Journal of Internal Medicine & Primary Healthcare Category: Medical Type: Research Article
Nutritional Status of Children Under 5 Years in Tribal Villages of Bastar Chhattisgarh India
- Gajendra Singh1*, Teeku Sinha2*, Urya Nag3
- 1 Public Health Specialist, Indian Institute Of Health Management Research, Jaipur, India
- 2 Department Of Community Medicine, HOD, Late BRKM Govt. Medical College, Jagdalpur, Chhattisgarh, India
- 3 State Program Manager, National Health Mission, Chhattisgarh, India
*Corresponding Author:Gajendra Singh
Public Health Specialist, Indian Institute Of Health Management Research, Jaipur, India
Department Of Community Medicine, HOD, Late BRKM Govt. Medical College, Jagdalpur, Chhattisgarh, India
Received Date: Sep 30, 2019 Accepted Date: Oct 21, 2019 Published Date: Oct 28, 2019
The problem of malnutrition among children of age less than 5 years can be used to determine the need for nutritional surveillance, nutritional care or appropriate nutritional intervention program in community. National Family Health Survey-4 (2015-16) data revealed 42.3% (Chhattisgarh-39.6%) of children under five years are stunted and 53.1% (Chhattisgarh -39.2%) are under weight due to chronic under nutrition in rural area of Bastar. India accounts for more than 3 out of every 10 stunted children in the world.
To assess the health and nutritional status of under 5 year children in the rural areas of Bastar.
Material & methods
A community based cross-sectional study was conducted in village Dimrapal, Biringpal and Pandripani catchment area of RHTC Tokapal. Door to door survey conducted during the months of July-September 2017. Data was collected using predesigned semi structured questionnaire. Mother who has children under 5 years of age were interviewed. The anthropometric measurements categorization among children was done using World Health Organization (WHO) guidelines. Data was analyzed using Microsoft Excel 2010.
Out of 140 children (55 boys and 85 girls) participated in study and around 40.7 % children were found to be stunted 29. 3% found to have wasting and around 44.3 % were found underweight.
The findings are in line of results from NFHS-4 Genuine and appropriate assessment of the children using a valid tool can help to eliminate this emerging problem of malnutrition among our future generations.
Nearly, half of all deaths in children under-5 are can be attributed to undernutrition, translating into avoidable loss of about 3 million young lives globally each year . Additional 165 million children with stunted growth have compromised cognitive development and physical capabilities with almost all cases occurring in developing countries . India has a very high burden of childhood stunting as 61 million (37%) of the 165 million stunted children aged under 5 years globally are Indian children . India is home to almost half the tribal population of the world .
The Scheduled Tribe population of the country, as per the 2011 census, was 104 million, constituting 8.6% of the total population . ST constitutes about 8.2% of the total population of the country. They live in difficult circumstances in hills, forests, and difficult-to-reach geographical areas with limited access to public services . According to the Census of India 2011, only 14% of the Tribal population in rural areas have a source of drinking water within their premises and 22.6% households have toilet facility in their households. Extreme poverty, cultural habits, lack of formal education, challenges of geographical conditions, and natural disasters are related with poor nutrition and health of Tribal people.
The Rapid Survey of Children (RSOC), 2013-2014 conducted by the Department of Women and Child Development showed that 38.7 % of under 5 children are stunted, 15.1% are wasted and 29.4% are underweight. National Family Health Survey -4 also presents the same case for Chhattisgarh which has high tribal population. Within State, stunting (42.2%), wasting (26%) and underweight (43.8%) are highest among Scheduled Tribes (ST) children . The situation is same in NFHS-3 also.
Malnutrition is a silent emergency . It is frequently part of a vicious cycle that includes poverty and disease. These three factors are interlinked in such a way that each contributes to the presence and permanence of the others. Socioeconomic and political changes that improve health and nutrition can break the cycle; as can specific nutrition and health interventions. The health and social consequences of the current high prevalence of impaired child growth in developing countries are severe. The major outcomes of malnutrition during childhood may be classified in terms of morbidity, mortality, and psychological and intellectual development; there are also important consequences in adult life in terms of body size, work and reproductive performances, and risk of chronic diseases.
Several authors have examined the association between anthropometry and morbidity. The leading childhood diseases are diarrhoea, respiratory infections, measles, tuberculosis etc. It is known that a child may get affected several times in a year; the incidence increases with the aggravation of a state of malnutrition . The three main indicators used to define under nutrition, i.e., underweight, stunting, and wasting, represent different histories of nutritional insult to the child. Occurring primarily in the first 2-3 years of life, linear growth retardation (stunting) is frequently associated with repeated exposure to adverse economic conditions, poor sanitation, and the interactive effects of poor energy and nutrient intakes and infection. Low weight-for-age indicates a history of poor health or nutritional insult to the child, including recurrent illness and/or starvation, while a low weight-for-height is an indicator of wasting (i.e., thinness) and is generally associated with recent illness and failure to gain weight or a loss of weight .
