Role of Health Management in Evaluation of Programs Monitoring the Growth of Children Aged 0-5 in Tehran, Iran

Transcription

1 Pakistan Journal of Nutrition 8 (6): , 009 ISSN Asian Network for Scientific Information, 009 Role of Heal Management in Evaluation of Programs Monitoring e Grow of Children Aged 0-5 in Tehran, Iran Fereshteh Farzianpour*, Ali Rabbani, Azizolah Batabi, Javad Rasouli and Masomea Amini Kashani 1 Department of Heal Care Management, School of Public Heal, Tehran University of Medical Sciences, Tehran, IR Iran Department of Diseases of Children, Tehran University of Medical Sciences, Tehran, IR Iran Department of Heal Education, School of Public Heal, Tehran University of Medical Sciences, IR Iran 4 Department of Statistics and Epidemiology School of Public Heal, Tehran University of Medical Sciences, Tehran, IR Iran 5 Tehran University of Medical Sciences, Tehran, IR Iran 3 Abstract: This study was conducted to evaluate e children's grow monitoring program in e souern part of Tehran-Iran. This descriptive cross-sectional study was done on 119 children aged 0-5 in heal facilities in e souern part of Tehran. The data was collected rough existing data in e children's grow monitoring system, anropometric indicators and also gaering demographic variables rough observation, interview and questionnaire. The data was statistically analyzed using SPSS software and Z and X tests. Findings indicate at out of 119 children in e study, 618 (50.7%) were girls and 601 (49.3%) boys. Considering weight, 46.35% of e children 0-1 mons old were between e 50 and 97 standard percentile. Wi e increase of age, e figure increased to 48.49%, 53.85% and 55.41%, at e age of 13-4 mons, 5-36 mons and mons respectively. But at e age of mons it decreased to 5.15%. Statistical analysis based on X tests indicates at ere is a significant statistical relationship between sex and weight (p = 0.000), but no significant relationship is found between sex and height (P = 0/05170). The results indicate low weight in children in e study, considering NCHS standard. Wi regard to e mean difference of weight and height percentage between e children in e study and eir peers in oer countries, international standard NCHS can be a suitable indicator for monitoring children's physical grow. Key words: Evaluation, programs, monitoring grow, children, Heal management, INTRODUCTION Evaluation of e grow trend of children aged 0-5 is one of e most important functions of heal management in offering heal services to e community. Measuring e infant s weight at bir, eir height and head circumference is e simplest but e most reliable means to evaluate eir heal and e amount of care provided (Hatami et al., 004). Using weigh and height indicators to find out children s heal and nutritional status in e society is getting more and more important (Kaller et al., 1976; WHO, 1986). Grow as one of e heal indicators from e beginning of infancy to e end of maturation has always been wory of attention and it is so important at all who are involved in children s heal and hygiene should be familiar wi e concept of grow and its natural extent in order at ey can recognize unnatural cases and find out e causes and if possible, to restore natural grow rough removing obstacles (Kanawati, 1976). By 1985 using grow curve and recording weight curve seemed impossible and impractical in e ird world countries, but now due to an increase grow nutritional information and e importance of nutrition in children s heal and planning in monitoring it is now possible to perform grow monitoring in e ird world countries as well (Ayatollahi and Ahmadi, 001; Ayatollahi, 1993). Deviation in grow patterns is also an unspecific but very important sign to diagnose severe diseases. This deviation is often e first sign indicating at e child has a problem which sometimes even e parents don t realize. Measuring over and over is much more valuable an measuring once, because in is way deviation, in specific grow patterns, even natural ones, can be recognized (Veghari, 007). Measuring grow criteria is one of e best ways to estimate heal and nutritional status in children (Amy et al., 000). The most important indicator of children s grow is gradual increase in eir weight which is easily affected by right nutrition, but e grow rate of body leng and e skull is lower and changes later. Similarly, malnutrition causes decrease in weight more quickly (Nakhshab and Nasieri, 003). Malnutrition or failure to rive is a clinical syndrome indicating at e infant or child has deviated from natural grow pattern and moves downward e grow curve and always ranks below 3% in weight and height curve or below e 89

