Letters to the Editor

Abstract

17 June 2008 Dear Editor, UNDERWEIGHT AND STUNTING AMONG SLUM CHILDREN OF MIDNAPORE, INDIA India accounts for about 40% of undernourished children in the world, which contribute to high morbidity and mortality in the country.1 Most of these malnourished children are underprivileged and many reside in slums. Slums are those areas which are characterised by insecure residual status, poor structural quality of house, overcrowding, inadequate access to safe water and sanitation.2 Therefore, slum dwellers are more vulnerable to infections which results in deterioration of their nutritional status. Hitherto, data are lacking on malnutrition,3 as assessed by WHO-recommended Z-score method, of urban slum children of West Bengal. The present study reports the prevalence of underweight and stunting among urban slum children in Midnapore town of West Bengal. Data were collected in a slum area in Midnapore town of West Bengal during November–December, 2005. All information was collected by a trained investigator (SD). Parents were informed about the objectives of the study and their written consent was obtained. The protocol of the study was approved by the institutional ethical committee. Information on age, sex, weight and height was recorded with the help of structured questionnaire. Childrens' age were recorded as reported by mothers and verified further with other senior members of the household. Weight and height measurements were made following standard technique4 using weighing scale and anthropometer rod to the precession of 0.5 kg and 0.1 cm, respectively. Underweight and stunting was assessed as weight-for-age and height-for-age Z-score <−2.0 from the National Center for Health Statistics reference population5 using EPI6 Software (Centers for Disease Control and Prevention, Atlanta, CA, USA). Severe and moderate malnutrition was considered as Z-score <−3.0 and Z-score between ≥−3.0 and <−2.0, respectively. Risk was measured based on odds ratio (OR) between age groups based on nutritional status, that is, undernutrition versus normal. The data from the present study comprised of 316 children aged 6–18 years, out of whom 44.0% were boys and 56.0% were girls (Table 1). They were grouped according to three different stages of growth as late childhood (6–9 years), early adolescent (10–14 years) and late adolescent (15–18 years), respectively. The overall (sex combined) prevalence of underweight was 47.8%. Of these, 7.6% and 40.2% children were found to be severely and moderately underweight, respectively. Similarly, the overall prevalence of stunting was 45.6%, with 17.7% and 27.8% children found to be severely and moderately stunted, respectively. Results revealed that prevalence of underweight was higher among boys (48.9%) compared with girls (46.9%). In contrast, prevalence of stunting was higher in girls (49.7%) compared with boys (40.3%). The girls had 1.47 (OR = 1.47 95% confidence interval: 0.91–2.36) fold higher risk to be stunted compared with boys, indicating that girls were suffering from long-term nutritional stress. It was important to note that children in the age group of 10–14 years had lower risk to be underweight and stunted compared with age groups 6–9 years and 15–18 years (except for stunting among girls). The prevalence of stunting among girls was lower in 6–9 years age group and these rates increased with advancement of age (χ2 = 13.06, P < 0.01). They were 43% and 167% less likely to be stunted compared with age groups of 10–14 and 15–18 years, respectively. Based on the WHO classification of severity of malnutrition,6 the overall prevalence of underweight and stunting were very high (≥30% and ≥40.0%). In conclusion, the nutritional status of the slum children in this area is critical. There is an urgent need for steps to be taken to improve nutritional status of these slum children. The authors express their thanks to the guardian for providing their time and cooperation during the study period.