Malnutrition in Indian Children (0-5 years)

This extensive report delves into the critical issue of malnutrition among children aged 0-5 years in India. It begins with an introduction outlining the scope and purpose of the research, focusing on identifying contributing factors to malnutrition and exploring the relationship between malnutrition and child mortality from diseases like diarrhea, measles, and malaria. A comprehensive literature review examines existing research on malnutrition in India, including its determinants, impact, and the differences between malnutrition and undernutrition. The report details the research methodology employed, including both quantitative and qualitative approaches, data collection methods (interviews with healthcare professionals and secondary data analysis), and the analytical techniques used. The data analysis and findings section (not fully provided in the excerpt) would present the results of the research. The conclusion and recommendations section would summarize the findings and suggest preventive measures to reduce malnutrition in India. Finally, a reflective statement would discuss the significance of the research and its potential impact.

qwertyuiopasdfghjklzxcvbnmqwertyui
opasdfghjklzxcvbnmqwertyuiopasdfgh
jklzxcvbnmqwertyuiopasdfghjklzxcvb
nmqwertyuiopasdfghjklzxcvbnmqwer
tyuiopasdfghjklzxcvbnmqwertyuiopas
dfghjklzxcvbnmqwertyuiopasdfghjklzx
cvbnmqwertyuiopasdfghjklzxcvbnmq
wertyuiopasdfghjklzxcvbnmqwertyuio
pasdfghjklzxcvbnmqwertyuiopasdfghj
klzxcvbnmqwertyuiopasdfghjklzxcvbn
mqwertyuiopasdfghjklzxcvbnmqwerty
uiopasdfghjklzxcvbnmqwertyuiopasdf
ghjklzxcvbnmqwertyuiopasdfghjklzxc
vbnmqwertyuiopasdfghjklzxcvbnmrty
uiopasdfghjklzxcvbnmqwertyuiopasdf
ghjklzxcvbnmqwertyuiopasdfghjklzxc
FACTORS CONTRIBUTING TO MALNUTRITION IN CHILDREN 0-5 YEARS
ADMITTED TO HOSPITALS IN INDIA
03-Apr-13

ACKNOWLEDGMENT

ABSTRACT

TABLE OF CONTENTS
CHAPTER 1 – INTRODUCTION.........................................................................................................................1
1.1 Overview..............................................................................................................................................1
1.2 Structure of the report..........................................................................................................................3
1.3 Focus and Purpose...............................................................................................................................4
1.4 Research Question...............................................................................................................................5
1.5 Framework and analysis......................................................................................................................5
1.6 Potential Significance..........................................................................................................................7
CHAPTER – 2 LITERATURE REVIEW...............................................................................................................8
2.1 Introduction..........................................................................................................................................8
2.2 Some facts about India.........................................................................................................................8
2.3 Determinants of Malnutrition..............................................................................................................9
2.4 Impact of Malnutrition.......................................................................................................................10
2.5 Difference between malnutrition and under-nutrition.......................................................................11
2.6 Immune System.................................................................................................................................12
2.7 Relationship between malnutrition and infection..............................................................................13
2.8 Signs and Symptoms of malnutrition.................................................................................................14
2.9 Causes of malnutrition.......................................................................................................................15
2.10 Diagnosis of Malnutrition................................................................................................................17
2.11 Malnutrition Treatment....................................................................................................................17
2.12 Prevention of Malnutrition...............................................................................................................17
CHAPTER – 3 RESEARCH METHODOLOGY....................................................................................................21
3.1 Introduction........................................................................................................................................21
3.2 Research Aim and Objectives............................................................................................................21
3.3 Research Approach and Philosophy..................................................................................................22
3.4 Research Type....................................................................................................................................23
3.5 Research Methods..............................................................................................................................24
3.6 Data Collection Methods...................................................................................................................25
CHAPTER – 4 DATA ANALYSIS AND FINDINGS............................................................................................26
CHAPTER – 4 CONCLUSION AND RECOMMENDATIONS................................................................................27
CHAPTER – 5 REFLECTIVE STATEMENTS.....................................................................................................28
REFERENCES.................................................................................................................................................29

LIST OF FIGURES

CHAPTER 1 – INTRODUCTION
The gravest single warning to worldwide public health is Malnutrition
1.1 Overview
Children are in a regular stage of development. Their corpse is in a period of continuous
repair and growth. These developing children need regular supplementation of calories, micro-
nutrients and protein for the reason to maintain the velocity of enhanced demands of the body.
Since, childhood is the most susceptible stage in the human life, so nutritional shortfalls will lead
to obstructing the development of the body. If such nutritional shortage is continued for a long
duration, it affects on the growth faltering apparent in the type of small height, low weight and
low IQ. The country’s future is determined by the rising generation of the nation. It is the health
position of the nation’s children, which signifies the health status of individuals of that
countryside (Burke, 2012).
As this increasing generation is going to be the productive citizens of upcoming period,
they must be healthy enough so that they can have maximum utilization of their productive age.
Scientific evidence has given that beyond the age of 2-3 years, the chronic malnutrition effects
are irreversible. The single largest contributor to mortality of below five is child malnutrition,
which is mainly due to slow recovery from illness and higher susceptibility of infections.
Misconception prevailing in the recent period is the unavailability of an adequate amount of
food. In between 6 to 18 months, a young child needs only 200-300 kcal food, in order to
maintain the normal development and growth, but due to the inadequate knowledge or
understanding of parents about feeding practices, they don’t supply enough food to their children
leading to uncertain growth and as a result illness or death of a child (Chopra, 2013).
By no means, India is a poorest nation on the globe, as it doesn’t have the lowest
expectancy of life and literacy rate as well as it has highest AIDS/HIV rate. It is estimated by the
World Bank that India is ranked second in the world in regards to the number of children
suffering from the problem of malnutrition. India is one of the largest in the globe where
underweight children are quite common. It is nearly double that of Sub-Saharan Africa with
terrible consequences for mortality, mobility, economic growth and productivity. The UN
measures that 2.1 million of Indian children die before attaining the age of 5 years, mostly due to
preventable illnesses, such as typhoid, diarrhea, measles, pneumonia and malaria. Recent
1

estimates propose that malnutrition is allied with about 50 percent of all deaths within children
(Denyer, 2013).
The malnutrition prevalence in India varied across states, with Madhya Pradesh recording
the highest rate (55%) and Kerala is amongst the lowest (27%). In children malnutrition is not
exaggerated by food eating alone, it is also inclined by quality of care for the child, access to
health services and good hygiene practices and pregnant mother (Malnutrition, 2011). Girls are
at more risk of malnutrition than boys, due to their low level of social status. Malnutrition in the
early period of childhood has serious, long term outcomes as it impedes sensory, motor,
emotional, social and cognitive development. Malnourished children are less expected to achieve
well in their school and more possible to grow into malnourished adults, at higher risk of disease
as well as early death. Around one third portion of all adult women in India is underweight.
Inadequate care of girls and women, particularly at the time of pregnancy, results in babies’ low-
birth weight. Almost 30 percent of every newborn has a low birth weight, which make them
vulnerable to further disease and malnutrition (Muoneke and et.al., 2011).
Mineral and vitamin deficiencies also influence the development and survival of children.
According to DeMaeyer and Adiels – Tegman (1985), the prevalence of Anemia in children is
very high, particularly in the case of developing countries and commonly it is multifactorial.
Anemia affects 74 percent of children below the age of three, 50 percent of women and above 90
percent of adolescent girls. Deficiency of iodine that reduces capacity of learning by up to 13
percent is general, as less than half of all households use iodized salt. Vitamin A deficiency that
increases morbidity and mortality as well as causes blindness among pre-schoolers, also remains
a health issue of public (Nordqvist, 2010).
In the subsequent chapter of this report, the researcher is doing an in depth analysis of
malnutrition. In this regard the research will be conducted on topics related to the relationship
between malnutrition and child mortality from acute respiratory illness, diarrhea, measles and
malaria conditions, which account for over 50 percent of deaths in children globally. Moreover,
the factors that lead to malnutrition in Indian people will also be examined in the body of the
report (Basavanthappa, 2008). In addition to this, the reader would be able to know about
symptoms, tests, treatment, complications and ways of prevention for such type of health issue.
Further, many people are found confused with the terms of hunger and malnutrition as well as
believe that both have equal meanings and consequences. In reality malnutrition and hunger is
2

