Regional Variation in the Prevalence of Undernutrition and its Correlates Among Under Five-Year Children in North India.

Background: Undernutrition is an important public health problem affecting one-third of under five-year-old children in India. Objectives: To assess the nutritional status of under five-year-old children along with child feeding practices. Materials and Methods: We adopted a systematic sampling procedure to carry out this community-based, cross-sectional study in all the districts of Haryana. Data was collected on socioeconomic and demographic particulars along with anthropometric measurements. Analysis was done using SPSS Windows 23. Results: The overall prevalence of stunting, underweight, and wasting was 34%, 27.5%, and 11%, while that of severe undernutrition was 11%, 8%, and 3%, respectively. The odds of underweight were significantly higher among children of the Muslim religion, children of scheduled caste, children of illiterate mothers, lower per capita income, HHs without electricity, landless HHs, low birth weight, no ANC care, and those early ages at complementary feeding. Stunting was significantly higher among children whose mothers were illiterate, children whose fathers were laborers, among landless HHs, with no separate kitchen and lower birth weight, while wasting was higher among children of Muslim religion, children of scheduled caste, with no sanitary latrine facility, low-birth-weight children and early initiation of complementary feeding. Conclusions: Undernutrition is observed to be associated with religion, community, education of mother, per capita income, land holding status, birth weight, and age at complementary feeding. Thus, improving maternal nutrition can improve birth weight, improving maternal knowledge about child feeding, and the household's socio-economic status may improve the nutritional status of children.

SARS-CoV-2 seroprevalence in the city of Hyderabad, India in early 2021.

Background: COVID-19 emerged as a global pandemic in 2020, spreading rapidly to most parts of the world. The proportion of infected individuals in a population can be reliably estimated via serosurveillance, making it a valuable tool for planning control measures. Our serosurvey study aimed to investigate SARS-CoV-2 seroprevalence in the urban population of Hyderabad at the end of the first wave of infections. Methods: This cross-sectional survey, conducted in January 2021 and including males and females aged 10 years and above, used multi-stage random sampling. 9363 samples were collected from 30 wards distributed over six zones of Hyderabad, and tested for antibodies against SARS-CoV-2 nucleocapsid antigen. Results: Overall seropositivity was 54.2%, ranging from 50% to 60% in most wards. Highest exposure appeared to be among those aged 30-39 and 50-59 years, with women showing greater seropositivity. Seropositivity increased with family size, with only marginal differences among people with varying levels of education. Seroprevalence was significantly lower among smokers. Only 11% of the survey subjects reported any COVID-19 symptoms, while 17% had appeared for COVID-19 testing. Conclusion: Over half the city's population was infected within a year of onset of the pandemic. However, ∼ 46% of people remained susceptible, contributing to subsequent waves of infection.

Prevalence of overweight/obesity, hypertension and its associated factors among women from Northeast India.

OBJECTIVE: To assess prevalence of overweight/obesity, hypertension and its risk factors among women from North-eastern States of India. METHODS: A community based cross-sectional study was carried out in two north-eastern States. Information was collected on household's socio-economic & demographic particulars. Height (cm), weight (kg), waist and hip circumferences and blood pressure were measured on all the selected women. Association between overweight/obesity, hypertension with socio-demographic variables was tested using Chi-square and logistic regression was done. Total 1047 women were covered from both the states. RESULTS: The prevalence of chronic energy deficiency was 19% & 10%, overweight/obesity (BMI≥23) was 17.5% & 26% and hypertension was 15% & 17% (age adjusted 19.6% & 17%) respectively among women from Meghalaya & Nagaland. The prevalence of pre-hypertension was observed more among women from Nagaland (36.5%) as compared to Meghalaya (18.3%). Only 31% women were aware of hypertension and 6% had history of hypertension and 82% of them were on treatment. The prevalence of hypertension was observed high among 36-49 years and among overweight/obese women. On logistic regression, only age, BMI and use of additional salt was observed to be significantly associated with hypertension, while living in pucca house was associated with overweight/obesity. CONCLUSIONS: The prevalence of hypertension was similar in both the states (15-17%) and pre-hypertension was high among women from Nagaland. This is warning sign for women in Nagaland. There is an urgent need to undertake more health & nutrition education sessions along with regular check-up for early diagnosis and treatment of hypertension.

