research article undernutrition and its correlates among...

Research ArticleUndernutrition and Its Correlates among Children of 3ndash9 Yearsof Age Residing in Slum Areas of Bhubaneswar India

Ansuman Panigrahi and Sai Chandan Das

Department of Community Medicine Kalinga Institute of Medical Sciences KIIT University Bhubaneswar Odisha 751024 India

Correspondence should be addressed to Ansuman Panigrahi dransuman3gmailcom

Received 31 July 2014 Revised 7 November 2014 Accepted 30 November 2014 Published 17 December 2014

Academic Editor Mieke Faber

Copyright copy 2014 A Panigrahi and S C Das This is an open access article distributed under the Creative Commons AttributionLicense which permits unrestricted use distribution and reproduction in any medium provided the original work is properlycited

Undernutrition among children is a major public health concern worldwide more prevalent in Asia and Africa It manifests itselfin various forms such as wasting or stunting or underweight and retards physical and mental development increases susceptibilityto infection and reduces educational attainment and productivity The present study was undertaken to assess the level of wastingstunting and underweight and determine its associates among slum children of 3ndash9 years of age residing in Bhubaneswar cityIndia After obtaining informed consent a total of 249 children from 249 households were studied and their parentsguardianswere interviewed to collect all relevant information 233 574 and 454 of children were found to have wasting stuntingand underweight respectively Variables like birth order of child period of initiation of breastfeeding and motherrsquos education werefound to be strong predictors ofwasting whereas toilet facility in household and practice of drinkingwater storagewere significantlyassociated with stunting among slum children as revealed in multiple regression analysisThus a multipronged approach is neededsuch as giving priority to improve education for slum community especially for women creating awareness regarding benefitsof early initiation of breastfeeding small family size and proper storage of drinking water and providing toilet facility in slumhouseholds which could improve the nutritional status of slum children

1 Introduction

Nutrition has been recognized as a basic pillar for socialand economic development Adequate nutrition is necessaryin early childhood to ensure healthy growth proper func-tioning of organs strong immune system and neurologicaland cognitive development [1] Undernutrition is a leadingcontributor to infant child and maternal morbidity andmortality playing a role in about half of all child deaths [1 2]Undernutrition directly affects many aspects of childrenrsquosdevelopment such as retarding physical and mental devel-opment increasing susceptibility to infections like sepsisdiarrhoea pneumonia and so forth and further enhancingthe probability of undernutrition [2 3] It also undermineseducation attainment and productivity thereby affecting theeconomic growthThe prevalence of underweight children inIndia is among the highest in the world and is nearly doublethat of sub-Saharan Africa [4] Undernutrition manifestsitself in different forms in children such as wasting (indicator

of acute undernutrition) or stunting (indicator of chronicundernutrition) or underweight (combined indicator forboth acute and chronic undernutrition) [3]

According to WHO-UNICEF-World Bank report it wasestimated that in 2012 about 162 million 99 million and 51million of under five children were stunted underweightand wasted respectively worldwide More than half of thesechildren lived in Asia [5] According to the National FamilyHealth Survey-3 among under five children about 48 43and 20 are stunted underweight and wasted respectivelywhereas about 24 are severely stunted and 16 are severelyunderweight [6] Odisha is one of the high prevalence statesof India where almost 50 of under five children areunderweight [2 4]

Urban slum dwellers are exposed to poor housing over-crowding poor quality drinkingwater inadequate sanitationwhich is further aggravated by their ignorance illiteracyand low socioeconomic status and lack of access to basichealth care facilities Children living under such conditions

Hindawi Publishing Corporatione Scientific World JournalVolume 2014 Article ID 719673 9 pageshttpdxdoiorg1011552014719673

2 The Scientific World Journal

are always at a high risk of developing health and nutritionalproblems [7] Although numerous studies have been donein different states of India to assess the nutritional status ofchildren there are very limited studies involving childrenboth in preschool age and in school age group especiallyin Odisha one of the high prevalence states of India Thusthe present study was undertaken to ascertain the level ofdifferent forms of undernutrition such as wasting stuntingand underweight and determine its associates among slumchildren of 3ndash9 years residing in Bhubaneswar city Odisha

2 Methodology

The present cross-sectional study was carried out in urbanslums of Bhubaneswar Odisha India involving childrenof age group (3ndash9 years) during the year 2013-2014 Thesample size of 190 was calculated assuming the prevalenceof undernutrition as 45 [8] precision of 10 at 95confidence interval with a design effect of 2 Multistagecluster random sampling technique was adopted to select thestudy population

