Prevalence of

malnutrition in under-5
children
A Case Study in Nehru Ekta
Vihar
Community Medicine Group Project:
Group A
1
 Mentors
Faculty-In- Dr. Richa Kapoor,
Director Professor,
Charge Dept. of Community Medicine

SupervisorsDr. Venu G. Toppo - SR

Dr. Ashwini Priyadarshini - PG3
Dr. Pankaj Nathe - PG2
Dr. Mohit Jain - PG2

2
 INDEX
1. Introduction
2. Rationale of Study
3. Aims and Objectives
4. Review of Literature - Global
5. Review of Literature - Indian
6. Methodology
7. Results & Discussion
8. Conclusions
9. Limitations
10. References
11. Questionnaire
3
 INTRODUCTION
• Malnutrition in early childhood is a serious global concern, leading to increased
morbidity, mortality, and impaired development.[1] The World Health
Organization (2021) attributes nearly half of all deaths in children under five to
undernutrition, which is further exacerbated by socioeconomic disparities and
inadequate diets[3].

• In India, despite nationwide child health initiatives, malnutrition remains prevalent.

While rates in Delhi are lower, urban slum areas in South Delhi often exceed
national figures. This issue is most critical in the first 59 months of life, as
malnutrition weakens immunity, hinders cognitive development, and raises long-
term health risks. Addressing its prevalence is crucial for effective intervention.

4
 RATIONALE
To study various factors associated with Malnutrition in
children of under 5 age group living in slum area of Delhi.
In Nehru Ekta Vihar, like many urban slums, this study will provide crucial data
on its prevalence and causes.

Need for Targeted Interventions

Our study assesses the nutritional status of under-five children in Nehru Ekta
Vihar, an urban slum of South Delhi, and explores the knowledge and practices
of caregivers. By integrating standardized anthropometry and caregiver
interviews, we aim to identify local drivers—such as diarrhoea, anaemia, and
respiratory infections—and inform targeted interventions in this underserved
setting.
5
 AIM OF STUDY

To determine the prevalence of malnutrition by

assessing the anthropometric status of children
under 5 years of age residing in an urban slum of
Delhi.

6
 Objectives of study

PRIMARY OBJECTIVE
• To assess the anthropometric status of children under 5 years of age residing in an
urban slum of Delhi.

SECONDARY OBJECTIVE
• To assess various factors associated with anthropometric status of the study population.
• To evaluate the knowledge & practices of caregiver regarding feeding and child nutrition.

7
 REVIEW OF LITERATURE
Review of literature (Global)- Anthropometric
failure
Year of
Study Sample
S.no Author publicatio Methodology Findings
design size
n

Data Collection: Conducted from Prevalence of Stunting in

Shahinur
July to August 2023 at the Children Under
Akter, Cross-
400 household level in Bangladesh. 5:Severely stunted:
1 Nishana 2025 sectional
mothers Anthropometric measurements 57.5%Moderately
Afrin study
(height-for-age) used to assess stunted: 29%Normal
Nishu
stunting. height: 13.5%

Picbougo
um TB, Data collected from 537 villages in
10,032 - Stunting (40.1%),
Somda Cross- 24 districts of Burkina Faso,
children Wasting (25.1%), and
2 MAS, 2023 Sectional (Sovereign state in Africa).
under 5 Underweight (34%) were
Zango Study Anthropometric indicators were
years prevalent.
SH, et assessed using WHO standards.
al.
 Year of
Study
s.no Author publicat Sample size methodology findings
design
ion

Multistage random sampling

to select 395 households
with 487 under-five children
in Nigeria.Two states
randomly selected, followed
Adeyonu
by one senatorial district per
, A.G.,
Cross- state, then two Local Prevalence of Malnutrition:44.0%
Obisesa
sectio Government Areas (LGAs) of under-five children were
3 n, A.A., 2022 487 children
nal per district, and ten villages malnourished.10% at risk of
&
study per LGA.Structured malnutrition.46% well-nourished.
Balogun,
questionnaire covering child,
O.L.
maternal, household, and
community factors.Mid-
Upper Arm Circumference
(MUAC) tape used to assess
malnutrition status

Data collection:
Cross- 1. Trends in Stunting Over 15 Years
Pavitra Anthropometric
sectio 35,490 (2000–2015):Stunting prevalence
4 Paul et 2021 measurements (Height-for- 9 to
nal children decreased from 13.05% in 2000
al. Age Z-score, HAZ) used to
 Review of literature (India)- Anthropometric failure

