It is done by Denver II Developmental Screening Test (DDST-II). 125 Performance based and parent report items are used to screen children’s development in four areas of functioning: fine motor-adaptive, gross motor, personal-social, and language skills. In gross motor sitting, walking, jumping and overall muscle movements are assessed. In fine motor adaptive, eye hand coordination, manipulation of small objects; problem solving are assessed. In language hearing, understanding and using language is tested. In social, getting along with people and caring for personal needs are assessed. Child’s exact age was calculated and marked on the score sheet; for premature infants, number of months of
children especially under five. Similar types of results were obtained in two studies done in India by Aryan A et.al.  and Gupta MC et.al., . In the study conducted by Arya A. and Devi R et.al. The impact of maternal literacy status on the nutritional status of pre- school children was studied. Two hundred children of both the sexes aged between 1-5 years were randomly selected for the study. Results revealed that the children of literate mothers had better anthropometric measurements than children of illiterate mothers. No mother in PEM group was a job holder where as one fourth of mothers in control group were working women. Mothers in PEM group were twice in labour work than in control group. Housewife mothers, if husband is a farmer or labourer, also help their husbands in their work so have little time to care their children. PEM children were more prevalent among children whose fathers were illiterate. The education of fathers above SSLC (equivalent to 10 th standard) in control group was more than twice as in PEM group. The major occupations in fathers of PEM group were farmer and labourer and that in control group were service-holder and farmer. So the result showed children of labourer are more prone to PEM. Also fathers of control group were more than three times in job than that of PEM group. In the study conducted by Gupta MC et. al  in India, 390 children aged 24-72 months participated. Out of these, 26 severely malnourished children weight for age 55.27 ±3.17 were identified in a colony of predominantly Muslim urban slum dwellers of low socio-economic status. An equal number (n=26) of normally nourished children match for age, sex and per capita income were identified, a strong correlation was found between nutritional status subjects and educational level of their mothers (p<0.025). Father’s education was unrelated to children’s nutritional status. The study showed no significant difference in the types of family structure in PEM in comparison to control group. Larger proportion of births took place at home in both groups, though more in case of PEM group. Larger proportion children were immunized in both groups, lower immunization in case of PEM group in comparison to control group. A large proportion of births occurred at home so mothers didn’t know the exact birth weight of their children. Among known cases low birth baby was higher in PEM group than control group.
Abstract: Protein-energymalnutrition (PEM) is a form of malnutrition that is common in children under 5 years of age in the developing countries and even the developed countries. Young children are the most vulnerable to the vicious cycles of malnutrition, infection and disability, all of which influence the present condition of a child and the future human resource development of the nation as a whole. The prevalence of PEM in the children under five years of age has been shown not to witness a great improvement in Tanzania. It even increased in some districts including Kigoma District. Thus, this research was designed to assess the factors contributing to the high prevalence of PEM in children under 5 years of age in Kigoma District Hospital of Tanzania. This study was a cross-sectional study that involved randomly selected 100 women, who had children under 5 years of age. The women and their children were assessed for their nutritional status and the factors that affect the nutritional status. The results showed a high prevalence of PEM in the children under 5 years of age as shown by the clinical symptoms such as poor weight gain, slowed linear growth, behavioral changes, anemia, muscle wasting, peripheral edema, glossitis, cheilosis, sparse hair and nail spooning. The poor socioeconomic status that might have resulted from poverty was also indicated. The high prevalence of PEM in Kigoma District could be due to infections and low educational status of the mother resulting in poor nutritional status of their children.
