Integration of immunization and health care services on the nutritional status of children 6-59 months of age in flood-affected areas of South Punjab
DOI:
https://doi.org/10.70347/svsthya.v1i2.15Keywords:
Child nutrition disorders, floods, immunization programs, malnutrition, Pakistan, public healthAbstract
Child malnutrition remains a serious public health problem in many parts of the developing world, particularly in South and Southeast Asia and sub-Saharan Africa. The situation is exacerbated by natural disasters, particularly floods, which increase the risk of infectious diseases and worsen the nutrition crisis in vulnerable areas. In Pakistan, the 2018 National Nutrition Survey showed high levels of stunting, underweight and wasting among children under the age of five. This study aimed to determine whether integration of immunization and health services can improve the nutritional status of children aged 6-59 months in flood-affected areas of South Punjab, Pakistan. This study used a mixed methods approach, combining a cross-sectional observational study with structured interviews. A sample of 384 children aged 6-59 months was selected through convenience sampling in flood-affected areas. Data were collected through surveys and interviews with families, focusing on maternal feeding practices and factors affecting child nutritional status. Statistical analysis was conducted using IBM SPSS version 25, including frequency distributions for categorical variables and Pearson correlations to determine the association between upper arm circumference (MUAC) and nutritional status, weight, and height. Results showed significant correlations between MUAC and child nutritional status (p=0.035), MUAC and child weight (p=<0.001), and MUAC and child height (p=<0.001). Of the total 384 participants, 60.68% had MUAC more than 12.5 cm, while 39.32% had MUAC less than 12.5 cm. This study confirms the importance of integrating health and immunization services in addressing child malnutrition in disaster-prone areas. Findings show that factors such as parents' socioeconomic status, occupation, education and living environment are significantly related to children's nutritional status.
Downloads
References
Dyregrov A, Yule W, Olff M. Children and natural disasters. Eur J Psychotraumatol 2018;9:150082. https://doi.org/10.1080/20008198.2018.1500823.
Corie AH, Syakurah RA. Evaluation of the supplementary feeding programme targeted at malnourished toddlers in Prabumulih City, Indonesia. Malahayati Int J Nurs Health Sci 2024;7:413–24. https://doi.org/10.33024/minh.v7i4.288.
Marshall SK, Monárrez-Espino J, Eriksson A. Performance of mid-upper arm circumference to diagnose acute malnutrition in a cross-sectional community-based sample of children aged 6–24 months in Niger. Nutr Res Pract 2019;13:247. https://doi.org/10.4162/nrp.2019.13.3.247.
Akhtar S. Malnutrition in South Asia—a critical reappraisal. Crit Rev Food Sci Nutr 2016;56:2320–30. https://doi.org/10.1080/10408398.2013.832143.
Sahiledengle B, Mwanri L. Unveiling the crisis of the double burden of malnutrition. Lancet Glob Health 2024;12:e348–9. https://doi.org/10.1016/S2214-109X(24)00001-9.
Haq I ul, Mehmood Z, Afzal T, Khan N, Ahmed B, Nawsherwan, et al. Prevalence and determinants of stunting among preschool and school-going children in the flood-affected areas of Pakistan. Braz J Biol 2022;82:e249971. https://doi.org/10.1590/1519-6984.249971.
Ochani S, Nazir A, Aaqil SI, Athar FB, Ullah K. Neonatal and child health crises due to recent floods in Pakistan. Ann Med Surg 2022;84:e104837. https://doi.org/10.1016/j.amsu.2022.104837.
Davis KF, Downs S, Gephart JA. Towards food supply chain resilience to environmental shocks. Nat Food 2020;2:54–65. https://doi.org/10.1038/s43016-020-00196-3.
