ORIGINAL ARTICLE

Risk Correlates of Diarrhea in Children Under 5 Years of Age

in Slums of Bankura, West Bengal
Avisek Gupta, Gautam Sarker1, Arup Jyoti Rout1, Tanushree Mondal2, Ranabir Pal3
Department of Community Medicine, Bankura Sammilani Medical College, Bankura, 2Department of Health and Family
Welfare, Government of West Bengal, Swasthya Bhavan, Block-GN, 29, Sector-5, Saltlake City, Kolkaka, West Bengal,
1
Department of Community Medicine, MGM Medical College, Kishanganj, Bihar, 3Department of Community Medicine
and Family Medicine, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India

ABSTRACT
Background: Diarrheal diseases are an important cause of mortality and morbidity globally in children under 5 years of age.
Objective: To find the prevalence and risk factors of diarrhea among children under 5 years. Materials and Methods: A population-
based analytical cross-sectional study was conducted in the urban slums of Bankura, West Bengal on the prevalence of diarrhea
and feeding practices, nutrition, and immunization among 152 children under 5 years (69 males and 83 females). Results:
Overall prevalence of diarrhea was 22.36%; 21.73% males and 22.89% females were affected with diarrhea. There were 57.69%
diarrhea cases in children of 7-12 months age group, followed by 25.71% in those of 13-24 months age group; with increasing
age, the prevalence of diarrhea gradually decreased. Diarrhea was noted to be 20.33% in exclusively breastfed children and
31.57% in children who were breastfed for less than 6 months. In bottle-fed children, the frequency of diarrhea was 26.08%.The
prevalence of diarrhea was 21.83% in completely immunized children and 30% in partially immunized children. Risk of diarrhea
was 19.80% in normal participants and 27.45% in undernourished children. Conclusion: The present study identified a high
prevalence of diarrhea in children under the age of 5 years. Findings of the study also revealed the demographic features, feeding
practices, immunization practices, and nutritional status as risk factors of diarrhea, which can be tackled by effective education
of the community.

Key words: Diarrhea, Exclusive breastfeeding, Immunization, Nutrition, Children under 5 years

INTRODUCTION 2005-2006, we analyzed information on 2687 children

under 5 years of age who were living in urban slums located

D iarrhea is one of the most important causes of death in

the world. Globally, more than 10 million children die
each year, of which about 1.5 million die from diarrhea.[1,2]
in eight selected Indian cities. The results revealed that
about 8.3% of slum children under 5 years of age suffered
from diarrhea during 2 weeks preceding the survey. About
Diarrheal diseases are the leading causes of mortality 14.6% infants suffered from diarrhea, compared to 12%
and morbidity in children under the age of 5 years in among those aged 12-23 months.[5] The factors related to
developing countries and definitely threaten the attainment higher prevalence of diarrhea are lack of education of
of Millennium Development Goal 4.[3] Worldwide, acute mother, lack of exclusive breastfeeding, breastfeeding for
diarrhea causes 16% of deaths in children under 5 years. less than 1 year, roundworm infestation, nutritional status,
Most of these deaths occur in low- and middle-income immunization status, night blindness, female sex, literacy,
countries; these deaths are avoidable by the existing personal hygiene, overcrowding, garbage disposal, source
interventions.[4] Using data obtained from the third round of water supply, and toilet facility.[6-8]
of National Family Health Survey (NFHS) conducted in
Population in the urban slums is a heterogeneous
Access this article online conglomerate of all castes, creed, and religions with
Quick Response Code: a diversified lifestyle. In addition, the risk factors for
Website:
www.jgid.org childhood diarrhea are also related to the feeding practices

DOI: Address for correspondence:

10.4103/0974-777X.150887 Dr. Gautam Sarker,
E-mail: dr.gsarker@gmail.com

Journal of Global Infectious Diseases / Jan-Mar 2015 / Vol-7 / Issue-1 23

 Gupta, et al.: Diarrhea in under 5 children

and nutritional and immunization status. With this The principal investigator collected the data using the
background, the study was undertaken in the urban slums interview technique by conducting house-to-house
of Bankura in West Bengal to elicit the prevalence and risk visits in the households of the selected slums. Children
factors of diarrhea among children under 5 years of age. below 5 years of age were surveyed, with an average of
7-8 children per day, till 152 children were covered. Then
MATERIALS AND METHODS the pre-designed, pre-tested, semi-structured questionnaire
was used to collect the data regarding socio-demographic,
A population-based analytical cross-sectional study was economic, feeding practices, and morbidity of infant and
undertaken in the urban slums of Bankura for 1 month in children. Socio-economic status of the family of the family
children under 5 years of age. Ward no. 15 (of Lokepur) of was determined by modified Kuppuswamy scale, according
Bankura Municipality was randomly selected for the study, to price index 2012.[9]
with four slums in the mentioned ward from the list of
slums under Bankura Municipality. Two slums (50%) were All efforts were made to collect the correct age of the child
selected randomly, namely Bakultala and Kadampara slums. on the basis of information from the caregivers, age of
Total enumeration of children under 5 years of age was other siblings, birth certificate, immunization cards/mother
conducted, and thus, a sample size of 152 was obtained. and child protection card, other available medical records,
etc. The nutritional status was assessed and graded on the
The data collection tool was an interview schedule that was basis of expected weight for age by plotting in the growth
developed at the institute with assistance from the faculty chart as classified by the Indian Academy of Pediatrics. The
members and other experts of Department of Community weight of the children was measured with a standardized
Medicine, Bankura Sammilani Medical College. Detailed weighing scale (bathroom scale) with minimal clothes and
information regarding socio-demographic characteristics, barefoot. When the child was unable to stand, the weight
socio-economic status (SES), and health parameters was of the child with the caregiver was taken and then the
collected from each participant using this structured schedule. weight of the caregiver was deducted to get the weight to
Initial translation, back-translation, and re-translation the nearest 500 g.
followed by a pilot study were conducted on mothers of
20 children under 5 years of age born in slums other than Operational definitions
the selected slums and living in the study area to check the
Diarrhea
comprehensibility and acceptability of the questionnaire.
Any of the selected children having acute diarrhea a t the
Inclusion criteria time of interview or h a v e had acute diarrhea in the
preceding 2 weeks was taken as a case of acute diarrhea
Children under the age of 5 years residing in the selected for this study.[7]
study area (Bakultala and Kadampara slums)
Immunization status
Exclusion criteria Immunization status of the participants was obtained
from their immunization cards and for the evaluation of
The cases with persistent diarrhea for more than 2 weeks immunization status, the criterion described by Narain
duration and non-consenting caregivers were excluded was followed.[10] Completely immunized children were
from the study. those who received three doses of DPT, three doses of
oral polio vaccine (OPV), and three doses of hepatitis
Data collection vaccine administered between 6 weeks and 9 months at
an interval of 4 weeks, plus one dose of BCG plus one
Necessary approval was obtained from the institutional dose of measles within 1 year of life. Partially immunized
ethical committee. Cooperation from the Anganwadi children were those who received one or more doses of
workers was sought for recruiting the study participants. the primary doses of the National Immunization Schedule.
The respondents were the caregivers of the children. So,
all the caregivers were explained the purpose of the study Feeding practices
and were ensured strict confidentiality. Written informed Exclusively breastfed children were those who received only
consents were taken from the respective caregiver prior to breast milk from birth to 6 months of age, while bottle
the study. They were given the option of not to participate fed children received cow’s milk or other animal’s milk or
in the data collection of the study if they wanted. reconstituted infant milk formula from birth onward.
24 Journal of Global Infectious Diseases / Jan-Mar 2015 / Vol-7 / Issue-1
 Gupta, et al.: Diarrhea in under 5 children

