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