Diet and nutritional status of rural preschool children in Punjab.

OBJECTIVE: To assess diet and nutritional profile of rural preschool children of Punjab. STUDY DESIGN: Multistage random sampling method was adopted by following probability proportion to population size (PPS). SUBJECT: Four hundred households (HH) were covered in each district of Punjab for socio-economic and demographic information. All the available individuals from these HHs were included for anthropometry and clinical examination. Every fourth household was covered for 24-hour recall method of diet survey (individual dietary intake). RESULTS: At the state level, the intake of macro and micronutrient rich foods such as cereals, pulses and green leafy vegetables, milk and milk products and fats and oils were lower than the RDI among preschool children. Except for protein, calcium and thiamine, the mean intake of all the nutrients was lower than the recommended level. About a half of the preschool children (50.3%) were undernourished (> 2SD weight for age); 60% were stunted (> 2SD height for age) and 12% were wasted (> 2SD weight for height). The extent of undernutrition and stunting was lower than that reported for the country. There was significant variation in the prevalence of severe stunting between the districts (p < 0.001), with the highest being observed in the Rupnagar (55%) and the lowest in Hoshiarpur and Sangrur (30% each). CONCLUSION: Despite, the reported high rates of economic growth and food production in the state, a higher proportion of preschool children were consuming diets, which are inadequate with respect to energy, fat, iron, riboflavin, vitamin A and vitamin C. The prevalence of undernutrition was high as was found in other states.

Profile of drug use in urban and rural India.

Information on pharmacoepidemiology is particularly important in developing countries where a rational drug policy has not been adopted. In the present study, a profile of 1769 doctors' prescriptions and 763 self-orders were monitored at pharmacy outlets in the twin cities of Hyderabad and Secunderabad and 4 rural areas of Andhra Pradesh with the aim of identifying urban and rural differences, if any, in the self-medication rate, prescription costs, types of drugs purchased and factors influencing self-medication. Self-medication, expressed as the percentage of the total population that self-medicates, was found to be high in urban areas (37%) compared with rural areas (17%), and the majority of the over-the-counter sales were for prescription-only drugs. The majority of physicians' prescriptions were incomplete with respect to diagnosis and dosage regimen. The mean cost of the drugs purchased on doctors' prescriptions was 2-fold higher than the cost of drugs sold over the counter. A higher proportion of patients from rural areas (80%) purchased all the prescribed drugs compared with those from urban areas (54%). Financial constraints in urban areas were a major determinant in the partial purchase of prescribed drugs. In addition, the urban elite (i.e. professional people with high incomes, who comprise 18% of the total population) considered that all of the prescribed drugs were not necessary for their present disease. Nutritional products, potent compounds with analgesic, antipyretic and anti-inflammatory effects, and broad spectrum antibiotics constituted a high proportion of prescriptions in both urban and rural areas. The consumption of food supplements was higher in rural areas than in urban areas. Based on WHO criteria, most of the drugs (60%) prescribed in rural areas were nonessential, compared with 47% in urban areas. The results of this study emphasise the need for comprehensive measures, including information, training, legislation and education at all levels of the drug delivery system, to rationalise drug therapy by improving prescribing patterns and influencing self-medication.

Nutritional status of tribal preschool children in three ecological zones of Madhya Pradesh.

A health and nutrition survey was conducted on tribals in three ecological zones of Madhya Pradesh namely Jhabua (West Zone), Bastar (South Zone) and Sarguja (East Zone) taking into consideration the relative contribution of agriculture, forest and a combination of both to the economy, respectively. The consumption of both foods and nutrients appear to be worse among preschool children of Jhabua compared to Bastar and Sarguja. Clinically overt forms of Protein Energy Malnutrition and other vitamin deficiency signs were strikingly low. However, 4% of children in Sarguja exhibited signs of goitre. Both by extent and severity of malnutrition, the children of Jhabua appear to be worse followed by Bastar and Sarguja.

