TITLE OF THE PROJECT

A study of acute malnutrition among children

in NRC

INTRODUCTION

Acute malnutrition is a recent and severe weight loss as a result of acute food shortage and/or
illness. It is the leading causes of morbidity and mortality of children aged 659 months as
risk of death is nine times higher than that of children without it. In Guna district despite
recent economic progress; nutritional status of children is among the worst in the world and it
remains major public health problem.
Acute malnutrition remains one of the most common causes of morbidity and mortality
among children throughout the world through its direct, non-synergistic effects and through
its synergistic effects on mortality from infectious diseases.
Globally different literatures revealed that the determinants of acute malnutrition in children
aged 659 months include poverty, parental illiteracy, parental decision making, inadequate
feeding practices, large family size, non-exclusive breastfeeding, diarrhea, low birth weight,
immunization status, disturbed (broken) family, maternal hand washing habit and repeated
pregnancies according to published works.
Despite the fact that there is persistently high magnitude of acute malnutrition in Guna
district, the reasons behind it is still poorly understood and there is inconsistency across
studies regarding the determinant factors behind child acute malnutrition; in addition the
previous studies do not provide sufficient evidence on its determinants at all corners of the
country and most of the surveys used were cross sectional designs which are not appropriate
to identify the determinants factors affecting the under five children. As a result it is
important to understand its determinants at different levels in the given society as they are
multitude and hierarchically interrelated.
Definition
The World Health Organization (WHO) defines malnutrition as "the cellular
imbalance between the supply of nutrients and energy and the body's demand for them to
ensure growth, maintenance, and specific functions." The term protein-energy malnutrition
(PEM) applies to a group of related disorders that include marasmus, kwashiorkor, and
intermediate states of marasmus-kwashiorkor.2
The term marasmus is derived from the Greek word marasmos, which means
withering or wasting. Marasmus involves inadequate intake of protein and calories and is
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characterized by emaciation. The term kwashiorkor is taken from the Ga language of Ghana
and means "the sickness of the weaning." Williams first used the term in 1933, and it refers to
an inadequate protein intake with reasonable caloric (energy) intake. Edema is characteristic
of kwashiorkor but is absent in marasmus.2

LITERATURE REVIEW
Nutrition is a main component of health and development. Healthy eating is related to the
infant evolution, maternal and child health, healthier pregnancy and delivery, lower risk of
chronic diseases and better academic achievement (World Health Organization, 2011).
Dietary diversity (DD) and the amount of animal source foods that individual consumers are
two commonly used measures for dietary quality. Healthy growth and development
essentially need a balanced diet of nutrients and vitamins which includes a variety of foods
from different food groups (vegetables, fruits, grains, and animal source foods) (Belachew et
al., 2004).
Malnutrition among under-five children is a major public health problem in India. This is
reflected by the fact that the prevalence of under-weight children in India is among the
highest in the world, and is nearly double that of Sub-Saharan Africa.[ World Bank. India,
Undernourished children] It is also observed that the malnutrition problem in India is a
concentrated phenomenon that is, a relatively small number of states, districts, and villages
account for a large share of the malnutrition burden only 5 states and 50% of villages
account for about 80% of the malnutrition burden.[ World Bank. India, Undernourished
children] Each year approximately 2.3 million deaths among 6-60 months aged children in
developing countries are associated with malnutrition, which is about 41% of the total deaths
in this age group.[ Schroeder DG] A recent study, among children aged between 3 months
and 3 years of age conducted in 130 districts through Demographic and Health Surveys in 53
countries over a period from 1986 to 2006 found that variance in mild under-weight has a
larger and more robust correlation with child mortality than the variance in severe underweight.[ Bhagowalia P] The study concluded that the prevalence of mild under-weight
deserves greater attention as a useful signal of changing public health conditions among
preschool children in developing countries.[ Bhagowalia P] Therefore, it is important for the
health system to detect malnutrition at an early stage for planning and implementing timely
interventions at the community level.
Millennium Development Goal 1 (Target 2) aims to halve, between 1990 and 2015, the
proportion of people who suffer from hunger as measured by the prevalence of under-weight
among under-5 years children.[ Park K] The burden of under-nutrition among under-five
children has not changed much even though various intervention programs are in operation in
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India. Current changing dietary patterns are also affecting the nutrition status of under-five
children resulting in increased prevalence of adult noncommunicable diseases such as
obesity, diabetes, hypertension and coronary heart disease. The need of the hour is to examine
the burden of under-nutrition and obesity, study it's determining factors and assess the
effectiveness of the various approaches to combat malnutrition among under-five children.
The present review article discusses the issues and strategies for strengthening service
delivery to under-five malnourished children in India

