| Purpose of the study
Undernutrition among children aged ≤5years is one of the major public health problems in India and the burden is even more prevalent in tribal communities. The growth and development of under-five children mostly depend on the nutrition one has acquired during the early period of their life. Factors such as maternal nutrition, health status during pregnancy, pre-term delivery, low birth weight, faulty feeding practices, frequent respiratory or gastrointestinal infections can lead to wasting. The persistence of such a condition for an extended period of time can result in stunting.
Under-five children from tribal communities are no exception in this regard and with the prevailing low socio-economic status, lack of safe drinking water supply and poor housing conditions in the tribal communities, their children are at a higher risk of having malnutrition during their childhood and could affect their growth and development.
As there is a dearth of published literature addressing these issues among particularly vulnerable tribal groups (PVTG) in this region, there is a pressing need to determine the prevalence of malnutrition among under-five children belonging to this community and to identify the factors associated with it. So, a community-based study has been proposed among Koraga population (a PVTG) residing in Udupi district.
Objectives 1. To assess the nutritional status of under-five children belonging to a PVTG in Udupi district.
2. To identify the socio-economic, cultural and health system and administrative determinants of nutritional status in this study population.
3. To assess the utilization of nutritional supplementation services with respect to mothers. and under-five children in the study population and to correlate it with the nutritional status of children.
Detailed description of Procedure
The list of eligible houses with under-five children in the Koraga community will be obtained from ITDP Office, Udupi prior to initiation of the survey. Following this, the survey team will make door-to-door visits and the purpose of their visit will be explained to the mothers of under-five children within the family. After explaining the details about the study (Participant Information sheet in local language), a written informed consent (Informed consent form) will be obtained by the mothers before recruiting them into the study. If a mother has more than one child belonging to the age group of 0 to 5 years, then all eligible children from that household will be recruited into the study.
Socio-demographic details of the household will be collected by administering a pretested, semi-structured questionnaire to the mothers of under-five children. The socio-economic status will be assessed using modified BG Prasad’s scale. Details regarding prenatal, natal and postnatal history, breastfeeding, immunization, feeding practices, health status and any infectious diseases etc. will be documented. Utilization of nutritional supplementation services provided through Integrated Child Development Services (ICDS) scheme and from ration obtained from ITDP will be queried.
Examination
Screening & examination will be carried out by the trained team members (with nursing background)
Children will be screened for iron deficiency anaemia by examining/inquiring regarding the following features:
(i) Pallor: conjunctival screening
(ii) Poor general health: history of frequent infections notably with recurrent upper respiratory tract infection, diarrhoea and other infections such as eye, ear etc.
(iii) Underweight (weight for age measurement)
(iv) Pica is defined as chronic ingestion of inedible substances such as clay/soil, etc.
(v) Worm infestation (history of perianal itching/passing worms in stools, abdominal pain)
(vi) Fever other than malaria, history of COVID etc
(vii) children will also be screened for the presence of Bitot’s spots (vitamin deficiency), cheilosis/angular stomatitis (vitamin B2 deficiency) (viii) History of any underlying medical conditions.
Dietary assessment Using 24 hours dietary recall method, the nutritional intake of mothers and children will be assessed with respect to calories, protein, vitamin A and iron as per National Institute of Nutrition (NIN) guidelines.
Anthropometric assessment:
The child’s weight will be measured as per WHO guidelines and the growth chart will be plotted. Anthropometric measurements such as height and weight will be documented for the mothers’ of under-five children. They will be categorized based on the BMI values as per WHO classification.
Screening for anaemia:
Haemoglobin will be estimated through the finger-prick method using a handheld portable haemoglobin meter for both mothers and children (1-5 years) at the household level. Haemoglobin levels < 11 gm/dl will be considered as the presence of anaemia for mothers and children in the age group of 12-48 months. Haemoglobin levels <11.5 gm/dl will be considered as anaemia for children aged between 49-60 months. Peripheral smears will be done using the finger-prick method for those children who are found anaemic.
Ethical Considerations Permission was obtained from the Integrated Tribal Development Project (ITDP), Udupi to carry out this study among tribal populations. obtained Institutional Ethics Committee Clearance for the study Objectives of the survey and procedure involved will be explained to the study participants (mothers) in the local language. Written informed consent will be obtained before recruiting them into the study. Privacy and confidentiality of collected information will be ensured at all levels of the study. |