CHAPTER 2

REVIEW OF LITERATURE

This chapter reviews previous research on the nutritional status of children

and the various factors associated with it. The researcher has made an extensive

study of reviews available.

The available reviews have been organized and presented under the following heads:

 Reviews related to Nutritional Status of Preschool Children in India.

 Reviews related to Nutritional Status of Tribal Preschool Children in India.

 Reviews related to Impact of ICDS on Nutritional Status of Preschool Children

in India.

 Reviews related to Nutrition Health Education of preschool children’s Mother’s

knowledge (ICDS) in India.

2.1 : Reviews related to Nutritional Status of the preschool children in India.

Steinhoff M.C, Hilder A.S, Srilatha V.L, and Mukarji (1983) conducted a cross-

sectional investigation on the prevalence of malnutrition in India among 1223

preschool children in a developing area of Tamil Nadu state by using a multistage

sampling technique to select the families for the data collection. It was found that 45

per cent of the children were underweight (low weight-for-age), 51 per cent were

stunted (low height-for-age), and 21 per cent were wasted (low weight-for-height).

Only 9.6 per cent of children were severely wasted and stunted in the study. The

rates of stunting increases with the increase in age, and reaching 63 per cent in the

fifth year of the children, whereas rates of wasting pointed at 36 per cent in the

second year of children and later diminished to 14 per cent in the fifth year. The

study concluded that under-nutrition strongly depended on the age.

21
Mahapathra (2002) carried out a community based cross-sectional study on

nutritional status of preschool children in the drought affected area in the

Kalahandhi District of Orissa. Random sampling technique was used to select 75

children below 5 years in the study by using anthropometrical and clinical signs of

nutritional deficiency. The result showed that there was no significant relationship

found between male and female nutritional status, 57.1 per cent of the children were

underweight, 21.3 per cent of children were with less body weight (BMI), 41.8 per

cent of children had stunting and 27.9 per cent had wasting. The main finding of the

study was that the prevalence of malnutrition among children below one year of age

had relatively lower than other age groups.

Kapur, D, Sharma.S, Agarwal KN (2005) conducted a study on the dietary intake

and growth pattern of 545 children in 9-36 months of age by using random sample

in Nand Nagri area located in Northeast of Delhi. It revealed that nutrient intake of

children for energy was 56 per cent of the current recommended daily allowances.

The anthropometric measurement showed that the children were undernourished. 75

per cent of children were underweight (<2 SD) while 35 per cent were severely

underweight (<3SD). Around 74 per cent were stunted with 39 per cent severely

stunted, and 19 per cent of children were wasted. The degree of malnutrition among

children revealed that 9.6 per cent of girls had severe malnutrition as compared to

6.5 per cent in males. The study concluded that due to inadequate food/low nutrient

intake, the malnutrition was high among early childhood and it was statistically

significant.

Narkhede Vinod, Likhar Swarnkanta, Pitale Smite and Durga Pushpa (2011)

investigated a cross-sectional study on the nutritional status and dietary pattern of

children under five years from urban slum, Nagpur, India. A house to house

assessment was made by adopting systematic random samplings. 434 children were

22
included in the study. Each child was measured by using standard technique and also

dietary survey had been done. The evidence from the study showed that 52.23 per

cent were suffering from various grades of malnutrition, in which, 32.18 per cent

children were in grade I, 16.09 per cent were in grade II, 3.46 per cent in grade III

and 0.5 per cent in grade IV malnutrition. The mean calorie intake of children

between age group 2 and 3 years was 842.6 Kcal, 3 and 4 years was 956.12 Kcal and

4 and 5 years was 1096.24 Kcal respectively.

Mukhopadhyay. K, Sinhababu. A, Saren AB, Biswas AB (2013) investigated

cross sectional study among 245 children under-two years in a slum area of Bankura

town in West Bengal to evaluate their feeding practices and its relationship with

nutritional status. Standard Living Index (SLI) and Household Food Security (HFS)

were included in an interview to collect data from the mothers. Child feeding

practices were calculated with Composite Child Feeding Index and Infant and

Young Child Feeding (IYCF) indicators and expressed in IYCF score. The main

indicators of nutrition status, i.e weight and height of the children were measured by

using World Health Organization Growth Standard 2006. The outcomes showed that

IYCF score was significantly lesser in undernourished children than those with

normal grades. By using the model, when the per unit increase in IYCF score is

likely to reduce the prevalence of underweight, stunting and wasting by 2-3 per cent

after adjusting for other variables. Overall, the result showed that, low household

food security, low standard living index and female sex were associated with

underweight and stunting.

Sanjit Sarkar (2013) carried out a cross-sectional examination on child

malnutrition and associated risk factors among children in Bankura district of West

Bengal, India in the year 2013. The samples were selected through a multi-stage

sampling procedure from 485 households below the age of five years children. As a

23
part of this research, children nutritional status was calculated by using WHO

growth standard. Bivariate analyses logistic regression model were used to study the

consequences of different socio-economic factors on child malnutrition. The

analysis outcome showed that 51 per cent of children were stunted, 41 per cent were

underweight and 22 percent were wasting. Also showed that gender bias among

children increased with age and girls were more disadvantaged (as measured by

nutritional indices) compared to boys at very young ages. The outcome from logistic

regression analyses revealed that age, religion, caste and birth order of the child was

significant with the child’s nutritional status.

