Thesis Paper

On
Comparative Study on Nutritional Status of
Children (aged 6 to 24 months) and their Mothers
between Selected Slum and Nonslum !reas of
"ha#a City
Submitted by
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93
This cross sectional comparative study was conducted in purposively selected slum areas of
Kamrangirchar and different non-slum areas of Dhaka city to assess and compare the nutritional
status of children aged 6 to 24 months and their mothers The purpose of the study was to
compare the nutritional profile in terms of knowledge! "ttitude and #ractice $K"#% a&out
pregnancy! delivery! lactation! child feeding practice and mor&idity as well as socio-economic
conditions to identify the significant influential factors! if any affecting the e'isting nutritional
situation " total of (9) child-mother pairs! 9* pairs from slum areas and another 9* pairs from
non-slum areas! were randomly selected +tructured ,uestionnaires were administered to mothers
while anthropometric measurements and &lood samples were collected &y -emo.ue method
from the target children and their mothers .ollected &lood specimens were tested in the
la&oratory of /nstitute of 0utrition and 1ood +cience $/01+% the following day to identify the
&lood hemoglo&in level +tatistical package for +ocial +cientists $+#++% was used for data
analysis /ndices of nutritional status that is weight-for-age 2-score $3"4%! height-for-age 2-
score $-"4% and weight-for height 2-score $3-4% for children and &ody mass inde' $56/% for
mothers were computed using the 3-7 "nthro program Dietary analysis of the data collected
from mothers &y 24 hour recall method! was carried out &y using 5angladeshi 1ood consumption
ta&le developed &y /01+ &y using 1ortran 88 software
+ignificant associations &etween 56/ of mothers and -"4 of children $#9 ))(! r:)86(% for
slum areas! education level of mothers and 3"4 of children $#9 ))(! r:)(4(% for non-slum
areas were found " significant difference in energy! protein! fat! car&ohydrate! calcium! iron!
thiamin! ri&oflavin! niacin! vitamin . and 4inc intake $as for all nutrients #9))(% was also
prevalent &etween slum and non-slum areas +ignificant association prevailed &etween anemic
mothers and occurrences of anemia among children in non-slum areas $#9))(! r: )4;6% "
significant association was found &etween hemoglo&in level and -"4 of slum children $#9 ))(!
as r :)48(% /n non-slum areas significant association &etween 56/ and percentage of
fulfillment of <D" for energy among mothers was found $#9))*% +ignificant association was
found &etween having sanitary toilet facilities and worm infestation of mothers of slum area $#9
))(! r : -)38% #ositive correlation for -"4 of children with mother=s hemoglo&in level!
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mother=s 56/! child hemoglo&in level in slum areas were found in the study whereas per capita
monthly food cost! mother=s hemoglo&in level! mother=s 56/! child hemoglo&in level in non-
slum areas possess positive correlation with -"4 of children "gain in slum areas child=s 3"4
possess positive correlation with child hemoglo&in level and negative correlation with num&er of
a&ortions /n non-slum areas per capita monthly food cost! child hemoglo&in level! protein intake
of mother had positive correlation with child=s 3"4 /t was evident that in slum areas mother=s
hemoglo&in level had positive correlation and num&er of a&ortions had negative correlation with
child=s 3-4 /n non-slum areas mother=s protein intake and per capita monthly food cost had
positive correlation and num&er of a&ortions had negative correlations with child=s 3-4 56/
of mothers were positively correlated with their energy intake! hemoglo&in level! per capita
monthly food cost and was negatively correlated with parity in slum areas -owever! in non-
slum areas per capita monthly food cost! hemoglo&in level and energy intake of mothers were
seen positively correlated with 56/ of mothers /t was therefore concluded that there were
various influential factors those resulted in nutritional profile of study children and their mothers
&etween slum and non-slum areas
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Contents
CONTENTS............................................................................................................................................... IV
LIST OF TABLES......................................................................................................................................... V
LIST OF FIGURES..................................................................................................................................... VIII
LIST OF ABBREVIATIONS............................................................................................................................. X
C$!PT%& '((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((( )*
1.1.INTRODUCTION.................................................................................................................................... XI
1.2.RATIONALE OF THE STUDY................................................................................................................. XV
C$!PT%& +((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((( ),***
2.1.LITERATURE REVIEW....................................................................................................................... XVIII
C$!PT%& -((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((( )),**
3.1.OBJECTIVES................................................................................................................................... XXVII
3.1.1.GENERAL OBJECTIVE................................................................................................................... XXVII
3.1.2.SPECIFIC OBJECTIVES................................................................................................................. XXVII
3.2.HYPOTHESIS................................................................................................................................. XXVIII
3.3.CONCEPTUAL FRAMEWORK.............................................................................................................. XXIX
C$!PT%& .(((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((( )))*
4.1.MATERIALS AND METHODS.............................................................................................................. XXXI
4.1.1.STUDY DESIGN............................................................................................................................ XXXI
4.1.2.STUDY LOCATION....................................................................................................................... XXXIII
4.1.3.STUDY POPULATION................................................................................................................... XXXIII
4.1.4.SAMPLE SELECTION CRITERIA..................................................................................................... XXXIII
4.1.5.SAMPLE SIE CALCULATION........................................................................................................ XXXIV
4.1.!."UESTIONNAIRE DESIGN AND FIELD TRIAL................................................................................... XXXV
4.1.#.OVERVIEW OF DATA COLLECTION METHOD.................................................................................. XXXV
4.1.$.ANALYTICAL METHODS............................................................................................................... XXXIX
4.1.%.LIMITATIONS OF THE STUDY............................................................................................................. XL
C$!PT%& /(((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((( )0
5.1.RESULTS OF THE STUDY.................................................................................................................... XLI
5.1.1.SOCIO&ECONOMIC ' DEMOGRAPHIC INFORMATION...........................................................................XLI
5.1.2.KAP RELATED INFORMATION AMONG MOTHERS........................................................................... XLVIII
5.1.3.ANTHROPOMETRIC FINDINGS......................................................................................................... LXIV
5.1.4.BIOCHEMICAL ASSESSMENT ....................................................................................................... LXVIII
5.1.5.DIETARY INFORMATION OF MOTHERS............................................................................................ LXIX
5.1.!.CLINICAL FINDINGS...................................................................................................................... LXXII
5.1.#.COMPARATIVE ANALYSIS OF INFLUENTIAL FACTORS AND NUTRITIONAL STATUS OF CHILDREN AND
MOTHERS............................................................................................................................................ LXXIII
5.1.$.CAUSAL ANALYSIS AND MODELING OF NUTRITIONAL STATUS OF CHILDREN AND MOTHERS.............LXXXIV
C$!PT%& 1(((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((( )C*
!.1.DISCUSSION..................................................................................................................................... XCI
!.2.CONCLUSION................................................................................................................................. XCVIII
!.3.RECOMMENDATIONS........................................................................................................................... CI
C$!PT%& 2((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((( C***
#.1.REFERENCES.................................................................................................................................... CIII
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C$!PT%& 3((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((( C,**
$.1.ANNEXURE....................................................................................................................................... CVII
$.1.1.OPERATIONAL DEFINITIONS........................................................................................................... CVII
$.1.2."UESTIONNAIRE........................................................................................................................... CXIII
List of Tables
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93
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93
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(((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((( 0))*)
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!&%!(((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((( 0)))*
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O7 S06M((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((( 0))),
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O7 S06M(((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((( 0))),*
T!40% .;5 &%9&%SS*ON !N!08S*S O7 C$*0"@S $!A :*T$ OT$%& *N"%P%N"%NT ,!&*!40%S
O7 NONS06M((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((( 0))),*
93
T!40% />5 &%9&%SS*ON !N!08S*S O7 C$*0"@S :!A :*T$ OT$%& *N"%P%N"%NT ,!&*!40%S
O7 NONS06M(((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((( 0))),**
T!40% /'5 &%9&%SS*ON !N!08S*S O7 C$*0"@S :$A :*T$ OT$%& *N"%P%N"%NT ,!&*!40%S
O7 NONS06M !&%!(((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((( 0))),***
T!40% /+5 &%9&%SS*ON !N!08S*S O7 MOT$%& (4M*) :*T$ OT$%& *N"%P%N"%NT ,!&*!40%S
O7 S06M(((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((( 0)))*)
T!40% /-5 &%9&%SS*ON !N!08S*S O7 MOT$%& (4M*) :*T$ OT$%& *N"%P%N"%NT ,!&*!40%S
O7 NONS06M(((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((( )C
List of Figures
7*96&% '5 P%&C%NT "*ST&*46T*ON O7 $O6S%$O0"S 48 N6M4%& O7 7!M*08 M%M4%&S((((()0*
7*96&% +5 P%&C%NT "*ST&*46T*ON O7 OCC6P!T*ON O7 MOT$%&S O7 S06M(((((((((((((((((((((((()0***
93
7*96&% -5 P%&C%NT "*ST&*46T*ON O7 OCC6P!T*ON O7 M!*N *NCOM% %!&N%&S O7 S06M
((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((( )0***
7*96&% .5 P%&C%NT "*ST&*46T*ON O7 OCC6P!T*ON O7 NONS06M MOT$%&S((((((((((((((((((((()0*,
7*96&% /5 P%&C%NT "*ST&*46T*ON O7 OCC6P!T*ON O7 NONS06M M!*N *NCOM% %!&N%&S
((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((( )0*,
7*96&% 15 P%&C%NT "*ST&*46T*ON O7 $O6S%$O0"S O7 S06M 48 MONT$08 *NCOM%((((((((()0,
7*96&% 25 P%&C%NT "*ST&*46T*ON O7 $O6S%$O0"S O7 NONS06M 48 MONT$08 *NCOM%
(((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((( )0,
7*96&% 35 P%&C%NT "*ST&*46T*ON O7 $O6S%$O0"S 48 S%CTO& :*S% !,%&!9% MONT$08
%)P%N"*T6&%(((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((( )0,**
7*96&% ;5 P%&C%NT "*ST&*46T*ON O7 MOT$%&S !CCO&"*N9 TO T$%*& !9% O7 M!&&*!9%
((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((( )0*)
7*96&% '>5 P%&C%NT "*ST&*46T*ON O7 S06M $O6S%$O0"S !CCO&"*N9 TO !"OPT*ON O7
7!M*08 P0!NN*N9(((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((( 0
7*96&% ''5 P%&C%NT "*ST&*46T*ON O7 $O6S%$O0"S 48 7*&ST 7%%" !7T%& 4*&T$((((((((((((0*,
7*96&% '+5 P%&C%NT "*ST&*46T*ON O7 $O6S%$O0"S 48 M%T$O"S 7O& P&%0!CT%!0
7%%"*N9((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((( 0*,
7*96&% '-5 P%&C%NT "*ST&*46T*ON O7 $O6S%$O0"S 48 7*&ST ST!&T*N9 T*M% O7 4&%!ST
7%%"*N9(((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((( 0,
7*96&% '.5 P%&C%NT "*ST&*46T*ON O7 C$*0"&%N !CCO&"*N9 TO %)C06S*,% 4&%!ST
7%%"*N9(((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((( 0,**
7*96&% '/5 P%&C%NT "*ST&*46T*ON O7 S06M C$*0"&%N !CCO&"*N9 TO S6PP0%M%NT!&8
7%%"*N9((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((( 0,***
7*96&% '15 P%&C%NT "*ST&*46T*ON O7 NOONS06M C$*0"&%N !CCO&"*N9 TO
S6PP0%M%NT!&8 7%%"*N9(((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((( 0,***
7*96&% '25 P%&C%NT "*ST&*46T*ON O7 C$*0"&%N !CCO&"*N9 TO COMP0%M%NT!&8
7%%"*N9 ((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((( 0)
7*96&% '35 P%&C%NT "*ST&*46T*ON O7 C$*0"&%N !CCO&"*N9 TO S677%&*N9 O7 "*S%!S%S
:*T$*N 0!ST - MONT$S P&%C%"*N9 T$% ST6"8(((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((0)***
7*96&% ';5 P%&C%NT "*ST&*46T*ON O7 $O6S%$O0"S !CCO&"*N9 TO T&%!TM%NT S%%<*N9
4%$!,*O& 7O& T$%*& C$*0"&%N(((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((( 0)*,
7*96&% +>5 P%&C%NT!9% O7 6N"%& :%*9$T C$*0"&%N 48 S%) 4%T:%%N S06M !N" NON
S06M !&%!S((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((( 0),*
7*96&% +'5 "*ST&*46T*ON O7 N6T&*T*ON!0 ST!T6S O7 MOT$%&S !CCO&"*N9 TO 4M*(((0),***
7*96&% ++5 !N%M*! 0%,%0 O7 C$*0"&%N !9%" 1+. MONT$S((((((((((((((((((((((((((((((((((((((((((((((((((0)*)
7*96&% +-5 !N%M*! 0%,%0 O7 MOT$%&S((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((( 0)*)
7*96&% +.5 P%&C%NT!9% O7 7607*00M%NT O7 &"! O7 %N%&98 O7 0!CT!T*N9 MOT$%&S O7
S06M !N" NONS06M !&%!S(((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((( 0))*
93
List of Abbreviations
44S B()*+(,-./ B01-(0 23 S4(45.456.
4M* B2,7 M(.. I),-8
4"$S B()*+(,-./ D-92*1(:/56 (), H-(+4/ S01;-7
4NNS B()*+(,-./ N(452)(+ N0415452) .01;-7
4&!C B()*+(,-./ R01(+ A,;()6-9-)4 6299544--
Cm C-)459-4-1
9"P G12.. D29-.456 P12,064
9o4 G2;-1)9-)4 23 B()*+(,-./
$!A H-5*/4&321&(*- <&.621-
$b H-92*+2=5)
$<* H-++-) K5++-1 I)4-1)(452)(+
$t H-5*/4
*C""&4 I)4-1)(452)(+ C-)4-1 321 D5(11/2-(+ D5.-(.- R-.-(16/> B()*+(,-./
*"! I12) D-3565-)67 A)-95(
*M& I)3()4 M214(+547 R(4-
*N7S I).45404- 23 N0415452) (), F22, S65-)6-
*P$N I).45404- 23 P0=+56 H-(+4/ (), N0415452)
*6 I)4-1)(452)(+ U)54
*8C7 I)3()4 (), Y20)* C/5+, F--,5)*
<cal ?5+2 6(+215-
<g ?5+2*1(9
<gBm+ K5+2*1(9 :-1 9-4-1 .@0(1-
04: L2A B514/ W-5*/4
MgBdl M5++5*1(9 :-1 ,-65+54-1
C g M5612*1(9
C l M5612 +54-1
Mm 95++59-4-1
N9O N2)&*2;-1)9-)4(+ O1*()5<(452)
No( N09=-1
O" O:456(+ ,-).547
P%M P124-5)&-)-1*7 M(+)0415452)
93
&"! R-6299-),-, D5-4(17 A++2A()6-
SPSS S4(45.456(+ P(6?(*- 321 S265(+ S65-)45.4.
6N%SCO U)54-, N(452). E,06(452)(+> S265(+ (), C0+401(+ O1*()5<(452)
6N*C%7 U)54-, N(452) C/5+,1-) F0),
:!A W-5*/4&321&(*- <&.621-
:$O W21+, H-(+4/ O1*()5<(452)
:$A W-5*/4&321&/-5*/4 <&.621-
:t A-5*/4
B :-16-)4
Chapter 1
1.1. Introduction
0utritional status is the result of comple' interactions &etween food consumption! overall
health status and care practices "t the individual level inade,uate or inappropriate
feeding patterns lead to malnutrition 0umerous socio-economic and cultural factors
influence patterns of feeding and nutritional status #oor nutritional status is one of the
most important health and welfare pro&lems facing 5angladesh 6alnutrition is a result
and cause of the social and economical underdevelopment of 5angladesh The prevalence
of malnutrition in 5angladesh is among the highest in the world 6illions of children and
women suffer from one or more forms of malnutrition including low &irth weight!
wasting! stunting! underweight and anemia
6alnutrition not only affects individuals &ut its effects are passed from one generation to
the ne't as malnourished mothers give &irth to infants who struggle to develop and thrive
" factor that contri&utes to malnutrition among infants is that *) percent of children in
5angladesh are &orn with low &irth weight $>53% This is caused &y maternal
malnutrition and high prevalence $8* percent% of anemia during pregnancy ?lo&ally
malnutrition is attri&uted to almost one-half of all children deaths
(
+urvivors are left
vulnera&le to illness! stunted growth and lack of intelligence /f these children are girls!
they often grow up to &ecome malnourished mothers themselves
93
The gift of nature is that a malnourished mother can even is a&le to provide enough good
,uality milk for the normal growth of her child! as indicated &y growth pattern of
e'clusively &reastfed infants
2
5reastfeeding also affects mothers &y physiologically
suppressing the return to fertility! there&y affecting the length of interval &etween
pregnancies @0/.A1 and 3-7 recommend that children &e e'clusively &reastfed for
the first si' months of life and that children &e given solid or semisolid complementary
foods &eginning with the seventh month of life The standard indicator of e'clusive
&reastfeeding is the percentage of children less than si' months of age who are
e'clusively &reastfeeding The standard indicator of timely complementary feeding is the
percentage of children age 6-9 months who are &reastfeeding and receiving
complementary foods The 3-7 recommends that &reastfeeding &e continued through
the second year of life
3
/f infants are e'posed to faulty feeding and weaning practices they &ecomes
malnourished and already >53 &a&ies can not catch up growth 5reastfeeding and
weaning practices are crucial for optimal growth and development during infancy and
play a vital role in determining the optimal development of infants #oor &reastfeeding
and infant feeding practices have adverse conse,uences for the health and nutritional
status of children This! in turn! has conse,uences for their mental and physical
development 1or e'ample! if complementary foods are introduced inappropriately and
with insufficient dietary diversity malnutrition occurs
4
"fter the age of two years! the
effects of under nutrition are largely irreversi&le 6issing the Bwindow of opportunityC D
the thousand-day period from conception to two years of age D to improve nutrition can
result in long-term permanent damage
*
These pro&lems are very crucial and common factors contri&uting to high prevalence of
malnutrition in 5angladesh 1rom an initially disadvantaged &eginning! many
5angladeshi infants &riefly improve in nutritional status during the first si' months of life
due to near-universal &reast-feeding -owever after weaning at age 6 months! inade,uate
food intake and a high &urden of diarrhoea and other diseases e'ert a serious toll on the
nutritional status of a child /n most cases! in our country complementary foods are
introduced too early or too late with insufficient ,uality and ,uantity "lthough there is a
93
national /nfant and Eoung .hild 1eeding $/E.1% strategy! there is no implementation
plan for that and as a result! the strategy has not led to the desired impact @0/.A1
supports the 0ational 0utrition #rogramme to scale-up community-&ased peer counseling
through mothersF support groups "n estimated *)!))) pregnant women and lactating
mothers are getting counseling on /nfant and Eoung .hild 1eeding $/E.1% through
6other +upport ?roups in ten upo2illas covered &y the 0ational 0utrition programme
and supported &y @0/.A1
6

#revalence of anemia among women of reproductive age and children are very common
in 5angladesh +uccessive pregnancy! high rate of a&ortion! inappropriate maternal care
for pregnant and lactating mothers! intra-household insecurity of food Dall these are
contri&utory factors for anemia among lactating females To prevent anemia in children!
adolescent girls and pregnant and lactating women some packages of interventions have
&een taken &y government and different national and international 0?7 These proGects
include iron-folate supplements! deworming ta&lets and counseling to improve dietary
intake! control disease and improve iron-folate intake " network of adolescent girls
groups is used to reach those who do not have regular contact with health services /n
some ur&an slums of Dhaka and seven selected upa2illas! 6ultiple 6icronutrient #owder
is &eing provided to families to prevent and correct anemia in children under five &y
@0/.A1
6
/n the recent decades rapid ur&ani2ation has &ecome a trend in almost all developing
countries 6aGority of the world=s &iggest cities are in the developing countries and 6)
percent of their population lives in the ur&an slums
8
@r&ani2ation is associated with
industriali2ation and economic development and results in an increase in slum and
s,uatter settlements
;
@r&an population growth is also occurring at an alarming rate
throughout 5angladesh Thirty millions of people! over 2) percent of the population of
5angladesh! live in ur&an areas @r&an growth is currently estimated at over 9 percent per
year in 5angladesh
9
This rate includes a significant num&er of poor and landless
households moving to city slums from rural areas in search of &etter opportunities
93
/n 2)()! the population of the city of Dhaka has &een proGected at (86 million people!
with upto 6) percent in the slums Averyday we o&serve the influ' of hundreds of new
people to Dhaka city There are two factors &ehind mostly encouraging people to come to
Dhaka These are - pull factor and push factor 5angladesh is ur&ani2ing fast #eople are
moving to places where there are or perceived to have Go&s and opportunities The cities
are the new centers of Go&s and opportunities The &igger the center! the stronger is the
pool Dhaka is the primate city in 5angladesh according for over 3) percent of the total
?D# /t is pulling rural migrants faster and larger than any other cities in 5angladesh
1indings showed that! *6 percent people migrated to Dhaka city for economic reasons
There are also some push factors working in the process of migration to the cities!
especially to Dhaka city 0ow-a-days ma'imum slum dwellers are one kind of
environmental migrants The often natural disastersH flood! drought! cyclones! river&ank
erosion destroys the agricultural outcomes every year 3hile 5angladesh is an agro-&ased
country these disasters are much painful for the farmers and they are o&liged to go to the
cities The Go& sectors of rural areas are not much strong so people are pushed to the
cities "nd for many other people demonstration effect is &ig enough to push them to the
cities
()
This uncontrolla&le rapid growth of ur&an population is accompanied &y
increasing poverty! food insecurity and malnutrition! which leaves serious implications
for welfare and well &eing of the country=s ur&an population
((
-owever ur&ani2ation
adversely affects the social environment when it outstrips the capacity of the
infrastructure to meet people=s needs /n addition! overcrowding and poor working
conditions can lead to an'iety! depression and chronic stress and have a detrimental effect
on the ,uality of life of families and communities
(2
The population of slums in 2)); was estimated at &etween si' and seven million people!
