MALNUTRITION AMONG CHILDREN

Transcription

1 CHAPTER III MALNUTRITION AMONG CHILDREN 111.1: Introduction Malnutrition Nutrition is defined as the science of food and its relationship to health. Nutrition is one of the determinants of human health and growth. Good nutrition is a basic component for health and quality of life of the population. Nutrition is an integral part of health and well being of all individuals. It is one of the major factors responsible for maintenance of health and physical fitness of man and it plays an important role for national development. Good nutritional status is very essential for the normal development and functions of the organs of the body, so that working efficiently, resistance against infections and ability to repair body damage or injury can be efficiently maintained for survival. Optimal growth of the human body is determined by genetic, metabolic, environmental and nutritional factors. Nutritional status is the physical health of a person as a result of consumption and utilization of food. The nutritional status of an individual is determined by the kind and amount of nutrients supplied to the body and how completely they are used to meet body needs. It is generally believed that undernourished people are more susceptible to infectious disease, have a low level of function, and that they may suffer from apathy, indifference, and lower intelligence. The actively growing tissues and the high energy output demand more of the protective nutrient to regulate the various functions of the body and keep the young one in perfect health (Venkatachalam and Rebello, 2002). 49

2 Malnutrition means more than feeling hungry or not having enough food to eat. It is a state of disease caused by deficiency, excess or imbalance of the supplies of calories, nutrients, or both, that are available for use in the body. It may be due to dietary content, to faulty utilization of food eaten, or to a combination of both. Undernutrition is the body condition that results from inadequate amount of calories or nutrients, or both. Retarded growths, underweight are some of the most common evidences of undernutrition. Malnutrition can also be caused by many socio-economic and demographic factors. Breast feeding, complementary feeding and immunization are also related to malnutrition. As a result malnutrition increases the incidence, severity and duration of common childhood diseases, such as diarrhoea, acute respiratory infections and measles. Approximately. 55 percent of under five mortality in developing countries is associated with malnutrition. Child malnutrition, a major hindrance to human development, jeopardize and impairs prospects for productive social integration in adulthood, reduces economic growth, and contributes to the intergenerational reproduction of poverty and inequality. Although the immediate causes of malnutrition are inadequate nutrient intake and high disease exposure, underlying factors include social and ethnic disparities, as well as lack of access to basic health services (Carlos Larrea and lchiro Kawachi, 2005) : Research Problem The quality of human resources of any country is largely determined by the quality of its Child development services. The children of today are the generation of tomorrow. To be sure, there has been some improvement in the state of health of children, as reflected by modest reductions in infant and child mortality rates, and declines in the incidence of 'severe' malnutrition in children in recent years. However, the vast bulk of children 50

3 continue to be in a substandard state of health and nutrition. These are the children who may 'survive' but who will grow into undernourished adults of tomorrow, with varying degrees of impairment of physical stamina and productivity (Gopalan, 1993). Children are the invaluable assets of the nation and their physical and educational development determines the extent to which they can contribute to the national growth and prosperity. Their nutritional status exerts a significant effect on physical and intellectual advancement of children and India being a developing country needs healthy children with better manpower. Nutrition is an integral part of health and well being of all individuals. It is one of the major factors responsible for maintenance of health and physical fitness of man and it plays an important role for national development. Good nutritional status is very essential for the normal development and functions of the organs of the body, so that working efficiently, resistance against infections and ability to repair body damage or injury can be efficiently maintained for survival. Malnutrition is a condition resulting from disparity between demand of the body for a certain nutrient and its intake. It contributes directly or indirectly to high mortality and morbidity. It leads to retarded physical growth and may adversely affect the mental development. Chronic malnutrition can adversely affect mental ability either indirectly through the child's general state of health and resistance or more directly by influencing growth. Malnourished children have been found to perform, poorly in intelligence tests and also, protein calorie inadequacy during childhood can lead to irreversible impairment of mental functions in later life. Malnutrition arises from a common group of adverse social conditions, including poverty, ignorance, poor hygiene, over crowding and lack of education, parasitic and communicable diseases. People with malnutrition contribute little to national progress and become a big burden. 51

