A study on nutritional status of preschool children and knowledge with special references to breastfeeding practice in urban area

INTRODUCTION

The nutritional status of preschool children is a critical indicator of their overall health and development. The growth of children is largely affected by two important factors-malnutrition and infections.

Deficiencies, excesses, or imbalances in an individual's energy and/or nutrient consumption are referred to as malnutrition. Three major categories of conditions are covered by the term malnutrition: undernutrition, which includes wasting (low weight for height), stunting (low height for age), and underweight (low weight for age); micronutrient-related malnutrition, which comprises micronutrient excess or deficiencies (a lack of essential vitamins and minerals); and obesity, excess weight, and noncommunicable diseases linked to diet (including diabetes, heart disease, stroke, and some types of cancer).

1.9 billion adults worldwide were overweight or obese in 2014, compared to 462 million underweight adults. 37 million children under the age of five were overweight or obese in 2022, while an anticipated 149 million children under the age of five suffered from stunting. Undernutrition is a factor in about half of the deaths of children under the age of five. These primarily emerge in countries with low and moderate incomes.¹

In India especially, malnutrition is a major problem of public health concern. According to the global hunger index 2022 report, the population's prevalence of undernutrition is 16.3%, while the rates of child stunting, child wasting, and child mortality are 35.5%, 19.3%, and 3.3%, respectively.²

The world health organization defines low birth weight as less than 2500 grams at birth. Prematurity, intrauterine growth restriction, or both might result in low birth weight. It is intimately linked to several adverse health consequences, including stunted growth and cognitive development, foetal and neonatal mortality and morbidity, and noncommunicable diseases (NCDs) in later life. Compared to heavier infants, low birth weight babies have a nearly 20 times higher chance of mortality.³

Breastfeeding provides best start of life to babies as well as benefits the health of both mothers and babies. Human breastmilk provides an infant with optimal nourishment at a period when gene expression is being fine-tuned for life, making it possibly the most specific and individualized medication the child will ever receive.⁴ It is secure, hygienic, and loaded with antibodies that help fend off a host of common kid ailments. For the first few months of life, breastmilk supplies all the energy and nutrients an infant requires. It also meets up to half or more of a child's nutritional demands in the second half of the first year and up to one third in second year of life.⁵

For the first six months of life, a baby ought to be exclusively breastfed to achieve ideal growth, development, and health. After that, babies should continue to be breastfed for at least two years, or longer, while receiving safe, supplementary foods that fulfil their changing nutritional needs.⁶

METHODS

The present cross-sectional study was conducted is an urban slum area in Maharashtra. The duration of the study was 1 year, from January 2021 to January 2022. Approval was obtained from institutional ethics committee prior to conducting the study. All the children of age group 3 to 6 years in the area were included in the study. Line listing of children of age group 3-6 years was done from the records of Anganwadi. Accordingly, house to house survey was done. A total of 334 study participants took part in the study. The children were clinically examined. The sociodemographic details household details and knowledge and practices of mothers on breastfeeding were recorded using a pretested questionnaire. Data was entered in MS excel and Chi-square statistical test was applied. All data is represented as graphs and tables. The mothers were also educated on the importance of breastfeeding, complementary feeding and child care.

RESULTS

A total of 334 children and their mothers took part in the study of which 168 (50.29%) were girls and 166 (49.71%) were boys, 161 (48.2%) belonged to the age group of 3 to 4 years, 133 (39.82%) in the age group 4 to 5 years and 40 (11.97%) in the age group of 5-6 years. The mean age of the children was found to be 4.19 years. Figure 1 and 2 shows this distribution.

Figure 1 pie chart showing gender wise distribution of study participants. (n=334).

Figure 2 pie chart showing age wise distribution of study subjects, (n=334).

The 62 (18.56%) children had history of low birth weight.

The prevalence of malnutrition was found to be noticeable among the study participants, 25 (7.48%) were stunted, 210 (62.87%) were underweight, 143 (42.81%) were wasted ad 105 (31.43%) had malnourishment with respect to mid upper arm circumference (MUAC). The distribution is depicted in Figure 3.

Figure 3 bar diagram showing prevalence of malnutrition among study subjects, (n=334).

In the age group of 3 to 4 years, 57 (35.4%) were malnourished with respect to mid upper arm circumference, 13 (8.07%) were stunted, 93 (57.8%) were underweight and 105 (65.2%) were wasted. In the age group of 4 to 5 years, 38 (28.6%) were malnourished with respect to MUAC, 10 (25.00%) stunted, 90 (67.70%) were underweight and 72 (54.10%) were wasted. In the age group of 5-6 years, 10 (25.00%) were malnourished with respect to MUAC, 2 (5%) were stunted, 27 (67.50%) were underweight and 14 (35.00%) were wasted.

