Assessment of under nutrition among under 5 tribal children in a rural area in West Bengal.

Tribal population is socio economically disadvantaged group. Knowledge about nutritional status of various tribal populations is important because it impels to identify under nutrition which is a leading cause of morbidity and mortality. This study is conducted to assess under nutrition among under 5 tribal children. In this cross sectional study with a sample of 68 under 5 tribal children selected through complete enumeration fulfilling the inclusion criteria after obtaining ethical clearance from Institutional Ethics Committee. Anthropometric measurements were recorded to determine types of under nutrition prevailing among them using World Health Organization Anthro software. 24 h recall of dietary history of children was taken for 7 days to assess mean energy, protein, and fat intake per day and compared with recommended daily allowances. A total of 30.8% children were stunted, 30.8% were wasted, and 14.7% were both stunted and wasted. The consumption of energy, protein, and fat was much low. Chi square test showed a significant association of under nutrition with gender, education of father, type of family, socio economic status, and birth order but binary logistic regression showed significant association only with socioeconomic status. Under nutrition in form of stunting and wasting and low dietary intake of energy, protein, fat was found among these children. Multi sectoral approach is suggested. Copyright:

Introduction

Tribal communities are defined as those communities which have primitive traits, distinctive culture, geographical isolation, shyness of contact with the community at large, and backwardness.[1] India has second largest tribal population in the world, representing 8.6% of India's population.[2]

Undernutrition continues to be a main cause of ill health and mortality among children in developing countries. In general, data are scanty on anthropometric and nutritional status of various tribal population of India.[34] With this backdrop, the present study has been carried out to assess under nutrition among under 5 tribal children.

Material and Methods

In West Bengal, tribal population is mainly concentrated in the District of Medinipur, Purulia, Jalpaiguri, and Bardhaman districts.[5] Among those villages randomly Burda village in Purulia was selected. Agriculture is the sole activity of these tribes, even today and also depends on fishing, hunting, and forest products.

A community-based cross-sectional study was conducted among under 5 tribal children permanently in Burda village from September 2019 to November 2019, after obtaining Ethical clearance from Institutional Ethics Committee of Calcutta National Medical College. Permission was also taken from Panchayat of Burda village. There were 71 under 5 children, among them two were not present at home during data collection and one child's parents did not give consent for conducting the study, so by complete enumeration method final sample size achieved was 68. A list of under 5 beneficiaries was obtained from Accredited Social Health Activist (ASHA) of the village, all under 5 child fulfilling the inclusion criteria (permanent resident of village, present at the time of interview and whose parent's gave informed consent) were considered as the study sample.

Pretesting was done. Data were collected after obtaining informed consent from parents of study subjects by the means of schedule following interview regarding sociodemographic profile, dietary history of under 5 children (24 h recall for 7 days) and under 5 children were examined for anthropometric data during home visits. In dietary survey children below 2 years were not considered as they were both on breast milk and complimentary feeding, amount of breast milk consumed cannot be assessed, so we were not able to calculate its nutritional value. Standardized katori was given to the mothers and they were asked to show the amount of food they fed their child using those katories, and the amount of food consumed was hence calculated. Data were entered in MS Excel and analyzed using IBM SPSS 20.0 version (Armonk, NY: IBM Corp) and WHO Anthro software.

Results

Majority (83.8%) of mothers were illiterate and 69.1% belonged to joint family. A total of 97.1% fathers were farmers, whereas 86.8% mothers were home makers. Majority (75%) of the families belonged to socioeconomic status Class V according to Modified B. G. Prasad Scale 2019. It was good to note that prevalence of institutional deliveries was 88.2% [Table 1].