Agrawal KH, Bhatta B, Agrawal NK (2016) carried out a cross sectional

investigation on nutritional status of children in rural area among children between

the age of 12-36 months in the catchment area of Kheda Primary Health Center,

Dhule District, Maharashtra, India, from 23rd October to 1st November 2011. By

using a cluster sampling technique totally 210 children were drawn. The result

showed from Mid Upper Arm Circumference among children was 40 percent. The

prevalence of severe malnutrition was found to be 13 per cent, and which was higher

among female as compared to males. The evidence provided that statistical

significant relationship was observed between malnutrition and gender of child,

birth order, children from Scheduled Tribes, literacy status of parents and the type of

family.

Meshram II et al (2016) carried a community based cross-sectional study on the

prevalence of under-nutrition and its predictors among children below five years in

the Surat region of Gujarat by using a systematic random sampling procedure of

total 3133 under the age of 5 years. The mean age of rural children (2600) and urban

children (533) were found to be 26.2 ± 15.9 months. The prevalence of underweight,

stunting and wasting was 44 percent, 39 percent and 22.5 per cent, respectively, and

24
statistically significantly (p<0.01) higher among rural children (46.7 percent, 40.3

percent and 16.4 percent) as compared to urban children (32 percent, 32.5 percent

and 16.4 percent). The result showed that under-nutrition were significantly higher

among children belonging to ST communities than other communities and also

found that the risks of underweight and wasting were two times higher among

children of illiterate mothers. From the analysis, the danger of underweight and

stunting were three times higher among children who were born with low weight

(<2.5 kg), while the danger of underweight were two times higher among those

children whose mother’s delivered at home. Overall the risk of under-nutrition was

significantly associated with gender, community, household’s wealth and mother’s

literacy.

Rouf A. Dar (2017) carried out cross-sectional study on the nutritional status of

children below five years of age across 5 altitudinal zones in South Kashmir

Himalayas. By using stratified random sampling technique 30 villages were selected

and totally 400 children were drawn from 1023 households. The prevalence of

wasting was 21.04 percent, stunting 23.78 percent and underweight was 17.53

percent among the children. The study concluded that due to unhygienic practices

and cultural habits i.e early weaning lead to malnutrition among children.

2.2: Reviews Related to Nutritional Status of Tribal Children in India

Rao DH, Rao KM, Radhaiah G, Rao NP (1994) carried out a study on the health

and nutritional status among the tribal preschool children in ecological zones namely

Sarguja, Bastar and Jhabua in Madhya Pradesh. A multi-stage random sample was

used to collect samples among 1401 preschool children from Sarguja (351), an

agricultural and forested area; from Bastar (731), a forest economy; and Jhabua

(319), an agricultural economy. The nutritional status was determined by using food

25
intake using 24-hour recall survey; a clinical examination and also deficiencies in

growth were determined by Gomez and Waterlow measurement methods. Based on

Gopalan Food Composition Tables the nutritive value was calculated. The

researcher found that the staple food grains in Sarguja and Bastar were rice, millets

and maize whereas jowar eaten in Jhabua and also found low intake of milk was in

all three zones, people also consumed pulses, leafy vegetables, roots, tubers and wild

fruits. As per the ICMR recommendation, highest intake of cereal was in Bastar

(210g) and followed by Sarguja (193g) between 1-3 years old children, whereas, the

children in Jhabua had less intake of cereals. As per recommended, consumption of

35g of pulses per day, only Sarguja close to 31g consumed per day, followed by

Bastar (13g) and 7g in Jhabua (7g). Intake of calories was found to be 35 per cent in

Jhabua compared to 60 per cent in the rest two zones. Based on the Waterlow’s

classification malnourishment was 11.7 per cent in Sarguja, 23.5 per cent in Bastar,

and 26.0 per cent in Jhabua; stunting was 50 per cent, 48 per cent, and 59 per cent.

33.6 per cent in Sarguja, 27.1 per cent in Bastar, and 17.3 per cent in Jhabua were

found to be normal.

Sharma.B, Mitra. M., Chakrabarty.S., and Bharati.P. (2003) undertook a cross-

sectional examination of the nutritional status in Raj Gond (tribal community of

Central India) preschool children (62 boys and 61 girls; aged 1 to 5 years) in the

Waratola village of the Balaghat district of Madhya Pradesh, India. Totally 123

children were included between 1 and 5 years of age in the study. By using

anthropometric measurement, the nutritional status had been calculated based on

WHO criterion (SD classification) and nutritional deficiency was also investigated

by clinical signs. The outcome exposed that there was a high prevalence of

underweight (37.4 per cent), stunting (46.3 per cent), wasting (41.5 per cent) and

low MUAC (50.4 per cent) in the study area. As the degree of malnutrition was

26
compared with other tribal preschool children within Central India, it was noticed

that the sampled children suffered more from Protein Energy Malnutrition (PEM).

The poorer clinical signs were also observed from high prevalence of sparse hair

(18.7 per cent), conjunctival xeroxis (18.7 per cent), and angular stomatitis (32.5 per

cent). Overall the finding showed that boys suffered more than girls.