4 Malnutrition is the major health problem in the world today. More than half of the next generation is growing up undernourished. Of 850 million children under the age of five, 350 million are estimated to be undernourished. The out standing manifestations of under-nutrition in children are retardation of growth and development and specific nutritional deficiency signs. Of the latter, protein-energy malnutrition, vitamin A deficiency, Iron deficiency diseases are the most important (Shanti Ghosh, 1990). Many children below five years of age suffer from different grades of malnutrition. In the absence of care and follow-up, these children may not able to manifest their full genetic potential and human capability (Kumar, 1999). Clearly, the Indian population is passing through a transition phase where subsistence conditions are being replaced by plentiful food but reduced physical work and therefore, an understanding of the changing nutritional scene is crucial (Shobha Rao, 2001 ). Nutritional research in India has made several advances over the years and contributed significantly to the improvement in the nutritional status of the Indian population and also has made a niche in the global nutritional research scenario (Kamala Krishnaswamy and Bhaskaram, 2001 ). Nutritional research in India has been mainly public health oriented and thus is immediately relevant to the national needs. Several solutions on laboratory based research have led to strategies and national programmes for prevention and control of malnutrition. The following table shows the percentage distribution of malnourished children in India. Table Ill. 1: Percentage Distribution Malnourished Children In NFHS (India) Stunting Underweight Wasting India NFHS NFHS NFHS

5 Here stunted and severely stunted are categorized as stunted, underweight and severely underweight are categorized as underweight and wasted and severely wasted as wasted. National Family Health Survey, which was conducted on (NFHS-1), showed that there were 80.9 percent children stunted, 73.0 percent children underweight and 20.7 percent children wasted. The NFHS-2 report that published on revealed that there were 68.5 percent children were stunted, 65.0 percent children underweight and 18.3 percent children were wasted. But in the recent NFHS report ( ) showed that there were 71.7 percent stunted children, 58.3 percentage children were underweight and 26.2 percentage children were wasted. This shows that from NFHS-2 to NFHS-3 India have only improvement in the case of underweight children. So there should be a serious concern over this issue. So it is interesting to see the condition of Kerala in NFHS reports. The following table gives the percentage distribution of malnourished children in NFHS. Table 111.2: Percentage Distribution Malnourished Children in NFHS (Kera/a) Stunting Underweight Wasting Kera la NFHS NFHS NFHS National Family Health Survey, which was conducted on (NFHS-1) for Kerala, reported that there were 36.4 percent children stunted, 34.6 percent children underweight and 12.9 percent children wasted. The NFHS-2 report for Kerala that published on showed that there were 29.2 percent children were stunted, 31.6 percent children underweight and 11.8 percent children were wasted. The recent NFHS report ( ) showed that there were 30.1 percent stunted children, 26.6 percentage children were underweight and 19.0 percentage 53

6 54 children were wasted. This result revealed that even though there is improvement from NFHS-1 to NFHS-2, the nutritional status of Kerala is deteriorating from NFHS-2 to NFHS-3. So there should have some studies which identify the reasons for malnutrition in Kerala. It can also be seen from the census 2001 results that children under 6 years of age form about percentage of Kerala population and the below 14 age group form 27.3 percentage. Inspite of the State having the best indicators of Child and Development, certain disturbing trends have emerged in recent years affecting this developmental status, especially in the child population. This includes low birthweight babies, stunting of growth, wasting, and low weight for age, poor maternal nutritional status, prevalence of anaemia among women and adolescent girls. Any further reduction in IMR is impossible without a reduction of LBW babies, as most of the deaths take place within first 28 days. Ensuring Child Survival means elimination of LBW. Low birthweight, constituting 17.6 percentage of population, is directly related to maternal nutritional status and statistics showed that 50 to 55 percent of women (Pregnant and lactating) are anaemic. The prevalence of Anaemia among children under 3 years is 33.7 percent. The data presented by NNMB 2003, showed that percent of children are underweight, 30 percent stunted and 33.8 percent wasted. The prevalence of Nutritional deficiency Goitre is recorded as 4.5 percent. Anaemia among adolescent girls is a staggering 23 percent. Vitamin A deficiency in the form of Conjunctival Xerosis also exists in about 0.1 percent of the population. NFHS-3 showed that infant mortality rate in Kerala is still the lowest in the country at 15 (15 infant deaths per 1000 live birth). Anaemia is another major problem that the state has totally failed to tackle. If the I percentage of children in 6-35 months age group who are anaemic was 43.9 percent in NFHS-2, the figure currently stands at 55.7 percent. However, what is significant from NFHS-3 finding is that Kerala has not

