|Year : 2017 | Volume
| Issue : 3 | Page : 181-186
An epidemiological study of acute malnutrition in children of age 6 months to 5 years in an Urban Slum of Mumbai, Maharashtra
Durgesh Prasad Sahoo1, Armaity Dehmubed2, Mahesh B Jajulwar3
1 Department of Community Medicine, Indira Gandhi Government Medical College, Nagpur, Maharashtra, India
2 Department of Community Medicine, Topiwala National Medical College and B. Y. L. Nair Hospital, Mumbai, Maharashtra, India
3 Department of Community Medicine, Government Medical College, Nagpur, Maharashtra, India
|Date of Web Publication||2-Feb-2018|
Dr. Durgesh Prasad Sahoo
Department of Community Medicine, Indira Gandhi Government Medical College, Nagpur - 440 018, Maharashtra
Source of Support: None, Conflict of Interest: None
Introduction: Malnutrition continues to be one of the major causes of morbidity and mortality among under-five children in developing countries. There are numerous factors that directly or indirectly affect the nutritional status of the children. Aim: This study aims to study the prevalence and associated risk factors of acute malnutrition in children 6 months to 5 years of age in an urban slum. Subjects and Methods: This community-based cross-sectional study was carried out in an urban slum in Mumbai. A total of 270 children of age 6 months to 5 years were enrolled in the study. Samples were selected by simple random sampling from various sectors. All mothers/informant were interviewed, and anthropometric measurements were recorded. Data were analyzed using SPSS version 20.0 and Chi-square test was used to find out the association between two qualitative variables. Results: The prevalence of underweight, stunting, and wasting were 52.2%, 42.2%, and 50.4%, respectively. The factors associated with acute malnutrition were age of the child, mother's educational status, occupation of mother, type of family, socioeconomic status, age at marriage below 18 years, children who were given prelacteal feeds, were not exclusively breastfed and were partially immunized. Conclusions: The findings of the present study revealed that higher prevalence of acute malnutrition was found in the children of urban slum in Mumbai. Socioeconomic development along with counseling on breast-feeding practices and nutrition education among the urban slum masses needs to be ensured which is an important factor to combat malnutrition.
Keywords: Acute malnutrition, anthropometry, under-five, urban slum
|How to cite this article:|
Sahoo DP, Dehmubed A, Jajulwar MB. An epidemiological study of acute malnutrition in children of age 6 months to 5 years in an Urban Slum of Mumbai, Maharashtra. J Datta Meghe Inst Med Sci Univ 2017;12:181-6
|How to cite this URL:|
Sahoo DP, Dehmubed A, Jajulwar MB. An epidemiological study of acute malnutrition in children of age 6 months to 5 years in an Urban Slum of Mumbai, Maharashtra. J Datta Meghe Inst Med Sci Univ [serial online] 2017 [cited 2018 Sep 25];12:181-6. Available from: http://www.journaldmims.com/text.asp?2017/12/3/181/224705
| Introduction|| |
Malnutrition is a major public health problem in developing countries. With the advent of urbanization, it is spreading to urban slums also. Poor socioeconomic status, poor environmental conditions, etc. have been postulated in the etiopathogenesis of malnutrition. The most vulnerable groups are children under 5 years of age. Hence, nutritional status of these children is a very sensitive indicator of the community health. The consequences of malnutrition are high level of morbidity, mortality, and disability apart from poor physical growth and development.
According to the United Nations International Children's Emergency Fund (UNICEF) world estimates for the year 2014, the prevalence of wasting is estimated to be 7.5% and that of severe wasting it is 2.4%. Almost all of these wasted children are in Asia and Africa. The childhood stunting rates have decreased from 39.7% in 1990 to 26.7% in 2010. Among these, Asia showed a dramatic decrease from 49% in 1990 to 28% in 2010. The UNICEF country-level estimates of India for wasting and stunting were 15.1% and 38.7%. Around the world, the underweight prevalence was projected to decrease from 26.5% in 1990 to 17.6% in 2015. As per the National Family Health Survey-4 data, the prevalence of stunting, wasting, severe wasting, and underweight in children under 5 years of age in urban area of Maharashtra were 29.3%, 24.9%, 9.5%, and 30.7%, respectively.
Considering this magnitude of the malnutrition, this study was conducted to estimate the prevalence of malnutrition (severe acute malnutrition and moderate acute malnutrition) in 6 months to 5 years children, of urban slum in Mumbai which is attached to the Department of Community Medicine of Topiwala National (T. N.) Medical College.
| Subjects and Methods|| |
This community-based cross-sectional study was carried out in an urban slum in Mumbai which is attached to the urban health center of the Department of Community Medicine of T. N. Medical College. The population consists of people who have migrated from different parts of India, but predominantly from Tamil Nadu. They have migrated to the city in search of jobs and are now engaged in small-scale industries such as zari-work, bag making, mat weaving, carpentry, and tailoring.
