Young Children In India Research Articles

Geographical altitude and stunting among children aged under 5 years in India

IntroductionPrevious studies have found positive associations between higher geographical altitude and increased risk of stunting in children under 5 years old, but little evidence exists on this relationship in the...

Associated factors of child wasting among children aged 0 – 23 months in India: Analysis of the National Family Health Survey-5

The enduringly high prevalence of child wasting (weight-for-height-2SD) in India is a significant cause for concern. The objective of this study is to identify areas with high incidence of wasting among children aged 0 – 23 months and to uncover the factors influencing wasting among young children in India. The analysis utilized individual and district-level data from the National Family Health Survey-5 in 2019 – 2021. The wasting prevalence exceeding 30% was found in 81 districts, with 501 districts surpassing 15%. Our analysis indicated that children from the poorest households (adjusted odds ratio [AOR] = 1.60, 95% confidence interval [CI] = 1.43 – 1.79), those lacking access to improved sanitation facilities (AOR = 1.18, 95% CI = 1.11 – 1.25), belonging to other backward class families (AOR =1.12, 95% CI = 1.04 – 1.20), and born to mothers with body mass index (BMI) <18.5 (AOR = 1.30, 95% CI = 1.23 – 1.37) faced higher odds of wasting. In addition, low birth weight (<2500 g) increased the odds of wasting by 27% (AOR = 1.27, 95% CI = 1.20 – 1.36). The study further found that a minimum acceptable diet and female gender had protective effects on wasting among children aged 6 – 23 months. These findings underscore the need for a comprehensive programmatic response to addressing wasting in young children. Urgent policies and programmatic actions are warranted, with a specific focus on strengthening the care of low birth weight and premature babies, as well as promoting optimal child feeding practices. There is a call for intensified nutrition services as an integral component of routine health services for mothers. Early identification and management of wasting and counseling during pre-conception and pregnancy should be prioritized.

Nutritional status of infants and young children in India across three decades: Analysis of five national family health surveys.

Three indicators of early childhood undernutrition and associated factors are evaluated among under-5 children in five National Family Health Surveys in India spanning 1992 to 2021. Data for 533,495 children under 5 years of age (U-5) were analysed in the context of three commonly used indicators of early childhood undernutrition - wasting, stunting and underweight. In addition to descriptive and inferential statistics, binary logistic regression was used to estimate the effects of specific explanatory factors on the three indicators using adjusted odds ratios. Over the three-decade interval, stunting was reduced by 22.1% in boys and 20.9% in girls, followed by underweight, 19.3% in boys and 17.4% in girls; wasting, in contrast, was reduced to a considerably lesser extent, 2.8% in boys and 0.9% in girls. Demographic, maternal and socioeconomic factors were associated with the incidence of early childhood undernutrition, specifically among young mothers and those with less education in low-income families, and among children from Scheduled Tribes or Scheduled Castes. Stunting and underweight declined significantly over the past three decades while wasting changed negligibly. The disparity in the occurrence of early childhood undernutrition was apparent throughout socioeconomic categories and regions of India. The results highlight the need for special programs aimed at reducing waste among children and also the need for customized initiatives focused on the improvement of maternal education and wealth in addition to other ancillary factors related to regional variation.

Patterns of antibiotic use for acute respiratory infections in under-three-year-old children in India: A cross-sectional study.

Despite its mostly viral etiology, antibiotics are frequently used to treat acute respiratory infections (ARIs) in children. India is one of the largest global consumers of antibiotics and has one of the highest rates of resistance to antimicrobial treatments. However, the epidemiology of antibiotic treatment among young children in India is poorly understood. Using nationally representative household survey data from the Indian National Family Health Surveys (NFHS) conducted between 2015 and 2016 and 2019 and 2021, we estimated the prevalence of antibiotic use among 17 472 children under the age of three who reported ARI symptoms within two weeks before their mothers were interviewed. To assess the factors associated with antibiotic use for the treatment of ARI symptoms, we used multivariable logistic regression models that included sociodemographic, child-related, household, and health care related characteristics, with results reported on the prevalence difference (PD) scale. We estimated that 18.7% (95% CI = 17.8-19.6) of under-three-year-old (U3) children who exhibited ARI symptoms in the two weeks prior to the survey were given antibiotics as a treatment. The highest prevalence was observed in the southern and northern geographic zones of India. Furthermore, multivariable regression models indicated that children with greater access to health services were more likely to receive antibiotics for ARI treatment, regardless of the type of health care facility (public, private or pharmacy/unregulated). Additionally, the prevalence of antibiotic consumption was higher among children from families with religious affiliations other than Muslim and Hindu backgrounds (i.e. Christian, Sikh, Buddhist/neo-Buddhist, Jain, Jewish, Parsi, no religion and other) (PD = 11.7 (95% CI = 6.3-16.7)) compared to Hindu families and among mothers with a secondary or higher education (PD = 5.8 (95% CI = 1.7-9.9)) compared to mothers lacking formal education. Our findings provide an important baseline for monitoring the use of antibiotics for the treatment of acute respiratory infections, and for designing interventions to mitigate potential misuse among young children in India.