C.K. Dolla, P. Meshram, P. Shrivastava, C. Karforma, S. Das and M (2005)

conducted a community based cross-sectional study to determine the nutritional

status of preschool children in Kodaku tribe of Madhya Pradesh. A total 182

children were selected by stratified proportional sampling method out of 25 villages.

Anthropometric and clinical sign of nutritional deficiency was used based on

standard procedures. The outcome showed that the Kodaku boys and girls were

shorter and lighter than NCHS standard. Based on indicators, weight for age 59.8

per cent of the children were found to be underweight (<median-2SD) and 26.2 per

cent children found to be severely underweight (≤3 SD of the standard). Height for

age and weight for height data exposed that 43 per cent children suffered from

stunting and 35 per cent recorded wasting. On the other hand, 2.6 per cent of

children suffered from a higher prevalence of Vitamin A deficiency due to night

blindness and clinically PEM was not seen.

Mittal. A., Singh. J. and Ahluwalia S.K., (2007) undertook a study on Nutritional

status of children between 1 and 5 years based on cross-sectional investigation

conducted during January to June 2004 in three slum areas of Indira colony, Purani

basti, Guru Nanak Nagar situated in the Tripuri town of Patiala City. Totally 482

children were included, weight and height were recorded based on the IAP

classification. Out of 482 children, 185 children were found to be underweight

(38.38 per cent) and the IAP classification showed that 26.76 per cent had grade I

malnutrition, whereas 7.47, 3.32 and 0.83 per cent had grade II,II and IV

27
malnutrition, respectively. Lower grades of malnutrition (I and II) were more among

boys than girls (35.29 per cent vs 32.85 per cent), whereas severe grades (III and IV)

were more in girls (5.71 per cent vs 2.94 per cent). On the other hand, 46.06 per cent

of the children were stunted with 36.10, 8.09 and 1.87 per cent showing mild,

moderate and severe stunting.

Zanver.V., A.B. Arya and R. Devi (2007) conducted a study on the status of tribal

preschool children with special reference to Gomez classification. A total of 200

tribal preschool children from 1-5 years age from different socio-economic status

were selected from tribal areas of Nanded district of Maharashtra state. Out of 200

children, almost 90.5 per cent children were suffering from various grades of

malnutrition and the rest 9.5 per cent children found to be normal or healthy. Grade I

and grade III malnutrition were found more in age between 3 and 4 years children,

while grade II malnutrition was prevalence more between 4 and 5 years children.

Nearly 47 per cent male was suffering from different grades of malnutrition than

female (43 per cent). The socio-economic factors like occupation, paternal literacy

level and monthly income were influencing the nutritional status. Children from

families having educated parents and relatively more family income suffered less

from malnutrition.

Paramita Sengupta, Nina Philip and A.I.Benjamin (2010) analyzed a cross-

sectional study on epidemiological correlates of under-nutrition in under 5 years’

children in an urban slum of Ludhiana. In this study, by adopting simple random

sampling, a total of 200 children were drawn from 1450 children under-five

children. It showed that 74 per cent of the children were stunted, 42 per cent were

wasted and 29.5 per cent were underweight. The study concluded that female

gender, low birth weight, children aged 48-59 months, children born to older

mothers between 30 and 49 years, children with more than three siblings, breast-fed

28
for more than six months or less than four months, illiterate mother or unskilled

labor father, birth spacing of less than two years, incomplete vaccination of child,

occurrence of infections and worm infestation were found to be the highest risk of

childhood malnutrition.

Meshram I.I et.al (2012) conducted a community-based cross-sectional study

carried out in Maharashtra State, where tribal population was more than 50 per cent.

A total of 120 villages were selected from eight ITDA district of Maharashtra State

by using multistage stratified random sampling. Chi-square test and proportion test

were used to study the association between under-nutrition and age groups and for

comparison of the prevalence of under-nutrition at two time periods. New WHO

Growth Standards was used to assess the nutritional status of children. The

prevalence of underweight, stunting and wasting was 64 per cent, 61 per cent and 29

per cent, respectively. Based on the analysis the risk of underweight was 1.7 times

higher in children whose mothers were illiterate and had a recent occurrence of

morbidities, whereas stunting was 1.4 times higher in children who belonged to low

and middle household.

Samiran Bisai (2014) carried out a cross sectional study on the prevalence of under-

nutrition among the Santal tribe of preschool children in Paschim Medinipur district,

West Bengal. Multi-stage cluster sampling method was used to study 299 children

(boys=153, girls=146) below 5 years and NCHS standard was used to measure the

nutritional status. The prevalence of underweight, stunting and wasting found to be

65.2 per cent, 54.2 per cent, and 20.1 per cent respectively. The study concluded that

the rate of under-nutrition was very high in the study area and also the prevalence of

under-nutrition was higher among girls than boys.

29
Rekha Rachel, Krishnapillai Vijayakumar, Pillaveetil Sathyadas Indu,

Basavegowdanadoddi Marinaik Shrinivasa Thekkumkara Prabhakaran

Sreelal, Jayapaul Balaji (2015) undertook a cross-sectional survey among 438

tribal preschool children in Wayanad district of Kerala by using cluster sampling.

