PROJECT REPORT

NUTRITIONAL STATUS OF

PRESCHOOL (1-3 YEARS) CHILDREN

NAME: ………………………..

ENROLMENT NO: …………………..

SUBJECT CODE: DNHE 4

 TABLE OF
CONTENT
Chapter Titles Page

No. No.

I INTRODUCTION 2-7

II RESEARCH METHODOLOGY 8-10

III ANALYSIS AND 11-34

INTERPRETATIONS

IV CONCLUSIONS AND 35-38

RECOMMENDATIONS

BIBLIOGRAPHY 39-40

APPENDIX 41-50

1
 CHAPTER -1: INTRODUCTION

Rapid and unplanned urbanisation is a marked feature of Indian demography. The urban

population of India accounts for 27.8 percent of the total population equating to 285

million (Census of India, 2001). This represents a hundred fold increase in the past

century and 40 percent increase during the last decade. If urban India was considered as a

separate country, it would be the fourth largest in world, after China, India and the United

States (Agarwal, 2005).

Urbanisation is not an evil process. It is a welcome sign of transition. But unplanned

urbanisation can cause rapid migration to cities, resulting in slums having inhuman living

conditions (Davis, 2006). Urbanisation is also associated with several socioeconomic and

environmental problems. The major ones are housing shortage, unemployment,

congestion, pollution, possible increase in crime rates, inadequate services like water

supply, sanitation, drainage, sewerage and also defective educational, recreational, health

and welfare facilities.

However, the most basic and primary product of urbanisation is poverty and poor housing

conditions. It is reported that 23.6 percent of urban population is poor. Their expenditure

on consumption goods is less than Rs. 454 per month. These estimates, in fact, do not

reflect the true magnitude of urban poverty because of the unaccounted and unrecognized

squatter settlements, floating population and other „invisible‟ population residing on

pavements, construction sites, urban fringes etc.

Housing is a visible dimension of poverty in urban areas. Due to increasing economic

activities in the metropolitan cities, people move into cities, and consequently the urban

2
poor are forced to live in unhygienic slums and squatter settlements. Therefore

development of slums form an integral component of the phenomenon of urbanisation.

A slum represents a habitat unit with defective physical, social and economic living

conditions. UN‐Habitat Report (2003) attempts defining a slum household as „a group of

individuals living under the same roof that lacks one or more of the following conditions:

access to safe water, sanitation, secure tenure, durability of housing and sufficient living

area‟.

The concept of slums and its definition vary from country to country depending upon the

socioeconomic conditions of each society. The basic characteristics of slums as given by

Government of India are ‐ dilapidated and infirm housing structures, poor ventilation,

acute overcrowding and faulty alignment of streets, inadequate lighting and paucity of

safe drinking water, water logging during rains, absence of toilet facilities and non

availability of basic physical and social services (Chandramouli, 2003).

The pitiable living conditions in the slums of India have already been highlighted in the

Census of India (2001), referring to the fact that slums are usually unhygienic and

contrary to all norms of planned urban growth.

The global picture also presents the same trend depicting unacceptably high rate of

urbanisation and massive increase in slum population. Many cities across the world have

slums leading to over population of urban neighbourhood. It has been estimated that

about a third of the world‟s urban residents which comes upto three billion, dwell in

slums (UN‐ Habitat Report, 2003).

In developing countries also, the number of people living in slums and shanty towns

3
represent about one third of the people living in cities (Harpham and Stephens, 1991).

United Nations Development Programme (2009) reported that India‟s urban population is

also increasing at a faster rate than its total population. With over 575 million people,

India will have 41 percent of its population living in cities and towns by 2030.

The data provided by NSSO (2004) revealed that there are 52 thousand slums located in

the urban areas of the country and about 8 million urban households live in these slums.

This represented as high as 14 percent of the total urban households in the country.

Correspondingly, the total number of urban poor has also increased by 13.9 percent (9.86

million) in the year 2007 (Government of India, 2007). As reported by Government of

India (2004), the number of slums was highest in Maharashtra (32%) followed by West

Bengal (16%) and Andhra Pradesh (15%).

The living conditions in slums are generally not very conducive for the physical, mental,

moral and social development of its inhabitants. Insanitary living conditions coupled with

low purchasing power and poor nutrition add to the episodes of infection particularly

respiratory and diarrhoeal diseases (Gracey, 2002).

Such a situation ultimately has a negative impact on the health and nutritional status of

the slum population especially the women of reproductive age and their children. As

WHO (1999) rightly pointed out, when infrastructure and services are lacking, urban

slums and settlements are amongst the world‟s most life‐threatening environment. Even

the common infectious diseases can often become catastrophic to the children living

there.

