Indian J Pediatr 1987; 54 : 267-270

Nutritional status of preschool children in a backward community

C.P. Mishra, D.C.S. Reddy and I.C. Tiwari

Department o f Preventive and Social Medicine, Institute o f Medical Sciences,

Banaras Hindu University, Varanasi

The nutritional status of harijan and tribal preschool children upto 2 years of age in l~lanikpur block, Banda District, Uttar Pradesh was monitored at an interval of one year. Rates o f improvement, recovery and deterioration were computed. Of children with grade-I malnutrition 16" 4~ became normal while 37" 3% with grade 11 malnutri- tion entered either grade I or became normal. Maxumum improvement (i.e. 50%) was observed in grade 1II children. Thus, in all 30% of the children showed an improvement in their nutritional status, Le. recovery rate took place in 10" 6% only. In all, 31" 5% of subjects worsened or died (3" 0%). Of the children who were normal at the beginning 51" 2% deteriorated. The % o f children who deteriorated in grade I, 11 and HI cohorts respectively were 30"2%, 28.8% and 10"7%. Thus the rates of deterioration were higher than the rates of recovery in different cohorts studied.

Key words : Deterioration rate; Improvement rate; preschool children; recovery rate

Numerous studies conducted in differ- ent parts of the country ha,)e shown high prevalence of protein energy malnutrition (PEM) in children under the age of five years, 1-5 particularly amongst those be- longing to backward communities. How- ever, these studies have not answered the questions (i) what are the chances of spontaneous recovery in a child affected by PEM; and (ii) what proportion of normal and malnourished children deteri- orate over a period of time? This can be done only by repeat examination and by computing rates of recovery and deterior- ation of children in different ~ades of

Reprint requests : Dr. I.C. Tiwari, Professor, Department of Preventive and Social Medicine, Institute of Medical Sciences, Banaras Hindu University, Varanasi 221005, U.P.

malnutrition. This is of significance in understanding the antural history of PEM in a community and also in measuring the impact of any intervention measures 6 particularly in the light of management of PEM by adopting "high risk" approach. 7

Material and Methods

A sample of 220 children up to the age of 48 months was registered from six clusters of Manikpur block in Banda district, Uttar Pradesh. The clusters of population were selected on the basis of distance from Manikpur which is the block and primary health centre headquarter and the only important railway station and market in the area. Two clusters fell within 5 km, two between 5-10 km and

267

268 THE INDIAN JOURNAL OF PEDIATRICS Vol. 54, No. 2

remaining two beyond 10 km from Manik- put. The entire block is a forest and tribal area with very poor road communication.

For operational feasibility, the clusters selected were those which could be appro- ached during all seasons by motorcycle/ cycle. This was done to ensure longitudi- nal recording of data. In the selected clusters, all Harijan and tribal children up to 48 months of age were enumerated. A calendar of local events was utilised for recording the ages of children under study and this was also crossverified with the records of another research project being undertaken by the epartment.

Weights of 203 children were recorded in minimum clothes using Salter scales in January, 1983 and January, 1984 using standard techniques (Jelliffe).S Grading of nutritional status of the children was done on the basis of weight for age triteria using Indian Academy of Pediatrics (I.A.P.) classification. 9 No attempt was made to demarcate children between 51 to 6070 and equal to or less than 5070 of the reference standard. Any child equal to or less than 6070 of reference value was treated as grade-III. Also in this paper throughout prevalence rates of PEM have been referred to for computation of rates of deteriora- tion and recovery.

Results

Nutritional status of the study cohort as in January, 1983 is shown in Table I. Out of the 203 children, 43 (21-2%) were normal and 160 (78.8%) were below 80% of the reference standard. The percent- age of children in grade I, II and Ill malnutrition was 35-9, 29.1 and 13.8 respectively. The nutritional status of normal grade I, II and III cohorts after a period of one year has been presented in Table II. Six children could not be

examined in January, 1984 on account of death due to tespiratory tract infections (in 4 cases) and diarrhea (in 2 cases) in previous 12 months.

Out of 43 individuals who were normal in January, 1983, 21 (48.8%) remained normal one year later, while 17 (39. 570) entered grade I malnutrition, 2 (4.7%) children entered grade II and III each. One expired, similarly, from among the 73 children in grade I, 39(53"470) re- mained in the same grade, 20 (27.4Yo) and one (1"47o)deteriorated to grade II and III respectively. One child from this group also died during the study. From the 59 children in grade II malnutrition, 16 (27.170) went into grade III malnutri- tion and one child died. Among the 28 in grade III malnutrition there were three deaths. Thus, in all, 64 (31.570) of the children slipped down along I.A.P. scale to a severer grade of malnutrition or died. Deterioration rates were 30.2, 28.8 and 10.770 in grade I, II, III respectively.

It is evident from Table II that the percentage of children who showed im- provement at the end of one year was as follows--grade I 16.4% (12 out of 73), grade II 37.370 (22 out of 59) and grade III 50.070 (14 out of 28) and thus the overall improvement rate was 30Vo (48 out of 160). But the number of children showing complete improvement (i.e. re- turn to more than 80~ of the reference value) were 12, 4, 1 out of 73, 59, 28 individuals of grade I, II and III respecti- vely. Thus the recovery rate was 10.6~ (17 out of 160). Changes observed in the nutritional status at an interval of one year were highly significant (X2-39-17, df--1, P<0.001. For the purpose of computation of X 2 normal, grade I, grade II and grade III and deaths were clubbed on either side).

