INTRODUCTION:

Food is the one of the most important and basic biological needs of the man. People eat to live, and what they eat will affect in a high degree to their ability to keep well, to work, to be happy and to live long.

It is essential for life, growth and repair of human body, regulation of body mechanisms and production of energy. The above functions of food can be achieved only through adequate nutrition that should consist of essential nutrients and in the required proportion¹.

Nutrition may be defined as the science of food and its relationship to health. Good nutrition means maintaining a nutritional status that enables us to grow well and enjoy good health. Good nutrition helps to prevent acute and chronic illness, to develop physical and mental potential and to provide reserves for stress². Food consists of various organic and inorganic complexes known as nutrients. Any imbalance of nutrients either in excess or in deficiency can lead to malnutrition.

Malnutrition has been defined as a pathological condition resulting from a relative or absolute deficiency or excess of one or more nutrients³. Malnutrition continues to be a growing problem in most developing countries⁴. It comprises of four forms–under-nutrition, over-nutrition, imbalance and specific deficiency. This study will focus only on under-nutrition and over-nutrition. Malnutrition increases the economic burden of a society because it leads to increased risk of death from infectious diseases, more severe infections⁵ and higher case fatalities creating an additional psychological burden⁶.

Malnutrition is a general term that refers to poor or inadequate nutrition and includes both under-nutrition and over-nutrition. Undernourishment not only affects physical appearance and energy levels, but also directly affects many aspects of the children’s mental functions, growth and development which has adverse effects on children’s ability to learn and process information and grow into adults that may to be productive and contributing members of society⁷. Over nutrition that leads to obesity also affects the health of children. Over nutrition causes obesity, diabetes mellitus, hyper tension, renal diseases and disorders of liver and gallbladder etc⁸.

The world health organization defines malnutrition as “the cellular imbalance between supply of nutrients and energy and the body’s demand for them to ensure growth, maintenance and specific functions.” Malnutrition is the condition that results from taking an unbalanced diet in which certain nutrients are lacking in excess (too high an intake), or in the wrong proportions. A number of different nutrition disorders may arise depending on which nutrients are under or overabundant in the diet. Malnutrition is a disparity between the amount of food and other nutrients that the body needs and the amount that it is receiving. Malnutrition can also be defined as the insufficient, excessive or imbalanced consumption of nutrients. Several different nutrition disorders may develop depending on which nutrients are lacking or consumed in excess⁹.

Malnutrition is frequently part of our vicious cycle that includes poverty and disease. The leading cause of death in children in developing countries is malnutrition. This type of malnutrition is the result of inadequate intake of calories from proteins, vitamins and minerals. About 1% of children in United States suffer from chronic malnutrition in comparison to 50% of children in south East Asia. About two third of all the malnourished children in the world are in Asia with another one fourth in India⁹.

According to Nobel Prize Winner for Economics Angus Deaton, malnutrition in India is not just related to calorie intake, but India’s dependence on carbohydrate-based diet with low protein and fat content. In Tamil Nadu, a national family health survey reveals that 23% of Chennai children show moderately stunned growth. Madhya Pradesh has India’s highest number of malnourished children–74.1% of them under 6 suffer from anemia and 60% have to deal with malnutrition. At 56.5% Jharkhand has India’s second highest number of malnourished children. This is followed by Bihar, at 55.9%. Rajasthan has 44% stunted and 36.6% underweight children. Odisha has 41.5% and 39% of underweight children¹⁰.

Need for the study:

Malnutrition refers to the situation where there is an imbalanced diet in which some nutrients are in excess, lacking or wrong proportion. The problem of malnutrition is prevalent throughout the world. According to Joint malnutrition country database, May, 2017 UNICEFF, WHO and World Bank Group, moderate and severe percentage of children aged 0-59 months who are below minus two standard deviation from median weight for height of the WHO child growth standards, stunting: moderate and severe percentage of children aged 0-59 months who are below minus two standard deviation from median weight for age according to World Health Organization (WHO) child growth standard¹¹.

The most vulnerable period next to infancy is then age of 1-5 years. Preschool children constitute about 14% of the Indian population. This is a huge human resource which needs to be developed and nurtured for the country to progress¹².

India is developing country and its development depends upon various factors in which nutrition is the most important factor. In India, the national family health and welfare survey, under nutrition is found to be high in Haryana, Karnataka, Uttar-Pradesh, Orissa, Maharashtra, Tamil Nadu and Goa. Malnutrition is a broad term which refers to both under nutrition and over nutrition. Individuals are malnourished or suffer from under nutrition if their diet does not provide them with adequate calories and proteins for maintenance and growth, or they cannot fully utilize the food they utilize the food they eat due to illness. People are also malnourished or suffer from over nutrition if they consume too much calories. Malnutrition is insufficient excessive or imbalanced consumption of nutrients, several different nutrition disorders may develop depending on which nutrients are lacking or consumed in excess¹³.

Research Design:

An exploratory research design is used in the present study.

Research Setting:

The present study was conducted in selected rural Village Bhindran, District Sangrur, Punjab.

Target Population:

The target population was children in age group 1 to 5 years, residing in rural area under rural health centre of Bhindran, District Sangrur.

Sample size:

Total 30 children in age group 1 to 5 years from selected rural area of district Sangrur was taken as a sample.

Problem Statement:

An Exploratory study on the prevalence and factors contributing to malnutrition among children (1 to 5 years) in a selected rural area of district Sangrur, Punjab.