Irshad M, Hayat M, Ahmad A, Khalil B, Hussain M. Case fatality rate and etiological factors of malnutrition in children less than 5 years of age. J Postgrad Med Inst 2014;28:42–8. https://jpmi.org.pk/index.php/jpmi/article/view/1485
Rytter MJH, Kolte L, Briend A, Friis H, Christensen VB. The immune system in children with malnutrition—a systematic review. PLoS One 2014;9:e105017. https://doi.org/10.1371/journal.pone.0105017.
Keats EC, Das JK, Salam RA, Lassi ZS, Imdad A, Black RE, et al. Effective interventions to address maternal and child malnutrition: an update of the evidence. Lancet Child Adolesc Health 2021;5:367–84. https://doi.org/10.1016/S2352-4642(20)30274-1.
Piot P, Larson HJ, O’Brien KL, N’kengasong J, Ng E, Sow S, et al. Immunization: vital progress, unfinished agenda. Nature 2019;575:119–29. https://doi.org/10.1038/s41586-019-1656-7.
Darwin M, Mamondol MR, Sormin SA, Nurhayati Y, Tambunan H, Sylvia D, et al. Quantitative approach research method. 1st ed. Bandung: CV Media Sains Indonesia; 2021.
Paulus AY, Sulaeman, Mayasari AC, Ayu JD, Musniati N, Sari MP, et al. Biostatistika Epidemiologi. 1st ed. Bandung: CV. Media Sains Indonesia; 2023.
Adnyana IMDM. Evaluasi Sistem Surveilans. In: Akbar H, editor. Surveilans Kesehatan Masyarakat. 1st ed., Bandung: CV. Media Sains Indonesia; 2023, p. 63–93.
Adnyana IMDM. Populasi dan Sampel. In: Darwin M, editor. Metode Penelitian Pendekatan Kuantitatif. 1st ed., Bandung: CV. Media Sains Indonesia; 2021, p. 103–16.
Adeoya AA, Egawa S, Adeoya AS, Nagatomi R. Improving child nutrition in disasters by developing a modeled disaster preparedness nutrition education curriculum. Front Public Health 2023;11:1293875. https://doi.org/10.3389/fpubh.2023.1293875.
Agabiirwe CN, Dambach P, Methula TC, Phalkey RK. Impact of floods on undernutrition among children under five years of age in low- and middle-income countries: a systematic review. Environmental Health 2022;21:98. https://doi.org/10.1186/s12940-022-00910-7.
Thiede BC, Gray C. Climate exposures and child undernutrition: Evidence from Indonesia. Soc Sci Med 2020;265:113298. https://doi.org/10.1016/j.socscimed.2020.113298.
Ataullahjan A, Ahsan H, Soofi S, Habib MA, Bhutta ZA. Eradicating polio in Pakistan: a systematic review of programs and policies. Expert Rev Vaccines 2021;20:661–78. https://doi.org/10.1080/14760584.2021.1915139.
ul Haq I, Mehmood Z, Ahmed B, Shah J, Begum N, Nawsherwan, et al. Determinants of Diarrhea Among Children Aged 1 to 6 Years in Flood-Affected Areas of Pakistan: A Cross-Sectional Study. Am J Trop Med Hyg 2023;110:323–30. https://doi.org/10.4269/ajtmh.23-0611.
Haq I ul, Asra M, Tian Q, Ahmed B, Khan N, Ijaz Ahmad M, et al. Association of infant and child feeding index with undernutrition in children aged 6–59 months: a cross-sectional study in the Maldives. Am J Trop Med Hyg 2020;103:515–9. https://doi.org/10.4269/ajtmh.19-0972.
Aguilar A, Vicarelli M. El Niño and children: Medium-term effects of early-life weather shocks on cognitive and health outcomes. World Dev 2022;150:105690. https://doi.org/10.1016/j.worlddev.2021.105690.