Year of
Study
s.no Author publicatio Sample size methodology findings
design
n

A community-based cross-sectional
study was conducted among 196
under-five children in a rural field
practice area of NEIGRIHMS,
Meghalaya. Sociodemographic and
cross-
clinical data were collected using a Prevalence of
Aabha sectional
1 Jan 2024 196 pretested semi-structured Undernutrition:Underweight:
singh analytica
questionnaire, Anthropometric 9.2%Stunting: 28.6%Wasting: 6.1%
l study
measurements (height, weight, and
mid-upper arm circumference) were
taken, and Z-scores for weight-for-
age, height-for-age, and weight-for-
height were calculated.
s
Year of
. Study
Author publicatio Sample size methodology findings
n design
n
o

Study includes the anthropometric

Cross-
method to analyze Height-for-Age
sectional Child Undernutrition Prevalence:Stunting:
2 Akash porwal Dec2021 35452 (HAZ) → StuntingWeight-for-Height
analytical 33.9%Wasting: 17.3%Underweight: 32.7%
(WHZ) → WastingWeight-for-Age
study
(WAZ) → Underweight

Sampling: Systematic random

sampling without replacement (every
Community
4th house)Data Collection:Semi-
-based
April structured questionnaire Prevalence of Undernutrition:Underweight:
3 Deepti dabar cross- 520
2020 (sociodemographic, dietary, and 34.0%Stunting: 42.6%
sectional
lifestyle factors)Anthropometric
study
measurements (height, weight) using
WHO 2006 child growth standards

11
 Year of
Study
s.no Author publicatio Sample size methodology findings
design
n

This is a single-arm prospective study

conducted at a selected urban primary
health center area in Puducherry. All
the eligible 366 under-5 children and Breakdown of Undernutrition
Single their mothers were included. Data were Types:Underweight: 9.6%Wasting:
Sahu,
January arm collected using a pretested structured 7.6%Stunting: 7.3%Effectiveness of Weight-
4 Swaroop 366
2019 prospecti questionnaire. Assessment of for-Age Growth Chart:Identified 67% of
Kumar
ve study nutritional status was done using three stunted childrenIdentified 50% of wasted
types of growth charts. Three home children
visits were made, at an interval of
around 6 months, for monitoring the
nutrition status of children.

Data Analysis: Uses NFHS-4 and Prevalence & Trends of

Review
NNMB data to assess trends in Undernutrition:Wasting at Birth: 31.9% of
and
R Hemlatha undernutrition across states and children were wasted at birth, reducing to
5 Nov, 2018 secondar Not mentioned
et al. demographic factorsIndicators 17.7% by age five.State-Wise Variation in
y data
Assessed:Prevalence of wasting, Stunting:Lowest prevalence: 20% (Goa,
analysis 12
stunting, and underweight in children Kerala).Highest prevalence: 48% (Bihar).
 Year of
Study
s.no Author publicatio Sample size methodology findings
design
n

Sampling: Random sampling across 20

Commun villages, with 30 households per
ity-based villageData Collection Tools:Pretested
Prevalence of Undernutrition:Underweight:
6 Chyne DAL Nov 2017 cross- 603 structured
31%Stunting: 57%Wasting: 10%
sectional questionnairesAnthropometric
study measurements (height, weight, Mid-
Upper Arm Circumference - MUAC)

Two AWCs selected per PHC using

Nutritional Status of Children Under 5
simple random sampling.Children
Years:After one year:7.4% of children
classified into three categories based
improved to the normal category
on WHO growth standards:Green
(green).51.6% remained underweight
Retrospe (normal)Yellow (underweight: -2 to -3
(yellow).41% remained severely underweight
Kanan T. ctive SD)Red (severely underweight: < -3
7 June 2014 529 (red).Growth stagnation in 63% of children
Desai cohort SD)Follow-up assessment was done
and faltering in 20%, despite attending
study. after one year.Data
AWCs.Mean weight gain over one year: 1.7 kg
Collection:Questionnaire-based
(±1.4 SD).No significant difference in weight
interview with mothers.Measurement
gain between children in the yellow and13
red
of weight and mid-upper arm
categories.
circumference (MUAC)..
 Review of Literature -Assessment of knowledge & practice of a
caregiver
Year of
Study
s.no Author publicatio Sample size methodology findings
design
n

62.5% of caregivers had good perceptions of

breastfeeding practices. 59.5% had good
perceptions of complementary feeding.86.4% of
Conducted in rural Tamil Nadu; Data
Analytic children had adequate diet diversity.Higher
301 caregivers collected through interviews and
George N, al Cross- education and stable occupations were associated
1 2024 of children aged structured questionnaires assessing
et al. Sectional with better breastfeeding knowledge, but
12-59 months breastfeeding, complementary
Study paradoxically linked to lower complementary
feeding, and diet diversity;
feeding knowledge.Caregivers of children with
higher birth weights had better knowledge of
complementary feeding.

