41

Chapter II

REVIEW OF LITERATURE

Review of literature is defined as the broad, comprehensive,

in-depth, systematic and ethical review of scholarly publications. The

term literature is designating a written summary of the state of art as

research problem. This also refers to the activities involving identifying

and searching for information about a topic and developing an

understanding of the study and the knowledge on that topic.

Literatures relevant for this study were reviewed and have been

organized in the following sequence:

Section I : Nutritional status of under-five Children.

Section II : Prevalence of Malnutrition.

Section III : Prevalence of PEM.

Section IV : Determinants of malnutrition.

Section V : Knowledge of mothers on Nutrition

Section VI : Nutritional supplements and ready-to-use therapeutic

food.

Section I : Nutritional Status of Under-five Children

Purohit, et al. (2017) conducted a community based descriptive

cross sectional study on the Nutritional status of 650 under-five children

in a city of Maharashtra. The results showed that 40.46% under-five

children were stunted, 38.15% were underweight and 16% were wasted.
 42

Gautam, et al. (2018) conducted a study on the Nutritional status

and its correlates in 390 under-five (0-60 months) slum children of

Kanpur Nagar, India. The prevalence of stunting and severe stunting

was observed to be 31.28% and 13.59%. 14.62% study subjects were

wasted while 6.15% subjects had severe wasting. 40.51% had mild-

moderate malnutrition and 7.95% had severe malnutrition as per the

criteria of mid upper arm circumference. Malnutrition was significantly

associated with the age of the study subjects (p <0.05).

Ozor, et al. (2014) conducted a descriptive cross-sectional study

on prevalence of under-nutrition among 402 under-five year children in

Ekpoma, a community in central part of Edo state, Nigeria. The results

showed that the prevalence of underweight, stunting and wasting was

2.5%, 12.4% and 9.5% respectively. Male under-five’s were more likely

to be underweight (3.2%) and wasted (9.7%) compared to their female

counterparts (2.2% and 9.4% respectively). On the other hand, female

under-five’s were more stunted (12.9%) than the males (10%).

Chataut and Khanal (2016) conducted cross-sectional study

on the assessment of nutritional status of 243 children under-five

years of age in Dolakha and Kavre districts of rural Nepal. The results

revealed that, out of 243 children, according to WHO growth standards,

17 (7.0%) were wasted, 97 (39.9%) were stunted and 46 (18.9%) were

underweight.

Zemenu, et al. (2017) conducted a Facility based cross-sectional

study on malnutrition and associated factors among under-five children

(6-59 Months) at Shashemene Referral Hospital, West Arsi Zone,

 43

Oromia, Ethiopia. The results revealed that the magnitude of stunting,

underweight and wasting were about 38.3%, 49.2% and 25.2%,

respectively.

Gezae Brhane and Nigatu Regassa (2014) conducted a study

on the Nutritional status of 316 children under-five years of age in Shire

Indaselassie, North Ethiopia. The result showed that 56.6% of the

children under age five have stunting, underweight (20.9%) and wasting

(4.1%) with a mean z-score of –2.2, –1.0 and 0.3, respectively.

Steenkamp, et al. (2016) conducted a cross-sectional,

descriptive study to describe wasting and stunting in children aged

12–60 months, admitted to targeted supplementary feeding programmes

for the treatment of moderate acute malnutrition (MAM) in South Africa.

The results revealed that out of the total sample (n = 225), 13% were

diagnosed as wasted, 58% as stunted, and 21% as both wasted and

stunted. MUAC was significantly associated with wasting. Of the sample,

32% presented with severe stunting, and 29% with moderate wasting.

Sonkaria, et al. (2014) conducted a community based cross

sectional study on the nutritional status of 330 children between

1-5 years in field practice area of RHTC Naila, Jaipur. The results

showed that, out of total 330 children it was observed that 13.6% of

children were found to have under-nutrition. It was also revealed that

62.73% were anaemic (35.76% were mild anaemic, 26.36% were having

moderate anaemic and 0.61% were severely anaemic).

 44

Pushpa and Jancy Rani (2015) conducted a study on Nutritional

Profile of Children (0-5years) in the Service Villages of Gandhi gram

Rural Institute (GRI), Tamil Nadu, among 538 children. The results

revealed that out of 538 children, 50.2 percent were boys and 49.8

percent were girls. Over weight was found among 8.6 percent of

children. As per mid upper arm circumference, 87.2 percent of children

were normal, 10.4 percent of children were in the stage of underweight

and risk of malnutrition, 2.4 percent of children had severe malnutrition.

It was also observed that the nutrient intake of calcium and minerals by

the selected children were below the RDA. Intake of calcium and iron

among 0-1 year children was slightly excess of RDA by 0.04 and 0.02

percent.

Kalyan, et al. (2015) conducted a cross sectional study on

nutritional status of under three children in south India. The findings

showed that the prevalence of mild, moderate, severe and very severe

underweight children were 103 (11.5%), 24(2.8%), 2 (0.2%) and 3

(0.3%) respectively. The data showed male and female children as

having equal distribution of malnutrition. Among the study population,

the prevalence of stunting, wasting and stunting & wasting was 28.1%,

16.1% and 7.7% respectively. 243 (52.3%) of male children had

malnutrition as compared to 221(51.6%) of female children.

Sudarsan, et al. (2014) conducted community-based cross-

sectional analytical study to assess the nutritional status of 120 children

aged 0-14 years in a slum area of Chetla, Kolkata. The results revealed

that the overall prevalence of under-nutrition among the study population

 45

was found to be 54 (45%). Among infants 9 (25%) were underweight, 3

(8.3%) were stunted, 22 (61.1%) were wasted and 23 (63.9%) showed

thinness. Among 1-5 years aged children, 18 (30.5%) were underweight,

17 (28.8%) were stunted, 17 (28.8%) were wasted, 12 (20.3%) had

MUAC between12.5-13.5 cm and 17 (28.8%) showed thinness.

Dasgupta, et al. (2014) conducted a cross-sectional community

based study on the Assessment of under-nutrition with Composite

Index of Anthropometric Failure (CIAF) Among 113 under-five children

in a rural area of West Bengal. The results revealed that 37(32.7%)

were suffering from under-nutrition according to CIAF. Both the

underweight and wasting was present in 17.7% while stunting was

prevalent in 15%.

Safikul Islam, et al. (2014) conducted a study on the Nutritional

Status of under 5 Children belonging to Tribal Population Living in

Riverine (Char) Areas of Dibrugarh District, Assam. The results revealed

that overall prevalence of underweight, stunting, and wasting was 29%,

30.4%, and 21.6%, respectively. Significant association was observed

between the prevalence of under-nutrition and socioeconomic status,

literacy status of parents, infant, and young child feeding practices and

size of the family (P < 0.05).

Ravindra, et al. (2015) conducted an analytical cross-sectional

study on the factors associated with malnutrition and risk of infections

among 182 malnourished children admitted to McGann teaching

hospital, Shivamogga, Karnataka, India. Out of 182 children, 80

(43.96%) were boys and 102 (56.04%) were girls. More than
 46

2/3rd (68.6%) under nourished children were in the age group of

0-3 years. Most common co-morbidity found was respiratory tract

infection (44%) followed by acute gastro enteritis (22.5%) and fever

(Pyrexia of unknown origine-22.5%).

Sahana and Chandrasekhar (2016) conducted the study on

“mother’s status in the family and nutritional status of their 250 under-

five children” in Shimoga District of Karnataka. The results showed the

proportion of both underweight and stunting as more among children of

illiterate mothers (55.2% and 55.8 %) while comparing with children of

mothers having above primary education (41.0% and 42.9 %), employed

mothers (77.4% and 80.6 %) while comparing with children of house

wives (46.8% and 47.8 %) and mother who don’t have any control over

daily family expenditure (54.7% and 50.3%) while comparing with

children of mothers who had such control (25.6% and 30.0 %). More

than 80 % of families belonged to labour class and the differences

persisted irrespective of economic status of families.

Jai Prakash Singh, et al. (2013) conducted a hospital based

cross-sectional study on Nutritional Status Among 516 Under-five

Children Attending Out Patient Department at A Primary Care Rural

Hospital, Dhaura Tanda, Dept. of Community Medicine, SRMS Institute

of medical sciences, Bareilly (UP). The study revealed that the total

malnutrition cases were 394 with a prevalence of 76.36%. Malnutrition

was more common in males than females. It is observed that 53.86%

children were underweight, 43.22% children were stunted and 60.67%

were wasted.
 47

Radhamani and Rajeev (2017) conducted a cross-sectional

study on the nutritional status of Anganwadi children aged 2-5 years in a

rural area at Cheruthazham, Kannur district of North Kerala. The results

revealed that 14.6% of children were underweight; 10.6% were stunted

and 16.6% were wasted. Underweight, stunting, and wasting were most

prevalent in 2-3-year-old children and minimum among the 3-4-year old

children.