Impact of ambient air pollution and socio-environmental factors on the health of children younger than 5 years in India: a population-based analysis

Ambient air pollution and household environmental factors affect child health, particularly in low-income and middle-income countries. This study aimed to investigate the association between ambient air pollution (PM2·5) levels, socio-environmental factors (including household wealth, housing quality measures, smoking status), and the occurrence of respiratory illness in Indian children. In this retrospective and observational study, we analysed data from India's National Family Health Survey (NFHS-5, 2019-2021) combined with NASA's Global Annual PM2·5 Grids database. Bivariate and multivariable generalized additive models were employed to examine associations between key social-environmental factors and respiratory illness in children younger than 5 years. We analysed data from 224,214 children younger than 5 years, representing 165,561 families from 29,757 geographic clusters. Our results showed extremely high annual PM2·5 levels throughout India (median 63·4·g/m3, IQR 41·9-81·6), with higher exposure for rural and impoverished families. In bivariate analyses, PM2·5 was significantly associated with reported respiratory illness (p<0·001). Using generalized additive models and after accounting for key social and environmental factors, a monotonic increasing and non-linear relationship was observed between PM2·5 and respiratory illness (p<0·001), with increased likelihood of illness observed even at values near and below India's National Ambient Air Quality Standards of 40μg/m3. The study highlights the significant association of social-environmental conditions with health outcomes among young children in India. Efforts specifically targeting ambient air pollution and child health during monsoon season could have significant health benefits among this population and help achieve the goal of ending preventable deaths of children younger than 5 years. National Institutes of Health (NIH T-32-HL139443-3).

Corrigendum to- “Prevalence of Zero-Food among infants and young children in India: patterns of change across the States and Union Territories of India, 1993–2021”

Corrigendum to- “Prevalence of Zero-Food among infants and young children in India: patterns of change across the States and Union Territories of India, 1993–2021”

Prevalence of Zero-Food among infants and young children in India: patterns of change across the States and Union Territories of India, 1993–2021

The extent of food deprivation and insecurity among infants and young children-a critical phase for children's current and future health and well-being-in India is unknown. We estimate the prevalence of food deprivation among infants and young children in India and describe its evolution over time at sub-national levels. Data from five National Family Health Surveys (NFHS) conducted in 1993, 1999, 2006, 2016 and 2021 for the 36 states/Union Territories (UTs) of India were used. The study population consisted of the most recent children (6-23 months) born to mothers (aged 15-49 years), who were alive and living with the mother at the time of survey (n=175,614 after excluding observations that had no responses to the food question). Food deprivation was defined based on the mother's reporting of the child having not eaten any food of substantial calorific content (i.e., any solid/semi-solid/soft/mushy food types, infant formula and powdered/tinned/fresh milk) in the past 24hours (h), which we labelled as "Zero-Food". In this study, we analyzed Zero-Food in terms of percent prevalence as well as population headcount burden. We calculated the Absolute Change (AC) to quantify the change in the percentage points of Zero-Food across time periods for all-India and by states/UTs. The prevalence of Zero-Food in India marginally declined from 20.0% (95% CI: 19.3%-20.7%) in 1993 to 17.8% (95% CI: 17.5%-18.1%) in 2021. There were considerable differences in the trajectories of change in the prevalence of Zero-Food across states. Chhattisgarh, Mizoram, and Jammu and Kashmir experienced high increase in the prevalence of Zero-Food over this time period, while Nagaland, Odisha, Rajasthan and Madhya Pradesh witnessed a significant decline. In 2021, Uttar Pradesh (27.4%), Chhattisgarh (24.6%), Jharkhand (21%), Rajasthan (19.8%) and Assam (19.4%) were states with the highest prevalence of Zero-Food. As of 2021, the estimated number of Zero-Food children in India was 5,998,138, with the states of Uttar Pradesh (28.4%), Bihar (14.2%), Maharashtra (7.1%), Rajasthan (6.5%), and Madhya Pradesh (6%) accounting for nearly two-thirds of the total Zero-Food children in India. Zero-Food in 2021 was concerningly high among children aged 6-11 months (30.6%) and substantial even among children aged 18-23 months (8.5%). Overall, socioeconomically advantaged groups had lower prevalence of Zero-Food than disadvantaged groups. Concerted efforts at the national and state levels are required to further strengthen existing policies, and design and develop new ones to provide affordable food to children in a timely and equitable manner to ensure food security among infants and young children. This study was supported by a grant from the Bill & Melinda Gates Foundation INV-002992.