Children’s height, weight, mid-arm circumference and hemoglobin level were

measured. More than half of the children were found to be under-nourished, 58.7 per

cent in at least one of the three anthropometric indicators and the prevalence of

anemia was 95.7 per cent (419/438). The finding showed that the prevalence of

underweight, stunting and wasting was 39 per cent (171/438), 38 per cent (167/438)

and 20.5 per cent (90/438) respectively. By using bivariate analysis, it showed that

there was a significant relationship between under-nutrition and educational status of

parents, tribe cast of the children, diarrheal occurrence and low birth weight of the

infant. Overall, under-nutrition in the manifestation of stunting, wasting and

underweight was very high among the tribal preschool children and almost half of

the children, i.e 58.7 per cent (257/438) were deficient in at least one of the

indicators.

Sanjit Sarkar (2016) used a cross-sectional study of 485 sample households in

2013, to examine the prevalence and risk factors of child malnutrition among

children under the age of five using a multi-stage sampling procedure in West

Bengal, India. As a part of this investigation, children’s underweight status, wasting

and stunting were examined in order to determine child nutritional status using the

WHO growth standard. The researcher performed bivariate analysis in order to

elucidate differentials in nutritional indices and fitted multinomial logistic regression

models to examine the net effect of different socio-economic factors on the

likelihood of child malnutrition. The analysis result revealed stunting (51 per cent)

as the most common form of malnutrition among children below five years,

30
followed by an underweight status (41 per cent), and wasting (22 per cent). Gender

discrimination among children increased with age, whereby girls were more

deprived compared to boys later in children relative to the younger ages. And also

the results from multinomial analyses revealed age, religion, caste, and birth-order

of child as significant predictors of child’s nutritional status.

Srinivas Chakravarthy, Bhimisetti, Kiran Pamarthi, Srinivas P.J (2015)

examined a community based cross-sectional study in tribal areas of Visakhapatnam

district of Andhra Pradesh during 2014-15. By using random sampling technique

totally 236 children under the age of five were selected from three villages through a

semi structured questionnaire. Anthropometry measurement like height and weight

were measured by using Waterlow’s classification to grade stunting and wasting and

Gomez classification was used to grade underweight for age. Overall, out of 236

children, 122 (5.7 per cent) were found to be boys and 114 (48.3 per cent) were

girls. Girls were found to be more undernourished than boys. The prevalence of

underweight, stunting, and wasting was found to be 60.2 per cent, 27.1 per cent, and

31.3 per cent, respectively. Severely underweight, stunting and wasting was found in

12.7 per cent, 2.5 per cent, and 9.3 per cent, respectively. The research concluded

that the under nutrition rates in this study were very high which might have

significant negative impact on health, education and productivity of the children.

2.3: Reviews related to the Impact of ICDS on Nutritional Status in India

Samir J. Shah (1988) carried out a cross-sectional study to determine the Extent,

Pattern and Gender Differences in Malnutrition between the age 30 to 71 months

children in urban, rural and tribal blocks of ICDS, Vadodara District. The samples

were drawn from Dabhoi Taluka (rural block) and Tilakwada Taluka (tribal block)

in Baroda district. A sample of 2526 children was collected from total 700 children

31
in each sector from 30 AWC. NCHS anthropometric was used for measurements

and child background details were taken from the registers from the Anganwadi

Centres (AWCs). Children having underweight on an average moderate was 66 per

cent for males and 68 per cent for females. Severely underweight found to be 14 per

cent for males and 17 per cent for females and both wasted and stunted found to be 8

per cent. Female children were more malnourished than males in all anganwadi

blocks; excluding for tribal block where the female was slightly less malnourished

than males. The outcomes showed that these children were at a high risk of

morbidity and mortality.

B.N.Tandon and Neeru Gandhi (1995) investigated a study on immunization

coverage among children between the aged of 12 and 24 months in ICDS and in

Non-ICDS by using two stage random sampling techniques to collect data from the

children and mother. So, total 5367 children and 5111 mothers were selected from

ICDS group, whereas, 2018 children and 1890 mothers were selected in non-ICDS.

The result revealed that BCG, DPT and poliomyelitis vaccination completed for 65

per cent, 63 per cent and 64 per cent respectively, whereas in non-ICDS only 22 per

cent for BCG, 28 per cent for DPT and 27 per cent for poliomyelitis. Among

mothers, 68 per cent of mothers completed tetanus toxoid in ICDS group and only

40 per cent in non-ICDS. Overall, the coverage was higher in urban than tribal areas.

ICDS had significantly increased immunization coverage in India.

Biswas S, Bose K Muklopadhyay.A, Bhadra. M (1999) carried out a cross-

sectional study to evaluate the prevalence of under-nutrition among preschool

children between 3.0 and 5.9 years in rural areas of ICDS in West Bengal covered

by using Composite Index of Anthropometric Failure (CIAF). Random samples

were used to collect sixty six ICDS children between 3 and 5.9 years and it was

notable that boys were heavier and taller than girls in all group ages. There was a

32
significant age difference between the mean height and weight of boys and girls.

