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A study of factors influencing nutritional status of under five children in a tertiary teaching hospital

Good nutrition early in a life is a key input for human capital formation, a fundamental factor for sustainable and equitable economic growth. Any major deviation in the nutrient intake either in quality or in quantity from its requirement can affect growth in many ways. 1 Nutrition is a core pillar of human development, and the level of child under-nutrition remains unacceptable throughout the world, with 90% of the developing world’s chronically undernourished children living in Asia and Africa. In India 43% of children under five years are underweight, 20% of children under five years of age suffer from wasting due to acute under-nutrition. More than one third of the world’s children who are wasted live in India. 2 Normal growth and development take place only if there is optimal nutrition. Nutrition influences growth and development before as well as after birth. Retardation of growth rate is an indication of malnutrition. Measurement of weight and rate of gain in weight are the best single parameters for assessing physical growth. This is best done on growth chart. 3


INTRODUCTION
Good nutrition early in a life is a key input for human capital formation, a fundamental factor for sustainable and equitable economic growth. Any major deviation in the nutrient intake either in quality or in quantity from its requirement can affect growth in many ways. 1 Nutrition is a core pillar of human development, and the level of child under-nutrition remains unacceptable throughout the world, with 90% of the developing world's chronically undernourished children living in Asia and Africa. In India 43% of children under five years are underweight, 20% of children under five years of age suffer from wasting due to acute under-nutrition. More than one third of the world's children who are wasted live in India. 2 Normal growth and development take place only if there is optimal nutrition. Nutrition influences growth and development before as well as after birth. Retardation of growth rate is an indication of malnutrition. Measurement of weight and rate of gain in weight are the best single parameters for assessing physical growth. This is best done on growth chart. 3 Various maternal factors which influence nutritional status of under five children which includes, age at marriage, child bearing, child spacing, family size patterns, level of education, economic status, customs and beliefs. 4 Freedom from hunger and malnutrition is a basic human right and their alleviation is a fundamental prerequisite for human and national development. 5 An estimated 54% of all childhood deaths occurs globally because of malnutriton. 6 There are only few studies available regarding the factors influencing the nutritional status of under five children, hence the proposed study seeks information regarding the nutritional status of under five children attending under five clinic and also to assess nutritional status of children attending under five clinic.

METHODS
It is a retrospective record based study. The data for the purpose of the study was obtained from the registers of under-five clinic, Mandya Institute of Medical Sciences, Mandya with permission. After obtaining the permission and clearance from the Institutional Scientific committee and ethical committee, the data on nutritional status of children which has been recorded during the visit has been obtained and also the socio economic characteristic of the mother such as, age of mother, education of mother, SES and type of family are obtained from the register of the under-five clinic during the study period from September 2012 to August 2013. Children whose data were incomplete and out of study period were excluded. The data was entered and analysed using Microsoft excel software. Descriptive statistics were used to analyse the data. In the present study, 8506 mothers attended under five clinics. 68.0% of mothers were in the 20-25 years age group. 82% of mothers had education above secondary school level, while 6.2% of mothers are illiterate.

RESULTS
Majority of the families (88.4%) belongs to lower socio economic class and 67.9% were living in joint family (Table 1). Out of the total 8506 children, we found out that 2951 (34.7%) were found to be suffering from underweight and 451 (5.3%) from overweight. Children in the normal nutritional status were found to be 5103 (60%) ( Table 2).  Malnutrition in the form of overweight and underweight has been observed in 2517 (74.0%) children, who were class IV SES, followed by 640 (18.8%) in class V. Only 11(0.3%) of children who were found to be malnourished were in class I & II (Table 4).

DISCUSSION
In our study, 40.0% children were suffering from malnutrition (underweight and overweight). 52.3% female children were suffering from malnutrition compared to 30.6% male, which implicate that still there is a lot of negligence in the community regarding upbringing of female child. Malnutrition has also been observed in the low socio economic people.
Contrast to our findings, study conducted by Stalin 10,11 A study conducted in urban slum of Delhi, it was found that there was significant difference among male and female with respect to malnutrition with more females (9.6%) suffering from severe malnutrition as compared to male (6.5%). 12

CONCLUSION
The causes of under nutrition in under-five children are complex and involve multiple factors. Emphasis should be given on maternal nutrition and their education, and improvement of socio-economic status to reduce the burden of childhood under nutrition. Area-specific programmes are to be planned to create an enabling environment for comprehensive nutrition and health education to mothers or care-givers. The present study may also help the policy planners to develop strategies to combat different forms of malnutrition by targeting the high-risk groups.