Section - II : Prevalence of Malnutrition

Jomon Mathew John and Jomol Sara John (2018) conducted a

cross-sectional study on the Prevalence and risk factors associated with

underweight among 500 under-five children in a rural area of

Pondicherry. The results revealed that the prevalence of underweight

was found to be 23.8%.

Gul Nawaz Khan, et al. (2016) conducted a cross-sectional study

on the Prevalence and associated factors of malnutrition among 3964

children under-five years in Sindh, Pakistan. The results revealed that

the prevalence of stunting, wasting and underweight were 48.2%

(95% CI: 47.1–50.3), 16.2% (95% CI: 15.5–17.9), and 39.5% (95%

CI: 38.4–41.5), respectively. Stunting was slightly higher (51%) in boys

than in girls (45%) (p < 0.001). The proportion of wasting (p = 0.039)

and underweight (p = 0.206) was not significantly different between

boys and girls. Fifty percent children in the poorest households were

stunted as compared to 42% in the wealthiest households. Children in

the poorest households were two times more likely to be wasted (20.6%)
 48

than children in the wealthiest households (10.3%) (OR 2.33, CI 1.69–

3.21, p < 0.001).

Nagata, et al. (2016) conducted a prospective cohort study on

the prevalence and predictors of Malnutrition among 852 Children at 2

Years of Age in the Western Highlands, San Lucas Toliman, of

Guatemala. The results revealed that, 402 males and 450 females in the

cohort, mean weight-for-age Z-score (WAZ) declined from -0.67 ± 1.01

at 1 year to -1.07 ± 0.87 at 2 years, while mean height-for-age Z-score

(HAZ) declined from -1.88 ± 1.19 at 1 year to -2.37 ± 0.99 at 2 years.

Using multiple linear regression model, number of children <5 years old,

vomiting in the past week, fever in the past week, and WAZ at

1 year were significant predictors of WAZ at 2 years. Significant

predictors of HAZ at 2 years included household size, number of

children <5 years old, diarrhoea in the past week, WAZ at 1 year, and

HAZ at 1 year. Vomiting in the past week and WAZ at 1 year were

significant predictors of weight-for-height z-score (WHZ) at 2 years.

Rekha (2014) conducted a cross sectional study on high

prevalence of malnutrition in children under 5 years from rural Thane

district, Maharashtra. The results depicted that the height (83.8±12.2

cm) and weight (11.3 ±2.6 kg) was significantly found higher in boys

than that in girls [height (81.3±12.2 cm); weight (10.7±2.6)] (p<0.05). In

boys, 67.7% had stunting (HAZ <-1) and 73.6% boys were underweight

(WAZ <-1). In girls, 58.9% and 67.4% were stunted and underweight

respectively. When BAZ was evaluated 22.4% boys and 13.7% girls had

BAZ low (BAZ <-1). The mean energy 637 Kcal (p<0.012), carbohydrate
 49

123.65 gms (p< 0.023), protein 13.1 gms (p< 0.042) and fat 10 gms

(p<0.001) intake was significantly less than the recommended daily

allowances (RDA). 16.9 % of children suffered from Vitamin A

deficiency, 18.7 % from B complex deficiency, 8.5 % from Vitamin C

deficiency, 100 % from Iron deficiency and 55.3 % from Amoebiasis and

Worm infestations.

Stalin, et al. (2013) conducted a community based cross

sectional study on Prevalence of Underweight and its Risk Factors

among 563 parents/guardians of Under-five Children in a Rural Area of

Kancheepuram District in Tamil Nadu, India. The prevalence of

underweight among the under-five children was 52.9%. Around 7% of

children were severely malnourished. The prevalence of underweight

among children under the age of one year was 62.4%. Females (62.6%)

were more malnourished than males (44.0%). Children belonging to

higher socio-economic status (40.0%) were found less malnourished

than the lower socioeconomic status (47.2%).

Sanjana Gupta and Dinesh Kumar (2014) conducted a

Longitudinal Intervention Study in Malnutrition among the 206 under-five

Children in village Domana, rural field practice area of Postgraduate

Department of Community Medicine, Government Medical College,

Jammu in order to assess the impact of nutrition advice given to mothers

of under-five children. Totally, 43 children having varying degrees of

malnutrition as per IAP criteria were followed longitudinally for a period

of one year through monthly home visits. Episodes of illness and weight

was recorded every month and plotted on growth chart. The prevalence
 50

of malnutrition was 28.87%. Majority children had Grade I malnutrition.

Post intervention results revealed that nutrition education in mothers had

a positive effect on the nutritional status of their children.

Qureshi, et al. (2014) conducted a study on assessing the

prevalence of malnutrition in 4502 tribal children between 6-59 months

of age using MUAC as a screening tool, in seven Medicins Sans

Frontiers (MSF) Project mobile clinic sites located in states of Andhra

Pradesh and Chhattisgarh border areas in India. The overall prevalence

of malnutrition among 6-59 months children was 15.2%. However, the

prevalence of malnutrition was higher among children of 6-23 months

age group (25.8%) as compared to children of 24-59 months (5.4%).

Shreyaswi, et al. (2013) conducted a cross sectional study on

the Prevalence and risk factors of under-nutrition among 133 under-five

children in a rural community of Nitte, a field practice area of Department

of Community Medicine, K.S. Hegde Medical Academy among all the

children of the Anganwadis under ICDS scheme. The results revealed

that the overall prevalence of under-5 under-nutrition was found to be

high at 63.16%. More girls were found undernourished compared to

boys, lower grades of undernourishment were more common and the

prevalence of under-nutrition increased with increasing age.

Amrita and Nagaraj (2016) conducted a cross sectional study on

Malnutrition in 933 children below 6 years in Kamineni Institute of

Medical Sciences Narketpally in Nalgonda district, Telangana. Out of

933, there were 493 females and 440 males. Prevalence of overall
 51

malnutrition for underweight, stunting and wasting was found to be

56.59%, 62.59% and 25.72% respectively.

Renuka, et al. (2014) conducted community based cross-

sectional study on malnutrition Among Under-Five Children of

Kadukuruba Tribe of Mysore district. The results revealed that the

prevalence of underweight, stunting and wasting was 60.4%, 55.4% and

43% respectively which was significantly associated with respect to age,

presence of ration card in the family and egg in the child’s diet.

Sundari, et al. (2017) conducted a cross-sectional community-

based Study on the prevalence and pattern of malnutrition among

357 children under 5 years of an Anganwadi centre in an urban slum of

Egmore, Chennai. The results revealed that the overall prevalence of

underweight, stunting and wasting was found to be 19.9% (95% CI 15.9-

24.4), 17.1% (95% CI 13.3- 21.4) and 21.6% (95% CI 17.4 -26.2)

respectively. The prevalence of underweight and wasting was increased

with increasing age (p < 0.05). The difference in the prevalence of

under-nutrition among male and female children was small and this

difference was not found to be statistically significant (p >0.05). The

overall prevalence of overweight children was found to be 1.4%.

Fahmina, et al. (2013) conducted a community based cross

sectional study to estimate the prevalence of under-nutrition among 483

children aged 0-36 months carried out in the rural area of Varanasi,

India. The results revealed that the prevalence of stunting, underweight

and wasting were 43.1%, 35.2% and 31.5%, respectively. The

Composite Index of Anthropometric Failure (CIAF) shows 62.5% of

 52

children suffering from anthropometric failure. As much as 88 (42.9%)

children were suffering from malnutrition according to MUAC criteria

(<13.5cm). About two thirds of the children were in the zone of

anthropometric failure.

Yadav and Dixit (2017) conducted a quantitative descriptive

study to assess the prevalence of malnutrition among 100 under 5 year

children at selected Anganwadi centres of Jaipur district with a view to

develop an information booklet for parents. The major findings of the

study were that majority of the children i.e. 42% were found to be

moderately malnourished whereas 9% children were severely

malnourished. The overall mean prevalence of malnutrition was found to

be 51%. The study concluded that almost half of under-five children

were underweight.

Sarkar (2017) conducted a cross-sectional study on child

malnutrition and associated risk factors among 485 children aged under-

five in West Bengal, India. The analysis results revealed that stunting

(51%) as the most common form of malnutrition among children aged

under-five, followed by underweight status (41%), and wasting (22%).

Section - III : Prevalence of PEM

Soja and Kiran (2016) conducted a descriptive study on Protein

energy malnutrition among 109 under-five children in Kottayam district,

Kerala. The results revealed that out of 109 samples, 41.28% had

Grade I PEM.

MIssiriya (2013) conducted a cross sectional descriptive study on

prevalence of protein energy malnutrition among 1501 preschool

 53

children aged between 3-5 years at slums of North Chennai. The results

revealed that the prevalence of underweight was significantly higher in

children at 3 years than 4 and 5 years of age. Totally 50% of them were

underweight, 32% stunted, 37% wasted and 23% with impaired mid arm

circumference.

