Rajiv Gandhi University of Health Sciences, Karnataka, Bangalore s6

“A STUDY TO FIND THE PREVALENCE OF MALNUTRITION
AND ITS ASSOCIATION WITH HEALTH INFLUENCING
FACTORS AMONG UNDER FIVE CHILDREN
RESIDING IN SELECTED AREAS
OF BAGALKOT “
PROFORMA FOR REGISTRATION OF SUBJECT FOR
DISSERTATION
MR. IRANNA BANDI
SHRI. B.V.V.SANGHA’S
SAJJALASHREE INSTITUTE OF NURSING SCIENCES,
NAVANAGAR, BAGALKOT, KARNATAKA.
2012

RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES, KARNATAKA, BANGALORE

ANNEXURE – II

PROFORMA FOR REGISTRATION OF SUBJECTS FOR DISSERTATION

1.  / Name of the candidate and address
(in block letters) / MR.IRANNA BANDI
I YEAR M. Sc. NURSING
SAJJALASHREE INSTITUTE OF
NURSING SCIENCES, BAGALKOT
2.  / Name of the Institution / Shri B.V.VS SAJJALASHREE INSTITUTE OF NURSING SCIENCES, BAGALKOT.
3.  / Course of Study and Subject / M. Sc. NURSING
COMMUNITY HELTH NURSING
4.  / Date of Admission to the course / 28/05/ 2012
5.  / Title of the topic;
“A STUDY TO FIND THE PREVALENCE OF MALNUTRITION AND ITS ASSOCIATION WITH HEALTH INFLUENCING FACTORS AMONG UNDER FIVE CHILDREN RESIDING IN SELECTED AREAS OF BAGALKOT”
6.  Brief resume of the intended work:
Introduction
There is no finer investment for any community than putting milk into babies.
-- Sir Winston Churchill
Adequate nutrition is essential in early childhood to ensure healthy growth, proper organ formation and function, a strong immune system and neurological and cognitive development. Economic growth and human development require well nourished populations who can learn new skills, think critically and contribute to their communities. Child malnutrition impacts cognitive function and contributes to poverty through impeding individuals’ ability to lead productive lives. In addition, it is estimated that more than one-third of under-five deaths are attributable to under nutrition.1
Nutrition has increasingly been recognized as a basic pillar for social and economic development. The reduction of infant and young child malnutrition is essential to the achievement of the Millennium Development Goals, particularly those related to the eradication of extreme poverty and hunger and child survival . Given the effect of early childhood nutrition on health and cognitive development, improving nutrition also impacts Millennium Development Goals related to universal primary education, promotion of gender equality and empowerment of women, improvements of maternal health and combating HIV/AIDS.1
Malnutrition is widely recognized as a major health problem in developing countries. Growing children in particular are most vulnerable to its consequences. The frequency of malnutrition cannot be easily estimated from the prevalence of commonly-recognized clinical syndromes, such as Marasmus and kwashiorkor because these constitute syndromes only, Cases with mild-to-moderate malnutrition are likely to remain unrecognized because clinical criteria JHPN-0110:133-OP for their diagnosis are imprecise and are difficult to interpret accurately. It is widely accepted that, for practical purposes, anthropometry is the most useful tool for assessing the nutritional status of children. There are many anthropometric indicators in use, such as mid-upper arm circumference (MUAC), MUAC for- height, weight-for-age, height-for-age, and weight-for height, and body mass index of Quetlet. An ideal anthropometric indicator should have a high sensitivity to detect malnutrition accurately. At the same time, its specificity should be good so that the government resources and facilities meant for malnourished population may reach only those in need of them. The study was carried out to estimate the prevalence of wasting and stunting among children aged 12-60 months and to compare the commonly-used anthropometric indicators in terms of their sensitivity and specificity.2
Malnutrition is responsible, directly or indirectly, for 54% of the 10.8 million deaths per year in children under five and contributes to every second death (53%) associated with infectious diseases among children under five years of age in developing countries. Malnutrition is of particular concern in developing countries. A report by UNICEF published in 2006 states that around 146 million children in developing countries are underweight - that is one out of every fourth child. Out of these, over half of the world's underweight children live in just three countries: Bangladesh, India and Pakistan.2
Overall half of the young children in India are underweight 47%, stunted 46%, one in six children are wasted 16%, the levels of under nutrition are much higher in rural areas than urban areas, but even in urban areas more than one third of young children are stunted. Underweight under nutrition is most prominent in the states of Bihar, Madhya Pradesh and Rajasthan. About half of the children are underweight in Orissa ,Maharashtra and west Bengal. In rural areas ,20.3% of the children were severely malnourished, 30.2% were moderately malnourished, 50.5% were malnourished (moderate and severe). In urban areas 12% of the children were severely malnourished, 27% of the moderately malnourished and 39% were malnourished (moderate and severe). Malnutrition levels were much higher among tribal children in rural areas in Maharashtra the incidence is as high as 73.6% .3
