Introduction

Undernutrition refers to insufficient supply of energy and nutrients, and inability to meet the body’s requirements to ensure proper growth, maintenance and physiological functions.[1] It covers different health conditions such as stunting, wasting, underweight and thinness. Undernutrition remains an important public health issue affecting the growth and mortality of children, especially in low and middle-income countries.[2,3] Globally in 2022, 149 million children under 5 years of age were estimated to be stunted, 45 million were estimated to be wasted, and nearly half of deaths are linked to undernutrition.[4] According to the National Family Health Survey-5 (2019-20) report, India has the highest prevalence of stunting (36%), wasting (19%) and underweight (32%).[5] The negative effect of undernutrition among the children can be short-term or even last for life time. Children under 5 years of age are most vulnerable to the vicious cycles of malnutrition, infection and resultant disability.[6] Undernourished children have a higher risk of death from common childhood illnesses such as diarrhoea, pneumonia, malaria, poor physical and cognitive development, and an increased risk of chronic disease in older age.[7-9] Besides these, acute malnutrition can result in morbidity, death and disability.[10] Both physical and mental health development is a vital rights of children, and a proper diet may help them reach their best possible state of health.[11] The long-term undernutrition in children leads to delay in motor and skill milestones, low intelligence quotient, lack of socialization characteristics, and more prone to communicable diseases.[6] Other studies also reported the increased risk of cardiovascular disease, type 2 diabetes and rapid weight gain in later years of life due to childhood undernutrition.[12,13] Undernutrition in children is caused by a complicated interplay of the availability, accessibility, and use of food and healthcare services, adolescent pregnancy, low birth weight, lack of breastfeeding, poor socioeconomic conditions, and personal dietary preferences, etc.[14-16]

Therefore, under this backdrop, the present study is conducted among the Garo children of Chidaogre village of West Garo Hills, Meghalaya to assess the prevalence of undernutrition and some of the associated causal factors.

Materials and methods

Meghalaya is one of the hilly north-eastern states of India, bordering Assam on the north and east, while Bangladesh on the south and west, forming a 496 km long international border. Meghalaya consists of three major tribes, such as Khasi, Jaintia and Garo having their own unique cultures, religion and traditions. The Garo community is mainly found in West Garo Hills of Meghalaya and its neighbouring states like Assam, Tripura, Nagaland, and in Bangladesh as minorities. According to their beliefs and religion, the Garos are divided into the Songsarek (following their indigenous beliefs and practices) and the Christians. It is a matrilineal society, and women enjoy the highest privilege in the Garo family structure.

Chidaogre is a village located in the Rongram subdivision of West Garo Hills district of Meghalaya. It is situated 25km away from the sub-district headquarter Rongram and 37km away from the district headquarter Tura. Like any other village of the Garo Hills, Chidaogre was historically the Songsarek homeland. As a result of exposure to other cultures and religions over time, a considerable portion of the people, particularly the young people, became Christian. The main occupation of the Garo people in the Chidaogre village is agriculture. Traditionally, most of the Garo people practiced slash and burn agriculture. Now, with increasing access to education, few people in the village are engaged in government services like ASHA, Anganwadi worker, Anganwadi helper, etc.

The cross-sectional data for the present study were collected from 90 Garo children (40 girls and 50 boys) aged below 8 years through random sampling from Chidaogre village of West Garo Hills, Meghalaya. The data was collected during anthropological fieldwork from 16^th December, 2024 to 6^th January, 2025. Ethical approval was obtained from the head of the village prior to data collection. Participants were informed about the nature and purpose of the study, and their informed consent was obtained. The demographic data includes general information like the name of the informants, age, sex, family income, educational qualification, occupation, type of house, source of drinking water, etc. Data on the child’s health, intake of food supplements, immunization, duration of breastfeeding, mothers’ age at marriage, etc. were collected from mothers. Anthropometric measurements such as height and weight of children were also collected using an anthropometric rod and a weighing scale respectively, following the standard technique.[17]