It was estimated that in India, about 6 million children in the age group of zero to six

years live in slums (Census of India, 2001). High incidence of undernutrition, high

4
mortality and morbidity with a neonatal and child survival rate far lower than the urban

average, are some of the features observed by Agarwal (2005).

As per Fry et al. (2002) neonatal, infant and under five mortality rates are considerably

higher among urban poor when compared to the national averages. In urban dwellings,

one out of ten children born during an year, is not destined to see their fifth birthday and

one out of 15 children is not likely to see their first birthday especially in less developed

states like Uttar Pradesh, Madhya Pradesh, Rajasthan, Bihar and Orissa (Agarwal, 2005).

Infant mortality rate among slum population is 1.6 times higher than the corresponding

national figures. The debilitating environment in urban poor settlements where 1.1

million births take place every year, may be the root cause of this high mortality rate.

Further high incidence of low birth weight, at the rate of 50 percent of the urban poor

neonates and faulty feeding habits including inappropriate breast feeding also add to the

severity of this problem.

Although there has been a significant decline in child mortality over the past two

decades, more than 80 percent of all deaths in India still occur among children below five

years of age.

Among those who survive, more than half of these urban poor children do not attain their

full potential in terms of growth and development. They are underweight or stunted.

Protein energy deficiency of varying degrees continues to be a major health problem of

the under five category of the urban poor. Respiratory infection and diarrhoea, a product

of insanitary living environment are the common illnesses that add to the severity of

protein energy deficiency. Hookworm infestation, anaemia, vitamin A and B complex

deficiencies also pose equally tough challenges to the health and well being of

5
preschoolers.

Child malnutrition has its roots in mother‟s womb. There are clear‐cut evidences to show

that the growth and development of children and the predisposition to metabolic health

problems in the future, are closely associated with maternal nutrition and other

socioeconomic parameters like female literacy, family size, purchasing power etc. Yet,

poor maternal nutrition is the single most important factor for low birth weight babies,

who are at the risk of infection, undernutrition, impaired physical and mental

development. Rao et al. (2010) also pointed out that women with poor health and

nutrition are more likely to give birth to low weight infants.

The most prominent type of nutritional problems among mothers, which have a dent on

child health are chronic energy deficiency and low BMI (Body Mass Index), iron and

iodine deficiency disorders (Kotwal et al., 2008). A number of factors are responsible for

this, where the living environment does play a significant role. A transition in the life

style of women who live in urban slums; from the role of a wife and a mother, to

members of workforce demands a lot of compromise in their family and child rearing

practices. In fact they are forced to take up outside job to support their family in an urban

set up. Owing to illiteracy, lack of education and skill, they work in unorganised sectors.

They are often underpaid or exploited.

The mothers who involve in highly labour intensive task do not get sufficient time to

recuperate after delivery. This further stresses mother‟s nutritional status and reduces her

bodily reserves (Rode, 2009), which in turn affects the lactation performance of mothers

leading to early weaning and early introduction of improper supplementary foods. The

compulsion to take up jobs in the informal labour market and the fear of losing it even on

6
occasional absence, impose constraints on their child rearing practices too.

As a result, young children are fed insufficient number of times with ill balanced diet, by

other care givers; who may be older siblings, relatives or neighbours. Available health

facilities for prenatal and postnatal care, immunization, family planning and control of

communicable diseases are also not utilized appropriately because of mother‟s work in

unorganized sectors. Ultimately the young children in urban slums setup are deprived of

maternal care and attention, when they need it to the most.

It is therefore imperative to have some targeted strategies to improve the health and

nutritional profile of mothers and children among urban poor. The population projection

with a cent percent increase in urban agglomeration by 2026 (Prakash, 2002), further

demands the urgency for such an approach to tackle the challenges emerging out of such

situations.

An essential requisite to evolve viable strategies to mitigate health and nutritional

problems of slum dwellers is baseline information. The present study was an attempt in

this direction.

Janakpuri with largest agglomeration of slums was identified as a potential area. The

study was therefore been conducted in the urban slums of Janakpuri, with the main focus

on assessing the nutritional status of preschool children.

OBJECTIVES OF THE STUDY

The specific objective of the study is to analyze the nutritional status of preschool

children in slum areas of Janakpuri, New Delhi.

