LMC journal Vol. 2.indd 102 Study on Nutri onal Status of Children Under 5 Years in Palpa District, Nepal: Special Reference to Baal Vita Karki DK, Lall BS and Paul V Department of Community Medicine, Lumbini Medical College, Tansen, Pravas, Nepal Corresponding author: Dr. DK Karki, , Department of community Medicine, Lumbini Medical College Teaching Hospital and Research Centre, Pravas, P.O.Box-5, Tansen-11, Palpa, Nepal ABSTRACT Background: Malnutri on is a pathological state resul ng from a rela ve or absolute defi ciency or excess of one or more essen al nutrients. Malnutri on is a major underlying cause of the child morbidity and mortality in Nepal. Adequate nutri on is a fundamental right for every human being. Malnourished child is depriving from physical and mental development. Objec ves: To assess the nutri onal status of children under 5 years and to fi nd out the knowledge and prac ce regarding micronutrient powder “Baal vita”. Materials and Methods: Descrip ve cross sec onal community based study was conducted in Palpa district. A total of 390 respondents at the age of 6-59 months were selected with the help of mul stage sampling. Through anthropometry, prevalence of underweight, stun ng and was ng was determined. Results: Prevalence of underweight, stun ng and was ng was 25.9%, 27.2% and 7.3% respec vely. The associa on between age of the mother at the birth of the children and nutri onal status of children is not sta s cally signifi cant. Majority of the children (80.5%) used to take junk foods some mes, followed by 16.7% very o en and 2.8% children never used to take. Majority of the children (52.6%) were taken the micronutrient powder (fi rst course) but the coverage of second course of micronutrient powder was 29.5% followed by third course coverage only 18.9%. Conclusion: The nutri onal status of children in this study was found to be sa sfactory because compared to the Millennium Development Goals (MDGs) target but the coverage of micronutrient powder is low. Keywords: Underweight, stun ng, was ng, Malnutri on, Waterlow’s and Gomez classifi ca on INTRODUCTION Malnutri on is one of the major public health problems in developing countries including Nepal, remains a serious obstacle to child survival, growth and development. It does not only directly aff ect the children by reducing their physical and mental performance but makes the situa on worse by making the children suscep ble to infec on, slower recovery and higher mortality.1 It is one of the foremost underlying causes of the child morbidity and mortality. Malnutri on increases the risk of a child dying due to common infec ons such as pneumonia, diarrhoea, measles, and malaria by over 50%. According to WHO, nearly 55% of below fi ve years children’s death worldwide are caused by malnutri on. Among those who survive, inadequate nutri on reduces cogni ve growth. Not only severe malnutri on, but also mild to moderate malnutri on increases the risk of a child dying due to common infec ons. Around 40% under fi ve mortality results from diarrhoea or acute respiratory infec on; which are curable in fi rst stage with simple home remedies when nutri onal status is good. 2 There are many factors that directly or indirectly cause malnutrition among children. Children who suff er from repeated episodes of diarrhoea or Acute Respiratory Infec ons (ARI) are more likely to suff er from malnutri on which leads to insuffi cient intake of calories, proteins, vitamins and minerals.3 Children below 5 years and especially those aged 6 months to 24 months are at par cular risk. The common types of malnutrition in Nepal are: protein energy malnutrition, iodine deficiency disorders, iron deficiency anemia and vitamin A deficiency. Government of Nepal, Ministry of health and population has implemented many nutri onal interven on programmes. One of them is Micronutrient Powder or “Baal Vita” programme with the aim of reducing malnutrition specially micronutrient defi ciency at the age of 6 months 24 months. It provides one packet of “Baal Vita” per day and contains Vitamin A (400 mcg), Thiamine (0.5 mg), Ribofl avin (0.5 mg), Pyridoxin (0.5 mg), Cynacobalamin (0.9 mcg), Vitamin C (30 mg), Vitamin D3 (5 mcg), Vitamin E (5 mg), Folic acid (150 mcg), Niacin (6 mg), Copper- Cupric gluconate (0.56 mg), Iodine-Potassium iodide (90 mcg), Iron-Ferrous Fumarate (1010 mg), Zink (4.1 mg) and Selenium (17 mcg). It is started when child reaches 6 months of age providing one packet per day for 2 months. A er gap of 4 months, in 12 months again started for 2 months, again at the age of 18 months 60 packets are provided. Original Article L M Coll J 2013; 1(2): 102-104 103 Table 1: Nutri onal status of the children (weight for age)* Nutri onal status Frequency Percentage Normal (90-110%) 289.0 74.1 