Bhubaneswar city has been divided into 5 geographicalzones such as North East Central West and South outof which 3 were selected randomly From each zone oneward was randomly chosen and then all the notified slumsin the selected wards were considered for the study purposeOverall 6 slums were considered as study clusters It wasdecided to include 40 households from each of the selectedslum areas for the study purpose In each household only onechild aged between 3 and 9 years having no known healthdisorder was randomly chosen as study subject However atotal of 249 children of 3ndash9 years of age were included inthe studyTheir anthropometricmeasurements such as heightand weight were taken by the investigators and trained fieldworkers A predesigned and pretested schedule was used toelicit relevant information regarding sociodemographic andindividual characteristics like age sex education and occu-pation of parents per capita monthly income type of familymotherrsquos age at the time of birth of the child birth order andexclusive breastfeeding and environmental information suchas overcrowding toilet facility and drinking water storage

Ethical approval was obtained from the InstitutionalEthics Committee of Kalinga Institute of Medical SciencesBhubaneswar For participation of the study subjects par-entsguardians were informed about the study objectives andverbal consent was obtained prior to inclusion in the study

Weight and height measurements were made followingstandard operating procedures Weight was measured tothe nearest 05 kg in a standard weighing (bathroom) scale(model number PL8019 NOVA BS 112000) Weighing scalewas calibrated every time before a new measurement wastaken Children were asked to stand still over the centre ofthe scale with minimal clothing and without footwear andhold their head up and face forward arms hanging freely bythe sides of the body with palms facing the thigh Height wasmeasured to the nearest 01 cm with nonstretchable tape (TR-13ndash6010158401015840 Tailorrsquos tape)whichwas fixed to a vertical smoothwalland the subject was asked to stand erect without footwear on

a firmlevel surface with hisher back against the wall feetparallel and hands hanging by the sides Each measurementwas done twice and the average of the two readings wasrecorded Anthropometric data were analysed using WHOAnthroPlus version 104 software for assessing the growth ofthe children The children were classified using the followingcategories

(1) Wasting (acute undernutrition) is defined as a lowweight for height Childrenwith 119911 scores (WHZ)lt minus2are considered as wasted and those with WHZ lt minus3are severely wasted

(2) Stunting (chronic undernutrition) is defined as a lowheight for age Children with 119911 scores (HAZ) lt minus2 areconsidered as stunted and those with HAZ lt minus3 areseverely stunted

(3) Underweight (mixed acute and chronic undernutri-tion) is defined as a low weight for age Children with119911 scores (WAZ) lt minus2 are considered as underweightand those with WAZ lt minus3 are severely underweight

(4) Thinness (measure of body fat) is defined as a lowbodymass index Childrenwith 119911 scores (BMIZ)lt minus2are considered as thin and those with BMI lt minus3 areseverely thin

All the data were compiled and analysed using StatisticalPackage for Social Sciences (SPSS) software version 160 andappropriate statistical tests were applied ldquo119875rdquo value lt005 wasconsidered as statistically significant Univariate as well asmultivariate analyses were carried out to test associationsbetween various individual and sociodemographic character-istics and nutritional status of childrenThe variables found tohave ldquo119875rdquo value lt025 in univariate analysis were entered intologistic regression model As multistage sampling techniquewas used for data collection sample weights were calculatedand taken into consideration during the data analysis in orderto get more valid results

3 Results

Overall 249 slum children of age group between 3 and 9years were surveyed Majority of the study subjects weregirls (683) and the rest were boys (317) Mean age withstandard deviation (SD) of girls and boys was 507plusmn 16 yearsand 575 plusmn 207 years respectively The mean height (withSD) of the girls was 1003 plusmn 115 cm whereas that of boyswas 1031 plusmn 128 cm The mean weight (with SD) of the girlswas 150 plusmn 35 kg whereas that of boys was 157 plusmn 433 kgThe anthropometricmeasurements such as height andweightwere found to be more in boys than in girls in all the agegroups

Table 1 shows the nutritional status among slum childrenOut of 249 children 58 (233) 143 (574) 113 (454)and 57 (229)were wastedseverely wasted stuntedseverelystunted underweightseverely underweight and thinverythin respectively Overall 655 of slum children were foundto have undernutrition

Univariate analysis showing association between wastingand various individual and sociodemographic characteristics

The Scientific World Journal 3

Table 1 Nutritional status of children (3ndash9 years) in urban slums ofBhubaneswar India (119899 = 249)

