Background: Optimal childhood growth and nutrition are essential for lifelong physical, cognitive, and emotional development. Despite national efforts, India faces persistently high rates of growth deficiencies among children, especially in underserved regions. Himachal Pradesh, with its socio-economic diversity, offers a unique context for understanding public knowledge regarding childhood growth monitoring and nutritional needs. Material & Methods: This descriptive cross-sectional survey was conducted from August to October 2024, targeting adults aged 18 and above who were residents of Himachal Pradesh for at least 12 months. A sample of 400 participants was recruited using online platforms to ensure broad reach. Data were collected through a structured Google Forms questionnaire covering socio-demographic information and knowledge-based questions on childhood growth monitoring, nutrient needs, dietary sources, and common deficiency signs. Each correct response earned one point, with scores categorized as follows: >80% (Very Good), 60-79% (Good), 41-59% (Fair), and <40% (Poor). Statistical analysis of responses was conducted using Epi Info V7 software to calculate frequencies and percentages.Results: The study revealed moderate awareness levels regarding childhood growth and nutrition. While 53.5% of participants could identify essential nutrients necessary for a child’s growth, only 32.5% recognized Vitamin A deficiency's impact on vision, and 44% knew that iron deficiency leads to anemia. Awareness of preventive practices, such as growth monitoring’s role and balanced diet, varied, with 61.5% understanding growth milestones and 48.5% identifying a balanced diet as critical. Knowledge of government nutrition support initiatives was limited, with only 43.5% aware of Anganwadi services and 41.5% familiar with the Midday Meal Scheme. Overall, 24.5% of respondents scored “Very Good,” 36% scored “Good,” 26.75% scored “Fair,” and 12.75% scored “Poor.”Conclusion: This study identified both strengths and critical gaps in public awareness regarding childhood growth monitoring and nutrition in Himachal Pradesh. Limited knowledge of specific nutrient functions and available support programs points to the need for targeted educational campaigns. Initiatives focusing on nutrient-specific education, the preventive role of growth monitoring, and greater visibility of government programs could improve public knowledge and encourage proactive health practices for child development.
Optimal childhood growth and nutrition are foundational to a child’s lifelong physical, cognitive, and emotional well-being. Growth monitoring, combined with proper nutritional support, serves as an early intervention tool to identify and prevent malnutrition and developmental delays, both of which can have lasting impacts if not addressed promptly. Despite national efforts to combat malnutrition, India continues to face high rates of growth deficiencies among children, particularly in rural and underserved regions. Himachal Pradesh, with its distinctive geography and socio-economic diversity, presents an important context for examining public understanding of growth monitoring and children’s nutritional needs.[1-3]
Public awareness of childhood growth monitoring and nutrition is critical in supporting timely interventions and effective health outcomes. Awareness involves not only an understanding of growth check-ups and key developmental milestones but also knowledge of essential nutrients, their sources, and the early signs of deficiencies. However, factors such as limited healthcare access, variable education levels, cultural practices, and economic limitations influence community perceptions and behaviors surrounding child nutrition and growth tracking. Studies have shown that these awareness gaps often contribute to delays in recognizing growth issues or nutrient deficits, allowing potentially reversible conditions to escalate into chronic health concerns.[4-9]
This study seeks to explore public knowledge of childhood growth monitoring and nutritional needs among residents of Himachal Pradesh. By assessing adults’ understanding of growth standards, key dietary requirements for children, and the risks associated with deficiencies, we aim to identify knowledge gaps that may hinder early and effective interventions. Using a cross-sectional survey, this research examines knowledge levels, common misconceptions, and how socio-demographic factors such as age, education, and regional background influence public understanding of these critical issues. Findings from this study offer insights that could guide targeted public health initiatives and educational campaigns, ultimately strengthening community engagement in child health practices and reducing preventable growth and nutritional deficits among children in Himachal Pradesh.
Aims & Objectives
The primary aim of this study was to evaluate public knowledge regarding childhood growth monitoring and nutritional needs among residents of Himachal Pradesh. Specifically, it sought to assess awareness levels surrounding essential growth practices, key nutrients, dietary sources, and early signs of deficiencies. Additionally, the study aimed to explore the influence of socio-demographic factors, such as age, education, and geographic background, on awareness levels, ultimately identifying knowledge gaps and misconceptions that may hinder early and effective intervention in childhood health. Insights from this study are intended to inform targeted public health initiatives and educational efforts aimed at improving child health outcomes across the region.