Shraddha, et al. (2016) conducted a cross-sectional study on the

prevalence of protein energy malnutrition and its associated factors in

under 5 year children in an urban slum of Mumbai, India. The results

were found that the prevalence of PEM was 56%, more percent of PEM

64(66.7%), was found in 13-24 months of age, 120(54.1%) were found

in boys, 122(55%) belong to non-nuclear family dwellers, 198(89.2%)

children who were not given colostrums and 168(75.7%) who were not

given exclusive breastfeeding,152(68.5%) children were found to be

incompletely immunized, 122(55%) children had more than 3 episodes

of ARI, 142(64%) children had >3 episodes of diarrhoea, 86(82.7%)

children with PEM belonged to Class V, (B.G Prasad classification).

Priyanka (2017) conducted a cross sectional study on the

Prevalence of Protein Energy Malnutrition among 300 Under-Five

Children Belonging to Rural Areas of Ambala, Haryana, India. The

results revealed that according to the Gomez classification, 44.43% had

good nutritional status with the proportion of first, second and third

degree malnutrition was 39.34%, 15.66% and 0.66%, respectively.

Goudappa and Divyarani (2016) conducted a cross sectional

study on the prevalence of protein energy malnutrition among 180

children between 1-5 years in Bellary taluk. The results revealed that the
 54

prevalence of Protein energy malnutrition is 122(67.7%). The prevalence

of PEM is high among the rural children (71.1%) compared to urban

children (64.4%) and this difference is found to be statistically significant.

Shachi and Sushil (2015) conducted a study on the Protein

Energy Malnutrition among Preschool Tribe’s Children of Chhattisgarh,

India. A total of 449 children from 286 families were selected randomly.

The results revealed that 369(82.1%) children belonged to one or the

other grade of PEM. 189(42%) preschool children belonged to grade II,

92(20.4%) belonged to grade III and 84(18.7%) belonged to grade IV

while only 80(17.8%) preschool were healthy. The study also found that

only 99 children (22%) were normal, 206 children (45.8%) were stunted,

30 (6.68%) were wasted, 114 (25.3%) were wasted and stunted.

Ram, et al. (2014) conducted a cross-sectional and

epidemiological study of Protein Energy Malnutrition (PEM) among 400

children between the age group of 1-6 years in the Rural Health Training

Centre (RHTC), Carrier Institute of Medical Science, Lucknow, Uttar

Pradesh, India. The findings showed, according to Indian Academy of

Paediatrics (IAP), the prevalence of PEM was 54.8% with the proportion

of grade I, II and III being 33%, 18.3% and 3.5%, respectively and none

of the children was in grade IV under-nutrition. The prevalence of

underweight was significantly (p<0.001) higher in 1-3 years children

(71.2%) as compared to 3-6 years children (46.6%). Girls (61.8%) were

significantly (p=0.008) found more malnourished than boys (48.6%) in all

grade of underweight.
 55

Sekhar, et al. (2015) conducted a community based cohort study

to detect the Protein Energy Malnutrition among 503 children aged

between 1–5 Years and Nutritional Intervention to the Same Age

Children in Rural (Chennuru) and Urban (Akkayapalli) Field Practice

Areas of Rajiv Gandhi Institute of Medical Sciences, Kadapa.

Prevalence of PEM in the urban population was 24.2% and

prevalence of PEM in rural area was 47.3%. PEM was more in rural

female children and statistically significant association was found

between female sex and PEM (P<0.05). In the urban study population,

before supplementation of food, the prevalence of PEM in urban

area was 24.2% with following supplementation of food for 6 months

the PEM was 16.3%. In the rural area, before supplementation of

food, the prevalence of PEM in rural area was 47.3%, with following

supplementation of food the PEM was 40.3%.

Kavita, et al. (2012) conducted a cross-sectional epidemiological

study to assess the ecological factors, biological, socio-economic,

maternal and dietary factors influencing the nutritional status of 400

under-five (1-5 years) children in urban-slum area of (Sunderpur

community), I.M.S., B.H. U, Varanasi. The prevalence of PEM as per

“IAP classification” was 63.3%. The prevalence was higher in 3 years as

compared to 4th and 5th year. PEM prevalence was observed to be

lowest during 2nd year of life. The significant difference was found in the

prevalence of PEM in male children (58. 3%) as compared to female

children (68.6%).
 56

Section- IV : Determinants of Malnutrition

Deepali, et al. (2016) conducted a cross-sectional study on the

awareness of the weaning practices and the determinants affecting them

among 300 mothers in a rural hospital based paediatric outpatient clinic

of M.I.M.E.R Medical College, Talegaon (D) Maval Taluka, Maharashtra.

The results revealed that total unawareness regarding weaning was

the reason for not starting complementary feeding at 6 months in

64 respondents (21.1%). Majority of the respondents (210, 69.1%)

revealed that they prefer home based complementary feeding. A total of

125 respondents (41.1%) admitted that they stopped the feeding in the

event of illness.

Etim, et al. (2017) conducted a cross-sectional study of

Malnutrition-dependent Factors among 380 Under-five Children in

Ekureku Community, Abi Local Government Area of Cross River

State, Nigeria. The results showed that 108 (28.4%) of under-five

children were stunted, 47(12.3%) were wasted and 107(28.1%)

were underweight. Malnutrition was observed to be significantly higher

among females than male children (P < 0.05). Children aged >24

months were more stunted (22.4%), wasted (9.5%) and underweight

(22.1%) than children <24 months. Most respondents (54.2%) had poor

knowledge of child nutrition, while 45.8% had a fair knowledge.

Respondents (35.0%) breastfed their babies exclusively, while 63.0%

introduced complementary feeding when their children were less than

six months old.

 57

Andy, et al. (2016) conducted a descriptive study to determine

the prevalence of malnutrition and associated factors among the

250 under-five children in Borgu Local government area of Niger state,

Nigeria. The study findings revealed that the prevalence of stunting,

wasting and underweight was 47.6%, 8.8% and 25.6% respectively.

About 18% were diagnosed with various forms of protein energy

malnutrition and it was most common among the male children (23.2%),

younger children aged between 0-11 months (31.8%) and children of

mothers with no formal education (25.2%). Marasmus was the most

common form of protein energy malnutrition (63.6%).

Meena, et al. (2015) conducted a community based cross

sectional study on nutritional status of children under-five year of

age in Anganwadi centers in Kolar area of Madhya Pradesh. The

results revealed that, as per new WHO child growth standards, 51% of

under-five children had varying degree of malnutrition. On the basis of

clinical examination the prevalence of malnutrition was 49%. Around

40% of the children, above one year of age, had mid arm circumference

of less than 13.5 cm.

Habyarimana, et al. (2016) conducted a study on the key

determinants of malnutrition of children under-five years of age in

Rwanda: Simultaneous measurement of three anthropometric indices.

The study found that the age of the child, gender of the child, birth

weights, mother’s knowledge of nutrition, birth order, incidence of recent

fever, multiple births, education level of the mother, age of the mother at

childbirth, body mass index, prevalence of anemia, province, source of

 58

drinking water and wealth quintiles are the key determinants of

malnutrition of children under-five years of age in Rwanda. A positive

correlation between the stunting and underweight and wasting and

underweight was found.

Priyanka, et al. (2018) conducted a community based cross

sectional study on the nutritional status of 360 under-five children in a

rural area of Thrissur district, Kerala, India. The results revealed that out

of 360 children, 48.9% were males and 51.1% were females. The

prevalence of underweight and stunting was 28.3% and 14%

respectively and was found to be higher among females.

Sazedur, et al. (2017) conducted a study to identify and

determine the main factors for child malnutrition among 85 children

under 5 years in rural areas at Meherpur district, Bangladesh. The

results revealed family income, maintaining proper diet during pregnancy

period and proper diet maintenance for children had significant (p<0.05)

effect on child malnutrition, while family type, mother education, maintain

vitamin and vaccine were found to be insignificant (p>0.05) but have

negative effect on child malnutrition.

Anteneh, et al. (2018) conducted a community based cross

sectional study on the Nutritional Status and Associated Factors Among

645 Pastoralist Children Aged 6-23 Months in Benna Tsemay Woreda,

South Omo Zone, Southern Ethiopia. The results revealed that being

older child (12-23 months) (AOR=3.29, 95% CI, 2.03-5.32), being from

agro-pastoralist (AOR=0.46, 95%CI, 0.24-0.88), middle wealth quantile

household (AOR=0.40, 95%CI, 0.20-0.77), use of treated water

 59

(AOR=0.60, 95%CI, 0.37-0.96), being second birth order (AOR=2.17,

95% CI, 1.11-4.24), being female child (AOR=0.55, 95% CI, 0.37-0.82)

and good child feeding practice of mothers (AOR=0.47, 95% CI, 0.28-

0.78) were significantly associated with stunting of pastoralist children in

Benna Tsemay Woreda (p<0.05). Having large family size (R6

individuals) (AOR=30.93, 95%CI, 4.91-194.7), polygamous marriage

(AOR=2.46, 95%CI, 1.07-5.61), being from agro-pastoralist (AOR=0.19,

95%CI, 0.05-0.66) and farming as maternal occupation (AOR=3.00,

95%CI, 1.36-6.62) were significantly affected with thinness of children

(p<0.05). Being from pastoralist (AOR=3.18, 95%CI, 1.74-5.81) and

being female child (AOR=0.35, 95%CI, 0.14-0.89) were significantly

predicted underweight in children (p<0.05).

