Secular Trends in Growth of Preschool Children from Rural Maharashtra, India

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INTRODUCTION

Positive secular trends in body dimensions and growth rate have been apparent all over the world in both genders during the last century (1). The extent of secular changes has, however, varied during different periods in different populations and in intensity. Most important factors to influence secular growth changes are improvements in environment, food availability, and elimination of chronic hunger. In the 1980s', secular change has come close to a halt in Bulgaria, Italy, Sweden, Austria, and many developed countries while it continued in Belgium, Czech Republic, Germany, Hungary, and Poland (2). Studies in India investigating secular changes are scarce and more so with preschool children. Most studies have examined such changes for adolescent growth (3), or for menarcheal age in adolescent girls (4) or for the final sizes at adulthood (5,6).

Physical growth in children is one of the best indicators of overall health and well-being of a population. Secular changes in child growth are of primary importance in determining the impact of general social and economic changes and specific public-health interventions. Preschool age being a period for rapid growth would be ideal for observing secular changes. Moreover, it is a sensitive period as growth retardation during early period of life is known to affect the growth significantly during adolescence and the final size at adulthood (7).

India has progressed on several fronts and is believed to pass through a nutritional transition too (8). For example, government data (Table 1) reveal the changes in macro- and micro-level indicators during the 20 years period from 1981 to 2001. First, literacy in the state of Maharashtra increased from 46.7% to 70.84%. In particular, female illiteracy, which is known to be Associated with child health and mortality (9), has dropped from 79.34% to 45.84% in rural Maharashtra. In fact, the percentage of young mothers who had completed mid-level school education in our study during 2001 was very high (75%). Second, the developmental changes are notable in terms of the length of pucca roads, which has almost doubled during the said period of 15 years. Thus, roads for access to all study villages were improved greatly. Similarly, proportion of houses with electricity has increased by three times. Major occupation in 1981 was agriculture (cultivation and labour selling); 83% of families were engaged in it. However, this proportion reduced in the last 20 years, indicating that almost 35% heads of families in 2001 were engaged in occupations other than agriculture; especially individuals of younger generation were keen in searching jobs in nearby cities. The official data, thus, show a substantial increase from Rs. 2,435 to Rs. 29,204 in per-capita annual income of rural families. Consequently, changes in lifestyle and possession of various assets, like television (24.7%), two/four-wheelers (9.6%), and telephone (4.4%), were notable compared to negligible proportions in 1981.

At the micro-level too, several improvements were seen. For example, type of house improved considerably, and more so with regard to the reduction in houses having kaccha roof (73.5% to 58.6%). Similarly, number of houses with more than two dwelling rooms has also increased in the last 20 years. More importantly, significant increase (18.3% to 68.4%) in proportion of houses having access to safe drinking-water was observed. This was not true with regard to sanitation coverage as only 22% of households in 2001 had these facilities. Therefore, despite visible materialistic developments, living conditions in rural areas continue to remain unhygienic. As a result, most health problems in children, viz. childhood malnutrition, especially stunting (33.3%) and infant mortality (55 per 1,000 livebirths) remain to be the major public-health concerns in rural Maharashtra. In the light of the above developments, the study aimed to examine the secular changes in growth of preschool children during 1985 and 2001. …