Nutritional survey in rural population of Kumaon Hill area, North India

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1 editor: Robert B. Bradfield, Ph.D. international nutrition Nutritional survey in rural population Kumaon Hill area, North India B. N. Tandon, K. Ramachandran, M. P. Sharma and V. K. Vinayak Although several reports from South and Central India have recorded the prevalence protein-calorie malnutrition (-), nutritional surveys have not been done in North India. This lack information has led to a belief that protein-calorie malnutrition is not a significant problem in this part the country. The present study was carried out in the rural population the hill district Nainital, Uttar Pradesh, in North India to record the nutritional status and dietary habits the local residents. Methods and materials Kumaon hill region stretches in a wide area, miles southeast Delhi. The rural population resides in small colonies to houses. Twelve villages located, to, feet above sea level were surveyed. Almost all the houses each the villages were included in this field study, which resulted in a total 77 families studied. Detailed information about the family, environmental factors, hygienic conditions, dietary intake, and personal habits was recorded on a preplanned questionnaire. Each member the family was examined for clinical features nutritional deficiency. Anthropometric measurements were done for the height, weight, and triceps skin-fold thickness; head circumferences infants were also measured. Clinical and anthropometric data were recorded for primary schoolchildren from five schools in the same area. Stool examinations a number subjects were performed by the formal ether concentration technique () and hematocrits estimated by the capillary method. Results Table presents the age and sex distribution the 77 surveyed families. A total,7 family members and 7 schoolchildren in the age range to I years were examined. Dietary history was recorded by actual measurement the raw food to be prepared for consumption on day. Cereals, wheat, and rice were the main items food with per capita intake and g daily, respectively. Per capita consumption pulses and beans was only approximately g. Milk consumption was ml; meat, eggs, or fish were rarely consumed. Dietary intake protein and calories per consumption unit is presented in Table. Sixty percent the families ate no animal protein and only.% had an intake above g/day. Clinical signs nutritional deficiency were minimal, except caries and mottled tooth enamel, which were frequently recorded. Anthropometnic measurements revealed the evidence malnutrition in children under years by using the World Health Organization weight-for-head circumference s () and.6% the children had malnutrition according to this parameter for assessment (Table ). The Indian Council Medical Research (ICMR) weight-for-age s for children below age 6 () recorded evidence malnutrition in.% the male and.9% the female children From the Department Medicine and Department Preventive & Social Medicine, All-India Institute Medical Sciences, Ansari Nagar, New Delhi-6, India. Supported by the Indian Council Medical Research, New Delhi-6. Associate Pressor Medicine. Assistant Pressor Statistics. Senior Research Officer (Medicine). Senior Research Officer (Microbiology). The American Journal clinical Nutrition : APRIL 97, pp. -6. Printed in U.S.A. Downloaded from by guest on June,

2 NUTRITIONAL SURVEY IN RURAL INDIAN AREA TABLE Age and sex distribution surveyedfamilies Age, years Males Females Average family size = 6. members. Both sexes Less than or above Total 9,7. (Table ). The Harvard weight-for-age s (), with no consideration for sex, reported the presence malnutrition in 6.% the children in this age group (Table ). Thirty-three percent the males and 7.% the females in the 6- to -year age group had malnutrition by ICMR weight-for-age s. Jelliffe s () weight-for-height recorded evidence malnutrition in 9.6% the males and. % the females in the 6- to -year age group and 69.7% the males and 7.% the females who were 6 years and over (Table 6). The evidence malnutrition in different age groups using the Harvard s triceps skin folds-for-age () is presented in Table 7. A high proportion males and females in all age groups show a varying degree malnutrition. The male schoolchildren in the age range to 7 years showed evidence malnutrition in 9.,., and 7.% the cases by ICMR weight-for-age s (), Jelliffe s () weight-for-height, and the Harvard s triceps skin foldsfor-age (), respectively. Corresponding data for female schoolchildren were 9.,., and 7.%, respectively. Results the stool examination for ova and parasites are presented in Table. Sixtysix percent the subjects had stools that were positive for parasitic infection; Ascaris lumbricoides was the most common in.fection, followed by Entamoeba histolytica, and lastly hookworm. Multiple parasitic mice- TABLE Dietary intake protein and calories surveyed families Dietary intake consumption per unit member family Families Kcal Less than, 7.,-, ,-,99.,-,99.6,6-,999.,-,99.,-,799 6.,ormore.9 Total proteins, g#{76} Less than or more a One hundred five (9.%) the families did not ingest any animal protein and only eight families (.%) had an intake to g. TABLE Evidence malnutrition in children under age using weight-for-head circumference s Age, Less years than No. children 6 Wt%or below Children with low weight 7.% 6-7% below 6% Total.6 a Weight-for-head circumference s as in (). tions were detected in % the cases, and.9% the cases had a PCV below %. Personal and environmental hygiene the population was extremely poor; the people were residing in kacha houses, which have no sanitary facilities. One small room was Downloaded from by guest on June,