Deficiency of a single nutrient is an example of under nutrition or malnutrition, but deficiency of a single nutrient usually is accompanied by a deficiency of several other nutrients. Protein-energymalnutrition (PEM) is manifested primarily by inadequate dietary intakes of protein and energy, either because the dietary intakes of these 2 nutrients are less than required for normal growth or because the needs for growth are greater than can be supplied by what otherwise would be adequate intakes. PEM is almost always accompanied by deficiencies of other nutrients . Under- five children are the most susceptible age group for malnutrition. Malnutrition at the early stages of life can increase risk infections, morbidity, and mortality together with decreased mental and cognitive development. The effect of child malnutrition is long lasting and goes beyond childhood. For instance, malnutrition during early age decreases the educational achievement and labor productivity and raises the risk of chronic illnesses in later age [8-10]. Malnutrition is the major cause of illness and death among under-five children in Ethiopia. The rate of malnutrition among under-five children in the country is among the highest in the world and Sub-Saharan Africa. Moreover, malnutrition is the underlying cause for three-fifth of child death in the country [11-13]. According to the 2014 Ethiopian Mini Demographic and Health Survey (EMDHS) report, 42%, 26.7%, and 9% of under-five children were stunted, underweight, and wasted, respectively. The problem is even worse in rural areas. For instance, the prevalence of underweight and stunting among rural children was 27% and 42% compared with only 13% and 24% among urban children, respectively . The planning of an appropriate intervention requires the knowledge of the extent and the underlying causes of the problem. Thus, ProteinEnergyMalnutrition of under-five aged children is a public threat in Ethiopia, and there is no adequate scientific evidence in Sidama zone, south Ethiopia. Hence the aim of this study was to assess the magnitude and associated factors of Proteinenergymalnutrition among children aged 6-59 months at
shown even more marked difference (nearly 100-1000 times higher) in Ghrelin levels of healthy controls and PEM when compared to above studies. This could be related to the different assay (EIA) used in present study. Also, we believe that our patients were more acutely sick compared to other studies where estimation is done on either out-patient or less sick children who were in nutritional rehabilitation stage for PEM. Further, like other hormones in the body, the Ghrelin hormone is a dynamic hormone which could vary significantly in various physiological states including fasting, acute or chronic stress, time of the day etc. 19
There is a good evidance that infections may greatly influence the nutrilional status of children, they may do so in various ways ; the appitie is decreased, the metabolic break down of tissue is increased, diarrhoea may interfere with absorption and utilization of food. If the infection is long lasting or reoccure all the time, the unfavorable effect on the nutritional status was also be long lasting on the other hand malnutrition predispose the child to contract infection and to influence their course and outcome. Its quite clear that their is a vicious circule connecting malnutrition and infection, for that reason intervention procedures against certain types of infections diseases by vaccination, which may act as a useful weapon in the fight against malnutition (1). Reports from the developing conturies on family characteristic of children with proteinenergy malnutition often that malnourished infants are the children of grand multiparous mothers (3). While this study shows 74% of the cases were of 4 th birth order and below. A possible explanation is that the preschool children number in the family were high as a result of closely spaced pregnancies, which increase the burden on the mothers and increased the risk of protein – energymalnutrition among younger children. The same results obtained from the study done in Ibn Al- Balady hospital 1993 (3). The family size of (10) members and above produced 43% f the cases while 37% of the cases with the family size 5-9. In most of the cases more than one family live in the same house and sharing food, these circumstances of overcrowding accentuates cross infections and the interaction between this and a poor dietary intake accentuate the develpoment of malnutrition (4). Family income then precise family income was difficult to obtained in most of the cases, this is because most of the families had no fixed monthly income were present and secondaly because most of them had big families and had many people who share the income.
Our study showed association between socioeconomic levels and malnutrition, 85.3% of malnourished children were low, Mahmoud et al in a study showed a similar trend in the association between educational level and stunting in univariate analysis  . On the contrary, Rahman et al in 2016 showed that higher education of mother, better household socio-economic conditions and prolonged birth intervals alone are not sufficient in bringing about substantial reductions in prevalence of child malnutrition in Bangladesh  . .
The study is conducted in the pediatric service of the General Hospital of Bingerville (Côte d’Ivoire) from 1 st to 31 st August, 2014. The target population consisted of 129 children aged 0 to 59 months, composed of 65 females and 64 males. To determine the weight of children, two types of scales are used. Children who have not the ability to stand up are weighed by scale (SECA, France) with an accuracy of 100 g. Another Scale (SECA, France) with a maximum range of 150 kg is used to weigh the tallest children. The weight of children who are very restless or who refuse to stand up is determined le weighing. A measuring rod of 150 cm long is used as instrument to measure the height of children. The height of children under 24 months is measured by lying them down. The measuring rod is placed on a flat, solid floor; OF CURRENT RESEARCH
A total of 100 children in the age group between 1 and 5 years were included in the study. 50 children were malnourished (cases) and 50 children were healthy (controls). The ratio of male to female in the study was 3:2. Both the cases and the control were age and sex matched. In our study most of the children (both cases and controls) belong to class 3 and class 4 of the socio economic status as per modified Kuppuswamy scale. The mean hemoglobin level of the cases was significantly lower than those of controls similar to that seen in study done by Adegbusi HS et al and Sandeep et al. 3,4 The low
The adopted questionnaire was used to collect the data from the mothers of below five children. The data will give us the baseline information both demographic data and the knowledge about proteinenergymalnutrition. These questionnaires were collected in the form of pre-data and post data collection from mothers has under five year children who were participated in the research. The data was collected by inviting the mothers in small teaching program arranged in the community open place. In which 15-20 mothers age between 20- 35 years and willing to participate in this study are meet the inclusion criteria of the study has came to participate easily in that teaching session which would take 25-30 minutes.
Result: According to the Gomez classification, 44.43% had good nutritional status with the proportion of first, second and third degree malnutrition was 39.34%, 15.66% and 0.66%, respectively. A significant association of PEM was determined by the age of the children. Conclusion: Need to provide health education regarding antenatal diet, the importance of exclusive breastfeeding, importance of immunization among under-five children and development of the integrated child development scheme at the school level.
