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Indian Journal of Community Medicine

A Cross-Sectional Study of the Association of Postnatal Growth and Psychosocial Development of the Infants in an Urban Slum of Delhi

Author(s): Meenakshi, SK Pradhan, JG Prasuna

Vol. 32, No. 1 (2007-01 - 2007-03)

Abstract

Background: Rapid growth of urban slums due to alarmingly increasing urbanization is adversely affecting the growth and development of infants residing in such deprived areas.
Objectives: To study the association of postnatal growth and psychosocial development of urban slum infants.
Methods: 202 infants and their mothers were included in a cross-sectional study conducted in Raja bazaar in 2002. Growth was assessed using anthropometric measurements: weight and length for age and development by psychosocial developmental scale developed by ICMR.
Results: Development was delayed in significantly higher percentage of underweight (W/A<-2 S.D) than normal infants (p value <0.05): gross motor (15.3% & 4.5%), Vision &fine motor (21.1%, 4.6%) and social skills (27.6%, 12.1%). Development of gross motor milestones was also delayed in significantly high percentage of stunted infants with L/A<-2S.D (22.2%) compared to normal L/A (5.6%, p value=0.003). Difference in the percentages of infants was significantly very high (p value0.000) for vision & fine motor (27.5% & 6.9 ), hearing, language and concept development (22.5 & 4.2%) and social skills (42.5% & 11.9%).
Conclusions: Interventions to improve the postnatal growth will be helpful in facilitating the psychosocial development of infants living in urban slums.

Keywords: Postnatal Growth, Psychosocial Development, Infants, Urban Slum

Increasing urbanization has resulted in a faster growth of slum population. An alarming growth rate of population (5-6%) was observed over the past decade (1991-2000) in urban slums. Substandard housing, poor sanitation, malnutrition and poverty have a great impact on almost all the aspects of life especially the overall growth and development of children. As it is a well known fact that human being is more postnatal brain developer than prenatal. The growth velocity of human brain is particularly high during first six months of life. Therefore growth faltering during infancy might be a potential risk factor for the psychosocial development of such underprivileged infants residing in urban slums. Although the developmental milestones have been extensively studied in developed countries but there is a paucity of such studies in developing countries. Hence our knowledge of development of children especially those living in urban slums are inadequate. The present study aims to investigate the association of poor growth on the psychosocial development of the infants living in deprived urban slums.

Material and Methods

A cross sectional study was conducted in Raja bazaar, an urban slum near Gole Market with in the vicinity of Lady Hardinge Medical College, New Delhi. The approximate number of jhuggies was 1100 and the number of families residing there was 1900. All the infants and their mothers were enrolled in the study from April 2002 to December 2002. Study subjects were contacted personally by visiting them at their home. A total of 202 infants were examined and their mothers were interviewed. A pre-tested, semi-structured interview schedule was administered to obtain the information about socio-demographic factors. Growth was assessed by taking anthropometric measurements like weight and length. Infants were weighed using an infant weighing scale with an accuracy of +/- 50 gram with minimal clothing. Instrument was standardized periodically and zero error was corrected every time the weight was measured. Supine length of infants was measured with infantometer with fixed head piece. Help of the attendant was taken; infant was kept supine on infantometer and was asked to keep the vertex of the infant touching the fixed headpiece. Legs of the infants were kept fully extended by keeping the knees pressed. Feet were kept vertically at 90 degrees. Movable leg piece was opposed against the sole and the length was taken from attached scale to the nearest of 0.1 cm. the observed values for weight and length were compared with NCHS standards for age and sex and analyzed. Development was assessed using Psychosocial Development Screening Test developed by ICMR1 comprising of five major areas: 1) Gross motor 2) Vision and fine motor 3) Hearing language and concept development 4) Self help skills or personal skills 5) Social skills. Information regarding that was either self observed or retrieved from mothers. For assessing the development status of the infants, 50th percentile of age of achievement of psychosocial development milestones was taken as reference. Any infant who did not achieve the above named milestones up to 50th percentile of age was considered in the group of delayed milestones and those who achieved were in group of achieved in time. While assessing the development of infants care was taken to make the study subjects comfortable. All the infants were assessed for the items relevant for their age. The data thus collected was fed in computer (SPSS Software) and analyzed for cross tabulation, pertinent statistical test and test of significance.

