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Indian Journal of Community Medicine

An Intervention Study in Malnutrition Among Infants in a Tribal Community of West Bengal

Author(s): B. Banerjee, O.N. Mandal

Vol. 30, No. 1 (2005-03 - 2005-03)

Abstract

Research question : Is nutrition education of mothers effective in maintaining good nutritional status of their children?

Objectives: To study the magnitude of the problem and to assess the impact of nutrition advice given to mothers of infants, on the nutritional status of their children suffering from severe degree of malnutrition.

Study Design: Community based intervention study

Setting: Jamboni block in Midnapore district of West Bengal, consisting mainly of tribal population.

Participants: 300 infants selected from the infant register of 6 sub-centres by systematic random sampling, the sub centres in turn being selected by simple random sampling using lottery method.

Statistical analysis: Z test of proportion, Paired t test.

Results: Prevalence of malnutrition was 50.67% among the infants. Malnutrition was more common in females than males but this was not significant (p>0.05). Grade I malnutrition was more among males, while grade II and III were more in females. None were suffering from grade IV malnutrition. Prevalence also increased with increasing age and it was significantly more (p<0.001) among infants > 6 months of age than among those < 6 months. Post intervention follow up after nutrition education of mothers showed an average increase of 80.81 grams of the weight of their severely malnourished infants, over the expected weight gain. Paired t test, however, was not significant (p>0.05).

Conclusion: Nutrition education of mothers of infants has a positive effect on the nutritional status of their children.

Key Words : Intervention study, malnutrition in infants, nutrition education

Introduction

On all the factors that regulate the health and well being of an individual, nutrition is the most important. The requirement of different food stuff e.g. protein, fat, carbohydrate, minerals and vitamins are essential in proper ratio for adequate growth and nutrition. Malnutrition continues to be highly prevalent in India1-3. But it is erroneous to say that the root cause of all nutritional deficiencies is food shortage. Many at times, deficiency disorders occur as a result of aberrant food habits, prejudices, taboos, food fads and so on. Much can be done to rectify these through nutrition education. In the above background an intervention study was designed, with the objective to study the magnitude of the problem of malnutrition of infants and to assess the impact of nutritional advice given to mothers, to change the nutritional status of their malnourished children.

Material and Methods

A community based intervention study was carried out in Jamboni block in Midnapore district of West Bengal, the block mainly consisting of tribal population. The total number of infants in study area was approximately 2,000. Considering prevalence of malnutrition in tribal population to be 56 per cent as observed in the National Family Health Survey data4 and taking allowable error as 10 per cent, the sample size was calculated as 311.

This was rounded off to 300, which came to 15 per cent of the total infant population of the block. Thus 300 infants were taken as the sample. Out of the 20 subcentres situated in this block, 6 were selected by simple random sampling using lottery method. From each subcentre, 50 infants were selected from the enumerated list in the infant register, by systematic random sampling. Data was collected by house-to-house visit and mothers of infants were interviewed. In the absence of the mother, any other responsible adult member of the family, who was involved in taking care of the infant, was interviewed. Nutritional status of all the infants was noted. Infants with malnutrition grade III and grade IV were identified and detailed dietary enquiries were made for all these cases. Deficits in the diets of these infants were calculated and mothers were given proper advice on diet, among with demonstration of food preparation, according to the requirement of these children and also based on use of low cost, easily available food items. Follow up visit were made after 4 weeks and the dietary assessment and nutritional status of these infants was again determined.

Results

Prevalence of malnutrition was 50.67%. Malnutrition was observed to be more common among females than male (Table I), though this difference was not found to be statistically significant (p>0.05). Grade I malnutrition was more common among males while grade II and grade III were more among females. None of the infants were found to suffer from grade IV malnutrition.

Prevalence of malnutrition was seen to increase with increasing age in both the sexes, except that in females. The prevalence rate of malnutrition among 3-5 months old infants was lower than that among 0-2 months age group (Table II). Malnutrition was significantly more (p<0.001) among children > 6 months of age (64.04%) than among children < 6 months (42.47%). Though pre and post intervention dietary assessments were made by oral questionnaire method, a definite improvement in the dietary intake of the 13 grade III malnourished infants was observed during the follow up visit made after nutritional advice given to the mothers. The change in body weight of these infants was noted. As with increasing age the weight of an infant is expected to increase5, the gain in weight over this expected increase was considered. From Table III it may be observed that following the nutritional advice given to the mothers there was a slight gain in body weight in excess of the expected weight gain, in most of the grade III malnourished infants. But in a few cases the weight gain was as expected and in one case the increase in weight was less than expected. Significant relation was found between nutritional advice and improvement of body weight. Yet, there was an average increase of 80.77 gm more than expected weight gain.