3 TANDON ET AL. TABLE Evidence malnutrition in children under age 6 using ICMR weight-for-age s Males with low weight Females with low weight Age, years No. Wt % or below I 76-% 6-7% \Vt below I 6% No. \Vt % or below n \Vt Wt 76-$% 6-7% Wt below 6% stand- stand- ard ard Less than I 9 6 7,l l, I Total 6 H These weight s have been worked out on an all-india sample children from all socioeconomic strata. TABLE Evidence malnutrition in children under age 6 using Harvard weight-for-age s Children with low weight No. \Vt % or w Age, years children below 76-% 6-7% I stand- standn % ard ard Less thanl l7 7 l Total 9 6. TABLE 6 Evidence malnutrition using weight-for-height s Age, years Males Females Vt below 6% (9.6%) 9 (.%) 6 and over 76 9 (69.7%) 7 (7.%) See (). ten the sole possession six or seven members a family and a pet animal. The water supply was limited to rainwater col lection in small areas in the hills. 9 6 Comments This study records the prevalence malnutrition in the rural population a hill district in North India, assessed by anthropometric measurements. ICMR weight-for-age s recorded the evidence malnutrition in to 9% the subjects in all age groups (Table ). There was no significant difference between the two sexes or age groups, i.e., those under 6 or 6 to years. The data suggested only a mild to moderate deficiency weight with reference to age and it was rare to find weight below 6% the. Children below age had an almost similar prevalence rate % for malnutrition, calculated by the head circumference-for-weight (). However, Harvard weight-for-age () measurements revealed an alarmingly high malnutrition prevalence rate 6.% in children under 6 years age. Further, by this parameter, approximately % the children fell below 6% their weight. Harvard s triceps skin folds-for-age brought out the same inference very high prevalence malnutrition in both sexes and all age groups (Table ). Even 9.% the male and 6.7% the female adults were found to have symptoms malnutrition by Harvard s triceps skin folds (). Jelliffe s weight-forheight s () revealed almost similar Downloaded from by guest on June,

4 NUTRITIONAL SURVEY IN RURAL INDIAN AREA TABLE 7 Evidence malnutrition in different age groups using Harvard s triceps skin fold-for-age Males with low skin-fold thickness Females with low skin-fold thickness % or Age, years Lelow I 76-% No. measured stand- I ard % or below 76-% 6-7%! Below No. I 6% measured stand- stand- ard ard Less than or over I ! prevalence malnutrition in the - to - year age group as by ICMR weight-for-age s. However, both sexes above 6 years revealed a significantly high prevalence TABLE Results stool examination No. persons examined for stool 6 No. with positive stools No. with negative stools Single Multiple infection infection Ascaris lumbricoides Entamoeba histolytica E. harimanni E. izana Hookworm Giardia lamblia Others (H. nana,. buetsclzli) 6-7% Below 6% stand- ard Percentage malnutrition by Jelliffe s parameter compared with the ICMR. It is thus evident that nearly one-third the population under survey had anthropometric evidence malnutrition by ICMR s, but by the Harvard weight-for-age or triceps skin-fold s an alarmingly high preyalence malnutrition was recorded in all the age groups. It may not be correct to use Harvard s for the Indian population, but equally valid is the objection to the ICMR s that normal subjects were not selected by strict criteria and therefore subjects with subclinical malnutrition could have been included. Dietary history indicated primarily that the per capita intake good quality protein was low and, to a lesser extent, that a calorie deficiency existed in a good proportion the population (Table ). Parasitic infestation too was found to be quite common in this population (Table ). These two factors together could be responsible for anthropometric evidence protein-calorie malnutrition. Clinical manifestations malnutrition were insignificant, emphasizing the limitations this parameter in nutritional surveys. Only one case marasmic kwashiorkor was detected and the anthropometric data (ICMR s) also suggested only mild to moderate degrees malnutrition. Hygienic conditions this area are so poor that even with a mild to moderate degree malnutrition, the population is always at great risk contracting acute bacterial and viral infections, which can then precipitate the overt clinical manifestation protein-calorie malnutrition. The recorded evidence malnutrition by the Harvard triceps skin-fold measurements was significant in a high percentage the adult population. The adults suffering with malnutrition may not be able to perform physical work optimally, thereby decreasing their earning capacity and aggravating the nutritional problems the family. Summary A nutritional survey the residents villages in the Kumaon hills in North India has been performed on a total,7 family members and 7 schoolchildren. Signs nutritional deficiency and anthropometric measurements were recorded. Dietary history was taken by recorded actual measurement the raw food to be prepared for Downloaded from by guest on June,