14
 Year of
Study
s.no Author publicatio Sample size methodology findings
design
n

49.3% of mothers had an average knowledge

score on infant and young child feeding
(IYCF).74.5% of mothers had an average
Conducted in Nadia district, West practice score.Mothers with higher education
Commun Bengal using multi-stage random (>Higher Secondary) had better IYCF
ity-Based 351 mothers of sampling. Data collected via structured knowledge (OR=2.06, p=0.019).Mothers who
Saha R, Pal
2 2024 Cross- under-five questionnaires assessing IYCF (Infant received ASHA home visits within one month
J, Ghosh M
Sectional children and Young Child Feeding) knowledge had better IYCF practices (OR=1.72,
Study and practices. Bivariate analysis p=0.041).Only 30.4% of mothers correctly
performed using SPSS 21.0 initiated complementary feeding at 6 months,
while 36.9% started early.Only 12% of
children received food from all three
recommended food groups.

15
 Year of
Study
s.no Author publicatio Sample size methodology findings
design
n

Two AWCs selected per PHC using

Caregiver Knowledge & Practice on Child
simple random sampling.Children
Nutrition & Feeding:Children of literate
classified into three categories based
mothers had higher weight gain (p=0.02),
on WHO growth standards:Green
while father’s education had no impact.120
(normal)Yellow (underweight: -2 to -3
Retrospe (22.7%) parents were not explained their
SD)Red (severely underweight: < -3
Kanan T. ctive child’s nutritional status by Anganwadi
3 June 2014 529 SD)Follow-up assessment was done
Desai cohort workers.Children whose parents were
after one year.Data
study. counseled about undernutrition gained
Collection:Questionnaire-based
significantly more weight (p=0.01).97.5% of
interview with mothers.Measurement
children consumed supplementary food
of weight and mid-upper arm
provided by AWCs, but taste and awareness
circumference (MUAC).Data from
were barriers for some
growth charts at AWCs.

16
 Review of literature - To assess various factors
associated with nutritional status of the study
population.

Year of
Study
s.no Author publicati Sample size methodology findings
design
on

Used aggregate data from the

Tri Bayu Found a negative association between
Indonesia Nutrition Survey (2022);
Purnama, malnutrition and ARIs (path coefficient
Partial least squares structural
Keita = -0.072, p < 0.01). Malnutrition
Ecologic 334878 children equation modeling (PLS-SEM) was
1 Wagatsuma, 2024 mediated the relationship between
al study under 5 year used to analyze relationships between
Masdalina environmental factors and ARIs. Higher
wealth, environment, malnutrition,
Pane, Reiko wealth was associated with lower
and acute respiratory infections
Saito malnutrition and ARIs.
(ARIs).
 Year of
Study
s.no Author publicatio Sample size methodology findings
design
n

Factors Associated with ARI:Child-Specific

Data Collection:Information was Risk Factors:Diarrhea: Children with recent
collected from mothers about child diarrhea were 3.75 times more likely to have
health, including acute respiratory ARI.Malnutrition: Stunted children had a
Cross-
Md Masud infections (ARI), without medical higher prevalence of ARI than non-stunted
1 2022 sectional 238,945 children
Hasan et al. validation.Other variables included children.Age: Younger children (0-11 months)
study
child demographics, maternal were 34% more likely to suffer from ARI than
education, socioeconomic status, those aged 36-59 months.Sex: Male children
nutrition, and environmental factors. were 18% more likely to have ARI than
females

Data Source: DHS (Demographic and

Health Surveys) from 39 LMICs, Prevalence of Conditions: Among 380,357 children
including India (data from 2010 from 39 countries, including India:Fever:
Demogra
onwards).Survey Adjustments: Raw 18.8%Diarrhea: 12.5%Acute Respiratory Infection
phic and 380,000+
estimates were adjusted for DHS (ARI): 4.3%Wasting: 13.5%Co-occurrence of
Winskill et Health children in 39
2 2021 survey design to ensure Conditions:Commonly paired conditions: Fever +
al. Surveys countries,
accuracy.Analysis Approach:Used Diarrhea, Fever + ARI, and Fever +
(DHS) including India Wasting.Multiple conditions observed in
multilevel, multivariate Bayesian
analysis children:8.2% had two conditions, 1.8% had three,
logistic regression to examine
and 0.2% had all four. 18
associations between fever, ARI,
diarrhea, and wasting.
 METHODOLOGY
D ATA C O L L E C T I O N

Individuals selected by Simple IN THE SEMI STRUCTURED QUESTIONNAIRE,

Random Sampling Method. CERTAIN RISK FACTORS FOR DEVELOPMENT OF
MALNUTRITION LIKE BIRTH HISTORY, VACCINATION
HISTORY, ANTHROPOMETRIC MEASUREMENTS , PRE-
LACTEALS FEEDS, ETC. WERE ASKED.
Administered questionnaire by a
Add a little bit of body
trained interviewer. text
THEN AFTER ADMINISTERING THE QUESTIONNAIRE THE
DATA RECEIVED WAS ANALYSED FOR PREVALENCE OF
If person not available on first visit, MALNUTRITION.
they were tried to be contacted the
next day by visiting their house.

