nutritional status and strategy to combat malnutrition among preschool children of rural dharwad

222 Pages·2016·4.21 MB·English

NUTRITIONAL STATUS AND STRATEGY TO COMBAT
MALNUTRITION AMONG PRESCHOOL CHILDREN OF
RURAL DHARWAD

Thesis submitted to the
University of Agricultural Sciences, Dharwad
In partial fulfillment of the requirements for the

Degree of

Doctor of Philosophy

in

Food Science and Nutrition

By

SHILPA GUDDAD

DEPARTMENT OF FOOD SCIENCE AND NUTRITION
COLLEGE OF RURAL HOME SCIENCE, DHARWAD
UNIVERSITY OF AGRICULTURAL SCIENCES,
DHARWAD - 580 005

JUNE, 2014
ADVISORY COMMITTEE

DHARWAD (PUSHPA BHARATI)
JUNE, 2014 MAJOR ADVISOR

Approved by :
Chairman : ____________________________
(PUSHPA BHARATI)

Members : 1. __________________________
(BHARATI CHIMMAD)

2. __________________________
(KASTURIBA B.)

3. __________________________
(SHOBHA NAGNUR)

4. __________________________
(JYOTI .V. VASTRAD)
CONTENTS

Sl.
Chapter Particulars
No.
CERTIFICATE
ACKNOWLEDGEMENT
LIST OF TABLES
LIST OF FIGURES
LIST OF PLATES
LIST OF APPENDICES
1 INTRODUCTION
2 REVIEW OF LITERATURE
2.1 Protein-energy malnutrition
2.2 Nutritional status of preschool children
2.3 Development of supplementary foods
2.4 Impact of supplementation on nutritional status
2.5 Impact of supplementation on cognitive development
2.6 Impact of nutrition education
3 MATERIAL AND METHODS
3.1 Screening of preschool children for nutritional status
3.2 Development of protein and energy dense multigrain mix suitable for
preschool children
3.3 Impact of developed mix in combating malnutrition
3.4 Nutritional education of mothers of intervention group
3.5 Statistical Analysis
4 EXPERIMENTAL RESULTS
4.1Screening of preschool children of rural Dharwad for nutritional status
4.2 Formulation of Protein and Energy Dense multigrain mixes
4.3 Impact of feeding intervention on nutritional status
4.4 Details of nutrition education
5 DISCUSSION
5.1 Nutritional status of preschool children
5.2 Formulation of protein-energy dense mixes
5.3 Impact of developed mix in combating malnutrition
5.4 Educational intervention
6 SUMMARY AND CONCLUSION
REFERENCES
APPENDICES
LIST OF TABLES

Table
Title
No.
1 Details of malnourished children in Karnataka
2 Number of preschool children included for the study
3 Age and gender wise distribution of preschool children
4 Mean anthropometric measurements of preschool children
5 Categorization of children based on different indices
5a. Weight for Age
5b. Height for Age
5c. Weight for Height, Mid Upper Arm Circumference and Head to Chest
ratio
6 Mean food intake of preschool children
7 Mean nutrient intake of preschool children
8 Classification of children based on per cent adequacy of nutrient intake
9 Food provided in anganwadi centers
10 Formulation of protein and energy dense multigrain mixes
11 Energy, protein content and amino acid scores of formulated mixes
12 Product trials using selected mixes
13 Mean sensory scores for protein and energy dense mixes
14 Proximate, mineral and vitamin composition of selected protein and energy
dense multigrain mix flour
15 In vitro starch digestibility (IVSD) of protein and energy dense mixes
16 Effect of storage on moisture and free fatty acid content of protein and
energy dense mixes
17 Correlation among biochemical constituents of mixes during storage
18 Correlation among biochemical constituents and sensory scores during
storage of mixes
19 Acceptability of laddu and thepla by beneficiaries and stake holders
20a Cost estimation of PED mix I
20b Cost estimation of PED mix II
21 Utilization of the protein energy dense mixes
22 Demographic profile of preschool children selected for intervention

