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Indian Journal of Community Medicine

Effect of Maternal Factors on Nutritional Status of 1-5-Year-Old Children in Urban Slum Population

Author(s): A Mittal, J Singh, SK Ahluwalia

Vol. 32, No. 4 (2007-10 - 2007-12)

ISSN No. 0970-0218

A Mittal, J Singh, SK Ahluwalia

Abstract

Objective: To study the effect of various maternal factors on the prevalence of underweight and stunting among 1-5-year-old children in urban slum population. Design: Cross-sectional study. Materials and Methods: The study was carried out in three urban slums of Tripuri Town, Patiala. All 1-5-year children living in these slums were included, whose mother’s demographic profile, weight and height were recorded. Results: Out of 482 children who participated in the study, 185 (38.38%) had low weight for age whereas 222 (46.06%) had low height for age. Both kinds of malnutrition were common in females than in males. Prevalence of malnutrition was more where mother’s age was less than 20 years. Children of educated mothers were better nourished as compared to illiterate ones. Conclusion: Maternal factors significantly affect a child’s nutritional status, thus encouraging the improvement in the social status of women so as to have healthy children and thereby a healthy future.

Keywords: Maternal factors, prevalence, stunting, underweight

Protein energy malnutrition, which is manifested as decrease in weight for age or height for age or weight for height, is the most widely prevalent form of malnutrition among under-five children. Nutritional status of children is an indicator of nutritional profile of the entire community. Studies conducted worldwide show that 150 million (26.6%) are underweight, while 182 million (32.5%) are stunted all over the world.1 More than half of the world’s undernourished people live in India. Fifty-four percent children are underweight, 52% are stunted, while 17% are wasted.2 Factors which are responsible for the higher prevalence of malnutrition in south Asian countries including India comprise low birth weight, maternal health problems, delay in introduction of complementary feeds, faulty child care and other poor environmental conditions which are again more prevalent in slums.3 These factors are in turn influenced by various factors like age at marriage, child bearing, child spacing, family size patterns, level of education, economic status, customs and beliefs, role of women in society etc. The mental and social development of the child is dependant on the mother and if the mother dies, the child’s growth and development are affected. The mother is also the first teacher of the child, and that is why the mother and child are treated as one unit.4 Hence, the present study was conducted in slums to assess the nutritional status of 1-5-year-old children and to study the inß uence of various maternal factors on their nutritional status.

Materials and Methods

Nutritional status of 1-5-year children was assessed by population-based cross-sectional examination conducted during January 2004 to June 2004 in three slums viz Indira colony, Purani basti, Guru Nanak nagar situated in Tripuri town of Patiala City where healthcare is mainly provided by Government Medical College, Patiala through its Maternal and Child Care Centre. A slum is defined as an area where buildings are in any respect unfit for human habitation and are by reason of overcrowding, faulty arrangement of streets, lack of ventilation, light or sanitation facilities or a combination of these factors are detrimental to safety, health and morale.5 Hence, these three areas are designated as slums by Municipal Corporation of Patiala. The survey intended to include all children of 1-5 years of age residing in these three slums. Every house was visited once but if anyhow mother and child could not be contacted during the first visit, a second visit was given and if somehow the second visit also gave no results, the house was excluded from the study. The study instrument was a questionnaire with two sections. Section I obtained information about the socio-demographic variables of the child and the mother. Section II included the recording of height and weight of the child. During door-to-door survey, the mother was briefed about the study and her consent was obtained for the same. The weight and height were compared with NCHS Standards. Classification given by Indian Academy of Pediatrics was used for grading of weight for age (WFA).6 Height for age (HFA) was graded as normal (HFA > –1SD), mild stunting (HFA < –1SD), moderate stunting (HFA < –2SD) and severe stunting (HFA < –3SD).7 The data was compiled and statistically analyzed using the Chi-square test.

Results

There were a total of 487 children of 1-5-year age who were residing in the three slums. Only 482 children could be included, since rest five were not available even at the time of second visit. 272 male and 210 female children took part in the study whose mothers were interviewed and their anthropometric measurements I.e., height and weight, were taken. Total number of mothers was 481 as one mother was not alive at the time of the study.

Maximum number of participants (33.6%) were in the age group of 12-23 months and the number of participants decreased as the age increased, indicating that child mortality is still very high in slums, since only 19.09% children belonged to the age group of 48-59 months. Overall 38.38% (185/482) children were found to be underweight. IAP classification showed that 26.76% had Grade-I malnutrition, whereas 7.47%, 3.32% and 0.83% had Grade II, III and IV malnutrition, respectively. Lower grades (I and II) were more common among males than females (35.29% vs 32.85%), whereas severe grades (III and IV) were common in females (5.71% vs 2.94%). However, the results were statistically insignificant

Table 1: Sex wise distribution of 482 children according to the grades of PEM (IAP classification)

Grade of PEM Males (%) Females (%) Total (%)
0 168 (61.76) 129 (61.43) 297 (61.62)
I 70 (25.73) 59 (28.09) 129 (26.76)
II 26 (9.56) 10 (4.76) 36 (7.47)
III 8 (2.94) 8 (3.81) 16 (3.32)
IV 0 (0.00) 4 (1.90) 4 (0.83)
Total 272 (100) 210 (100) 482 (100)
Statistical analysis
χ2   2.045  
P-value   >0.05  

Overall 46.06% (222/482) of the children were stunted with 36.10%, 8.09% and 1.87% showing mild, moderate and severe stunting [Table 2].

