INTRODUCTION:

Nutritional status of children provides an indirect measurement of quality of life of an entire population. Under nutrition is a major threat to the survival, growth and development of Indian children. They are vulnerable to malnutrition due to low dietary intake, lack of child care, intrauterine growth retardation and a high rate of infectious diseases. The prevalence of underweight is extremely high in South Central Asia which accounts for almost half of the global problem.

Children below the age of 5 years constitute 15% of the total population of country and from nutritional point of view they form a vulnerable segment. The factors affecting child malnutrition is very complex and are influenced by multidimensional factors which have not yet been much explored specially among the tribes of Chhattisgarh. Child associated severe malnutrition so that appropriate nutrition. The present study was confined to Kamars which is a particularly vulnerable tribal group of Chhattisgarh.

Kamars are known as jungle tribe of Dravidian origin. They are the original inhabitants of Chhattisgarh. They earn their living by making bamboo items. They are known for their skill and they supplement their income by selling forest produce collected by them. Earlier studies (Mitra et al. 2006) have shown that Kamars have a high degree of child malnutrition and has been reported to have unique cultural, social, economical and demographical characteristics. Therefore, an attempt has been made to assess the nutritional status of Kamar children aged 12-59 months from Dhamtari district of Chhattisgarh. Kamars inhabit the hill districts of Raipur, Bilaspur, Durg and Sarguja and mainly concentrated in Gariaband and Dhamtari. According to census 2011 the total population of Kamar is 26,530 which is almost 0.34% of the scheduled tribe of the state.

Dhamtari district of Chhattisgarh state has 342 villages. It comprises of three tahsils and four blocks viz. Dhamtari, Nagri, Kurud and Magarlod. Out of the four blocks only two blocks were selected for the present study. Predominantly Kamar inhabited villages were selected purposively from Nagri and Magarlod block of Dhamtari district. Twenty villages each having more than twenty Kamar families were selected. All the households having 12-59 months were selected for data collection. In total 198 households were selected for the present study. 248 Children (123 boys and 125 girls) aged 12-59 months and their mothers/ care takers formed the sample for the present study. It was a cross sectional population based study. Interview schedule was developed pertaining to the demographic characteristics of household, nutritional status of children, child care practices, immunization status of children, clinical signs of malnutrition, mother’s nutritional status, etc. An attempt was made to assess the magnitude of child malnutrition and the factors affecting it among Kamar tribe of Dhamtari.

Techniques of Martin and Saller (1959) was followed for taking the anthropometric measurements. Z scores for height for age (HAZ), weight for age (WAZ) and weight for height (WHZ). Children who were below the median of the reference standards for these indicators were classified as stunted, underweight and wasted respectively. SPSS version 16.0 was used for data analysis.

RESULTS:

The data was analyzed and the results have been presented in table no.1-7. The age and gender structure of Kamar population showed that 49.46 % of the population were males and 51.51 % were females. 32.19 % of the population belonged to 0-5 years and the percentage decreased with the increase of age as observed in other populations. Majority of the respondents were either agricultural labourer or were observed to be working as a labourer in the field of others.

About half of the respondents possessed <2.5 acres of land and 28.79 % were observed to be landless. There were no irrigation facility and their fields were barren. Very few of the kamars have a monthly income of >4000-6000 Rupees and majority of them could be classified under Rs 500-2000 income group. Only 2.02 % had the facility of toilet located outside their house and majority of them were devoid of toilet facility. They had only a single connection of electricity facility.

61.61% of the males and 32.83% of the females were illiterate. The primary school education attainment of the males was 43.95% and it was 29.81% in females. Majority of the Kamar households had ≥4 family members. 95.96% of the families were of nuclear type. Monogamy was the general practice of marriage type. 65.66% of the Kamar women had their first conception at the age of 16-19 years .Birth order varied from 1-4 in majority of the cases. Majority of the Kamars had semi-pacca type of house.