Among the total 168 boys, 55 (32.7%) were malnourished with respect to MUAC, 14 (8.33%) were stunted, 100 (59.50%) were underweight and 68 (40.50%) were wasted. Among 166 total girls, 50 (30.10%) were malnourished with respect to MUAC, 11 (6.63%) were stunted, 110 (66.30%) were underweight and 75 (45.20%) were wasted. Table 1 shows the distribution.

The breastfeeding practices of the mothers of the study subjects were remarkably fair, 301 (90.12%) of the total children were exclusively breastfed, 295 (71.86%) of the children were breastfed for more than 2 years and 39 (28.14%) were breastfed till 2 years only (Table 2).

A significant association was found between birth order of study subjects and stunting (p=0.02) and wasting (p=0.03) respectively. Another significant association was found between history low birth weight and stunting (p=0.0197) and underweight (p=0.00133). Continued breastfeeding more than 2 years and stunting (p=0.022) and wasting (p<0.001) were also found to be significantly associated. Table 3 shows the distribution.

DISCUSSION

In a study conducted by Valleppalli et al in South India, prevalence of stunting was 22%, underweight 23.8%, and that of wasting was 12.4%. In present study, prevalence of stunting was 7.48%, underweight was 42.81% and wasting was 31.43%. It was also found that 68.4% of study subjects were exclusively breastfed. In our study, 90.1% were exclusively breastfed indicating good breastfeeding practices. Also, significant association between duration of breastfeeding and malnutrition was observed by them, similar to our study. Low birth weight had significant association with stunting and underweight. They also observed significant association between birth order of children and malnutrition. Similar findings were found in our study also.⁷

Rahman et al in a study conducted in Bangladesh observed that prevalence of stunting, wasting and underweight was 41%, 16% and 36% respectively. In our study the prevalence of stunting was less i.e.; 7.48%, wasting and underweight was found to be 42.81% and 31.43% respectively. Significant association between low birth weight and malnutrition was also observed by them similar to our findings in the present study.⁸

In a study done by Jana et al using NFHS data, prevalence of stunting, wasting and underweight was said to be 33% 19% and 30% respectively. In present study, the prevalence of the same conditions was 7.48%, 42.81% and 31.43% respectively. Significant association between Low birth weight and Birth order of children with malnutrition was also observed by them. Our study also had similar findings.⁹

A study conducted by Das et al in Mumbai also showed significant association between low birth weight and Malnutrition. Similar findings were found in present study also.¹⁰

In a study done by Veluswamy et al in south India, the percentage of children who were exclusively breastfed was 11.4%. But in our study most children, i.e., 90.1% wee exclusively breastfed.¹¹

A study done by Rezwan et al in Bangladesh also shows 100% exclusive breastfeeding among study subjects. Our study also shows good percentage of children (90.1%), who were exclusively breastfed.¹²

Raval et al in a study conducted in Gujrat, found very low percentage of exclusively breastfed children (28.33%). In contrary, our study shows a better percentage of exclusive breastfeeding (90.10%).¹³

Our study has a few limitations since it was done during COVID period. The population of the area was mostly migrated from other regions. Many had returned to their villages due to the lockdown. Hence the children and mothers of such families were to be omitted from the study.

CONCLUSION

The prevalence of stunting, underweight, wasting and MUAC malnutrition were 7.48%, 62.87%, 42.81% and 31.43% respectively. The 90.12% were exclusively breastfed and breastfeeding was continued up to 2 years for 28.14% and more than 2 years for 71.86% children. The breastfeeding practices were fair among the mothers of the children. It was found that 18.56% had history of Low birth weight. It was also found that history of low birth weight of children is significantly associated with malnourishment (i.e., stunting and wasting). The total duration of breastfeeding of children till current age is also significantly associated with malnourishment. (i.e., stunting and wasting). Targeted education and awareness programs to enhance the nutrition and breastfeeding practices can improve the overall health of preschool children in the urban setting can bring about greater improvements in current situations. Improving ANC care, identifying high risk mothers can also help in reducing the rate of low-birth-weight babies which in turn will result in healthy well-nourished children.

Funding: No funding sources

Conflict of interest: None declared

Ethical approval: The study was approved by the Institutional Ethics Committee

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