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Jasani KM, Gosalia VV, Misra SV. Diagnostic Accuracy of Mid-Upper Arm Circumference for the Detection of Acute Malnutrition Among Children Aged 6-60 Months: A Diagnostic Accuracy Study. J Res Health Sci 2024; 24:e00612. [PMID: 39072548 PMCID: PMC11264450 DOI: 10.34172/jrhs.2024.147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2024] [Revised: 04/02/2024] [Accepted: 05/11/2024] [Indexed: 07/30/2024] Open
Abstract
BACKGROUND Timely and accurate screening of malnutrition at the community level is essential to identifying malnourished children. The World Health Organization (WHO) guidelines classify non-oedematous acute malnutrition among children using mid-upper arm circumference (MUAC) or weight-for-height Z-score (WHZ). Study Design: A cross-sectional study. METHODS This study was conducted among children aged 6‒60 months. After necessary exclusions, 433 participants were selected using a multi-stage simple random sampling method. Using WHO guidelines for global acute malnutrition (GAM) [WHZ<-2, MUAC<12.5 cm], the sensitivity (Se), specificity (Sp), predictive values, likelihood ratios, Youden index, and receiver operating characteristic (ROC) curve were calculated for MUAC using WHZ as the criterion. RESULTS Out of 433 participants, 30% were diagnosed with GAM using WHZ, while 17.6% were found malnourished using MUAC measurements. As per WHO cut-offs, the Se, Sp, positive predictive value (PPV), negative predictive value (NPV), Youden index, positive likelihood ratio (LR+), and negative likelihood ratio (LR-) of MUAC were 48%, 96%, 83%, 81%, 0.44, 12, and 0.54, respectively. The ROC curve displayed an area under the curve of 0.86 (95% confidence interval=0.83, 0.90) for MUAC<12.5 cm. Bivariate Pearson correlation also demonstrated a positive linear relationship (R2=0.302) between the WHZ and MUAC variables. CONCLUSION Based on the findings, 48% of the children were correctly identified by the MUAC with an 83% probability of GAM (PPV=0.83). Moreover, there was 96% Sp in non-malnourished children, with only 4% false positives. Therefore, personnel at the grassroots level can use MUAC for timely and accurate screening of children in Anganwadi centers (AWCs) due to its ease of use and simplicity.
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Affiliation(s)
| | - Vibha V. Gosalia
- Department of Community Medicine, PDU Government Medical College, Rajkot, India
| | - Shobha V. Misra
- Department of Community Medicine, PDU Government Medical College, Rajkot, India
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Roy A, Rahaman M. Prevalence of Undernutrition and Change Detection among under five years Children of Empowered Action Group States in India: Scrutinizing from National Family Health Survey, 2016-2021. Ecol Food Nutr 2023; 62:223-242. [PMID: 37614031 DOI: 10.1080/03670244.2023.2247333] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/25/2023]
Abstract
Change detection and prevalence of child undernutrition among the Empowered Action Group (EAG) states of India were studied using National Family Health Survey-4 and 5 data. The results identified that the prevalence of undernutrition in most of the EAG states is still more than 30%. Although stunting and underweight have decreased in all EAG states, this pattern is higher than that of the national level but the prevalence of wasting has only increased in Bihar. Strengthening public health initiatives and collaborative endeavor between organizations, enhancing mother's education, increasing awareness, and raising the economic as well as sociopolitical empowerment of mothers are essential for addressing the undernutrition issue.
