A CASE-CONTROL STUDY OF RISK FACTORS FOR MALNUTRITION AMONG PRESCHOOL CHILDREN IN A SEMI URBAN AREA ADJOINING INDORE (MADHYA PRADESH)

Abstract

Background: Childhood malnutrition is a multi-dimensional problem. The prevalence of malnutrition among children in developing countries is very high. An increase in household income is not sufficient to reduce childhood malnutrition if children are deprived of food security, education, access to water, sanitation and health services. The aim of this study is to identify the characteristics of malnourished children between 3 to six years of age and to ascertain the risk factors of childhood malnutrition in a semi urban adjoining Indore (Madhya Pradesh, Central India.
 Objective: The objective of this case control study was to determine the risk factors for malnutrition among preschool children in a semi urban area adjoining Indore (Madhya Pradesh).
 Materials and Methods: A case-control study was carried out among preschool children, aged between three to six years, attending the Anganwadi centres and their mothers in a semi urban area of Tehsil & district Indore of Madhya Pradesh, India from 1 st April to 30th June 2019. Case was a child with moderate to severe malnutrition with z-scores < −2SD from the median of WHO reference. Control was a child without malnutrition with z-scores between -2SD and +2SD and the age matched with case’s. Face to face interviews with the respective child’s mother and measurements of the respective child’s weight and height were carried out. Information on socio-economic characteristics, household food security status, child’s dietary intake, caregiver’s practices and resources were enquired. A total of 1140 children (380 cases and 760 controls) were selected by multistage cluster sampling technique. A semi-structured risk factors questionnaire was used to identify the risk factors for malnutrition among children.
 Results: The majorities (45.8 and 45.5%) of the children in the study were in the age group of 3.0 to 4.0 years in case and control groups respectively. There was a slight preponderance of illiterate parents among cases in comparison to the controls. Largely, 87.4% of the children belonged to poor socio-economic status in the case groups compared to 82.4% in the control group. After adjusting for the confounders, underweight status was significantly associated with socio- economic status of the parents (aOR: 2.05, 95% CI: 1.06, 3.96), birth weight < 2000 g (aOR: 25, 95% CI: 0.10, 0.59), recurrent diarrhoea (aOR: 2.74, 95% CI: 1.56, 4.83), recurrent cold and cough (aOR: 3.88, 95% CI: 1.96, 7.67), worm infestation (aOR: 2.0, 95% CI: 1.19, 3.38) and pre-lacteal feed given (aOR: 3.64, 95% CI: 2.27, 5.86).
 Conclusion: Parental education, childhood illness, short birth interval, open defaecation, type of weaning and complimentary food given to children were some of the significant determinants of underweight that were found in the study. Information, Education and Communication (IEC) campaigns alleviating food habits and taboos and promoting birth spacing is the need of the hour for preventing the occurrence of malnutrition among preschool children.
 Keywords: Malnutrition, Anganwadi centres, preschool children, pre-lacteal feed, socio-economic characteristics, Information, Education and Communication (IEC), Adjusted Odds Ratio (aOR), Integrated Child Development Services (ICDS), Statistical Package for Social Sciences (SPSS).