Chataut J, Khanal K. Assessment of nutritional status of children under five years of age in rural Nepal. Kathmandu Univ Med J 2016;14:73–7. https://pubmed.ncbi.nlm.nih.gov/27892446/
Wells JC, Sawaya AL, Wibaek R, Mwangome M, Poullas MS, Yajnik CS, et al. The double burden of malnutrition: aetiological pathways and consequences for health. The Lancet 2020;395:75–88. https://doi.org/10.1016/S0140-6736(19)32472-9.
Galgamuwa LS, Iddawela D, Dharmaratne SD, Galgamuwa GLS. Nutritional status and correlated socio-economic factors among preschool and school children in plantation communities, Sri Lanka. BMC Public Health 2017;17:377. https://doi.org/10.1186/s12889-017-4311-y.
Haq I ul, Mehmood Z, Mujahid AM, Ahmed B, Shah J, Khan N, et al. Prevalence of Micronutrient Deficiencies among Preschool and School-Going Children in Flood-Hit Areas of Pakistan. Am J Trop Med Hyg 2021;105:1638–44. https://doi.org/10.4269/ajtmh.21-0705.
Tang AM, Chung M, Dong KR, Bahwere P, Bose K, Chakraborty R, et al. Determining a global mid-upper arm circumference cut-off to assess underweight in adults (men and non-pregnant women). Public Health Nutr 2020;23:3104–13. https://doi.org/10.1017/S1368980020000397.
Nambiar A, Agnihotri SB, Arunachalam D, Singh A. Undernu trition among children and its determinants across the parliamentary constituencies of India: a geospatial analysis. J Biosoc Sci 2024;56:338–56. https://doi.org/10.1017/S0021932023000251.
Sahoo H, Dhillon P, Anand E, Srivastava A, Usman M, Agrawal PK, et al. Status and correlates of non-communicable diseases among children and adolescents in slum and non-slum areas of India’s four metropolitan cities. J Biosoc Sci 2023;55:1064–85. https://doi.org/10.1017/S0021932022000530.
Haq I ul, Mehmood Z, Khan N, Khan MN, Israr M, Ali Khan E, et al. Risk factors of mid-upper arm circumference (MUAC) based child malnutrition in the flood-affected areas of pakistan: a cross-sectional study. Ecol Food Nutr 2021;60:491–507. https://doi.org/10.1080/03670244.2021.1872024.
Zaba T, Nyawo M, Álvarez Morán JL. Does weight-for-height and mid upper-arm circumference diagnose the same children as wasted? An analysis using survey data from 2017 to 2019 in Mozambique. Arch Pub Health 2020;78:94. https://doi.org/10.1186/s13690-020-00462-7.
Mengesha A, Hailu S, Birhane M, Belay MM. The prevalence of stunting and associated factors among children under five years of age in Southern Ethiopia: community based cross-sectional study. Ann Glob Health 2021;87:3432. https://doi.org/10.5334/aogh.3432.
Week DA, Wizor CH. Effects of flood on food security, livelihood and socio-economic characteristics in the flood-prone areas of the Core Niger Delta, Nigeria. Asian J Geogr Res 2020;3:1–17. https://doi.org/10.9734/ajgr/2020/v3i130096.
Joshi PooranC, Kaushal S, Aribam BS, Khattri P, D’Aoust O, Singh MM, et al. Recurrent floods and prevalence of diarrhea among under five children: observations from Bahraich district, Uttar Pradesh, India. Glob Health Action 2011;4:6355. https://doi.org/10.3402/gha.v4i0.6355.
Rodriguez-Llanes J, Ranjan-Dash S, Mukhopadhyay A, Guha-Sapir D. Flood-exposure is associated with higher prevalence of child undernutrition in Rural Eastern India. Int J Environ Res Public Health 2016;13:210. https://doi.org/10.3390/ijerph13020210.
Adam Birhan N, Bitew Belay D. Associated risk factors of underweight among under-five children in Ethiopia using multilevel ordinal logistic regression model. Afr Health Sci 2021;21:362–72. https://doi.org/10.4314/ahs.v21i1.46.
