E-ISSN:2349-3267
P-ISSN:2349-5499
RNI:MPENG/2017/74037

Research Article

Anthropometric Outcomes

Pediatric Review - International Journal of Pediatric Research

2025 Volume 12 Number 2 Apr-Jun
Publisherwww.medresearch.in

Understanding The Relation Between Antenatal Care, Vaccination, and Anthropometric Outcomes in Early Childhood: A Cross-Sectional Study

Purohit I1*, Verma A2, Purohit C3, Babu R4, Nimawat E5, Modi K6, Ashray GS7, Deshpande S8, Goel A9, Walia S10, Choudhary L11, Bagadia B12
DOI:https://doi.org/10.17511/ijpr .2025.i02.05

1* Isha Purohit, MBBS 4th Year Student, Geetanjali Medical College, Udaipur, Rajasthan, India.

2 Anjana Verma, Professor, Geetanjali Medical College, Udaipur, Rajasthan, India.

3 Chelsi Purohit, MBBS, Geetanjali Medical College, Udaipur, Rajasthan, India.

4 Raja Babu, MBBS 3rd year, AIIMS, Deoghar.

5 Esha Nimawat, MBBS 4th year, Geetanjali Medical College, Udaipur, Rajasthan, India.

6 Kanishk Modi, MBBS 4th year, Geetanjali Medical College, Udaipur, Rajasthan, India.

7 Guduru Satya Ashray, MBBS 3rd year, Mamata Medical College, Khammam.

8 Shruti Deshpande, MBBS 3rd year, Bharati Vidyapeeth Medical College, Pune, Maharashtra, India.

9 Anika Goel, MBBS 3rd year, Kakatiya Medical College, Warangal.

10 Sanya Walia, MBBS 3rd year, Government Institute of Medical Sciences, Greater Noida, UP, India.

11 Lokesh Choudhary, MBBS, Geetanjali Medical College, Udaipur, Rajasthan, India.

12 Bhoomi Bagadia, MBBS, Jawaharlal Nehru Medical College, Belgaum, Karnataka, India.

Background: One of the most sensitive measures of a country’s public health measures is under-5 mortality. Under-5 mortality is affected by many factors, including socioeconomic status, antenatal care, immunizations, education, etc. Maternal education is another important factor that ensures optimal child health outcomes, which has a sustained impact into adolescence. Despite government programs and initiatives in India, there are continuing gaps in antenatal care utilization and vaccination uptake, especially in rural areas. This research will examine antenatal care factors, immunization status, and anthropometric outcomes in early childhood.

Methods: A cross-sectional study was conducted in rural areas. Data were collected from 100 mothers regarding their demographic details, antenatal care visits, and children's anthropometric measurements. Chi-square tests were used to analyze associations between demographic variables and anthropometric measures, such as weight-for-age classifications based on the Indian Academy of Pediatrics and WHO growth charts, along with mid-upper arm circumference.

Results: Maternal education was significantly associated with weight-for-age classification (p-value= 0.016, p-value= 0.015). Positive associations were also observed between immunization status and anthropometric measures (p-value 0.040). Significance was also found between the mode of delivery and anthropometric measures (p-value 0.042), which was consistent with previous studies that associated delivery type with adolescent lean body mass. The results of this study emphasize how antenatal care is an important factor in determining early childhood growth patterns.

Conclusion: The results of this study indicate a need for better utilisation of antenatal care services to improve outcomes related to growth in children. Recognizing the factors that are causing antenatal care underutilization in rural locations is a critical aspect of developing continuity of care. Improvements in maternal health services can lead to improved anthropometric measures and decreased child mortality.

Keywords: Maternal education, vaccination, under-5 children, growth charts, antenatal care, anthropometry, malnutrition

Corresponding Author How to Cite this Article To Browse
Isha Purohit, MBBS 4th Year Student, , Geetanjali Medical College, Udaipur, Rajasthan, India.
Email: 		Purohit I, Verma A, Purohit C, Babu R, Nimawat E, Modi K, Ashray GS, Deshpande S, Goel A, Walia S, Choudhary L, Bagadia B, Understanding The Relation Between Antenatal Care, Vaccination, and Anthropometric Outcomes in Early Childhood: A Cross-Sectional Study. Pediatric Rev Int J Pediatr Res. 2025;12(2):47-53.
Available From
https://pediatrics.medresearch.in/index.php/ijpr/article/view/801

Manuscript Received Review Round 1 Review Round 2 Review Round 3 Accepted
2025-05-14 2025-05-22 2025-05-30 2025-06-07 2025-06-15
Conflict of Interest Funding Ethical Approval Plagiarism X-checker Note
None initiated None Yes 11.32

© 2025 by Purohit I, Verma A, Purohit C, Babu R, Nimawat E, Modi K, Ashray GS, Deshpande S, Goel A, Walia S, Choudhary L, Bagadia B and Published by Siddharth Health Research and Social Welfare Society. This is an Open Access article licensed under a Creative Commons Attribution 4.0 International License https://creativecommons.org/licenses/by/4.0/ unported [CC BY 4.0].

