild or moderate cases may not progress to severe form of malnutrition. Exclusive breast feeding, timely weaning and supplementary feeding is another way to improve nutritional status of the child .Since child nutrition ultimately depends upon maternal health, hence  mothers should be encourage for availing Anti Natal Care such as   registration, immunization against Tetanus , 100 IFA tablets and adequate diet during pregnancy. Nutritional and health awareness should be created among rural girls to ensure a better quality of life for the next generation.

It was realized that detailed interview with mothers regarding feeding habits, nutritional practices would give additional information regarding correlates of nutritional status of children but mothers were not willing to spare sufficient time for the interview which has posed constraint in this study. This may be subject matter of the future studies in this direction.

 References:

1.  Jelliffe DB: The assessment of nutritional status of the community, WHO Monograph 1966;

2.  .ACC/ SCN Second Report on the World Nutrition Situation (1992).

3.   National Plan of Action on Nutrition: Food and nutrition Board Department of women and child Development, Ministry of Human Resources Development 1995; Government of India, New Delhi.

4.  Dewan M. Malnutrition in Women. Stud Home Comm. Sci 2008; 2:7-10.

5.  Ghorbani J. Protein- Energy malnutrition prevalence in school children of Zanjan city. Sci J Med Uni Zanjan 1998; 23:24-8.  

6.  Dibley, M.J., J.B. Goldsby, N.W. Staehling,  F.L. Trowbridge. 1987a. Development of normalized curves for the international growth reference: Historical and technical considerations. American Journal of Clinical Nutrition 46(5): 736-748.

7.  Dibley, M.J., N.W. Staehling, P. Neiburg,  F.L. Trowbridge. 1987b. Interpretation of Z-score anthropometric indicators derived from the international growth reference. AmericanJournal of Clinical Nutrition 46(5): 749-762.

8.  WHO Working Group. Use and interpretation of anthropometric indicators of nutritional status. Bull World Health Organ 1986; 64:924-41.

9.  Horowitz B, Kishwar M. Family Life-The Unequal Deal. In: Madhu Kishwar and Ruth      Vanita (Eds.): In Search of Answers: India: Indian Women's Voices from Manushi; 1985

10.       National Family Health Survey (NFHS-3) 2005-2006, vol ( 1), p. 267-268