not the same thing; however, they often go simultaneously. At times everyone feels hungry and
is the signal for the body that it requires food. Once individual eat enough food to satisfy his/her
needs, hunger goes away until the stomach is unfilled again (Brothers, 2005). People who are
chronically malnourished does not have the nutrients being required for proper development of
health. Someone can be malnourished for very short or long period of time and the situations
may be severe or mild. People who are malnourished are more likely to have poor health
expected and in severe cases, they may even die. On the basis of the UN World Food Program,
925 million of people in the whole world do not have a sufficient quantity of food to eat.
Malnutrition and chronic hunger can cause major health issues. People who feel hungry
repeatedly are expected to be underweight, considering a lot less than an average person of their
size. If malnourished as a child, their development might also be stunted, making them much
shorter than average. In developing nations, 1 out of 4 children younger than age of 5 are
malnourished (Klerk, 2009).
1.2 Structure of the report
The present research report will progress in a sequential manner because every chapter
will be interlinked, i.e. the subsequent chapter would proceed only after the completion of its
preceding section. The report structure is as follows:
Chapter 1: Introduction – This part of the dissertation is inculcating an overview of the subject
matter, which will be analyzed in the research. Moreover, it also includes a brief synopsis of
focus and purpose, significance along with the framework and analysis of the study.
Chapter 2: Literature Review – This section of research will evaluate the work that is already
done by several other authors on a particular topic. The initial explanation of the literature review
will speak about malnutrition and it’s causing factors. Further, it will guide the reader about the
test, symptoms and prevention of this disease. Varied academic books, journals, articles and
online materials will be reviewed by the researcher to complete this part. The chapter holds
considerable worth as it will support in comprehending the viewpoint of other authors and in
determining a gap of their works.
Chapter 3: Research Methodology – This will present distinct methodologies that the researcher
will employ for gathering relevant information and analyzing it. The discussion will involve aims
3

and objectives, data collection techniques, research question, research approach, data analysis
method, ethical considerations and research limitations.
Chapter 4: Data Analysis and Findings – The data, which will be accumulated for the purpose of
primary research, will be examined under this heading. It will basically involve results
assessment so that appropriate inferences could be produced.
Chapter 5: Conclusion and Recommendations – This chapter will contain a conclusion drawn
from the research findings and on the basis of it, the researcher will recommend some preventive
measures to lessen the number of malnutrition in a country.
Chapter 6: Reflective Statement – This final chapter will provide importance of selecting the
particular topic for study. Moreover, it will also reflect the knowledge, which would be gained
by researcher after conducting the present research. Further, the discussion will define about the
agency or institution that may be benefited by getting the results of this study.
1.3 Focus and Purpose
The main focus of this research is on factors that are causing malnutrition among children
of age group 0 to 5 years admitted to the different hospitals of India. The area of study is Indian
rural and urban children that are suffering from chronic hunger and malnutrition. The particular
region is chosen for the study, as a consequence of malnutrition is largely found in Indian
population. This is basically due to poor health and lack of education in the country. Moreover,
the Indian government is less concerned about the health of its population that leads to higher
rates of malnutrition in the nation (Majumdar, 2005).
Aim – To identify the factors that are causing malnutrition in children belonging to the age group
of 0-5 years in India is the ultimate aim of this research report.
Objectives – In order to realize the overall aim of study the following objectives are required to
be accomplished by the researcher:
 To gain understanding about malnutrition and its symptoms.
 To identify the key diseases that are interlinked with the malnutrition.
 To examine the preventive measures and their effectiveness.
4

 To define reasons behind the excessive prevalence of malnutrition is children of age
group 0-5 years.
Various researches have been conducted on the topic of mal-nutrition in relation to Indian
children. Moreover, several researchers have made an attempt to find out its controlling
measures and preventive steps to be taken by the country’s government and the general
population. There are several factors, which are responsible for the rising problem of mal-
nutrition in the nation. Further, the diseases such as, malaria, acute respiratory, diarrhea and
measles leads to numerous deaths in children on a global level. But, till date no study has been
able to find out the relationship between mal-nutrition and child mortality due to these diseases
(Rice and et.al., 2000). Thus, the purpose of present research is to discover connection between
malnutrition and severe diseases. Moreover, the findings will provide that how different serious
diseases add in raising the number of malnutrition among Indian children. Further, the available
studies have not provided the effectiveness of preventive measures that are taken by the
government in relation to control such issue of public health, which will be addressed in this
particular research. In addition to this, the researcher will stress on finding out the reasons of
prevailing the given severe diseases and malnutrition in children of 0-5 years (Basit and et.al.,
2012).
1.4 Research Question
The given are some questions, which is required to be addressed by the researcher for the
purpose to complete the present dissertation adequately. These are as follows:
 What is meant by the term malnutrition and its symptoms?
 What are the main diseases that are interconnected with the malnutrition?
 How malnutrition can be prevented by taking effective measures?
 What are the reasons behind too much prevalence of malnutrition in children of 0-5
years?
1.5 Framework and analysis
The analysis and framework part of the dissertation basically gives details about the steps
in which the study will be performed. The framework section of the report presents an
explanation of several methodology and tactics adopted for undertaking the research. It primarily
presents the practical framework of varied research approaches utilized in the report. Discussions
5

in relation to data collection method, research techniques, analysis and sampling technique is
also given (Bhavsar, Hemant and Kulkarni, 2012). The significance of this part is substantial as
the authenticity and validity of the research will be recognized through it. An all encompassing
plan of analysis is essential, as it adds the researcher in espousing and identifying the correct
path while undertaking the research. The below mentioned techniques are implemented in the
present report for performing the research successfully:
 Research Design – It covers the methodology plus procedure employed for conducting a
study. The designs are of two types i.e. descriptive and casual and the other one is
exploratory. In this dissertation, descriptive research design will be utilized as there is
specific research question in the intellects of the researcher and will prove useful in
investigating factors that are increasing the number of children affected by malnutrition
in India (Massingham, Massingham and Diment, 2012).
 Research Philosophy – Research philosophy supports the investigator in identifying a
particular investigation pattern. Both Interpretivism and Positivism research philosophy
will be adopted in the present report (Janes, 2001).
 Research Approach – The researcher will make use of inductive research approach in the
dissertation, as he will firstly observe the things, assume activities pattern, form a concept
and then at last originate a theory. No hypothesis testing will be implemented in the
present case and hence, inductive approach will be used (Hansen, 2011).
 Research Type – Both quantitative and qualitative type of research will be adopted in the
current dissertation.
 Data Collection Method – Data will be gathered from secondary and primary sources.
Primary data will be accumulated by conducting interview of health practitioners
providing services in regions of India, which accounts for more malnutrition cases. The
researcher will ask both open and close ended questions to the interviewee. Secondary
information will be collected through books, journals and online articles containing
materials related to this topic (Dey, 2002).
 Sampling Technique – For selecting the sample of health practitioners in order to conduct
interview, which will represent the entire population, the researcher will make use of
simple random sampling (Coram, 2011).
6

 Data Analysis Technique – The accumulated data will be examined by using quantitative
and qualitative methods. For qualitative method, thematic analysis will be used to create
themes of data so attained. Further, graphical illustration of data will also be conducted to
bring a constituent of statistical accurateness of findings (Kelemen and Rumens, 2012).
1.6 Potential Significance
The present report holds an academic as well as practical significance. Till date only
general consequences and causing factors of malnutrition have been studied by several
researchers. The available report will provide insights about symptoms, test, treatment and
prevention of malnutrition. Further, there were no previous studies being conducted on
examining the effectiveness of the government and health sectors programs working towards
controlling the prevalence of malnutrition in India. There is no single cause of malnutrition;
rather it can be arise due to some severe diseases also. Thus, this research will provide discussion
on to what extent diseases like, diarrhea, cholera, malaria, etc. are contributing in increasing the
number of malnutrition. It will support others researchers with their part of work (Amaratunga
and et.al., 2002).
The research also holds possible relevance for practical purposes. At present, although
government and health care units are paying consideration to control the pervasiveness of
malnutrition, but the extent to which these policies and programs are valuable will be analyzed in
this report. Hence, the results will be helpful to Indian government in implementing adequate
strategies to lower down malnutrition in a country.
7

