LMC journal Vol. 2.indd 62 Original Article L M Coll J 2013; 1(2): 62-65 Prevalence of Low Calorie Intake by Rural Families in Palpa District of Nepal Ghimire M and Ghimire M Department of Community Medicine,Lubmini Medical College, Palpa Corresponding author: Dr. Madhusudan Grimire, Asistant Professor, Department of Community Medicine, Lubmini Medical College, Palpa, Nepal; e-mail: madhumds@gmail.com ABSTRACT Background: Healthy popula on is indispensable for na onal development. Adequate food intake by people is the key determinant to keep up their health. Malnutri on nevertheless remains pervasive in developing countries, undermining people’s health, produc vity, and o en their survival. Food insecurity and hunger remain persistent in Nepal. Prevalence of low calories intake by rural family is widespread throughout the country popula on. Mainly marginalized communi es, ethnic group with poor economic status, tradi onal socie es and lower cast people are exposed to food defi cit. Objec ve: to inves gate the prevalence of low calories intake by rural families and its associated determinants in Palpa district. Materials and methods: The cross-sec onal study was designed to achieve objec ve of the research. A random sample of 339 families was selected from rural areas (DUMRE, DAMKADA, GORKHEKOT and TELGHA villages) of this district. Data were analyzed by using the SPSS so ware for Windows (version 16.0). Results: The existence of inadequate food calorie intake among rural families was most common. Most of them were fall under the malnutri on. Conclusion: low calorie intake by ethnic group was considerably higher than other groups in community. Key words: Demographic variables, low food calories intake, malnutri on and Palpa district INTRODUCTION Freedom to work and the right to enjoy a healthy life are enshrined in the cons tu ons of most of the countries as fundamental rights of its ci zens. However this freedom does not always guarantee enjoyment of good health for the poor ci zens of many developing countries. Most of the developing na ons are plagued by problems of under nutri on and a host of infec ons.1 Nutri on is an input to and founda on for health and development. Be er nutri on is a prime entry point to ending poverty and a milestone to achieving be er quality of life.2 Adequate nutri on is essen al in early childhood to ensure healthy growth, proper organ forma on and func on, a strong immune system and neurological and cogni ve development.3,4 Undernutrition leads to increased mortality and morbidity which lead to loss of economic output and increased spending on health, individuals are less productive (both due to physical and mental impairment),and that children benefit less from educa on.5 Inadequate nutri on is perhaps the most important problem facing the poor people in the world today. In spite of the progress made in improving nutrient availability in the last decade, a large propor on of poor households in developing countries s ll have inadequate access to suffi cient food.6 Although per capita daily calorie intake in developing countries has increased substan ally in the last decade, the number of undernourished people is s ll around 923 Million and the recent food price increases has also triggered an increase in hunger worldwide.7 Malnutri on is a complex condi on that can involve mul ple, overlapping defi ciencies of protein, energy and micronutrients. The underlying causes are illnesses, poor dietary intake, lack of sanita on and hygiene, lack of mothers’ educa on, lack of awareness, lack of appropriate educa on, cultural prac ces and taboos, women’s low social status, poor transport linkages and low levels of agricultural technology, lack of poli cal will to improve the situa on and inadequate complementary feeding.8,9 Protein energy malnutri on (PEM) remains a major public health problem in Nepal to such extent that it is the most common cause of childhood morbidity and mortality. Nepal has a very high rate of child malnutri on: half (49%) of children under fi ve are stunted and one third (39%) are underweight. Maternal undernutri on is also a signifi cant problem in Nepal. The economic costs of malnutri on are very high – an es mated 2-3 % of GDP.10 Since 1990, at na onal level, overall food produc on is defi cit and Nepal has been a net cereal importer for most years during the last two decades.11 Poverty and malnutri on in Nepal are characterized by considerable regional and ethnic varia on.12 MATERIALS AND METHODS The cross-sectional study was designed to investigate the prevalence of low calories intake by rural 63 M Ghimire et al families in palpa district of Nepal. Sample size of 339 was calculated assuming margin of error 5%, non-response rate 10% with 95% confidence interval (CI). A random sample of 339 families was selected from rural areas (DUMRE, DAMKADA, GORKHEKOT and TELGHA villages) of this district. After getting the consent form concern authorities, local people and respondents, a structured questionnaire and checklist of food items (rice/wheat, potato, pulses, meat, fish, milk, eggs, vegetables, and fruits) were used to collect information (amount of continue three-day food consumed by family) from head of household (Data collection period was December 2012 to June 2013). Actual intake of calories by families was compared with the multiplication result of Expected Calories Consumption and consumption unit. Data were analyzed by using the SPSS software for Windows (version 16.0). Chi-square test was used to find out association of ordinal variables as: family type, house type, occupation and cast, with nutritional outcome. Anonymity of the respondents and their views were maintained in the study. RESULTS The study stated that sixty nine percent of respondents were connected to the nuclear family system. Most of them (41.9 %) were Magar. Unemployment rate was 9.4% and most of them (52.2%) had their own pucca house Table-1. Table 1: Socio-demographic characteris cs of the respondents 1. Family type Nuclear 234(69.0) Joint 105(31.0) 2. Caste Brahmin 60(17.7) Kshetri 66(19.5) Magar 142(41.9) Schedule cast 