This document discusses a study on determining severe acute malnutrition and managing children under 59 months in the Theni District of Tamil Nadu, India. The study analyzed 138 malnourished children between July 2012 and January 2013. It found high rates of malnutrition in female children and children cared for by mothers. Many common signs of malnutrition were observed including myopia, metropia, xerophthalmia, Bitot's spots, gum bleeding, and angular stomatitis. The study provided nutritional supplementation and found improvement in many symptoms over multiple visits from 1 to 3 months.

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. 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.

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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. 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. 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.
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