Assessment of Nutritional Status of Children Attending Paediatrics OPD of a Tertiary Care Hospital in Eastern Nepal

Address for correspondence Dr. Jitendra Thakur, Senior Resident Department of Paediatrics BPKHIS, Dharan-18, Sunsari, Nepal Tel No; +9779804019499 E-mail: Jthakur797@gmail.com 1Dr Jitendra Thakur, MBBS. MD Senior Resident. 2Dr Nisha Keshary Bhatta, MBBS. MD. Professor. 3Dr Prakash Poudel, MBBS. MD. Additional Professor. 4Dr Gauri Shankar Shah, MBBS. MD. Professor. 5Dr Rupa Rajbhandari Singh, MBBS. MD. Professor and Head. All from the Department of Paediatrics, BP Koirala Institute of Health Sciences, Dharan, Sunsari, Nepal. Abstract


Introduction
M alnutrition is a major health problem worldwide especially in developing world.It is a major cause of morbidity and mortality in Nepal.The term malnutrition refers to both under nutrition as well as over nutrition.But here malnutrition refers to under nutrition.Various factors are implicated as the cause for malnutrition.Here we have tried to study the burden of malnutrition in children visiting paediatrics OPD of BPKIHS as it could be an indirect indicator of nutritional status of children in Eastern Nepal as BPKIHS is the main tertiary health care centre in this region.

Material and Methods
This descriptive cross-sectional study was carried out from 25 th June to 23 rd July, 2010 for a duration of one month in paediatric OPD of BPKIHS with the objective to assess the nutritional status of children attending paediatrics OPD of BPKIHS and to fi nd the risk factors associated with malnutrition.All children between 1 to 5 years visiting paediatrics OPD with mother and parents giving assent were included in the study.Face to face interviews were conducted using semi structured questionnaire after properly explaining the questionnaire.
Anthropometry (weight, height, length) was taken using standard methods and appropriate instruments.Weight was recorded with weighing Secca scale with an accuracy of 50 g and crown to heel length in 1-2 years with infantometer and height using stadiometer in 2-5 years age group, with an accuracy of 0.1 cm.Oedema was diagnosed when there was bilateral pitting when pressure was applied above the medial malleolus for 30 seconds.Underweight was classifi ed using Indian Academy of Pediatrics (IAP), stunting and wasting was classifi ed according to World Health Organization (WHO).Data were analysed with Statistical Package for Social Sciences (SPSS) version 10 and p-value <0.05 was considered signifi cant.Underweight was compared with sex, maternal education, economic status, breast feeding, and use of iron, folic acid and tetanus toxoid (TT) in mother during pregnancy, hospitalization of child, birth spacing, and colostrum feeding and hospital delivery.
Parameters were arbitrarily classifi ed, maternal education: above and below SLC; monthly family income: <8,000, 8,000-16,000 and <16,000; breast feeding: exclusive up to 6 months, mixed feeding and no breast feeding; birth spacing: <3 years and >3 years and were analysed using bivariate analysis.

Results
A total of 192 children were interviewed out of which 110 were male and 82 were females out of all; 97, 91 and 19 were underweight, stunted and wasted respectively.

Discussion
According to NDHS 2016, the prevalence of wasting in Nepal is 10% which is comparable to our study.The prevalence of stunting and under nutrition was higher in our study compared to national data 3 .The reason behind this could be a hospital based study.The factors they assessed which had high proportion of malnutrition were low birth weight, under nourishment in mother, maternal illiteracy, low family income and food insecurity.But the prevalence of stunting, wasting and under nutrition in study in Allahabad, India in 2006 was 51.6%, 10.6% and 36.4% which was similar to our study 4 .Similarly in same study by Bantamen G et. al. in northwest Ethiopia, factors that were found responsible for malnutrition were inappropriate child caring and feeding practices such as using unprotected source of water for drinking and frequency of diarrheal episode, child vaccination status, food handler or care giver poor hand washing practices, parental decision making on use money for child care 5 .In a study done by Sharma KR in Mugu district, Nepal, following factors were associated with malnutrition: food scarcity, poor hygiene and environmental practices, lack of care of the mother towards her child due to priority given to work and lack of knowledge about proper child feeding/care 6 .

Diff erent Classifi cations of Malnutrition
In a study done by Md.Israt Rayhan and M. Sekander Hayat Khan in Bangladesh 45% were stunted, 10.5% wasted and 48% under nutrition 7 .These studies were similar to our study.In the same study factors responsible for stunting were less birth spacing, small birth weight and maternal illiteracy; factors responsible for wasting were small birth weight and under nourished mother; factors for underweight were less birth spacing, small birth weight and under nourishment in mother.
In a study done by Ruwali D, prevalence of under nutrition, stunting and wasting was found to be respectively 22.7%, 37.3% and 25.7% and socioeconomic factor being the most important factor associated with malnutrition 8 .Similarly in a study done by Joshi H S, prevalence of stunting, wasting and under nutrition were respectively 13%, 12% and 26% and factors associated with malnutrition were determined to be maternal education status, socioeconomic status, occupation and dietary knowledge 9 .The diff erence in the result between our study and above two study is probably because of diff erence in population, geographical area and hospital based study.
Thus there is diff erence in prevalence of malnutrition in diff erent parts of the world and there is diff erence within diff erent parts of Nepal but the size remains remarkably alarming.Diff erent study assessed diff erent factors to assess the risk factors associated with malnutrition and common factors among them were family income, maternal education and birth weight.

Conclusion
Malnutrition still prevalent in children visiting paediatric OPD at BPKIHS and in the eastern part of Nepal.Factors responsible for underweight were female sex, low education level of mother, poor economic condition, less birth spacing, lack of exclusive maternal breast feeding and previous hospitalization.Thus these parameters should be taken care of to deviate the curve of malnutrition.
Further we have tried to see the association of various factors with malnutrition.The indicators of malnutrition are Stunting, Wasting and Underweight 1 .

Table 3 :
Distribution of various aspects of malnutrition