Allied Journal of Medical Research

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Research Article - Allied Journal of Medical Research (2019) Volume 3, Issue 1

Feeding practices and nutritional status of children with rheumatic fever in Bangladesh.

Tazun Akhter1,2, Ratna Khatun3, Shima Begum4, Shirin Sultana5, Rita Khandaker5, Faisal Muhammad2*

1Department of Vitreo-Retina, National Institute of Ophthalmology and Hospital, Sher-e-Bangla Nagar, Dhaka, Bangladesh

2Department of Public Health, Faculty of Allied Health Sciences, Daffodil International University, Dhaka 1207, Bangladesh

3Department of Adult Medical and Surgical Nursing, Grameen Caledonian College of Nursing, Mirpur-2, Dhaka, Bangladesh

4Department of Pediatric Nursing, Dhaka Shishu Hospital, Sher-e-Bangla Nagar, Dhaka, Bangladesh

5Department of Midwifery and Community Health Nursing, Ibn Sina Nursing Institute, Kallyanpur, Dhaka, Bangladesh

Corresponding Author:
Faisal Muhammad Department of Public Health Daffodil International University (DIU) 102 and 102/1 Shukrabad, Mirpur Road Dhanmondi, Dhaka-1207 E-mail: [email protected]

Accepted date: October 01, 2019

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Abstract

Background: The children must be well-nourished and healthy so as to grow into healthy adults. The growth and development of the children continues to be a major public health problem in Bangladesh. Objective: This study was aimed to identify the feeding practices and nutritional status of children with rheumatic fever in Bangladesh. Methods: A descriptive cross-sectional study was conducted among 110 children aged 5-15 years, who suffered from rheumatic fever and attended National Centre for Control of Rheumatic Fever and Heart Diseases (NCCRFand HD) during March to June of the year 2016. The instrument used for data collection was a semi-structured questionnaire. Data collection was done using face-to-face interview with parents/caregivers of the children. Data analysis was done by using SPSS version 16. Results: In this study more than half (53.6%) of the children were aged 13-15 years and 60.0% of them were males. Slightly above half (50.9%) of the respondents were from urban area and 67.3% of the family had ≥ 4 children. More than two-fifths (44.5%) of the respondent’s housing condition was semipacca and 45.5% of them lived at least 3 person per bedroom. Little above three-fifths (60.9%) of the children’s duration of suffering rheumatic fever was ≤ 48 months. About 73.6% of the children were fed colostrum. About 35.5% of the fathers had SSC level of education and 33.6% of the mothers had primary level of education. Conclusion: The overall nutritional status of the study participants (children) was not satisfactory. Our findings reveal that more than sixty percent of the children were underweight. The children should be properly immunized and vaccination program for the children against common infectious diseases of childhood should be provided.

Keywords

Feeding practice, Nutritional status, Children, Rheumatic fever.

Introduction

Rheumatic fever is prevalent in many part of the world such as Indian subcontinent, Arab countries, Africa and some portion of Central and South America [1]. According to community and school surveys, the prevalence rates range from 1 to 22 per 1000 children [2]. However the prevalence of rheumatic fever (RF) and rheumatic heart disease (RHD) has declined sharply although in developing countries, RF is still a leading cause of heart disease and consequently, death in children and young adults [3]. Acute rheumatic fever is the most common cause of cardiac disease. A study estimated that about 12 million people in developing countries were affected by acute rheumatic fever and rheumatic heart disease, with the majority of these being children [4]. Another study stated that this level of morbidity is comparable to that in developed countries earlier this century, prior to an increase in the standard of living and the establishment of penicillin [5,6]. Globally, it was estimated that over 2.4 million children aged 5-14 years were having rheumatic heart disease (RHD) in the year 2005, and close to four-fifths (79.0%) of all these cases were from less-developed countries and Bangladesh was included [7]. According to revised Jones criteria among children aged 5-15 years in rural Bangladesh the prevalence was 1.2 [8]. A study reported that rheumatic fever is likely to be associated with protein energy malnutrition [9]. Nutrition is a process by which living organism utilize food for tissue functions, life maintenance and energy production. New generation are the future of every country. The children must be well-nourished and healthy so as to grow into healthy adults. The growth and development of the children continues to be a major public health problem in Bangladesh [10]. The problem is directly or indirectly related to abnormally high child mortality and morbidity in the country, especially 5-15 ages of children.

