Nutritional Status of Under Five -Children in Urban Slums: A Cross-Sectional Study in Sambalpur District, Odisha

Tripti Kumari¹*, Chandrashree Lenka² and Pravabati Guru³

¹Research Scholar, Sambalpur University, India
²Professor & Head R. D womens University, BBSR, India
³Former Regional Director, RDE Sambalpur, India

*Corresponding Author:Tripti Kumari, Research Scholar, Sambalpur University, India

Received: September 12, 2024; Published: September 26, 2024

Citation: Tripti Kumari., et al. “Nutritional Status of Under Five -Children in Urban Slums: A Cross-Sectional Study in Sambalpur District, Odisha". Acta Scientific Dental Sciences 8.10 (2024):58-64.

Abstract

Background: The nutritional status of children under five in slums is vital for evaluating the overall health of these populations. Malnutrition in these children reflects broader issues of inadequate nutrition and poor living conditions. Limited accesses to essential resources in slum environments exacerbate their vulnerability to growth problems and infectious diseases.

Methods: A community-based cross-sectional study was carried out from 2022 to 2023 in urban slums of Sambalpur District, involving 550 children aged 6-60 months selected via simple random sampling from 20 urban slums. Data were gathered through home visits and interviews with mothers using a pre-designed, pre-tested interview schedule. Anthropometric measurements and nutritional assessments followed WHO (2006) guidelines.

Results: In the study of 550 children, the analysis showed that stunting was the most prevalent i.e. 42.8%, followed by underweight 34.7%, and wasting at 22.4%. The rates of overweight were 1.5% in boys and 2.1% in girls. The study found no significant association between malnutrition and gender.

Conclusion: Malnutrition among under-five children was notably high. Childhood malnutrition results from multiple factors, addressing it effectively requires a comprehensive, multifaceted approach rather than focusing on a single cause.

Keywords: Mild; Moderate; Severe; Stunting; Wasting; Underweight; Under-Nutrition

Introduction

Nutrition is crucial for a child's health, playing a vital role in preventing disease and reducing mortality. Malnutrition is a multifaceted issue that encompasses several categories: undernutrition, which includes wasting, stunting, and underweight; micronutrient deficiencies; and conditions such as overweight, obesity. This global challenge affects every country. According to the WHO, approximately 45 million children under five years old are wasted, with 17 million of these being severely wasted. Additionally, 155 million children are stunted, and 41 million are either overweight or obese. Malnutrition remains a leading cause of mortality in children under five, accounting for nearly half of all deaths in this age group. Furthermore, low- and middle-income countries are experiencing a growing prevalence of childhood overweight and obesity. In India, malnutrition among children under five is a significant public health issue. Odisha is one of the poor state of India, faces significant malnutrition issues, particularly in urban slum areas where inadequate healthcare infrastructure and a large migrant population exacerbate child health problems. Sambalpur, located in western Odisha, is notably affected due to its substantial slum population, and there is a lack of recent research on malnutrition in under five children in this region.

Objectives

To determine the prevalence of stunting, underweight, and wasting among children under five in the urban slums of Sambalpur District.

Materials and Methods

An observational, descriptive, community-based cross-sectional study was conducted among under-five children in the urban slums of Sambalpur District, Odisha, after getting permission from the DSWO. The study was conducted during 2022-23.