Nutritional status prevalence of diarrhea was found to be 22.36%. Females

The nutritional status was assessed and the grade of were more affected with diarrhea (22.89%) than males
malnutrition was calculated on the basis of expected weight (21.73%) in the study population. As the children grew
for age by plotting in the growth chart as classified by the older, the prevalence of diarrhea gradually decreased
Indian Academy of Pediatrics,[11] i.e. 80-100% normal, [Table 1].
71-80% Grade I, 61-70% Grade II, 51-60% Grade III, and
less than 50% Grade IV. Children belonging to scheduled castes and scheduled
tribes formed 97.37% in our study. Highest number of
The principal investigator personally contacted the health the families belonged to upper-lower socio-economic
care providers, Anganwadi workers in the respective ward, class according to modified Kuppuswamy scale. Diarrhea
and appraised the findings of the research with remedial was seen in 20.33% of exclusively breastfed children and
measures. The study findings were also shared with the in 31.57% of children who were breastfed for less than
caregivers of the study participants by the principal 6 months. Again in bottle-fed children, prevalence of
investigator. As morbidity due to diarrhea in the study diarrhea was 26.08%, compared to 21.70% in non-bottle-
population was high, emphasis was given for utilization fed children. Diarrhea prevalence was 21.83% among
of locally available services like timely vaccination and completely immunized children and 30.00% among
regular growth monitoring in the Anganwadi centers, partially immunized children. Children with completed
as well as early initiation of breastfeeding and exclusive primary immunization status were compared with partially
breastfeeding for 6 months for prevention of diarrhea in immunized children in determining the risk for diarrhea
children of under 5 years of age. The concept of Baby- in relation to immunization status. In the present study,
friendly Hospital Initiative was discussed in connection the risk of diarrhea was 19.80% in normal children and
with childhood diarrhea. 27.45% in undernourished children [Table 2].

Statistical analysis DISCUSSION

The collected data were entered into MS-Excel spreadsheets The present study has identified a high prevalence of
for analysis. The statistical analyses were done using diarrhea among children under 5 years and pointed out
GraphPad InStat3 software. Percentages and Chi-square various socio-demographic, immunization, and nutritional
tests were used in this study to analyze epidemiological risk factors. The overall prevalence of diarrhea was found
variables. to be 22.36%. In our study, children of the age group 7-12
months were mostly affected with diarrhea. As the children
RESULTS grew older, the prevalence of diarrhea gradually decreased.

The study population consisted of children in the age group A study conducted in South India reported the prevalence
of less than 5 years from a heterogeneous group in terms of diarrhea to be 22.5% which once again reinforces the
of caste, occupation, and income. Totally 45.39% male and fact that acute diarrhea in children is an important health
54.61% female children under 5 years participated in the priority and that every effort has to be taken to control
present study. Majority (26.97%) of the study participants and prevent acute diarrhea and its sequelae. There are few
were in the age group of less than 1 year and the prevalence studies done on the prevalence of acute diarrhea in children
of diarrhea was highest in the age group of 7-12 months under 5 years in different parts of India and outside India.[7]
(57.69%) followed by 13-24 months (25.71%). The overall A study done in Bhopal by Tiwari et al. has reported the

Table 1: Distribution of diarrhea among the study participants

Age in months Male Female Total n (%) Overall diarrhea (%)
Diarrhea Diarrhea Total (%) Diarrhea Diarrhea Total n (%)
present n (%) absent n (%) present n (%) absent n (%)
0-6 1 (14.28) 6 (85.72) 7 (10.14) 2 (25.00) 6 (75.00) 8 (9.64) 15 (9.86) 3 (20.00)
7-12 6 (54.54) 5 (45.46) 11 (15.94) 9 (60.00) 6 (40.00) 15 (18.08) 26 (17.11) 15 (57.69)
13-24 4 (26.66) 11 (73.34) 15 (21.74) 5 (25.000 15 (75.00) 20 (24.09) 35 (23.03) 9(25.71)
25-36 2 (28.57) 5 (71.43) 7 (10.15) 1 (11.11) 8 (88.89) 9 (10.85) 16 (10.52) 3 (18.75)
37-48 1 (5.55) 17 (94.45) 18 (26.08) 1 (4.76) 20 (95.24) 21 (25.30) 39 (25.66) 2 (5.12)
49-59 1 (9.09) 10 (90.91) 11 (15.95) 1 (10.00) 9 (90.000) 10 (12.04) 21 (13.82) 2 (9.52)
Total 15 (21.73) 54 (78.27) 69 (100) 19 (22.89) 64 (77.11) 83 (100) 152 (100) 34 (22.36)