7
 CHAPTER-2: RESEARCH METHODOLOGY

Research methodology is a way to systematically investigate the research problem. It

gives various steps in conducting the research in a systematic and a logical way. It is

essential to define the problem, state objectives and hypothesis clearly. The research

design provides the details regarding what, where, when, how much and by what means

enquiry is initiated. Every piece of research must be planned and designed carefully so

that the researcher precedes a head without getting confused at the subsequent steps of

research. The researcher must have an objective understanding of what is to be done,

what data is needed, what data collecting tools are to be employed and how the data is to

be statistically analyzed and interpreted. There are a number of approaches to the design

of studies and research projects all of which may be equally valid. Research is a

systematic attempt to obtain answers to meaningful questions about phenomenon or

events through the application of scientific procedures. It an objective, impartial,

empirical and logical analysis and recording of controlled observation that may led to

the development of generalizations, principles or theories, resulting to some extent in

prediction and control of events that may be consequences or causes of specific

phenomenon. Research is a systematic and refined technique of thinking, employing

specialized tools, instruments and procedures in order to obtain a more adequate solution

of a problem than would be possible under ordinary mean. Thus, research always starts

from question. There are three objectives of research factual, practical and theoretical,

which gives rise to three types of research: historical, experimental and descriptive.

Research design has been defined by different social scientists in a number of ways. All

these definitions emphasize systematic methodology in collecting accurate information

8
for interpretation. Selltize et al. (1962) expressed their views as, “Research designs are

closely linked to investigator‟s objectives. They specify that research designs are either

descriptive or experimental in nature.” Research design tells us how to plan various

phases and procedures related to the formulation of research effort (Ackoff Russell,

1961). Miller (1989) has defined research design, “as the planned sequence of the entire

process involved in conducting a research study.”

Kothari (1990) observes, “Research design stands for advance planning of the method to

be adapted for collecting the relevant data and the techniques to be used in their research

and availability of staff, time and money.” In this way selecting a particular design is

based on the purpose of the piece of the research to be conducted. The design deals with

selection of subjects, selection of data gathering devices, the procedure of making

observations and the type of statistical analysis to be employed in interpreting data

relationship”.

Keeping in view the requirements for an adequate design as discussed above, the

investigator formulated an appropriate design for the purpose of the present study. The

details about the same are given as under.

This is a descriptive study to analyze the nutritional status of preschool children in slum

areas of Janakpuri, New Delhi. Two slums areas were randomly selected and a

comprehensive list of the registered slum areas in this ward was obtained from the local

government secretariat in New Delhi. Parents of attending under-2 children were

contacted and informed for their consent.

Sample Selection

Total 100 young mothers and their preschool children (150) were selected for the

9
proposed study.

Data Collection

Data collection was carried out with a socio-economic and nutritional survey based on

Gomez Classification (1956) and Kuppuswamy (1981).

Data collection was also being carried out with a clinical nutrition survey.

Clinical Assessment

Clinical examination has always been and remains an important practical method for

assessing nutritional status (Jelliffe, 1989). Clinical examination also helps to assess the

level of health of individuals or of population groups in relation to the food they

consume. It involves external examination of the body for changes in superficial

epithelial tissues especially hair, face, skin, gums, teeth, eyes and lips with the help of a

qualified physician, using a clinical assessment schedule (Appendix).

Data Analysis

In this study, statistical analysis of the data was done using students t-test, Chi square,

and coefficient of correlation. Chi square test was used to analyze the association

between variables. Besides percentages, mean and standard deviation will also be used in

data analysis.

10
CHAPTER-3: ANALYSIS AND INTERPRETATIONS

When data has been obtained, it is necessary to organize them for the interpretation.

Qualitative data may have to be summarized and treated statistically to make significant

clean.” Olive R.A.G.

According to Good, Barr and Scates, “Analysis is a process which enters into research in

one form or another, from the very beginning. It may be fair to say that research, in

general, consists of two large steps i.e. gathering of data and the analysis of research

data.”

NUTRITIONAL STATUS OF PRESCHOOL CHILDREN

Nutrition is an input to and foundation for health and development (WHO, 2010).

Childhood undernutrition remains a major health problem in India especially in slums

(Bisai et al., 2009). To assess the nutritional status of children a number of techniques are

made use of in these days.

Child growth is the most widely used indicator of nutritional status (World Health

Statistics, 2009). Anthropometric measurements are the most widely used method to

assess nutritional status. The use of these measurements depends on age assessment and

normal values for comparison (ICMR, 2005).

11
Age and gender wise distribution

Age and gender wise distribution of the sample is presented in table 1.

Table 1: Age and gender wise distribution of preschool children

Age (yrs) Male Female Pooled

1 25.83 34.13 29.52

1.5 14.35 11.97 13.29

2 28.7 22.15 25.79

2.5 12.91 6.58 10.10

3 18.18 22.15 21.27

Pooled 55.6 44.4 100

(Number indicates percentages)

12
 Figure 1: Age and gender wise distribution of preschool children

35
30
25
20 Male
15 Female
Pooled
10
5
0
1 1.5 2 2.5 3
Sample for the study included 150 children out of which 55.6 percent were boys and 44.4

percent girls.

