Samiran Bisai

Body mass index and nutritional status of adult Savar tribals of Keonjhar District, Orissa, India.

A cross-sectional study was undertaken to determine sex differences in mean body mass index (BMI) and nutritional status (based on BMI), as well as the effect of age on BMI and nutritional status of adult Savars, a tribal population of Orissa, India. A total of 600 adult (aged > 18 years) Savars of four villages, namely, Bonianiposi, Morabali, Panchapolli and Sailong of Keonjhar District, Orissa, India, were studied. Height and weight were measured and BMI computed. Mean ages of both sexes were similar (men: mean = 38.9 years, sd = 15.3; women: mean = 38.0, sd = 13.9). Men had significantly greater mean height (p < 0.001), weight (p < 0.001) and BMI (p < 0.05). The prevalence (sex combined) of undernutrition (BMI < 18.5) was found to be very high (43.5%). Moreover, there was a significant (chi2 = 7.39, p = 0.025) difference in the prevalence of undernutrition between men (38%) and women (49%). Age was significantly (p < 0.001) negatively correlated with BMI in both sexes (men: r = -0.20; women: r = -0.16). In general, the frequency of undernutrition increased with increasing age. In conclusion, this study demonstrated that the prevalence of adult undernutrition was very high among Savar women and high among Savar men. These rates increased with increasing age. Therefore, from the public health point of view, immediate nutritional intervention programmes are needed for implementation among Savars, especially among older individuals. Moreover, further research is needed not only among this ethnic group but also other tribal populations of India to fully understand the causes and consequences of adult undernutrition.

Undernutrition in the Kora Mudi tribal population, West Bengal, India: a comparison of body mass index and mid-upper-arm circumference.

Background Undernutrition among adult tribal women is a major health problem in India. Objectives To compare the utility of two different anthropometric indicators of chronic energy deficiency (CED) among tribal Kora Mudi women and to determine which of these two is a better indicator of undernutrition. Methods A cross-sectional study of 123 individuals was conducted. The body mass index (BMI) and mid-upper-arm circumference (MUAC) were used to evaluate CED. Results The prevalence of CED based on BMI less than 18.5 was 55.3%, and the prevalence of CED based on MUAC less than 22.0 cm was 51.2%. Both of these prevalence rates are classified in the very high-prevalence category (≥ 40%) and indicate a critical situation according to World Health Organization recommendations. Mean BMI increased significantly with higher quartile of MUAC. There was a significant difference in the prevalence of CED between the MUAC quartiles. The risk ratio for CED for women in the lowest quartile of MUAC was 9.33 compared with those in the highest quartile. There was a significant positive association between MUAC and BMI. Regression analysis demonstrated that MUAC had a significant positive impact on BMI; the percentage of the variation in BMI explained by MUAC was 52%. Logistic regression analysis demonstrated that overall, 82.11% of cases of CED were correctly classified with the use of MUAC. The use of MUAC correctly diagnosed 82.35% of cases of CED and 81.82% of women with normal nutritional status. Conclusions This population was facing severe nutritional stress. With limited resources and in the absence of skilled manpower, it may be more appropriate to use MUAC for human population surveys, particularly among tribal populations of developing countries.

Prevalence of undernutrition among Kora-Mudi children aged 2-13 years in Paschim Medinipur District, West Bengal, India

BackgroundNutritional status of tribal children in West Bengal has not been investigated adequately. The present study was undertaken to determine the prevalence of underweight, stunting and wasting in Kora-Mudi children of Paschim Medinipur, West Bengal, India.MethodsA cross sectional study was undertaken in two villages of the Paschim Medinipur District. Of 119 children aged 2–13 years, 59 boys and 60 girls were studied. Height and weight measurements were made by standard techniques. Children were considered as underweight, stunting and wasting if their weight-for-age, height-for-age and weight-for-height Z-scores <−2.0 SD of the National Center for Health Statistics reference standards.ResultsThe overall prevalence of underweight, stunting and wasting was 52.9%, 49.6% and 22.7%, respectively. About 16.0%, 24.4% and 1.7% of children were found to be severely underweight, stunted and wasted. The prevalence of underweight, stunting and wasting was higher in preschool children than in school going children. The chance of underweight, stunting and wasting was 1.80, 1.10 and 1.58 times greater in preschool children than in school going children. Moreover, the prevalence of underweight, stunting and wasting was higher in boys than in girls. The boys had 1.45, 1.66 and 2.02 times greater risk to be underweight, stunted and wasted. According to the WHO classification of severity in malnutrition, the overall prevalence of underweight, stunting and wasting was as high as ≥30%, ≥40 and ≥15%.ConclusionsThe nutritional status of Kora-Mudi children in West Bengal is critical. Appropriate measures should be taken by the respective authorities to improve childhood health and nutritional status.

