INTRODUCTION:

Malnutrition, in India, continues to be an important public health problem, in spite of several nutritional intervention programs. Nutritional problems are most prevalent among the age group of under-five children and PEM is one among them. Malnutrition is associated with about half of all child deaths worldwide. Malnourished children have lowered resistance to infection, they are more likely to die from common childhood ailments like diarrheal diseases and respiratory infections and for those who survive, frequent illness saps their nutritional status, looking them into a vicious cycle of recurring sickness, faltering growth and diminished learning ability.

Despite India’s considerable social and economic progress over the decades, malnutrition continues to be a grave problem, particularly among vulnerable population of the community. Child malnutrition is a biggest challenge; our country is facing today even when the economy is said to surging ahead. Every second child under age of three in the country is malnourished. NFHS data also show that 46% of the under age of 3 years’ children had been suffering from malnutrition. The number for under five children is 55 million which is two and half times the population of Australia. 35% of the world's malnourished children live in India.

Half the number of child deaths takes place due to malnutrition which can be prevented. The malnutrition is influenced by a variety of factors like lack of food, sanitation and health care, some social and cultural customs and taboos and poor childcare practices at family level. Different health and nutritional programs are trying to address this issue at community level.

Due to increase morbidity and mortality under five year of age there is a need to assess the growth of children and to find out the associative factors which affects the growth of toddlers.

It is also necessary to frequently assess the nutritional status of such children.

· To screen the ‘high risk ‘cases and prevent the disease.

· It is useful to mother to get informed and to get involved in the process of improving the health of children and mother.

OBJECTIVES OF THE STUDY:

· To assess the prevalence rate of PEM.

· To find out associative factors of PEM.

· To correlate the prevalence of PEM with selected demographic variables.

· To compare the prevalence of PEM between under-five children of rural and urban areas.

ASSUMPTIONS:

1. There is prevalence of PEM among the under five children of rural and urban areas.

2. The associative factors such as Environmental Factors, Maternal Health, Breast Feeding technique, Weaning Practices and Cultural effect, Immunization and family history will show the association with PEM.

3. Selected demographic variables like age, gender, Types of the family, Socio-economic status, Occupation of father and mother, Monthly income of family, Religion, Dietary pattern will influence the incidence of PEM in Under five Children.

4. The Prevalence of PEM in under-five children of rural areas is higher than and under-five children of urban areas.

HYPOTHESIS:

H₁: There is a significant association between prevalence of PEM and demographical variables.

H₂: There is significant difference between prevalence of PEM among under five children in rural areas and urban areas.

RESEARCH APPROACH AND DESIGN:

A quantitative research approach was used for this study to assess the prevalence of PEM and its associative factors among the under-five children of selected rural and urban areas of Navsari District.

The research design used in this study was the Exploratory Descriptive research design.

SETTING OF THE STUDY:

Study was conducted in the rural areas (Munsad and Chovisi) and urban areas (Rustamvadi) of Navsari District. The investigator has selected these areas by probability cluster sampling method.

Target Population:

In this study, Target Population consisted of 865 under five children (0 to 5 years of age) of the selected rural and urban areas of Navsari district.

SAMPLE AND SAMPLING TECHNIQUE:

The sample of this study comprised of total 707 under five children, out of which 66 samples who were having PEM were taken from selected rural area and the other 23 samples who were having PEM from selected urban areas of Navsari District of Gujarat state shows in table 1.

Table 1: Total number of selected samples from rural and urban areas of Navsari District.

Sr. No.	Area	Name of the selected areas	Total no. of Sample	Total no. of Sample with PEM
1.	Rural areas	Chovisi	286	42
		Munsad	109	24
2.	Urban areas	Rustamvadi	312	23
	Total	3		89

Sampling technique: “Multi-stage (Cluster) sampling” technique was used for the selection of the samples.

Fig.1: Flow Chart Showing Sampling Technique

Selection of Tools/Instruments for Data Collection:

Structured Interview Questionnaire, Standard WHO BMI chart, Weighing scale, Measuring tape

Description of Tools:

The structured interview questionnaire was developed for the present study and for the monitoring of the growth, measuring tape, weighing scale, and WHO BMI chart were used. The structured interview questionnaire developed for data collection was in three sections, with 11 questions for demographic data, 5 questions included for Anthropometric measurement and 30 questions for collecting data regarding associative factors.

Analysis and Interpretation of Data:

Analysis and interpretation of data collected for prevalence of PEM among under-five children:

Data collected on Section- I deals with assessment of prevalence of PEM by assessing height, weight, head circumference, chest circumference, mid arm circumference and calculating BMI. The under five children of rural and urban areas data were categorized as malnourished by using standard WHO BMI chart. The result was tabulated in terms of frequency and percentage.

Table 2: Frequency and percentage wise distribution of prevalence of protein energy malnutrition among under-five children of rural and urban areas

Area	Frequency	Percentage
Rural	66	74.2
Urban	23	25.8
Total	89	100.0

As shown in the above table, the prevalence of PEM among under five children of rural areas is 74.2% which is higher than the prevalence of PEM among the under five children of urban areas which is 25.8%.

