Indian Journal of Community Medicine Vol. XXVI, No, Jul-Sept., 2001 WEIGHT GAIN PATTERN IN SEVERELY MALNOURISHED CHILDREN IN ICDS SCHEME ‘Umesh Kapil Deptt. of Human Nutrition, {All India Institute of Medical Sciences, Ansari Nagar, New Dethi - 110029 Abstract: (Geez etn: Does inn by weight vary in iret seo te yer to vaion nab of ood and mien ‘ ectives: 1, To study the weight gai pater amongst severely mainourshed children (SMN) during different seasons 4st tn nae take SUN chan Gay cere cetoso eye me Sia design Prospective sud Sample sn: 61 sctrety malnourished children (grade It and 1¥) ‘Study period: April 1997 to March 1999. Seting ICDS project, 25 angunuadcenres. Study variables Nuon intake, body weigh gal, morbiiy. Sata! anaes: Chiesquce text eae Dring iy sete ly Seem, 25 chien from rade I nV mado grade go, Dang winter ton 1" October to March out of toa 39 children who were in severe mafratnion eaegory. 13 children moved cher normal ree Tt ffeil dsing summer season Apel oft, ony 2 chien moved om grade Vi er ona ga. clusion There was apraual provement nur iona status of SMIN chien Gurng rainy, winter und sme season, The weight nin was highest rng tbe wine season) Key words: Severe malnutrition, Weight gain Introduction: in the district which were operational for more than S years Undernutttion is a major public health problem in Were enlisted and one ICDS project was selected for India. According to National Nutrition Monitoring Bureau _ ‘detailed study. In the project selected, 25 anganwadi centres, (NNMB), during 1988-90, the percentages of children in (AWC), which constituted one circle of ICDS project, were normal, grade I, land If and IV malnutrition were 21.3, selected. All the children registered in the selected 47.4, 21.5 and 3.8 respectively’, Inadequate caloric intake _anganwadi centres were included for the detailed study. has been documented as the primary cause of growth Nutritional status of all the children registered with each retardation amongst children. AWC was assessed by utilizing weight for age criterion. It has been hypothesised that gain in body weight The NCHS standards for weight for age were utilized for varies indifferent seasons of the year. This is possibly due classification of children in various grades of nutritional to differences in food availability which leads to variation status. Age of children was assessed from the records in the nutrient intake, Very few studies have been available at the anganwadi centre and from the birth documented from India, particularly on the weight gain certificate available with parents. Whenever the age of the pattern and nutrient intake of severely malnourished child was not available the local events calender was children in different seasons of the year. utilized to have nearest approximation of date of birth Material and Methods: ‘The SECA electronic weighing scale (procured from ‘The present study was conducted in the State of UNICEF India country office) was utilized to record the Rajasthan between July 1996 to June 1997. All the districts body weight to the nearest 100 gms. Weight ofthe subjects inthe state, were enlisted. District Alwar was selected by was measured with minimal clothing and bare feet. Tared using purposive sampling procedure. All the ICDS projects weight was taken incase of children below two years of age.Baseline data on each SMN child was collected by undertaking family visit. The information was collected on socio-economic status, educational status of parents, number of siblings et. A total of 61 children were identified as severely malnourished (grade II and IV) and constituted the study population. Each SMN child was given a unique code number. Monthly domiciliary visits were made tocach ‘of the 61 SMN children. The body weight and the nutrient intake of each SMN child was recorded at a monthly interval (22 days) for @ period of 12 consecutive months. Every month, the body weight of the SMN child. was assessed by utilizing standard technique. The mother of the child was interviewed in detail collect the data on nutrient intake. The nutritional intake of child was calculated by utilizing 24 hour dietary recall methodology’, The raw mount of food used for cooking the family meal, the total volume of cooked food and the volume of food consumed bby the indexed child was recorded using standardised utensil. From this data, the raw amount of food consumed by SMN child was calculated and then subsequently nutrient intake was estimated, The amount of SN consumed by the child atthe ICDS anganwadi centre in last 24 hours was specifically inquired. The nutrient intake of each child was calculated by using computer software programme Results: Indian Joumal of Commurity Medicine Vol. XVI, No, dul-Sapt, 2001 based on the nutritive value of fndian foods developed at All India Institute of Medical Sciences, New Delhit Recommended dietary allowances suggested by the Indian ‘Council fo Medical Research (ICMR) for different age groups ie. 6 months tol year, | to <3 year and 3 to <6 year of age, were utilized to assess the adequacy of nutrient intake of the subject’. ‘At the end of 12 months, the nutritional status of all children registered with anganwadi centre was again assessed by weight for age criterion. The same standardised technique and tools were used as done in the baseline survey. Repeat home visits were undertaken whenever the child was not present atthe time of first home visit. Ten percent of the data collected by research workers was checked again to see the validity and consistency. The ‘weighing scales were checked regularly to ensure their accuracy and reproducibility with the help of standard ighs. For the purpose of the study, July to September constituted the rainy season. Similarly, October to March and April to June constituied winter and summer season, respectively. ‘Table I: Nutritional status of SMN children in different seasous of the year. ‘Nutritional status Baseline Rainy Winter ‘Summer (April) ‘Guly-Sept.) (Oct-March) (April-June) 1996 1996 1996-97 1997 Normal : : 4 1 Grade I - - 6 2 Grade 11 : 25 28 35 Grade 111 50 ra 7 19 Grade 1V ul 8 5 3 Total 61 oo" 60" 60" **One child expired within first month of the follow-up. ‘Weight gain pater in severely malnourished children 134 KeptIndian Joumal of Commarity Medicine Vol. XVI, No, Jul-Sept, 2001 ‘The nutritional status of the SMN children in different ‘seasons of the year has been depicted in Table I. It was found that in the baseline survey, $0 and 11 children were in grade 111 and grade IV degree of undernutrition. It was observed that during rainy season ie. July to September, 25, children from grade III and TV moved to grade Il category. ‘twas found that during winter season i.e. October to March, out of total 35 children who were in severe ‘malnutrition category, 13 children moved to either normal, ‘grade I or grade Il category. During summer season April to June, 2 children moved from grade TV to better nutritional grade, ‘Table 11: Mean nutrient intake of 6 months to 1 year SMN children during different seasons of a year (n=16). Notrient RDA Rainy Winter Summer MeantD MeanéSD MeanéSD Energy (Keal) 83 Tare321 544274 3018281 Protein (gms) 14 19410 2649 24410 ‘Table II depicts the nutrient intake of children in 6 rmonihs to 1 year age group in different seasons. It was found thatthe highest intake of energy and protein was during winter season. The total calories consumed by the children in this age group was 88% and 95% during rainy and summer seasons respectively as compared to the RDA. ‘Table IIT: Mean nutrient intake of 1-3 years SMN children during different seasons of a year (n=32). Nutrient RDA, Energy (Kal) 1240 Protein (gms) 2 Rainy Winter ‘Summer Mean#SD. MeantSD MeantSD 7262264 8582313 7924269 23410 29413 2847 “The nutrient intake of Ito <3 years age group children revealed that the calorie and protein consumption was highest in winter season (Table I), The mean calorie ‘Table IV: Mean nutrient ‘consumption was less than 70%, when compared with RDA, in ll the three different seasons. ‘Nutrient RDA Rainy Winter ‘MeantSD MeantSD Energy (Keal) 1690 7992399 9664316 Protein (gms) 30 25414 32417 ‘Weight gain patam In savaraly malnourished children 138 apt u