|Year : 2012 | Volume
| Issue : 3 | Page : 198-209
Influence of mothers' chronic energy deficiency on the nutritional status of preschool children in Empowered Action Group states in India
Ravishankar Athimulam Kulasekaran
Department of Population Studies, Annamalai University, Annamalai Nagar, Tamil Nadu, India
|Date of Web Publication||8-Aug-2012|
Ravishankar Athimulam Kulasekaran
Department of Population Studies, Annamalai University, Annamalai Nagar - 608 002 Tamil Nadu
| Abstract|| |
Introduction: Malnutrition not only blights the lives of individuals and families, but also acts as a major barrier to social and economic progress In India, particularly in the EAG states. Under this backdrop, this study aims to assess degree of chronic energy deficiency and its determinants and to investigate the impact of low BMI of women on children's health status. Materials and Methods: Data drawn from the National Family Health Survey-III, conducted 2005-06, from Empowered Action Group (EGA) states. A multiple linear regression analysis was done to see the relation between CED status of women and different socioeconomic factors and to find out the influence of CED on children's health status. Results: The 20th century witnessed a significant proportion of overweight and obese individuals coexist with the undernourished in many developing countries however the EAG states experiencing high prevalence of under-nutrition (34percent) and low incidence of overweight (13percent). Jharkhand, Bihar and Chhattisgarh reported significantly higher profession of chronic energy deficiency than the rest of the EAG states. The results of the multivariate logistic regression analyses show that age of women, place of residence, caste, women's education, and wealth index are significantly associated with underweight. The chronic energy deficiency women produce more number of anaemic children than the counterparts. Around forty percent of the low weight babies are born to the chronic energy deficit women. Conclusion: The burden of chronic energy deficiency indicates that there is a need for special public health programs that are able to address chronic energy deficiency.
Keywords: Anemia, body mass index, obesity, undernutrition
|How to cite this article:|
Kulasekaran RA. Influence of mothers' chronic energy deficiency on the nutritional status of preschool children in Empowered Action Group states in India. Int J Nutr Pharmacol Neurol Dis 2012;2:198-209
|How to cite this URL:|
Kulasekaran RA. Influence of mothers' chronic energy deficiency on the nutritional status of preschool children in Empowered Action Group states in India. Int J Nutr Pharmacol Neurol Dis [serial online] 2012 [cited 2014 Nov 29];2:198-209. Available from: http://www.ijnpnd.com/text.asp?2012/2/3/198/99471
| Introduction|| |
Malnutrition worldwide includes a spectrum of nutrient-related disorders, deficiencies, and conditions such as intrauterine growth retardation, protein-energy malnutrition, iodine deficiency disorders, vitamin A deficiency, and iron-deficiency anemia.  In recent years, dramatic progress has been made globally in tackling malnutrition; however, around 800 million people are chronically malnourished and more than a billion are sick or disabled because of nutrient deficiencies in the world.
Specifically, malnutrition poses a variety of threats to women. It weakens women's ability to survive childbirth, makes them more susceptible to infections, and leaves them with fewer reserves to recover from illness. In addition, malnutrition in women undermines their productivity, capacity to generate income, and ability to care for their families. Above all, it leads to economic losses for families, communities, and countries. Moreover, women are more likely to suffer from nutritional deficiencies than men are, for reasons including women's reproductive biology, low social status, poverty, and lack of education. Socio-cultural traditions and disparities in household work patterns can also increase women's chances of being malnourished. It is difficult to determine exactly what proportion of those losses are due to maternal malnutrition, but recent research indicates that 60% of deaths of children under age 5 are associated with malnutrition and children's malnutrition is strongly correlated with mothers' poor nutritional status.  Although malnutrition's effects on this group have been recognized for decades, there has been little measurable progress in addressing the specific nutritional problems of women. Ignorance about the symptoms of malnutrition, such as the lethargy and depression caused by iron deficiency, may be dismissed as "normal" or unimportant, further exacerbating the problem. 