Table no. 1 Table showing distribution of Kamar Population according to age and gender

S. No.	Age in years	Males		Females		Total
S. No.	Age in years	No	Percent	No	Percent	No	Percent
1	0-5	142	15.71	149	16.48	291	32.19
2	6-10	65	7.20	77	8.51	142	15.71
3s	11-15	30	3.32	31	3.43	61	6.75
4	16-20	8	0.89	19	2.10	27	2.99
5	21-25	52	5.76	94	10.39	146	16.15
6	26-30	81	8.97	63	6.96	144	15.93
7	31-35	43	4.76	22	2.43	65	7.19
8	36-40	11	1.22	5	0.55	16	1.77
9	41-45	5	0.55	2	0.22	7	0.77
10	46-50	1	0.11	2	0.22	3	0.33
11	51-55	0	0	2	0.22	2	0.22
Total		438	48.49	466	51.51	904	100

Table no. 2 Educational level of Kamars

Education	Mothers	%	Fathers	%	Total	%
Illiterate	122	61.61	65	32.83	187	47.22
Primary	59	29.81	87	43.95	146	36.88
Middle	16	8.08	32	16.16	48	12.12
Secondary	1	0.05	10	5.05	11	2.78
Higher Secondary	0	0	3	1.51	3	0.75
Graduation and above	0	0	1	0.50	1	0.25
Total	198	100	198	100	396	100

Table no. 3 SES among the Kamar respondents according to Kuppuswamy scale (2017)

Socio-economic level	Number	Percentage
Upper lower class	2	1.01
Lower class	196	98.99
Total	198	100

Table no. 4 Height for age Z score of the Kamar children under study

Z-Score	Sex	12-23 Months	%	24-35 months	%	36-47 months	%	48-59 months	%
-1 < HAZ < 0 Normal (Well nourished)	Boys	6	19.35	3	11.11	6	15.38	1	3.85
-2 < HAZ <-1 Marginally Stunted (Mildly Malnourished)	Boys	6	19.35	4	14.81	9	23.07	10	38.46
-3 < HAZ <-2 Moderately Stunted (Moderately Malnourished)	Boys	10	32.26	7	25.93	13	33.33	9	34.62
HAZ <-3 Severely Stunted (Severely Malnourished)	Boys	9	29.04	13	48.15	11	28.22	6	23.07
Total		31	100	27	100	39	100	26	100
-1 < HAZ < 0 Normal (Well nourished)	Girls	5	18.52	1	4.16	2	4.88	2	6.06
-2 < HAZ <-1 Marginally Stunted (Mildly Malnourished)	Girls	6	22.22	1	4.16	4	9.75	9	27.27
-3 < HAZ <-2 Moderately Stunted (Moderately Malnourished)	Girls	3	11.11	8	33.34	19	46.34	10	30.30
HAZ <-3 Severely Stunted (Severely Malnourished)	Girls	13	48.15	14	58.34	16	39.03	12	36.37
Total		27	100	24	100	41	100	33	100

Table no. 5 Weight for age Z score of Kamar children under study

Z-Score	Sex	12-23 Months	%	24-35 months	%	36-47 months	%	48-59 months	%
-1 < WAZ < 0 Normal (Well nourished)	Boys	10	32.26	4	14.82	4	10.25	2	7.69
-2 < WAZ <-1 Marginally Underweight (Mildly Malnourished)	Boys	6	19.35	8	29.63	12	30.77	12	46.15
-3 < WAZ <-2 Moderately underweight (Moderately Malnourished)	Boys	6	19.35	10	37.03	18	46.15	9	34.62
WAZ <-3 Severely Underweight (Severely Malnourished)	Boys	9	29.04	5	18.52	5	12.83	3	11.54
Total		31	100	27	100	39	100	26	100
-1 < WAZ < 0 Normal (Well nourished)	Girls	8	29.63	3	12.50	2	4.87	3	9.09
-2 < WAZ <-1 Marginally Underweight (Mildly Malnourished)	Girls	1	3.70	5	20.84	9	21.95	10	30.30
-3 < WAZ <-2 Moderately underweight \(Moderately Malnourished)	Girls	7	25.93	9	37.50	14	34.15	11	33.34
WAZ <-3 Severely Underweight (Severely Malnourished)	Girls	11	40.74	7	29.16	16	39.03	9	27.27
Total		27	100	24	100	41	100	26	100