Results: Most of the children (35.71%) were under the age of 6 months to one year. Male (55.71%) children are more affected than female (44.29%) children. Undernutrition was observed in 85.71% of cases. Parenteral infection (44.28%) was noticed as major risk factor among children. E. coli was the organism isolated from stool culture in about 73.91% of cases with gut infection. The total fatality rate in the study population was 10%. Multivariable regression revealed significant associations between persistent diarrhoeal disease in children and proteinenergymalnutrition (OR- 1.812; 95% CI- 1.406-2.335), irrational antibiotic use (OR- 2.414; 95% CI- 1.195-4.877), parenteral infection (OR- 2.275; 95% CI-1.165-4.443) and use of unsafe drinking water (OR- 2.738; 95% CI- 1.221- 6.143) and were found to be independent risk factors. Other factors found to be insignificant.
In the present study, the mean serum zinc and copper decreased significantly with increasing severity of malnutrition. Highest serum zinc values were observed in underweight patients and the least value in kwashiorkor patients. This is consistent with earlier findings indicating that antioxidant minerals copper and zinc decreased significantly in malnourished children [25-27]. Mean serum albumin and α -tocopherol levels also decrease significantly in the different classes of PEM patients. Our findings are consistent with the report of Abrol et al. , who reported gradual decrease in serum levels of α - tocopherol with the severity of malnutrition. This could be attributed to the disturbed low density lipoprotein (LDL) metabolism since α -tocopherol is known to be delivered to cells via the high affinity receptors for LDL. It is possible that the low levels of circulating antioxidants such as zinc, copper and α -tocopherol is due to either increased utilization of the antioxidant micronutrients or decreased synthesis of such antioxidants in protein malnourished children .
100 The safety of iron supplementation has also been controversial especially in severe malnourished children. Whilst some studies reported an increase predisposition of malarial infection with iron supplementation, others have seen no harmful effects. Studies have suggested that iron deficiency anaemia might be a protective factor for malarial infection and iron supplements might increase morbidity and mortality of malaria. A study in Zanzibar, Tanzania prompted the WHO and UNICEF in a joint statement recommending that iron should only be given to children with anaemia and not as a preventative measure in children in malaria-endemic areas (Harding and Neufeld, 2012). It was discovered during the process of the investigations that iron supplementation in children led to higher hospitalisation or deaths (Sazawal et al., 2006). However, a recent study discovered that use of micronutrient powder with iron supplementation was not a risk factor for increased malaria incidence in malaria endemic countries with the use of insecticide treated bed nets with appropriate malaria treatment (Zlotkin et al., 2013).
thyroid function is attributed to changes in iodine metabolism and decreased level of circulating proteins. These changes play an important role in the adaptive process of energy and protein metabolism in children with PEM; and help in conservation of energy when energy producing substrate is scarce and protects the child from early death due to low calorie reserve. 9 Several studies have been done to estimate the individual biochemical parameters in PEM. However, few studies have been conducted to see if there is any correlation between serum thyroid hormone levels and serum total protein, albumin levels in children with PEM. In this study, an attempt has been made to study the concentration of serum thyroid hormone levels in PEM children and its correlation with serum total protein and albumin levels.
Proteinenergymalnutrition is a major public health problem in India that affects children in their crucial period of growth and development. Only supplementation of food items is not sufficient but many other things also play an Dosha, Dushya etc. of the are also important for its management. PEM can be and Snehana chikitsa immunobooster, calorie enhancer
Dursun odabas et al studied the auditory brainstem potentials in children with proteinenergymalnutrition to determine the effects of PEM on developing brain in children. Significant differences were recorded in mean latencies of the waves I, II, III, IV, V on both ears and in the mean interpeak latencies of waves III – V & I – V on right ear between study and control group. They also observed longer latency of Wave I on left ear & mean IPL of III – V on right ear in children with PEM and iron deficiency anemia suggesting the defect in myelination of auditory brainstem pathways in children with moderate / severe PEM. The present study results agreed with this result.
One of the major causes for malnutrition in India is gender inequality. Due to the low social of Indian women, their diet lacks in both quality & quantity. Women who suffer from malnutrition are less likely to have healthy babies. In India, mothers generally lack proper knowledge in feeding children. They do not breastfeed their children or feed them poorly. Consequently newborn infants are unable to get adequate amount of nutrition from their mothers .
(P , 0.05), but there was no relationship between maternal age at child birth or presence of chronic disease and childhood malnutrition. Table 2 shows that, of the maternal factors, those that were directly related to childhood malnutrition were short maternal stature, maternal unemployment, and hyperemesis of pregnancy (Table 2). In addition, of the environmental factors, age close to that of the next oldest sibling, poor latrine hygiene in the home, passive exposure to cigarette smoke, use of kerosene instead of gas as the main domestic fuel at home were factors that had a significant relationship with childhood malnutrition (Table 3). The socioeconomic factors in this study which had a significant relationship with childhood malnutrition were migration during the previous 5 years and poverty in the family (Table 4). Ultimately, after logistic regression analysis, the only variables that maintained a significant relationship with childhood malnutrition were maternal height, female gender, poverty, and presence of unhygienic latrines in the home (Table 5).