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Prevalence and risk factors associated with underweight among under-five
children in a rural area of Puducherry
Article in Muller Journal of Medical Sciences and Research · January 2018
DOI: 10.4103/mjmsr.mjmsr_16_17
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ISSN 0975-9727
Volume 9 | Issue 1 | January-June 2018
Muller Journal of Medical Sciences and Research • Volume 9 • Issue 1 • January-June 2018 • Pages 1-***
Official Publication of Father Muller Charitable Institutions
www.mjmsr.net
ORIGINAL ARTICLE
Prevalence and risk factors associated with
underweight among under‑five children in a rural
area of Puducherry
Jomon Mathew John, Jomol Sara John1
ABSTRACT
Background: Nutrition has been recognized as a basic pillar for social and economic development. One in every three malnourished
children in the world lives in India. The objective of this study was to measure the prevalence and to study the selected factors
associated with underweight among the under‑five children in a rural area of Puducherry. Aims: This study aims to study the
prevalence of underweight among children under‑five years of age and to study the associated risk factors. Methodology: This
was a cross‑sectional study conducted over a period of 13 months with a sample size of 500. The anthropometric assessments
were taken and plotted on the Indian Academy of Pediatrics growth charts. Results: The prevalence of underweight was found to
be 23.8%. The age of the child, gender, socioeconomic status, duration of exclusive breast feeds, birth order, and birth weight were
found to have statistical significance in underweight. However, the maternal education did not show any significance in underweight.
Conclusion: Nutritional status of under‑five years children is one of the important indicators of overall development of community
and thus country. Intervention to reduce the burden of underweight should be directed toward the education of the mothers regarding
the importance of nutrition by community health workers.
Key Words: Indian Academy of Pediatrics chart, risk factors, under‑five children, underweight
Introduction
Malnutrition is the principal cause of deaths in the children
under‑five years of age. Malnutrition is more common
in India than in Sub‑Saharan Africa. One in every three
malnourished children in the world lives in India. The
National Family Health Survey (NFHS) in India reported
the prevalence of underweight among children younger
than 5 years in 2015–2016 to be nearly 35.7%, which has
declined from the rates recorded in 2005–2006 (42.5%),
1992–1993 (51%), and 1998–1999 (47%).[1,2] The NFHS
in the Union Territory of Puducherry shows only a minor
decline in underweight children below 5 years from
23.8% (2012–2013) to 22% (2015–2016).[3,4]
Malnutrition is called invisible emergency because, much
like an ice berg, its deadly menace lies mostly hidden from
view. Each year malnutrition is implicated in about 40%
of 11 million deaths of under‑five children in developing
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countries and lack of exclusive breast feeding in infancy
causes additional 1.5 million of these deaths. Data from
UNICEF states that the highest level of underweight
children is found in South Asia, involving 46% of all
under‑fives in the region.[5] It is often found to start in
the womb and end in the tomb. The inadequate nutrition
does not result from paucity of nutrients but largely due to
ignorance, beliefs, lack of knowledge and unawareness
about normal eating habits. Nutritional status is also
influenced by factors such as household income, the
Department of Paediatrics, Azeezia Medical College, Kollam, Kerala,
1
Department of Paediatrics, Pondicherry Institute of Medical Sciences,
Kalapet, Puducherry, India
Address for correspondence: Dr. Jomol Sara John,
Department of Paediatrics, Pondicherry Institute of Medical Sciences,
Ganapathichettikulam, Kalapet ‑ 605 014, Puducherry, India.
E‑mail: sarahjo2009@gmail.com
This is an open access article distributed under the terms of the
Creative Commons Attribution‑NonCommercial‑ShareAlike 3.0
License, which allows others to remix, tweak, and build upon the
work non‑commercially, as long as the author is credited and the
new creations are licensed under the identical terms.
For reprints contact: reprints@medknow.com
How to cite this article: John JM, John JS. Prevalence and risk factors
associated with underweight among under-five children in a rural area
of Puducherry. Muller J Med Sci Res 2018;9:7-11.