Douglas, et al. (2016) conducted a cross sectional descriptive

study on nutritional status of 774 under-five years children and

associated factors in Kalale District, Benin. The results revealed that, up

to 40% of the children were stunted; 11% were wasted; and 24%

underweight. The prevalence of underweight was significantly greater in

boys than in girls (P =0.023). The individual dietary diversity score

showed that the most consumed food group was cereals (71%). Eggs

and legumes were the least consumed foods. Low food diversity was

recorded for 54% of the children (<4 food groups), 33% had medium

scores (4–5 food groups); while 13% had high scores (6–8 food groups).

Stunting had a significant association with low child dietary diversity

scores [OR=2.33; 95% CI (1.21–4.50)], low mother dietary diversity

scores [OR=1.96; 95% CI (1.92–3.77)] and poor access to health

services [OR=1.84; 95% CI; (1.75–3.54)]. In addition, 6–11 months old

 60

children [OR=1.58; 95% CI (1.08–2.53)], male sex [OR=1.53; 95% CI

(1.06–2.21)], and large family size [OR=4.14; 95% CI (1.18–15.11)] were

found to be the associated factors with underweight. The predictors of

wasting, in this study, were low child dietary diversity scores [OR= 1.17;

95%CI (1.07–2.95)] and poor access to health services [OR=2.05; 95%

CI; (1.60–4.85)].

Ghane and Ranjith (2017) conducted a prospective cross-

sectional study on nutritional status of 315 under-five children of Mumbai

suburban region. The results revealed that, as per WHO classification,

moderate underweight was present in 74(23.49%) and severe

underweight in 38(18.71%). Wasting in the form of Moderate Acute

Malnutrition (MAM) was noted in 64(20.32%) and Severe Acute

Malnutrition (SAM) in 42(13.33%). Height for age revealed moderate

stunting in 37(11.75%) and severe stunting in 5(1.59%). The socio-

demographic determinants birth weight, exclusive breastfeeding,

immunization status, maternal education and socioeconomic status had

statistically significant association with malnutrition. The study concluded

that malnutrition is common in the age of 12 to 24 months.

Khanna, et al. (2017) conducted a community based cross

sectional study on the prevalence and socio demographic determinants

of malnutrition on 573 under-five children in rural communities of

district Fatehgarh Sahib, Punjab. It was found that 14.14%, 15.71%

and 18.85% of the children were malnourished with respect to

weight for age (WHZ) and Height for age (HAZ) z-scores. It is found that

parental education, socio economic status, an increase in number of

 61

children in household and children born in second or third order were

some of the socio-demographic factors, which had an impact on the

nutritional status of the under-five children. Significantly, for stunting

children from a lower caste had a 2.2 fold higher odds (OR 2.24),

second or higher birth order was associated with 26% higher odds (OR

1.262) and children born to parents with lower literacy (primary and

below) had 52% and 33% higher odds for mother’s and father’s

education respectively (OR 1.52 and 1.32).

Berhanu, et al. (2018) conducted a study on the major

determinants of malnutrition among sick children under-five years of age

and evaluated and compared with well-nourished children of Jimma

town of South West Ethiopia. The nutritional statuses of the subjects

(80 malnourished and 80 well nourished) were determined by measuring

MUAC. The results revealed that the most of the severely malnourished

were resident of rural area (88.8%). Out of 80 malnourished children,

51(63.75%) were belong to families having monthly income <500 birr,

where as in well nourished group (80 children) only 22 (27.5%) were

belong to families having monthly income <500 birr. In malnourished

group, 61.8% of children were having diarrheal episode during past

2 weeks. The prevalence of diarrhea in malnourished group was

21.3% which is higher than well-nourished group. The study concluded

that the place of residence, literacy status of mother, family size, family

income, vaccination, presence TB, marital status of mother, diarrhoea,

timing of supplementary diet and water sources are the major

determinants of SAM.
 62

Gupta, et al. (2016) conducted a cross-sectional study to

evaluate the Effect of Various Maternal Factors on the Nutritional Status

of 349 Under-Five Children selected from some rural and urban regions

of West Bengal. The study findings revealed that the prevalence of

underweight and stunting among children was higher where the mother’s

age was below 20 years. Mother’s age showed significant effect

(p=0.0045) on the prevalence of stunting thereby indicated the risk of

early marriage of females resulting in developing long term under-

nutrition of child. Maternal literacy, maternal nutritional status and

maternal nutritional knowledge were identified as the most significant

determinant of child’s nutritional status.

Deelip, et al. (2017) conducted a cross sectional community

based study on Determinants of Malnutrition of 390 Under 5 Years

Children in the Palpa District of Nepal. The results revealed that one fifth

(20.51%) of children were mild malnourished followed by 5.13 percent

were moderate malnourished on the basis of weight for age. On the

basis of height for age, around one quarter (22.31%) were mildly

impaired, followed by 3.84 percent were moderately and 1.03 percent

severely impaired. On the basis of weight for height, mild impaired

children were 4.62 percent, moderate impaired 1.79 percent and severe

impaired were 0.51 percent.

Abate, et al. (2018) conducted a community based un matched

case control study on determinants of severe acute malnutrition among

311 under-five children (0-59 mon) (64 cases and 247 controls) in rural

Enebsie Sarmidr District, East Gojjam Zone, North West Ethiopia. The
 63

results revealed that severe acute malnutrition was significantly

associated with age groups birth-24 months (AOR = 2.64, 95%

CI: 1.17–5.95), late initiation of breastfeeding greater than an hour after

birth (AOR = 4.26, 95% CI 1.74–10.42), nonexclusive breastfeeding

(AOR =5.81, 95% CI 1.80–18.79), diarrheal disease in the preceding

2 weeks before SAM (AOR = 7.98, 95% CI 2.57–24.74), febrile

illnesses preceding 2 weeks before SAM (AOR = 2.87 95% CI: 1.13–

7.63), decreased or maintained mealing of the mother compared to the

regular during pregnancy or lactation (AOR = 8.15, 95% CI 3.70–17.98)

and birth interval less than 2 years (AOR = 3.34, 95% CI 1.55–7.20)

after controlling other variables effect.

Nilesh, et al. (2017) conducted a community based case control

study on Determinants of severe acute malnutrition among

292 children under 5 years (6-59mon) (146 as cases and 146 as

controls) of age in Bara district of Nepal. The results revealed that the

prevalence of SAM among the children under the age of 5 years was

4.14%. The following factors were significantly associated with SAM: low

socioeconomic status (adjusted odds ratio (AOR) 17.13, 95% CI 5.85 to

50.13); mother’s age at birth <20 or >35 years (AOR 3.21, 95% CI 1.30

to 7.94); birth interval <24 months (AOR 4.09, 95% CI 1.87 to 8.97);

illiterate father (AOR 3.65, 95% CI 1.62 to 8.20); bottle feeding (AOR

2.19, 95% CI 1.73 to 12.03); and not initiating complementary feeding at

the age of 6 months (AOR 2.91, 95% CI 1.73 to 12.03). Mother’s

 64

educational level, initiation of breastfeeding, colostrum feeding, and

exclusive breastfeeding were not significantly associated with SAM.

Rakesh, et al. (2014) conducted a cross-sectional study on the

determinants of Nutritional status of 933 Under-five Children aged

1-5 years. The results revealed that, out of 933 (453 males and 480

females) under-five children. The prevalence of wasting, stunting and

underweight (< -2 SD) by WHO standards was 23.7%, 38.2% and 37%

respectively. Type of family, overcrowding, birth weight, duration of

exclusive breastfeeding and administration of pre-lacteal feeds were

found to have an effect on the nutritional status. Literacy of mother also

contributed to malnutrition in children.

Subramanian and Subrahmanyam (2013) conducted a cross-

sectional study on the determinants of protein energy malnutrition

among the 268 rural preschool children in Hoskote Rural Health Centre

area of Vydehi Institute of Medical Sciences and Research Centre. The

results revealed that 63.8% of the children were undernourished

according to IAP classification. Birth weight and anaemia were

significant risk factors associated with the development of protein energy

malnutrition (Odds Ratio 1.4 and 2.5 respectively). Only 26.9% of these

children had received colostrums. 13.8% had received exclusive

breastfeeding for six months. Complementary feeding was initiated

either too early (<4 months) in 22.0% or too late (>7 months) in 39.9% of

the children. 66.7% of the children were completely immunized. During

the study, 30.2% of the children suffered from illnesses, acute

 65

respiratory infections 57(21.3%), diarrhoea 10(3.7%) and 14 (5.2%) had

viral fever, fits or acute suppurative otitis media.

Edward, et al. (2016) conducted a descriptive cross-sectional

study on the Determinants of Malnutrition among the 350 Children Aged

6-59 Months in Trans-Mara East Sub-County, Narok County, Kenya.