Maternal nutritional status is important for a host of reasons - for the woman herself, for her capacity to reproduce, and for the development of her children, with implications for the health and reproductive capacity of the next generation's mothers. However, for decades, issues in women's nutrition have centered on nutrition during pregnancy and lactation and much of the concern has thus been for the newborn's health and well-being.  The nutritional issues of women themselves have rarely been investigated and not many nutritional data are available from non-pregnant women. In recent decades, India has established a framework of programs with the potential to combat malnutrition, including a Public Distribution System (PDS), an Integrated Child Development Services (ICDS) program, a National Mid-day Meals Program (NMMP), and several employment schemes providing food for work. Despite these programs, India continues to bear the burden of malnutrition - high prevalence of chronic energy deficiency (CED) and anemia among mothers and more number of severely undernourished children. Even today, 6400 million Indians (64%) of the population of India are chronically malnourished.  Studies conducted in central India have also reported similar findings.  The World Bank estimates that India is ranked second in the world of the number of children suffering from malnutrition, after Bangladesh, where 47% of the children exhibit a degree of malnutrition.  In India, volumes have been written about the nature and cause of adult and child malnutrition and the means of reducing it. But the role of women's CED in children's nutritional status has gone largely unnoticed until recently. With this backdrop, this paper made an attempt to investigate the malnutrition problem among mothers and children in Empowered Action Group (EAG) states. The main objectives of the study are to explore the nutritional status of women in the EAG states to understand the nutritional profile of the children less than 5 years of age in EAG states to investigate the determinants of CED and anemia (severe, mild, and moderate) among EAG states' women to find out the impact of women CED condition on the nutritional status of their children.
| Materials and Methods|| |
The anthropometric data used for analysis in this paper were derived from the National Family Health Survey-III (NFHS-III), a nationally represented large-scale sample survey conducted in India during 2005-2006. The structure of the survey is similar to that of the DHS conducted in various Asian and African countries. The study samples were drawn from the EGA states which comprise totally eight states, namely Uttaranchal (1905), Rajasthan (2814), Uttar Pradesh (8154), Bihar (2634), Jharkhand (2070), Orissa (3074), Chhattisgarh (2574), and Madhya Pradesh (4549). The study covered totally 27,708 currently married women in the reproductive age group (15-49) for the background analysis. With regard to nutritional status analysis, women who were all pregnant and those who had given birth in the month of interview were excluded. This is to avoid the exaggerated body mass index (BMI) values for the women due to their pregnancy status. Consequently, a total of 26,728 married females alone were considered for this study. In addition, out of 12,238 children born to women in 1 year preceding the survey, only 10,338 children were considered for anthropometrics indices analysis (the height and weight measured children alone), about 8811 children were considered for the anemic analysis, and for the baby weight at birth analysis, around 2971 children were considered.
In Guatemala, during 1987, the term "chronic energy deficiency" was used to indicate an inadequate household food supply. Since then, attempts to define, measure, and assess CED have evolved, using the BMI of individuals as the index of CED. It reflects both health and nutrition and predicts performance, health, and survival. Many studies have shown that BMI is a reasonable measure of adiposity. ,,,,,, Hence, this study also uses the BMI to explain the nutritional status of women in India. BMI is defined as the weight in kilograms divided by the height in meters squared (kg/m 2 ). Women were classified as chronically energy deficient or obese as described by James et al.  and the World Health Organization.  A BMI of less than 18.5 indicates CED. CED grades I, II, and III correspond to BMI 17.0-18.4, 16.0-16.9, and <16.0, respectively. Women with BMI 18.5-24.9 were classified as normal.
Three indices of nutritional status were calculated for children - height-for-age, weight-for-height, and weight-for-age. The height-for-age index examines linear growth retardation and is an indicator of chronic undernutrition. The weight-for height index compares body mass to body length. This index reflects acute undernutrition. Weight-for-age is a composite measure of both chronic and acute undernutrition. Undernourished children on the weight-for-age index are referred to as "underweight," on the height-for-age index as "stunted," and on the weight-for-height index as "wasted." The measurements on these three indices were compared with the international reference population as recommended by WHO (Dibley et al. 1987). The weight of children and women was measured using a solar-powered digital scale, which gives results with an accuracy of +100 g. Height/length was measured using an adjustable wooden measuring board that provides accurate measurement to the nearest 0.1 cm.
Direct measurement of the hemoglobin levels of all children under age 5 years was undertaken during survey to recognize the anemic condition by using the HemoCue Hb 201+ analyzer. The cut-off points of hemoglobin for different anemic levels are as follows: any anemic condition <11.0 g/dl, mild anemia ranges between 10.0 and 10.9 g/dl, moderate anemia from 7.0 to 9.9 g/dl, and severe anemia <7.9 g/dl.