© 2018 Muller Journal of Medical Sciences and Research | Published by Wolters Kluwer - Medknow
7
John and John: Prevalence and risk factors for underweight among under-five children
skills and capacity of care givers especially mother, use
of limited resources for better care of children, as well
as local availability of health‑care services.[6]
Growth is the key component of nutritional status and
indicator of health and well‑being for individual and in
population, with every aspect of child’s health being
affected by his or her nutritional status. Nutrition has
been recognized as a basic pillar for social and economic
development. Adequate nutrition is necessary in early
childhood to ensure healthy growth, proper functioning
of organs, strong immune system, and neurological and
cognitive development. Children are in a constant phase
of development. Future of the country is determined by
the growing generation of the country. It is the health
status of children of any country that represents the
health status of people of that country. Since this growing
generation is going to be the future productive citizens,
they should be healthy enough to make use of the full
potential of their productive. Undernutrition is a leading
contributor to infant, child, and maternal morbidity and
mortality playing a role in about half of all child deaths.[7,8]
Undernutrition directly affects many aspects of children’s
development such as retarding physical and mental
development, increasing susceptibility to infections like
sepsis, diarrhea, pneumonia, and so forth, and further
enhancing the probability of undernutrition.[8,9]
The present study was conducted to measure the
prevalence of underweight and to study the selected
factors associated with underweight among children
under‑five years of age residing in a rural area of
Puducherry.
Methodology
This cross‑sectional study was conducted from June
2012 to July 2013. Children under‑five years attending
various camps and those who had come to the outpatient
department of our Medical College in Puducherry were
included in this study by simple random sampling. The
Institutional Ethical Committee had approved of the
study and written informed consent from parents of all
the children in the study were taken. Any children with
chronic illness, those with a history of any acute illness
that lead to departure from normal growth pattern,
those with known or clinically recognizable endocrine
or other system dysfunction or those on chronic drug
usage known to impair growth, were excluded from this
study. A pretested structured questionnaire was used
to collect the data regarding age, gender, mother’s
education, socioeconomic status, natal history, feeding
practices and birth order of the participant children from
the parents.
8
The minimum sample calculated was 397 with the
formulae n = 4 pq/d2, with P taken as 46% and d taken
as 0.05. Hence 500 children were included in this study,
of which 271 were boys, and 229 were girls. Weight was
recorded by using standard weighing machine to the
accuracy nearest to 25 g with the child wearing minimum
clothing. Children more than 2 years of age were made to
stand with bare feet on a flat floor against a stadiometer,
with feet parallel and with heels, buttocks, shoulder and
occiput touching the wall. The head was held erect with
eyes aligned horizontally and ears vertically without any
tilt (Frankfurt plane). With the help of a wooden spatula
or plastic ruler, the topmost point of the vertex was
identified on the wall and height was recorded against
the chart affixed. In children below 2 years of age, length
was measured with the help of an infantometer. The
footboard of the infantometer was moved to touch the
feet to measure the length. Two readings were averaged
for analysis.
After the anthropometric measurements, weight for
age and height for age were plotted on the IAP growth
charts. The data collected were coded and entered into
Microsoft Excel. The relationship of nutritional status
with various factors such as age, gender of the child,
birth order, birth weight, duration of exclusive breast
feeding, maternal education and socioeconomic status
were compared. Chi square test for categorical data
was used for statistical analysis. P < 0.05 was taken as
statistically significant.
Results
The study group included 500 children, of which 271 were
boys, and 229 were girls [Table 1]. Underweight was seen
in 119 children (23.80%) according to Indian Academy
of Pediatrics (IAP) growth charts. Table 2 shows the
prevalence of underweight among under‑five children
in relation to the sociodemographic factors.
Our study showed the prevalence of underweight was
higher in children <1 year of age (37.2%) compared
with other age groups. Females were found to be more
underweight (27.95%) compared to the males (20.29%).
Figure 1 shows that under‑five children who received
exclusive breast feeding for <3 months were found
Table 1: General features of the study population
Age group
0-12 months
1-2 years
2-3 years
3-4 years
4-5 years
Total
Females
30
17
62
17
103
229
Males
34
27
74
36
100
271
Muller Journal of Medical Sciences and Research | Volume 9 | Issue 1 | January - June 2018
John and John: Prevalence and risk factors for underweight among under-five children
to have more prevalence of underweight (50%)
compared to the other children. Figure 2 shows that
prevalence of underweight was found to be more in
children with uneducated mothers (29.5%) compared
to children whose mothers studied more than higher
secondary school (20.93%). Children belonging to
lower socioeconomic status, according to modified
Kuppuswamy scale, were more underweight (74.33%).