The results revealed that out of 350 children, 31%, 22% and 8% of the

children were stunted, underweight and wasted, respectively. Besides,

9% and 4% of the children suffered from overweight and obesity

respectively. The key determinants for stunting were number of children

in the household (adjusted Odds Ratio (aOR): 1.86; 95%CI: 1.01-3.43),

mother being a house wife (aOR: 3.63; 95%CI: 1.08-12.24), and being

poor (aOR: 3.33; 95%CI: 1.44-7.68). For obesity, the predictors were

child age with 12-23 months (Crude Odds Ratio: 2; 95%CI: 0.175-22.8);

24-35 months (odds ratio of 2.22; 95%CI: 0.22-22.3), child gender with

males more likely to be obese relative to females (OR: 3.27; 95%CI:

0.856-12.5).

Emmanuel, et al. (2017) conducted a non-experimental, cross-

sectional descriptive study on the Predisposing Factors to Protein

Energy Malnutrition among 150 Children (0-5 Years) in Umuogele

Umuariam Community in Obowo Local Government Area of Imo State,

Nigeria. The findings revealed that the mothers do not have very good

knowledge of protein-energy malnutrition and ignorance on food

nutrition, non-practice of exclusive breastfeeding and poor weaning

methods were the major factors that predisposed children to protein

energy malnutrition. The result showed that proper nutrition, exclusive

 66

breastfeeding and proper weaning can be an effective tool in reducing

PEM among under-five children.

Dinesh Kumar, et al. (2014) conducted an observational analytic

and cross sectional study to know the impact of mother education on

feeding practices of infants aged one and half to 12 months, who came

in OPD of Department of Paediatrics UPRIMS and R, Saifai for

immunization or some problem. The results revealed that the total

267(75.2 %) out of 355 women had initiated breastfeeding within

24 hours of birth. 172(48.5%) mothers exclusively breast fed their

infants. Total 166(46.8%) practiced prelacteal feed. Out of 166 subjects,

121(34.1%) practiced for 7 days and 41(12.7%) beyond 7 days. There

were highly significant relationship found between the education level

of mothers with type of breastfeeding, in the form of exclusive or

non-exclusive breastfeeding and prelacteal feeding practices (p <.05).

The relation between education level of mother with time of initiation of

breastfeeding since birth was not found statistically significant (p>0.05).

Augustine, et al. (2017) conducted a study on the factors

influencing malnutrition in 100 under-five children in Yemoh Town

community; Bo city, Southern Sierra Leone. The study revealed that

48 percent of the under-five children were malnourished and out of this

55 percent were females. The findings revealed the demographic factor

associated with under-five children as the age distribution of the mother

at birth. The socio-economic factors are level of education of parent,

parent’s knowledge on the causes and methods of prevention of

malnutrition, number of meals taken by the child per 24 hours,

 67

breastfeeding practices, household’s, employment status, alcohol intake

by respondent mother/ caregiver, and parent’s marital status. The health

related factors are Antenatal Clinic Consultation (ANC), immunization

status, vitamin A supplementation, and institution where child was

delivered.

Parul S Katara, et al. (2013) conducted a study on the feeding

practices among 561 children 6 Months to 2 years and its effect on their

Nutritional status in urban slums. The results revealed that only 27% of

children had started receiving complementary feeding at 6 months of

age. Majority (82.5%) of children had feeding problem. Almost all

(98.7%) the children with moderate to severe wastinghad feeding

problem. The study concluded that the feeding problem was seen which

was due to late initiation, incorrect quantity and type of complementary

feeding given to the children.

Rahel, et al. (2017) conducted a community based study on the

Magnitude of Nutritional Underweight and Associated Factors among

595 Children Aged 6-59 months in Wonsho Woreda, Sidama Zone

Southern Ethiopia. The results revealed that the overall prevalence of

underweight was 122(20.5%) (95% CI, 17.3-23.8%), meanwhile, the

prevalence of severe and moderate underweight was 7.1% and 13.4%

respectively. Male children were 1.78 times more likely to be

underweight than female children (AOR=1.78; 95%CI=1.17, 2.70).

Unimmunized, children were 2.45 times more likely to be underweight

(AOR=2.45; 95%CI=1.41, 4.24).

 68

Bantamen, et al. (2014) conducted Case Control study on the

Assessment of Factors Associated with Malnutrition among Under-five

Years Age Children at Machakel Woreda, Northwest Ethiopia. Cases

were children of aged 6-59 months who have malnutrition (weight for

height <2 sd, weight for age S 2Sd, height for age S 2Sd, Mid-Upper Arm

Circumstance (MUAC) <12 cm, if there is oedema) and controls were 6-

59 months of children those who have not having malnutrition. A total of

102 cases and 201 controls were included in the study with overall

response rate of 94.4%. Sixty five (63.20%) of cases and 49 (24.40%)

controls had fathers who cannot read and write. Thirty nine (38.23%) of

cases and 44(21.89%) of controls had history of diarrheal episode.

Those children whose family used drinking water from unprotected

source were 3 times more likely to have malnutrition as compared to

those children whose family used drinking water from protected source

with [AOR=3.04, 95%CI (1.01, 9.17)].

Abena, et al. (2015) conducted a study on the Immediate Risk

Factor Associated with Child Malnutrition in Ghana. A Critical Analysis of

the Ashiedu Keteke Sub-metro Area in Accra. The results revealed that

more numbers of males were found to be malnourished than the

females. A total of 54.0% of children that did not complete their

immunization program still sufficiently nourished. 74.7% of children who

completed their immunization found to be well nourished. The study

concluded with the point that immunization practices significantly

reduces the incidence of child malnutrition moderately (Phi = 0.277) and

53.9% of children with birth weight below 2.5kg were actually

malnourished.
 69

Bharathi, et al. (2014) conducted a community based cross

sectional study on feeding the practices of infants in the field practicing

area of rural health training centre, Santhiram Medical College, Nandyal,

Andhra Pradesh. The results revealed that the 60.7% of infants were

males. 39.3% of infants were females. The correlation was found

between the social class and the birth weight (p<0.02). A total of 90.6%

of infants were not given colostrums; 94% of infants were breast fed;

41% of infants weaning was started between 9 to 12 months. Totally

20% infants were normal and 52.7% were with grade-1 malnutrition.

20.7% mothers were boiling utensils which were used for feeding the

infant. A majority of 96.7% mothers told breastfeeding was best for

babies.38.7% mothers were not aware that colostrums given in first hour

would reduce infant mortality rate.

Anwar, et al. (2017) conducted a Case Control study on the

Determinants of Acute Malnutrition among Children Aged 6–59 Months

in Public Health Facilities of Pastoralist Community, Afar Region,

Northeast Ethiopia. A facility based unmatched case control study was

employed on 420 (140 cases and 280 controls) children aged 6–59

months with their caregivers. The results revealed that the children aged

12–23 months [AOR = 10.51, 95% CI = 4.93, 22.34], rural residence

[AOR = 2.42, 95% CI = 1.22, 4.79], illiterate father [AOR = 2.47, 95%

CI = 1.32, 4.61], Monthly income of less than 1000 birr [AOR = 3.98,

95% CI 2.05, 7.69], and food served together with family [AOR = 2.18,

95% CI = 1.10, 4.30] were associated with acute malnutrition. The study

concluded with the point that the rural residence, illiterate father, monthly
 70

income of less than 1000 birr, and food served together with family are

statistically associated with acute malnutrition.

Aurangzeb, et al. (2018) conducted a hospital based analytical

study on the Determinants of severe acute malnutrition among children

105 under-five years in a rural remote setting from Tharparkar district,

Sindh, Pakistan. The results revealed 48% children, admitted in the

hospital, as identified with severe acute malnutrition. More males (55%)

were found malnourished as compared to females (45%). Maternal

education, household income, family size, breastfeeding, vaccination

status, and frequent infections were found to be significantly associated

with the severe acute malnutrition.

Ogunsuyi and Gladys (2016) conducted a descriptive study on

the Assessment of Weaning Practices of Mothers of Under-Five Children

Attending Infant Welfare Clinic, Wesley Guild Hospital, Ilesa, Osun

State. The study findings showed a majority of 92.6% as having good

knowledge about weaning practices. A 55.6% initiated weaning at

4-6 months of age. About two-third (65.2%) wean their babies with solid

foods and larger percentage used milk substitutes for their child.

Maternal smoking, lack of knowledge, lack of support, low maternal

education, and low socio-economic status were factors identified

influencing weaning practices of mothers. The findings also showed that

65.9% of the respondents’ babies had normal weight, while 28.9% had

underweight. Significant association was found between maternal

Tasiq, et al. (2018) conducted a study on the factors associated

with under-nutrition in 984 children under the age of two years:

 71

secondary data analysis based on the Pakistan Demographic and

Health Survey 2012–2013. The incidence of stunting, wasting, and

underweight in children was 28.3%, 12.1%, and 27.9%, respectively.

