Problem of Stunting In an
Urban Slum among Pre-school Going students
Rathi HB1, Bansal
AK1, Sinha T1, Baghel B2, Sahu A2,
Singh K3 and Singh S4
Department
of 1Community Medicine, 2Paediatrics, 3Medicines, 4Orthopaedics, Govt. Medical College, Jagdalpur (Bastar).
ABSTRACT
On analysis of the collected data it was found that
52.6, 5.4 and 10.5% children were stunted, wasted, wasted stunted respectively.
Stunting showed an increasing trend as the age advances. It was minimum in
children under 6 months of age and maximum among 48 to 60 months old children.
As per sex there was no significant difference.
Keywords: Stunt,
Wasted, Stunted-wasted.
INTRODUCTION:
India is a paradox .While it is one of the fastest
growing economies in the world,it
is also home to 57 million of the world’s146 million malnourished children.
Malnutrition continues to remain a silent emergency in India, with 47 percent
of children under five either under weight, stunted, wasted or with
micronutrient malnutrition. Malnutrition not only retards their physical and
cognitive growth and increases their susceptibility to infection, but it also
effects their educational achievements, health and overall productivity when
they grow up (9). Anthropometric measurements of a child’s growth are easily
quantified and practical for use in the field as an indicator of nutritional
status. The growth of the children as assessed by anthropometry has long been
known to be influenced in preschoolers is attributed to inadequate protein and
energy in take and there fore
linked to Protein Energy Malnutrition (PEM). It may however be that some
retardation is caused by other specific nutrient deficiencies. For evaluation
of growth performance the observed level of growth has to be compared with a
standard which is considered to best represent normal growth i.e. as the level
of growth which is attained the child
when its innate genetic potential for growth finds full expression in a
situation where in dietary and environmental constraint on growth are
eliminated . India has a whooping 61 million stunted children, the largest in
any country. In other words, 3 out of 10 stunted children are from India
distantly followed by china that has 12 million children.
Stunted growth is a consequence of long term poor
nutrition in childhood. Stunting is associated with development problems and is
often impossible to correct child who is stunted is likely to experience a lifetime
of poor health and under achievement a growing concern in India that is
demographically a young nation.
MATERIAL AND METHODS:
Grade of Nutritional status of Children Zero to Five
years of Age by height for age and weight for height was done as per water
low’s qualitative classification using National centre for health statistics
(NCHS) standard of USA as reference.
|
Height for Age (% of
Standard) |
Weight for Height (% of
Standard) |
|
|
>_ 80 |
>_ 80 |
|
|
>_
90 |
Normal |
Wasted |
|
<
90 |
Stunted |
Wasted
and Stunted |
TABLE – I: NUTRITIONAL STATUS OF CHILDREN
(ZERO TO FIVE YEAR) AS PER WATERLOW’S QUALITATIVE CLASSIFICATION
|
Age In Month (1) |
Nutritional Grade |
Total Malnourished 4+5+6
(7) |
||||
|
Total (2) |
Normal (3) |
Stunted (4) |
Wasted (5) |
Stunted and Wasted (6) |
||
|
0 - < 6 |
39 |
23 (59.0) |
11 (28.2) |
4 (10.3) |
1 (2.5) |
16 (41.0) |
|
6 - < 12 |
58 |
30 (51.8) |
20 (34.5) |
6 (10.3) |
2 (3.4) |
28 (48.2) |
|
12 - < 24 |
135 |
39 (28.9) |
57 (42.2) |
17 (12.6) |
22 (16.3) |
96 (71.1) |
|
24 - < 36 |
113 |
22 (19.5) |
76 (67.3) |
1 (0.8) |
14 (12.4) |
91 (80.5) |
|
36 - < 48 |
111 |
40 (36.0) |
57 (51.4) |
2 (1.8) |
12 (10.8) |
71 (64.0) |
|
48 - < 60 |
99 |
21 (21.2) |
71 (71.7) |
- |
7 (7.1) |
78 (78.8) |
|
0 - 60 |
555 |
175 (31.5) |
292 (52.6) |
30 (5.4) |
58 (10.5) |
380 (68.5) |
Figures in parenthesis indicate
percentage
TABLE – II: NUTRITIONAL STATUS OF CHILDREN
(ZERO TO FIVE YEAR) BY SEX AS PER WATERLOW’S QUALITATIVE CLASSIFICATION
|
Age In Month (1) |
Sex (2) |
Nutritional Grade |
Total Malnourished 5+6+7 (8) |
||||
|
Total (3) |
Normal (4) |
Stunted (5) |
Wasted (6) |
Stunted and Wasted (7) |
|||
|
0
- 60 |
Male |
267 |
83
(31.1) |
144
(53.9) |
10
(3.7) |
30
(11.3) |
184
(68.9) |
|
Female |
288 |
92
(31.9) |
148
(51.4) |
20
(7.0) |
28
(9.7) |
196
(68.1) |
|
|
Total |
555 |
175 (31.5) |
292 (52.6) |
30 (5.4) |
58 (10.5) |
380 (68.5) |
|
Figures in parenthesis indicate
percentage
So
categorize malnutrition as per duration viz short
duration, long duration and current long duration malnutrition for both heights
for age and weight for height was assessed as suggested by water low’s
qualitative classification.
