Elsevier

HOMO

Volume 61, Issue 4, August 2010, Pages 271-276
HOMO

Sex differences in the effect of birth order and parents’ educational status on stunting: A study on Bengalee preschool children from eastern India

https://doi.org/10.1016/j.jchb.2010.03.001Get rights and content

Abstract

One of the greatest problems facing developing countries, including rural India, is undernutrition in terms of stunting among under 5-year-old children. However, there exists scanty information on the prevalence of stunting among preschool children in India and in particular in West Bengal. This study investigated prevalence of stunting and identified the predictor(s) of stunting among 1–5-year-old Bengalee rural preschool children of Integrated Child Development Services (ICDS) centres. This cross-sectional study was undertaken at different ICDS centres of Chapra Block, Nadia District, West Bengal, India. A total of 673 preschool children (323 boys and 350 girls), aged 1–5 years were selected from 30 randomly selected ICDS centres to study the impact of parents’ educational status and child birth order on stunting. The overall (age and sex combined) rate of stunting was 39.2%. Child birth order (BO) (χ2 = 14.10, df = 1, p < 0.001), father educational status (FES) (χ2 = 21.11, p < 0.001) and mother educational status (MES) (χ2 = 14.34, df = 1, p > 0.001) were significantly associated with the prevalence of stunting among girls. Logistic regression analyses revealed that both FES (Wald = 19.97, p < 0.001) as well as MES (Wald = 13.95, p < 0.001) were strong predictors of stunting among girls. Similarly BO (Wald = 13.71, p < 0.001) was a strong predictor of stunting among girls. Girls with ≥3rd BO had significantly higher risk (OR = 2.49, CI = 1.54–4.03) of stunting than those with ≤2nd BO. Moreover, girls with FES lower than secondary level had significantly (OR = 3.30, CI = 1.96–5.58) higher rate of stunting than those with FES  secondary level. Similarly, girls with MES < secondary level had significantly (OR = 2.50, CI = 1.54–4.03) higher rate of stunting than those with FES  secondary level.

In conclusion our study revealed that BO as well as parents’ educational status were strong predictors of stunting among girls but not boys. Sex discrimination could be a likely cause for this sex difference in the impact of BO and parents’ educational status.

Introduction

Although anthropometric indicators represent indirect measures of undernutrition that do not take into account nutrient intake or biochemical examination, their wide use is justified due to the ease of the method and its high sensitivity to nutritional alterations in a population (Post and Victoria, 2001). Cross-sectional studies are ideal for nutritional condition monitoring in developing countries as this type of study can provide relevant information for understanding the connection between health status and living conditions. Undernutrition in childhood is one of the reasons behind the high child mortality rate in developing countries such as India. It is also highly detrimental to health in those children who survive to adulthood. Their survival may be simply adding to the pool of under nourished children causing severe handicaps for the population in the future.

It is well established that undernutrition in terms of stunting is associated with poor health outcomes among preschool children. It also poses a considerable nutrition problem, the health consequences of which are less understood. Many stunted children will never achieve their full growth potential and will mature into stunted adolescents and adults (Martorell et al., 1994).

Statistics on prevalence of stunting in India indicate that an average of 48% of children were stunted (UNICEF, 2006). This figure provides important evidence of a global nutrition problem that must be addressed. However, these statistics mask the variation in proportion of stunted children that migrate from country to country, the variation in different life styles, and different bio-social determinants.

Children in the preschool age period have special nutritional needs due to their extensive growth and development (Bishnoi et al., 2004). Stunting among them is an important health problem in rural India (Ray, 2005) including West Bengal (Mustaphi and Dobe, 2005). However, only scanty information exists on the prevalence of stunting among preschool children in India (Kumari, 2005) and West Bengal (Mustaphi and Dobe, 2005). The Integrated Child Development Services (ICDS) scheme of the Government of India is the largest national programme in the world for the promotion of mother and child health and child development. The beneficiaries include preschool children, pregnant and lactating mothers, and other women in the age group 15–44. The package of services provided by the ICDS scheme includes supplementary nutrition, immunisation, health check-up, referral services, nutrition and health education, and preschool education. The scheme's services are provided essentially through workers called “Anganwadi”, workers at village “Anganwadi” centres (Kapil and Pradhan, 1999). There is, therefore, an urgent need to evaluate the nutritional status of children at ICDS centres to determine whether they have low rates of stunting, underweight and wasting. Low rates of stunting would imply that the supplementary nutrition being administered to the children is effective in reducing the rates of undernutrition.

