lndlan Journal of Commumty Medicine Vd XXV, h&.1, Jan.

-Mar ,200O

RAPID ASSESSMENT OF NUTRITIONAL STATUS AND

DIETARY PATTERN IN A MUNICIPAL AREA
Sandip Kumar Ray’, Akhil Bandhu Biswas**, Samir Das Gupta”‘, Dipankar Mukherjee”“,
Satish Kumar***” , Biswajeet Biswas*, Goutam Joardar”
‘Department of Commumty Medicine. Medical College, Calcutta
“R G Kar Mechcal College, Calcutta
“‘NRS Medlcal College Calcutta
““Survclllance Officer, WHO
““‘ProJect Officer, UNICEF, Calcutta
Abstract:
Research question What 1s the nutrmonal status of the children under five years of age and dietary pattern of the famlhes
l-
Objective Rapld assessment of the magmtude of the problem of malnutntlon m a munlclpal area of North Bengal and also to assess dietary
pattern and average calorie Intake
Study destgn Cross-secttonal study based on 30 cluster sampling techmque
Settmgs Mumclpal area ot Shgun
Partlclpants 316 underfive chtldren m 30 clusters for assessment of nutrltlonal status and 92 famlhes for assessment ot dietary pattern
Results Prevalence ot malnutrltton was observed to be 62 97% and prevalence of severe degree of malnutrltlon was 6 65%. more so
amongst 12-23 months ot age and amongst females Average calone intake was 2271 7 K cals and nearly halt (47 8%) of the studied IJ
famlhes were getting less than 2400 K cals

Introduction: evaluation, was followed The random number and

The magmtude of the problem of malnutrltlon
amongst children under 5 years of age IS high throughout
the country and also m the state of West Bengal Natlonal
Family Health Survey data (1992-93) projected that 56 8%
ctuldren (O-4 years) suffered from malnutrltron m West
Bengal with 18% havmg severe grades’ Most of the
information on the magmtude of the problem of
malnutrltlonwas avallable mamly from the rural areas
Therefore, as per the recommendation of the slate level
workshop on nutntlon’, a survey was undertaken m the
Slllgurl mumclpal a r e a with t h e objective o f rapldly
assessmg the mdgmtude of the problem of malnutrmon as
well as dietary pattern of the famllles Some
epldernlologlcal factors associated with malnutrltlonwere
also explored
Material and Methods:
Slllgurl IS a sub-dlvlsional town m the DarJeelmg
dlstrlct ot the state of We\t Bengal The then Slllgurl
Mumclpal Corporation had 30 wards with a population of
2,15,382 Ward-wise population w a s obtamcd from the
mumclpal authorltles and formed the samplmg frame 30
cluster samplmg technique, as followed m case of UIP
samplmg Interval were 1397 and 7180 respectively. 30
clusters were ldentlfied by using the standard techmque3
Sample size:
For assessment of the nutrltlonalstatu\ of the children
under 5 years of age, the prevalence of malnutrltlon in
earher studies m urban areas of West Bengal was
considered for sample size calculation In one urban area,
7 6 % prevaleme w a s observed4 5 It was used for
determmatlon of sample size, which was calculated to be
126, based on the formula 4PQ/L*, where P IS the
prevalence, Q IS 1-P and L IS the permlsstble error I e. 10%
m the present study The sample size was multlphed by
design effect on nutrltlonwhlLh was 2”
To study dietary pattern, the sample size was
determmed based on the data of the lowest magmtude of
poor which was around 50% as per Bapna (1990-9 I)’ Thus,
sample srL!e was found to be 400 Consldermg the average
family-sizeof 5, around 80 famllles were to be covered to
have an adequate sample size of 400 Therefore, m each
cluster 2 6 I e 3 famllles were randomly choosen for
studymg chetary pattern

I
 Indian Journal of Community Medicine Vol. XXV, No.1, Jan.-Mar., 2000

Pretested proforma was used for data collection.
Weight of the children was recorded by Salter weighing
tiachine. Grading of malnutrition was done as per IAP
classification’. Age was assessed either from records or by
asking question and comparing it with local events
calendar. The diet survey was carried out by oral
questionnaire using 24 hours recall method.
Results and Discussion:
A total of 316 under five children and 92 families
were studied for observing nutritional status and dietary
pattern respectively.