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Affiliation(s)
- Arabinda Roy
- Department of Geography, Dr. Meghnad Saha College (affiliated to University of Gour Banga), Itahar, Uttar Dinajpur, India
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Anuradha K, Ketan G, Vaman K, Veena E. Greater Reduction in Stunting Than Underweight and Wasting in Indian Under-Five Children: A Comparison of Growth Indicators from 4 National Family Health Surveys. Indian J Pediatr 2023; 90:982-987. [PMID: 35713770 DOI: 10.1007/s12098-022-04143-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Accepted: 12/16/2021] [Indexed: 11/05/2022]
Abstract
OBJECTIVE To assess change in nutritional status in Indian under-five children from four rounds of national surveys (round 1 to 4). METHODS National Family Health Survey data from 4 rounds (1992-2016) were analyzed. Height and weight for age (HAZ, WAZ), and weight for height (WHZ) z scores were calculated. Children under -2 z score were classified as malnourished by HAZ, WAZ and WHZ. RESULTS A greater reduction in stunting (from 54 to 38%, p < 0.05) than in underweight (from 44 to 34%, p < 0.05) and wasting (from 19 to 20%, p > 0.1) status over the period of 4 NFHS rounds was observed from 1992 to 2016. In line with this, combination of improved height for age (-2.1 ± 1.8 to -1.5 ± 1.7) but relatively less improved weight for age (-1.8 ± 1.4 to -1.5 ± 1.2), the change in wasting status was either nil or meagre (-0.8 ± 1.4 to -0.9 ± 1.4), (p < 0.05 for all). The percentage of children malnourished by all 3 indicators together reduced from 9 to 6% (p < 0.05). At the 4th NFHS round, higher percentage of boys (8%) than girls (6%) and rural (7%) than urban (5%) children were malnourished by all 3 indicators (p < 0.05). CONCLUSION Greater reduction in stunting than underweight and wasting was observed over the period of 4 rounds. There is a need for more focused efforts to combat malnutrition in rural children and boys.
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Affiliation(s)
- Khadilkar Anuradha
- Pediatric and Endocrine Department, Hirabai Cowasji Jehangir Medical Research Institute, Jehangir Hospital, 31, Sassoon Road, Pune, Maharashtra, 411001, India.
- Interdisciplinary School of Health Sciences, Savitribai Phule Pune University, Pune, Maharashtra, India.
| | - Gondhalekar Ketan
- Pediatric and Endocrine Department, Hirabai Cowasji Jehangir Medical Research Institute, Jehangir Hospital, 31, Sassoon Road, Pune, Maharashtra, 411001, India
| | - Khadilkar Vaman
- Pediatric and Endocrine Department, Hirabai Cowasji Jehangir Medical Research Institute, Jehangir Hospital, 31, Sassoon Road, Pune, Maharashtra, 411001, India
- Interdisciplinary School of Health Sciences, Savitribai Phule Pune University, Pune, Maharashtra, India
| | - Ekbote Veena
- Pediatric and Endocrine Department, Hirabai Cowasji Jehangir Medical Research Institute, Jehangir Hospital, 31, Sassoon Road, Pune, Maharashtra, 411001, India
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Impact of low birth weight and breastfeeding practices on the nutritional status of children aged 2 to 5 years in the slums. EUREKA: HEALTH SCIENCES 2023. [DOI: 10.21303/2504-5679.2023.002730] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/03/2023] Open
Abstract
Malnutrition among children in developing countries is a major public health problem, especially in India. Inappropriate feeding practices, in combination with other causes such as infection and food shortage, may be responsible for 1/3rd of malnutrition. Moreover, the risk of mortality is inversely related to children's height-for-age and weight-for-height.
The aim: To assess the nutritional status of children aged 2 to 5 years in the urban field practice area of SVIMS-Sri Padmavathi Medical College for Women, Tirupati and to determine the impact of low birth weight, breastfeeding practices and other related factors on the nutritional status of the above study population.
Materials and methods: This is a community-based observational cross-sectional study conducted among 282 children aged 2 to 5 years in the urban field practice area of SVIMS-Sri Padmavathi Medical College for Women, Tirupati. Socio-demographic data, Birth history, breastfeeding practices and anthropometric measurements were noted in the study questionnaire. Nutritional status was determined using HAZ, WHZ and WAZ scores of WHO child growth standards. Data was entered and analyzed using IBM SPSS Statistics 26 version to test for association between categorical variables, and a p-value < 0.05 was considered statistically significant.
Results: A total of 282 school children with mean age of 39.9 (+10.4) months participated in the study, of which 132 (46.8 %) were boys and 150 (53.2 %) were girls. This study observed exclusive breastfeeding in 193 (68.4 %) children. Prevalence of stunting, wasting and being underweight were 22 %, 12.4 % and 23.8 %, respectively. A statistically significant association was found between stunting (p=0.006) and underweight (p=0.001) with low birth weight children.
Conclusions: The present study revealed a high prevalence of malnutrition, especially stunting, a common outcome of long-term malnutrition among young children. Low birth weight and inappropriate breastfeeding practices result in long-term adverse consequences on the nutrition of preschool children, which should be prevented through appropriate strategies.