Based on the WHO cut-offs, a three-category variable of nutritional status of women was created, indicating underweight (BMI < 18.50 kg/m 2 ), normal weight (BMI 18.5-24.9 kg/m 2 ), and overweight or obese (BMI ≥ 25.00 kg/m 2 )
The effect of one variable on the prevalence of CED is likely to be confounded with the effects of other variables. Therefore, socioeconomic and demographic characteristics are controlled statistically. The variables included as controls were current age, residence, religion, caste, education, occupational status, and wealth index.
In analyzing the data, both bivariate and multivariate analyses were carried out. In the bivariate analysis, the chi-square test was employed to see the association between each of the independent variables and the nutritional status of women. The chi-square test in the bivariate analysis does not consider the confounding effects. Therefore, the net effects of each independent variable were estimated controlling other factors using the logistic regression multivariate analysis. Multivariate analysis was carried out through binary logistic regression procedures, with mothers' BMI as the dependent variable. Significance level for variable inclusion in the model was established in 1% for any of the dependent variable categories. Statistical analysis was performed using SPSS for Windows. Adjusted odds ratio (OR) and 95% confidence intervals (95% CI) were calculated for the variables remaining in the multivariate model. The regression model was used to identify and compare the factors associated with women who were underweight (BMI < 18.50 kg/m 2 ).
Among the 27,708 currently married women from whom anthropometric data were collected, the women whose measurements of height and weight were incomplete or affected by measurement errors, the women who were pregnant at the time of the survey, and the women who had given birth during the 2 months preceding the survey were excluded from the analysis. Thus, 26,728 currently married women were included in the malnutrition analysis. Further, the survey (NFHS-III) being cross-sectional, anthropometric measurements were taken only once. Therefore, issues of seasonal variation that may occur in measurements were not addressed.
| Results and Discussion|| |
Characteristics of currently married women in EAG states
The study covered totally 27,708 currently married women of the reproductive age group (15-49) in the EAG states. Among the eight EAG states, Uttar Pradesh had the highest proportion of women (29.4%), followed by Madhya Pradesh (16.4%). Orissa and Rajasthan together shared one-fifth of the total surveyed women [Table 1]. Almost an equal proportion of women were interviewed at Bihar and Chhattisgarh (9% each). Jharkhand and Uttaranchal shared around 7% each. With regard to age data, only 6% of the women fell in the adolescent married women in the study area and the young women shared more than one-third of the total sample (20-24 years: 16.1%; 25-29 years: 19.5%).
|Table 1: Percentage distribution of EGA states women by their characteristics|
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More than 60% of the women were residing in rural areas (62.3%) and an overwhelming majority of them were Hindus (85.7%). With regard to the literacy status, more than half of the respondents were illiterate (54.1%) and only 7.6% had completed their higher education. Majority of the women in the study area fell in the not working category (56.8%) and around 40% were working in agricultural sectors. More than two-fifths of the women in the EAG states were either in poorest (23.6%) category or in poorer category (19.2%) and about 23% fell in the richest group.
BMI status of women in EGA states
BMI is most effectively used as an indicator to describe the nutritional status of population and as an expression of the magnitude and distribution of undernutrition and overnutrition. Even though there is progress in the nutritional status of adults, the incidence of CED has remained high in India over the past two decades. National Nutrition Monitoring Bureau Survey (2000-2001) recorded that 39.4% of adult females suffered from CED in rural areas of nine sample states. The EAG states also showed almost similar findings that 34% of women in the reproductive age group (15-49 years) fell below the cut-off of 18.5, indicating that the level of CED was relatively high in the EAG states.
BMI status of 26,728 currently married women in the age group 15-49 is given in [Table 2]. About one-third (33.9%) of women had CED of grades I-III underweight (5.7, 8.6, and 19.6%, respectively). At the other end of the spectrum, women with obesity percentage in EAG states was almost equal (12.7%) to the country's average (12.6%) and obesity I and II degrees were found among 9.8 and 2.9% of women, respectively. It can be inferred that in EAG states, underweight problems among women are overshadowed (more than 2.5 times) by the overweight problem.
[Table 3] shows that the proportion of women suffering from CED malnutrition was significantly higher in Jharkhand, Chhattisgarh, and Bihar (each around 39%), followed by Madhya Pradesh (34.9%). Uttaranchal registered the lowest prevalence of CED among the EAG states (25.5%). Further, the table shows that in the all the EAG states, the CED problems were more serious than obesity problems among the married women.
Prevalence of CED by characteristics of the respondents
Undoubtedly, the socio-cultural and economic characteristics play a significant role in shaping the women's nutritional status. The table furthermore supports this fact that the disparities in background conditions increase women's chances of being malnourished.
