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Indian Journal of Community Medicine

Nutritional Status and Dietary Intake of Pre-School Children in Urban Slums of Varanasi

Author(s): R.N. Mishra, C.P. Mishra, P. Sen, T.B. Singh*

Vol. 26, No. 2 (2001-04 - 2001-06)

Deptt. of P.S.M., Institute of Medical Sciences, B.H.U. Varanasi *Deptt. of Paediatrics, Institute of Medical Sciences B.H.U. Varanasi


Research question: What is the nutritional status and dietary intake of pre-school children of urban slums of Varanasi district?

Objective: To assess nutritional status and the dietary intake of the pre-school children of urban slums.

Study design: Cross-sectional.

Setting: Urban slums of Varanasi district. Sample size: 520 pre-school children.

Statistical analysis: Chi-square test.

Results: According to waterlow classification, about 75% of pre-school children were malnourished with 20% suffering from severe degree of malnutrition. Although intake of protein and vitamin A was comparatively better in more than 90% of study subjects, consumption of calories, iron and calcium was below 50% of Recommended Dietary Allowance (RDA).

Conclusions: Study reveals gross deficiency in dietary intake of pre-school children of urban slums. Malnutrition seemed universal in the study subjects.

Recommendations: Urgent child health promotion activities coupled with nutrition education programmes to be directed towards these underprivileged and vulnerable group. ICDS to be prioritised and vigourously implemented for this segment of the society.

Keywords : Pre-school children, Urban slums, Recommended dietary allowance, Malnutrition, Nutritional status


The convention on the rights of the child, drafted by the UN Commission on Human Rights and adopted by the General Assembly of the United Nations in 1989, is a set of international standards and measures intended to protect and promote the well-being of children in society. Our country ratified this convention in 19921. The right to nutrition receives its fullest expression in the 1989 convention on the rights of the child, under which virtually every government in the world recognizes the right of all children to the highest attainable standard of health, including the right to good nutrition and its three vital components: food, health and care. Under the convention's pre-eminent principle, good child nutrition is a right because it is in the best interests of the child. We are facing the vicious cycle of PPE spiral i.e. poverty, population explosion and environmental degradation. The brunt of all health hazards is automatically directed on those below poverty line living in underprivileged section of the society viz. mothers and children. The pre-schoolers have to cope up with the killer triad of diarrhoeal diseases, respiratory tract infections and malnutrition. All these result in high morbidity and mortality in pre-school age group.

Over the past five decades India's urban population has increased many fold. With rapid urbanisation and having one of the highest growth rates in the world, around 20% of urban population is forced to reside in urban slums5. Areas which are found to be overcrowded with dilapidated structures, faulty layout and lacking in essential services are generally termed as 'slums'. Slums are the physical and social expression of inequalities in the distribution of the beneficiaries of economic growth, as well as the structure, performance and spatial pattern of the urban economy7. This study was undertaken on such a socio-cultural and economically underprivileged group i.e. pre-school children of urban slums of Varanasi.

Material and Methods:

This study was conducted on 520 pre-school children of urban slums of Varanasi district. The sample size was decided on the basis of 75% prevalence rate of malnutrition in slums and 5% permissible error in the estimate. The study subjects were selected adopting two stage random sampling technique. The slums are scattered all over the urban area in 209 pockets. Out of these 209 urban slums, 5 pockets were selected following simple random sampling technique. The decided sample size was 520 pre-school children. After enumeration in 5 selected pockets, the no. of pre-school children was 720, therefore, simple random sampling was adopted to select households with children under 5 years, so that desired sample size was achieved. All the children of the selected household under 5 were covered. The pre-school children suffering from any chronic episode of illness (duration >6 months) and those with visible disability were excluded from the study. Those who had experienced persistent diarrhoea (duration >14 days) in the last one month were also not included in the study. Care was taken to ensure that the family of the particular under-five was not frequent migrant and was more or less permanent resident of the urban slum. The nutritional status of the pre-school children included in the study was assessed as per Waterlow classification. Information regarding dietary intake was elicited by '24 hour recall method' preferably by interviewing the mother of the study subjects. Nutritive value of foods were calculated in terms of calories and proteins and micronutrients by taking values from 'Nutritive Value of Indian Foods'2. All the information was recorded on a pre-designed and pre-tested proforma. Appropriate statistical procedures were adopted to analyse the observations.


Table I: Age and sex distribution of study subjects.

Male Female Total
No. (%) No. (%) No. (%)
<1 51 (17.59) 40 (17.39) 91 (17.50)
1-2 59 (20.34) 41 (17.83) 100 (19.23)
2-3 45 (15.52) 52 (22.61) 97 (18.65)
3-4 66 (22.76) 53 (23.04) 119 (22.89)
4-5 69 (23.79) 44 (19.13) 113 (21.73)
Total 290 (100.0) 230 (100.0) 520 (100.0)

The age distribution of pre-school children for both the sexes is statistically similar (X2=5.17; df=4, p>0.05). The proportion of children below one year of age is comparatively less which may be due to temporary migration of mother to her parent's home after the delivery as per prevailing social customs.