53(15.6) Janaja (except Magar) 18(5.3) 3. House type Kaccha 162(47.8) Pucca 177(52.2) 4. Occupa on Unemployed 32( 9.4) Teacher 32( 9.4) Farmer 82( 24.2) Business 117( 34.5) Others 76( 22.4) Results from the study found that 66.96% families were suffering from malnutrition in study areas (Fig. 1.). Table 2: shows that family type, cast, occupa on and house type were strongly associated (p=0.000) with calories intake by families. Fig 1: Prevalence of malnutri on DISCUSSION Dietary assessment is a process designed to determine what kinds of foods a person is consuming and in what amounts. The present study was conducted to fi nd out whether families are mee ng their dietary needs and to iden fy associa on between demographic veriables and nutri onal outcome. United Na ons Universal Declara on of Human Rights 1948 Ar cle 25 stated that “Everyone has the right to a standard of living adequate for the health and well-being of himself and his family, including food, clothing, and housing and medical care and necessary social services, and the right to security in the event of unemployment, sickness, disability, widowhood, old age or other lack of livelihood in circumstances beyond his control.”13 But the food and nutri on security remain most fundamental challenge for human welfare and for economic growth. In many countries, suffi cient food to meet the needs of all ci zens is not even available at a na onal level.14 Nepal is a food defi cit, land locked and Table 2: Impact of demographic variables on nutri onal status of the families N =339 1. Family type Calories intake Less than 2400Kcl 2400Kcl Total nuclear 122 112 234 joint 105 0 105 Pearson Chi-Square value (75.053), df (1 ), (p=0.000) 2. Cast Brahmin Chhetri Magar only Schedule cast indigenous Pearson Chi-Square value (1.149) df(4), (p=0.000) 3. Occupa on unemployed 32 0 32 teacher 11 21 32 farmer 82 0 82 business 71 46 117 others 31 45 76 Pearson Chi-Square value (97.222), df(4), (p=0.000) 4. House type kaccha 127 35 162 pacca 100 77 177 Pearson Chi-Square value(18.334), df(1), (p =0.000) 64 Journal of Lumbini Medical College least developed country. Around forty nine percent of under-fi ve children are chronically malnourished.15 About eighty per cent of Nepal's people live in rural areas and depend on subsistence farming for their livelihoods. Poor rural people in Nepal generally have large families, very small landholdings or none at all, and high rates of illiteracy, concentrated in specifi c ethnic, caste and marginalized groups, par cularly those of the lowest caste (dalits), indigenous peoples (janaja s) and women. Household food insecurity and poor nutri on are major concerns in these areas.16 The fi rst health survey of Nepal which was done in 1965/66 among the 6,321 people from 957 households from nineteen diff erent sites of country found that the diet as a whole was lacking in protein, calcium, Vitamin A, riboflavin and ascorbic acid.17 A random- sampled nutri on survey conducted in Mugu and Humla districts also showed a precarious nutri on situa on.18 Na onal Nutri on Council of Bangladesh es mated that about 45-51% of the total popula on in Bangladesh were poor based on their calorie consump on. The prevalence of poverty and resul ng low calorie consump on was higher in rural than in urban areas.19 The calorie intake by people of sub-Saharan Africa found 2098Kcal/capita/day only.20 Similar situa on has observed in other developing countries as: Na onal Sample Survey Organiza on of India conducted a study during 2004 - 2005 found that average daily intake of calories by rural popula on had 2047 Kcal.21 Above situa ons have indicated the food calories intake by rural people in developing countries was found to be low, so it could be key determinant to decline the level of public health in such countries. Results of the study revealed that, low calories intake among the families was widespread and persistent in rural Palpa. The prevalence of low calories intake by families was to be 66.96%. A study conducted by National Nutrition Monitoring Bureau (NNMB) at diff erent me in India also showed that prevalence of under nutri on in adults was higher in rural areas as compared to urban areas but majority of the urban popula on who could work in White or blue collar jobs, their energy expenditure for these ac vi es was low, Where average intake of calories by men was 2000 kcal energy/capita/day only.22 Another survey carried out by NNMB in the rural communi es of nine states viz. Kerala, Karnataka, Tamil Nadu, Andhra Pradesh, Maharashtra, Madhya Pradesh, Gujarat, Orissa and West Bengal found that the propor on of preschool children underweight was about 55%, while that of severe underweight was 18%. 33% males and 36% females had chronic energy deficiency. Food and nutrient intake levels were rela vely lower in Kerala compared to other states, but the prevalence of under nutri on among young children was low.23 Welfare of a household depends on nature of occupa on, socio economic condi on house type and family type or size, which in turn is based on the nature of the work of the main household earner. All of these veriables are most important to determine level of calorie consump on.24 Present study indicated that the demographic variables as: family type, occupa on of head of the household and type of house were strongly associated (p<0.000) with low calories intake by families as compared to the result from a study conducted by Masuma Khatun, SM Ziauddin Hyder, Abbas Bhuiya and Mushtaque Chowdhury in Bangladesh, where the associa on between occupa on of the household head and family size with prevalence of low calorie consump on among the rural families was Signifi cantly (p<0.001) observable.25 CONCLUSION Most of the indigenous families could spend their life with low calories intake. Nature of occupa on, socio economic condi on house type and family type or size found to be strong predictors to nutri onal outcome in rural communi es of Palpa district. REFERENCES 1. Thomas V. Health care in developing countries- Need for fi nance, educa on or both? 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