Role of Ayurveda in Delayed Speech in Children –A Case Series

Developmental delay in speech is a common occurrence among young children in India with a prevalence of up to 17%. If left undiagnosed and untreated, speech delay can lead to other adverse developmental and health outcomes. The purpose of this paper is to present unusual cases that showed the uncommon role of Ayurveda in the treatment of speech delay among three separate patient case studies of children aged 24 to 29 months who presented with the inability to formulate words. Theayurvedic concept of speech formation involves the initiation of sound waves from the umbilicus, which travels upward and then eventually gets manifested through vocal cords.Understanding the health of the umbilicus and surrounding anatomical structures in the abdomen was critical in the diagnosis and treatment of the three case studies. The cleansing treatment provided is similar to that given for worm infestation, which has distant similarities in the mechanism of disease as speech delay. In all three cases, the treatments provided led to a gradual increase in word formation and verbalization including the number of words and the sentences spoken. One of the patients demonstrated significant improvement by speaking full sentences and expressing words distinctly, 30-day post-treatment. The other two patients started speaking complete sentences and expressing words by month three post-treatment. The presentation of the three cases provides a unique lens on the use of Ayurveda principles and may provide an alternative approach to treating speech delays that focus more on lifestyle and individual constitution.

Factors associated with suboptimal complementary feeding practices among mothers of infants and young children in India.

To examine the current complementary feeding practices among infants and young children aged 6 to 23 months in India, and factors influencing these practices at child, parental, household and community levels. Data on 74,095 last-born children aged 6 to 23 months used in this study were obtained from the 2015 India Demographic and Health Survey (IDHS). Complementary feeding indicators (timely introduction of complementary foods to infants aged 6 to 8 months old, minimum meal frequency, minimum dietary diversity, and minimum acceptable diets) were estimated, and their associated factors were identified using descriptive and multivariate (logistic regression) analyses. The prevalence of the timely introduction of complementary foods to infants aged 6 to 8 months was 45.1%. The proportion of children between ages 6 to 23 months who received the minimum meal frequency, minimum dietary diversity and minimum acceptable diets were 36%, 21% and 9.1%, respectively. Findings from the multivariate analyses revealed that mothers of infants delivered at home, mothers who had no antenatal check-up, mothers who are Hindus, mothers living in rural areas or those from the Western/Northern geographical regions of India were at higher risk of suboptimal complementary feeding practices.

PREVALENCE OF INTESTINAL PARASITIC INFESTATION AND ITS ASSOCIATED RISK FACTOR IN RURAL AREAS CHILDREN OF VARANASI DISTRICT, UTTAR PRADESH

Intestinal parasitic infection is a major cause of morbidity among young children in India, due to low socioeconomic status and poor personal hygiene practices. Intestinal parasitic infestations are majorly challenged by the rural areas school children of Varanasi district. Considering the fact, the current study was conducted among rural areas school children from 06-16 years of age, with an aim to know the prevalence of Intestinal worm infestation. The study was conducted on 246 school children's fecal specimens. The collected specimens were examined with the Saline wet mount and Iodine wet mount method. Out of the total studied subjects, the prevalence of Intestinal worm infestation was found to be 17%. In our study, Protozoan infections are 8% commonly found followed by Helminthic infection (Ascaris lumbricoides 4%, Hookworm 3%, H. nana 2%,) in the study participants. Worm infestation association was found to be statistically signicant and to rule out the status of nutrition and hygiene practices. Anemia is a major health issue in children of growing age in our country which causes high morbidity and mortality rate. Besides this helminthic infection in children is also a common problem due to unhygienic habitat. Hence the policy of iron and folic acid supplementation and the anti-helminthic drug should be administered globally as recommended by WHO may be practically enforced besides health and hygiene education.

