Prevalence of undernutrition and effectiveness of a community-based nutritional support programme to reverse stunting among children under five years of age in an urban slum in Kolkata, India: findings of a one-year longitudinal study

Abstract

# Background Stunting, defined as z-score height-for-age (HAZ) \< -2, is an important contributor to the burden of childhood undernutrition among slum-dwelling residents in India’s metropolitan areas. Calcutta Rescue (CR) is a non-governmental organisation that provides medical care and nutritional support to slum-dwellers in Kolkata, India. CR undertook a study in Liluah Bhagar, an urban slum, to 1) establish the prevalence of undernutrition among children under five years of age, 2) evaluate the impact of a pilot nutritional support programme on growth patterns of a consecutively selected group of stunted children, and 3) identify socio-economic predictors of stunting. # Methods For the prevalence assessment (April-June 2018), we conducted anthropometric measurements using standardised World Health Organization (WHO) growth measurements for weight-for-age (WAZ), height-for-age (HAZ), and weight-for-height (WFH). For the longitudinal study, we recruited stunted children and collected anthropomorphic data every three months for one year (December 2018-December 2019). # Results The prevalence assessment of 116 children revealed 59% of stunting, 44% underweight and 12% of wasting. Follow-up of 42 stunted children in a pilot nutritional programme improved stunting over time (*b* =0.07, 95% CI 0.05 to 0.039, *P*\<0.001), with a trend towards clinical improvement at one year. Linear mixed model analysis revealed household income was a negative predictor of stunting (*b* =-0.38, 95% CI -0.66 to -0.09, *P*=0.010). # Conclusions This study highlights the burden of undernutrition in marginalised slum-dwelling children in India and the benefits of a pragmatic, education-focused nutritional intervention programme. Further studies are required to determine what predictors other than income are associated with stunting to then determine what interventions are likely to effect long-lasting and sustainable changes to growth in this vulnerable population.