A comparative study on maternal nutritional status in 16 of the 18 DHS conducted countries  and several studies in Ethiopia , showed that rural women are more likely to suffer from CED than women in urban areas. These higher rates of rural malnutrition were also reported by Teller and Yimar.  The present study also reflects a similar trend that relatively a higher proportion of the rural mothers (40.8%) suffered from CED problem than urban mothers (22.3%). DHS surveys conducted in Burkina Faso, Ghana, Malawi, Namibia, Niger, Senegal, and Zambia, and studies conducted by Zerihun  and Winkvisit (1992) show that a greater proportion of mothers of age 40-49 years exhibit CED than young mothers. This study shows a different picture that CED is a more severe problem among young and adolescent women (40.9% and 39.0%, respectively) than in the aged women (45-49 years: 26.8%).
Religion did not play any significant role in the prevalence rate of CED in the EAG states. All the religions reported almost the same proportion of incidence of CED (around 33%), except the "other" category. With regard to the caste, about half of the ST women had the nutritional problem (CED). This proportion for SC was 40.3% and for OBC was 34.3%. In the EAG states, the prevalence of CED was almost four times higher among women with no education than those with 12 and more years of schooling. This result coexists with the findings of Loaiza  and Teller and Yimar. 
A significant association between malnutrition in women and their working status was also observed. Toyamal et al.  found that the children of non-working mothers had significantly higher height-for-age z-score (HAZ) (P < 0.05) than those of working mothers. This finding is reflected in the present study that the women who were working in the agricultural sector were more affected by CED (42.5%) than the non-working women (28.9%) and women who were engaged in the non-agricultural sectors (18.1%).
A study of most of the DHS surveys conducted in developing countries  and a study in the Southern Nations, Nationalities and Peoples Region (SNNPR) of Ethiopia  showed that women from low economic status households are the most affected by malnutrition. The present study also confirms the above results and shows that the women living in the poorest (50.2%) and poorer categories (43.2%) had a higher proportion of CED incidence than their counterparts (richer (27.9%) and richest (13.0%). As can be seen in [Table 4], the bivariate analysis was performed using a chi-square (χ2 ) test, and results of this study showed a significant association between nutritional status of women and each of the explanatory variables under study. The analysis of adjusted data for mother's BMI by their socioeconomic and demographic status demonstrated that mothers' age, place of residence, religion, caste, education, occupation, and their wealth index showed a significant association with nutritional status (P < 0.000).
|Table 4: Percentage distribution of women's BMI status by background conditions|
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Determinants of women's nutritional status
The influences of socioeconomic and demographic variables in determining the prevalence of CED were examined by logistic regression among the women. The logistic regression analysis results table shows that the odd ratios [Exp (B)] indicate the effect of each of the predictor variables on the prevalence of CED, controlling for other variables included in the model. The results of the multivariate analysis are presented in the form of regression coefficients and OR. Estimates of odds less than 1.0 indicate that the risk of malnutrition is less than that for the reference category of each variable and estimates of odds greater than 1.0 indicate that the risk of malnutrition is greater than that for the reference category. The results of the logistic regression model comparing CED women with those of normal and obese weight women (normal and obese = 0; CED = 1). The regression result reveals that almost in each of the variables, the odds decreased with the categories of a variable when compared to the respective variable's first category, indicating a decreasing chance for experiencing CED when improving the background conditions of women (except religion). In this model, place of residence, caste, occupation, and wealth index were found to be highly significant risk factors of CED in women. There was a significant positive relationship between age of mother and prevalence of CED. It is found that the adolescent age group (15-19) and young women in the age group 20-29 years in this EAG states were at a significantly higher risk of CED malnutrition.
The regression table revels that women in the age group 40-44 and 45-49 had significantly lower probability of having CED as compared with adolescent (15-19) and young women (OR = 0.794 and 0.765, respectively). There was a significant association between place of residence and prevalence of CED, as in comparison with urban women, the probability of having CED was lower among rural women (0.899).
