Vitamin A Deficiency, Anemia, and Nutritional Status of under 5-Year Children from Northeast India.

BACKGROUND: Vitamin A deficiency (VAD) and Anemia are important public health nutritional problems in India. OBJECTIVE: To assess nutritional status and prevalence and correlates of undernutrition, anemia, and VAD among children. MATERIALS AND METHODS: A community-based cross-sectional study was carried out adopting systematic random sampling. Information on socio-demographic particulars was collected and 20 µL blood was collected for hemoglobin and free-flowing drop on Whatman filter paper for Vitamin A estimation. Hemoglobin was estimated using indirect cyanmethemoglobin and Vitamin A by high-pressure liquid chromatography. Nutritional status was assessed using the WHO Child Growth Standard. RESULTS: The overall prevalence of anemia and VAD was 68% and 59%, respectively, while underweight, stunting, and wasting was 30%, 55%, and 11%, respectively, among under 5 year children. Stepwise logistic regression analysis revealed no significant association of anemia and VAD with any sociodemographic variables, while the odd of stunting was four times higher among children of mothers engaged in labor and two times among children from low-income group, while underweight was two times higher among children from households not having sanitary latrine. Exclusive breastfeeding was observed to be associated with undernutrition among infants. CONCLUSIONS: Anemia, VAD, and stunting were high among children. Low intakes of green leafy vegetables and milk and milk product may be the reasons for the higher prevalence of anemia and VAD. There is a need to strengthen supplementation of iron and folic acid tablets and Vitamin A and also public distribution system.

Current scenario of consumption of Lathyrus sativus and lathyrism in three districts of Chhattisgarh State, India.

Lathyrism is a disease caused by excessive consumption of grass pea, Lathyrus sativus especially under conditions of severe drought. Grass pea contains 3-N-oxalyl-L-2, 3-diaminopropanoic acid (ß-ODAP) a putative neurotoxin which acts through excitatory mechanism causing Neurolathyrism. Due to awareness of the disease, availability of food and levels of consumption of L. sativus there is reduction in lathyrism cases where higher consumption of L. sativus is reported in India. The present study was undertaken with the objective to assess the current scenario of consumption of L. sativus, incidence of cases of lathyrism, ß-ODAP, protein and amino acids content in L. sativus pulse collected from three districts (Bilaspur, Durg and Raipur) of Chattisgarh state. For this purpose, a total of 17,755 (13,129 rural and 4626 urban) individuals from 151 villages and 60 wards from urban area were covered for clinical examination. Out of total 5769 households (HHs) covered during the survey, 1602 HHs were cultivators, 1791 HHs non-cultivators and 2376 agricultural and other labourers. A one day 24-hour re-call diet survey was carried out in 5758 HHs (4549 rural and 1209 urban). A total of 360 split grass pea (SGP) samples were collected to estimate ß-ODAP, protein and amino acids content. Results of the study revealed that an average consumption of SGP was 20.9 gm/CU/day in Bilaspur and no consumption was reported among urban population of Raipur. Only nine old cases of lathyrism were found during the study. The mean ß-ODAP content in SGP was 0.63 ±â€¯0.14, 0.65 ±â€¯0.13 and 0.65 ±â€¯0.14 gm/100 gm, whereas the protein content was 27.0 ±â€¯2.39, 27.0 ±â€¯1.99 and 26.7 ±â€¯1.90 gm/100 gm in samples collected from Bilaspur, Durg and Raipur districts respectively. Arginine content was high in SGP and sulphur containing amino acids (cysteine and methionine) were less than other amino acids. In conclusion, the consumption of SGP was lower in these three districts with lower ß-ODAP content than earlier reports, thus the lower prevalence of lathyrism in the districts surveyed.

Trends in nutrient intakes, nutritional status, and correlates of undernutrition among rural children below 5 years of age: The National Nutrition Monitoring Bureau Survey 2012.