If person not available on Second

visit, they are excluded from study.
 METHODOLOGY
Study
Cross
Design : sectional study.

Study
Setting:
Urban slum of Nehru Ekta Colony, Delhi, India.

Study
Population:
Children aged 5 years and below and caregiver.

Sampling
technique:
Simple random sampling method.
20
 METHODOLOGY
Inclusion
• Children aged 0–59 months.
criteria
• Caregivers willing to participate.

Exclusion
criteria
• Children with severe congenital anomalies.
• Caregivers unable to respond. (eg: cognitive impairment)

21
 Sample size
Based on a study conducted in South Delhi, the
prevalence of anthropometric failure in urban slums is
45%​​. Sample Size
(Goyal et al)
= Z²PQ/L²
Z=1.96 (for 95% confidence interval) = 95.04
= 105
P= 45%
(Considering to 10% Non response rate)
Q= 55% (100-P)
L= 10 %

Additional sample= 105 caregivers for evaluation of knowledge

and practices of infant and young child care.

22
 Tool of data collection

• The study was conducted using a semi-structured questionnaire, which was translated
into Hindi to ensure clarity and accessibility for participants. A pilot test was carried out
with 30 individuals who were not part of the study population, allowing for refinement of
the questionnaire.

• Caregivers residing in households with children aged 5 years or younger were the target
participants. A trained interviewer administered the questionnaire to these caregivers. In
the event that a household member was unavailable during the first visit, a second
attempt was made to contact the caregiver on a subsequent visit. If the participant was
still unavailable after the second visit, they were excluded from the study.

23
A list of total houses was
obtained from local health
workers.
Households with under 5 child were
identified by simple random method.

Under 5 child and caregiver were

identified as per the inclusion
Criteria
After taking an informed consent questionnaire was
administered to the caregiver, anthropometric
measurements were done and growth charts were plotted.

24
 Statistical Analysis
• Data was entered in Microsoft Excel sheet and was cleaned for errors
and missing values. Data analysis was done using licensed SPSS
software version 21.0.

• Data is presented in the form of tables and appropriate diagrams.

• Categorical data is summarized as proportions while continuous data as

mean, median and appropriate measures of dispersion including
confidence intervals.

• Appropriate tests of significance like chi square test wherever applicable.

25
Table 1 : Groups of anthropometric failure among
children

Boregowda GS, Soni GP, Jain K, Agrawal S. Assessment of Under Nutrition Using Composite
Index of Anthropometric Failure (CIAF) amongst Toddlers Residing in Urban Slums of Raipur
City, Chhattisgarh, India. J Clin Diagn Res. 2015 Jul;9(7):LC04-6. doi: 26

10.7860/JCDR/2015/12822.6197. Epub 2015 Jul 1. PMID: 26393147; PMCID: PMC4572978.

Table 2:

Frequenc Percenta Cumulati

Score
e ge ve Scale

0 54 54.55 54.55

1 45 45.45 100.00

Total 99 100.00

0= anthropometric failure ; 1= no failure

27
 Table 3 : Distribution of CIAF Scores amount under 5 children

Cumulative
Groups Frequency Percentage Scale

45 45.45 45.45
3 3.03 48.48
7 7.07 55.56
8 8.08 63.64

1 14.14 77.78
4
21 21.21 98.99
1 1.01 100.00

Total 99 100.00
28
Table4:

Sex 0 1 Total

F 30 (57.69%) 22 (42.31%) 52 (100%)

M 24 (51.06%) 23(48.94%) 47(100%)

Total 54 (54.55%) 45(45.45%) 99(100%)

0= anthropometric failure ; 1= no failure

29
Birth Order Ciaf score Total

22 19 41
1
53.66 46.34 100

15 20 35
2
42.86 57.17 100

11 6 17
3
64.71 35.29 100

5 0 5
4
100 0 100

1 0 1
5
100 0 100

54. 45 99
total
54.55. 45.55 100
30
 Ethical considerations

• Ethical clearance was sought from the Institutional Ethics Committee of VMMC
and Safdarjung Hospital. Written informed consent was taken from the
participants.

• Personal information is kept strictly confidential.

• The study does not involve any method that puts the subject or subject’s family
members or the investigator at any kind of risk.

• Data collected during the study is used for educational purposes only.

• All participants identified with malnutrition were referred to Safdarjung Hospital

for further investigation and appropriate management.
31
 Operational definitions
Caregiver
A caregiver is a person who provides essential care to a young child, including feeding, supervision, affection,
communication, and attending to child's needs, including seeking medical attention when necessary.

Slum
A contiguous settlement where inhabitants are characterised by having inadequate housing and basic services.

