Source document: https://docs-lawep.s3.us-east-2.amazonaws.com/1694841902665.pdf (Pakistan)
J Agric.

Res., 2020, Vol.
58(4):297-301 www.jar.com.pk Agriculture Department Government of Punjab SOCIOLOGY RURAL DEMOGRAPHIC FACTORS OF CHILD MALNUTRITION: A CASE STUDY OF RURAL AREAS OF DISTRICT FAISALABAD Anam Afzal * 1, Nazia Malik 2 and Farhana Nosheen 3 1 Ph.D. Scholar, 2 Assistant Professor, Department of Sociology, 3 Assistant Professor, Department of Home Economics, Government College University, Faisalabad, Pakistan *Corresponding author’s email: anamafzal930@gmail.com Article received on: 12/03/2020 Accepted for publication: 04/11/2020 ABSTRACT Child malnutrition remains one of the important causes of mortality and morbidity in the world.
In developing countries, malnutrition is still a public health concern including Pakistan.

This study aims to assess the prevalence of malnutrition and associated factors in rural children (under 5 year) by the world health organization newly developed growth standards.

A cross-sectional community-based survey was conducted among children aged 0-60 months, living in the all four rural towns of district Faisalabad, Pakistan from February 2018 to November 2018.
By multistage sampling method, a sample of 400 rural mothers of malnourished children were carefully chosen and structured questionnaires were used for data collection.

Malnutrition was measured based on the indicators as stunting, wasting and underweight.

Research results indicate that rural mother’s age, mother’s education, monthly family income, number of children under five years were associated factors with childhood malnutrition.
Research findings indicated the government must take action to create awareness among rural mother for education and child birth spacing (interval).

So, there is a need to improve socioeconomic status of study area to prevent children from malnutrition.
KEYWORDS: Malnutrition; factors; rural; children; Faisalabad; Pakistan INTRODUCTION Malnutrition burden remains a crucial public health problem in developing countries including Pakistan, Bangladesh and India (Schott et al., 2013; Black et al., 2013; Akhtar et al., 2013).

Globally, malnutrition is still an emerging policy concern due to alarming health issues particularly in South-East Asia (Black et al., 2003; WHO, 2018).
Malnutrition in developing countries is measured by anthropometric data by using body weight, height with age, which contains three indicators as stunting (height for age), underweight (weight for age), and wasting (weight for height).

If these parameters fall below the anthropometric cut off <-2 standard deviation of the median of the WHO international reference population, this is referred as, underweight, wasting, and stunting (WHO, 2016).

Adequate nutrition is important in early childhood.
Stunting “height for age” is a linear growth measurement among children which is an outcome of chronic malnutrition.

If a child failed to received adequate nutrition to a long period, the outcome would be facedas chronic illness or recurrent.

Wasting “weight-for-height” is a particular body composition measurement for the muscles plus fat mass (WHO, 2018).

Wasting is a particular body composition measurement for the muscles plus fat “weight-for-height” to mass.
Wasting is the results of current nutritional deficiency and as an outcome of acute malnutrition.

It is highly connected by the prevalence of illnesses as well as food availability in the sectional shift (WHO, 2006).

Underweight “weight-for-age” is for both chronic and acute malnutrition measurement.

In 2018 Globally, wasting effects life-threatening an estimated 49 million (7.3%) of under 5 children and stunting continued an estimated 149 million (21.9%) children under 5 years.
More than half (55%), stunted of all under 5 children lived in Asia and more than two- thirds of all wasted children under 5 lived in Asia (68%) (WHO, 2019).

Globally, it is attributed to almost half of the morbidity and mortality cause among under-five children around the world (WHO, 2018; Crowe et al., 2014; Schott et al., 2013).
Malnutrition is a severely hinder to children’s mental (delay in motor and cognitive) and physical development (Pelletier et al., 2006; Black et al., 2013) and also for educational achievements (Pelletier et al., 2006; Walker et al., 2007; Adair et al., 2013) and further it can compromise different diseases in the late- life as weaken the immune system and related growth (Herrador et al., 2014).

297 J. Agric.

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297 J. Agric.

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2020, 58(4) Factor of child malnutrition in rural areas of Faisalabad Millennium development goals (MDGs) is attention to draw the problems specifically related to health, MGDs focus on health with, three goals out of total eight, eight goals to 18 targets and 18 targets to 48 total indicators (WHO, 2018).

This is the reason that millennium development goal 1 is to eradicate extreme poverty and hunger, goal 4 is aimed to reduce under-five mortality in 2015.
However, in Pakistan, no significant improvement is witnessed (Mahmud et al., 2011).