Research Approach: This descriptive study was designed to capture existing knowledge and awareness levels within the population.
Research Design: A cross-sectional survey approach was employed to systematically evaluate public awareness regarding childhood growth monitoring and nutrition across a representative sample in Himachal Pradesh.
Study Area: The study was conducted across diverse regions of Himachal Pradesh, a state known for its varied socio-economic backgrounds and healthcare access levels, allowing for a representative sample that included both urban and rural populations.
Study Duration: Data collection was conducted over a three-month period from August to October 2024, ensuring ample time to capture responses from different population segments.
Study Population: The target population included adults aged 18 and above who had been residents of Himachal Pradesh for a minimum of 12 months, ensuring that respondents were familiar with local dietary norms, child-rearing practices, and regional healthcare resources.
Sample Size: A sample size of 400 participants was determined using a 95% confidence level, an estimated 50% awareness level regarding childhood growth and nutrition, and a 5% margin of error. A conservative non-response rate of 5% was incorporated into this calculation to ensure robust data collection.
Study Tool: Data were gathered through a structured questionnaire distributed via Google Forms. The questionnaire included two primary sections:
Socio-demographic Details: Questions captured age, gender, education level, occupation, and area of residence.
Knowledge Assessment: Twenty structured questions assessed awareness regarding childhood growth practices, essential nutrients, dietary sources, and signs of common nutritional deficiencies. Each correct answer was awarded one point, with scoring classified as follows: >80% (16-20) = Very Good, 60-79% (12-15) = Good, 41-59% (8-11) = Fair, and <40% (<8) = Poor. The questionnaire underwent pre-testing to ensure clarity, and its validity was reviewed by experts in nutrition and public health.
Data Collection: The questionnaire was circulated online through multiple platforms, including email, WhatsApp, Facebook, Instagram, and LinkedIn, maximizing reach and encouraging responses across various demographic groups. Data collection continued under expert supervision until the target of 400 responses was achieved to ensure precision and adherence to the study methodology.
Data Analysis: Responses were entered into Microsoft Excel for initial organization and cleaning. Epi Info V7 software was used for statistical analysis, computing frequencies, percentages, and other descriptive statistics to offer a clear understanding of awareness levels and demographic correlations.
Ethical Considerations: Confidentiality and anonymity of participants were strictly maintained, with no identifying information recorded. Informed consent was obtained from each participant, who was informed of their right to withdraw from the study at any time, ensuring compliance with ethical standards for human research.
A total of 400 respondents participated in the study, providing insights into public awareness regarding childhood growth monitoring and nutritional needs.
The sociodemographic profile of the study participants reveals a diverse and representative sample from Himachal Pradesh, with 54.5% female and 45.5% male respondents. Participants predominantly belonged to the 26-35 age group (31.25%), followed by 36-45 years (22.75%) and 18-25 years (24%), indicating a balanced representation across working-age and younger adults. Educational levels varied, with 36.25% holding undergraduate degrees, 27% completing secondary school, and 14.75% attaining postgraduate qualifications, while 7.75% reported no formal education, reflecting a broad spectrum of educational attainment. Occupation-wise, 34.25% were employed in private or government services, 21.25% engaged in agriculture or labor, and 20.5% were homemakers, illustrating a mix of professional and domestic roles. Rural residents constituted a significant majority (64%), mirroring the region’s demographic distribution. Monthly household income showed diversity, with 34.5% earning INR 10,001-20,000, 31.75% in the INR 20,001-40,000 range, and 18.25% exceeding INR 40,000. Family structure leaned toward nuclear families (66.75%), and the majority (70%) had resided in Himachal Pradesh for over 10 years, ensuring familiarity with local cultural and dietary practices.