The results revealed that as compared with ST women, OBC women and none category women were less likely to be malnourished (OR = 0.806 and 0.779, respectively). However, religion failed to show a significant association with the prevalence of CED (except Muslims). The illiterate women had a significantly higher probability of having CED. It was found that higher educated mothers had a 0.639 (95% CI: 0.537-0.760; P < 0.000) lesser chance of being seen as underweight than illiterate mothers. When compared with not working women, women working in agricultural sector had significantly higher probability of having CED (OR = 1.132). The women working in the non-agricultural sector had a 0.819 lesser chance of being malnourished than the non-working category women. As compared with women living in poorest wealth index, women of richer and richest categories were less likely to be CED (OR = 0.496 and 0.242, respectively). It can be inferred from [Table 5] that the logistic regression analysis identified the most important explanatory variables of nutritional status in EAG states' women. In this model, age, place of residence, caste, education, household economic status (WI), and employment status of women were found to be the determinants of women's nutritional status. Finally, the table reveals that women in Bihar, Jharkhand, Orissa, and Madhya Pradesh were more than 1.2 times more likely to have CED problem than women in Uttaranchal.
|Table 5: Odds ratios from logistic regression examining the effect of selected SED variables on CED condition of women in EAG states|
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Children's nutritional status in the EAG states
The nutritional status of under-five children is of particular concern, since the early years of life are crucial for future growth and development. Globally, nutritional status is considered the best indicator of the well-being of young children and a parameter for monitoring progress toward the Millennium Development Goals (MDGs), especially MDG1.  In developing countries, an estimated 50.6 million children aged less than 5 years are malnourished.  Recent estimates show that about 40% of the undernourished children in the world are in India although India accounts for less than 20% of the children in the world.  Sharda Sidhu et al. revealed a high prevalence (81.66%) of anemia in Scheduled Caste preschool children of Punjab. Stunting was the most common manifestation (48%) of undernutrition for under-five children; 42.5% of children were underweight. Underweight rates in the first 3 months remained similar to low birth-weight rates. There was a progressive increase in underweight rates between 3 and 24 months. 
Low birth weight (LBW; <2500 g) is an especially important indicator, both as a marker of overall health of the mother and as a predictor of ill health for newborns. Relative risk of morbidity has been shown to be higher and more consistently associated with low BMI in Indian preschool children.  Poor nutrition severely hinders personal, social, and national development.  Recently, it has been reported that wasting at 6 months was a good predictor of infant mortality in India. 
It is well understood from the above discussion that nutritional status among children under age five is not so well in developing countries, especially in India. Yet, more work is needed to identify the more influential factors which can improve the nutritional status among children. Sudhagandhi  and Kapoor  also stated that the recent studies on the prevalence of anemia have been on preschoolers only, so there is a need for more studies related to anemia in school children. With these views, this paper documents the extent of undernutrition among children aged less than 5 years and explores the association between mothers' BMI and children's nutritional status in EAG states in India.
[Table 6] shows the percentage of children suffering from anemic condition in EAG states. It is found from the table that more than 70% of the children (72.5) in EAG states are suffering from anemia. The degree of children's anemic level varies from as high as 78% in Bihar to 61% in Uttaranchal. About three-fourths of the children from Uttar Pradesh and Chhattisgarh and 70% of the children from Jharkhand are experiencing the anemia. [Table 6] also shows the percentage distribution of children under 5 years old by their nutritional status. The representative data from EAG states show that more than 70% of children below 5 years experienced any one kind of anemia (25.9% had mild, 43.5% had moderate, and 3.1% had severe anemia). The prevalence of anemia varied from 81% in the age group of 6-12 months to 62.8% in the age group of above 24 months. This finding is reflected in Yip's  observation that the prevalence of anemia is higher during infancy and early childhood than at any other time in the life cycle.
|Table 6: Percentage distribution of children less than 5 years of age classified by their nutritional status|
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The anemic level is comparatively higher among 12-24 month old children (37.2%) than among babies of 6-11 months (18.6%) and above 24 months (17.0%). With regard to severe anemic condition, again the 12-24 month old children recorded the highest prevalence rate (4.7%) than the rest of the groups. It can be concluded that even though the Indian government has implemented better child health care programs, the anemic levels of the children of the EAG states are still high, especially among the less than 2-year-old children.
With regard to anthropometrics indices among the EAG states' children, the overall prevalence of stunting (height-for-age) was 68.7%. The incidence of stunting condition proved the positive association with the age of children, specifically in severe stunting condition. The severe stunting condition is as high as 27% in the children above 24 months and this proportion for children less than 6 months is only 8.7%. Anderson  and Aschalew  also supported the above observation in their study that a cumulative indicator of growth retardation (height-for-age) in children is positively associated with age. Studies in Ethiopia have also shown an increase in malnutrition with increasing age of the child. ,,
Regarding low weight-for-age (underweight) data, the children above 24 months suffered more (47.9%) than the children less than 6 months old (32.6%). A similar pattern was observed even among the severe underweight children. Again, the prevalence rate of underweight shows a significant positive relationship with the children's age. By contrast, the prevalence rate of wasting (thin for their height) was relatively high among the early ages (<6 months) than the rest of age group, which shows the negative association between age of the child and incidence of wasting.
