Meso level situational analysis of nutritional status of children and prevalence of anaemia among children, adolescent girls and pregnant women in selected districts of India

Abstract

Malnutrition remains a complex scenario claiming a lot of lives and creating loss of time to disability among the vulnerable populations which are children below five years, adolescent girls, women and pregnant women. Poor nutritional status and high prevalence of anaemia in the Indian population is among the highest globally despite government efforts to avert the nutritional situation in the country. The primary aim of this comparative and correlation study is to analyse the nutritional status of children and women and the prevalence of anaemia among children, adolescent girls and pregnant women in selected districts and states of India so as to understand the differences and predictors in each location and changes over time. Analysis was carried out using SAS and SPSS on secondary data of NFHS-2 and NFHS-3 in Prakasam, Mahbubnagar, Akola, Solapur, Bijapur, Tumkur districts and Andhra Pradesh, Maharashtra, Karnataka states respectively and results presented on the basis of bivariate analysis using chisquare for correlation and ordinal logistic regression for predictors of malnutrition and results showed variations across districts and states. Prevalence of underweight in children below five years was 58.8 percent in (Prakasam), 81 percent (Mahbubnagar), 83.7 percent (Akola), 79.2 percent (Solapur), 73.1 percent (Bijapur) and 79 percent (Tumkur) districts during NFHS-2 survey. Regression results revealed that the common predictors of underweight at district level were age of the child, child anaemia and occupation of the mother. At state level however, prevalence varied in trends between the two surveys with (74.9 % vs 74.1 %) for Andhra Pradesh, (75.5 % vs 79.7 %) for Maharashtra and (70.9 % vs 76.0 %) for Karnataka states. The common predictors were residence, age of the child, ethnicity (caste), education and occupation of mother, child immunization and toilet facility. xlvi Prevalence of malnutrition among women (15-49 years) ranged between 46.7 percent and 56.1 percent for NFHS-2 and NFHS-3 respectively. However, CED ranged between (31.3 % to 50.5 %) while OW/OB ranged between (10.2 % to 23.2 %). Results also show that between the two surveys, CED decreased slightly while OW/OB increased giving rise to a dual burden of malnutrition in women especially Andhra Pradesh state. Comparison of NSSO data and NFHS data in the studied population (women and children) revealed that SES of the woman affects her dietary consumption of food nutrients with higher percentage of inadequate consumption of calories and proteins being among low SES and consumption improving with improvement of SES. This explains the higher prevalence of CED among low SES. Consumption of fat was almost adequate in all SES but remains highest among high SES which explains the higher prevalence of OW/OB. Also in all studied areas, no significant differences were found between males and females. Prevalence of child anaemia was (62.3 %, 52.0 %, 55.5 %, 69.0 %, 69.3 %, and 63.0 %) for Prakasam, Mahbubnagar, Akola, Solapur, Bijapur and Tumkur districts respectively. Regression analysis found stunting, wasting, age of child, mothers‘ education and occupation as predictor variables for child anaemia in Prakasam, Mahbubnagar and Tumkur districts only as none of the variables predicted anaemia prevalence in the remaining districts. However, trend analysis between the surveys at state level revealed a prevalence of (67.3 % vs 66.0 %, 74.6 % vs 62.3 % and 66.4 % vs 68.7 %) for Andhra Pradesh, Maharshatra and Karnataka states during NFHS-2 and NFHS-3 respectively. The prominent predictors were age, caste, poor nutritional status of the child and poor education of the mother. Prevalence of anaemia among adolescent girls (15-19 years) was (69.1 %, 60.2 %, 43.7 %, 51.1 %, and 51.7 %) for Prakasam, Mahbubnagar, Solapur, Tumkur and Bijapur districts respectively during NFHS-2. Regression results found age, caste, wealth and occupation as predictors of anaemia at district level except for Akola which was not included in the analysis. However, at state level, anaemia increased in Andhra Pradesh and Maharashtra state with a prevalence of (59.4 % vs 69.4 % and 54.9 % vs 55.2 %) for NFHS-2 and NFHS-3 respectively while anaemia decreased in Karnataka adolescent girls of the same age (54.8 % vs 48.9 %) over the years. Predictors identified were age, BMI, caste, education, wealth and occupation. Among the pregnant women, trend analysis of anaemia prevalence revealed an increase in anaemia prevalence over the years between the two surveys. The prevalence of anaemia was (38.8 % vs 61.0 %, 50.2 % vs 60.9 % and 47.3 % vs 60.6 %) for Andhra Pradesh, Maharashtra and Karnataka states between NFHS-2 and NFHS-3 respectively. Across the years, socio-economic factors (caste, education of woman and partner, occupation and BMI were identified as predictors for anaemia. Due to the persistently poor nutritional status of all the vulnerable population and variations in districts and states, nutritional programmes should be tailored and designed to suite the targeted groups at district level in order to capture variations in causes/ predictors so as to effectively tackle the problem of malnutrition with quick and evident positive results rather than at national level which will not cater for variations in this vast population in the country. Also, at national level, nutrition and sanitation education should be incorporated into the school curriculum as a compulsory subject at an early stage so as to equip all individuals with the necessary knowledge to care for themselves better irrespective of the level of education they might attain. Lastly, intervention programmes should aim at improving SES of families