Globally, malnutrition leads to inappropriate growth in one out of every three children. Improper growth is seen as stunting (low height for age), wasting (low weight for height) and overweight. In India, 38% of children are stunted and 21% are wasted; and most under five death are related to malnutrition.1According to the National Family Health Survey 2015-16, in Maharashtra, 34% of under-five children were stunted and 26% were wasted.2 Despite different nutrition programs such as Maharashtra Nutrition Mission (2005), the under nutrition scenario in Maharashtra remains poor.3

Diet with adequate nutrition value is essential for proper growth of children.4Food shortage in the household and lack of nutritive knowledge can result in malnutrition. Hence, nutrition education and healthy diet is important to combat malnutrition in under-five children.4

Main objective of the study is to assess the impact of nutritional advice and special nutrition mix in terms of improved nutrition status in malnourished under-five children.

The interventional longitudinal study was conducted from June 2022 to May 2023 on 240 under-five children, catered by three Anganwadi centers which were randomly selected and located in the urban field practice area and urban health center (UHC), Kasaba Bawada, Kolhapur. Purpose of the study was explained to Anganwadi worker and caregivers of under-five children. Informed consent from parents of children and ethical approval was obtained before initiation of the study. The nutritional status was evaluated and graded according to weight for age criteria of the nutrition sub-committee of the Indian academy of paediatrics.5 Counselling session on nutrition and promotion of health was carried out for all the mothers of the children. Malnourished children were given a nutrition mix to be taken thrice a week consisting of (g): soybean (30), wheat flour (15), and ragi (15), groundnut (10), jaggery (30g), and ghee. The nutritive value per 100gm of special nutrition mix was 380 calories with protein (18.8g), fat (14.7g), carbohydrates (30.1g), iron (4.8mg), calcium (130mg), carotene (770µg). The special nutrition mix was a supplement and not a substitute for the routine diet or nutrition supplement under integrated child development service (ICDS). Weekly dispense of the required amount of special nutrition mix was provided to Anganwadi centers for distribution. In the case of absentee, the balanced supplement was provided on the up-coming week. At the end of the study, the nutrition status of the children was determined for the assessment of the changes.

Data collected were analyzed by SPSS v 21 software. Association between gender and grades of malnutrition was determined by chi-square test; paired t-test to determine the significant weight increase. P-value <0.05 was considered statistically significant.

Total Of 240 children, 51.3% (n=123) were male and 48.7 % female (n=117).

The prevalence of malnutrition was observed in 25% (n=60) children. Out of which 17.5% (n=42) and 6.7% (n=16) children had grade 1 and 2 malnutrition, respectively. Only 2 (0.8%) children were found with grade 3 malnutrition. Grade 1 malnutrition was observed more in females (n=23), whereas most of the males had grade 2 (n=10) and 3 (n=2) (table 2).

Table 1: Gender wise distribution of Nutritional Status (IAP classification)

No association was observed between gender and malnutrition grades (P=0.51).Post intervention, all grades of malnutrition improved by a grade. A significant improvement was observed between initial weight and final weight of under five children male (table 3a) and female (table 3b) at 5% level of significance (P<0.001).

Table 3: Nutritional status grading of underweight children at the end of 18 months

SD = Standard deviation. N-Normal

Malnutrition impacts child survival, growth, rate of infection, and disease.6 the determinants of malnutrition are poverty, food insecurity and maternal education.1Evidence suggests intervention in the form of education and diet can help improve malnutrition.4, 7This study was aimed to collectively assess the effect of nutritional advice given to caregivers and a premade nutritional mix given to malnourished children.

The varying grades of malnutrition in under five children is similar to previous.4,8,9 Female children were predominantly affected by grade 1 malnutrition while in male children, it was grade 2 and 3 contrary to the observations made by Gupta et al.4However, the lack statistical significance between gender and malnutrition; gender and weight gain implies that malnutrition is a grave condition affecting the under-five children of either gender and is reversible with dietary changes. According to previous reports,11-13 nutritional advice to the caregiver of children under the age of five and dietary intervention can effectively improve nutritional status. This is evident from our study as significant weight gain, post interventions. Findings of the study further validate the premix to be an effective supplement to improve the nutritional status and suitable for children of either gender or age (below 5 years).

In current pilot study, the limitations were that stunting, and wasting were not calculated; post interventional, anthropometric parameters were not evaluated. Improvement in weight could also be age related which was not studied here.

Special nutrition mix is effective in improving the nutrition status of malnourished under-five children. Dietary intervention is an effective strategy in the improvement of malnutrition.

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