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Determinants and Prevalence of Stunting Among Rural Kavreli Pre-school Children
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Kharel Sushil, Mainalee Mandira, Pandey Niraj
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April/May 2017 - Volume 15, Issue 3

Determinants and Prevalence of Stunting Among Rural Kavreli Pre-school Children


Kharel Sushil (1)
Mainalee Mandira
(2)
Pandey Niraj
(3)


(1) Lecturer, Department of Physiology,
Kathmandu Medical College and Teaching Hospital,
Kathmandu, Nepal
(2) Community Social Worker, Kavre
(3) Department of Anatomy, KMCTH

Correspondence:
Sushil Kharel
Lecturer, Department of Physiology,
Kathmandu Medical College and Teaching Hospital,
Kathmandu,
Nepal

Email:
drsushilkharel@gmail.com

Abstract


Background: Stunting is a reduced growth rate in human development. It is "height for age" value to be less than two standard deviations of the WHO Child Growth Standards median. Different studies have shown that inadequate nutrient intake, infections, unsafe water and poor child care are among its main determinants. In rural Nepal, stunting in children is one of the most serious public health concerns.

Aims and Objective: The objective of this study was to find the prevalence of stunting including severe stunting and its determinants in pre-school children aged 3-4 years in Kharelthowk VDC, Nepal.

Materials and Methods: A community based cross-sectional survey was conducted from July 2016 to January 2017 with systematic random sampling technique. Total 464 pre-school children of rural Kharelthowk VDC( Kavre district), both males and females of age between 3-4 years were enrolled in the study. A structured questionnaire was used to obtain information on socioeconomic characteristics and life style factors of children. WHO Anthro Software V3.2.2 was used for analyzing anthropometric parameters of the children and Statistical package for Social Sciences (SPSS) Windows version 21 was used to analyze the data.

Result: The prevalence of stunting in pre-school children was 46.9%. The prevalence of stunting was significantly higher among male children (51%) than female children (42.7%). The study revealed that stunting was significantly associated with inadequate nutrition intake, infections, poor child care and socio-economic status of the family. Conclusion: The magnitude of stunting is very high compared to developed countries. Thus, proper attention should be given for the intervention on causes of stunting among pre-school children in order to avoid further risks in future.

Key words: Stunting; Pre-school children; Kavre


INTRODUCTION

Stunting in pre-school children is associated with adverse physiological consequences, including poor cognition and educational achievements, lost productivity and, when accompanied by huge weight gain later in childhood(1). In developing countries, it is estimated that 29% of children aged less than five years (under-five children) are stunted [<-2 standard deviation (SD) height-for-age] or malnourished. Although stunting has declined recently, prevalence is still extremely high, especially in South Central Asia, which alone accounts for about half of the global problem(2). Child malnutrition is affected by several determinants, such as intrauterine growth retardation, lack of exclusive breastfeeding, inappropriate complementary feeding, and continuous attacks of infectious illnesses, food unavailability, and micronutrient deficiencies(3). Although the pathogenesis of stunting is not yet well-understood, many studies have shown that inadequate nutrient intake, infections, unsafe water and poor child care, literacy rate of mothers, are among its main determinants(4). Other factors in developing countries include low socioeconomic status, residence and poor access to health care services(5, 6). There is a wide variation in rates of malnutrition throughout Nepal, both ecologically and regionally. Nepal Demographic and Health Survey indicates that more rural children are stunted (low height for age), 42% than urban children (27%). Regional variation in nutritional status of children is substantial. Stunting levels are very high in the mountains (53 %) (7).

The present analyses describe levels and trends of stunting in pre-school children based on the WHO standards. Moreover, while the earlier research covered only stunting in urban areas and reported the trends, the present study was focused on the rural scenario of childhood stunting.

