EPIDEMIOLOGIQAL STUDY OF NUTRITIONAL DISORDERS IN PRE-SCHOOL CHILDREN IN URBAN COMMUNITY.

Abstract

Explanation of the Problem: The prevalence of severe protein energy malnutrition is reported to range from 0-to-7.6% in children below 5 years of age, while the prevalence of moderate forms range between 4.4 and 43.1 %. Malnutrition in children is widely prevalent in the developing countries of the world. For the majority of young children, starting from pre-school years, the degree of malnutrition is sufficient to retard their physical growth and development; it may also affect the mental functions if it is early enough and sufficiently severe to influence the brain development and subsequent learning behaviour. Malnutrition further lowers the resistance to infection and loads to a vicious circle of malnutrition and infection which if not detected and treated early, leads to permanent developmental retardation. Malnutrition in children often starts from the prenatal period. A great number of mothers from lower socio-economic group have suffered from under nutrition and diseases during pregnancy and lactation. Their newborns are born of low weight and show signs of nutritional deficiency already at birth. The common form of serious nutritional disorders in infants and children is the calorie deficiency syndrome of marasmus, in combination with recurrent diarrhoea, malaria, respiratory infections, tuberculosis, and worm infestations. There is a great need of serious clinical and field research into the possible prevention and rehabilitation of established cases of under nutrition during early life in the poor communities. The main predisposing factors of malnutrition in children is not poverty alone, but also ignorance which may indeed by attacked with maximum results at minimum costs. It is possible to find definite targets in teaching of better hygiene and nutritional habits to the mothers, and through them to improve the nutrition status of child. In order to elicit the causes of malnutrition and to find a solution to this problem in a community of poor socioeconomic group in an urban area, this project was carried out at Mahmoodabad colony, Karachi. The survey included baseline data of 750 families (approximate population 5000), during the first year. This covered the local predisposing factors of maternal and child-hood undernutrition by interview, screening, and investigations in the population sample. Details of income, occupation of male earning members, availability and quality of food, personal hygiene, water supply, water pollution and toilet facilities, ware all noted. Certain other factors such as cultural influences in the distribution and restriction of foods to certain groups, ages or sexes, food fads ( "hot " and "cold" foods) and child rearing practices were also studied. Clinical examination of children was carried out including anthropometric measurements (height, weight, head and mid-arm circumferences): to assess the degree of malnutrition, the type of nutritional deficiencies, the incidence and types of diseases, and their effect on nutrition of the children. Birth and death statistics were maintained. From the weights of newborns the incidence of prematurity, and its relation to rnother7R nutrition was elicited. From this study it was noted that only 26.7% of 1300 pre-school children were in the normal category, while the rest were suffering from malnutrition. Most of the families (90%) live in unhygienic surroundings, with little water supply, (as they have to collect the water from community taps), and poor toilet facilities. The refuse is thrown in the little lanes between houses, as the municipal dumps are few and far between. The illiteracy rate is high (70.2%); the literate have only primary education and few have only primary education and few have any idea of hygiene and cleanliness. The child mortality is very high, most deaths being due to diarrhoea, respiratory infections, tuberculosis and measles, The deaths are more in the malnourished children. There is a lack of medical care in this area as there is only one dispensary of Karachi Municipal Corporation which is open in the morning hours. There is no MCH Centre for mothers and children and no immunisations were carried out for prevention of infectious diseases in children. Most mothers delivered at home and were attended to by untrained “dais", leading to a high neonatal mortality, chiefly due to tetanus, prematurity and complications during delivery,