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 Table of Contents  
ORIGINAL ARTICLE
Year : 2021  |  Volume : 2  |  Issue : 1  |  Page : 15-20

The role of familial characteristics on the nutritional status of preschool children: A comparative study on rural and urban children


1 Department of Community Medicine, Himalayan Institute of Medical Sciences, Swami Rama Himalayan University, Dehradun, Uttarakhand, India
2 Department of Community Medicine, SRMSIMS, Bareilly, Uttar Pradesh, India
3 Department of Community Medicine, GMERS Medical College, Patan, Gujarat, India
4 Department of Community Medicine, Dr. D. Y. Patil Medical College, Pune, Maharashtra, India

Date of Submission27-Nov-2020
Date of Acceptance14-Dec-2020
Date of Web Publication31-Mar-2021

Correspondence Address:
Dr. Neha Sharma
Department of Community Medicine, Himalayan Institute of Medical Sciences, Swami Rama Himalayan University, Jolly Grant, Dehradun - 248 016, Uttarakhand
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jphpc.jphpc_17_20

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  Abstract 


Introduction: Nutritional status of underfive children is a proxy indicator for assessing the nutrition of the entire community and also the key predictor of child survival. While several studies have focused on the determinants of child's nutrition status in India, little attention has been given to the aspect of rural-urban variation in child's nutritional status in terms of their determinants. The present study is aimed to ascertain the magnitude and the factors affecting the malnutrition across rural & urban areas of Uttar Pradesh. Methodology: A community-based study was conducted for 2 months in the field practice areas of a tertiary care hospital. Multistage random sampling technique was used for the selection of study subjects. A total of 117 under-five children were studied equally from rural and urban area. A pre-designed pre-tested proforma was used to assess the feeding practices. Stunting and underweight were used to proxy the child nutrition status. Data were evaluated on SPSS version 17. Chi-square test was used to find out the association of family characteristics with nutritional status in the two areas. Results: Undernutrition was more prevalent in rural children than their urban counterparts. It was seen that in the rural areas, 1-3 year children were more wasted & underwt whereas 0-1 yr children were more stunted, whereas in urban areas0-1 yr children were more affected in terms of wasted & underwt whereas stunting was more prevalent in 3-5 yr children. Religion, family size, Environment & Social Class was found to have association with significant association with Undernutrition. Parental Education as well as Father's Occupation was also found to have Significant association with the nutritional status of underfive children. Conclusion: Familial characteristics have an important bearing on the nutritional status of underfive children. Hence Improvement in literacy especially female literacy will go a long way in improving the nutritional status of the child. Strategies are needed to improve the economic status of the community.

Keywords: Familial characteristics, rural, urban, underfive, undernutrition


How to cite this article:
Vyas S, Sonkar S, Sharma N, Srivastava AK, Sharma P, Srivastava K. The role of familial characteristics on the nutritional status of preschool children: A comparative study on rural and urban children. J Public Health Prim Care 2021;2:15-20

How to cite this URL:
Vyas S, Sonkar S, Sharma N, Srivastava AK, Sharma P, Srivastava K. The role of familial characteristics on the nutritional status of preschool children: A comparative study on rural and urban children. J Public Health Prim Care [serial online] 2021 [cited 2021 Jun 21];2:15-20. Available from: http://www.jphpc.com/text.asp?2021/2/1/15/312694




  Introduction Top


Malnutrition among Indian children is a known public health problem due to paucity of adequate nutrients in diet both in quality and quantity. The nutritional status of under-five children is causing great concern among social scientists and planners nowadays because child is the principal victim of interaction of nutritional, social, economical and also health related factors that lead to malnutrition.[1] Nutritional status of children under 5 years of age is very important, since the foundation of healthy life is laid during that period. Malnutrition in early childhood has serious, long-term consequences because it impedes motor, sensory, cognitive, social and emotional development.[2] Global evidence suggests that undernutrition continues to affect millions of children. Maternal and child under nutrition, and unstimulating household environments contribute to deficits in children's development, health and productivity in adulthood.[3]