According to Pakistan demographic and health survey (2018) results show that 38% of children were stunted, while 23% were underweight and 7% children were wasted at moderately malnourished.

In Punjab 29.8% of children were stunted, 14% were underweight and 4% were wasted at below -2 SD.
Although multifaceted “malnutrition” as underweight (low weight-for-age), wasting (low weight-for-height) and stunting (low height-for-age), which are commonly used indicators in the literature to measure malnutrition (Das and Gulshan, 2017; Ntenda and Chuang, 2018).

In this paper, we study complex phenomenon “malnutrition” with its contributing rural demographic factors toward under-five children.
MATERIALS AND METHODS The aim of the study was to access the prevalence of malnutrition and its associated factors among under five years children in district Faisalabad, Pakistan.

A rural household-based survey was conducted from February 2018 to November 2018 to measure the health status of rural children of Faisalabad.

Sampling technique Multistage sampling technique was used for final sample units (respondents).

The universe of the study was Faisalabad.

It has four districts, i.e.


Chiniot, Faisalabad, Toba Tek Sing and Jhang.

Faisalabad district was selected randomly.

All four rural town of district Faisalabad; namely, Tandlianwala, Jhumrah, Jaranwala and Sammundri were selected conveniently.

Firstly, by simple random sample technique, four rural union councils (from each rural town) were carefully chosen.
Secondly, a sample of 400 (25 mother-child pair from each rural union council) mothers having a child with low height or weight according to age were purposively selected.

Study respondents The target population was malnourished children with age 0-60 months, to enhance the scope of study, four rural towns were selected.

If the selected household had two or more children within the age category of 0 to 60 months, then one child was selected randomly.
Sample size According to the recent Pakistan demographic and health survey (2018), the approximate proportion (P) of stunting was (38%).

On this base the sample size was calculated with population equation (z2 × p ×q/d2) with single proportion by using 5% error margin and 95% confidence interval (CI).

Therefore, the estimated sample were measured with the prevalence of stunting which is relatively high from wasting and underweight, 362 ~ 400 were taken as sample for this research.
Child height and weight anthropometric measurements were taken.

Face-to-face structured-interviewer- administered schedule was used from mothers of under five years malnourished children.

Data analysis To analysis and enter data SPSS version 23.0 was used according to WHO (2006) stunting child’s weight and height according to age with Z-score has converted through Anthro 3.2.1 software.

International criteria <−2 SD were used for anthropometric classifications.
Univariate, and bivariate analysis was used to identify the relationship between variables (dependent and independent).

Chi-square test was use to check association among variables.

RESULTS AND DISCUSSION In this study 400 children were taken purposively by anthropometric measurements with height and weight according age.

In above added table prevalence of children malnutrition is given.
The study results indicated, a total of 42.4% children were stunted, 28.25% were wasted and 29.25% were underweight (below -2 SD) (Table 1).

The study focused on factors associated with rural demography with children malnutrition.

Among the factors considered for consideration were mothers age, mothers’ education, family income, total number of under five children and family income.

Majority of the mothers 29.3% current age were 26-30 years, while 47.0% of mothers age at first birth were 20-25 years.
Majority of mothers 43.0% and 26.5% were primary and illiterate, respectively.

However, 60.8% respondent’s family income were between 20,000-40,000 (Table 2).

In Table 3 results further investigates the rural children demographic malnutrition under five years.

Person’s chi square test was used to check association between variables.

Malnutrition is a still silent emergency (Chemma and Abbas, 2016).

Above results despite that as the mother age higher the prevalence of stunting also higher.
A study finding reported that less than 20 years mothers had more number of stunted children as compare to those mothers who had above twenty years of age factors associated with 298 J. Agric.

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2020, 58(4)A. Afzal et al.

Table 1.