Contd…
Table
Title
No.
23 Family characteristics and physical facilities of the households of
preschool children
24 Feeding practices of selected children
25 Type and form of supplementary foods given to preschool children
26 Mean anthropometric measurements of preschool children selected for
intervention study
27 Impact of feeding intervention on anthropometric measurements of
preschool children
28 Impact of feeding intervention on head and chest circumference of
preschool children
29 Impact of intervention on shift in category of malnutrition
29a. Based on weight for Age
29b. Based on height for Age
29c.Based on Weight for Height, Mid Upper Arm Circumference and Head
to Chest ratio
30 Impact of intervention on food intake of selected preschool children
30a Analysis of variance for impact of intervention on dietary intake of
preschool children
31 Impact of intervention on nutrient intake of selected preschool children
31a Analysis of variance for impact of intervention on intake of nutrients
32 Classification of children based on per cent adequacy of nutrient intake
before and after intervention
33 Impact of feeding intervention on morbidity status of selected preschool
children
34 Impact of intervention on cognitive score of preschool children
35 Distribution of preschool children by level of cognitive abilities before and
after intervention
36 Association of nutritional status with family characteristics and physical
facilities of the households of preschool children of experimental group
37 Association of nutritional status with family characteristics and physical
facilities of the households of preschool children of control group

38 Association of nutritional status with feeding practices of selected
preschool children

Contd…
Table
Title
No.
39 Details of educational intervention sessions
40 Mean knowledge scores of mothers on different aspects of malnutrition before and
after the education intervention
41 Distribution of mothers based on knowledge scores before and after intervention
42 Impact of intervention on knowledge scores of mothers
43 Association of mothers knowledge level with nutritional status of children of
experimental and control group
44 Nutritional status of subject (Case 1)
44a Food intake of subject before and after intervention
44b Nutrient intake of subject before and after intervention
45 Nutritional status of subject (Case 2)
45a Food intake of subject before and after intervention
45b Nutrient intake of subject before and after intervention
46 Nutritional status of subject (Case 3)
46a Food intake of subject before and after intervention
46b Nutrient intake of subject before and after intervention
47 Nutritional status of subject (Case 4)
47a Food intake of subject before and after intervention
47b Nutrient intake of subject before and after intervention
48 Nutritional status of subject (Case 5)
48a Food intake of subject before and after intervention
48b Nutrient intake of subject before and after intervention
49 Nutritional status of subject (Case 6)
49a Food intake of subject before and after intervention
49b Nutrient intake of subject before and after intervention
50 Nutritional status of subject (Case 7)
50a Food intake of subject before and after intervention
50b Nutrient intake of subject before and after intervention
51 Nutritional status of subject (Case 8)
51a Food intake of subject before and after intervention
51b Nutrient intake of subject before and after intervention
52 Nutritional status of subject (Case 9)
52a Food intake of subject before and after intervention
52b Nutrient intake of subject before and after intervention
53 Nutritional status of subject (Case 10)
53a Food intake of subject before and after intervention
53b Nutrient intake of subject before and after intervention
54 Categorization of children based on different classifications
55 Categorization of children based on different classifications before and after
intervention
LIST OF FIGURES
Figure
Title
No.
1 Undernourishment in 2010, by region (millions)
2 Malnutrition throughout life cycle
3 Conceptual framework for understanding causes of malnutrition
4 Study Design
5 Map showing study area
6 Flow diagram for preparation of protein and energy dense mixes
7 Adequacy (%) of nutrient intake of preschool children
8 Energy and protein content of anganwadi food provided to preschool
children and per cent adequacy
9 Dietary fibre content of protein and energy dense mix I and II
10 In vitro protein digestibility of protein and energy dense mix I and II
11 Per cent increase in moisture and free fatty acid (FFA) content of protein
and energy dense mixes on storage
12a Effect of storage on the sensory attributes of laddu of PED mix I
12b Effect of storage on the sensory attributes of thepla of PED mix II
13 Per cent change in height, weight and MUAC of selected preschool children
on intervention
14 Per cent change in head and chest circumference of selected preschool
children on intervention
15 Impact of intervention on deviation in height and weight from NCHS
standards
16a Per cent gain in knowledge scores of mothers on different aspects of
malnutrition
16b Per cent retention in knowledge scores of mothers of experimental group on
different aspects of malnutrition
LIST OF PLATES