In view of this, the present investigation was undertaken to determine age and sex variations in the prevalence of stunting, and to assess the impact of parents’ educational status and child birth order on stunting among 1–5-year-old children of Bengalee ethnicity.

Section snippets

Materials and methods

This cross-sectional study was undertaken at Chapra Block, Nadia District, West Bengal, India. The study area is situated at the India–Bangladesh international border, 140 km from Kolkata, the provincial capital of West Bengal (coordinates: 23°31′N to 23°52′N and 88°35′E to 88°58′E). The area is remote and mostly inhabited by Bengalee Muslims. All preschool children (1–5 years old) living in Chapra Block are enrolled at these centres.

Thirty (30) centres were randomly selected out of 335 centres

Results

Table 1 presents the age and sex specific mean heights of the children. Girls were shorter than boys at all ages except at 5 years. Significant age differences in mean height were observed among boys(df1=4,df2=318) (F = 316.93, p < 0.001) and girls(df1=4,df2=345) (F = 278, p < 0.001). Significant sex differences (p < 0.05) also existed in mean height at ages 2–4 years.

The overall (age and sex combined) rate of stunting was 39.2% (Table 2). The rate of stunting was higher among boys (43.4%) compared with

Discussion

Stunting is an indicator of chronic undernutrition, the result of prolonged food deprivation and/or disease or illness. This index is compared against an international reference population developed from anthropometric data collected in the United States by the NCHS (Hamill et al., 1979, WHO, 1983). Children whose measurements fall below −2 z-scores of the reference population median are considered undernourished, i.e. to have stunting. This index reflects distinct biological processes, and is

Conclusion

We suggest that similar studies should be undertaken among children of other populations not only of West Bengal but also from other parts of India. Children of rural areas should be given priority. The findings of our study have important implications for public health policy-makers, planners and organizations seeking to meet national and international developmental targets. Of paramount importance is not only to increase the amount of food supplementation given to children but also to promote

Acknowledgements

All subjects who participated in the study are gratefully acknowledged. Special thanks are due to the ICDS authorities of these centres. S. Biswas is a recipient of UGC (Government of India) financial assistance in the form of a PhD fellowship. Dr. S. Bisai is gratefully acknowledged for his assistance. Partial financial assistance was obtained from Loka Kalyan Parishad, Kolkata, India.

References (22)

  • P.V. Hamill et al.

    Physical growth: National Center for Health Statistics Percentiles

    Am. J. Clin. Nutr.

    (1979)
  • R.D. Semba et al.

    Effect of parental formal education on risk of child stunting in Indonesia and Bangladesh: a cross-sectional study

    Lancet

    (2008)
  • R. Abel et al.

    Tamil Nadu nutritional survey comparing children aged 0-3 years with the NCHS/CDC reference population

    Indian J. Pediatr.

    (1998)
  • D. Alasfoor et al.

    Protein-energy malnutrition among preschool children in Oman: results of a national survey

    East Mediterr. Health J.

    (2007)
  • P. Bishnoi et al.

    Anthropometric measurements of preschool children as effected by socioeconomic factors

    Asia Pacif. J. Clin. Nutri. Suppl.

    (2004)
  • E. Bloss et al.

    Prevalence and predictors of underweight, stunting, and wasting among children aged 5 and under in western Kenya

    J. Trop. Pediatr.

    (2004)
  • U. Kapil et al.

    Integrated Child Development Services scheme (ICDS) and its impact on nutritional status of children in India and recent initiatives

    Indian J. Public Health

    (1999)
  • S. Kumari

    Nutritional status of scheduled caste pre-school children

    Indian J. Public Health

    (2005)
  • T.G. Lohman et al.

    Anthropometric Standardization Reference Manual

    (1988)
  • G.C. Mandal et al.

    Undernutrition among Integrated Child Development Services (ICDS) Scheme. Children aged 2-6 years of Arambag, Hooghly District, West Bengal, India: a serious public health problem

    Italian J. Public Health

    (2008)
  • R. Martorell et al.

    Reversibility of stunting: epidemiological findings in the children from developing countries

    Eur. J. Clin. Nutr. Suppl.

    (1994)
  • Cited by (18)

    View all citing articles on Scopus
    View full text