Along with the children, 48.20 per cent, 10.60 per cent and 48.30 per cent were

found to be stunting, wasted and underweight, respectively. The CIAF result showed

that 60.40 per cent of children were suffering from higher under-nutrition based on

anthropometric failure when compared with other indicators.

SP Mitra (2007) conducted a study on Dietary Intake and Growth Pattern of

children under five years in a slum area of Kolkata. By using random sample

method 540 children were selected between the age of 9 and 36 months and their

mother for information on food consumption by using “24 hours recall method.”

The anthropometric measurement was calculated by using NCHS and also nutritive

value was calculated based on calories and protein. The prevalence of different

grade of malnutrition found to be 61.1 per cent and the rest 38.9 per cent were

normal. Nutrient intake of children ranged from 81 per cent for calorie intake, 80 per

cent for iron, to 60 per cent for vitamin A and 68 per cent for protein which is below

the current RDA of India. The nutrition status of children was very poor in the slum

areas of Kolkata. 81 per cent of children were taking below 50 per cent of calorie as

per the RDA and 68 per cent of children were taking less than 70 per cent of RDA.

60 per cent of children were consumed more than 50 per cent of vitamin A and 80

per cent of children consumed less than 50 per cent of iron as per the RDA.

Prekshi, S.Sehgal, Salil, A. Kawatra, A.K. Bhatnagar (2008) carried out a study

to determine the anthropometric measurements of preschool children affected by

socioeconomic status (4-5 years) in Gurgaon district of Haryana. Totally 300

preschool children (150 boys and 150 girls) were selected randomly by selecting 6

villages namely, Vazirabad, Jharsa, Chakarapur, Badshahpur, Teekli and Palra. The

result showed that the mean height of boys and girls were 87.49 cm and 84.67 cm

respectively, which was radically lesser than the reference value and the mean

33
weight of boys was 13.67 kg and girls was 12.81 kg. Still, weight of boys and girls

was considerably lesser than the reference. Overall, the weights of the boys were

more than the girls, whereas, the height was almost similar. The finding showed that

caste, income, the size of the family, land holding and father’ occupations were the

main reasons for affecting the nutritional status.

Kumar A (2009) carried out a cross-sectional study on the nutritional status of 585

children under-five beneficiaries of Integrated Child development Service in 35

centers of 11 villages situated in rural Karnataka situation in Southern India. The

nutritional status was measured by using the ICDS growth chart and exposed that

32.2 per cent (n=189) of children suffered from malnourishment, out of it, 166

children were suffering from grade I malnourished and 23 children suffer from grade

II malnourished. Girls (46.2 per cent) were more malnourished than boys (33.6 per

cent) and also there was no significant relationship found between the nutritional

status of children and their duration of attending an Anganwadi Centres (p=0.56).

The study concluded that malnutrition was still a significant problem among

children even after attending anganwadis.

Aswini Kumar, Veena G Kamath, Asha Kamath, Chythra R Rao, Sanjay

Pattanshetty, Afrin Sagir (2010) conducted a cross-sectional study on the

nutritional status assessment of under-five children beneficiaries of Integrated Child

Development Services program in rural parts of Karnataka by selecting 35 centers in

11 villages in Southern India. Totally 585 children were selected, out of it, 189 (32.3

per cent) of the children were malnourished, out of it, 166 children were in grade I

malnourishment and 23 children were in grade II malnourishment. Girls (46.2 per

cent) were found to be more malnourished than boys (33.6 per cent). There is no

significant relationship between the nutritional status among children and their

period of attending in an Anganwadi Centre (p=0.56).

34
Vandana P, Shalley A, Srivatava VK, AK Nigam, PK Srivastava (2011)

undertook a cross-sectional study in Lucknow district in the year 2011 to study the

nutritional status of children who received supplementary food for more than one

year under ICDS Scheme. So, in order to study the impact of the nutritional status,

one block was chosen randomly (Kalkori). The result showed that malnutrition in

ICDS group was found to be 45.9 per cent in male, 53.0 per cent in female

(stunting), 11.2 per cent in males and 14.5 per cent in female (wasting) and 39.8 per

cent in male and 41.0 per cent in female (underweight) respectively, while in non

ICDS Utilizes, stunting was 69.2 per cent of male and 64.1 per cent in female,

wasting 22.0 per cent in male and 23.1 per cent in female and underweight was 54.9

per cent of male and 64.1 per cent in female respectively. The mean weight of ICDS

beneficiaries was more than non ICDS utilizes. The researcher concluded that the

reason for undernourishment was due to unbalanced diet among children as

compared to ICMR Standard.

Mohamedanas Patni, Abhay Kavishvar, Mohmmedirfan Monin (2013)

conducted a prospective cohort study on quantitative effect of supplementary

nutrition provided in anganwadi in predicting physical growth of preschoolers

during September 2010 to August 2011. 104 children between three and five years

of age were selected randomly from 6 anganwadi of Jhagadia block of Bharuch

district. The data was collected through pretested and predesigned questionnaires

from the mother of the children at their home and anthropometric measurements

were done at Anganwadi Centres. The child background details were collected from

Anganwadis attendance and the anthropometric measurements were done twice in a

year. The results showed that 70 (67.3 per cent) received sufficient and 34 (32.7 per

cent) did not receive sufficient supplementary nutrition. Weight and height gain

were added in the children who received sufficient supplementary nutrition as

35
compared to the children who did not receive sufficient supplementary nutrition.