PIP: The study examined the health and nutritional status among tribal pre-school children in a variety of ecological zones in Madhya Pradesh state, India. The sample was a multi-stage random sample villages according to the availability of health services. 1401 pre-school age children were selected from Sarguja (351), an agricultural and forested area; from Bastar (731), a forest economy; and Jhabua (319), an agricultural economy. Food intake was determined by a 24-hour recall survey; a clinical examination was performed to determine nutritional status. Deficiencies in growth were determined based on measurement methods established by Gomez and Waterlow. The standard values were based on the 50th percentile of the US National Center for Health Statistics. Gopalan et al.'s Food Composition Tables were used to calculate the nutritive value of Indian foods. The results showed that the staple food grains in Sarguja and Bastar were rice; millets, maize, and jowar were the basic grains eaten in Jhabua. Milk intake was very low in all districts, but people also consumed a variety of pulses, leafy vegetables, roots and tubers, and wild fruits. Cereal intake was highest in Bastar (210 g) and Sarguja (193 g) among children 1-3 years old. These areas had higher intake of cereals and millets than the recommended dietary allowances of ICMR. Children in Jhabua had low intake of cereals and millets. Only Sarguja (31 g) had close to the recommended intake of pulses: 35 g. Pulse intake was 13 g in Bastar and 7 g in Jhabua. Intake of GLV; other vegetables, roots and tubers; milk, fats and oils, and sugar and jaggery was under the recommended values in all three districts. Only 35% of recommended intake of calories was met among children in Jhabua compared to 60% in the other two districts. Jhabua was the least close to recommended protein intake. This tribal sample had low clinical forms of protein energy malnutrition and vitamin A deficiency compared to others in the rural districts. Some iodine deficiency appeared among 4% of children in Sarguja. Tribal children were smaller and weighed less than the NCHS standard. Children from Sarguja tended to be taller and heavier than other Madhya Pradesh rural children. Malnourishment was 11.7% in Sarguja, 23.5% in Bastar, and 26.0% in Jhabua; stunting was respectively 50%, 48%, and 59%. 33.6% in Sarguja, 27.1% in Bastar, and 17.3% in Jhabua were normal based on Waterlow's Classification.

Effect of massive dose vitamin A on morbidity and mortality in Indian children.

The effect of vitamin A supplementation on preschool child morbidity and mortality was assessed in a prospective double-blind placebo-controlled study around Hyderabad, India. Every six months 200,000 IU vitamin A was given to 7691 children (treatment group) whereas 8084 children received a placebo (control group). Morbidity and mortality data were collected every three months. Risk of respiratory infection was higher in children with mild xerophthalmia than in children with normal eyes. Vitamin A supplementation had no effect on morbidity status. Mortality rates were similar in the two groups; it was highest in children who did not receive either vitamin A or placebo. The findings suggest that vitamin A supplementation alone may not reduce child mortality.

The adolescent growth spurt of height among rural Indian boys in relation to childhood nutritional background: an 18 year longitudinal study.

The Adolescent Growth Spurt (AGS) was studied in rural Hyderabad boys of 5+ years of age with known childhood nutritional background. Longitudinal data on height measurements of pre-school children available for 13 to 16 points of follow-up, during an 18 year period of study (i.e., from 1965-66 to 1983-84) were utilized for this purpose. A Preece and Baines model 1 (PB 1) function was fitted for height measurements of 323 boys aged 19-24 years in 1984. The boys were classified into three groups according to degree of under-nutrition at the age of 5+ years, using Boston reference values for height. Boys with severe height deficit at age 5+ were considered to have had a background of severe undernutrition and were referred as Group III. Boys with normal range height measurements at age 5+ were considered to have a normal nutritional background and were referred to as Group I. Group II boys had height deficits in between the above two groups and were considered to have milk to moderate undernutrition backgrounds. Group I boys had similar timing, intensity, duration of Adolescent Growth Spurt Period (AGSP) and gained a similar amount of height during puberty as did British boys. Group III boys differed significantly from British boys for AGS. They entered late into puberty, with significantly depressed intensity, but gained a similar amount of height, as a result of prolonged AGSP, which continued till 19.2 years. Thus a childhood background of undernutrition did not lead to any additional deficit in height during puberty. However, pre-pubertal height deficits were carried into adult height. The growth curves of rural Hyderabad children were parallel to the British distance height curve after 12 years of age. The mean constant height velocity curve of group I boys was superimposable on the British curve during puberty.