Maximum children who were underweight, were in the age group of 12-23 months (40.74%) and the number of underweight children decreased as the age group increased [Table 3].

Stunting was most commonly found in the age group of 36-47 months (51.89%) followed by 12-23-month age group (50.64%) and it was lowest in the oldest age group, i.e. 48-59 months (39.13%). But the difference in prevalence of both kinds of malnutrition in the various age groups when statistically analyzed was found to be insignificant.

Maximum number of mothers were in the age group 21-25 years (203/481, i.e. 42.2%) followed by 26-30-year age group (184/481, i.e. 38.25%) and no mother was above 40 years. Chances of being underweight decreased as the mother’s age increased. Prevalence of underweight children was 75.0% where mother’s age was <20 years, whereas it was 39.9%, 32.6% and 32.2% for the age groups 21-25, 26-30 and >30 years. Similarly, prevalence of stunting also decreased with increasing mother’s age, i.e. it was 87.5%, 46.31%, 40.22% and 40.3% in the same age groups [Table 4]. Chi-square testing of the differences showed them to be highly significant.

Table 2: Sex wise distribution of 482 children according to the level of stunting

Level of stunting Males (%) Females (%) Total (%)
Normal 153 (56.25) 107 (50.95) 260 (53.94)
Mild stunting 100 (36.76) 74 (35.24) 174 (36.10)
Moderate
stunting
15 (5.51) 24 (11.43) 39 (8.09)
Severe
stunting
4 (1.47) 5 (2.38) 9 (1.87)
Total 272 (100) 210 (100%) 482 (100)
Statistical analysis
χ2   1.23  
P-value   >0.05  

Table 3: Age wise distribution of 482 children according to the grades of underweight

Weight Normal Under weight Total
I II III IV
Age (in months)
12-23 96 (59.26) 47 (29.01) 12 (7.41) 7 (4.32) 0 (0.00) 162 (100)
24-35 73 (59.84) 34 (27.87) 13 (10.65) 2 (1.64) 0 (0.00) 122 (100)
36-47 66 (62.26) 25 (23.58) 7 (6.60) 6 (5.66) 2 (1.89) 106 (100)
48-59 62 (67.39) 23 (25.00) 4 (4.35) 1 (1.09) 2 (2.18) 92 (100)
Total 297 (61.62) 129 (26.76) 36 (7.47) 16 (3.32) 4 (0.83) 482 (100)
Statistical analysis
χ2     1.77      
P-value     >0.05      

Figures in parentheses are in percentage

Table 4: Nutritional status of 482 children in relation to their mother’s age

Mother’s age (in years) Underweight Stunting Total
Present Absent Present Absent
<20 24 (75.00) 8 (25.00) 28 (87.50) 4 (12.50) 32 (100)
21-25 81 (39.90) 122 (60.10) 94 (46.31) 109 (53.69) 203 (100)
26-30 60 (32.61) 124 (67.39) 74 (40.22) 110 (59.78) 184 (100)
>30 20 (32.20) 42 (67.80) 25 (40.30) 37 (59.70) 62 (100)
Total 185 (38.38) 296 (61.62) 221* (45.95) 260 (54.05) 481* (100)
Statistical analysis
χ2 20.16 24.51  
P-value <0.001 <0.001  

*One mother was not alive at the time of study, Figures in parentheses are in percentage

Mother’s education seemed to play a protective role against child’s malnutrition. Overall 70.75% of the mothers were literate though up to different levels. Prevalence was the highest where mothers were illiterate (60.9%) vs value of 21.2% where mother had education more than high school. Similarly, figures for stunting were 65.25% where mother was illiterate and 31.3% where education level was more than high school. Differences were statistically significant for both the cases.

Only 8.1% (39/481) mothers were engaged in some kind of employment and that too as daily wager or domestic servant. Mother’s occupation did seem to affect the nutritional status of the child as 46.15% were underweight and 58.97% were stunted where the mother was working as compared to 37.8% were underweight and 44.8% were stunted where the mother was a housewife. But statistical analysis showed that the difference was insignificant.

Discussion

Nutritional assessment was done in three urban slums, namely, Indira colony, Purani basti and Guru Nanak nagar and included 272 males and 210 females of 1-5 years of age.