The study concluded that supplementary nutrition and the cast of the child were

found to be the most important factors in predicting the weight gain by using

Multivariate analysis.

Mona Narain, Akash Rajender, B.N. Sharma, C.Chaudhary, Gaurav R. Reshu

Gupta (2013) undertook a cross-sectional study among twelve districts namely

Ajmar, Bhilwara, Churu, Bikaner, Jhunjhunu, Nohar, Bharatpur, Alwar,

Pali,Nagaur, Sriganganagar and Tonk in Rajasthan. On the first stage, five

Anganwadi centres (AWCs) were randomly selected from each project and after that

stratified random sampling was made in the second phase to select twelve ICDS

projects (Rural 10 and Urban 2) for the in depth nutritional status investigate. At the

final stage, five Anganwadi centers were selected randomly (AWCs) and overall 60

AWCs included below the age of six years beneficiaries registered. The result

showed those children between zero and three year age group, 29.46 per cent were

found in grade I & II, 0.95 per cent in grade III & IV under-nutrition and 69.52 per

cent normal respectively. The children between 3 and 6 years age group, 69.27 per

cent were found to be normal 31.21 per cent in grade I &II, 0.52 per cent in grade III

& IV under-nourished state and 68.27 per cent normal.

Shibulal.A (2013) carried out a cross-sectional study among children from

anganwadi of the Malapuram district in Kerala. Height and weight of the children

were measured by using standard equipments and procedures. Also structured

questionnaire was used to collect information on birth details, socio-demographic

characteristics, etc. through an interview with the mother. Total 535 children were

selected by using multi stage cluster sampling method. The outcomes showed that

the rates of under-nutrition (37 per cent), stunting (39.5 per cent) and wasting (20.8

per cent) were found to be high in among beneficiaries of ICDS program. There

36
were no significant associations found between male and female, but rural children

were better than the urban children. Under-nutrition was increasing with the age of

the child, birth order, lower social class, and lower levels of immunization and tend

to decrease with reported birth size, increasing maternal age, better maternal

education and better socioeconomic status and father’s employment status.

Asha Ram Tyagi and Sambit Pradhan (2015) conducted a cross-sectional study

on assessment of nutritional status of children under 5 years of age attending rural

and urban Anganwadi Centre of Jabalpur District by using multistage random

sampling. From each area, 25 samples were collected from rural and urban

Anganwadi Centres between 0 and 5 years in the month of March 2012. The result

showed that more rural children (3.7 per cent) were found to be severe underweight

than urban children (1.9 per cent) below 3 years. (Red zone on WHO growth chart)

(p=<0.001). It was observed in 3-5 years moderately underweight (yellow zone)

children were more in rural 29.8 per cent than in urban 20.2 per cent (p=0.001). So,

overall severely and moderately underweight children were significantly more in

rural areas than in urban areas.

Vanita G Pinto Silva, Savita G Pinto Silva (2015) carried out a cross-sectional

study on the nutritional status of anganwadi children under Integrated Child

Development Services Scheme in rural areas of Goa from January to June 2015. By

using simple random sampling method totally 782 children were selected for the

study between aged 6 months and 6 years (72 months). The incidence of

underweight, wasting and stunting in the study was found to be 33.4 per cent, 24 per

cent and 31.5 per cent, respectively. Severely underweight was found to be 9.2 per

cent, 10.4 per cent severely wasted, and 8.7 per cent severely stunted. The result

showed that the ratio of underweight children in the age group of 6-36 months was

higher (38.1 per cent) than the underweight children (24.9 per cent) in the age group

37
of 37-72 months and this disparity was found to be statistically significant at 5 per

cent of the level. Underweight children were found to be higher (51.3 per cent) in

lower class, and the last (17.1 per cent) in upper class and it is statistically

significant between socioeconomic status and nutritional status (p<0.00).

Varsha Kumari and Akanksha Singh (2017) carried out a survey among two

anganwadis (ICDS) in two wards of labor colony, Hisar, during October 2015. The

sample consisted of 60 preschool children between 6 months and 6 years through a

structured questionnaire by using simple random sampling technique.

Anthropometric measurements (height and weight) were used to find out the

nutrition status of the children based on the McLaren’s and Gomez’ classifications.

Based on Gomez classification, 90 per cent children were found to be normal

between 6 months to 1.5 years and 77.14 per cent of children were moderately

malnourished between 3 and 6 year, whereas, McLaren’s classification (height for

age) 80 per cent of children were normal between 6 month and 1.5 years and 67.74

per cent between 3 and 6 years age. Therefore, the researcher concluded that with

the increase in age, malnutrition also increased.