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Lee C, Lakhanpaul M, Stern BM, Sarkar K, Parikh P. Associations between the household environment and stunted child growth in rural India: a cross-sectional analysis. UCL OPEN ENVIRONMENT 2021; 3:e014. [PMID: 37228801 PMCID: PMC10171403 DOI: 10.14324/111.444/ucloe.000014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/06/2019] [Accepted: 01/25/2021] [Indexed: 05/27/2023]
Abstract
Stunting is a major unresolved and growing health issue for India. There is a need for a broader interdisciplinary cross-sectoral approach in which disciplines such as the environment and health have to work together to co-develop integrated socio-culturally tailored interventions. However, there remains scant evidence for the development and application of such integrated, multifactorial child health interventions across India's most rural communities. In this paper we explore and demonstrate the linkages between environmental factors and stunting thereby highlighting the scope for interdisciplinary research. We examine the associations between household environmental characteristics and stunting in children under 5 years of age across rural Rajasthan, India. We used Demographic and Health Survey (DHS)-3 India (2005-2006) data from 1194 children living across 109,041 interviewed households. Multiple logistic regression analyses independently examined the association between (i) the primary source of drinking water, (ii) primary type of sanitation facilities, (iii) primary cooking fuel type, and (iv) agricultural land ownership and stunting adjusting for child age. The results suggest, after adjusting for child age, household access to (i) improved drinking water source was associated with 23% decreased odds [odds ratio (OR) = 0.77, 95% confidence interval (CI) 0.5-1.00], (ii) improved sanitation facility was associated with 41% decreased odds (OR = 0.51, 95% CI 0.3-0.82), and (iii) agricultural land ownership was associated with 30% decreased odds of childhood stunting (OR 0.70, 95% CI 0.51-0.94]. The cooking fuel source was not associated with stunting. Our findings indicate that a shift is needed from nutrition-specific to contextually appropriate interdisciplinary solutions, which incorporate environmental improvements. This will not only improve living conditions in deprived communities but also help to tackle the challenge of childhood malnutrition across India's most vulnerable communities.
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Affiliation(s)
- Charlotte Lee
- Whittington Health NHS Trust, Magdala Avenue, London N19 5NF, UK
- UCL Great Ormond Street Institute of Child Health, 30 Guildford Street, London WC1N 1EH, UK
| | - Monica Lakhanpaul
- Whittington Health NHS Trust, Magdala Avenue, London N19 5NF, UK
- UCL Great Ormond Street Institute of Child Health, 30 Guildford Street, London WC1N 1EH, UK
| | - Bernardo Maza Stern
- Engineering for International Development Centre, University College London, Bartlett School of Construction and Project Management, 1–19 Torrington Place, London WC1E 7HB, UK
| | - Kaushik Sarkar
- Aceso Global Health Consultants Limited, B-78-A FF Front Side, Chanakya Place–1, Uttam Nagar, New Delhi 110059, India
| | - Priti Parikh
- Engineering for International Development Centre, University College London, Bartlett School of Construction and Project Management, 1–19 Torrington Place, London WC1E 7HB, UK
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Rehan A, Kishore S, Singh M, Jain B, Reddy NKK, Kumar D, Usha P, Parveen R. A study to assess undernutrition and its sociodemographic correlates in under-five children in urban and rural areas of Rishikesh, Uttarakhand. J Family Med Prim Care 2020; 9:4980-4984. [PMID: 33209832 PMCID: PMC7652190 DOI: 10.4103/jfmpc.jfmpc_663_20] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Revised: 06/10/2020] [Accepted: 06/19/2020] [Indexed: 12/05/2022] Open
Abstract
Context: Nutrition is one of the most important factors that affect a child's health. It plays a vital role in the prevention and control of disease morbidity and mortality. It is a major public health problem in a developing country like India. Aims: To assess undernutrition in under-five children and various sociodemographic factors affecting it. Settings and Design: A community-based cross-sectional study was conducted among under-five children of rural and urban Rishikesh. A total sample size of 400 under-five children was taken. Multistage sampling was done to select the areas and systematic random sampling was done for selection of households. Subject and Methods: A predesigned, pretested, and semistructured questionnaire was used to collect information on the sociodemographic characteristics and status of undernutrition in study participants. Statistical Analysis Used: Data was entered into excel sheets and analyzed using SPSS version 23 utilizing appropriate statistical methods. Results: The prevalence of underweight was 37.3%, stunting 43.3% and wasting 24.5%. Underweight (40.5% v/s 35.0%), stunting (46.5% v/s 40.0%), and wasting (27.0% v/s 22.0%) was more prevalent in urban areas as compared to rural areas. Sociodemographic factors such as religion, caste, parental education, father's occupation, and family size emerged as significant predictors of under nutrition. Conclusion: Undernutrition in under-five children was quite high. Since childhood malnutrition is multifactorial, there is no single cause big enough to blame but a multifaceted approach is required to combat malnutrition.