MISHRA ET AL : NUTRITION MONITORING IN UNDERFIVES

Table I. Nutritional status of the study cohort as in January, 1983

269

Nutritional status based on weight for age criteria Period

January, 1983 Above 80yo 71-80~0 61-70y0 <~60~, Total

Number 43 73 59 28 203 21.2 35.9 29.1 13-8 100

Table II. Dynamics of nutritional status during one year period using weight for age indexing

Nutritional status (as in Jan. 1984)

Nutritional status (as in Jan. 1983)

Normal Grade I Grade II Grade III Total

No. % No. % No. % No. % No. %

Normal 21 48.8 12 16"4 04 6.8 1 03.6 38 18.7 Grade I 17 39"5 39 53-4 18 30"5 5 17.8 79 38"9 Grade II 02 04.7 20 27- 4 20 33" 9 8 28" 6 50 24- 6 Grade III 02 04.7 01 01.4 16 27.1 11 39.3 30 14-8 Died 01 02.3 01 01"4 01 01.7 3 10"7 06 03"0

Total 43 I00.0 73 100.0 59 100.0 28 100.0 203 100.0

Discussion

The percentage of children whose nutritional status was similar to that observed one year earlier was 53.4 in case of grade I, 33.9 .in grade II, 39.3 in grade III. In a similar analysis, reported by Sunderlal 6 on a cohort of I.C.D.S. child- ren, corresponding figures for grade I, wade II and grade I I I were 89.7%, 72.2% and 64.2% respectively. Also in his study improvement rates (i.e. grade I 7.4%, grade II 19.2% and grade III 35.75%) were lower than the present study. Though recovery rates were comparable in the two studies (i.e. 10.6% in present study

and 10.6% as reported by Sunderlal) percentage of children showing improve- ment was higher (30.0% as against 14.5%) in the present study in spite of the fact that in Ro ~k study, nutritional supple- mentation ader strict supervision was offered to c ldren below 70% of reference value throl [1 Aganwadi workers besides other packl es of I.C.D.S. services. Shah et al 7 in their series of 369 children re- ported improvement in nutritional status ranging from 56 to 62.1 per cent. Children in the study by Shah were provided nutri- tional supplements and all were severely malnourished. The nutritional tatus in a considerable number of children--52.2,

270 THE INDIAN JOURNAL OF PEDIATRICS Vol. 54, No 2.

30.2 and 2 8 . 8 ~ of children with normal, grade I, I I slided to lower grades of mal- nutrition. This was definitely much higher in comparison to observation by Sunderlal 6 and Shah et al 7 which observed deterior- ation of nutrition status in 4.6 to 16-2~ children only.

In conclusion, in the community stu- died, chances of spontaneous recovery of children who are afflicted by PEM to normalcy are only 10"6yo, Of normal child population 51.2~o was found to be deteriorating in their nutritional grade over a period of one year. Once the per- centages are extrapolated to 100 million preschool children and the period is extended to 4-5 years, the problem assumes formidable proportions and demands ur- gent attention. Any attempt for the im- provement of nutritional status of children must enhance the process of recovery from malnutrition and simultaneously check the deterioration of nutritional status. This is likely to require rigorous implementation of nutrition programmes and child health related services.

References

I. Satyanarayana K, Rao D Hanumantha, Susheeta TP. Nutritional status of people of

Andaman and Nicobar islands. Indian J Med Res 1974; 62 : 662-671

2. Rao D Hanumantha, Satyanarayana K. Nutritional status of tribal preschool children of Andhra Pradesh. Indian J Nutr Dieter 1974; 11 : 328-334

3. Luwang NC, Singh PI. Protein energy mal- nutrition amongst the undertives of a hill tribal population of Manipur. Indian J Nutr Dietet 1981; 18 : 139-143

4. Reddy DCS, Singh K, Tiwari IC. Epidemio- logy of nutritional deficiency disorders among tribal preschool children around Manikpur, Banda District, Uttar Pradesh. Indian J Prey See Meal 1984; 15 : 57-61

5. Mishra CP, Reddy DCS, Tiwari IC. Magni- tude of protein energy malnutrition among Harijan and Tribal preschool children in Manikpur Block, Banda District, Uttar Pradesh. Indian J Prey See Med 1985; 16 : 45-48

6. Sunderlal. Monitoring of nutritional status of under six--a prospective study in villages of Integrated child Development Services Block. Indian J Prey See Med 1982; 13 : 72-75

7. Shah PM, Junnarkar AR, Khare RD, Dhole VS. Community wide surveillance of 'at risk' underfives in need of special care. J Trop Pediatr 1976; 22 : 103-107

8. Jelliffe DB. The assessment of the nutritional status of the community. World Health Orga- nisation Monograph Series 1976; 53 : 64-67

9. Indian Academy of Pediatrics. Suggestions and recommendation of Workshop on Protein calorie malnutrition. Indian Pediatr 1975; 12 : 116-117