Overall 38.38% children were found to be underweight where 26.76% had Grade I undernutrition and 0.83% had Grade IV undernutrition, thus revealing that there is marked decrease in the severe grades of undernutrition.6 More males (35.29%) were affected with lower grades than females (32.85%), whereas severe grades were common in females (5.71%) than in males (2.94%). The findings were consistent with the studies conducted by Dwivedi et al., in urban slums.8 The 12-23-month age group had maximum number of underweight children (40.74%). These findings were similar to the study conducted in Bolivian children by Blount et al.,9 whereas Reifen et al. found the peak prevalence in the age group of 24-35 months.10

Mother’s age showed highly significant (P = 0.001) effect on the prevalence of undernutrition, i.e. where mother’s age was <20 years, the prevalence was 75.0% as compared to 32.2% where mother’s age was >30 years. However, the data was not adjusted for parity.

Education of mother significantly influenced the nutritional status of under-fives as the prevalence of undernutrition was 60.9% where mother was illiterate and it was only 21.2% where education level was more than high school.

Chances of being underweight increased if the mother was employed (46.15%) than the group where the mother was unemployed (37.8%).

Stunting, i.e. low HFA was more common in females (49.05%) than in males (43.75%). The peak prevalence of stunting was seen in 36-47-month age group (51.9%), whereas studies conducted by Saleh and El Sherif showed that it was the commonest in 24-35-month age group.11

Stunting was commonest where mother’s age was <20 years (87.5%) as compared to prevalence of 40.3% where the age was more than 30 years.

Mother’s education was inversely related to the prevalence of stunting, as it was lowest (31.3%) where schooling was more than high school as compared to prevalence of 65.25% where mother was illiterate.

Mother’s engagement in some occupation adversely affected child’s growth as shown by the results that 58.97% were stunted where mother was employed as compared to prevalence of 44.8% where mother was a housewife.

The above results reveal that prevalence of low WFA was less than the values of NFHS survey where it was found to be 47%. Stunting was found to be equally prevalent as it was depicted by the NFHS survey, i.e. 46%.12

High prevalence of undernutrition of both kinds among under-fives highly suggests that there is a strong need for educating the mothers about timely weaning and weaning foods which are easily available in the local market, that too at low cost. Effect of mother’s age on prevalence of undernutrition clearly favours the promotion of delaying marriage of females and further delaying the birth of the first child. The work in this field can be handled by local leaders, NGOs with much more effectiveness.

Better nutritional profile of under-fives of educated mothers indicates that right to have education and to achieve 100% literacy will help in promoting the nutritional status of children as educated mothers are more aware of the health services available and also the acceptance to utilize the same is better among them.

Poor nutritional status of children of working mothers suggests that working places should be provided with crèches/playways where kids can be taken care of while the mother is at work. In the same way, strengthening of anganwadis and balwadis will also help as they help in taking care of the child, and educating the child along with providing meals which complement the child’s diet, thus improving their nutritional status.

References

  1. Alhaji M, Allen S. Paediatric review: Management of severe malnutrition-time for a change? Africa Health 2002;24: 21-3.
  2. Mishra VK, Lahiri S, Luther NY. Child nutrition in India. National Family Health Survey Subject Reports, International Institute of Population Sciences: Mumbai, India; 1999.

    39.

  3. Ramalingaswami V, Jonsson U, Rhode J. Malnutrition: A south Asian enigma. Malnutrition in South Asia: A regional profile, UNICEF Regional Office for South Asia. ROSA Publication: Kathmandu, Nepal; 1997. p. 11-22.
  4. Park K. Preventive medicine in Obstetrics. Pediatrics and Geriatrics. Park’s Textbook of Preventive and Social Medicine. 17th ed. M/S Banarsidas Bhanot: Jabalpur; 2002. p. 380.
  5. Narain MK. Problems of slums in India. Contemp Soc Work 1997;14:65-71.
  6. Ghai OP, Gupta P, Paul VK. Protein Energy Malnutrition, Nutrition and Macronutrient disorders, Ghai Essential Pediatrics. 6th ed. CBS Publishers and Distributors: New Delhi; 2004. p. 101-7.
  7. Prahlad Rao N, Reddy V. Textbook of Human Nutrition. Oxford IBH Publishing Company Pvt Ltd: New Delhi and Calcutta; 1996. p. 287-97.
  8. Dwivedi SN, Banerjee N, Yadav OP. Malnutrition among children in an urban Indian slum and its associations. Indian J Matern Child Health 1992;3:79-81.
  9. Blount BW, Krober MS, Gloyd SS, Kozakowski M, Casey L. Nutritional status of rural Bolivian children. Mil Med 1993;158:367-70.
  10. Reifen R, Haftel L, Manor G, Sklan D, Edris M, Khoshoo V, et al. Ethiopian-born and native Israeli school children have different growth patterns. Nutrition 2003;19:427-31.
  11. Saleh SM, El Sherif MA. Growth and nutritional status of rural preschool Children in El Minia governorate. New Egypt J Med 1993;8:820-3.
  12. Available from: http://www.nfhsindia.org/factsheet.html.

Government Medical College, Patiala (Punjab), India

Correspondence to:
Dr. A. Mittal,
Department of Community Medicine, M.M. Institute of Medical Sciences and Research, Mullana (Ambala), Haryana – 133 203, India.
E-mail: avianshu(at)rediffmail.com
Received: 15.05.07
Accepted: 24.08.07

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