Child Undernutrition among the Bhoksa Tribe of Uttarakhand in India

Gupta V

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OJHAS Vol. 21, Issue 4: October-December 2022

Original Article
Child Undernutrition among the Bhoksa Tribe of Uttarakhand in India

Authors:
Vaidehi Goswami, PhD Research Scholar,
Vipin Gupta, Associate Professor,
Department of Anthropology, University of Delhi, Delhi-110007.

Address for Correspondence
Vipin Gupta,
Associate Professor,
Department of Anthropology,
University of Delhi,
Delhi-110007, India.
E-mail: drvipiing@gmail.com.

Citation
Goswami V, Gupta V. Child Undernutrition among the Bhoksa Tribe of Uttarakhand in India. Online J Health Allied Scs. 2022;21(4):10. Available at URL: https://www.ojhas.org/issue84/2022-4-10.html

Submitted: Nov 16, 2022; Accepted: Jan 5, 2023; Published: Jan 31, 2023

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This work is licensed under a Creative Commons Attribution-No Derivative Works 2.5 India License

Abstract: Aim: The study aimed to investigate the prevalence of undernutrition in terms of low birth weight, stunting, wasting, and underweight among children up to 3 years of age. Materials and Methods: We recruited 150 children of the Bhoksa Tribe aged between 2 to 36 months. Information related to nutritional indicators (length-for-age, weight-for-age, and weight-for-length) of the child and socio-demographic variables of the household were collected. Results: The prevalence of undernutrition in terms of low birth weight, stunting, wasting, and underweight was 15.4%, 32%, 29.98%, and 36.66%, respectively. The prevalence percentage of undernutrition was high among girls but the difference based on sex was not significant. A significant difference in mean birth weight was observed between low and high SES (2.45 kg v/s 2.93 kg). Conclusion: High prevalence of undernutrition concerning birth weight among the children of the Bhoksa Tribe was observed which may be due to socioeconomic inequality in the population.
Key Words: Undernutrition, Bhoksa Tribe, Stunting, Wasting, Underweight, Low Birthweight, Rural, Under three years.

Introduction:

Global evidence shows that millions of children are still suffering from malnutrition. Undernutrition is a contributing factor in at least half of all childhood deaths worldwide.(1) The prevalence of stunting was 149.2 million children under 5 years as of 2020 and 45.6 million suffered from wasting worldwide.(2) Malnourishment, especially undernutrition is seen as a major public health problem in India and other developing nations.(3)

Undernutrition (a form of malnutrition) like wasting, stunting, and being underweight is coined as the "silent emergency" by the United Nations Children's Fund.(4) According to a comprehensive national nutrition survey report- India (2016-2018), children under the age of 0- 4 years, 17% were wasted, 33% were underweight and 35% were stunted.(5) Undernutrition in both the mother and the child, as well as unsatisfying household environments, all contribute to deficits in children's growth, health, and productivity as adults.(6)

Tribal populations are already socioeconomically disadvantaged groups. More than half of tribal children under the age of five in India are stunted.(3) Due to the dearth of studies on undernutrition among tribal children of Uttarakhand and no previously published literature available on the nutritional status of preschool children of the Bhoksa tribe. Therefore, the present study was carried out to assess the prevalence of undernutrition among the Bhoksa tribe children under three-year age in the Dehradun district of Uttarakhand, India.

Material and Methods:

A community-based, cross-section study was conducted in three villages (Shrepur, Tiparpur, and Sabhawala) of the Dehradun district, Uttarakhand, India. Based on inclusion criteria children were recruited in the age group of 2 months to 36 months, of the Bhoksa tribe. Data was collected in the year 2020, after taking informed written consent from their parents.

The sample size was estimated using the prevalence of stunting in the rural area of Uttarakhand i.e., 10.2%.(5) Based on the prevalence sample size was calculated as 145. Ethical clearance was obtained before conducting the study from the Department of Anthropology, University of Delhi. A pre-designed and semi-structured questionnaire was used to collect information related to socio-demographic variables, wealth-related information, and anthropometric measurements. Socioeconomic status was assessed using an asset-based wealth index score based on National Family Health Survey-4.(7) Further, assets-based wealth index is divided into tertiles for classification of the lower, middle, and upper socioeconomic categories.

Anthropometric measurements like length, weight, and mid-upper arm circumference (AC) were taken. The recumbent length of the child was measured using an infantometer, weight using a weighing machine, and mid-upper AC using a flexible measuring tape as per standard protocol recommended by WHO.(8) Further, these measurements were converted into Z-scores using WHO Anthro software (version 3.2.2) as per WHO child growth standards. Length-for-age, weight-for-age, and weight-for-length indices were classified as stunting, underweight, and wasting, respectively. Indices with Z-score less than two standard deviations (<-2SD) were classified as stunted, wasted, and underweight. The participants with Z-scores < -3 standard deviations were classified as severely stunted, wasted, and underweight. Mid-upper AC cut-off of less than 11.5 cm was categorized as severe acute malnutrition (SAM) and 11.5 cm to 12.5 cm is recommended to diagnose moderate acute malnutrition (MAM).(8)

Statistical analysis: Data were entered into an excel sheet and further for analysis SPSS version 20 was used.

Results

This study recruited a total of 150 children. Out of which 67 (44.67%) were males and 83 (55.34%) were females. The majority of participants (48%) belong to the middle SES category. In the present study, 90.66 % of the fathers were semi-skilled workers, most of them worked in agriculture (sugarcane fields), factories, and some in construction sites or other private industries. Only 5.44% of fathers were illiterate, whereas 12.66% of mothers were illiterate. Of the mothers, 80.66% had an education above the 5th class and 92.66% of fathers had an education above the 5th class.