Results

In all 202 infants and their mothers were enrolled in the study.59.4% infants were below 6 months (9.9% infants were below one month of age) and 40.6% were above 6 months of age.45% females and 55% male infants were their in study group. 88.2% mothers were between age of 18-29 years, 3% less than 18 years and 8.8% were more than 30 years of age.62.9% mothers were illiterate. Of the 37.1% educated mothers, 15.8% were primary school pass, 14.4% middle school pass and 6.9% were high school pass or above.15.7% mothers were working involved in unskilled works. Majority of families (84.7%) were Hindu and 70.8% families were nuclear in structure. 70.8% families belong to upper-lower socioeconomic status followed by 18.8% to lower-middle, 9.4% to upper-middle socioeconomic class according to modified Kuppuswami scale.

Table 1: Psychosocial Development of Study Infants According to Weight for Age

Development status
of infant
Length for
age Normal (≥2SD)
Length for
age Less than -2SD
Total
n (%) n (%) n (%)
Gross motor*
Delayed 4(4.5) 11(15.3) 15(9.4)
In time 84(95.5) 61(84.7) 145(90.6)
Total 88(100) 72(100) 160(100)
Vision & fine motor**
Delayed 5(4.6) 16(21.1) 21(11.4)
In time 104(95.4) 60(78.9) 164(88.6)
Total 109(100) 76(100) 185(100)
Hearing language and concept development
Delayed 6(5.6) 9(1.8) 15(8.2)
In time 102(94.4) 67(88.2) 169(91.8)
Total 108(100) 76(100) 184(100)
Self help skills
Delayed 1(3.0) 4(10.5) 5(7.0)
In time 32(97.6) 34(89.5) 66(93)
Total 33(100) 38(100) 71(100)
Social skills*** 13(12.1) 21(27.6) 34(18.6)
Delayed
In time 94(87.9) 55(72.4) 149(81.4)
Total 107(100) 76(100) 183(100)
*x2 =5.369, df=1, p value=.021
**x2=12.064, df=1, p value=.001
***x2=7.041, df=1. p value=.008

Table 1 shows the development status of all the five domains of psychosocial development of study infants according to their weight for age i.e. normal and under weight (less than 2 S.D). Achievement of gross motor mile stones was delayed in 15.3% infants with W/A less than -2S.D compared to 4.5% infants with normal W/A. Difference was statistically significant( p value=0.021). Development of vision & fine motor (4.6% in normal W/A & 21.1% in W/A l7;-2S.D, p value= 0.001) and social skills (12.1% in normal W/A & 27.6% in W/A < -2S.D, p value= 0.008) was delayed in significantly higher percentage of infants with W/A less than 2S.D. Even the achievement of hearing, language and concept development and self help skills was delayed in higher percentage of infants with W/A < -2S.D but the difference was not found to be statistically significant (p value>0.05).

Table 2 shows the development status of all the five domains of psychosocial development of study infants according to their length for age i.e. normal and stunted (less than 2 S.D). Development of all the domains except self help skills was observed to be delayed in significantly higher percentage of stunted infants. Development of gross motor milestones was delayed in 22.2% of stunted infants compared to 5.6% of infants with normal length for age (p value=0.003).

Difference in the percentages of the infants with delayed achievement of milestones was very significantly high for vision and fine motor (27.5% in stunted and 6.9 % infants with normal length for age, p value= 0.000), hearing, language and concept development (22.5% in stunted, 4.2% in infants with normal length for age, p value=0.000) and social skills (42.5% in stunted, 11.9% in infants with normal length for age, p<0.001).The development of self help skills was also delayed in higher percentage of stunted infants but the difference was not statistically significant.