Population estimates and determinants of severe maternal thinness in India.

OBJECTIVE: To examine prevalence, risk factors, and consequences of maternal severe thinness in India. METHODS: This mixed methods study analyzed data from the Indian National Family Health Survey (NFHS)-4 (2015-2016) to estimate the prevalence of and risk factors for severe thinness, followed by a desk review of literature from India. RESULTS: Prevalence of severe thinness (defined by World Health Organization as body mass index [BMI] <16 in adult and BMI for age Z score < -2 SD in adolescents) was higher among pregnant adolescents (4.3%) compared with pregnant adult women (1.9%) and among postpartum adolescent women (6.3%) than postpartum adult women (2.4%) 2-6 months after delivery. Identified research studies showed prevalence of 4%-12% in pregnant women. Only 13/640 districts had at least three cases of severely thin pregnant women; others had lower numbers. Three or more postpartum women aged ≥20 years were severely thin in 32 districts. Among pregnant adolescents, earlier parity increased odds (OR 1.96; 95% CI, 1.18-3.27) of severe thinness. Access to household toilet facility reduced odds (OR 0.72; 95% CI, 0.52-0.99]. Among mothers aged ≥20 years, increasing education level was associated with decreasing odds of severe thinness (secondary: OR 0.74; 95% CI, 0.57-0.96 and Higher: OR 0.54; 95% CI, 0.32-0.91, compared with no education); household wealth and caste were also associated with severe thinness. CONCLUSION: This paper reveals the geographic pockets that need priority focus for managing severe thinness among pregnant women and mothers in India to limit the immediate and intergenerational adverse consequences emanating from these deprivations.

Screening and management options for severe thinness during pregnancy in India.

This paper answers research questions on screening and management of severe thinness in pregnancy, approaches that may potentially work in India, and what more is needed for implementing these approaches at scale. A desk review of studies in the last decade in South Asian countries was carried out collating evidence on six sets of strategies like balanced energy supplementation (BEP) alone and in combination with other interventions like nutrition education. Policies and guidelines from South Asian countries were reviewed to understand the approaches being used. A 10-point grid covering public health dimensions covered by World Health Organization and others was created for discussion with policymakers and implementers, and review of government documents sourced from Ministry of Health and Family Welfare. Eighteen studies were shortlisted covering Bangladesh, India, Nepal, and Pakistan. BEP for longer duration, preconception initiation of supplementation, and better pre-supplementation body mass index (BMI) positively influenced birthweight. Multiple micronutrient supplementation was more effective in improving gestational weight gain among women with better pre-supplementation BMI. Behavior change communication and nutrition education showed positive outcomes on dietary practices like higher dietary diversity. Among South Asian countries, Sri Lanka and Nepal are the only two countries to have management of maternal thinness in their country guidelines. India has at least nine variations of supplementary foods and three variations of full meals for pregnant women, which can be modified to meet additional nutritional needs of those severely thin. Under the National Nutrition Mission, almost all of the globally recommended maternal nutrition interventions are covered, but the challenge of reaching, identifying, and managing cases of maternal severe thinness persists. This paper provides four actions for addressing maternal severe thinness through available public health programs, infrastructure, and human resources.

Subclinical Vitamin A Deficiency and Anemia among Women and Preschool Children from Northeast India.

