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Prevalence of Protein Energy Malnutrition Among Under-Five Children

Belonging to Rural Areas of Ambala, Haryana, India

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Priyanka Kumari
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 Research & Reviews: Journal of Medicine
ISSN: 2249-8648 (Online), ISSN: 2348-7917 (Print)
Volume 7, Issue 3
www.stmjournals.com

Prevalence of Protein Energy Malnutrition Among

Under-Five Children Belonging to Rural Areas of Ambala,
Haryana, India
Priyanka Kumari*
Department of Community Health Nursing, M.M. Institute of Nursing, Maharishi Markandeshwer
University, Mullana, Ambala, Haryana, India

Abstract
Objective: A study to assess the prevalence of protein energy malnutrition (PEM) among under-
five children with various sociodemographic variables which affect the nutritional status among
under-five children in selected rural areas of Ambala, Haryana, India.
Study Design and Setting: House to house visits by cross-sectional study covering 300 under-
five children in rural areas of Ambala, Haryana, India. Data analysis consisted of descriptive
statistics and inferential analysis of nonprobability consecutive sampling.
Result: According to the Gomez classification, 44.43% had good nutritional status with the
proportion of first, second and third degree malnutrition was 39.34%, 15.66% and 0.66%,
respectively. A significant association of PEM was determined by the age of the children.
Conclusion: Need to provide health education regarding antenatal diet, the importance of
exclusive breastfeeding, importance of immunization among under-five children and
development of the integrated child development scheme at the school level.

Keywords: prevalence, malnutrition, protein energy malnutrition (PEM), under-five children,

Gomez classification

*Author for Correspondence E-mail: priyankakumari@mmumullana.org

INTRODUCTION happened because the mucosal surfaces are

Protein energy malnutrition (PEM) is possibly
a fatal body depletion disorder [1]. The term
PEM is related to a group of associated
disorders that include kwashiorkor and
marasmus. Severe form of malnutrition,
associated with the cognitive effect [2]. Mostly
affected are the infants and young children
because of their high protein and energy needs
related to body weight and their particular
susceptibility to infection[3]. PEM leads to
chronic short- and long- term mental, physical
retardation and worse resistant to the infection,
and increased death rate among children [4].
Nearly one in five children who are under five
years in the developing world is malnourished
and it remains to be a major cause of mortality
and ill health among children. The World
Health Organization has reported hunger and
related malnutrition as the only threat to the
world's health problem [5]. Nutritional disorder
is the main subsidising factor affecting
malnourished children to infections and
increased prevalence and prolongation of
vomiting and diarrhoea in children. This
mainly prone to be attacked by
microorganisms, and decreased immunity
within this age [6]. Malnutrition is the leading
cause of the global burden for disease [7]. In
developing countries, almost 65% of children
under the age of five years are underweight and
50% of these children die as a result of PEM
[8]. Most common causes of morbidity and
mortality among children is malnutrition in all
over world [9]. In Southern Asia and sub
Saharan Africa, malnutrition is public health
problem in developing world. These countries
are having scarcity with diet of micronutrients
(vitamin, water, mineral) and macronutrients
(fat, carbohydrates, and protein etc.)[2]. In
developing countries, around 9% of under five
children were having muscle wasting,
27.6%were having underweight and 32.5%
were stunted [10]. Around 70% of children are
delivered by malnutritious mother.[11].
Deficiency apart from the single nutrition such
as essential fatty acid can cause muscle
degeneration and osteoporosis. [12]. In
developing countries, parasitic and bacterial