Data on household income were collected directly from the mother or father of the child. The income was cross-checked, taking into consideration some aspects of socio-economic conditions like type of occupation, type of house, etc. The income was classified as high income group (above 75^th percentile), middle income group (between 75^th – 50^th percentile) and low income group (below 50^th percentile). Data on the educational qualification of mothers and fathers were classified into two groups such as primary/below primary (≤ class V) and secondary and above (≥ class VI). Data on the occupation of mothers were classified as farmers and others. Others include government employees, daily wage earners and housewives. Mother’s age at marriage was classified as marriage before 18 years and marriage at 18 years and above. Duration of breastfeeding was classified as one year/below and two years/above in the present study.

MS- Excel software was used for statistical analyses of the data. The information gathered during fieldwork was entered and compiled in the MS-Excel. All the parameters taken were analyzed statistically to find out the mean and standard deviation. Z-score of -2SD for age and sex was used to classify underweight (weight for age), stunting (height for age) and thinness (BMI for age) according to WHO.[18] The prevalence of underweight, stunting and thinness was analyzed with different variables. In order to test the level of significance, t-test and chi-square test were used in the present study.

Results

The Table 1 shows that the majority of the mothers were farmers (52.2%) and attained secondary and above level of education (61.1%). Similarly, the majority of the fathers were farmers (58.9%) and attained secondary and above level of education (53.3%). Most of the informants in the studied population belong to middle-income group (38.9%). The Table further shows that 57.8 percent of the informants lived in nuclear families, and 61.1 percent of them lived in kuccha houses. Jal Jeevan Mission was the major source of drinking water (64.4%) in the studied village.

Table 2 shows that the mean height of the boys (103.54±15.30 cm) was slightly higher than the mean height of girls (100.03±17.70 cm). However, the mean weight was found to be more or less the same between boys (15.06±4.75 kg) and girls (14.61±4.81 kg). The frequency of both underweight (boys-30.0%, girls-15.0%) and thinness (boys-32.0%, girls-20.0%) was higher among boys than girls. The frequency of stunting was found to be higher among girls (22.5%) than boys (16.0%).

The higher frequency of underweight was found to be more or less the same between high-income families (18.2%) and middle-income families (17.6%) among girls (table-3). The frequency of stunting (27.3%) and thinness (33.3%) was higher among girls from high-income families and low-income families respectively. However, the frequency of underweight (43.7%) and stunting (37.5%) was found higher among boys from low-income families. The frequency of underweight (23.5%), stunting (23.5%) and thinness (35.3%) was higher among girls whose mothers are either illiterate or attained primary education. However, the frequency of underweight (37.5%), stunting (18.8%) and thinness (34.4%) was higher among boys whose mothers attained secondary and above level of education. The frequency of underweight (15.0%) and thinness (20.0%) was found the same among girls whose mothers are farmers and engaged in other occupations. The frequency of thinness (25.0%) was higher among girls whose mothers are engaged in other occupations. However, the frequency of underweight (39.1%), stunting (26.1%) and thinness (39.1%) was higher among boys whose mothers are engaged in other occupations.

The higher frequency of underweight (22.2%), stunting (33.3%) and thinness (33.3%) was found among girls whose mothers married before 18 years of age (table-4). Similarly, the higher frequency of underweight (56.2%), stunting (31.2%) and thinness (43.7%) was also found among boys whose mothers married before 18 years of age. The frequency of underweight (girls-17.6%; boys-39.4%), stunting (girls-26.5%; boys-21.2%) and thinness (girls-20.6%; boys-39.4%) was higher in both boys and girls who received supplementary foods. The frequency of underweight (50.0%), stunting (50.0%) and thinness (50.0%) was higher among girls who did not receive immunization. However, it varies among boys. The frequency of underweight (25.0%), stunting (31.2%) and thinness (37.5%) was higher among girls who breastfed for one year. Among boys, underweight (33.3%) and stunting (20.0%) were found higher in those who breastfed for two years. However, the frequency of thinness (40.0%) was higher among boys who breastfed for one year.