Age wise distribution indicated that children of 1 years constituted 29.52 percent of the

sample which was the highest followed by 2 year old children (25.79%) and three years

(22.15%). Female population outnumbered males in the age group of one and three years

Figure 1 presents age and gender wise distribution of preschool children.

13
Nutritional status based on Gomez classification

Various methods have been suggested to classify children into various nutritional grades,

the most widely used one is the Gomez classification (Gomez et al., 1956), in which the

children are classified as having first, second or third degree malnutrition if their weight

for age range is 75 to 90 percent, 60 to 75 percent or less than 60 percent respectively of

the reference median (Bamji et al., 1998). The following table presents the details.

Table 2: Nutritional profile of preschool children based on Gomez classification®

Age Male Female

(yrs)

Normal Grade I Grade II Grade III Normal Grade I Grade II Grade III

(≥90) Malnutrition Malnutrition Malnutrition (≥90) Malnutrition Malnutrition Malnutrition

(75-89.99) (60-74.99) (<60) (75-89.99) (60-74.99) (<60)

1 20.4 42.6 37.0 Nil 21.1 49.1 24.6 5.3

1.5 36.7 46.7 16.7 Nil 25.0 60.0 15.0 Nil

2 25.0 48.3 21.7 Nil 29.7 54.1 16.2 Nil

2.5 18.5 33.3 44.4 5.0 27.3 45.5 27.3 Nil

3 36.8 44.7 18.4 3.7 45.2 23.8 31.0 Nil

Pooled 26.79 44.01 27.27 1.91 29.94 44.91 23.35 1.79

(Number indicates percentages)

14
 Figure 2: Nutritional profile of boys based on Gomez classification®

50
45
40 Normal
35
30 Grade I
25 Malnutrition
20 Grade II
15 Malnutrition
10 Grade III
5 Malnutrition
0
1 2 3

15
 Figure 3: Nutritional profile of girls based on Gomez classification®

60

50 Normal
40 Grade I Malnutrition
Grade II Malnutrition
30 Grade III Malnutrition
20

10

0
1 2 3

As per Gomez classification 26.79 percent boys and 29.94 percent of girls were found to

have normal nutritional status. Girls were in a slightly better position than boys. More

number of normal children irrespective of gender were in the age group of 3 years.

Among the various grades of malnutrition, majority of boys (44.01%) and girls (44.91%)

had Grade I malnutrition followed by Grade II and Grade III. Here also gender

differences was not noticed much. The rate of prevalence of Grade I malnutrition was

uniformly high in all age groups among boys (33.3% to 48.3%). Almost half of the

population fell under this category. Grade II malnutrition found to occur among 27.27

percent with highest incidence among 4.5 year age group. Grade III malnutrition was

observed on only 1.91 percent of boys. This was also noticed among 4.5 to 5 year age

16
group.

This trend in prevalence of malnutrition among various age groups was followed in the

case of girls also; with the highest incidence of (44.91%) followed by Grade II (23.35%)

and Grade III (1.79%). The only difference observed was the incidence of severe

malnutrition (Grade III) among younger age groups (1 yrs) in girls; as against older

groups (2.5 to 3.0 years) in boys.

According to a study conducted by Mridhula et al. (2004) as per IAP criteria 60.5 percent

under five children were found to be suffering from various grades of protein energy

malnutrition and severe protein energy malnutrition was present in 5.2 percent. Girl

children are more likely to be undernourished than boys (Chaudhuri, 2007).

17
SOCIOECONOMIC STATUS AND NUTRITIONAL STATUS OF PRESCHOOL

CHILDREN

Socioeconomic scale formulated by Kuppuswamy (1981) was used for reference to

classify the economic status of the sample. The association between socioeconomic status

and different grades of malnutrition was studied and presented in table 3.

Table 3: Socioeconomic status and nutritional status of preschool children

Socioeconomic Gomez Classification Pooled X2 ‘p’

Status Normal Grade I Grade II Grade III value value

(≥90) Malnutrition Malnutrition Malnutrition

(75-89.99) (60-74.99) (<60)

Middle 22.2 35.6 37.8 4.4 11.96 6.383 0.094NS

Low 29.0 45.6 23.9 1.5 88.04

(Number indicates percentages) NS = Not Significant

18
 Figure 4: Socioeconomic status and nutritional status of preschool children

Socioeconomic status of family affects the nutritional status (Harishankar et al., 2004).

When the incidence of different grades of malnutrition was distributed as per

socioeconomic status.

There observed no significant difference. This indicated that children in both middle and

low socioeconomic status were equally affected by malnutrition. Figure 4 presents the

details. It was also surprising to note that children with normal nutritional status were

more in the low socioeconomic status (29.0%) than the middle class group (22.2%). So

also the Grade II and Grade III malnutrition.