CHAPTER – 2 LITERATURE REVIEW
2.1 Introduction
India being the biggest democracy with several booming and dominating sectors has
developed a lot on its rate of literacy as well as other such things at worldwide level. But, still
various evils exist in India, which is strongly affecting the society along with the development of
nation as a whole. Among them, one of the major health issues is “Malnutrition”. Every year
numerous innocent children die because of malnutrition, as they are not able to get sufficient
food and moreover the food they receive is of inferior quality. In addition to this, lack of health
facilities, awareness plus cleanliness are further annoying the problem (Kaur, 2013).
At present, the condition is so grave that it requires an immediate action. Today, India has
enough resources and food such that they can feed almost all underprivileged children. But data
proves that every year many children died due to malnutrition. On one side, India is making
adequate development in many sectors however, on the other side, its children are not getting
enough quantity or quality of food (Overcoming the Curse of Malnutrition in India: A
Leadership Agenda for Action, 2008).
2.2 Some facts about India
Around 42.5 percent of Indian children are suffering from malnutrition, which means that
each second a child is not getting adequate amount of food. On the contrary, 11 percent of Indian
population is over nourished and are consuming wrong or extra calories. All across the globe,
figure of underweight children is on peak in India and it is more shocking truth that this digit is
double than the Sub-Saharan African area.
It is confronted by the study known as “Save the Children” that in the development of
child, India ranks lower in comparison with the other poor nations of the world. Malnutrition,
ultimately results in the death of children. Out of all child deaths in India, 50 percent are the
resultant of undernourishment. Lack of adequate food makes a child more prone to several
diseases like malaria, diarrhea, measles and pneumonia, which ultimately result in the death of
children, even though all such diseases are curable (Rodríguez, Cervantes and Ortiz, 2011).
Moreover, several studies reveal that malnutrition cases are high in Madhya Pradesh, i.e.
55 percent, while Kerala stands at lower point by 22 percent cases of malnutrition. Girls suffer
more from this health problem as compared to boys in India, due to prevalence of gender
8

discrimination in the country. A malnourished infant will develop into an adult by having less
mental and physical growth, as the damage caused by the reduced availability of food in the
initial two years of life is almost not possible to be reversed back. Altogether, it will create less
income strata in the society (Tarozzi and Mahajan, 2006).
Moreover, illiterate mothers are unaware about the right or wrong for their kid, who is
being suffering from malnutrition or is undernourished. It is another issue, which has to be
tackled appropriately. Even though good campaigns will definitely play their role in lessening
this health problem but there must be an effective system in which the food should be directly
made obtainable to these people with no involvement of so called long chains. Furthermore,
there is one more clear cause of malnutrition, which is related to dreadful state of public health
and it involves poor availability of fresh drinking water, lack of knowledge regarding
cleanliness, non-availability of sanitation facilities and the significance of all these. Together
with food supply, inhabitants living in remote areas are required to be adequately taught about
importance of all these. It will support in decreasing the gastrointestinal infections, hence aid in
lessening the impact of malnutrition, although won’t remove it totally. This will then surely
assist the government in attaining success like their level of completion in Polio obliteration
program (Pada, 2010).
2.3 Determinants of Malnutrition
There are various determinants of underfeeding that can be grouped as environmental, economic,
health, cultural, political and agricultural factors. Some main factors are given below:
 Environmental – It involves poor sanitation, inferior hygienic practices and lack of fresh
drinking water.
 Economic – This includes poverty, poor purchasing power, major inequality in asset
control and distribution, livelihood insecurity plus gender inequalities (ITHACA, 2003).
 Cultural – It involves dilemmas like, insufficient awareness of nutrition, cultural
practices and beliefs, which lead to poor nutrition (for e.g., restricting food consumption
at the time of sickness or pregnancy), biased intra-familial food distribution, cultural
shifts to choose less micronutrient rich foods, inadequate time available with woman for
infant child care and feeding, high workload on females, early marriage and
discrimination against women or girls.
9

 Agriculture – It involves failure to incorporate nourishment in relation with main farming
as well as cropping systems, which gives result in less availability of nutrient rich foods,
inequalities in distribution of food, seasonal shortages of eatables, decreases in home
gardening and alteration to cash crops (MALNUTRITION, 2013).
 Administrative and Political – This comprises lack of central mechanism for coordinating
nutrition extending from the local to national level, less nutrition surveillance system
concentrated on nutritional outcomes, inappropriate decision making, weak monitoring
and implementation systems, poor governance and lack of accountability too.
 Health – It is related to weak service systems for health, weak educational systems,
recurrent infections, inadequate utilization of services, lack of awareness regarding
nutrition issues and low immunization rates (Mandal, 2013).
2.4 Impact of Malnutrition
Best nutrition is guaranteed by the constant intake of balanced diet that is capable of
helping the people consuming it, in a state of proper health by giving the desired nutrients in
needed amounts. It should deliver the correct amount of fuel to carry out ordinary physical
activity. If an insufficient amount of nutrients provided in the diet of person then it cause a state
of under nutrition. This ultimately led to malnutrition or a severe malnutrition. The complete life
of a child is determined in big measures by the food supplied to him at the time of his initial five
years (Llc, 2010).
Malnutrition is distinguished by huge array of health issues, including, stunted growth,
extreme loss of weight, weakness resistance to injury of intellect and infectious disease. Severe
situations of underfeeding could lead to death of a person. The malnutrition effects on a society
as whole are both indirect (high mortality and morbidity rate among adults) and direct
(subclinical nourishment deficiency disease like Protein Energy malnutrition and kwashiorkor),
which finally distress the overall community. Harmful effects of undernourishment can surpass
from one generation to another. Providing a good nutrient to a child in his initial age can impact
on his/her entire life along with social, mental and physical development. It can also be noted
that a nutritional feature of child’s begins before conception through the mother’s nutritional
condition prior to the pregnancy (Chandhoke and Priyadarshi, 2009).
Nutrition is not only significant for a child but for their mother too. If a woman is not
getting enough nutrition at the time of pregnancy then her child can have Low Weight as well as
10

if a child is not consuming proper nutrition after birth, he/she may be ill with nutritional anemia,
protein energy malnutrition, rickets, night blindness and also from adverse mental growth
(Kapila, 2009).
Nutrition and development of child are two terms, which often go on parallel lines. The
more proper nutritious diet a child consumes, the healthier he/she would be on later stages of life.
The nutrition necessity of an adolescent differs from that of an adult, as the child witnesses the
growth phase. It is owing to such reality that the need to promote healthy nourishment for child
arises. The guidelines for better nourishment of child are given below:
 Persuade child to consume plenty of cereals, but prefer inculcating the eating habit of
wholegrain.
 Child should be offer a huge range of nutritious foods like fresh fruits, green leafy
veggies, legumes, etc (Dancer and Rammohan, 2009).
 Milk products as well as milk are must for the development or growth of child. They act
as great sources of calcium, which guarantees child’s healthy teeth and bones. Low fat
skim milk should not be given to children below the age of 2, but adolescents and young
children could definitely opt for varieties of low fat milk.
 Young children should not be provided with alcohol intake.
 With regards to non-vegetarian food, child must be given fish, lean meat and poultry.
 Foods that contain high sugar and more fat should be avoided.
 Choose foods, which are less spicy and less salty (Khetarpaul and Khetarpaul, 2005).
 When it comes to food preparation, adequate cooking techniques should be used, such as
baking, boiling and steaming, rather than going in for frying, as it tends to involve more
usage of oil, hence making the eatables high in calories.
 Food for a child should be chosen that are less spicy and less salty.
2.5 Difference between malnutrition and under-nutrition
Hunger and poverty are two big issues that the world is facing nowadays. Terms
commonly discussed and heard with respect to hunger are under-nutrition and malnutrition.
Children require food on a regular basis to get energy for the purpose of maintaining as well as
growth of some of the important functions of body. There are several essential nutrients, which
are required by human body in varied quantities on a daily basis. Individuals remain confused
between the terms under-nutrition and malnutrition when reading related articles or when hearing
11