Table no. 6 Weight for Height Z score of Kamar children under study

Z-Score	Sex	12-23 months	%	24-35 months	%	36-47 months	%	48-59 months	%
-1 < WHZ < 0 Normal	Boys	18	58.06	14	51.86	17	43.59	16	61.54
-2 < WHZ <-1 Marginally Wasted	Boys	4	12.91	9	33.33	11	28.20	6	23.07
-3 < WHZ <-2 Moderately Wasted	Boys	4	12.91	1	3.70	7	17.96	1	3.85
WHZ <-3 Severely Wasted	Boys	5	16.12	3	11.11	4	10.25	3	11.54
Total		31	100	27	100	39	100	26	100
-1 < WHZ < 0 Normal	Girls	9	33.33	12	50.00	14	34.14	14	42.42
-2 < WHZ <-1 Marginally Wasted	Girls	8	29.63	10	41.67	16	39.02	8	24.24
-3 < WHZ <-2 Moderately Wasted	Girls	9	33.33	2	8.33	9	21.96	10	30.30
WHZ <-3 Severely Wasted	Girls	1	3.71	0	0	2	4.88	1	3.04
Total		27	100	24	100	41	100	33	100

Table no. 7 Correlation matrix of parental characteristics with height for age Z score of the Kamar children

Variables	Height for age Z-score	Age of Mothers	Height of Mothers	Weight of Mothers	Age of first Conception	BMI of Mothers	Mothers age at Marriage	Fathers age at Marriage
Height for age Z-score	1
Age of Mothers	.077	1
Height of Mothers	-.203^**	.369^**	1
Weight of Mothers	-.031	.482^**	.684^**	1
Age of first Conception	.087	.287^**	.040	.108	1
BMI of Mothers	-.167^*	.282^**	.883^**	.451^**	.011	1
Mothers age at Marriage	.020	-.074	.101	.130	.525^**	.072	1
Fathers age at Marriage	.124	.117	.083	.113	.417^**	.067	.628^**	1
**. Correlation is significant at the 0.01 level (2-tailed).
*. Correlation is significant at the 0.05 level (2-tailed).

Nutritional status

Anthropometric indicators are widely used in evaluation of nutritional status as they represent the state of under nutrition indirectly and have a high sensitivity. The height and weight of Kamar children has been observed to be higher in boys as compared to girls at all age groups. The overall (age and sex combined) rates of stunting, underweight and wasting were 30.6%, 40.3% and 72.1% respectively.

The Z scores for weight for height categorized 58.06%, 51.86%, 43.59% and 61.54% of the boys under normal category of 12-23 months, 24-35 months, 36-47 months and 48-59 months respectively and only 33.33%, 50%, 34.14% and 42.42% of the girls were observed to be normal in 12-23 months, 24-35 months, 36-47 months and 48-59 months respectively.

Marginally wasted children showed the highest frequency in 24-35 months age group (33.33%). Severely wasted children were observed to be maximum in 12-23 months age group boys. Girls showed a lower frequency in all age groups as compared to normal boys.

The Z score for weight for age categorized only 32.36%, 14.82%, 10.25% and 7.69% of the Kamar boys under normal category belonging to 12-23 months, 24-35 months, 36-47 months and 48-59 months respectively.

The height for age Z scores showed highest frequency of stunting in 24-35 months age groups in both the sexes. Severely stunting was observed to be higher in girls of all age groups as compared to boys. The heights and weights of Kamar boys were consistently higher in boys as compared to girls. The mean values of HAZ, WAZ and WHZ values were lower than (negative values) those of NCHS for both the sexes at all ages. Based on the WHO classification for assessment of severity of malnutrition by percentage prevalence range (WHO 1995) of underweight was very high (>30%) while those of stunting also was observed to be very high in all the age groups of both sexes.