Middle class more affected than the low status group. Birth order, age, type of family,

number of living children, literacy status of mother and calorie intake were significantly

associated with grades of malnutrition and frequent episodes of infection are also

19
correlated to stunting (Hassan and Jain, 2009). Children of poor socioeconomic status

group had moderate and severely malnourished (Elankumaran, 2003). In the present

study middle class group was also equally affected suggesting that the factors other than

poverty and poor access to services play an important role as determinants of under

nutrition in preschool children (Ramachandran, 2007).

NUTRITIONAL DISORDERS

Nutrients obtained through food have vital effects on physical growth and development,

maintenance of normal body function, physical activity and health. Nutritious food is

important to sustain life (ICMR, 1991). Nutritional disorders occur on deficiency of

nutrient intake.

Occurrence of clinical manifestations

Clinical examination has always been and remains an important practical method for

assessing nutritional status of a community (Jelliffe, 1966). The data procured by the

clinical survey conducted among the preschoolers, was analysed and presented in this

section.

Clinical signs of protein energy and mineral malnutrition

Protein energy malnutrition is the most common nutritional disorder among children in

developing countries like India (Bamji et al., 1998). Age wise distribution of sample

based on clinical signs is furnished in the following table:

20
 Table 4: Clinical signs of protein energy and mineral deficiencies among

preschoolers

Particulars Age in years (n = 150) Pooled

1.0 1.5 2.0 2.5 3.0

Protein energy deficiency

Lack of Hair luster

Boys 22 10 10 15 18 15.4

Girls 26 10 5 36 21 19.2

Iron deficiency

Pale tongue

Boys 13 7 3 7 8 7.7

Girls 5 10 8 18 7 7.8

Flourosis

Boys 21 33 20 15 47 26.3

Girls 23 20 22 46 36 26.9

Dental Caries

Boys 24 43 50 48 34 39.2

Girls 44 4 38 27 50 41.9

(Number indicates Percentage)

21
20

15

10 Boys
Girls
5

0
Lack of Hair Luster

8
7
6
5
4 Boys
3 Girls
2
1
0
Pale Tongue

22
 27
26.8
26.6
26.4
26.2 Boys
26 Girls
25.8
25.6
25.4
Flourosis

42
41.5
41
40.5
40
Boys
39.5
Girls
39
38.5
38
37.5
Dental caries

Protein energy malnutrition was present among the children of all age groups, but severe

cases of kwashiorkor and marasmus were absent.

23
While symptoms like lusterless dry rough hair was found among the boys (15.4%) as

well as girls (19.2%).

Anaemia cases were there in both the groups. The symptoms of paleness of tongue was

observed, while koilonychia was absent. Irrespective of gender, paleness of tongue was

seen among both boys (7.7%) and girls (7.8%). The incidence of anaemia among 1 year

boys and 2.5 year girls.

Flourosis was noticed among the sample involving 26.3 percent of male and 26.9 percent

of female children. Severe form of flourosis as chalky, pitted and mottled teeth was seen

among 3 year old boys (47.4%) and 2.5 year old girls (45.5%).

Results of dental observation showed that dental hygiene was low among the children.

Dental caries was comparatively more in girls (41.9%) than in boys (39.2%). Half of the

boys in the age group of 2 years and girls of 3 years had dental caries.

In short, the clinical manifestation of protein energy and iron deficiencies were more

prevalent among the preschoolers in the slum areas severe form of flourosis was also seen

in all age groups irrespective of gender. Dental caries was the most prominent problem,

affecting both boys (39.2%) and girls (41.9%). Girls in general were more affected than

boys.

Age wise prevalence showed that irrespective of gender the upper age groups (2.5 to 3

years) were more seriously affected than younger ones. Only exception was the

nutritional deficiencies among boys, where 1 year old children were most affected.

24
Clinical signs of vitamin deficiencies

The details are shown in table 5.