It is observed from the table that the children's nutritional status in the EAG states have shows very high prevalence of stunting, underweight and wasting according to the classification established by the World Health Organization to indicate the levels of child malnutrition. The overall picture discloses the fact that both acute and chronic stunting and wasting are a serious concern among children in the EAG states.
Impact of mother's BMI status on children's health status
Large number of studies have provided evidence that the household socioeconomic characteristics determine to a large extent the nutritional status of children,  and a positive relationship between socioeconomic status and the ability of mothers to provide adequate food and primary care has been observed.  Besides, the mothers' malnutrition status also decides the children's nutritional status. In India, poor fetal growth has been attributed to widespread maternal undernutrition.  On the other hand, worldwide studies of energy and protein supplementation during pregnancy have produced variable results.  With this backdrop, in the present study, an attempt has been made to assess the effects of mothers' CED on their children's nutritional status.
Mother's BMI on children's anemia
The [Table 7] highlights a close correlation between mothers' BMI with the incidence of anemia among the children. The women with BMI less than 18.5 (CED) had given birth to 77.6% of anemic children; it includes 3.6% of severe anemic children. But the obese women had given birth to about 57% of anemic children in the EAG states.
|Table 7: Percentage distribution of mothers' BMI status on children's nutritional level|
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Further, the table shows that the proportions of moderate and mild anemic children were closely associated with chronic energy deficit women than with the normal and obese women. With regard to the proportion of sever anemic children, the chronic energy deficit women produced twofold more severe anemic children (3.6%) than the obese women (1.8%). It can be inferred that a positive association exists between the mothers' BMI status and their children's anemic condition.
Mother's BMI on anthropometrics indices
As expected, women with poorer nutritional status, as indicated by the CED condition, had registered higher risk of severe thinness (height-for-age) and severe underweight (weight-for-age) children (27.1 and 23.3%, respectively). Further, severe wasting (weight-for-height) in children was also associated with women's BMI. The women with low BMI had given birth to about 10% of severe wasting children; on the other hand, the obese women had given birth to only 4% of severe wasting children. A similar relationship (correlating CED with anemic condition) was also observed in the anthropometric indices among the obese women who had less significant risk of having underweight, stunting, and wasting children.
Mothers' nutritional status and weight of the child at birth
For social and biological reasons, women of the reproductive age are amongst the most vulnerable to malnutrition. Increased perinatal and neonatal mortality, a higher risk of LBW babies, stillbirths, and miscarriage are some of the consequences of malnutrition in women.  One-third of babies born in India are of LBW (<2.5 kg) and this continues to be a major public health problem. In addition to the short-term consequences, such as high infant mortality and childhood growth failure among survivors,  LBW carries long-term risk in the form of high rates of adult coronary heart disease and type II diabetes.  Some findings on the relationship between maternal and child nutrition ,, showed that a high proportion of LBW and stunted children is observed among malnourished mothers.
The study results also are in accordance with the above findings that the proportion of LBW babies was associated with low BMI mothers. Among the children who weighted at birth, The women with low BMI (<18.5 CED) had given birth to more than one-fourth (27.7%) of the underweight children (500-1999 kg: 10.8%; 2000-2499 kg: 16.9%), whereas this proportion was reduced to 18% for the obese women. Again, it shows the strong negative correlation between mother's BMI and their baby's weight.
| Conclusion|| |
The overall goal of this study is to explore the nutritional status of mother and children in EAG states and to understand the links between women's nutritional status, specifically CED and child's nutrition status.
It is can be concluded that women of the EAG states are facing higher degree of nutritional disorder. It is found from the study that CED is a more severe problem in the EAG states than the obesity problem. The prevalence rate of CED is nearly equal to (33.9%) to the national average (35.6%). This study found evidence that socioeconomic and demographic variables have a significant influence on the odds of CED in EAG states women. It is also established from the above discussion that there is a strong association between maternal nutritional status and children's nutritional status and birth weight. It is evident that the mothers' BMI condition has a positive association with children's anemic condition. Further, it has provided evidence that the risk of malnutrition is higher among the children whose mothers suffer from CED.
Recommendation: Based on the above observations, this study highlights the need for re-examining the existing programs, identifying their limitations, ensuring logistics and feasibility rather than proposing new programs.