The odds of stunting, wasting, and underweight increased with the

child’s age. The odds of stunting and underweight increased with the

mother’s low body mass index, low access to information, high birth

order of child, consanguineous marriages, father’s low education, rural

settlement, poor toilet facilities, and low vitamin A consumption. The

odds of wasting increased in children who were not being breastfed, but

no significant relation was seen between stunting and underweight.

Section-V : Knowledge of Mothers on Nutrition

Anindita, et al. (2015) conducted an observational cross

sectional study on assessment of the knowledge, attitude and actual

practices of breastfeeding in the 286 mothers of children aged less than

2 years who attended the Immunization clinic of Hi-Tech Medical

College and Hospital, Bhubaneswar, in Odisha, India. Knowledge of

initiation of breastfeeding within half an hour to one hour of birth was

there in 52.78% mothers and 40% had an idea about the importance of

colostrums. The meaning of exclusive breastfeeding was known to

34.97% while almost 48% mothers initiated breastfeeding within half an

hour of birth, 75% fed colostrums to their newborns, 61% were practicing

exclusive breastfeeding for first 6 months and 90% were practicing night

feeds. Inappropriate attachment and positioning was observed in 55% of

mothers. Only 15% started weaning (supplementary feeding) after

6 months of baby’s age.

 72

Seema (2013) conducted a cross sectional study on Knowledge

and practices of 250 mothers for complementary feeding in babies

(aged 6 – 12 months) visiting paediatrics OPD of Jinnah hospital,

Lahore. The results revealed the fact that about 79.6% mothers

exclusively breastfed their babies and 84% continued breastfeeding

along with complementary feeding. The correct knowledge of initiation of

complementary feeding was found in 54% of mothers, but it was

practiced by only 43%. The overall knowledge of 24% mothers was good

and 28% had poor knowledge of complementary feeding, whereas

only 7% women had good overall practices. There is statistically

significant association between the education of the parents and the

practices of complementary feeding (p-value = 0.012 and 0.0295 of

mothers and fathers).

Yadav (2016) conducted a descriptive study on the knowledge

and practices regarding Prevention of Protein Energy Malnutrition

among 100 mothers of under-five children at the selected area of

Gajipur, New Delhi. The results revealed that the majority, 45.36 percent

of mothers had knowledge related to general information of PEM,

followed by 43.44 percent of the mothers who knew about the causes,

signs and symptoms of PEM. A majority of 46.3% of the respondents

had the right dietary practice and 42 percent of mothers had the good

practice of management of diarrhoea. There is significant association

observed between the knowledge and educational status of the mother.

Overall findings showed the existing, knowledge and practice as found

to be 45.52% and 41.66% in the prevention of protein energy

malnutrition.
 73

Divya, et al. (2013) conducted a rural community based

descriptive cross sectional study on the assessment of knowledge of

mothers of 50 under-five children on nutritional problems. The results

revealed that nearly half of the mothers 27(54%) had poor knowledge,

around 19(38%) had average knowledge, and only 4(8%) had good

knowledge regarding the common nutritional problems and its

prevention. None of the mothers had very good knowledge.

Mishra, et al. (2017) conducted a quantitative study to assess the

knowledge of mothers regarding malnutrition and its prevention and

evaluate the effectiveness of structured teaching program regarding

malnutrition among 45 mothers of under-five children attending a crèche

run by an NGO in a slum area of New Delhi. The study findings revealed

that, in pretest, 18(40%) mothers had poor knowledge, 15(33.3%) had

average knowledge and 12(26.7%) had good knowledge about

malnutrition and its prevention, while in posttest, 12(26.7%) had poor

knowledge, 21(46.7%) had average knowledge and 12(26.7%) had good

knowledge about malnutrition and its prevention which indicated that the

intervention was effective.

Agize, et al. (2017) conducted a community-based cross-

sectional study to assess the level of knowledge and practice of 700

mothers on minimum dietary diversity practices and associated factors

for 6–23 month-old children in Adea Woreda, Oromia, Ethiopia. The

results revealed the point that, 357(51%) were knowledgeable on dietary

diversity but 112(16%) practiced appropriate dietary diversity practice for

their 6–23-month-old children.

 74

Aparna (2015) conducted a study to assess the effectiveness of

planned health teaching programme on knowledge regarding p

rotein-energy malnutrition among 60 mothers of under-five children in

selected area of Sangliwadi. Quasi experimental one group pre-test and

post-test design was used. Planned teaching programme significantly

increased the mothers' knowledge as compared before the teaching

programme (p<0.05).

Angela, et al. (2015) conducted a descriptive study on mothers’

knowledge on the nutritional deficiency disorders in children in selected

villages under Rural Maternity and Child Welfare (RMCW) centres of

KMC, Manipal. The findings of the study showed a majority 130(65%)

mothers as having average knowledge, 60(30%) possessed poor

knowledge and remaining 10(5%) had good knowledge on nutritional

deficiency disorders.

Kavitha (2015) conducted descriptive cross sectional study to

assess the Knowledge on Malnutrition among 30 Mothers in Vinayaka

Mission Hospital, Salem. The findings showed the overall mean score as

11.4 revealing that 50% of the mothers having average knowledge and

30% of mothers having poor knowledge, further 20% of mothers having

good knowledge.

Nmer, et al. (2014) conducted a cross-sectional study on the

Nutritional knowledge, attitude, and practice of parents and its impact on

growth of their children. The results revealed that there was no

significant correlation between nutritional knowledge (KAP) of parents

and nutritional practice of their children (P>0.05), whereas there was a

 75

significant correlation between parent's knowledge score and healthy

food intake in general by children (r = 0.222; P < 0.05).

Manikyamba, et al. (2015) conducted a study on the Impact of

Nutritional Education on the Knowledge of 500 Mothers Regarding Infant

and Young Child Feeding Practices admitted to paediatric wards in

Government General Hospital, Kakinada. The results revealed 97.6% of

the mothers as having knowledge on feeding of colostrums, and 85%

being aware of adequate night feeds and knowledge on other aspects of

breastfeeding like initiation of breastfeeds (60%), exclusive breastfeeds

for 6 months (66.6%) and continuing breastfeeds for 2 years (48.8%)

was low. 62% of the mothers had knowledge on correct age of

introduction of complementary feeds.

Vinod and Bharatesh (2015) conducted a descriptive study to

assess the knowledge and attitude regarding malnutrition among

parents of under-five children. This finding showed that 29(58%) of

parents were having moderately adequate knowledge. The mean value

of knowledge on malnutrition was 8.64 with a SD of 2.57 and attitude

43(86%) of parents were having moderately positive attitude. The mean

value of attitude on malnutrition was 32.84 with a SD of 3.38. It revealed

that there is a strong positive correlation between knowledge and

attitude regarding malnutrition among the parents of under-five children

(r= 0.097) and this implies if there is increase in knowledge, the attitude

also increases.

Ansuya, et al. (2018) conducted a community based cross

sectional descriptive study to assess the knowledge of 570 mothers of

 76

preschool children regarding malnutrition and its management in Udupi

Taluk. The results revealed that the majority (31.8%) of the mothers’

educational qualification was lower primary and 32.6% of them have

completed high school. Majority (83.0%) of the mothers belonged to

poor socio-economic status, 16.0% were from middle socioeconomic

status and 1.0% was from Below Poverty Line (BPL) family. About

65.44% of mothers had average knowledge about malnutrition, 31.58%

of mothers had poor knowledge and only 1.0% was having good

knowledge.

Saiprasad, et al. (2013) conducted a longitudinal interventional

study on the Impact of Health Intervention (health and nutritional

education) on Nutritional status of all Malnourished Children attending

Anganwadi in Rafiq nagar Mumbai, India. The results revealed 194

children 93 (47.9%) as males, 59.8% children as malnourished and 90

(46.4%) were completely immunized. Malnutrition was prevalent in the

age group of 1-2 years. Improvement in weights and heights of children

was seen after health intervention for 6 months.

Section-VI: Nutritional Supplements and Ready – to – Use

Therapeutic Food
Missiriya (2014) conducted a study on the effect of nutritional

bolus with planned teaching programme on protein energy malnutrition

from north Chennai. 174 children in intervention group and 168 children

in control group with grade I and II malnutrition according to IAP

classification were selected randomly. The intervention is the Nutritional

bolus with mixed powder (100gms) made by grinded rice (30gms), Soya

(20gms), groundnut (20gms), Bengal gram (10gms) and Jaggery

 77

(20gms) were provided to all children regularly for 6 months in

intervention group with planned teaching programme on PEM. In

59.8% improvement was observed after intervention and the study

concluded that nutritional bolus on PEM was effective to improve the

nutritional status of children.