3) per cent of the metropolitan population and a&out (* percent of the overall ur&an
population /n other words! the population of slums is a&out * percent of the total
population or a&out 8 million people in 2)() 0um&er of migrants is increasing everyday
in Dhaka! which is leading towards new slum areas " 3orld 5ank study counted (!92*
slums in Dhaka comprising 28*!))) households $(* million people%
(3
3ithin the fast
growing ur&an slums in each of the three maGor cities - Dhaka! Khulna and .hittagong!
93
there e'ists such communities where prevalence of malnutrition is higher than in the
worst affected rural areas of 5angladesh
(4
.ompared to other parts of the country!
currently Khulna has the lowest prevalence of underweight population $3;9 percent%!
followed &y Dhaka $4*2 percent%
(*

+lum dwellers are distressed migrants from rural areas! with poverty-driven ur&ani2ation
due to unsustaina&le rural economy .onsistent with a (993 @0/.A1 report! the main
reasons for migration to Dhaka remain poverty! landlessness! unemployment and river
erosion The ur&an poor have &een noted to pay very high rent for dismal housing and
dwellings in Dhaka are often on government-owned land! moving within slums is
common due to land re-appropriation @nsanitary latrine conditions are found in 866
percent and many pay intermediaries for utilities Though most slum dwellers uses
pumpedItap water for drinking while open or surface water is used for non-drinking
purposes
(6
The inha&itants of slums are e'posed to new environmental dynamics of poor
housing! water supply and sanitation with poor access to health care 6oreover! most
ur&an slum dwellers face particular hardships that contri&ute to high rates of child illness!
malnutrition and food insecurity 6any of the main ha2ards to health are present in these
ur&an slum areas such as over-crowding! together with the unhealthy environment due to
poor sanitation! inade,uate supply of clean water! pollution and lack of systematic
removal of gar&age and solid wastes
(8
+lum people are e'posed to greater risk of
nutritional deficiency disease than non-slum ur&an areas Eoung children and women of
reproductive age among slum dwellers are more vulnera&le to nutritional deficits
1.2. Rationale of the Stud
6alnutrition is a serious pu&lic health and socio-economic pro&lem of 5angladesh! where
the most affected populations are under * years= children! adolescent girls! pregnant and
lactating women The infant mortality rate $/6<% is *8 per ())) in the country -owever!
43 percent preschool age children are stunted and (8 percent of them are severely
93
stunted "gain! (3 percent are wasted and ( percent is severely wasted /n our country 4;
percent of the children are underweight! with (3J severely underweight
(*
<ates of child malnutrition rise very rapidly from 6 months of age and reach their peak
during weaning age among nutritionally vulnera&le children aged 6 to 24 months
There are many factors which accelerate malnutrition 0on-e'clusive &reast feeding!
delay of early initiation of &reast milk! delayed and faulty weaning practices! prolong
&reast feeding are the most crucial factors among those 6aternal malnutrition is another
significant cause of child malnutrition " malnourished mother gives &irth of >ow 5irth
3eight $>53% &a&ies -owever! if those children are not taken care with proper feeding
practices! it e'pedites malnutrition
"nemia is a most common pu&lic health concern among all age groups! &ut highest
among children and pregnant and lactating women and affects a&out 2 &illion people in
developing countries The conse,uences of anemia in pregnant women include increased
risk of low &irth weight or premature delivery! pre-natal and neonatal mortality!
inade,uate iron stores for the new&orn! lowered physical activity! fatigue and increased
risk of maternal mor&idity /t is also responsi&le for almost a ,uarter of maternal deaths
/nade,uate iron store in a new&orn child! coupled with insufficient iron rich food intake
during the weaning period! causes impaired intellectual development &y adversely
affecting language! cognitive! and motor development of the child /ron deficiency
among adults contri&utes to low la&or productivity A'clusive &reastfeeding until age of 6
months and continuation of &reastfeeding after this age com&ined with ,ualitatively and
,uantitatively appropriate feeding may contri&ute towards an increase in hemoglo&in
concentration in the first year of life +o! in a nutshell infant and young child feeding
practices not only influence the growth! development! nutritional and health status of the
child &ut also have life long implications on the health of a person

/ntra-uterine malnutrition resulting in low &irth weight of the new &orn coupled with
early childhood malnutrition is the maGor cause of diet related chronic diseases like
dia&etes! hypertension! cardio-vascular diseases and other chronic diseases in later life
93
-owever! nutritional deficiency disorders affect productivity of the person resulting in
household food insecurity thus making a vicious cycle of poverty and malnutrition
Through precipitating disease and speeding its progression! malnutrition is a leading
contri&utor to infant! child and maternal mortality and mor&idity .hildren and lactating
mothers living in slum areas are more affected as they &elong to an overcrowded under
hygienic environment The ur&an non-slum children along with their mothers are
e'pected to give a different picture &ecause of their &etter socio-economic and
educational attainment
The study was taken to evaluate the nutritional status of children aged 6 to 24 months and
their mothers to identify the current nutrition situation " comparison has &een done
&etween the slum and non-slum child-mother pairs This study will help decision making
to ma'imi2e utili2ation of limited resources particularly important for developing
countries like us &urdened with numerous health! nutrition and economic pro&lems to
address
93
Chapter 2
2.1. Literature Revie!
/n developing countries inade,uate access to food and nutrients! inade,uate care of
mother and children! inade,uate health services and unhealthy environment are very
common all of which leads to malnutrition >eading scientists link 6) percent of all
childhood deaths to malnutrition
(9
The five maGor nutrition pro&lems in "sia and the
#acific <egion are- >ow &irth weight $>53% which related to maternal malnutrition!
early childhood growth failure! iron deficiency anemia $/D"%! Kitamin " deficiency and
/odine deficiency disorders $/DD%
2)
.hild under nutrition is not spread evenly across the glo&e &ut is instead concentrated in a
few countries and regions 6ore than 9) percent of the world=s stunted children live in
"frica and "sia! where rates of stunting are 4) percent and 36 percent respectively
2(
93
5angladesh is a poverty stricken malnourished nation with a population of ((2 million
denser than any other country 6alnutrition is endemic in the country with high infant!
under five children and maternal mor&idity and mortality "lmost the whole population
suffers from micro nutrient deficiencies! chronic dietary deficiencies! non food factors
such as personal and environmental hygiene! sanitation! ,uality of water that is used for
drinking and washing! the ways of waste disposal all contri&ute to the present state of
malnutrition 5oth food and non food factor assumed special importance in case of
e'pected and nursing mothers! adolescent girls and children who constitute the vulnera&le
group of the population
22
The prevalence of malnutrition in 5angladesh is amongst the highest in the world 24J
of all children was severely malnourished &y ?ome2 classification of 6alnutrition
$3"6 9 6)J%! 348J were moderately malnourished $3"+ : 6) - 84J% and *)8J
were mildly malnourished $3"6 : 8* D ;9J% ((*J children were normal $3"6 : 9)
D ()9J% &y ?ome2 classification and )6 J were over weight $3"6 L (()J%
23

/n 5angladesh 43 percent of children under five are stunted! and (6 percent are severely
stunted! seventeen percent of children under five are wasted! and 3 percent are severely
wasted 3eight-for-age results show that 4( percent of children under five are
underweight! with (2 percent are severely underweight $measured in 3-7 .hild ?rowth
+tandard% in our country
(*
/n the recent decades child malnutrition has &een addressed at a successful rate
#revalence of underweight in children under five years $J% in 5angladesh in (9;;D92
was *6*M whereas in 2))3D); it decreased to 4(3
24
This rate is still alarming
To assess the nutritional status and to determine potential risk factors of malnutrition in
children under 3 years of age in 0ghean! Kietnam a study was undertaken The study
carried out in 0ovem&er 2))8! a total of 3;3 childImother pairs were selected &y using a
2-stage cluster sampling methodology " structured ,uestionnaire was administered to
mothers in their home settings "nthropometric measurement was defined as &eing
underweight $3eight-for-age%! wasting $weight-for-height% and stunting $-eight-for-age%
93
on the &asis of reference data from the 0ational .enter for -ealth +tatistics $0.-+% I
3orld -ealth 7rgani2ation $3-7% >ogistic regression analysis was used to into account
the hierarchical relationships &etween potential determinants of malnutrition The mean
4-score for weight-for-age was -(*( $9*J ./ -(64! -(3;%! for height-for-age was -(*(
$9*J ./ -(6*! -(38% and for weight-for-height was -)63 $9*J ./ -)8;! -)4;% 7f the
children! ()3 $288;J% were underweight! (3* $363J% were stunted and 3; $()2J%
were wasted <egion of residence! ethnic! mother=s occupation! household si2e! mother=s
56/! num&er of children in family! weight at &irth! time of initiation of &reast-feeding
and duration of e'clusive &reast-feeding were found to &e significantly related to
malnutrition The findings of this study indicate that malnutrition is still an important
pro&lem among children under three and socio-economic! environmental factors and
feeding practices are significant risk factors for malnutrition among under-three years of
age in 0ghean! Kietnam This study also identified that a greater risk of malnutrition was
associated with poor knowledge of mothers on child feeding practice These findings are
very importance! suggesting the need for improving knowledge of mothers on child
feeding practice
2*
#regnant women and children during growth stages are the groups most vulnera&le to
iron deficiency anemia This is a highly prevalent disease worldwide! &ut rates are
highest in developing countries The highest prevalence is detected among children in the
6 to 24 month age group! a period which coincides with the termination of &reastfeeding
There is also evidence that the occurrence of anemia decreases as the child grows! even
though anemia is still an important health pro&lem among preschool children
" study was undertaken to assess the relationship &etween hemoglo&in concentration and
&reastfeeding and complementary feeding during the first years of life in the city of
+alvador! 5ahia! in northeastern 5ra2il! &etween Nuly (99; and "ugust (999 " .ross-
sectional study was conducted among **3 children under age (2 months! who attended
pu&lic healthcare facilities -emoglo&in concentration was measured &y
cyanmethaemoglo&in method! using the -emo.ue system "s an outcome of the study
93
-emoglo&in concentrations compati&le with anemia were identified in 62;J of the
children studied! with greater occurrence among the 6-(2 months age group $826J%
A'clusive &reastfeeding during the first si' months of life was associated with the highest
levels of hemoglo&in The remaining feeding regimes were associated with different
levels of reduction in hemoglo&in levels! which &ecame compati&le with anemia in
children fed with formula $p:)!))9% Tea andIor water consumption was associated with
a reduction in hemoglo&in concentration of )86 gIdl $p9)!))(% among children under age
6 months 1or children aged 6-(2 months! hemoglo&in concentrations increased
significantly with the consumption of sugar $p:))(8% and &eans $p:))(;%! and
decreased significantly with the consumption of fruit $p9)))(%
26
6icronutrient deficiencies especially iron and folic acid deficiencies that result in
nutritional anemia in children and women and neural tu&e defects in new&orns remain a
pu&lic health pro&lem in 5angladesh #oor intake of foods rich in iron and folic acid and
multiple infections have resulted in high rates of anemia among pregnant women and
children under two years .overage of pre and postnatal iron and folic acid supplements
is very low $only (*J of pregnant women in rural areas take at least ()) ta&lets during
pregnancy%
28
due! in part! to low compliance rates and low coverage of antenatal
services .overage of multiple micronutrient supplements formulated to address iron and
other micronutrient deficiencies is also very low
@r&an population growth is occurring at an alarming rate throughout 5angladesh The
national census conducted in 2))( showed that the ur&an population had grown &y 3;J
in the previous ten years! compared with only ()J in rural areas
2;
The scale of ur&an
poverty in 5angladesh has &ecome a critical policy issue /f current trends continue! it is
predicted that the num&ers affected &y ur&an poverty will rise to 23 million &y 2)()
29
The
rate of ur&ani2ation in 5angladesh includes a significant num&er of poor and landless
households moving to city slums from rural areas in search of &etter opportunities
9
-owever! it adversely affects the social environment when it out strips the capacity of the
infrastructure to meet peoples= need /n addition! overcrowding and poor working
93
condition can lead to an'iety! depression and chronic stress and have a detrimental effect
on the ,uality of life of families and communities
(2

@nder-nutrition remains a maGor pro&lem in most developing countries! especially in
underserved areas such as ur&an slums " cross-sectional study was planned to know the
role of various factors influencing the nutritional status The study was conducted in the
ur&an slums of <ohtak! a city in -aryana! on *4) children aged (-6 years and the relation
of under-nutrition with age! se'! &irth order! and type of family! literacy! and calorie
intake were studied and analy2ed using percentages and chi-s,uare test *84J of
children were found malnourished #roportion of malnourishment was more in males
5irth order! age type of family! num&er of living children! literacy status of mother and
calorie intake were statistically significantly associated with grades of malnutrition
3)
/n 5angladesh the prevalence of stunting $J9-2 2-score% among the pre-school children
was higher in the ur&an slums! followed &y the rural and ur&an non-slum areas $662J!
6((J! and *2*J% respectively in (996
;
The 0utrition +urveillance #roGect conducts nutrition and health surveillance in
partnership with 0?7s in 4 ur&an slum working areas of Dhaka! .hittagong and Khulna
and 4( sites throughout rural 5angladesh /n Decem&er (996! the -elen Keller
/nternational $-K/% and the /nternational .entre for Diarrhoeal Disease <esearch!
5angladesh colla&orated on a crosssectional health and nutrition study in >al&agh! a non-
slum area in Dhaka Data from the Decem&er round of the 0+# for slum areas $n:(!8;;%
and the rural sites $n:(6!(4)% were used with the non-slum site $n:(!392% The
prevalence of stunting $J9-2 2-score% among the pre-school children was higher in the
ur&an slums! followed &y the rural and ur&an non-slum areas $662J! 6((J! and *2*J%
respectively "nalysis of the household socioeconomic situation showed that there was
also great disparity within each of these areas .omparing nutritional status among the
children from vulnera&le households $landless andIor where the main earner is a casual
worker% &y area revealed the severity of underweight in the ur&an slumsH 8()J vs
6(9J in the ur&an non-slums vs 64;J in the rural areas Diarrhoea! vulnera&ility! and
slum ha&itat were significantly associated with increased risk of &eing underweight
93
"s seen from this analysis! the pre-school children in the slum areas of Dhaka and other
sites were at e,ual or greater risk of poor health and malnutrition than their counterparts
in the rural and non-slum areas 3hile the malnutrition rates for children living in the
areas are also high &y international standards! the results of the study suggest that
particular attention should &e given to improve the situation for children living in the
ur&an slums
;
/n selected upa2ilas of .hittagong -ill Tracts! seven 0ational 0utrition #rogram
convergence upa2ilas and selected slums of Dhaka and .hittagong .ity .orporation
areas .ommunity-&ased models for preventing anemia in children! adolescent girls and
women have &een piloted This pilot proGect is &eing e'panded to other areas in ur&an and
rural 5angladesh! targeting 8*!))) children! (*!))) adolescent girls and 6!))) women
(
/n many developing countries! the low status of women is considered to &e one of the
primary determinants of under nutrition across the life cycle 3omen=s low status can
result in their own health outcomes &eing compromised! which in turn can lead to lower
infant &irth weight and may affect the ,uality of infant care and nutrition " study in
/ndia showed that women with higher autonomy $indicated &y access to money and
freedom to choose to go to the market% were significantly less likely to have a stunted
child when compared with their peers who had less autonomy
32
The mean height of 5angladeshi women is (*) centimeters! which is a&ove the critical
height of (4* centimeters Thirty percent of women are chronically malnourished! their
&ody mass inde' $56/% &eing less than (;* 7ne in weight women was found to &e
overweight or o&ese $56/ 2* or higher% " woman=s place of residence! level of
education and household wealth status are strongly associated with her nutritional status
1or e'ample! 33 percent of rural women are considered thin $9(;*%! compared with 2)
percent of their ur&an counterparts 5etween the 2))4 and 2))8 5D-+ surveys! the
proportion of women who are over-weight or o&ese increased slightly from () percent to
(2 percent The average height of women did not change
(*
93
>ower health care facilities for women of reproductive age result in higher maternal
malnutrition in the country /n 5angladesh ( in * women $2( percent% with a live &irth
receives postnatal care from a medically trained provider! and mostly only in the first two
days after delivery
(*

Data from the 2))8 5D-+ show that under-five mortality $6* deaths per ())) live &irths%
has continued its nota&le decline >arge decreases were o&served in child mortality $age
(-4 years% The num&er of children die &efore reaching the first &irthday has decreased
from one in fifteen children compared to one in (9 $*2 deaths per ())) live &irths% in the
2))4 5D-+
(*
"nother contri&uting factor for malnutrition is faulty treatment seeking &ehavior and
a&sence of health care facility for the target population "mong children under * years
of age! * J showed the symptoms of acute respirator illness in the two weeks preceding
the 5angladesh Demographic and -ealth +urvey 2))8 7f these! only 38J were taken to
a health facility or a medically trained provider for the treatment while (3J received no
treatment at all "mong thirty eight percent of children under five years had a fever in the
two weeks preceding the survey 7f these 24 percent were taken to a medically trained
provider or health facility for treatment 1or 23 percent of children with fever! help was
sought at a pharmacy
(*
There is a strong association &etween under-five mortality and mother=s education /t
ranges from 32 deaths per ())) live &irths among children of women with secondary
complete or higher education to 93 deaths per ())) live &irths among children of women
with no education
(*
" greater risk of malnutrition is associated with poor knowledge of mothers on child
feeding practice "lmost all $9; J% 5angladeshi children are &reastfed for some period of
time 1orty-five percent of last-&orn infants who ere ever &reastfed were put to the &reast
within one hour of &irth! and ;9 percent started &reastfeeding within the first day The
median duration of any &reastfeeding in 5angladesh is 32 months A'clusive
93
&reastfeeding of children under si' months $&ased on 24-hour period &efore the survey%
has not improved in the past (* yearsM it remained unchanged at around 4* percent in
&etween (993-94 and (999-2)))! declined to 42 percent in 2))4! and remained
essentially unchanged! 43 percent in 2))8
(*
The maGority of mothers &reastfed their
children well into the second year of life $O;;J of children aged (2-(4 mo and O84J of
children aged 2(-23 mo%! and many for much longer
33
7n the other hand! supplementary feeding of children who are also &reastfed has greatly
increased over the past (* years /n (993-(994! only 29 percent of children age 6-9
months received complementary foods while &eing &reastfed! compared with 62 percent
in 2))4 and 84 percent in 2))8The most commonly used complementary foods are those
made from grains such as rice! wheat and porridge $over 6) percentM one-third of the
children in this age group received fruits and vegeta&les rich in vitamin " +i'teen
percent received meat! fish! poultry or eggs
(;

6aternal malnutrition! insufficient health care facilities! lower education level! poor
knowledge! attitude and practices a&out child feeding are more common in slum areas
6a'imum people of the slum are &elow poverty level and are living vulnera&le life as
malnutrition and poverty in interlinked Their housing conditions are appalling with many
living in flimsy shakes $Nhupri% 7nly 4(J have access to sanitary toilets 6ost of their
income is spent on food They enGoy any utility services very hardly They use open
spaces and drains for defecation and cook their food on the street
34
6any tens of thousands of people live in desperately poor circumstances in the slums of
towns and cities of 5angladesh and all the evidence suggests that their num&ers are
rising The num&er of slum settlements has grown rapidly in recent years and the ur&an
poor are now estimated at around (( million or 38J of the ur&an population of
5angladesh 6ost of these slums only provide shelter for poor people
((

" study was done to asses the determinants of malnutrition among the children under 2
years of age of Dhaka city 1or this purpose! two hundred and twenty five mothers of
93
Dhaka medical college hospital are interviewed to investigate of determinants of
malnutrition "ll of the respondents were under two years of age 7ne hundred fourteen
of them were girls and rests ((( were &oys "ll of the children were from different socio-
economic status coming different places of 5angladesh 2;J of the respondents= family
monthly income was &elow 3))(-*)))! 36J were &elow 2)!)))-2*!))) and (64J were
()!)))-(*!)))! 2(3J respondents= mothers were illiterate! 244J mothers completed
primary level! 32J completed secondary level! (((J completed higher secondary level
and (((J mothers were graduated The nutritional status children were not found very
from normal to 3 degree malnourishment 0early 4*;J were normal! (;J was over
nourished and 22J were 3 degree malnourished
3*
<ecent findings from a survey of slums in Dhaka suggested that anemia is a serious
pu&lic health pro&lem among the school children +pecial study from the ur&an slum
sides of the ?75I-K/ nutrition surveillance proGect $0+#% showed that 8*;J of
children aged 6-*9 months suffered from anemia $-emoglo&in 9 (()gI>% The
prevalence of anemia was highest among children aged 6-(( months $923J% and
children aged (2-23 months $;84J% 6any mothers and children are still malnourished
and according to 3-7 definitions! prevalence of malnutrition was very high or serious
during most time of the year Data showed that *;-8)J of households in slums of Dhaka
had an energy intake P 2(22KcalI#ersonIDay indicating at least moderate poverty The
maGority of these households also had an intake &elow (;)*KcalI#ersonIDay $29-34J% in
Dhaka "ppro'imately a ,uarter of mothers were under weight +everity of child wasting
$>ow weight of height% was poor $4-;J% prevalence was higher among )-23 months old
children in the slums of Dhaka
9
/n the a&ove conte't! it can &e concluded that a large num&er of the population of
5angladeshi children are suffering from malnutrition and are likely to grow smaller and
smaller This is implication of the fact that we are heading towards a nation that will see
its children to &e of small status and low weight population +o! we need to give highest
priority to child health and nutrition if we hope for a &righter future of our country
93
Chapter 3
".1. #b$ectives
".1.1. %eneral #b$ective
To assess the nutritional status of children aged 6 to 24 months and their mothers from
selected slum and non-slum areas of Dhaka city and to compare the e'isting nutritional
situation in terms of feeding practices as well as socio-economic conditions
".1.2. S&ecific #b$ectives
( To assess the socio-economic and demographic situation of the slum and non-
slum target populations
2 To evaluate the nutritional status of children $6 to 24 months% and their mothers
&y anthropometric measurements and clinical o&servations &etween two target
populations
93
3 To estimate &lood hemoglo&in level of &oth mothers and children $aged 6 to 24
months% from two target populations using -emo.ue method
4 To assess Knowledge! "ttitude and #ractice $K"#% &etween two target
populations in terms of pregnancy! delivery and lactation aspects of the mothers
* To find out child feeding practices and to evaluate dietary intake pattern of the
mothers using 24 hours dietary recall method of &oth target populations
6 To understand the mor&idity pattern of children and treatment seeking &ehavior of
two target populations
8 To compare the e'isting situation &etween the selected slum and non-slum
populations of Dhaka city in terms of study parameters
; 1inally! to recommend appropriate interventions to improve the feeding practices
as well as nutritional status of &oth target populations &ased on the study findings
".2. '&othesis
There exists influential factors affecting nutritional status
and feeding behavior of urban slum and non-slum children
(aged 6 months to 24 months) and their mothers of Dhaka
city.