Impacts of climate change mitigation and clean cooking access on future childhood stunting in India

BACKGROUND AND AIM: Many children in India face the double health burden of high exposure to ambient (AAP) and household air pollution. Although climate change mitigation is expected to decrease AAP, climate policies could increase the cost of clean fuels. We aimed to quantify the impacts of climate change mitigation and clean cooking access on future childhood stunting in India. METHODS: We linked 2015-2016 Demographic Health Survey data with satellite-based particulate matter (PM2.5) data to estimate the association between in-utero exposure to ambient PM2.5, cooking fuel type, and stunting among children 5 years. Ambient PM2.5 and clean cooking access were projected under global climate change mitigation scenarios in line with the 2°C Paris Agreement target and a range of national energy access scenarios with an integrated assessment model. We used a modified substitution estimator approach to estimate the number of children with stunted growth under each scenario in 2030 and 2050 according to state and urbanicity and accounting for demographic change. RESULTS:In-utero exposure to ambient PM2.5 significantly increased the odds of child stunting (OR: 1.04, 95%CI: 1.05-1.03 per 10 μg/m3 increase in PM2.5) and clean compared to polluting cooking fuel decreased the odds of stunting (OR: 0.86, 95%CI: 088-0.84) in confounder-adjusted models. Under the 2°C target and a range of policies to support clean energy access, national average exposure to ambient PM2.5 was 45.9 μg/m3 and clean cooking access was 74% -97% in 2050 compared to 57.4 μg/m3 and 91%-99% under business-as-usual. Reductions in AAP under the 2°C Paris Agreement target prevented stunting in 1 million children in rural and 0.8 million in urban areas in India in 2050 compared to business-as-usual. CONCLUSIONS:Air pollution reductions achieved by meeting the Paris Agreement target combined with policies to offset increased costs of clean cooking could contribute to improved linear growth in young children in India. KEYWORDS: co-benefits, clean cooking access, childhood stunting

Nutritional knowledge, attitude and practice (KAP) of mothers on the nutritional status of school children – A study from south India

Undernutrition is a major serious health concern that contributes to mortality and morbidityamong young children in India. There are few studies on the relationship of mother’s nutritionKnowledge, Attitude and Practice on the nutritional status of school children. It is a cross-sectionalstudy aimed to associate the nutritional Knowledge, Attitude and Practice (KAP) of mothers and thenutritional status of children. About 100 children and their mothers were selected, according to theinclusion criteria, such as children with the specified age group between 6-12 years. We collected theinformation related to socio demographic profile, Knowledge, Attitude and Practice of mother usingthe developed questionnaire adopted from FAO manual. The nutritional status of the children wasassessed through anthropometric measurement. The SPSS 16.0 version was used for the statisticalanalysis. The study results showed that the illiterate mother secured higher mean KAP scores.Although, the socio economic status of the family influenced the nutritional Knowledge, Attitudeand Practice score of the mother, the statistical significance was not found. The higher meannutrition knowledge, attitude and practice score of the mother was associated highly with the highermean height, weight and BMI of the children.

Effectiveness of Nutritional Supplement in Growth and Development of Children aged 2-12 years.

Objective: Observational study to determine the effect of 6 months consumption of nutritional supplement on growth and development of children aged 2-12 years. Background: Young children in India suffer from some of the highest levels of stunting, underweight, and wasting observed in any country in the world. The levels of over-nutrition are also on a rise. Prevention of child malnutrition require diets providing adequate energy and essential nutrients to promote catch-up growth, strengthen resistance to infection, and support normal mental, physical and metabolic development. Methods: This is an observational study, where an oral nutritional supplement is given to 776 children, aged 2-12 years, for 6 months along with normal diet. Anthropometric parameters (height, weight and BMI) are assessed at baseline, 3 and 6 months. The z score for height, weight and BMI is used to analyze the results using Khadilkar growth chart, Indian Pediatrics 2009. Results: A total of 763 subjects are included in the analysis. Each child is grouped according to age bracket (2-3 yrs; 4-6 yrs; 7-9 yrs; 10-12 yrs). After consumption of nutritional supplement for 6 months, z-scores for height, weight and BMI are shown improvement in almost all age groups, compared to baseline. The improvement is significant in weight and BMI z-score. The standard deviation scores from expected increase in mean of weight, height and BMI is well within the permissible range. No adverse event is observed. Conclusion: This study showed that 6 months intake of nutritional supplement by children provided a significant improvement in anthropometric parameters, with no adverse event.