Therefore, the following strategies and programs should be included in the government planning:
- To develop community-based interventions giving priority to rural and very poor households, with an aim to reduction of poverty
- To empower women could therefore be important interventions to improve their nutrition status
- To make behavioural change to generate greater access the to health services and to make awareness about the importance of health services and nutrition education and micronutrient supplementation among the women
- Mothers should be educated on exclusive breastfeeding up to 6 months of age of the child
| Acknowledgments|| |
The author thanks Dr. S. Ramachandran for helping in statistical analysis and Dr. A. Subbiah for editing and proofreading. The views expressed in this article are those of the author and do not necessarily reflect the Ministry of Health and Family Welfare, Government of India.
| References|| |
|1.||Ratzan SC, Filerman GL, Lesar, John W. Attaining global health: Challenges and opportunities. Population Bulletin of the Population Reference Bureau; 2000. 55. |
|2.||Pelletier DL, Frongillo EA. Changes in child survival are strongly associated with changes in malnutrition in developing countries. J Nutr 2003;133:107-19. |
|3.||Galloway R. Women's perceptions of iron deficiency and anemia prevention and control in eight developing countries. Soc Sci Med 2002;55:4. |
|4.||Shepard MJ, Bakketeig LS, Jacobsen G, O'Connor T, Bracken MB. Maternal body mass, proportional weight gain, and fetal growth in parous women. Paediatr Perinat Epidemiol 1996;10:207-19. |
|5.||Kurtz, Paul. India's Population Time Bomb. Free Inquiry Magazine, Spring; 1999. |
|6.||Sinha N, Deshmukh PR, Garg BS. Epidemiological correlates of nutritional anemia among children (6-35 months) in rural Wardha, Central India. Indian J Med Sci 2008;62:45-54. |
|7.||World Bank Report. World Bank Report on Malnutrition in India. Washington, D.C.: The World Bank; 2009. |
|8.||Keys A, Fidanza F, Karvonen MJ. Indices of relative weight and obesity. J Chronic Dis 1972;25:329-43. |
|9.||Khosla T, Lowe R. Indices of obesity derived from body weight and height. Br J Prev Soc Med 1967;21:122-8. |
|10.||Garrow JS, Webster DJ. Quetelets's index (W/H') as a measure of fatness. Int J Obes 1995;9:147-53. |
|11.||Smalley KJ, Knerr AN, Kendrick ZV. Reassessment of body mass indices. Am J Clin Nutr 1990;52:405-8. |
|12.||Deurenberg P, Weststrate AJ, Seidell CJ. Body mass index as a measure of body fatness: Age- and sex-specific prediction formulas. Br J Nutr 1991;65:105-14. |
|13.||Strain GW, Zumoff B. The relation of weight-height indices of obesity to body fat content. J Am Coll Nutr 1991;11:715-8. |
|14.||Bose K, Chakraborty F, Bisai S, Khatun A, Bauri H. Body mass index and nutritional status of adult Savar tribals of Keonjhar District, Orissa, India. Asia Pac J Public Health 2006;18:3-7. |
|15.||James WP. Definition of chronic energy deficiency in adults: Report of the working party of the international Dietary Energy Consultative Group. Eur J Clin Nutr 1988;42:969-81. |
|16.||World Health Organization. Maternal anthropometry and pregnancy outcomes, A WHO collaborative study. Bull WHO, Geneva: WHO; 1995. |
|17.||Loaiza, Edilberto. Maternal nutritional status. DHS Comparative Studies No. 24, Calverton, Maryland, USA: Macro International Inc.; 1997. |
|18.||Zerihun T, Larson CP, Hanley JA. Anthropometric status of Oromo women of child bearing age in rural south-western Ethiopia. Ethiop J Health Dev 1997;11:1-7. |
|19.||Ferro-Luzzi A, Scaccini C, Taffese S, Aberra B, Demeke T. Seasonal energy deficiency in Ethiopian rural women. Eur J Clin Nutr 1990;44(Supp.1):7-18. |
|20.||Teller H, Yimar G. Levels and determinants of malnutrition in adolescent and adult women in southern Ethiopia. Ethiop J Health Dev 2000;14:57-66. |
|21.||Toyama NS, Wakai Y, Nakamura, Arifin A. Mother's working status and nutritional status of children under the age of 5 in urban low income community, Surabaya, Indonesia. J Trop Pediatr 2001;47: 179-81. |