Indicator Number PercentageWeight for height

Normal 191 767Wasted 44 177Severely wasted 14 56

Height for ageNormal 106 426Stunted 64 257Severely stunted 79 317

Weight for ageNormal 136 546Underweight 42 169Severely underweight 71 285

Body mass indexNormal 192 771Thin 42 169Very thin 15 60

is given in Table 2 The prevalence of wasting was foundto be more in children in higher age category and moreboys had wasting than girls though these differences arestatistically insignificant More children with birth orderge2 were suffering from wasting as compared to childrenhaving first birth order which is statistically significant (119875 =0010) Higher proportions of wasted children were observedin mothers having lower education and vice versa Hencehigher maternal education appeared to be associated withbetter child nutrition (119875 = 0056) Almost similar pattern ofchildrsquos nutrition was found with fatherrsquos education Furtherhouseholds where the practice of storing drinking water wassatisfactory had less number of wasted children (139) ascompared to 276 children in households with unsatisfac-tory practice of drinking water storage This difference isstatistically significant (119875 = 0016) Other factors such asperiod of initiation of breastfeeding motherrsquos age at birth ofchild type of family per capita monthly income presenceof overcrowding and toilet facility in household were notfound to be significantly associated with wasting among slumchildren

All the variables found to have ldquo119875rdquo value lt025 inthe univariate analysis were entered into logistic regressionmodel (Table 3) When controlling for other variables prac-tice of drinking water storage lost its significance Howeverbirth order of child period of initiation of breastfeedingand motherrsquos education came out as strong independentpredictors of wasting in slum children

Table 4 depicts the association between stunting amongslum children and various individual and sociodemographiccharacteristics In contrast to wasting the prevalence ofstunting was more among children of lower age Howevermore boys (633) were found to be stunted than their coun-terparts (547) The motherrsquos age at childrsquos birth appearedto be significant risk factor for stunting in children as morechildren (714) born to younger mothers (le20 years of age)

had stunting compared to children born to older women (119875 =0015) Households having toilet facilities had significantlyless number of stunted children (524) as compared to 679children in households without toilet facilities (119875 = 0019) Itwas also observed that the practice of storing drinking watersatisfactorily in the households had a significant positiveimpact on the child nutrition (119875 = 0007) as more (635)children were having stunting in households where practiceof drinking water storage was unsatisfactory compared toless (443) number of children in households having sat-isfactory storage of drinking water Other factors such asbirth order of the child period of initiation of breastfeedingparentsrsquo education type of family per capitamonthly incomeand overcrowding were not found to significantly affect thestatus of stunting among slum children

All the variables found to have 119875 lt 025 in the univariateanalysis were entered into logistic regressionmodel (Table 5)Variables like toilet facility and practice of drinking waterstorage in household cameout as strong predictors of stuntingamong slum children whereas motherrsquos age at birth of childlost its significance

4 Discussion

Childhood undernutrition is a major public health problemin India especially in slums [9ndash12] Starting with the positiveaspect of results found in the present study it was found thatalmost 90 of slum children were completely immunised tilldate but the prevalence of undernutrition was still very high(655) Taking different indicators of undernutrition intoaccount wasting (233) stunting (574) and underweight(454) found in the children under study is unacceptablyhighMost studies worldwide have also reported high rates ofundernutrition among slum children [8 13ndash16]The results ofthe present study are consistent with these findings

Various studies have established the fact that boys aremore likely to be stunted wasted and underweight thangirls [17ndash20] which was also observed in the present studyIn contrast some other studies found no such associationbetween gender and undernutrition [21ndash23]

Logistic regression analysis revealed the net effect of indi-vidual predictor on the dependent variable It was observedthat children of birth order of 3 or more were almost threetimes having wasting than children of first order Childrenwith higher birth order might get less attention and carecompared to children of first order Elkholy et al revealed intheir study that highmeans of wasting were found among thegroup of high birth order [24] Association of undernutritionwith high birth order has been shown by many studies[25ndash28] The odds of having wasting rise 42 times in caseof children whose mothers initiated breastfeeding after 24hours of birth as compared to children who were breastfedwithin 1 hour of their birth Early initiation of breastfeedingpositively affects childrsquos overall nutritional status [29 30]Motherrsquos education was found to have a strong independenteffect on childrsquos nutrition controlling the effects of other vari-ables Illiterate mothers and mothers with primary educationwere about thrice more likely to have wasted children as


Table 2 Univariate model showing association between wasting among slum children and various individual and sociodemographiccharacteristics

Independent variableWasting

Total () ldquo119875rdquo valuelowastAbsent PresentNumber () Number ()

Age (in years) of child3ndash6 132 (825) 28 (175) 160 (643) 01186ndash9 59 (663) 30 (337) 89 (357)

Gender of childFemale 135 (794) 35 (206) 170 (683) 0117Male 56 (709) 23 (291) 79 (317)

Birth order of childFirst 74 (892) 09 (108) 83 (333) 0010Second 87 (702) 37 (298) 124 (498)Third 30 (714) 12 (286) 42 (169)

