Concerning public health situation of under-nutrition in children and anemia in women in Indian Sundarbans delta: a community based cross-sectional investigation

BACKGROUND: The National Family Health Survey-Round 3 in India during 2005–2006 recorded more children and women as anaemic compared to the prevailing situation eight years ago; more children also had wasting. Analysis of this dataset further linked adversity, rather than intrauterine biological processes, with under-nutrition running across generations. Against this background we conducted the present situation assessment in the Sundarbans area of India. The Sundarbans is world’s largest delta with mangrove forest and prone to natural disasters. METHODS: The current community based investigation was undertaken in five villages under Patharpratima block of the Sundarbans. Participants were selected randomly from the lists of eligible children (aged ≤5 year) and married women (≤49 year) prepared for each of the villages. Interviewer administered questionnaire, tools for anthropometry and hematologic auto-analyzer were used. Data from 561 children and 1145 married women (of which 55 were pregnant) were analysed. RESULTS: Underweight and stunting were recorded in 40 and 51 % of the children respectively. Of the 561 children, 47 (8 %), had severe acute malnutrition. Weight for height z-score reflecting acute and chronic state of nutritional deprivation revealed that four of the five villages were in critical stage. One fourth of the women had low body-mass-index (BMI). Hygienic practices of women were also poor; 41 % reportedly used water, mud/ash and not soap to wash hands after defecation. Anaemia prevalence in women of all the villages was >40 % underscoring a sever public health situation. Factors independently associated with anaemia in non-pregnant women (698/1090; 64 %) were residential-village, low (<18.5 kg/m2) BMI of women (Adjusted Odds Ratio; AOR = 1.39; 95 % CI of AOR 1.02–1.89), non-adoption of family planning method (AOR 1.86; 95 % CI of AOR 1.36–2.54; p < 0.001) and adopting contraceptive practices other than oral pills (AOR 1.84; 95 % CI of AOR 1.32–2.56; p < 0.001). CONCLUSIONS: Sundarbans poses its unique public health challenge due to geographical-vulnerability. Securing nutritional support emerges as an immediate need for the study population residing in this natural-disaster prone area of islands and estuaries. The existing situation of anaemia in women requires innovative intervention development and would require addressing health seeking practices. Behavioural intervention appears to be the key