Composite Index of Anthropometric Failure and its correlates: a crosssectional study of under five children in an urban informal settlement of
Mumbai, India
Abstracts of studies that were presented at IFPRI-POSHAN's event on "Strengthening Actions for Nutrition in India: Insights from the National Family Health Survey" (4 Sept 2018, IIC, New Delhi) where multiple researchers from organizations such as International Food Policy Research Institute (IFPRI), Brookings India, International Institute for Population Sciences (IIPS), Society for Applied Studies (SAS), Population Council and more, shared insights from their ongoing/completed analyses of NFHS data on maternal and child nutrition.
Prevalence of Undernutrition among Baalwadi Going Children between 2 5 Years ...ijtsrd
Children are the backbone of any country. Under nutrition is the underlying cause of more than half of all deaths in children aged less than five years worldwide. This study was designed majorly to study the prevalence of undernutrition in children. The objectives of the study were to assess the prevalence of undernutrition stunting, underweight and wasting in children between 2 5 years of age and to analyse major determinants influencing undernutrition. 102 children aged between 2 5 years of age were selected from two different baalwadis of Mumbai through purposive, random sampling. Socio demographic data was collected using a self designed, structured questionnaire from mothers. Anthropometric measurements like weight, height, MUAC were done to determine nutritional status. Anthropometric data revealed that out of total children screened n=102 , 34 children were well nourished and 66 children were undernourished where 27 children were underweight, 24 were wasted 16 were stunted. 55 children had low MUAC. The factors that were found to be significantly associated with child undernutrition were age p=0.046 , gender p=0.000 , maternal education p=0.007 , employment status of mother p=0.001 and number of meals taken by the child daily p=0.000 . The prevalence of undernutrition among children of Baalwadi was high considering the sample size was small. Shraddha Shripal Parmar | Dr Rupali Sengupta ""Prevalence of Undernutrition among Baalwadi Going Children between 2-5 Years of Age in Western Mumbai"" Published in International Journal of Trend in Scientific Research and Development (ijtsrd), ISSN: 2456-6470, Volume-3 | Issue-3 , April 2019, URL: https://www.ijtsrd.com/papers/ijtsrd23133.pdf
Paper URL: https://www.ijtsrd.com/home-science/child-care-and-development/23133/prevalence-of-undernutrition-among-baalwadi-going-children-between-2-5-years-of-age-in-western-mumbai/shraddha-shripal-parmar
ABSTRACT- Background: Malnutrition constitutes a major public health concern worldwide and serves as an indicator
of hospitalized patient’s prognosis. Nutritional support is an essential aspect of the clinical management of children
admitted to hospital. Malnutrition has been long associated with poor quality, poor diet and inadequate access to health
care, and it remains a key global health issue that both stems from and contributes to weakness, with 50% of childhood
deaths due to principal under nutrition.
Methods: The present hospital based cross sectional study was conducted in April to Dec 2015 among 300 rural
adolescents of 9-18 years age (146 boys and 154 girls) attending the outpatient department at Patna Medical College and
Hospital, Bihar, India, belonging to the all caste communities. The nutritional status was assessed in terms of under
nutrition (weight-for-age below 3rd percentile), stunting (Height-for-age below 3rd percentile) and thinness (BMI-for-age
below 5th percentile). Diseases were accepted as such as diagnosed by pediatrician, skin specialist and medical officer.
Results: The prevalence of underweight, stunting and thinness were found to be 31%, 22.3% and 30.7% respectively. The
maximum prevalence of malnutrition was observed among early adolescents (23% - 54%) and the most common
morbidities were diarrhoea (16.7%), carbuncle / furuncle (16.7%) and scabies (12%).
Conclusion: Malnutrition among hospitalized under five children and around suffers moderately high rates of
malnutrition. Present nutrition programs attention on education for at risk children and referral to regional hospitals for
malnourished children. Screening tools to classify children at risk of developing malnutrition might be helpful.
Key-words- Malnutrition, Hospitalized children, Morbidities, Prevalence, Stunting
Abstracts of studies that were presented at IFPRI-POSHAN's event on "Strengthening Actions for Nutrition in India: Insights from the National Family Health Survey" (4 Sept 2018, IIC, New Delhi) where multiple researchers from organizations such as International Food Policy Research Institute (IFPRI), Brookings India, International Institute for Population Sciences (IIPS), Society for Applied Studies (SAS), Population Council and more, shared insights from their ongoing/completed analyses of NFHS data on maternal and child nutrition.
Prevalence of Undernutrition among Baalwadi Going Children between 2 5 Years ...ijtsrd
Children are the backbone of any country. Under nutrition is the underlying cause of more than half of all deaths in children aged less than five years worldwide. This study was designed majorly to study the prevalence of undernutrition in children. The objectives of the study were to assess the prevalence of undernutrition stunting, underweight and wasting in children between 2 5 years of age and to analyse major determinants influencing undernutrition. 102 children aged between 2 5 years of age were selected from two different baalwadis of Mumbai through purposive, random sampling. Socio demographic data was collected using a self designed, structured questionnaire from mothers. Anthropometric measurements like weight, height, MUAC were done to determine nutritional status. Anthropometric data revealed that out of total children screened n=102 , 34 children were well nourished and 66 children were undernourished where 27 children were underweight, 24 were wasted 16 were stunted. 55 children had low MUAC. The factors that were found to be significantly associated with child undernutrition were age p=0.046 , gender p=0.000 , maternal education p=0.007 , employment status of mother p=0.001 and number of meals taken by the child daily p=0.000 . The prevalence of undernutrition among children of Baalwadi was high considering the sample size was small. Shraddha Shripal Parmar | Dr Rupali Sengupta ""Prevalence of Undernutrition among Baalwadi Going Children between 2-5 Years of Age in Western Mumbai"" Published in International Journal of Trend in Scientific Research and Development (ijtsrd), ISSN: 2456-6470, Volume-3 | Issue-3 , April 2019, URL: https://www.ijtsrd.com/papers/ijtsrd23133.pdf
Paper URL: https://www.ijtsrd.com/home-science/child-care-and-development/23133/prevalence-of-undernutrition-among-baalwadi-going-children-between-2-5-years-of-age-in-western-mumbai/shraddha-shripal-parmar
ABSTRACT- Background: Malnutrition constitutes a major public health concern worldwide and serves as an indicator
of hospitalized patient’s prognosis. Nutritional support is an essential aspect of the clinical management of children
admitted to hospital. Malnutrition has been long associated with poor quality, poor diet and inadequate access to health
care, and it remains a key global health issue that both stems from and contributes to weakness, with 50% of childhood
deaths due to principal under nutrition.