Dukhi N, Sartorius B, Taylor M. Mid-upper arm circumference (MUAC) performance versus weight for height in South African children (0–59 months) with acute malnutrition. South South Afr J Clin Nutr 2017;30:49–54. https://doi.org/10.1080/16070658.2016.1255483.
Sendaula, Kalyango J, Obeng GAO, Nabukeera-Barungi N, Opio D, Babirye EK, et al. Performance of MUAC and associated factors in the prediction of acute malnutrition among children 6-59 months at Mulago Hospital, Kampala. vol. 4. 2020.
Singh SN. Nutrition in emergencies: Issues involved in ensuring proper nutrition in post-chemical, biological, radiological, and nuclear disaster. J Pharm Bioallied Sci 2010;2:248. https://doi.org/10.4103/0975-7406.68507.
Adelia S, Susanto JC. Mid-upper arm circumference measurement for severe malnutrition screening in underfives. Paediatr Indones 2020;60:42–52. https://doi.org/10.14238/pi60.1.2020.42-52.
Fiorentino M, Sophonneary P, Laillou A, Whitney S, de Groot R, Perignon M, et al. Current MUAC cut-offs to screen for acute malnutrition need to be adapted to gender and age: the example of Cambodia. PLoS One 2016;11:e0146442. https://doi.org/10.1371/journal.pone.0146442.
Sougaijam R, Gupta S, Raut A, Bharambe M, Garg B. Validating the MUAC (Mid-upper arm circumference) cut-off for detection of severe acute malnutrition in children aged 6–59 months in rural Maharashtra. Indian Pediatr 2019;56:209–12. https://doi.org/10.1007/s13312-019-1502-x.
Park J, Baek S, Hwang G, Park C, Hwang S. Diet-related disparities and childcare food environments for vulnerable children in South Korea: a mixed-methods study. Nutrients 2023;15:1940. https://doi.org/10.3390/nu15081940.
Sunguya BF, Poudel KC, Mlunde LB, Shakya P, Urassa DP, Jimba M, et al. Effectiveness of nutrition training of health workers toward improving caregivers’ feeding practices for children aged six months to two years: a systematic review. Nutr J 2013;12:66. https://doi.org/10.1186/1475-2891-12-66.
Kimani IW. Evaluation of the supplementary feeding programme targeted at moderately malnourished children aged 6 to 59 months in Baringo County, Kenya. Thesis. University of Stellenbosch, 2018.
Pradhan PMS, Dhital R, Subhani H. Nutrition interventions for children aged less than 5 years following natural disasters: a systematic review. BMJ Open 2016;6:e011238. https://doi.org/10.1136/bmjopen-2016-011238.
Adnyana IMDM, Eljatin DS, Sudaryati NLG, Adiwinoto RP, Raza SM, Da Cruz ZV. CRISPR-Cas9 Genome Editing Technology for Zoonotic Disease Control in Indonesia: A Comprehensive Review. J Med Health Tech 2024;1:21–39. https://doi.org/10.12962/j30466865.v1i1.1172.
Ejiohuo O, Onyeaka H, Unegbu KC, Chikezie OG, Odeyemi OA, Lawal A, et al. Nourishing the mind: how food security influences mental wellbeing. Nutrients 2024;16:501. https://doi.org/10.3390/nu16040501.
Putri NAS, Adiwinoto RP, Arundani P, Nugraheni PA, Adnyana IMDM. The Relationship Between Feeding Patterns and Maternal Knowledge about Nutrition with the Incidence of Stunting in Children Age 0-5 Years in the Working Area of the Gedongan Health Center, Mojokerto City. AgriHealth J Agri-Food, Nutrition Public Health 2024;5:21. https://doi.org/10.20961/agrihealth.v5i1.83808.
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2024 Muhammad Tanveer

This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
This license enables reusers to copy and distribute the material in any medium or format in unadapted form only, for noncommercial purposes only, and only so long as attribution is given to the creator.