METHODS

A cross-sectional community-based study was conducted in pre-school children of Kharelthowk VDC. The study was carried out from July 2016 to January 2017. Five trained volunteers were actively involved in collecting the data of pre-school children. Informed written consent was taken from the parents/guardian and school authority and Helsinki guidelines were followed. A self-designed structured questionnaire regarding lifestyle factors of child, economic status of family, etc was given to them. Anthropometric assessment was done, their weight, height, head circumference, mid-upper arm circumference were measured three consecutive times. Later on, mean was taken as their actual weight and height, which helped in calculating the BMI (body mass index). Anthropometric measurement was done by LG digital weighing machine (with a difference of only 20 grams), by Stadiometer and non stretchable measuring tape. The condition of the weighing machine was checked then was kept on firm flooring (heavy clothing and shoes were removed). Children were told to stand with both feet in the center of the scale and weight was recorded. Height measurement was done by Stadiometer; children were asked to stand up straight with feet and heels together keeping the heels back against the upright section of the stadiometer (arms relaxed by sides). Children were asked to look straight ahead at the marker. Three standard indices of physical growth given by WHO-Height-for-age (Stunting), Weight-for-age (Underweight) and weight-for-height (Wasting) that described the nutritional status of children was considered in this study.

WHO Classification (8).
Stunting: Height for age < -2 Standard Deviations (SD) of the WHO growth standard Median
Underweight: Weight for age < -2 Standard Deviations (SD) of the WHO growth standard Median
Wasting: Weight for Height < -2 Standard Deviations (SD) of the WHO growth standard Median
Overweight: Weight for Height > + 2 Standard Deviations (SD) of the WHO growth standard Median

Inclusion criteria: The pre-school children aged between 3 to 4 years.
Exclusion criteria: The children who were not in good health and uncooperative. Analysis was done by universally accepted WHO Anthro Software Version 3.2.2 and SPSS Version 21. Z test was used to calculate the P value. P-value of < 0.05 was considered as statistically significant

RESULTS


A total of 464 pre-school children aged between 3-4 years were enrolled in the study. Of these 464 participants 237(51.07%) were males and 227(49.93%) were females (Figure 1). Among the mothers of participants, 54.5% (254) were literate and 45.5% (210) were illiterate (Figure 2). Prevalence of overall stunting was 46.9% (218). Prevalence of severe stunting in males and females were 8.8% and 3.5% respectively. Males were more stunted as compared to females. The prevalence of stunting in male and female population compared to its own counterpart was 51% and 42.7% respectively (Table 1). The prevalence of underweight and wasting of the study population was 31.2% and 17.5% respectively whereas overweight was among 4.3 % of the study population (Figure 4).

Figure 1: Sex wise distribution of the pre-school children


Figure 2: Literacy rate among mothers of pre-school children in the study population




Table 1: Weight-for-height Stunting in the study population (95% CI)



Figure 3: Comparison of Stunting among male and female pre-school children in the study population


Figure 4: Prevalence of stunting, underweight, overweight and wasting among study children
(3-4 Years of age)


Table 2: Socio-demographic characteristics of study children


Table 3: Life style factors and health condition of the children

DISCUSSION

In developing countries like Nepal, stunting in children has become a public health concern in recent times due to its bad impact on the health of the child in the future. People are still unaware of the situation and this may lead to epidemic causing increase risk of diabetes, hypertension and other diseases in future. In the present study the average age of the child was 3.5± 0.2 years. The youngest child was 36 months whereas the oldest among study population was 48 months. A study in Andhra Pradesh, India assessed 1013 tribal children and found that 48.27% were stunted (9). This study showed similar results to our study which showed 46.9% of children of age 3-4 years were stunted. Bisai et al. found the overall prevalence of stunting was 47.8 % in 3-6 years children(10). Another study from Rajasthan reported that 60 % were stunted among rural children less than 3 years (11). Rao et al. found that 51.6% were stunted among tribal pre-school children(12). In a study in Saudi Arabia it showed that a prevalence of stunting was 10.9% in under 5 children which is far lower as compared to us and our region(13). One noticeable aspect of our study is significantly higher prevalence of stunting among boys as compared with girls. Rao et al. in their study also had found a higher prevalence of stunting (54.4% vs. 48.8 %) among boys(12). But Stalin et al. in his study found that malnutrition was more prevalent among girls than boys in Tamilnadu, India (62.6% vs. 44%) (14).

The study clearly showed that the stunting was significantly associated with feeding habit, sleeping condition, health condition of child, child birth weight (Table 3) and lower socio-economic status of the family (Table 3).

CONCLUSION

The prevalence of stunting found in this study is very high as compared to developed countries. This is due to poor child nutrition, illness, low birth weight of child and poor economic conditions. Thus, proper attention should be given for the intervention on causes of stunting among pre-school children in order to avoid the diseases in future.