Methods: The present hospital based cross sectional study was conducted in April to Dec 2015 among 300 rural
adolescents of 9-18 years age (146 boys and 154 girls) attending the outpatient department at Patna Medical College and
Hospital, Bihar, India, belonging to the all caste communities. The nutritional status was assessed in terms of under
nutrition (weight-for-age below 3rd percentile), stunting (Height-for-age below 3rd percentile) and thinness (BMI-for-age
below 5th percentile). Diseases were accepted as such as diagnosed by pediatrician, skin specialist and medical officer.
Results: The prevalence of underweight, stunting and thinness were found to be 31%, 22.3% and 30.7% respectively. The
maximum prevalence of malnutrition was observed among early adolescents (23% - 54%) and the most common
morbidities were diarrhoea (16.7%), carbuncle / furuncle (16.7%) and scabies (12%).
Conclusion: Malnutrition among hospitalized under five children and around suffers moderately high rates of
malnutrition. Present nutrition programs attention on education for at risk children and referral to regional hospitals for
malnourished children. Screening tools to classify children at risk of developing malnutrition might be helpful.
Key-words- Malnutrition, Hospitalized children, Morbidities, Prevalence, Stunting
Undernutrition is a lack of quantity or quality of food required for optimal growth and health.
Undernutrition includes: Undernourished people (insufficient calorie intake), being underweight for one’s age, too short for one’s age (stunted), dangerously thin (wasted), and deficient in vitamins and minerals (micronutrient malnutrition).
“I would take the next 1000 children born, randomize them in two different groups and have half of them eat nothing but fresh fruits and vegetables for the rest of their lives, and other half eat nothing but fried snacks and cola; and then I will measure their susceptibility to NCD’s”
IJRET : International Journal of Research in Engineering and Technology is an international peer reviewed, online journal published by eSAT Publishing House for the enhancement of research in various disciplines of Engineering and Technology. The aim and scope of the journal is to provide an academic medium and an important reference for the advancement and dissemination of research results that support high-level learning, teaching and research in the fields of Engineering and Technology. We bring together Scientists, Academician, Field Engineers, Scholars and Students of related fields of Engineering and Technology
NCCR 2020: Conference Of Very Important Disease (COVID-19) | 24 - 26 August 2020
Young Investigator Awards Presentation
Mohammad Hasnan Ahmad
Nutritionist
Principal Investigator
Centre for Nutrition Epidemiology Research
Institute for Public Health
National Institutes of Health
Ministry of Health Malaysia
https://doi.org/10.5281/zenodo.4004505
Evaluation of the impacts of care givers on malnourished children in Ishaka A...PUBLISHERJOURNAL
This study was done to evaluate the knowledge, attitude and practices of care givers of malnourished children less than five years in Ishaka Adventist Hospital, Uganda. This was a cross-sectional descriptive study that targeted care givers of malnourished children below five years. Forty two care givers (using fishers’ method) were sampled using simple random technique and basing on the inclusion and exclusion criteria stated therein. Data was collected using semi structured questionnaires and data was analyzed using SPSS version 22.1 and was also assisted by excel in drawing charts and figures. During data collection, absolute ethical considerations were followed. 100% response rate was achieved, and the results showed that the majority of participants 20 (48%) were aged 18-24 years and 83% were females and majority of care takers were peasants 37(88%) and surprisingly 30(74%) had never completed primary level. 71% of respondents defined malnutrition as when the child is having a big head and a swollen stomach and a majority 26(62%) mentioned poor hygiene, un safe water, diseases and infection were the causes of malnutrition, good enough majority of them had knowledge on signs of malnutrition, care takers had a mixed attitude about malnutrition and some attributed it to bad lack in the family and majority of the mothers were breast feeding their children. In conclusion, participants had good knowledge and the care takers also had good attitude towards different feeding habits and it was recommended that outreach programs targeting care takers should be emphasized.
Keywords: malnutrition, feeding habits, care takers, infection
Background: Childhood stunting is the most widely prevalent among under-five children in Ethiopia. Despite the
individual-level factors of childhood stunting are well documented, community-level factors have not been given
much attention in the country. This study aimed to identify individual- and community-level factors associated with
stunting among under-five children in Ethiopia.
Methods: Cross-sectional data from the 2016 Ethiopian Demographic and Health Survey was used. A total of 8855
under-five children and 640 community clusters were included in the current analysis. A multilevel logistic
regression model was used at 5% level of significance to determine the individual- and community-level factors
associated with childhood stunting.
Prevalence of Stunting among School Children in Sri LankaAJHSSR Journal
ABSTRACT: Stunting is a state of the children fail to grow the proper height for their age. By measuring the
Height for age, it can be determined if children are stunting. Low height-for-age reflects an indication of a chronic
deficiency in growth, such as prolonged illness or undernutrition. It is considered as a measure of past nutrition.
The prevalence of stunting among children is a major risk in having child development in developing countries.
