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6
ISSN (Online): 2349-056X
International Journal of Pharmacy Education and Research
Jul-Sept 2015; 2(3): 6-10.
Available o...
Immanuel et al. IJPER | Jul-Sept, 2015; 2(3): 6-10.
7
population who are below the age of 6 years[1]
.
Malnutrition refers...
Immanuel et al. IJPER | Jul-Sept, 2015; 2(3): 6-10.
8
Among the total population, 70% childrens
are cared by their mothers...
Immanuel et al. IJPER | Jul-Sept, 2015; 2(3): 6-10.
9
Table 7: Xerophthalmia
Yes (Mean±SD) No (Mean±SD)
First 12 (0.86±0.2...
Immanuel et al. IJPER | Jul-Sept, 2015; 2(3): 6-10.
10
about the diet control and the malnutrition and
reduced.
ACKNOWLEDG...
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J IJPER Immanuel et al

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J IJPER Immanuel et al

  1. 1. 6 ISSN (Online): 2349-056X International Journal of Pharmacy Education and Research Jul-Sept 2015; 2(3): 6-10. Available online: www.ijper.net Email: editor.ijper@gmail.com Research Article Determination of severe acute malnutrition and management of children below 59 months in Theni District of Tamilnadu Immanuel JEBASTINE MASILAMANI*1 , Gudanagaram RAMAMOORTHI VIJAYASANKAR1 , Apollo JAMES2 *1 Vinayaka Mission’s College of Pharmacy, Yercaud Main Road, Kondappanaickenpatty, Salem – 636 008, Tamilnadu, INDIA. 2 Nandha College of Pharmacy, Koorapalayam Pirivu, Pitchampalayam, Erode – 638 052, Tamilnadu, INDIA. INTRODUCTION The World Bank estimates that India is ranked 2nd in the world of the number of children suffering from malnutrition, after Bangladesh (in 1998), 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 of Sub-Saharan Africa with dire consequences for mobility, mortality, productivity and economic growth. The United Nations estimate that 2.1 million Indian children die before reaching the age of 5 every year, four every minute, mostly from preventable illnesses such as diarrhoea, typhoid, malaria, measles and pneumonia. Every day, 1,000 Indian children die because of diarrhoea alone. According to the 1991 census of India, it has around 150 million children, constituting 17.5% of India's Received on: 24 Jul, 2015 Revised on: 30 Jul, 2015 Accepted on: 1 Aug, 2015 *Corresponding author: Immanuel Jebastine M. Department of Pharmacy Practice, Vinayaka Mission’s College of Pharmacy, Salem – 636 308, Tamilnadu, INDIA. Mobile #: +91-99941-69248 Email: masilaarul@gmail.com ABSTRACT The aim of the study was to determine the malnutrition and its management in children below 59 months. The study was conducted in the community health area in Theni District of Tamilnadu State in India between July 2012 to January 2013 with 138 malnourished children who have taken malnutritious food and most of the children have eye deficiency. We found that the children having Myopia, Metropia and fewer children have Xerophthalmia. In addition, they also have Gum Bleeding, Bitot’s Spots and Angular Stomatitis due to vitamin deficiency. The results were compared with WHO Growth Standards. A questionaire was prepared to collect the status after finding the malnourished child; and after providing a healthy nutritious food. The children under investigation were taken proper care and the results in triplicate were compared with the improvement from time to time with a gap of 30 days. Key words: Malnutrition, Eye defect, Vitamin deficiency, Malnourished.