|22.||Semba RD, de Pee S, Sun K, Sari M, Akhter N, Bloem MW. Effect of parental formal education on risk of child stunting in Indonesia and Bangladesh: A cross-sectional study. Lancet 2008;371:322-8. |
|23.||Best CM, Sun K, de Pee S, Bloem MW, Stallkamp G, Semba RD. Parental tobacco use is associated with increased risk of child malnutrition in Bangladesh. Nutrition 2007;23:731-8. |
|24.||Shrimpton R, Victora CG, de Onis M, Lima RC, Blössner M, Clugston G. Worldwide timing of growth faltering: Implications for nutritional interventions. Pediatrics 2001;107:e75. |
|25.||Sidhu S, Kumari K, Uppal M. Prevalence of anemia in schedule caste preschool children of Punjab. Indian J Med Sci 2002;56:218-21. |
|26.||Ramachandran P, Gopalan HS. Assessment of nutritional status in Indian preschool children using WHO 2006 Growth Standards. Indian J Med Res 2011;134:47-53. |
|27.||Ramachandran P, Gopalan HS. Undernutrition and risk of infections in preschool children. Indian J Med Res 2009;130:579-83. |
|28.||Shafique S, Akhter N, Stallkamp G, Pee SD, Panagides D, Bloem MW. Trends of under- and overweight among rural and urban poor women indicate the double burden of malnutrition in Bangladesh. Int J Epidemiol 2007;14:124-32. |
|29.||Vesel L, Bahl R, Martines J, Penny M, Bhandari N, Kirkwood BR. WHO Immunization-linked Vitamin A Supplementation Study Group. Use of new World Health Organization child growth standards to assess how infant malnutrition relates to breastfeeding and mortality. Bull World Health Organ 2010;88:39-48. |
|30.||Sudhagandhi B, Sundaresan S, William WE, Prema A. Prevalence of anemia in the school children of Kattankulathur, Tamil Nadu, India. Int J Nutr Pharmacol Neurol Dis 2011;1:184-8. |
|31.||Kapoor D, Agarwal KN, Sharma S, Kela K, Kaur I. Iron status of children aged 9-36 months in an urban slum Integrated Child Development Services project in Delhi. Indian Pediatr 2002;39:136-44. |
|32.||Yip R, Ramakrishnan U. Experiences and challenges in developing countries. Forging effective strategies to combat iron deficiency. J Nutr 2002;132:827-30. |
|33.||Anderson MA, Krasovec K. Maternal nutrition and pregnancy outcome. Washington, DC: Pan American Health Organization, Scientific Publication, 529; 1991. |
|34.||Aschalew G. Determinants of nutritional status of children in Amhara Region: A case study of Misrak Gojjam and Semen Wello Zones. M.Sc Thesis, DTRC/IDR, AAU, 2000. |
|35.||Yimer G. Malnutrition among children in southern Ethiopia: Levels and risk factors. Ethiop J Health Dev 2000;14:283-92. |
|36.||Genebo T, Girma W, Hadir J, Demmissie T. The association of children's nutritional status to maternal education in Ziggbaboto, Guragie Zone South Ethiopia. Ethiop J Health Dev 1999;13:55-61. |
|37.||Samson T, Lakech G. Malnutrition and enteric parasites among under five children in Aynalem village, Tigray. Ethiop J Health Dev 2000;14:67-75. |
|38.||Devadas RP, Rajalakshmi R, Kaveri R. Influence of family income and parents' education on the nutritional status of preschool children. Indian J Nutr Dietet 1980;17:237-44. |
|39.||Sims LS. Demographic and attitudinal correlates of nutrition knowledge. J Nutr Educ 1976;3:122. |
|40.||Rao S. Nutritional status of the Indian population. J Biosci 2001;26: 481-9. |
|41.||Kramer M. Effects of energy and protein intakes on pregnancy outcome: An overview of the research evidence from controlled clinical trials. Am J Clin Nutr 1993;58:627-35. |
|42.||Krasovec K, Anderson MA. Maternal nutrition and pregnancy outcomes: Anthropometric assessment. Washington D.C.: Scientific Publication, No. 529, Pan American Health Organization; 1991. |
|43.||Pojda J, Kelley L. Low birth weight. ACC/SCN Nutrition Policy Paper, No. 18, 2000. |
|44.||Barker DJ. Mothers, babies and health in Later life. Edinburgh: Churchill Livingstone; 1998. |
[Table 1], [Table 2], [Table 3], [Table 4], [Table 5], [Table 6], [Table 7]