BACKGROUND: Micronutrient deficiencies such as iron, Vitamin A, and iodine are important public health problems in India. OBJECTIVE: The objective of the study was to assess subclinical Vitamin A deficiency (VAD) and anemia among women and preschool children from Northeast India. Methodology: A community-based cross-sectional study was carried out by adopting systematic sampling in Phek district of Nagaland. Data were collected from women on sociodemographic particulars, and finger prick blood was collected for hemoglobin and free-flowing drop for Vitamin A estimation on Whatman no. 1 filter paper. RESULTS: The overall prevalence of anemia was 27%, 40%, 44%, and 52% among preschool children, nonpregnant nonlactating women, lactating mothers, and pregnant women, respectively, whereas VAD was 37% among preschool children and 24%-32% among adult women. The prevalence of VAD was observed high among those living in kutcha house, illiteracy of head of households, big family size, and low per capita income. CONCLUSIONS: Anemia and VAD are important public health problems among tribal population in spite of the rich biodiversity.

Association between anthropometric-based and food-based nutritional failure among children in India, 2015.

Inadequate dietary intake is a critical underlying determinant of child undernutrition. This study examined the association between anthropometric-based and food-based nutritional failure among children in India. We used the 2015-2016 National Nutrition Monitoring Bureau data where anthropometric outcomes and food intake were both measured for each child. We followed the World Health Organization child growth reference standards to define anthropometric failures (i.e., height-for-age z score < -2 SD for stunting, weight-for-age z score < -2 SD for underweight, and weight-for-height z score < -2 SD for wasting), and the Indian Council of Medical Research recommended dietary allowance (RDA) to define adequacy in intake of calorie, protein, and fat. We used descriptive and regression-based assessments to test the association between the two indicators of nutritional failure and also computed the area under the receiver operating characteristic curve (AUC). The prevalence of stunting, underweight, and wasting was 28.6%, 24.3%, and 12.8%, respectively, whereas 78.2%, 27.4%, and 50.8% of the children had below RDA norms consumption of calorie, protein, and fat, respectively. We found weak-to-null correlation between anthropometric failures and food failures (Pearson correlation ranging from -0.013 to 0.147) and poor discriminatory accuracy (AUC < 0.62), suggesting that in the Indian context, anthropometric failures are not directly associated with food intake. This finding highlights the need for improving adequate intake of macronutrients and draws attention toward adopting a multifactorial approach to improve child nutrition in India. Poor food intake itself merits exclusive policy focus as it is an important nutrition and health concern.

Infant and young child feeding practices, sociodemographic factors and their association with nutritional status of children aged <3 years in India: findings of the National Nutrition Monitoring Bureau survey, 2011-2012.

OBJECTIVE: To study infant and young child feeding (IYCF) practices and their association with nutritional status among young children. DESIGN: A community-based, cross-sectional study was carried out in ten states of India, using a multistage random sampling method. Anthropometric measurements such as length/height and weight were conducted and nutritional assessment was done using the WHO child growth standards. SETTING: National Nutrition Monitoring Bureau survey, 2011-2012.ParticipantsChildren aged <3 years and their mothers. RESULTS: Only 36 % of infants received breast-feeding within an hour of birth and 50 % were exclusively breast-fed up to 6 months. Prevalence of underweight, stunting and wasting was 38, 41 and 22 %, respectively. The chance of undernutrition among <3-year-old children was significantly higher among those from scheduled caste/scheduled tribe communities, the lowest-income group, with illiterate mothers and lack of sanitary latrine. Among infants, the chance of undernutrition was significantly higher among low-birth-weight babies, and among children whose mother had not consumed iron-folic acid tablets during pregnancy. Immunization practices and minimum dietary diversity were observed to be associated with undernutrition among 12-23-month-old children. CONCLUSIONS: Undernutrition is still an important public health problem in India and observed to be associated with low socio-economic status, illiteracy of mother, low birth weight and dietary diversity. Improving socio-economic and literacy status of mothers can help in improving maternal nutrition during pregnancy and thus low birth weight. Also, improving knowledge of mothers about IYCF practices will help in improving children's nutritional status.

Mother and child nutrition among the Chakhesang tribe in the state of Nagaland, North-East India.