2 Pak. J. Nutr., 8 (6): , 009 mean percentage wi more an two standard 1997; WHO, 1995; Lohman et al., 1988; Hamill et al., deviations (Malek and Sharifian 1990; Nakhshab and 1979). Nasieri, 003; Bisai et al., 008). In is research, e relationship between independent Almost 9% of children below 5 in e world suffer nutritional and no nutritional status variables has been wasting, i.e. considering eir height; ey are low weight studied. These variables include age, gender, and are subject to dea or severe disturbance in physical and /or mental grow (Amy et al., 000). Based on statistics reported by ministry of heal and medical education (autumn 1998), 10.9% of children below 5 (4-9 mons of age) are moderately or severely under weight and 15.4% encounter severe delay in grow or are not as tall as is naturally expected (Ministry of Heal and Medical Education and UNISEF, 1998). demographic, economic, social and cultural status, moer s occupation, parents education, e way e child is fed in e first six mons of age (exclusive barest feeding or predominant breast feeding), e duration of complement nutrition, if e child has not been predominantly breast fed, e use of multivitamin drops. To show some of e variables and to show e relationship between qualitative variables, absolute and Nutritional disturbances in children below 5 are e relative frequency distribution table been used, X have greatest heal problems in our age. Economic, social used respectively. and cultural poverty and lack of e families access to heal and treatment services to prevent diseases and also lack of e correct use of a right diet when children are growing play a significant role in causing RESULTS Findings indicate at 618 out of 119 children in e study were girls (50.7%) and e rest were boys (49.3%) malnutrition and low weight (Farzianpour et al., 008), It and also 13.17% of em had been solely breast fed by is obvious at evaluation of e function and e time ey were seven mon old. Only one moer effectiveness of programs monitoring children grow is who had twin children had used complement milk to highly important and monitoring children s grow is e feed em.1.3% of moers had started giving best means of promoting eir heal (Haidary et al., complement milk since eir children were ree mons old. 68.% of children under one had been only breast 006). For is reason e present study tries to fed or given powdered milk or cow s milk. determine and control programs monitoring children s Tables, 3 show children s weight grow status based grow from bir to 5 years in e souern part of on standard percentiles. The weight of 46.35% of Tehran and en to compare its results wi e children 0-1 mons of age is between e 50 and 97 international NCHS standard. MATERIALS AND METHODS The study was a cross-sectional one and was carried out based on e existing data in e children grow monitoring system. The sample in e study consisted of 119 children aged 0-5 who had taken based on census. They had referred to e heal and treatment centers in souern part of Tehran and who lived in e same area. The information collected in e study was based on observation, interview and measuring anropometric indicators as well as questionnaires about demographic variables. The research was done in 004 and took one year. To show some variables, table of e absolute and relative distribution and to show e relationship between qualitative variables, X test was used. Anropometric indicators had already been determined by experts based on instructions of ministry of heal and medical education. Grow information related to different ages, from bir to 5 was obtained from e children s files and e situation of children s grow curve at different ages based on standard percentiles of grow card was determined. Statistical analysis of e information was done using SPSS software and e curve of grow percentiles was