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| ORIGINAL ARTICLE |
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| Year : 2022 | Volume
: 9
| Issue : 2 | Page : 77-83 |
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Malnutrition: Prevalence and risk factors – A cross-sectional study among school going children in Varanasi, the Ancient City of India
Mamta Tiwari1, Neeru Nathani1, Govind Prasad Dubey2
1 Department of Swasthavritta and Yoga, Faculty of Ayurveda, IMS, BHU, Varanasi, Uttar Pradesh, India
2 Department of Kriya Sharir, Faculty of Ayurveda, IMS, BHU, Varanasi, Uttar Pradesh, India
| Date of Submission | 28-Feb-2022 |
| Date of Decision | 24-May-2022 |
| Date of Acceptance | 07-Jul-2022 |
| Date of Web Publication | 20-Feb-2023 |
Correspondence Address:
Mamta Tiwari
Department of Swasthavritta and Yoga, Faculty of Ayurveda, IMS, BHU, Varanasi, Uttar Pradesh
India
 Source of Support: None, Conflict of Interest: None
DOI: 10.4103/AYUHOM.AYUHOM_16_22
Background: Child malnutrition continues to exist as a major public health concern worldwide mainly in most of the low- and middle-income countries such as India. The screening of the school children is an effective tool to quantify the current prevalence in the country. There are various determinants that influence the risk of malnutrition as parental educational status, socioeconomic status, and family size are considered important determinants of the nutritional status of the child. Objective: The present study in selected school in Varanasi District aimed to evaluate the overall the prevalence of malnutrition (i.e., stunting, underweight, overweight, and obesity) in 11–15 years aged school children of urban and rural parts of Varanasi and analyze the associated socioeconomic factors. Materials and Methods: The school-based study of 729 (336 from rural and 393 urban) school children was carried out and compared against World Health Organization reference standards to determine the nutritional status. The association of various socioeconomic factors was analyzed. Results: The prevalence of undernutrition (stunting) in both the study areas is 20.8% (24% in rural and 21.7% in urban). In body mass index analysis, 15.77% were thin, 6.25% were severely thin and only 2.38% were overweight in rural area while 14.24% were thin, 7.8% were severely thin and 11.9% were overweight in the urban area schools. The significant association between house type, mother education, father education, mother education, and father education with nutritional status. Conclusion: Malnutrition is the emerging problem for adolescent age group children in India. The nondietary determinants of the malnutrition need to be addressed with comprehensive strategy.
Keywords: Adolescent, India, malnutrition, school-age children
How to cite this article:
Tiwari M, Nathani N, Dubey GP. Malnutrition: Prevalence and risk factors – A cross-sectional study among school going children in Varanasi, the Ancient City of India. AYUHOM 2022;9:77-83 |
How to cite this URL:
Tiwari M, Nathani N, Dubey GP. Malnutrition: Prevalence and risk factors – A cross-sectional study among school going children in Varanasi, the Ancient City of India. AYUHOM [serial online] 2022 [cited 2023 May 30];9:77-83. Available from: http://www.ayuhom.com/text.asp?2022/9/2/77/370084 |
| Introduction | |  |
Good nutrition is essential for child health and development. Child malnutrition continues to exist as a major public health concern worldwide. The double burden of undernutrition and overnutrition is an emerging problem for the most of the low- and middle-income countries of the world. India also bears a tremendous burden of Malnutrition with substantial differences in urban and rural areas and in different states of country. The state of Uttar Pradesh is the most populous state in the Northern part of India contributes 16.16% of the total population of country.[1] The state has the highest prevalence of stunting (62%) among children below 5 years of age, while the underweight (44.9%) and wasting prevalence is also high.[2]
Malnutrition in children has profound influence on the health, cognitive development, and disease course throughout the life.[3] The majority of children suffering from such growth deviations go unnoticed. Hence, the screening of the school children is an effective tool to quantify the current prevalence in the country. Despite the urgent need to address the issue in all age groups the Millennium Development Goal 1 and Sustainable Development Goal2 focused on the problem in under 5 years of age group. Hence, school children aged 5–19 years of age remain largely excluded from the monitoring and screening programs despite the fact that significant impact of nutrition in adolescent age in terms of health, educational achievements, cognition, and future economic productivity. There is a wide difference in the nutritional status of under 5 years of age group in India, according to the National Family Health Survey (NFHS) data stunting in children under 5 years of age is highest in Bihar (48%), Uttar Pradesh (46%), Jharkhand (45%), and lowest in Kerala and Goa. Furthermore, there is a disparity in nutritional status in urban and rural areas. Stunting is higher in rural areas (41%) than urban areas (31%).[4] The present study in selected school of Varanasi District aimed to evaluate the overall the prevalence of malnutrition (i.e., stunting, underweight, overweight, and obesity) in 11–15 years aged school children of urban and rural parts of Varanasi.