Despite the importance of the nutritional status and food systems of Indigenous Peoples, the subject has received very little attention, especially in North-East India. Therefore, a community-based cross-sectional descriptive study was carried out among Chakhesang mothers with children under 5 years of age to evaluate their nutritional status and prevalence of chronic diseases in the context of their dietary habits. From 558 households (HHs), 661 children and 540 mothers were covered using standard anthropometric measurements as well as blood collection for haemoglobin and vitamin A. Data were collected from mothers on HH socio-demographic particulars and infant and young child feeding practices. The results showed that the prevalence of underweight, stunting, and wasting among children <5 years of age was 14%, 22%, and 7%, respectively. The prevalence of anaemia and vitamin A deficiency was 26% and 33% among children <5 years, whereas it was 33% and 26%, respectively, among mothers. Hypertension was observed in 16% of women, whereas diabetes was seen in 0.8%. Approximately 35% and 24% of HHs suffered mild or moderate food insecurity, respectively, which was associated with literacy of the parents, per capita income, and family size. Utilization of the rich agrobiodiversity and wild foods by the Chakhesangs appears to be a strong reason for their better nutritional and health status as compared to the rest of India. Therefore, this Indigenous knowledge and food system must be documented and kept vital, especially in policies and intervention programmes addressing food and nutrition security among the Chakhesangs.

Nutritional status, food insecurity, and biodiversity among the Khasi in Meghalaya, North-East India.

A community-based cross-sectional study was carried out with 603 children ages 5 and under and 500 of their mothers from 510 households to examine the prevalence of undernutrition and chronic diseases among the Khasis of North-East India. Anthropometric measurements including Mid-Upper Arm Circumference, height, and weight were taken. Dry blood spots to estimate haemoglobin and vitamin A were collected from children and women separately by finger prick. Mothers provided data about household socio-demographic particulars and infant and young child feeding practices. The prevalence in children of underweight was 31%, stunting was 57%, and wasting was 10%. Undernutrition was higher among boys as compared to girls. Nutrient intakes were below recommended levels. The prevalence of anaemia among children ages 1 to 5 years old was 68%, and vitamin A deficiency was 59%, and they were 83% and 48%, respectively, among women. Hypertension was observed in 15% of women, whereas diabetes was less than 1%. Only about 20% of households were food secure, and this was associated with parental literacy, per capita income, and family size. Undernutrition was unacceptably high among the Khasis despite rich food biodiversity. Proper implementation of nutritional intervention programs such as Integrated Child Development Services, Mid Day Meal, and the Public Distribution System will improve the nutrient intake and nutritional status of the population. Additionally, preservation of forest lands and products paired with judicious use of the rich food biodiversity available will promote dietary diversity and ultimately better nutrition and health.

Indigenous and tribal peoples' health (The Lancet-Lowitja Institute Global Collaboration): a population study.

BACKGROUND: International studies of the health of Indigenous and tribal peoples provide important public health insights. Reliable data are required for the development of policy and health services. Previous studies document poorer outcomes for Indigenous peoples compared with benchmark populations, but have been restricted in their coverage of countries or the range of health indicators. Our objective is to describe the health and social status of Indigenous and tribal peoples relative to benchmark populations from a sample of countries. METHODS: Collaborators with expertise in Indigenous health data systems were identified for each country. Data were obtained for population, life expectancy at birth, infant mortality, low and high birthweight, maternal mortality, nutritional status, educational attainment, and economic status. Data sources consisted of governmental data, data from non-governmental organisations such as UNICEF, and other research. Absolute and relative differences were calculated. FINDINGS: Our data (23 countries, 28 populations) provide evidence of poorer health and social outcomes for Indigenous peoples than for non-Indigenous populations. However, this is not uniformly the case, and the size of the rate difference varies. We document poorer outcomes for Indigenous populations for: life expectancy at birth for 16 of 18 populations with a difference greater than 1 year in 15 populations; infant mortality rate for 18 of 19 populations with a rate difference greater than one per 1000 livebirths in 16 populations; maternal mortality in ten populations; low birthweight with the rate difference greater than 2% in three populations; high birthweight with the rate difference greater than 2% in one population; child malnutrition for ten of 16 populations with a difference greater than 10% in five populations; child obesity for eight of 12 populations with a difference greater than 5% in four populations; adult obesity for seven of 13 populations with a difference greater than 10% in four populations; educational attainment for 26 of 27 populations with a difference greater than 1% in 24 populations; and economic status for 15 of 18 populations with a difference greater than 1% in 14 populations. INTERPRETATION: We systematically collated data across a broader sample of countries and indicators than done in previous studies. Taking into account the UN Sustainable Development Goals, we recommend that national governments develop targeted policy responses to Indigenous health, improving access to health services, and Indigenous data within national surveillance systems. FUNDING: The Lowitja Institute.

