- The document presents a proposal on factors associated with underweight among children below 24 months in Tribeni Municipality, Bajura, Nepal. - It outlines the background, problem statement, rationale, objectives, conceptual framework, research questions, hypotheses, methodology, and action plan of the study. - The study aims to identify socio-demographic, maternal, and child-related factors associated with underweight in children under 2 years old in the region.

1. Proposal on the topic “Factors
associated with underweight
among children below 24
months at Tribeni Municipality
Bajura”
Presented by:
Kumar Nyaupane

2. Outline of presentation
• Background/Introduction
• Statement of problem
• Rationale of study
• Objectives of study
• Conceptual framework
• Research question and hypothesis
• Methodology
• Ethical consideration
• Action plan
• Annex

3. Introduction
• Underweight is a composite index of height-for-
age and weight-for-height. Children whose
weight-for-age Z-score is below minus two
standard deviations (-2 SD) from the median of
the reference population are classified as
underweight.
• Children are most vulnerable to malnutrition in
developing countries because of low dietary
intakes, lack of appropriate care, and
inequitable distribution of food within the
household.

4. • The basic and underlying causes of under
nutrition, including the environmental,
economic, and sociopolitical contextual
factors, with poverty having a central role.
• Childhood illnesses such as diarrhea and acute
respiratory infections, which are associated
with poor hygiene and access to sanitation, are
common causes of under-nutrition in
developing countries including Nepal.

5. Statement of problem
• Childhood and maternal underweight consists of
138 million DALY which causes about 10% of
global burden of disease. In the poorest regions of
world maternal and childhood underweight are
major contributors to loss of healthy life.
• Over 10 million under-five children annually die
from the diseases which are preventable and
treatable almost all these deaths occur in poor
countries including the childhood malnutrition as
a major cause of death.

6. • The prevalence of underweight among under 5
children is in the pattern of declined trend in
Nepal. In 2006 the prevalence of underweight
was 39, it slightly reduced to 29 in 2011 and
27 in 2016.

7. Rationale of study
• This study will help to identify the major causes
of underweight among children and their root
causes. Rural communities of Nepal are facing the
burden of malnutrition due to many underlying
causes associated to social determinants.
• By identifying the factors related to underweight
we can aware people and manage the status
.Many promotional activities regarding
malnutrition can be initiated in rural setting after
identifying factors associate with it

8. Objectives
General objectives :
• To assess the factors associated with underweight
among children below 24 month at Tribeni municipality
Bajura.
Specific objectives :
• To assess the socio demographic characteristics of
respondents.
• To determine the association between socio
demographic characteristics and underweight.
• To determine the association between maternal factors
and underweight.
• To determine the association between children related
factors and underweight.

9. Conceptual framework
Socio demographic
factors
•Ethnicity
•Family size
•Fathers education
•Fathers occupation
•Maternal education
•Maternal occupation
Maternal factors
•ANC/PNC
•Institutional/home delivery
•Mode of delivery
•Mothers age at marriage
•Mothers age at birth of first
baby
•Parity
•Mothers BMI during
•Pregnancy
•Anemia
•Smoking mother
Child factors
•Sex
•Age
•Initiation of breastfeeding
•Exclusive breastfeeding
•Frequency of breastfeeding
•Complementary feeding
•Supplementary feeding
•Perceived size at birth
•Birth order
•Birth interval
•Presence of diarrhea in last
6 months
•Immunization
Underweight
among children

10. Research questions
• What are the factors associated with
underweight among children below 24
months?
• Is there any association between demographic
characteristics and underweight among
children?
• Is there any association between maternal
factors and underweight among children?
• Is there any association between children
related factors and underweight among
children?

11. Hypothesis 1:
• There is no significant association between socio
demographic characteristics and underweight among
children
• There is statistically significant association between socio
demographic characteristics and underweight among
children
Hypothesis 2:
• There is no significant association between maternal factors
and underweight among children
• There is statistically significant association between
maternal factors and underweight among children
Hypothesis 3:
• There is no significant association between child related
factors and underweight among children
• There is statistically significant association between child
related factors and underweight among children

12. Methodology
Study type
A quantitive study will be carried out.
Study design
Descriptive cross sectional study will be conducted.
Study population
The study population will be Children below 24
months of Tribeni municipality Bajura.
Study area
The study area will be Tribeni municipality Bajura.