Purpose of the study:

The purpose of the study was to assess the prevalence and factors contributing to malnutrition among children (1 to 5 years) and to prepare IEC material in the form of pamphlets regarding prevention of malnutrition.

OBJECTIVES:

1. To assess the prevalence of malnutrition among children.

2. To assess factors contributing to malnutrition among children.

3. To find out association of prevalence of malnutrition with factors contributing to malnutrition.

4. To find out association of prevalence of malnutrition with selected demographic characteristics.

5. To prepare and provide IEC material in the form of pamphlets regarding prevention of malnutrition.

Sampling Technique:

Convenience sampling technique is adopted to recruit study sample.

Inclusion Criteria:

· Children in the age group of 1 to 5 years

· Mothers of children residing in the selected rural area of district Sangrur

Exclusion Criteria:

· Child having any physical illness or disability.

· Child having any chronic disease.

· Child with any congenital anomalies.

· Subjects not willing to participate.

Description of research tool(s):

Tool is divided into three parts:-

Part A:

Socio-biodemographic profile

a) Height and weight of the child

b) Socio-demographic profile

Part B:

Checklist to assess factors contributing to malnutrition.

Part A:

This part is divided into two parts:-

First part consists of taking weight and height of the child, then computing weight for age, height for age and weight for height and comparing it with WHO child growth standards.

Second part consists of 14 items for obtaining personal information i.e. age, education of mother, education of father, occupation of mother, occupation of father, religion, dietary habits, type of family, number of siblings, no of under-five siblings, socio-economic scale (as per MUAP), type of house, source of drinking water, material used to wash hands after defecation.

Part B:

This part consists of 14 items to assess the factors contributing to malnutrition. Items are rated as ‘yes’ or ‘no’ for the presence or absence of factors.

Validity of the Tool:

It was determined by expert’s opinion and suggestions on the relevance of items. Tools was given to experts from different specialties. The experts suggestion were considered and modifications were made.

Reliability of the Tools:

It was determined by test re-test method. Reliability coefficient was found to be r=0.82 for checklist. These values are very high. So, based upon statistical criteria, the tool was considered to be reliable, which was calculated using Pearson’s correlation coefficient (r).

DISCUSSION:

The finding of the study is based on its objectives and discussed under the following:-

Objective 1:-To assess factors contributing to malnutrition:

Depicts that the most occurring contributory factor of under-nutrition was inadequate dietary intake present in more than half 20 (66.6%) under-nourished children followed by children whose mother’s proceeding birth interval was less than 24 months, present in 5 (16.6%) under-nourished children. Mother is under-weight, this factor was present in 5 (16.6%) children and ranked as third most common factor of under-nutrition as per frequency distribution.

Early weaning (before completion of six months of age) was present in 17 (21.5%) malnourished children. Factors low birth weight babies as well as children having history of worm infestations both were present in 15 (19%) children. There were 12 (15.2%) children whose mother’s age was less than 20 years during delivery and this factor is ranked at sixth position followed by bottle feeding which was present in 11 (13.9%) children.

Inadequate funds for food this factor was present in just 2 (2.5%) children. Gestational age less than 37 weeks and late weaning both were present in only on child. There were three factors recurrent infections, ignore seeking medical help during illness and incomplete immunization were not present in any of the children. So, it can be concluded that the most common factor causing under-nutrition among children is inadequate dietary intake followed by children whose mother’s preceding birth interval was less than 24 months and mother is under-weight respectively. Factors like recurrent infections, ignore seeking medical assistance during illness and incomplete immunization were not present in any of the children.

Hence it can be inferred that factor “inadequate dietary intake” was the most occurring contributory factor for malnutrition among children followed by children whose mother’s preceding birth interval was less than 24 months and mother is under-weight respectively.

Objective 2:- to find out the association of prevalence of malnutrition with the selected socio-demographic characteristics.

The association of prevalence in birth order under five siblings and education of mother education of father, occupation of father, social economics status, gender, religion had no significant association with prevalence of malnutrition.

On the basis of analysis it can be concluded that variables like number of under five siblings, education of mother and birth order are significantly associated with prevalence of malnutrition. Variables like occupation of mother and education of father had no significant association with the prevalence of malnutrition.

CONCLUSION:

The present study was conducted among 30 children in the age-group of 1 to 5 years in a rural area, Bhindran of District Sangrur and it has been concluded that the prevalence of malnutrition among children was 28%. 26.7% children were under-nourished and 1.3% were over-nourished.

More number of malnourished children was in age-group of 1 and 2 years, belonged to Sikh religion, born as a second child in the family, mother’s had education upto elementary level and were non-working, laborer father and educated up to secondary level, middle socio-economic status, live in a semi-concrete houses and had tap water as the source of drinking water.

Birth order, education of mother and under five siblings had significant impact on malnutrition. Most occurring contributory factor of malnutrition were inadequate dietary intake followed by mother had birth interval of less than 24 months and mother is under-weight.

RECOMMENDATIONS:

The following recommendations were made on the basis of the findings of the present study:-

1. This study can be replicated on a large sample to validate and generalize the findings.

2. A comparative study on the prevalence and factors contributing to malnutrition in a selected rural area and urban area can be conducted.

3. During home visits, the health workers and ASHA should provide the information regarding malnutrition and its prevention.

4. EIC activities must be strengthened to create awareness among community.

REFERENCE:

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Received on 28.04.2018 Modified on 16.05.2018

Int. J. of Advances in Nur. Management. 2018; 6(3): 175-178.

DOI: 10.5958/2454-2652.2018.00040.9