Journal of Global Infectious Diseases / Jan-Mar 2015 / Vol-7 / Issue-1 25

 Gupta, et al.: Diarrhea in under 5 children

Table 2: Correlates of diarrhea among the study participants

Correlates Diarrhea present Diarrhea absent Total Statistical analysis
n (%) n (%) Odds ratio Chi-square test
Breastfeeding (n = 137)
Less than 6 months 6 (31.57) 13 (68.43) 19 1.8 χ2 = 0.64, df = 1, P = 0.4237
For 6 months 24 (20.33) 94 (79.67) 118
Bottle feeding (n = 152)
Yes 6 (26.08) 17 (73.9) 23 1.27 χ2 = 0.04, df = 1, P = 0.8415
No 28 (21.70) 101 (78.30) 129
Immunization status (n = 152)
Partially immunized 3 (30.0) 7 (70.0) 10 1.53 χ2 = 0.04, df = 1, P = 0.8415
Completely immunized 31 (21.83) 111 (78.17) 142
Nutritional status (weight for age) (n = 152)
Underweight 14 (27.45) 37 (72.55) 51 1.53 χ2 = 0.74, df = 1, P = 0.3897
Normal 20 (19.80) 81 (80.20) 101

prevalence of acute diarrhea among children under 5 years of diarrhea at the age of 6-11 months can be attributed
as 27.4%, which is little higher than that found in the present to the introduction of contaminated weaning foods.[21] In
study.[12] Ansari et al. have reported the prevalence as 16% addition, crawling starts at this age and the risk of ingesting
in their study done in Aligarh of Uttar Pradesh. The study contaminated materials may cause diarrhea. The risk of
by Ansari et al. relates to the patients attending the clinics diarrhea decreases subsequently after 6-11 months; this is
under Rome scheme, which may not be representative of probably because the children begin to develop immunity
the population.[13] A study done in East Africa by Mtike to pathogens after repeated exposure.[22]
has reported the prevalence of diarrhea to be 18% among
children in both rural and urban populations.[14] The study In all the NFHS [NFH-1 (1992), NFHS-2 (1998-1999),
done in South India has shown a very high prevalence and NFHS-3 (2005-2006)], the prevalence of diarrhea was
of acute diarrhea (40.7%) in the age group 7-12 months calculated as the percentage of children who had diarrhea
compared to other age groups and the difference is also at the time of interview or during the preceding 2 weeks,
statistically significant. This may be because at this age, as done in this study. NFHS-1 had reported the prevalence
weaning foods are introduced and the child is also exposed of diarrhea in children under 4 years of age, NFHS-2 had
more to the environmental condition as it starts crawling reported it in children under 3 years of age, and NFHS-3
and walking. The next vulnerable age group was found to had reported the prevalence in children under 5 years of
be 13-24 months (32.1%). The prevalence of diarrhea was age. Prevalence was 16.3% in the age group of 6-11 months
found to be only 17% in the age group 0-6 months, which and 12.8% in 12-23 months age group in NFHS-1; similar
probably reflects the protection offered by breastfeeding.[7] findings were observed in the other surveys (9.9 and 9.3%,
A study conducted at Saudi Arabia revealed that the overall respectively, in NFHS-2; 10.4 and 9.9%, respectively, in
incidence of diarrhea was 9.9%. The highest incidence of NFHS-3).[23-25]
reported episodes (23.3%) was seen in infants aged 7-12
months, followed by 8.4% in less 7 months, while the Gender
lowest incidence (3.8%) was in the 1-5 years age group.[15]
This calls for intensive health education of parents and Among the participants in our study, females were more
proper immunization of the child.[16] A study conducted affected with diarrhea (22.89%) than males (21.73%).
at Iraq showed that the prevalence of diarrhea was 21.3%. Similar pattern was reported in the South Indian study;
Compared to children aged 48-59 months, children in the hough female children had slightly higher prevalence of
age groups 6-11 months and 12-23 months were 2.22 and acute diarrhea (23.8%) than males (21.4%), the difference
1.84 times, respectively, more likely to have diarrhea.[17] A was not statistically significant.[7] In the study conducted
study conducted in Pakistan revealed that the prevalence of at Saudi Arabia, the incidence in males was 6.8%, but in
diarrhea was 51%.[6] A study conducted at Ethopia revealed females, it was almost twice as much (13.3%). This might
the prevalence of diarrhea to be 22.45%. The study showed point to a possible cultural influence in this region by which
that diarrhea was significantly associated with children in the nutrition of female children is neglected, restricting
the age groups 6-11 months and 12-23 months, compared their access to health.[15] The prevalence of diarrhea was
to children aged above 35 months.[18] This finding is in marginally higher among girls than boys (53% vs 49%,
agreement with other studies.[19-20] The peak prevalence respectively).[6] No gender difference in the prevalence of
26 Journal of Global Infectious Diseases / Jan-Mar 2015 / Vol-7 / Issue-1
 Gupta, et al.: Diarrhea in under 5 children