Mild malnutri on (Gr. I) (75-89%) 79 20.3 Moderate malnutri on (Gr. II) (60-74%) 20 5.1 Severe malnutri on (Gr. III) (≤60%) 2 0.5 Total 390 100.0 *Weight for age calculated according to Gomez Classifi cation (WHO standard) The nutri onal status of children in Nepal has improved over the past 15 years and is close to achieving the Millen- nium Development Goals (MDGs) target of reducing the percentage of underweight children to 29 percent by 2015. The percentage of stunted children declined by 14 percent between 2001 and 2006 and declined by an addi onal 16 percent between 2006 and 2011. A similar pa ern is ob- served for the percentage of underweight children reduced by 9 percent between 2001 and 2006, 26 percent between 2006 and 2011. Similarly, the percentage of was ng declined by 15 percent between 2006 and 2011.4 The Millennium Development Goals (MDGs) will never be met without signifi cant accelera on in addressing under nutri on as one of the primary cause of child mortality. MATERIALS AND METHODS Descrip ve cross sec onal community based study was conducted where mul stage sampling technique was used. Palpa district was selected purposively, out of 65 VDC, 13 VDCs were selected randomly. Out of 9 wards, 3 wards were selected randomly. A er that, 10 respondents selected from each ward by using random table. Thus a total of 390 respondents at the age of 6-59 months were selected where the face to face interview was taken to mother of child by using structural ques onnaire. Anthropometric measurement was taken by taking weight in kilogram, with the help of weighing machine, height was measured in cm with the help of measuring tape and mid upper arm circumference (MUAC) of le hand was measured by using measuring tape (shakir tape). Nutri onal status was determined by calcula on of weight for age (underweight), height for age (stun ng) and weight for height (was ng) by using Waterlow’s and Gomez classifi ca on. Tabula on and Analysis of data: A er collec on of data, data were entered into the Sta s cal Package for Social Science (SPSS). Analysis and interpreta on of data were done in detail with the help of sta s cal measures accordingly. Dura on of the study: The period of data collec on was 1st June, 2013 to 30 November, 2013. RESULTS Majority of respondents (95.14%) had ownership of radio, followed by 76.45% had television at home and only 4.74% were subscribers of newspaper. Radio (16.11%), television (13.91%) were the sources of informa on about nutri on. Majority of children (74.1%) were normal in weight but around one quarter (20.3%) were mild malnourished fallowed by 5.1% were moderate malnourished and very few (0.5%) were severe malnourished. Majority of the children (72.8%) were normal in height but around one quarter (22.3%) were mildly impaired, followed by 3.8% were moderately impaired and 1% severely impaired as well as Was ng (weight for height) were 7.3%. Majority of the children (87.1%) were normal and 12.9% were 1st degree, mild malnourished among the 6-11 months children, similarly among 18-23 months children, half (50%) were normal and half were 1st degree, mild malnourished, but few (9.1%) among 24-29 months children were 3rd degree, severe malnourished. Around one third (32.84%) children were 1st degree mild malnourished who were born to mothers 15-17 years of age and remaining were normal whereas majority of children (90.91%) were 2nd degree, moderate malnourished born to mothers 24-26 years of age, less than 1% (0.78) were 3rd degree, severe malnourished borne to mother 21-23 years of age. However the associa on between age of the mother at the birth of the children and nutri onal status of children is not sta s cally signifi cant. Majority of the children (80.5%) used to take junk foods Table 2: Nutri onal status of the children (height-for-age) p://mohp.gov.np/english/fi les/ new_publica ons/9-1- Frequency Percent Normal (>95%) 284 72.8 Mild Impaired (87.5%-95%) 87 22.3 Moderate Impaired (80%-87.5%) 15 3.8 Severely Impaired (<80%) 4 1.0 Total 390 100.0 *Height for age according to Waterlow’s classifi cation DK Karki et al 104 Journal of Lumbini Medical College some mes, followed by 16.7% very o en, 2.8% children never used to take. There is no association between consumption of junk food and malnutrition. Majority of mothers (77.9%) had heard about the micronutrient powder, but around one quarter (22.1%) mothers had not heard about it. Majority of the children (52.6%) were taken the fi rst course of micronutrient powder but the coverage of second course of micronutrient powder was 29.5% and followed by third course coverage was only 18.9%. All mothers who qui ed it, reported that taste of micronutrient powder is not good and child does not want to con nue. Table 3: Nutri onal Status of Children by