Genotypic determination of human group A rotaviruses from Goa and Meghalaya states, India

IntroductionRotavirus is the leading cause of diarrhoea in young children in India, responsible for an estimated 21357 mean numbers of deaths in 2010. Various genotypes of rotaviruses evolved due to mutational changes have been recognized. In this study, we determined the genotypes of rotaviruses involved in diarrhea in Goa and Meghalaya states of India. MethodsThe dsRNA of rotaviruses was extracted from stool samples and detected by Ribonucleic Acid-Polyacrylamide gel electrophoresis (RNA PAGE) and Reverse transcription-polymerase Chain Reaction (RT-PCR) targeting the partial VP7 gene. The full length VP7 and partial VP4 genes of rotavirus strains were amplified by RT-PCR followed by nucleotide sequencing. The RotaC classification tool was used to determine the genotypes. ResultsThe positivity of rotavirus by PAGE and RT-PCR was observed to be 43.10% and 39.65% in Goa and 38% and 36% in Meghalaya, respectively. Though long electrophoretic profile was appeared to be the most predominant rotavirus type in circulation in these two states, 96% of long and 84.61% short electropherotype profiles could be detected by RT-PCR. The dsRNA of rotavirus extracted from 36 samples could be transcribed and amplified by beg9end9 primers for G genotyping, while, 41 by con3con2 primers for P genotyping. G1P[8] and G1P[6] genotypes were commonly circulated in Goa and G1P[8] and G1P[4] genotypes in Meghalaya. On nucleotide analysis, 6 samples from Goa showed G1 genotype specificity, while, 3 showed P[8] specificity indicating the G1P[8] rotavirus circulating in Goa. In Meghalaya state, 3 strains showed P[8] and 2 showed P[4] genotype specificity. The majority of the G and P genotypes were closely related to each other and G1 genotypes appeared in two separate clusters, while, P[8] and P[4] appeared in the respective clusters. ConclusionThe circulation of G1P[8], G1P[6] genotypes in Goa and the presence of G1P[8] and G1P[4] genotypes in Meghalaya was observed.

Picking winners: An empirical analysis of the determinants of educational outcomes in India

We use data from the Young Lives longitudinal survey to analyse the effect of socioeconomic conditions and gender on the educational performance of young children in India. In particular, we use data for standardised scores on two cognitive tests: the Peabody Picture Vocabulary Test (PPVT) and a maths test. Our results show that there are significant gender differences in the way that household wealth affects the educational performance of children. Specifically, boys born into wealthier households perform significantly better in maths than those from worse‐off economic backgrounds. The effect of wealth on the PPVT is stronger for girls than it is for boys. The results are robust across a range of specifications. The effect of household wealth on performance differed between the genders, even when we focused our analysis on the bottom 10% and top 10% of the performance distribution. One possible explanation for these differences is parental aspirations. We tested this hypothesis and found that boys from wealthier households with higher parental educational aspirations are positively and significantly associated with higher maths scores. Further analysis showed that the moderating role of parents’ educational aspirations was more pronounced at the top of the test score distribution, an indication that more able children are associated with wealthier and more ambitious parents.

Worldreader: Leveraging Mobile Phones for Reading to Young Children in India and Jordan

Access to education can be increased, even for previously marginalized populations, by harnessing technologies, such as mobile phones, that have become affordable options for communication and connectivity around the world.

A Randomized Crossover Study to Evaluate Recipe Acceptability in Breastfeeding Mothers and Young Children in India Targeted for a Multiple Biofortified Food Crop Intervention.