professionals on varied forums. Both the terms have different meanings, such as malnutrition is a
condition when child is not getting enough as well as proper food (Rani, Arends and Brouwer,
2010). Whereas, under nutrition is that form of malnutrition where an individual suffers from
lack of necessary nutrients. Under nutrition and malnutrition are those terms, which are often
loosely referred to as a situation in which children is not able to receive a balanced diet. Though,
malnutrition can be technically both over and under nutrition. In children anemia, scurvy, goiter,
etc. are some health problems that are caused by malnutrition. On the other hand, starvation is
disease occur due to under nutrition and is seen in poor nation with high populace. Malnutrition
can include digestion and absorption problems, while under- nutrition refers to people who are
not getting a sufficient amount of food. In malnutrition, there can be excess, deficiency or
inequity of nutrients, but there is only deficiency in case of under-nutrition (Vemula, Kumar and
Polasa, 2012).
2.6 Immune System
The immune system is competent of swelling effectual immune reactions to an almost
infinite variety of tumor cells or foreign pathogens, while evading injurious immune responses to
self. This system consists of a complicated range of cells, which have developed mechanisms to
both eradicate as well as recognize a broad mixture of pathogenic microorganisms. Both adaptive
immune and innate immunity responses based upon the activities of leukocytes or white blood
cells. Acquired or adaptive immune reactions create in response to particular pathogens and
antigens plus exhibit qualities of memory, moreover quickly responds if the pathogen or antigen
is encountered yet again in the host’s life span. Innate immune defenses are those constituents of
the immune system, such as monocytes, neutrophils and macrophages, which function without
requiring prior exposure to specific antigen. The mixture of these two systems protects the host
against virus (Lawal and Jibowo, 2006).
Innate immunity gives a foremost line of protection against pathogens and could be
quickly activated by following infection. Moreover, positive acute-phase proteins (APP) and
complement proteins also play an active role in fighting with infections. Besides to killing
microorganisms, various phagocytes also stimulate the subsequent stage of the early reaction and
if illness is not cleared, they can start adaptive immune responses too (Amuna and et.al., 2000).
12

2.7 Relationship between malnutrition and infection
A large number of field studies have established that there is bidirectional relationship
within malnutrition and infection. The nutritional condition of host critically concludes the
infection outcome. There are many mechanisms of action in the association among malnutrition
and vulnerability to bacterial infections illness. For example, Protein-calorie malnutrition
damages growth of immune system. Infection itself can results in loss of critical body stores of
energy, protein, vitamins and minerals. During a reaction if immune, expenditure of energy
increases, as the infected host experiences a reduction in nutrient ingestion. Malnourished
children suffer in higher percentage from respiratory and bacterial gastrointestinal infections
(Ijarotimi and Ashipa, 2006). Due to such infection, several diseases arise in the body of child,
which is explained in below paragraphs:
 Stunting – Together with recognized risk factors, such as poor weaning foods and
frequent infection, there is strong facts that various micronutrients (basically iron, zinc
and vitamin A) plays a significant role in linear growth and that deficiencies in such key
nutrients might result in stunting. Vitamin A and zinc affect functioning of immune and
thus create risk of morbidity. Further, iron and zinc shortages can leads to anorexia,
causing decreased intakes of all nutrients that can also limit the child growth.
Macronutrient scarcities in energy and protein may also influence the linear growth of
kids. As stunted linear growth remains common in nation undergoing the nutrition
transition, where supply of energy is usually not constrained, it is logical to assume that
micronutrient shortages are likely to be the major growth limiting nutritional, which
affects in these settings (Ijarotimi and Ashipa, 2006).
 Obesity – Rate of obesity is rising rapidly in India undergoing the nutrition alteration
despite the continued high prevalence of childhood stunting, an indicator of chronic
under nourishment. Although it may seem contradictory, there is rising indication that
below nutrition in early stage of life may predispose individuals towards obesity at later
stages. In this context, it is said by Martorell, Stein, and Schroeder in 2001 that stunting
may predispose child to later stage obesity, but this relationship may only be expressed if
he/she is exposed to energy-dense diet, which are seen in nations including India,
experiencing the nutrition transition (Buam, 2005).
13

 Chronic Disease – The stunting process takes place in the period of early childhood when
nutrient shortages damage linear development during the phase of highest growth speed
and after which revival is seen rarely. Therefore, stunting in early infancy usually leads to
short adult stature. There are also some facts for the untimely emergence of chronic
disease risk features amongst stunted children. Short stature and stunting are connected
with chronic diseases, such as hypertension and diabetes, as they are signs of childhood
undernourishment that might produce alterations in the physiological growth, which
enhance risk factors of chronic disease (Eckhardt, 2006).
2.8 Signs and Symptoms of malnutrition
A symptom is something that the patient reports and feels, whereas a sign is something,
which is detected by other people, such as doctor. For instance, rash may be a sign while a pain
may be a symptom (Ogunba, 2004). Following are symptoms and signs of malnutrition:
 Depression
 Loss of fat
 Higher complications risk after surgery
 Difficulty in breathings or high risk of respiratory failure
 Hypothermia risk, i.e. abnormally low temperature of body
 Some types of white blood cells drops; as a result, the immune system is damaged, by
increasing the infections risk
 Longer healing times for wounds
 Longer recovery from illness
 Higher susceptibility to feeling cold
 Reduced tissue mass
 Reduced mass of muscle
 Irritability
 Fatigue, tiredness or apathy
Moreover, in severe cases following symptoms can be seen on patient body:
 Hair becomes sparse and dry plus falling out easily
 Skin may become dry, thin, pale, cold and inelastic
 Finally, as fat in the face is lost, the eyes sunken and cheeks look hollow
14

 If deficiency of calorie continues for long, there may be failure of liver, heart and
respiratory system
 Sometimes, severe malnutrition might lead to impassiveness
In the context of children belonging to age group of 0-5 years, the malnutrition symptoms
include:
 Sluggishness, excessive crying and irritability together with changes in behavior, like
attention deficit and anxiety are common in children having malnutrition (Fortified milks
documents significant reduction of morbidity in young children, 2007).
 Failure of growth, which means breakdown to grow at ordinary expected rate in terms of
height, weight or both.
 Child may face lack of strength in muscles or muscle wasting, moreover their limbs may
emerge stick similar.
 The skin becomes flaky plus hair may turn dry, straw like and dull in appearance.
Further, there may be loss of hair as well.
 Swelling of the legs and abdomen.
 Typically there are two types of protein energy malnutrition in a child, such as
Kwashirkor and Marasmus (Kataki and Babu, 2002).
 In Kwashirkor, kid is between 1 and 2 with hair changing color to a listless grey, blonde
or red. Face appears round with swollen legs and abdomen. Skin is dark and dry with
stretch or splits marks.
 In Marasmus there may be obvious loss of weight with wasting of muscles. There is no or
little fat under the skin. Hair is brittle or spare.
2.9 Causes of malnutrition
There are several causes of malnutrition, which arises due to lack of important nutrients
that lead to poorer health of a child. In India, long lasting undernourishment is more prevalent
just because people do not have sufficient food to eat. The causes of malnutrition can be divided
into two and first is food related causes, which includes:
 Indigestive and harmful diet – One of the main causes of malnutrition among children is
intake of harmful and indigestive diet. Children that are belonging to rich class families
do have costly eatables but generally such food items are harmful plus indigestive. Intake
15

