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Indian Journal of Community Medicine

Weight Gain in Severely Malnourished Children in ICDS Scheme

Author(s): Umesh Kapil

Vol. 26, No. 3 (2001-07 - 2001-09)

Abstract:

Research question: Does gain in body weight vary in different seasons of the year due to variation in availability of food and nutrient intake.

Objectives: 1) To study the weight gain pattern amongst severely malnourished children (SMN) during different seasons. 2) To assess the nutrient intake of SMN children during different seasons of the year.

Study design:Prospective study.

Sample size:61 severely malnourished children (grade III and IV).

Study period:April 1997 to March 1999.

Setting:ICDS project, 25 anganwadi centres. Study variables: Nutrient intake, body weight gain, morbidity. Statistical analysis: Chi-square test.

Results:During rainy season i.e. July to September, 25 children from grade III and IV moved to grade II category. During winter season i.e. October to March out of total 35 children who were in severe malnutrition category, 13 children moved to either normal, grade I or grade II. during summer season i.e. April to June, only 2 children moved from grade IV to better nutritional grade.

Conclusion: There was a gradual improvement in nutritional status of SMN children during rainy, winter and summer season. The weight gain was highest during the winter season.

Keywords :Severe malnutrition, Weight gain

Introduction:

Undernutrition is a major public health problem in India. According to National Nutrition Monitoring Bureau (NNMB), during 1988-90, the percentages of children in normal, grade I, II and III and IV malnutrition were 21.3, 47.4, 27.5 and 3.8 respectively1. Inadequate caloric intake has been documented as the primary cause of growth retardation amongst children.

It has been hypothesised that gain in body weight varies in different seasons of the year2. This is possibly due to differences in food availability which leads to variation in the nutrient intake. Very few studies have been documented from India, particularly on the weight gain pattern and nutrient intake of severely malnourished children in different seasons of the year.

Material and Methods:

The present study was conducted in the State of Rajasthan between July 1996 to June 1997. All the districts in the state, were enlisted. District Alwar was selected by using purposive sampling procedure. All the ICDS projects in the district which were operational for more than 5 years were enlisted and one ICDS project was selected for detailed study. In the project selected, 25 anganwadi centres (AWC), which constituted one circle of ICDS project, were selected. All the children registered in the selected anganwadi centres were included for the detailed study. Nutritional status of all the children registered with each AWC was assessed by utilizing weight for age criterion. The NCHS standards for weight for age were utilized for classification of children in various grades of nutritional status. Age of children was assessed from the records available at the anganwadi centre and from the birth certificate available with parents. Whenever the age of the child was not available the local events calender was utilized to have nearest approximation of date of birth.

The SECA electronic weighing scale (procured from UNICEF India country office) was utilized to record the body weight to the nearest 100 gms. Weight of the subjects was measured with minimal clothing and bare feet. Tared weight was taken in case of children below two years of age.

Baseline data on each SMN child was collected by undertaking family visit. The information was collected on socio-economic status, educational status of parents, number of siblings etc. A total of 61 children were identified as severely malnourished (grade III and IV) and constituted the study population. Each SMN child was given a unique code number. Monthly domiciliary visits were made to each of the 61 SMN children. The body weight and the nutrient intake of each SMN child was recorded at a monthly interval ( 2 days) for a period of 12 consecutive months. Every month, the body weight of the SMN child was assessed by utilizing standard technique. The mother of the child was interviewed in detail to collect the data on nutrient intake. The nutritional intake of child was calculated by utilizing 24 hour dietary recall methodology3. The raw amount of food used for cooking the family meal, the total volume of cooked food and the volume of food consumed by the indexed child was recorded using standardised utensil. From this data, the raw amount of food consumed by SMN child was calculated and then subsequently nutrient intake was estimated. The amount of SN consumed by the child at the ICDS anganwadi centre in last 24 hours was specifically inquired. The nutrient intake of each child was calculated by using computer software programme based on the nutritive value of Indian foods developed at All India Institute of Medical Sciences, New Delhi4. Recommended dietary allowances suggested by the Indian Council fo Medical Research (ICMR) for different age groups i.e. 6 months to 1 year, 1 to <3 year and 3 to <6 year of age, were utilized to assess the adequacy of nutrient intake of the subjects5.

At the end of 12 months, the nutritional status of all children registered with anganwadi centre was again assessed by weight for age criterion. The same standardised technique and tools were used as done in the baseline survey.

Repeat home visits were undertaken whenever the child was not present at the time of first home visit. Ten percent of the data collected by research workers was checked again to see the validity and consistency. The weighing scales were checked regularly to ensure their accuracy and reproducibility with the help of standard weights.

For the purpose of the study, July to September constituted the rainy season. Similarly, October to March and April to June constituted winter and summer season, respectively.

Results:

Table I: Nutritional status of SMN children in different seasons of the year.