Table 1

Distribution of study subjects according to sociodemographic variables (n=68)

Sociodemographic variables		Frequencies	Percentages (%)
Sex	Male	39	57.4
	Female	29	42.6
Education of mother*	Illiterate	57	83.8
	Primary	8	11.8
	Secondary	3	4.4
Education of father*	Illiterate	33	48.6
	Primary	29	42.6
	Secondary	6	8.8
Type of family	Nuclear	21	30.9
	Joint	47	69.1
Occupation of father	Farmer	66	97.1
	Others**	2	2.9
Occupation of mother	Home maker	59	86.8
	Farmer	9	13.2
Socioeconomic status	IV	17	25
	V	51	75
Birth order	1	36	52.9
	2	28	41.2
	3	4	5.9
Place of delivery	Institutional	60	88.2
	Home	8	11.8

*Indian standard classification of education. **Others - Group D staff in primary health center, school teacher, etc.

A total of 30.8% were stunted among which 11.7% were boys and 19.1% were girls. Again 30.8% were wasted among which 11.7% were boys and 19.1% were girls. Whereas 14.7% among study subjects were under weight. It was also noted that 69.1% of children had normal nutritional status [Table 2].

Table 2

Types of under nutrition among study subjects (n=68) (multiple response)

Types of under nutrition	Boys	Girls	Total
Stunting	8 (11.7%)	13 (19.1%)	21 (30.8%)
Wasting	8 (11.7%)	13 (19.1%)	21 (30.8%)
Under weight	4 (5.9%)	6 (8.8%)	10 (14.7%)
No under nutrition	27 (39.7%)	20 (29.4%)	47 (69.1%)

A significant association between under nutrition and sex of child (P = 0.032), education of father (P = 0.045), type of family (P = 0.046), socioeconomic status (P = 0.049), and birth order (P = 0.030) was observed using Chi-square test [Table 3]. But binary logistic regression showed a significant association between socioeconomic status and under nutrition among study subjects [Table 4].

Table 3

Bivariate analysis showing association of different sociodemographic variables with under nutrition (n=68)

Sociodemographic variables		Under nutrition		Significance
		Present	Absent
Sex	Male	8	31	χ2=4.607, df=1, OD=0.318/1, P=0.032
	Female	13	16
Age	≤2.5 years	9	27	χ2=1.240, df=1, OD=0.556/1, P=0.265
	>2.5 years	12	20
Education of mother	≤Primary	16	41	χ2=1.306, df=1, OD=0.468/1, P=0.253
	>Primary	5	6
Education of father	≤Primary	14	19	χ2=4.001, df=1, OD=2.947/1, P=0.045
	>Primary	7	28
Type of family	Joint	11	36	χ2=3.987, df=1, OD=0.336/1, P=0.046
	Nuclear	10	11
Occupation of father	Farmer	20	46	χ2=0.353, df=1, OD=0.435/1, P=0.553
	Others	1	1
Occupation of mother	Home maker	17	42	χ2=0.894, df=1, OD=1.976/1, P=0.344
	Farmer	4	5
Socioeconomic status	IV	2	15	χ2=3.881, df=1, OD=0225/1, P=0.049
	V	19	32
Birth order	<2	7	29	χ2=4.689, df=1, OD=0.310/1, P=0.030
	≥2	14	18
Place of delivery	Institutional	18	42	χ2=0.186, df=1, OD=0.714/1, P=0.666
	Home	3	5

Table 4

Binary logistic regression analysis for association of different sociodemographic variables with under nutrition (n=68)

Sociodemographic variables		Significance	Odds ratio	95% CI
				Lower	Upper
Sex	MaleFemale	0.079	0.322/1	0.091	1.139
Education of father	≤Primary>Primary	0.388	1.751/1	0.491	6.242
Type of family	Joint Nuclear	0.066	0.295/1	0.081	1.085
Socioeconomic status	IVV	0.044	0.151/1	0.080	0.948
Birth order	<2≥2	0.085	0.341/1	0.024	1.162

Energy consumption for boys of 2-3 years (16.1%) and 4-5 years (11.9%) and girls of 2-3 yeas (19.2%) and 4-5 years (24.2%) low as compared to Recommended Dietary Allowance (RDA) [Figure 1]. Protein consumption for boys of 2-3 years (25.2%) and 4-5 years (20.2%) and girls of 2-3 yeas (28.1%) and 4-5 years (20.1%) low as compared to RDA [Figure 2]. Fat consumption for boys of 2-3 years (54.7%) and 4-5 years (43.6%) and girls of 2-3 yeas (53.9%) and 4-5 years (44%) low as compared to RDA [Figure 3].