diarrhea was observed in NFHS-1, NFHS-2, and NFHS- Complete immunization status (in participants above
3.[23-25] 12 months)

Excusive breastfeeding and bottle feeding Partially immunized children were found to be at an
increased risk for diarrhea in our study. The prevalence
In the present study, diarrhea was found in 20.33% of of diarrhea was 21.83% among completely immunized
the exclusively breastfed children and 31.57% of children children and 30.00% in the partially immunized group,
who were breastfed for less than 6 months. Again in which was statistically not significant. Partially immunized
bottle-fed children, the incidence of diarrhea was 26.08%, children had higher risk for diarrhea [odds ratio (OR) 4.6]
compared to 21.70% in breastfed children. About one- compared to fully immunized children.[7] This is obviously
third of the cases (36.1%) were bottle fed, while 12.7% due to the protective effect of immunization, especially
were breastfed.[15] Terminating breastfeeding at 6 months with reference to measles immunization.[31] The percentage
increases the probability of occurrence of diarrhea and of fully immunized children in the study population was
Acute respiratory infection by 19% and 25%, respectively, 88.9%. Improving immunization coverage will help to
compared to counterparts who breastfeed longer than reduce the burden of illnesses due to diarrhea in children.
6 months.[3] It has long been established that bottle-fed
children are at great risk of diarrhea than those who Nutritional status (weight for age)
are breastfed, due to milk contamination. Even though
it was not statistically significant in the multivariate Our study reflected that undernourished children had
analysis, the odds of bottle-fed children having diarrhea 27.45% risk of diarrhea, as compared to 19.80% in normal
was approximately one and a half times greater than for participants. The undernourished children had 14.4 times
children who were not bottle fed. Bottle feeding was higher risk for acute diarrhea than normal children.
significantly related with higher diarrheal morbidity in This is in conformity with the statement made by the
bivariate analysis.[26] Similar findings were reported from International Center for Diarrheal Disease Research in
Bangladesh that diarrhea is common among malnourished
India and Ethiopia.[27]
children. The prevalence of undernutrition in the
It was found that mixed-fed infants aged between 0 above study population was 23.1%. It is very important
and 11 months tend to have a higher risk of diarrhea to prevent undernutrition by proper implementation
than fully breastfed children, while the risk of diarrhea of the various nutritional supplementation programs
among weaned infants is twice that of mixed-fed infants. for reducing the problem of diarrhea in children. [7]
In essence, the health risks of mixed feeding are real, The poor nutritional status of a child is a major risk factor
particularly for infants aged less than 7 months, and of mortality. A study in Dhaka, Bangladesh identified the
are even worse for those weaned before 6 months of risk factors of mortality among children with diarrhea who
age. [28] To address this question, a historical cohort were severely malnourished and hospitalized. In this study,
study of the associations between feeding modes and hypothermia, clinical septicemia, and bronchopneumonia
diarrhea incidence and severity in children aged 0-14 were identified as the major risk factors of mortality among
the severely malnourished children with diarrhea.[32]
months at baseline was done in Al Ain city, United
Arab Emirates. In this city located in a newly developed
Strengths of the study
country, modern water supply and sanitation facilities
have become available to everyone during the last two Diarrhea is still a public health problem killing millions of
decades. During 3 months of follow-up of 249 children, our future citizens. The study would be an eye-opener for
the non-breastfed children had more diarrhea than the further research in this part of country with resource-poor
partly breastfed children.[29] health care settings. The risk factors identified for diarrhea
would help the planners and program managers of our state
A case-control study in Brazil has shown that young infants of West Bengal and neighboring states to select and plan
who are not breastfed have 25 times greater risk of dying approaches in curbing the menace in Northeastern states.
of diarrhea than those who are exclusively breastfed. A
longitudinal study in the urban slums of Lima, Peru found Limitations of the study
that exclusively breastfed infants have a reduced risk of
diarrheal morbidity when compared with infants receiving The study was undertaken in the urban slums of Bankura
only water in addition to breast milk.[30] city. Due to diversity of slum population in different parts
Journal of Global Infectious Diseases / Jan-Mar 2015 / Vol-7 / Issue-1 27
 Gupta, et al.: Diarrhea in under 5 children