93
".". Conce&tual Fra(e!or)
93
" conceptual framework was drawn to summari2e all influential factors that affecting
nutritional status of mothers and in turn their children 6aternal malnutrition is the
outcome of poor socio-economic and demographic condition $ie low income! low level
of education! occupation and family si2e%! which is e'pedite &y poor sanitation! fre,uent
mor&idity! lack of health care facilities! lack of pure water source for different usages!
93
unhealthy environment and living condition "n unhealthy mother with poor &ody
storage of different nutrients and short stature gives &irth of a low &irth weight $>53%
&a&y in most cases "gain improper treatment seeking &ehavior! fre,uent mor&idity! lack
of proper Knowledge! "ttitude and #ractice $K"#% of mothers a&out pregnancy! delivery!
lactation and faulty feeding practices $non-e'clusive &reast feeding! faulty
complementary feeding practice! prolonged &reast feeding% D all these leaves a dangerous
impact on child growth and development .hildren at their early life fail to catch-up
growth +uch trauma at the &eginning of life has &ad conse,uences in the long run "
malnourished child &ecomes a malnourished adult and the cycle of malnutrition continues
from generation to generation
Chapter 4
4.1.*aterials and *ethods
4.1.1. Stud +esign
93
This was a comparative cross-sectional study The study was conducted among the
children aged 6 to 24 months and their mothers of selected slum and non-slum areas of
Dhaka 6etropolitan city The aim of the study was to investigate the comparison &etween
the target populations from slum and non-slum areas The study was! therefore designed
into the following four schematic partsH
Part one: +ocio-economic Q demographic informationH
/t included age! education! religion! occupation! total family mem&er! monthly income!
sector wise e'penditures! utility facilities and water sources for different household
usages
Part two: K"# related /nformation among mothersH
/ /nformation related to pregnancy! lactation and delivery
// 1eeding #racticesH .olostrum feeding! #re-lacteal feeding! e'clusive &reast
feeding! supplementary feeding and complementary feeding practices
/// 6or&idity and treatment seeking &ehavior
Part three: "nthropometric assessmentH
-eightIlength and weight of target children
-eight and weight of their mothers
Part four: 5iochemical assessmentH
-emoglo&in level of target children and their mothers
Part five: Dietary assessmentH
1ood /ntake of mothers &y 24 hour recall method
Part six: .linical "ssessmentH
.linical signs and symptoms of target children and their mothers
Part seven: +tatistical analysisH
Different statistical analysis was undertaken These are-
Descriptive analysis
93
#earson=s .hi-s,uare test
5ivariate correlation
>inear regression
Time Frame: The study was carried out from Nanuary to Decem&er 2)() which includes
study design! data collection! data analysis and write up
4.1.2. Stud Location
The study was conducted at Koilarghat slum! .handirghat slum at Kamrangirchar slum
area and randomly selected non-slum areas of Dhaka city Data for non-slum areas were
collected from the mother-child $aged 6 to 24 months% pairs visiting different
immuni2ation centers in Dhaka city These were the immuni2ation centers of -oly
1amily <ed .rescent 6edical .ollege and -ospital! 6onowara -ospital #rivate >td and
5righton -ospital! Dhaka The places were chosen in a purpose to reach the target
population during the limited time of data collection " large num&er of mother-child
pairs from different parts of non-slum Dhaka attended these centers for immuni2ation
4.1.". Stud ,o&ulation
The study was conducted among 9* child-mother pairs from &oth slum and non-slum
areas of Dhaka city &y simple random sampling The study su&Gects included children
aged 6 to 24 months and their mothers "ges of the children were confirmed mostly &y
using the childFs &irth certificate or immuni2ation card The purpose of the study was
e'plained to the authority of those centers and all the respondents To conduct the study!
consent was taken from the mothers of the children
4.1.4. Sa(&le Selection Criteria
Inclusion Criteria:
6other alive as well as care giver of 6-24 months child
<esiding in the ha&itation for at least 6 months
93
Exclusion Criteria:
+everely sick child or mother
6other is not the caregiver
4.1.-. Sa(&le Si.e Calculation
The sample si2e was estimated &y considering the prevalence of malnutrition among the
children aged less than two years of slums of Dhaka The prevalence of underweight
children of less than 2 years of age in ur&an slum of Dhaka is 46J
36
The sample si2e for slum and non-slum children $6 -24 months% was estimated using the
following formulaH
.onsidering p:)46 $,:)*4%! 2:(96 and d:()J we o&tain
3here!
p : )46 $ma'imum varia&ility ie prevalence of underweight in 9 2 years
children in ur&an slum Dhaka%
, : $(-p% : $(-)46% : )*4
4 : the value associated with 9*J confidence interval : (96
e : level of precision $R()J% : )(
" total of 9* children aged 6 to 24 months were thus selected in the study having e,ual
num&er of their mothers +imilarly for comparative purpose e,ual num&er that is 9*
child-mother pairs were included in the study! even though the prevalence of malnutrition
among non-slum area children is much lesser in num&er
93
Thus a total of (9) child-mother $6-24 months% pairs who were residing in their
ha&itation for more than 6 months were selected randomly for the study purposes
4.1.6. /uestionnaire +esign and Field Trial
" standard close ended ,uestionnaire was developed to o&tain relevant information &ased
on the o&Gectives of the study /n order to standardi2e the data collection procedure! pre-
testing of the ,uestionnaire was conducted in &oth slum and non-slum areas who were not
included in the study 5ased on the o&servations and pre-test findings necessary
corrections were made in the ,uestionnaire The ,uestionnaire was then finali2ed "
detail ,uestionnaire is given in anne'ure(
4.1.0. #vervie! of +ata Collection *ethod
The mothers were interviewed to collect information /n the slum areas target child-
mother pairs were reached &y door to door visit Data for non-slum areas were collected
from the target child-mother pairs visiting different immuni2ation centers in Dhaka city
These were the immuni2ation centers of -oly 1amily <ed .rescent 6edical .ollege and
-ospital! 6onowara -ospital #rivate >td and 5righton -ospital! Dhaka The places were
chosen in a purpose to reach the target population during the limited time of data
collection
To avoid information missing or faulty information! the collected information from the
locations were checked! coded everyday and crosschecked at the field sites in order to
avoid any misreporting "ny confusion arising in this matter was settled on the following
day during su&se,uent spot visit
Socio-economic & emogra!hic ata Collection:
/nformation regarding socio- economic and demographic condition was collected as an
essential part of the study &y a personal interview with target mothers +ocio-economic
information such as educational attainment! occupation! num&er of family mem&ers!
93
income! monthly e'penditure age! religion! sector wise e'penditures! utility facilities and
water sources for different household usages were carefully investigated and recorded in
the specified portion of the ,uestionnaire
"AP relate# ata Collection:
Data was collected a&outH
/ /nformation related to pregnancy! lactation and delivery
// .hild feeding practicesH colostrum feeding! pre-lacteal feeding! e'clusive &reast
feeding! supplementary feeding! complementary feeding practices
/// 6or&idity and treatment seeking &ehavior
Anthro!ometric ata Collection:
0utritional status of the target children and their mothers were assessed with the help of
anthropometric measurements
$eight: 5ody weight of children and their mothers were weighed &y using weighing
scale! which was cali&rated with known weight and &alanced at 2ero &efore each series of
measurements 6other was made to stand at the center of the platform with hands on his
side! &arefoot and in light clothing and her weight was recorded to the nearest )(
kilogram Then the mother was made to stand with the &a&y in her lap and then their
com&ined weight was taken Then &y su&tracting the two values the weight of the child
was estimated
%eight: 1or mothers and children $who were a&le to stand alone%! the height was
measured using a vertical scale 5oards for measuring height were manufactured with the
assistance of /01+ "fter removing the shoes! the su&Gect was made to stand on the flat
surface of the scale with feet parallel to heels and eyes looking straight ahead with arms
hanging loosely at the sides The headpiece of the measuring device was a metal &ar!
which gently lowered crushing the hair and contact with the top of the head The
measuring scale was (8* cm and height was measured to an accuracy of )( cm
93
+ince the measurement of standing height for most of children was not possi&le! a
recum&ent length $crown-heel length% was measured The child was laid on a ta&le or flat
surface placing head firmly against the fi'ed metal headpiece with the &a&y=s eyes
looking vertically and e'tending the knee &y firm pressure! and fle'ing the feet at right
angles to the lower legs against the upright foot piece of the height scale The length of
the child was read to the nearest )( cm
3eight-for-age! height-for-age! weight-for-height $in 2-scores% were adopted for
characteri2ing the childFs anthropometric status The cut-off points for 3-7 ?lo&al
Data&ase on .hild ?rowth and 6alnutrition was used in this study as standards for
classification of children in various grades of nutritional status
The cut-off levels are given &elowH
%eight-for-age &-score '%A&( Classification
9 D3+D +evere stunted
9 -2+D to D3+D 6oderate stunted
L -2+D 0ormal $not stunted%
$eight-for-age &-score '$A&( Classification
9 D3+D +evere under weight
9 -2+D to D3+D 6oderate under weight
L -2+D 0ormal $not under weight%
$eight-for-height &-score '$%&( Classification
9 D3+D +evere wasted
9 -2+D to D3+D 6oderate wasted
L -2+D to 2+D 0ormal $not wasted%
O 2+D 7ver weight
6others= nutritional status was measured &y 5ody 6ass /nde' $56/% 56/ is calculated
&y dividing weight in kilogram &y the s,uare of height in meter The cut-off value was
adopted for characteri2ing mother=s nutritional status &y using 3-7 reference $(99*%
)*I '+g,m-(
Princi!al cut-off !oints
Classification
P (;49 @nder 0utrition
(;*) D 2499 0ormal
L 2*)) 7&ese
93
)loo# Collection:
>evel of &lood hemoglo&in was used as an inde' of &iochemical status -emoglo&in
concentration was determined in the field using the cyanmethemoglo&in method! in
-emo.ue system $3-7! 2))(%! considered as relia&le and recommended for the
determination of hemoglo&in concentration during fieldwork 5lood collection was done
&y fingertip lancing! using disposa&le lance 2) micro liter of &lood was collected &y
microcuvettes from each target population 3hich was preserved &y soaking in &lotting
paper and was stored in the refrigerator until the &lood test was carried out the following
day
Estimation of %emoglo.in:
#hotometric .olorimetric Test $cyanmethemoglo&in method% has &een carried out for the
determination of hemoglo&in from collected &lood sample using Dra&kin=s solution
prepared previously in the la&oratory of /01+ The a&sor&ance $optical density% was
measured in the spectrophotometer at *4) nm
Calculation of %emoglo.in Concentration:
5lood hemoglo&in level was calculated using the following e,uationH
-emoglo&in $gIdl% : 36; S7ptical Density
The cut-off values for hemoglo&in concentration to determine anemia was considered
&ased on the suggested criteria for the diagnosis of anemia $3-7! 2))(%
Po!ulation /rou! 0evels of %emoglo.in consi#ere# anemic
.hildren aged 6 months to 6 years 9(( gIdl
"dult 1emales H non pregnant 9(2 gIdl
ietar1 Information:
Data regarding mothers= dietary intake were collected &y 24 hour recall method The
mothers were interviewed and asked to demonstrate the amounts of food eaten over the
past 24 hours &y her Detailed information on menu! family measurement and food
93
ingredients were collected from mothers 5angladeshi food conversion ta&le developed
&y /01+ was used to code and calculate the weight of all foods /nformation on the
childFs regular food consumption was o&tained at the time of interviewing mothers
Clinical 2.servations:
The target children and mothers from &oth slum and non-slum areas were carefully
o&served to e'amine if there are any clinical signs and symptoms
4.1.1. Analtical *ethods
" data entry form was first prepared and data from the finally checked ,uestionnaires
were entered in that form using +tatistical #ackage for +ocial +cientists $+#++% 3indows
version(8 software and this was followed &y an e'tensive period of logical checking to
identify any data entry errors Those identified errors were corrected &y consulting the
original ,uestionnaires
Then data analy2ed &y applying percentages! means! standard deviations! chi-s,uare test!
correlation test and regression analysis "nthropometric status evaluation was carried out
using 3-7 "nthro program Dietary analysis was done &y using 1ortran 88 software
Descriptive analysis was undertaken to e'plore the differences in household
socioeconomic! demographic! monthly income! sector wise monthly e'penditure! parity!
num&er of a&ortion! delivery place! &irth weight! colostrums feeding! e'clusive &reast
feeding! supplementary feeding! complementary feeding! mor&idity and treatment
seeking &ehavior! anthropometric status! dietary intake! anemia level! clinical findings
among the children aged 6 to 24 months and their mothers of &oth slum and non-slum
areas .hi-s,uare test was done to see the level of significance and &ivariate correlation
test was done to estimate the strength of correlation &etween two varia&les >inear
regression analysis was done for estimating the correlation coefficient &etween dependent
and independent varia&les for the target population from &oth slum and non-slum areas
of Dhaka
93
4.1.2. Li(itations of the Stud
During the time of the study some difficulties and challenges were faced which were
addressed and mitigated properly to ensure most accuracy Those areH
( The study was conducted in different areas of Dhaka city where the level of
education and standard of living were different than those of slum dwellers who
were sometimes difficult to communicate
2 The respondents $mothers% had to give the history of dietary intake &y 24 hours
recall method! where assumption of amount of food consumed may not &e
accurate
3 6ost of the respondents were unwilling to e'press their original monthly income
+everal of them tried to lessen their income
4 +ome of the households in non-slum areas were not cooperative for allowing
&lood collection for hemoglo&in estimation! so it needed more persuasion to
convince them
* 6anaging time for interview of non-slum mothers were one of the difficult tasks
which was overcome &y repeated motivations
6 3hile collecting age of the mothers in slum! some difficulties were faced as few
of them had no &irth cards or immuni2ation cards and even they could not
remem&er the e'act year Karious referral ,uestions related to remarked incidents
were asked to make her recall for calculating the appro'imate age +o! there is a
chance of recall &ias
Chapter 5
93
-.1.Results of the Stud
-.1.1. Socio3econo(ic 4 +e(ogra&hic Infor(ation
)ac+groun# Characteristics:
Ta&le ( shows the composition of respondents &y their religion 948J of the respondents
from slum area were 6uslim! *3J of them were -indu "mong the non-slum
respondents ;;4J were 6uslim! ;4J were -indu and 32J was .hristian 9(6J of all
respondents were 6uslim +o! it is clear that in the total sample most of the respondents
were 6uslims
Ta.le 3: Percent istri.ution of %ousehol#s .1 4eligion
4eligion Slum '5( 6on-slum '5( Total '5(
/slam 948 $9)% ;;4 $;4% 9(6 $(84%
-indu *3 $*% ;4 $;% 6; $(3%
.hristian ) $)% 32 $3% (6 $3%
Total ())) $9*% ())) $9*% ())) $(9)%
T $1igures in parenthesis are num&ers of respondents%
1igure ( represents that most of the respondents &elong to small family with ma'imum 4
family mem&ers 7nly 32 slum families and 2( percent non-slum families were large
Figure 3: Percent istri.ution of %ousehol#s .1 6um.er of Famil1 *em.ers
ercent Distribution of !ouseholds by "umber of #amily
$embers
28.4
3.2
60
37.9
2.1
68.4
0
10
20
30
40
50
60
70
80
<5 (small) 5-8 (medium) >8 (large)
"umber of #amily $embers

e
r
c
e
t
a
g
e
Slum ( n=95)
Nn-slum (n=95)
Ta&le 2 represents that most of the slum mothers $*;9 percent% were &etween (9 and 2*
years! whereas the largest portion of mothers $49* percent% in the non-slum areas were
from 26 to 32 years of age
93
Ta.le 7: istri.ution of *others accor#ing to their age
Age of *others
Slum
' n89:(
6on-slum
'n89:(
(6 to (; years ()* 2(
(9 to 2* years *;9 232
26 to 32 years 22( 49*
33 years Q a&ove ;4 2*3
Total ())) ()))
E#ucation 0evel
6arked variations were found in the education level of slum and non-slum population
Ta&le 3 shows the education level of the mothers and main income earners of &oth slum
and non-slum areas -owever! 3*; percent of the mothers from slum were illiterate! 48
percent had completed primary level and 29* percent had completed ++.! no mother
in the slum found completed -+. level 7n the contrary! education level of mothers of
non-slum areas was at least ++. level "gain! *26 percent mothers reported having
had graduation or a&ove! (;9 percent mothers from non-slum areas had completed
primary level and 2;4 percent had completed -+.
/n case of education level of the main income earner a &ig portion $889 percent% from
non-slum areas were graduated or had higher education level! 84 percent had completed
++. and (48 percent had completed -+. 7n the other hand! in the slum area! 3)*
percent of the main income earners were illiterate! 3*; percent reported having had
primary education! 2;4 percent had completed ++. and only *3 percent had
completed -+. /t is thus evident that! respondents from slum were lagging &ehind in
terms of education level than from non-slum respondents
Ta.le ;: E#ucation 0evel .1 Areas
E#ucation 0evel
*other *ain Income Earner
Slum '5( 6on-slum '5( Slum '5( 6on-slum '5(
93
/lliterate 3*; ) 3)* )
@pto #rimary level 348 ) 3*; )
.ompleted ++. 29* (;9 2;4 84
.ompleted -+. ) 2;4 *3 (48
L ?raduate ) *26 ) 889
Total ()) ()) ()) ())
Economic Con#ition:
1igure 2 shows that in slum areas! *89 percent of the mothers reported &eing housewives
whereas! 232 percent was industry workers! ((6 percent was day la&orer and *3 percent
was involved in small &usiness! while 2( percent reported as worker
6ain occupations of the main income earners of the households have &een given in figure
3 "mong them 3*4 percent of slum areas was involved in small &usiness " large part
$348 percent% reported as day la&orer
Figure 7: Percent istri.ution of 2ccu!ation of mothers of slum
Figure ;: Percent istri.ution of 2ccu!ation of main income earners of slum
93
1igure 4 and * respectively represents the occupation of mothers and main income
earning mem&ers of non-slum areas 6*3 percent mothers of non-slum areas were
housewives 6aGor portion $*48 percent% of the main income earning mem&ers of non-
slum areas was service holder ** percent maGor income earning mem&ers were found
working at a&road
Figure <: Percent istri.ution of occu!ation of 6on-slum mothers
Figure :: Percent istri.ution of occu!ation of 6on-slum *ain Income Earners
93
1igure 6 demonstrates that (6; J households of slum had a monthly income less than
Tk 4)))! (;9 J had a monthly income Tk 4))( to Tk 8)))! *(6 J had a monthly
income Tk 8))( to Tk ())))! (26 J had a monthly income Tk ()))( to Tk (*)))
1igure 8 shows that 2( J households of non-slum areas had a monthly income from Tk
()))( to Tk (*)))! 63 J had a monthly income Tk (*))( to Tk 2))))! 484 J had a
monthly income Tk 2)))( to Tk 3))))! 389 J had a monthly income Tk 3)))( to Tk
*)))) and 63J had more than Tk*))))
Figure =: Percent istri.ution of %ousehol#s of Slum .1 *onthl1 Income
Figure >: Percent istri.ution of %ousehol#s of 6on-slum .1 *onthl1 Income
93
Data on per capita monthly income is shown in ta&le 4 /n the slum areas! 389 percent of
households reported having per capita monthly income of Tk (*)) or less! 62( J a per
capita monthly income of Tk (*)( to Tk 2*)) /n the non-slum areas! 42( percent of
households reported having per capita monthly income of Tk 4))( to 6)))! 42( J a per
capita monthly income of Tk 6))( to Tk ;)))! (*; percent a per capita monthly
income was a&ove Tk ;)))
Ta.le <: Percent istri.ution of %ousehol#s .1 Per Ca!ita *onthl1 Income
Per Ca!ita *onthl1 Income
'Ta+a(
Slum '5(
' n89:(
6on-slum '5(
'n89:(
9(*)) 389 ))
(*)(-2*)) 62( ))
4))(-6))) )) 42(
6))(-;))) )) 42(
O;))) )) (*;
Total ())) ()))
1igure ; shows monthly mean e'penditure in different sectors in slum and non-slum
areas The mean food cost in slum area was Tk*242! whereas the mean food cost was
Tk((;*; in non-slum areas and the mean treatment cost in slum areas was Tk4))!
whereas the mean treatment cost was Tk(6(( in non-slum areas /n each sector a huge
difference e'isted
93
Figure ?: Percent istri.ution of %ousehol#s .1 Sector wise Average *onthl1
Ex!en#iture
@tilit1 Facilities an# Practices:
The respondents in slum did not use to live a decent life in healthy a&odes They did not
have any gas or water supply "ccording to ta&le * in slum areas! it was found that *;9
percent of them only had kitchen facilities During data collection it was o&served that
most of the accommodation set up in slum was mostly a house with * to 6 rooms! one
toilet and one kitchen! where each family resides in a room and share the single &athroom
and kitchen with other residents 84; percent respondents reported having sanitary
latrine in slum areas
Ta.le :: Percent istri.ution of %ousehol#s .1 selecte# varia.les regar#ing @tilit1
@tilit1 Facilities
Slum '5(
' n89:(
6on-slum '5(
'n89:(
+anitary
>atrine
Ees 8*; ()))
0o 242 ))
Kitchen
Ees *;9 9;9
0o 4(( ((
3ater
+upply
Ees )) 948
0o ())) *3
?as
+upply
Ees )) 9(6
0o ())) ;4
93
+ource of water is of great importance for &etter health and nutritional status Though
663 percent slum people reported drinking deep tu&ewell waterM only 46* percent used
water from deep tu&ewell for cooking purpose
"ll respondents in slum areas reported washing utensils in the nearer river or pond!