Table-1: Sociodemographic Variables of Study Participants
Variable | Categories | Frequency (n) | Percentage (%) |
Gender | Male | 182 | 45.5% |
Female | 218 | 54.5% | |
Age Group (Years) | 18-25 | 96 | 24.0% |
26-35 | 125 | 31.25% | |
36-45 | 91 | 22.75% | |
46-55 | 61 | 15.25% | |
56 and above | 27 | 6.75% | |
Education Level | No formal education | 31 | 7.75% |
Primary school | 57 | 14.25% | |
Secondary school | 108 | 27.0% | |
Undergraduate degree | 145 | 36.25% | |
Postgraduate degree or higher | 59 | 14.75% | |
Occupation | Agriculture/Labor | 85 | 21.25% |
Homemaker | 82 | 20.5% | |
Service (Private/Government) | 137 | 34.25% | |
Business | 50 | 12.5% | |
Student | 46 | 11.5% | |
Area of Residence | Urban | 144 | 36.0% |
Rural | 256 | 64.0% | |
Monthly Household Income (INR) | <10,000 | 62 | 15.5% |
10,001-20,000 | 138 | 34.5% | |
20,001-40,000 | 127 | 31.75% | |
>40,000 | 73 | 18.25% | |
Family Type | Nuclear | 267 | 66.75% |
Joint | 133 | 33.25% | |
Duration of Residence in Himachal Pradesh | 1-5 years | 48 | 12.0% |
6-10 years | 72 | 18.0% | |
More than 10 years | 280 | 70.0% |
Table-2: Knowledge Regarding Childhood Growth Monitoring and Nutritional Needs among Study Participants
S.No. | Questions | Options | Frequency of Correct Responses | Percent (%) |
1 | What are the essential nutrients required for a child’s healthy growth? | a) Fats and Sugars | 214 | 53.5 |
2 | What is the purpose of regular growth monitoring in children? | a) To check weight only | 246 | 61.5 |
3 | Which nutrient deficiency causes iron-deficiency anemia in children? | a) Calcium | 176 | 44 |
4 | What health issue is associated with Vitamin A deficiency? | a) Digestive problems | 130 | 32.5 |
5 | Which nutrient is essential for bone growth and development in children? | a) Iron | 262 | 65.5 |
6 | Why is protein essential for a child’s development? | a) Increases height only | 186 | 46.5 |
7 | What role does iodine play in a child’s health? | a) Boosts energy | 182 | 45.5 |
8 | How does Vitamin D benefit a child’s body? | a) Improves digestion | 150 | 37.5 |
9 | What are good dietary sources of iron for children? | a) Dairy products | 222 | 55.5 |
10 | Which of the following foods is rich in Vitamin C and supports immunity? | a) Citrus fruits | 258 | 64.5 |
11 | What is the main source of energy in a child’s balanced diet? | a) Carbohydrates | 158 | 39.5 |
12 | How can malnutrition impact a child’s cognitive development? | a) Improves focus | 246 | 61.5 |
13 | Which are common signs of severe malnutrition in children? | a) Weight gain | 204 | 51 |
14 | What preventive measure can help avoid nutritional deficiencies in children? | a) Skipping meals | 194 | 48.5 |
15 | Why is breastfeeding important for infants? | a) Causes dependency | 306 | 76.5 |
16 | Which are affordable, nutrient-dense foods suitable for children? | a) Chips and sodas | 186 | 46.5 |
17 | How do hygiene practices support a child’s nutrition? | a) Decrease energy | 222 | 55.5 |
18 | Which government initiative focuses on providing nutrition support to children? | a) Local parks | 174 | 43.5 |
19 | What program provides subsidized nutrition to children in schools? | a) Water subsidies | 166 | 41.5 |
20 | How can community awareness programs benefit child nutrition knowledge? | a) Improve understanding of balanced diet | 210 | 52.5 |
In this study, participants' knowledge scores were classified based on total points earned out of a possible 20. Findings indicated that 24.5% (98 participants) demonstrated very good knowledge (scoring 16-20 points), 36% (144 participants) had good knowledge (12-15 points), 26.75% (107 participants) displayed fair knowledge (8-11 points), and 12.75% (51 participants) exhibited poor knowledge (<8 points).
Figure-1: Knowledge Scores on Childhood Growth Monitoring and Nutritional Needs among Study Participants
The findings from this study provide a detailed understanding of public awareness surrounding childhood growth monitoring and nutritional needs among residents of Himachal Pradesh. As shown in Table 1, while a foundational awareness of essential nutrients and growth practices is evident, there are critical gaps in specific knowledge that could impact early intervention for childhood malnutrition and growth deficits. For example, 53.5% of participants correctly identified the essential nutrients required for healthy growth, including proteins, vitamins, and minerals, which suggests a basic understanding of dietary components. However, when it came to more detailed questions regarding nutrient deficiencies, awareness levels were notably lower. Only 44% of respondents could identify iron as the nutrient associated with preventing iron-deficiency anemia, and just 32.5% knew that Vitamin A deficiency is linked to vision problems. This indicates a limited understanding of specific nutrient roles, which may prevent timely identification of early deficiency symptoms in children.