5 6 TANDON ET AL. consumption on day. Stool examination was done by the formal ether concentration method and hematocrit was estimated by the capillary method. Dietary histories revealed a substantially poor intake proteins; 6% the families consumed no animal protein and only.% had an intake above g/day. Except for dental abnormalities, clinical signs nutritional deficiency were not cornmon. Anthropometric measurements, using the Harvard and ICMR s, established wide prevalence malnutrition, which can be summarized as follows: a) ICMR weight-for-age, children under 6 years age,.% the male,.9% the female. b) Harvard weight-for-age for the above age group, 6.%. c) Weight-for-head circumference, children under years,.6%. d) ICMR weight-for-age, persons 6 to years, % the male, 7% the female. e) Harvard triceps-for-age, diflerent ages and sexes, range.9 to 9.%. f) Weight-for-height, both sexes and different age groups, to 7%. g) ICMR weight-for-age and Harvard triceps skin folds-for-age, children both sexes to years, 9% the male, 7.% the female. Parasitic infestation was detected in 66% the cases. Ascariasis was the most common infestation. Packed cell volume studies showed low values in.9% the cases. It was further noted that family planning is rarely practiced by the families, living and hygienic conditions are extremely bad, and a number tropical diseases are widely prevalent in this area. The authors are grateful to Drs. B. Pastak.ia, H. S. Juneja, V. K. Arora, Ramesh Bijlani, and R. K. Tandon; interns Mrs. K. K. Goyel, V. K. Sawhney, R. K. Japra; and the medical students the All-India Institute Medical Sciences who participated in this field study. References. SMEswARARA, K., A. D. TAsr AND M. K. RAMANATHAN. Nutrition and haemoglobin surveys in children in Nilgiris District. indian J. Med. Res. :, 9.. PATWARDHAN, V. N. Influence malnutrition child groh and physical development. Calcutta Med. I. : 7, 9.. SoMEswARAR.&o, K., M. C. SWAMINATHAN, S. Sw AND V. N. PATWARDHAN. Protein malnutrition in South India. Bull. World Health Organ. : 6, 99.. SWAMINATHAN, M. C., S. V. APTE AND K. SoME- SWARARAO. Nutrition the people Ankola Taluk (N. Kanara). indian I. Med. Res. : 76, 96.. GoPLz, C. Nutrition in India. World Med. I. 9:, GOPALAN, C. Current nutritional problem in India. Trans. Far East Symp. Nutr. Saigon, March -6, 96. National Institutes Health,Bethesda, l96l,p GOPALAN, C. Protein malnutrition in South- East Asia: its prevalance and importance. Rept. Sem. Protein Malnutrition in Children. Geneva: World Health Organ. 96, p Jyonu, N. K., R. DHAKSHAYANI, M. C. SwArii- NATHAN A.ND P.. VENK.ATACHALAM. A study the socio-economic diet and nutritional status a rural community near Hyderabad. Trop. Geograph. Med. :, GoP.L.N, C. Major nutritional problems India and South East Asia. Proc. 7th intern. Congr. Nutr. (Hamburg) :, 96.. GOPALAN, C. Malnutrition in children in the tropics. Brit. Med. I. : 6, SRIKANTIA, S. G. Protein-calorie malnutrition in Indian children. indian I. Med. Res. 7: 6, Pmuw RA, N., DARSHAN SINGH AND M. C. SWAMINATHAN. Nutritional status pre-school children rural communities near Hyderabad city. Indian I. Med. Res. 7:, VINAYAK, V. K., B. N. TANDON AND. PRAxAs}i. A comparative evaluation formal ether, zinc sulphate and magnesium sulphate concentration techniques for diagnosis helminthic ova and protozoal cysts. Indian I. Med. Res. :, JELLIFFE, D. B. The assessment nutritional status the community. World Health Organ. Monograph Ser. No., 96, p... Groh and Physical Development indian infants and Children. All India-Part (96). New Delhi: Indian Council Med. Res. Downloaded from by guest on June,