Plate
Title
No.
1 Assessment of nutritional status of preschool children
2 Assessment of cognitive performance of preschool children
3 Protein and energy dense mixes and its products
4 Storage quality evaluation
5 Acceptability by target group and stake holders
6 Utilization of PED mix I
7 Utilization of PED mix II
8 Feeding intervention to children of experimental group
9 Teaching aids developed for educational intervention
10 Conducting nutritional education sessions
11 Children selected for case study
LIST OF APPENDICES
Appendix No. Title
I Preparation of products of developed mixes
II
Score card for evaluation of products of protein and energy
dense mixes
III
Estimation of total dietary fibre (AOAC 2000)
IV
Estimation of in vitro protein digestibility
V
Estimation of in vitro starch digestibility
VI
Estimation of free fatty acids
VII
Schedule to elicit information from mothers of selected preschool
children
VIII
Pandey's Cognitive Development Score Card
IX
Nutritional knowledge of mothers
X
Effect of storage on the sensory attributes of PED MIX I and II
XI
Power point presentation on Malnutrition and its preventive
measure
XII
Booklet on Malnutrition and its preventive measure
XIII
Folder on balance diet for preschoolers
XIV
Brochure on protein and energy dense foods for prevention
of malnutrition
INTRODUCTION
“The years between birth and age five are the foundation upon which successful lives are built”
Preschool children are the children in the age group of 3-6 years. Preschool children
constitute one of the most nutritionally vulnerable segments of the population. Nutrition during the first
five years has an impact not only on growth and morbidity during childhood, but also acts as a
determinant of nutritional status in adolescent and adult life.
Malnutrition is derived from the etymological origins malus (bad) and nutire (to nourish). It
conveys and denotes the sense of improper nutritional status, outside the norm of healthy boundaries.
Dynamic changes in the nature of developing societies and deepening of our understanding of human
and clinical nutrition have put a changing face on the problem of malnutrition in developing countries
(Szajewska, 2009).
According to WHO (Anon., 2012), globally, 162 million under-fives were stunted among them
56 per cent lived in Asia and 36 per cent in Africa; 99 million under-fives were underweight among
them 67 per cent lived in Asia and 29 per cent in Africa. Fifty million children under-five were wasted
and 17 million were severely wasted. Approximately 71 per cent of them lived in Asia and 28 per cent
in Africa, with similar figures for wasted children (69 and 28 % respectively).
Children who suffer from wasting face a markedly increased chance of death. According to
UNICEF, 13 per cent of children under five years old in the developing world were wasted and five per
cent were extremely wasted, an estimated 26 million children (Anon., 2011).
In the developing world UNICEF estimates 129 million children under five to be underweight,
nearly one in four and ten per cent of them being severely underweight. The prevalence of
underweight is higher in Asia than in Africa, with rates of 27 and 21 per cent, respectively (Anon.,
2011).
Nineteen per cent of world’s children live in India. India is home to more than one billion
people, of which 43 crores were children in the age group of 0-18 years; 16 crores children were in
the age group of less than six years. Among these around 46 per cent of all children below the age of
three were too small for their age, 47 per cent were underweight and at least 16 per cent were
wasted. Many of these children were severely malnourished (Anon., 2012a).
According to National Family Health Survey (2010-12) of Karnataka, among 30 crore
preschool children 63.61 per cent were mildy malnourished with 34.23 and 2.17 per cent moderate
and severe malnourishment. About 3,323 children were suffering from malnutrition in Dharwad district
alone. According to a survey conducted up to August 2012 the number of malnourished children in
Hubli-Dharwad were 836, Dharwad rural were 808, Navalgund - 516, Kalghatagi - 442, Kundgol - 374
and Hubli rural were 347 (Mulla, 2012).
Although India has made tremendous advances in science, medicine, information technology
and many other fields have experienced unprecedented economic growth over the past decade,
malnutrition remains unacceptably high. Poor nutrition is a major cause of other health problems in
the country, including high infant and maternal mortality. The then Prime Minister, Dr. Manmohan
Singh, declared the problem of malnutrition to be a “curse that we must remove” from India, in his
address to the nation on Independence Day, 15th August 2008.
The national costs of malnutrition are indicated to be very high: a vicious intergenerational
cycle of poor health, high death rates, poor quality of life, decreased mental capacity and reduced
work productivity. Productivity losses are estimated at more than ten per cent of lifetime earnings for
individuals and three per cent of gross domestic product for the nation. This means that improvements
in nutrition are important for a healthy and productive life as well as for continued economic growth
and development (Anon., 2012).
The global community has set a target of halving the prevalence of underweight children by
2015 as a key indicator of progress towards the Millennium Development Goal (MDG) of eradicating
extreme poverty and hunger. During 1996-2004, more than 26 per cent of world's under-five years
children were underweight for their age. The proportion ranged from one per cent in developed
countries to 27 per cent in developing countries (Sengupta et al., 2010).
The global prevalence of stunting in children under the age of five has declined 36 per cent
over the past two decades – from an estimated 40 per cent in 1990 to 26 per cent in 2011. This