drawn and en compared wi NCHS standard wi e help of Z test (Schroeder and Brown, 1994; Nasiri Rineh, percentiles. As age increases is figure reaches 48.49%, 53.85%, 55.41% for 13-4, 5-36 and mon age group, respectively. It shows a decrease of 5.15% for mon age group. When e above figures are compared in boys and girls, rd e number of girls under e 3 percentile and from e rd 3 to e 5 is more an at of boys but e number of e boys from e 50 to e 97 and above e 97 is more an at of girls. Table 1: Frequency distribution of 0-5 years of age children s height, weight and sex status in e souern part of Tehran Types of variables (P. value) Height and sex in whole children Weight and sex in whole children Height and sex in children above Weight and sex in children above Furermore, e weight of 48% of children 0-1 mons rd old ranks from e 3 to e 50 percentile. Whereas e figures are 44., 36.86, 4.59 and 35.13% for 13-4, 5-36, and age group, respectively. According to e results, as age increases e grow curve of e children above e 50 percentile falls to under e 50. The application of X test present at ere is a significant relationship. Between sex and weight (p = 0.000) but ere is no such a relationship between sex and height (Table 1). Also in children above 3 ere is no 830

3 Pak. J. Nutr., 8 (6): , 009 Table : Weight grow curve of children of 0-5 years of age based on standard NCHS rough monitoring grow considering age and sex in 004 Grow curve Under e Between e Between e ird rd 3 and and 97 Above e 97 percentile percentile percentile percentile Total Age (mon) P-value Sex N Percent N Percent N Percent N Percent N Percent Boy Girl * Boy Girl Boy Girl Boy * Girl Boy * Girl *Relationship between sex and Grow curve into age group (mon), *Significant, Non Significant. Table 3: Frequency distribution of 0-5 years of age children s height, Weight in e souern part of Tehran in 004 Age Mon N Height Cm N Percent Weight gr N Percent highest highest Total * ** 100 *There is a significant relationship between age and height (p = 0.000). **There is a significant relationship between age and weight (p = 0.000). significant relationship between sex and weight. Using linear regression a significant statistical relationship was observed between weight (X4) and age in terms of mon (X) (p = ) and regression model was provided as follows: X =03.9X Also using linear regression, a significant relationship between height (X5) and age in terms of mon (X) was observed (p = 0.000). The regression model is as follows: X =0.8X Tables 4 and 5 show absolute and relative frequency distribution of e nutritional status of e children in e study based on low weight indicator considering age (Table 4) and sex (Table 5). Based on Z score classification, 10.5% of e children suffer malnutrition and are under weight in terms of eir age and.7% of e children suffer average malnutrition. The prevalence of malnutrition in girls (10.03%) is less an at in boys (10.4%). Furermore, malnutrition is prevalent in 0-1 mon age groups (36.63%) and it decreases in age groups. Demographic variables are shown in Table % of e moers have a job outside home, 89.99% of em are literate, e average number of e family members is 5.6 and e youngest parents (15-19) constitute 14.4% % of e children are solely Table 4: Absolute and relative frequency distribution of e nutritional status of e children 0-5 years of age based on low weight indicator considering age in 004 Malnutrition:mild, moderate and Frequency severe Age group N Percent N Percent Total *p = *Relationship between age group and malnutrition breast fed, 86.69% of em are fed wi complement foods after e age of 7 mons and 83.59% take multivitamin regularly. DISCUSSION The findings of e research revealed at weight percentages in two age groups, 13-4 and 0-1 mons, were higher in boys an similar percentages in NCHS standard. Weight decrease in girls under twelve mons of age indicates malnutrition and grow problems generally occur from under twelve mons of age on. In e present study, mild and moderate malnutrition is seen in age groups 0-1 (36.63%) and 13-4 mons (10.98%), which is a noticeable point. These results are similar to ose of e research conducted into e trend of grow of children less an two years of age in 831