Additionally, there is a gap in awareness of the preventive role that growth monitoring plays in assessing a child’s health trajectory. While 61.5% understood that growth monitoring helps track growth milestones, a significant portion of participants did not recognize this as a critical tool in identifying developmental delays. Knowledge of preventive dietary practices was also moderate; for example, 48.5% of participants identified a balanced diet including all food groups as a measure to avoid deficiencies, while others held misconceptions that could limit dietary diversity. Furthermore, although hygiene plays a crucial role in nutritional health by preventing absorption issues, only 55.5% were aware of its importance, suggesting that public health efforts could emphasize the combined importance of nutrition and hygiene in childhood health.10-12
The survey results further underscore limited awareness of existing healthcare initiatives that provide nutrition support for children. For example, just 43.5% of respondents were aware of Anganwadi services as a resource for child nutrition support, and 41.5% were familiar with the Midday Meal Scheme’s role in addressing malnutrition among school-aged children. This limited awareness of government programs points to a need for more visible and accessible outreach efforts that could connect families to essential resources and encourage greater community engagement with these programs. Encouragingly, over half of respondents (52.5%) saw community awareness programs as beneficial for improving knowledge of child nutrition, indicating a favorable perception of health education initiatives that could be leveraged to enhance public knowledge in this area.13-15
In Table 2, knowledge levels are further clarified by categorizing participant scores into four groups: Very Good, Good, Fair, and Poor. The distribution shows that while 24.5% of participants demonstrated very good knowledge (scoring between 16-20 points), the majority of participants scored in the Good (36%) and Fair (26.75%) categories. This suggests that while a foundational level of knowledge exists, there is a lack of comprehensive understanding across the population. Those scoring in the "Good" range may have a basic grasp of essential growth monitoring and nutritional needs but may not fully understand the specific details necessary for early intervention and effective prevention. Meanwhile, 12.75% of respondents scored in the "Poor" category, highlighting a subset of the population with minimal knowledge regarding essential nutrients, growth monitoring, and preventive measures for childhood nutrition.
This distribution of knowledge indicates that while a considerable portion of the population possesses basic information, many still lack a well-rounded understanding of childhood nutritional requirements and growth assessment practices. These findings suggest that targeted, accessible educational programs could be highly beneficial, especially for those scoring in the lower ranges. By addressing identified knowledge gaps, particularly regarding specific nutrient functions, growth monitoring’s preventive role, and the importance of government support programs, public health initiatives could strengthen community engagement and empower caregivers with the knowledge needed to support healthy childhood development effectively.
Limitations
This study, while offering valuable insights into public awareness of childhood growth monitoring and nutritional needs, has certain limitations. The use of an online survey may have excluded individuals with limited internet access, potentially skewing the sample toward more educated or technologically connected individuals. Additionally, as data collection relied on self-reported responses, there is a possibility of response bias, with participants potentially overstating their knowledge. These factors may impact the generalizability of the findings across the broader population of Himachal Pradesh. Future research incorporating in-person surveys or a mixed-methods approach could provide a more comprehensive picture of public knowledge and help address these limitations.
The findings of this study reveal both strengths and gaps in public awareness regarding childhood growth monitoring and nutritional needs among residents of Himachal Pradesh. While a foundational understanding of essential nutrients and growth practices is evident, critical knowledge gaps remain, particularly regarding the specific functions of nutrients, signs of deficiencies, and the preventive role of growth monitoring. The majority of participants demonstrated basic to moderate knowledge, highlighting the potential for improvement in community understanding of these important health areas. Limited awareness of government programs like the Anganwadi services and Midday Meal Scheme also indicates a need for increased outreach and education on available resources. Targeted, accessible educational initiatives focusing on nutrient-specific knowledge, the benefits of regular growth monitoring, and promoting the utilization of existing healthcare programs could enhance public understanding and empower caregivers. By addressing these knowledge gaps, public health initiatives can strengthen community engagement and support the long-term health and development of children in Himachal Pradesh.
