|
Nutritional Status Of Rural
Non-Pregnant Non- Lactating Women In Reproductive Age |
M. Srivastava, D.K. Agarwal, A. Agarwal, S. Agarwal and K.N. Agarwal*
From the Maternal and Child Health Unit, Department of Pediatrics, Institute of Medical Sciences, Banaras Hindu University, Varanasi
221 005 and Department of Pediatrics*, University College of Medical Sciences, Delhi-ll0 095, India.
Reprint requests: Prof. K.N. Agarwal, D-115/Sector 36, Noida (U.P.) 201301, India.
Manuscript received: February 2, 1998; Initial review completed: March 18, 1998;
Revision accepted: July 10, 1998
Abstract:
Objective: To find out the degree of current under-nutrition in rural reproductive age women. Setting: 49 villages of
two adjoining rural blocks of Varanasi. Methods: 6130 non-pregnant and non-lactating rural women in the age group ), 8-45 year were studied for sociodemographic characteristics and anthropometry, i.e.,
weight, height and midarm circumference. Their percentiles for age and for weight for height were calculated by using cubic spline method. Results: The women in 10th centile weighed <38kg and those in >90th celltile weighed
47-48
kg;
74.2%
had weight <45 kg. The 50th centile height ranged between 148-150 cm; 13.5% were <145 cm. For mid arm circumference 50th and 90th centile values were around 22 and 24 cm, respectively. Mid arm circumference and height had significant linear correlation with weight. Conclusion: Around 50% rural UP women in pre-pregnancy state are undernourished. With age these rural women did not change in
weight or mid-arm circumference.
Key
words:
Non-lactating, Non-pregnant, Nutritional status, Rural.
T HE
average height of Indian women
as documented in some studies is 150 cm which is 13.7 cm less than the average height of 163.7 cm of women in USA(1-4). However, it is comparable to average height of women of lower income groups
.
of Indonesia, Philippines, Guatemala and Chile(5-8). Little can be done about stunted height during pregnancy but these women deviate sharply from their contemporaries in their weight for height which is amenable to improvement.
In a limited survey conducted in Bihar and Uttar Pradesh, 17.4% and 10.8% pregnant women weighed <40 kg, 57.1 % and 60%, weighed <45 kg, respectively,
suggesting poor nutritional status(1). In the
present study reproductive age rural women (non-pregnant and non-lactating) vvere
measured anthropometrically with an objective to find the degree of current under nutrition in pre-pregnancy state. An attempt was also made to prepare percentiles for anthropometric measurements.
Subjects and Methods
The present study data were collected during 1988-1990 in two Blocks of District Varanasi, Uttar Pradesh:
I.
Kashi Vidya Peeth block (non-ICDS) is approximately 10 km from Institute of Medical Sciences, Varanasi. It is spread out in 147 sq. km. having 121 villages. According to 1988-1989 census
of
Varanasi district the total population of the block was 1,28,683 consisting of 69,313 males and 59,370 females. The block has 61 schools, 11 middle schools and 5 intermediate colleges. Of these, 14 schools are only for girls.
II. Harahua block having 148 villages is situated 25 km away from the Institute of Medical Sciences, Varanasi, India. Integrated Child Development Services (ICDS) scheme was launched in this area in 1983. The total population of this block was 1,32,072 (69,390 males and 62,682 females). In all there are 69 schools, of which 54 are primary, 8 junior and 5 high schools and 2 intermediate colleges.
Population selected:
In Kashi Vidya Peeth
Block (non-ICDS)-21 villages having a population of 32,307 and in Harahua Block (ICDS)-28 Anganwadi centers having a population of 33,770 were selected using random sampling technique (ICMR Statistical Unit). There were a total of 4,582 households in non-ICDS and 4,492 in ICDS area. There were 27.2% family planning acceptors and postmenopausal women in non-ICDS and 24.2% in ICDS area thus leaving the target women of 4,327 in non-ICDS and 4,694 in ICDS areas.
The present study is restricted to the noh-pregnant non-lactating (NPNL) Women
of the study area in reproductive age group. Non-lactating women were those who
had the youngest child 6f more than one year of age. Women having history of any chronic illness which was likely to affect their current nutritional status were excluded from the study. In all 6130 healthy women were subjected to anthropometric measurements (number of women in ICDS Block=3282, Non-ICDS
Block=2848).
A pre-tested semi structured questionnaire was administered to eligible women
from each household to elicit information regarding their family, education,
occupation, socio-economic status and socio-demographic profile. The
socio-economic index was calculated on the basis of patient's education,
occupation, caste and per capita income. A linear composite score was obtained by combining the rank order scores of these six variables(9). Anthropometric measurements were taken by using Chattilon weighing scale (USA), anthropometric rod and fibre glass tape by standard techniques(10). Age of women was assessed using age of menarche, marriage,
consummation of marriage and age of children by using calendar of important local events. The women were examined at their house by a team of nutritionist and. social
.
scientists with the help of female village worker.