The study area was divided into 13 sectors, namely, A, B, C, D, E, F, G, H, I, J, K, L, and M. The sample to be taken was stratified sector wise as per the proportion of population of children of age 6 months to 5 years in each sector. The entire list of children from age 6 months to 5 years was made available from the ward office. The sample was collected from each sector by the simple random method. The baseline data were collected during the period November 2014–June 2015. The mother/informant, who were residing at least for 6 months in that community and willing to participate, were included in the study and children, who were apparently ill were excluded from the study. As per a study conducted by Bhavsar et al., the prevalence of acute malnutrition was 59.8% in urban slums. Using this prevalence, with 95% confidence interval and 10% relative error the minimum sample size calculated was 269. The study was approved by Institutional Ethics Committee of T. N. Medical College Mumbai.
Data were collected using pretested and predesigned questionnaire. The data collection tool included the sociodemographic variables such as age, gender, and socioeconomic status, occupation of the mother, immunization status, breast-feeding practices, etc. and anthropometric variable. The age of child was confirmed either by parents or by immunization card. Height/Length, weight, and mid-arm circumference were recorded using standard guidelines. Socioeconomic status was classified using the modified BG Prasad Classification.
The height and weight of each child were compared with WHO reference data for that particular age and sex to get weight for height index. Further, acute malnutrition was classified into moderate, severe, and global acute malnutrition based on the WHO/UNICEF guidelines.
The collected data were entered and analyzed using SPSS version 20.0 (SPSS Inc., IL, Chicago). Descriptive statistics were obtained for different parameters and Chi-square test was used to find out the association between two qualitative variables and P < 0.05 was considered as statistically significant.
| Results|| |
[Table 1] shows the maximum number of children were in the age group of 25–36 months. Most of the females 42 (33.0%) were in the group 25–36 months while most of the males 35 (24.4%) were in the age group 37–48 months.
[Table 2] shows, out of the 270 children, 78.9% were Muslim, 53.4% of the mothers were studied up to primary, 64.1% of the mothers were homemakers, 56.7% were from nuclear family, and 39.6% were belonged to class IV as per Modified BG Prasad classification.
[Table 3] shows, most of the children had birth order two (44.8%), 19.6% children had low birth weight and only 23.8% children had spacing between births was more than 36 months. One hundred and two children who were of first birth order were excluded from the denominator. Most of the mothers (76.3%) had age at marriage 18 years and more.
|Table 3: Distribution of children according to birth order, birth weight, birth interval, and age at marriage|
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[Table 4] shows, prelacteal feed was given to 45.9% of the children, and exclusive breast-feeding practices were given to only 29.3% of the children. Most of the children (76.3%) were immunized till date as per the schedule.
|Table 4: Distribution of children according to prelacteal feeds given, exclusive breastfeeding and immunization status|
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[Table 5] shows, 37.8% of the children were underweight (weight for age Z score <2 but >−3) and 14.4% were severely underweight (Z score <−3). Stunting (height for age Z score <2 but >−3) was present in 37% of the children, and 5.2% were severely stunted (Z score <−3). Wasting (weight for age Z score <2 but >−3) was present in 35.6% of the children, and 14.8% were severely wasted (Z score <−3).
|Table 5: Distribution of children according to the WHO classification of malnutrition|
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[Table 6] shows, out of 224 children who were between 1 and 5 years, based on mid-upper arm circumference mild malnutrition was present in 9.4% children and severe malnutrition was present in 4.0% children.
[Table 7] shows significant association of age group, education of mother, occupation of mother, type of family, socioeconomic status, age at marriage, prelacteal feeds, exclusive breastfeeding, and immunization status.
| Discussion|| |
This community-based cross-sectional study inferred that the prevalence of underweight, stunting, and wasting were 52.2%, 42.2%, and 50.4%, respectively. The factors associated with acute malnutrition were age of the child, mother's educational status, occupation of mother, type of family, socioeconomic status, age at marriage below 18 years, children who were given prelacteal feeds, were not exclusively breastfed and were partially immunized.
