Introduction

Undernutrition continues to be a primary cause of ill-health and premature mortality among children in developing countries ₁ . Undernutrition among children is prevalent in almost all the states in India ₂ . The children living in rural areas of India disproportionately suffer from undernutrition compared with their urban counterparts ₃ . Although several recent studies have studied the problem of undernutrition among rural children in different parts of India ₄,₅,₆,₇,₈,₉,₁₀,₁₁,₁₂,₁₃ , there is a scanty information regarding undernutrition among rural children of Bankura District, West Bengal.

Three commonly used indicators of undernutrition among children are stunting (low height for age), thinness (low body mass index for age) and underweight (low weight for age). Stunting is an indicator of chronic undernutrition, the result of prolonged food deprivation and/or disease or illness; thinness is an indicator of acute undernutrition, the result of more recent food deprivation or illness; underweight is used as a composite indicator to reflect both acute and chronic undernutrition, although it cannot distinguish between them ₁₄ . In view of this, the present investigation assessed the prevalence of undernutrition among 6-14 year old rural school children of Onda, Bankura District, West Bengal, India.

Materials and methods

Study Area and Subjects

Anthropometric Measurements

Evaluation of nutritional status

Three commonly used undernutrition indicators, i.e., underweight, stunting and thinness were used to evaluate the nutritional status of the subjects. The United States National Centre for Health Statistics (NCHS) ₁₇,₁₈ age and sex specific – 2 z-scores were followed to define underweight, stunting and thinness. The following scheme was utilized:

Underweight : < - 2 WAZ (Z-score for weight-for age)
Stunting : < - 2 HAZ (Z-score for height-for age)
Thinness : < - 2 BMIZ (Z-score for BMI-for-age)

where WAZ, HAZ and BMIZ to height-for-age, weight-for-age and BMI- for- age, age and sex specific z scores, respectively, of NCHS ₁₉ .

The WHO ₁₄ classification (Table 1) was followed for assessing severity of malnutrition by percentage prevalence ranges of these three indicators among children.

Figure 1

Table 1: WHO classification of severity of malnutrition.

Statistical Analyses

Results

Details age and sex wise distribution of the study sample are given in Table 2.

Figure 2

Table 2: Age-sex distribution of study population.

The age-wise means and standard deviations of weight, height and BMI, in both sexes, are presented in Table 3. There were no significant sex differences in mean weight and BMI. There were significant (p < 0.05) sex differences in mean height at ages 10 (t = 2.19) and 12 (t = 3.11) years.

Figure 3

Table 3: Age and sex-specific mean weight (kg), height (cm) and BMI (kg/m ) of the children.

Table 4 presents the mean WAZ, HAZ and BMIZ. Mean z scores had negative values in both boys as well as girls. The overall (sex combined) mean (sd) WAZ, HAZ and BMIZ were -1.09 (0.95), -0.79 (1.28) and -1.26 (1.17), respectively. The mean z-scores ranged from – 1.29 (BMIZ, boys) to – 0.77 (girls, HAZ).

Figure 4

Table 4: Mean WAZ, HAZ and BMIZ of the subjects.

Table 5 presents the prevalence underweight, stunting and thinness by age and sex. The overall age and sex combined prevalence of underweight, stunting and thinness were 16.9%, 17.2% and 23.1%, respectively. According to the WHO ₁₄ public health problem of undernutrition among children, these rates were medium (10-19%), low (< 20%) and very high ( 15%), respectively. Among boys, underweight was high (20.9%) while thinness was very high (27.8%). In case of girls, underweight was medium (13.8%) while thinness was very high (19.4%). Both sexes had low (< 20%) rates of stunting.

Figure 5

Table 5: Prevalence underweight, stunting and thinness by age and sex.

Discussion

Improved child health and survival are considered universal humanitarian goals. In this respect, understanding the nutritional status of children has far-reaching implications for the better development of future generations ₄ . However, reports have stated that child malnutrition has risen in recent years in India ₂₀ .

Malnutrition continues to be a problem of considerable magnitude in most developing countries of the world ₂ . Several studies ₂₁,₂₂,₂₃,₂₄,₂₅,₂₆ have shown that dietary and environmental constraints are the major determinants of differences in growth performance between children of developing and developed countries. In the present study, the overall age and sex combined prevalence of underweight, stunting and thinness were 16.9%, 17.2% and 23.1%, respectively. Both sexes had similar rates of stunting but significantly more boys were underweight and thin. According to the WHO classification of severity of malnutrition among children, the overall age and sex combined rates of underweight, stunting and thinness were medium, low and very high, respectively. The rates of undernutrition in the present study were lower than those reported among similar aged school children of tea workers of Assam, North East India ₅ as well as Kamar tribal children of Chhattisgarh, central India ₇ .

While stunting reflects a failure to reach linear growth potential due to sub optimal health and/or nutritional conditions, underweight reveals low body mass relative to chronological age, which is influenced by both, a child's height and weight. Underweight thus cannot distinguish between a child that is small in weight relative to his/her height and a child that is low in height relative to his/her age, but who may be normal in weight-for-height. On the other hand, thinness is an indicator of acute undernutrition, the results of more recent food deprivation ₁₄ .

In conclusion, this study provided evidence that these children were under acute and chronic nutritional stress indicating the requirement of immediate appropriate public health nutritional intervention programmes. This has important implications for public health policy-makers, planners and organizations seeking to meet national and international development targets. However, it must be noted here that the conclusion drawn may not be applicable for all districts of India but to a certain extent, it may be true for West Bengal State.

Acknowledgements

Correspondence to

Kaushik Bose, Reader, Department of Anthropology, Vidyasagar University, Midnapore – 721 102, West Bengal, India. e-mail: banda@vsnl.net Tel: (91) (3222) 276554 Fax: (91)(3222) 275329.