4 Pak. J. Nutr., 8 (6): , 009 Table 5: Absolute and relative frequency distribution of e nutritional status of e children 0-5 years of age based on low weight indicator considering sex in 004 Sex Girl Boy Total Nutrition status N Percent N Percent N Percent Natural Mild malnutrition Moderate malnutrition Sum of malnutrition Total* P= *Relationship between sex and nutrition status (natural and sum of malnutrition) Table 6: Characteristics of 119 children of 0-5 years of age in souern of part of Tehran in 004 Characteristics Number Percent Moer's Occupation Housewife Employed Moer's Education Literate Illiterate 1 10 Way of e feeding child PBF & EBF Breast feeding Beginning of Three mons of age After 7 mons of age Multivitamin consumption Regular Irregular The number of family members Fewer an 3 children More an 3 children The average house hold is 5.6 people. The youngest parents of years of age, 14.4%. Tehran (1987) indicating. The onset of malnutrition and 16.8% in main villages and less important ones, grow decrease at six mons of age (WBO, 1980). respectively (Minay et al., 1999). According to e report published by ministry of heal In Bushehr and Natanz 7.8% and.% of children in 5- and medical education (1988), 7.7% of e children in 36 mon age group respectively were reported under is age group were moderately or severely low weight weight considering eir height (Alipour, 1999; Ershadi, (Nasiri Rineh, 1997). The percentage of low weight in 1998) in mon age group weight percentiles of Zabol, Kerman, e province of Systan and Beluchestan, boys are more an ose of girls. 58.6% of boys rank Mazandaran, Golestan province were 35.75%, 34.4%, between e 50 and 97 percentile, but e figure is.8%,.3% and.4%, respectively (Nasiri Rineh, 45.7% for girls. It seems at weight decrease in girls 1997). Low weight also has been reported in Ghom, suffering malnutrition in e form of e low weight is Tehran and East Azarbijan. The results of e studies more, considering e fact at weight average in girls is which have been carried out in oer countries reveal lower in proportion to boys. The results of e studies at ere is a significant relationship between e conducted on children aged 6-9 in Kashan and nursery percentage of e percentage low weight and economic children (children from -5 years old) in sou of Nigeria and social development, in at in developed countries revealed at girl s weight and height was lower in (America, Frances, England and Japan) malnutrition proportion to ose of boys. This statistical difference prevalence has been reported zero. While e figure was was significant (Abidoye and Pearce, 000;.5% in England and Japan in e 80 (Xiao et al., 1998). Montazerifard and Mohammad, 005). In Sou African countries it has been reported 30-40% The results of e study on boys aged 4 in souern part (Labbafi Qashemi et al., 1997). Weight percentage in of Tehran show an increase of weight at is age. These age group 5-36 mons of age in bo girls and boys results are similar to ose obtained from studying on are above e similar percentiles in NCHS. In is age children under six years of age, especially, four-year age group ere is no low weight. Furermore, e results group in Zahedan, considering NCHS (Montazerifard of e study on monitoring e grow of e children in and Mohammad, 005). Weight percentiles in e study reveal at in is age group 5.6% and 55.1% mon age group in bo girls and boys are higher an of e children rank between e 50 and 97 percentile, similar percentiles in NCHS standard. In is age group respectively. Above 50% shows quite a desired grow. ere is no low weight. The results of e study indicate The percentage of low weight in children under 3 years at 48.% of girls and 63.6% of boys 4-5 years of old of age in rural areas of Isfahan in 1984 was reported rank between e 50 and 97. While e results also in 83

