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ORIGINAL ARTICLE Table of Contents   
Year : 2007  |  Volume : 32  |  Issue : 1  |  Page : 46-48
 

A cross-sectional study of the association of postnatal growth and psychosocial development of the infants in an urban slum of Delhi


Deptt. of Community Medicine, Lady Hardinge Medical College, New Delhi, India

Date of Web Publication6-Aug-2009

Correspondence Address:
Meenakshi
Deptt. of Community Medicine, Lady Hardinge Medical College, New Delhi
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0970-0218.53400

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   Abstract 

Background: Rapid growth of urban slums due to alarmingly increasing urbanization is adversely affecting the growth and development of infants residing in such deprived areas.
Objectives: To study the association of postnatal growth and psychosocial development of urban slum infants.
Methods: 202 infants and their mothers were included in a cross-sectional study conducted in Raja bazaar in 2002. Growth was assessed using anthropometric measurements: weight & length for age and development by psychosocial developmental scale developed by ICMR.
Results: Development was delayed in significantly higher percentage of underweight (W/A<-2 S.D) than normal infants (p value<0.05): gross motor (15.3%& 4.5%), Vision &fine motor (21.1%, 4.6%) and social skills (27.6%, 12.1%). Development of gross motor milestones was also delayed in significantly high percentage of stunted infants with L/A<-2S.D (22.2%) compared to normal L/A (5.6%, p value=0.003). Difference in the percentages of infants was significantly very high (p value0.000) for vision & fine motor (27.5% & 6.9 %), hearing, language & concept development (22.5% & 4.2%) and social skills (42.5% & 11.9%).
Conclusions: Interventions to improve the postnatal growth will be helpful in facilitating the psychosocial development of infants living in urban slums.


Keywords: Postnatal Growth, Psychosocial Development, Infants, Urban Slum


How to cite this article:
Meenakshi, Pradhan S K, Prasuna J G. A cross-sectional study of the association of postnatal growth and psychosocial development of the infants in an urban slum of Delhi. Indian J Community Med 2007;32:46-8

How to cite this URL:
Meenakshi, Pradhan S K, Prasuna J G. A cross-sectional study of the association of postnatal growth and psychosocial development of the infants in an urban slum of Delhi. Indian J Community Med [serial online] 2007 [cited 2019 Nov 21];32:46-8. Available from: http://www.ijcm.org.in/text.asp?2007/32/1/46/53400


Increasing urbanization has resulted in a faster growth of slum population. An alarming growth rate of population (5-6%) was observed over the past decade (1991-2000) in urban slums. Substandard housing, poor sanitation, malnutrition and poverty have a great impact on almost all the aspects of life especially the overall growth and development of children. As it is a well known fact that human being is more postnatal brain developer than prenatal. The growth velocity of human brain is particularly high during first six months of life. Therefore growth faltering during infancy might be a potential risk factor for the psychosocial development of such underprivileged infants residing in urban slums. Although the developmental milestones have been extensively studied in developed countries but there is a paucity of such studies in developing countries. Hence our knowledge of development of children especially those living in urban slums are inadequate. The present study aims to investigate the association of poor growth on the psychosocial development of the infants living in deprived urban slums.


   Material and Methods Top


A cross sectional study was conducted in Raja bazaar, an urban slum near Gole Market with in the vicinity of Lady Hardinge Medical College, New Delhi. The approximate number of jhuggies was 1100 and the number of families residing there was 1900. All the infants and their mothers were enrolled in the study from April 2002 to December 2002. Study subjects were contacted personally by visiting them at their home. A total of 202 infants were examined and their mothers were interviewed. A pre-tested, semi-structured interview schedule was administered to obtain the information about socio-demographic factors. Growth was assessed by taking anthropometric measurements like weight and length. Infants were weighed using an infant weighing scale with an accuracy of +/- 50 gram with minimal clothing. Instrument was standardized periodically and zero error was corrected every time the weight was measured. Supine length of infants was measured with infantometer with fixed head piece. Help of the attendant was taken; infant was kept supine on infantometer and was asked to keep the vertex of the infant touching the fixed headpiece. Legs of the infants were kept fully extended by keeping the knees pressed. Feet were kept vertically at 90 degrees. Movable leg piece was opposed against the sole and the length was taken from attached scale to the nearest of 0.1 cm. the observed values for weight and length were compared with NCHS(National Centre for Health Statistics) standards for age and sex and analyzed. Development was assessed using Psychosocial Development Screening Test developed by ICMR [1] comprising of five major areas 1) Gross motor 2) Vision and fine motor 3) Hearing language and concept development 4) Self help skills or personal skills 5) Social skills. Information regarding that was either self observed or retrieved from mothers. For assessing the development status of the infants, 50th percentile of age of achievement of psychosocial development milestones was taken as reference. Any infant who did not achieve the above named milestones up to 50th percentile of age was considered in the group of delayed milestones and those who achieved were in group of achieved in time. While assessing the development of infants care was taken to make the study subjects comfortable. All the infants were assessed for the items relevant for their age. The data thus collected was fed in computer (SPSS Software) and analyzed for cross tabulation, pertinent statistical test and test of significance.


