ABSTRACT
A study includes 50 preschool children, a quantitative,
descriptive study. Purposive sampling technique were adopted, basic
anthropometric were assessed, and it was found 1 child is 3rd degree
malnourished, 9 children were 2nd degree malnutrition, and 12
children were 1st degree malnourished, and 28 children were well
nourished
Key: Protein energy malnutrition, Preschool children and
Prevalence
INTRODUCTION:
Nearly one in five children under age
five in the developing world is underweight (MDG report, 2012)1 and it
continues to be a primary cause of ill health and mortality among children. The
World Health Organization (WHO) has reported hunger and related malnutrition as
the greatest single threat to the world's public health. One in every three
malnourished children of the world lives in India and under-nutrition is a
major cause in more than half of under-five deaths. In India, around 43% of
under five children were underweight according to the report of third national
family health survey (NFHS- 3) conducted during 2005-06 whereas in rural Uttar Pradesh,
it was44.1%.(1) Malnutrition has shown to be an important concern in children
because of rapid growth and development.(2) Pre-school children are most
vulnerable to the effect of protein energy malnutrition (PEM) and their
nutritional status is considered to be a sensitive indicator of community
health, so that the present study was conducted to study the epidemiology of
protein energy malnutrition among pre school children (3-6 years) in rishikesh.
PEM results from various factors,
including inadequate intake of nutrients, abnormal gastrointestinal
assimilation of the diet, and stress response to acute injury or chronic
inflammation Studies in developing
countries investigating the possible determinants of child growth showed the
nutritional status of children has a significant inverse relationship with the
household income , immunization status and childhood illness, intestinal
parasitic infections and childhood nutrition also have been significantly
associated with the nutritional status of children.
Several studies showed that maternal
education emerges as a key element of an overall strategy to address
malnutrition 3 .The best global indicator of children’s well being is growth.
Poor growth is attributable to a range of factors closely linked to overall
standards of living and the ability of populations to meet their basic needs,
such as access to food, housing and health care. Assessment of growth is the
single measurement that best defines the nutritional and health status of
children, and provides an indirect measurement of the quality of life of the
entire population.
Problem statement:
A descriptive study
to assess the prevalence of PEM among preschool children in Rishikesh,
Uttarakand.
Objectives:
·
To
assess the prevalence of PEM among preschool children
·
To
assess the distribution of various degree of PEM according to Gomez
classification.
·
To
associate the prevalence of PEM among pre school children with selected
demographic variables.
METHODOLOGY:
A quantitative approach, non experimental descriptive study
design was adopted for this current study. A study was carried out in three Anganwadi in Rishikesh, Dehradum dist. The target population was preschool
children’s. Purposive sampling technique was adopted to select 50 preschool
children’s. The parents were
interviewed to get the necessary information. A structured tool was used to
collect the data. The tool contains
demographic variables and anthropometric measurement of the child. General
information like name of the child, father’s name, age and sex of the child, place
of living ,birth order of the child, number of sibling, parents educational
status, , type of family, income of the family,
food habit of the children, immunization history and current illnesses was collected from the parents. Basic
anthropometric measurement was taken from each child includes, weight, height,
mid arm circumference. Descriptive and inferential statistics where used to
analyse the data. The grading of PEM was done as
per the Gomez classification.
RESULT:
It was found that there was
44% percentage of children malnourished and 56 % of children were nourished up
to their age. (Refer table: 1)
Table: 1
Distribution
of PEM:
|
Distribution
of PEM
|
Frequency
|
Percentage b
|
|
Presence of PEM
|
22
|
44%
|
|
Adequately
Nourished
|
28
|
56%
|
It was found that more than
half of the children were nourished well and 24 % of preschool children having
1st degree PEM, 18% of preschool children were suffering from 2nd
degree PEM and only 2% of preschool children is suffering from 3rd
degree PEM. (Refer table-2)
Table: 2
Distribution
of Degree of protein energy malnutrition (Gomez classification)
|
Degree
of malnutrition
|
Grading
|
Frequency
|
Percentage
|
|
Nourished
|
>90%
|
28
|
56%
|
|
1st degree PEM
|
76-90%
|
12
|
24%
|
|
2nd
degree PEM
|
60-75%
|
9
|
18%
|
|
3rd
degree PEm
|
<60%
|
1
|
2
|
It was found that there3 is