Therefore, identifying the prevalence of stunting and its characteristics is important in the attempt of reducing the
prevalence of stunting focusing the country development through well-nourished children. This study aims to
identify the prevalence of stunting and its characteristics among school children in Sri Lanka based on the NuwaraEliya district. The primary data gathered through a sample survey was employed in this study. The sample size is
378 school children and it was selected using stratified random sampling technique. Descriptive statistics;
percentages, tables, pie charts, bar charts and line charts were used in analyzing the prevalence of stunting. Gender
comparison suggest that male children are more better off than female children. Children coming from urban
sector are more likely to be stunted than the children from rural and estate sectors. Increasing income lowering
the prevalence of stunting. It is evident that the lowest incidence of stunting is appearing among the children who
learning in types 1AB schools. The highest incidence of stunting was recorded for the children belonged to poor
families compared to non-poor. Mother’s working group has increased the prevalence of stunting. Thus, the study
suggests to be of concern with gender, living sector, type of school, income, poverty and mother’s employment
in targeting nutritional program to overcome the incidence of stunting.
Keywords: Gender, Income, Mother’s employment, Prevalence of stunting, School children
Abstract—Adolescents are the future resources for any country to progress and prosper. According to Census 2001, in India, adolescent constitute one-fifth of the total population. Adolescent AGs are one of the important segments of the population for they are the future mother whose nutritional status affects that of the newborn baby. Anemia being a major public health problem among adolescent girls, a study was conducted with the objective to determine the socio-demographic correlates of anemia among girls. Methodology: A cross-sectional study was conducted among 467 adolescent AGs in Ahmadabad city during May 2011 to august 2012 in Adolescent Friendly Health Services clinics. Results: Prevalence of anemia among adolescent girls was 85.9%. Highest prevalence was observed during mid-adolescence phase. As the age of girls increases, Hemoglobin tends to get on the lower side. A statistically significant association was observed between anemia and nutritional status. No association was observed between anemia and religion, birth order, type of -family, education of parents and occupation of parents. Conclusion: Association between anemia and under-nutrition has been reported earlier in numerous studies; however present study highlights the fact that it is not common to have anemia among girls who are over nourished or obese. Hence, special efforts should be made to address this issue among girls by doing dietary modifications.
International Journal of Humanities and Social Science Invention (IJHSSI) is an international journal intended for professionals and researchers in all fields of Humanities and Social Science. IJHSSI publishes research articles and reviews within the whole field Humanities and Social Science, new teaching methods, assessment, validation and the impact of new technologies and it will continue to provide information on the latest trends and developments in this ever-expanding subject. The publications of papers are selected through double peer reviewed to ensure originality, relevance, and readability. The articles published in our journal can be accessed online.
A Study on Knowledge, Attitude and Practice KAP on Anemia and Socio Economic ...YogeshIJTSRD
Anemia is a critical public health problem in India that affects women and children throughout the lifecycle. The Govt. of India took an effort by launching the programme called “12 by 12 initiatives- addressing the problem of anemia in adolescents. Under Rajiv Gandhi Scheme for Adolescent Girls SABALA programme initiated in 2011, adolescent girls are being received weekly supplementation of iron folic acid tablets and biannual de worming tablets. Age at menarche, family type, mother’s educational status, personal hygiene and sanitation facilities and the gain score of knowledge, attitude and practice. There is a significant difference between the family income and the gain score of the knowledge, attitude and practice of anemia at the 0.05 level of significance. Thus, it is concluded that the demographic variables would have influence over the knowledge, attitude, and practice on anemia. Dr. Sandhya Rani Mohanty "A Study on Knowledge, Attitude and Practice (KAP) on Anemia and Socio Economic Characteristics of Rural Adolescent Girls in Odisha" Published in International Journal of Trend in Scientific Research and Development (ijtsrd), ISSN: 2456-6470, Volume-5 | Issue-5 , August 2021, URL: https://www.ijtsrd.com/papers/ijtsrd45033.pdf Paper URL: https://www.ijtsrd.com/home-science/food-and-nutrition/45033/a-study-on-knowledge-attitude-and-practice-kap-on-anemia-and-socio-economic-characteristics-of-rural-adolescent-girls-in-odisha/dr-sandhya-rani-mohanty
This presentation aims at explaining all the components of malnutrition. Such as types, causes, criteria of diagnosis, treatment & Government health initiatives to tackle the problem of malnutrition.
Use of Mask in Prevention of Coronavirus manali9054
COVID-19 (the virus) spreads mainly by droplets produced as a result of coughing or sneezing of a COVID-19 infected person. This can happen in two ways:
More Related Content
Similar to Composite-Index-of-Anthropometric-Failure-Report.pdf
Undernutrition is a lack of quantity or quality of food required for optimal growth and health.
Undernutrition includes: Undernourished people (insufficient calorie intake), being underweight for one’s age, too short for one’s age (stunted), dangerously thin (wasted), and deficient in vitamins and minerals (micronutrient malnutrition).
“I would take the next 1000 children born, randomize them in two different groups and have half of them eat nothing but fresh fruits and vegetables for the rest of their lives, and other half eat nothing but fried snacks and cola; and then I will measure their susceptibility to NCD’s”
IJRET : International Journal of Research in Engineering and Technology is an international peer reviewed, online journal published by eSAT Publishing House for the enhancement of research in various disciplines of Engineering and Technology. The aim and scope of the journal is to provide an academic medium and an important reference for the advancement and dissemination of research results that support high-level learning, teaching and research in the fields of Engineering and Technology. We bring together Scientists, Academician, Field Engineers, Scholars and Students of related fields of Engineering and Technology
NCCR 2020: Conference Of Very Important Disease (COVID-19) | 24 - 26 August 2020
Young Investigator Awards Presentation
Mohammad Hasnan Ahmad
Nutritionist
Principal Investigator
Centre for Nutrition Epidemiology Research
Institute for Public Health
National Institutes of Health
Ministry of Health Malaysia
https://doi.org/10.5281/zenodo.4004505
Evaluation of the impacts of care givers on malnourished children in Ishaka A...PUBLISHERJOURNAL
This study was done to evaluate the knowledge, attitude and practices of care givers of malnourished children less than five years in Ishaka Adventist Hospital, Uganda. This was a cross-sectional descriptive study that targeted care givers of malnourished children below five years. Forty two care givers (using fishers’ method) were sampled using simple random technique and basing on the inclusion and exclusion criteria stated therein. Data was collected using semi structured questionnaires and data was analyzed using SPSS version 22.1 and was also assisted by excel in drawing charts and figures. During data collection, absolute ethical considerations were followed. 100% response rate was achieved, and the results showed that the majority of participants 20 (48%) were aged 18-24 years and 83% were females and majority of care takers were peasants 37(88%) and surprisingly 30(74%) had never completed primary level. 71% of respondents defined malnutrition as when the child is having a big head and a swollen stomach and a majority 26(62%) mentioned poor hygiene, un safe water, diseases and infection were the causes of malnutrition, good enough majority of them had knowledge on signs of malnutrition, care takers had a mixed attitude about malnutrition and some attributed it to bad lack in the family and majority of the mothers were breast feeding their children. In conclusion, participants had good knowledge and the care takers also had good attitude towards different feeding habits and it was recommended that outreach programs targeting care takers should be emphasized.