   Results Top


In all 202 infants and their mothers were enrolled in the study.59.4% infants were below 6 months (9.9% infants were below one month of age) and 40.6% were above 6 months of age.45% females and 55% male infants were their in study group. 88.2% mothers were between age of 18-29 years, 3% less than 18 years and 8.8% were more than 30 years of age.62.9% mothers were illiterate. Of the 37.1% educated mothers, 15.8% were primary school pass, 14.4% middle school pass and 6.9% were high school pass or above.15.7% mothers were working involved in unskilled works. Majority of families (84.7%) were Hindu and 70.8% families were nuclear in structure. 70.8% families belong to upper-lower socioeconomic status followed by 18.8% to lower-middle, 9.4% to upper-middle socioeconomic class according to modified Kuppuswami scale.

[Table 1] shows the development status of all the five domains of psychosocial development of study infants according to their weight for age i.e. normal and under weight (less than 2 S.D). Achievement of gross motor mile stones was delayed in 15.3% infants with W/A less than -2S.D compared to 4.5% infants with normal W/A. Difference was statistically significant( p value=0.021). Development of vision &fine motor (4.6% in normal W/A & 21.1% in W/A <-2S.D, p value= 0.001) and social skills (12.1% in normal W/A & 27.6% in W/A < -2S.D, p value= 0.008) was delayed in significantly higher percentage of infants with W/A less than 2S.D. Even the achievement of hearing, language & concept development and self help skills was delayed in higher percentage of infants with W/A < -2S.D but the difference was not found to be statistically significant (p value>0.05).

[Table 2] shows the development status of all the five domains of psychosocial development of study infants according to their length for age i.e. normal and stunted (less than 2 S.D). Development of all the domains except self help skills was observed to be delayed in significantly higher percentage of stunted infants. Development of gross motor milestones was delayed in 22.2% of stunted infants compared to 5.6% of infants with normal length for age (p value=0.003). Difference in the percentages of the infants with delayed achievement of milestones was very significantly high for vision & fine motor (27.5% in stunted and 6.9 % infants with normal length for age, p value= 0.000), hearing, language & concept development (22.5% in stunted, 4.2% in infants with normal length for age, p value=0.000) and social skills (42.5% in stunted, 11.9% in infants with normal length for age, p<0.001).The development of self help skills was also delayed in higher percentage of stunted infants but the difference was not statistically significant.


   Discussion Top


Results of present study indicates that the development of gross motor, vision & fine motor and social skills was delayed in significantly higher percentage of under weight and stunted infants. Even the development of hearing language & concept development was delayed in significantly higher percentage of stunted infants but higher percentages were not significant in under weight children. Development of self help skills in study infants was not fond to be influenced significantly by the weight and length for age. Such results are due to lesser number of children assessed for the development of this domain under psychosocial development. Vazir et al [2] also observed early attainment of milestones in children with more than equal to 75% of standard weight for age in Hyderabad rural children (0-6yr). Similar results were observed in other two centers at Jabalpur, Chandigarh [3] and Ajmer [4] . Delayed cognitive development in underweight children was also reported by Freeman HE et al [5] , Johnston FE et al [6] and Siman et al [7] . In Pakistani infants also post natal stunting and wasting was found to be inversely related to the age at commencement of motor milestones [8] .


   Conclusions Top


Postnatal stunting was found to be more influential in delaying the development during infancy compared to their weight for age. Interventions to improve the postnatal growth may be helpful in facilitating the psychosocial development of such deprived infants living in urban slums.

 
   References Top

1.Vazir S, Naidu AN, Vidyasagar P. Screening test battery for assessment of psychological development. Ind Pediatr 1994; 31:1465-1475.  Back to cited text no. 1    
2.Vazir S, Naidu AN, Vidyasagar P. Nutritional status, Psychosocial development and the home environment of Indian rural children. Ind Pediatr 1998; 35:959-966.  Back to cited text no. 2    
3.WHO Report of the Workshop of Investigators of Collaborative Study on physical Growth and Psychosocial development. Maternal and Child Health and Family Planning Division, World Health Organization, Geneva, 1991; MCH/ 91.8.  Back to cited text no. 3    
4.Talwar R and Chowdhary B. Cross sectional study of milestones in healthy infants up to age of one year. Indian Medical Gazette May 2001: 125 -34.  Back to cited text no. 4    
5.Freeman He, Klein RE, Townsend JW, Lechtig A. Nutrition and cognitive development among rural Guatemalan children. Am J Public Health 1980; 70; 1277-85.  Back to cited text no. 5    
6.Johnston FE, Low SM, de Bassa Y, MacVean RB. Interaction of nutritional and socioeconomic status as determinants of cognitive development in disadvantaged urban Guatemalan children. Am J Phys Anthropol 1987; 73: 501-6.  Back to cited text no. 6    
7.Sigman M, Neumann C, Jansen Ake AJ, Bwibo N. Cognitive abilities of Kenyan children in relation to nutrition, family characteristics and education. Child Dev 1989; 60: 146374.  Back to cited text no. 7    
8.YB, Yip PSF, Karlberg JPE. Fetal growth, early postnatal growth and motor development in Pakistani infants. Int J Epidimiol 2001; 30:66-72.  Back to cited text no. 8    



 
 
    Tables

  [Table 1], [Table 2]



 

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