whereas 938 percent also reported &athing &y this same source of water " maGor part of
non-slum respondents reported same source of water for drinking! cooking! utensil
washing and &athing which is tap water Data on different sources of water is given in
ta&le 6
Ta.le =: Percent istri.ution of %ousehol#s .1 selecte# varia.les regar#ing $ater
Sources
$ater @sage Sources of $ater
Slum '5(
' n89:(
6on-slum '5(
'n89:(
Drinking 3ater
Tap )) 948
<iverI#ond 338 ))
Deep tu&ewell 663 32
Tu&ewell )) 22
.ooking 3ater
Tap )) 948
<iverI#ond *3* ))
Deep tu&ewell 46* 32
Tu&ewell )) 22
@tensil 3ashing
3ater
Tap )) 948
<iverI#ond ())) ))
Deep tu&ewell )) 32
Tu&ewell )) 22
5athing 3ater
Tap )) 948
<iverI#ond 938 ))
Deep tu&ewell 63 32
Tu&ewell )) 22
-.1.2. 5A, related Infor(ation a(ong *others
Information relate# to Pregnanc1A eliver1 an# 0actation:
93
<eproductive health situation in slum and non-slum areas of Dhaka city has &een focused
through the given ta&les and figures
1igure 9 demonstrates most $86; percent% of the non-slum respondents got married at the
age of more than (; years! whereas in slum the situation was found completely different
7nly (26 percent mothers in slum were of more than (; years of age while marrying
"doption of family planning was higher among the non-slum occupants 1igure () and
figure (( respectively demonstrate the percentage of households adopted family planning
or not in slum and non-slum areas -owever! 3) percent of slum respondents reported
adopted family planning! whereas adoption of family planning was much higher $68
percent% among non-slum households
Figure 9: Percent istri.ution of *others accor#ing to their Age of *arriage
93
Figure 3B: Percent istri.ution of Slum
%ousehol#s accor#ing to a#o!tion of
Famil1 Planning
-igh parity and a&ortion rate &oth are very crucial incidences for women health +ocio-
economic different influential factors promote their occurrences 1rom ta&le 8! it is clear
that percentage of parity was almost similar in &oth slum and non-slum areas This was
&ecause the target children were mostly the first children of slum mothers
7ccurrence of a&ortion is higher $3;9 percent% among the non-slum mothers /t is clear
from the ta&le that among the mothers who had incidence of a&ortion in their life! most of
them $69*percent in slum and 632 percent in non-slum area% e'perienced multiple
a&ortions
.hild spacing is important for maternal and child health +hort &irth intervals are
associated with an increased risk of death for mother and child +tudies have shown that
children &orn at less than 24 months after a previous si&ling are generally of poorer
health +hort &irth intervals also threaten maternal health
-owever! 88 percent slum mothers did not have child spacing for at least 3 years! while
the value for this in non-slum area is *; percent
Figure 33: Percent istri.ution of 6on-
slum %ousehol#s accor#ing to a#o!tion
of Famil1 Planning
93
Ta.le >: Percent istri.ution of *others accor#ing to 4e!ro#uctive Characteristics
4e!ro#uctive Characteristics
Slum '5(
' n89:(
6on-slum '5(
'n89:(
#arity
9 3 ;32 ;84
L3 (6; (26
Total ())) ()))
"&ortion
7ccurred 29* 3;9
0ever 7ccurred 8)* 6((
Total ())) ()))
0o of "&ortion
92 3)* 36;
L2 69* 632
Total ())) ()))
.hild +pacing
L3 Eears 23) 42)
9 3 Eears 88) *;)
Total ())) ()))
Ta&le ; shows that a maGor part of the respondents= place of delivery was the nearest
0?7 delivery centre 6ost of them reported mainly 5<". delivery centre as their
delivery place /n case of non-slum part of Dhaka! 9(6 percent mothers reported different
hospitals and clinics as their delivery place
-owever! 663 percent of non-slum mothers reported that their last &a&y was caesarean!
whereas in slum most &a&ies $69* percent% were delivered normally 6aGor respondents
from &oth areas $(*; percent for slum and 232 percent form non-slum% did not report
a&out much &lood loss after delivery
/t was seen that 432 percent mothers of slum reported that their last child &orn &etween ;
to 9 months "gain! 663 percent non-slum mothers reported giving last child &irth at less
than ; months of pregnancy
>ow &irth weight leads to malnutrition in later life Ta&le ; shows that *;8 percent
mothers gave &irth of >53 &a&ies in slum and 2*; percent non-slum mothers also
reported giving &irth of >53 &a&ies
93
Ta.le ?: Percent istri.ution of *others accor#ing to eliver1 Information
eliver1 relate# Information
Slum '5(
' n89:(
6on-slum '5(
'n89:(
#lace of
Delivery
-ome 33.7 8.4
0?7 Delivery .entre 54.7 0.0
-ospitalI .linic 11.6 91.6
!"al 100.0 100.0
Type of
Delivery
0ormal 69.5 33.7
.aesarean 30.5 66.3
!"al 100.0 100.0
5lood >oss
"fter Delivery
7ccurred (*; 232
0ot 7ccurred ;43 86*
!"al 100.0 100.0
6onth of
.hild 5irth
9; 6onths 338 663
;-9 6onths 432 284
O9 6onths 232 63
!"al 100.0 100.0
5irth 3eight
of .hild
92* Kg $>53% 58.7 25.8
L2* Kg $normal% 41.3 74.2
!"al 100.0 100.0
"AP regar#ing Anemia
"nemia is very common among women of reproductive age in our country 5efore and
during pregnancy if it is not corrected mother gives &irth of &a&y with depleted iron store
and most dangerously the mother=s &ody iron status &ecome poorer and she &ecomes
more anemic Knowledge a&out "nemia can help one to win against it
Ta&le 9 shows that 6;4 percent of slum mothers did not have knowledge a&out anemia
which is very alarming 2*3 percent non-slum mothers also did not know a&out this
8)* percent of slum mothers even did not know that if they were suffering from anemia
during pregnancy or not 432 percent non-slum mothers had anemia during pregnancy
whereas 2(( percent among them also did not know that if they had anemia during
pregnancy or not
93
7nly 232 percent slum mothers got /ron supplementation during pregnancy "mong
them *2 percent had taken ( to (*) iron ta&lets during whole pregnancy*89 percent
mothers reported that they did not take any folic acid supplementation during pregnancy
period
Ta.le 9: Percent istri.ution of *others accor#ing to "nowle#geA Prevalence of
Anemia an# Su!!lementation 'IronA Folic aci#( ta+en #uring Pregnanc1
Criteria Caria.les
Slum '5(
' n89:(
6on-slum '5(
'n89:(
Knowledge a&out
"nemia
Know 3(6 848
Don=t Know 6;4 2*3
Total ())) ()))
"nemia During
#regnancy
Ees 2)) 432
0o 9* 3*;
Don=t Know 8)* 2((
Total ())) ()))
/ron
+upplementation
Taken 263 8(6
0ot Taken 838 2;4
Total ())) ()))
0o of /ron Ta&let
Taken
(-(*) *2) 398
(*(-3)) ;) ((;
3)(-*)) 4) (86
@nlimited 36) 3)9
Total ())) ()))
1olic "cid
+upplementation
Taken 84 *;9
0ot Taken *89 2))
Don=t Know 348 2((
Total ())) ()))
Information relate# to Fee#ing Practices
Fee#ing Practices of 6ew.orns
5reast feeding is the first fundamental right of a &a&y The initiation of &reast feeding and
the timely introduction of ade,uate and safe appropriate complementary foods in
conGunction with continued &reast feeding are of prime importance for the growth!
development! health and nutrition of infants and children
5reast feeding also have importance for mothers 5reast feeding promotes uterine
contractions and e'pels the placenta in the immediate postpartum period and reduces
maternal &lood loss
93
"ccording to 1igure (2! most new&orns from &oth slum $6(( percent% and non-slum
$684 percent% areas were first introduced colostrum Gust after &irth " &ig portion of the
respondents gave different pre-lacteal foods to their new&orns other than colostrum (*;
percent of slum respondents used to give sweetened water as pre-lacteal feed to their
&a&ies /t is to &e mentioned that introducing formula milk to the new&orns as first feed is
higher $(48 percent% among non-slum respondents
Figure 33: Percent istri.ution of %ousehol#s .1 First Fee# after )irth
1igure (3 represents the usage of different methods for pre-lacteal feeding 32* percent
&a&ies used finger tip for pre-lacteal feeding @sage of plastic feeder &ottle is higher in
non-slum areas $(48 percent% than in non-slum counterparts $32 percent%
Figure 37: Percent istri.ution of %ousehol#s .1 *etho#s for Pre-lacteal Fee#ing
93
Aarly initiation of &reastfeeding is encouraged for a num&er of reasons /t is also
&enefitial for mothers &ecause early suckling stimulates &reast milk production and
facilitates the release of o'ytocin! which helps the contraction of the uterus and reduces
postpartum &lood loss The first &reast milk is known as colostrum! which is highly
nutritious and contains anti&odies that protect the new&orn from infection and diseases
Aarly initiation of &reastfeeding also encourages &onding &etween a mother and her
new&orn 5reast feeding within an hour or two after delivery is associated with the
esta&lishment of e'clusive &reast feeding and also for longer or more successful &reast
feeding
#ercentage of mothers who had started &reast feeding immediately after &irth has &een
shown in figure (4! where it is seen that the rate is higher in non-slum areas which is *6;
percent -owever! ()* percent of slum children were never &reast fed and in the non-
slum areas it was 63 percent 1irst starting time of &reast feeding of 84 percent &a&ies of
slum was after 4; hours of &irth
Figure 3;: Percent istri.ution of %ousehol#s .1 First Starting time of )reast
Fee#ing
93
.olostrum is important for child=s nutrition! immunological protection and &rain
development @0/.A1 and 3-7 recommend that children &e fed colostrum $the first
&reast milk% immediately after &irth and continue to &e e'clusively &reastfed even if
regular &reast milk has not &egun flowing Ta&le () illustrates that maGor parts of &oth
slum and non-slum areas had fed colostrum to their new&orns The reason to reGect
colostrum was mostly mother=s illness -owever this percentage was *6* in non-slum
areas and 3)* percent in slum areas
>ack of knowledge a&out &enefit of colostrum reflects a practical reasoning of the &asic
cause of reGecting colostrum "lmost all non-slum respondents $9*6 percent% reported
that they knew a&out the &enefits of colostrum! this percentage was 89; for slum
respondents
Ta.le 3B: Percent istri.ution of Information relate# to Colostrum fee#ing
Criteria Caria.les
Slum '5(
' n89:(
6on-slum '5(
'n89:(
1ed
.olostrum
?iven 69* 889
<eGected 3)* 22(
Total ())) ()))
<eason to
<eGect .olostrum
6other=s /llness 4;3 *6*
/gnorance (82 (84
Don=t 1eel it 0ecessary (3; (84
1amily Discourage (82 ;8
Total ())) ()))
5enefits of
.olostrum
Known 89; 9*;
0ot Known 2)2 42
Total ())) ()))
Exclusive )reast Fee#ing an# Su!!lementar1 Fee#ing
A'clusive &reast feeding is recommended &y 3-7 for the first si' months from &irth
6other=s milk alone provides all the re,uired nutrients for the &a&y at proper ,uantity
and ,uality during this period 1igure (* shows that e'clusive &reast feeding was not
practiced in almost half of the total respondents in &oth slum$4;2 percent% and non-slum
areas $*)* percent%
93
Figure 3<: Percent istri.ution of Chil#ren accor#ing to Exclusive )reast Fee#ing
/t is recommended that no supplementary food is needed from &irth till 6 months if
mother is not severely ill "lmost every mother is capa&le of &reast feeding! rare
e'ceptions can &e due to -/K positive cases and other selective communica&le disease
conditions -owever &reast si2e! diet! fluid intake! e'ercise! multiple &irths sometimes
cause less milk production 5ut infant suckling can initiate and sustain this &reast
feeding process "rtificial feeding is e'pensive and carries risks of additional illness!
particularly where the levels of infectious disease are high and access to safe water is
poor +o! if supplementary food is given to the child it has to ensure that foods are
prepared and given in a safe manner! meaning that measures are taken to minimi2e the
risk of contamination with pathogens "nd they are given in a way that is appropriate!
meaning that foods are of appropriate te'ture and given in sufficient ,uantity
"ccording to figure (6! +uGi was the most common $333 percent% as supplementary
feeding among slum respondents -owever! 266 percent of slum respondents reported
feeding confectionary or snacks as supplementary feeding which was very health
ha2ardous 5ecause eating confectionary or snacks leads to less appetite and the growth
chart automatically starts declining
93
Figure 3:: Percent istri.ution of Slum Chil#ren accor#ing to Su!!lementar1
Fee#ing
1igure (8 illustrates the percentage of feeding different supplementary foods in non-slum
areas @se of formula milk as supplementary feeding is found most common $*2(
percent% among non-slum respondents
Figure 3=: Percent istri.ution of 6oon-slum Chil#ren accor#ing to Su!!lementar1
Fee#ing
93
Com!lementar1 fee#ing
Aarly cessation of &reast feeding causes post partum depression in mothers "gain
prolonged &reast feeding may cause anemia and growth retardation to children 5reast
feeding is promoted internationally to &e continued up to two years with the addition of
weaning food after 6 months
Ta&le (( shows the duration of &reast feeding of the respondents*9( percent slum
mothers showed their interest to &reast feed their children more than 2 years of children=s
age! this percentage was 333 percent for non-slum mothers 364 percent slum mothers
showed their interest to &reast feed their children up to 2 years! this percentage was 633
percent for non-slum mothers "mong the mothers who already ceased &reast feeding
reported that 3* percent &reast fed their children up to ( year from slum and 389 percent
non-slum mothers= &reast fed their children up to 6 months
Ta.le 33: Percent istri.ution of Chil#ren accor#ing to )reast Fee#ing Practices
)reast Fee#ing
Slum '5(
' n89:(
6on-slum '5(
'n89:(
.ontinuing 5reast 1eeding 886 626
0ot .ontinuing 5reast 1eeding 224 384
Total ())) ()))
3ill continue
5reast 1eeding
upto
924 months 4* 33
(2-24 months 364 633
O24 months *9( 333
Total ())) ()))
1ollowed
5reast 1eeding
till
)-(month (*) 33
)-4months 2)) ((;
)-6months (*) 389
)-(2months 3*) 294
)-(;months (*) (86
Total ())) ()))
.omplementary feeding should &e timely! meaning that all infants should start receiving
foods in addition to &reast milk from 6 months onwards /t should &e ade,uate! meaning
that the nutritional value of complementary foods should parallel at least that of &reast
milk 3-7 recommendation for weaning is starting complementary feeding gradually at
93
6 months of age 1rom the ta&le (2! it is seen that among the slum respondents 4);
percent started weaning at si' to seven months of age /t is to mention that 3*2 percent
slum children were introduced weaning at eight to twelve months /n the study it was
found that 42( percent non-slum mothers started weaning &efore si' months *38
percent children were started weaning at proper time in non-slum areas
Ta.le 37: Percent istri.ution of Chil#ren accor#ing to $eaning Practices
Fee#ing Practices
Slum '5(
' n89:(
6on-slum '5(
'n89:(
1irst +tart of
3eaning 1ood
9 6 months (98 42(
6-8 months 4); *38
;-(2 months 3*2 2(
O (2 months 42 2(
Total ())) ()))
.auses of 3eaning
&efore 6 months
5reast milk not enough for children (2* *6
>ess 5reast 6ilk #roduction 62* 444
Due to 3ork >oad (2* 222
1amily #ressure *6 222
7thers 69 *6
Total ())) ()))
3hen &reast milk is no longer enough to meet the nutritional needs of the infant!
complementary foods should &e added to the diet of the child .omplementary feeding
typically covers the period from si' to 24 months of age! and is a very vulnera&le period
/t is the time when malnutrition starts in many infants! contri&uting significantly to the
high prevalence of malnutrition in later ages
1igure (; represents that all foods were gradually introduced among only 334 percent
slum-children and 42( percent non-slum children " very few respondents also reported
a&out feeding fruits! cerelac! suGi! animal milk or formula milk individually as
complementary feeding! which is a &ad practice "gain!()* percent of non-slum children
were introduced rice and Dahl or khuchuri with vegeta&les only without giving meat !
fish or egg due to digestional pro&lem of child
Figure 3>: Percent istri.ution of Chil#ren accor#ing to Com!lementar1 Fee#ing
93
1oods should &e prepared and given in a safe manner to minimi2e the risk of
contamination "nd they should &e given in a appropriate way that is in appropriate
te'ture and sufficient ,uantity 1eeding young infants re,uires active care and
stimulation! where the caregiver is responsive to the child clues for hunger is easily
understood and caregiver also encourages the child to eat
Ta&le (3 illustrates different child feeding practices that indirectly influence child
nutritional status -owever! *38 percent slum mothers maintain preselected fi'ed timing
for feeding their &a&ies The percentage of feeding non-slum children according to
child=s wish $442 percent% and at fi'ed time $4*3 percent% is almost e,ual #ercentage of
providing fresh cooked food is higher $49* percent% among non-slum respondents!
93
though almost half of the non-slum respondents reported not feeding their child fresh
cooked food every time -owever ;4* percent slum mothers also reported that they did
not use to feed their child fresh cooked food each time "mong these slum mothers 64;
percent said that they can not afford feeding fresh cooked food always /t is to &e
mentioned that 38; mothers found unaware of the &enefit of feeding fresh cooked food
/n the study it was found that only ((6 slum mothers used to cook separate food for their
children! whereas 83( percent non-slum mothers reported cooking separate food for their
children
Ta.le 3;: Percent istri.ution of *others accor#ing to Chil# fee#ing Practices
Criteria Caria.les
Slum '5(
' n89:(
6on-slum '5(
'n89:(
Time of 1eeding
.hildren
.hild=s wish 326 442
"t fi'ed time *38 4*3
6other-in-law=s wish 2( ;4
3hen the child cries ((6 42
Total ())) ()))
1resh .ooked 1ood
Ees (** 49*
0o ;4* *))
Total ())) ()))
.ause of 0ot
#roviding 1resh
.ooked 1ood
@naware 3(8 38;
.an not afford 6;3 *62
Total ())) ()))
#repare +eparate
food for children
Ees ((6 83(
0o ;;4 269
Total ())) ()))
Information relate# to *or.i#it1 an# Treatment See+ing )ehavior
#oor nutritional status leads to fre,uent mor&idity and again mor&idity contri&utes to
poor nutritional status 1igure (9 interprets that among the study population! the highest
prevalence of mor&idity prevailed among slum children! which is ;*3 percent The
percentage of children suffered from disease within last 3 months preceding the study
was not so less -owever 642 percent non-slum children were found suffering from
different diseases
93
Figure 3?: Percent istri.ution of Chil#ren accor#ing to suffering of iseases
within last ; months !rece#ing the stu#1
The prevalence of diarrhea is highest at age 6 to 24 months! a period during which solid
foods are first introduced into the child=s diet This pattern is &elieved to &e associated
with increased e'posure to illness as a result of &oth weaning and the greater mo&ility of
the child! as well as with the immature immune system of children in this age group
Ta&le (4 translates that prevalence of diarrhoea was higher $2)8 percent% among slum
children -owever! (22 percent slum children suffered from cold and another (22
percent slum children were attacked &y pneumonia -owever (9* percent of slum
children were found suffered from &oth fever and cold 0on-slum children suffered
mostly $2;9 percent% from fever The second highest prevalent $244 percent% disease
was fever and cold among non-slum children
Ta.le 3<: Percent istri.ution of Chil#ren accor#ing to iseases the1 suffere#
iseases
Slum '5(
' n89:(
6on-slum '5(
'n89:(
93
1ever 83 2;9
.old (22 (8;
1ever U .old (9* 244
Diarrhoea 2)8 ;9
Diarrhoea U 1ever 6( 44
Diarrhoea U 1ever U .old 9; 44
Typhoid 6( 68
#neumonia (22 44
Naundice 24 ))
6easles 38 ))
Total ())) ()))
" huge difference in treatment seeking &ehavior &etween slum and non-slum respondents
was found in figure 2) "mong non-slum respondents 86; percent reported that they
used to take their children to physician when their children used to get sick! in case of
slum respondents this measure was 284 percent -omeopathy seems to &e the most
common $284 percent% mode of treatment " total of (6; percent slum respondents used
to go to the traditional healer for treatment purpose for their &a&ies "nother (6; percent
of them reported following traditional ways
Figure 39: Percent istri.ution of %ousehol#s accor#ing to Treatment See+ing
)ehavior for their chil#ren
-.1.". Anthro&o(etric Findings
93
Anthro!ometric Information of Chil# of slum an# non-slum area:
Ta&le (* shows that mean height and weight of children aged 6 to 24 months in the slum
areas was 84 cm and mean wt was ;(2 kg 6ean -eight-for-age 2-score! 3eight-for-age
2-score! height for weight 2-score were -(82! -23)! -(43 respectively 6ean height and
weight of children aged 6 to 24 months in the non-slum areas was 883; cm and mean wt
was 996 kg 6ean -eight-for-age 2-score! 3eight-for-age 2-score! height for weight 2-
score were -)86! -)84! -))* respectively
Ta.le 3:: *ean an# Stan#ar# eviation of Anthro!ometric in#icators of Slum an#
6on-slum chil#ren
Anthro!ometric
In#icators for
Chil#ren
Slum '5(
' n89:(
6on-slum '5(
'n89:(
*ean %td. Deviation *ean %td. Deviation
#eig$" (%m) 74.00 6.51 77.38 8.24
&eig$" ('g) 8.12 1.54 9.96 1.71
&#(#)* -1.72 1.53 -0.76 1.75
&#(&)* -2.30 .95 -0.74 1.02
&#(&#* -1.43 1.43 -0.05 2.18
"ccording to -eight-for-age 2-score in ta&le (6! among slum male children 49 percent
had normal nutritional status! 333 percent were moderately stunted and (86 percent
were severely stunted "mong slum female children *6; percent had normal nutritional
status! (86 percent were moderately stunted and ((4 percent were severely stunted
-owever in case of non-slum children ;4* percent male children were found not stunted!