of these kinds of eateries often leads to lack of hunger and thus, sometimes children may
become malnourished (Dao, 2008).
 Lack of balanced and nutritious diet – Lack of balanced and nourishing diet is
accountable to a large extent for causing malnutrition in India. In our nation, due to the
poverty, there is lack of necessary elements like, carbohydrates, proteins, fats, etc in
regular meal, thus, the appearance of malnutrition in children is usual.
 Lack of regulated diet – Irregular food intake in another leading cause of malnutrition.
The time period of lunch, breakfast and dinner should more or less be permanent. In this
regards indiscipline is very bad. Such bad habits of taking unbalanced meals results in
indigestion and ultimately lead to malnutrition (Oduwole and Okorie, 2010).
In addition to this, there are some general causes of malnutrition in the country:
 Lack of rest and sound sleep – Suffocated bedroom and lack of space affects the sleep of
a person to a great extent. Moreover, excess watching of television and homework in late
hours are some of the causes of improper sleep. This leads to indigestion and in turn
results in malnutrition among the children. Further, lack of sufficient and proper rest also
causes malnutrition.
 Dirty environment – Dirty environment of school and home also leads to malnutrition. In
Indian cities the school and home atmosphere becomes dirty, because of lack of pure and
fresh air, non-availability of playground, lack of sunlight and dirty lanes that hampers
correct nutrition of children. The children working in leather industry, glass factories,
brick industry etc, face the type of unhygienic, dirty and unhealthy environment that is
hard to imagine. Thus, child labor should also be entirely banned, for the reason to avoid
kids from such filthy environment (Microcapsules against malnutrition, 2010).
 Bodily diseases – Several children being infected from the illness are neither able to have
balanced diet nor their body functions in proper way, which results in malnutrition.
 Negligence of children – The children who are neglected in school and at home are more
likely to have a feeling of anger, which also leads to their malnutrition.
 Lack of games and exercise – The lack of games and exercise may also leads to
malnutrition. Although a child takes nutritious and balanced diet, the lack of games and
exercise results in slowing down of their digestive process and therefore, the food is not
digested appropriately causing malnutrition. It also causes bodily deficiencies in children.
16

 Heavy work – The children digestive process gets affected, due to their regular hard
work. Particularly for the children belonging to lower income group, the heavy work
uncoupled with balanced diet take a toll on their mental plus physical growth (SAINI,
2012).
2.10 Diagnosis of Malnutrition
Clinically the malnutrition diagnosis is made by examining the patient, furthermore, mid
arm and body mass index circumference. Those, with less than 18.5 BMI, are required to see
their health care specialists for malnutrition assessment. Children with stunting and development
retardation are needed to be assessed too for malnutrition. Several other diagnostic tests involve
routine blood tests of detection of chronic infection and anemia, etc (Svedberg, 2011).
2.11 Malnutrition Treatment
For those who are able to eat normally, malnutrition treatment involves providing a
complete diet plan with additional nutrient content. The balanced diet plan is required to be made
so as to permit for weight gain together with provisions of minerals and vitamins. On the other
hand, for those who are not capable or able to eat normally, nutrients obtainable as injectable
preparations can be infused directly into one of the blood vessels or a tube of feeding can be
utilized to give nutrients directly into the digestive system (Bhandari and Zaidi, 2004).
2.12 Prevention of Malnutrition
The attempt to bring modern techniques of agriculture initiate in the West, such as
pesticides and fertilizers, to Asia referred to Green Revolution, resulted in declines in
malnutrition level similar to those seen prior in Western countries. This was possible due to
available institutions and infrastructure, such as appropriate facility of roads or public seed
organizations that made seed available in the country. Investments in agriculture, such as
subsidized seeds and fertilizers, reduced prices of food and increases harvesting of food. In
addition to this, breastfeeding in the initial two years as well as exclusive breastfeeding in the
first six months can save lives of 1.3 million children’s (Preventing malnutrition, 2011).
Moreover, restricting size of inhabitants is a projected solution. It is argued by Thomas
Malthus that growth of population can be controlled by voluntary limits through “moral
restraint” and natural disasters. According to Robert Chapman an intervention through policies
of government is an essential ingredient of curtailing worldwide growth of population. Though
17

there are many researchers who believe that the earth has more than enough resources, in order
to sustain its whole population. Instead, these theorists spot to under or unutilized arable land and
unequal distribution of resources as the major cause of malnutrition issues. One effective policy,
for the reason to resolve the access problems of undernourishment is food sovereignty, i.e. the
right of peoples to describe their own agriculture, food, fisheries and livestock systems in
contrast to having food basically subjected to international forces of market. One more possible
long term solution would be to enhance access to health facilities to rural area of the globe.
These facilities can monitor malnourished children, working as supplemental distribution centers
of food and give them proper education on dietary needs (Malnutrition Prevention Program,
2012).
In addition to this, new techniques in agriculture production also have huge potential to
combat malnutrition. By increasing yields of agriculture, farmers can lessen poverty by growing
incomes along with opening area for diversification of crops for the use of households. The
World Bank itself declares to be part of undernourishment solution, stating that the excellent way
for nations to succeed in breaking poverty cycle as well as malnutrition is to develop export-led
economies, which will provide them the financial wealth to purchase foodstuffs on the market of
world.
In order to prevent malnutrition, rather than treat overeating, the Indian government has
started health education in schools. It is one of the best policies, as the education that children
receive today will assist them to select healthier foods in their childhood and in adulthood too.
Moreover, educated people will be more able to provide enough protein and nutrient eatables to
children at their growing or initial stages of life, which will ultimately result in reducing
malnutrition level in the country (Pandey and et.al., 2011).
2.13 Current Indian Response
The Indian government has been adopting a range of programs that have the probability
to improve the present nutrition security state, through the Ministries of Health & Family
Welfare (MHFW), Women & Child Development (MWCD), Panchayati Raj and the Urban
Poverty program and Rural Development. The government also has various cross cutting
programs including the National Food Security Mission, National Rural Health Mission,
Jawaharlal Nehru National Urban Renewal Mission, Horticulture Mission the Rajiv Gandhi
National Drinking Water Mission and National Rural Employment Guarantee Act. Even though,
18

there are several programs in relation to nutrition, there are major gaps in efforts of these public
sectors. It can be that taking in consideration of issue only at state and national level is improper
and there is a requirement for the better attention on community and household levels (Khanand
Azid, 2011). Following are some of the challenges faced by country in removing malnutrition:
 There is no complete national approach or program particularly aimed at enhancing
nutrition, resulting in lack of synergy and convergence between present programs.
 Several programs of government that have the possibility to impact nutrition, like the
programs of well funded agriculture development, lack attention on nutrition as a major
result.
 Most programs are not getting proper target groups such as, young children, infants,
women or the most vulnerable and needy.
 India has not developed a public health nutritionist’s cadre.
 Inadequate national systems to gather and analyze data on nutrition outcomes, lack of
adequate data for decision making and monitoring.
 Poor governance and weak implementation systems lead to the low efficiency of most of
the above mentioned programs (Torpy, Lynm and Glass, 2004).
In addition to this, the Finance Minister of country announced an increase of over 20% in
the budget of agriculture for the period 2013-2014. In a latest initiative, the budget allocated a
huge amount of money for exploiting innovative technologies for agriculture to get better
nutrition. Many in the food and science policy establishment in India have started to consider
that agriculture gives a way to solving India’s serious problem of malnutrition. Many decades
ago, the green revolution has supported in lessening food scarcity problem by introducing high-
yielding varieties of rice and wheat (Collins and et.al., 2006). Dr. M.S. Swaminnathan, the guru
of green revolution and World Food Prize Winner in India, believes that it is now time to tackle
dietary quality. Many people do not get enough nutritious food in their diets, particularly
eatables, which are rich in mineral plus vitamins. Some of these foods, such as pulses, leafy
green vegetables and lentils are too costly for the poor. This is when biofortification comes in
that is referred to strategy of breeding significant minerals and vitamins (for e.g. zinc, iron and
vitamin A) into staple food crops (such as rice or wheat), which is eaten by people on daily basis.
The currently released Indian budget (2013-2014) outlines an arrangement to develop
Nutri-farms, in which zinc-rich rice and wheat, protein-rich maize and iron-rich pearl millet will
19

be grown. These nutri-farms will be piloted in the 200 Indian districts, which are majorly
affected by malnutrition (Nutri-farms to Tackle Malnutrition in India, 2013).
Action of UNICEF – It helps the government in its objectives to prevent and reduce malnutrition
and to progress the development of kids under three years old, particularly those in marginalized
clusters. Moreover, it is supporting the administration to further enhance plus expands the ICDS
quality in many ways; by developing new communication approaches with mothers, by
improving the training of anganwadi workers, by developing community based early childcare
interventions, providing essential supplies and helping to improve monitoring and reporting
systems. The program of UNICEF also aids in Vitamin A supplementation for children and iron
supplementation for adolescent girls. It promotes the universal utilization of properly iodized salt
by educating the locals and working together with salt industry. UNICEF’s contributes to
decreasing malnutrition and hunger rates, specifically among the three main vulnerable clusters,
such as children of socially excluded groups, children of economically disadvantaged
populations and children between 0-35 (Khor, 2003).
20