The correlation of height for age Z score with age of mothers, height of mothers, weight of mothers, BMI of mothers and age at conception showed significant results with BMI of mothers and highly significant results with height of mothers. Both however showed negative correlation with height for age Z score,. Weight for age showed significant results only with height of mothers. Weight for height also showed significant results with height of mothers. Significant results showed negative correlation with height of mothers.

Height for age Z score showed significant results with father’s age at marriage but it was positively correlated. The other variables however showed non-significant results. Weight for age and weight for height failed to show significant results with mother’s age at marriage, father’s age at marriage, educational status of parents, occupational status of parents, household income and size of family. Weight for age, weight for height showed significant result with birth weight of child but both of them were negatively correlated.

Height for age showed significant results with the mother’s knowledge of causal factors of malnutrition, knowledge about prevention of malnutrition and ways of treatment of malnutrition but the results showed negative correlation in all the cases.

Height for age also showed significant results with awareness regarding the awareness of programmes for acute malnutrition and the association was negatively correlated.

DISCUSSION:

Joshi et al. (2011) observed the prevalence of malnutrition to be higher in the age group of 3-6 years. Zottarli et al. (2006) have also observed that age has a significant effect on nutritional status of children. Feahun, Wubshet and triku (2016) has also shown the association of child’s age (12-23 months) with stunting and wasting. Ramli et al. (2009) also showed association of stunting with child’s age.

Joshi et al. (2011) showed association of sex with prevalence of malnutrition. Zottarli et al. (2006) also showed similar observations. Mitra et al. (2006) showed that Kamar boys suffered more from under nutrition as compared to girls. Saito et al. (1997) also concluded that gender is a significant factor for malnutrition. Sarghi et al. (2011) observed higher prevalence of malnutrition among females.

Joshi et al. (2011) showed family type as a possible factor for influencing malnutrition.

Low socio-economic status was associated with malnutrition by Joshi et al. 2011; Jing Zhang et al.2011; Ramli et al.2009; Meshram et al. 2010; Florencio de Souza et al. 2012; Stuart Gillespie, 2013; Sarghi et al. 2011; Fentahun, Wubshet and Triku (2016) Mother’s literacy was associated with malnutrition by Joshi et al. 2011; Jing Zhang et al. 2011; Chisti et al. 2007; Amsalu and Tigabu; 2009; Ambadkar and Jodpey, 2016; Meshram et al. 2012; Hien and Kam (2008)

CONCLUSION:

The present study has revealed the prevalence of malnutrition to be unacceptably high (especially wasting) among the Kamar children of 12-59 months of Dhamtari district of Chhattisgarh state. The factors that appeared to be determinants of malnutrition were mother’s knowledge about malnutrition, mother’s awareness of the programmes for acute malnutrition, awareness of clinical symptoms of malnutrition, Birth weight of child and exclusive breast feeding.

Looking at the nature of significant variables discussed in the section of discussion, close monitoring and evaluations of the existing programmes of the studied area is essential. Practices related to infant and child feeding should be strengthened. Appropriate medical treatment for proper child care, complete immunization, regular distribution of supplementary food through anganwadi centres, management of illnesses at P.H.C. level, local community based approach at community level to enhance the nutritional awareness programmes level should be taken up in the studied area. The study draws attention towards the importance of strengthening the early diagnosis and treatment of childhood diseases like diarrhea and dysentery.

RECOMMENDATIONS:

In order to attain full growth potential the children aged 12-59 months should be matured in healthy environments and their caregivers should follow the recommended health, nutrition, and care practices. Child care practices should be focused through nutrition education and counseling.

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Received on 27.09.2024 Revised on 24.10.2024

Accepted on 21.11.2024 Published on 11.12.2024

Available online on December 31, 2024

International Journal of Technology. 2024; 14(2):105-110.

DOI: 10.52711/2231-3915.2024.00015

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