BACKGROUND: In spite of several national nutrition intervention programs that have been in operation since the past four decades, undernutrition continues to be an important public health problem in India. AIM: The aim of the present study was to assess the trends in food and nutrient intakes and nutritional status of children in India below 5 years of age. SETTING AND DESIGN: A community-based, cross-sectional study was carried out in ten National Nutrition Monitoring Bureau states by adopting a multistage random sampling procedure. METHODS: Data were collected on the household (HH) socioeconomic and demographic particulars, and anthropometric measurements of the children, such as their length/height and weight, were noted. A 24-h dietary recall method was used for assessing dietary intake. RESULTS: Intake of all the foodstuffs except pulses, vegetables, and fats and oils declined over a period of time (1975-1979 to 2011-2012) while the intake of all the micronutrients except Vitamins A and C declined during the same period. The prevalence of undernutrition, i.e. underweight, stunting, and wasting has declined from 76%, 82%, and 27%, respectively in 1975-1979 to 42%, 44%, and 19%,respectively, in 2011-2012 among 1-5 year children. The severe form of undernutrition has also declined during the same period. The prevalence of undernutrition was significantly (P < 0.01) higher among children of illiterate mothers, those belonging to lower socioeconomic status, and those living in nuclear families. CONCLUSIONS: The prevalence of undernutrition declined over the period despite the decrease in food and nutrient intake. However, the pace of decline was slower and it was attributed to improved health-care services coupled with control of communicable diseases and increase in the HHs income. Further efforts are needed to improve the literacy of parents, environmental and personal hygiene, along with the food security of HHs through a public distribution system.

Regional variation in the prevalence of overweight/obesity, hypertension and diabetes and their correlates among the adult rural population in India.

A community-based, cross-sectional study was carried out in five regions of India by adopting a multistage random sampling procedure. Information was collected from the participants about socio-demographic particulars such as age, sex, occupation, education, etc. Anthropometric measurements such as height, weight and waist and hip circumferences were measured and three measurements of blood pressure were obtained. Fasting blood sugar was assessed using a Glucometer. Data analysis was done using descriptive statistics, χ(2) test for association and logistic regression analysis. A total of 7531 subjects were covered for anthropometry and blood pressure. The overall prevalence of overweight/obesity and abdominal obesity was 29 and 21%, respectively, and was higher in the Southern region (40% each) as compared with other regions. The prevalence of hypertension was 18 and 16% and diabetes was 9·5% each among men and women, respectively. The risk of hypertension and diabetes was significantly higher among adults from the Southern and Western regions, the among elderly, among overweight/obese individuals and those with abdominal obesity. In conclusion, the prevalence of overweight/obesity and hypertension was higher in the Southern region, whereas diabetes was higher in the Southern and Western regions. Factors such as increasing age, male sex, overweight/obesity, and abdominal obesity were important risk factors for hypertension and diabetes. Appropriate health and nutrition education should be given to the community to control these problems.

Trends in nutritional status and nutrient intakes and correlates of overweight/obesity among rural adult women (≥18-60 years) in India: National Nutrition Monitoring Bureau (NNMB) national surveys.

OBJECTIVE: To assess trends in nutrient intakes and nutritional status of rural adult women (≥18-60 years) and the association of sociodemographic characteristics with overweight/obesity. DESIGN: Community-based cross-sectional studies carried out during 1975-79 to 2011-12 by the National Nutrition Monitoring Bureau (NNMB) were used. Anthropometric measurements such as height, weight and waist circumference, carried out during the surveys, were used. Association and logistic regression analyses between sociodemographic characteristics and overweight/obesity and abdominal obesity were conducted using a complex samples procedure. SETTING: Ten NNMB states of India. SUBJECTS: Non-pregnant and non-lactating rural women aged ≥18-60 years covered during the above periods from ten states in India. RESULTS: The prevalence of chronic energy deficiency has declined from 52 % during 1975-79 to 34 % during 2011-12, while that of overweight/obesity has increased from 7 % to 24 % during the same period. Median intakes of most of the nutrients have increased over the same period, although they were below recommended levels. The chance of overweight/obesity and abdominal obesity was significantly (P<0·01) higher among women aged 40-60 years, those belonging to Christian religion and other backward communities, women living in pucca houses, literate women, women engaged in service and business, and those having higher per capita income. CONCLUSIONS: Prevalence of chronic energy deficiency has declined significantly; however, overweight/obesity has increased during the same period. This increase in overweight/obesity may be attributed to increased consumption of fatty foods, sedentary lifestyle and improved socio-economic status. There is a need to educate the community about regular physical exercise, low intakes of fats and oils, and a balanced diet.