Methodology

Study design and study site

This study was a descriptive cross-sectional study conducted at out-patient department of National Centre for Control of Rheumatic Fever and Heart Diseases (NCCRF and HD) in Dhaka capital city of Bangladesh.

Study period, study population and sampling technique

This study was conducted for a period of 3 months (March to June) in the year 2016. The children who suffered from rheumatic fever and had attended a National Centre for Control of Rheumatic Fever and Heart Diseases (NCCRF and HD) during the period of this study were selected using purposive sampling technique. A total of 110 children aged between 5-15 years in the National Centre for Control of Rheumatic Fever and Heart Diseases (NCCRF and HD) were recruited and seriously sick children were excluded for participation.

Data collection method

The questionnaire used in this study was pre-tested and finalized prior to the data collection. The questionnaire was prepared using the selected variables according to the study objectives. The English version of the questionnaire was developed and translated to Bangla for data collection. Data were collected from the parents/caregiver of the children using face to face interview technique.

Data processing and analysis

All the collected data were checked, verified and edited. Data analysis was done using a Statistical Software i.e. SPSS version 16.0. Data were analysed according to the study objectives. The descriptive statistics included the frequencies, percentage, mean, median and standard deviation. A Pearson chi-square test was conducted to find the association between variables; P-value less than or 0.05 was considered statistically significant. While assessing the nutritional status of the children, the anthropometric measurementswere taken to identify the Body Mass Index (BMI) of the children. A method previously used in another study was adopted to identify the nutritional status of the children [11].

Results

Socio-demographic characteristic and other information of the children

Table 1 shows that more than half (53.6%) of the children were aged 13-15 years and 60.0% of them were males. Slightly above half (50.9%) of the respondents were from urban area, followed by 29.1% rural area and the rest were from slum (20.0%). About 67.3% of the family had ≥ 4 children. More than two-fifths (44.5%) of the respondent’s housing condition was semi-pacca and 45.5% of them lived at least 3 person per bedroom. Little above three-fifths (60.9%) of the children’s duration of suffering from rheumatic fever was ≤ 48 months. About 69.1% of the children had completed their immunization and 73.6% of the children were fed colostrum. Little above seven-tenths (71.8%) of the children were exclusively breastfed.

Variable Frequency Percentage
Age group (years)  
05-Aug 10 9.1
09-Dec 41 37.3
13-15 59 53.6
Sex  
Male 66 60
Female 44 40
Residence  
Urban 56 50.9
Rural 32 29.1
Slum 22 20
Number of children in the family  
01-Mar 36 32.7
≥ 4 74 67.3
Housing condition  
Pacca 29 26.4
Semi-pacca 49 44.5
Kacha 32 29.1
Persons per bedroom  
2 Person 22 20
3 person 50 45.5
≥ 4 person 38 34.5
Duration of suffering from rheumatic fever  
≤ 48 months 67 60.9
49-96 months 38 34.5
≥ 97 months 5 4.5
Completed Immunization  
Yes 76 69.1
No 34 30.9
Fed colostrum  
Yes 81 73.6
No 29 26.4
Exclusive breastfeeding  
Yes 79 71.8
No 31 28.2

Table 1: Socio-demographic characteristic and other information of the children (n=110).

Socio-demographic characteristics of the parents

Table 2 shows that 35.5% of the fathers had SSC level of education, followed by 20.0% no formal education, 16.4% primary, 15.5% HSC and the rest (12.6%) had bachelor and above level of education. About 32.7% of the fathers were service holders, followed by 29.1% businessmen, 10.9% were daily labourer and 10.0% of them were farmers. Regarding the mothers educational level 33.6% of them had primary level of education, followed by 26.4% who had no formal education and 17.3% had SSC. Most (41.8%) of them were housewives, followed by 19.1% who were business holders and 18.2% of them were service holders. Most (48.2%) of the parent’s family monthly income was ≤ 10000 taka.