Early childhood malnutrition can have lasting effects on growth and functional status. Anthropometric measurements remain the most practically useful means for the assessment of the nutritional status of a population.[4] Weight, height and mid arm circumference are considered as the most sensitive parameters for assessing nutritional status of under-five children. The use of appropriate anthropometric indicators allows the identification of the nature and extent of protein energy malnutrition in the country. The inadequate energy and protein intake leads to malnutrition in the form of wasting, stunting and underweight.[5] Occurring primarily in the first 2-3 years of life, stunting is frequently associated with repeated exposure to adverse economic conditions, poor sanitation, and the interactive effects of poor energy and nutrient intakes and infection. Underweight or low weight for age indicates a history of poor health or nutritional insult to the child, including recurrent illness and/or starvation, while a low weight-for-height is an indicator of wasting (i.e., thinness) and is generally associated with recent illness and failure to gain weight or a loss of weight.[6]

Malnourished children are more likely to become malnourished adults and they face increased risks of morbidity and mortality. It is essential to pay more attention to correlate between children's nutritional status and their capability to attain the required physical growth and mental development.[7],[8]

Though there are several studies conducted on malnutrition, in this region, whereas none of the studies compare the rural & urban determinants of malnutrition. This community based study was undertaken to assess the prevalence of undernutrition in under five children and to know its determinants in rural and urban areas of Uttar pradesh.


  Methodology Top


The study was carried in permission with Institutional Ethics Committee. This community based cross sectional study was conducted in the rural & urban field practice areas of the Department of Community Medicine, of a Tertiary care hospital of U.P.The urban health training center (U.H.T.C) has 9 registered peri-urban localities with a registered popula-tion of 36,146. The rural health training center (R.H.T.C.) has 24 registered villages having a registered population of 52543. The estimated sample size was calculated according to the formula

n = 4 p q/d2 n = Sample size

= 4 X 42.5 X 57.5/72 p = Prevalence of underweight

= 199 children (42.5%)

d = Absolute precision

= 7%

q = 100 − p

Considering a nonresponse rate of 10% the sample size came out to be 219. Thus, the actual sample size as calculated = 219. A total of 234 households were covered in both the areas, of which 117 underfive were studied from the rural area & an equal no of underfive were studied from the urban area giving equal representation to both the areas in order to have a better comparative analysis. Multistage Random sampling technique was used for the selection of study subjects. In the First stage, a list of all the villages/areas from RHTC & UHTC under the Department of Preventive and Social Medicine, was prepared. .Using Simple random sampling technique one Village was randomly selected from the list of villages under RHTC (Rural health Training centre), similarly one urban locality was selected randomly from UHTC (Urban health Training centre) .In the next stage, all the households in the selected areas having children less than five years fulfilling the selection criteria were included in the study. The households were visited personally. Data was collected using predesigned semi structured questionnaire. All mothers who have children under 5 years of age were interviewed. A semi-structured pretested interview schedule was used to collect information from the mother.Parents were informed about the objectives of the study and their consent was taken. Children who had come visiting or who have been residing for less than one month were not included. Children who were too unwell, agitated & unwilling for anthropometric measurements were excluded from the study.

Children who were too unwell, agitated & unwilling for anthropometric measurements were excluded from the study.Informed consent was taken from the parents of all children. The date of birth the child was used to calculate the exact age of the child. When the exact date of birth was not known, the age as told by the mother was used corrected to the nearest month The information obtained from child's mother was filled in the proforma. In the absence of the mother, any other responsible adult member of the family, Information was collected onstructured, pretested performa by interviewing the mothers. After collecting socio-demographic data like age, sex, monthly income, type of family, nutritional status was assessed by anthropometry. Children were weighed and measured as per the WHO guidelines on anthropometry. Data collection was done over a period of one month.

Weight was measured with minimal clothing using an electronic weighing machine which measures up to 100 kg to a precision of 0.1 kg (100g). For children less than 2 years, recumbent length was measured to the nearest 0.1 cm with an infantometer with the children lying down. For children more than 2 years height was measured to the nearest 0.1cm using a stadiometer with the child standing, with the occiput, buttocks and heel touching the vertical board and head in the Frankfurt line. All measurements were taken twice and the average of two readings was used for analysis. The children are classified using three categories:

Underweight (low weight-for-age).

Stunting (low height-for-age).

Wasting (low weight-for-height).