Table 5: Clinical signs of vitamin deficiencies among preschoolers

Particulars Age in years (n = 150) Pooled

1.0 1.5 2.0 2.5 3.0

Vitamin A deficiency

Night Blindness

Boys Nil Nil Nil Nil 4 0.5

Girls Nil Nil Nil Nil Nil Nil

Conjunctival Xerosis

Boys 9 30 13 11 18 15.3

Girls 21 5 13 18 14 15.6

Bitot’s Spot

Boys Nil Nil Nil Nil 4 0.5

Girls Nil Nil Nil Nil Nil Nil

Corneal Xerosis

Boys Nil Nil 2 Nil 5 1.4

Girls 2 Nil 3 9 7 3.6

Vitamin B Complex deficiency

25
Angular stomatitis

Boys 6 Nil 5 4 3 3.82

Girls 7 Nil 3 9 2 4.19

Cheilosis

Boys 1.9 Nil Nil Nil Nil 0.5

Girls Nil Nil Nil Nil Nil Nil

Glossitis

Boys 7 Nil 8 4 5 5.74

Girls 7 10 5 9 Nil 5.4

Phrynoderma

Boys 3 Nil Nil Nil Nil 1

Girls Nil Nil 3 Nil Nil 0.6

Vitamin C deficiency

Spongy and bleeding Gums

Boys 2 Nil 2 Nil 3 1.5

Girls Nil Nil Nil Nil Nil Nil

Vitamin D deficiency

Knock knee

Boys 4 Nil Nil 11 Nil 2.4

26
Girls 2 Nil Nil 2 Nil 1.2

Bow legs

Boys 2 Nil Nil Nil Nil 0.5

Girls Nil 5 Nil Nil Nil 0.6

(Number indicates Percentage)

0.5

0.4

0.3
Boys
0.2 Girls

0.1

0
Night Blindness

27
 15.6
15.55
15.5
15.45
15.4 Boys
15.35
Girls
15.3
15.25
15.2
15.15
Conjunctival Xerosis

0.5

0.4

0.3
Boys
0.2 Girls

0.1

0
Bitot's Spot

28
 4
3.5
3
2.5
2 Boys
1.5 Girls

1
0.5
0
Corneal Xerosis

4.2

4.1

3.9 Boys
Girls
3.8

3.7

3.6
Angular Stomatitis

29
0.5

0.4

0.3
Boys
0.2 Girls

0.1

0
Cheilosis

5.8

5.7

5.6

5.5 Boys
Girls
5.4

5.3

5.2
Glossitis

30
 1

0.8

0.6
Boys
0.4 Girls

0.2

0
Phrynoderma

1.6
1.4
1.2
1
0.8 Boys
0.6 Girls

0.4
0.2
0
Spongy and bleeding

31
2.5

1.5
Boys
1 Girls

0.5

0
Knock Knee

0.6
0.58
0.56
0.54
0.52 Boys
0.5 Girls

0.48
0.46
0.44
Bow Legs

32
Vitamin A deficiency

Conjunctival xerosis and corneal xerosis, the two manifestations of vitamin A deficiency

were diagnosed among the preschoolers. Among the sample 15.3 percent of boys and

15.6 percent of girls had conjunctival xerosis followed by corneal xerosis involving 1.4

percent of boys and 3.6 percent of girls. Only one case each of nightblindness and bitot‟s

spot was also reported among 3 year old boys. Age wise distribution indicated that senior

age group (2.5 to 3.0 years) was slightly more affected; although not much a difference

was observed among the different age groups studied.

In India, Vitamin A Deficiency (VAD) is still a major micronutrient deficiency lurking

beneath childhood morbidity and mortality due to common illnesses (Bains et al., 2009).

Vitamin A deficiency often in association with protein energy malnutrition principally

affects preschool children. It is estimated that almost 250 million children in developing

countries are at risk (NIPCCD, 2007).

As given by Aneja et al. (2000) signs of Vitamin A deficiency like bitot‟s spot,

xeropthalmia and increased morbidity in terms of repeated bouts of acute respiratory

illness, diarrhoeal disease in infants and children and resultant mortality as well as night

blindness in pregnant women were rampant across most communities.

Ocular signs of vitamin A deficiency were more present among the children aged 1-5

years. Children of illiterate mothers suffered from vitamin- A deficiency. Nutrient intake

decreases with the increase of family size, and in children of multipara mothers

(Chatterjee et al., 2009).

The prevalence of night blindness, conjunctival xerosis and bitot‟s spot was more and it

increased significantly with increase in age, even this was higher among the children of

33
lower socioeconomic communities, in 3-5-year age group and those children of illiterate

mothers (Arlappa et al., 2009). All the deficiencies were more common amongst male

children (Sharma et al., 2009).

Vitamin A supplementation proved to be definitely effective to improve the health status

of the slum dwellers, about 75 percent of them suffered from at least one episode of acute

respiratory infections irrespective of the vitamin A supplementation (Kar et al., 2001).

Das et al. (2009) observed the overall prevalence of night blindness, bitot‟s spot and

conjunctival xerosis. Higher morbidity rate of diarrhoea, respiratory disease, measles and

skin disease was suggestive of high prevalence of vitamin A deficiency.

Vitamin B complex deficiency

Angular stomatitis, cheilosis, glossitis and phrynoderma were the symptoms observed. Of

which angular stomatitis and glossitis presented a slightly more prevalence rate than

others. However the overall prevalence rate was less than 5 percent. Here also girls of all

age groups were more affected than boys.

Vitamin C deficiency

Occurrence of vitamin C deficiency as spongy and bleeding gums was found only among

1.5 percent of the sample; that too among boys, not among girls.