Initiation of breastfeedingWithin 1 hr 89 (824) 19 (176) 108 (434) 0083Between 1 and 24 hrs 83 (755) 27 (245) 110 (442)After 24 hrs 19 (613) 12 (387) 31 (124)

Motherrsquos age (in years) at birth of childle20 57 (814) 13 (186) 70 (281) 023121ndash30 108 (74) 38 (26) 146 (586)ge30 26 (788) 07 (212) 33 (133)

Motherrsquos educationIlliterate 48 (686) 22 (314) 70 (281) 0056Primary 54 (730) 20 (270) 74 (297)Middle 63 (829) 13 (171) 76 (305)High school and above 26 (897) 03 (103) 29 (117)

Fatherrsquos educationIlliterate 51 (671) 25 (329) 76 (305) 0071Primary 45 (703) 19 (297) 64 (257)Middle 58 (879) 08 (121) 66 (265)High school and above 37 (860) 06 (140) 43 (173)

Type of familya

Joint 25 (806) 06 (194) 31 (124) 0573Nuclear 166 (761) 52 (239) 218 (876)

Per capita monthly incomeb

ltRs 2000 29 (659) 15 (341) 44 (177) 0262Rs 2000ndashRs 4000 104 (782) 29 (218) 133 (534)geRs 4000 56 (806) 14 (194) 72 (289)

OvercrowdingAbsent 58 (806) 14 (194) 72 (289) 0072Present 133 (751) 44 (249) 177 (711)

Toilet facilityAbsent 61 (753) 20 (247) 81 (325) 0694Present 130 (774) 38 (226) 168 (675)

Drinking water storageSatisfactory 68 (861) 11 (139) 79 (317) 0016Unsatisfactory 123 (724) 47 (276) 170 (683)

lowastSignificance is based on adjusted chi-square statisticaJoint family consists of two or more married couples and their children living together in the same household all the men being related by blood of patrilinealdescent Nuclear family consists of the married couple and their dependent children residing in the same householdbOne US dollar is equivalent to Rs 60 (approximately)


Table 3 Multiple logistic regression model showing association between wasting among slum children and various factors

Independent variableDependent variable (wasting)

119875 valuelowastNormal = reference category120573 Exp(120573)

Age (in years) of child3ndash6 minus0762 0467 02206ndash9R

Gender of childFemale minus0480 0619 0053MaleR

Birth order of childFirst minus1059 0347 0013Second 0378 1460 0392Third or moreR

Initiation of breastfeedingWithin 1 hr minus1445 0236 0035Between 1 and 24 hrs minus0713 0490 0151After 24 hrsR

Motherrsquos age (in years) at birth of childle20 0190 1209 052221ndash30 0174 1190 0534ge30R

Motherrsquos educationIlliterate 1179 3250 0024Primary 1136 3115 0024Middle 0558 1747 0329High school and aboveR

Fatherrsquos educationIlliterate 1036 2817 0208Primary 0835 2304 0303Middle minus0114 0892 0792High school and aboveR

OvercrowdingAbsent minus0499 0607 0147PresentR

Drinking water storageSatisfactory minus0909 0403 0099UnsatisfactoryR

Note R = reference category 120573 = regression coefficient (log odds ratio) and Exp(120573) = odds ratioModel fit statistics pseudo-119877 squaresmdashCox and Snell = 0188 Nagelkerke = 0283 and Mcfadden = 0191 classification table reports that the overall expectedmodel performance is 811 that is 811 of the cases can be expected to be classified correctly by the model

compared to mothers who had attained higher education(high school and above) It might be due to the reasonthat higher educated women can take independent decisionsand have greater exposure to outside world and thus accessto various resources which help them in securing propernutrition of their childrenThey aremore aware about propernutrition maintenance of hygiene and various health issuesas compared to uneducated or less educated women Earlier

studies have also documented the positive impact of motherrsquoseducation on wasting [31ndash33]

Two independent predictors of stunting were also iden-tified Children residing in households without having toiletfacility were 15 times more at risk of developing stuntingas compared to children in households with toilet facilityThis finding has been corroborated in other studies [34ndash37] Unavailability of toilet facility in households would


Table 4 Univariate model showing association between stunting among slum children and various individual and sociodemographiccharacteristics

Independent variableStunting









Type of familya

Joint 10 (323) 21 (677) 31 (124) 0327Nuclear 96 (44) 122 (560) 218 (876)








Table 5 Multiple logistic regression model showing association between stunting among slum children and various factors



Age (in years) of child3ndash6 0334 1396 02076ndash9R


Motherrsquos age (in years) at birth of childle20 0371 1450 018721ndash30 minus0471 0624 0173ge30R