13. Sample size
• Confidence interval (CI) 95% (standard value of 1.96)
• An acceptable marginal error of 7% (0.07)
• n = Z²pq/d²
• Where,
• Here, Percentage of underweight among under 5 children
according to NDHS 2016 = 27%
i.e.p=0.27
and q= 1-0.27=0.73
q = 1-p
d = (7% = 0.07)
• now, sample size( n )= 1.96²*[0.27*(1-0.27)]/0.07²
• = 155
• Non response rate = 10%
• i.e. (155*10)/100 = 15.5~16
• Now the sample size will be 155+16 =171

14. Sampling technique
• All the wards from Tribeni municipality will be included in
this study. Sample frame will be the list of children from the
nutritional register at different health institution of Tribeni
municipality. The children will be selected randomly by
simple random sampling method.The sample size will be
171 children from all wards and 19 children from each
ward.
Data collection tools
• A pre tested well administered questionnaire will be used.
The questionnaire related to socio demographic factors,
maternal factors and child related factors will be prepared .
Data collection technique
• Data will be collected by face to face interview with the
help of questionnaire to the mothers of children below 2
years.

15. Data analysis
Descriptive summary statistics
• Under this descriptive summary statistics the
frequency and percentage will be calculated
for those data which are categorical in nature.
Chi square test
• Chi square test will be used to measure the
association between two variable ie
independent and dependent variable.

16. Ethical consideration
• Ethical clearance will be taken from Institutional
Review Committee, Nobel College.
• Additionally, college authorities will be contacted
to get permission and favorable time for data
collection.
• A formal letter of college will be submitted to
ward for conducting this study. The objectives of
the study will be well communicated to villagers
and local representatives.
• Data collection will be conducted after verbal and
written consent obtained from participants.

17. S
N
Activities Mansir Poush Magh Falgun Chaitra Baisakh
Weeks 1 2 3 4 1 2 3 4 1 2 3 4 1 2 3 4 1 2 3 4 1 2 3 4
1
Topic discussion
2
Literature review
3
Topic finalization
4
Proposal development
5
Proposal presentation
6
Preparation of tools
7
Ethical approval
8
Data collection
9
Data analysis and
interpretation
10
Draft report submission
11
Dissertation preparation
1
Final report
submission

18. Annex
QN Section- A :Socio demographic information Code Skip
A1 Respondents code: ………..
A2 Ethnicity : ………….
A3 Number of family members : a. Less than equal 5
b. More than 5
A4 Mothers education : a. Can't read and write
b. Primary (1-8)
c. Secondary(9-12)
d. Above secondary
A5 Mothers occupation : a. Agriculture
b. Business
c. Service
d. Labor
e. Foreign employ
A6 Fathers education : a. Can't read and write
b. Primary (1-8)
c. Secondary(9-12)
d. Above secondary
A7 Fathers occupation : a. Agriculture
b. Business
c. Service
d. Labor
e. Foreign employ

19. Section-B Maternal factors
B1 What was your age at marriage? a. Less than equal to 20
b. More than 20
B2 What was your age at the birth of first baby? a. Less than equal to 20
b. More than 20
B3 Have you visited ANC ( for last baby) a. Yes
b. No
If no skip
to c5
B4 How many times you visited ANC a. 1-3 visits
b. 4 or more
Have you checked up your BMI during last pregnancy? a. Yes
b. No
If no go to
B6
B5 Mothers BMI during pregnancy for last baby? Underweight
Normal weight
Overweight
Obese
Have you assessed your anemia condition during your last
pregnancy ?
Yes
No
If no go to
B7
B6 Presence of anemia during pregnancy for last
baby?
a. Yes
b. No
Have you visited PNC after birth of children ? a. Yes
b. No
How many times You visited PNC ? 1
2
3
B7 Where did you deliver your baby? a. Home
b. Health facility
B8 Type of delivery? Normal
Caeserian section
B9 Attendance of SBA during birth a. Yes
b. No
B10 Do you smoke? a. Yes

20. Section C Children Factors
C1 Number of children below 24 months : a. 1
b. More than 1
C2 Age of last baby a. Below 6 month
b. 6-24 months
C3 Sex of last baby a. Male
b. Female
C4 Birth order of a baby
a. 1st
b. 2nd
c. 3rd
d. 4th
e. More
C5 Birth interval with previous baby None
Below 24 months
Above 24 months
C6 Have you breastfed your children : a. Yes
b. No
C7 Initiation of breastfeeding : Within first hour
After 1 hour
C8 Initiation of complementary feeding : a. Before 6 months
b. After 6 months
C9 How long have you breastfed your children : a. 6 months
b. 12 months
c. 24 months
d. More than 24 months
C10 Presence of diarrhea on children in last 6 months a. Yes
b. No
C11 Have you fully immunized your children Yes
No
C12 Any physical defects/genetic abnormalities during birth a. Yes
b. No
C13 Have you growth monitored your children in last 6 months? a. Yes
b. No
C14 What was the condition of children?