Nutritional health status: association of stunted and wasted children and their mothers

The study design was randomized controlled clinical trial (MacMahon and Trichopoulos 1996). According to this design, firstly I had selected children of age group 6 to 60 months and their mothers, because stunting and wasting condition found in children of that age group. To found association of stunted and wasted in children and their mothers I had assessed nutritional health status of children and their mothers. Assessment consisted of four parts i.e., demographics, biomarkers, anthropometrics, and food frequency questionnaire.

The target population was approached; the research project was explained and discussed in detail. The information, education and communication (IEC) materials were provided to mothers. The informed consent was taken from the parents of the children who were part of research project (Martinez and Gonzalez [22]).

The demographic data of the agreed parents was taken on pre-designed Performa of questionnaires. The children and their mothers who meet the said criteria were selected for further studies.

The blood samples of selected children were collected by hospital lab in charge in coded and specified blood (1-2 cc) collecting containers for determination of CBC, serum albumin, serum globulin, serum creatinine, and level of urea nitrogen in blood to fulfill the criteria of inclusion and exclusion as mentioned earlier.

The ethically inform consent was taken from Punjabi mothers of children. Children below 5 years aged and the sample size of my study was 57 for stunted children and 25 for wasted children were screening out for stunting and wasting and their mothers (18–30 and 30-45 years) were also assessed to find relationship between stunted and wasted children and their mothers and they belong to low socio-economic status for study by method as adapted by [36].

Primary and Secondary Healthcare Department DHQ hospital, Hafizabad was selected as study site for the research work after getting written permission from the competent authorities. The families belong to Rular, Pri-urban, urban area (adapted from: [17]).

The stunted and wasted children and their mothers were the target population. The selection of the children was carried out in according with two Stage Sampling that is convenience sampling technique; which a part of Non-Probability Sampling method as described by Muhammad [36].

Data was presented with the help of tables, charts, and graphs where necessary. Data collected was analyzed with the help of statistical software (SPSS). Appropriate statistical tests were used. Both parametric and non-parametric tests were used for testing significance. Descriptive statistics were run to check the distribution and frequency of data. Analysis of variance and post hock LSD was applied to seek the level of significance.

The written permission from mothers of Dist. Hafizabad was taken to collect data from them.

The children and their mothers were screened out for stunted and wasted, selected stunted and wasted for study by method as Adapted by Mahmood and Butt [32].

The research proposal was approved by Biosafety and Ethical Review Committee, University of Sargodha, Sargodha (Adapted from Gibney [19]).

The sample size for stunted and wasted children and their mothers were calculated by the following formula; considering estimated prevalence of variable of interest (stunted and wasted), required level of confidence (95%) and 5% margin of error (adapted by [31]).

Table 1 showed that all mothers who come with children in hospital were Pakistani. The prevalence of stunted, wasted, and stunted and wasted children was 27.17, 17.34 and 50.87%, respectively. Majority of mothers having stunted and wasted children which are about 60.0% belonged to age group of is 30–45 years while 47.07% mothers having stunted and wasted children belonged to age group of 18–30 years. It is evident that children of those mothers of age group 30–45, were more prone to be stunted and wasted. In a study it was observed that if age of mother is more than 18 years and visit parental care clinic more than 3 times during pregnancy, children of those mothers were likely to less stunted [24]. In some studies it was observed that most of mothers with stunted and wasted children mean average rang of age were 30.3 ± 6.0 years about 75.3% with stunted and wasted children [3]. Children whose mothers lived in rural areas were more likely to have stunted and wasted children i.e. 57.6%, whereas those mothers who lived in urban areas 44.1% belonged to stunted and wasted children. Majority of mothers of those children who were likely to be more stunted and wasted lived in rural areas i.e. 56.7% [24]. In a dissimilar study, it was observed in Indonesia that children who lived in rural areas were less prone to be stunted as compared to those children who lived in urban area [48]. In a similar study, prevalence of stunting and wasting higher in rural areas as compared to urban areas [4]. Mothers who lived nuclear family system, i.e. 60.5% belonged to stunted and wasted children on the other hand 41.4% mothers who come to hospital were lived in joined family system, belonged to stunted and wasted children. In a similar study, it was observed that the children of nuclear family more likely to be stunted and wasted [25]. In another similar study, which was conducted in Pakistan, results showed that stunting and wasting mostly prevalent among children of nuclear family system as compared to joint family system (Mahmood et al. [33]). It was revealed that mothers who had sedentary physical activity were belonged to 50% stunted and wasted children, whereas those mothers who had light active physical activity belonged to 51.2% stunted and wasted children. In a study, it was indicated mothers who did not work had less significant proportions of stunting i.e. 43.4% in contrast to mothers who work for the same period that was 49.8%, whereas proportion of wasting was significant in those mothers who did not work in contrast to those mothers who worked [27].