Analysis and interpretation of data collected for associative factors of PEM among under-five children:

Data collected on Section- II deals with associative factors such as maternal factors, environmental factors, health factors and family factors which were found out using structured interview questionnaire. The results were tabulated in terms of frequency and percentage. The associative factors like incomplete immunization during pregnancy (59.6%), intake of protein supplements (20.2%) show higher incidence. The antenatal visits taken by the mother have 88.8% out of which 40.4% have taken only one antenatal visit. the associative factors like Type of house (Kuccha) (84.3%), Poor environmental sanitation (73.0%) shows higher incidence which indicates that the environmental factors can affect nutritional status of children. The data collected for child health factors, it shows that birth order of the child i.e second (46.1%), age of stopping breast feeding, 6 to 12 months (65.2%), Incomplete immunization of the child (51.7%) has more incidence. From the data collected for assessing influence of family factors, health habits of father (addictions) (75.3%) has higher incidence.

Analysis and interpretation of data collected for demographic data of under-five children:

Data collected in section-III deals with the demographic data of the selected under-five children such as age, sex, religion, dietary pattern and family structure in terms of frequency and percentage and comparison of rural and urban areas. The data collected showed that the majority of the under five children were of 25 to 36 months of age (31.5%), the majority were of male gender (60.7%), Hindu by religion (76.4%). Most of the children were following non-vegetarian diet pattern (84.3%). It was also found that the majority of the under five children live in joint family (71.9%), the majority had two siblings (49.4%). The educational status of the father (83.3%), and mother (93.3%) was below 10th std. The low income status of the family (55.1%) has more prevalence and can contribute to PEM.

Graph 1: Shows age wise distribution of under five children

Graph 2: Shows gender wise distribution of under five children

Frequency and percentage distribution was done for each demographic data and then its association was done using Chi-Square test. It was seen that the type of family of the child was having p-value of 0.009 which is significant at the level of p-0.05. The other demographic variables were having p-value more than 0.05 which indicates that these variables are statistically not significant at the level of p-0.05

Analysis and interpretation of data collected for comparison of prevalence of PEM between under-five children of rural and urban areas:

In this section, the data collected deals with comparison of prevalence of PEM between under-five children of rural and urban areas. Frequency and percentage wise distribution was tabulated to see prevalence of PEM among under-five children of rural and urban areas.

The prevalence rate of malnutrition in rural areas (16.71%) is higher than the prevalence rate of malnutrition in urban areas (7.37%). The rate of children with adequate nutritional status in rural areas (73.67%) was less than the urban areas (81.41%). It can be seen that the number of obese children in urban areas (11.22%) was higher than that of rural areas (9.62%).

Graph 3: Shows comparison of prevalence of PEM between underfive children of rural and urban areas.

MAJOR FINDING OF THE STUDY:

The data were analyzed and interpreted in terms of objectives of the study. Descriptive and inferential statistics were utilized for the data analysis.

1. Majority of the under five children were of age group of 25-36 months (31.5%) and the majority were male children (60.7%)

2. Majority of under five children were Hindu by religion (76.4%) with a majority dietary pattern of non-vegetarian type (84.3%)

3. The majority of the children were of low socio-economic group with a monthly family income upto 10,000/- Rs. (55.1%)

4. It was found the majority (88.8%) of the mothers had taken the antenatal visit with 40.4% only taken one visit.

5. It was found that majority of the mothers (59.6%) had take incomplete TT vaccine.

6. In the environmental factors it was found that the majority (84.3%) live in a kuccha house and the sanitation pattern was poor (73%).

7. It was found that (52.8%) of the under five children were having birth weight more than 2.5 kg. The majority were having two siblings (52.8%) and the birth order of the majority was second.

8. The period of exclusive breast feeding in the majority (83.1%) was of 6 months, but breast feeding was stopped at an early age at 6-12 months of the age in the majority (65.2%). Weaning was started at 6 months of the age in the majority (74.2%)

9. It was found that majority of the children (51.7%) had incomplete immunization schedule according to age.

10. There was no significant illness in the children or in the family members.

11. It was found that the majority of the fathers had bad habits/addictions (75.3%), whereas only 27% of the mothers had addiction.

12. The prevalence rate of PEM was higher (16.71%) in rural areas when compare to urban areas (7.37%).

CONCLUSION:

There was a prevalence of malnutrition in selected rural and urban areas of Navsari district. From the above findings, it was concluded that the prevalence of PEM was higher in rural areas than the urban areas. It was found that the variables like educational status of parents, exclusive breastfeeding practice, number of siblings, quantity of diet of toddlers had positive effect on growth of the children. It was also found out that the certain factors were more associated with the prevalence of PEM among the under five children. When the data were compared it was found that there was higher prevalence of PEM among under five children of rural areas than those of urban areas.

RECOMMENDATIONS FOR FURTHER STUDY:

1. A similar study may be replicated using the large sample and among more number of areas so that findings can be generalized for a larger population.

2. A similar study can be replicated among the various group of children like preschool, school going.

3. A comparative study can be conducted in order to compare the prevalence of PEM among two District or two states.

4. A comparative study can be conducted in order to compare the growth and development.

A study can be conduct to identify the factors responsible for poor growth among the higher socioeconomical status and lower socio-economic status group.

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Received on 21.07.2021 Modified on 13.02.2022

Int. J. Nur. Edu. and Research. 2022; 10(3):193-197.

DOI: 10.52711/2454-2660.2022.00045

Area	No. of samples	Mal Nutrition		Normal		Obese
Area	No. of samples	Frequency	percentage	Frequency	percentage	Frequency	percentage
Rural:
Munsad	109	24	22.02%	73	66.97%	12	11.01%
Chovisi	286	42	14.69%	218	76.22%	26	9.09%
Total	395	66	16.71%	291	73.67%	38	9.62%
Urban	312	23	7.37%	254	81.41%	35	11.22%