Undernutrition is a widely observed variant of malnourishment which makes the child susceptible to infections that complement its effect to continue the vicious cycle of malnutrition. This accounts for 22% disease burden in India and has a negative impact on the adult productivity and economic growth of the country.[5] In the past two decades, the per capita food production has increased by 75% and poverty has declined even then, the rates of undernutrition are slightly improved[6] therefore there is a need to explore the determinants responsible for persisting high prevalence of undernutrition in Uttar Pradesh. This study is an attempt to estimate the malnutrition prevalence among the children enrolled in urban and rural selected higher secondary schools, to assess age and sex trends in the level of malnutrition in the area and attempts to determine the possible risk factors.
| Materials and Methods | | |
The cross-sectional study was conducted to estimate the malnutrition prevalence (i.e., stunting, underweight, overweight, and obesity) among 11–15 years school-going children in Varanasi district of Uttar Pradesh, India. The underweight among children 5–19 years of age are defined in the same manner as those among the children under 5 years of age (i.e., by employing z scores for (body mass index [BMI] - for-age and height-for-age). This study was carried out at 6 selected higher secondary schools belonging to government and private sector in urban and rural areas of Varanasi, with classes from Classes IV to VIII. Each class had three sections and children from all sections were screened irrespective of sex, socioeconomic status, or academic performance. The study was carried out on children in the age group of 11–15 years. The sample size was calculated taking alpha error as 5%, P = prevalence of stunting is 38.6 in rural area and 48.6 in urban area as per NFHS 4. With 5% nonparticipant rate, sample size for Rural and Urban was 383 and 403, respectively. As per the above assumptions, the sample size calculated was 786. The schools were chosen randomly for one block among the 8 blocks of rural Varanasi and two wards of all the wards in the urban area. All the children in these classes of three schools were selected for the study. However, due to time restriction of schools and willingness of the subjects, the children whose all assessments were complete are included in the data analysis. Thus, a total of 729 (336 from rural and 393 urban) school children were analyzed.
Children evaluated as malnutrition for weight-for-height, height-for-age, and weight-for-age based on BMI [WHO]. According to WHO Global Database on Child Growth and Malnutrition: Growth Reference Data for 5–19 Years).[7] Thinness is defined as those having a z scores <−2 for BMI for age, while stunting is defined as those having a z score <−2 for height for age. The study is school-based cross-sectional descriptive conducted between March and October 2019 in 6 selected higher secondary schools belonging to the government and private sector in urban and rural areas of Varanasi. The Ethical Committee Approval was obtained from the Institute with Letter Number (Dean/2014–15/EC/937, dated December 15, 2014).
A predesigned and pretested self-constructed questionnaire was prepared to collect the baseline information of the students regarding personal profile such as residence, religion, type of family, education, and occupation of parents, family income, and information on individual characteristics such as age and sex. The questionnaire was pretested on 5 children from each school. Necessary changes were made to the questionnaire before the start of the study. To gauge the risk of malnutrition in the subject anthropometric status was assessed by measuring the weight and height of every student using the standard technique recommended by the WHO.[8]
The height of the students was measured by stadiometer capable of measuring to an accuracy of 0.1 cm. The child was made to stand erect with feet together, hands by side, and head in forward position. The weight was measured using a portable balance with an accuracy of ±100 g. Each school child was made to stand on the balance without holding onto any support without footwear and accessories with feet closed, hands by the sides, and head in a forward position. The weight was recorded to the nearest value. BMI calculated as “body weight (in kilograms)/height (in meters) squared. All data were compared with the WHO growth standard tables for height for age and BMI for age. A value of mean −2 standard deviation (SD) was taken as the cut-off point for the detection of underweight and stunting. BMI more than +2 SD (z score) was categorized as overweight and more than +2 SD (z score) as obesity.
Data analysis
The data were collected and coded and entered into spreadsheets. Statistical analysis was done using SPSS for windows Inc. 22.0, West Madison Street Suite 2300 Chicago, IL 60606 United State. The findings were described as mean, median values, and properties. An appropriate statistical test (Chi-square) was done and logistic regressions were carried out to find the association of the variables. Multivariate analysis at 95% confidence interval was computed.
| Results | | |
A total of 729 children's data were collected 393 from urban and 336 from rural areas of Varanasi. Out of 729 respondents, 225 (30.9%) were girls and 504 (69.1%) were boys. Majority (94.8%) of the subjects were Hindu and only 5.2% were Muslims. The number of students of age 11, 12, 13, 14 was 28.4%, 31.8%, 20.6%, 12.8%, 6.4% of respondents, respectively.