Percentile for weight, height, midarm circumference for age were calculated using the cubic spline
method(11). Weight for height percentile at each cm height were also calculated(12):
Weight of women at that height
----------------------------------------------------------x 100
Weight at 90th centile for that height
The basic method of systematic curve smoothing is spline polynomial smoothing of the observed percentile value. Alternatively,
in the present study the system was raised from cubic to quadratic to allow better interrelationship between the percentile lines. It was seen that existing cubic spline technique had strength of placing (fixed or variable) knots. Using the fixed knots alternatively gives some degree of parallelism and interrelationship between the per centile(10). Pregnancy outcome data
coresponds to the prospective conceptions followed. As pre-pregnancy weight, height and mid-arm circumference were interrelated the regression equations. were developed using mid-arm circumference
and height data for calculation of weight. Mean, standard deviation and error,
percentile, Pearson correlation matrix, linear regression, paired 't' tests, chi square test and analysis of variance were also calculated.
Results
The mean age, family size, gravida, parity, mean pregnancy interval and socio-economic index were comparable in the
selected women of two blocks
(Table
I).
The
socio-economic and environmental characteristics of study women showed that 64.6% of the study women belonged to
backward class followed by
24.2%
in
scheduled caste and only 11.1% belonged to upper class. The average income of these women was found to be Rs.
169.0±1.3
per month. As many as 67.5% were still using well water for domestic use. Only
33% of the households had electrification, remaining used kerosene lamp as a source of light. Illiterate women comprised 87.0%
of the total and their main occupation was domestic activities (housewives). The means for height, weight and midarm circumference (MAC) in the ICDS were higher as compared to the non-ICDS by 0.8 cm, 1.1 kg and 0.2 cm, respectively. These differences are significant in view of large sample size. However, the 50th centile values for height and mid arm circumference did not differ >3% and for weight >6% for both the blocks at any point as compared to the corresponding 50th percentile of the pooled data. It was felt that study women in two blocks are not varying much and therefore data were pooled to have a larger sample for calculation of percentiles in pre-pregnancy state(13).
Anthropometric Characteristics
The frequency and percentage distribution of women in the ICDS and non-ICDS blocks for weight and height are given in
Table II. The analysis o( combined data showed that 56.0% women were having height less than 150 cm, 13.5% less than 145 cm and 40.5% were between 145-150 cm while 27.1% women had their weight less than 40.0 kg and about 74.2% less than 45 kg.
TABLE I
Characteristics of Rural Non-pregnant Non-lactating Women (Mean
±SE).
Characteristics
|
Harahua
(ICDS)
(n
=
3282)
|
K.V. Peeth
(Non-ICDS)
(n
= 2848)
|
|
Age (yr) |
26.0±0.10 |
25.2±0.10 |
|
Family size |
8.1±0.06 |
9.2±
0.09 |
|
Parity |
3.0
±
0.04 |
2.9
±
0.03 |
|
Gravida |
3.6±0.04 |
3.5±0.03 |
Socio-economic
index (caste,
education-
mother and
father, per
capital income) |
10.7±0.04 |
10.7±0.04 |
|
Mean pregnancy
interval (months) |
21.2±0.29 |
23.2±0.19 |
|
Anthropometry |
|
|
|
Height (cm) |
149.4±0.07 |
148.6±0.01 |
|
Weight (kg) |
42.6
±0.07 |
41.5±0.09 |
|
Mid-arm circumference (cm) |
22.1±0.03 |
21.9
±
0.03 |
Table III shows that the weight and mid arm circumference percentiles with the advancement of age did not show any change. The 90th percentile MAC averaged 24 cm and corresponded to 10th centile value of NCHS for 18-34 yr of age. The averages for.. US women were invariably higher than the 90th centile values of rural women except for height 152-154 cm(4). The 50th centile height values for 18-19 and 34-35 years remained 149 cm, with similar pattern for 5th and 90th centiles, indicating possibly no secular trend.
TABLE II
Percentage Distribution of Height and Weight of Non-pregnant and Non-lactating Women
Categories
|
Block |
Pooled
|
|
ICDS |
N6n-ICDS |
|
|
|
% |
(n) |
% |
(n) |
% |
(n) |
|
Weight (kg) |
< 35.0 |
1.6 |
(52) |
5.6 |
(159) |
3.4 |
(211) |
|
|
35.0-39.9 |
19.0 |
(620) |
29.2 |
(832)
|
23.7
|
(1452) |
|
|
40.0-44.9 |
51.3 |
(1687) |
42.1 |
(1199) |
47.1 |
(2886) |
|
|
45.0-49.9 |
23.5 |
(771) |
17.3 |
(492) |
20.6 |
(1263) |
|
|
50.0-54.9 |
3.6 |
(118) |
4.4 |
(125) |
4.0 |
(243) |
|
|
55.0-59.9 |
0.8 |
(27) |
1.2 |
(34) |
1.0 |
(61) |
|
|
≥60 |
0.2 |
(7) |
0.2 |
(7) |
0.2 |
(14) |
|
|
Mean±S.E.