7 ss made any gains on the health front in the past few years, while several states like Andhara Pradesh, Tamil Nadu, and Himachal Pradesh have been surging ahead. This showed that health indicators of Kerala not improved but rural states like Himachal Pradesh have gone ahead of Kerala and now comes third if we were to rate the health system. But even with a great deal of effort in getting the right amount and kind of food to the home it still does not mean that children will necessarily have good nutrition. Some nutrition programmes have distributed large amounts of food in schools and feeding centers, but most of these activities have not helped the nutrition of children as much as had been hoped. The fact is also noted that the amount of money spent on nutrition was low in the State. Government expenditure on nutrition was Rs.167 per child in Tamil Nadu, in Kerala it was just Rs.72. The problem of malnutrition has many roots like inadequate food, poor purchasing power, inadequate access to food and health care, ignorance, infections and poor status of women. Most of these causes occur in various combinations in different periods of time. In many situations, the problem is further complicated by inadequate political commitments and administrative support available at different levels. It is not enough to talk about the demographic advantage that Kerala enjoys; the real challenge lies in ensuring that the young in Kerala do enjoy improved nutritional and other facilities. For better understanding of the problem, it is informative and necessary to study the nutritional status of Kerala, particularly the nutritional status of the young children : Relevance of the Study Early childhood (0-4 years) is a very critical period for a child's physical and socio-psychological development. The Government, state and the voluntary sector have implemented a large number of programmes for the children and nursing and expectant mothers to enable children to

8 56 develop their full potential. Despite these efforts, the situation of children.is far from satisfactory, notable gains on most health, nutrition and other indicators notwithstanding. The IMR, even though is showing definite downward trend, was still disturbing (Archana Sinha, 2000). This race continues to be high as compared to those prevalent in several developing countries. About one-third babies born are of low birth-weight;. i the incidence of malnutrition and morbidity especially among children below 3 years form the under privileged sections of the society continues to be high. She also proposed that for the nation to have a reliable and efficient programmes as well as information system on the three focal concerns of early childhood, namely; survival, growth and development. Children are the invaluable assets of the nation and their physical and educational development determines the extent to which they can contribute to the national growth and prosperity. Their nutritional status exerts a significant effect on physical and intellectual advancement of children and India being a developing country needs healthy children with better manpower. Children of under the age of 5 years are most vulnerable group succumbed to nutritional diseases (Yasoda Devi and Geervani, 1994). In homogeneous poor communities living under fairly uniform socioeconomic and environmental conditions, considerable variation is observed in health and nutrition status of pre-school children. There are many factors influence the nutritional status of children. So in order to understand the real problem of nutritional status one has to study the influential factors of nutritional status. The quest for food and other basic necessities for survival has been the major preoccupation of mankind right through the ages. It is sad that, even with the spectacular advances in science and technology over the last several centuries, nearly half of the mankind continues to be engaged in the quest for basic necessities for survival. As in the case of several developmental indicators in India, the state of Kerala presents itself as an

9 57 interesting case in the matter of food security also. While Kerala finds itself a lower level it terms of the average intake of food among various states in India, it is in the forefront in such food security indictors as the incidence of under nutrition, poverty, infant mortality and life expectancy. The problem of 'availability' may have compelled Kerala, in a manner of speaking, to concentrate on the distribution of food. But an important aspect of availability is the question of internal production of food. Kerala is known as 'food deficit' state in India because of the wide gap in the consumption and production of food grains especially rice which is the staple diet of the population. However, if food is viewed from a broader angle in terms of a food basket consisting of a number of items of daily consumption, a different picture emerges. Of the 15 items for which actual consumption data were calculated, it is found that Kerala produces more than that its requirement for two-thirds, that is 10 items (Kannan, 2000). Child rearing in most families is made the primary responsibility of mothers. It is important for fathers too to recognize their role in child care and share the burden with mothers. Since most of the mothers can accurately identify malnutrition in their children, and are well aware of the measures for prevention and cure of malnutrition, food security and the availability of appropriate health care facilities are key ways to improve children's nutritional status. The mother's ability to identify malnutrition should be given high priority in child health and nutrition and food security programmes. The nature and extent of a given nutrition problem must be understood in order to design a sound nutrition surveillance program with appropriately focused and prioritized activities (Nancy Mock and William Bertrand, 1993). An assessment of the nutrition situation should spell out the types and magnitudes of existing problems, as well as the likely causes of malnutrition and data sources available for measuring both malnutrition and its causes. In many cases such an assessment can be performed by