The mean height of boys and girls of the study group was lower than the WHO standards in all age groups and this difference is highly significant [Table 1]. In this study, overall prevalence of undernutrition in both the study areas is 20.8%, i.e., 152 out of 729, and rest of the students had 79.14% had normal height for age. In the total students screened 24% in rural and 21.7% in urban had height less for age [Table 2]. The girls are more undernourished as compared to boys showing statically significant difference in the prevalence of long-term malnutrition in girls and boys [Table 3]. BMI for age was calculated using weight in kg and height in meters squared. The result of the study shows that 75.29% of students were normal, 15.77% were thin, 6.25% were severely thin, and only 2.38% were overweight in rural area schools while 63.86% were normally nourished, 14.24% were thin, 7.8% were severely thin and 11.9% were overweight in the urban area schools [Table 4]. The gender difference was significantly observed as 81 (16.1%) boys and 28 (12.4%) girls were thin and 44 (8.7%) boys and 8 (3.6%) girls were severely thin in the present study, thereby suggesting that boys are more likely to be wasted than the girls [Table 5]. No statistically significant association between socioeconomic status as recorded using modified BG Prasad socioeconomic scale for February 2019, type of family and nutritional status of the children. The study shows a significant association between house type, mother education, father education, mother occupation, and father occupation with nutritional status [Table 6]. The logistic regression analysis shows that mother education as strong predictor of the nutritional status of school children in Varanasi [Table 7]. | Table 1: Comparison of mean height and weight of the subjects with World Health Organization standards on the basis of age
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 | Table 2: Age-wise classification of nutritional status of children in urban and rural Varanasi as per the World Health Organization scaling (height for age)
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 | Table 3: Gender-wise classification of nutritional status of children as per the World Health Organization scaling (height for age)
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 | Table 4: Age-wise classification of nutritional status of children in urban and rural Varanasi as per the World Health Organization scaling (body mass index for age)
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 | Table 5: Gender-wise classification of nutritional status of children as per the World Health Organization scaling (body mass index for age)
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 | Table 6: The association between various socioeconomic factors and the nutritional status of school children in Varanasi
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 | Table 7: Logistic regression for factors associated with nutritional status of school-going children in Varanasi
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| Discussion | | |
This study explored the pattern of malnutrition in adolescents in urban and rural areas of Varanasi District. Despite several government initiatives almost one-fifth of the total students screened were stunted and thin. Stunting is a sign of chronic undernutrition. Adolescence is the period of rapid growth and increased requirement of calories and micronutrients. Adolescence is the only period after infancy when the velocity of growth increases. During 10–19 years of age, nearly 15% of the final adult height is gained. This period is also critical for appropriate weight gain as nearly half of the adult weight is gained in this phase. This study reported that the mean height and BMI of the students were less the standard WHO height and BMI for age in both the sexes in almost all age groups in both the study areas. Thus, this finding is suggestive of long-term calorie and micronutrient deficiency in daily diets of the children in this area. This finding is similar to the study done in the Bareilly district of Uttar Pradesh by Srivastava et al.[9] This study reveals the prevalence of stunting was 20.8% but it is higher in rural area and less in urban area. The data from NFHS states that the prevalence of undernutrition is more in rural children. The present data reveal that the total children stunted were 17.28% and 3.5% were severely stunted. The similar finding is reported by Nitish Kumar[10] in primary and upper primary school children of Varanasi (rural and urban) which observed 20.3% of children were in a mild degree of stunting and 5% were in a moderate degree of stunting while a very less (1.9%) children were in a severe degree of stunting. The study confirms the higher prevalence of malnutrition in girls than boys as reported by Debnath.[11] The observed BMI of the children shows that nearly 25% of subjects in rural are undernourished but in the urban area, 20% are undernourished 12% are overweight. After independence, the rapid economic transition that has come to picture in India after the adoption of a mixed economy for the development of agriculture and industrial sectors has paved the way for the diseases such as overweight and obesity in the adolescent population mainly in urban areas. Thus, this study shows that the Indian adolescent population in urban area has double burden of coexistence of under and overnutrition. The similar findings are reported by Abraham[12] and Daga.[13] Besides nutritional, there are other factors that can directly or indirectly affect the nutritional status of children. Literacy, occupations, family per capita income, and social status of the family are key factors contributing to malnutrition in children. The present study no statistically significant association between socioeconomic status and type of family and nutritional status of the children. The study shows a significant association of house type, mother education, father education, mother occupation, and father occupation with nutritional status. This fact is supported by various other studies. This study highlights the effect of maternal education on the nutritional status of children has been demonstrated decades ago and is far-reaching than any other determinant. The maternal education influences the child health through her ability to acquire the health knowledge, following the recommended feeding practices and increased command over resources. This study also depicts the same observations supporting the fact that mother education is strongly associated with improved nutritional status of children.
| Conclusion | | |
The malnutrition is complex and multidimensional issue still alarming problem in India. Most of the studies done Uttar Pradesh are done on the nutritional status of under 5 years' age of children or mothers but adolescent nutrition studies are scare and limited. This study provides the primary data to address the problem of malnutrition with new plans such as face-to-face counseling sessions with parents and children in school to address the multiple issues involved in the high prevalence of the disease.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
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[Table 1], [Table 2], [Table 3], [Table 4], [Table 5], [Table 6], [Table 7]
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