Suganya E, Vrushabhendra H.N and Srikanth S and Sudha (2017) carried out a

cross section study on nutritional status and preference of nutrition supplements

among anganwadi children below 5 years in the year 2015 for a period of two

months by selecting randomly three villages, Rural Field Practice Area, Sri

Venkateshwara Medical College Hospital & Research Centre, Pondicherry. The

most important indicators, weight and height were measured for all beneficiaries’

children by using World Health Organization (WHO) growth standards procedure to

evaluate their nutritional status. The mothers were interviewed about the utilization

supplement and type of nutrition supplement (HCM/THR) utilized by their children

and the reasons for preference by using the chi-square test. Totally 153 children

38
included in the study, 138 (90 per cent) children were consuming Hot Cooked Meals

and rest 15 (10 per cent) children utilized Take Home Ration. The incidences of

underweight, stunting and wasting were 28 per cent, 28 per cent and 38.5 per cent

respectively, and it was statistically significant at 5 per cent. Overall, children who

were receiving HCM were better nourished than THR utilizes and also HCM was

preferred more than THR.

S.P. Giri, S.Biswas and K.Bose (2017) carried out a cross sectional study among

656 (326 boys; 330 girls) between 3 to 5 years old rural preschool children (ICDS)

of Bengalese ethnicity by randomly collected 28 AWC of Sagar Block, South 24

Parganas district, west Bengal, India. Anthropometric measurement was recorded

according to World Health Organization Guidelines standard procedure and <- Z-

scores were used to evaluate the level of stunting, wasting and underweight,

respectively. The overall age and sex combined data showed that rates of stunting,

wasting and underweight were 26.22 per cent, 35.37 per cent and 51.07 per cent,

respectively. The rates of stunting, wasting and underweight were higher among

boys (stunting=28.22 per cent, wasting=40.80 per cent, underweight =53.37 per

cent) compared with girls (stunting=24.24 per cent, wasting=30.00 per cent,

underweight=48.79).

2.4: Reviews on Nutrition Health Education Practices of Mothers with their

Children

Chaturvedi S, Prasad M, and Singh JV (1989) has completed a comparative study

to evaluate mother’s attitude towards child’s Nutrition Health Education and play in

ICDS and non-ICDS areas in two different areas that of Dalmau and Lalganj blocks

of Uttar Pradesh in India, among 419 mothers of children. The study result showed

that there was a major difference in the positive attitude of the mother regarding the

39
child’s health among ICDS children (38.78 per cent) than the non-ICDS children

(17.56 per cent). Also found that mothers in an ICDS block (24.76 per cent of

children) had positive attitude concerning about the child’s education than those in

the non-ICDS block (16.59 per cent) (p=001). The study concluded that the ICDS

program certainly had a great impact on changing positive attitude regarding health

and education.

Vasundhara MK and Harish BN (1993) did a research in Integrated Child

Development Services (ICDS) with 52 Anganwadi Workers (AWWs) and 156

mothers (BMs) of the children in Nelamangala, Bangalore, India, to find out the

practices of mothers managing nutrition. The finding showed that 51.92 per cent of

mothers were illiterate & agricultural laborers and 92 per cent of mothers had

monthly income of less than Rs.300. 86.53 per cent of mothers were aware of the

growth monitoring and 61 per cent knew it’s conducted every month. 42 per cent of

mothers said that AWWs explained the meaning of growth monitoring and the

significance of weight procedures and also 28.84 per cent of mothers said they are

aware of the pre and post weight the consequence. 38.64 per cent of mothers

believed that information had positive effects.

Joshi and Anita (2001) conducted a comparative study of knowledge, attitude and

practices of nutrition of total 480 beneficiary mothers (BMs) and 60 AWWs was

selected. The study was conducted in three blocks of Madhya Pradesh namely

Indore (urban), Sanwer (rural) and Nalcha (tribal). The result showed that AWWs

and BMs in urban areas had maximum awareness about the nutritive value that was

100 per cent & 87.5 per cent respectively, whereas rural and tribal AWWs areas

were somewhat well aware but BMs were lacking in knowledge regarding the same.

Lactating mothers of tribal area had better practices in their diet (milk, egg, dal,

ghee), when compared to urban and rural mothers. Almost all urban AWWs (100

40
per cent) had correct awareness about BF practice within an hour after infant was

born, compared to 85 per cent in rural and 65 per cent in tribal. Likewise, 90 per

cent urban mothers breastfed within one hour in comparison with other group

mothers. The awareness about vaccination was found to be 86.6 per cent in rural,

82.5 per cent in urban and 76.2 per cent in the tribal areas. Both rural and tribal

AWWs and BMs had fair awareness about maintenance of space between child

births, whereas, in urban AWWs were 100 per cent aware that there should be a gap

and 71.3 per cent of BMs. The study concluded that there should be regular training

programme both for AWWs and BMs.

Bhandari N, Bahi R, Mazumdar S, Martines J, Black RE, Bhan MK (2003)

carried out a study on the effect of community based promotion of exclusively

breastfeeding on diarrhea illness and growth in Haryana during the year 1998-2002.

Totally 1115 children were selected from ICDS (552) and non-ICDS (473) group.

The result showed that 79 per cent (n=381) children were exclusive BF at the age of

3 months in ICDS and 48 per cent (n=197) in non-ICDS. The episode of diarrhea

among children in one week was 22 per cent for ICDS group and 30 per cent in non-

ICDS group. The infant between 4 and 6 months, exclusive BF was given at 5 per

cent (n=78) in ICDS and 8 per cent (n=74) in non-ICDS. Again, 13 per cent of

infant between 4 and 6 months had diarrhea in the past one week of survey among

ICDS and 15 per cent for non-ICDS group. The study concluded that exclusive BF

should be followed till 6 months of age.

