Indian Pediatrics 1999; 36:37-42 

Nutritional Status and Dietary Intake in Tribal Children of Bihar

THE low nutritional status of tribal population in general and that of children in particular is a matter of a serious concern. It is feared that the nutritional status of tribal children is much lower as compared to that of the rest of the population. The National Nutrition Monitoring Bureau (NNMB) (1) has data on nutritional status of children in general population. Although, there is a. study by NNMB for tribal population, Bihar is not covered in that. The Institute for Research in Medical Statistics (IRMS) Delhi, therefore, undertook a study to assess the nutritional status of children in the tirbal districts of Bihar.

Subjects and Methods

About one third of the districts in Bihar (17 out of 50 pre-divided) are classified as tribal on the basis of concentration of tribal population. Bihar is the third largest state of tribal concentration in the country. The study relates to 9352 households from 198 blocks of 17 tribal districts of' Bihar namely Bokaro, Dhanbad, Dumka, Garwah, Giridh, Godda, Gumla, Hazaribagh, Jamuahi, Katihar, Khagaria, Kishanganj, Lonardagga, Palamu, Ranchi, Singhbhum (East) and Singhbhum (West). This is part of the study under taken by Institute for Research in Medical Statistics (IRMS), Delhi in all the districts of Bihar during 1995-96. For selection of the sample from each block, two villages, one upto a population of 1000 and another of more than 1000 was selected by using probability proportional to size (PPS) sampling. In each selected village, ;20 households were then selected. An urban sample of 20 per cent was also covered in each district. For this, the district headquarter city/town and two other towns (selected randomly) were taken. In each town, two wards were' selected randomly and a sample of 20 households per ward was taken. The selection of households from the wards was also contiguous with a random start.

Information was collected on household characteristics, demographic profile and anthropometry. Anthropometric rods used for measuring the height were Seka while Infantometer was used for recording recumbent length. Both had an accuracy level of 1 mm. Spring balances were used for measuring the weight with accuracy level of 100 g. Health status and measurement on height and. weight were carried out for the members of these 20 households per village/town. Further, for 10 households detailed information on the dietary intake (5 households for family and 5 households for individual diet) was collected. Recall diet survey schedule, food frequency, socio-cultural aspects of food consumption and nutritional assessment schedule were used. All individuals covered for anthropometry were also examined for presence of clinical signs of nutritional deficiency. Dietary intake was assessed by actual weighment for 24 hour recall method. Care was taken to avoid fasting and festival days while noting the intake. Calories and other nutritive intake were calculated by using the table of nutritive value of Indian food(2). To further validate the 24 hour nutritive intake data, the consumption of major food items was assessed using food frequency table.

Results

The number of children studied district wise are given in Table I.

The food consumption by age and sex categories groups are presented in Table II. Consumption of cereals and pulses were almost same in younger. age groups for boys and girls. For milk products, fats and oils, the consumption was higher for boys as com- pared to girls.

The nutrient intake in different age and sex groups is summarized in Table Ill. Intake of protein was broadly in line with the recommended dietary allowances (RDA) in all age groups whereas energy intake was about 80% of RDA. The intake of fat and other nutrients was also lower as compared to RDA in all the age groups.
Table IV summarizes the percentage of children by calorie and protein sufficiency as per RDA. A child was considered to be deficient if the intake was less than the recommended dietary allowance (RDA). Based on this, the calorie. deficiency among children was 38%, protein deficiency was 19% and both calorie and protein deficiencies was 19%. Children who were calorie adequate were also protein adequate.

The nutritional status as per Standard Deviation (SD) classification for height for age, weight for age and weight for height is summarized in Table V. The prevalence of malnutrition in urban and rural areas was largely comparable. About 60% of children were stunted <-2SD) while 40% were severely stunted <-3 SD). According to weight for age criteria, the overall prevalence of under nutrition <-2 SD) was about 55%. The prevalence of stunting. and underweight was comparable in boys and girls. However, wasting was more frequent in girls (urban -34.5% vs 16.3% and rural -34.9% vs18%).

The two way distribution of districts according to nutritional anthropometry (severe malnutrition as per Gomez classification) and caloric sufficiency is summarized in Table VI.

A high proportion of children in the districts of Bokaro and Singhbhum (W) are calorie deficient as well as severely malnourished. A significant proportion of the children in districts of Garwah, Khagria, Lohardagga and Palamu are severely malnourished even with relatively moderate level of calorie deficiency. However, with a relatively lower level of calorie deficiency, some proportion of children in Kishanganj, Dumka and Ranchi were severely malnourished.

Discussion

The results of this study indicate that among tribal children of Bihar, the energy intake is very low as compared to RDA
 

whereas the protein intake was broadly in line with RDA in all age groups. In the states covered by NNMB(1), the intake of energy was also lower as compared to RDA and that of protein at the level of RDA. However, the deficiency is much higher among tribal chil- dren as compared to those studied by NNMB(l). In particular, the level of severely malnourished children<- 3 SD) among tribal areas of Bihar were. much higher (about threefold as compared to those in the popula- tionstudied by NNMB(l). Similar findings were documented for Bihar in the National Family Health Survey(3). In the present survey, the gender bias became apparent for wasting.

In conclusion, the nutritional status and dietary intake of tribal children in Bihar is very poor. Urgent remedial measures are required in this context, particularly on a war footing in especially vulnerable districts identified by this survey.

Acknowledgement

The authors are grateful to. Food and Nutrition Board, Department of Women and Child Development, Ministry of Human Resource Development for financial support and Government of Bihar for their cooperation.