A semi-structured pretested interview schedule was used to collect information from the mother. In some cases (if mother was not available), information was collected from the caregiver. Weight and height were measured for all the selected children. Anthropometric measurements were carried out following standard methods. The data included weight, recumbent length (for children less than 24 months of age) and height (for children more than 24 months of age). Weight was measured using analog weighing machine Height was measured against a non-stretchable tape fixed to a vertical wall, with the participant standing on affirm/level surface and it was measured to the nearest 0.5 cm. Recumbent length (for children less than 24 months of age) was measured by using a measuring tape. All measurements were taken twice and the average of two readings was used for analysis. 0-5 year’s children were taken for underweight and stunting in this study. Socioeconomic Status (SES) - was determined by using Modified Prasad’s scale .
Based on the age, body weight and height, several indices such as height-for-age, weight-forage and weight-for-height have been suggested . The children are classified using three categories:
- Underweight (low weight-for-age)
- Stunting (low height-for-age)
- Wasting (low weight-for-height)
- Underweight is defined as low weight-for-age and it reflects past (chronic) and present (acute) under nutrition. Children with z-scores < -2.00 are said to be underweight
- Stunting is defined as a low height-for-age for children, and it measures the past (chronic) child under nutrition. Children with z-scores < -2.00 are said to be stunted
- Wasting is defined as low weight-for-height for children, and it is a measure of current or acute under nutrition. Children with z-scores < - 2.00 are said to be wasted
Inclusion criteria & Exclusion criteria
Toilet and handwashing
Age at Marriage and pregnancy
Care around birth
Nutritional and dietary practices
Birth details and immunizations
Other relevant history
The present study confirms that despite several nutrition programmes, the extent of undernutrition has remained high in the children living in predominantly tribal rural areas of Bastar Region. As the main underlying cause of undernutrition among the tribal children is the poor socioeconomic conditions of the tribal population, there is a need for a multi-pronged strategy for redressing this problem.
Aside from increasing the budgetary allocation for nutrition specific interventions, the state needs to ensure appropriate usage of funds. In addition, there is an urgent need to tighten the implementation mechanism of the Public Distribution System (PDS) in the tribal areas of Bastar. The department of Civil Supplies (food security) must ensure that tribal families are not deprived of the ration that they are entitled to because of issues like non-possession of card. Besides that, State should seriously consider providing other nutritious food items through PDS in the tribal areas so that the nutritional needs of the tribal children and adults are met, and the problem of micronutrient deficiencies is effectively addressed.
Aside from improving socioeconomic conditions of the tribal population, there is a need to improve the child care and feeding practices. The positive breastfeeding practices related to exclusive breastfeeding during the first half of infancy and continued breastfeeding through the second year of life and beyond encountered in the population should be strongly promoted. Practices that require attention are the delay in introduction of complementary foods and the low dietary diversity. This should be addressed by providing education about child care and feeding practices to women from time they become pregnant.
In the current study, the prevalence of undernutrition was found to be associated with children’s age, their health status, family size and ethnicity. The older children seemed to be at a relatively higher risk of stunting and underweight, but they were found to have lower odds of wasting than the younger children. Children who were weaned much later (10 months or more) than the recommended age of 4 to 6 months were significantly less likely to be stunted. This implies that despite weaning at the recommended age, those children did not receive the necessary nutrition through the complementary feeds and missed out on the nutrition available through breast milk.
Having sickness episode was another risk factor of undernutrition. Children who did not suffer from any disease like Diarrhoea, cold or any other acute illness were significantly less likely to be underweight. The result was consistent with previous studies that malnourished children would be more prone to sickness or sick children would tend to be underweight, thus confirming the two-way relationship between undernutrition and health [22,23].
Children living in larger households with more than 6 members (and hence, most likely to be in multigenerational households) were more likely to be stunted or underweight than those from smaller families with not more than 5 members. A high prevalence of stunting among the children living in larger households was also documented by other studies . Inadequate availability of food and inequality in the intra-household distribution of food may possibly explain the reason behind the higher prevalence of undernutrition in larger households.
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Citation:Sinha T, Singh G, Nag U(2019) Nutritional Status of Children Under 5 Years in Tribal Villages of Bastar Chhattisgarh India. J intern Med Prim Healthcare 3: 007.
Copyright: © 2019 Gajendra Singh, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.