LIMITATIONS

The trend of studies in developing countries is only focused in urban areas. The problem of stunting in children is more in rural areas so this type of study should be concentrated more in rural areas.

Acknowledgements
I express my deep sense of gratitude to my participants who were very little children without their cooperation this study might not have been successful. A special thanks to Mr. Sunil Kharel (Head of the Department of Economics, Uniglobe College) for his help and support in statistical analysis.

REFERENCES

1. Victora CG, Adair L, Fall C et al., for the Maternal and Child Undernutrition Study Group (2008) Maternal and child undernutrition: consequences for adult health and human capital. Lancet 371, 340-57.
2. United Nations. 4th report-the world nutrition situation: nutrition throughout life cycle. Final report to the ACC/SCN by the Commission on the Nutrition Challenges of the 21st Century. New York, NY: United Nations, 2000:1-144. (http://www.unscn.org/layout/ modules/resources/files/rwns4.pdf, accessed on 10 November 2010).
3. Ahmed T, Ahmed AMS. Reducing the burden of malnutrition in Bangladesh. BMJ 2009; 339: b 4490.
4. Stewart CP, Iannotti L, Dewey KG, et al. Contextualising complementary feeding in a broader framework for stunting prevention [Internet]. Matern Child Nutr 2013;9(Suppl. 2):27-45. http://www.ncbi.nlm.nih.gov/ pubmed/24074316 (10 December 2014, date last accessed)
5. Abubakar A, Uriyo J, Msuya SE, et al. Prevalence and risk factors for poor nutritional status among children in the Kilimanjaro region of Tanzania [Internet]. Int J Environ Res Public Health 2012;9:3506-18. Multidisciplinary Digital Publishing Institute. http://www.mdpi.com/1660- 4601/9/10/3506/htm (18 July 2014, date last accessed)
6. Masanja H, Schellenberg JA, de Savigny D, et al. Impact of Integrated Management of Childhood Illness on inequalities in child health in rural Tanzania [Internet]. Health Policy Plan 2005;20(Suppl. 1):i77-84. http://www.ncbi. nlm.nih.gov/pubmed/16306073 (27 July 2014, date last accessed)
7. Population Division, Ministry of Health and Population, Department of Health Services, Government of Nepal. Nepal Demographic and Health Survey (NDHS), report. [Internet]. 2011. Available from: h t t p : / / w w w. m o h p . g o v. n p / e n g l i s h / p u b l i c a t i o n / NDHS%202011%20Full%20version.pdf
8. World Health Organization. WHO child growth standards: length/height-for-age, weight-for-age, weight-for-height and body mass index-for-age: Methods and development. Geneva, Switzerland: World Health Organization; 2006. Available at http://www.who.int/childgrowth/publications/technical_report_pub/en/index.html
9. Sukhdas G, Challa S, Bhatia P, Rao AR, Rao PK. Nutritional status of tribal children in Andhra Pradesh. Int J Med Res Health Sci 2014; 3(1): 76-9.
10. Bisai S, Bose K, Dikshit S. Under-nutrition among slum children aged 3-6 years in Midnapore town, India. Internet J Biol Anthropol 2008; 2 (2). Available at: https://ispub.com/IJBA/2/2/10564.
11. Bisla G, Archana Kapoor M. Nutritional status of Toddlers (1-3 Years) of Rural area of Niwai Tehsil, Tonk, Rajasthan, India. Int J Trop Med, 2012; 7 (5,6): 157-64.
12. Rao VG, Yadav R, Dolla CK, Kumar S, Bhondeley MK & Ukey M. Undernutrition & childhood morbidities among tribal preschool children. Indian J Med Res 2005; 122(1): 43-7.
13. Mohammad et al. Prevalence of malnutrition in Saudi children: a community-based study. Ann Saudi Med. 2010 Sep-Oct; 30(5): 381-385.doi: 10.4103/0256-4947.67076
14. Stalin P, Bazroy J, Dimri D, Singh Z, Senthilvel V, Sathyanarayanan S. Prevalence of Underweight and its Risk Factors among Under Five Children in a Rural Area of Kancheepuram District in Tamil Nadu, India. IOSR-J Dental and Med Sci 2013; 3 (6): 71-4.


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