A better nourished world is a better world. The global community is dealing with numerous nutritional challenges.1 Eighty eight percent several nations are suffering from two or three types of malnutrition2. Malnutrition is a serious medical condition marked by a deficiency of energy, essential proteins, fats, vitamins and minerals in a diet. Over 10 million children aged less than five years (under-five children) die annually from diseases that are both preventable and curable, almost all these deaths occur in poor countries3. Prevalence of underweight children in India is among the highest in the world, roughly double that of Sub-Saharan Africa, with disastrous effects for morbidity, mortality, productivity, and economic growth.4

Nutritional health status assessment includes evaluating information related to demographics, anthropometric measurement, clinical health and eating habits.5, 6

Malnutrition occurs when total nutrient consumption is less than needs. Malnutrition causes a chain reaction of physiological changes, metabolic abnormalities, decreased tissue and organ function, and body mass deterioration7. The primary goal of such studies is to determine the quantity, kinds, and distribution of malnutrition in various geomorphologic locations in order to identify risky groups and manage contributory factors.8

A key focus of the health-related Sustainable Development Goal (SDG) is universal health coverage (UHC), including access to safe, effective, quality, and affordable essential medicines and vaccines8. Childhood immunisation programmes contributed significantly to significant decreases in worldwide morbidity as well as death among children under the age of five. Childhood vaccination can only provide population-level advantages if a large proportion of children get inoculated9. Historically, low vaccination uptake was assumed to be primarily due to impediments to vaccine access10. With the fall in polio vaccination coverage, polio was transmitted from Nigeria to other nations that had previously been proclaimed polio-free.10, 11

There are many unvaccinated and under-vaccinated youngsters in India. As of 2019, India has the world's second biggest number of babies who had not received their first dose of the diphtheria-tetanus-pertussis vaccination.12

Children between age group 3 to 6 years are 77% and age group between 0-3 were only 21 children (23%).

Maximum number of births in Devarayasamudra took place in DRS PHC which was 33%, whereas in Mulbagal Hospital and RLJ Hospital it was 23.1% and 22% respectively out of which 66.7% of them had Normal delivery and 33.3% underwent LSCS. Those who underwent LSCS were due to short stature, increased birth weight and due to existence of co-morbidity condition.

Extreme Low Birth Weight was not noted in the present study absent. Out of 90 children 32 were born with underweight (less than 2.5kg) and the reasons for low weight was due to low socio-economic status and anaemia in pregnancy as per the opinion of the posted Medical Officer in Devarayasamudra Primary Health Center. As the birth order increased the birth weight also decreased correspondingly. As per the survey, most of them (55.6%) were having single child and those who are having more than 2 children were 8.9%.

30 % underwent LSCS and whose birth weight were above 3.5kg.

68.8% of children had normal mid upper arm circumference, 12.6% children were in at risk of malnutrition, 7.7% had moderate acute malnutrition and children suffering from severe acute malnutrition were 7.7%. The reason for malnutrition is due to low socio-economic status and illiteracy of parents.

In our study, 50% of the children were males and the majority (69%) of the children were between the ages of three and six. Mandal et al found that 49.20% of the children in their research were males and 51% were girls. Deshmukh et al.13 found that 52% of children under the age of six were male and 48% were female.14

In this study, more female children (10.84%) were thin built than male children (5.9%), (p>0.05). According to Mandal et al., the frequency of thinness among boys was 84.8% and 85.6% among females14. Another cross-sectional study conducted at Vydehi Institute of Medical Sciences Bengaluru in a rural field practice area revealed that the prevalence of underweight among male and female children was 56 (46.3%) and 60 (48.4%), respectively15. According to this study, 30% of women experienced LSCS and 70% had a normal vaginal birth. Those experiencing LSCS had it due to their short stature, excessive birth weight, or a co-morbidity condition. According to the general public, the high number of normal births in the public sector was attributed to improvements in the quality of treatment and facilities. Another cross-sectional study indicated that the prevalence of underweight, stunting, and wasting was 34.14%, 45.52% and 35.52%, respectively, in the urban field practise area of a medical college in Tumkur. Undernutrition was linked to age, socioeconomic position, immunisation status, religion, and mother's education1. According to the current study, 74% of children have normal midarm circumference, 5% are at risk of malnutrition, and 9% have severe acute malnutrition. Malnutrition is caused by parents' poor socioeconomic level and illiteracy. Preschool children's nutrition is critical since they are at high risk of malnutrition due to the growing period's high protein and calorie requirements7. During the current decade, poor infant and young child feeding, and poor utilization of healthcare are emerging as important determinants of undernutrition in children. Nutrition, health education, and good access and utilization of healthcare can be very effective interventions which could result in substantial reduction in undernutrition in children over the next decade. Children with growth faltering and undernutrition should be identified, counselled and provided with supplements regularly and monitored for improvement. Children with severe acute malnutrition should be referred to primary health care for care and counselling. Based on the observations made during the study and the results, there is a need to educate parents to provide energy-rich, locally available, and nutritionally balanced food items. Because the causes of childhood malnutrition are multifactorial, improvement in one aspect does not reflect the desired change. The necessity of the hour is for all responsible departments and individuals to work together to enhance the nutritional status of children. So now is the time to set the basis for a lifetime of health, strength and mental vigour’s a consequence, it is critical for a primary care physician to examine and comprehend aspects influencing nutritional status in children in order to handle them appropriately. The study appears to indicate a relationship.

The present study reveals that, the rural school going children in Devarayasamudra PHC were fully immunised. Nonetheless, difficulties to increasing regular vaccination coverage remain. Despite significant increases in immunisation coverage between 2000 and 2010. Study participants are suffering from minimal grades of malnutrition. Mothers of these children should be educated about the importance of balanced diet. Consumption of foods like cereals, pulses, green leafy vegetables, roots and tubers, sugar and jaggery, fats and oil, milk and milk products, fruits etc., should be promoted.

Routine immunisation and Vitamin A supplementation are two main services offered by Government of India to reduce child mortality and morbidities. Auxiliary Nurse Midwives from health department, Anganwadi Workers from women and child development department and Accredited Social Health Activists (ASHAs) are responsible for raising awareness and demand for these services.

Under the National Health Mission in India, the Community Level Workers are expected to be the main source and channel for generating health awareness in the community, improving communities’ knowledge and motivating them to access the health system and programs. The study findings revealed that CLWs had strong expertise, particularly ASHA, who is the community's initial point of contact. There is a need for improved induction and periodic refresher training for CLW’s on knowledge about benefits of health programs like immunization, their counselling and communication skills.