Socio-economic & demographic determinants of hypertension & knowledge, practices & risk behaviour of tribals in India.

BACKGROUND & OBJECTIVES: An increase in prevalence of hypertension has been observed in all ethnic groups in India. The objective of the present study was to estimate prevalence and determinants of hypertension among tribals and their awareness, treatment practices and risk behaviours in nine States of India. METHODS: A community based cross-sectional study adopting multistage random sampling procedure was carried out. About 120 Integrated Tribal Development Authority villages were selected randomly from each State. From each village, 40 households were covered randomly. All men and women ≥ 20 yr of age in the selected households were included for various investigations. RESULTS: A total of 21141 men and 26260 women participated in the study. The prevalence of hypertension after age adjustment was 27.1 and 26.4 per cent among men and women, respectively. It was higher in the s0 tates of Odisha (50-54.4%) and Kerala (36.7-45%) and lowest in Gujarat (7-11.5%). The risk of hypertension was 6-8 times higher in elderly people and 2-3 times in 35-59 yr compared with 20-34 yr. Only <10 per cent of men and women were known hypertensives and more than half on treatment (55-68%). Men with general and abdominal obesity were at 1.69 (CI: 1.43-2.01) and 2.42 (CI: 2.01-2.91) times higher risk of hypertension, respectively, while it was 2.03 (CI=1.77-2.33) and 2.35 (CI 2.12-2.60) times higher in women. Those using tobacco and consuming alcohol were at a higher risk of hypertension compared with the non users. INTERPRETATION & CONCLUSIONS: The study revealed high prevalence of hypertension among tribals in India. Age, literacy, physical activity, consumption of tobacco, alcohol and obesity were significantly associated with hypertension. Awareness and knowledge about hypertension and health seeking behaviour were low. Appropriate intervention strategies need to be adopted to increase awareness and treatment practices of hypertension among tribals.

Prevalence and determinants of undernutrition and its trends among pre-school tribal children of Maharashtra State, India.

A community-based cross-sectional study carried out in tribal areas of Maharashtra covering 1751 pre-school children to assess nutritional status. Nutritional status was assessed using new WHO Growth Standards. Household wealth index was constructed using principle component analysis. The prevalence of underweight, stunting and wasting was 64, 61 and 29%, respectively. There was a significant (p < 0.05) reduction in the prevalence of underweight and stunting over two time periods (1999 and 2008). Logistic regression showed that the risk of underweight was 1.7 times higher among children of illiterate mothers and those suffering from morbidities, while stunting was 1.4 times higher among children belonging to lowest and middle household's wealth indexes. Undernutrition is a public health problem and is associated with literacy of mother, household wealth index and morbidities. Therefore, improving socio-economic condition along with literacy of mothers and preventing infections through personal hygiene might help in improving the nutritional status of children.

Impact of feeding and breastfeeding practices on the nutritional status of infants in a district of Andhra Pradesh, India.