for female children this percentage was 86 percent "mong them ((( percent &oy and (2
percent girl were moderately stunted! 44 percent &oy and (2 percent girl were severely
stunted
Ta.le 3=: Percentage of Stunte# Chil#ren .1 Sex .etween Slum an# 6on-slum areas
Area %A&
Sex of the Chil#
*ale '5( Female '5(
+lum 9 -3+D $+evere % (86 ((4
93
9-2+D to -3+D$6oderate% 333 (86
L-2+D $0ormal% 49) *6;
Total ())) ()))
0on-slum 9 -3+D $+evere % 44 (2)
9-2+D to -3+D$6oderate% ((( (2)
L-2+D $0ormal% ;4* 86)
Total ())) ()))
"ccording to 3eight-for-age 2-score in figure 2( among slum male children 294 percent
had normal nutritional status! 4*( percent were moderately under weight and 2**
percent were severely under weight "mong slum female children 4** percent had
normal nutritional status! 4)9 percent were moderately under weight and (36 percent
were severely under weight /n case of non-slum children 88; percent male children
were not found under weight! for female children this percentage was 94 percent "mong
the slum 222 percent &oy and 6 percent girls was moderately under weight
Figure 7B: Percentage of @n#er $eight Chil#ren .1 Sex .etween Slum an# 6on-
slum areas
"ccording to weight-for-height 2-score in ta&le (8! among slum male children 6;6
percent had normal nutritional status! (96 percent were moderately wasted and 9;
percent were severely wasted "mong slum female children 636 percent had normal
93
nutritional status! 228 percent were moderately wasted and (36 percent were severely
wasted
-owever in case of non-slum children ;22percent male children were found not wasted!
for female children this percentage was 84 percent "mong them ;9 percent &oy and 6)
percent girl were moderately wasted! ;9 percent &oy and 4 percent girl were severely
wasted -owever 2) percent slum male children were found over weight! on the contrary
among non-slum children (6 percent female were found o&ese
Ta.le 3>: Percentage of $aste# Chil#ren .1 Sex .etween Slum an# 6on-slum areas
Area $%&
Sex of the Chil#
*ale '5( Female '5(
+lum 9 -3+D $+evere % 9; (36
9-2+D to -3+D$6oderate% (96 228
L-2+D to 2+D $0ormal% 8)6 636
O 2+D $7verweight% )) ))
Total ())) ()))
0on-slum 9 -3+D $+evere % ;* 42
9-2+D to -3+D$6oderate% ;* 63
L-2+D to 2+D $0ormal% 8;8 8*)
O 2+D $7verweight% 43 (46
Total ())) ()))
Anthro!ometric Information of *others of slum an# non-slum area:
" woman=s height can &e used to predict the risk of difficulty during pregnancy! given
the relationship &etween height and pelvic si2e The risk of giving &irth to low-weight
&a&ies is also higher among women of small stature Ta&le (; demonstrates the mean and
standard deviations of different anthropometric indices 6ean height of slum mothers
was (*);) cm! mean weight was 4;28 kg and mean 56/ was 2(23 kgImV "ccording
to the ta&le mean height of non-slum mothers was (*499 cm! mean weight was *86; kg
and mean 56/ was 24(8 kgImV +tandard deviation for 56/ of slum mothers was 3(9
and for non-slum mothers it was 369
Ta.le 3?: *ean an# Stan#ar# eviation of Anthro!ometric in#icators of mothers
from Slum an# 6on-slum areas
93
Anthro!ometric
In#icators for *others
Slum
' n89:(
6on-slum
'n89:(
*ean %td.Deviation *ean %td. Deviation
-eight $cm% (*);) 48* (*499 (22*
3eight $Kg% 4;28 88( *86; ;9;
56/ of 6others$kgImV% 2(23 3(9 24(8 369
1rom the figure 22 it is seen that **3 percent non-slum mothers had normal nutritional
status! 2;9 percent were o&ese and (*; percent were malnourished according to their
56/ /t was also found that 4*3 percent slum mothers had normal nutritional status! (26
percent were o&ese and 42( percent were malnourished according to their 56/
Figure 73: istri.ution of 6utritional status of mothers accor#ing to )*I
-.1.4. 6ioche(ical Assess(ent
5lood hemoglo&in levels of mothers and children were measured as an inde' of
&iochemical status 1igure 23 illustrates that 42( percent children aged 6-24 months of
slum were anemic and in non slum 2(( percent were anemic
93
Figure 77: Anemia level of Chil#ren age# =-7< months
1igure 24 demonstrates that 6) percent mothers of slum were anemic and in non slum
2;4 percent mothers were anemic
Figure 7;: Anemia level of *others
-.1.-. +ietar Infor(ation of *others
1rom the ta&le (9! it is found that mean energy intake of slum mothers was (*443 Kcal
and for non-slum mothers it was 2)4;8 kcal 6ean protein intake of slum mothers was
93
396 g and for non-slum mothers it was 89* g "gain! mean iron intake of slum mothers
was (33 mg and for non-slum mothers it was 283 mg /n case of vitamin intake! mean
vitamin " intake of slum mothers was (4(( /@ and for non-slum mothers it was ;*2;
/@ -owever! mean vitamin . intake of slum mothers was 3)9 mg and for non-slum
mothers it was 623 mg
Ta.le 39: Per Ca!ita 6utrient Inta+e of *others
6utrients
Slum
' n89:(
6on-slum
'n89:(
*ean St#. eviation *ean St#. eviation
Anergy $Kcal% (*443 3492
2)4;
8
6;44
#rotein $g% 396 (4* 89* 4(2
1at $gm% 8* 29 224 (42
.ar&ohydrate $g% 32*9 ;2) 389; ((*8
.alcium $mg% 28*6 (928 493* 3(;*
/ron $mg% (33 ((; 283 (93
Kitamin " $/@% (4(( 3639 ;*2; 2(4*8
.arotene $Wg% *)8;2 6(38(
6)83
(
924*;
Thiamin $mg% (); 32 (88 ;2
<i&oflavin $mg% 3; (; 86 34
0iacin $mg% (8( 42 226 8;
Kitamin . $mg% 3)9 32( 634 623
4inc $g% 6) (8 2;) 338
Ta&le 2) shows that mean meat intake of slum mothers was 2) g and non-slum mothers
was 63 "gain fruit intake of slum mothers was 2) g and non-slum mothers was 63 ! as
well as fats Q oils intake of slum mothers was 4 g and non-slum mothers was (2
Ta.le 7B: Foo# Inta+e of *others .1 Foo# /rou!
Foo# /rou!
Slum
' n89:(
6on-slum
'n89:(
*ean St#. eviation *ean St#. eviation
.ereal 384 99 3;8 ((2
93
<oots Q tu&ers *; 8( ;* ;6
3 #otato *4 68 *8 6)
#ulses Q nuts () 33 84 (*4
>eafy vegeta&les (4) (66 (66 (39
?reen vegeta&les 3* 49 3* ;2
?reen Eellow vegeta&les 42 86 *9 8)
0on-leafy Kegeta&les 63 (6( 82 9*
1ruits 2( 6) 4) 8(
6eats 2) 46 63 86
Aggs 4 (3 (4 2*
1ish 26 34 44 48
6ilk #rotein ( 8 6 22
1ats Q 7ils 4 ) (2 (6
6iscellaneous 1oods 3 9 ; 22
Total 1ood 662 (98 9(8 266
.alorie re,uirement for lactating mothers needs additional **) kcal per day other than
normal re,uirement "ccording to the figure 2*! ())J <D" was fulfilled among ()*
percent slum mothers and 234 percent non-slum mothers! 8*-99J <D" was fulfilled
among 232 percent slum mothers and 4)4 percent non-slum mothers -owever! *)-84J
<D" was fulfilled among 62( percent slum mothers and 2;8 percent non-slum mothers!
less than *)J <D" was fulfilled among (38 percent slum mothers and 84 percent non-
slum mothers
Figure 7<: Percentage of fulfillment of 4A of energ1 of lactating *others of slum
an# non-slum areas.
93
-.1.6. Clinical Findings
.linical assessment consists of a routine physical e'amination to detect physical sign $ie
o&servations made &y a ,ualified e'aminer% and symptoms $ie manifestation reported &y
the patient% associated with malnutrition These findings are most useful during the
advance stages of nutritional definition! when overt disease is present
"ccording to Ta&le 2( maGor clinical findings among slum mothers and children were
discolored hair! angular stomatitis and worm infestation "mong them 263 percent
mothers and (89 percent children were found having discolored hair! ((6 percent
mothers and 63 percent children were found suffering from angular stomatitis -owever!
63 percent mothers and (89 percent children were worm infested
Ta.le 73: Percentages of mothers an# Chil#ren '= -7< months( of .oth Slum an#
6on-slum areas having clinical signs an# s1m!toms
93
Clinical Signs
Slum 'n89:( 6on-slum 'n89:(
*others
5
Chil#ren
5
*others
5
Chil#ren
5
-air
Discolored 263 $2*% (89 $(8%
+parce (48 $(4%
Ayes
0ight 5lindness *3 $*%
5itot=s +pot
.onGunctival Xerosis
.orneal Xerosis
Keratomalacia
#allor
>ips
"ngular +tomatitis ((6 $((% 63 $6% 2( $2% 3( $3%
"ngular +cars
.heilosis 42 $4% 3( $3% (( $(% (( $(%
?ums
5leeding gums
+wollen red #apillae
1ever
Tongue +mooth 2( $2%
<aw and <ed
0ose 0asola&ial Dysse&acea 2( $2%
?land Anlarged Thyroid ?land (38 $(3% 84$8%
+kin
1lakypaint dermatosis 2( $2%
1ollicular hyperkeratosis
0ail Koilonychia 63 $6%
+keletal Knock KneeI 5ow leg 42 $4%
7thers
Adema 2( $2% (( $(% 3( $3%
Anlarged a&domen
$3orm /nfestation%
63 $6% (89 $(8% 2( $2% 42 $4%
(Figures in parenthesis are number of mothers or children)
-.1.0. Co(&arative Analsis of Influential factors and 7utritional
Status of Children and *others
Ta&le 22 shows the relationship &etween 56/ of mothers and -eight-for-age 4-score of
children 1rom the ta&le we found that there was a significant association &etween 56/
of mothers and -eight-for-age 4-score of children for slum areas as #9 ))(/t can &e
said that this association is significant at (J level
0o association &etween 56/ of mothers and -eight-for-age 4-score of children for non-
slum areas were found
93
Ta.le 77: Calue of chi-sDuare test of Chil#Es %eight-for-age &-score with their
motherEs )*I for slum an# non-slum areas
Area *othersE )*I
%eight-for-age &-score
Total P Calue F- 7.BB S
'Stunte#(
G8 -7.BB S
'6ormal(
+lum
9(;49$6alnourished% 92* 8* ()))
)))) (;*)-2499$0ormal% 48 9*3 ()))
L2*)) $7&ese% ;3 9(8 ()))
0on-slum
9(;49$6alnourished% 268 833 ()))
)(*9 (;*)-2499$0ormal% 3() 69) ()))
L2*)) $7&ese% (32 ;6; ()))
" correlation test has &een carried out and given in ta&le 23to see how strongly the two
varia&les- 56/ of mothers and -eight-for-age 4-score of children for slum areas were
correlated -owever! from ta&le 23! it is found that these two varia&les were strongly
correlated as r value is nearer to (
Ta.le 7;: Correlations for Chil#Es %eight-for-age &-score with their motherEs )*I
for slum area
Correlation Tests Mother@s 4M*
$eightforage A
score
Mother@s 4M*
P-(1.2) C211-+(452) 1.CCC C.#!1DD
S5*. E2&4(5+-,F C.C C.CCC
N %5 %5
$eightforage
Ascore
P-(1.2) C211-+(452) C.#!1DD 1.CCC
S5*. E2&4(5+-,F C.CCC C.C
N %5 %5
TT .orrelation is significant at the ))( level $2-tailed%
Ta&le 24 shows the relationship &etween education level of mothers and 3eight-for-age
4-score of children of slum area 1rom the ta&le we found that there was a significant
association &etween education level of mothers and 3eight-for-age 4-score of children
for slum areas as #9 ))(/t can &e said that this association is significant at (J level
Ta.le 7<: Calue of chi-sDuare test of E#ucation level of *others an# $eight-for-age
&-score of Chil#ren of Slum area
93
E#ucation level of
*others
F -7.BB S '@n#er
weight(
H -7.BB S '6ormal( Total P value
/lliterate
61.8 38.2 100.0
.007 @pto #rimary level
81.8 18.2 100.0
.ompleted ++.
42.9 57.1 100.0
.orrelation test &etween the two varia&les- education level of mothers and 3eight-for-
age 4-score of children for slum areas were carried out -owever! from ta&le 2*! it is
seen that these two varia&les were moderately correlated $as r :)(4(%
Ta.le 7:: Correlation of E#ucation level of *others an# $eight-for-age &-score of
Chil#ren of Slum area
Correlation Tests
$eight-for-age &-
score
E#ucation level of *others
$eight-for-age &-
score
#earson .orrelation ())) )(4(
+ig $2-tailed% )) )(82
0 9* 9*
E#ucation level of
*others
#earson .orrelation )(4( ()))
+ig $2-tailed% )(82 ))
0 9* 9*
Ta&le 26 shows the relationship &etween education level of mothers and 3eight-for-age
4-score of children of non-slum area 1rom the ta&le we found that there was a significant
association &etween education level of mothers and 3eight-for-age 4-score of children
for slum areas as #9 )(/t can &e said that this association is significant at ()J level
Ta.le 7=: Calue of chi-sDuare test of E#ucation level of *others an# $eight-for-age
&-score of Chil#ren of 6on-slum area
E#ucation level of
*others
F -7.BB S
'@n#er nutrition(
H -7.BB S
'6ormal(
Total P Calue
#rimary to ++. 28; 822 ()))
)94
-+. 84 926 ()))
?raduate and
a&ove
()) 9)) ()))
93
.orrelation test &etween the two varia&les- education level of mothers and 3eight-for-
age 4-score of children for non-slum areas were carried out -owever! from ta&le 28! it is
seen that these two varia&les were moderately correlated $as r :)(6*%
Ta.le 7>: Correlation of E#ucation level of *others an# $eight-for-age &-score of
Chil#ren of 6on-slum area
Correlation Tests $eight-for-age &-
score
E#ucation level of *others
$eight-for-age &-
score
#earson .orrelation ())) (6*
+ig $2-tailed% (()
0 9* 9*
E#ucation level of
*others
#earson .orrelation (6* ()))
+ig $2-tailed% (()
0 9* 9*
"ssociation has &een found &etween weaning practice &etween slum and non-slum area
Ta&le 2; illustrates that there was a significant association &etween first starting time of
weaning food in slum and non-slum areas as #9 ))(/t can &e said that this association is
significant at (J level
Ta.le 7?: Calue of chi-sDuare test of slum an# non-slum Chil#ren accor#ing to
starting time of $eaning
Fee#ing Practices
Slum '5(
' n89:(
6on-slum '5(
'n89:(
P value
1irst +tart of
3eaning 1ood
9 6 months (98 42(
)))
6-; months 4); *38
9-(2 months 3*2 2(
O (2 months 42 2(
Total ())) ()))
Ta&le 29 demonstrates that there is weak correlation &etween Time of starting weaning
1ood in slum area and that is in non-slum area $as r : -)429%
93
Ta.le 79: Correlation of slum an# non-slum Chil#ren accor#ing to starting time of
$eaning
Correlation Tests
Time of starting
weaning Foo#
Area
Time of starting
weaning Foo#
#earson .orrelation ())) -429
+ig $2-tailed% )))
0 (66 (66
Area
#earson .orrelation -429 ()))
+ig $2-tailed% )))
0 (66 (9)
TT .orrelation is significant at the ))( level $2-tailed%
Ta&le 3) shows the relationship &etween time of starting weaning food and -eight-for-
age 4-score of children of slum and non-slum area 1rom the ta&le we found that there
was a significant association &etween education level of mothers and 3eight-for-age 4-
score of children for slum areas as #9 ))*/t can &e said that this association is
significant at *J level
"ssociation &etween these two varia&les non-slum area were found significant at ()J
level $as p9)(%
Ta.le ;B: Calue of chi-sDuare test of time of starting weaning foo# an# %eight-for-
age &-score of Chil#ren .etween Slum an# 6on-slum areas
Area
Time of starting
weaning
%eight-for-age &-score '5(
Total
P Calue
F- 7.BB S 'Stunte#( G8 -7.BB S '6ormal(
+lum 96 month 2(4 8;6 ()))
)28
O6 month *44 4*6 ()))
0on-slum 96 month (8* ;2* ()))
(3;
O6 month 3)9 69( ()))
.orrelation test &etween time of starting weaning food and -eight-for-age 4-score of
children of slum area was carried out -owever! from ta&le 3(! it is seen that these two
varia&les were weekly correlated $as r :-)262%
93
Ta.le ;3: Correlation of time of starting weaning foo# an# %eight-for-age &-score
of Chil#ren for slum area
Correlation Tests %eight-for-age &-score Time of starting weaning
%eight-for-age &-
score
#earson .orrelation ())) -262
+ig $2-tailed% )28
0 8( 8(
Time of starting
weaning
#earson .orrelation -262 ()))
+ig $2-tailed% )28
0 8( 9*
T .orrelation is significant at the ))* level $2-tailed%
.orrelation test &etween time of starting weaning food and -eight-for-age 4-score of
children of slum area was carried out -owever! from ta&le 32! it is seen that these two
varia&les were weekly correlated $as r :-)(*2%
Ta.le ;7: Correlation of time of starting weaning foo# an# %eight-for-age &-score
of Chil#ren for non-slum area
Correlation Tests
%eight-for-age &-
score
Time of starting weaning
%eight-for-age &-
score
#earson .orrelation ())) -(*2
+ig $2-tailed% (4)
0 9* 9*
Time of starting
weaning
#earson .orrelation -(*2 ()))
+ig $2-tailed% (4)
0 9* 9*
TT .orrelation is significant at the ))( level $2-tailed%
#earson .hi s,uare tests for nutrient intake of slum and non-slum mothers 1rom ta&le
33! it was found that there is significant difference in energy! protein! fat! car&ohydrate!
calcium! iron! X thiamin! ri&oflavin! niacin! vitamin . and 4inc intake $as for all nutrients
#:))))% There was also significant difference in vitamin " intake &etween slum and
non-slum areas $#: )))2% 0o significant difference in carotene intake was found
Ta.le ;;: Calue of chi-sDuare test of Per Ca!ita 6utrient Inta+e of slum an# non-
slum *others
93
6utrients Slum '6ean% 6on-slum '6ean% P Calue
Anergy (*443 2)4;8 )))
#rotein 396 89* )))
1at 8* 224 )))
.ar&ohydrate 32*9 389; )))
.alcium 28*6 493* )))
/ron (33 283 )))
Kitamin " (4(( ;*2; ))2
.arotene *)8;2 6)83( 3;3
Thiamin (); (88 )))
<i&oflavin 3; 86 )))
0iacin (8( 226 )))
Kitamin . 3)9 634 )))
4inc 6) 2;) )))
# values for intake of roots Q tu&ers! pulses Q nuts! fruits! meats! eggs! fish! milk protein!
fats Q oils is less than ))* +o it can &e said that there is significant difference in intake
of these foods &etween slum and non-slum areas
Ta.le ;<: Calue of chi-sDuare test of Foo# Inta+e of *others .1 Foo# /rou!
Foo# /rou!