• Sample size: The sample size was determined based on a stunting prevalence of 40.7% in Sambalpur District. By using the formula 4PQ/L², P = Prevalence of malnutrition (taking as 40.7%), Q = 100-P. L = Allowable error (5%) = 4*40.7*59.3/5*5 = 387.However, the study included 550 subjects for study.
• Inclusion criteria: All under-five children whose mothers consented to participate in the study and children present during household visits and not seriously will, were included.
• Exclusion criteria: Children with congenital malformations, mental disabilities, or serious illness were excluded, as were those whose mothers did not consent to participate in the study.
• Data Collection: Twenty urban slums were randomly selected for the study. Data were collected through interviews with mothers or caregivers present during house visits using a pre-designed, pre-tested questionnaire. Anthropometric measurements followed WHO guidelines: weight was recorded in kilograms with minimal clothing, length was measured using an infant-meter for children under two, and height was measured with a stadiometer or tape for those who could stand. MUAC and Head Circumference (HC) were assessed with appropriate measuring tools. Nutritional status was evaluated based on height-for-age (stunting), weight-for-age (underweight), and weight-for-height (wasting). Nutritional grades were categorized as normal, mild, moderate, or severe according to WHO standards. A total of 550 children (268 boys and 282 girls) were included in the study.
• Study tools: Using WHO Anthro Software version 3.2.2, Z-scores for various nutritional conditions, including height-for-age, weight-for-age and weight for height, were plotted according to WHO standards.
• Data Analysis: The data was coded and entered into Microsoft Excel, and the analysis was performed using SPSS version 23.

Results and Discussion

Table 1 presented a comparison of nutritional status by gender based on height-for-age Z-scores. Among boys, 37.3% were normal, while 22.8% had mild stunting, 20.9% had moderate stunting, and 19.0% had severe stunting. For girls, 33.3% were normal, with 25.2% experiencing mild stunting, 25.5% moderate stunting, and 16.0% severe stunting.  Gender did not significantly influence the prevalence of stunting among the children. In a similar study by Gautam S.K., et al. (2018) [1], it was observed that severe stunting was more prevalent among males (14.81%) compared to females (12.44%). However, the relationship between gender and height-for-age was not statistically significant (p > 0.05).

Table 2 detailed the nutritional status of boys and girls based on weight-for-age Z-scores. Among boys, 1.5% were overweight, 42.5% were normal, 18.7% were mildly underweight, 23.9% were moderately underweight, and 13.4% were severely underweight. For girls, 2.1% were overweight, 40.4% were normal, 25.2% were mildly underweight, 22.7% were moderately underweight, and 9.6% were severely underweight. The chi-square test revealed that no significant difference between boys and girls, indicating similar patterns of underweight and overweight across genders. A similar study done by Camala B. (2019) [2], reported a slightly different distribution but similar trends. Among boys, 42.25% were well-nourished, while the percentages for mild, moderate, and severe underweight were 29.41%, 19.25%, and 9.09%, respectively. For girls, 40.71% were well-nourished, with 37.17% mildly underweight, 15.93% moderately underweight and 6.19% severely underweight. A chi-square test indicated no significant difference in nutritional status between boys and girls based on weight-for-age.

Another study done by Gupta V., et al. (2019) [3], moderate underweight was observed to be more common in girls (29.7%) compared to boys (25.2%). On the other hand, severe underweight was more prevalent among boys (11.6%) than girls (10.6%). However, these differences were found to be statistically insignificant.

Table 3 displayed the nutritional status of boys and girls based on weight-for-height Z-scores. Among boys, 60.4% were classified as normal, 15.7% had mild wasting, 15.7% had moderate wasting, and 8.2% had severe wasting. For girls, 57.1% were normal, 22.0% had mild wasting, 12.8% had moderate wasting, and 8.2% had severe wasting. There was no significant gender difference for wasting. In a study by Gupta V., et al. (2019), it was observed that moderate wasting was more prevalent among girls (13.3%) compared to boys (12.2%). Conversely, severe wasting was more common in boys (6.8%) than in girls (4.2%). However, these differences were found to be statistically insignificant.

Table 4 compared head circumference (HC) nutritional status between boys and girls. Among boys, 42.9% had normal head circumference, 28.7% had mild HC, 19.8% had moderate HC, and 8.6% had severe HC. For girls, 33.3% had normal HC, 36.2% had mild HC, 20.6% had moderate HC, and 9.9% had severe HC. There was no significant gender difference (χ2 = 5.96, p = 0.113), showing that head circumference status was similar between boys and girls. A study done by Tigga PL., et al. (2016) [3], it was found that the overall prevalence of undernutrition, as assessed by head circumference, was slightly higher among girls compared to boys. The prevalence of severe undernutrition was lower than that of moderate undernutrition for both genders. While the differences in the overall age-specific prevalence of undernutrition between boys and girls were not statistically significant, both sexes were equally affected.