  Results Top


[Figure 1] shows that the Rural children were more stunted & underweight & wasted as compared to urban children except for severe wasting which was found to be equal in both the areas.
Figure 1: Severity of undernutrition in underfive children according to their area

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The prevalence of wasting (52.8%) & underwt (42.2%) was mostly found in 1-3 yr age group children, whereas the prevalence of stunting was maximally seen in 3-5yr children (45.4%).

[Figure 2]a and [Figure 2]b shows the Areawise distribution of undernutrition, in 0-1yr age gp urban children were found to be more wasted(-2SD = 80% & -3SD = 54.5%)& underwt ((-2SD = 60% & -3SD = 56.3%) whereas stunting was seen more in rural children. In 1-3yr & 3-5yr age gp rural children were found to be more undernourished i.e., wasted, underwt & stunted, except for stunting in 3-5 yr age gp which was more seen in rural children.
Figure 2: (a) Agewise distribution of severity of undernutrition in the rural area. (b) Agewise distribution of severity of undernutrition in the urban area

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[Table 1] shows the nutritional status of children according to biosocial characters. It was found that the prevalence of underweight & stunted children were found to be a bit higher in Hindus i.e., 63.5% & 44.4% as compared to Muslims in both the areas i.e., Rural & Urban although the proportion was much higher in the rural area as compared to the urban area. Majority of children staying in nuclear family were found to be underwt (64.71%& 50%) & stunted (82% & 64.7%) in both the areas, though the association was not found to significant. [Table 2] shows Nutritional status of children according to parental correlates.
Table 1: Nutritional status of children according to biosocial characteristics

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Table 2: Nutritional status of children according to parental correlates

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The prevalence of underwt (75%& 55.6%) & stunting (83.3%& 66.7%) was maximally found in children staying in a larger family (>10 members) in both the areas, although more in the rural area, while the association was found to be significant only for stunting.

It was further seen that majority of underweight (65.9%& 60.9%) & stunting (82.9% & 65.9%) in both areas were found in children living in Poor Housing, although the prevalence was found to be much higher in the rural areas.The association was also found to be significant. Children of lower socioeconomic class were likely to be more stunted (74.5 & 59.4) & underwt (83.7 & 43.8).The association was also significant.


  Discussion Top


A total of 234 children in the age group of 0-5 years formed the universe of the study. Of the total children, 18.40% children were in the age group of 0-1yr, 38.9% in 1-3yrs of age & 42.7% in 3-5yrs of age.

Our study reflects that Overall, majority of the children were found to be stunted (69.7%), followed by underweight (54.7%) & wasting (29.9%). Our findings are found to be on the higher side when compared with a study done in Uttarakhand.[9] Comparable findings are also found in a study at Pondicherry by Vasudevan and Udayashankar.[2] The study findings revealed that chronic malnutrition was more prevalent than acute malnutrition in our study subjects .A high prevalence of malnutrition is indicative of the poverty and poor living conditions prevailing in areas of UP. As the study was carried out in a setting where majority of children were in low socioeconomic status which influences the nutritional status of children either directly or indirectly.

Areawise, Rural children were more undernourished than urban children. Contradictory findings were seen in another study at Uttarakhand where urban children were more undernourished.[9] Overall, majority of the children in 1-3yr age group, were found to be wasted & underwt whereas stunting was found in majority of 3-5 yr children. Our findings are supported by Vasudevan and Udayashankar in Pondicherry where proportion of moderate and severe underweight and wasting was highest in the age group of 11-23 months while proportion of moderate and severe stunting was highest in the age group of 48-59 months.[2] In another study at Chattisgarh by Sinha T it was found that the older children were at higher risk of stunting and underweight, than the younger ones, in contrast findings were reported by a Uttarakhand study,[10] whereas a coimbatore study found no statistically significant association between different age groups of the under-five children and malnutrition.[1],[3]

Another important finding observed in the present study was that female children were at higher risk of undernutrition, more so in rural areas though the difference was not found to be significant. Our study finding is apt in Indian context where females are prone to get neglected and sex wise prevalence of undernutrition is usually on the higher side in females as compared to male children.[11],[12] Contradictory findings were reported by Anuradha et al. at Tamil nadu & Singh et al where under nourishment was higher among male children,[13],[14],[15] whereas a coimbatore study found no statistically significant difference in among both the sexes in their study.[1]

In our study, religion was found to have a positive association with undernutrition in both the areas as found in another study at Karnataka.[13] Further, children staying in nuclear family were found to face undernutrition in both the areas, though the association was not found to be significant . Corroborative findings were seen in a study at Tamil Nadu by Anuradha et al., where no significant association was found between family size and nutritional status of the children. Whereas contrast findings were reported by a study at Chattisgarh, where children living in larger households were more likely to be stunted or underweight.[3],[14] Inadequate availability of food and inequality in the intra-household distribution of food may possibly explain the reason behind the higher prevalence of undernutrition in larger households.

