Nutritional Status among 6-59 Months Children in a Selected Community of a VDC

ABSTRACT Introduction Adequate nutrition is essential for proper growth and development of the child. We conducted a cross-sectional descriptive study to find the prevalence of nutritional status of 6-59 month old Tharu children in Duruwa of Dang District. This study also deliberates the socioeconomic and demographic character, maternal and child character and child feeding status of the Tharu community children. Methods This study was a descriptive cross sectional study and was done between February and March, 2017 in Tharu community of Duruwa, Dang. Total 189 children of age group 6-59 months were selected by using systematic random sampling technique; anthropometric measurements were performed to find the nutritional status of children. Pre-coded questionnaire was used to collect information from caretaker. WHO Anthro version 3.2.2 and SPSS version 20 were used to analyze data. Results Prevalence of wasting, stunting, and underweight were 25 (13.2%), 51 (27%), and 40 (21.2%) respectively. The prevalence of stunting was seen more in females than in males while underweight was higher among males, whereas wasting was very similar in both sexes. Conclusions The findings showed that there is still high prevalence of malnutrition in Tharu children of Duruwa so monitoring of nutrition status in Tharu children should be taken seriously and needs to be addressed.


INTRODUCTION
Adequate nutrition is essential in children for their good mental and physical development. 1Thirty-six percent of children under five in Nepal are stunted, 10% are wasted and 27% are underweight. 2aru community are deprived due to poor health, low economic status, lack of decision making on developmental works, poor value for their labor works, less rights in natural resources, no market access, and other various social factors. 3There have been no Free Full Text Articles are Available at www.jnma.com.npprior studies assessing the nutritional status of Tharu's children.In this regard, this study provides nutritional status of Tharu's children and factors associated with it.This study would help policy makers and program implementers to consider evidence regarding nutritional status among children of this specific group.
The objective of the study was to find the nutritional status of 6-59 month old Tharu children in Duruwa VDC of Dang District.

METHODS
This study was descriptive cross-sectional conducted in Duruwa VDC that lies in mid-western development region, currently province 5 of Nepal.The study population was all 6-59 month old Tharu children living in concerned VDC.Written consent was obtained from the caretakers of the children.Those who denied participation in the project, seriously ill, or were not available at during the period of the study were excluded.The response rate was 100%.
A pre-coded questionnaire (partially adopted from Nepal Demographic Health Survey (NDHS) and was modified based on extensive literature review) was used to collect information and was administered to the caretakers.Anthropometric measurements (weight, height) were carried out to assess the nutritional status of children.
The samples of 189 children were selected by using simple random sampling technique for assessing nutritional status.Sample size estimation: s= Z 2 x p x q = 171 d 2 Where, Z =1.96 for Confidence Interval of 95% p = Prevalence, 50% from previous studies q = 1-p d= 0.075 Taking 10% non-response rate,the total sample size calculated was 189.In households with more than one child of the age between 6-59 months, the younger child was chosen.Data collection period was between February and March, 2017.
For the analysis of Individual Dietary Diversity Score (IDDS), the questionnaire was classified with 12 food groups and we categorized IDDS on the following basis. 4 Low

Egg
Stadiometer was used to measure the height of children.The length of children below 2 years was measured by recombinant method and the height children of 2 years and above was measured in standing position. 5l clothes worn by children were removed and weight was measured by digital weight scale and read to the nearest 0.1 Kg.For children below two years of age and unable to stand by themselves, their weight was obtained from the difference between the weight of the mother as she holds her child and the weight of the mother alone.Age was determined from the birth certificate from the VDC and vaccination card based on availability.
The data was checked for completeness and consistency.The collected data was first organized, coded and entered into MS Excel and then into Statistical Package for Social Sciences (SPSS) version 20.0 and into World Health Organization (WHO) Anthro version 3.2.2.Response rate was 100% and there were no missing data.Descriptive analysis was carried out to describe the percentages and number distributions of the respondents by socio-demographic characteristics and other relevant variables in the study.
For IDDS cutoff point was used for categorizing in Low, medium and high dietary diversity. 4Anthropometric indices were calculated using reference medians recommended by WHO and classified according Z-score, based on WHO criteria.
Assuming the potential recall bias related to dietary intake and age of mother and children, to overcome this, cross questions were incorporated.Immunization card and birth registration card were cross-checked for the reported age.
Ethical clearance was obtained from Nepal Health Research Council.Verbal consent from parents/care taker of participants was obtained and the objective of the study was explained lucidly to them.Written consent was obtained from each caretaker of the participants before data collection.

DISCUSSION
Stunting and underweight among children of Duruwa VDC was found to be better than national average (stunting: 36%, underweight: 27%) whereas wasting was found to be worse than the country's national average (wasting: 10%). 2 The prevalence of wasting and underweight was found somehow similar withthe nutritional status of under five children in Western Nepal where 15.1% were wasted and 20.2% were underweight respectively but the stunting was somehow lower in Duruwa VDC than in western Nepal. 6he inappropriate time of initiation of complementary feeding, outbreaks of diarrhea and other diseases may be the reason behind this.This may be due to low hygiene and sanitation in the community which may cause disease outbreak and parasitic infection in children causing wasting in children.
Children under five years of age are very vulnerable to the malnutrition.The children from the low income families are not breastfed properly and complementary foods are also not provided sufficiently so there is a high chance of malnutrition. 7During the survey, it was found that household having larger family use noniodized salt as it is bought in bulk, making it relatively cheaper.So lack of iodine in both mother and child may hinder the adequate physical and mental development of child. 8The most of the mothers of Tharu community of Duruwa VDC were adolescent mother and had very less knowledge regarding feeding of children.Hence, long term inappropriate feeding behavior causes nutrient deficiency in children leading them towards malnutrition.Family having low income have very small allocation of budget for the food, the quality of the food might not be maintained, proper healthcare service might not maintained which may cause stunting in the children.Inadequate individual dietary diversity might be a risk factor for chronic malnutrition in Tharu children.Long term poor dietary diversity is likely to be reflected in stunting. 9Socio-economic indicator was solely based on income which measures limited facets of it.Study didn't measure actual calorie consumption and food consumption was based on food frequency questionnaire and individual dietary diversity scores only.There may be seasonal variation as the study was cross sectional.This study was conducted among limited population of specific Tharu community so it may not be generalizable to all population with different socio-economic settings.

CONCLUSIONS
This study demonstrated that under-nutrition continues to be a serious problem in the Tharu community of Duruwa VDC.Interventions with integrated approach that improves overall socio-economic status, child care practices including maternal and child nutrition improvement is needed for overcoming the current nutritional problem.Also, to tackle the malnutrition related problem there is a great need to focus the attention of policy-makers on the nutritional status and government should prioritize nutrition related programs and implement it fully.

Figure 1 .
Figure 1.Present status of malnutrition in Tharu children of Duruwa VDC.

Table 2 . Child caring practices.
Bhattarai et al.Nutritional Status among 6-59 Months Children in a Selected Community of a VDC Free Full Text Articles are Available at www.jnma.com.np