In studies conducted by Sengupta et al. (29.5%) and Popat et al. (32.4%), the prevalence of underweight was lower than our study. The prevalence of severe underweight in our study was 14.4%. This was higher than study conducted by Popat et al. (11.6%) but lower than study conducted by Sengupta et al. (16.5%). The prevalence of stunting in our study was 42.2% which was in concordance with studies conducted by Popat et al. (46.1%). However, the prevalence was higher when compared to study by Patil et al. (22%) and lower when compared to study by Sengupta et al. (74.0%). The prevalence of wasting in our study was 50.4% which was higher than studies conducted by Patil et al. (20%), Sengupta et al. (42.0%), and Popat et al. (17.2%). The prevalence of severe stunting and wasting in our study was 5.2% and 14.8%, respectively. This was in accordance with studies by Patil et al. and Popat et al.
Acute malnutrition was more common in 6 months - 3 years age group 92 (54.4%), compared to 3–5 years age group 44 (43.6%), and the association between age and acute malnutrition was statistically significant (P = 0.018). Similar findings were noted by a study conducted by Mathad et al. Acute malnutrition was almost similar in females 64 (50.4%) and males 72 (50.3%), and the difference was not statistically significant (P = 0.994). Similar findings were observed by Khargekar et al. and Bhavsar et al. where the association between gender and acute malnutrition was not significantly associated.
Acute malnutrition was more common in illiterate mothers 64 (88.89%) of illiterate mothers compared to literate mothers 72 (36.36% of literate mothers), and the difference was statistically significant (P = 0.001). Similar findings were noted by Mittal et al. in their study. This finding might be explained by the fact that mother's education is associated with the awareness about the proper child-rearing practices, better health-seeking attitude, better knowledge about breastfeeding and complementary feeding, updated knowledge about immunization. Thus, maternal education is significantly has a profound effect on nutritional status of the child.
Acute malnutrition is more common in working mothers (81.1%) as compare to homemakers (32.9%). The difference is found to be statistically significant (P = 0.001). Similar findings were observed by Joshi et al. in their study. Acute malnutrition was more common in nuclear families 87 (56.9%), followed by three generation family 12 (44.4%), and joint family 37 (41.1%). The difference was statistically significant (P = 0.049). Similar results were found in a study conducted by Patel et al. This finding might be explained by, as in nuclear family, most of the females were working females, so no one was there to take care of the child properly.
In our study, the association between lower socioeconomic status and acute malnutrition was statistically significant (P = 0.001). Studies conducted by Dwivedi et al. and Avachat et al. came up with similar inferences. Better socioeconomic conditions are associated with more spending capacity, better living conditions, more availability of the resources per head in the family, and the better-updated knowledge of the parents.
The association between higher birth order and malnutrition was not statistically significant (P = 0.170) while the study conducted by Dwivedi et al. and Verma and Prinja et al. found that birth order was significantly associated with malnutrition. We found that the association between acute malnutrition and low birth weight was not statistically significant (P = 0.104). The association between mothers marriage at <18 years and acute malnutrition was statistically significant (P = 0.016) Similar findings were observed by Raj et al. in their study.
In our study, the children who were given prelacteal feeds were not given exclusive breast feeding, and were partially immunized were having a significant risk of acute malnutrition. Similar findings were reported by Khargekar et al., and Kuchenbecker et al. for association of breast-feeding practices and acute malnutrition. Studies conducted by Asfaw M et al., Legesse et al., and Amsalu and Tigabu et al. inferred that prelacteal feeds were associated with increased risk of acute malnutrition in the child. The effect of immunization of the nutritional status of the children was inferred by studies conducted by Abedi and Srivastava et al. and various documents by UNICEF and WHO also substantiate the fact.
The sample size of the present study may not be representative of the population since we selected only one urban slum from Mumbai. In spite of these limitations, the study can give certain insight about the nutritional status of the children of the urban slum.
| Conclusions and Recommendations|| |
In our study, higher prevalence of acute malnutrition was found in the children of urban slum of Mumbai. We also found that lower proportions of children are being exclusively breastfed and a quarter of them are not being completely immunized. Further, we found that age, mother's education, occupation, type of family, Socioeconomic status, age at marriage of the mother, prelacteal feeds, breast-feeding practices, and immunization status affect the overall nourishment of the child on a long run.
Socioeconomic development among the urban slum masses needs to be ensured which is an important factor to tackle malnutrition, mainly undernutrition. Special efforts have to be made to improve the acceptance of family planning methods for limiting the family size and to increase the interval between the two successive pregnancies. Nutritional education has to be imparted to the people regarding consumption of a cost-effective nutritious diet. Ensure 100% immunization. Importance of exclusive breastfeeding for the first 6 months of the baby's life and proper weaning thereafter should be properly explained to the mother.