RATIONALE OF THE STUDY

The information generated from this study will provide program managers and policy makers
at national level with a foundation for appropriate nutritional interventions and useful
information to improve on nutritional care programs particularly among women of
reproductive age.
The study will help the government and the development partners in designing appropriate
nutrition interventions in Guna district. Prevalence of under-nutrition among under-five
children is relatively high and varied widely depending on the assessment methodology
adopted, and there are limited studies on assessment of over-nutrition. The distribution of risk
factors and its influence on malnutrition among children in a given set up should be analyzed
in planning diverse control measures. Strengthening public health interventions for mild
malnutrition cases among the vulnerable groups with a focus on socioeconomic development
and research on overweight, obesity and its etiological factors in the country are the
prerequisites required to tackle malnutrition among under-five children in India

OBJECTIVES OF THE STUDY:

The major objective of the study is
1. To study a sub acute malnutrition among children in NRC in Guna district?
2. To assess the level of knowledge of dietary diversity of infant children in Guna district?
3. To determine the dietary diversity of children in Guna district.

RESEARCH METHODOLOGY
It is a way to systematically solve the research problem; it may be understood as a
science of study how research is done scientifically. According to Clifford Woody, Research
comprises collecting, organizing and evaluating data; making deductions and reaching
conclusions and at last carefully testing the conclusions to determine whether they fit the
formulating hypothesis. Thus research methodology is not only concerned with research
methods but also consider the methods used in conduct of research study and explain why
particular methods or technique and others are not, so that research result are capable of
being evaluated either by researcher himself or by others.
RESEARCH DESIGN
A research design specifies the methods and procedure of conducting the particular
research study. Choice of the research design will depend upon the nature of the problem on
which the research is to be understood. Another factor that is also relevant in this respect is the
scope of the proposed study. If the scope is wide enough covering a number of aspects, then the
research design will be very different from a study having an extremely limited scope.
METHODOLOGY:
This study will undertaken by collecting data from Guna District. The data will be collected
through two sources
i.

primary data collection methods

ii.

secondary sources.

PRIMARY DATA: Most of the information will be gathered through primary sources.
The primary data will be collected through two methods :
Personal Interview & Questionnaire
(a) Personal Interview - As per discussion with people.
(b)

Questionnaire The data would be collected from the 100 people.

The questionnaire will be applied for collecting data from people from Guna District.

SECONDARY DATA: The Secondary data will be collected through records & reports and
published materials as well as through websites.
SAMPLE SIZE: 100
SAMPLING TECHNIQUE: The selection of respondents will be doing on the basis of
convenience sampling (Non- Probability).
STASTICAL TOOLS:
The collected data will be classified and tabulated to derive meaningful results The tools used
in this study were MS-EXCEL, MS-WORD. MS-EXCEL was used to prepare pie- charts and
graphs. MS-WORD was used to prepare or write the whole project report. Appropriate
statistical tools will be used such as mean, deviation/correlation etc. wherever necessary .

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REFERENCES
1. Shasidhar, Harohalli R. Bathia, Jatinder. Malnutrition. Available from: http: //
emedicine.medscape. com/ article/985140-show all/. Accesed on June 10th, 2011
2. Scheinfeld, Noah S. Elston, Dirk M. Protein-Energy Malnutrition. Available from:
http://emedicine.medscape.com/article/1104623-show all. Accesed on June 10th, 2011
3. House Health Survey 1995, and 2001 updated. Nutritional status of infant and
children in Indonesia. Division of Research and Development, Department of Health
Republic of Indonesia, 2003.
4. William C H., Food Insecurity, Hunger, and Undernutrition. In: Richard E B, Robert
M K, Hal B J. Nelson Textbooks of Pediatrics, 17th Edition. Philadelphia: The curtis
Center Independence Square West Philadelphia, Pennsylvania; 2004
5. Neil S L, Miriam H., Nutritional Deficiency States. In: Colin et al,. Rudolphs
Pediatrics, 21st Edition. California: McGraw Hill; 2002
6. Rabinowitz, Simon S. Bhatia, Jatinder. Marasmus.

Available

from

http://emedicine.medscape.com/article/984496-show all. Accesed on June 10th 2011

7. Dennis M S, Leonna C., Normal Pubertal Development. In: Colin et al., Rudolphs
Pediatrics, 21st Edition. California: McGraw Hill; 2002
8. Waterlow, J C., Clasification and Diagnosis of Protein-Calorie Malnutrition. Available
from: http://bmj.wholibdoc.who.int/article/1098334-show. Accesed on June 10th,
2011
9. Buku Bagan Tatalaksana Anak Gizi Buruk I/II. Direktorat Gizi Masyarakat, Dirjen
Bina Kesehatan Masyarakat. Jakarta, 2005
10. World Health Organization. Management of Severe Malnutrition: A Manual for
Physicians and Other Senior Health Worker. Geneva, 2002
11. Maria R M., Vitamin Deficiencies and Excesses. In: Fredric et al., Gellis & Kagans
Current Pediatric Therapy, 17th Edition. Philadelphia, 2002

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