CHAPTER – 3 RESEARCH METHODOLOGY
3.1 Introduction
The methodology part of research report represents the theoretical facts that are
considered as a base of the survey procedure. Various techniques together with policies are used
for the survey or interview, which is adequately described under this section. Different
possibilities and limitations of research are described by research methodology and it positions
the study undertaken with traditional system of information and current research. The particular
segment specially aims towards the data collection with an exact reason (Hansen, 2011). The
accumulated information could be for practical and theoretical research projects. The ultimate
objective of this section is to assess the basic facts plus figures that has not been determined till
date and identifies the proper solutions for the research subject by a systematic process of
application. In any kind of research paper, the methodology is referred to as an initial important
part that is based on all methodical results and it aids in evaluating information about present
situation prevailing in country, understanding of probable problems, etc (Crossan, 2003).
With respect to this particular research paper, this section will provide a view on different
factors, which contribute towards malnutrition in India. The investigator will employ several
approaches of research, which can be implemented in the present report. This will help to reach
at the final result. The area of investigation taken in this study is the country India where children
were reported to be suffering from malnutrition (Hill and McGowan, 1999). In addition to this,
the investigator will also study the impact of malnutrition on children between 0-5 years of age.
The main reason for malnutrition in children is because of lack of food but there are various
other reasons which lead to malnutrition. The symptoms which show that a child is suffering
from this are also investigated by the researcher. Malnutrition results in short of various essential
elements like proteins and vitamins required in the body which then lead to fatal diseases in
adults as well as children and especially the children. All this have lead to a thought that how
various measures can be implemented so as to reduce the rate of malnutrition.
3.2 Research Aim and Objectives
The present report has been prepared with an aim to identify different factors that lead to
malnutrition among children who belong to the age group of 0-5 years in India. Now, in order to
21

fulfill the above mentioned aim, some objectives have been framed by the researcher which will
provide a guidance to reach the final aim of the research. Following are the objectives-
 To examine the preventive measures and their effectiveness.
 To gain understanding about malnutrition and its symptoms.
 To define reasons behind the excessive prevalence of malnutrition is children of age
group 0-5 years.
 To identify the key diseases that is interlinked with the malnutrition.
3.3 Research Approach and Philosophy
The research philosophy is known as methods which are used to provide knowledge on
different methods in which information has to be assembled. Along with this, it also provided on
how the data is utilized in order to examine them. Through use of a philosophy in research it is
easier to determine the pattern of survey which will be used in the research. This is essential so
that the researcher is able to sustain the process of methodology (Hotho and Pedersen, 2012).
The research philosophy can be classified, broadly, in two types and they are interpretivism and
positivism. The interpretivism approach is the one through which small sample is examined in a
definite time period. It also aims on developing several thoughts and meaning with help of data
induction. On the other side, positivism approach focus on facts as well as figures in place of
meaning as is done in interpretivism philosophy. In addition to this, positivism develops a theory
which is then assessed on this basis and this approach is adequate to be used in case of large
sample survey (Spens and Kovács, 2006).
The research approach aids in increasing the value or usefulness of research report and in
any study type, it could be qualitative and quantitative in nature. In below report, the researcher
will be making adequate utilization of interpretivism beliefs, which will be supportable
identifying the actual facts that is existing in the analysis and in the understanding each section
of dissertation (Rod, 2009). In the review, the researcher will make effective use of both
quantitative and qualitative methods of research. The qualitative approach will support in
accumulating plus assessing data as well as will bring out unidentified relationship between
different infections and malnutrition. Qualitative data will be attained from various existing
sourced on this particular topic. The secondary analysis will help in understanding the affects of
malnutrition and its level of impact on Indian children belonging to age group of 0-5 years.
22

In order to gather the updated plus exact information, the researcher is performing
primary research to know the exact cause of malnutrition and rising reasons in Indian children
through standard questionnaire (Ittonen, 2012). The primary data collection will help in creating
a vivid picture of research topic and will also facilitate the understanding of potential plus
current response or actions of country’s government and several other institutions towards
reducing malnutrition problem. The area of primary research will be Indian health specialists and
data evaluation will be conducted on qualitative basis. After successful data collection, the
thematic analysis will be performing, in order to derive the best results. To accumulate proper
data, the investigator will conduct focus group interview of 50 health specialists of India through
a predefined questionnaire, which will comprise both open and close ended questions for the
respondent’s convenience (Mansourian and Madden, 2007).
3.4 Research Type
At the designing phase of research, the most essential decisions, which is taken by the
investigator is in relation to selection of research type. This selection holds considerable
importance as the methodology by which valuable data will be attained is identified by the
effective support of this approach. The appropriate methods to conduct data analysis are decided
by the type of data in hand and the interest variables along with the distribution of these
variables. Different analysis of single data might reveal several facets of basic data structure
(Ireland, Webb and Coombs, 2005).
The approach towards research has been categorized mainly into three types, such as
analytical, exploratory and descriptive. Exploratory research type is basically done, when
problem in hand has not been adequately defined or at the time its actual scope is unknown. This
type of research helps in indentifying the most pertinent data collection tools and techniques
together with research design (Massingham, Massingham and Diment, 2012). Exploratory
research type is quite casual in nature and commonly reliant on qualitative approach like,
discussion with customers, employees, management or secondary data collection techniques like
evaluating existing data and literature. The main aim of researcher in implementing this kind of
research is to get knowledge regarding several phenomenon’s or attain in depth acquaintance
about it, in order to create proper statement of problem (McDonald and Adam, 2003).
On contrary, descriptive research is more numerical approach, as it describes the
characteristics of phenomenon or population being evaluated. This type of research simply
23

provides a systematic plus factual description of data, but doesn’t define the exact case of
problem. Hence, while developing casual relationship among variables, this specific approach
cannot be adopted. In addition to this, in the analytical research, the researcher is needed to use
the facts or information, which are available on particular subject matter and analyze these to
make critical evaluation of topic (Perry, 1998).
Here, in this report the area involves identification of malnutrition due to the severe
infection and its prevention. The research needs findings of actual facts by interview or survey,
thus, descriptive type of research will be used by the investigator. Further, to measure the
changes, which are being occurred in the country in past several periods, certain existing facts,
information or figures is required to be assessed by the researcher and hence analytical research
will also be implemented in this research, to solve the issue as well as conclude final outcomes
(Reynolds and et.al., 2003).
3.5 Research Methods
The research methodologies can be classified as qualitative, case study and quantitative
method. Qualitative technique of research is intended towards rising plus sharpening the
understanding level of researcher with regards to behavioral aspect of study. The main
qualitative methods of undertaking research are interviews, focus group interview and
discussions (Scandura and Williams, 2000).
Quantitative method presents the information or data in arithmetical terms. Most of the
descriptive researches use this type of methodology. It generally uses technique of survey for
which questionnaire is furnished by the researcher. The significance of survey is in its organized
and planned layout for all respondents. On the data collection through survey, it can be analyzed
by using both statistical practices and qualitative techniques of theme formation. Generally,
researchers integrate both qualitative and quantitative methods simultaneously to obtain a
magnified vision into the particular problem (Wüihrer and Werani, 2001).
Under the method of case study, considerable details are gathered in relation to actual
time and unfurnished conditions, which assist the realm of study. Information is demonstrated in
an absolutely organized way in this methodology type. A structured format facilitates
comparative study under the technique of case study. Here, in this report, the information will be
gathered by using interview method, to accomplish the desired outcomes (Chung and
Alagaratnam, 2001).
24