Table I: Age-wise distribution of malnutrition. &

Age in months Nutritional status

Normal Grade I Grade II Grade III Grade IV

I
No(%) No( %) No(%) No(%) No( %)

O-5 (n= 18) 1 l(61.1) 4(22.22) 3( 16.67) 4-J 4-J

6-l 1 (n=39) 16(41.03) I 2( 30.7) 6(15.38) 4( 10.26) l(2.56)

12-23 (n=62) 16(25.81) 17(27.42) 23(37.09) 6(9.68) 4-l

24-35 (n=68) 23(33.82) 23(33.82) 20(29.41) l(l.47) l(l.47)

36-59 (n= 129) 51(39.53) 45(34.88) 25( 19.38) 6(4.65) 2( 1.55)

Total (n=3 16) 117(37.03) 101(31.96) 77(24.37) 17(5.38) 4( 1.27)

Overall prevalence of the malnutrition in children
under 5 years was found to be 62.97% and prevalence of
severe degree malnutrition (Grade III and IV) was 6.65%.
Prevalence of malnutrition in the present study, appeared to
be comparauvely lower than the earlier studies in Calcutta
slums (7S.68%)J.s and Ausgram tribal community of West
Bengal (79.9%)J while the overall prevalence was more or
less same with that of a rural community of Gosaba Block
(66%)J.-‘. This could be due to better literacy rate in these
two areas.
Similarly, the prevalence of severe degree of
malnutrition was also found to be highest in tribal area
(9.26%) followed by Calcutta urban slum area (8.10%) and
lowest at Gosaba rural area (4.33%)4,“. Findings of the
present study as regards severe degree was in between the
later two studied areas. ICDS surveys conducted at various
areas on different occasions also reported similar types of
observations on malnutrition among children aged 1 to 6
ycars4.
Overall prevalence of malnutrition was highest
(74.19%) in the age group 12-23 months. followed by 24-35
months (66.18%) and 36-59 months (60.47%). But the trend
was somewhat different in case of severe degree of
malnutrition (Grade III and IV) which was highest in 6-l I
months of age group (I 2.82%) followed by 12-23 months
(9.68%) age group. Higher prevalence of severe degree in
6-11 months age group could be due to delayed initiation
or faulty complementary feeding practices. However, no
case of severe degree of malnutrition was observed among
the infants aged O-5 months. The findings of present study

Rapid assessment of nutritional status 15 Ray S.K. et al

 Indian Journal of Community Medicine Vol. XXV, No.1, Jan.-Mar., 2000

corroborated with the findings of the studies carried out in
other areas in relation to severe degree of malnutrition
amongs children under 2 years of ageJ’. Special attention
should be paid to this group of beneficiaries, mainly through
ICDS scheme.
Sex-wise distribution:
64.74% males and 61.58% females were
malnourished. For overall prevalence of malnutrition, the
sex differential was not statistically significant (p >0.05),
but statistically significant sex difference (~~0.05) was
observed in prevalence of severe degree of malnutrition,
which was almost double in female children (8.47%) in
comparison to male children (4.3%). Studies at Ausgram
block also revealed similar trcndsJ. Similar observations
were noted in a number of ICDS surveys carried out in this
decade which also showed that prevalence of malnutrition
was more in females than in male children’. This could be
due to the neglect of female children particularly with
respect to intra familial food distribution.

Parental literacy and malnutrition:

Table II: Parental literacy and malnutrition.

Normal Grade I Grade II Grade III Grade IV

No(%) No(%) No( 5670) No(%) No(%)

Father:
Literate (n=2 13) 9 l(42.72) 69(32.39) 39( 18.3 I ) I l(5.16) 3(1.41)

Illiterate (n=103) 26( 25.24) 32(3 1.07) 38(36.89) 6(5.83) l(O.97)

Total (n=3 16) 117(37.03) lOl(31.96) 77(24.37) 17(5.38) 4( I .27)

Mother:
Literate (n=142) 64(45.07) 40(28.17) 30(21.13) 6(4.23) 2( I .4 I )

Illiterate (n= 174) 53(30.45) 61(35.06) 47(27.01) I l(6.32) 2(1.15)

Total (n=3 16) 117(37.03) lOl(31.96) 77(24.37) 17(5.38) 4( I .27)

S u b s t a n t i a l d i f f e r e n c e s i n t h e prevalcncc of status of children.

malnutrition were observed among children belonging to
illiterate fathers (74.76%) and literate fathers (57.28%)
which was statistically significant (~~0.05). It was revealed
further that the prevalence of malnutrition among the
children of literate mothers was comparatively lower
(54.93%) than the illiterate mothers (69.55%) and the
difference was also statistically significant (p<O.O5). Severe
malnutrition was also more prevalent in children belonging
to illiterate parents. These findings were indicative of a
strong association between parental literacy and nutritional
Number of siblings, sibling interval and nutritional
status:
It was observed that 56.07% children with two or less
member of siblings,’ were malnourished. On the contrary
71.33% children were malnourished when number of
siblings were 3 or more. The difference was statistically
significant Q~cO.05). Relationship between sibling interval
and nutritional status was also studied. Among the children
with sibling interval of less than 36 months, 68.7% children
were malnourished. However, the prevalence rate was

Rapid assessment of nutritional status 16 Ray S.K. et al

 .