(n) |
42.58±0.07
(3282) |
41.47±0.09
(2848) |
42.49±0.09
(6130) |
|
Height (cm) |
< 140.0 |
1.5 |
(48) |
3.8 |
(107) |
2.5 |
(155) |
|
|
140.0-144.9 |
8.5 |
(279) |
13.9 |
(397) |
11.0
|
(676) |
|
|
145.0-149.9
|
41.8 |
(1371) |
38.9 |
(1109) |
40.5 |
(2480) |
|
|
>150 |
48.2 |
(1584) |
43.4 |
(1235) |
46.0 |
(2819) |
|
|
Mean±S.E.
(n) |
149.41±0.07
(3282) |
148.60±0.01
(2848) |
149.26±0.06
(6130)
|
The Pearson correlation matrix Was applied to study the impact of socio- demographic variables on weight and midarm circumference. The education of husband and socio-economic index was significantly positively related to weight and midarm circumference in these women. The gravida, parity and pregnancy interval did not show any relationship with weight and MAC
(Table
IV).
As socio- economic index was related to weight and MAC, interrelation between these two parameters was studied to predict weight. The linear equation derived was;
y
=
1.75 x + 3.2755 where y
=
weight
(kg) and x
=
mid arm circumference (cm).
Similarly using height to predict weight
equation was:
y
=
0.458 x - 26.72 where y
=
weight (kg)
and x
=
height (cm).
The reliability of these equations was checked by using paired 't' test and it was found that the difference in the observed and calculated values was non-significant. Calculating weight for height centile charts in case of these rural women presented a problem as 13.5% of the women were shorter than 145
cm, below which average and range for weight as international standards are not available. Thus study women weight for height centiles were calculated
(Table
V).
The 90th centile weight at that
height was taken as reference value (possibly optimal attainable). The women having weight for height < 90% of the reference weight for height derived by the manner were 53.2% (undernourished 49.2% and 57.6% in the ICDS and non ICDS), those having weight for height 90-110% considered as normal were 45.2% (49.2% and 40.6% in the ICDS and non ICDS blocks)
and>
i
10% considered as over-nourished were 1.6%.
TABLE
III
Weight (kg), Height (cm), Mid Arm Circumference (cm) Percentiles for Non-pregnant and Non-
lactating Women (Smoothed)
|
|
|
Age
|
(Yrs)
|
N
|
Percentile
|
|
5th |
10th |
50th |
75th |
90th |
|
18-19 |
i |
612 |
35.1 |
36.4 |
41.6 |
44.4 |
47.0 |
|
|
ii |
|
141.3 |
143.0 |
149.0 |
151.0 |
154.8 |
|
|
iii |
|
20.0 |
20.0 |
22.0 |
23.0 |
24.0 |
|
20-21 |
i |
1010 |
35.2 |
36.5 |
41.7 |
44.5 |
47.0 |
|
|
ii |
|
141.6 |
143.4 |
148.2 |
151.6 |
154.0 |
|
|
iii |
|
19.5 |
20.0 |
22.0 |
23.0 |
24.0 |
|
22-23 |
i |
755 |
35.5 |
36.6 |
41.6 |
44.6 |
47.3 |
|
|
ii |
|
142.0 |
143.8 |
149.2 |
151.8 |
154.3 |
|
|
iii |
|
19.5 |
20.0 |
22.0 |
23.0 |
24.0 |
|
24-25 |
i |
874 |
35.9 |
37.2 |
41.8 |
45.0 |
47.6 |
|
|
ii |
|
142.3 |
144.5 |
149.3 |
152.0 |
154.4 |
|
|
iii |
|
19.5 |
20.0 |
22.0 |
23.0 |
24.0 |
|