Keywords: malnutrition, feeding habits, care takers, infection
Background: Childhood stunting is the most widely prevalent among under-five children in Ethiopia. Despite the
individual-level factors of childhood stunting are well documented, community-level factors have not been given
much attention in the country. This study aimed to identify individual- and community-level factors associated with
stunting among under-five children in Ethiopia.
Methods: Cross-sectional data from the 2016 Ethiopian Demographic and Health Survey was used. A total of 8855
under-five children and 640 community clusters were included in the current analysis. A multilevel logistic
regression model was used at 5% level of significance to determine the individual- and community-level factors
associated with childhood stunting.
Prevalence of Stunting among School Children in Sri LankaAJHSSR Journal
ABSTRACT: Stunting is a state of the children fail to grow the proper height for their age. By measuring the
Height for age, it can be determined if children are stunting. Low height-for-age reflects an indication of a chronic
deficiency in growth, such as prolonged illness or undernutrition. It is considered as a measure of past nutrition.
The prevalence of stunting among children is a major risk in having child development in developing countries.
Therefore, identifying the prevalence of stunting and its characteristics is important in the attempt of reducing the
prevalence of stunting focusing the country development through well-nourished children. This study aims to
identify the prevalence of stunting and its characteristics among school children in Sri Lanka based on the NuwaraEliya district. The primary data gathered through a sample survey was employed in this study. The sample size is
378 school children and it was selected using stratified random sampling technique. Descriptive statistics;
percentages, tables, pie charts, bar charts and line charts were used in analyzing the prevalence of stunting. Gender
comparison suggest that male children are more better off than female children. Children coming from urban
sector are more likely to be stunted than the children from rural and estate sectors. Increasing income lowering
the prevalence of stunting. It is evident that the lowest incidence of stunting is appearing among the children who
learning in types 1AB schools. The highest incidence of stunting was recorded for the children belonged to poor
families compared to non-poor. Mother’s working group has increased the prevalence of stunting. Thus, the study
suggests to be of concern with gender, living sector, type of school, income, poverty and mother’s employment
in targeting nutritional program to overcome the incidence of stunting.
Keywords: Gender, Income, Mother’s employment, Prevalence of stunting, School children
Abstract—Adolescents are the future resources for any country to progress and prosper. According to Census 2001, in India, adolescent constitute one-fifth of the total population. Adolescent AGs are one of the important segments of the population for they are the future mother whose nutritional status affects that of the newborn baby. Anemia being a major public health problem among adolescent girls, a study was conducted with the objective to determine the socio-demographic correlates of anemia among girls. Methodology: A cross-sectional study was conducted among 467 adolescent AGs in Ahmadabad city during May 2011 to august 2012 in Adolescent Friendly Health Services clinics. Results: Prevalence of anemia among adolescent girls was 85.9%. Highest prevalence was observed during mid-adolescence phase. As the age of girls increases, Hemoglobin tends to get on the lower side. A statistically significant association was observed between anemia and nutritional status. No association was observed between anemia and religion, birth order, type of -family, education of parents and occupation of parents. Conclusion: Association between anemia and under-nutrition has been reported earlier in numerous studies; however present study highlights the fact that it is not common to have anemia among girls who are over nourished or obese. Hence, special efforts should be made to address this issue among girls by doing dietary modifications.
International Journal of Humanities and Social Science Invention (IJHSSI) is an international journal intended for professionals and researchers in all fields of Humanities and Social Science. IJHSSI publishes research articles and reviews within the whole field Humanities and Social Science, new teaching methods, assessment, validation and the impact of new technologies and it will continue to provide information on the latest trends and developments in this ever-expanding subject. The publications of papers are selected through double peer reviewed to ensure originality, relevance, and readability. The articles published in our journal can be accessed online.
A Study on Knowledge, Attitude and Practice KAP on Anemia and Socio Economic ...YogeshIJTSRD
Anemia is a critical public health problem in India that affects women and children throughout the lifecycle. The Govt. of India took an effort by launching the programme called “12 by 12 initiatives- addressing the problem of anemia in adolescents. Under Rajiv Gandhi Scheme for Adolescent Girls SABALA programme initiated in 2011, adolescent girls are being received weekly supplementation of iron folic acid tablets and biannual de worming tablets. Age at menarche, family type, mother’s educational status, personal hygiene and sanitation facilities and the gain score of knowledge, attitude and practice. There is a significant difference between the family income and the gain score of the knowledge, attitude and practice of anemia at the 0.05 level of significance. Thus, it is concluded that the demographic variables would have influence over the knowledge, attitude, and practice on anemia. Dr. Sandhya Rani Mohanty "A Study on Knowledge, Attitude and Practice (KAP) on Anemia and Socio Economic Characteristics of Rural Adolescent Girls in Odisha" Published in International Journal of Trend in Scientific Research and Development (ijtsrd), ISSN: 2456-6470, Volume-5 | Issue-5 , August 2021, URL: https://www.ijtsrd.com/papers/ijtsrd45033.pdf Paper URL: https://www.ijtsrd.com/home-science/food-and-nutrition/45033/a-study-on-knowledge-attitude-and-practice-kap-on-anemia-and-socio-economic-characteristics-of-rural-adolescent-girls-in-odisha/dr-sandhya-rani-mohanty
This presentation aims at explaining all the components of malnutrition. Such as types, causes, criteria of diagnosis, treatment & Government health initiatives to tackle the problem of malnutrition.