We would like to thank and acknowledge the faculty of the Department of Community medicine Topiwala National Medical College, Mumbai, for their support during the study.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Lal S. Combating malnutrition in India through community efforts. Indian J Community Med 2003;27:99-106.
Sundar Lal. Textbook of Community Medicine. 3rd
ed. Vol. 184. New Delhi, India: C B S Publihsers; 2011. p. 6.
de Onis M, Blössner M, Borghi E. Prevalence and trends of stunting among pre-school children, 1990-2020. Public Health Nutr 2012;15:142-8.
de Onis M, Blössner M, Borghi E, Frongillo EA, Morris R. Estimates of global prevalence of childhood underweight in 1990 and 2015. JAMA 2004;291:2600-6.
National Family Health Survey-4 (2015-16). State Fact Sheet, Maharashtra; 2015.
Bhavsar S, Hemant M, Kulkarni R. Maternal and environmental factors affecting the nutritional status of children in Mumbai Urban Slum. Int J Sci Res Publ 2012;2:2250-3153.
Dudala SR, Reddy KA, Prabhu GR. Prasad's socio-economic status classification – An update for 2014. Int J Res Health Sci 2014;2:875-8.
Popat C, Chaudhari A, Mazumdar V, Patel SV. A cross sectional study to measure the prevalence of malnutrition and factors associated with malnutrition among under five children of an urban slum of Vadodara city. J Res Med Dent Sci 2014;2:59-64.
Patil CR, Thakre SS, Khamgaonkar MB, Thakre S. Prevalence of stunting and wasting among Anganwadi school children of rural and urban area of Central India: A cross-sectional study. Int J Med Sci Public Health 2017;6:413-7.
Mathad V, Shivprasad S. Malnutrition. A daunting problem for India” s spectacular growth. Indian J Clin Pract 2013;23:760-4.
Khargekar NC, Khargekar VC, Shingade PP. A cross-sectional study to assess the protein energy malnutrition in children between one to five years of age in a tribal area Parol, Thane district, Maharashtra, India. Int J Community Med Public Health 2017;3:112-20.
Mittal A, Singh J, Ahluwalia SK. Effect of maternal factors on nutritional status of 1-5-year-old children in urban slum population. Indian J Community Med 2007;32:264. [Full text]
Joshi HS, Gupta R, Joshi MC, Mahajan V. Determinants of nutritional status of school children – A cross sectional study in the Western region of Nepal. NJIRM 2011;2:10-5.
Patel KA, Langare SD, Naik JD, Rajderkar SS. Gender inequality and bio-social factors in nutritional status among under five children attending anganwadis in an urban slum of a town in Western Maharashtra, India. J Res Med Sci 2013;18:341-5.
Dwivedi SN, Banerjee N, Yadav OP. Malnutrition among children in an urban Indian slum and its associations. Indian J Matern Child Health 1992;3:79-81.
Avachat SS, Phalke VD, Phalke DB, Aarif SM, Kalakoti P. A cross-sectional study of socio-demographic determinants of recurrent diarrhoea among children under five of rural area of Western Maharashtra, India. Australas Med J 2011;4:72-5.
Verma R, Prinja S. Assessment Of nutritional status and dietary intake of pre-school children in an urban pocket. Int J Epidemiol 2007;6:1-3.
Raj A, Saggurti N, Winter M, Labonte A, Decker MR, Balaiah D, et al.
The effect of maternal child marriage on morbidity and mortality of children under 5 in India: Cross sectional study of a nationally representative sample. BMJ 2010;340:b4258.
Kuchenbecker J, Jordan I, Reinbott A, Herrmann J, Jeremias T, Kennedy G, et al.
Exclusive breastfeeding and its effect on growth of Malawian infants: Results from a cross-sectional study. Paediatr Int Child Health 2015;35:14-23.
Asfaw M, Wondaferash M, Taha M, Dube L. Prevalence of undernutrition and associated factors among children aged between six to fifty nine months in Bule Hora District, South Ethiopia. BMC Public Health 2015;15:41.
Legesse M, Demena M, Mesfin F, Haile D. Prelacteal feeding practices and associated factors among mothers of children aged less than 24 months in Raya Kobo district, North Eastern Ethiopia: A cross-sectional study. Int Breastfeed J 2014;9:189.
Amsalu S, Tigabu Z. Risk factors for severe acute malnutrition in children under the age of five: A case-control study. J Health Dev 2008;22:21-5.
Abedi AJ, Srivastava JP. The effect of vaccination on nutritional status of pre-school children in rural an d urban Lucknow. Ind Res 2012;1:173-5
[Table 1], [Table 2], [Table 3], [Table 4], [Table 5], [Table 6], [Table 7]