Per capita monthly incomeltRs 2000 1003 2725 0100Rs 2000ndashRs 4000 0634 1885 0190geRs 4000R

Toilet facilityAbsent 0436 1546 0031Present



promote open defecation which facilitates various waterborne diseases that can negatively affect the health andnutrition of young children Further children in householdswith unsatisfactory practice of storing drinking water were22 times more likely to have stunting than children livingin households with satisfactory practice of drinking waterstorage Merchant et al showed in their study that childrencoming from homes with water and sanitation had a 17greater chance of reversing stunting than those coming fromhomes without either facility [35] Similar results have alsobeen found in other studies [38 39]

The estimation in the study is not a good measure ofcausal association between independent variables and nutri-tion of children because of cross-sectional nature of the study

There might be recall bias as some of the information wasbased on response of the study participants In spite of theselimitations the study has certain important implications

5 Conclusion and Recommendation

The present study was probably the first of its kind in Odishato assess the nutritional status among the slum children bothin preschool age and in primary school age group usingWHO child growth standards It is evident from the studythat nutritional status of children shows a gloomy picturein slums of Odisha Thus utmost care and attention mustbe focused on these socioeconomically and disadvantagedchildren living in slums to attain the MDG goals Sincere


efforts must be undertaken to make a significant impact onchildrsquos nutrition with multipronged approach such as givingpriority to education for slum community especially forwomen creating awareness regarding benefits of factors likeearly initiation of breastfeeding limiting family size properstorage of drinking water and so forth and providing toiletfacility in the household Similar studies need to be carriedout among slum children of different regions to find outwhether there are any ethnic and regional variations in theprevalence of undernutrition and also operational researchcan be planned regarding deliverance of multipronged strate-gies to curb this public health menace

Conflict of Interests

The authors declare that there is no conflict of interestsregarding the publication of this paper

Acknowledgment

The authors thank and express their gratitude to all theparentsguardians for providing their time and cooperationthroughout the study

References

[1] Levels and trends in child malnutrition UNICEF-WHO-TheWorld Bank joint childmalnutrition estimates httpwwwwhointnutgrowthdbjme unicef who wbpdf

[2] K Park Parkrsquos Textbook of Preventive and Social Medicine MSBanarasidas Bhanot Jabalpur India 22nd edition 2013

[3] O P Ghai V K Paul and A Bagga Nutrition Ghai EssentialPediatrics CBS New Delhi India 7th edition 2009

[4] M Gragnolati M Shekar M Dasgupta C Bredenkamp andY K Lee ldquoIndiarsquos undernourished children a call for reformand actionrdquo HNP The World Bank 2005 httpsiteresourcesworldbankorgSOUTHASIAEXTResources223546-1147272-668285IndiaUndernourishedChildrenFinalpdf

[5] Joint UNICEF-WHO-The World Bank Child MalnutritionDatabase Estimates for 2012 and Launch of Interactive DataDashboards httpwwwwhointnutgrowthdbjme 2012 sum-mary note v2pdfua=1

[6] NFHS-3 httpwwwrchiipsorgnfhsNFHS-320DataVOL-1India volume I corrected 17oct08pdf

[7] UN-HABITAT ldquoDefining slums towards an operational def-inition for measuring slumsrdquo Background Paper 2 ExpertGroup Meeting on Slum Indicators United Nations NairobiKenya October 2002 httpww2unhabitatorgmediacentredocumentssowcr2006SOWCR205pdf

[8] S Mandal V R Prabhakar J Pal R Parthasarathi and RBiswas ldquoAn assessment of nutritional status of children aged0ndash14 years in a slum area of Kolkatardquo International Journal ofMedicine and Public Health vol 4 no 2 pp 159ndash162 2014

[9] S Ghosh and D Shah ldquoNutritional problems in urban slumchildrenrdquo Indian Pediatrics vol 41 no 7 pp 682ndash696 2004

[10] S Nandy M Irving D Gordon S V Subramanian and GD Smith ldquoPoverty child undernutrition and morbidity newevidence from Indiardquo Bulletin of theWorld Health Organizationvol 83 no 3 pp 210ndash216 2005

[11] K Bose S Biswas S Bisai et al ldquoStunting underweight andwasting among Integrated Child Development Services (ICDS)scheme children aged 3ndash5 years of Chapra Nadia District WestBengal IndiardquoMaternal ampChild Nutrition vol 3 no 3 pp 216ndash221 2007

[12] D Kapur S Sharma and K N Agarwal ldquoDietary intake andgrowth pattern of children 9-36months of age in an urban slumin Delhirdquo Indian Pediatrics vol 42 no 4 pp 351ndash356 2005