Use of Mask in Prevention of Coronavirus manali9054
COVID-19 (the virus) spreads mainly by droplets produced as a result of coughing or sneezing of a COVID-19 infected person. This can happen in two ways:
Community mobilisation to prevent violence against women and girls in eastern India through participatory learning and action with women’s groups facilitated by accredited social health activists .
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At the outset, we thank our Chief Executive officer Ms. Vanessa D’souza and our Executive Director Dr. Shanti Pantvaidya for supporting us in pivoting counselling interventions to the
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Persistently high unmet need of family planning in India points to the significance of understanding women’s
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Research: Studying gene function to unlock new knowledge.
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Eugenics: Misusing CRISPR for designer babies raises social and ethical questions.
Equity: High costs could limit access to this potentially life-saving technology.
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1. Composite Index of Anthropometric Failure and its correlates: a cross-
sectional study of under five children in an urban informal settlement of
Mumbai, India
Manjula Bahuguna, Sushmita Das, David Osrin, Dr. Shanti Pantvaidya, Anuja Jayaraman
March 2021
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Abstract
Introduction: The use of conventional anthropometric indices by malnutrition management programs may miss
children with dual or multiple forms of growth failure. The Composite Index of Growth Failure (CIAF) helps to identify
such vulnerable children
Objective: We aimed to assess the prevalence of undernutrition and its subgroups using the CIAF among children
under five residing in urban informal settlements of Mumbai, India. We also examined the factors associated with
undernutrition.
Methods: Data from a cross-sectional survey was used to construct CIAF; WHO Z-scores were used to categorize
children into seven subgroups: (A) no failure, (B) wasting only, (C) wasting and underweight, (D) wasting, stunting,
and underweight, (E) stunting and underweight, (F) stunting only, (G) underweight only. Undernutrition prevalence
was assessed by combining all these subgroups except subgroup A. Factors associated with undernutrition were
explored using multilevel logistic regression models adjusted for child, maternal and households socioeconomic
characteristics.
Results: 3394 out of 6489 children (52.3%) were undernourished. Of these undernourished children, 37.2% had
single anthropometric failure, 51.1% had dual anthropometric failures, and 11.6% had multiple anthropometric
failures. Among all subgroups of undernourished children, “stunting and underweight” had the highest prevalence
(44.2%). Child’s age, mother’s age and education, parity, type of toilet facility used, and household economic status
were associated with undernutrition.
Conclusions: The CIAF can be used by nutrition programs to develop need-specific interventions to reduce the risk of
aggravated morbidities and mortality. To improve child health and nutrition, Government programs should continue
to focus on issues related to women’s education and early pregnancies.
Keywords: Malnutrition, Child Health, Community-based nutrition program, Composite Index of Anthropometric
Failure, Urban Health, India
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Introduction
Malnutrition is one of the major underlying causes of preventable child deaths worldwide [1-3]. In low and middle-
income countries approximately 45% of all child deaths can be attributed to poor nutrition [4]. The Global Nutrition
Report (2018) suggests that India has the most children with stunting (46.6 million) and wasting (25.5 million) [5].
Maharashtra, one of the most urbanized states in the country, has the highest proportion of people living in slums
(18.1%), characterized by overcrowding, unhealthy living conditions, lack of basic facilities, poverty and social
exclusion [6]. Children under five years of age living in slums are at higher risk of poor health than children living in
non-slum areas [7]. They are particularly vulnerable to recurrent infections and malnutrition, which have long-term
effects on cognitive development [8].
Malnutrition management programs use anthropometric screening to assess growth patterns and nutritional status,
to identify individuals at risk, to customize nutritional counselling, and to make appropriate referrals [9]. India’s
National Family Health Survey uses World Health Organization indices - low weight for age (underweight), low height
for age (stunting) and low weight for height (wasting) - to assess undernutrition among children under five [10]. The
Integrated Child Development Services (ICDS), India’s foremost early childhood care and development program, uses
underweight for anthropometric screening and provides supplementary nutrition to undernourished children in
communities [11]. Development economist Peter Svedberg suggested that conventional indices might be insufficient
as a measure of prevalence of child undernutrition due to indices overlapping; a child who is underweight may also
be stunted and/or wasted. Svedberg proposed an alternative indicator, the Composite Index of Anthropometric
Failure (CIAF), to categorise children into six subgroups according to wasting, stunting and underweight status [12].
The CIAF was later modified to include another subgroup of children who were only underweight [13].
A UNICEF, WHO and World Bank Group report on levels and trends in child malnutrition also suggests that some
children suffer from more than one form of malnutrition and currently there are no global or regional estimates for
such children [14]. Nandy et al. (2005) suggested that children with dual anthropometric failure were more likely to
have diarrhoea than single anthropometric failure and children who were simultaneously wasted, stunted and
underweight had the highest odds of having diarrhoea and acute respiratory infections [13]. Mcdonald et al. (2013)
suggest that children with dual anthropometric failure were at a heightened risk of mortality and children with all
three anthropometric failures had a 12-fold elevated risk of mortality [15].
In a single classification, the CIAF gives a comprehensive picture of the scale of undernutrition and can help to
identify the type of intervention required for the most prevalent subgroup in the community. In India, a few studies
have assessed undernutrition prevalence using the CIAF and a few have also studied associated factors such as child
age and sex, socioeconomic status, maternal education, birth order, birth intervals, exclusive breastfeeding,
childhood morbidities, and number of siblings [16-20].