Undernutrition among Adult Dhimals of Naxalbari, West Bengal: Comparison with other Tribes of Eastern India

Background The tribes of India comprise approximately 8% of the total population of the country, which probably has the largest number of tribal communities in the world. In general, the tribal populations are among the most underprivileged and undernourished people in India. Objectives To determine the anthropometric characteristics and prevalence of undernutrition, based on body mass index (BMI), of adult Dhimals, a tribal population of Naxalbari, West Bengal, India, and to compare these results with those from four other tribes of Eastern India: the Bathudis, Kora Mudis, Santals, and Savars. Methods A total of 305 adult (18 years or older) Dhimals (159 men and 146 women) from three villages (Maniram, Hatighisa, and Buraganj) in the Mallabari area of Naxalbari were studied. These villages are located 5 km from Siliguri town, which is approximately 580 km from Kolkata, the provincial capital of West Bengal. Anthropometric measurements included height and weight. BMI was calculated by the standard equation. Undernutrition was evaluated according to World Health Organization (WHO) cutoff points. Results The overall prevalence of undernutrition (BMI < 18.5) was very high (36.4%). The prevalence was significantly higher in women than in men (46.4% vs. 27.0%; χ2 = 12.54; p < .001; odds ratio, 2.35). According to the WHO criterion, the prevalence of undernutrition was high and the situation was serious in men. Among women, the prevalence of undernutrition was very high and the situation was critical. However, in general, compared with other tribal people of eastern India except the Santals, adult Dhimals had better anthropometric and nutritional profiles. Conclusions This study provides evidence that although the anthropometric and nutritional profiles of adult Dhimals are better than those of some of the other tribal populations of eastern India, immediate appropriate nutritional intervention programs are needed for implementation among this ethnic group.

Undernutrition among Integrated Child Development Services (ICDS) Scheme Children aged 2-6 years of Arambag, Hooghly District, West Bengal, India: A serious public health problem

Background : Childhood undernutrition is a major public health problem in developing countries. In view of this, the objective of the present study was to evaluate the rates of stunting, underweight and wasting among 2-6 year old rural children of Bengalee ethnicity. Methods : In this study, 20 Integrated Child Development Services (ICDS) Centres of Bali gram panchayet, Arambag, Hooghly District, West Bengal, India, were selected. A total of 1012 (boys = 498; girls = 514) 2-6 year old children were studied. Height-for-age (HAZ), weight-for-age (WAZ) and weight-for-height (WHZ) < -2 z-scores were used to evaluate stunting, underweight and wasting, respectively, following the National Center for Health Statistics (NCHS) Guidelines. Classification of severity of malnutrition was done based on the World Health Organization recommendations. Results : Boys were significantly heavier than girls at ages 2-4 years; they were significantly taller at ages 2 and 4. Significant age differences existed in mean height and weight in both sexes. Mean HAZ, WAZ and WHZ were less than those of NCHS for both sexes at all ages. The overall (age and sex combined) rates of stunting, underweight and wasting were 26.6 %, 63.3 % and 50.0 %, respectively. The prevalence of stunting (boys = 24.9 %; girls = 28.2 %), and underweight (b = 62.2 %; g = 64.4 %) was higher among girls whereas that of wasting was higher among boys (b = 52.4 %; g = 47.4 %). Based on World Health Organization classification of severity of malnutrition, the overall prevalence of stunting was medium (20 . 29 %), whereas those of underweight (. 30 %) and wasting (. 15 %) were very high, in both sexes. Conclusions : The nutritional status of the subjects was unsatisfactory indicating a major public health problem. There is scope for much improvement in the form of enhanced supplementary nutrition.

Maternal early second trimester pregnancy weight in relation to birth outcome among Bengalee Hindus of Kolkata, India