5 Pak. J. Nutr., 8 (6): , 009 e study carried out on children 0-5 years of age from Amy, L.S., H. Rice, Adnan and R.E. Black, 000. Calvin revealed at e grow percentiles of boys and girls were lower in low percentages an high ones. In e study conducted by Montazerifard and his colleagues in 004 malnutrition and low weight in mon age group was reported 13.5% (Mahyar et al., 009). According to statistics of WHO, e prevalence of malnutrition in children under five years of age is 5.7%, 8.3% and 56.3% in Brazil, Turkey Bangladesh, respectively (Xiao et al., 1998) in Iran e rate of dea in children under five years of age was reported 3 out of 1000 (Naghavi, 003). In most countries of e world e rate of dea in children under five years of age and children aged 1 has decreased considerably, which is due to improvement in family planning programs and children s heal care, but is decrease, has been less in babies. Investigating e causes of dea in babies in 18 provinces of Iran has shown at e most prevalent cause of dea in babies is low weight at bir (Eghbalian, 007). Fortunately we didn't have any limitation in is study. Conclusion: The pattern of grow shows low weight in children of 0-1 mons of age and mild and moderate malnutrition in children of 5-36 mons of age, which is indicative of poor nutrition and also lack of enough nutrition which in turn reflects cultural, economic and social poverty. Finally, e results indicate weight decrease in children in e study based on NCHS standard. Considering e difference between percentile of weight and height in boys and girls and ose of children of e same age in oer countries, it seems at using e international NCHS standard is a good indicator for monitoring children s physical grow. ACKNOWLEDGMENT The auors would like to ank e office of Vice chancellor for research And Research Eics Committee of School of public Heal. Tehran University of Medical Sciences for support of is study. Also we are grateful to respectable managers of heal and treatment centers located in souern part of Tehran, specifically experts of moers and children unit and all moers who filled our questionnaires. REFERENCES Abidoye, R.O. and A.P. Pearce, 000. Nutritional status of nursery school children: comparison between logos state (Souern Nigeria) and Jos. Plateau state (Norern Nigeria) Nutr. Heal, 14: Alipour, R., The study of nutritional status and some of its effects on children 0-36 mons old in urban and rural areas under heal treatment centers in Natanz. Fif conference on Iran s nutritional status Tehran, 163: -5 (Persian). Malnutrition as an underlying cause of childhood deas associated wi infectious diseases in developing countries. Bulletin of e WHO, 78: Aytollahi, S-M., Standard Weight and Height for Shiraz children. Shaheed Beheshti University of Sciences. J. Fac. Med., 16: Ayatollahi, S.T.M. and K. Ahmadi, 001. Infants' grow chart for souern Iran. Annals o f Human Biology, 8: Bisai, S., K. Bose and A. Ghosh, 008. Prevalence of under nutrition of Lodha Children aged 1-14 Years of Paschim Medinpur District, West Bengal India. Iran. J. Pediatr, 18: Available at: tums.ac.ir. Ershadi, A., The study of weight and height of children under six years of age in Kashan. Qazvin. J. Univ. Med. Sci., : 17-0 (Persian). Eghbalian, F., 007. The study of factors rectors related to low weight at bir. Iran. J. Pediatr, 17: Available at: Farzianpour, F., A. Rabbani, A. Batebbi, J. Rasuli and M. Amini Kashani, 008. Evaluation of e function of programs monitoring e grow of children aged 0-5 in heal facilities located in e souern part of Tehran (a study on quality improvement in heal management). 1 International congress of pediatrics.9-13 Oct 008. Available at: iranped.ir. Haidary, S.T., F. Emam Gorishi and M. Amini, 006. Survey of grow children under aged in Jahrum- Iran comparison wi NCHS.Gonabad. J. Faculty Medical Sci.,11: Hatami, H., S.M. Razavi, H. Eftakhar, F. Majlesi, M. Sayed Nozadi and S.M.J. Parizadeh, 004. Public Heal. 1st ed, Ardjman publication, 3: (Persian). Available at:http//: date: Jan 7, 009. Hamill, P.V., T.A. Drizd and C.L. Johnson, Physical grow: National Center for Heal Statistics Percentiles. Am. J. Clin. Nutr., 3: Kaller, W.T., G. Donoso and E.M. Demayaer, Anropometry in nutritional surveillance, a review based on result of WHO collaborative study on nutritional anropometry. Nutr. Abstr. Rev., 46: Kanawati, A.A., Assessment of nutrition status in community Mclaren London, pp: Labbafi Qashemi, R., Q.H. Sadri and M. Mehdizadeh, A study of grow status of children under e age of ree years from rural areas of Isfahan province Isfahan. J. Univ. Med. Sci., 1998; 15: (Persian). 833

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