Sharadha, et al. (2011) conducted a study on IEC strategy in

knowledge on the protein energy malnutrition among 40 mothers of

under-five children in Nayappakkam Village in Kancheepuram District,

South India. The IEC strategy which includes health education on PEM,

nutrition exhibition on dietary management of PEM and cooking

demonstration on nutritional bolus (50 gms of bolus that contains 20 gms

Rice, 10 gms Soya, 5 gms Ground nut, 5 gms Bengal gram and 10 gms

Jaggery in powder form and is made as a ball with boiled water) which

gives 250 kcal and 20gms protein. After one week, the posttest was

conducted for the same. The results revealed that the mean pretest

knowledge score was 6.4 with S.D 0f 2.79 and the mean posttest

knowledge score was 19.2 with S.D of 1.95 and found the nutrition

exhibition was found to be effective with paired ‘t’ value at P<0.001 level.

Neelam, et al. (2015) conducted a cross sectional study of

Community Based Nutritional Intervention and prevention of malnutrition

among 100 under-five children carried out in two villages of Jabalpur

districts. Intervention such as Nutrition education and provision of High

Protein Mix Diet were given to malnourished children then 4 follow ups

were done at the interval of 15 days. The findings revealed that

12% children were identified as malnourished where 7% were having

 78

mild grade malnutrition and 5% with moderate grade of malnutrition.

14.04% male children were malnourished while 9.3% female children

were malnourished. After the intervention, 50% children were showing

change in the grade where one shifted to normal grade and 4 to mild

grade. Weights of malnourished children were steadily increased during

follow-up.

Srikanth, et al. (2014) conducted a study on Improvement of

Protein Energy Malnutrition by Nutritional Intervention with Moringa

Oleifera among Anganwadi Children in Rural field practice area of

Vydehi Institute of Medical Sciences and Research Centre, in

Bangalore, India. Of the 60 children, 30 were enrolled in the intervention

group and 30 were put in the control group. Nutritional Intervention was

given in the form of Moringa oleifera leaf powder 15 g twice daily for two

months. Reassessment of the nutritional status was done following the

intervention. The findings showed that 70% children with grade II PEM

improved to grade I, and 60% children with grade I PEM had shown

significant (P < 0.01) improvement in their nutritional status.

Tushar, et al. (2013) conducted a community based

interventional study associated with Improvement in Nutritional Status of

190 Children, in India to assess the impact of health interventions in the

form of health and nutritional education on nutritional status of

malnourished children. Out of 190 children, 102 were malnourished

which was later divided into intervention group (50 children) and control

group (52 children). Post intervention data were collected, after

6 months, from baseline data collection. Significant difference was seen

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between the weight gains by both groups. In this study according to IAP

grades of nutritional status 88(46.32%) children were normal, while

52(27.37%) were in Grade I of malnutrition, 41(21.58%) in Grade II and

9(4.74%) children were in grade III malnutrition. It is also found that

48(51.61%) children from the age group 12 months to 23 months were

malnourished while 54(55.61%) children belonging from age group

24 to 35 months were malnourished. After six month of intervention

more weight gain was seen in intervention group compared to control

group. The difference was statistically significant. Mean weight gain by

intervention group was 1.47 kg compare to control group (i.e.1.2 kg).

Manda and Avinash (2014) conducted a study on Effectiveness

of ‘Krishna Poshak Mix’ on Nutritional Status of 54 Rural Anganwadi

Children. The experimental group was given ‘Krishna Poshak mix’(jowar,

rice, wheat, Bengal gram dhal, black gram dhal, green gram dhal,

ground nuts, ghee and jiggery) laddus 50 gms two laddus daily for one

month, whereas the control group received adlib ICDS supplementary

diet for one month. The results revealed the fact that from experimental

group 2, 16, 8, 1 subject had normal, mild, moderate and severe degree

malnutrition respectively and in the control group 1, 20, 4, 2 subjects had

normal, mild, and moderate and severe degree malnutrition respectively.

The children from experimental group gained adequate weight and mid

arm circumference after the post intervention.

Taneja, et al. (2012) conducted a study to evaluate the effect of

nutritional intervention measures on 100 children who were admitted in

selected nutrition rehabilitation centres of Indore and Ujjain divisions of

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the state of Madhya Pradesh. The study group consisted of 48 boys and

52 girls. 60% of children were between 13 and 36 months of age.

93 children were analyzed for anthropometric indicators following a

dropout rate of 7%. A statistically significant difference was obtained

between the weight of children at admission and discharge (t=14.552,

P<0.001); difference of Mid-Upper Arm Circumference (MUAC) at

admission and discharge was statistically significant (t=9.548, P<0.001).

The average weight gain during the stay at the centres was 9.25 ± 5.89

g/kg/day. Though the number of severe malnourished children

decreased from 85 to 43 following the stay at NRCs (X2 = 44.195,

P<0.001); 48.78% of the children lost weight within 15 days of discharge

from the NRCs.

Savithri, et al. (2017) conducted a true-experimental study to

evaluate the effectiveness of Krishna Poshak Mix (adopted from IAPSM

(Indian Association of preventive and social Medicine) on Nutritional

Status of 50 Rural Anganawadi Children of Pedaparimi Village,

Mangalgiri Mandalam, Guntur District, Andhra Pradesh. The results

revealed that Krishna Poshak mix laddus were effective in improving the

nutritional status of the preschool children. As it was evidenced by their

improved mean values form the initial assessment of weight (12.72) and

UMAC (13.16) in the experimental group and in control group weight

(12.01) and UMAC (12.91) to after 6 weeks assessment of weight

(13.31) with ‘t’ value (29) and UMAC (13.6) with ‘t’ value (17.4) in

experimental group and the control group mean values of weight (12.04)

with ‘t’ value (0.54) and UMAC (12.91) with t’ value (1) which shows

statistically significance association at p<0.05 level.

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Sawyer, et. al., (2013) conducted a comparative cross-sectional

study on the Nutrition Intervention Program and Childhood Malnutrition

among 105 respondents in two rural Riverine Communities in Bayelsa

State, Nigeria. Toruorua benefited from the nutrition intervention

program of UNICEF between 1999 and 2008 is taken for experimental

group, while Gbaranbiri did not benefit and it is taken for control group.

The prevalence of wasting, under-weight and stunting were, however,

found to be significantly higher in the reference community, as 20.0%

(21/105) of the children were found to be wasted, compared to 5.0%

(6/105) in the intervention community (P < 0.01); 17.1% (18/105) were

found to be underweight, compared to 9.5% (10/105) in the exposed

community (P = 0.01); while 24.8% (26/105) were stunted, compared to

10.5% (11/105) in the exposed community (P = 0.01).

Zavoshy, et al. (2012) conducted a study on the Nutritional

Intervention on Malnutrition in 2385 children between 3-6 years old rural

children in Qazvin Province, Iran. In this interventional study, 48.8%

were female and 51.2% were male. The children were received a

cooked meal based on 360±20 kcal energy, 17% protein, 53%

carbohydrate and 30% fat per day for 175 days at lunch time. The

anthropometric indices were collected before and after the intervention.

Prevalence of wasting (mild and moderate) and (severe malnutrition)

after intervention reduced from 14.2 and 0.95-12.6 and 0.5%,

respectively (p<0.05). Receiving a cooked meal significantly decreased

wasting (15.2-13.2%) in all children (p<0.05).

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Mustafa Mahfuz, et al. (2014) examined the rate of Weight Gain

in 161 malnourished underweight children (weight for- age Z score < Y2)

aged 6 - 24 months after 5 Months of Food Supplementation living in a

slum of Dhaka city, Bangladesh. In total 161 children, including

68 healthy children representing the control group, were enrolled for

the 5 months supplementation. The two regimens of feeding were

either ready-to-use therapeutic food (RUTF, Plumpy’Nut) or locally made

cereal-based supplementary food Pushti packet which was

recommended in the National Nutritional Program. No food

supplementation was provided to control children. Multiple micronutrient

powder (MNP) was provided only to Pushti packet and control children.

The rate of weight gain on RUTF was 1.69 g/kg/day during the first

month and gradually declined to 0.9 g/kg/day at the final month of the

trial, whereas, the rate of weight gain on Pushti packet was 0.77

g/kg/day during the first month declining to 0.70 g/kg/day at the end of

the trial. Rate of weight gain in the control group was steady between

0.47 - 0.50 g/kg/day. Absolute weight gains of 1085 g, 790 g and 730 g

were observed in the RUTF, Pushti packet and the control groups,

respectively which were significantly higher in the RUTF group.

Shivasankar and Thalagala (2017) conducted a community

based quasi experimental study on the effectiveness of a Homemade

Supplementary Food (HMSF) in the management of severe acute

malnutrition in 2-5 year old children in the Kopay MOH area. HMSF

consisted of a pre-packed cereal mixture (50g), with sugar (20g) and

scraped coconut (20g) added at home (calorie content =500 kcal/90g),

as a daily snack to the intervention group. The results revealed that the
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mean age of experimental and control group was 42.6 months and

43.1 months respectively. There was no difference in the baseline

weight of the two groups (95%CI -0.059-0.416: p=0.14). The mean

weight gain in the test group and control group after 3 months was

688.5g (SD=437gm) and 583g (SD=461gm) respectively (p=0.006). The

mean gain in length in the test group and control group after 3 months

was 1.5cm (SD=0.93cm) and 1.66cm (SD 1.3 cm) (p=0.234)

respectively.