Objective: The study examined to what degree maternal early second trimester pregnancy weight is useful and efficient in predicting birth outcome of Bengalee women. Subjects and methods: The cross-sectional retrospective study was conducted in a government general hospital in South Kolkata, India. This hospital serves the needs of people belonging to lower and lower middle class socio-economic groups. Data were collected by one-to-one interview for confirmation of age, history of last menstrual period (LMP) including medical disorders. Mothers weight was recorded at 14–18 weeks of pregnancy from the history of LMP. Birth weight was measured within 24 h of delivery and gestational age was assessed by Ballards method using newborn physical and neurological maturity scoring. Of the 331 Bengalees, 295 mother–baby pairs met the recruitment criteria and were included in this study. Result: Mean ± SD maternal early second trimester pregnancy weight and birth weight were 45.9 ± 7.0 kg and 2612 ± 371 g, respectively. The difference in mean weight (3.74 kg) between mothers who delivered low birth weight (LBW) and normal birth weight (NBW) babies was statistically significant (t = 4.497, p < 0.001). Overall, the prevalence of LBW was nearly 34%. A higher incidence of LBW and lower mean birth weight was observed in first quartile or low weight (≤40 kg) mothers. The rate of LBW decreased (χ2 = 14.47, p < 0.01) and mean birth weight increased significantly with increasing maternal weight (F = 9.218, p < 0.001). Risk ratio (RR) for LBW, intrauterine growth retardation (IUGR) and preterm birth in low weight (first quartile or <40.0 kg) mothers were 2.72 (95% confidence interval (CI): 1.45–5.10), 3.54 (95% CI: 1.17–10.74) and 1.97 (95% CI: 0.56–6.90), respectively, compared with heavier (>50.0 kg) mothers. Finally, the present data showed that the maternal weight of <46.0 kg is the best cut-off for detecting LBW with 66% sensitivity and 75% negative predictive power. Conclusion: The findings suggest a positive association between maternal early second trimester pregnancy weight and birth outcome. The present study provided an efficient cut-off point for detecting LBW. Antenatal caregivers in health institutions and community health workers in the field can use this cut-off value for screening pregnant women at early second trimester.

Relationship of family income and house type to body mass index and chronic energy deficiency among urban Bengalee male slum dwellers of Kolkata, India

A cross-sectional study of 469 adult (>18 years) Bengalee male slum dwellers of Dum Dum, Kolkata, India, was undertaken to study the relationships of family income and house type with body mass index (BMI) and chronic energy deficiency. The overall frequency of chronic energy deficiency was 32.0%. Based on the World Health Organization classification, the prevalence of chronic energy deficiency among this population was high and thus the situation is serious. Overall, monthly family income was significantly positively correlated with BMI. Significant differences in mean weight, BMI and monthly family income, were observed between the two house type groups. All values were found to be significantly higher in the brick household group who also earned a comparatively higher income as evident from the mean monthly family income values. The prevalence of chronic energy deficiency was also found to be significantly higher in the bamboo-fenced household group. Subjects belonging to the lowest family income group had the lowest mean BMI and the highest rate of chronic energy deficiency while those in the highest family income group had the largest mean BMI and lowest rate of chronic energy deficiency. There was a significant family income group difference in mean BMI. There existed significant differences in chronic energy deficiency rates in family income group categories. Linear regression analyses showed that monthly family income and house type had a significant impact on BMI. Subsequent multiple regression analyses revealed that both monthly family income and house type had a significant impact on BMI, even after controlling for each other.

Nutritional Status of Adult Santal Men in Keonjhar District, Orissa, India

Background Although tribal people constitute a sizable proportion of Indias population, there is little information on their anthropometric and nutrition status. Objective The present study was undertaken to study the anthropometric characteristics of adult Santal males. It also attempted to evaluate their nutritional status based on body-mass index (BMI) and mid-upper-arm circumference (MUAC). Methods A cross-sectional study was conducted of adult (aged > 18 years) male Santals, a tribal population of Keonjhar District, Orissa, India. A total of 332 Santals from five villages (Gourshinga, Kashibera, Kumunia, Majhisahi, and Sonatangri) in the Anandapur Region of Keonjhar District were included in the study. These villages are located approximately 150 km from Bhubaneswar, the provincial capital of Orissa. Anthropometric measurements, including height, weight, and MUAC, were performed according to a standard protocol. Nutritional status was evaluated on the basis of internationally accepted cutoff points of BMI and MUAC. Results The mean height, weight, MUAC, and BMI of the men were 162.5 cm, 51.7 kg, 23.7 cm, and 19.6 kg/m2, respectively. The prevalence of undernutrition (chronic energy deficiency [CED]) based on BMI was 26.2%; 3.3%, 3.9%, and 19.0% had grades III, II, and I CED, respectively. According to MUAC cutoff points, the prevalence of undernutrition was 33.7%. Conclusions The level of undernutrition among adult Santal males was high. Appropriate nutritional intervention programs should be implemented immediately.