3.6 Data Collection Methods
In the current report data will be acquired with the help of both primary and secondary
data collection method. The most common primary data collection techniques utilized in
researches is interview method, observation, survey etc. Primary data in respect to current report
will be acquired through interview method through a questionnaire (Hoth . and Pedersen, 2012).
In this research report primary data collection is essential and mainly information will be
acquired from all those respondents who are providing their services in those areas of India that
is accountable for increased number of malnourished children. A total number of 50 respondents
will be selected to undertake this interview.
To conduct interview a well structured questionnaire will be prepared by the researcher
that will include both close and open ended questions (Greckhamer and Cilesiz, 2012). The
questions will be designed by giving attention in the area of research and will be intended
towards accumulation of data in regard to malnutrition. Moreover, focus would be given to attain
information from respondents regarding malnutrition and the major issues that they face in the
region suffering from malnutrition of India, this information would be collected with the help of
questionnaire (Perera and Liyanage, 2001).
In this process secondary sources will also be accessed through different articles,
scholarly books and journals. Secondary data will include facts and figures that are already been
accumulated form previous researches and is represented in the form of different sources that can
easily be accessed by anyone. In this research report the researcher will use different secondary
sources that have been published on the research topic through various sources (Cheng, Bischof,
and Nathanson, 2002).
25

CHAPTER – 4 DATA ANALYSIS AND FINDINGS
26

CHAPTER – 4 CONCLUSION AND RECOMMENDATIONS
27

CHAPTER – 5 REFLECTIVE STATEMENTS
28

REFERENCES
Online
Bhandari, L. and Zaidi, L., 2004. Reviewing the Costs of Malnutrition in India. [pdf]. Available
through: <http://www.indicus.net/Research/New_Database_website
%5CWebsite_hierachy%5CStudies_Presentation%5CAll_Studies_list%5CHEALTH
%5CReviewing_the_cost_of_malnutrition_on_India%5CReport
%5CReviewing_cost_of_malnutrition.pdf>. [Accessed on 5 April 2013].
Burke, J., 2012. Over 40% of Indian children are malnourished, report finds. [Online]. Available
through: <http://www.guardian.co.uk/world/2012/jan/10/child-malnutrition-india-
national-shame>. [Accessed on 3 April 2013].
Chopra, R., 2013. Malnutrition stunting growth in Indian children, says report. [Online].
Available through: <http://indiatoday.intoday.in/story/malnutrition-stunting-growth-in-
indian-children-report/1/223810.html>. [Accessed on 3 April 2013].
Denyer, S., 2013. India wakes up to child malnutrition ‘shame,’ begins to make progress.
[Online]. Available through: <http://www.washingtonpost.com/world/india-wakes-up-to-
child-malnutrition-shame-begins-to-make-some-progress/2012/12/26/9b90e488-3a02-
11e2-b01f-5f55b193f58f_story.html>. [Accessed on 3 April 2013].
Eckhardt, L. C., 2006. Micronutrient Malnutrition, Obesity, and Chronic Disease in Countries
Undergoing the Nutrition Transition: Potential Links and Program/Policy Implications.
[Online]. Available through:
<http://www.ifpri.org/sites/default/files/pubs/divs/fcnd/dp/papers/fcndp213.pdf>.
[Accessed on 5 April 2013].
ITHACA, N. Y., 2003. Moderate Malnutrition Kills Millions Of Children Needlessly. [Online].
Available through: <http://www.sciencedaily.com/releases/2003/06/030630110813.htm>.
[Accessed on 8 April 2013].
Kaur, R., 2013. ‘Malnutrition Quit India’ – A campaign for better India. [Online]. Available
through: <http://www.mapsofindia.com/my-india/society/malnutrition-quit-india-a-
campaign-for-better-india>. [Accessed on 4 April 2013].
Malnutrition Prevention Program. 2012. [Online]. Available through:
<http://www.health.qld.gov.au/psq/malnu/webpages/malnu_home.asphttp://
www.health.qld.gov.au/psq/malnu/webpages/malnu_home.asp>. [Accessed on 8 April
2013].
Malnutrition. 2011. [Online]. Available through:
<http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001441/>. [Accessed on 3 April
2013].
29

MALNUTRITION. 2013. [Online]. Available through:
<http://health.nytimes.com/health/guides/disease/malnutrition/overview.html>.
[Accessed on 8 April 2013].
Mandal, A., 2013. Symptoms of malnutrition. [Online]. Available through: <http://www.news-
medical.net/health/Symptoms-of-malnutrition.aspx>. [Accessed on 8 April 2013].
Muoneke, U.V. and et.al., 2011. Factors Associated with Mortality in Under-Five Children with
Severe Anemia in Ebonyi, Nigeria. [Online]. Available through:
<http://indianpediatrics.net/feb2012/feb-119-123.htm>. [Accessed on 3 April 2013].
Nordqvist, C., 2010. What Is Malnutrition? What Causes Malnutrition. [Online]. Available
through: <http://www.medicalnewstoday.com/articles/179316.php>. [Accessed on 3
April 2013].
Nutri-farms to Tackle Malnutrition in India. 2013. [Online]. Available through:
<http://www.harvestplus.org/content/nutri-farms-tackle-malnutrition-india>. [Accessed
on 8 April 2013].
Overcoming the Curse of Malnutrition in India: A Leadership Agenda for Action. 2008. [pdf].
Available through: <http://www.nutritioncoalition.in/pdf/Curse-of-Malnutrition.pdf>.
[Accessed on 8 April 2013].
Pada, G., 2010. Putting the smallest first. [Online]. Available through:
<http://www.economist.com/node/17090948>. [Accessed on 8 April 2013].
Preventing malnutrition. 2011. [Online]. Available through:
<http://www.nhs.uk/Conditions/Malnutrition/Pages/Prevention.aspx>. [Accessed on 8
April 2013].
SAINI, K., 2012. What are the causes of Malnutrition. [Online]. Available through:
<http://www.preservearticles.com/201107309541/what-are-the-causes-of-
malnutrition.html>. [Accessed on 5 April 2013].
Svedberg, P., 2011. Why malnutrition in shining India persists. [pdf]. Available through:
<http://www.isid.ac.in/~pu/conference/dec_08_conf/Papers/PeterSvedberg.pdf>.
[Accessed on 5 April 2013].
Tarozzi, A. and Mahajan, A., 2006. Child Nutrition in India in the Nineties. [pdf]. Available
through: <http://emlab.berkeley.edu/users/webfac/emiguel/e271_s06/child.pdf>.
[Accessed on 8 April 2013].
Books
Basavanthappa, 2008. Community Health Nursing. 2nd ed. Jaypee Brothers Publishers.
Brothers, J., 2005. Textbook of Pediatrics Iap by Parthasarathy. 3rd ed. Jaypee Brothers
Publishers.
30