  2. 2. Immanuel et al. IJPER | Jul-Sept, 2015; 2(3): 6-10. 7 population who are below the age of 6 years[1] . Malnutrition refers to the situation where there is an unbalanced diet in which some nutrients are in excess, lacking or wrong proportion. Simply, we can categorize it to be under-nutrition and over-nutrition. Despite India's 50% increase in GDP since 1991, more than one third of the world's malnourished children live in India. Among these, half of them under three are underweight and a third of wealthiest children are over-nutrient[2] . Malnutrition can be identified into two constituents, protein-energy malnutrition and micronutrient deficiencies, where protein-energy malnutrition is clearly observed in India and other developing countries. There are different methods of identifying malnutrition; physical findings generally help in the diagnosis of advanced malnutrition. In identifying it early in the development malnutrition, it is of advantage to allowing early rehabilitation one of the classifications of protein-energy malnutrition is done by Gomez, which uses anthropometric indices[3] . MATERIALS AND METHODS The study carried out in a community based area and in primary health centre in Theni district of Tamilnadu, India between July-2012 to January-2013 with 138 children who were suffering from nutrition deficiency. A questionaire was used to collect the malnutrition status in the children to find the demographical data’s such like age, sex, the care giver of the child and it says whether the childs parent are educated are not. The information collected regarding all the deficiency was recorded in a Master Sheet[4] . STATISTICAL ANALYSIS The information collected regarding all the selected cases were recorded in a Master Chart. Data analysis was done with the help of computer using Epidemiological Information Package (EPI 2010) developed by the Centre for Disease Control, Atlanta. Using this software range, frequencies, percentages, means, standard deviations, chi square and 'p' values were calculated. Kruskul Wallis chi-square test was used to test the significance of difference between quantitative variables and Yate’s chi square test for qualitative variables. A 'P' value less than 0.05 is taken to denote significant relationship[5,6] . RESULTS AND DISCUSSION The study give a brief description of sample characteristics, the children data like age, sex, malnutrition status, parents occupation, educational qualification mal nutrition status and the stage involved in the management of children below 59 months are discussed[7] . DEMOGRAPHIC DATA In every study before going into the target area, it’s necessary to about the demographic of that community. The study was undertook in Gudalur, Theni District. This study focused on the 138 children who are accepted with severe acute malnutrition. SEX DISTRIBUTION Among 138 children 84.05% are females and 15.94% are males (Table 1). According the cense 2010, already it was determined that female ratio is more in this area. Due to the lack of education in many parents are not admitting their children’s to school especially female children. Government is already supplying noon meals, nutrition food vitamin A supplement are being provide by the Government but the population which prevails in this area, basic school education so, this paved the way for the severe acute malnutrition. In this study, 116 female children have acute malnutrition which is higher while 22 male were suffering from severe acute malnutrition[8-10] . Table 1: Sex distribution Sl. No. Female Male No. of Patients % No. of Patients % 1 116 84.05 22 15.94 DISTRIBUTION BASED ON AGE From the total nunmer of children, 20 children belong to the group of 1-12 months, 30 childrens belongs to 13-24 months, 25 children’s belong to 25-36 months, between 37-48 months 30 childrens are present and 33 numbers of children comes under the group of 49-60 months (Table 2). Hence, the least amount are present in the each between 1 to 12 months through there is no significant in the age group distribution. Table 2: Age distribution Sl. No. Age group (month) No. of patients % 1 1-12 20 14.492 2 13-24 30 21.739 3 25-36 25 18.115 4 37-48 30 21.739 5 49-60 33 23.913 CARE GIVE DISTRIBUTION Of the total 138 patients, mother care 96 patients, father care 12 patients, grand-mother care 20 patients, and grand-father care 10 patients (Table 3). The child growth is based on the person behind whom they are being cared. Show the study aimed to determine who are those caregivers and difference analyzed.
