Determinants of Protein Energy Malnutrition Among Rural Preschool Children

Abstract

This was a cross-sectional study in Hoskote Rural Health Centre area of Vydehi Institute of Medical Sciences and Research Centre conducted a) to assess nutritional and health status of the anganwadi children and b) to determine factors contributing to protein energy malnutrition. METHODS AND MATERIAL: 268 children under five years of age formed the study group. Interview of the mothers, clinical and anthropometric measurements of the children was conducted. RESULTS: 63.8% of the children were undernourished according to IAP classification. Multivariate analysis revealed that birth weight and anemia were significant risk factors for development of protein energy malnutrition (Odds Ratio 1.4 and 2.5 respectively). Only 26.9% of these children had received colostrum. 13.8% had received exclusive breast feeding for six months. Complementary feeding was initiated either too early (<4months) in 22.0% or too late (>7months) in 39.9% of the children. 66.7% of the children were completely immunized. During the study 30.2% of the children suffered from illnesses, acute respiratory infections 57(21.3%), diarrhea 10(3.7%) and 14 (5.2%) had viral fever, fits or acute suppurative otitis media. CONCLUSIONS: a) antenatal nutrition to be improved to prevent low birth weight b) nutrition education for mothers to prevent anemia in children c) advocacy for breast feeding and appropriate complementary feeding practices by all health functionaries and anganwadi workers d) nutrition and health education should be given for mothers to enable them to prevent protein energy malnutrition in their children. KEY WORDS: protein energy malnutrition, health, under five children. INTRODUCTION: Protein energy malnutrition (PEM) is a widespread problem in developing countries. About 60-70% of children with PEM suffer from mild to moderate type and 2-5% is of severe type. [1] PEM in turn makes children more prone to infections. Infections and helminthic infestations are important contributing factors in the causation of malnutrition in preschool children consuming inadequate diets. [2] Other factors such as poverty, illiteracy, large family have been shown to contribute to malnutrition. The risk of death from common childhood diseases is doubled for a mildly malnourished child, tripled for a moderately malnourished child and eight times for a severely malnourished child. [3] A strong foundation in the very early years of a child are important in the form of care and nurturing , good nutrition including exclusive breast feeding for six months, immunization, access to safe water and sanitation. It also requires that mothers are well cared for during antenatal, intranatal and postnatal period so that children will have a good start in life. [4] The Integrated Child Development Services Programme was started in 1975 incorporating interventions such as food supplementation, immunization, health care and referral services for children as well as pregnant and lactating mothers. The following study was conducted in Anganwadis in Hoskote,

Assessment of Nutrition and Immunization Status of Children Attending to Anganwadis at Field Practice Area of a Rural Medical College, Karnataka

“…Deshmukh et al 13 found that 52% of children under the age of six were male and 48% were female. 14 In this study, more female children (10.84%) were thin built than male children (5.9%), (p>0.05). According to Mandal et al, the frequency of thinness among boys was 84.8% and 85.6% among females 14 .…”

“…14 In this study, more female children (10.84%) were thin built than male children (5.9%), (p>0.05). According to Mandal et al, the frequency of thinness among boys was 84.8% and 85.6% among females 14 . Another cross-sectional study conducted at Vydehi Institute of Medical Sciences Bengaluru in a rural field practice area revealed that the prevalence of underweight among male and female children was 56 (46.3%) and 60 (48.4%), respectively 15 .…”

Assessing Factors Contributing to the Prevalence of Protein–Energy Malnutrition Among Children Under Five Years of Age Attending Kigoma District Hospital, Tanzania

“…Thus, as one grows older, the nutrition priorities change is often towards meeting increased nutrient needs with reduced energy requirement, and minimizing lean muscle loss [6,7]. The malnutrition affects height, growth, cognitive development, learning ability, social behavior and health of the children making them more prone to infections [8]; even common diseases like influenza can lead to the children's death during PEM [9] The PEM increases susceptibility to diseases because it leads to high expression of arginase from monocytes and macrophages and the arginase, in turn, causes immunosuppression [7,10]. It is also associated with numerous poor health outcomes, including high health care costs, mortality rates and poor physical functioning in older adults [11].…”

“…The occurrence and severity of PEM in any country are related to its socio-economic development [24] Age group, gender, dietary habits, literacy rate and living conditions essentially affect the predominance of PEM. Also, low birth weight, improper breastfeeding, early or late initiation of complementary diet and incomplete immunization were mainly responsible for malnutrition [9] In terms of gender factor, females were reportedly more prone to PEM than males [17] resulting mainly from lack of attention toward the female children. Age, education, occupation, marital status and economic status of the women significantly regulate the risk of malnutrition.…”