Age Age of the children in months Weight for age Total Normal 1st deg 2nd deg 3rd deg 6-11 87.1% 12.9% .0% .0% 100.0% 12-17 96.4% 3.6% .0% .0% 100.0% 18-23 50.0% 50.0% .0% .0% 100.0% 24-29 90.9% .0% .0% 9.1% 100.0% 30-35 91.7% .0% 8.3% .0% 100.0% 36-41 64.3% 17.9% 16.1% 1.8% 100.0% 48-53 23.5% 61.8% 14.7% .0% 100.0% 54-59 98.5% 1.5% .0% .0% 100.0% Total 74.1% 20.3% 5.1% .5% 100.0% Table 4: Nutri onal status of the children by age of the mother at birth of the child Age of the mother at birth (year) Weight for age Normal 1st deg 2nd deg 3rd deg 15-17 67.16% 32.84% 0% 0% 18-20 79.24% 19.68% 0.54% 0.54% 21-23 75.97% 16.28% 6.98% 0.78% 24-26 9.09% 0% 90.91% 0 Total 74.10% 20.25% 5.13% 0.52% χ² cal = 1.86, df = 9, χ² tab=14 (not signifi cant) DISCUSSION 41 percent of children below 5 years of age are stunted, 29 percent are underweight and 11 percent of children suff er from was ng in Nepal (NDHS, 2011). These fi ndings are li le similar to fi nding of present study where stun ng is 27.2%, underweight 25.9% and was ng 7.3%. This fi gure was quite low than the study conducted in eastern Nepal where it was reported as 61% underweight.5 Another study conducted in Jirel community in Jiri VDC, Dolakha to assess the nutri onal status of children age group between 12 months to 60 months. It was found that 64% had mild to moderate malnutri on. Another study, the prevalence of stun ng in primary school children in Pokhara valley was found 14.9% which is higher than present study.7 This study shows most of the children (92.1%) were from Hindu and few were from Buddhist. These fi ndings were similar to religion wise distribu on of popula on of Nepal where 80.6% of the total popula on was Hindu and 10.7% of the popula on was Buddhist.8 This study represents that majority of the children were from joint family. Half percent of mothers were primary level, one third mothers were secondary level and very few (9%) were illiterate. Around one third (32.84%) children were 1st degree mild malnourished who were born to mothers 15-17 years of age and remaining were normal. Majority of children (90.91%) were 2nd degree, moderate malnourished born to mothers between 24-26 years of age. However the associa on between age of the mother at the birth of the children and nutri onal status of children was not sta s cally signifi cant. On contrary, the study conducted in Dhankuta District of Nepal found maternal age more than 35 years at pregnancy, was a risk factor for stun ng and underweight in children.9 This study reveals that coverage of micronutrient powder, fi rst, second and third courses are 52.6%, 29.5% and 18.9% respec vely. CONCLUSION The nutri onal status of children in this study were found to be sa sfactory because compared to the Millennium Development Goals (MDGs) target of reducing the percentage of underweight children age 6-59 months to 29 percent by 2015, which is already achieved in this district before 2015 but government has launched micronutrient Powder programme which coverage is very low. Therefore the importance of micronutrient powder should be disseminate to all people, focus on awareness about it, should be contribute from all the sectors and taste should be modifi ed. REFERENCE 1. Nepal Demographic and Health Survey 2006, Family Health Division, Department of Health Services 2. National Nutrition Policy and Strategy, Ministry of Health and Population, Government of Nepal. 2008. Retrieved from: http://mohp.gov.np/english/files/ new_publica ons/9-1- Nutri on-Policy-and-strategy.pdf 1. UNICEF. Atlas of South Asian Children and Women. 1996. UNICEF, ROSA. Nepal. 3. Mishra VK, Retherford RD. Women’s Education Can Improve Child Nutri on in India. In Bulle n Na onal Family Health Survey, Interna onal Ins tute for Popula on Sciences, Mumbai, 2000:15.4. 4. Popula on Division, Ministry of Health and Popula on, Department of Health Services, Government of Nepal. Nepal Demographic and Health Survey (NDHS), 2011. Available from: h t t p : / / w w w. m o h p . g o v. n p / e n g l i s h / p u b l i c a t i o n /NDHS%202011%20Full%20 version.pdf 5. Shakya SR, Bhandary S and Pokharel PK. Nutri onal status and morbidity pattern among governmental primary school children in the eastern Nepal. Kathmandu Univ Med J 2004; 2: 307-14 6. Chapagain RH, Adhikari AP, Dahal R et al. A Study on Nutri onal Status of under fi ve Jirel Children of Eastern Nepal. J NHRC. 2005; 3: 2. 7. Pradhan E, Leclerg SC, Khatry SK. Child Growth: A Window to child health in the terai, NNIPS Monograph, 1991, 1 : 19-21. 8. Sta s cal Pocket Book, His Majesty’s Government of Nepal, Na onal Planning Commission, Kathmandu, Nepal, 2002; 5, 15,159. 9. Sapkota VP, Gurung CK. Prevalence and Predictors of Underweight, Stunting and Wasting in Under-Five Children. J NHRC 2009; 7(15): 120-6.