Children with birth weight of <2 kg were found to be more
underweight (60%) compared to children with birth weight
of more than 2 kg, as shown in Figure 3. Prevalence of
Table 2: Sociodemographic features
Well child
Underweight
P
27
22
28
130
174
16
13
9
23
55
<0.05
216
165
55
64
0.045
29
157
120
75
84
32
2
1
<0.05
WELL
300
240
150
113
75
5
0
5
50
<3
60
3-5
In our study, the prevalence of underweight was 23.8%.
The age of the child, gender, socioeconomic status,
duration of exclusive breast feeds, birth order and birth
weight were found to have statistical significance in
underweight. However, the maternal education did not
show any significance in underweight.
Limitation of this study was that it was conducted in a
single rural area of South India and hence, the study
population may not be representative of the entire
Indian population. The details regarding the history of
the child were based on the information furnished by
the parents/caregivers and are subjected to recall bias.
The prevalence of underweight in this study was
23.8% according to IAP growth chart. According to
the study done by Stalin et al. in Kancheepuram
prevalence of underweight among under‑five children
was 52.9%.[10]
175
UNDERWEIGHT
225
Discussion
NUMBER OF CHILDREN
NUMBER OF CHILDREN
Age wise
<1 months
1–2 years
2–3 years
3–4 years
4–5 years
Gender wise
Male
Female
Socioeconomic status
Lower
Upper lower
Lower middle
Upper middle
underweight was found to increase with increase in birth
order, as shown in Figure 4.
19
5-7
3
WELL
140
140
118
105
70
35
80
43
0
UE
DURATION OF EXCLUSIVE BREAST FEEDING IN MONTHS
WELL
158
250
139
120
80
67
40
0
2
3
<2KG
47
2-2.5KG
53
15
2.5-3KG
3-3.5KG
15
1
>3.5KG
WELL
>12TH
UNDERWEIGHT
200
150
191
144
100
50
0
33
1
BIRTH WEIGHT IN KG
Figure 3: Association between birth weight and underweight
<10TH
10-12
EDUCATION OF MOTHERS
children with underweight
UNDERWEIGHT
160
37
Figure 2: Association between education of mothers with number of
NMBER OF CHILDREN
NUMBER OF CHILDREN
200
38
26
18
>7
Figure 1: Association between exclusive breastfeeding and underweight
UNDERWEIGHT
52
45
2
3
ORDER OF BIRTH
30
1
4
4
Figure 4: Association between the order of birth with number of children
with underweight
Muller Journal of Medical Sciences and Research | Volume 9 | Issue 1 | January - June 2018
9
John and John: Prevalence and risk factors for underweight among under-five children
In our study, out of 271 male children 55 (20.29%) were
malnourished; out of the total 229 female children,
64 (27.9%) were malnourished, which was statistically
significant (odds ratio [OR]: 1.5233, 95% confidence
interval [CI] 1.0075–2.3033). In a study done by
Sharma had shown similar results with female being
more underweight than males.[11] This in contrast with
the study done by Ray et al. which reported statistically
no significant difference between male (64.74%) and
female (61.58%) underweight children.[12] Goel et al.