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Purohit I et al. The Relation Between Antenatal Care, Vaccination

Introduction

The under-five mortality rate is an important indicator of a country's public health system. It is a direct reflection of a country’s healthcare structure, socioeconomic disparities, and sanitation. [1] It is expressed as number of children under age of 5 (59 months) dying per 1,000 live births. Even though global under-5 mortality rate has significantly decreased (93 per 1,000 live births in 1990 to 37 per 1,000 live births in 2022), it remains a major public health concern, with recent data indicating that infectious diseases like lower respiratory tract infections, diarrhea, pneumonia, malaria, etc. are major contributors to under-5 mortality rate. [2], [3] The majority of such diseases are preventable, and with improvement in public health infrastructure and sanitation, their instances can be reduced. The implementation of routine vaccination has also reduced incidence of such diseases. [4], [5] Therefore, implementation of a national immunization program could result in a significant decrease in mortality. However, despite presence of routine vaccines, presence of concomitant malnourishment can impair a person's immune responses, leading to a decrease in efficiency of vaccinations and increasing susceptibility to such diseases. [6] Therefore, prompt diagnosis and treatment of malnutrition using anthropometric measures, an inexpensive method, is essential.

Under Sustainable Development Goal 3.2, India aims to lower the under-five mortality rate from 32 per 1,000 live births to 25 per 1,000 live births. [7] The nation has started a number of national health initiatives aimed at enhancing medical facilities and offering dietary supplements in order to address these issues. Antenatal care (ANC) is the care provided to a mother during pregnancy, which includes regular checkups, immunization against tetanus, screening for infections, high blood pressure, and nutrient supplementation. To reduce the high number of maternal deaths and their fatal outcomes, the Ministry of Women and Child Development in India launched Pradhan Mantri Surakshit Matritva Abhiyan, which provides free ANC care to expecting mothers on the ninth of each month. Regular antenatal check-ups have been known to decrease low birth weight in infants; however, there is a significant lack of literature that studies the association between ANC care and the health outcomes in children under five. [8], [9]

To understand the long-term benefits of antenatal care on malnutrition in children under five years, we are conducting this research to assess its impact on growth, immunity, and overall health outcomes.

Material And Method

Study Design:

This multicentric, cross-sectional study was started after receiving approval from the institute's ethics committee. Using random selection, five states were selected from 28 states and 8 union territories in India. With the assistance of medical students currently enrolled in a medical college in those states, we collected data from 130 mothers and children under the age of five from rural areas. After applying the inclusion criteria, 100 responses were chosen.

Inclusion and Exclusion Criteria:

This study strictly adhered to the inclusion criteria, enrolling children under the age of five (59 months). Children with medical conditions that could affect their anthropometric measurements, such as ascites, limb deformities, etc., and those who did not consent to have their measurements taken were excluded.

Ethical Considerations:

The study began after obtaining ethical clearance from the hospital's ethics committee.

Research Instruments:

To obtain a thorough assessment of the demographic, ANC, immunization, and anthropometric details, we devised a questionnaire that was administered to the mother.

1. Demography: Details regarding the age and sex of the child, caste, religion, and schooling received were obtained from the mother.

2. ANC care received: Details regarding the type and place of delivery, intrapartum and postpartum complications, immunization against tetanus, and the gap between two pregnancies were recorded.

3. Immunization: The immunization history of the mother and child was taken verbatim from the Mamta card, which is an identity card made for the mother and children used to record their health information.


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Purohit I et al. The Relation Between Antenatal Care, Vaccination

4. Anthropometry: Measurements, including height, head, and chest circumference, were recorded using an inch tape. A digital scale was used to measure weight. The collected data were then mapped onto the growth chart from the Indian Academy of Pediatrics to calculate the weight-for-age. Children below -3 SD were classified as severely underweight, those between -2 SD and -3 SD as mildly to moderately underweight, those between -2 SD and +2 SD as normal, and those above +2 SD as overweight. To calculate the weight-for-age according to the WHO standards, we used the WHO Anthro Survey Analyser: Software for analyzing survey anthropometric data for children under 5 years of age. Built-in software edition. Version 1.0. Geneva, World Health Organization, 2018.

