Malnutrition And Its Influential Factors In Children At Age Of 6-24 Months In Poverty-stricken Areas Of Gansu Province

Objectives A survey concerning feeding and nutrition status among children at age of 6 to 24 months was delivered in poverty areas of Gansu province, meanwhile, influential factors associated with children’s nutrition status in poor areas had also been discussed and analyzed so as to provide baseline data and scientific evidences for the government to carry out the Children Nutrition Improvement Project in Poor Areas and further to improve prevention strategies and intervention measures on children malnutrition. Methods Multi-stage stratified cluster sampling method combined with the PPS(Probability Proportion to Size) sampling method were used to select the respondents, including 3663 children at age of 6 to 24 months and their parents or caregivers. Questionnaire survey and laboratory examination were used to collect information, including infants and young children’s basic information, children’s birth and feeding, parents’ feeding and nutrition knowledge. Epidemiological information was collected through questionnaire survey, and children’s fingertips peripheral blood was detected by portable analyzers for the contents of children’s hemoglobin. Kangwa(ws-rt-1b) intelligent medical instruments were used to determine the body length and weight of infants and young children. Epidata3.1 was used for data entry and management, and Anthro3.2.2 for calculating height z scores and weight z scores. Statistical analyses were carried out by using SPSS(Statistical Package for Social Sciences, v.20.0). The chi-square test or Fisher’s exact test was used to assess the association between two qualitative variables wherever appropriate. Multiple logistic regressions were used to estimate the risk of different factors on the prevalence of different kinds of malnutrition(0 for absent and 1 for present). The adjusted odds ratios and their 95% CI for significantly associated factors were reported. Results(1) The basic composition of respondents: ① A sample of 3663 children and their caregivers were investigated, among which including 1907(52.1%) boys, 1756(47.9%) girls, and the sex ratio is 1.1:1. There were 3.3% of infants and young children with low birth weight, and 3.6% of infants and young children with high weight, which were called giant babies. The ethnic composed of Han, Tibetan, Hui and Dongxiang, of which were 2562(69.9%), 847(23.1%), 150(4.1%), 104(2.8%) respectively. ② Children fathers’ average age was 28.5±28.5 years old(19 ~ 50 years old), while mothers’ was 26.5 ± 4.3 years old(16 ~ 50 years old). Parents’ age distributed mainly between 20 to 29 years old. About 47.1% of fathers and 42.7% of mothers respectively received junior high school education. About 38.6% of children’s father had no jobs, and 32.5% were engaged in agricultural production. 62.0% of children’s mother had no jobs, and 19.1% were engaged in agricultural production.(2) Caregivers’ conditions of infant and young children: 75.0% of infant caregivers were infants’ mother, and 21.5% were their grandparents. Caregivers’ knowledge on infant feeding and nutrition scored an average of 1.9 ± 2.3, and the pass rate was 16.5%.(3) Feeding conditions of infant and young children: ① Infant and young children within six months were mainly mixed feeding(60.6%), and 34.7% of children were exclusive breastfeeding. 58.6% of children started adding assistant foods at age of six months, and 21.1% of children started adding foods at age of 4 to 5 months. ② There were 47.6% of children among 6 to 24 months feeding with formula. 90.8% of infants and young children have been added assistant foods, but 9.2% has not. The assistant foods mainly included grains(with which 84.9% of children feeding), white heart potato(with which 53.5% of children feeding), eggs(with which 43.7% of children feeding) and a small amount of meat. There were only 8.8% of infants and young children fed with nutrients supplements. The proportion of having calcium supplement was the highest, accounting for 16.2%, the proportion of having zinc supplement was the lowest, only 5.0%.(4) Detection index of infant and young children: ① The average hemoglobin was 11.5 ± 1.6 g/dl, and 59.0% of children’s hemoglobin was lower than normal standard. ② The malnutrition rate among 6 to 24 months’ children was 21.3%, and the prevalence of overweight, wasting, underweight and stunning was 7.0%, 4.0%, 3.2% and 7.0% respectively.(5) The influential factors on infant and young children’s nutrition status: ① Single factor analysis showed that the factors impacted malnutrition among children within 6 to 24 months included: children’s age(months), gender, anemia, premature birth, birth height and weight, how to feed in 6 months, time to introduce assistant food, type of assistant food and nutrient supplement, as well as caregivers’ educational background and occupation. ② Multifactor analysis showed that the factors impacted malnutrition among children within 6 to 24 months included: children’s age(months), gender, premature birth, time to introduce assistant food, type of assistant food, as well as caregivers’ occupation and knowledge of feeding or nutrition. Conclusions(1) The major nutritional problems among children within 6 to 24 months of poverty-stricken areas in Gansu province were the high prevalence of overweight and anemia. The prevalence of overweight was higher than the world average level(6%), and the prevalence of anemia was higher than most other areas.(2) The exclusive breastfeeding rate is lower than the regulation of Chinese children development compendium(2011-2020)(50%) among children within 6 to 24 months of poverty-stricken areas in Gansu province. It was difficult for infants and young children to get the optimal breast milk nutrition, which was detrimental to children’s growth and development.(3) There were several problems in adding complementary food among infants and young children aged 6 to 24 months in poverty-stricken areas of gansu province, including that the time was earlier than proper, the types was single, the quality was low, and the feeding frequency was unreasonable, which did not favor the growth and development of infants and young children.(4) The influential factors of infant and young children’s nutrition in poverty-stricken areas in Gansu province included children’s gender, age, birth status, caregivers’ knowledge for scientific feeding and nursing children, time and type of starting complementary food.