Introduction Child malnutrition is a wide spread
public health problem having international consequences because good nutrition
is an essential determinant for their well-being. The most neglected form of
human deprivation is malnutrition, particularly among preschool children. India
is one of the few countries in the world where poor nutritional status among
preschool children is detrimental to their health outcome. Malnutrition is a condition that
develops when the body does not get the proper amount of protein, energy,
vitamins and other nutrients. Malnutrition is technically a category of
diseases that includes: undernutriiton, over nutrition and micronutrient
deficiencies. Malnutrition occurs in children who are either undernourished or
over nourished. In most of the world, malnutrition is present in the form of
undernutriiton, which is caused by a diet lacking adequate calories and
protein. Under nutrition reflects a number of
intermediary processes such as household access to food, access to health
services and caring practices. In India, since a large number of people are
poor, illiterate and ignorant of the importance of hygiene and sanitation, they
consume inadequate amount of nutrients and suffer from infections that result
in poor utilization of nutrients which leads to under nutrition. This form of
malnutrition is more common in our country. UNICEF classifies the immediate causes of
childhood malnutrition as insufficient diet as well as stress, trauma, frequent
infections and poor psychosocial care. Insufficient dietary intake may refer to
poor breastfeeding practices, early weaning, delayed introduction of
complementary foods and insufficient protein in the diet. Other factors that influence food intake
include health status, food taboos, growth and personal choice related to diet.
Malnutrition can also develop due to neglect, abnormal mealtimes with a carer
or parent or insufficient quantities of food. Because of insufficient parental
knowledge, poor appetite in the child or neglect, physical or emotional abuse,
sometimes the mother restricts the child’s food intake. The effect of undernutriiton on young
children (ages 0-8) can be devastating and enduring. Delayed physical growth
and motor development. It can impede behavioral and cognitive development,
lower educational achievement, deficient social skills, decreased attention,
deficient learning and reproductive health, thereby undermining future work
productivity. Malnutrition in early childhood has serious, long-term
consequences; it increases morbidity, greater risk of disease and early death. Background of the study Global scenario of Malnutrition:
Globally it is estimated that under nutrition is responsible, directly or
indirectly, for at least 35% of deaths in children less than five years of age.
More than a quarter of World’s children are still malnourished – 26.7%
(150million) children are underweight and 32.5% (182 million) stunted of whom
70% are in Asia, 26% in Africa and 4% in Latin. An estimated 32% or 186
million, children below five of age in developing countries are stunted and
about 10% or 55 million are wasted. UNICEF states that the highest level
of underweight children are found in South Asia, involving 46% of all
under-fives in the region. There are more than 6 million preventable child
deaths every year in developing countries. Unfortunately, this is the tip of
the iceberg. Estimated that, more than 200 million underfive children who fail
to reach their potential in cognitive development because of poor health and
nutrition and deficient care. Malnutrion in India: More than half of World’s
malnourished children live in India. Malnutrition is a major public health
emergency in India today. It is estimated that, 57 million children are
underweight (moderate and severe). India has a high prevalence of PEM about 50%
of the population suffering from it in some form - protein-calorie deficit
and/or micro-nutrient malnutrition. 46% of Indian children under 6 years are
underweight, and 38% are short for their age. It is the underlying cause of at
least 50% of deaths of under -five children in the country. WHO world health statistics (2009)
revealed 43.5% underweight underfive in India and 39.8% in Bangladesh among
SEAR which are high prevalence in the world also. In India the prevalence of
undernutriiton is the highest in Madhya Pradesh (55%), followed by Bihar (54%),
Orissa (54%), Uttar Pradesh (52%) and Rajasthan (51%), while Karnataka (41%),
Kerala (37%) and Tamil Nadu (27%). Malnutrition in
Karnataka: The findings of the third National
Family Health Survey (NFHS-3) reveals an unacceptable prevalence of
malnutrition among children:42.5% of children under the age of ï¬ve years are
underweight (low weight for age), 48 % are stunted, 19.8% are wasted. In poorer states the situation is
even worse with over 50 % of children underweight. 2.1 million children are mildly
malnourished, 1.13 million are moderately malnourished and 71,605 are severely
malnutrition children in Karnataka.8According to data provided by women and
child welfare department, 2,689 children have died due to malnutrition, of
which 811 died in 2009 and 1,233 in 2010. As many as 645 such deaths have been
recorded till August 2011.Over 4,531 number of children suffering from severe
malnutrition and 2,600 children died of malnutrition in Raichur District of
Karnataka. A cross sectional study was conducted
on prevalence of malnutrition among preschool children in Azad Nagar,
Bangalore. The prevalence of
malnutrition among children was 68%. Among that, male children malnutrition was
57.94% and females 42.06%. Malnutrition in Udupi : A cross-sectional study was conducted
in 11 villages of the field practice area of Community Medicine Department of
Manipal in Udupi taluk among Anganawadi children. Result showed that, 32.3% children are
malnourished. Proportionally girls (46.2%) were more malnourished than boys
(33.6%). A case control study was carried out
among under five children in Udupi taluk. Study found under-nutrition was
associated with illness in the last one month , feeding diluted milk and having
more than two children with a birth interval < 2 years. Study concluded that, childhood illness,
short birth interval, mothers negligence about diet and consumption of diluted
milk were significant contributory factors. On July 3rd 2012, as per District
Health Officer, Udupi, 371 children who are less than 6years of age, in the
district are suffering of malnutrition. According to report from CDPO, Udupi
(August 2012), a total 7859 underfive children were malnourished, 649 children
were severely malnourished in Udupi district. Malnutrition and
cognitive development: Bhoomika R Kar (2007) conducted study
on malnourished children in NIMHANS, Banglore. Cognitive development was
assessed by using Gessell’s developmental schedule. Children with grade II and
III malnutrition had poor development in all areas of behaviour ie. motor,
adaptive, language and social development. Agarwal DK, Upadhyay SK, Agarwal KN
(1989) conducted a study among rural children studying in primary school in
Banglore between the age of 6-8 years were assessed on measures of social
maturity. Study found, malnutrition was associated with deficits of social
competence, visuo-motor coordination and memory. IQ scores decreased with the
severity of malnutrition. Thus present study intends to assess
the prevalence and identify the risk factors for malnutrition and provide need
based intervention such as education, food demonstration and counseling to
mothers to improve nutritional status and cognitive development of preschool
children. Problem statement: “Prevalence and risk factors for
malnutrition and effectiveness of need based intervention on nutritional status
and cognitive development of preschool children in Anganawadi centers of Udupi
Districtâ€. Purpose of the study: To identify the prevalence and risk
factors of malnutrition among preschool children. Study also aims to find out
the effect of need based intervention to mothers of malnourished preschooler on
modifying the various factors, which will further help to improve the
nutritional status and cognitive development of preschool children. Objectives: The objectives of the study are to : identify the
prevalence of malnutrition among preschool children Identify the risk
factors for malnutrition among preschool
children. determine the
effectiveness of need based intervention in terms of ·
changes
in nutritional status of malnourished preschool children. ·
changes
in cognitive development of malnourished
preschool children. Hypotheses: Will be tested at 0.05 level of
significance ·
There
will be a significant difference in the pre and posttest measurement of
nutritional status and cognitive development of malnourished preschool children
in intervention group. ·
The
posttest measurement of nutritional status of malnourished preschool children
in the intervention group will be significantly higher than control group.
·
The
posttest cognitive development of malnourished preschool children in the
interventional group will be significantly higher than the control group.
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