The present study also showed a significant association between Poor Housing & undernutrition in both the areas which is in line with a study in Uttarakhand & Coimbatore studies, which stated that environment is known to influence both acute and chronic undernutrition, signifying the importance of environment on the growth & development of child.[1],[16]

In our study, children belonging to the lower social classes and hence feeding was inappropriate were significantly more stunted & underweight than the rest. Synonymous findings were reported a tUttarakhand and at Tamil nadu by Anuradha et al.[14],[16] These results indicate that unavailability of food, insuffi-cient purchasing power, inappropriate distribution and inadequate utilization might make the children vulnerable to malnutrition in a deprived community.

It was further observed in our study, that majority of undernourished children had illiterate parents in both the areas .Our findings are in line with other studies as well , where majority (75.50%) of undernourished children had illiterate parents.[16],[17],[18],[19],[20] whereas Anuradha et al., found no significant association was found between educational status of parents and nutritional status of the children.[14] The findings depicts that , the educational level of parents, specifically of the mothers was positively related to the better nutritional status of children. Educated mothers are more conscious about their child's health & well being & lay it as utmost priority, also as mothers as most of the time they are with their children at home, and they tend to look after their child in a better way as compared to fathers. Better nutritional profile children of educated mothers indicates that educated mothers are more aware of the health services available and also the acceptance to utilize the same is better among them. Literate mothers can easily introduce new feeding practices scientifically, which helps to improve the nutritional status of their children.

Further, in our study it was observed that, majority of undernutrition was found in children of labourer whereas children of farmers/cultivators were least likely to be malnourished whereas in the urban area children of professionals were least at risk for undernutrition. The findings suggest that children of farmers have abundant/surplus foodgrains throughout the year,& hence are less likely to be undernourished whereas children of labourers, who has an unpredictable source of income & hence resources & therefore are more likely to suffer from undernutrition Primarily Professionals are literates & hence do understand the nutritional needs of their child also, they have a constant source of income, hence can also satisfy the nutritional needs of their child. With respect to the mother's occupation, it was lowest among housewives. Supportive findings were reported by a study at atTamilnadu&Uttarakhand.[14],[20] This is because mothers are working may tend to give less time for child feeding and health, with possible adverse nutritional outcomes. Poor nutritional status of children of working mothers suggests that working places should be provided with crèches where kids can be taken care of while the mother is at work. In contrast findings were reported by a study at Coimbatore, by Senthilkumar et al., where mother's working for salary came as a protective factor for malnutrition when compared to home-makers.[1]


  Conclusion Top


The article concludes that majority of under five children were undernourished, more in rural areas , girl child being affected more in both the areas. Undernutrition was more prevalent among children from rural families. Religion, family size, socioeconomic status, Parental education and father's occupational status had significant effect on child's nutritional status. Inspite of having several programmes focussing on underfive nutrition, the prevalence of undernutrition remains high especially in the rural areas. Here the role of primary care physicians is vital as primary care is an ideal setting where early screening and management of those 'at risk' of malnutrition could be done. Assessment of the nutritional status of children should be a standard practice in the Primary Care setting . Every opportunity, should be utilized by the primary physicians to screen children and keeping a check on their nutritional status which may guide an adequate nutritional intervention and avoid the risks added by malnutrition itself. Additionally, Primary physicians, are in a unique position so as to influence change due to the wide range of patients accessing primary care services irrespective of caste, creed or gender and another aspect being the relationship and familiarity patients often have with the primary care team.

Acknowledgement

The authors are thankful to ICMR for supporting this study under Short Term Studentship. We are also thankful to SRMSIMS Bareilly, for allowing us to conduct this research and for providing all assistance for the same.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
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