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Affiliation(s)
- Abu Rehan
- Department of Community and Family Medicine, AIIMS, Rishikesh, India
| | - Surekha Kishore
- Department of Community and Family Medicine, AIIMS, Rishikesh, India
| | - Mahendra Singh
- Department of Community and Family Medicine, AIIMS, Rishikesh, India
| | - Bhavna Jain
- Department of Community and Family Medicine, AIIMS, Rishikesh, India
| | | | - Deepak Kumar
- Department of Community and Family Medicine, AIIMS, Rishikesh, India
| | - Preeti Usha
- Department of Community and Family Medicine, AIIMS, Rishikesh, India
| | - Rukhsar Parveen
- Medical Officer, CHC Jawalapur, Haridwar, CHC, Jawalapur, Uttarakhand, India
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Murarkar S, Gothankar J, Doke P, Pore P, Lalwani S, Dhumale G, Quraishi S, Patil R, Waghachavare V, Dhobale R, Rasote K, Palkar S, Malshe N. Prevalence and determinants of undernutrition among under-five children residing in urban slums and rural area, Maharashtra, India: a community-based cross-sectional study. BMC Public Health 2020; 20:1559. [PMID: 33066763 PMCID: PMC7565769 DOI: 10.1186/s12889-020-09642-0] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2019] [Accepted: 10/04/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Undernutrition among under five children in India is a major public health problem. Despite India's growth in the economy, the child mortality rate due to undernutrition is still high in both urban and rural areas. Studies that focus on urban slums are scarce. Hence the present study was carried out to assess the prevalence and determinants of undernutrition in children under five in Maharashtra, India. METHODS A community-based cross-sectional study was conducted in 16 randomly selected clusters in two districts of Maharashtra state, India. Data were collected through house to house survey by interviewing mothers of under five children. Total 2929 mothers and their 3671 under five children were covered. Multivariate logistic regression analysis was carried out to identify the determinants of child nutritional status seperately in urban and rural areas. RESULTS The mean age of the children was 2.38 years (±SD 1.36) and mean age of mothers was 24.25 years (± SD 6.37). Overall prevalence of stunting among children under five was 45.9%, wasting was 17.1 and 35.4% children were underweight. Prevalence of wasting, stunting and underweight were more seen in an urban slum than a rural area. In the rural areas exclusive breast feeding (p < 0.001) and acute diarrhea (p = 0.001) were associated with wasting, children with birth order 2 or less than 2 were associated with stunting and exclusive breast feeding (p < 0.05) and low maternal education were associated with underweight. Whereas in the urban slums exclusive breast feeding (p < 0.05) was associated with wasting, sex of the child (p < 0.05) and type of family (p < 0.05) were associated with stunting,and low income of the family (p < 0.05) was associated with underweight. CONCLUSIONS Factors like sex of the child, birth order,exclusive breast feeding,economic status of the family, type of family,acute diarrhea and maternal education have influence on nutritional status of the child. Improvement of maternal education will improve the nutritional status of the child. Strategies are needed to improve the economic status of the community. TRIAL REGISTRATION Trial registration number: CTRI/2017/12/010881 ; Registration date:14/12/2017. Retrospectively registered.