no significant association exit between age, sex, place of living, birth order
of the child, educational status of the parents, types of family, economic
status of the family, child food habit, and immunization status, but there was
significant association exit between the prevalence of PEM and number of
siblings, recent or current illness like diarrhoea, URTI. It was tested with X2
with “p” value of 5%. (Refer
table-3)
Table-3
Frequency,
percentage distribution and Association of demographic variables:
|
Demographic variables
|
frequency
|
percentage
%
|
X2
|
‘P’ value
|
|
Age
3-4years
4-5yeqars
5-6years
|
20
18
12
|
40
36
24
|
1.919
|
5.99
|
|
Sex
Male
Female
|
24
26
|
48
52
|
1.413
|
3.84
|
|
Place of living
Rural
Urban
|
29
21
|
58
42
|
0.169
|
3.84
|
|
Birth order
1
2
3
4&above
|
28
14
5
3
|
56
28
10
6
|
2.37
|
7.82
|
|
Number of siblings
0
1
2
3
& above
|
15
21
10
4
|
30
42
20
8
|
29.97*
|
7.82
|
|
Educational status of the
father
Educated
Uneducated
|
49
1
|
98
2
|
0.397
|
3.84
|
|
Educational status of the
mother
Educated
Uneducated
|
46
4
|
92
8
|
0.912
|
3.84
|
|
Types of family
Joint
nuclear
|
24
26
|
48
52
|
0.082
|
3.84
|
|
Economic status of the
family
Low
class
Middle
class
Upper
middle
Upper
class
|
12
30
5
3
|
24
60
10
6
|
4.60
|
7.82
|
|
Food habit of the child
Vegetarian
Non
vegetarian
Ova
vegetarian
|
17
26
7
|
34
52
14
|
0.983
|
5.99
|
|
Immunization history
Complete
Incomplete
|
48
2
|
96
4
|
0.478
|
3.84
|
|
Suffering with diarrhoea or
URTI etc
Yes
No
|
39
11
|
88
22
|
4.96*
|
3.84
|
Note: * =
significant difference
DISCUSSION:
The
WHO (2000) has estimated that 182 million children, representing 32.5% of all
preschool children fewer than 5 years of age in developing countries are
malnourished and over two-thirds of them live in Asia, especially southern
Asia. Many studies have been carried out regarding the prevalence and
determinant factors of PEM in India.
In present study prevalence of PEM and
its relation to various epidemiological factors was assessed in 50 children on
the basis of weight for age. Out of total 50, 40% (20) were in 3-4 year, 36%
(18) were 4-5years, and 24% (12) were 5-6 years of age. According to sex more
than half of the children were female (52%) and 48% (24) were male children.
Over all it was found that more than half of the children (56%) were health and
nourished, and only 44% of children were malnourished. The incidence of 3rd
degree PEM was found to be just 2%, were as 1st degree PEM was 24 %(12)
and 2nd degree PEM was 18% (9).
In this study, grade 1 and grade 2 PEM
is higher rate than grade 3 PEM. The
number of sibling and current health problem was having significant influence
on development of various grades of PEM among children of 3-6 age groups.
CONCLUSION:
India stands at a very vulnerable position with
one of the highest prevalence of under nutrition in the world in spite of
improvement in food availability and poverty alleviation. In addition to it,
numerous determinants play a role in its causation. The interplay of these
determinants and their complementary effect makes it difficult to isolate one
key factor in causing under nutrition.(4)
The extent of malnutrition can be
countered by educating the parents with respect to basic nutritional
requirements of their children and encouraging them to consume locally
available low cost nutritious foods(5)
REFERENCE:
1.
Ram, Sudhir, Saurabh, Mukeshand Kanaujiya “ An
epidemiological study of Protein Energy Malnutrition (PEM) among 1-6 years
children in rural Lucknow, Uttar Pradesh, India”OSR Journal of Dental and
Medical Sciences (IOSR-JDMS)e-ISSN: 2279-0853, p-ISSN: 2279-0861.Volume 13,
Issue 3 Ver.II. (Mar. 2014), PP 10-14
2.
MS
Hesham Al-Mekhlafi, Johari Surin, AS Atiya, WA Ariffin, AK Mohammed Mahdy and H Che Abdullah , Current Prevalence And Predictors Of
Protein-Energy Malnutrition Among Schoolchildren In Rural Peninsular Malaysia,
Vol 39 No. 5 September 2008.
3.
HS
Joshi , MC Joshi , Arun Singh , Preeti Joshi , AND Nadeem
Israr Khan, Determinants Of Protein
Energy Malnutrition (Pem) In 0-6 Years Children In Rural Community Of Bareilly
, ISSN- 0301-1216 Indian J. Prev. Soc. Med. Vol. 42 No.2, 2011.
4.
S.
Chakraborty, S.B. Gupta, B. Chaturvedi, S.K. Chakraborty . A Study of Protein
Energy Malnutrition (PEM) in Children (0 to 6 Year) in a Rural Population of
Jhansi District (U.P.), Indian Journal of Community Medicine Vol. 31, No. 4,
October-December, 2006
5.
Harishanker,
Dwivedi S, Dabral SB, Walia DK. Nutritional status of children under 6 years of
age. Ind J. Prev. Soc. Med. 2004; 35 (3 & 4): 156-162.
6.
Vijayaraghavan
K, Rao DH; Diet and nutrition situation in rural India ;Indian J Med Res.1998
;108:243-53.
7.
Shrivastava
VK, Srivastava BC, Nandan D, Vidya Bhushan. Protein energy malnutrition among
pre-school children in a rural population of Lucknow. Indian Pediatr 1979;
16(6): 507.
8.
Indian
Academy of Paediatrics, Classification of Protein Calories Malnutrition, Ind.
Paediatrics, 1972, 9:369
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