Objective: To determine the association of literacy of mothers with malnutrition among children under three years of age in rural area of district Malir, Karachi.
Methods: A cross-sectional study was conducted on four hundred children under three years of age, residing in the rural area of district Malir, Karachi. The selection of the children was irrespective of gender, ethnicity and religion.
Results: Three hundred nineteen mothers (79.75%) were illiterate and 81 (20.25%) were literate. In the latter group, three mothers could read or write only, 38 had primary, 10 middle, 15 matric, 12 intermediate and 3 mothers had education upto graduate level. Maximum malnutrition regarding stunting (40.75%) was seen in children who's mothers were illiterate and maximum underweight (57.89%) was seen in children who's mothers had education up to primary level and maximum wasting (33.33%) was seen in children who's mothers (only 3 mothers out of 400) were graduates.
There was a significant difference regarding underweight between the children who's mothers were illiterate or had education up to primary level in comparison to the children who's mothers had education to more than primary level (P<0.016), but in significant difference regarding stunting and wasting was found.
Overall a total of 217 (54.25%) children were underweight, 156 (39%) were stunted and 86 (21.5%), had wasting.
Conclusion: Mother's literacy status has a definite association with the malnutrition of the children <3 years of age regarding underweight. In order to combat this an uplift of mother's literacy status is badly needed especially in the rural areas (JPMA 55;550:2005).
Child malnutrition may be defined as a pathological state resulting from inadequate nutrition, including undernutrition (protein-energy malnutrition) due to insufficient intake of energy and other nutrients; overnutrition (overweight and obesity) due to excessive consumption of energy and other nutrients; deficiency diseases due to insufficient intake of one or more specific nutrients such as vitamins or minerals. 1 In this study, the term malnutrition has been used for the condition of under nutrition only.
Children whose weight-for-age (W/A), children whose height-for-age (H/A) and children whose weight-for-height (W/H) is below minus two standard deviation (-2SD) from the median of the reference population (National Centre for Health Statistics) are considered to be underweight, stunted and thin or wasted respectively. 2
Malnourished children are much more likely to die as a result of a common childhood disease than those who are adequately nourished. Malnutrition lowers the body's ability to resist infection by undermining the functioning of the main immune-response mechanism. This leads to longer, more severe and more frequent episodes of illness. Of the nearly 12 million children under five who die each year in developing countries mainly from preventable causes, the deaths of over 6 million, or 55 percent, are either directly or indirectly attributable to malnutrition. Some 2.2 million children die from diarrhoeal dehydration as a result of persistent diarrhoea that is often aggravated by malnutrition. 3
According to the national figures of Pakistan given by the State of world's children UNICEF 2004, adult literacy rate in females is only 28% and mother's literacy status must be much lower than this actual figure.4 Prevalence of stunting and wasting is 32.50% and 16.5% respectively in rural areas of Pakistan which is higher in comparison to the urban areas. 5 This difference may be attributed to limited access and utilization of health services. Only 35% of rural areas have access to health whereas 90% of urban areas have these facilities. 6
There is no scientific data available on prevalence of malnutrition among children under three years of age in rural area of district Malir, Karachi. The present study was designed to assess the prevalence of malnutrition and to identify the risk factor/factors specific to this particular community.
Study Design, Subjects and Setting
A cross-sectional study design was used. Four hundred Children under three years of age residing in the rural area of district Malir, Karachi were enrolled for the study. The selection of the children was irrespective of gender, ethnicity and religion. Youngest child under three years of age was selected from each household. If a person had more than one wife, then youngest child of either of the wife was enrolled. If there were twins, then one was selected randomly. The exclusion criteria were children more than 3 years of age, children with mental retardation, congenital deformity, chronic diseases/disorder e.g. Tuberculosis, and thalassemia and parents who refused to consent were excluded.
Through statistical formula sample was derived as
The total number of children included in the study were 400, 209 (52.25%) males and 191 (47.75%) females. Frequency distribution of age variables in these children was 48 (12%) less than 6 months, 89 (22.25%) between > 6 months and <12 months, 150 (37.5%) between > 12 months and <24 months and 113 (28.25%) between > 24 months and <36 months.
Regarding the educational status of the mothers, majority of them, 319 (79.75%) were
|Table 1. Frequency distribution of mother's education by type of malnutrition.|
|S. No.||Education||Total||Weight for age||Height for age||Weight for height|
Our study proved that literacy status of mothers strongly affects the nutritional state of the children where illiterate mothers are a risk for the development of malnutrition in children <3years of age especially underweight. This coincides with the studies of Ahmad 11 , Bouvier 12 , Tumwine 13 and Chen. 14 All of them have identified illiteracy of mothers as a strong risk factor for malnutrition in children <3 years of age.
Lu 15 found in both the crude analysis and after controlling for confounding variables that maternal education in the population remains statistically relevant to children's dietary and nutritional status. The proportion of low body weight and stunted children was highest in the group with maternal education level below preliminary school, the lowest proportion was seen where educational level was above high middle school.
Islam 16 in a multivariate analysis found maternal illiteracy and lack of breastfeeding to be associated with approximately fourfold increased risk of severe malnutrition in their children.
