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Cross-sectional study of child malnutrition and associated risk factors among children aged under five in West Bengal, India

lower mortality rates associated with pneumonia, measles, and severe neonatal infections (Mathers,
Stevens and Mascarenhas, 2009). In addition, malnutrition in early childhood prevents overall phys-
ical, mental, and psychological growth of the children (Victora, Adair, Fall et al., 2008; Victora, Onis,
Hallal et al., 2010). Previously, the term ‘malnutrition’ has been often incorrectly associated solely
with under-nutrition only, whereas it now refers to both excess and deficiency in nutrition confined
to a specific population (Shrimpton and Rokx, 2012). The co-existence of under-nutrition and obesi-
ty in a population has been popularly referred to as ‘The Double Burden of Malnutrition’. This con-
cept first emerged at the International Conference on Nutrition (ICN) in 1992, held by the Food and
Agriculture Organization of the United Nations (FAO) and World Health Organization (WHO, 1995).
Moreover, the WHO has used the term ‘malnutrition’ to imply all of its forms, namely un-
der-nutrition, growth faltering, micronutrient deficiency, over-nutrition, and obesity.
A wide range of socio-demographic and economic factors are associated with the child malnutri-
tion, including mother’s nutrition, poverty, food security, healthcare practices, environment, hygiene,
and sanitation (Islam, Rahaman and Mahalanabis, 1994). Low birth weight is another factor that in-
creases the risk of malnutrition among children and makes them vulnerable to serious negative con-
sequences later in life, such as adulthood diabetes and cardiovascular disease (Fall, 2009). Childhood
malnutrition predisposes affected individuals to numerous long-lasting negative effects, including
physiologic dysfunctions and impaired cognitive development (Martins, Florencio, Grillo et al.,
2011). Owing to the high incidence of child malnutrition, an extensive body of research
has been conducted in India, focusing on its contextual determinants including child’s demograph-
ic characteristics (Talapalliwar and Garg, 2014), household level variables (Som, Pal and Bharati,
2007), mother’s characteristics (Imai, Annim, Kulkarni et al., 2014), community level factors, and
environmental factors (Aneja, Singh, Tandon et al., 2001) at both regional and national levels
(Bharati and Bharati, 2008; Bisai, Bose and Ghosh, 2008; Biswas, Bose, Bisai et al., 2009; Biswas,
Bose and Mukhopadhyay, 2009; Debnath and Bhattacharjee, 2014; Dey and Chaudhari, 2008;
Khokhar, Singh, Talwar et al., 2003; Kumar, Mohanan, Kotian et al., 2008; Kumari, 2005; Meshram,
Laxmaiah, Reddy et al., 2011; Rao, Yadav, Dolla et al.,2005; Talapalliwar and Garg, 2014).
The relationship between a child’s nutritional status and feeding practices (complementary
vs breast feeding) has been established through various studies conducted in India (Banapurmath,
Nagarajand Banapurmath, 1996; Bhandari, Mazumder, Bahl et al., 2004; Kumar, Goel, Mittal et al.,
2006; Sreedhara and Banapurmath, 2014). Recently, Khan and Raza (2014) demonstrated that the
probability of anthropometric failure increases with age, birth-order, and breastfeeding duration.
In contrast, a longer birth interval, childbirth in hospital, the wealth index of the household, and
mother’s BMI and education reduce the prevalence of child malnutrition in both rural and urban In-
dia (Gribble, Murray and Menotti, 2008; Kumar and Singh, 2013; Mandal, Prabhakar, Pal et al.,
2014). The present study aims to describe the prevalence of child malnutrition in terms of stunting,
wasting, and underweight status. Its further aim is to capture social and demographic differentials
of children’s anthropometric indices, by utilizing the individual- and household-level risk factors in
determining the nutritional status of children residing in West Bengal, India.

2. Data and Methodology
2.1 Data Sources

The present study is based on a cross-sectional survey that was conducted in Bankura district of
West Bengal, India in 2013. The study participants were selected via a multi-stage sampling proce-
dure, resulting in 485 households with children aged under five. Semi-structured household ques-
tionnaire and child questionnaire served as data collection instruments. The household question-
naire comprised basic household-level social and economic information, and was completed by any
adult household member. The children’s questionnaire aimed to elicit information on childcare prac-
tice, child health, and nutrition. In case of more than one eligible child (under the age of five) in the

90 International Journal of Population Studies | 2016, Volume 2, Issue 1