Influence of feeding practices and associated factors on the nutritional status of infants in rural areas of Madhya Pradesh state, India.

A community based cross-sectional study was undertaken in rural Madhya Pradesh (MP). The nutritional status of infants was assessed using WHO Child Growth Standards. Only 26% of infants received breast-feeding within 1 hour of birth. About 57% of children 6 to 11 months old received complementary feeding (CF). The prevalence of underweight, stunting, and wasting was 41%, 29%, and 33%, respectively. Multivariate analysis showed that the risk of underweight and stunting was 1.4 times higher among children belonging to scheduled castes and scheduled tribes compared with others, 1.4 to 1.6 times among children from households with the lowest wealth index, and 1.5 times among children of illiterate mothers. Hygienic practices, birth weight, home delivery, and CF practices were also significantly (P < .01) associated with undernutrition in multivariate analysis. Undernutrition is an important health problem in MP, and urgent steps are required to formulate policies and strategies to improve infant and young child feeding practices, socioeconomic conditions, and literacy and encouraging institutional delivery and personal hygiene.

Prevalence of undernutrition, its determinants, and seasonal variation among tribal preschool children of Odisha state, India.

A community-based cross-sectional study was undertaken in the tribal areas of Odisha state, India, covering 1951 preschool children to assess their nutritional status in terms of underweight, stunting, and wasting; its correlates; and seasonal variation in nutritional status. χ(2) Test, one-way analysis of variance, and unadjusted and adjusted odds ratios were used for data analysis. The prevalence of underweight, stunting, and wasting was 58%, 65%, and 20%, respectively. The risk of underweight and stunting was, respectively, 1.9 and 2.4 times higher among children of illiterate mothers, whereas underweight and wasting was 1.4 times higher among children who had morbidities during the preceding fortnight. The prevalence of undernutrition was significantly (P < .01) higher during monsoon as compared with winter season. Undernutrition is an important public health problem and is associated with literacy of mother, morbidity, and season. Thus, improving socioeconomic condition, literacy, and sanitation along with insuring food security during monsoon season might improve nutritional status.

Trends in the prevalence of undernutrition, nutrient and food intake and predictors of undernutrition among under five year tribal children in India.

Undernutrition among children under five year is a significant public health problem in India. The present study was carried out to assess trends in nutritional status, nutrient and food intake among children under five year over two time periods. It was a community-based cross-sectional study, carried out in tribal areas of India. A total of 14,587 children, 0-5 years old were covered for nutritional assessment in terms of underweight, stunting and wasting. A 24 hour diet survey was carried out in a sub-sample of households surveyed. Wealth index was constructed using principle component analysis. The prevalence of underweight and stunting had declined significantly over the periods (49% vs 57%, 51% vs 58%, respectively), while the prevalence of wasting remained similar (22% vs 23%). There was marginal decrease in the intake of foods and nutrients over the periods, and was below recommended levels. Stepwise regression showed that the risk of underweight and stunting was significantly (p<0.01) higher among children of illiterate mothers and children from lowest and middle households wealth index. Morbidities during preceding fortnight had 1.3 times higher risk of underweight and wasting. In conclusion, undernutrition is a significant health problem among tribal children and is associated with literacy status of mothers, household wealth index and morbidities. Therefore implementation of appropriate nutritional intervention strategies and improvement in households food security through public distribution systems, food intakes, socioeconomic condition, literacy of parents and personal hygiene may help in improving the nutritional status of tribal children.