Indian Journal of Community Medicine Vol. XXV, No.1, Jan.-Mar., 2000

significantly less (~~0.05) in children with sibling interval malnutrition and infection. ?

of 36 months or more. Earlier, studies by Ray et al at both Morbidity due to infectious diseases and nutritional
urban and rural areas also reported higher prevalence of status:
malnutrition in families having more than 3 siblingsY”‘.
Enquiry was made regarding occurrence of some
Immunisation status and malnutrition: major childhood morbidity over a recall period of 15 days.
A significantly higher (p<O.O5) prevalence of It was noted that 37.9% children suffered from diarrhoeal
malnourished children were observed amongst partially episodes. Out of them 75% were having different degrees of
immunised and non-immunised children (81.25% and malnutrition and it was significantly (~~0.05) higher than
88.23% respectively) in comparison to fully immunised the overall prevalence rate (62.97%). Prevalence of severe
children (62.07%). Severe degree of malnutrition was also degree of malnutrition was also more than double (14.58%)
significantly higher (~~0.05) among partially immunised in children who suffered from diarrhoea than the overall
and non-immunised children (12.5% and 1 1.76% prevalence of severe degree of malnutrition (6.65%) which
respectively) in comparison to the fully immunised children was also statistically significant (~~0.05). Among the
(6.89%). This implies that partially and non-immunised children with acute respiratory tract infection, 69.98 percent
children were at higher risk of malnutrition as they were not were suffering from malnutrition with 8.32% having severe
protected against the vaccine preventable diseases degree of malnutrition and both were significantly higher
including measles and contributing to the vicious cycle of than the overall prevalence (~50.05).
+ . . .
Dietary intake pattern: i
, .
Table III: Dietary intake pattern:
Project Area No. of Cereals Pulses GLV Roots Other veg. Fruit Milk Flesh Poultry Sugar/ Oil
families tubers food product Jaggery
Siligurt 92 515.5 34.2 33 132 58.2 101.4 105.1 31.7 5.9 32.6 36.1
(urban) 5‘,
cu=354.7 I’
:
RDA ,: 460 40 40 50 60 - I50 - - 30 40
(Sedentary)

GLV = Green leafy vegetables, CU = Consumption unit, RDA = Recommended daily allowances

Diet survey was undertaken in 92 families which
constituted a total of 354.7 consumption units. Average
intake of different categories of food-stuff per consumption
unit was calculated. Cereals and starchy foods formed the
main bulk of their diet. Intake of cereals and roots and tubers
were found to be higher than the ICMR recommended daily
allowances’*. Intake of pulses, green leafy vegetables, milk
and oil was less than the recommended daily allowances”.
Findings of the present study corroborated with the other
studies carried out at Ausgram, Gosaba and Calcutta as
regards cereals and starchy foods consumption while it did
not corroborate with the findings related to green leafy
vegetables consumption4.“.
Average calorie intake per consumption unit (CU.) *
was found to be 2271.7 K.cals. which is 94.6% of RDA for
a sedentary worker as per ICMR recommendation. It was
further observed that almost half (47.8%) of the studied
families were deprived of the basic minimum calories
requirement (2400 K.cals.) indicating more vulnerability to
widespread malnutrition and infection,

Rapid assessment of nutritional status Ray S.K. et al


Conclusion:
The present study findmgs amply reveal that problem
of malnutrltlonIS multlfaceted and has lmks with various
4ocIo-economic a n d dcmographlc f a c t o r s So a
multlprongcd dttack mvolvmg VLLIIOUS depdrtments IS of
utmost concern m order to reach the goal of reducmg
malnutntlon to half by the end of this century Therefore. an
drea \pcclflc Integrated dccentrallscd pldnnmg as well as
sensltlsatlon WOI kshop for the perlpherdl level functIonarIes
on nutrltlon Ielated Issues based on “Triple A” approach
should be planned” a n d conducted with the above
per$pcLtlve
Acknowledgement:
Authors deeply acknowledge UNICEF Calcutta for
their support and Prlnclpal Medlcal College, Calcutta for
hmdly pcrmlttlng authors to carry out the study
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Rapid assessment of nutritional status
lndlan Journal of Community Medlclne Vol XXV, No 1, Jan.-Mar ,200O
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18 RaySK &al