Abstract

Background: Twenty years after the implementation (1995) of the mid-day-meal program to improve nutritional status and academic efficiency among school-children, under-nutrition remained a major concern in India. Efforts to quantify the problem and identify its determinants were handful, especially in the eastern part of the country. Thus the purpose of this study was to determine the burden and predictors of under-nutrition among primary and upper-primary school-children in eastern India.

Methods: Using stratified cluster random sampling with proportional recruitment, a multistage cross-sectional study was conducted involving all twenty educational districts of West Bengal, a highly populous state in eastern India. During 2014-15, using structured questionnaire, standard anthropometry and laboratory testing a representative sample of 24,108 primary and upper-primary students from the whole state of West Bengal were interviewed and assessed. Descriptive and regression analyses were conducted using SAS-9.4.

Results: Among 24,108 recruited students aged between six and thirteen years, prevalence of under-nutrition was alarmingly high (about twenty-three percent). Furthermore, over half of the students (fifty-four percent) were at-risk of developing malnutrition. On the other hand, only seventeen percent students had ideal nutritional status. Odds of being malnourished were higher among male students (compared to females), those belonging to younger age (studying in primary compared to upper-primary classes), Muslim religion (with reference to Hindus), and under-privileged caste (in comparison with general caste) as well as those residing in rural areas (as opposed to urban). Parental education was negatively associated with the likelihood of under-nutrition. Those who had more than three siblings, unemployed father and students whose mother died were more likely to be under-nourished.

Conclusions: Prevalence of under-nutrition was high among school-children in the study area. School-based interventions targeting high-risk, under-privileged children, especially in rural areas with lower parental education and poor level of sanitary practices seemed to be urgently required.

Keywords: Adolescent nutrition; Child nutrition, Malnutrition; Nutritional epidemiology; Indian children; Determinants of malnutrition