Slum 6on-slum
P Calues
*ean *ean
<oots Q tu&ers *; ;* )(9
#ulses Q nuts () 84 )))
1ruits 2( 4) )39
6eats 2) 63 )))
Aggs 4 (4 ))(
1ish 26 44 ))3
6ilk #rotein ( 6 )44
1ats Q 7ils 4 (2 )))
Ta&le 3* shows the relationship &etween time of colostrum feeding and delivery place of
slum and non-slum respondents 1rom the ta&le we found that there was a significant
association &etween these two varia&les for slum areas as #9 ))(/t can &e said that this
association is significant at (J level
Ta.le ;:: Calue of chi-sDuare test of Place of #eliver1 an# Colostrum fee#ing of
slum
93
eliver1 Place
Colostrum Fee#ing
Total P Calue
Ees 0o
"t home 3(3 6;; ()))
))) "t 0?7 delivery centre 942 *; ()))
"t hospital 636 364 ()))
.orrelation test &etween time of colostrum feeding and delivery place of slum
respondents was carried out -owever! from ta&le 36! it is seen that these two varia&les
were weekly correlated $as r :-)429%
Ta.le ;=: Correlation of Place of #eliver1 an# Colostrum fee#ing of slum
Correlation Tests eliver1 Place Colostrum Fee#ing
eliver1 Place
#earson .orrelation ())) -429
+ig $2-tailed% )))
0 (66 (66
Colostrum Fee#ing
#earson .orrelation -429 ()))
+ig $2-tailed% )))
0 (66 (9)
TT .orrelation is significant at the ))( level $2-tailed%
Ta&le 38 shows the relationship &etween child=s anemia and mother=s anemia for &oth
slum and non-slum respondents 1rom the ta&le! we found that there was a significant
association &etween these two varia&les for slum areas as #9 )(/t can &e said that this
association is significant at ()J level " significant association &etween these two
varia&les for non-slum areas was also found as #:))))+o! /t can &e said that this
association is significant at (J level
Ta.le ;>: Calue of chi-sDuare test of chil#Es anemia an# their motherEs anemia
Area
%emoglo.in level
of chil#
hemoglo.in level of mother
Total P Calue
H 37 gm,#l 'normal( I 37 g,#l 'anemic(
Slum
L (( gmIdl $normal% 6;4 *)9 *89
)6; P (( gIdl $anemic% 3(6 49( 42(
Total ())) ())) ()))
6on-Slum
L (( gmIdl $normal% 98( 333 8;9
))) P (( gIdl $anemic% 29 668 2((
Total ())) ())) ()))
93
.orrelation test &etween child=s anemia and mother=s anemia for non-slum respondents
was carried out -owever! from ta&le 3;! it is seen that these two varia&les were strongly
correlated $as r :)4;6%
Ta.le ;?: Correlations of chil#Es anemia an# their motherEs anemia in non-slum
area
%emoglo.in 0evel Correlation Test
%emoglo.in 0evel of
Chil#ren
%emoglo.in 0evel of
*other
%emoglo.in 0evel
of Chil#ren
#earson .orrelation ())) 4;6
+ig $2-tailed% )))
0 9* 9*
%emoglo.in 0evel
of *other
#earson .orrelation 4;6 ()))
+ig $2-tailed% )))
0 9* 9*
TT .orrelation is significant at the ))( level $2-tailed%
Ta&le 39 shows the relationship &etween hemoglo&in level of child and -eight-for-age 4-
score for &oth slum and non-slum respondents 1rom the ta&le! we found that there was a
significant association &etween these two varia&les for slum areas as #9 ))(+o! /t can
&e said that this association is significant at (J level " significant association &etween
these two varia&les for non-slum areas was also found at ()J level $as p:))62%
Ta.le ;9: Calue of chi-sDuare test of %emoglo.in level of chil# an# %eight-for-age
&-score
Area
%eight-for-age &-
score
hemoglo.in level of Chil#
Total P Calue H 33 g,#l
'normal(
I 33 g,#l
'anemic(
Slum
9 -2)) +D
$@nder nutrition%
2(; ;2* 484
))) L -2)) +D
$0ormal%
8;2 (8* *26
Total ())) ())) ()))
6on-Slum
9 -2)) +D
$@nder nutrition%
(6) 3*) 2))
)62
L -2)) +D
$0ormal%
;4) 6*) ;))
Total ())) ())) ()))
93
.orrelation test &etween hemoglo&in level and -eight-for-age 4-score of children for
slum area was carried out Ta&le 4) shows that these two varia&les were strongly
correlated $as r :)48(%
Ta.le <B: Correlations of hemoglo.in level an# %eight-for-age &-score of slum
chil#ren
Caria.les Correlation Test %emoglo.in 0evel of Chil#ren %eight-for-age &-score
-emoglo&in
>evel of
.hildren
#earson .orrelation ())) 48(
+ig $2-tailed% )))
0 (9) (9)
-eight-for-
age 4-score
#earson .orrelation 48( ()))
+ig $2-tailed% )))
0 (9) (9)
TT .orrelation is significant at the ))( level $2-tailed%
Ta&le 4( shows the relationship &etween 56/ of 6others and percentage of fulfillment
of <D" of mothers of slum and non-slum respondents 1rom the ta&le we found that
there was a significant association &etween these two varia&les for slum areas as #9
))(/t can &e said that this association is significant at (J level
1or non-slum area significant association was found at *J level as #9))*
Ta.le <3: Calue of chi-sDuare test of )*I of *others an# !ercentage of fulfillment
of 4A of mothers
Area )*I of *others
Classification
Total P Calue Energ1 inta+e
F>:5 of reDuire#
Energ1 inta+e
H>:5 of reDuire#
Slum
9(;49
$6alnourished%
8*) 2*) ()))
))3 (;*)-2499
$0ormal%
93) 8) ()))
L2*)) $7&ese% *)) *)) ()))
6on-Slum
9(;49
$6alnourished%
668 333 ()))
)4(
(;*)-2499
$0ormal%
4)* *9* ()))
L2*)) $7&ese% 668 333 ()))
93
.orrelation test &etween 56/ of 6others and percentage of fulfillment of <D" of
mothers of slum area was carried out -owever! from ta&le 42! it is seen that these two
varia&les were weekly correlated $as r :-))62%
Ta.le <7: Correlations of )*I of *others an# !ercentage of fulfillment of 4A of
mothers of slum area
Caria.les Correlation Test )*I of *other Percentage of fulfillment of 4A
56/ of 6other
#earson .orrelation ())) )62
+ig $2-tailed% **)
0 9* 9*
#ercentage of
fulfillment of
<D"
#earson .orrelation )62 ()))
+ig $2-tailed% **)
0 9* 9*
TT .orrelation is significant at the ))( level $2-tailed%
.orrelation test &etween 56/ of 6others and percentage of fulfillment of <D" of
mothers of non-slum area was carried out -owever! from ta&le 43! it is seen that these
two varia&les were moderately correlated $as r :-)249%
Ta.le <;: Correlations of )*I of *others an# !ercentage of fulfillment of 4A of
mothers of non-slum area
Caria.les Correlation Test )*I of *other
Percentage of fulfillment of
4A
56/ of 6other
#earson .orrelation ())) 249
+ig $2-tailed% )(*
0 9* 9*
#ercentage of
fulfillment of
<D"
#earson .orrelation 249 ()))
+ig $2-tailed% )(*
0 9* 9*
TT .orrelation is significant at the ))( level $2-tailed%
"ssociation has &een found &etween having sanitary toilet facilities and worm infestation
of mothers of slum area Ta&le 44 illustrates that there was a significant association
&etween these two varia&les "s #9 ))(/t can &e said that this association is significant
at (J level
93
Ta.le <<: Calue of chi-sDuare test of having sanitar1 toilet facilities an# worm
infestation of mothers of slum area
Sanitar1 latrine
$orm infestation of mother
P Calue
Jes 6o
Ees (68 ;)9
))) 0o ;33 (9(
Total ())) ()))
.orrelation test &etween having sanitary toilet facilities and worm infestation of mothers
of slum area was carried out Ta&le 4* illustrates that these two varia&les were weekly
correlated $as r : -)38)%
Ta.le <:: Correlation .etween having sanitar1 toilet facilities an# worm infestation
of mothers of slum area
Caria.les Correlation Test Sanitar1 latrine
$orm infestation
of mother
+anitary latrine
#earson .orrelation ())) -38)
+ig $2-tailed% )))
0 9* 9*
3orm infestation of
mother
#earson .orrelation -38) ()))
+ig $2-tailed% )))
0 9* 9*
TT .orrelation is significant at the ))( level $2-tailed%
-.1.1. Causal analsis and (odeling of nutritional status of children
and (others
Ta.le <=: 4egression anal1sis of Chil#Es %A& with other in#e!en#ent varia.les of
slum
*o#el
@nstan#ar#iKe#
Coefficients
Stan#ar#iKe#
Coefficients t Sig.
) St#. Error )eta
$.onstant% -;8(6 2(*4 -4)48 )))
6other=s -emoglo&in
level
))68*4 (24 )*4 *44 *;;
6other=s 56/ ))2362 )3* )69 9)9 364
0o of a&ortions -)(63 24* -)9) -66* *);
.hild -emoglo&in level )*(2 (4( 3*4 362; )))
Dependent Karia&leH 3-7-"4
93
Ta&le 46 shows the correlation coefficient &etween the dependent varia&le -eight-for-age
of slum children with the independent varia&les
The e,uation that can &e formed from this ta&le is given &elowH
3-7-"4 : -;8(6 U ))68*4 $6other=s -emoglo&in level% U ))2362 $6other=s 56/%
- )(63 $0o of a&ortions% U )*(2 $.hild -emoglo&in level
+o! it is evident that in slum areas! with the increase of ( unit change in mother=s
hemoglo&in level! child=s -"4 will positively change almost for ))8 unit! with the
increase of ( unit change in mother=s 56/ .hild=s -"4 will positively change almost for
))2 unit! with the increase of ( unit change in 0o of a&ortions! .hild=s -"4 will
decrease for almost )(6 unit and for ( unit change in child hemoglo&in level! child= -"4
will &e positively change for )*( unit
Ta.le <>: 4egression anal1sis of Chil#Es $A& with other in#e!en#ent varia.les of
slum
*o#el
@nstan#ar#iKe#
Coefficients
Stan#ar#iKe#
Coefficients t Sig.
) St#. Error )eta
$.onstant% -3869 ()29 -366* )))
0o of a&ortions -))(263 ((* -)(( -()9 9(3
.hild -emoglo&in
level
)(33 )93 (49 (43* (**
Dependent Karia&leH 3-73"4
Ta&le 48 shows the correlation coefficient &etween the dependent varia&le 3eight-for-
age of slum children with the independent varia&les
The e,uation that can &e formed from this ta&le is given &elowH
3-73"4 : -3869- )(263$0o of a&ortions% U )(33 $.hild -emoglo&in level%
93
+o! it is evident that within slum areas! the increase of ( unit change in 0o of a&ortions!
.hild=s 3"4 will decrease for almost )(3 unit and for ( unit change in child
hemoglo&in level! child=s 3"4 will &e positively change for )(3 unit
Ta.le <?: 4egression anal1sis of Chil#Es $%& with other in#e!en#ent varia.les of
slum
*o#el
@nstan#ar#iKe# Coefficients Stan#ar#iKe# Coefficients
t Sig.
) St#. Error )eta
$.onstant% -(662 ()(4 -(639 ()*
0o of a&ortions -))2232 (86 -)(3 -(28 ;99
6other=s
-emoglo&in level
))((*9 )48 )26 248 ;)6
Dependent Karia&leH 3-73-4
Ta&le 4; shows the correlation coefficient &etween the dependent varia&le weight-for-
height of slum children with the independent varia&les
The e,uation that can &e formed from this ta&le is given &elowH
3-73-4 : -(662 - ))2232 $0o of a&ortions% U ))((*9 $6other=s -emoglo&in level
+o! it is evident that in slum areas! with the increase of ( unit change in mother=s
hemoglo&in level! child=s 3-4 will positively change almost for ))( unit! with the
increase of ( unit change in 0o of a&ortions! .hild=s 3-4 will decrease for almost ))2
unit
Ta.le <9: 4egression anal1sis of Chil#Es %A& with other in#e!en#ent varia.les of
non-slum
*o#el
@nstan#ar#iKe# Coefficients Stan#ar#iKe# Coefficients
t Sig.
) St#. Error )eta
$.onstant% -8962 (;88 -4243 )))
#er capita monthly
food cost
))*89; ))4 ()6 (34) (;2
6other=s
-emoglo&in level
))*4(( ((( )3* 4;8 628
6other=s 56/ ))3(*6 )3* )69 9)9 364
.hild -emoglo&in
level
)44* ((* 28( 3;;3 )))
93
Dependent Karia&leH 3-7-"4
Ta&le 49 shows the correlation coefficient &etween the dependent varia&le -eight-for-age
of non-slum children with the independent varia&les
The e,uation that can &e formed from this ta&le is given &elowH
3-7-"4 : -8962 U ))*89; $#er capita monthly food cost% U ))68*4 $6other=s
-emoglo&in level% U ))2362 $6other=s 56/% U )*(2 $.hild -emoglo&in level%
+o! it is evident that in non-slum areas! with the increase of ( unit change in per capita
monthly food cost! child=s -"4 will positively change almost for )))* unit! with the
increase of ( unit change in mother=s hemoglo&in level! child=s -"4 will positively
change almost for ))* unit! with the increase of ( unit change in mother=s 56/! .hild=s
-"4 will positively change almost for ))3 unit and for ( unit change in child
hemoglo&in level! child= -"4 will &e positively change for )4* unit
Ta.le :B: 4egression anal1sis of Chil#Es $A& with other in#e!en#ent varia.les of
non-slum
*o#el
@nstan#ar#iKe# Coefficients Stan#ar#iKe# Coefficients
t Sig.
) St#. Error )eta
$.onstant% -4)*( ;;6 -4*8* )))
#er capita monthly
food cost
))(*;6 ))3 392 *42) )))
.hild -emoglo&in
level
)(2) )8; )99 (*3( (28
#rotein intake of
mother
)))4)89 ))2 ((9 (64; ()(
Dependent Karia&leH 3-73"4
Ta&le *) shows the correlation coefficient &etween the dependent varia&le 3eight-for-
age of non-slum children with the independent varia&les
The e,uation that can &e formed from this ta&le is given &elowH
3-73"4 : -4)*( U ))2 $#er capita monthly food cost% U )(2 $.hild -emoglo&in
level% U )))4 $#rotein intake of mother%
93
+o! it is evident that in non-slum areas! with the increase of ( unit change in per capita
monthly food cost! child=s 3"4 will positively change almost for ))2 unit and for ( unit
change in child hemoglo&in level! child= 3"4 will &e positively change for )))4 unit
and for ( unit change in protein intake of mother! )))4 unit positive change will take
place for .hild=s 3"4
Ta.le :3: 4egression anal1sis of Chil#Es $%& with other in#e!en#ent varia.les of
non-slum area
*o#el
@nstan#ar#iKe#
Coefficients
Stan#ar#iKe# Coefficients
t Sig.
) St#. Error )eta
$.onstant% -2);) 33; -6(*3 )))
#rotein intake of
mother
))();2 ))4 2)2 2*;6 )()
#er capita monthly
food cost
))2); ))* (9( 2466 )(*
0o of a&ortions -))(636 (** -))8 -()6 9(6
Dependent Karia&leH 3-73-4
Ta&le *( shows the correlation coefficient &etween the dependent varia&le weight-for-
height of non-slum children with the independent varia&les
The e,uation that can &e formed from this ta&le is given &elowH
3-73-4 : -2);) U ))2); $#er capita monthly food cost% U ))();2 $#rotein intake
of mother% - ))(636 $0o of a&ortions%
+o! it is evident that in non-slum areas! for ( unit change in protein intake of mother! ))(
unit positive change will take place for .hild=s 3"4! with the increase of ( unit change
in per capita monthly food cost! child=s 3-4 will positively change almost for ))2 unit!
with the increase of ( unit change in 0o of a&ortions! .hild=s 3-4 will decrease for
almost ))( unit
93
1rom these results $ta&le 46! 48! 4;! 49! *)! *(% it can &e said that the general hypothesis
which was assumed for the study is proved as there are different influential factors
affecting nutritional status of slum and non-slum children aged 6 to 24 months
Ta.le :7H 4egression anal1sis of *other ')*I( with other in#e!en#ent varia.les of
slum
*o#el
@nstan#ar#iKe#
Coefficients
Stan#ar#iKe#
Coefficients t Sig.
) St#. Error )eta
$.onstant% (4629 3;22 3;28 )))
Anergy intake of
mother
))4*4* )23 2)6 2))8 )4;
6other=s
-emoglo&in level
)2*8 28* )99 93* 3*2
#arity -)329 4); -((* -;)6 422
#er capita monthly
food cost
))6429 )*6 (23 ((*( 2*3
Dependent Karia&leH 6other=s 56/
Ta&le *2 shows the correlation coefficient &etween the dependent varia&le mother=s 56/
of slum with the independent varia&les
The e,uation that can &e formed from this ta&le is given &elowH
6other=s 56/ : (4629 U ))4*4* $Anergy intake of mothers% U)2*8 $6other=s
-emoglo&in level% - )329 $#arity% - )*43 $0o of a&ortions% U ))6429 $#er capita
monthly food cost%
+o! it is evident that in slum areas! for ( unit change in energy intake of mother! ))* unit
positive change will take place for mother=s 56/! with the increase of ( unit change in
mother=s hemoglo&in level! mother=s 56/ will positively change almost for )26 unit!
with the increase of ( unit change in parity! mother=s 56/ will decrease for almost )33
unit and with the increase of ( unit change in per capita monthly food cost! mother=s 56/
will positively change almost for ))6 unit
93
Ta.le :;H 4egression anal1sis of *other ')*I( with other in#e!en#ent varia.les of
6on-slum
*o#el
@nstan#ar#iKe#
Coefficients
Stan#ar#iKe#
Coefficients t Sig.
) St#. Error )eta
$.onstant% (;*9( 2;8; 646) )))
#er capita monthly
food cost
))48;8 ))9 39; *(43 )))
#arity -))2429 2(( -)); -((* 9)9
6other=s
-emoglo&in level
)((3 23; )34 483 638
Anergy intake of
mother
))2*4( )23 2)6 2))8 )4;
Dependent Karia&leH 6other=s 56/
Ta&le *3 shows the correlation coefficient &etween the dependent varia&le non- slum
mother=s 56/ with the independent varia&les
The e,uation that can &e formed from this ta&le is given &elowH
6other=s 56/ : (;*9( U ))48;8 $#er capita monthly food cost% - ))2429 $#arity% U
)((3 $6other=s -emoglo&in level% U ))2*4( $Anergy intake of mothers%
+o! it is evident that in non-slum areas! with the increase of ( unit change in per capita
monthly food cost! mother=s 56/ will positively change almost for ))* unit! with the
increase of ( unit change in mother=s hemoglo&in level! mother=s 56/ will positively
change almost for )(( unit and for ( unit change in energy intake of mother! ))3 unit
positive change will take place in case of mother=s 56/
1rom these results $ta&le *2! *3% it can &e said that the general hypothesis which was
assumed for the study is proved as there are different influential factors affecting the
nutritional status of mothers having children aged 6 to 24 months in selected slum and
non-slum areas
93
Chapter 6
6.1. +iscussion
This is a cross sectional comparative study which was conducted to assess and compare
the nutritional status of children aged 6 to 24 months and their mothers &etween the
selected slum and non-slum areas of Dhaka city /n the study! a comparative picture was
found &etween target populations of slum and non-slum areas of Dhaka city in respect to
socio-economic and demographic condition! K"# regarding pregnancy! delivery!
lactation! child feeding practices! mor&idity and treatment seeking &ehavior as well as
anthropometric! dietary! &iochemical and clinical assessment These findings of the study
has &een compared with different national level studies conducted mostly from
5angladesh Demographic and -ealth +urvey $5D-+! 2))8%! .hild and 6aternal
0utrition +urvey of 5angladesh $.60+! 2))*%! 5angladesh 0ational 0utrition +urvey
$500+!(99*-96%! +tudy of @r&an #overty in 5angladesh $2))*% as well as few studies
similarly done in a&road
/n this study it is found that! (6; J households of slum had a monthly income less than
Tk 4)))! (26 J had a monthly income Tk ()))(-(*))) $figure 6% /n case of non-slum
areas! 2( J households of non-slum areas had a monthly income within Tk ()))(
-(*)))! 63 J had a monthly income Tk(*))(-2))))! 484 J had a monthly income
Tk2)))( -3)))) $figure 8%"ccording to a study to assess the determinants of
malnutrition among the children under 2 years of age of Dhaka city 2;J of the
respondents= family monthly income was &elow Tk3))(-*)))! 36J were &elow
Tk2))))-2*))) and (64J were Tk())))-(*)))
3*
/t is seen that monthly income is
lower in slum and higher in non-slum areas in this study compared to the previous study
in Dhaka
/n the study! the mean food cost in slum and non-slum areas was Tk*242 and Tk((;*;
The mean house rent cost was Tk(289 and Tk((82( for slum and non-slum areas
"ccording to +tudy of @r&an #overty in 5angladesh $2))*% the ur&an poor mostly spend
93
their earnings to fulfill their &asic needs especially for food and shelter
38
+o! the findings
are similar to this result though there were ,uite difference in &oth study sample
/n the studied slum areas! 3*; percent of the mothers were illiterate! no mother in the
slum reported completed -+. level and 3)* percent of the main income earner were
illiterate! only *3 percent had completed -+. $ta&le 3% "ccording to an @0A+.7
report! education figures for slums in 5angladesh=s capital Dhaka are among the worst in
the +outh-"sian country
()
The result in the study also suggests that the education level in
slum areas were also very low
/n this study! (;9J completed primary level and 2;4J had completed -+.! *26
percent mothers were graduate or more educated $ta&le 3% "ccording to a study to assess
the determinants of malnutrition among the children under 2 years of age of Dhaka city!