Our study aimed to establish the overall extent of undernutrition along with its associated factors, using the CIAF in
urban informal settlements of Mumbai. The objectives were (1) to assess the prevalence of undernutrition and its
subgroups using the CIAF in children aged 0-59 months residing in urban informal settlements of Mumbai, and (2) to
determine the association of undernutrition with child, maternal and household socioeconomic characteristics.
Methods
Study setting, program description and participants:
In 2011, a randomized control trial was initiated in urban informal settlements of Mumbai. 40 areas (20 control, 20
intervention) of M-East ward (HDI 0.05) and L ward (HDI 0.29); wards with lowest human development index, were
chosen for intervention [21]. Each intervention areas had a community resource centre to provide community-level
access to a range of services related to health, nutrition, and safety to women and children. Married women of
reproductive age (15-49 years) and children (0-5 years) were the primary beneficiaries. Key intervention activities
were growth monitoring through monthly anthropometric screening, regular home visits to provide information on
family health needs and appropriate referrals, day-care centres for early childhood care and development activities
for severely malnourished children, service provision by clinicians and counsellors, group meetings and community
events to create a conducive environment for women’s and children’s health.
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Data source: We used the trial’s post-intervention census data collected between February 2014 and September
2015. In each household, the youngest married woman of reproductive age (15-49 years) was interviewed to obtain
information on socioeconomic status, household characteristics, obstetric history, family planning practices and
uptake of health services. Anthropometric data of all children in census were collected by measuring height/length
and weight. Lengths of children younger than two years were measured with a Rollameter accurate to 1mm with an
assistant holding the child’s head. Heights of children aged two years and older were measured with a Leicester
stadiometer accurate to 1 mm, at the end of expiration with feet together against the backboard, back straight, and
head in the Frankfort plane. Weights were measured with Seca 385 electronic scales accurate to 10g. Training for
data collectors was repeated on two occasions, for which the indicative technical errors of measurement for height
were 0·6%, and 0·5% [22].
Study variables: Nutritional status was assessed by both conventionally used undernutrition indices (wasting,
stunting, underweight) and CIAF. Age- and sex-specific weight-for-age Z scores (WAZ), height-for-age Z scores (HAZ)
and weight-for-height Z scores (WHZ) were generated using World Health Organization growth standards and the Z
SCORE06 module in Stata/IC (version 13.1). Following Nandy et al. 2005, CIAF was constructed using Z-scores to
categorize children into seven subgroups: (A) no failure, (B) wasting only, (C) wasting and underweight, (D) wasting,
stunting, and underweight, (E) stunting and underweight, (F) stunting only, and (G) underweight only [13]. Based on
the CIAF, a child was considered undernourished if they had any form of anthropometric failure.
Data Analysis: Factors associated with undernutrition in children (0-59 months) were explored using multilevel
logistic regression model adjusting for child, maternal and socioeconomic characteristics of the household.
Independent variables with p <0.25 in bivariate analysis were included in the final regression model. These included
child’s age, mother’s age, religion, education, length of residence in Mumbai, parity, exposure to violence, uptake of
health services, number of household residents, source of drinking water, type of toilet facilities, and asset index
quartile. For each explanatory variable, the crude odds ratio was presented along with the adjusted odds ratio (AOR)
and 95% confidence intervals (CI). All analysis was conducted in STATA 12.0 (StataCorp, College Station, TX).
Ethical statement
The study received ethical approval from the Multi-Institutional Ethics Committee of the Anusandhan Trust,
Mumbai, India, in sequential reviews: formative research (February, 2011), cluster vulnerability (May, 2011), the pre
intervention census (August, 2011), and the intervention and assessments (January, 2012). It was also approved by
the University College London Research Ethics Committee, UK, in January, 2012 (reference 3546/001).
Results
Post-intervention census data were collected from 24,939 households. 16,236 married women aged 15-49 years
were interviewed including 7601 women with 10,551 children under age five. A total of 6489 children under age five
were included in the analysis for this study, as seen in Figure 1.
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Figure 1: Study profile
Table 1 presents the prevalence of child undernutrition. Based on the CIAF classification, more than half of the
children were undernourished.
Table 1: Prevalence of undernutrition as per CIAF classification
CIAF classification n %
Group A No failure 3095 47.7
Group B Wasting only 109 1.7
Group C Wasting and underweight 237 3.7
Group D Wasting, stunting, and underweight 393 6.0
Group E Stunting and underweight 1499 23.1
Group F Stunting only 963 14.8
Group Y Underweight only 193 3.0
Total 6489 100.0
Undernutrition (Group B + Group C + Group D + Group E + Group F + Group Y) = 52.3%
Conventional indices of undernutrition showed 11.4% wasting, 35.7% underweight and 44.0% stunting. Conventional
wasting includes children of CIAF groups B, C, and D, but omits the 40.9% of children of groups E, F, and Y.
Conventional underweight includes children of CIAF groups C, D, E, and Y, but omits the 16.5% of children of groups
B and F. Conventional stunting includes children of CIAF groups D, E, and F, but omits the 8.3% of children of groups
B, C, and Y.
10,551 children: 4544 children under 2 y and 6007 2- 5 y
children
4062 children excluded
- 2642 second born
- 298 third born/more
- 19 sets of twins
- 30 incomplete information
- 1054 anthropometry data not available
6489 children in the study
- 3578 under 2 y children in the study
- 2911 2-5 y children in the study
-
7601 married women aged 15–49 y with under 5 children
15,907 households with 17,568 married women aged 15–49
y eligible for interview
16,236 married women aged 15–49 y interviewed
24,939 households
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Table 2 presents frequencies and proportions of respondent characteristics, along with prevalence of CIAF growth
failure for each characteristic.