Table II: Nutritional status of study subjects.

Nutritional status No. (%)
Normal 133 (25.58)
Mild malnutrition 122 (23.46)
Moderate malnutrition 160 (30.77)
Severe malnutrition 105 (20.19)
Total 520 (100.0)

When the study subjects were assessed for their nutritional status as per Waterlow classification, it was observed that only 25.58% of the pre-school children could be labelled as within normal limits while 74.42% fell in different grades of malnutrition.

One fifth of them suffered from severe malnutrition whereas, 23.46% and 30.77% were in mild and moderate degree of malnutrition respectively.

Table III: Intake of nutrients by study subjects.

RDA (%) Protein Calories Iron Calcium Vitamin A
No. (%) No. (%) No. (%) No. (%) No. (%)
>90 3 (0.58) 0 (0) 11 (2.12) 0 (0) 0 (0)
89-70 72 (13.85) 4 (0.77) 11 (2.12) 27 (5.19) 169 (32.5)
69-50 335 (64.42) 48 (9.23) 14 (2.69) 20 (3.85) 77 (14.81)
<50 <50 110 (21.15) 468 (90.0) 484 (93.07) 473 (90.96) 274 (52.69)
Total 520 (100.00) 520 (100.00) 520 (100.00) 520 (100.00) 520 (100.00)

As regards the dietary intake, it was observed that calorie intake of 90% of pre-school children was below 50% of RDA while consumption of protein in more than 85% study subjects was less than 70% of RDA. Although intake of vitamin A was comparatively better with 47.7% of subjects above 50% of RDA but as regards iron and calcium, more than 90% of the pre-school urban slum children were consuming below 50% of the recommended dietary allowances.


Not getting basic human necessities adversely affect the growth and nutritional status of the weaker section of a disadvantaged community i.e. children of an urban slum. Most slum dwellers in India belong to the category of 'permanent necessitarians' who are forced to live in the existing eco-cultural slum situations on account of poverty and social discard. Being the most vulnerable segment of the community the pre-schoolers are at greatest risk of malnutrition since it is their growing period which demands high intake of proteins and calories.

The problem of malnutrition among under-fives of slums has been estimated to be more than 70% compared to 53% for the country as a whole3,4.

This study undertaken on a representative and adequate sample of urban slums of Varanasi revealed that as per Waterlow classification, around 51% of study subjects fell within moderate to severe degrees of malnutrition while only 25% of the pre-school children could be labelled as normal. The young children are transitional as regards to diet, immunity to infection and physiological dependence and there is extra demand of high quality diet, especially proteins, during pre-school age as compared to older children and adults. Studies conducted in different parts of our country revealed that large proportion of pre-school children do not receive adequate protein in diet for their optimal growth and development5. In our country still considerable population of pre-school children suffers from different grades of malnutrition. This study revealed malnutrition to the extent of 75% which is quite alarming considering the positive advances made in the field of various national nutrition programmes. It seems as if this underprivileged and disadvantaged segment of the society has been totally neglected. Due to low purchasing power, the under-fives of the study area consume diets which are much below the requirements for optimum growth and development. Energy deficiency coupled with micronutrient deficiency is alarming in the study area. As a result, growth failure and delayed psychomotor and cognitive development could get concentrated in under-fives of urban slums.

With rapid growth of urban slums malnutrition of children will be an increasing problem unless urgent child health promotion activities coupled with nutrition education programmes are directed towards this under privileged and vulnerable group6. To effect a positive result the integrated child development services scheme should cover all the slum areas and be rigorously implemented so as to enable the children in the slums realise their full growth and development potential7.


  1. UNICEF. The right to be a child. UNICEF India Background paper, 1994: 1-29.
  2. Gopalan C, Rama Sastri BV. Balasubramanian SC. Nutritive value of Indian foods. National Institute of Nutrition, ICMR, Hyderabad. Reprint 1993.
  3. Tiwari S. Nutritional status and physical development of children of an urban slum community of Varanasi. MA dissertation (Home Sc.). Banaras Hindu University, Varanasi, 1997: 1-38.
  4. UNICEF. United Nations Children Fund. The State of the World's Children (Summary), 1998: 1-41.
  5. Gopalan C, Narsinga Rao BS. Nutritional constraints on growth and development in current dietetics. Proceedings of the Nutritional Society of India, 1971; 10: 14-19.
  6. Govt. of India. Profile of the Child in India: Policies and programmes. Ministry of Social Welfare, Shastri Bhawan, New Delhi, 1980.
  7. Govt. of India. Integrated Child Development Services Scheme. Ministry of Education and Social Welfare, New Delhi, 1979.
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