BackgroundA multiple biofortified food crop trial targeting iron, zinc, and vitamin A deficiencies among young children and their breastfeeding mothers is planned in India.ObjectiveTo determine the acceptability of recipes prepared with control and biofortified pearl millet, wheat, lentils, and sweet potato.MethodsChildren (6-24 months) and their mothers were enrolled as pairs (n = 52). Weight and height/length were determined. Mothers and children were separately, individually randomized in a crossover design to control or biofortified recipes. Children’s 3-day intake was measured per recipe and crop variety. For mothers, a 9-point hedonic scale evaluated color, odor, taste, and overall acceptability.ResultsChildren’s mean (SD) length-/height-for-age Z-score was −1.2 (1.7), with 27% < −2 (stunted). Mean weight-for-length Z-score was −0.6 (1.2) with 9.6% < −2 (wasted). Mother’s body mass index showed 17% <18.5 and 38% >25. There was no difference in the children’s intake of biofortified versus control varieties of any recipe (P ≥ .22); overall median daily intake was 75 g (Q1: 61, Q3: 100). Mother’s hedonic scores for color, odor, taste, or overall acceptability did not demonstrate any notable differences (P ≥ .23 for overall acceptability); combined median overall acceptability score was 8.5 (Q1: 8.0, Q3: 9.0).ConclusionsRecipes were consumed readily, were rated as highly acceptable, and did not show any differences between biofortified and control varieties.

Dietary Adequacy Among Young Children in India: Improvement or Stagnation? An Investigation From the National Family Health Survey.

This study assessed the trend of minimum acceptable dietary practices among children aged 6 to 23 months in India in the past decade. Data collected in the National Family Health Survey during 2005 to 2006 (NFHS-3) and 2015 to 2016 (NFHS-4) were used. The sample size for this study was 11 727 children for NFHS-3 and 61 158 children for NFHS-4. Bivariate and multivariate analyses were done to identify the predictors of feeding practices. We analyzed data of last-born singleton children aged 6 to 23 months who were living with their mother (ever-married women aged 15-49 years). In India, a low proportion (10%) of children aged 6 to 23 months received a minimum acceptable diet, and its estimate remained the same in the past 10 years. Older mothers, educated mothers, antenatal care, high economic status, and place of residence were the most consistent predictors of minimum acceptable dietary intake. Over the past decade, however, the minimum acceptable dietary intake has declined among older children (odds ratio [OR] = 0.57, 95% confidence interval [CI], 0.47-0.70; P < .001), children with overweight mothers (OR = 0.40, 95% CI, 0.31-0·50; P <.001), and children of well-off families (OR = 0.29, 95% CI, 0.23-0.37; P < .001). The odds for minimum acceptable dietary intake were significantly higher among children of high (4+) birth order (OR = 1.74, 95% CI, 1.41-2.15; P < .001), rural areas, and children living in the central, eastern, and north-eastern region. Results indicate the need for further investigations of poor dietary intake among children living in well-off families and in the northern region. This study suggests policymakers and program managers to address contextual barriers against minimum acceptable dietary intake among children and to reconsider existing strategies in India.

A study on prevalence and factors associated with protein energy malnutrition among 1 - 5 years of children's: A cross sectional study