of India and also the living conditions, the findings cannot 7. Stanly AM, Sathiyasekaran BW, Palani G. A population based study of acute
diarrhea among children under 5 years in a rural community in South India.
be generalized. Further, it could have been better if other Sri Ramchandra J Med 2009;1:1-7.
related risk variables like type of family, housing conditions 8. Siziya S, Muula AS and Rudatsikira E. Diarrhea and acute respiratory
such as ventilation, overcrowding, parental current smoking infections prevalence and risk factors among under-five children in Iraq in
2000. Ital J Pediatr 2009;35:1-9.
habit, location of kitchen, fuel used for cooking, as well as
9. Kumar N, Gupta N, Kishore J. Kuppuswamy’s socioeconomic scale:
literacy status of parents could be included in the study. Updating income ranges for the year 2012. Indian J Public Health
Apart from that, manpower, money, and time also an 2012;56:103-4.
important consideration. 10. Narain JP, Banerjee KB. Epidemiology of ARI acute respiratory infections.
Indian J Pediatr 1987;54:153-60.
11. Ghai OP, Gupta P, Paul VK. Nutrition and macronutrient disorders. 6th ed.
Future directions of the study Essential Pediatrics. New Delhi: Revised Reprint; 2005. p. 101-6.
12. Tivari SC, Saraf Y, Nambiar G. Study of diarrheal diseases in 0-5 years old
There is a need to carry out extensive multicentric studies children and practices of oral rehydration solution, Bhopal, Madhya Pradesh
in Conference Proceedings of the 9th Asian conference on diarrheal diseases
involving both rural and urban areas to identify all the risk and nutrition. New Delhi; Sep 28-30, 2001.
factors precipitating diarrhea, so that preventive program 13. Ansari MA, Khan Z, Khan IM. A clinico social study to assess the magnitude
becomes more successful in India. Not only the array of of diarrheal diseases among children in rural areas of Alligarh, Uttar Pradesh
in Conference Proceedings of the 9th Asian conference on diarrheal diseases
socio-demographic, socio-economic, and environmental and nutrition. New Delhi; Sep 28-30, 2001.
factors along with the health-seeking behavior, but also 14. Mtike G. Prevalence of acute and persistent diarrhea in North Gondar
other physiological and behavioral risk factors need to be zone, Ethiopia. East Afr Med J 2001;78:433-8.
explored for effective control of diarrhea in under-five 15. Alshehri M, Abdelmoneim I, Gilban HM. Analysis of diarrhea episodes in
children reported at a primary health care centre in Abha city in the year
segment of the population. 2002. J Family Community Med 2004;11:35-8.
16. Scrinshaw NS. Historical concepts of interactions, synergism and
antagonism between nutrition and infection. J Nutr 2003;133:316S-21.
CONCLUSION
17. Siziya S, Mulla AS, Rudatsikira E. Diarrhea and acute respiratory infections
prevalence and risk factors among under-five children in Iraq in 2000. Ital
The present study identified a high prevalence of diarrhea J Pediatr 2009;35:1-9.
among children under 5 years. It also pointed out various 18. Mengistie B, Berhane Y, Worku A. Prevalence of diarrhea and associated