Table 2: Child, maternal, socioeconomic characteristics and proportionate undernutrition prevalence
CIAF no failure
N=3095
CIAF failure
N=3394
Total
N=6489
Child Characteristics
Age n % N % n %
Less than 2 years 1928 62.3 1650 48.6 3578 55.1
2-5 years 1167 37.7 1744 51.4 2911 44.8
Sex
Male 1575 50.9 1772 52.2 3347 51.6
Female 1520 49.1 1622 47.8 3142 48.4
Maternal Characteristics
Age
Less than 25 years 840 27.1 883 26.0 1723 26.5
25-29 years 1216 39.3 1302 38.4 2518 38.8
30 years or above 1039 33.6 1209 35.6 2248 34.6
Religion
Muslim 2605 84.2 2820 83.1 5425 83.6
Hindu 484 15.6 568 16.7 1052 16.2
Other 6 0.2 6 0.2 12 0.18
Education
Illiterate 764 24.7 1080 31.8 1844 28.4
Primary (grades 1-4) 142 4.6 192 5.7 334 5.1
Secondary (grades 5-10) 1867 60.3 1880 55.4 3747 57.7
Higher (grade 11 or higher) 322 10.4 242 7.1 564 8.7
Length of stay in Mumbai
<=1 year 293 9.5 359 10.5 652 10.7
2-5 years 608 19.6 652 19.2 1260 20.8
6-10 years 492 15.9 537 15.8 1029 16.9
>10 years 1501 48.5 1625 47.9 3126 51.5
Missing 201 6.5 221 6.5 422 0.06
Parity
3 or more children 1413 45.7 1732 51.0 3145 48.5
1 or 2 children 1682 54.3 1662 49.0 3344 51.5
Exposure to spousal
violence in last 2 years
No 2754 89.0 2964 87.3 5718 88.1
Yes 341 11.0 429 12.6 770 11.9
Missing 0 0.0 1 0.0002 1 0.0001
Uptake of health services
in last 1 year
None 892 28.8 995 29.3 1887 29.0
Only government
(ICDS/BMC) 824 26.6 832 24.5
1656 25.5
Community resource
centre 643 20.8 736 21.7
1379 21.2
Both 736 23.8 831 24.5 1567 24.1
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Socio-economic characteristics
Number of household
members
Less than or 5 1612 52.1 1735 51.1 3347 51.6
5 or more 1483 47.9 1659 48.9 3142 48.4
Drinking water source
Public 2295 74.1 2688 79.2 4983 76.8
Private 800 25.9 706 20.8 1506 23.2
Type of toilet facility
Public 2451 79.2 2890 85.1 5341 82.3
Private 644 20.8 504 14.9 1148 17.7
Asset index quartile
1 (Poorest) 752 24.3 1009 29.7 1761 27.1
2 680 22.0 874 25.8 1554 23.9
3 807 26.0 784 23.1 1591 24.5
4 (Least poor) 856 27.7 727 21.4 1583 24.4
Factors associated with undernutrition: The results of multivariable logistic regression suggest that child’s age,
mother’s age, her education, parity, type of toilet facility and economic status were associated with undernutrition.
Table 3 shows that children in the age group 2-5 years had higher odds [AOR 1.93, 95% CI 1.72, 2.15] of being
undernourished than children less than two years old. Older mothers (>=30years) had lower odds [AOR 0.73, 95% CI
0.62, 0.86] of having undernourished children than mothers below 25 years of age. Compared with children of
women with no education, children of women with secondary [AOR 0.78, 95% CI 0.69, 0.89] or higher education
[AOR 0.67, 95% CI 0.54, 0.84] were less likely to be undernourished. Women with one or two children had lower
odds [AOR 0.83, 95% CI 0.72, 0.94] of having an undernourished child than women with three or more children.
Households using private toilets were less likely [AOR 0.78, 95% CI 0.66, 0.91) to have undernourished children than
households using public toilets. Children living in less poor [AOR 0.75, 95% CI 0.64, 0.87] or wealthier [AOR 0.71, 95%
CI 0.59, 0.84] households had lower odds of being undernourished than children residing in poorer households.
Table 3: Factors associated with undernutrition
Child Characteristics Crude odds ratio (95% CI)
Adjusted odds ratio (95%
CI)
Age
Less than 2 years 1 1
2-5 years 1.74 (1.58, 1.92) 1.93 (1.72, 2.15) ***
Sex
Male 1 1
Female 0.94 (0.86, 1.04) 0.96 (0.86, 1.06)
Maternal Characteristics
Age
Less than 25 years 1 1
25-29 years 1.01 (0.90, 1.15) 0.81 (0.71, 0.94) **
30 years or above 1.10 (0.97, 1.25) 0.73 (0.62, 0.86) ***
Religion
Muslim 1 1
Hindu 1.08 (0.94, 1.23) 1.14(0.99, 1.32) *
Education
Illiterate 1 1
Primary (grades 1-4) 0.95 (0.75, 1.21) 0.90 (0.70, 1.16)
Secondary (grades 5-10) 0.71 (0.63, 0.79) 0.78 (0.69, 0.89) ***
Higher ( grade 11 or higher) 0.53 (0.43, 0.64) 0.67 (0.54, 0.84) ***
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Length of stay in Mumbai
<=1 year 1 1
2-5 year 0.87 (0.72, 1.05) 1.0 (0.81, 1.22)
6-10year 0.89 (0.73, 1.08) 0.93 (0.75, 1.15)
>10year 0.88 (0.74, 1.04) 0.99 (0.82, 1.20)
Parity
3 or more children 1 1
1or 2 children 0.80 (0.73, 0.88) 0.83 (0.72, 0.94) **
Exposure to spousal violence in last 2 years
No 1 1
Yes 1.16 (1.0, 1.35) 1.11 (0.94, 1.30)
Uptake of health services in last 1 year
None 1 1
Government (ICDS/BMC) 0.90 (0.79, 1.03) 1.05 (0.91, 1.22)
Community resource centre 1.02 (0.89, 1.17) 1.06 (0.91, 1.23) *
Both 1.01 (0.88, 1.15) 1.21 (1.04, 1.40)
Socio-economic characteristics
Number of household members
Less than or 5 1 1
More than 5 1.03 (0.94, 1.14) 1.13 (1.00, 1.26) *
Drinking water source
Public 1 1
Private 0.75 (0.67, 0.84) 0.92 (0.80, 1.07)
Type of toilet facility
Public 1 1
Private 0.66 (0.58, 0.75) 0.78 (0.66, 0.91) **
Asset index quartile
1(Poorest) 1 1
2 0.95 (0.83, 1.09) 0.97(0.84, 1.13)
3 0.72 (0.63, 0.82) 0.75(0.64, 0.87) ***
4 (Least poor) 0.63 (0.55, 0.72) 0.71(0.59, 0.84) ***
“Statistical significance is calculated using mixed effects logistic regression models: * p value: ≤0.05; * * p value:
≤0.01; *** p value: ≤0.001"
Discussion
Undernutrition prevalence was higher as per CIAF, which can be attributed to the ability of CIAF to count children
with dual and multiple anthropometric deficits. Recent studies have assessed undernutrition prevalence using the
CIAF as 48.5% in Ethiopia, 21.7% in rural China and 47.9% in urban Bangladesh [23-25]. In India, studies from
different states used CIAF to estimate undernutrition prevalence and report a higher prevalence as compared to our
study. According to various studies from West Bengal, undernutrition prevalence ranged from 57.6% to 73.1%, much
