Healthcare. 1. Healthcare. 1. Public Health and Epidemi

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Public Health and Epidemiology
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Title of the Project: Undernutrition in children under two years of age in Lahore, Pakistan
Study Duration: 24 months
Project Summary
Undernutrition is one of the leading causes of childhood mortality in developing countries.
Studies have shown a positive significant association between poor childhood nutrition and
functional impairment and slow cognitive development. Pakistan is experiencing childhood
mortality due to undernutrition at an alarming rate. Studies reveal that multiple factors affect the
nutritional status of children, but there is a dearth of information on undernutrition of children
aged two years and below. The goal of this research proposal is to ascertain the status of
undernutrition in children aged 2 years and below in Lahore, Pakistan. A detailed literature
review will be carried on the research topic.
The study will be carried out at Children Hospital in Lahore, Pakistan. A case-control study
method will be used to determine the nutritional status of the children. A multistage cluster
sampling method will be used to recruit all the children that meet the inclusion criteria. A semi-
structured questionnaire will be presented to the mothers and the data obtained recorded in either
English or Urdu. A sample size of 100 cases and 200 controls will be used.
SPSS version 20 will be used to analyze data using descriptive and quantitative statistics. Some
of the ethical considerations include informed consent, ethical approval, and voluntary
withdrawal from the study at any time. However, the rather small sample size of the study is
likely to limit the generalizability of the outcomes. The potential outcomes include high
prevalence of childhood undernutrition due to risk factors such as literacy levels of the parents,
environmental factors, early marriage, income level. The findings are likely to be useful to the

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Ministry of health and healthcare experts who can use them to make or revise public health
policy
Rationale and Background
Undernutrition is the leading cause of child mortality globally. The 2013 report by the Global
Burden of Disease Study showed that 21 per cent of the total deaths in children aged five years
and below was caused by childhood undernutrition (Mokdad et al., 2016). The problem is still a
public health concern in most of the low- and middle-income countries such as Nigeria, India
and Pakistan (Akhtar et al., 2013). For instance, the report by Mokdad showed that childhood
undernutrition in those aged five years and below was responsible for 428 deaths per 100,000,
whereas 96% of those aged two years and below did not receive sufficient diet based on the
World Health Organization (WHO) recommendations (Rawe, 2012). The standard recommended
diet for children below two years include breastfeeding, consumption of semisolid, solid and soft
foods, a variation of foods containing proteins, carbohydrates, and fruits (World Health
Organization, 2010). An improper diet affects the health of children and leads to a high death
rate (Black et al., 2013). Multiple studies have found a positive significant association between
poor childhood nutrition and functional impairment and slow cognitive development (Tariq,
Sajjad, Zakar, Zakar, & Fischer, 2018; Grantham-McGregor, Fernald, Kagawa, & Walker,
2014).
Child health is deemed a critical pointer of socio-economic development. It is for this reason that
the fourth aim of the Millennium Development is to minimize and control childhood mortality by
75% by 2015. However, Pakistan is still experiencing childhood mortality due to undernutrition
at an alarming rate (Unicef, 2014). For instance, the 2013 report on Child Nutrition of children

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aged below five years showed that 42% were affected by stunting, 14% by wasting and 31%
were underweight (UNICEF, 2013). There is an increase in stunting among Children in Pakistan
by 12.7% within 10 years (Government of Pakistan, 2011). Likewise, wasting increased by 3.5%
within the same period.
An evaluation of the nutritional status of children is a significant aspect of improving child
health. Studies reveal that multiple factors affect the nutritional status of children. These include
maternal literacy, the use of healthcare services and financial status (Katepa-Bwalya et al., 2015;
Owoaje, Onifade, & Desmennu, 2014), other factors include migration, awareness and economic
equality (Keino, Plasqui, Ettyang, & van den Borne, 2014; Bain et al., 2013). Nevertheless,
micronutrient consumption is deemed to be the most appropriate in improving child health
(Black et al., 2013). The most prevalent nutritional problem in low-income countries includes
deficiency in Vitamin A, Iron and anaemia; which lead to stunting, underweight and wasting
(Food and Agriculture Organization, 2015). Most of the studies on undernutrition in children in
Pakistan have focused on children aged five years and below and others have considered few
health factors. There is, therefore, a need to undertake a study that could highlight undernutrition
in children aged 2 years and below in addition to focusing on multiple health factors. This is
because childhood undernutrition needs to be considered at an early age when the child is
developing because when left to an advanced age, the child is likely to have developed
permanent cognitive and physical impairment.
Study Goals and Objectives
The goal of this research proposal is to ascertain the status of undernutrition in children aged 2
years and below in Lahore, Pakistan. The study will accomplish this objective by undertaking a