Relationship of Income with Anthropometric Indicators of Chronic Energy Deficiency among Adult Female Slum Dwellers of Midnapore Town

Abstract A cross-sectional study of 333 adult (> 18 years) female slum dwellers (mean age = 34.2 years) of Midnapore town, West Bengal, India, was undertaken to study the relationships of monthly per capita income (MPCI) with two anthropometric measures, namely body mass index (BMI) and mid-upper arm circumference (MUAC). It also investigated the association of MPCI with chronic energy deficiency (CED). Results revealed that the mean height, weight, MUAC and BMI of the subjects were 148.2 cm, 43.2 kg, 22.7 cm and 19.6 kg/m2, respectively. The overall frequency of CED based on BMI (BMI < 18.5 kg/m2) and MUAC (MUAC < 22.0 cm) was 46.8 % and 43.5%, respectively. Based on the World Health Organization classification, the prevalence of CED among this population was very high (≥40%) and thus the situation is critical. Overall, MPCI was significantly (p < 0.001) positively correlated with BMI (r = 0.21) and MUAC (r = 0.25). Moreover, MUAC was very strongly correlated (r = 0.81; p < 0.0001) with BMI. Linear regression analyses showed that MPCI had significant impact (p < 0.001) on BMI (T = 3.92) and MUAC (T = 4.74). MPCI explained 4.1% and 6.1% variation in BMI and MUAC, respectively. Subjects belonging to the lowest per capita income group (PCIG) had the lowest mean BMI (18.9 kg/m2) and mean MUAC (21.9 cm) and the highest rate of CED (BMI based CED = 52.3%; MUAC based CED = 53.5%). Those in the highest PCIG had the largest mean BMI (20.7 kg/m2) and MUAC (23.9 cm) and lowest rate of CED (BMI based CED = 39.0 %; MUAC based CED = 35.4 %). There were significant PCIG differences in mean BMI (F = 4.115, p < 0.05) and MUAC (F = 6.995, p < 0.001). Moreover, there existed clear PCIG differences in CED rates using both BMI as well as MUAC. In conclusion, this study provided evidence that PCI was significantly associated with BMI, MUAC and the presence of CED. The relationships of PCI with BMI and MUAC were similar. The rate of CED was very high indicating a critical situation. These findings may have severe public health implications. It is recommended that immediate appropriate nutritional intervention programmes be initiated among this population along with serious efforts to increase their PCI. In this population, either BMI or MUAC can be effectively used to study the effect of PCI on nutritional status.

Inter-relationships of income, chronic energy deficiency, morbidity and hospitalization among adult male slum dwellers of midnapore, west bengal, india

A cross-sectional study of 212 adult (>18 years) male slum dwellers (mean age=34.6+/-14.4 years) of Midnapore town, West Bengal, India, was undertaken to study the inter-relationships of chronic energy deficiency (CED), monthly family income (MFI), self-reported morbidity and hospitalization due to severe illness. The mean height, weight and body mass index (BMI) of the subjects were 160.0 cm, 50.8 kg and 19.9 kg/m2, respectively. The overall frequencies of CED (BMI<18.5 kg/m2), morbidity and hospitalization were 38.2%, 34.4% and 13.7%, respectively. Based on the WHO classification, the prevalence of CED among this population was high (20-39%), indicating a serious situation. Overall, MFI was significantly (p<0.01) positively correlated with BMI (r=0.21). Linear regression analyses showed that MFI had a significant impact (t=3.08; p<0.002) on BMI. Overall, MFI explained 3.9% variation in BMI. Subjects belonging to the lowest family income group (FIG I) had the lowest mean BMI (19.1 kg/m2) and the highest rate of CED (46.3%) and morbidity (36.6%). Those in the highest family income group (FIG III) had the largest mean BMI (20.8 kg/m2) and lowest rate of CED (30.2%) and morbidity (30.2%). The highest rate (18.9%) of hospitalization was found in this group. There were significant family income group differences in mean BMI (F=3.134, p<0.05). The frequency of morbidity (24.6%) and hospitalization (11.9%) was lowest among normal BMI individuals. Morbidity was significantly higher (chi2=11.92, p=0.0026) among CED (48.2%) subjects compared with normal BMI individuals (OR=2.85; CI=1.49-5.46). Similarly, compared with normal BMI subjects, morbidity was higher (38.5%; OR=1.92; 95% CI=0.50-7.18) among overweight subjects. Hospitalization was more common among CED subjects (16.1%; OR=1.42; CI=0.58-3.45) compared with normal BMI subjects. Similarly, the frequency of hospitalization was more among overweight individuals (15.4%; OR=1.35; 95% CI=0.0-7.59). In conclusion, this study provides evidence that the frequency of CED among this population is high, indicating a serious situation. Moreover there exists strong inter-relationships between BMI, CED, MFI and morbidity.