Vitamin D deficiency

Knock knee (1.2 % to 2.4%) and bow legs (less than 1.0%) were the two manifestations

observed among preschool children. The age group of 1.0 years and 2.5 years were more

affected than other age groups.

34
 CHAPTER 4: CONCLUSIONS AND

RECOMMENDATIONS

CONCLUSIONS

Sample for the study included 150 children out of which 55.6 percent were boys and 44.4

percent girls.

Age wise distribution indicated that children of 1 years constituted 29.52 percent of the

sample which was the highest followed by 2 year old children (25.79%) and three years

(22.15%).

As per Gomez classification 26.79 percent boys and 29.94 percent of girls were found to

have normal nutritional status. Girls were in a slightly better position than boys. More

number of normal children irrespective of gender were in the age group of 3 years.

Among the various grades of malnutrition, majority of boys (44.01%) and girls (44.91%)

had Grade I malnutrition followed by Grade II and Grade III. Here also gender

differences was not noticed much. The rate of prevalence of Grade I malnutrition was

uniformly high in all age groups among boys (33.3% to 48.3%). Almost half of the

population fell under this category. Grade II malnutrition found to occur among 27.27

percent with highest incidence among 4.5 year age group. Grade III malnutrition was

observed on only 1.91 percent of boys. This was also noticed among 4.5 to 5 year age

group.

This trend in prevalence of malnutrition among various age groups was followed in the

case of girls also; with the highest incidence of (44.91%) followed by Grade II (23.35%)

and Grade III (1.79%). The only difference observed was the incidence of severe

35
malnutrition (Grade III) among younger age groups (1 yrs) in girls; as against older

groups (2.5 to 3.0 years) in boys.

It was also surprising to note that children with normal nutritional status were more in the

low socioeconomic status (29.0%) than the middle class group (22.2%). So also the

Grade II and Grade III malnutrition.

Protein energy malnutrition was present among the children of all age groups, but severe

cases of kwashiorkor and marasmus were absent.

While symptoms like lusterless dry rough hair was found among the boys (15.4%) as

well as girls (19.2%).

Anaemia cases were there in both the groups. The symptoms of paleness of tongue was

observed, while koilonychia was absent. Irrespective of gender, paleness of tongue was

seen among both boys (7.7%) and girls (7.8%). The incidence of anaemia among 1 year

boys and 2.5 year girls.

Flourosis was noticed among the sample involving 26.3 percent of male and 26.9 percent

of female children. Severe form of flourosis as chalky, pitted and mottled teeth was seen

among 3 year old boys (47.4%) and 2.5 year old girls (45.5%).

Results of dental observation showed that dental hygiene was low among the children.

Dental caries was comparatively more in girls (41.9%) than in boys (39.2%). Half of the

boys in the age group of 2 years and girls of 3 years had dental caries.

In short, the clinical manifestation of protein energy and iron deficiencies were more

prevalent among the preschoolers in the slum areas severe form of flourosis was also seen

in all age groups irrespective of gender. Dental caries was the most prominent problem,

36
affecting both boys (39.2%) and girls (41.9%). Girls in general were more affected than

boys.

Age wise prevalence showed that irrespective of gender the upper age groups (2.5 to 3

years) were more seriously affected than younger ones. Only exception was the

nutritional deficiencies among boys, where 1 year old children were most affected.

Conjunctival xerosis and corneal xerosis, the two manifestations of vitamin A deficiency

were diagnosed among the preschoolers. Among the sample 15.3 percent of boys and

15.6 percent of girls had conjunctival xerosis followed by corneal xerosis involving 1.4

percent of boys and 3.6 percent of girls. Only one case each of nightblindness and bitot‟s

spot was also reported among 3 year old boys. Age wise distribution indicated that senior

age group (2.5 to 3.0 years) was slightly more affected; although not much a difference

was observed among the different age groups studied.

Angular stomatitis, cheilosis, glossitis and phrynoderma were the symptoms observed. Of

which angular stomatitis and glossitis presented a slightly more prevalence rate than

others. However the overall prevalence rate was less than 5 percent. Here also girls of all

age groups were more affected than boys.

Occurrence of vitamin C deficiency as spongy and bleeding gums was found only among

1.5 percent of the sample; that too among boys, not among girls.

Knock knee (1.2 % to 2.4%) and bow legs (less than 1.0%) were the two manifestations

observed among preschool children. The age group of 1.0 years and 2.5 years were more

affected than other age groups.

37
RECOMMENDATIONS

 Similar studies may be conducted among the slum population of other cities of

New Delhi.

 A detailed study with a wider sample coverage could be undertaken to obtain

more information on these lines.

 An in-depth exclusively on goitre prevalence among preschool children of slum

could be done.