From Table 2, it was revealed that results were highly significant, the level of all components of blood were decreased in stunted and wasted children. Hb is most important component of blood, its decrease level show that children were anemic. Hb of normal children was 12.59 (mg/dL), stunted children Hb was 11.8 (mg/dL), wasted children Hb was 10.85 (mg/dL), and whereas those children who were both stunted and wasted have Hb 9.88 (mg/dL). In a similar study, level of Hb decreased in stunted and wasted children, anemia was observed in them [15]. Low level of Hb was observed in stunted children, prevalence of anemia is higher among stunted children [41]. In other similar study, it was observed that stunted and wasted children anemic [43].

In Table 3, non-significant results were found. It was found that normal children have 63.6 average value of pulse rate, stunted have 62.63 pulse rates, wasted have 60.77 pulse rate, and whereas both stunted and wasted have 57.31 pulse rates. In a similar study, it was observed that stunting and wasting children were at risk of developing congenital heart disease and is associated with anemia and heart failure due to pulse rate of children decreased [6]. Non-significant result was concluded, from it was found children who were normal have 98.58 °F temperature, stunted children have 98.38 °F, wasted children have 98.28 °F, and those children who were both stunted and wasted have 97.87 °F. Non-significant results were observed related to blood oxygen saturation. It was observed that children who were normal have 98.25, stunted have 97.32, wasted have 95.34, and both stunted and wasted children have 94.76 blood oxygen saturation levels. In Table 6, significant results were concluded. So, it was observed that those children who were normal have average height 76.03 cm, stunted children have average height 72.75 cm, wasted children have average height 72.5 cm, whereas those children who were both stunted and wasted have average height 68.6 cm. In a study, it was concluded that children who were stunted and wasted, were at greater risk of linear growth retardation particularly in children aged 12–23 months [42]. Highly significant results were obtained related to weight of children. Children who were normal have 9.41 kg was average weight, stunted children have 9.13 kg was average weight, wasted children have 7.23 kg average weight, and some children who were both stunted and wasted have 7.11 kg average weight. In a study, it was observed that the wasted children were interpreted as those children who have low value of weight for height in that condition muscle and body fat were reduced, that is, the child is wasted [21]. Highly significant value of triceps was obtained. Average value of triceps in normal children 8.22 mm, in stunted children 8.04 mm, in wasted children 6.32 mm, in those children who were both stunted and wasted low value of triceps 6.05mmwas observed. In one study, significant results related to triceps were found, 8.57 mm in girls and 8.15 mm in boys triceps [18]. Non-significant value of biceps was revealed. Average value of biceps was found in normal children have 6.65 mm, in stunted children have 6.56 mm, in children have wasted 6.25 mm, and least average value of biceps observed in both stunted and wasted have 5.65 mm. Highly significant result related to subscapular was observed. Normal children have 8.39 mm, stunted children have 8.3 mm, wasted children have 6.22 mm, and whereas those children who were both stunted and wasted have 6.13 mm average value of subscapular. In a similar study highly significant result were found, girls had 6.31 mm and boys had 5.98 mm of subscapular [18]. Non-significant results were obtained related to suprailiac. Average value of suprailiac in different group of children such as normal children have 9.09 mm, stunted children have 7.19 mm, wasted children have 6.58 mm, and those children who were both stunted and wasted have 5.79 mm.

From Table 4, highly significant results were found about waist circumference of children. Average value of waist circumference that observed in normal children group has 43.18 cm, group of stunted children have 42.25 cm, group of wasted children have 39.5 cm, and group of those children who were both stunted and wasted have 39.26 cm. In a study, dissimilar results were found, in most of children waist circumference of children was normal [34]. Average value of MUAC that had been observed in group of normal children had 13.91 cm, stunted children had 13.74 cm, wasted children had 11.69 cm, and group of those children who were both stunted and wasted had 11.45 cm. in a similar study similar result were found, MUAC of children was low, who were stunted wasted and underweight [39]. In a study similar most significant results were found, children who were wasted had MUAC less than 11.5 cm [7]. It was observed that normal children have 44.5 cm, stunted children have 44.27 cm, wasted children have 42.87 cm, and a group of those children who were both stunted and wasted have 42.14 cm average value of head circumference. In a similar study, significant results of head circumference were obtained [18]. In a similar study, significant results related head circumference were obtain that stunted children had 44.67 cm and waste children had 48.54 cm head circumference [40]. Group of normal children have 43.63 cm chest circumference, group of stunted children had average value of chest circumference 41.57 cm, group of wasted children have average value of chest circumference that was 39.84 cm, and in group of those children who were both stunted and wasted had 39.16 cm average value of chest circumference. In a study, non-significant result were revealed, stunted children had 49.17 cm and wasted children and 49.79 cm chest circumference [40]. Neck circumference of children who were normal had 24.73 cm, stunted had 23.86 cm, wasted had 23.17 cm, and group of both stunted and wasted had 21.4 cm average value.