  3. 3. Immanuel et al. IJPER | Jul-Sept, 2015; 2(3): 6-10. 8 Among the total population, 70% childrens are cared by their mothers while the 8% of the childrens care by the father. This is because in the community setting male are the workers, who supported their family need. While female are confined to the house works, in community the educated parents are confined to their works. Hence, 21% are cared by the grandparents. This lead to the bypass of the mother feeding, at the yearly stage children are exposed to synthetic products which may lead to the outcome of acute malnutrition. Table 3: Care give distribution No. of Children % Mother care 96 69.5652 Father care 12 8.6956 Grand mother care 20 14.92 Grand father care 10 7.2463 WORKING AND NON-WORKING This data is collected by a pharmacist from the patients who are caring their children who are caring their children from our analysis. It was found that 80 children are working the nature of the work is crop cultivation and building works 36 childrens are not working the higher no.of fathers are working (Table 4). Therefore, it was found that the malnourished child can be controlled by which the help of their caregivers. Table 4: Working and Non-working distribution Working Non-working Mother 80 36 Father 22 0 Grand parents 0 0 Total patients 138 MYOPIA Myopia is commonly known as being near sighted and short sighted is a condition of the eye where the light that comes in does not directly focus on the retina but in front of it. Absence of vitamin B and vitamin A cause myopia. In the total number of patients at the first visit 72 children have myopia at the 30th day visit, 60 children having myopia at the 60th day visit and myopia in the 90th day visit almost came down to 39. Table 5 shows the first visit followed by 90th day visit the P value of which is significant. After giving non-pharmacological treatment, the patient get improved from the 1st visit to 3rd intervention. Nutrition supplement has been given to the patient. Table 5: Myopia Yes (Mean±SD) No (Mean±SD) First 72 (0.54±50) 66 (1.08±1.00) 30th 60 (0.86±1.00) 78 (0.56±50) 60th 50 (0.78±98) 88 (60.86±49) 90th 39 (0.56±91) 99 (0.71±45) Chi square “P”; P value (One way ANOVA); 0.0072 significant METROPIA Metropia it is known as retraction of the eye due the vitamin B12 deficiency. In the total number of patients at the first visit 60 child have metropia at the 30th day visit, 50 child having metropia at the 60th day visit and metropia in the 90th day visit almost came down to 42. Table 6 shows the first visit followed by 90th day visit the P value of which is significant. Table 6: Metropia Yes (Mean±SD) No (Mean±SD) First 60 (0.84±1.00) 78 (0.56±0.50) 30th 50 (0.78±0.98) 88 (0.60±0.43) 60th 48 (0.69±0.96) 90 (0.65±0.48) 90th 42 (0.60±0.93) 96 (0.69±0.46) Chi square “P”; P value (One way ANOVA) < 0.53 not significant (P>0.05) After giving non-pharmacological treatment, the patient get improved from the 1st visit to 3rd intervention. Nutrition supplement has been given to the patient. XEROPHTHALMIA Xerophthalmia is a medical condition in which the eye fails to produce tears it may be caused by a deficiency in vitamin A[11,12] . In the total number of patients at the first visit 12 children have xerophalmia at the 30th day visit, 9 children having xerophalmia at the 60th day visit and xerophalmia in the 90th day visit almost came down to 2. Table 7 shows the first visit followed by 90th day visit the P value of which is significant. In the first visit 12% of patients were having Xerophthalmia while 126 patients were not having this on the second visit. It decreased to 9%, third visit it decreased to 4.
  4. 4. Immanuel et al. IJPER | Jul-Sept, 2015; 2(3): 6-10. 9 Table 7: Xerophthalmia Yes (Mean±SD) No (Mean±SD) First 12 (0.86±0.28) 126 (0.82±0.56) 30th 9 (0.06±0.24) 124 (1.86±0.49) 60th 3 (0.02±1.95) 135 (1.95±0.29) 90th 2 (0.21±0.14) 134 (1.91±0.41) Chi square “P”; P value (One way ANOVA) < 0.0001*** Statistical value extremely significant. BITOT’S SPOTS Bitot’s spots foamy gray, triangular spots of keratinized epithelium on the conjunction associated with vitamin A deficiency. In the total number of patients at the first visit 99 children have Bitot’s spots a at the 30th day visit, 78 children having Bitot’s spots at the 60th day visit and Bitot’s spots in the 90th day visit almost came down to 54. Table 8 shows the first visit followed by 90th day visit the P value of which is significant. Table 8: Bitot’s spots Yes (Mean±SD) No (Mean±SD) First 99 (1.43±0.91) 39 (0.28±0.45) 30th 78 (1.13±1.00) 60 (0.43±0.50) 60th 60 (0.86±1.00) 78 (0.56±0.50) 90th 54 (0.78±0.98) 84 (0.60±0.49) Chi square “P”; P value (One way ANOVA) < 0.0071 GUM BLEEDING Gum bleeding which is also known as bleeding gums or gingival bleeding is a term used by deutists is dye to vitamin C deficiency. In the total number of patients at the first visit 108 children have Gum Bleeding at the 30th day visit, 78 children having myopia at the 60th day visit and Gum Bleeding in the 90th day visit almost came down to 60. Table 9 shows the comparative chart shown for first visit followed by 90th day visit the P value of which is significant. Angular stomatitis refers to inflammation cracking, or irritation at the cotners of the mouth. As may be initial sign of anemia or vitamin deficiency. Table 9: Gum bleeding Yes (Mean±SD) No (Mean±SD) First 108 (1.56±0.83) 30 (0.21±0.41) 30th 78 (1.13±1.00) 60 (0.43±0.50) 60th 60 (0.86±1.00) 78 (0.56±0.50) 90th 60 (0.86±1.00) 84 (0.56±0.50) Chi square “P”; P value (One way ANOVA) < 0.0005*** In the total number of patients at the first visit 105 children have Angular Stomatitis at the 30th day visit, 78 children