Chandhoke, N. and Priyadarshi, P., 2009. Contemporary India: Economy, Society, Politics.
Pearson Education India.
Kapila, U., 2009. Indian Economy Since Independence. 19th ed. Academic Foundation.
Kataki, K. P. and Babu, C. S., 2002. Food Systems for Improved Human Nutrition: Linking
Agriculture, Nutrition, and Productivity. Routledge.
Klerk, D.G., 2009. NSSC Geography Student's Answer Book. 2nd ed. Cambridge University
Press.
Llc, B., 2010. Poverty in Indi: Slums in India, Poverty in India, Malnutrition in India, Dharavi,
Yamuna Pushta, India State Hunger Index. General Books LLC.
Majumdar, M., 2005. Ency.Of Gen. Equ.Through Women Empowerment. Sarup & Sons.
Journals
Amaratunga, D. and et.al., 2002. Quantitative and qualitative research in the built environment:
application of “mixed” research approach. Work Study. 5(1).
Amuna, R. and et.al., 2000. The role of traditional cereal/legume/fruit-based multimixes in
weaning in developing countries. Nutrition & Food Science. 30 (3).
Basit, A. and et.al., 2012. Risk factors for under-nutrition among children aged one to five years
in Udupi taluk of Karnataka, India: A case control study. Australasian Medical Journal.
5(3). pp.163-167.
Bhavsar, S., Hemant, M. and Kulkarni, R., 2012. Maternal and Environmental Factors Affecting
the Nutritional Status of Children in Mumbai Urban Slum. International Journal of
Scientific and Research Publications. 2(11).
Buam, L. D., 2005. Towards bridging the digital divide for all-round socio-economic
development in India of the 21st century. Social Responsibility Journal. 1 (1/2).
Cheng, R., Bischof, S., and Nathanson, A.J., 2002. Data collection for user-oriented library
services: Wesleyan University Library’s experience. OCLC Systems & Services. 18 (4).
pp.195-204.
Chung, E., and Alagaratnam, S., 2001. “Teach ten thousand stars how not to dance”: a survey of
alternative ontologies in marketing research. Qualitative Market Research: An
International Journal. 4 (4). pp.224-234.
Collins, S. and et.al., 2006. Management of severe acute malnutrition in children. THE LANCET.
368 (9551). pp.1992-2000.
Coram, S., 2011. Rethinking Indigenous Research Approval - The Perspective of a ‘Stranger’.
Qualitative Research Journal. 11(2).
Crossan, F., 2003. Research philosophy: towards an understanding. US National Library of
Medicine National Institute of Health. 11(1). pp. 46-55.
Dancer, D. and Rammohan, A., 2009. Maternal autonomy and child nutrition: Evidence from
rural Nepal. Indian Growth and Development Review. 2 (1).
Dao, Q. M., 2008. Human capital, poverty, and income distribution in developing countries.
Journal of Economic Studies. 35 (4).
Dey, C., 2002. Methodological issues: The use of critical ethnography as an active research
methodology. Accounting, Auditing & Accountability Journal. 15(1).
Fortified milks documents significant reduction of morbidity in young children. 2007. Nutrition
& Food Science. 37 (2).
Greckhamer, T., and Cilesiz, S., 2012. Critical and Poststructural Approaches to Strategy
Research: Theoretical and Methodological Suggestions. Research Methodology in
Strategy and Management. 8. pp.3-38.
31

Hansen, A., 2011. Relating performative and ostensive management accounting research:
Reflections on case study methodology. Qualitative Research in Accounting &
Management. 8(2).
Hansen, A., 2011. Relating performative and ostensive management accounting research:
Reflections on case study methodology. Qualitative Research in Accounting &
Management. 8 (2). pp.108 – 138.
Hill, J., and McGowan, P., 1999. Small business and enterprise development: questions about
research methodology. International Journal of Entrepreneurial Behaviour & Research.
5 (1). pp.5 – 18.
Hoth, J.J. and Pedersen, T., 2012. Institutions and International Business Research: Three
Institutional Approaches and Recommendations for Future Research, Progress In
International Business Research. 7. pp.135-152.
Hotho, A.J., and Pedersen, T., 2012. Institutions and International Business Research: Three
Institutional Approaches and Recommendations for Future Research. Progress In
International Business Research. 7. pp.135-152.
Ijarotimi, S. O. and Ashipa, F., 2006. Evaluation of nutritional composition, sensory and physical
property of home processed weaning food based on low cost locally available food
materials. Nutrition & Food Science. 26 (1).
Ireland, R.D., Webb, J.W., and Coombs, J.E., 2005. Theory and Methodology Research
Methodology in Strategy and Management, 2. pp.111-141.
Ittonen, K., 2012. Market reactions to qualified audit reports: research approaches. Accounting
Research Journal. 25 (1). pp.8-24.
Janes, J., 2001. Categorical relationships: chi-square. Library Hi Tech. 9(3).
Kelemen, M. and Rumens, N., 2012. Pragmatism and heterodoxy in organization research:
Going beyond the quantitative/qualitative divide. International Journal of Organizational
Analysis. 20(1).
Khan, R.E.A., and Azid, T., 2011. Malnutrition in primary school-age children: A case of urban
and slum areas of Bahawalpur, Pakistan. International Journal of Social Economics. 38
(9). pp.748 – 766.
Khetarpaul, M. and Khetarpaul, N., 2005. Nutritional profile of Indian rural preschoolers.
Nutrition & Food Science. 35 (6).
Khor, G. L., 2003. Update on the prevalence of malnutrition among children in Asia. Nepal
Medical College Journal. 5 (2). pp.113-122.
Lawal, O. B. and Jibowo, A. A., 2006. Impact of household food security and nutrition
programme on the nutritional status of children in Oyo state, Nigeria. Nutrition & Food
Science. 36 (5).
Mansourian, Y., and Madden, A.D., 2007. Methodological approaches in web search research.
Electronic Library. 25 (1). pp.90-101.
Massingham, P., Massingham, R., and Diment, K., 2012. Q methodology: is it useful for
accounting research?. Qualitative Research in Accounting & Management. 9 (1). pp.66 –
88.
Massingham, P., Massingham, R. and Diment, K., 2012. Q methodology: is it useful for
accounting research. Qualitative Research in Accounting & Management. 9(1).
McDonald, H. and Adam, S., 2003. A comparison of online and postal data collection methods
in marketing research. Marketing Intelligence & Planning. 21(2). pp.85 – 95.
Microcapsules against malnutrition. 2010. Nutrition & Food Science. 40 (1).
32

Oduwole, A. A. and Okorie, N. C., 2010. Access to agricultural information and millennium
development goals. Library Hi Tech News. 27 (1).
Ogunba, O. B., 2004. Protein energy malnutrition in complemented breast-fed babies:
implications of the timing of complementary feeding. Nutrition & Food Science. 34 (5).
Pandey, D. and et.al., 2011. Assessing malnutrition among chemotherapy and/or radiotherapy
cancer Benghazi outpatients. Nutrition & Food Science. 41 (5).
Perera, T., and Liyanage, K., 2001. IDEF based methodology for rapid data collection.
Integrated Manufacturing Systems. 12 (3).pp.187-194.
Perry, C., 1998. Processes of a case study methodology for postgraduate research in marketing.
European Journal of Marketing. 32 (9/10). pp.785 – 802.
Rani, V., Arends, E. D. and Brouwer, D. I., 2010. Dietary diversity as an indicator of
micronutrient adequacy of the diet of five to eight year old Indian rural children.
Nutrition & Food Science. 40 (5).
Reynolds, N.L. and et.al., 2003. Theoretical justification of sampling choices in international
marketing research: key issues and guidelines for researchers. Journal of International
Business Studies. 34. pp.80-89.
Rice, L.A. and et.al., 2000. Malnutrition as an underlying cause of childhood deaths associated
with infectious diseases in developing countries. Bull World Health Organ. 78(10).
Rod, M., 2009. Marketing: philosophy of science and epistobabble warfare. Qualitative Market
Research: An International Journal. 12 (2). pp.120-129.
Rodríguez, L., Cervantes, E. and Ortiz, R., 2011. Malnutrition and Gastrointestinal and
Respiratory Infections in Children: A Public Health Problem. Int J Environ Res Public
Health. 8 (4). pp.1174-1205.
Scandura, T.A. and Williams, E.A., 2000. Research methodology in management: current
practices, trends, and implications for future research. Academy of Management Journal.
43(6). pp.1248-1264.
Spens, K.M., and Kovács, G., 2006. A content analysis of research approaches in logistics
research. International Journal of Physical Distribution & Logistics Management. 36 (5).
pp.374 – 390.
Torpy, M. J., Lynm, C. and Glass, M. R., 2004. Malnutrition in Children. JAMA. 292 (5).
Vemula, R. S., Kumar, N. R. and Polasa, K., 2012. Foodborne diseases in India – a review.
British Food Journal. 114 (5).
Wüihrer, G.A., and Werani, T., 2001. Integration of qualitative and quantitative research
approaches in business-to-business marketing. Advances in Business Marketing and
Purchasing. 9. pp.467-489.
33