Table I : Nutritional Status of Infants According to Sex

Nutritional Male Female Total
Status No % No. % No. %
Grade I 52 33.7 43 29.4 95 31.6
Grade II 15 9.7 29 19.8 44 14.6
Grade III 05 3.2 3.2 08 5.4 13 4.3
Grade IV 0 0 0 0 0 0
Total 72 46.8* 80 54.8* 152 50.6
Malnutrition Normal 82 53.2 66 45.2 148 49.3
Total 154 100 146 100 300 100
* Z = 1.39, P>0.05

Table II : Nutritional Status of Children According to Age

Age Group Male Female Total
(Months) Total MN % Total MN % Total MN %
0.2 49 18 36.7 42 21 50.0 91 39 42.8
3-5 51 22 43.1 44 18 40.1 95 40 42.1
6-8 31 18 58.1 43 29 67.4 74 47 63.5
9-11 23 14 60.9 17 12 70.6 40 26 65.0
9-11 23 14 60.9 17 12 70.6 40 26 65.0
Total 154 72 46.8 146 80 54.8 300 152 50.6
* Z = 3.63, p <0.001, MN = Malnutrition

Table III : Changing Pattern of Nutritional Status of Infants Suffering from Grade III Malnutrition as Recorded in Follow-up Visit

Sex and age of Grade III infants Body wt. during 1st visit (Kg) Body wt. during 2nd visit (Kg) Weight increased in grams (Kg) Expected increase of weight in 4 weeks Net weight increase probably due to nutritional advice
A) Male (months)
i) 11+ 5.5 5.8 300 250 50
ii) 9+ 5.2 5.7 500 250 250
iii) 7+ 4.5 5.1 600 400 200
iv) 8+ 4.7 5.1 400 400 000
v) 6+ 4.2 4.8 600 600 00
B) Female (months)
i) 1+ 2.5 2.9 400 800 -400
ii) 6+ 4.3 5.0 700 600 100
iii) 7+ 4.4 5.0 600 400 200
iv) 8+ 4.5 5.0 500 400 200
v) 8+ 5.0 5.4 400 400 00
vi) 7+ 4.1 4.6 700 400 300
vii) 9+ 5.0 5.4 400 250 150
viii) 8+ 4.7 5.2 500 400 100
Total 13 infants : Male -5 and Female -8 Total 1050 gm
Average 80.77 gm
t (paired) = 1.16, df = 12, p>0.05

Discussion

Protein Energy Malnutrition (PEM) has been identified as a major health and nutritional problem in India. It occurs particularly in weaklings and children in the first years of life. It is not only an important cause of childhood morbidity and mortality, but leads also to permanent impairment of physical and possibly of mental growth of these who survive6. The first indication of PEM is under-weight for age. The most practical method to detect this is to maintain growth charts. The growth chart recommended by the government of India shows 3 degrees of malnutrition6.

Prevalence of malnutrition in the study population was found to be 50.67%. Taking weight for age as the criterion, only 2.5% of pre school children could be labeled as normal and the rest were underweight, with about 60% weighing less than 70% or below weight of reference standard1. In other reports it is observed that 26.9% and 58.2% of under of under 3 years old children to be malnourised7. In a study as per Waterlow classification, 74.42% of pre school children found to be malnourished8. In a study in South-East Asia 51% children were underweight9. Of the different types of malnutrition, grade I was maximum i.e. 95%. None of the infants had grade IV malnutrition. Children with grade I malnutrition comprised the largest group (39.2%) followed by grade II (19.2%), grade III and grade IV incidence was much less3.

Malnutrition was more common among females than males, although this was not statistically significant. In a study in Ludhiana2, the female child was observed to be not only suffering more from PEM as compared to the male, but also suffering more from the server degree of malnutrition and the differences in the prevalence and severity of PEM based on sex had been observed to be statistically highly significant. In the present study too, grade II and III were much higher among females than males. Hossain et at10, however, failed to observe any significant difference in nutritional status between boys and girls. A higher incident of malnutrition among boys (53.0%) than girls (35.6%) of 1-5 year age, reported in both rural and urban areas of Andhra Pradesh11.

Prevalence of malnutrition increased with increasing age group among infants, similar to the findings of Pratinidhi et at3. In the current study, prevalence was significantly higher (p<0.001) among infants more than 6 months of age (64.04%) than those aged 6 months or less (42.47%). Higher prevalence of malnutrition reported among 6-11 month old infants (21.6%) than among 0-5 month old infants (9.1%)2. Amongst all the children under 3 years of age, they found the lowest rate of malnutrition among 0-5 month group, due to the practice of breast-feeding. The infants more than 6 months of age are susceptible to malnutrition due to improper weaning and faulty nutritional supplementation.

Maternal literacy has been seen to influence the nutritional status of children. Food consumption pattern was found to be better in children with literate mothers as compared to illiterate mothers12. Maternal education and KAP were found to be significantly associated with children's nutritional status, by another author13. In the present study, nutrition education to mothers resulted in slight increase in weight over expected weight gain. Though this change was not statistically significant, an average increase of 80.77 gm more than the expected weight gain was observed.

In a study conducted to evaluate the role of developmental stimulation and nutritional supplementation in rehabilitation of malnourished children in the hospital and community settings, showed both the interventions to produce a significant positive impact on growth and development in the hospital study, while in the community study the prevalence of PEM reduced significantly after the interventions14. Nutrition education has been seen to have a definite impact on infants' nutritional status. In a study done in Gaza it was observed that growth monitoring, staff and maternal education, supplementation with vitamins and iron were associated with marked improvements in feeding pattern and the growth status of children aged 3-15 months15.

Malnutrition in under-5 children, especially infants, is still a major problem in our country. Every endeavour should be made to combat this problem through multi pronged approach like growth monitoring, nutritional supplementation, nutritional rehabilitation and last, but not the least, nutrition education

References

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  15. Tulchinsky TH, Ebweini SE, Ginsberg GM et al. Growth and nutrition patterns of Infants associated with a nutrition education and supplementation programme Gaza, 1987- 92. Bulletin of the World Health Organization, 1994; 72(6): 869-875.

Deptt. of Public Health Administration,
All India Institute of Hygiene and Public Health, Kolkata 700 073
E-mail: [email protected]

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