Wasting
A condition in children where weight-for-height is below -2SD of WHO Child Growth Standards Median.

Underweight
A condition in children where weight-for-age is below -2 SD of the WHO Child Growth Standards median.

Stunting
A condition in children where height-for-age is below -2 SD of the WHO Child Growth Standards media.
Fully Immunized
A child who has received all immunization doses as per the National Immunization
Schedule by one year of age.

Completely Immunized
A child who has received all age appropriate vaccines recommended in the National
Immunization Schedule.

Partially Immunized
A child who has received some but not all vaccines recommended as per the National
Immunization Schedule.
 RESULTS
1. Demographic Details
2. Birth History
3. Anthropometry
4. Immunization History
5. History of Recent Illness
6. Breast - Feeding
7. 24 Hour dietary recall

34
 Birth
Order
Birth Order Frequency

1 48

2 42

3 18

4 5

5 1

Table
1
35
N=11
4
 Birth Weight

Weight Category Frequency

Normal Birth Weight

99
(NBW)

Low Birth Weight (LBW) 12

High Birth Weight

3
(HBW)

Table
2

N=
114
36
 Birth History

Birth. History Frequency

Full Term 112

Pre Term 2

Table
3

N=
114
37
Mode of Delivery

Mode of delivery count

Normal vaginal
97
delivery

LSCS 17

Table
4

N=
114

38
Place of
delivery

place count

Home 26

Hospital 88

Table 5

N=
114
39
Delivered by

deliver by count

Doctor 87

Trained dai 20

Untrained dai 7

Table
6

N=
40
114
 Congenital
malformation
Congenital
count
malformation

Yes 2

No 112

Table
7

N=
114

41
 Episode of acute
numbers
illness in past 3 month

1 35

2-3 43

More than 3 20

Table
10

42
 Child cried
immediately
cried
count
immediately

yes 107

No 7

Table
8

N=
114
43
Acute illness in past 3
month Illness count

yes 98

No 16

Table
9

N=
114
44
Health Seeking Behaviour

Illness count

yes 104

No 10

Table
11

N=
114
45
46
Medication Administration

Illness count

yes 106

No 8

Table
12

N=
114
47
How did they manage child’s illness at
Percentage
home

Increase fluid intake 28.9%

Stop food intake 0%

Continue feeding 14%

ORS 3.5%

Home remedies 13%

Mothers using multiple strategies 40.6%

N=
114
Table
13
48
Breast feeding during child illness
:
Continued or stop?
Breastfeeding count

Continue 112

Stop 2

Table
14

N=
114

49
 Gender
distribution
No. Of boys No. Of girls

55 59

Table
15

50
 AGE GROUP OF CHILDREN
UNDER 5
Age of children
No. of children
(In months)

0-12 19

13-36 53
Number

37-59 42

Table
16
N=
114 51

Age group in
 Education status of
mothers Education Numbers

Illiterate 47

Primary school 12

Middle School 20
Numbe

High school 19
r

Intermediate 12

Graduate 4

Table
N= 17

114
 Educational status of
father Education Number

Illiterate 28

Primary school 12

Middle school 22
Numbe

High school 32
r

Intermediate 12

Graduate 8

N=11
Table 53
18
 Profession of
mothers
OCCUPATION NUMBER

Unemployed 106

Unskilled 3

Semi-skilled 4
Numbe
r

Skilled 1

Table
19

54
 Professions of
father OCCUPATION NUMBER

Unemployed 1

Unskilled 45

Semi-skilled 49
Numbe

Skilled 11
r

Clerical 6

Semi-professional 1

Professional 1
55
Table
Monthly Family
Income
Monthly Income
No.of
( in Rupees)
Families

< 9226 25

9232 -27648 82

27654 - 7
46089
Table
21
Average Monthly Income - 56
15,283
 Are you currently
breastfeeding your child?
Answe
Frequency
r

Yes 70

No 44

Table
22

n=114
57
Should a child be breastfed
during illness?
N=1
14
Answer Frequency

Yes 112

No 2

Table
58
23
Do you breastfeed your
child when he/she falls
N=1
ill?
14
Answer Frequency

Yes 112

No 2

Table
24 59
 At what age should
complementary breastfeeding
be started?
Months Frequency

N=1
1 month 1

3 months 10

14
6 months 73

7 months 15

8 months 9

9 months 1

table
25
Are there any foods you avoid
giving to your child? N=1
14
Answer frequency

Yes 40

No 74

Table 26

61
 Foods avoided giving to
children
Food Frequency

Chocolate 1

Chowmein 1

n=4 Non veg 2

table
Momos 2

26
Oily 2

Pizza 6

Spicy 7

Packaged 10

Junk 9
How often does your child
consume outside food in a
Frequency

week? 0 13
N=1
14 1 8

2 16

3 18

Table
4 7

5 6

6 5

7 41
 What do you do if your
child refuses to eat?
Frequency

Use distractions 35

Force feeding 23

Try feeding later 12

N=1 Packaged foods 18

14 Different food child likes 26

Table
28
 Which of the following outside
Packaged foods Frequency
packaged foods your child consumes?
Bread 37

Namkeen 23

N=114 Chocolate 59

Chips 56

Kurkure 46

Burger 8

Pizza 13

Noodle 31

Biscuit 48
Table
All 11
29
 Should bottle feeding be done in
children ?