In Table 5, non-significant result was revealed. Mothers of normal children average pulse rate were 96.13, those of stunted children’s mother have 92.87 average pulse rate, mothers of wasted children average pulse rate were 90.26, and whereas it was observed that mothers of stunted and wasted average pulse rate was 88.68. Observations were made that non-significant results were revealed related to body temperature of mothers. Mothers of normal children have 98.4 °F, mothers of stunted children have 98.3 °F, and mothers of wasted children have 98.19 °F, and while, mothers of stunted and wasted children have 98.06 °F average body temperature. Non-significant results were observed related to blood oxygen saturation, Blood oxygen saturation of mothers, who have normal children was 97.79, mother of stunted children has 97.53, mothers of wasted have 97.4, and mothers of both stunted and wasted have 97.13. In Table 8, non-significant results about height were observed, mothers had average height of normal children had 152.17 cm, while, mothers of stunted children had 151.27 cm, whereas mothers of wasted had 151.15 cm and mothers of both stunted and wasted 150.25 cm respectively. In a dissimilar study, significant result related to height of mothers, it was observed in that study that mothers whose were short statures <145 cm height were more likely to had stunted children [24]. In another study, it was revealed that those mothers have height less than 150.1 cm were more like to have stunted children [2]. In one study, it was observed that height of mothers showed negative relation with stunted but not wasted children [3]. Non-significant results were obtained about weight of mothers, mothers had average weight of normal children had 64.55 kg, while, mothers of stunted children had 61.67 kg, whereas mothers of wasted had 60.46 kg, and mothers of both stunted and wasted 57.72 kg respectively. Body fat of mothers was showed non-significant results, mothers’ body composition was assessed, through assessment body fat, was observed, from which mothers of normal children had 34.39%, mothers of stunted children, 34.74%, mothers of wasted children had 35.75%, and, mothers of both stunted and wasted had 37.38%. Non-significant result about body water in mothers was found, mothers of normal children had 44.66% body water, stunted children mothers had 43.74% body water, mothers of wasted children had 43.65% body water, and mothers of both stunted and wasted had 42.54% body water. Non-significant results were revealed about the muscle mass of mothers. Muscle mass was measured of mothers by BF105 machine, mothers of normal children had 31.58%, mothers of stunted children had 31.17%, mothers of wasted children had 30.89%, and mothers of both stunted and wasted children had 31.49%. Non-significant results were found about bone mass of mothers. In Table 8, mothers of normal children have 9.44% bone mass, mothers of stunted children have 9.33% bone mass, mothers of wasted children have 9.33% bone mass, and mothers of stunted and wasted children have 9.19% bone mass.

In Table 6, non-significant results were obtained, mothers of healthy children AMR were assessed, whereas mothers of normal children had 1676.75, mothers of stunted children had 1650.94, mothers of wasted had 1627.01 mothers of both stunted and wasted had 1579.93. Mothers BMR was assessed, whereas mothers of normal children had 1368.23, mothers of stunted children had 1317.75, mothers of wasted had 1267.62 and mothers of both stunted and wasted had 1238.23. Head circumference of mothers were revealed, mothers of normal children had 52.07 cm head circumference, stunted children’s mothers had 52.92 cm, those of wasted children’s mothers had 52.92 cm, and while mother of both stunted and wasted had 52.5 cm. In Table 6, non-significant results were disclosed about waist circumference of mothers, mothers of normal children had 95.63 cm waist circumference, mothers of stunted children had 92.55 cm waist circumference, mothers of wasted children had 91.87 cm waist circumference, and mothers of both stunted and wasted mothers had 91.63 cm waist circumference. In a study dissimilar result was revealed that mothers’ waist circumference show positive relationship with their children who were stunted [14]. Non-significant result was divulging related to MUAC, mothers of healthy children had 27.35 cm MUAC, mothers of stunted children had 26.08 cm MUAC, mothers of wasted children had 25.88 cm MUAC, and mothers of both stunted and wasted had 25.36 cm MUAC. In a study, MUAC of mothers who were belonged to stunted and wasted children had less than 23.5 cm [40]. It was founded that mothers of normal children had 89.88 cm, stunted children’s mothers had 87.65 cm, mothers of wasted children had 86.65 cm, and on the other hand, mothers of both stunted and wasted mothers had 86.4 cm. Neck circumference of mothers was measured, mothers of normal children had 32.89 cm, stunted children’s mothers had 32.68 cm, wasted children’s mothers had 32.16 cm, and mothers of both stunted and mothers had 31.55 cm.