Variable Frequency Percentage
Father’s Education
No formal education 22 20
Primary 18 16.4
SSC 39 35.5
HSC 17 15.5
Bachelor and above 14 12.6
Father’s Occupation
Daily laborer 12 10.9
Farmer 11 10
Service holder 36 32.7
Business 32 29.1
Others 19 17.3
Mother’s Education
No formal education 29 26.4
Primary 37 33.6
SSC 19 17.3
HSC 15 13.6
Bachelor and above 10 9.1
Mother’s Occupation
Housewives 46 41.8
Daily laborer 11 10
Service holder 20 18.2
Business 21 19.1
Others 12 10.9
Family monthly income (taka)
≤ 10000 53 48.2
10001-15000 28 25.5
>15000 29 26.3

Table 2: Socio-demographic characteristics of the parents (n=110).

Nutritional status of the children

Figure 1 shows that close to seven-tenths (67.3%) of the children were underweight, followed by 20.9% who had normal body weight and the remaining (11.8%) were overweight.

Figure 1: Nutritional status of the children (n=110).

Distribution of the children by their feeding practices

Table 3 shows that most of the children (63.6%) consumed rice more than 5 times in a week and 46.4% of them took bread more than 5 times per week. More than half (56.4%) of the children took egg 1-3 times in a week and 51.8% of them never took beef in a week. About 51.8% of the children took poultry meat 1-3 times in a week and 41.8% of them took fish 1-3 times in a week.

Name of food Never/week 1-3 time/week 4-5 time/week >5 time/week
Rice 0(0.0) 11(10.0) 19(17.3) 80(63.6)
Bread 8(7.3) 16(14.5) 35(31.8) 51(46.4)
Egg 29(26.4) 62(56.4) 10(9.1) 9(8.1)
Beef 57(51.8) 40(36.4) 8(7.3) 5(4.5)
Poultry meat 50(45.5) 57(51.8) 2(1.8) 1(0.9)
Fish 22(20.0) 46(41.8) 34(30.9) 8(7.3)
Vegetable 5(4.5) 14(12.7) 21(19.2) 70(63.6)
Milk 31(28.2) 39(35.5) 4(3.6) 36(32.7)
Green leafy vegetables 15(13.6) 44(40.0) 30(27.3) 21(19.1)
Yellow fruit 74(67.3) 24(21.8) 5(4.5) 7(6.4)
Sour fruit 82(74.5) 23(21.0) 2(1.8) 3(2.7)

Table 3: Distribution of the Children by their Feeding Practices (n=110).

About 63.6% of the children took vegetables more than 5 times in a week and 35.5% of the children consumed milk 1-3 times in a week. Two-fifths (40.0%) of the children consumed green leafy vegetables 1-3 times in a week and 67.3% of them never took yellow fruit in a week. About 74.5% of the children never took sour fruit in a week.

Association between nutritional status and some demographic characteristics

Table 4 shows the nutritional status of the child was not significantly associated (P>0.05) with age of the child, residence, and father’s educational level. However the immunization status, colostrum feeding, exclusive breastfeeding, mother’s educational level and family monthly income were significantly associated (P<0.05) with nutritional status of the child.

Variables Body Mass Index (BMI) X2 df p-value
Underweight (<18.5) Normal Overweight (25.0-29.9)
Age of the Child
43682 5(6.8) 3(13.0) 2(15.4) 10(9.1) 18.203 2 0.403
43808 33(44.6) 7(30.4) 1(7.7) 41(37.3)      
13-15 36(48.6) 13(56.6) 10(76.9) 59(53.6)      
Residence
Urban 33(44.6) 14(60.9) 9(69.2) 56(50.9) 24.101 1 0.301
Rural 28(37.8) 2(8.7) 2(15.4) 32(29.1)      
Slum 13(17.6) 7(30.4) 2(15.4) 22(20.0)      
Completed Immunization
Yes 44(57.9) 20(87.0) 12(92.3) 76(69.1) 18.1 1 0.021
No 30(42.1) 3(13.0) 1(7.7) 34(39.1)      
Fed Colostrum
Yes 47(63.5) 22(95.7) 12(92.3) 81(73.6) 22.202 1 0.002
No 27(36.5) 1(4.3) 1(7.7) 29(26.4)      
Exclusive Breastfeeding
Yes 46(62.2) 21(91.3) 12(92.3) 79(71.8) 17.601 1 0.001
No 28(37.8) 2(8.7) 1(7.7) 31(28.2)      
Father’s Education
SSC and below 54(73.0) 15(65.2) 10(76.9) 79(71.8) 15.221 2 0.211
HSC and above 20(27.0) 8(34.8) 3(23.1) 31(28.2)      
Mother’s Education
SSC and below 63(85.1) 13(56.5) 9(69.2) 85(77.3) 28.111 1 0.003
HSC and above 11(14.9) 10(43.5) 4(30.8) 25(22.7)      
Family Monthly Income (taka)
≤ 10000 47(63.5) 4(17.4) 2(15.4) 53(48.2) 23.208 2 0.01
>10000 27(36.5) 19(82.6) 11(84.6) 57(51.8)      
Total 74(67.3) 23(20.9) 13(11.8) 110(100)  