In our study highest number of children i.e. 130 (40.75%) were found to be stunted. They were the children of illiterate mothers. Maximum underweight and wasting were found in 22 (57.89%) and 10 (26.32%) children respectively and their mothers had education upto primary level. This coincides with the studies of Ahmed 17 and Ojofeitimi. 18
In our study population, 360 (90.00%) mothers of the 400 were illiterate or who had education up to primary level only. Of these 360 mothers 203 children were underweight which on statistical evaluation was found to be significant P<0.01. This coincides with the study of Rikimaru 19 , while stunting and wasting was found in 144 and 79 children respectively which were non-significant. This coincides with the study of Setswe. 20
In our study 54.25% children were underweight, 39.0% stunted and 21.50% were wasted. This coincides with the national figures of 37% stunting but not with those 38% underweight and 13% of wasting which has been stated in state of world's children by UNICEF. 21 The cause could be attributed to the deference in ages of children. Our study analyzed malnutrition in children below 3 years age where the national figures are of children less than 5 years.
Another factor is the location of the study. Our sample was from a specified rural area with poor basic health facilities where the national survey included children from the entire country population. 6 The study concluded that a mother's literacy status and level of education has a significant influence on state of nutrition of her children. It is therefore recommended that education of females especially in the rural areas should the promoted and given due importance.
1. Young H, Susanne J. Nutrition Matters: People, food and famine, Intermediate Technology Publications, London: 1995, pp. 17.
2. UNICEF. Nutrition-Definition of the Indicators, UNICEF, The State of the world's children, Oxford University Press, New York: 2004, p. 109.
3. UNICEF. Malnutrition - Silent emergency, UNICEF, The State of the world's children, Oxford University Press, New York: 1998, pp. 9-11.
4. UNICEF. Statistical Tables 5 - Education, UNICEF, The State of the world's children, Oxford University Press, New York: 2004, p. 120.
5. Pakistan Medical Research Council. National Health Survey of Pakistan, 1990-94, Islamabad, Pak. Med. Res. Coun., 1997, pp. 20-27.
6. UNICEF. Atlas of South Asian Children and Women, UNICEF Regional Office South Asia, 1996, pp. 54-55.
7. Rosner B. Sample size estimation, Michael P. Fundamentals of Bio-statistics, PWS Publishers Company, Boston: 1986,
8. WHO Publication Western Pacific Education in Action Series No. 5, Health Research Methodology, Regional office Manila- Philippines, 1992, p. 88.
9. Falkner F. Growth monitoring: fetus to the first two postnatal years. In: Clinical Nutrition of the Young Child. Vevey: Nestlé Nutrition, 1985; New York: Raven Press, 1985, pp. 23-38.
10. Haithami SS, Gabal MS, Masher AA, d-Nofely A. Anthropometric assessment of nutritional status of children in democratic Yemen. Journal of the Egypt Public Health Association 1989;LXIV: pp. 431-44.
11. Ahmed S, Akram DS.; Nutritional risk factors in a Well Baby clinic, J Pak Med Assoc 1984;34:335-8.
12. Bouvier P, Papart JP, Wanner P, Picquet M, Rougemont A. Malnutrition of children in Sikasso (Mali): prevalence and socio-economic determinants. Soz Praventivmed 1995;40:27-34.
13. Tumwine JK, Barugahare W. Nutrition status of children in Kasese district at the Uganda-Congo border. East Afr Med J 2002;79:427-34.
14. Chen M, He W, Fu Z, Wang Y. Multiple factors analysis on malnutrition of children and under five in different patterns in China in 2000 Wei Sheng Yan Jiu 2003;32:249-53.
15. Lu B, Zhai F, Jin S, Poprin BM. The impact of maternal education on the dietary and nutritional status of preschool children--a case study in 8 provinces of China, Wei Sheng Yan Jiu 1998;27:328-31.
16. Islam MA, Rahman MM, Mahalanabis D. Maternal and socioeconomic factors and the risk of severe malnutrition in a child: a case-control study. Eur J Clin Nutr 1994;48:416-24.
17. Ahmad M. Nutritional status of children under five years of age in a slum community in Lahore, Pak J Med Res 1993:32:31-3.
18. Ojofeitimi EO, Owolabi OO, Aderonmu A, Esimai AO, Olasanmi SO. A study on under five nutritional status and its determinants in a semi-rural community of Ile-Ife, Osun State, Nigeria. Nutr Health 2003;17:21-7.
19. Rikimaru T, Yartey JE, Taniguchi K, Kennedy DO, NRrumah FK. Risk factors for the prevalence of malnutrition among urban children in Ghana. J Nutr Sci Vitaminol (Tokyo) 1998;44:391-407.
20. Setswe G, Prevalence and risk factors for malnutrition among children aged 5 years and less in the Lefaragatlha village of Bophuthatswana. Curationis 1994;17:33-5.
21. UNICEF, Statistical Tables 2 - Nutrition, UNICEF, The State of the world's children, Oxford University Press, New York, 2004, p. 108.