66
Answer Count

4 Yes 48

8
No 66

Table 30

N=114
 Did you bottle feed your
child ?
69 Answer Count

Yes 45

45 No 69

Table
31
N=1
14 67
What method of cleaning (sterilization) you use to
clean the bottle used for feeding?

Method Count

Boiling only 23

Detergent only 1

Boiling + Detergent 12

Brush with either of the three 9

N=4 Table
68
5 32
 Does the child eat
from his/ her
7
plate?
Answer Count
7
Yes 77

No 37

3 Table
7 33
N=114

69
With what foods do you Food Frequency

start complementary Dal 76

N=1 feeding? Dal water 58

14
Biscuit 53

Daliya 48

Khichdi 61

Milk cow 33

Milk buffalo 18

Rice 12

Mashed fruit 26

Cerelac 19 70
 Number of Major
Meals
No. Of major
Frequency
meals

0 1
N=1
1 4
14
2 42

3 51

4 9

5 3

6 4
Table
 Number of Meals
(Snacks)
No. Of Snacks Frequency

0 14

N=1 1 30

14
2 51

3 16

4 4

Table
36
 Is deworming
important for
children?
Answer Count

Yes 100

N=1 No 16

14 Table
37

73
 Last
Deworming
Time since last
Frequency
deworming

Within 1 month 21

2-5 months 35

6-12 months 16

Not Given 35

Caregiver can’t recall 7

Table
N=1 38
Child registered in
Anganwadi or not?
N=11
4
Answer Frequency

Yes 67

No 47

75
Child fed from
Anganwadi or not?
N=11
4

Answer Frequency

Yes 53

No 64

76
 RESULT
INTERPRETATION
The entire survey included a sample size of 114 under children out of
which 55 (52%) were boys and (59%) were girls

• 16% of the children were under 1 year of age while 46% belonged to 1-3 years
range and 46% were 3 to 5 years of age.
• 41% of the mothers were illiterate and 92% of all the mothers worked as
housewife.
• While 99% of the fathers were earning and 82% of all fathers were employed in
unskilled to semi skilled work
• Average household income was Rs 15,283 per month.

77
 RESULT
INTERPRETATION
• 42% of the children were of 1st birth order and 36% of 2nd .
• 98% were born at full term of pregnancy, Out of 114 , 97 were born by Normal Vaginal Delivery and
remaining 17 by LSCS.
• 86% of the babies were of Normal Birth weight while none of them was of very low or severe low birth
weight.
• 23 % of the deliveries were done at home and 77% at hospital . And a total of 6% children were
delivered by untrained Dai.
• 93% of the children cried immediately at birth .
• Out of 114 , 2 children were born with some congenital malformation..

78
 RESULT
INTERPRETATION
• 41% of children consume outside food daily and majority of children
consume chocolate and chips.
• 66% mother believes that bottle feeding should be done in children and
69% of mothers bottle feed their child
• 51.1% of mothers use boiling only method to clean the bottle used for
feeding.
• 51% of children consumes 3 major meals in a day and 42% of children
consumes 2 major meals in a day
• 100/114 families believe that deworming is important for their children
• 67/114 child are registered in Anganwadi and out of those 53 % of child are
fed from anganwadi.
79
 Nutritional assessment
according to the WHO Z-scores

• In the current study, the prevalence of underweight, stunting,

and wasting was 22.8%,39.4% , and 12.2%,respectively .
• Among those underweight, 16.6% of children were severely
underweight (WFA z < -3SD).
• Among those present with stunting , 17.5 % of children have
severe Stunting (HFA z < -3SD).
• Among those present with wasting , 7 % of children have
severe Wasting (WFH z < -3SD).
 Immunization
• A majority of the children (98.2%) have received vaccinations,
reflecting strong immunization coverage.
• Most caregivers (91.2%) have immunization cards, indicating
good record-keeping and awareness among parents.
• Among the vaccinated children,71.2% are Completely
immunized, 19.2% are fully immunized, while 9.6% are
partially immunized.
• A majority of caregivers (93%) were informed by healthcare
providers about the need for further vaccinations.
 History of recent illness

• 86 % of child have experienced acute illnesses in the past 3 months (2-3

times)
• 96.4 % seek medical care for child's illness ,half of them went to private
hospital

Breastfeedi
• 98 % of them continued Breastfeeding during
illness
ng
• 61% of them are currently breastfeeding their
child.
• 64% of them started complementry feeding after 6 months.