Table 4: Association between nutritional status and some demographic characteristics of the children (n=100).

Discussion

This study was conducted to identify the feeding practices and nutritional status of children with rheumatic fever in Bangladesh. In this study about 67.3% of the family had ≥ 4 children. A similar study conducted in Bangladesh reported that more than half out of 477 patients came from a family comprising of ≥ 7 members [12]. More than two-fifths (44.5%) of the respondent’s housing condition was semi-pacca. A similar study conducted in the same hospital (NCCRF and HD) reported that most of the patients attending this hospital were residing at Kacha house and house consisting of less living rooms increases the incidence of rheumatic fever [12]. More than forty five percent of the respondents lived at least 3 person per bedroom. A study conducted in Bangladesh reported that crowding in one sleeping room facilitates the risks of infection. More than two-fifths of the households use only 1 room nationally [13].

Regarding the educational level of the parents, 35.5% of the fathers had SSC level of education and 33.6% of the mothers had primary level of education. A study reported that the literacy rate in Bangladesh is low, 38.2% people have got no education and 55.1% of those aged ≥ 5 years can write a letter for communication [14].

Close to seven-tenths (67.3%) of the children were found underweight. A study in Bangladesh reported that nearly half of children in Bangladesh have chronic malnutrition [15]. A study in 2013 reported that close to half of the world’s 161 million stunted children lived in Asia and more than one-third in Africa [16].

A study reported that mostly the nutritional status of children is highly influenced by feeding practices [17]. About 46.4% of the children took bread more than 5 times in a week and 56.4% of the children took egg 1-3 times per week. More than half of the children took poultry meat 1-3 times in a week and 35.5% of the children consumed milk 1-3 times in a week. About 67.3% of them never took yellow fruit in a week and 74.5% of the children never took sour fruit in a week. In a study carried out in NCCRF and HD, reported that higher risk of rheumatic fever was observed; low consumption of eggs, milk, chicken, fruits, and bread [9].

The nutritional status of the child was not significantly associated with age of the child, residence, and father’s educational level. However the immunization status, colostrum feeding, exclusive breastfeeding, mother’s educational level and family monthly income were significantly associated with nutritional status of the child. A study reported that all children who were simultaneously stunted were also underweight [18].According to the World Health Organization (WHO) conceptual framework there are many factors responsible for childhood stunting, i.e. maternal disease, age, short stature, low educational level of the caregiver, short birth intervals, poor care practices, poor nutritional status, inadequate feeding, poor-quality food, low dietary diversity, inadequate water supply, early cessation of breastfeeding, non-exclusive breastfeeding; and clinical and subclinical infection such as diarrhea and malaria etc. [17,19].

Conclusion

The overall nutritional status of the study participants (children) was not satisfactory. Our findings reveal that more than sixty percent of the children were underweight. It also reveals that 69.1% of the children had completed their immunization and most of them were exclusively breastfed. Nevertheless the immunization status, colostrum feeding, exclusive breastfeeding, mother’s educational level and family monthly income found significantly associated with nutritional status of the child.

Recommendations

The children should be properly immunized and vaccination program for the children against common infectious diseases of childhood should be provided.

Complimentary feeding frequency should be maintained and should contain proper calorie and protein.

Education and more awareness regarding nutrition, breastfeeding and complimentary feeding should be given to the mothers.

References