Malnutrition is responsible for 55% of all childhood deaths. The two main forms of malnutrition worldwide are anaemia and stunting height for age <sd below WHO international growth reference. In 2000, 32.5%children under 5 years in developing countries were stunted and in 2005,the estimated global prevalence will be 29%.4
Worldwide about 780 million people are estimated to be energy deficient according to WHO standards. The prevalence of stunting may be as high as 65% in India .Protein energy malnutrition raises the risk of death and may reduce physical and mental capacity.4
6.1 Need for the Study
The UN ranks India in the bottom quartile of countries by under-1 infant mortality (the 53rd highest), and under-5 child mortality (78 deaths per 1000 live births). According to the 2008 CIA fact book, 32 babies out of every 1,000 born alive die before their first birthday. At least half of Indian infant deaths are related to malnutrition, often associated with infectious diseases. Malnutrition impedes motor, sensory, cognitive and social development, so malnourished children will be less likely to benefit from schooling and will consequently have lower income as adults. The most damaging effects of under-nutrition occur during pregnancy and the first two years of a child’s life. These damages are irreversible, making dealing with malnutrition in the first two years is crucially important.5
Some factors are believed to influence health and play an important role in prevalence of malnutrition those are age of weaning ,birth weight, antenatal visits of mother, breast feeding ,immunization, diarrhoeal episodes in past 2 weeks ,frequency of food intake per day, height of mother, practise of exclusive breast feeding practices, use of unhygienic latrines etc ,because of these factors the under five children suffer from malnutrition and it leads to the mortality ,morbidity in under five children.
In fact, there is no obvious linkage between levels of child malnutrition and income poverty. 26 per cent of India’s population lives below the poverty line, yet 46 percent of children under three are malnourished. Most Sub-Saharan countries report higher levels of income poverty than India even though levels of child malnutrition in India are consistently higher. And within India itself, 35 per cent of children were reportedly malnourished with 25 per cent of the population under the poverty line. In Assam, 36 per cent of children were malnourished, yet a full 41 per cent lived in poverty. In other words, although the destitute poor have higher rates of malnutrition than the rich, poverty itself is not a sole cause. The quantity of food required to adequately feed an infant is affordable for practically all families – half a chapatti or half a banana or a boiled potato or a bowl of dal.5
TheWorld Bankestimates thatIndiais ranked 2nd in the world of the number of children suffering frommalnutrition, afterBangladesh, where 47% of the children exhibit a degree of malnutrition. The prevalence of underweight children in India is among the highest in the world, and is nearly double that ofSub-Saharan Africawith dire consequences for mobility, mortality, productivity and economic growth.The UN estimates that 2.1million Indian children die before reaching the age of 5 every year, four every minute mostly from preventable illnesses such as diarrhoea,typhoid,malaria,measlesandpneumonia. Every day, 1,000 Indian children die because ofdiarrhoeaalone.6
The 2011Global Hunger Index(GHI) Report ranked India 15th, amongst leading countries withhungersituation. It also places India amongst the three countries where the GHI between 1996 and 2011 went up from 22.9 to 23.7, while 78 out of the 81 developing countries studied, including Pakistan, Nepal, Bangladesh, Vietnam, Kenya, Nigeria, Myanmar, Uganda, Zimbabwe and Malawi, succeeded in improving hunger condition.6
According to a report from tv9 Kannada on 8th and 9th October 2011 on child malnutrition in Karnataka especially in north Karnataka, has come to the fore. TV9 has highlighted the issue at the State level. The impetus of the visit came from the renewed and intense media coverage around starvation deaths in north Karnataka following a TV expose, which likened malnutrition deaths in north Karnataka to the conditions in Sub-Saharan Africa. TV-9 showed clippings of one particular child Anjeneya, over and over again. What was deeply tragic about the news clipping was the shame of seeing children in Karnataka found with distended bellies and bony hands and feet, literally being carried around as they lacked the strength to walk. What added a sense of heartbreaking loss was that, the child was 5 years old and had been officially recognized as being severely malnourished as early as 2010. However the apathy of the state system was such that the child quietly slipped through the cracks and finally died ironically.7
Malnutrition is the underlying cause of at least 50 per cent of deaths of children under five. Even if it does not lead to death, malnutrition, including micronutrient deficiencies, often leads to permanent damage, including impairment of physical growth and mental development. For example, iron, folic acid and iodine decencies can lead to brain damage, neural tube defects in the newborn and mental retardation.7