244J mothers completed primary level! 32J completed secondary level! (((J
completed higher secondary level and (((J mothers were graduate
3*
Though these
studies are different in sample selection and methodology! education level of non-slum
mothers is found higher in this study
/n the study! 432 percent non-slum women got married and only 2(( percent slum
women got married $figure 9% "ccording to 500+ $(99*-96%! *42 percent ur&an women
get married at the age of (* to (; years
3*
+o! it is evident that there is a huge difference
in case of mother=s age at marriage &etween slum and non-slum areas even in respect to
national data @se of family planning has increased steadily in 5angladesh /n 2))8! ;)
percent of ever-married women of reproductive age reported having used a family
planning method at some time! compared with only (4 percent in (98*M this is more than
a fivefold increase over the past three decades
(;
/n the study! only 3) percent of slum
mothers and 68 percent of non-slum mothers adopted family planning $figure ()! ((% +o!
in compare to the national data the study population in &oth slum and non-slum areas use
family planning
93
/n this study! 663 percent of &irths in slum areas took place at a health facility! mostly in
0?7 sector- 5<". delivery center /n non-slum areas 9(6 percent child &irth took place
in hospitals or clinics $ta&le ;%The 2))8 5D-+ shows that (* percent of &irths in
5angladesh take place at a health facility! a&out half in the pu&lic sector and half in the
privateI0?7 sector
(;
+o! &oth slum and non- slum areas in the study showed &etter
situation in terms of place of delivery of child
/n this study! 3)* and 663 percent child &irth was caesarean is slum and non-slum areas
respectively $ta&le ;% "ccording to the 2))8 5D-+! ; percent of &a&ies &orn in the five
years preceding the survey were delivered &y caesarean section
(;
Though there were
difference &etween these two studies in terms of sample si2e and methodology! it can &e
said that caesarean deliveries were found many times manifold than that in this study
5reastfeeding is almost universal in 5angladesh /n the study! ;9* percent of slum
children and 938 percent from non-slum areas were &reastfed at some point $figure (4%
"ccording to 5D-+ 2))8! 9; percent 5angladeshi children were &reastfed(3 -owever!
according to 5D-+ 2))8! 92 percent of last-&orn children received first milk or
colostrum The likelihood of a child receiving colostrum increases with mother=s
education and! to a lesser degree! household wealth .hildren who are &orn in ur&an
areas! who are &orn at health facilities! and whose &irth is attended &y a health
professional are more likely to receive colostrum than other children
(;
"mong the
studied children 69* percent of slum areas and 889 percent of non-slum areas were
given colostrum $ta&le ()% /t was also found that place of delivery and colostrum feeding
were correlated $ta&le 3*% +o! it can &e concluded that &reast feeding rate is almost same
&ut colostrum feeding rate is lower in &oth studied slum and non-slum areas in respect to
national survey
#re-lacteal feeding is widely practiced in 5angladesh "mong the studied children! the
rate of pre-lacteal feeding was 3;9 percent and 326 percent in slum and non-slum areas
respectively $figure (2%"ccording to 5D-+! more than si' in ten new&orns $62 percent%
receive a pre-lacteal feed #re-lacteal feeds are more common in Dhaka! Khulna and
<aGshahi! compared with the other divisions
(;
/n this study! *6; percent among non-
93
slum children and 4(( percent among slum children were &reast fed immediately after
&irth "gain! 2*3 and (6; percent children were &reastfed within one day after delivery
$figure (4%"ccording to 5D-+ 2))8! overall! 43 percent of children are &reastfed within
one hour of &irth! and ;9 percent are &reastfed within one day after delivery /nitiation of
&reastfeeding within one day after &irth is highest in 5arisal $92 percent% and lowest in
Dhaka $;; percent% according to 5D-+ 2))8
(;
+o! though the study was ,uite different
in respect to sample si2e and other issues it can &e said that pre-lacteal feeding and the
percentage of starting &reast feeding immediately after &irth is found much lower in &oth
slum and non-slum areas in respect to national survey
/n this study we found that! *(; percent slum children and 49* percent non-slum
children were e'clusively &reast feed $figure (*% "ccording to 500+ $(99*-96%! ();
percent ur&an children aged ) to 24 months was e'clusively &reastfed
3;
+o! we can say
that e'clusive &reast feeding practice has changed positively &y these years in &oth of the
studied slum and non-slum areas in respect to national data
/n the study! among slum children prevalence of diarrhoea was most common and among
non-slum children fever and cold was found most fre,uently occurring diseases $ta&le
(4% "ccording to 5D-+! 6aGor contri&utors to childhood mor&idity and mortality in
5angladesh takes place due to childhood diarrhoea! acute respiratory infection $"</% and
fever "mong children under * years of age! * J showed the symptoms of acute
respirator illness and 3; percent of children under five years had a fever in the two weeks
preceding the survey
(;
-owever! in this study almost same! (9* percent of slum
children and 244 percent of non-slum children were found suffered from &oth fever and
cold "gain 83 and 2;9 percent children from slum and non-slum areas were suffering
from fever only $ta&le (4% Though this study differed much from the survey in respect to
sample si2e and methodology! it can &e said that suffering from fever is lower &ut
suffering from cold or respiratory illness is higher among &oth slum and non-slum target
children in respect to 5D-+ 2))8
/n this study! mean height-for-age 2-score! weight-for-age 2-score! height-for-weight 2-
score for slum children are -(82! -23) and (43 respectively 6ean height-for-age 2-
93
score! 3eight-for-age 2-score! height-for-weight 2-score for non-slum children are -)86!
-)84! -))* respectively $Ta&le (*%"ccording to a study on children under 3 years of age
in Kietnam in 2))8! the mean 4-score for height-for-age was -(*( ! for weight-for-age
was -(*(s and for weight-for-height was -)63
2*
so! it can &e said that mean height-for-
age 2-score! weight-for-age 2-score and height-for-weight 2-score for slum children is
lower &ut non-slum children is higher in compare to data for Kietnam
/n this study! 49 percent slum male children have normal nutritional status! 333 percent
are moderately stunted and (86 percent are severely stunted "mong slum female
children *6; percent have normal nutritional status! (86 percent are moderately stunted
and ((4 percent are severely stunted -owever in case of non-slum children! ;4*
percent male children are not stunted! for female children this percentage is 86 percent
"mong them ((( percent &oy and (2 percent girl are moderately stunted! 44 percent
&oy and (2 percent girl are severely stunted $ta&le (6%"ccording to a comparative study
on nutritional status among pre-school children living in rural! slum and ur&an Dhaka &y
/.DD<5--K/! in 5angladesh the prevalence of stunting $J9-2 2-score% among the pre-
school children was higher in the ur&an slums! followed &y the rural and ur&an non-slum
areas $662J! 6((J! and *2*J% respectively
;
+o! it can &e said this study findings
resem&les the results of study &y /.DD<5--K/ in terms of child nutritional status
/n this study! among slum male children 6;6 percent were not wasted! (96 percent were
moderately wasted and 9; percent were severely wasted "mong slum female children
636 percent had normal nutritional status! 228 percent were moderately wasted and (36
percent were severely wasted -owever in case of non-slum children ;22percent male
children were found not wasted! for female children this percentage was 84 percent
"mong them ;9 percent &oy and 6) percent girl were moderately wasted! ;9 percent
&oy and 4 percent girl were severely wasted -owever 2) percent slum male children
were found over weight! on the contrary among non-slum children (6 percent female
were found o&ese $ta&le (8% "ccording to a study of /#-0--K/! +everity of child
wasting $>ow weight of height% was poor $4-;J% and this prevalence was higher among
93
)-23 months old children in the slums of Dhaka
9
+o! the result of the study concludes
almost similarly of the result of the study of -K/
/n the study! slum male children 294 percent had normal nutritional status! 4*( percent
were moderately under weight and 2** percent were severely under weight "mong
slum female children 4** percent had normal nutritional status! 4)9 percent were
moderately under weight and (36 percent were severely under weight -owever in case
of non-slum children 88; percent male children were not found under weight! for female
children this percentage was 94 percent "mong the slum 222 percent &oy and 6 percent
girl were moderately under weight $figure 2(% 5D-+ 2))8 3eight-for-age results show
that 4( percent of children under five are underweight! with (2 percent are severely
underweight in our country
(;
+o! the result of this study concludes almost similarly of the
result of the national study
/n this study! the mean 56/ of mothers from slum and non-slum areas are 2(23 kgImV
and 24(8 kgImV respectively $ta&le (;% and the mean 56/ for women aged (* to 49
years was 2)6 kgImV according to 5D-+ 2))8 and 5D-+ 2))8 also shows that a&out
si' in ten women $*9 percent% are considered to have normal 56/! while 3) percent are
undernourished or thin $56/ less than (;*%! and (2 percent are overweight or o&ese
$56/ 2* or higher%
(;
3hereas in this study! **3 percent non-slum mothers had normal
nutritional status! 2;9 percent were o&ese and (*; percent were malnourished according
to their 56/ /t was also found that 4*3 percent slum mothers had normal nutritional
status! (26 percent were o&ese and 42( percent were malnourished according to their
56/ $figure 22% +o! it can &e said that the mean 56/ of mothers for &oth slum and non-
slum areas are higher comparing to the national data &ut the percentage of mothers
having normal 56/ in this study was less than that of in 5D-+ 2))8
/n this study! 42( percent children aged 6-24 months of slum are anemic $figure 23%
+pecial study from the ur&an slum sides of the ?75I-K/ nutrition surveillance proGect
$0+#% showed that 8*; percent of children aged 6-*9 months suffered from anemia
9
+o!
it is seen that prevalence of anemia is lower in studied slum areas than that of in 0+# /n
93
this study! in non-slum areas 2(( percent children aged 6-24 months are found anemic
$figure 23% "ccording to 500+ $(99*-96%! 3*6 percent ur&an male children aged 6 to
8( months were anemic and 433 percent female children were anemic +o! it can &e said
that prevalence of anemia in non-slum areas are lower comparing to national data for
ur&an children
3(
"gain according to 500+ $(99*-96%! ;)9 percent lactating female were anemic whereas
in the study 6) percent of slum and 2;4 percent of non-slum lactating mothers were
anemic $figure 24% +o! prevalence of anemia &oth in studied slum and non-slum areas are
lower than that of in national survey report
3(

/n this study! daily average intake of cereal of lactating mothers is 384 g and 3;8 g for
slum and non-slum areas! root and tu&er intake is *; and ;* g for slum and non-slum
areas! pulse intake is () g and 84 g for slum and non-slum areas! fruit intake is 2( g and
4) g! fish intake is 26 and 44 g! meat intake is 2) and 63 g! fat intake is 4g and (2 g $ta&le
(9% "ccording to 500+ $(99*-96%! daily average cereal intake of lactating mothers was
438( g! root and tu&er intake was 692 g! pulse intake was 692 g! fruit intake was 44 g!
fish intake was 483 g! meat intake was (*2 g and fat intake was ;4 g
3(
+o! it can &e
concluded that! in comparison to national survey report! cereal intake of the studied
population is less among &oth slum and non-slum mothers! root and tu&er intake is lesser
in slum areas and higher in non-slum areas! pulse intake is very low among slum mothers
whereas that is much higher among non-slum mothers! 1ruit and meat intake is higher in
&oth slum and non-slum areas and fish intake is lower in &oth slum and non-slum areas
than for all populations of Dhaka city

/n this study! mean energy intake of slum mothers is (*443 Kcal and for non-slum
mothers it is 2)4;8 kcal 6ean protein intake of slum mothers is 396 g and for non-slum
mothers it is 89* g "gain! mean iron intake of slum mothers is (33 mg and for non-
slum mothers it is 283 mg /n case of vitamin intake! mean vitamin " intake of slum
mothers is (4(( /@ and for non-slum mothers it is ;*2; /@ -owever! mean vitamin .
intake of slum mothers is 3)9 mg and for non-slum mothers it is 623 mg $ta&le 2)%
93
"ccording to 500+! per capita nutrient intake of population of Dhaka city in (99*-96
was (6922 kcal calorie! *)*6 g protein! 32*) g fat! 299 g car&ohydrate! (8 mg iron!
2;34 /@ vitamin " and 46(* mg vitamin .
3(
1or each nutrient amounts taken &y slum
mothers were less and amounts taken &y non-slum mothers were higher than that of the
500+ data mentioned previously
"ccording to 500+ $(99*-96%! prevalence of sparce hair among ur&an lactating mothers
is (* percent
3(
! which is (48 percent among slum mothers in the study $ta&le 2(%
-owever! 2 percent children aged ) to 4 years were found having knock knee or &owed
leg
3(
! whereas 42 percent target slum children had &owed leg or knock knee $ta&le 2(%
Though there are differences in sample si2e and methodology to some e'tent &etween
national survey and this study! prevalence of sparce hair of mothers has found almost
same in these two studies 5ut prevalence of knock knee or &owed leg in slum children
has found higher than the national data
6.2. Conclusion
The study revealed nutritional profile of target child-mother pairs &etween slum and non-
slum areas of Dhaka city from the specific point of views of socio-economic and
demographic situation! Knowledge! "ttitude and #ractice $K"#% of pregnancy! delivery
and lactation! child feeding practices! dietary intake pattern of the mothers! mor&idity
pattern of children and treatment seeking &ehavior .omparative analysis was done to
e'plore comparison of the e'isting situations &etween the slum and non-slum target
populations " conceptual framework was developed to address all influential factors
affecting the e'isting nutritional situation of &oth slum and non-slum areas in the conte't
of our country under the general hypothesis assumed for the study
/n the study! differences were found &etween slum and non-slum respondents in respect
to education level and occupation of mothers and main income earners! income! utility
facilities! age of marriage of mothers! adoption of family planning! child spacing!
percentage of e'penditure on house rent! place of delivery! type of delivery! age of child
&irth! knowledge a&out anemia! prevalence of anemia among pregnant mother! iron! folic
93
acid supplementation! supplement formula milk ! feeding cerelac as complementary food!
child=s age of starting weaning food! fre,uency of child=s diseases and practice of
visiting physician for treatment of children
7n the other hand! almost no differences were found &etween slum and non-slum
respondents in respect to parity $as most of the target children were the first &a&y among
slum population%! num&ers of a&ortion! colostrum feeding! time of first introducing &reast
milk and percentage of e'clusive &reast feeding
#revalence of moderate stunting in slum areas $4*( percent male! 4)9 percent female%
was higher than that of non-slum areas $((( percent male! (2) percent female% with
moderate wasting was also &eing higher in slum areas $(96 percent male! 226 percent
female% than that of non-slum areas $;* percent male! 63 percent female%3ithin the
slum children 294 percent male and 4** percent female were not under weight while in
non-slum children the percentages were higher $88; percent male! 94 percent female%
-owever! 43 percent male and (46 percent female children were found over weight in
non-slum areas! whereas no evidence of over weight in slum areas was found +lum
mothers $42( percent% were more malnourished than non-slum mothers $(*; percent%
with o&ese children &eing 2;9 percent and (26 percent respectively #revalence of
anemia was dou&le among slum children $42( percent% than those of non-slum $2((
percent%! whereas the prevalence of anemia among mothers was 6) percent for slum areas
and 2;4 percent for non-slum areas "t least 8* percent of <D" for energy was fulfilled
only among 242* percent slum mothers and 63; percent non-slum mothers -owever!
263 percent mothers and (89 percent children had discolored hair! ((6 percent mothers
and 63 percent children had angular stomatitis as well as! 63 percent mothers and (89
percent children had worm infestation in slum areas
+ignificant associations &etween 56/ of mothers and -"4 of children $#9 ))(!
r:)86(% for slums! education level of mothers and 3"4 of children $#9 ))(!
r::)(4(%% for non-slum areas were found " significant difference was found for energy!
protein! fat! car&ohydrate! calcium! iron! thiamin! ri&oflavin! niacin! vitamin . and 4inc
intake $as for all nutrients #9))(% +ignificant association was found &etween child=s
93
anemia and mother=s anemia for non-slum areas $#9))(! r: )4;6% " significant
association was found &etween child=s hemoglo&in level and -"4 for slum areas as #9
))(! as r :)48( 1or non-slum area significant association &etween 56/ of mothers and
percentage of fulfillment of <D" of mothers was found at * percent level " significant
association was found &etween having sanitary toilet facilities and worm infestation of
mothers in slum areas as #9 ))(! r : -)38
#ositive correlation for -"4 of children with mother=s hemoglo&in level! mother=s 56/!
child hemoglo&in level in slum areas and with per capita monthly food cost! mother=s
hemoglo&in level! mother=s 56/! child hemoglo&in level in non-slum areas was found
/n case of child=s 3"4 in slum areas child hemoglo&in level had positive and num&er of
a&ortions had negative correlation and in non-slum areas per capita monthly food cost!
child hemoglo&in level! protein intake of mother had positive correlation with child=s
3"4 /t was evident that in slum areas mother=s hemoglo&in level had positive and
num&er of a&ortions had negative correlation with child=s 3-4 and in non-slum areas
protein intake of mother! per capita monthly food cost had positive and num&er of
a&ortions had negative correlations 6other=s 56/ was positively correlated with energy
intake! mother=s hemoglo&in level! per capita monthly food cost was negatively
correlated with parity and in non-slum areas per capita monthly food cost! mother=s
hemoglo&in level! energy intake of mothers were seen positively correlated with mother=s
56/
The findings of this study indicate that malnutrition is an alarming pro&lem among
children aged 6 to 24 months and their mothers in slum areas A'isting risk factors and
prevalence of malnutrition in non-slum areas can not &e neglected also +ocio-economic!
environmental factors and feeding practices are risk factors for malnutrition among
children aged 6 to 24 months in our country This study also identified that a greater risk
of malnutrition was associated with poor K"# of mothers regarding pregnancy! delivery!
lactation! child feeding practices! treatment seeking &ehavior Twenty four hours dietary
recall method &rought up the misera&le picture mostly of slum mothers suffering from
poor ,uality and ,uantity of food at that stage of life when dietary re,uirement is the
93
highest for them .omparatively poor knowledge and high prevalence of anemia was
found in &oth slum and non-slum areas Thus the hypothesis of the study assumed &efore
has &een proved from the a&ove findings
These findings are very important! suggesting the need for improving K"# of mothers on
these aspects and taking other measures to com&at malnutrition @r&an planning for
health interventions and infrastructure for increasingly large slum areas needs to &e
undertaken in future
6.". Reco((endations
The study highlighted the e'isting situation of nutritional status! K"# in terms of
pregnancy! lactation! feeding practices and health seeking &ehavior of the respondents
households in &oth slum and non-slum areas of Dhaka city 5ased on the study findings
and comparative analysis the following recommendations are given &elowH
( /n order to improve the nutritional status of children $aged 6 to 24 months%
among slum population! e'tensive &ehavior change communication in terms
of nutritional awareness and appropriate feeding practices needs to &e
strengthened &y &oth government and 0?7 activities /nformation on feeding
practices can also &e disseminated using various electronic media channels for
the ur&an population There is a national /nfant and Eoung .hild 1eeding
$/E.1% strategy in our country &ut there is no implementation plan +o a
systematic planning is re,uired for /E.1 strategy to &ring the desired impact
2 To tackle the pro&lem of anemia periodic de-worming of the children as well
as ensuring iron folate ta&let to pregnant women needs to &e carried out
3 Ansuring nutrition education for adolescent girls! pregnant and lactating
mothers with innovative approaches of dissemination of information should
&e developed instead of traditional education procedure so that the target
population can adopt it easily and effectively
93
4 "n emphasis on adoption of family planning services can also help in
improving the child health situation in slum area
* " social safety net program should &e introduced for children aged 6 to 24
months from poor households as well as pregnant women and severely
malnourished mothers and children &y supplementary feeding program
6 ?rowth monitoring and promotion of low &irth weight $>53% &a&ies!
malnourished $mild to moderate% children and undernourished pregnant
women should &e followed up
8 +lum area will have to &e developed e'peditiously with utility facilities!
drains! and needed to &e upgraded with all other amenities to give the
occupants a new facelift
; +ystematic surveys are needed to &e undertaken in &oth slum and non-slum
areas to update comparison among health and nutritional status of vulnera&le
groups
93
Chapter 7
0.1.References
( @0/.A1 report! Y.hild and 6aternal 0utrition in 5angladesh=! "pril 2))9
2 "rifeen +A! 5lack <A! .aulfield >A! "ntelman ?! 5a,ui "- Determinants of infant
growth in the slums of DhakaH si2e and maturity at &irth! &reastfeeding and
mor&idity Aur N .lin 0utr 2))(M *3H (68-(8;
3 5angladesh .hild and maternal nutrition +urvey! 2))*
4 +chneider K! <oy # K and -asan! Amergencies! Amergency impact and 0utrition
surveys! /ssue 36! p2;! Nuly 2))9
* Kictora! . ?! > "dair! . 1all! # . -allal! < 6artorell! > <ichter! - +ingh
+achdev! for the 6aternal and .hild @ndernutrition +tudy ?roup 2)); 6aternal
and child undernutritionH .onse,uences for adult health and human capital The
>ancet 38( $96)9%H 34)D*8
6 @nderstanding @r&an /ne,ualities in 5angladeshM a prere,uisite for achieving Kision
2)2(! @0/.A1 5angladesh! 0ovem&er 2)()
8 +ting " @&er @r&ani2ation! Kerelendun and ?esundhei Kolum&ien 7ffi2telles
?esundherts-wesen (99)M *2H 288-2;(
; Kiess >! .omparison of 0utritional +tatus among #re-school .hildren >iving in
<ural! +lum and @r&an Dhaka!-elen Keller /nternational - the /nternational .entre
for Diarrhoeal Disease <esearch! 5angladesh! Decem&er (996
93
9 -K/I/#-0! -igh anemia prevalence among 5angladeshi children in ur&an slums
0utritional +urveillance #roGect 5ulletin 0o ( -K/! Dhaka! 2)))
() <u&el! 6D! +lums /n Dhaka .ityH >ife of 6isery! 6ay 2)()
(( Y-ealth and 0utrition +urveillance for Development=! 0ovem&er 2))2g! "nnual
<eport 2))(! 0+#! -K/ 5angladesh! ppH 99-((8
(2 B-ealth! 0utrition and #opulation +ector #rogram $-0#+#! Nuly 2))3 D Nune
2))6%C! #rogram /mplementation #lan $#/#%! 7cto&er 2))3
(3 5angladesh .ensus of @r&an +lums! 2))*
(4 Y-ealth and 0utrition +urveillance in @r&an slums in Dhaka! Khulna and .hittagong
divisons=! "nnual <eport 2))(! 0+#!-K/! 5angladesh! 5ulletin 0o 9! ()! ((! 0ovem&er
2))2d! 2))2e! 2))2f
(* Trends in child malnutrition! (99) to 2))*! 0utritional +urveillance #roGect! 5ulletin 0o
(9! "ugust 2))6
(6 0oorani +! 6ultiple /ndicators .lusters +urvey 5angladesh $6/.+% 2))6! 55+-@0/.A1!
Dhaka! 6ay 2))8
(8 5huyan 6"-! <eport on evaluation of @#-.#-( and developing a package of 0utrition
and -ealth interventions for @#-.#-2! 6ay 2))4
(; 5angladesh Demographic and -ealth +urvey! 0/#7<T! 1inal <eport! 2))8
(9 ?upta "! Dadhich N #! 1aridi 66"! /ndian Nournal of #ediatrics! KolH 36(! ppH 2226-
2234! 2)()
93
2) "llen! >- and ?illespie! +<! B3hat 3orksZ " review of the Afficacy and Affectiveness of
0utrition /nterventionsC! "D5 with @0 ".. +u&-committee on 0utrition! 2))(
2( @0/.A1 2))3D); 6aliH +tatistics! Tracking progress on child and maternal nutritionH "
survival and development priority 0ew Eork! 2))9&
22 B5angladesh 0ational 1ood and 0utrition #olicyC! (998! 6inistry of -ealth and 1amily
3elfare! ?overnment of the #eoples <epu&lic of 5angladesh
23 .hild 0utrition +urvey $.0+% of 55+! 2))2
24 The .hallenge of -ungerH 1ocus on the .risis of .hild @nder 0utrition! ?lo&al -unger
/nde'! 2)()
2* 0guyen 0goc -ien! 0guyen 0goc -oa! 0utritional +tatus and Determinants of 6alnutrition
in .hildren under Three Eears of "ge in 0ghean! Kietnam! #akistan Nournal of 0utrition!
volH;! issueM 8! pH9*;! Nan 2))9
26 "na 6arl[cia 7liveira "ssis/M Adileu2a 0unes ?auden2i/M ?ecynalda?omesTM <ita de
.\ssia <i&eiro/M +ophia . +2arfarc//M +onia 5 de +ou2a//! -emoglo&in concentration!