The assessment of undernutrition based on mid upper AC has shown that 2.67% of children have severe acute malnutrition (SAM) and 20% have moderate acute malnutrition, 28.67% are at risk for acute malnutrition, and 48.66% are well-nourished children. The prevalence of undernutrition in the studied population showed that 15.4% of children were born with low birth weight, 32% were stunted, 30% were wasted, and 36.6% were underweight. The prevalence percentage of undernutrition was slightly high among females compared to males, but the difference was not statistically significant.(Table 1)

Table 1: Baseline characteristics of population
S.No.	Variables		Count (%)
1.	Child Sex	Male	67 (44.66)
1.	Child Sex	Female	83 (55.34)
2.	Age distribution of child	2 months - 12 months	47(31.34)
		13 months - 24 months	48(32)
		25 months - 36 months	55(36.67)
3.	Child mid upper arm circumference (MUAC) (cm)	Red colour (0 to 11.5 cm)	4 (2.67)
		Orange colour (11.5 to 12.5 cm)	30 (20)
		Yellow colour (12.5 to 13.5 cm)	43 (28.67)
		Green colour (13.5 cm & more)	73 (48.66)
4.	Socioeconomic Status (SES)	Low SES	35 (23.34)
		Middle SES	72 (48)
		High SES	43 (28.66)
5.	Total population (N = 150)	Low Birth weight (LBW)	23 (15.4)
		Stunted	47 (32)
		Wasted	45 (29.98)
		Underweight	55 (36.66)
6.	Low Birth weight	Male	10 (14.92)
		Female	13(15.66)
		χ² (P-value)	0.901
7.	Stunted	Male	21(31.33)
		Female	26(31.32)
		χ² (P-value)	0.998
8.	Wasted	Male	15(22.38)
		Female	30(36.14)
		χ² (P-value)	0.06
9.	Underweight	Male	22(32.83)
		Female	33(39.75)
		χ² (P-value)	0.382

Table 2: Distribution of undernutrition (more than 12 months to 23rd months) among socioeconomic categories
Child Anthropometry Z-scores	Low SES Mean ± S.D.	High SES Mean ± S.D.	P-value
Weight-for-age	-1.63 ± 2.09	-1.22 ± 1.68	0.502
Height-for-age	-1.97 ± 2.94	-0.736 ± 2.3	0.147
Weight-for-length	-0.69 ± 2.07	-1.04 ± 1.86	0.562
Birth weight	2.45 ± 0.63	2.93 ± 1.16	0.05
*P-value = 0.05 significant.

The prevalence of undernutrition decreases from low SES to high SES, but the difference is not statistically significant. The mean value of Z- scores for nutritional indicator categories (weight-for-age, length-for-age, weight-for-length) among lower and high SES shows no significant difference but childbirth weight mean value is significantly low among low SES compared to high SES. Childbirth weight is less than 2.5 kg in low SES, and it is 2.9 kg for high SES (12 months to 23 months). (Table 2)

Discussion

Undernutrition contributes significantly to the global burden of disease.(9) Stunting that is caused due to chronic undernutrition that retards linear growth, however wasting is caused by inadequate nutrition over shorter periods, and being underweight compass both stunting and wasting.(10) Whereas, low Birthweight is an important factor for survival, growth, and physical and psychological development.(11)

This study provides data on the nutritional status of preschool tribal children. Here, the prevalence of undernutrition in terms of low birth weight, stunted, wasted, and underweight was 15.4%, 32%, 29.98%, and 36.66%, respectively. Prevalence of low birth weight is lower among Bhoksa compared with the national average of low birth weight i.e., 18.2% among the tribal population in India.(11) This could be due to better access to antenatal check-ups and ICDS service in this region.(12) In the present study prevalence of stunting is consistent with the finding of the CNNS report (Uttarakhand) but wasting and underweight are higher among Bhoksa children compared with a finding of NFHS-5 (Uttarakhand) and CNNS report of Uttarakhand.

It was also observed that prevalence of wasting was consistent with other studies conducted among tribal children but stunting and underweight was lower in present study compared with other studies.(13-15) This lower prevalence of stunting and underweight could be both access to ICDS programs and antenatal care, the state with better performance of undernutrition has higher utilization of ICDS and antenatal care.(11)

The prevalence percentage of undernutrition in the present study was found to be similar in both the sexes (p > 0.05) findings are supported by study conducted by Kshatriya GK, & Ghosh A.(16) In the present study child birthweight show a significant difference in low SES and high SES, similar finding is reported by Dey U. & Bisai S.(2019).(3)

Conclusion

In the present study, it is concluded that the prevalence of undernutrition is high among Bhoksa children. Socioeconomic status is an important determinant of low birth weight. Since, the high prevalence of undernutrition reported among children, it requires improved health infrastructure with a multisectoral and holistic approach, furthermore awareness and knowledge about nutrition shall be provided to mothers for improvement in nutritional status. This study is limited to small sample size future studies can be done on a large sample size and a more detailed study on determinants of undernutrition among Bhoksa.

Acknowledgements: We thank the parents and children of Bhoksa tribe (Dehradun District) Uttarakhand, India for participating in our study. This study was undertaken as a part of M.Sc. Dissertation for the Master of Science in Anthropology at the University of Delhi. Under the supervision of Dr. Vipin Gupta.

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