[13] M Shreyaswi Sathyanath Rashmi andN Udaya Kiran ldquoPreva-lence and risk factors of undernutrition among under fivechildren in a rural communityrdquo Nitte University Journal ofHealth Science vol 3 no 4 pp 2249ndash7110 2013

[14] S V Badami S Diwanji K Vijaykrishna et al ldquoNutrtionalstatus of underfive children in urban slums of BagalkotrdquoMedicaInnovetica vol 1 no 2 pp 28ndash34 2012

[15] S Bisai K Bose and S Dikshit ldquoUnder-nutrition among slumchildren aged 3-6 years in Midnapore town IndiardquoThe InternetJournal of Biological Anthropology vol 2 no 2 Article ID 105642008

[16] P Sengupta N Philip and A I Benjamin ldquoEpidemiologicalcorrelates of under-nutrition in under-5 years children in anurban slum of Ludhianardquo Health and Population Perspectivesand Issues vol 33 no 1 pp 1ndash9 2010

[17] A K M Shahabuddin K Talukder M Q-K Talukder et alldquoAdolescent nutrition in a rural community in BangladeshrdquoIndian Journal of Pediatrics vol 67 no 2 pp 93ndash98 2000

[18] A Hall ldquoThe anthropometric status of schoolchildren in fivecountries in the Partnership for Child Developmentrdquo Proceed-ings of the Nutrition Society vol 57 no 1 pp 149ndash158 1998

[19] M S Sebastian and S Santi ldquoThe health status of rural schoolchildren in the Amazon basin of Ecuadorrdquo Journal of TropicalPediatrics vol 45 no 6 pp 379ndash382 1999

[20] N J S Lwambo S Brooker J E Siza D A P Bundy andH Guyatt ldquoAge patterns in stunting and anaemia in Africanschoolchildren a cross-sectional study in Tanzaniardquo EuropeanJournal of Clinical Nutrition vol 54 no 1 pp 36ndash40 2000

[21] M Luthra and U C Parvan ldquoEpidemiological correlatesof undernutrition in 0ndash5 year old children In rural fieldpractice areas of SGRRIMandHS Dehradunrdquo Indian Jour-nal of Preventive amp Social Medicine vol 41 no 1-2 2010httpmedindniciniblt10i1iblt10i1p8pdf

[22] M K Goel R Mishra D Gaur and A Das ldquoNutritionsurveillance in 1ndash6 years old children in urban slums of a cityin Northern IndiardquoThe Internet Journal of Epidemiology vol 5no 1 pp 122ndash131 2007

[23] V Bhatia S Puri H M Swami M Gupta and G Singh ldquoMal-nutrition among under six children in Chandigarh scarcity inplentyrdquo Journal of Clinical and Diagnostic Research vol 6 pp483ndash487 2007

[24] T A Elkholy N H M Hassanen and Rasha ldquoDemographicsocio- economic factors and physical activity affecting thenutritional status of young children under five yearsrdquo Journalof American Science vol 7 no 10 2011

[25] D Barman and S Sarkar ldquoSocial exclusion and child nutritionalstatus among the scheduled population in Indiardquo DevelopingCountry Studies vol 3 no 3 2013

[26] LK Zottarelli T S Sunil and S Rajaram ldquoInfluence of parentaland socioeconomic factors in stunting in children under 5 yearsin Egyptrdquo Eastern Mediterranean Health Journal vol 13 no 6pp 1330ndash1342 2007


[27] S Das and H Sahoo ldquoAn investigation into factors affectingchild undernutrition in madhya pradeshrdquo Anthropologist vol13 no 3 pp 227ndash233 2011

[28] A Srivastava S E Mahmood P M Srivastava V P Shrotriyaand B Kumar ldquoNutritional status of school-age childrenmdashascenario of urban slums in IndiardquoArchives of Public Health vol70 no 1 article 8 2012

[29] E N Muchina and P M Waithaka ldquoRelationship betweenbreastfeeding practices and nutritional status of children aged0ndash24 months in Nairobi Kenyardquo African Journal of FoodAgriculture Nutrition and Development vol 10 no 4 2010

[30] D Kumar N K Goel P C Mittal and P Misra ldquoInfluenceof infant-feeding practices on nutritional status of under-fivechildrenrdquo Indian Journal of Pediatrics vol 73 no 5 pp 417ndash4212006

[31] D Makoka ldquoThe impact of maternal education on childnutrition evidence from Malawi Tanzania and ZimbabwerdquoDemographic and Health SurveysWorking Papers no 84 2013