&reastfeeding and complementary feeding in the first year of life! "ug 2))4
28 0utrition +urveillance #rogramme! -elen Keller /nternational I /#-0! 2))6
2; #opulation .ensus! #reliminary <eport! 5angladesh 5ureau of +tatistics! Dhaka! 2))(
29 /slam 0! @r&ani2ation! @r&an #lanning and Development! and @r&an ?overnance .entre
for @r&an +tudies! Dhaka! 2))(
3) 6 K ?oel! < 6ishra! D < ?aur Q " Das! 0utrition +urveillance /n (-6 Eears 7ld
.hildren /n @r&an +lums 7f " .ity /n 0orthern /ndia The /nternet Nournal of
Apidemiology! Kolume * 0um&er (! 2))8
93
3( 5angladesh 0ational 0utrition +urvey!(99*-96
32 Tracking #rogress on .hild and 6aternal 0utritionH " survival and development priority!
@0/.A1! 0ovem&er 2))9
33 0utritional +urveillance #roGect! 0utrition and -ealth +urveillance in @r&an +lums in
Dhaka! "nnual report 2))(! 5ulletin 0o9! -elen Keller /nternationalI/#-0! 0ovem&er
2))2
34 5angladesh 0ational 0utrition .ouncil! 5angladesh 0ational #lan of "ction for 0utrition
$0#"0%! (998
3* 0iger T! Khatun +! +ultana 6! /slam 0 and Ka2uhiro 7! YDeterminants of 6alnutrition
among the .hildren under 2 Eears of "geC! #akistan Nournal of 0utrition 9 $(%H 28-34! 2)()
36 .oncern=s @r&an 0utrition and -ousehold 1ood +ecurity #roGect $@01-+#%! 6ay 2))2 D
"pril 2))8
38 #overty and Kulnera&ility in Dhaka +lumsH The @r&an >ivelihoods +tudy 5angladesh e-
Nournal of +ociology Kol 2 0o ( Nanuary 2))*
93
Chapter 8
1.1.Anne8ure
1.1.1. #&erational +efinitions
Anemia: The condition of having less than the normal num&er of red &lood cells or less than the
normal ,uantity of hemoglo&in in the &lood The o'ygen-carrying capacity of the &lood is!
therefore! decreased
Angular stomatitis: This is an affection of the skin at the angles of the mouth! characteri2ed &y
heaping-up of grayish white sodden epithelium into ridges! giving the appearance of fissures
radiating outwards from the mouth Due to ri&oflavin! pyrido'ine deficiency or in association
with iron deficiency anemia it takes place
Anthro!ometr1: This is the techni,ue that deals with the measurement of the si2e! weight and
proportions of the human &ody The anthropometric measurements taken in this study are height
or length and weight
)iochemical Assessment: /t refers to measurement of a nutrient in &iological fluids or tissues!
measurement of the urinary e'cretion rate of the nutrient and measuring the production of an
a&normal meta&olite or changes in the activities of certain en2ymes or &lood components
dependent on a nutrient /n the study! hemoglo&in level was measured from &lood collected from
study population
)itotEs s!ot: ?rayish or glistening white pla,ues formed of des,uamated thickened conGunctival
epithelium! usually triangular in shape and firmly adherent to the underlying conGunctiva! which
is associated with vitamin " deficiency
)ivariate anal1sis: /t refers to testing hypothesis of ]association] and causality /n its simplest
form! association simply refers to the e'tent to which it &ecomes easier to know or predict a
93
value for the Dependent varia&le if we know a caseFs value on the independent varia&le "
measure of association helps us to understand this relationship These measures of association
relate to how well an independent varia&le relates to the dependent varia&le
)*I: /t is used to measure thinness or o&esity /t is defined as weight in kilograms divided &y
height in meters s,uared $kgIm2% The main advantage of the 56/ is that it does not re,uire a
reference ta&le from a well-nourished population " cutoff point in the 56/ of (;* is used to
define thinness or acute under nutrition " 56/ of 2* or a&ove usually indicates overweight or
o&esity and 3) or a&ove indicates o&esity
Chil# S!acing: A'amination of &irth intervals! defined as the length of time &etween two
successive live &irths
Chi-sDuare test 'L7 test(: /t is any statistical hypothesis test in which the sampling distri&ution
of the test statistic is a chi-s,uare distri&ution when the null hypothesis is true! or any in which
this is asymptotically true! meaning that the sampling distri&ution $if the null hypothesis is true%
can &e made to appro'imate a chi-s,uare distri&ution as closely as desired &y making the sample
si2e large enough
Clinical Assessment: /t consists of a routine medical history and a physical e'amination to
detect physical sign $ie o&servations made &y a ,ualified e'aminer% and symptoms $ie
manifestation reported &y the patient% associated with malnutrition These assessment procedures
are normally used in community nutrition surveys and in clinical medicine They are most useful
during the advance stages of nutritional definition! when overt disease is present
Colostrum: /t is also known as first milk is the sticky yellowish 6ilky fluid secreted for the first
day or two after parturition /t contains anti&odies to protect the new&orn against disease! as well
as &eing lower in fat and higher in protein than ordinary milk
Com!lementar1 fee#ing: The process starting when &reast milk alone or infant formula alone is
no longer sufficient to meet the nutritional re,uirements of an infant! and therefore other foods
93
and li,uids are needed along with &reast milk or a &reast milk su&stitute The target range for
complementary feeding is generally considered to &e 6D24 months
ConMunctival xerosis: The &ul&ar conGunctiva &ecomes dry! thickened! wrinkled and pigmented!
due to failure to shed the epithelial cells! and conse,uent keratinisation /t is common in children
under * years due to vitamin " deficiency
Corneal xerosis: Dull! ha2y appearance of cornea due to dryness and caused &y vitamin "
deficiency
Exclusive .reastfee#ing: /nfant receives only &reast milk 6edicines! oral rehydration solution!
vitamins and minerals! as recommended &y health providers! are allowed during e'clusive
&reastfeeding
Flac+1 !aint #ermatosis: This is characterstic of #A6 The skin &ecomes hyper pigmented and
keratin separates in flakes
Follicular h1!er+eratosis: The follicles &ecome &locked with plugs or keratin derived from the
epithelial lining which has undergone s,uamous metaplasia This pathological change has &een
attri&uted to vitamin " deficiency
%eight-for-age: /t measures linear growth " child who is &elow two standard deviations $-2
+D% from the median of the 3-7 reference population in terms of height-for-age is considered
short for hisIher age! or stunted This condition reflects the cumulative effect of chronic
malnutrition /f a child is &elow minus three standard deviations $-3 +D% from the reference
median! then heIshe is considered to &e severely stunted +tunting reflects a failure to receive
ade,uate nutrition over a long period of time and is worsened &y recurrent and chronic illness
-eight-for-age! therefore! reflects the long-term effects of malnutrition in a population and does
not vary apprecia&ly according to recent dietary intake
"eratomalacia: +oftening! dissolution of cornea! ulceration and inflammation takes place
3ithout treatment it results in perforation and at last in total &lindness
93
0ow .irth weight: "n infant weighing less than 2!*)) grams at &irth
*alnutrition: /t is a &road term commonly used as an alternative to under nutrition! &ut
technically it also refers to over nutrition #eople are malnourished if their diet does not provide
ade,uate nutrients for growth and maintenance or they are una&le to fully utili2e the food they
eat due to illness $under nutrition% They are also malnourished if they consume too many
calories $over nutrition%
6asola.ial #1sse.acea: The appearance of enlarged follicles around the sides of the nose and
sometimes e'tending over the cheeks and forehead due to ri&oflavin deficiency
6ight )lin#ness: /na&ility to see clearly in dim light! mainly due to a deficiency of vitamin "
6utrition: /t is a dynamic process concerning with ingestion! digestion! a&sorption and
assimilation $meta&olism% of food su&stances &y which growth! repair and maintenance of
activities in the &ody as well as a whole or in any of its parts are accomplished
6utritional Status: The condition of the &ody resulting from the utili2ation of the essential
nutrients availa&le to the &ody is termed as nutritional status
2.ese: /t is defined as weight-for-height a&ove three standard deviations from the median
weight-for-height of the standard reference population /t also refers to 56/ greater or e,ual to
thirty
2verweight: /t is defined as weight-for-height a&ove two standard deviations from the median
weight-for-height of the standard reference population
Parit1: the num&er of live &orn children a woman has delivered
93
PearsonNs chi-sDuare test: /t is also known as the chi-s,uare goodness-of-fit test or chi-s,uare
test for independence 3hen mentioned without any modifiers or without other precluding
conte't! this test is usually understood $for an e'act test used in place of ^2
Pre-lacteal fee#ing: it is the practice of giving other li,uids to a child during the first three days
of life
4egression anal1sis: /t includes any techni,ues for modeling and analy2ing several varia&les!
when the focus is on the relationship &etween a dependent varia&le and one or more independent
varia&les 6ore specifically! regression analysis helps us understand how the typical value of the
dependent varia&le changes when any one of the independent varia&les is varied! while the other
independent varia&les are held fi'ed
Stan#ar# eviation Score 'S score or &-score(: 4-score is a multiple of standard deviation /t
is estimated &y taking median value of the reference population! divided &y the standard
deviation for the reference population
4-score
Stunting: /t is defined as -eight-for-age &elow minus two standard deviations from the median
-eight-for-age of the standard reference population >inear growth is a more sta&le indicator of
nutritional status and stunting indicates reduced linear growth compared to the e'pected growth
in a child of same age +tunting is usually the end result of chronic and less severe inade,uate
nutrition
Su!!lementar1 fee#ing: "dditional foods provided to vulnera&le groups! including moderately
malnourished children
Twent1-four %our 4ecall *etho#: This is a method to recall the su&Gect=s e'act food intake
during the previous twenty-four hour period or preceding day Detailed descriptions of all foods
93
and &everages consumed! including cooking methods Kitamin and mineral supplement use is
also noted _uantities of foods consumed are usually estimated in household measures
@n#er nutrition: the outcome of insufficient food intake! inade,uate care and infectious
diseases /t includes &eing underweight for one=s age! too short for one=s age $stunting%!
dangerously thin for one=s height $wasting% and deficient in vitamins and minerals $micronutrient
deficiencies%
@n#erweight: /t means a deficit in &ody weight compared to the e'pected weight for the same
age! which may result either from a failure in growth or loss of &ody weight due to infections /t
is a composite form of under nutrition that includes elements of stunting and wasting and is
defined as weight-for-age &elow minus two standard deviations from the median weight-for-age
of the standard reference population
$asting: 3asting means a deficit in &ody weight $tissue and fat% compared to the e'pected
weight for the same height or length /f the child is under weight for his height or length he os
she is currently on a deficient diet and is classified as wasted /t is defined as weight-for-height
&elow minus two standard deviations from the median weight-for-height of the standard
reference population " child can &e moderately wasted $&etween minus two and minus three
standard deviations from the median weight-for-height% or severely wasted $&elow minus three
standard deviations from the median weight-for-height%
$eight-for-age: " child can &e underweight for his age &ecause heIshe is stunted! &ecause
heIshe is wasted! or &oth .hildren whose weight-for-age is &elow two standard deviations $-2
+D% from the median of the reference population are classified as underweight .hildren whose
weight-for-age is &elow three standard deviations $-3 +D% from the median of the reference
population are considered severely underweight
$eight-for-height: /t descri&es current nutritional status " child who is &elow two standard
deviations $-2 +D% from the reference median for weight-for-height is considered to &e too thin
for hisIher height! or wasted This condition reflects acute or recent nutritional deficit "s with
93
stunting! wasting is considered severe if the child is more than three standard deviations &elow
the reference median +evere wasting is closely linked to mortality risk
1.1.2. /uestionnaire
Institute of 6utrition an# Foo# Science
@niversit1 of ha+a
Com!arative Stu#1 on 6utritional Status of Chil#ren 'age# = to 7< months( an# their
*others .etween Selecte# Slum an# 6on-Slum Areas of ha+a Cit1
-ousehold noH
DateH ` ` ` ` ` ` ` ` ` ` ` ` `
0ame of the "reaH ` ` ` ` ` ` ` ` ` ` ` ` `
0ame of the /nterviewerH ` ` ` ` ` ` ` ` `
0ame of the <espondentH ` ` ` ` ` ` ` ` `
I#entification of the res!on#ent:
( 0ame of the -ead of the -ouseH
2 0ame of the 6otherH aaaa
3 6other=s "geHaaa Eear
4 0um&er of .hildren $from 6 month to 24 month%H aaaaaa
* 0ame of the childrenHaaaaaaaaaa
.hild /dentification
0um&er $./0%
0ame of the
.hild
?ender "ge $6onth%
(
2
.ode for ?enderH
6ale:(
1emale:2
A. Socio-economic & emogra!hic Information:
93
6 -ow long have you &een living in this slumI Dhaka cityZ ` ` ` ` ` ` ` ` ` ` ` ` `
8 <eligion of the familyH
.odeH
/slam:(
-indu:2
.hristian:3
5uddhist:4
7thers:*
; Total -ousehold mem&ersH
9 Aducation level of motherH
.odeH
/lliterate:(
.an +ign one=s name:2
.an read and write:3
.lass /-K:4
() Aducation level of main income earnerH
.odeH
/lliterate:(
.an +ign one=s name:2
.an read and write:3
.lass /-K:4
(( 7ccupation of motherH
.odeH
-ousewife:(
/ndustry worker:2
Day la&our :3
5usiness:4
7thers:*
(2 7ccupation of main income earner H
.odeH
<ickshaw puller I Kan driver : (
+mall &usiness:2
Daily la&our:3
6otor car driver :4
+ervice:*
7thers:6
(3 6onthly family income H
(4 1amily e'penditureH
.lass K/- K/// :*
.lass K///-++.:6
++.--+.:8
L ?raduate:;
.lass K/- K/// :*
.lass K///-++.:6
++.--+.:8
L ?raduate:;
93
1ood cost
-ouse rent cost
.lothing cost
Treatment cost
Aducation .ost
7ther cost
(* 1acilities you haveH
+anitary >atrine
Kitchen
3ater supply
?as supply for cooking
.odeH
Ees:(
0o:2
(6 3ater +ourcesH
Drinking water
.ooking water
@tensil washing water
5athing water
.odeH
Tu&e well:(
Tap water:2
). "AP relate# Information among mothers:
I. Information relate# to !regnanc1A 0actation an# #eliver1:
(8 3hat was your age at the time of marriageZ
.odeH
9(* years:(
(* -(; years:2
O(; years:3
(; 3hat is your parityZ
(9 Did a&ortion occur in your lifeZ
.odeH
Ees:(
0o:2
2) /f yes! how many times it took placeZ
2( 3as there child spacing for atleast 3 years &etween two childrenZ
<iverI#ond:3
Deep Tu&e well :4
7thers :*
93
.odeH
Ees:(
0o:2
0ot applica&le:3
22 Did you use any family planning &efore $last% pregnancyZ
.odeH
Ees:(
0o:2
23 3here did your last child deliveredZ
.odeH
"t home:(
"t 0?7 delivery centre:2
"t hospital:3
24 3hat was the type of deliveryZ
.odeH
0ormal:(
.aesarean:2
2* Did too much &lood loss take place after deliveryZ
.odeH
Ees:(
0o:2
26 "t what month did your child took &irthZ
.odeH
"t 9 ; month:(
"t ; to 9 month :2
"t O 9 month: 3
28 3hat was the &irth weightZ
.odeH
92* Kg:(
O2* Kg:2
Don=t Know:3
2; Do you know what is "nemiaZ
.odeH
Ees:(
0o:2
29 Did you have "nemia during pregnancyZ
.odeH
Ees:(
0o:2
Don=t Know:3
3) Did you take iron ta&let during pregnancyZ
.odeH
93
Ees:(
0o:2
3( /f yes! then how many did you takeZ
.odeH
(-(*):(
(*i-3)):2
Did not took:*
32 Did you take folic acid ta&let during pregnancyZ
.odeH
Ees:(
0o:2
Don=t Know:3
II. Fee#ing Practices:
33 3hat did you first feed to your infant after &irthZ
.odeH
.olostrum:(
-oney:2
+wteened water:3
#lain water:4
34 3hat was the method for postlacteal feedingZ
.odeH
Tip of finger :(
+poon :2
#lasti feeder &ottle :3
0eed not to use ant method :9
3* 3hen did you start &reast feeding to the infantZ
.odeH
0ever &reast fed:(
/mmediately after &irth: 2
3ithin 24 hours:3
3ithin 4; -ours:4
O 4; hours :*
36 Did you give colostrum to your new &ornZ
.odeH
Ees:(
0o:2
.an not remem&er:3
38 /f notM then what was the reason to reGect colostrumZ
6ilk $.owI?oat%:*
6ilk $1ormula%:6
7thers:8
3)(-*)):3
@nlimited:4
93
.odeH
6other=s illness:(
/gnorance:2
Don=t feel it necessary:3
1amily discourage:4
5ad for &a&y:*
1eed colostrum:9
3; Do you know the &enefits of colostrumZ
.odeH
Ees:(
0o:2
39 Did you e'clusively &reast feed your child upto 6 monthsZ
.odeH
Ees:(
0o:2
0ever &reast fed:3
4) /f no! then what did you offered for supplementationZ
.odeH
1ormula 6ilk:(
.ow=s milk:2
.erelac:3
+uGi $+emolina%:4
4( "re you continuing &reast feeding to your child Z
.odeH
Ees:(
0o:2
42 /f yes! how long will you continue &reast feeding to your childZ
.odeH
9 (2 months:(
(2-24 months:2
O 24 months:3
43 /f no! how long did you follow &reast feedingZ
.odeH
)- ( month:(
)-4 month- :2
)-6 months:3
44 3hen did you start weaning foodZ
.odeH
9 6 month:(
6-; month:2
9-(2 month:3
O (2 month:4
0ot yet:*
)-(2 months:4
)-(; months:*
0ot at all:6
.ontinuing &f:9
1ruitI1ruit Guice:*
.onfectionaryI+nacks:6
1ormulaI"nimal milk U +uGiI .erelac: 8
1ormulaI "nimal milk U all a&ove foods: ;
93
4* /f &efore 6 months! whyZ
.odeH
5reast milk is not enough to fulfill child re,uirement:(
>ess &reast milk production:2
Due to work load:3
1amily pressure:4
7thers:*
+tarted after 6 months :9
46 3hat are the foods do you give your chid as complementary
food nowZ
.odeH
1ormula 6ilk:(
+uGi $+emolina%:2
1ruitI1ruit Guice:3
<iceUDahlI Khichuri:4
<iceUDahlI Khichuri
with meatIfishIegg:*
48 3hen do you feed your childZ
.odeH
.hild=s wish:(
"t fi'ed time:2
6other-in-law=s wish:3
3hen the child cries:4
7ther:*
4; Do you give your child fresh cooked food every timeZ
.odeH
Ees:(
0o:2
0": 9
49 /f not! whyZ
.odeH
@naware :(
.an not afford:2
0ot "pplica&le:9
*) Do you prepare separate food for your childZ
.odeH
Ees:(
0o:2
0ot "pplica&le:9
III. *or.i#it1 an# Treatment See+ing )ehavior:
Did your .hild suffer from any disease within last 3 monthsZ
.odeH
Ees:(
.onfectionaryI+nacks:6
<iceU DahlI Khichuri with meat! fish! egg Q
vegeta&le:8
<iceU DahlI Khichuri Q vegeta&le:;
"ll 1ooed:9
.ow=s milk: ()
93
0o:2
*( /f yes! 0ame of the disease heIshe sufferedZ
.odeH
1ever:(
.old:2
1everU.old:3
Diarrhoea:4
DiarrhoeaU 1ever :*
*2 3hat do you do when your child gets sickZ
.odeH
To physician :(
To -omeopath :2
To Traditional healer:3
To the nearer 0?7 centre:4
. Anthro!ometric Assessment 'mother and target children(:
dentification
-eight I
>ength $cm%
3eight
$kg%
6other of the child
.hild /dentification
num&er $./0%
D )iochemical Assessment 'mother and target children(:
/dentification
7ptical
Density
-emoglo&in
$gmIdl%
6other of the child
.hild /dentification
num&er $./0%
?ive medicine from nearer pharmacy:*
1ollow traditional way:6
0othing:8
DiarrhoeaU 1everU.old :6
Typhoid:8
#neumonia:;
Naundice:9
#o' :()
6easles:((
7thers:(2
0ot "pplica&le:99
93
E. ietar1 Assessment :
Foo# Inta+e of mother .1 7< hour recall metho#:
"ge of the 6otherH ````````` Eear
-ow was yesterday in respect of food intakeZ
.odeH "s usual normal day :(
1estival :2
+ick :3
93
F. Clinical Assessment:
.linical +igns 6other
./0
( 2
-air Discolored
+parce
Ayes 0ight 5lindness
5itot=s +pot
.onGunctival Xerosis
.orneal Xerosis
Keratomalacia
#allor
>ips "ngular +tomatitis
"ngular +cars
.heilosis
?ums 5leeding gums
+wollen red #apillae
1ever
Tongue +mooth
<aw and <ed
0ose 0asola&ial Dysse&acea
?land Anlarged Thyroid ?land
+kin 1lakypaint dermatosis
1ollicular hyperkeratosis
0ail Koilonychia
+keletal Knock KneeI 5ow leg
Adema
7thers Anlarged a&domen
$3orm /nfestation%
Location Map of Slum and Non-slum areas of ha!a cit"
93