higher than in our study [16, 17, 26-28]. Jammu and Kashmir (73.2%), Gujarat (60.5%), Chhattisgarh (62.1%), and
Orissa (54.5%) also had higher undernutrition prevalence than observed in our study [20, 29-31]. In Nagpur,
Maharashtra, 51% of children were reported to be undernourished which was similar to that in our study and in the
western suburbs of Mumbai undernutrition prevalence was 47.8%, lower than that of our study [18, 32].
Our study found 6% of children had all three forms of anthropometric failure, which is less than the corresponding
prevalence in the study by Savanur et al. 2015 conducted in the western suburbs of Mumbai, suggesting that 8.2% of
children suffered simultaneously from wasting, stunting and underweight. We found that among all groups of CIAF,
group E, “Stunting and underweight,” had the highest prevalence (23.1%), which is similar to the study done in the
western suburbs of Mumbai that reported the stunting and underweight prevalence as the highest (16.1%) [32]. Our
study showed that by using weight-for-age criteria, we missed 16.5% of children who were considered
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undernourished using other indices, which is similar to other studies missing 12.1% to 21.9% of undernourished
children [33-35]. Failure to identify these children could have consequences including increased morbidity and
mortality [13, 15].
Our study found that as the age of the child increases, the risk of undernutrition increases, a finding consistent with
the studies conducted in India [16, 19] and Ethiopia [23]. Our study found that young mothers were at greater risk of
having undernourished children, which is consistent with the studies suggesting linear growth failure in children of
teenage mothers [36, 37]. The negative association found between level of maternal education and child
undernutrition was consistent with other studies in India [16-18], Ethiopia [23], China [24], and Bangladesh [25]. This
may be because mothers with higher education are most likely to follow healthy practices while taking decisions
about their child’s health [38-40]. The association between parity and undernutrition is similar to the studies
suggesting that children with more than three siblings are at higher risk of being undernourished [17-20]. In
addition, our study found a statistically significant association between use of public toilets and undernutrition,
which may be due to environmental enteropathy caused by living in poor and unhygienic conditions [41, 42]. This,
however, needs to be interpreted carefully considering recent WASH trials [43, 44]. We found that children of poor
socioeconomic status were at greater risk of undernutrition, which is consistent with studies from Ethiopia [23],
China [24], Bangladesh [25] and India [18, 19].
CIAF has its limitations similar to conventional anthropometric indices. Anthropometric indices are used as proxy
indicators for undernutrition among children and do not distinguish between different underlying causes such as
illness versus purely poor nutrition. CIAF may overestimate the undernutrition prevalence by including children with
anthropometric failure due to the outcome of diseases and other non-nutrition related factors [12]. These indices
also do not identify specific nutritional deficiencies, which should be assessed through other methods like
biochemical, clinical and dietary assessment [9]. Our study did not consider variables such as children’s diet and
morbidity which may have confounding effect on the results. Finally, the association between undernutrition and its
correlates was based on cross-sectional data and cannot be used to establish a causal relationship.
Conclusion
More than half of children in the age group 0-5 years were suffering from one or the combined forms of
anthropometric failure. Children having young and uneducated mothers, with siblings, using public toilets and from
poor socioeconomic backgrounds were at greater risk of falling into any category of anthropometric failure.
Therefore, government programs should continue to focus on improving women education and early pregnancies
among women in urban areas. Malnutrition management programs often use conventional anthropometric indices
separately which prevents the identification of the subgroup of children who are at greatest risk with dual or
multiple anthropometric deficits. We recommend the use of the CIAF to identify these vulnerable children for better
coverage of services to improve their health and nutritional status. Each category needs specific interventions - not
one size that fits all. Given the limited resources, drawing these finer distinctions will not only help in further
reduction of undernutrition but will help in prioritizing interventions for children with multiple anthropometric
failure to reduce the risk of aggravated morbidities and mortalities. Our findings further support the advocacy of
taking length/height measurement of children by the ICDS and thereby improve the precision by which this agency
identifies nutritionally vulnerable children.
Acknowledgements
We are very grateful to the women and their families who made this study possible by allowing us into their homes
to interview them. We thank the entire intervention staff for implementation of the program operations. We are
thankful to the field investigators for data collection and field officers for supervision. We thank Neena Shah More
for reviewing the paper and Latika Bhosale and Laxmi Solanki for data management. We are thankful to Archana
Bagra, Vanessa D’Souza and members of SNEHA Research Group.
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