[32] E W H Maiga ldquoThe Impact of Motherrsquos Education on ChildHealth and Nutrition in developing countries Evidence froma Natural Experiment in Burkina Fasordquo African Center forEconomicTransformation httpwwwunecaorgsitesdefaultfilespage attachmentsmaiga the impact of mothers educa-tion on child health and nutrition in develping countries 0pdf

[33] A SOyekale andTOOyekale ldquoDomothersrsquo educational levelsmatter in child malnutrition and health outcomes in Gambiaand Nigerrdquo UNICEF httpwwwsagacornelledusagaeduc-confoyekalepdf

[34] G Fink I Gunther and K Hill ldquoThe effect of water and sanita-tion on childhealth evidence from the demographic and healthsurveys 1986ndash2007rdquo International Journal of Epidemiology vol40 no 5 pp 1196ndash1204 2011

[35] A T Merchant C Jones A Kiure et al ldquoWater and sanitationassociated with improved child growthrdquo European Journal ofClinical Nutrition vol 57 no 12 pp 1562ndash1568 2003

[36] M R Vitolo C M Gama G A Bortolini P D B Campagnoloand M D L Drachler ldquoSome risk factors associated withoverweight stunting and wasting among children under 5 yearsoldrdquo Jornal de Pediatria vol 84 no 3 pp 251ndash257 2008

[37] D Spears A Ghosh and O Cumming ldquoOpen defecation andchildhood stunting in India an ecological analysis of new datafrom 112 districtsrdquo PLoS ONE vol 8 no 9 Article ID e737842013

[38] G Bantamen W Belaynew and J Dube ldquoAssessment offactors associated with malnutrition among under five yearsage children at Machakel Woreda Northwest Ethiopia a casecontrol studyrdquo Journal of Nutrition amp Food Sciences vol 4 no 1article 256 2014

[39] S Demissie and A Worku ldquoMagnitude and factors associatedwith malnutrition in children 6-59 months of age in pastoralcommunity of Dollo Ado district Somali region EthiopiardquoScience Journal of Public Health vol 1 no 4 pp 175ndash183 2013

Submit your manuscripts athttpwwwhindawicom

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Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014


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EndocrinologyInternational Journal of



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OncologyJournal of



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The Scientific World JournalHindawi Publishing Corporation httpwwwhindawicom Volume 2014

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Parkinsonrsquos Disease

Evidence-Based Complementary and Alternative Medicine

Volume 2014Hindawi Publishing Corporationhttpwwwhindawicom


are always at a high risk of developing health and nutritionalproblems [7] Although numerous studies have been donein different states of India to assess the nutritional status ofchildren there are very limited studies involving childrenboth in preschool age and in school age group especiallyin Odisha one of the high prevalence states of India Thusthe present study was undertaken to ascertain the level ofdifferent forms of undernutrition such as wasting stuntingand underweight and determine its associates among slumchildren of 3ndash9 years residing in Bhubaneswar city Odisha

2 Methodology

The present cross-sectional study was carried out in urbanslums of Bhubaneswar Odisha India involving childrenof age group (3ndash9 years) during the year 2013-2014 Thesample size of 190 was calculated assuming the prevalenceof undernutrition as 45 [8] precision of 10 at 95confidence interval with a design effect of 2 Multistagecluster random sampling technique was adopted to select thestudy population

Bhubaneswar city has been divided into 5 geographicalzones such as North East Central West and South outof which 3 were selected randomly From each zone oneward was randomly chosen and then all the notified slumsin the selected wards were considered for the study purposeOverall 6 slums were considered as study clusters It wasdecided to include 40 households from each of the selectedslum areas for the study purpose In each household only onechild aged between 3 and 9 years having no known healthdisorder was randomly chosen as study subject However atotal of 249 children of 3ndash9 years of age were included inthe studyTheir anthropometricmeasurements such as heightand weight were taken by the investigators and trained fieldworkers A predesigned and pretested schedule was used toelicit relevant information regarding sociodemographic andindividual characteristics like age sex education and occu-pation of parents per capita monthly income type of familymotherrsquos age at the time of birth of the child birth order andexclusive breastfeeding and environmental information suchas overcrowding toilet facility and drinking water storage

Ethical approval was obtained from the InstitutionalEthics Committee of Kalinga Institute of Medical SciencesBhubaneswar For participation of the study subjects par-entsguardians were informed about the study objectives andverbal consent was obtained prior to inclusion in the study