Figure 1

Bar diagram showing consumption of calories (Kcal) by study population (n = 38)

Figure 2

Bar diagram showing protein (gm) consumption of study population (n = 38)

Figure 3

Bar diagram showing fat (gm) consumption of study population (n = 38)

Though majority of mothers (94.1%) initiated breast feeding on the first day of delivery, others (5.9%) had a prelacteal feeding with cow milk, jaggery water. 16.2% did not start complementary feeding at the age of completed 6 months.

Discussion

The present study reflectsthat under nutrition in form of stunting and wasting were widely prevalent among under 5 tribal children. A total of 30.8% were stunted, 30.8% were wasted, and 14.7% were underweight similar to a study in Birbhum district of West Bengal among Santal tribe by Caroline Katharina Stiller, et al.[3] where 51.9% were stunted, 19% wasted and 49.2% were under weight. In Assam Das et al.[4] conducted on under 5 tribal children where 41.33%, 27.56%, 30.22% were stunted, wasted, and underweight respectively. Whereas in a study in Maharashtra by Ghosh and Varerkar on tribal children of Palghar observed that 59%, 20%, and 53% were stunted, wasted, and underweight, respectively.[6] This variation may be due to well-functioning Integrated Child Development Services (ICDS) centers and awareness among mothers about food fed to under-fives. Apart from these it is also reflected that girls suffered more under nutrition in various forms than boys.

In this study, the consumption of energy was low, for boys of 2-3 years (16.1%) and 4-5 years (11.9%), and girls of 2-3 yeas (19.2%) and 4-5 years (24.2%) as compared to RDA, similar to a study on Lodha tribe by Sabud et al.[7] which also shows low energy consumption where RDA for girls (1062 ± 85.4 Kcal) and boys (1055 ± 79.2 Kcal).

In our study, consumption of protein was low for boys of 2-3 years (25.2%) and 4-5 years (20.2%) and girls of 2-3 yeas (28.1%) and 4-5 years (20.1%) as compared to RDA in accordance with a study on Lodha tribe by Sabud et al.[7] had a low consumption of protein (17.92 ± 3.5%) in girls, (18.08 ± 3.1%) in boys as compared to RDA. Also our study shows, low fat consumption for both boys and girls, similar picture is revealed by other studies.[7]

So, it could be stated that under nutrition among under 5 tribal children was not only due to dietary inadequacy but also various sociodemographic factors similar to the study by Das in Udalguri district of Assam.[4] In accordance to our study, a systematic review by Dey and Bisai also revealed that among sociodemographic factors, socioeconomic status plays an important role in undernutrition among under 5 tribal children.[8]

Conclusion

This study highlights that 30.8% of under 5 tribal children suffered from Under nutrition in form of stunting and wasting. This is not only due to dietary inadequacy but also due to various sociodemographic variables like sex, education of father, type of family, and birth order but particularly due to socioeconomic status. Knowledge of undernutrition will guide primary care physicians to plan adequate nutritional interventions and preventive strategies, and hence reduce risks added by undernutrition. This study could not be done in larger frame, which could have fetched more significant factors related to undernutrition of under 5 tribal children due to resource and time constraints.

Multisectoral approach is strongly recommended in these tribal areas to improve the nutritional status of these children. Awareness and behavioral change interventions for mothers shall be planned on nutrition, safe cooking practices, and balanced diet.

This study reveals that still a proportion of under 5 tribal children is suffering from undernutrition, and need immediate interventions to be taken to reduce its ill effects; physically, mentally, and socially. A spectacular observation was made during this study that percentage of undernourished under 5 tribal children was less compared to studies done in the past; and a major cause for prevailing undernutrition was socioeconomic status of family.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.