RRJoM (2017) 14-20 © STM Journals 2017. All Rights Reserved Page 14
Prevalence of PEM among Under-Five Children
diseases contribute greatly to malnutrition [13].
In developing countries more than one quarter
of children younger than 5 years of age were
malnourished. According to the United Nations
Children's Fund (UNICEF), 27% of children
with more than 5 years of age in developing
countries were suffering from muscle wasting
[14]. In Korea, incidence of malnourished
children ranges from 3.6% to 21.6%.In middle
class families poverty is found to be a major
cause of underweight. A well-nourished child
has good access to care and food supply. A
child will have height and weight
measurements that compare very healthy with
the standard normal distribution of weights and
heights of fit children of the same sex and age.
Therefore, the great technique to assess the
nutritional status and complete health of a child
is to associate the child’s development,
manifestations with the standard normal
distribution of healthy-nurtured children that
are related to sufficient growth [15, 16].
METHODOLOGY
A total of 300 children were taken as the sample
from the rural areas of Ambala district, from
house to house data collection among under-
five children. Data were collected with the help
of weighing machine and measuring tape.
Diagnosis of PEM was based on the following
parameters such as standard height, weight, and
Fig. 1: Schematic Representation of Research Methodology.
RRJoM (2017) 14-20 © STM Journals 2017. All Rights Reserved
Kumari P.
head circumference according to the age group.
Semistructure questionnaire contained
socioeconomic and demographic information
such as question related to age of child,
religion, type of family, dietary pattern of
family, educational status of mother,
occupation of mother, birth order of child
through oral interviews of mothers. Data
analysis consisted of inferential statistics and
descriptive analysis by using nonprobability
convenient sampling. Degree of malnutrition
was assessed on the basis of Gomez
classification. Figure 1 represents the flow
diagram of methodology contained in this
research.
ANTHROPOMETRIC INDICES
Height, weight, mid arm and head
circumference of malnourished children was
measured. Gomez classification and
biochemical factors deliver the degree of
malnutrition among under five year children.
PEM [17,18]. Height was measured in standing
position with heels close together with the
height board; weight was determined by digital
balance and mid arm circumference was
measured by placing the measuring tape around
the head circumference over the supra orbital
and glabella ridges anterior occipital eminence
posteriorly, nearly 2 cm above the ear.
Page 15
Research & Reviews: Journal of Medicine
Volume 7, Issue 3
ISSN: 2249-8648 (Online), ISSN: 2348-7917 (Print)

RESULTS because p-value is less than or equal to 0.25.

Result was found out by applying Gomez Study conducted in Ethopia also shows that
classification which is most unique systems for different factors are responsible for the
classifying PEM in children, based on malnutrition[19].
percentage of expected weight for age.
Table 1: Prevalence of Protein Energy
Gomez Classification Malnutrition (PEM) Among Under Five Year
Weight for age (%) = Children. N=300
𝑊𝑒𝑖𝑔ℎ𝑡 𝑜𝑓 𝑡ℎ𝑒 𝑐ℎ𝑖𝑙𝑑 Total number of
Weight of the normal child in the same age
× 100 Sr. no.
cases
Percentage

1 Normal cases 133 44.44

90 and 100%: Normal nutritious status 2 Cases of PEM 167 55.66
75and 89%: 1stdegree, Mild malnutrition
60–74%: 2nddegree, Moderate malnutrition Table 2: Frequency and Percentage
Below 60%: 3rd degree, Severe malnutrition Distribution of Degree of Protein Energy
Malnutrition Among Under-Five
Table 1 shows that out of 300 cases, 133 cases Children.N=300
are found to be normal while 167 cases are of Sr Number of Percentage
Level
PEM among under-five children.Out of 167 no children (%)
cases of PEM degree of malnutrition was also 1 Normal cases 133 44.44
determined as depicted in Table 2.
2 1st degree malnutrition 118 39.3
Figure 2 indicates that out of 300 children, 3 2nd degree malnutrition 47 15.7
44.34% of children havea good nutritional
4 3rd degree malnutrition 2 0.6
status while 1st,2nd, and 3rd degree
malnutrition were 39.34%, 15.7%and 0.66%,
respectively. DISCUSSION
In the present study, the prevalence of PEM and
Table 3 shows the association of protein energy its relation to the various circumference was
malnutrition with different seven parameters of determined for the same age, using Gomez
sociodemographic variable. According to the classification. The result indicated that out of
finding of study age is one of the associated 300 children only 133 children has a good
factor which affect the growth of children nutritional status.

50
44.44%
45
39.3%
40
35
30
25
20
15.7%
15
10
5
0.6%%
0
Normal cases 1st degree Malnutrition 2nd degree Malnutrition 3rd degree malnutrition

Fig. 2: Percentage of Degree of Protein Energy Malnutrition Among Under-Five Children.

RRJoM (2017) 14-20 © STM Journals 2017. All Rights Reserved Page 16
Prevalence of PEM among Under-Five Children Kumari P.

Table 3: Association between Protein Energy Malnutrition and Sociodemographic Variables.