conducted a cross‑sectional study in the urban slums
of Rohtak, a city in Haryana on 540 children aged
1–6 years. There was no significant association between
nutritional status and sex of the child (P = 0.928).[13]
who were illiterate, and the prevalence in children whose
mothers were more than 12th grade educated were
20.9%. There was no significant correlation observed
between mother’s education status and malnutrition in
our study (OR‑0.7138, 95% CI‑0.3943–1.2922). Children
born to the graduated parents were noted to have normal
nutritional status. Similar results were observed by
Mathad et al., in Karnataka which found that mother’s
literacy status was not significantly associated with
underweight.[20] In contrast to this, a study conducted
by Stalin et al. showed that children of mothers who
had completed higher secondary/graduation were
better nourished than other children compared to the
uneducated.[10]
In our study, the prevalence of malnutrition decreases
when the birth weight is above 2.5 kg. When the birth
weight is below 2 kg, the prevalence of malnutrition
is 60% whereas the prevalence for above 3 kg birth
weight is 6.25% with P < 0.0001 which is statistically
significant (OR: 3.276, 95% CI‑2.093–5.127) there are
various studies to show that the birth weight of more
than 2.5 kg have more favourable relationship with
nutrition.[14,15]
The prevalence of underweight in the lower socioeconomic
status in this study was 74.33%, whereas the prevalence
in the upper middle was 1.31% which was found to be
statistically significant with P < 0.05. This is comparable
with studies done by Bhanderi and Choudhary in
Gujarat and Sengupta et al. in Ludhiana.[21,22] Dwivedi
et al. conducted a cross‑sectional study in Bhopal
slum children which showed inverse correlation was
between socioeconomic status and the prevalence of
malnutrition (P < 0.05).[18]
Out of 500 children, 300 children were exclusively
breastfed for 5–7 months. In our study, the prevalence
of malnutrition in children who were exclusively breast
fed for 3 months or less was 50%. P =0.0086 which
is statistically significant (OR‑3.2920). Suman et al.
conducted a cross‑sectional study among Shabar tribal
community in the districts of Orissa found a similar
result in the prevalence of underweight among children
who were exclusive breastfeed for <6 months were
significantly higher (P < 0.01) than those who were
breastfed more than 6 months.[16]
Out of 224 first born babies, 33 (14.73%) were
malnourished. Eighty percent of the fourth order children
were malnourished showing a significant increase in the
prevalence of malnutrition with increase in birth order
with P < 0.05 which is statistically significant. Hence,
the birth order <2 was found to be of lesser risk of
underweight (OR‑2.9130) This could be because the
care given to the children by mothers would decrease
as the birth order increases. This result is comparable
with the study conducted by Verma et al. in Rohtak,[17]
Dwivedi et al. in Bhopal slum children,[18] Bhavsar et al.
in the urban slums of Mumbai[19] and Priyanka et al. in
Thrissur, Kerala.[14]
In our study, total 61 mothers were uneducated, and
117 mothers were educated more than 12th grade. The
prevalence of malnutrition was around 29.5% in mothers
10
Conclusion
Nutritional status of under‑five years children is one of the
important indicators of overall development of community
and thus country. The gender preferences are still persisting
in the community which can be clearly seen by the increased
prevalence of the malnutrition among female children
than male. Maternal education did not show a significant
association as compared to the other studies. This may be
due the increased awareness provided by the community
health workers. Despite rapid economic development
along with increase in food production in recent decades
and several nutritional intervention programs in operation
since the last three decades, childhood undernutrition
remains an important public health problem in India. It is
one of the important reasons for ill health and child mortality.
[23]
The proper awareness regarding the importance of
nutrition for children, especially the nutritional education
regarding the complementary feeds to mothers/caregivers
is compulsory. By targeting children at an early age and by
proper awareness for mothers, the burden of underweight
can be further reduced.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
Muller Journal of Medical Sciences and Research | Volume 9 | Issue 1 | January - June 2018
John and John: Prevalence and risk factors for underweight among under-five children
References
1.
National Family Health Survey. Available from: http://www.
nfhsindia.org/data/ka‑pre.pdf. [Last accessed on 2017 Mar 20].
2.
National Family Health Survey (NFHS-3) 2005-06. Ministry of
Health and Family Welfare, Government of India. International
Institute of population sciences, Deonar, Mumbai.Available at:http://
dhsprogram.com/pubs/pdf/FRIND3/FRIND3-Vol1andVol2.pdf.
[Last Cited on 2014 Oct 12].
3.
District Level Household and Facility Survey 4 (2012‑2013).
Available from: http://www.rchiips.org/pdf/dlhs4/report/
PU.pdf. [Last on 2017 Mar 20].
4.
National Family Health Survey for Union Territory of Puducherry.
Available from: http://www.rchiips.org/NFHS/pdf/NFHS4/PY_
FactSheet.pdf. [Last accessed on 2017 Mar 20].