The mid-upper arm circumference was recorded using Shakir’s tape. A circumference above 12.5 cm was classified as normal, between 12.5 cm and 11.5 cm as moderate malnutrition, and below 11.5 cm as severe malnutrition.

Statistical Analysis

After the data was organized in Microsoft Excel 2019, it was then analyzed in IBM SPSS version 26 (trial version). To assess the association between antenatal care received and the anthropometric outcomes, and to evaluate the impact of vaccine coverage on the growth and nutritional status of children under five, the chi-square test was used. To explore the potential interactions between antenatal care and vaccination on childhood anthropometric measures, regression analysis was performed, with significance determined by a p-value of less than 0.05.

Result

Demographic details and procedures

The data were manually collected from rural areas by the researchers. The children's data were obtained from their mothers, who provided demographic details in the case record form, including age, caste, sex, religion, and the mother's level of schooling, as shown in Table 1. To determine the association between these demographic variables and weight-for-age anthropometric measures (according to the Indian Academy of Pediatrics and WHO standards) as well as mid-upper arm circumference, we used the Chi-square test.

Significant associations were found between the mother's level of schooling and the weight-for-age classification using both the Indian Academy of Pediatrics (p-value = 0.016) and the WHO classification (p-value = 0.015).

Table 1: The demographic details of children under the age of five are presented in a tabular format (N=100)

Demographic characteristicsNumberP-value(IAP classification)P-value(WHO classification)MUAC
Age32.62 ± 1.90 months
Caste
SC30
ST10
OBC350.0650.3730.218
General20
Other5
Sex
Male620.1960.2800.578
Female38
Religion
Hindu73
Muslim240.9410.1140.507
Christian3
Schooling of the mother
Till 5th13
Till 10th36
Till 12th18
Holds a bachelor's degree80.0160.0150.908
Holds a master's (or above)6
Uneducated19

*Significance was found between the schooling of the mother and the Weight for age measure according to both IAP and WHO classification

Weight-for-age Anthropometric measure and Immunization status

Using the anthropometric data (height, weight, and age), we calculated weight-for-age according to the Growth Chart used by the Indian Academy of Pediatrics and weight-for-age Z-score according to the WHO standards using the WHO Anthro software. We compared these with the vaccination status. A child who received BCG, OPV, DPT, and Measles before age of one was classified as fully immunized.


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Purohit I et al. The Relation Between Antenatal Care, Vaccination

Any child aged one but who did not receive all four vaccines (BCG, OPV, DPT, and Measles) before the age of one was referred to as partially immunized. Those who did not receive any vaccine were classified as never vaccinated. To find the association between these parameters, we used the Chi-square test. A significant association was found between the WHO weight-for-age Z-score classification and the vaccination status of children under five (p-value = 0.040). The data is presented in Table 2.

Table 2: The Weight-for-age anthropometric measures and immunisation status in tabular format

(significance <0.05)

VariableStatusP-valueP-valueMUAC
Fully vaccinatedPartially vaccinatedNever Vaccinated(IAP classification)(WHO classification)
Severely underweight761
Overweight2000.0800.0400.256
Normal weight36350
Mild to Moderate
underweight		1130

*Significance was found between immunisation status and WHO classification for WAZ (weight-for-age Z score)

Antenatal care details and Anthropometric measures

To find the association between the antenatal care a mother receives during the nine months of pregnancy and its long-term benefits seen in children under five, we used the ANC details and compared them with the anthropometric variables (weight-for-age and mid-upper arm circumference) using the Chi-square test. We found significant associations between the type of birth and mid-upper arm circumference (p-value = 0.038) and between delivery method and mid-upper arm circumference (p-value = 0.004). The data are presented in Table 3.

*Significance was found between the type of birth and mid-upper arm circumference (p-value = 0.038), as well as between delivery method and mid-upper arm circumference (p-value = 0.004).

Table 3: Associations between Antenatal care and the anthropometric measures using Chi-square test (significance <0.05)

Antenatal Care DetailsNumberP-value(IAP classification)P-value(WHO classification)MUAC
Place of birth
Institutional940.8070.6180.834
Home6
Type of birth
Vaginal birth670.0540.0420.038
Caesarian section33
Antenatal care received
Yes890.2890.390.584
No11
Delivery
At-term940.3790.7490.004
Pre-term6
Intrauterine complications
Yes140.8630.7910.186
No86
Immunization against tetanus
Yes900.3440.4680.617
No10
Was the immunization against tetanus complete?
Yes230.1860.4650.186
No77