risk factors among children under five years of age in estern Ethopia.
socio-demographic, nutritional, and environmental A cross-sectional study. Open J Prev Med 2013;3:446-53.
modifiable risk factors which can be tackled by effective 19. Desalegn M, Kumie A, Tefera W. Predictors of under-five childhood
education of the community. diarrhea: Mecha District, West Gojjam, Ethiopia. Ethiopian Journal of
Health Development 2011;25:174-232.
20. Boadi KO, Kuitunen M. Childhood diar- rheal morbidity in the Accra
ACKNOWLEGMENT Metropolitan Area, Ghana: Socio-economic, environmental and behavioral
risk de- terminants. Journal of Health and Population in Develop- ing Countries.
We are grateful to the department of community Medicine, Available from: http://www.jhpdc.unc.edu/ [Last accessed on 2005].
21. Dewey KG, Adu-Afarwuah S. Systematic review of the efficacy and
Bankura Sammilani Medical college for helping us to conduct the
effectiveness of complementary feeding interventions in developing
study. We are also grateful to Anganwadi workers and specially countries. Matern Child Nutr 2008;4(Suppl 1):24-85. Available from:
to slums dwellers where the study was conducted. http://www.dx.doi.org/10.1111/j.1740-8709.2007.00124.x [Last accessed
on 2014 Nov 10].
22. Motarjemi Y, Käferstein F, Moy G, Quevedo F. Contaminated weaning food:
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31. Jawetz M, Adel berg. Clinical guide to the role of microorganisms play in
health and illness. Review of Medical Microbiology. XIV ed. New York: Source of Support: Nil. Conflict of Interest: None.

Author Help: Reference checking facility

The manuscript system (www.journalonweb.com) allows the authors to check and verify the accuracy and style of references. The tool checks
the references with PubMed as per a predefined style. Authors are encouraged to use this facility, before submitting articles to the journal.
• The style as well as bibliographic elements should be 100% accurate, to help get the references verified from the system. Even a
single spelling error or addition of issue number/month of publication will lead to an error when verifying the reference.
• Example of a correct style
Sheahan P, O’leary G, Lee G, Fitzgibbon J. Cystic cervical metastases: Incidence and diagnosis using fine needle aspiration biopsy.
Otolaryngol Head Neck Surg 2002;127:294-8.
• Only the references from journals indexed in PubMed will be checked.
• Enter each reference in new line, without a serial number.
• Add up to a maximum of 15 references at a time.
• If the reference is correct for its bibliographic elements and punctuations, it will be shown as CORRECT and a link to the correct
article in PubMed will be given.
• If any of the bibliographic elements are missing, incorrect or extra (such as issue number), it will be shown as INCORRECT and link to
possible articles in PubMed will be given.

Journal of Global Infectious Diseases / Jan-Mar 2015 / Vol-7 / Issue-1 29

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