Prevalence of malnutrition among under five children in rural tehsils of district Faisalabad Children Total children Total Males Females 400(100%) 205(51.3) 195(48.7) Stunted Wasted Under weight Yes N (%) 170(42.4%) 75 (36.5%) 95 (48.7%) No N (%) 230(57.5%) 130(63.)
100(51.28) Yes N (%) 113(28.25%) 61 (29.7%) 52 (26.6%) No N (%) 287(71.75%) 144(70.24%) 143(73.33%) Yes N (%) 117(29.25%) 69 (33.8%) 48 (24.6%) No N (%) 283(70.75%) 136 (66.34%) 147(75.38%) Table 2.
Frequency distribution according rural demographic characteristics Respondent current age (years) Up to 20 20-25 26-30 31-35 36 and above Total Respondent’s education Illiterate Primary (0-5 years schooling) Secondary (6-10 years schooling) Higher (11 and above years schooling) Total Monthly family income (RS) Up to 20,000 20,000-40,000 Above40,000 Total Total number of ever born children 1-2 3-4 5-6 7 and above Total Number of children 5 and under 1 2 3 4 and above Total Frequency 9 108 117 83 83 106 172 78 44 400 Frequency 108 243 49 400 143 129 69 59 400 60 145 155 40 400 Percentage 2.3 27.0 29.3 20.8 20.8 100.0 26.5 43.0 19.5 11.0 100.0 Percent 27.0 60.8 12.3 100.0 35.8 32.3 17.3 14.8 100.0 15.0 36.3 38.8 10.0 100.0 Table 3.
Child malnutrition associated factors in all rural tehsils of district Faisalabad Mother’s age (years) Up to 20 20-25 26-30 31-35 36& above Stunting N (%) 4(44.4%) 8(7.4%) 16(19.3%) 95(81.2%) 47(56.6%) Mothers education level Illiterate Primary Secondary Higher Monthly income Up to 20,000 20,000-40,000 above 40,000 45(42.5%) 74(43.0%) 33(42.3%) 18(40.9%) 47(43.5%) 105(43.2%) 18(36.7%) Chi square p-value 115.226 0.000 3.452 0.896 0.435 0.543 Total number of ever born children 1-2 3-4 56 7 and above 39(27.3) 28 (21.7) 85(85.5) 44(74.6) 113.460 0.000 Number of children under 5 years 1 2 3 4 and above 10(15.6%) 51(35.2%) 79(51.0%) 30(83.3%) 51.212 0.000 Wasting N (%) 4(44.4%) 34(31.5%) 18(21.7%) 38((32.5%) 19(22.9%) 26(24.5%) 45(26.2%) 29(37.2%) 13(29.5%) 34(31.5%) 62(25.5%) 17(34.7%) 48(33.6) 28(21.7) 22(31.9) 15(25.4) 25(39.1%) 44(30.3%) 37(23.9%) 7(19.4%) Chi square p-value 5.693 0.245 Under-weight N (%) 1(11.1%) 36(33.3%) 23(27.7%) 36(30.8%) 21(25.3%) Chi square p- value 4.704 0.561 4.199 0.121 0.762 0.867 5.408 0.239 6.65 0.151 60(56.6%) 43(25.0%) 9(11.5%) 5(11.4%) 68(63.0%) 41(16.9%) 8(16.3%) 43(30.1) 37(28.6) 23(33.3) 14(23.7) 17(26.6%) 45(31.0%) 50(32.3%) 5(13.9%) 85.453 0.000 81.259 0.000 10.012 1.492 6.341 0.630 299 aPearson’s chi-square test was used to compare the data across sites for statistically significance (P < 0.05) J. Agric.
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2020, 58(4) Factor of child malnutrition in rural areas of Faisalabad (Gebre et al., 2019).

The studies reported that the risk of being underweight was higher of those children whose mother was illiterate as compared to those children whose mothers were literate (Meshram et al., 2015;Gebre et al., 2019).

An educated mother could provide a more nutritious diet to their children and manage households in a better way.
These findings are similar to other study conducted in Pakistan said that women’s education is very low which becomes a contributing factor to the high underweight burden toward children in Pakistan (Chemma and Abbas, 2016).

Mothers who have no education were more less likely to be moderately underweight, with the children of highly educated mothers.
However, mothers of child who had completed at least primary or middle school education were significantly less likely to be underweight than children of mothers having no education (Kumar et al., 2019).

Other studies revealed that in the household two and more number of children under 5 years strongly risk factor for stunting among children (Kumar et al., 2019; Black et al., 2003).
The study findings revealed that, as the income increased, the level of under nourishment among children aged 0-59 months also decreased (Kumar et al., 2019).

CONCLUSION Malnutrition prevalence was very high in rural towns of district Faisalabad.

In this study contributed factors toward malnutrition are mothers age, mother’s education, number of under 5 children and monthly family income.

Government must take action to create awareness among rural mother for education, and child birth spacing (interval).
Also, there is a need to improve socioeconomic status of study area by promoting income generating activities for women.

Because if women empowered, so that they can make better decisions, and children can be prevented from morbidities and mortality.

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Anam Afzal Collected the data Nazia Malik Analyzed the data Farhana Nosheen Prepared and proof read the manuscript 301 J. Agric.

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