Sociodemographicvariable Mean SD ‘F’ value df P value
1. Age(in yrs)
1–2 75.46 7.4
2–3 77.88 7.95
4.81 3,163 0.0031*
3–4 76.69 9.33
Above 4 81.81 6.84
2. Religion
Hindu 78.11 8.18
Muslim 84 1.41
0.511 2,164 0.600NS
Sikh 77.96 8.76
Christian 0 0
3. Types of family
Nuclear 76.47 9.17
Joint 78.79 7.75 2.20 2,164 0.601NS
Extended 81.66 5.17
4. Dietary pattern of family **
Vegetarian 78.96 7.63 “t” value
0.3382NS
Nonvegetarian 76.11 9.08 1.702
5. Educational status of mother
Illiterate 80.12 6.53
Primary 77 8.36
Secondary 78.98 7.78 0.468 4,162 0.759NS
Senior secondary 77.88 9.05
Graduate 77.78 8.35
6. Occupation of mother
Housewife 78.23 8.21
Employee 78 7.6
1.319 2,164 0.270NS
Self employed 71.5 12.02
Private employees 0 0
7. Order of birth
First 78.52 8.16
Second 77.33 8.96
1.25 3,163 0.290NS
Third 77.44 7.35
Fourth 83.83 3.43
*= Significant,**= “t” Test
NS =Non-Significant

In the present study,39.34% of children had
first degree, 15.7% had 2nd degree and 0.66%
belongs to 3rd degree malnutrition category.
The same kind of result was reported by Singh
et al. in rural districts of India, among 406
children. The study showed that percentage of
malnourished children was 57.4% [20]. At the
time of birth, neonates who were very small in
size having two times higher risk of being
malnourished. The study investigated the risk
factor for underweight status among children
under 3 years of age in Kerala. The result
indicated the significant risk factor for current
child underweight status [21]. Mahgoub
conducted a study in Botswana and showed that
malnutrition is a problem that affect
stunting(38.7%), wasting (5.5%), and
underweight (15.6%) among children under
three years of age[22].Children of good
nutritional status of mother had lower risk of

RRJoM (2017) 14-20 © STM Journals 2017. All Rights Reserved Page 17
Research & Reviews: Journal of Medicine
Volume 7, Issue 3
ISSN: 2249-8648 (Online), ISSN: 2348-7917 (Print)
underweight. The present study showed a
significant relation with age factor of children
for malnutrition. The proportion of stunting and
underweight reached a peak level of 81.5% and
45.5%, respectively during 13–24 months of
age and then it decreased gradually. Another
study also reported prevalence of malnutrition
among children within the age group [23–25].
While other variable such as religion, dietary
pattern, order of children, types of family and
education status of motherhood are not showing
significant relation among children. Different
socioeconomic factors lead to the underweight
among under-five children [26, 27]. Children
are not offered adequate breast milk that also
leads to deficient nutrition. A report suggested
that the possibility for under nutrition differs
from different age groups of children and
specially who are living in rural areas are being
at a higher risk [28]. Exclusive breastfeeding
can also boost good immunity among children.
In India, still there is huge gap between
mother’s awareness regarding exclusive
breastfeeding. Delayed initiation of
breastfeeding, improper weaning, and
deprivation of colostrum is a significant factor
for underweight among under-five children
[29]. Many mothers breastfeed for 12–24
months, but do not provide exclusive
breastfeeding in addition, food not hygienically
handled can also lead to the prevalence rate of
PEM. Hence incident of diarrhoea and vomiting
were common in children. The study showed
the difference between rural and urban
women’s knowledge and attitude about
exclusive breastfeeding practices in India, due
to difference in age group of mother, education
and occupational status of mothers [30].
Women with higher status in the society have
the capability to make decision and helps to
develop the proper nutritional status of
children.[31]
CONCLUSION
The present study showed that 56% of children
were suffering from malnutrition. This result
indicated that the majority of population should
be concerned about the diet of children from
birth to school age group. Hence there is a need
to provide health education related to diet in the
antenatal period for the mothers, importance of
exclusive breastfeeding, and importance of
immunization among under-five children.
RRJoM (2017) 14-20 © STM Journals 2017. All Rights Reserved
Government of India launched a welfare
programme of integrated child development
scheme, which provides preschool education,
food, and primary healthcare to children under
five years of age and their mothers. Another
welfare programme, Mid-Day Meal Scheme,
was launched to improve the nutritional status
of children in classes one through five in
government schools. These kind of welfare
schemes helps to improve the nutritional level
especially for the valuable group of under-five
children.
CONFLICT OF INTEREST
No conflict of interest has been declared by the
author.
ACKNOWLEDGEMENT
The author would like to thank all the parents
of children who so willingly participated in the
study.
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ISSN: 2249-8648 (Online), ISSN: 2348-7917 (Print)

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Cite this Article
Kumari P. Prevalence of Protein Energy
Malnutrition Among Under-Five Children
Belonging to Rural Areas of Ambala,
Haryana, India. Research & Reviews:
Journal of Medicine. 2017; 7(3): 14–20p.

RRJoM (2017) 14-20 © STM Journals 2017. All Rights Reserved Page 20

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