Weight and height measurements were made followingstandard operating procedures Weight was measured tothe nearest 05 kg in a standard weighing (bathroom) scale(model number PL8019 NOVA BS 112000) Weighing scalewas calibrated every time before a new measurement wastaken Children were asked to stand still over the centre ofthe scale with minimal clothing and without footwear andhold their head up and face forward arms hanging freely bythe sides of the body with palms facing the thigh Height wasmeasured to the nearest 01 cm with nonstretchable tape (TR-13ndash6010158401015840 Tailorrsquos tape)whichwas fixed to a vertical smoothwalland the subject was asked to stand erect without footwear on

a firmlevel surface with hisher back against the wall feetparallel and hands hanging by the sides Each measurementwas done twice and the average of the two readings wasrecorded Anthropometric data were analysed using WHOAnthroPlus version 104 software for assessing the growth ofthe children The children were classified using the followingcategories

(1) Wasting (acute undernutrition) is defined as a lowweight for height Childrenwith 119911 scores (WHZ)lt minus2are considered as wasted and those with WHZ lt minus3are severely wasted

(2) Stunting (chronic undernutrition) is defined as a lowheight for age Children with 119911 scores (HAZ) lt minus2 areconsidered as stunted and those with HAZ lt minus3 areseverely stunted

(3) Underweight (mixed acute and chronic undernutri-tion) is defined as a low weight for age Children with119911 scores (WAZ) lt minus2 are considered as underweightand those with WAZ lt minus3 are severely underweight

(4) Thinness (measure of body fat) is defined as a lowbodymass index Childrenwith 119911 scores (BMIZ)lt minus2are considered as thin and those with BMI lt minus3 areseverely thin

All the data were compiled and analysed using StatisticalPackage for Social Sciences (SPSS) software version 160 andappropriate statistical tests were applied ldquo119875rdquo value lt005 wasconsidered as statistically significant Univariate as well asmultivariate analyses were carried out to test associationsbetween various individual and sociodemographic character-istics and nutritional status of childrenThe variables found tohave ldquo119875rdquo value lt025 in univariate analysis were entered intologistic regression model As multistage sampling techniquewas used for data collection sample weights were calculatedand taken into consideration during the data analysis in orderto get more valid results

3 Results

Overall 249 slum children of age group between 3 and 9years were surveyed Majority of the study subjects weregirls (683) and the rest were boys (317) Mean age withstandard deviation (SD) of girls and boys was 507plusmn 16 yearsand 575 plusmn 207 years respectively The mean height (withSD) of the girls was 1003 plusmn 115 cm whereas that of boyswas 1031 plusmn 128 cm The mean weight (with SD) of the girlswas 150 plusmn 35 kg whereas that of boys was 157 plusmn 433 kgThe anthropometricmeasurements such as height andweightwere found to be more in boys than in girls in all the agegroups

Table 1 shows the nutritional status among slum childrenOut of 249 children 58 (233) 143 (574) 113 (454)and 57 (229)were wastedseverely wasted stuntedseverelystunted underweightseverely underweight and thinverythin respectively Overall 655 of slum children were foundto have undernutrition

Univariate analysis showing association between wastingand various individual and sociodemographic characteristics













4 Discussion















Type of familya

Joint 25 (806) 06 (194) 31 (124) 0573Nuclear 166 (761) 52 (239) 218 (876)



































Type of familya

Joint 10 (323) 21 (677) 31 (124) 0327Nuclear 96 (44) 122 (560) 218 (876)





























Acknowledgment


References














































of






Disease Markers



OncologyJournal of





PPAR Research



Journal of

ObesityJournal of




























4 Discussion















Type of familya

Joint 25 (806) 06 (194) 31 (124) 0573Nuclear 166 (761) 52 (239) 218 (876)



































Type of familya

Joint 10 (323) 21 (677) 31 (124) 0327Nuclear 96 (44) 122 (560) 218 (876)





























Acknowledgment


References














































of






Disease Markers



OncologyJournal of





PPAR Research



Journal of

ObesityJournal of



























Type of familya

Joint 25 (806) 06 (194) 31 (124) 0573Nuclear 166 (761) 52 (239) 218 (876)



































Type of familya

Joint 10 (323) 21 (677) 31 (124) 0327Nuclear 96 (44) 122 (560) 218 (876)





























Acknowledgment


References














































of






Disease Markers



OncologyJournal of





PPAR Research



Journal of

ObesityJournal of












































Type of familya

Joint 10 (323) 21 (677) 31 (124) 0327Nuclear 96 (44) 122 (560) 218 (876)





























Acknowledgment


References














































of






Disease Markers



OncologyJournal of





PPAR Research



Journal of

ObesityJournal of






































Acknowledgment


References














































of






Disease Markers



OncologyJournal of





PPAR Research



Journal of

ObesityJournal of



































of






Disease Markers



OncologyJournal of





PPAR Research



Journal of

ObesityJournal of
















research article undernutrition and its correlates among...

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