Association of Some Socio-Economic and Socio-Demographic Variables with Wasting Among Pre-School Children of North Bengal, India

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Abstract

Background

Undernutrition is a global public health problem that causes premature morbidity and ill-health conditions and has long-lasting physiological effects in children. The present study assesses the prevalence of wasting [low mid-upper arm circumference (MUAC)-for-age] among children and to determine the association of wasting with different socio-economic and socio-demographic variables.

Methods

The present cross-sectional study was conducted among 1222 pre-school children (boys: 589; girls: 633), aged 1–5 years, in Darjeeling district, North Bengal, India, using multistage stratified random sampling method. The MUAC was measured using the standard anthropometric procedure. Low MUAC-for-age was assessed by comparing with a standard age-sex-specific reference population (WHO, 1995). Children with MUAC value were found to be the z-scores <-3SD, and <-2 SD were considered to be severely and moderately wasted, respectively. The socio-economic and socio-demographic variables were recorded using structured schedule methods. The data were statistically analyzed based on descriptive statistics, chi-square analysis and logistic regression using SPSS (version, 17.0).

Results

The age-specific mean MUAC ranged from 126.1–142.5 mm (boys) and 126.9–136.4 mm (girls). The prevalence of wasting was very high (boys: 62.3%; girls: 63.3%) (p>0.05). The logistic regression analysis observed that age, gender, birth order, area (rural), maternal education, household income and mothers' age were significantly associated with the prevalence of wasting (p<0.05).

Conclusion

Using MUAC-for-age, a high prevalence of wasting was observed among the children. Birth order, maternal education and maternal occupation were important determinants of wasting. There is an urgent requirement of nutritional intervention programmes to ameliorate the nutritional status of the children.

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Most cited references 57

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Anthropometric measurement error and the assessment of nutritional status.

S Ulijaszek, D A Kerr (1999)

Anthropometry involves the external measurement of morphological traits of human beings. It has a widespread and important place in nutritional assessment, and while the literature on anthropometric measurement and its interpretation is enormous, the extent to which measurement error can influence both measurement and interpretation of nutritional status is little considered. In this article, different types of anthropometric measurement error are reviewed, ways of estimating measurement error are critically evaluated, guidelines for acceptable error presented, and ways in which measures of error can be used to improve the interpretation of anthropometric nutritional status discussed. Possible errors are of two sorts; those that are associated with: (1) repeated measures giving the same value (unreliability, imprecision, undependability); and (2) measurements departing from true values (inaccuracy, bias). Imprecision is due largely to observer error, and is the most commonly used measure of anthropometric measurement error. This can be estimated by carrying out repeated anthropometric measures on the same subjects and calculating one or more of the following: technical error of measurement (TEM); percentage TEM, coefficient of reliability (R), and intraclass correlation coefficient. The first three of these measures are mathematically interrelated. Targets for training in anthropometry are at present far from perfect, and further work is needed in developing appropriate protocols for nutritional anthropometry training. Acceptable levels of measurement error are difficult to ascertain because TEM is age dependent, and the value is also related to the anthropometric characteristics of the group of population under investigation. R > 0.95 should be sought where possible, and reference values of maximum acceptable TEM at set levels of R using published data from the combined National Health and Nutrition Examination Surveys I and II (Frisancho, 1990) are given. There is a clear hierarchy in the precision of different nutritional anthropometric measures, with weight and height being most precise. Waist and hip circumference show strong between-observer differences, and should, where possible, be carried out by one observer. Skinfolds can be associated with such large measurement error that interpretation is problematic. Ways are described in which measurement error can be used to assess the probability that differences in anthropometric measures across time within individuals are due to factors other than imprecision. Anthropometry is an important tool for nutritional assessment, and the techniques reported here should allow increased precision of measurement, and improved interpretation of anthropometric data.

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Global Burden of Maternal and Child Undernutrition and Micronutrient Deficiencies

Tahmeed Ahmed, Muttaquina Hossain, Kazi Sanin (2013)

Maternal and child undernutrition and micronutrient deficiencies affect approximately half of the world’s population. These conditions include intrauterine growth restriction (IUGR), low birth weight, protein-energy malnutrition, chronic energy deficit of women, and micronutrient deficiencies. Although the rates of stunting or chronic protein-energy malnutrition are increasing in Africa, the absolute numbers of stunted children are much higher in Asia. The four common micronutrient deficiencies include those of iron, iodine, vitamin A, and zinc. All these conditions are responsible directly or indirectly for more than 50% of all under-5 deaths globally. According to more recent estimates, IUGR, stunting and severe wasting are responsible for one third of under-5 mortality. About 12% of deaths among under-5 children are attributed to the deficiency of the four common micronutrients. Despite tremendous progress in different disciplines and unprecedented improvement with many health indicators, persistently high undernutrition rates are a shame to the society. Human development is not possible without taking care to control undernutrition and micronutrient deficiencies. Poverty, food insecurity, ignorance, lack of appropriate infant and young child feeding practices, heavy burden of infectious illnesses, and poor hygiene and sanitation are factors responsible for the high levels of maternal and child undernutrition in developing countries. These factors can be controlled or removed by scaling up direct nutrition interventions and eliminating the root conditions including female illiteracy, lack of livelihoods, lack of women’s empowerment, and poor hygiene and sanitation.