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Affiliation(s)
- Sujata Murarkar
- Department of Community Medicine, Bharati Vidyapeeth Deemed to be University Medical College, Off Pune Satara Road, Pune, 411043, India
| | - Jayashree Gothankar
- Department of Community Medicine, Bharati Vidyapeeth Deemed to be University Medical College, Off Pune Satara Road, Pune, 411043, India.
| | - Prakash Doke
- Department of Community Medicine, Bharati Vidyapeeth Deemed to be University Medical College, Off Pune Satara Road, Pune, 411043, India
| | - Prasad Pore
- Department of Community Medicine, Bharati Vidyapeeth Deemed to be University Medical College, Off Pune Satara Road, Pune, 411043, India
| | - Sanjay Lalwani
- Department of Pediatrics, Bharati Vidyapeeth Deemed to be University Medical College, Pune, India
| | - Girish Dhumale
- Department of Community Medicine, Bharati Vidyapeeth Deemed to be University Medical College, Sangli, India
| | - Sanjay Quraishi
- Department of Community Medicine, Bharati Vidyapeeth Deemed to be University Medical College, Sangli, India
| | - Reshma Patil
- Department of Community Medicine, Symbiosis Medical College for women, Pune, Maharashtra, India
| | - Vivek Waghachavare
- Department of Community Medicine, Bharati Vidyapeeth Deemed to be University Medical College, Sangli, India
| | - Randhir Dhobale
- Department of Community Medicine, Bharati Vidyapeeth Deemed to be University Medical College, Sangli, India
| | - Kirti Rasote
- Department of Community Medicine, Bharati Vidyapeeth Deemed to be University Medical College, Sangli, India
| | - Sonali Palkar
- Department of Community Medicine, Bharati Vidyapeeth Deemed to be University Medical College, Off Pune Satara Road, Pune, 411043, India
| | - Nandini Malshe
- Department of Pediatrics, Bharati Vidyapeeth Deemed to be University Medical College, Pune, India
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Agarwal N, Chaudhary N, Pathak PK, Randhawa A. Composite Indexing for Nutritional Status Evaluation: A Snapshot of Malnutrition across India. Indian J Community Med 2020; 45:343-347. [PMID: 33354016 PMCID: PMC7745825 DOI: 10.4103/ijcm.ijcm_387_19] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2019] [Accepted: 04/13/2020] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Data from several sources revealed that huge incongruity persists in nutritional status across the states in India. Thus, this study was undertaken to generate a nutritional index, so that these disparities could be quantified and comparison be done. MATERIALS AND METHODS A nutritional index for 21 major states of India has been constructed on the basis of eight important nutrition-related indicators. The scaled value of each indicator for all the states was calculated. Each indicator was assigned an arbitrary weight (Wi) on the basis of its impact on nutritional status. On the basis of the scaled value and weight given to the particular indicator, a composite-weighted index was thus calculated. RESULTS States were ranked on their nutritional status as per the final composite score they attained. Out of 21 major states, Kerala took the top position followed by Jammu and Kashmir and Himachal Pradesh on the 2nd and 3rd position, respectively, while Uttar Pradesh got the lowest rank followed by Bihar and Jharkhand on the 2nd and 3rd lowest positions. CONCLUSION Our study concludes that not taking an account of the burden of malnutrition when disbursing funds leads to ineffective implementation of various nutritional programs. Integrated Child Development Services has already been brought in mission mode under Poshan Abhiyan. Other determinants, i.e., illiteracy, poor sanitation, diseases, and infections, should also be considered and addressed through nutritional programs.
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Affiliation(s)
- Neeraj Agarwal
- Department of Community and Family Medicine, AIIMS, Patna, Bihar, India
| | - Neha Chaudhary
- Department of Community and Family Medicine, AIIMS, Patna, Bihar, India
| | | | - Avneet Randhawa
- Department of Community Medicine, GMC, Patiala, Punjab, India
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Rasheed W, Jeyakumar A. Magnitude and severity of anthropometric failure among children under two years using Composite Index of Anthropometric Failure (CIAF) and WHO standards. Int J Pediatr Adolesc Med 2018; 5:24-27. [PMID: 30805528 PMCID: PMC6363267 DOI: 10.1016/j.ijpam.2017.12.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2017] [Revised: 12/04/2017] [Accepted: 12/06/2017] [Indexed: 11/04/2022]
Affiliation(s)
| | - Angeline Jeyakumar
- Interdisciplinary School of Health Sciences, Savitribai Phule University of Pune (Formerly University of Pune), Maharashtra, India
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