Immunisation details and Anthropometric measures

Table 4: The association between Immunization details and the Anthropometric measures (significance <0.05)

Immunization DetailsNumberP-value(IAP classification)P-value(WHO classification)MUAC
Distance to the Primary health care facility
<1 km45
1-2 km300.7310.7230.472
>2 km25
Place of immunization
Hospital36
Anganwadi600.1070.4780.955
Home3
Not immunized1
Does the mother follow the MAMTA card?
Yes860.6180.9540.726
No14
Do the parents have to pay a fee for the immunization?
Yes930.3680.9850.459
No7

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Purohit I et al. The Relation Between Antenatal Care, Vaccination

We compared the immunization details of the child while also considering other variables, such as the distance to a primary health care facility, with the anthropometric variables using the Chi-square test. However, no significant association was found. The data are presented in Table 4.

Discussion

This study aimed to find an association between various factors of antenatal care and immunization in both the mother and child, and to study the long-term effects on anthropometric measures for children under five years of age. The goal was to understand the benefits of timely antenatal care and immunization while also considering several other demographic factors, such as the mother's level of schooling, place and type of delivery, distance to the nearest primary health care centre, and fees paid for vaccination. We used these variables to gain a better understanding of all the factors that may affect a child's anthropometric measures, thereby contributing to under-five mortality.

When we compared the demographic characteristics with the anthropometric measures, we found a significant association between the schooling of the mother and both IAP and WHO standard weight-for-age distribution, proving that maternal education can impact the nutritional status of a child. The education of a mother significantly contributes to the nourishment of a child. [10] The justification is that a mother who is educated about the basics of nutrition is more likely to feed her child a balanced meal. In a study conducted in the United States, it was found that, along with maternal education, other factors such as race and socioeconomic conditions also affect the birth weight of an infant. [11] In another study conducted in China, it was found that even in an environment rich in quality food, low maternal education led to poor nutrition in school-going children. [12] Low maternal education has also been linked to lower levels of cognition in adults. [13] The more educated a mother is, the more diverse approaches she will be able to take to protect her child, such as nutrient supplementation and maintenance of proper sanitation. [14] Along with corroborating our findings, these studies highlight the importance of secondary factors, such as maternal education, in preventing malnutrition in children and, in turn, preventing them from preventable diseases, which are the largest contributors to under-5 mortality. 2

In our study, we found a significant association between anthropometric variables and immunization status, highlighting the important role immunization plays in decreasing the risk of malnutrition. [15] Vaccination is one of the most effective tools in reducing under-5 mortality, particularly when administered early in infancy, preferably during the first year, as it can be highly effective [16]. However, if given after malnutrition has set in, their effectiveness diminishes, offering little protection against infections. Therefore, the early mobilization of resources is essential, especially in areas with higher rates of malnutrition. While comparing antenatal care factors and anthropometric measures, we established that the type of delivery was associated with anthropometric outcomes. Previous studies have documented that the mode of delivery significantly impacts the body mass index of adolescents. [17]

Several studies have shown that undernutrition in mothers is associated with low birth weight in infants, which makes them susceptible to several diseases in their adult life. [18], [19] This underlines the importance of antenatal care in enhancing a child's health. Pregnancy-related malnutrition can also impact fetal development by altering the distribution of fat, which can ultimately lead to the emergence of numerous adult-onset diseases. Despite the presence of several government schemes, there are still gaps in implementation. In the NFHS-5 survey, it was found that only 58% of pregnant women in India obtain at least four prenatal care visits. [20] Even though maternal care in India has improved since the last survey (NFHS-4), there is still much work to be done to ensure good-quality maternal care. Our study emphasises the effect of antenatal care on the anthropometric outcomes of children, making it crucial to investigate the reasons behind the underutilization of antenatal care in rural regions. Because of the lasting impact on body composition and susceptibility to chronic diseases, it is crucial to take into account both maternal health and prenatal care aspects when analyzing the long-term health outcomes of children.

Conclusion

This study aimed to highlight the importance of factors such as antenatal care, maternal education, and immunization in the health outcomes of children under 5 years.


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Purohit I et al. The Relation Between Antenatal Care, Vaccination

According to our study, factors such as maternal education, vaccination, and schooling of the mother influenced long-term anthropometric outcomes in children under 5 years. Additionally, we also noticed a significant association between the type of birth (caesarean section and vaginal delivery) and the anthropometric outcomes. Inadequacy in providing antenatal care and routine vaccination can increase the risk of diseases in a child. Target interventions at these stages can thus reduce under-5 mortality.

Permission of Institutional Research Board: Yes

Funding: None

Conflict of interest: None initiated

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