having Angular Stomatitis at the 60th day visit and Angular Stomatitis in the 90th day visit almost came down to 66. Table 9 shows the comparative chart shown for first visit followed by 90th day visit the P value of which is significant. ANGULAR STOMATITIS Angular stomatitis refers to inflammation cracking, or irritation at the cotners of the mouth. As may be initial sign of anemia or vitamin deficiency. In the total number of patients at the first visit 105 children have Angular Stomatitis at the 30th day visit, 78 children having Angular Stomatitis at the 60th day visit and Angular Stomatitis in the 90th day visit almost came down to 66. The table 10 shows the first visit followed by 90th day visit the P value of which is significant. Table 10: Gum bleeding Yes (Mean±SD) No (Mean±SD) First 105 (1.52±0.86) 33 (0.23±0.43) 30th 78 (0.86±1.00) 60 (0.56±0.50) 60th 66 (1.01±1.00) 72 (0.50±0.43) 90th 60 (1.13±1.00) 78 (0.43±0.50) Chi square “P”; P value (One way ANOVA) < 0.047* DISCUSSION Malnutrition is a condition which the body lacks the essential which needs the daily life possible. In children in both age 3 months the nutrition essential are being reached to the baby through his mother through breast feeding of that essential diet supplement has to reach to the child through food. In the study which conducted in rural area the result found that the total area has been much effected with malnutrition, even the malnurrtion has cause many disease to the infants. The ladies also go for work on early that’s daily work based on did not even go time to feed the babies properly. The lack of education has through made a big impact on the children and made them nutritionally deficient. CONCLUSION The study shows that there comes a high change the in diet of the children and the malnutrition has been quiet due to this study. Finally it’s found that the malnutrition due to the lack of education and uncontrolled diet. The study established the people
  5. 5. Immanuel et al. IJPER | Jul-Sept, 2015; 2(3): 6-10. 10 about the diet control and the malnutrition and reduced. ACKNOWLEDGEMENTS The authors are grateful to the Management of Nandha College of Pharmacy, Erode, Tamilnadu, India, and Vinayaka Mission’s College of Pharmacy, Salem, Tamilnadu, India, for providing the necessary facilities to carry out this research work. REFERENCES 1. ACC/SCN. Fourth report on the world situation. Geneva, United Nations Administrative Committee on Coordination/Subcommittee on Nutrition. 2000. 2. WHO. Management of the child with a serious infection or severe malnutrition: guidelines for care at the first-referral level in developing countries. Geneva; World Health Organization; 2000. 3. Bakketeig LS, Butte N, de Onis M, Kramer M, O’Donnell A, Prada JA, and Hoffman HJ. Report of the IDECG Working Group on definitions, classifications, causes, mechanisms and prevention of IUGR. European Journal of Clinical Nutrition. 1998; 52(Suppl. 1): S94-S96. 4. de Onis M, and Blossner M. The World Health Organization Global Database on Child Growth and Malnutrition: methodology and application. International Journal of Epidemiology. 2003; 32: 518–526. 5. PAHO. Nutrition, health and child development. Washngton, DC, Pan American Health Organization (Scientific Publication No. 566). 1998. 6. Pelletier D. Relationships between Child anthropometry and mortality in developing countries. Ithaca, NY, Cornell University (Cornell Food and Nutrition Policy Program, Monograph 12). 1991. 7. Waterlow JC, Buzina R, Keller W, Lane JM, Nichaman MZ, and Tanner JM. The presentation and use of height and weight data for comparing the nutritional status of groups of children under the age of 10 years. Bulletin of the World Health Organization. 1977; 55: 489-498. 8. Diop el HI, Dossou NI, Ndour MM, Briend A, and Wade S. Comparison of the efficacy of a solid ready-to-use food and a liquid, milk-based diet for the rehabilitation of severely malnourished children: a randomized trail. American Journal of Clinical Nutrition. 2003; 78: 302-307. 9. Ashworth A. Khanum S, Jackson A, and Schofield C. Guidelines for the Inpatient Treatment of Severely Malnourished Children. Geneva: WHO; 2003. 10. Penny ME, Creed-kanashiro HM, Robert RC, et al. Effectiveness of an education intervention delivered through the health service to improve nutrition in young children: A cluster-randomised controlled trial. Lancet. 2005; 365:1863-1872. 11. May QI, and Wolff E. A case of xerophthalmia. Lancet. 1938; 235: 252–253. 12. Hume E M, and Krebs H A. Compilers: Vitamin A requirement of human adult. An experimental study of Vitamin A deprivation in man. Medical Research Council, Great Britain, Special Series No. 264. London, 1949. --------------------------------------------------------------------------------------------------------------------------------------- International Journal of Pharmacy Education and Research www.ijper.net editor.ijper@gmail.com ---------------------------------------------------------------------------------------------------------------------------------------

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