Mlauzi and Mzengereza (2017) conducted a study on

contribution of fish consumption to reduction of malnutrition among

80 under-five children in Salima, Malawi. The results showed about 90%

of the infants in fishing community as having normal nutrition status,

10% of the infants were moderately malnourished and no case of severe

malnutrition was reported. In a non-fishing community 75% of the

children were normal, 17.5% had moderate malnutrition and infants with

severe malnutrition were 7.5%. In the fishing community, prevalence

rate of Marasmus was at 7%, Kwashiorkor (9%), Night blindness (6%),

Goitre (1%), Rickets (2%). In non-fishing community the prevalence rate

for Marasmus was at 15%, Kwashiorkor (19%), Night blindness (8%),

Goitre (2%) and rickets.

Kavita, et al. (2010) conducted a cross-sectional study on

Nutritional Status of 175 Children after a Food-Supplementation

Program Integrated with Routine Health Care through Mobile Clinics in

Migrant Communities in the Dominican Republic. Children 18 years and

younger were eligible, if they received routine health care from local
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mobile clinics. The food-supplementation package evolved from 2 lbs. of

oatmeal and 1 lb. of milk powder in the initial stages of the program to 5

lbs. of rice, 1.5 lbs. of oatmeal, 2 cans of sardines, and 1.5 lbs. of dry

milk currently. Acute under-nutrition rates decreased from 40% to 23%

(P = 0.001) after initiation of the food-supplementation program. Rates of

chronic under-nutrition decreased from 33% to 18% after the initiation of

the food-supplementation program (P = 0.003).

Govind, et al. (2012) conducted a Non-randomized Controlled

Trial to compare the efficacy of locally-prepared ready-to-use therapeutic

food (LRUTF) and locally-prepared F100 diet in promoting weight-gain in

6 to 60 months children with severe acute malnutrition during

rehabilitation phase in Paediatric ward of tertiary care public hospital in

Central India. Subjects receiving either of the two therapeutic foods were

temporally separated to minimize the spill over effect. Children in LRUTF

group received measured quantity of 12 g/kg/day of LRUTF daily.

Children in F100 group received 60 mL/ kg/day of F100 in 4 quarters.

There were 49 subjects in each group. Rate of weight-gain was found to

be (9.59±3.39 g/kg/d) in LRUTF group and (5.41 ± 1.05 g/kg/d) in locally

prepared F100 group. Significant difference in rate of weight gain was

observed in LRUTF group (P<0.0001; 95% CI 3.17-5.19).

Azara, et al. (2010) conducted a randomized open label,

controlled study to evaluate the effectiveness of a locally made ready-to-

use therapeutic food (RUTF) in decreasing mild to moderate malnutrition

in Pre-schools run by the Department of Community Health in

Kaniyambadi administrative block, Vellore, India. Pupils aged 18-60

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months with Weight-for- Age S2 SD were enrolled for the study. The

nutritive values of the 2 products are dissimilar, RUTF containing

550 Cal per 100 g of product and HCCM containing 187 Calories per

100 mL. The study finding revealed that there is increase in weight-for-

age status; increase in levels of plasma zinc, vitamin B12, serum

albumin and haemoglobin. The Mean (SD) weight gain at 3 months was

higher in the RUTF group: RUTF (n=51): 0.54 kg; (SE =0.05; 95%

CI = 0.44 – 0.65) vs. HCCM (n=45): 0.38 kg; (SE = 0.06; 95% CI =

0.25 – 0.51), P = 0.047.

Peerkhan, et al. (2010) conducted a study on the Effects of

weaning biscuits on the nutritional profile and the cognitive development

of 150 preschool children in three primary schools, Salem District,

Tamilnadu, India. About 80 primary school children with Grade II

malnutrition were selected for the experimental study. The increments in

weight, in Group II children given with potato flour biscuits, was higher

(1.80 kg) compared to the other three groups followed by Group III with

the mean increment of 0.87 kg. Group IV registered a mean increment of

0.55 kg and Group I (control group) registered the least increment of

0.30 kg. Clinical examinations of the children were carried out and

symptoms like pot belly, oedema, dry skin, dry hair, brittle and spoon

shaped nails were prevalent in all the four groups. Majority of children

(90-100%) in Group II given potato flour biscuits showed good cognition

with respect to all the criteria studied, except string beads, folding paper

horizontally and building tower after supplementation. A comparatively

better picture for cognition was identified in Group III (75-90% children

responding) given wheat biscuits as against group IV with 70-85 percent

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responding and group I with 51-68 percent responding after

supplementation.

Amegovu, et al. (2014) conducted a single-blind randomized trial

on the Efficacy of sorghum peanut blend and corn soy blend plus in the

treatment of moderate acute malnutrition in 392 children aged 6–59

months in Karamoja, Uganda. In this trial, the efficacy of sorghum

peanut blend (SPB) mixed with ghee and honey for the treatment of

MAM was compared to that of Corn soy blend plus (CSB+) mixed with

vegetable oil and sugar CSB+. Each child received a daily ration of

either CSB+ or SPB for a maximum period of 3 months (SPB group 194;

CSB+ group 198). The recovery rates were not significantly different for

the SPB group and the CSB+ group (82.3% and 76.8%, respectively;

chi-square test P=0.093). Duration of recovery was, significantly, shorter

for the SPB+ group, with a median of 43 days compared to 57 days for

the SPB group. The recovery rate and the duration of stay in the

program were all within the acceptable Sphere Standards (R75% and

S90 days, respectively). SPB has the potential to treat MAM.

Fefe Khuabi, et al. (2016) conducted a prospective study on

Spirulina Supplements Improved the Nutritional Status of 50

Undernourished Children (6-60months) quickly and significantly:

Experience from Kisantu, the Democratic Republic of the Congo. The

intervention group consisted of 16 children who received 10g of Spirulina

daily, as well as the local diet administered by the nutritional centre, and

the control group of 34 children who just received the local diet. Both

groups of children were assessed on day zero, day 15 and day 30.
 87

After treatment, the weight-for-age Z scores and weight-for- height

Z scores increased significantly in the intervention group. At day 15,

there was a, statistically, significant difference between the mean

corpuscular volume, total proteins, and albumin (p < 0.05) in both

groups, in favour of the intervention group, and at day 30, this difference

extended to all of the studied parameters (P < 0.05).

Femke, et al. (2013) conducted a study to evaluate the effect of a

school feeding programme (Kenya) on anaemia and nutritional status,

together with an investigation for socioeconomic determinants at the St.

George primary school on Sixty-seven children in Kibera, Nairobi,

Kenya. The data were compared with a control group of children

attending the same school, of the same age and with the same gender

distribution without participation in a feeding programme. The results

revealed the point that the children participating in the school feeding

programme were less stunted (p = 0.02) and wasted (p = 0.02) than

children in the control group, and levels of anaemia were lower

(p = 0.01). Having no father (p = 0.01) and living in small families (p =

0.003) overruled the effect of the feeding programme. Also, the higher

the mother’s education, the more wasting was seen (p = 0.04) despite

participation in the programme.

Susan, et al. (2017) conducted a Pilot Randomized Controlled

Trial of a New Supplementary Food Designed to Enhance Cognitive

Performance during Prevention and Treatment of Malnutrition in

Childhood living in villages in Guinea-Bissau. An 11 week, village-

randomized, controlled pilot trial was conducted in 78 children aged

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1–3 or 5–7 years children. The supplement contained 291 kcal /d for

young children and 350 kcal/d for older children and included 5 nutrients

and 2 flavan-3-ol–rich ingredients not present in the current food-based

recommendations for MAM. Local bakers prepared the supplement from

a combination of locally sourced items and an imported mix of

ingredients and it was administered by community health workers

5 d/wk. The results revealed that there were no significant differences in

any outcome between groups at baseline. There was a beneficial effect

of random assignment to the supplement group on working memory at

11 week in children aged 1–3 years (P < 0.05).

Liana, et al. (2015) conducted a study to indicate catch-up

growth in children with moderate acute malnutrition (MAM) on targeted

supplementation using Ready-to-Use Supplementary Food (RUSF) on

children aged 12–60 months. An impact study was done to determine

anthropometric changes who received RUSF (175 kcal/kg/day) for six

weeks, managed as outpatients and followed up for 12 weeks until a

final assessment. The default rates were high, with 30% of children

returning to the primary healthcare facility for follow-up only once or

twice. Despite significant improvement in height-for-age Z-score (HAZ),

weight-for-age Z-score (WAZ), weight-for-height Z-score (WHZ) and

mid-upper arm circumference (MUAC), 70.5% of the sample remained in

the same malnutrition classification and only 26% recovered. The

growth velocity of children with a lower initial WHZ was significantly

higher (r = –0.15, p < 0.05) than those with less wasting, but only 20%

grew at a rate to achieve catch-up growth.