26-27 |
i |
588 |
36.0 |
37.3 |
41.8 |
45.0 |
48.0 |
|
|
ii |
|
142.4 |
144.5 |
149.5 |
152.0 |
154.7 |
|
|
iii |
|
19.5 |
20.0 |
22.0 |
23.0 |
24.0 |
|
28-29 |
i |
736 |
35.3 |
37.1 |
42.0 |
45.0 |
48.3 |
|
|
ii |
|
142.1 |
144.2 |
149.8 |
152.0 |
154.7 |
|
|
iii |
|
19.5 |
20.0 |
22.0 |
23.0 |
24.0 |
|
30-31 |
i |
641 |
35.0 |
36.6 |
41.8 |
44.8 |
48.0 |
|
|
ii |
|
141.6 |
143.6 |
149.8 |
152.0 |
154.8 |
|
|
iii |
|
19.1 |
20.0 |
22.0 |
23.0 |
24.0 |
|
32-33 |
i |
240 |
34.6 |
36.5 |
41.7 |
44.7 |
47.8 |
|
|
ii |
|
141.2 |
143.2 |
149.8 |
152.0 |
154.5 |
|
|
iii |
|
19.2 |
20.0 |
22.0 |
23.0 |
24.0 |
|
34-35 |
i |
293 |
35.5 |
36.7 |
41.6 |
44.8 |
47.2 |
|
|
ii |
|
141.6 |
143.5 |
149.5 |
151.9 |
158.1 |
|
|
iii |
|
19.2 |
20.0 |
22.0 |
23.0 |
24.0 |
|
36-37 |
i |
88 |
35.6 |
37.1 |
42.0 |
45.3 |
48.1 |
|
|
ii |
|
140.4 |
143.8 |
149.8 |
152.1 |
154.6 |
|
|
iii |
|
19.0 |
20.0 |
22.0 |
23.0 |
24.0 |
|
38-39 |
i |
99 |
35.0 |
37.5 |
41.6 |
45.0 |
4~.7 |
|
|
ii |
|
138.4 |
143.7 |
149.6 |
151.8 |
154.8 |
|
|
iii |
|
19.2 |
19.5 |
21.8 |
23.1 |
24.0 |
|
40-41 |
i |
139 |
35.0 |
37.5 |
41.6 |
44.7 |
47.8 |
|
|
ii |
|
137.0 |
144.0 |
149.8 |
151.7 |
154.3 |
|
|
iii |
|
18.2 |
19.0 |
22.0 |
23.2 |
25.0 |
|
42-43 |
i |
35 |
37.0 |
38.0 |
41.5 |
44.2 |
46.9 |
|
|
ii |
|
138.7 |
144.3 |
149.8 |
151.4 |
153.6 |
|
|
iii |
|
18.2 |
19.0 |
22.0 |
23.2 |
25.0 |
|
44-45 |
i |
20 |
37.5 |
37.0 |
43.0 |
45.0 |
47.5 |
|
|
II
|
|
141.5
|
146.5 |
150.5 |
155.0 |
156.0 |
|
|
iii |
|
20.0 |
20.5 |
22.5 |
23.5 |
24.0 |
|
Total |
|
6130 |
|
|
|
|
|
i=weight (kg);
ii= height (cm);
and
iii=mid arm circumference (cm)
TABLE IV
Pearsons
Correlation Matrix of Socio-demographic
Variables of
Study Women.
| Variables |
Weight |
Height |
Mid arm
circumference |
| Socio-economic index |
0.1885** |
0.1795** |
0.127** |
| Education of husband |
0.1435** |
0.151** |
0.0965** |
| Gravida |
0.013 |
0.0265 |
0.025 |
| Parity |
0.031 |
0.024 |
0.018 |
| Pregnancy interval |
0.0205 |
0.0305 |
0.0195 |
TABLE IV
Weight
for Height Percentiles of Non-pregnant and Non-lactating Women
(Smoothed)
(n =
6130)
Height
(cm) |
n |
Weight percentile (kg)
|
WHO 1995 (14)
average range |
|
5th |
10th |
50th |
75th |
90th |
|
138 |
104 |
31.8 |
32.8 |
36.6 |
38.7 |
43.2 |
|
|
|
139 |
51 |
32.0 |
32.9 |
36.8 |
38.9 |
43.4 |
|
|
|
140 |
92 |
32.1 |
33.0 |
36.9 |
39.0 |
43.6 |
|
|
|
141 |
98 |
32.3 |
33.1 |
37.8 |
40.3 |
43.9 |
|
|
|
142 |
129 |
32.5 |
33.8 |
38.8 |
41.1 |
44.2 |
|
|
|
143 |
164 |
33.4 |
34.8 |
39.4. |
42.0 |
44.3 |
|
|
|
144 |
193 |
33.9 |
35.5 |
39.7 |
42.4 |
44.5 |
|
|
|
145 |
320 |
34.7 |
36.2 |
40.2 |
42.8 |
44.8 |
46.0 |
42-53 |
|
146 |
366 |
35.2 |
36.5 |
40.3 |
43.0 |
45.1 |
|
|
|
147 |
471
|
35.5
|
37.0 |
40.5 |
43.3 |
45.2 |
|
|
|
148 |
692 |
35.8 |
37.3 |
41.0 |
43.5 |
45.5 |
46.5 |
42-54 |
|
149 |
631 |
36.0 |
37.7 |
41.5 |
44.2 |
46.1 |
| |