Background: Malnutrition is a major health problem, especially in developing countries. It affects almost 800 million people. Prevalence rates vary among different continents of the world. PEM is undoubtedly the most serious nutritional problem affecting several thousand young children in India. Objective: To find the prevalence of Protein energy malnutrition between urban and rural areas to study the factors associated with PEM among children of age 1 5 years in Guntur District. Study design: Cross-sectional study carried out during 01 Jan 2018 to 31 Dec 2018 in the Department of Paediatrics, KATURI Medical College & Hospital, Guntur, Andhra Pradesh, India. Comprised children of age group 1 5 years and total of 180 included in this study. Method of Collection of Data: The instrument used is a predesigned and pretested semi structured questionnaire. Physical measurements such as height and weight measured using standard methods. Statistical Analysis: Proportion, Chi square test, Independent t test. Results: The prevalence of Protein energy malnutrition is 67.7% (122). The prevalence of PEM is high among rural children (71.1%) compared to urban children (64.4%) and this difference is found to be statistically significant. Many preventable variables are found to be significant associates of Protein energy malnutrition. Study subjects included were both boys and girls, boys constituted 43.3% (78) and girls 56.7% (102). Each Urban and rural area constituted 50% i.e urban 50%(90) and rural 50% (90). Among 180 study subjects, 70% of children have MAC more than 13.5cms and 22.3% of children have MAC between 12.5 cms and13.5 cms whereas only 7% of children have MAC less than 12.5%. Mean weight was more among urban children(10.86) compared to rural children(9.54) and also mean height was higher among urban children(84.98) than rural children(81.69).The prevalence of Protein energy malnutrition is 67.7% (122).The prevalence of PEM is high among rural children (71.1%) compared to urban children (64.4%).36% of study subjects have Grade I PEM followed by Grade II (24.6%), Grade III (21.4%) and Grade IV (18.0%).Among urban children Grade I(43.1%) is common whereas among rural children, Grade II and III are common. The prevalence of PEM is high in 2 3 years of age group (97.9%). The prevalence of PEM is more among boys (74.3%) compared to girls (62.7%). The prevalence of PEM is more among Hindus (78.9%) compared to Muslims (48.2%). The prevalence of PEM is high among the subjects who belong to family size more than five (72.1%). The prevalence of PEM is high among socioeconomic class IV (82.5%). The prevalence of PEM is high among those study subjects whose fathers are illiterates (76.9%). The prevalence of PEM is high among those study subjects whose mothers are educated up to primary (75.0%). The prevalence is found to be high in those students whose fathers are unemployed (50.0%) /unskilled (69.6%) /semiskilled (68.6%). The prevalence is found to be high in those students whose mothers are unemployed (68.4%) /unskilled (71.2%) /semiskilled (33.3%).The prevalence of PEM is high among study subjects of Nuclear family (76.3%). The prevalence of PEM is more among study subjects mother who had ANC visits of less than 6 (around 80%). There is no statistical difference in prevalence of PEM among study subjects based on mode of delivery. The prevalence of PEM is more among birth weight less than 2.5 kgs (85.4%). The prevalence of PEM is more among study subjects mother who had initiated breast feeding after four hours (85%).The prevalence of PEM is more among study subjects mother who had not fed colostrum (78.5%).The prevalence of PEM is high among non exclusive breast feeding (71%).Housing conditions revealed that prevalence of PEM is more among semi puccka house (73.0%), in adequate ventilation (73.8%), overcrowding (77.2%) and solid fuel user (74.0%). Conclusion: Since it is a cross sectional study, no causal relationships can be established from this study. Dietary intake was assessed by 24-hour recall basis method and application of better and elaborate methods of dietary intake assessment was beyond the scope of the study.

Multiple micronutrient status and predictors of anemia in young children aged 12-23 months living in New Delhi, India.

Anemia has been identified as a severe public health concern among young children in India, however, information on the prevalence of anemia attributed to micronutrient deficiencies is lacking. We aimed to assess multiple micronutrient status (iron, zinc, selenium, vitamin A, vitamin D, folate and vitamin B12) in young Indian children and to investigate the role of these seven micronutrients and other non-nutritional factors on hemoglobin concentrations and anemia. One-hundred and twenty children aged 12 to 23 months were included in a cross-sectional nutritional assessment survey, of which 77 children provided a blood sample. Hemoglobin (Hb), serum ferritin, soluble transferrin receptor (sTfR), total body iron, zinc, selenium, retinol binding protein (RBP), folate, vitamin B12 and 25-hydroxyvitamin D (25(OH)D) were measured, and adjusted for inflammation using C-reactive protein (CRP) and α-1-acid glycoprotein (AGP), where appropriate. Predictors for hemoglobin and anemia were identified in multiple regression models. Most of the children were classified as anemic, of which 86 to 93% was associated with iron deficiency depending on the indicator applied. Deficiencies of folate (37%), and notably vitamin D (74%) were also common; fewer children were classified with deficiencies of vitamin B12 (29%), zinc (25%), and vitamin A (17%) and selenium deficiency was nearly absent. Multiple micronutrient deficiencies were common with over half (57%) deficient in three or more micronutrients, and less than 10% of children were classified with adequate status for all the micronutrients measured. Iron status was found to be the only nutritional factor statistically significantly inversely associated with anemia (P = 0.003) in multivariate analysis after controlling for sex. A coordinated multi-micronutrient program is urgently needed to combat the co-existing micronutrient deficiencies in these young children to improve micronutrient status and reduce the high burden of childhood anemia.