Table 5 showed the distribution of wasting among boys and girls. Normal nutritional status was observed in 54.1% of boys and 51.1% of girls. Mild wasting affected 30.2% of boys and 34.8% of girls, while moderate wasting was seen in 13.1% of boys and 11.7% of girls. Severe wasting was present in 2.6% of boys and 2.5% of girls. The chi-square test indicated no significant gender difference, similar levels of wasting among both genders.

Table 6 compared the prevalence of nutritional issues among boys and girls, focusing on underweight, stunting, wasting, MUAC, and HC below -2 SD. In boys, 37.3% were underweight, 42.2% were stunted, 23.9% had wasting, 15.7% had low MUAC, and 28.4% had low head circumference. Among girls, the corresponding figures were 32.3% underweight, 43.6% stunted, 20.9% wasted, 14.2% with low MUAC, and 30.5% with low head circumference. It showed highest prevalence of stunting followed by underweight and least for wasting. Similar trends for prevalence were noticed in NFHS-5 of Odisha (stunting 31.0%, underweight 29.7%, and wasting 18.1%) and Sambalpur District (stunting 40.7%, underweight 36.3%, and wasting 25.5%). There was no significant gender difference in these nutritional parameters. Both boys and girls had similar prevalence of malnutrition.  A similar study done by Camala B. (2019), the overall prevalence of underweight was 28.3% among boys and 22.1% among girls, while stunting was more common in boys at 28.9% compared to 14.2% in girls. Wasting prevalence was 29.9% for boys and 23.0% for girls, with MUAC Z-scores showing 20.3% in boys and 26.6% in girls, and SFT Z-scores indicating 26.7% in boys and 25.7% in girls. The chi-square test revealed no significant gender differences in these nutritional indicators. Another study done by Bisai S., et al. (2010) [5]. It was noted that boys were more malnourished in the form of underweight, stunted and wasted (65.5%; 53.5%; 23.8%;) than the girls (60.9 %; 51.6%; 19.6%), but this was not statistically significant. However, prevalence of severe underweight was significantly higher among boys 19.3 % than their girls 12.8% [6-22].

Table 7 revealed varying prevalence rates of stunting, underweight, and wasting across different study locations, shedding light on regional differences compared to the urban slums of Sambalpur District, Odisha. Stunting rates in Sambalpur (42.2%) were similar to those in Berhampur, Odisha (42%), suggesting common socio-economic and environmental challenges, such as poor living standards and limited nutrition. Conversely, higher stunting rates in Amritsar City, Punjab (50%), and Vijayawada and Guntur (46.63%) may reflect more severe socio-economic hardships, including poverty and inadequate sanitation. In contrast, lower stunting rates in Bankura Municipality, West Bengal (15.9%), and Srikakulam District, Andhra Pradesh (20.7%) suggest better healthcare access and improved living conditions. These variations underscore the significant impact of socio-economic factors, healthcare, and local interventions on child nutrition.

Conclusion

The study found that stunting, underweight, and wasting rates in slum areas exceeded both national and state averages (NFHS-5), though wasting rates was lower than those in District Sambalpur. This highlights a higher incidence of malnutrition among children in slum areas. The analysis showed that malnutrition rates were comparable between boys and girls. Notably, the prevalence of stunting and underweight was more pronounced compared to wasting