Nutritional status Baseline (April) 1996 Rainy (July-Sept.) 1996 Winter (Oct.-March) 1996-97 Summer (April-June) 1997
Normal - - 4 1
Grade I - - 6 2
Grade II - 25 28 35
Grade III 50 27 17 19
Grade IV 11 5 5 3
Total 61 60* 60* 60*

*One child expired within first month of the follow-up. The nutritional status of the SMN children in different seasons of the year has been depicted in Table I. It was found that in the baseline survey, 50 and 11 children were in grade III and grade IV degree of undernutrition. It was observed that during rainy season i.e. July to September, 25 children from grade III and IV moved to grade II category.

It was found that during winter season i.e. October to March, out of total 35 children who were in severe malnutrition category, 13 children moved to either normal, grade I or grade II category. During summer season i.e. April to June, 2 children moved from grade IV to better nutritional grade.

Table II: Mean nutrient intake of 6 months to 1 year SMN children during different seasons of a year (n=16).

Nutrient RDA Rainy Mean SD Winter Mean SD Summer Mean SD
Energy (Kcal) 843 741 321 854 274 801 241
Protein (gms) 14 19 10 26 9 24 10

Table II depicts the nutrient intake of children in 6 months to 1 year age group in different seasons. It was found that the highest intake of energy and protein was during winter season. The total calories consumed by the children in this age group was 88% and 95% during rainy and summer seasons respectively as compared to the RDA.

Table III: Mean nutrient intake of 1-3 years SMN children during different seasons of a year (n=32).

Nutrient RDA Rainy Mean SD Winter Mean SD Summer Mean SD
Energy (Kcal) 1240 726 264 858 313 792 269
Protein (gms) 22 23 10 29 13 28 7

The nutrient intake of 1 to <3 years age group children revealed that the calorie and protein consumption was highest in winter season (Table III). The mean calorie consumption was less than 70%, when compared with RDA in all the three different seasons.

Table IV: Mean nutrient intake of 3-6 years SMN children during different seasons of a year (n=12).

Nutrient RDA Rainy Mean SD Winter Mean SD Summer Mean SD
Energy (Kcal) 1690 799 399 966 316 875 290
Protein (gms) 30 25 14 32 17 29 10

Table IV depicts the mean nutrient intake of children in 3 to <6 years as compared to their RDA in different seasons of the year. It was found that highest intake of energy was again during the winter season. However, the total calories consumed was only 47, 57 and 51% of the RDA in rainy, winter and summer seasons respectively.

Discussion:

The present study was conducted in an ICDS project in district Alwar. A total of 61 children were identified as suffering from severe malnutrition (grade III and IV). All these children were followed up each month for their nutrient intake and body weight. One child expired during the first month of survey and hence a cohort of 60 children was followed for 12 months.

It was found that there was a gradual improvement in nutritional status of SMN children during rainy, winter and summer seasons. The weight gain was highest during the winter season. This was probably due to more availability of food and less incidence of morbid conditions. The nutrient intake of children in the age group of 6 months to <1 year, 1 to <3 years and 3 to <6 years also revealed that the highest intake of energy was in winter season followed by summer and rainy season. The high intake of calories during winter season is possibly again due to more availability of the food during the winter months.

The present study clearly revealed that there is a deficit in the energy intake of the children below 6 years of age. The deficit was maximum during 1 to <3 and 3 to <6 years age group. Improvement in the nutritional grades of the children could be possibly attributed to integrated delivery of health and nutritional services under ICDS scheme.

The findings of the present study highlighted that during summer and rainy season there is a need of providing extra nutritional care to the young children as their growth and nutrient intake is comparatively lower than during winter season. The peripheral MCH workers should put extra efforts on educating the mothers to provide adequate food to the young children during the summer and rainy seasons so that malnutrition can be prevented.

References:

  1. National Nutrition Monitoring Bureau. Report of Repeat Survey (1988-90). National Institute of Nutrition. ICMR, NIN press, Hyderabad 1991; 22-9.
  2. George SM, Latham MC, Abel R, Ethirajan N, Frongillo Jr EA. Evaluation of effectiveness of good growth monitoring in South Indian villages, Lancet 1993; 91: 342-8.
  3. Thimmayamma BVS. A handbook of schedules and guidelines in socio-economic and diet surveys. National Institute of Nutrition, ICMR, NIN Press, Hyderabad 1987; 12-7.
  4. Gopalan C, Ramasastri BV. Nutritive value of Indian Foods. National Institute of Nutrition, ICMR, NIN Press, Hyderabad 1993; 156.
  5. Nutrient requirement and recommended dietary allowances. NIN, ICMR, NIN press Hyderabad 1990; 65-9.

Umesh Kapil
Deptt. of Human Nutrition,
All India Institute of Medical Sciences, Ansari Nagar, New Delhi - 110029

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