Factors associated with nutritional status of under five children in Rara Chhayanath Municipaity, Mugu district

INTRODUCTION

Good nutrition is the bedrock of child survival, health and development.¹ Nutritional status is the major indicator for assessing the health status of whole population in country. Malnutrition is the major causes of death among under-five year children in Nepal.¹ Good nutrition is essential for children’s growth and development, and can substantially reduce their risk of death.¹

In 2019, 21.3%, or more than one in five children under age 5 worldwide had stunted growth.² Between 2000 and 2019, stunting prevalence globally declined from 32.4 to 21.3%, and the number of children affected fell from 199.5 million to 144.0 million. In 2019, nearly two out of five stunted children lived in South Asia while another two out of five lived in sub-Saharan Africa.³

Recent data from the 2016 Nepal demographic and health survey indicated that 36% of children under 5 years of age were stunted, 10% were wasted and 27% were underweight.⁴ Nepal multiple indicator cluster survey 2019 shows that 31.5% were stunted, wasted 12% and underweight 24.3% of children under 5 years of age.⁵ The sustainable development goals (SDG) by 2030 target for stunting is 15%, wasting 4% and underweight is 10% among the children below 5 years of age and the target of multi sectorial nutritional plan (MSNP) by 2022 is 28% for stunting, 7% for wasting and 20% for underweight.⁵ The aim of the study was to assess the factors affecting the nutritional status of under five years’ children in Rara Chhayanath Municipality, Mugu district of Nepal.

METHODS

An analytical cross-sectional study design was carried out to assess the factors associated with nutritional status among children of 6-59 months in Rara Chhayanath Municipaity, Mugu district of Nepal. Mugu district is located in Karnali Province of Nepal and is one of the districts with lowest HDI. The study duration was of 10 months i.e., from April 2020 to January 2021. Approval for the study was taken from department of public health, Little Buddha college of health science and Rara Chhayanath Municipality, Mugu District. Verbal and written informed consent were taken from the participants before data collection process. According to the NDHS 2016 the prevalence of stunting was 55%, wasting 8% and underweight were 36% in Karnali Province.

Sample size calculation

Sample size was calculated using the formula:

Where, Z=standard normal deviate, p=prevalence=55% (prevalence of stunting according to NDHS 2016 in Karnali province), q= (1-p), d=allowable error.

The total sample size of the study was 194 and adding 10% non-response rate, the final sample size was 203. Purposive sampling was used for selecting study area (or ward) and systematic random sampling was used to select the study units within each selected ward. The vitamin A registers were used to identify the total number of households having U5 year’s children in the Rara Chhayanath Municipality.

The variables under study were: sex of the child, age of the child, family type, mothers’ education, main source of income, family income, exclusive breast feeding, weaning, minimum meal frequency and intake of diverse food. Semi-structured questionnaire was used to interview the mothers of the children. Weighing machine and measuring tapes were used for measuring the weight and height of the under five children for determining stunting and wasting. The weight of the participants was measured in kilogram and height was measured in the unit cm with nearest 0.1 cm. Mentally ill, physically disabled mothers of the children and the children who were ill during and 7 days prior to data collection were excluded from the study.

RESULTS

The socio-demographic and socio-economic characteristics of the participants is depicted in (Table 1).

Among the total participants, more than half (53.5%) were female and almost two third (61.4%) were of age more than 24 months. More than half (55.9%) of the participants had joint family. Regarding educational status of the participants, almost half (47.5%) of mothers had completed primary school. Agriculture was the main source of income (33.8%) followed by job/service (30.5%). More than half (54%) had family income more than or equal to Nrs. 15000. Infant and young child feeding and meal related characteristics of the respondents are given in (Table 2). Regarding exclusive breastfeeding and weaning practice of children, more than one-third (69%) of the participants were exclusively breastfed and almost one-third (30.5%) were weaned before 6 months. Food frequency of more than four-fifth (78.4%) of the children was more than 4 times. Regarding intake of diverse food in a day by the children, cent percent were given grains roots and tubers followed by legumes and nuts (98.6%) and Vitamin A rich fruits and vegetables (88.4%).

The nutritional status of the under five years’ children is shown in (Figure 1). Among the children, 40.4% were stunted and 14.1% were wasted. The association between stunting and different socio-demographic, socio-economic and nutritional variables of the participants is shown in (Table 3). Among the variables, Ethnicity (p=0.016), education of mother (p=0.029), main source of income (p=0.006), monthly income (p=0.003), exclusive breast feeding (p=0.002) and meal frequency (p=0.029) were significantly associated with stunting. The association between wasting and different socio-demographic, socio-economic and nutritional variables of the participants is depicted in (Table 4). Among the variables, Ethnicity (p=0.040), education of mother (p<0.001), main source of income (p=042), monthly income (p=0.040), Exclusive breast feeding (p=001) and meal frequency (p=0.008) were significantly associated with wasting.

DISCUSSION

The prevalence of stunting and wasting was found to be 40.4% and 14.1%, respectively among children of 6-59 months in Rara Chhayanath Municipaity, Mugu district of Nepal. Stunting and wasting were higher than the National data of Nepal demographic and health survey 2016.³ But stunting is lower and wasting is higher than the Karnali province level data of NDHS 2016.³ The prevalence of stunting and wasting were lower than the national data of NMICS 2019 of Karnali Province which are 47.8% and 17.6% respectively.⁵

Stunting and wasting were not significantly associated with sex of children of under five years children and the results were supported by study conducted in Bhadrapur, Nepal.⁶ Another study conducted in East Gojjam zone, Northwest Ethiopia also supported the finding of this study.⁷ Age of children under five years was not significantly associated with stunting and wasting in this study. According to a community-based cross-sectional study was conducted in Wolaita district from May to June 2015, stunting was not statistically significant with child’s age.⁸ The finding of stunting in relation to children age was in line with a study conducted in Bhadrapur district of Nepal.⁶ Stunting and wasting were significantly associated with education of mothers in this study and the result is supported by different studies conducted around the world.^7,8,9 The finding from NDHS 2016 also has stated that the children of mothers with low education had higher level of undernutrition.¹¹ Main sources of income were statistically significant with stunting and wasting of the under five children.

Regarding income of the family of the children in the community, Both the stunting (p=0.003) and wasting (p=0.04) were significantly associated with income of the family. The finding is supported by different studies conducted in low-middle income countries.^6,7,12-14 Stunting and wasting in this study were not significantly associated with weaning period and the study is in line with the study conducted in Bhadrapur district of Nepal.⁷ Stunting and wasting were statistically significant with exclusive breastfeeding in the study as the results are supported by the study conducted in Nepal, Srilanka and India.^6,15,16 Similarly minimum meal frequency of the under five children was statistically significant with the stunting and wasting and the study is supported by a study conducted in Nepal.^6,17

CONCLUSION

There was higher prevalence of stunting and wasting in the Rara Chhayanath municipality, Mugu district of Nepal in comparison to the National and provincial figure. The study revealed that maternal education, family income, exclusive breastfeeding and minimum meal frequency were significantly associated with under nutrition (stunting and wasting). The municipality as well as province should focus on different nutrition related activities to upgrade the status of under five children in Mugu district of Nepal.

ACKNOWLEDGEMENTS

Authors are grateful to Rara Chhayanath municipality office and health posts whose support for making this study possible is significant.

Funding: No funding sources

Conflict of interest: None declared

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

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