To find better result related to food intake of children, they were divided into two groups according to their age i.e. 6–24 months and 24 to 60 months. The intake of children whose age below than 24 months as compared to those whose age is more than 24 months. From Table 7: it concluded that intake of all food groups were less in children of age group (6–2 months), they take 2.1 serving per week of cereals, 2.74 servings per week of fruit, 0.47 servings per week of vegetables, 0.66 servings per week of meat group, 68.86 servings per week of milk, 0.34 servings per week of fat & oil, 4.78 servings per week of junk/snack, 0.86 servings per week of miscellaneous, and 0.73 litter per week of water. On the other hand, children belong to age group (24–60 months), were taking more food groups servings per week. They take average 10.41 servings per week of cereals, 7.87 servings per week of fruits, 1.18 servings per week of vegetables, meat 2.87, 53.61 servings per week of milk, fat & oil 3.13 servings per week, junk/snack 8.6 servings per week, miscellaneous 6.73 servings per week, and 1.75 l per week of water. In one study, it was found about food that consumption of starchy staples, legumes, and oil was common. Whereas, intake of fruits and vegetables were less in children. About half children were consumed dairy products. Intake of egg and fish was also limited [13]. In other study, they also divided the children in two group i.e. 6–24 and 24–60 months, it was revealed that intake of children, that they daily consumed less amount of vegetables and meat but high intake of soft drink, fried food salty snack, and sweets [9].

In Table 8, non-significant results were obtained related to intake of cereals, it was concluded that 63.13 servings per week of cereals were taken by mothers of children who were stunted and wasted, they were take less serving of cereals as compared to mothers of healthy children i.e. 72.5 servings per week. It was observed that all mothers were taking more 6 servings per day of cereals either they belong to mothers of stunted and wasted children or mothers of healthy children. Non-significant results were observed related to intake of fruits servings, it was concluded that least 9.5 servings per week of fruits were taken by those mothers of children who were both stunted and wasted, they were taking less servings as compared to recommended servings of fruits, for healthy persons it is recommended that they should take 2–4 servings of fruits on daily basis. While mothers of healthy children were taking 16.81 servings per week of fruits, they are taking more than 2 servings of fruits. So it was concluded that mothers of stunted and wasted taking less fruits due to lack of affordability of fruit due to which nutritional status of children was also affected. It was disclosed that less 15.25 servings per week of vegetables were taken by mothers of stunted and wasted children. They were taking less than 3–5 servings per day of vegetables that recommended according to food pyramid, whereas mothers of healthy children were taking 24.67 servings per week of vegetables, they were taking more than 3 servings per day of vegetables, so it showed that less intake of vegetables by mothers had its effect on the health of children. It was observed that mothers of stunted and wasted children had least intake of meat i.e., 5.73 servings per week as compare to mothers of healthy children i.e. 7.5 servings per week. From study it was concluded that mothers of all children were taking less than recommended servings of meat group i.e. 2–3 servings per day. Results related to intake of milk showed variations, it can be concluded that mothers of stunted and wasted children have least 7.88 servings of milk per week as to compare to mothers of healthy children i.e. 12.77. It was revealed that mothers of stunted and wasted children were taking less 2 servings of milk per day which also affected the nutritional status of children. It was observed that mothers of stunted and wasted children had high 18.17 servings per week of fat and oil intake as compared to mothers of healthy children, whose intake was 12.75 servings per week. Sparingly used of fat and oil is recommended but their intake of fat and oil was increased. This also affected the nutritional status of children. It was concluded that highest 26.98 servings per week of junk and snack were observed in mothers of stunted and wasted children but zero serving of junk and snack was recommended. So this showed that all mothers had intake of junk and snack food group, this showed negative impact on the health of children. Non-significant results were concluded related to miscellaneous food intake, it was observed that highest 1.75 servings per week of miscellaneous food were taken by mothers of stunted and wasted children. Fewer servings were taken by mothers of healthy children. Non-significant results were concluded related to water intake, mothers of children who were stunted and wasted taken 7.19 L per week; they had least intake of water than mothers of healthy children.