Table 2: Psychosocial Development of Study Infants According to Length for Age

Development status
of infant
Length for
age Normal (≥2SD)
Length for
age Less than -2SD
Total
n (%) n (%) n (%)
Gross motor*
Delayed 7(5.6) 8(22.2) 15(4.5)
In time 117(94.4) 28(77.8) 145(90.6)
Total 124(100) 36(100) 160(100)
Vision & fine motor**
Delayed 10(6.9) 11(27.5) 21(11.4)
In time 135(93.1) 29(72.5) 164(88.6)
Total 145(100) 40(100) 185(100)
Hearing language and concept development ***
Delayed 6(4.2) 9(22.5) 15(8.2)
In time 138(81.7) 31(77.5) 169(91.8)
Total 144(100) 40(100) 184(100)
Self help skills
Delayed 3(5.2) 2(15.4) 5(7.0)
Delayed 55(94.8) 11(84.6) 66(93)
Total 58(100) 13(100) 71(100)
Social skills****
Delayed 17(11.9) 17(42.5) 34(18.6)
In time 126(88.1) 23(57.5) 149(81.4)
Total 143(100) 40(100) 183(100)
*x2 =0.024, df=1, p value=.003
**x2=13.226, df=1, p value=.000
***x2=14.052, df=1. p value=.000
****x2=19.363, df=1. p value=.000

Discussion

Results of present study indicates that the development of gross motor, vision and fine motor and social skills was delayed in significantly higher percentage of under weight and stunted infants. Even the development of hearing language and concept development was delayed in significantly higher percentage of stunted infants but higher percentages were not significant in under weight children. Development of self help skills in study infants was not fond to be infl uenced significantly by the weight and length for age. Such results are due to lesser number of children assessed for the development of this domain under psychosocial development. Vazir et al2 also observed early attainment of milestones in children with more than equal to 75% of standard weight for age in Hyderabad rural children (0-6yr). Similar results were observed in other two centers at Jabalpur, Chandigarh3 and Ajmer4. Delayed cognitive development in underweight children was also reported by Freeman HE et al5, Johnston FE et al6 and Siman et al7. In Pakistani infants also post natal stunting and wasting was found to be inversely related to the age at commencement of motor milestones8.

Conclusions

Postnatal stunting was found to be more infl uential in delaying the development during infancy compared to their weight for age. Interventions to improve the postnatal growth may be helpful in facilitating the psychosocial development of such deprived infants living in urban slums.

References

  1. Vazir S, Naidu AN, Vidyasagar P. Screening test battery for assessment of psychological development. Ind Pediatr 1994; 31:1465-1475.
  2. Vazir S, Naidu AN, Vidyasagar P. Nutritional status, Psychosocial development and the home environment of Indian rural children. Ind Pediatr 1998; 35:959-966.
  3. WHO Report of the Workshop of Investigators of Collaborative Study on physical Growth and Psychosocial development. Maternal and Child Health and Family Planning Division, World Health Organization, Geneva, 1991; MCH/ 91.8.
  4. Talwar R and Chowdhary B. Cross sectional study of milestones in healthy infants up to age of one year. Indian Medical Gazette May 2001: 125 -34.
  5. Freeman He, Klein RE, Townsend JW, Lechtig A. Nutrition and cognitive development among rural Guatemalan children. Am J Public Health 1980; 70; 1277-85.
  6. Johnston FE, Low SM, de Bassa Y, MacVean RB. Interaction of nutritional and socioeconomic status as determinants of cognitive development in disadvantaged urban Guatemalan children. Am J Phys Anthropol 1987; 73: 501-6.
  7. Sigman M, Neumann C, Jansen Ake AJ, Bwibo N. Cognitive abilities of Kenyan children in relation to nutrition, family characteristics and education. Child Dev 1989; 60: 1463-74.
  8. YB, Yip PSF, Karlberg JPE. Fetal growth, early postnatal growth and motor development in Pakistani infants. Int J Epidimiol 2001; 30:66-72.

Deptt. of Community Medicine, Lady Hardinge Medical College,
New Delhi, Email: [email protected]
Received: 31.5.05

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