 A field based research on behaviour modifications of preschool children to

improve the nutritional status of children may be conducted.

 An action research could be undertaken on slum development: “to uplift one or

two selected slums by providing cost effective infrastructural and service needs

by a joint action of Governmental and Non- Governmental agencies and slum

organizations and an evaluation study on its impact on nutrition /health profile of

vulnerable groups.

38
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12-22.

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43
 APPENDIX

SOCIO ECONOMIC SCALE

Kuppuswamy’s Socioeconomic Status Scale

Ref: Kuppuswamy B. Manual of socioeconomic status (Urban), Manasayan, Delhi, 1981.

(A) Education Score

1. Profession or Honours 7

2. Graduate or post graduate 6

3. Intermediate or post high school diploma 5

4. High school certificate 4

5. Middle school certificate 3

6. Primary school certificate 2

7. Illiterate 1

(B) Occupation Score

1. Profession 10
2. Semi-Profession 6

3. Clerical, Shop-owner, Farmer 5

4. Skilled worker 4

5. Semi-skilled worker 3

6. Unskilled worker 2

7. Unemployed 1

Income Score

1. Rs.19575 12
2. Rs.9788-19574 10

3. Rs.7323-9787 6

4. Rs.4894-7322 4

44
5. Rs.2936-4893 3

6. Rs.980-2935 2

7. Rs.=979 1

Total Score Socioeconomic class

1. 26-29 Upper (I)

2. 16-25 Upper Middle (II)

3. 11-15 Middle Lower middle (III)

4. 5-10 Lower Upper lower (IV)

5. <5 Lower (V)

CLINICAL NUTRITION SURVEY

Name of slum:

Name of the sample:

Age

Sex

Serial No.

I. General appearance Scores

Good 3

Fair 2

Poor 1

45
 Very Poor 0

II Eyes (A) Conjunctiva

1. Xerosis

Absent 3

Slightly Dry 2

Dry wrinkled 1

Very dry and Bitots spots 0

2. Pigmentation

Normal 3

Slight discolour 2

Brown Patches 1

Earthy discolour 0

3. Discharge

Absent 3

Watery 2

MicroPurulant 1

Purulant 0

B) Cornea

1. Xerosis

46
 Absent 3
Slightly dry 2
Diminished transparency 1
Ulceration 0

2. Vascularisation

Absent 2

Infection of blood vessels 1

Vascular Cornea 0

C) Lids

1. Excoriation

Absent Q 2

Slightly excoriation 1

Blepharitis 0

2. Folliculosis

Absent 3

Few granules 2

Extensive granules 1

Hypertrophy 0

3. Angular Conjunctiva

47
 Absent 1

Present 0

4. Functional night blindness

Absent 1Present 0

III Mouth

1. Lips Condition

Normal 3

Angular stomatitis mild 2

Angular stomatitis marked 1

Cheilosis 0

2. Tongue Colour

Normal

Pale not coated 2

Red 1

Red and raw 0

3. Surface

Normal 3

Fissured 2

48
 Ulcered 1

Glazed Atrophic 0

4. Normal Buccal mucosa

Normal 1

Stomatitis 0

5. Gums

Normal 4

Spongy 3

Bleeding 2

Pyorrhoea 1

Retracted 0

IV. Teeth

1. Flourosis

Absent 3

Chalky 2

Pitting 1

Mottled &Discouloured 0

2. Caries

Absent 2

49
 Slight 1

Marked 0

Hair Condition

Normal 3

Loss of luster 2

Discoloured and dry 1

Sparse &brittle 0

Skin

(A) General

Appearance

Normal 3

Loss of luster 2

Dry and rough or 1

Crazy pavements 1

Hyperkeratosis,Phrynoderma 0

Elasticity

Normal 2

Diminished 1

Wrinkled skin 0

50
(B) Regional

Trunk

Normal 1

Dermatitis pigmentation 0

Face

Normal 2

Nasolabial Seborrhoea 1

Suborbital pigmentation 0

Perinium

Normal 1

Dermatitis 0

Extremities

Normal 1

Dermatitis 0

Adipose tissue

Normal 1

Deficient 0

Oedema

Present 0

51
 Absent 1

Bones

Normal 1

Stigmata 0

Alimentary System

Appetite

Normal 1

Anorexia 0

Stools

Normal 1

Diarrhoea 0

Liver

Not palpable 1

Palpable 0

Spleen

Not palpable 1

Palpable 0

Nervous system

Calftenderness 0

52
 Paresthesia 1

Normal 2

Glands enlargement

Thyroid 0

Parotid 0

Nails

Normal 1

Koilonychia 0

Rachitic changes

Knock knees 0

Bow legs 0

Pigeon chest 0

Epiphyscal enlargement 0

53