Discussion

The present study shows that the mean height of the boys was higher than girls. However, the mean weight was found to be more or less the same between boys and girls. The present study shows a high prevalence of undernutrition such as underweight, stunting and thinness in both boys and girls. The findings of the National Family Health Survey (NFHS-5) also highlight Meghalaya as one of the highest child malnutrition rates in India, particularly among tribal communities.[5] Several studies show undernutrition as a major public health problem in low and middle-income countries.[8] The prevalence of underweight, stunting and thinness varies across different income groups among girls in the present study. However, among boys, the prevalence of both underweight and stunting was higher in low-income families. Poor socioeconomic conditions, cultural, insufficient nutrient intake and environmental factors are considered as the main causes of undernutrition in developing countries.[19,20] The present study shows a higher prevalence of underweight, stunting and thinness among girls whose mothers are either illiterate or have attained primary education. However, it was higher among boys whose mothers attained secondary and above levels of education. Several studies show that children whose mothers attended secondary or higher secondary education are at lower risk of malnutrition compared to children of mothers with no education.[21,22] Another study shows that children of illiterate or less educated mothers are more likely to be undernourished than children of better educated mothers.[23] Parents with higher education are more effective in protecting their children from childhood undernutrition.[24]

The prevalence of underweight and thinness was found the same among girls whose mothers engaged in different occupations, but stunting was higher among girls whose mothers engaged in other occupations than farmers in the present study. However, these are found higher among boys whose mothers engaged in other occupations than farmers. A study shows that children of mothers who work in agricultural fields have a higher risk of malnutrition.[23] Women working in agricultural fields and household chores may be attributed to economic hardship, low levels of education, and lack of necessary knowledge about proper child care, especially in rural areas.[25]

The present study shows a higher prevalence of underweight, stunting and thinness in both boys and girls whose mothers married before 18 years of age. Children of adolescent mothers are more likely to be stunted and underweight compared to the adult mothers. This could be due to poor maternal nutrition, less education, less access to health services, poor supplementary feeding practices, and substandard housing situations.[26] Another study found that young mothers’ age was associated with infants' low birth weight, preterm birth, stunting, and failure to complete secondary school.[27]

The girls who did not get immunization show higher prevalence of underweight, stunting and thinness in the present study. However, it varies among boys. Immunization is a cornerstone of public health, preventing numerous infectious diseases that can lead to malnutrition and death in children.[28] India is home to one-third of the world’s under-five children with no immunization despite being a major producer of vaccines.[29,30] Undernourished children often exhibit weak immune responses, and increased susceptibility to infections even after immunization.[28] The present study further shows the higher prevalence of underweight, stunting and thinness among girls who breastfed for one year. However, the prevalence of underweight and stunting was higher among boys who had been breastfed for over two years. This undernutrition was higher in both boys and girls who received supplementary foods. Breastfeeding protects children from infectious diseases and affects the nutritional status of the children.[31] With increasing age, children need supplementary foods in addition to breastfeeding. A study shows that an insufficient supply of supplementary foods could be a reason for increasing undernutrition in developing countries.[32]

In conclusion, the present study highlights the high prevalence of different forms of undernutrition in both boys and girls. Underweight and stunting are higher among boys from low-income families, though it varies in different income groups among girls. Girls of mothers who are illiterate or have attained primary education show a higher prevalence of undernutrition. Mothers who married before 18 years of age have higher undernourished children. Immunized girls have a low prevalence of undernutrition, although it varies among boys. High frequency of undernourished children in remote regions like Chidaogre village could be attributed to lack of proper health care facilities, poor socioeconomic conditions, poor connectivity, improper nutrition, and lack of cleanliness, etc. Therefore, it is necessary to educate, spread awareness and knowledge, especially in rural areas about undernutrition and its health consequences in later years of life.

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