Nutritional profile of preschool children of armed forces families around Hyderabad.

Three hundred and fifty three preschool children (1 to 5 years) belonging to armed forces families of non-officers (who often come from rural background) stationed at Military Station, Golconda, Hyderabad were studied for their clinical examination and anthropometric status. Diet survey by oral questionnaire was also carried out on a sub-sample of 48 children. The heights and weights of children from families of armed forces were far superior to those of rural Indian preschool children, but they were marginally shorter and lighter than those of well-to-do Hyderabad children. About 92% of the children had weights above 80% of Harvard median. The practical implication of these findings is that the children of rural families, with the usual socioeconomic constraints, when provided with steady income and comprehensive health care can be expected to achieve a growth status which is almost comparable to that of well-to-do children.

A drug survey--precepts and practices.

An attempt has been made to quantitate drug consumption in a conurbation. The prescribing habits of physicians, self medication rate and therapeutic classes of drugs purchased have been evaluated. The study indicates that some of the prevailing practices in the area are unhealthy. The high self medication rate, faulty prescribing habits of physicians and liberal dispensing methods of pharmacist need to be viewed with concern. The wide gap between the precepts and practices prevailing among practitioners, the use of potent medicines without proper medical advice and the uninhibited sale of scheduled drugs over the pharmacy counter require careful consideration. If such unhealthy trends persist iatrogenic problems may surface in the near future. The physician, pharmacist and the public need to cooperate to create the proper pattern of drug usage.

Studies on interactions of vitamin E with thiamine, niacin and vitamin B12.

The effects of simultaneous administration of thiamine, niacin or vitamin B12 with vitamin E on plasma vitamin E levels were studied in 20 adult male volunteers belonging to the low socio-economic class. The effect of vitamin E on the nutritional status of pyridoxine, riboflavin and thiamine as judged by the erythrocyte enzymes, aspartate aminotransferase, glutathione reductase and transketolase, respectively was also studied. None of the members of the B-complex vitamins studied here had any effect on plasma vitamin E levels. This was in contrast to the observation made earlier that pyridoxine and riboflavin can reduce plasma vitamin E. There was a transient reduction in both the basal and stimulated activities of erythrocyte aspartate aminotransferase, the significance of which needs further investigation.

Relationship between biochemical and clinical indices of B-vitamin deficiency. A study in rural school boys.

1. A study amongst schoolboys in villages around Hyderabad, India, showed that almost all the boys had riboflavin deficiency, 61% had pyridoxine deficiency, and 9.4% had thiamin deficiency as judged by enzymic tests. 2. The prevalence of angular stomatitis was 41.3% and that of glossitis was 18.2%. Biochemical deficiency of riboflavin and pyridoxine was marginally higher in children with angular stomatitis with or without associated glossitis, than in children without oral lesions. 3. Treatment with B-complex vitamins (containing 4 mg riboflavin and 10 mg pyridoxine) daily for 1 month produced significant reduction in the prevalence of glossitis but had no effect on angular stomatitis. The latter responded to topical application of gentian violet. 4. Small but significant changes in erythrocyte enzymes occurred over the period of 1 month even without vitamin supplements. 5. Results suggest that while glossitis is a relatively early manifestation of riboflavin or pyridoxine deficiency or both, angular stomatitis has a more complex aetiology perphaps associated with infection.