Bibliography

1. Bisai S., et al. “Prevalence of Underweight, Stunting and Wasting Among Urban Poor Children Aged 1- 5 Years of West Bengal, India”. International Journal of Current Research 6 (2010): 039-044.
2. Biswas A and Bisanka Biswas B. “Anthropometric Assessment of Nutritional Status among Under-five Children Attending Government Immunization Centres in Bankura Municipality, West Bengal”. Indian Journal of Public Health Research and Development4 (2023): 46-56.
3. Camala B. “A study to assess the nutritional status of under five children and to evaluate the effectiveness of nutritional intervention programme on Protein-Energy Malnutrition in selected villagers of Moinabad Mandal, Ranga Reddy District Telengana, D thesis, Annamalai University (2019).
4. Chaudhary P and Agrawal M. “Malnutrition and associated factors among children below five years of age residing in slum area of Jaipur City, Rajasthan, India”. Asian Journal of Clinical Nutrition 1 (2019): 1-8.
5. District Fact Sheet Sambalpur Odisha. “The National Family Health Survey 2019-21 (NFHS-5)”. Provides information on population, health and nutrition for India (2021).
6. Gautam SK., et al. “Nutritional status and its corelates in under five slum children of Kanpur Nagar, India”. International Journal of Contemporary Pediatrics 2 (2018): 584-590.
7. Goyal M., et al. “Assessment of Nutritional Status of Under-Five Children in an Urban Area of South Delhi, India”. Cureus2 (2023): e34924.
8. Gupta V., et al. “Nutritional assessment among children (1–5 years of age) using various anthropometric indices in a rural area of Haryana, India”. Indian Journal Community Family and Medicine 5 (2019): 39-43.
9. Huey SL., et al. “Prevalence and Correlates of Undernutrition in Young Children Living in Urban Slums of Mumbai, India: A Cross Sectional Study”. Frontiers in Public Health 7 (2019): 1-13.
10. India Fact Sheet. “The National Family Health Survey 2019-21 (NFHS-5)”. Provides information on population, health and nutrition for India (2021).
11. Murarkar S., et al. “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 20 (2020):
12. Nanda NP., et al. “Malnutrition and Comorbidity Pattern Among Under Five Children in Urban Slums of Berhampur: A Cross-Sectional Study”. Asian Journal Pharmaceutical and Clinical Research7 (2023): 112-116.
13. Prusty RK., et al. “Socio-biomedical predictors of child nutrition in India: an ecological analysis from a nationally representative Demographic and Health Survey, 2015–2016”. Journal of Health, Population and Nutrition 1 (2016): 2-14.
14. Ram AS and Rao MM. “Assessment of nutritional status in children less than 4 years in rural areas of Andhra Pradesh”. World Journal of Pharmceutical Sciences3 (2016): 564-569.
15. Saigal N and Shrivastava S. “Access to Nutrition in Odisha”. South Asia Research1 (2021): 109-120.
16. Sethy G., et al. “Assessment of Morbidity Profile Among Under-Five Children In Urban Slum Area of Berhampur, A Southern City Of Odisha- A Cross-Sectional Study”. Journal of Evidence Based Medicine and Healthcare93 (2017): 5692-5696.
17. Sethy PGS., et al. “Nutritional Status of Preschool Children in Association with Some Trace Elements in Rural Gram Panchayatas of Bhubaneswar, Odisha, India”. Advanced Science Letters 20 (2014): 868-873.
18. Singh J., et al. “Morbidity profile of under-5 slum dwellers of Amritsar city: A descriptive cross-sectional study”. Journal of Family Medicine and Primary Care 11 (2021): 4131-4136.
19. State Fact Sheet Odisha. The National Family Health Survey 2019-21 (NFHS-5). Provides information on population, health and nutrition for India (2021).
20. Tigga PL., et al. “Head circumference as an indicator of undernutrition among tribal pre-school children aged 2-5 years of North Bengal, India”. Human Biology Review1 (2016): 17-33.
21. Twinkle V., et al. “Nutritional Status of School Age Children in Urban Slum Area in Vijayawada and Guntur”. Journal of Clinical and Diagnostic Research4 (2020): 1-4.
22. WHO child growth standards: length/height-for-age, weight-for-age, weight-for-length, weight-for-height and body mass index-for-age: methods and development (2021).

---

Copyright: © 2024 Tripti Kumari., et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.