The findings of the third National Family Health Survey (NFHS-3) reveals an unacceptable prevalence of malnutrition in Indian children: 42.5% of our children under the five years of age areunderweight(low weight for age) 48 % of our children arestunted(low height for age – chronically malnourished) 19.8 % of our children arewasted(low weight for height – acutely malnourished). In poorer states the situation is even worse with over 50 % of children underweight.7
As per a cross sectional study was conducted on prevalence and determinants of chronic malnutrition in Dhaka city Bangladesh the prevalence of stunting among preschool children in Dhaka city was 39.5%, with 25% severely stunted and 14% moderately stunted (p<0.001). Results of bivariate analysis revealed that socioeconomic and demographic factors were most significantly associated with the stunting of children. Children were found to be well-nourished if their parents had a tertiary-level education or higher and if the mother held a job and had good knowledge of nutrition. Well-nourishment of the children were also associated with the height of mothers (above 148 cm), good family educational background, normal birth weight, greater frequency of food intake (more than six times/day), and fewer fever episodes in the last six months. Results of multivariate linear regression models showed that height of mothers, birth weight of children, education of fathers, knowledge of mothers on nutrition, and frequency of feeding were the most significant factors that had an independent and direct influence on the stunting of children. To achieve the Millennium Development Goal target of 34% malnutrition prevalence by 2015, it is important to have specific government intervention to focus on the causes that directly influence the
stunting of children.8
The present problem has high prevalence rate in India, so many under five children are suffering from malnutrition, and some factors influence and cause the prevalence of malnutrition in Karnataka hence the researcher found that it is necessary to find the prevalence and find its association with health influencing factors among under five children in selected areas of Bagalkot.
6.2 Review of Literature
Review of Literature is a key step in research process. Nursing research may be considered as a continuing process in which knowledge gained from earlier studies is an integral part of research in general. In review of literature a researcher analyses existing knowledge before delving into a new study and when making judgement about application of new knowledge in nursing practice. The literature review is an extensive, systematic, and critical review of the most important published scholarly literature on a particular topic.
A cross sectional study was conducted on prevalence of Malnutrition among children aged one to six years in field practice area of J. N. Medical college Belgaum. A Sample of 630 children was selected. The data was collected by the Methods of Interview, Physical examination, Anthropometry and Haemoglobin estimation. The Results showed that the prevalence of underweight, stunting and wasting was 34.60%, 23.33% and 16.19% while severe degree of underweight, stunting and wasting was present in 11.27%, 7.94% and 6.51% respectively. No child was found to have over weight. Mothers’ literacy had a much higher impact than fathers’ literacy on better nutritional status of children. Lower socio-economic condition, higher birth order, lower birth interval, faulty feeding habits and partial immunization were found to have adverse effect on nutritional status of children. The study Concluded the presence of, There are significant malnourished children in this study area. Nutrition education, regular growth monitoring and other appropriate measures will go a long way in combating the same.9
A cross sectional study was conducted to assess the nutritional status of Anganwadi children in Nagamangala taluk, Mandya district Karnataka ,India the study was carried out with cluster sampling method for a period of 12 months from January 2009 to December 2009. The method of Assessment of the nutritional status was done by clinical examination, anthropometry and health records maintained in Anganwadi centres. The results revealed that, Among the 1920 children, majority were males (51%) and most of them belong to 3 to 4 year age group. Hindus formed majority group (88.75%). 52.97% and 24.22% belong to class IV and III socio economic status respectively. Diffuse pigmentation on face was seen in 13.18% of male children compared to 10.95 % in female children. Prevalence of pale conjunctiva was 23.02%. Presence of caries teeth was 15.36%. Presence of dry and scaly skin in children was 11.41%. In the present study prevalence of PEM according to the IAP classification was 40.05%. 23.39% of male children and 25.29% of female children were of grade I malnutrition. In the present study, 44.74% of class IV, 38.33% of class V and 35.91% of class III were malnourished children. This study concluded that the prevalence of PEM according to the IAP classification was 40.05%. Main reason for this malnutrition is children does not like the food provided by Anganwadi. Worm infestation, low hygiene and sanitation, intercurrent infections not managed timely and adequately are other possible reasons.10