• 57 % of them did not bottle feed their 82

child
 Limitations
Recall Bias
• The study relies on caregivers’ self-reported data for child feeding practices, immunization,
and illness history.
• There is a possibility of misreporting or memory lapses, especially regarding exclusive
breastfeeding duration or dietary recall thus higher recall bias

Study Design
• The study is cross-sectional, meaning it captures a snapshot in time rather than tracking the
progression of malnutrition over time
thus longitudinal data is absent

Possible Underreporting of Illnesses

• Some mild infections or subclinical malnutrition cases may go unreported by caregivers.
• If a child’s illness was not diagnosed by a healthcare professional, it may not be considered by
the caregiver as a significant health issue.

83
Selection Bias
• Certain groups might be underrepresented if they are harder to reach
 Conclusion
High Malnutrition Prevalence in Nehru Ekta Vihar
• 18% of children in urban slums of South Delhi suffer from wasting (low
weight-for-height).
• 35.5% of children are stunted (low height-for-age), and 32.1% are
underweight (NFHS-5).

📌 Key Contributing Factors

• Poor Infant & Young Child Feeding (IYCF) Practices:
• Only 30.4% of mothers initiated complementary feeding at the correct time.
• 36.9% introduced feeding too early, leading to inadequate nutrition.
• Frequent Infections Affecting Nutrition:
• 3.75 times higher risk of acute respiratory infections in malnourished
children.
• Diarrhea and anemia are common among under-five children in the study
area.

📌 Impact on Child Development

• Stunting leads to cognitive deficits and long-term health issues.
• Urban slums have higher malnutrition rates due to poor sanitation and
healthcare access.

📌 Caregiver Knowledge Gaps 84

• Only 49.3% of caregivers had sufficient knowledge about proper feeding.
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middle-income countries: variable progress towards an unfinished agenda. Lancet. 2021;397(10282):1388–1399.
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Cureus. 2023;15(2):e34924.
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2019;11(1):1–8.
9.Mishra A, Bhardwaj UD, Rani S. Knowledge regarding malnutrition and its prevention: a study on slum-dwelling mothers. Int J Nurs Midwifery.
2017;4(2):32–37.
10.Murarkar S, Gothankar JS, Doke PP, et al. Prevalence and determinants of undernutrition among under-five children residing in urban slums
and rural area, Maharashtra, India: a community-based cross-sectional study. BMC Public Health. 2020;20:1559.
11.Cusick S, Georgieff MK. The first 1,000 days of life: the brain’s window of opportunity. UNICEF Office of Research; 2013.
12.UN-Habitat UN, Alliance C. Expert group meeting on urban indicators: secure tenure, slums and global sample of cities. United Nations Human
Settlements Programme, UN-Habitat, United Nations Statistics Division & Cities Alliance. Nairobi, Kenya. Retrieved on February. 2002;15:2018.
13.Picbougoum TB, Somda MS, Zango SH, Lohmann J, De Allegri M, Saidou H, Hien H, Meda N, Robert A. Nutritional status of children under five
years and associated factors in 24 districts of Burkina Faso. PLOS global public health. 2023 Jul 31;3(7):e0001248.
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distribution of stunting–A study from Armenia. PLoS One. 2021 May 26;16(5):e0249776.
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Food research. 2022 Feb 1;6(1):215-22.
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Medical Research. 2018 Nov 1;148(5):612-20.
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children under 5 years in India: Evidence from the Comprehensive National Nutrition Survey 2016–18.
7.Chyne DA, Meshram II, Rajendran A, Kodali V, Getti N, Roy P, Kuhnlein HV, Longvah T. Nutritional status, food insecurity, and biodiversity
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86
 Questionnaire
Section A:

I. Socio-demographic profile of participant II. Birth History

1. Name 1. Birth order :
2. Date of Birth 2. Birth history : ( )Pre-term ( ) Full-term
3. Age (in months) 3. Mode of delivery : ( ) NVD. ( )LSCS. ( )Forceps. ( )
4. Sex Vacuum.
5. Mother’s Name 4. Birth weight : ……………(in kgs)
6. Father’s Name 5. Delivered by : Doctor / Trained Dai / Untrained
7. Head of family Dai / Other
8. Relation with head of family 6. Place of delivery : Home/ Hospital
9. Mother’s educational status 7. History of any congenital malformation : If Yes
10. Father’s educational status specify
11. Mother’s Occupation 8. Child cried immediately after birth :
12. Father’s Occupation
13. Monthly Family Income
14. Socioeconomic Status (as per modified
kuppuswamy scale)
87
 Questionnaire
III. Anthropometry
1. Weight (kg) : __________ Birth Dose OPV -0 ,BCG , HepB
2. Height/Length (cm) : ________
3. Head circumference : ________
6 Weeks OPV-1, RVV- 1, fIPV- 1, Penta- 1, PCV- 1
4. Chest circumference : ________
5. MUAC (Mid-Upper Arm
Circumference) : ______ 10 weeks OPV- 2, RVV- 2, Penta- 2
6. Stunting (Height for Age): ( ) Yes ( ) No
7. Wasting (Weight for Height): ( ) Yes ( )
No 14 weeks OPV- 3, RVV- 3, fIPV- 2, Penta- 3, PCV- 2
IV. Immunization(Weight
8. Underweight Status for Age): ( ) Yes (
1.
) NoHas your child received any vaccinations till date ?
9 - 12
(1)Yes (2)No MR-1, fIPV-3, PCV Booster, JE 1
months
2. Do you have an immunization card for your child ?
3. Tick the vaccines as per the card if available and
categorize as per the record. 16 -24
OPV Booster, MR- 2, DPT- Booster, JE2
(If card not available go to next question) months

Category- Fully immunized / Completely immunized /

5 - 6 years DPT Booster
Partially immunized
88
 Questionnaire
Section B: Knowledge & Practices regarding infant and young
child feeding.

1. Time of Initiation of
breastfeeding after birth

1. Within 30mins of
delivery.
a. When should breastfeeding be
2. Within 1 hour of
started after the birth of a baby?
delivery.
3. 3 hours
4. 12 hours
5. 24 hours

1. Within 30mins of
delivery.
2. Within 1 hour of
b. When did you start breastfeeding
delivery.
the baby?
3. 3 hours
4. 12 hours
89
5. 24 hours
 Questionnaire
Section B: Knowledge & Practices regarding infant and young
child feeding.

3. Did you give anything to

2. Colostrum
the child before initiating ( ) Yes ( )
breastfeeding (Ghutti, gripe No
a. Should the first milk be given water, honey, cow milk etc)?
( ) Yes ( ) No
to the child?

b. Did you give first milk to the If yes, why?

( ) Yes ( ) No
child?

4. For how long was the child

c. If not, why? exclusively breastfed?

5. According to you, what is

exclusive breastfeeding?

90
 Questionnaire
Section B: Knowledge & Practices regarding infant and young
child feeding.
6. According to you, till what age breastfeeding should
be done?

( ) Yes ( )
For how long did you continue breast feeding ?
No

( ) Yes ( )
Are you currently breastfeeding your child?
No

7. Should a child be breastfed during illness?

8. Do you breastfeed your child when he/ she falls ill?

9. At what age should complementary feeding be

started?

10. When did you start complementary feeding for your 91

child?
 Questionnaire
Section B: Knowledge & Practices regarding infant and young
child feeding.
1. Force feed the child
2. Try a different food that child likes to
eat
3. Try to feed the child later
12. What do you do if your child refuses to eat?
4. Use distraction(s) to feed the child (like
story, screen, etc)
5. Offer packaged food / outside food
6. Other………

13. Are there any foods that you avoid giving to your ( )Yes ( )No
child? If Yes,specify

14. How often does your child consume outside food/

packaged food in a week?

15. Which of the following packaged/ outside foods does

the child consume (bread, Biscuit, namkeen, kurkure ,
92
chips, chocolates, cadbury , noodles, french fries, tikki
burger, pizza, any other)?
 Questionnaire
Section B: Knowledge & Practices regarding infant and young
child feeding.
16. Should bottle feeding be done in children? ( ) Yes ( ) No

17. Did you bottle feed your child? ( ) Yes ( ) No

18. What method of cleaning (sterilization) you use to

clean the bottle used for feeding?
(warm water & detergent wash/ bottle brush/ boiling/ etc)

19. Does the child eat from his/her plate? ( ) Yes ( ) No

Major meals -
20. How many meals does your child usually take?
Snacks -

21. Is deworming important for children? ( ) Yes ( ) No

93
22. When did you last deworm your child?
 Questionnaire
Section B: Knowledge & Practices regarding infant and young
child feeding.
23. Is your child registered in Anganwadi? (Age = 3 to 5
years only)

24. Is the child being fed with food given from Anganwadi? ( ) Yes ( ) No

25. Which food items should a child must

Food Items
eat?

Cereals (rice, wheat, jowar, bajra, ragi etc) ( ) Yes ( ) No

Pulses (Moong dal, Arhar dal, beans, peas, etc)

Vegetables- green leafy ( ) Yes ( ) No

Vegetables- Other
94

Fruits
 Questionnaire
Section B: Knowledge & Practices regarding infant and young
child feeding.

Eggs

Milk &Dairy Products

Nuts

Meat

Section C: 24 hour Diet Recall

95
96