So
categorize malnutrition as per duration viz short
duration, long duration and current long duration malnutrition for both heights
for age and weight for height was assessed as suggested by water low’s
qualitative classification.
|
Height for Age |
*Weight for Height |
Nutritional Grade |
Type of Malnutrition as per Duration |
|
< 90 |
< 80 |
Wasted and Stunted |
Current long Duration |
|
< 90 |
>_ 80 |
Stunted |
Long Duration |
|
>_ 90 |
< 80 |
Wasted |
Short Duration |
|
>_ 90 |
>_ 80 |
Normal |
Normal |
*Percent of standard.
Data
of 555 children of zero to five years of age of slum area were collected in a
predawn Performa and analyzed. Chi-square Test and “Z” test was applied on and
when required. .
OBSERVATIONS AND DISCUSSIONS:
(Table
- I) shows that out of 555 children 175 (31.5 %) were in normal grade and 380
(68.5 %) were suffering from various categories of malnourishment as per waterlow’s qualitative classification viz 52.6 %, 5.4 %
and 10.5 % children were stunted, wasted and stunted wasted categories
respectively. Table further reveals that 48.2 % children of 6 - < 12 months
age were malnourished in comparison to 41.00 of 0 - < 6 months. Though the difference were found statistically insignificant.
X2 = 0.49, d. f. =
1, P > 0.05
Table further shows that on comparing the figure i.e.
73.4 % children of 12 – 60 months of age were found malnourished in comparison
to only 45.4 % of 0 - < 12 months.
This difference was found statistically significant (X2 = 29.07, d. f. = 1, P >
0.01).
As
per sex of children, (Table - II) reveals that out of 267 males 31.1 % were in
normal grade while 68.9 % belong to various degree of malnutrition in
comparison to their 31.9 % normal and 68.1 % malnourished out of 388 females
counterparts. Though this differences was found statistically insignificant.
X2 = 0.04, d. f. = 1, P >
0.05
Water
low qualitative classification not only indicates the extent of the problem,
but also its duration viz current i.e. of shorter
duration assessed in terms of wasting and prolonged malnutrition in term of
stunting. National Nutrition Monitoring Bureau collected the anthropometric
data from 1974 to 1980 of 18938 rural 1 to 5 years of age children and found
that prevalence of stunting indicating chronic malnutrition is of higher
magnitude compared to wasting as well as wasting stunting. Stunting increased
with increasing age. In the present study it was also observed that stunting
was of higher magnitude comprising 52.6 % stunting showed on increase trend as
the age advances. It was minimum 28.2 % in among 0 - < 6 months of age
children and maximum i.e. 71.7 % among 48 to 60 months of all the groups current long duration i.e. wasted and stunted should
be considered as high priority for immediate nutritional intervention.
Malnutrition among children occurs almost entirely during the first two years
of life and is virtually irreversible after that. Thus it is important for
government and non government programmes to invest
greater effort and resources on malnutrition prevention and early action rather
than coping with malnutrition when it has already set in (9).
Global
aid is being spent on diseases like HIV, TB and malaria rather than addressing
malnutrition and sanitation in the 30 high burden countries that have the worst
statistics relating to maternal and child health (Himanshi
Dhawan - 2010).
An
independent study said “mismatch” between global aid and demands from worst
affected countries could be one of the primary reasons for missing the
millennium development goals for maternal mortality and child health.
In
a report released on 18th March 2010, NGO World Vision said aid was
not being directed to the countries with the greatest need. Three countries –
India, Nigeria and Congo – together contributed 40 % of total child deaths, yet
received 17 % of aid for health between 2006 and 2007.
Also,
the aid currently given to health was not just poorly targeted but was
“insufficiently focused on child and maternal health: in recent years aid for
child and maternal health has accounted for only around 3 % of overall
developmental assistance”.
The
‘Child Health Now – Together we can end Preventable Deaths’ report pointed out
that 30 high burden countries including India were spending less than $ 10 on
maternal and newborn health per birth.
Incidentally,
principal diseases and underlying causes of child death are not receiving the
“lion’s share of aid for health”.
“A
lot of political energy and donor funding in recent years has been directed
towards vertical programmes to address specific
diseases – particularly HIV, TB and malaria – at the expense of key causes of
death like malnutrition and lack of hygiene and sanitation,” the report said.
Globally,
a child under five dies every 3.5 seconds which amounts to 24,000 deaths a day
and almost 9 million a year. India shares the highest burden with 1.95 million
under five deaths according to the Child Health report.
Launching
its five year campaign to bring down under five deaths that occur due to
preventable causes, World Vision global ambassador Dean Hirsch said, “We want
to focus on reducing preventable deaths for children under five. Maternal and
child health are missing the target the most. The campaign is our contribution
to the growing chorus of leaders from UN, NGOs and other organizations calling
for urgent action to save mothers and children from preventable deaths”.
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Received on 15.04.2010
Accepted on 17.04.2010
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Research J. Science and Tech. 2(1):Jan. – Feb. 2010:16-18