5.
Progress for children, A Report Card on Nutrition, Number 4,
Unicef (Online); 2006 May.Available at:https://www.unicef.org/
publications/files/Progress_for_Children_-_No._4.pdf. [Last
accessed on 2014 Oct 12].
et al. Rapid assessment of nutritional status and dietary pattern
in a municipal area. IJCM 2000;25:14‑8.
13. Goel MK, Mishra R, Gaur D, Das A. Nutrition surveillance in
1‑6 years old children in urban slum of a city in Northern India.
Int J Epidemiol 2007;5:1‑5.
14. Priyanka R, Vincent V, Jini MP, Saju CR. An assessment of the
nutritional status of under five children in a rural area of Thrissur
district, Kerala, India. Int J Community Med Public Health
2016;3:3479‑86.
15. Rodriguez‑Llanes JM, Ranjan‑Dash S, Degomme O,
Mukhopadhyay A, Guha‑Sapir D. Child malnutrition and recurrent
flooding in rural Eastern India: A community‑based survey. BMJ
Open 2011;1:e000109.
16. Suman C, Rohini G, Premananda B. Breastfeeding Practices and
Nutritional Status of Preschool Children among the Shabar Tribal
Community in Orissa, India Proceeding of National Symposium
on Tribal Health 2006. p. 227‑34.
17. Verma R, Khanna P, Gaur D, Meena, Prinja S. Assessment of
Nutritional Status and Dietary Intake of Pre-School Children in an
urban pocket. The internet journal of nutrition and wellness 2008;
6(1).
6.
Pongou R, Ezzati M, Salomon JA. Household and community
socioeconomic and environmental determinants of child nutritional
status in Cameroon. BMC Public Health 2006;6:98.
7.
Levels and trends in child malnutrition: UNICEF-WHO-The
World Bank joint child malnutrition estimates, http://www.who.int/
nutgrowthdb/jme_unicef_who_wb.pdf. [Last cited on 2014 Oct 12].
8.
Park K, editor. Preventive medicine in obstetrics, paediatrics and
geriatrics. Park’s Textbook of Preventive and Social Medicine.
23rd ed. Jabalpur, India: M/S Banarasidas Bhanot; 2013. p. 572‑5.
19. Bhavsar S, Hemant M, Kulkarni R , Maternal and Environmental
Factors Affecting the Nutritional Status of Children in Mumbai
Urban Slum. International Journal of Scientific and Research
Publications 2012;(2):11.
9.
Ghai OP, Paul VK, Bagga A. Nutrition.In:GhaiOP, Essential
Pediatrics, 7th edition. New Delhi, CBS; 2009. p. 95-100.
20. Mathad V, Metgud C, Mallapur MD. Nutritional status of under‑fives
in rural area of South India. Indian J Med Sci 2011;65:151‑6.
10. Stalin P, Bazroy J, Dimri D, Singh Z, Senthilvel V, Sathyanarayanan S.
Prevalence of underweight and its risk factors among under five
children in a rural area of Kancheepuram District in Tamil Nadu,
India. IOSR‑JDMS 2013;3:71‑4.
21. Bhanderi D, Choudhary SK. An epidemiological study of health and
nutritional status of under five children in semi‑urban community
of Gujarat. Indian J Public Health 2006;50:213‑9.
11. Sharma S. Child Health and Nutritional Status of Children: The
Role of Sex Differentials. Population Research Center, Punjab
University, Chandigarh, 2005. Retrieved from: http://www.iegindia.
org/upload/publication/Workpa p/wp262.pdf. 2005.
12. Ray SK, Biswas AK, Gupta SB, Mukherjee D, Kumar S, Biswas B,
18. 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.
22. Sengupta P, Philip N, Benjamin AI. Epidemiological correlates
of under‑nutrition in under‑5 years children in an urban slum of
Ludhiana. Health Popul Perspect Issues 2010;33:1‑9.
23. Nandy S, Irving M, Gordon D, Subramanian SV, Smith GD.
Poverty, child undernutrition and morbidity: New evidence from
India. Bull World Health Organ 2005;83:210‑6.
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