The authors declare that they have no conflict of interest
No funding sources
The study was approved by theJawaharlal Nehru Medical College, Aligarh Muslim University(AMU).
Tsomu, S., Chakraborty, O., et al. "Public Understanding of Pediatric Nutrition and Its Impact on Child Growth in Chamba." Himalayan Journal of Community Medicine and Public Health 5.2 (2024), pp. 1-6.
Pathania, N. S., Biswas, R. "Assessment of Nutritional Status of Adolescent School-going Boys of Himachal Pradesh." International Journal of Community Medicine and Public Health 8 (2021), pp. 4960-4966. DOI: https://doi.org/10.18203/2394-6040.ijcmph20213194.
Khandelwal, R., Singh, G., et al. "Nutrient Intake of Adolescents in Rural Area of Himachal Pradesh." Indian Journal of Community Health 29.2 (2017), pp. 194-197.
Saavedra, J. M., Prentice, A. M. "Nutrition in School-age Children: A Rationale for Revisiting Priorities." Nutrition Reviews 81.7 (2023), pp. 823-843. DOI: https://doi.org/10.1093/nutrit/nuz10
Rosales, F. J., Reznick, J. S., Zeisel, S. H. "Understanding the Role of Nutrition in the Brain and Behavioral Development of Toddlers and Preschool Children: Identifying and Addressing Methodological Barriers." Nutrition Neuroscience 12.5 (2009), pp. 190-202. DOI: https://doi.org/10.1179/147683009X12434446644339.
Taylor, M., Tapkigen, J., et al. "The Impact of Growth Monitoring and Promotion on Health Indicators in Children under Five Years of Age in Low- and Middle-Income Countries." Cochrane Database of Systematic Reviews 10 (2023), Article CD014785. DOI: https://doi.org/10.1002/14651858.CD014785.pub2.
Ashworth, A., Shrimpton, R., Jamil, K. "Growth Monitoring and Promotion: Review of Evidence of Impact." Maternal and Child Nutrition 4.1 (2008), pp. 86-117. DOI: https://doi.org/10.1111/j.1740-8709.2007.00156.x.
Chandrakar, J., Chandravanshi, L., Agrawal, N. "Understanding the Concept of Undernutrition among Children up to 5 Years of Age." International Journal of Scientific Research and Archives 13.1 (2024), pp. 426-435.
Taylor, M., Tapkigen, J., et al. "The Impact of Growth Monitoring and Promotion on Health Indicators in Children under Five Years of Age in Low- and Middle-Income Countries." Cochrane Database of Systematic Reviews 10 (2023), Article CD014785. DOI: https://doi.org/10.1002/14651858.CD014785.pub2.
Hemalatha, R., Radhakrishna, K. V., Kumar, B. N. "Undernutrition in Children & Critical Windows of Opportunity in Indian Context." Indian Journal of Medical Research 148.5 (2018), pp. 612-620. DOI: https://doi.org/10.4103/ijmr.IJMR_1245_17.
Ashworth, A., Shrimpton, R., Jamil, K. "Growth Monitoring and Promotion: Review of Evidence of Impact." Maternal and Child Nutrition 4.1 (2008), pp. 86-117. DOI: https://doi.org/10.1111/j.1740-8709.2007.00156.
Kapil, U., Joshi, A., Nayar, R. "Utility of Growth Monitoring: Its Relevance in the Promotion of Child Health." Indian Pediatrics 31.2 (1994), pp. 239-244.
Andersen, C. T., Chopra, P. K., et al. "Maternal and Child Nutrition Services Associated with Nutritional Knowledge and Practices, India." Bulletin of the World Health Organization 102.1 (2024), pp. 9-21. DOI: https://doi.org/10.2471/BLT.23.272079.
Manhas, S., Dogra, A. "Awareness among Anganwadi Workers and the Prospect of Child Health and Nutrition: A Study in Integrated Child Development Services (ICDS) Jammu, Jammu and Kashmir, India." Anthropologist 14.2 (2012), pp. 171-175.
Debata, I., Ranganath, T. S. "Evaluation of the Performance of Anganwadi Workers in Delivering Integrated Child Development Services in the Rural Field Practice Area of a Tertiary Medical College in South India." Cureus 15.1 (2023), Article e34079. DOI: https://doi.org/10.7759/cureus.34079.