10 58 an interdisciplinary team of local experts. Nutritional surveillance means to watch over nutrition. in order to make decisions which will lead to improvements in nutrition in populations. The nutritional surveillance system in India is the offing and is still at the stage of infancy. Nevertheless. the system of nutritional monitoring is fairly well established, at least in the States where National Nutrition Monitoring Bureau (NNMB) is in operation. Nutrition monitoring helps to assess nutritional problems prevalent in the community, in terms of their nature. magnitude and distribution among the population groups as well as geographical C3reas (Braham, 2007). Such monitoring needs over a period of time. This information is necessary to evolve policies. to formulate appropriate programmes and implement the same for the prevention and effective control of nutritional deficiency disorders. It highlights the need to evaluate the ongoing nutrition programmes. identification of bottlenecks if any and to initiate corrective steps, wherever necessary. In the last five decades, though the mortality rate has come down by 50 percent and the fertility rate by 40 percent, the reduction in undernutrition in children is only 20 percent. There is growing concern that an increase in outlays for the nutrition sector has not brought about commensurate improvement in equality and coverage undernutrition programmes and nutritional status. The undernourished children are at greater risk of morbidity and mortality has been shown by a number of studies. If this is so, children at risk need to be identified and the methods used should be the most accurate, feasible and economic for the population being studied. In terms of health planning. the numbers at risk and their location need to be known. as resources are invariably restricted (Harvey and Darnton Hill, 1981). These issues are being discussed worldwide in view of their implications and have high relevance, especially for formulating effective interventions, for have conducted longitudinal community nutrition studies on maternal nutrition and fetal growth, nutritional status of pre-school children and would like to report factual data

11 and results from these studies in the light of the above issues and discuss strategies for achieving better health of our people. It may not come as a rude surprise to many, but Kerala no longer figures on tape of the list of States which are making rapid advancement on the health front. The result of NFHS-3, all major health indicators for the State are now sliding down, a clear indication that Kerala has been resting on the glory of its past achievements for far too long. As far as trends in children's nutritional status are concerned, most of the other states seem to have made gains but in Kerala lost its credentials. So a research on nutritional status of Kerala can highlights the need for re-exan:,ining the existing programmes, identifying their limitations, ensuring logistics and feasibility rather than proposing new programmes. The information gathered from the study of nutritional status of children in Kerala will serve as baseline data for preparing a nutrition education package. Hence a study which covers the anthropometric measurement and diet intake of preschool children is very relevant in this context : Conceptual Framework Mosley and Chen (1984) proposed a conceptual framework. Keeping in view this framework, the model proposed here uses. the nutritional status of the children. Like Mosley and Chen framework, the socio-economic variables affect the outcome through the three proximate determinants, namely socio-economic and demographic factors, maternal and child health factors and dietary factors which determines the nutritional status and this leads to a 'Healthy Child'. 59

12 Maternal and Child Health Factors Socio Economic and Demographic Factors Nutritional Status of Children Child Health Diet Intake 111.5: Objectives of the Study 1. To give an overview of the dietary intake of pre-school children in the sample population. 2. To elucidate the nutritional status of pre-school children in Kerala. That is, Stunting, Underweight and Wasting. 3. To study the socio-economic and demographic correlates of nutritional status of pre-school children. 4. To give recommendation and suggestion for the effective intervention for nutritional surveillance : Hypotheses of the Study 1. The Socio economic factors like parental education, place of residerice, and family income have profound effect on nutritional status of children. 2. The Demographic factors like birth order, birth interval, age of the child, and sex of the child have sound impact on nutritional status of children. 60

13 3. Maternal and Child health factors like breast feeding, complementary feeding, frequency of diet, birthweight, premature birth, illness, prenatal care and immunization status affect the nutritional status of children. 4. Diet intake like breast feeding, complementary feeding and frequency of diet associates with the nutritional status of children : Conclusion This chapter explained the research problem of malnutrition among children of under five in Kerala. The conceptual framework established here showed the various factors which leads to the health of the child. The objectives and hypotheses are also discussed in this study. The information on data which used to test the hypothesis and methodology which use to analyze the data is given in the next chapter. 61