Indian Journal of Medical Sciences Medknow Publications on behalf of Indian Journal of Medical Sciences Trust ISSN: 0019-5359 EISSN: 1998-3654 Vol. 57, Num. 7, 2003, pp. 286-289

Indian Journal of Medical Sciences, Volume 57, Number 7, July 2003, pp. 286-289

A study of malnutrition among children aged 6 months to 2 years from a resettlement colony of Delhi

A Khokhar,* S Singh,** R Talwar,* S K Rasania**, S r Badhan,*** M Mehra****

*Assistant Professor; **Professor, Dept of Community Medicine, VMMC & Safdarjang Hospital, Delhi; *** Medical Officer, U.H.C., Gokulpuri, Delhi and ****Director-Professor & Head, Dept of Community Medicine, M.A.M.C., Delhi.
Correspondence: Dr. Anita Khokhar, 374-A, Pocket-II, Mayur Vihar, Phase-I, Delhi 110091.

Accepted on 10-3-2003.

Code Number: ms03001

Protein energy malnutrition (PEM) has been identified as a major health and nutrition problem in India. It not only leads to childhood morbidity and mortality but also leads to permanent impairment of physical and possibly of mental growth of those who survive.¹ In 1997, it was estimated that about 170 million children under five years of age i.e. 30% of the world's children are malnourished in terms of being underweight, over two thirds of these malnourished children belong to Asia. It is recognized that 56% of the deaths in under five children, in developing countries are attributed to malnutrition.² In India 47% of all children below 3 years of age are undernourished. National Family Health Survey data highlights the critical period when growth faltering occurs to be six months to 2 years.³ About 50-60% of children are reported to be undernourished by another source.⁴

The present study was undertaken with the objective to assess the factors contributing to PCM among the children in the vulnerable age group of 6 months to 2 years from a resettlement area of Delhi.

MATERIALS AND METHODS

The study was conducted in all the 1661 children aged between 6 months and 2 years who attended the Well Baby Clinic at Urban Health Centre, Gokulpuri, Delhi during the year 2000. This centre is located in North West Delhi. The data was collected using a pre-tested and pre-structured questionnaire. The mothers were interviewed to collect information regarding socio-demographic factors, breast feeding and weaning practices.

Nutritional status of the child was assessed with the help of anthropometric measurements and using weight for age criteria. The NCHS standards for weight for age were utilized for classification of children in various grades of nutritional status. The weight of the subjects was recorded using weighing scale with minimal clothing and bare feet.

RESULTS

A total of 1661 children who attended the Well Baby Clinic of UHC, Gokulpuri, Delhi, during the year 2000 were studied. 974 (58.6%) of them were males and 687 (41.4%) females. 1512 (91%) were Hindus, 87 (5.2%) Muslims, 50(3.0%) Shikhs & 12(3%) Christians.1029 (61.9%) belonged to nuclear families and 632 (38%) to joint families. 221 (13.3%) belonged to upper middle 1124 (67.7%) to lower middle and 316 (19%) to lower income group. l474 (88.7%) of the father's were literate as against 1124 (67.7%) of the mothers.

A total of 1009 (60.7%) of the subjects were malnourished. (Table 1). Colostrum was given by 712(42.9%) as against 949(57.1%) who had not given. 64.8% of those who were not exclusively breast fed for the first four months of life were malnourished as compared to 35.2% of those who were exclusively breast fed till four months of age and the difference is statistically significant.(p<0.05). Similarly, significant association was found between practice of commercial formula feeding and malnourishment. (Table 2). As high as 1425 (85.8%) of the subjects were given diluted top milk. Only 335 (20.2%) had used a katori and spoon to feed the children (Table 3). Over half of the subjects were given solid/semi-solid food by the age of 6-7 months (Table 4).

DISCUSSION

The prevalence of malnutrition was 60.7% in the present study. According to NFHSII, 47% of the children aged less than 3 years are malnourished.³ Similar results have been observed by others.^4-6

Colostrum which is considered healthy for the newborn was give to only 42.2% of the subjects. This has been observed by a number of other workers also.^8-11 It reflects that mothers need to be sensitized especially during the ante-natal period regarding the feeding of colostrum.

In the current study 54% of the children were exclusively breasted till four months, this figure is comparable with 55% as reported by NFHSII whereas Aneja et al from slums of Delhi have reported that only 20% of the children were exclusively breast fed till six months of age.^3,7 Use of commercial formula feeds by over 50% in this study and 37% from slums of Delhi shows that probably in urban areas women are hard strung for time and do not find it convenient to use home available food items or that correct messages of feeding the child have submerged under the influence of advertisements for commercial feeds. Dilution of top milk by majority of the women as also observed by others,⁷ again goes to prove that women do not have correct and adequate knowledge about feeding of the children. The use of bottles with nipples, a practice which is not recommended for feeding of children at any age was again observed in over half of the subjects. NFHSII reports this practice to be common in Delhi.³ By the age of 6-7 months a low percentage of women had introduced solid/semi-solid food items, this practice of delayed weaning is in agreement with observation of Aneja et al.

Till the women are educated about the recommended feeding practices, nutritional status of the children, which is the determinant of their health and well being, will not show any signs of improvement.

SUMMARY

Nutritional status of 1661 children aged 6 months to 2 years who attended the Well Baby Clinic of UHC Gokulpuri, Delhi during the year 2000 was studied.60.7% of them were malnourished. Undesirable practices of discarding the colostrum, not exclusively breast feeding the child till at least 4 months of age, delayed weaning, dilution of top milk, use of bottle and nipple for feeding the children are still widely prevalent.

REFERENCES

1. Park K. Park's Text book of Preventive and Social Medicine. 17th edn. Jabalpur: Banarsidas Bhanot Publishers; 2003. pp. 435.
2. Ghai OP, Gupta P. Essental Preventive Medicine, 1st edn. Jangpura, Delhi: Vikas Publishing House Pvt Ltd; 1999. pp. 142.
3. National Family Health Survey II, Key Findings, International Institute of Population Sciences. Mumbai, India: IIPS Press; l998. Vol 99. pp. 17-8.
4. Gopujkar PV, Chaudhari SN, Ramaswami MA, Gore MS, Goplan C. Infant Feeding Practices with special reference to the use of Commercial Infant Foods. Nutrition Foundation of India, Scientific Report No.4. New Delhi: Ratna Offset; 1984. pp. 115.
5. National Nutritional Monitoring Bureau. Report of Second repeat survey. National Institute of Nutrition. Vol 97. Hyderabad: ICMR, NIN Press; 1996. pp. 1.
6. Laxmaiah A, Mallikharjuna Rao K, Brahmam, GNV, et al. Diet & Nutritional Status of Rural Preschool Children in Punjab. Indian Pediatr 2002;39:331-8.
7. Aneja B, Singh P, Tandor M, Pathak P, Singh C, Kapil U. Etiological factors of Malnutrition among infants in two urban slums of Delhi. Indian Pediatr 2001;38:160­5.
8. Ray G, Reddy DCS. Some aspects of feeding and weaning practices in an urban slum community. Indian J Pub Health 1998;32:207-8.
9. Kapil U, Verma D, Narula S. Study of Breast Feeding Practices in schedule caste communities in Haryana state. Indian Pediatr 1994;31:1227-32.
10. Kalara A, Kalara K, Dugal RS. Breast feeding practices in different residential, economic and educational groups. Indian Pediatr 1982;19:419-25.

Copyright 2003 - Indian Journal of Medical Sciences.

The following images related to this document are available:

Photo images