BACKGROUND: Infant feeding practices have a major role in determining the nutritional status of children and are associated with household socioeconomic and demographic factors. We did a cross-sectional household study to assess feeding practices of infants and young children in rural areas of Medak district, Andhra Pradesh. METHODS: A total of 805 child-mother pairs were included using systematic random sampling. Age-specific feeding patterns were described using frequencies, proportions and survival analysis. Logistic regression was done with feeding practice as dependent and sociodemographic factors as independent variables. RESULTS: Breastfeeding was universal in the study area. Only 22% of mothers initiated breastfeeding within one hour whereas 44% initiated it within three hours after delivery. The median duration of exclusive breastfeeding was 5.5 months. Pre-lacteal use was high (44.7%). Only 41% of infants were exclusively breastfed for 6 months and 58% of infants (6-11 months) received complementary feeding at 6-9 months of age. Timely initiation of breastfeeding and exclusive breastfeeding for 6 months was significantly more likely among mothers belonging to scheduled castes and scheduled tribes (OR 0.27, 95% CI 0.10-0.76 and OR 0.24, 95% CI 0.08-0.76). Timely initiation of complementary feeding was more likely among scheduled caste and scheduled tribe communities (OR 0.24, 95% CI 0.11-0.54). CONCLUSION: Early initiation of breastfeeding (within an hour of birth) and other feeding practices were associated with community, type of family and education of mother. Efforts are needed to promote early initiation of breastfeeding, exclusive breastfeeding for 6 months and age-appropriate complementary feeding among infants.

Prevalence of hypertension, its correlates and awareness among adult tribal population of Kerala state, India.

BACKGROUND: Increasing prevalence of hypertension is a public health problem in India. AIMS: To study prevalence, correlates, and awareness of hypertension among tribal adult population in Kerala. SETTING AND DESIGN: A community-based, cross-sectional study was carried out in tribal areas of Kerala by adopting multistage random sampling procedure. MATERIALS AND METHODS: Data was collected on socio-demographic and behavioral factors, and anthropometric measurements were carried out. Body mass index (BMI) was categorized using the classification recommended for Asians. Waist circumference ≥ 90 cm for men and ≥ 80 cm for women was used cut off for defining an abdominal obesity. Bivariate and multivariate analysis was carried out to study association of hypertension with socio-demographic variables, personal habits, and obesity. RESULTS: A total of 4,193 adults (men 1,891, women: 2,302) of ≥ 20 years of age were covered. The overall prevalence of hypertension was 40% (n=1671). The prevalence of hypertension increases with increase in age among both the genders. Regression analysis showed that the risk of hypertension was significantly (P<0.001) lower among educated and among higher socio-economic status group. Sedentary activity had 1.3 times (CI=1.09-1.60) and alcohol consumption had 1.4 (CI=1.17-1.73) times higher risk of hypertension. The risk of hypertension was 1.7 times higher among overweight/obese subjects. Overall, only 10% (n=164) of the adult population was aware of hypertension status, and about 8% (n=129) were on regular treatment. CONCLUSION: It was observed that the prevalence of hypertension was higher among tribal adult population of Kerala and was associated with age, gender, education, HHs wealth index, physical inactivity, alcohol consumption, and overweight/obesity.

Prevalence of under-nutrition and its correlates among under 3 year-old children in rural areas of Andhra Pradesh, India.

BACKGROUND: Under-nutrition continues to be a major public health problem, especially among young children in India. The present study was undertaken to assess the nutritional status of under-3 year-old children and factors associated with under-nutrition. METHOD: A community-based cross-sectional survey was carried out in 40 Anganwadi centre villages of Medak district of Andhra Pradesh, India. A total of 805 children were selected for nutritional assessment in terms of under-weight, stunting and wasting using the new WHO growth standards. Wealth index was calculated using principal components analysis. A conceptual hierarchical framework was used as a basis for controlling for the explanatory factors in multivariate analysis. RESULTS: Prevalence of under-weight, stunting and wasting was ~39%, 30% and 22%, respectively. The risk of under-weight and stunting was 1.80- and 3.02-times higher among 12-23 months and 3.13- and 5.50-times higher among 24-36 months children as compared to children under 12 months, respectively. The risk of under-weight was 2.74- and 1.73-times higher among children belonging to the lowest and middle household wealth index, respectively. CONCLUSIONS: Under-nutrition is a significant public health problem among under 3 year-old children. The prevalence of under-nutrition was significantly higher among boys and those belonging to the lowest and middle wealth index. Thus, implementation of appropriate nutritional intervention strategies and improvement in household socio-economic condition may help in improving nutritional status.