Anita Singh (2003) conducted a study on some simple nutrition education package

for improving the nutrition of mothers and infant- a pre and Post evaluation in an

ICDS block of Varanasi district in Uttar Pradesh. Total 150 mothers were selected

for the study from the village. The mean age of the mother was 25 years and they

were mostly illiterate and housewives. During pre-evaluation, 63.7 per cent of

41
mothers were not aware about the importance of quality and quantity of diet during

pregnancy and after executing NHE, there was 60 per cent improvement for the

same. Overall, the study showed that there was gain in knowledge about nutrient

requirements during pregnancy (60.00 per cent), the significance of colostrums

breastfeeding (100.00 per cent) and supplementary feeding (33.40 per cent).

Sumati vaid and Nidhi Vaid (2005) conducted studies on Nutritional Status of

ICDS and non-ICDS children, their mothers in Resham Ghar Colony of Jammu city

(Jammu and Kashmir State). Purposive sampling technique was used to collect data

through Interview, checklist and recall dietary method. The finding showed that

most of the mothers had awareness about the nutritional status of children through

Anganwadi Workers and all the mothers’ noticed some changes in children after

enrolling in anganwadi centre. Mother immunized their children in Primary Health

Centres. It was found that children who attended Anganwadi Centres had good

health or appearance as compared to their counterparts.

Rajni Dhingra and Iffat Ghani (2013) conducted a study on the Knowledge of

ICDS women beneficiaries in the district Bugam of Kashmir region regarding

prenatal care in the years 2011.Totally 600 beneficiaries were randomly selected

from four blocks. The outcome of the survey showed that maximum (79.1 per cent)

of the mother were aware about the significance of medical discussion during

pregnancy and about 48.65 were fully aware with proper time of consultation. All

the mothers were aware of weight gain during pregnancy, importance of timing of

TT vaccination during pregnancy to avoid pregnancy complications in order to

reduce maternal mortality.

42
Deepak Upadhya, Mithila Bisht, Shyam Sunder Deepti, Tejbir Singh (2014)

conducted a cross sectional study regarding awareness among mothers of children

from 12 to 23 months about growth charting and its determinants in rural areas of

Verka block of district Amritsar from January to May 2012. By using stratified

random sampling methods total of 186 children were selected through the interview.

38.17 per cent of mothers had a low level of awareness regarding the growth chart

and there was a significant relationship between the socioeconomic status and

educational level with the presence of awareness among mothers.

Uzma Eram and Tamanna Z (2015) conducted a cross-sectional study on

knowledge, attitude and practices of breastfeeding in rural areas of Aligarh from

May to June, 2015 in the rural areas of registered villages of rural Aligarh. The

sample comprised of mothers who had an infant below 12 months age and totally 70

mothers were chosen for the study. Almost all the mothers’ breast fed their infants

within an hour. More than half of mothers, i.e 55.7 per cent exclusively breastfed for

6 months while 44.2 per cent did not practice. Majority of mothers i.e 97.1 per cent

gave colostrums and the rest did not discard. Nearly all the mothers knew the

significance of breastfeeding.

Sarbjit Singh Kular (2016) conducted a study to examine the impact of Nutrition

and Health Education (NHE) of ICDS on the pregnant women in terms of enhancing

their knowledge into practice. The study was conducted in all three ICDS projects in

Bamala, Sehna and Mehal Kalan of the Bamala District of Punjab. From each

project 10 villages were selected (total 30 villages) randomly. Two pregnant women

were selected randomly from the village. So, totally 60 pregnant women were

sampled from all 30 villages of anganwadi which were running at least 25 years of

ICDS scheme. It was found that 80 per cent of the pregnant women received two

doses of tetanus toxoid and 63.32 per cent received iron and folic acid tablets as per

43
nutrition norms. 66.66 per cent of the pregnant women did not receive

supplementary nutritious food from the anganwadi and also women were not aware

about initial breastfeeding for a newly born infant. More than three-fourth (81.66 per

cent) of the pregnant women were not aware of different types of vaccination name

given to their children. 81.66 per cent mother knew the introduction of weaning food

on time and 91.4 per cent of mothers knew to continue breastfeeding even after

introducing weaning food. The study concluded that most of the rural women were

aware of breastfeeding.

Research Gap:

From the above reviews of literature, the researcher found that almost all the

studies are based on the weight of the children. The dependent variable taken is

weight-for-age of the children, i.e underweight; which is only a short term

malnutrition. Underweight varies from month to month based on many direct or

indirect factors, the child may gain or lose weight in a short period of time. But in

the case of height-for-age indicator has long term impact on chronic malnutrition.

The negative effects of chronic malnutrition can even reach the next generation.

So, the researcher is using Height for Age (H/A) score to identify the determination

of under-nutrition for better policy recommendations for reducing child

malnutrition. Moreover, there is no study pertaining to Kalvarayan Hills of

Villupuram District which ranks low in Human Development Index, Child

Development Index, and Multidimensional Poverty Index.

44