Nutritional Status and Morbidity Among School Going
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Scholars Journal of Applied Medical Sciences (SJAMS) ISSN 2320-6691 (Online) Sch. J. App. Med. Sci., 2014; 2(1D):379-383 ISSN 2347-954X (Print) ©Scholars Academic and Scientific Publisher (An International Publisher for Academic and Scientific Resources) www.saspublisher.com Research Article Nutritional status and morbidity among school going children: A scenario from a rural India JP Singh1*, Peeyush Kariwal2, SB Gupta3, AK Singh4, Danish Imtiaz5 1, 4, 5Assistant Professor, Department of Community Medicine, SRMS Institute of Medical Sciences, Bareilly (UP), India 2Associate Professor, Department of Community Medicine, SRMS Institute of Medical Sciences, Bareilly (UP), India 3Professor & Head, Department of Community Medicine, SRMS Institute of Medical Sciences, Bareilly (UP), India *Corresponding author Dr. JP Singh Email: Abstract: School health has been regarded as a high priority intervention in developing countries. However it has not been prioritized in India for many years. Malnutrition is one of a major public health concern affecting a significant number of school children influencing their health, growth and development and school academic performance. The objective of this study was to find out the nutritional status and morbidity pattern in school going children. A cross sectional descriptive study was conducted using a structured questionnaire and anthropometric measurements to assess underweight, stunting and thinness for 561 children at 5 to 18 years age, including 285 boys and 276 girls at Dhaura Tanda, Bareilly district, Uttar Pradesh. The prevalence of malnutrition was calculated using World Health Organization (WHO) Anthro Plus software. This study shows that prevalence of under-nutrition in both male and female was 44.56 and 37.32% respectively. The prevalence of chronic malnutrition (stunting) in male was 26.31% and in females was 21.37%. The prevalence of acute malnutrition in both males and females according to the BMI-for-age was 38.24% and 34.05% respectively. The most common morbidities were upper respiratory tract infection 240 (42.78%), diarrhea 81 (14.44%), carbuncle/furancle 78 (13.90%) and scabies 63 (11.23%).Malnutrition in the form of underweight, stunting and thinning were 41.00%, 23.28% and 36.18% respectively among school going children. URTI & Diarrhea were the most common morbidity. Keywords: Cross-sectional study, Underweight, Stunting, Thinness, World Health Organization (WHO) Anthro Plus INTRODUCTION Nutritional status is the condition of health of In developing countries like India various an individual as influenced by nutrient intake and forms of malnutrition affect a large segment of utilization in the body. Malnutrition is major public population and both macro and micronutrient health problem in developing countries. Freedom from deficiencies are of major concerns. The school age hunger and malnutrition is a basic human right and their period is nutritionally significant because this is the alleviation is fundamental prerequisite for human and prime time to build up body stores of nutrients in national development. Usually referred to as silent preparation for rapid growth of adolescence. Nutrition emergency, it has devastating effects on children, plays a vital role, as inadequate nutrition during society and future humankind. childhood may lead to malnutrition, growth retardation, reduced work capacity and poor mental and social Although the World Bank has included school development [3]. In children, protein/calorie deficient health as one component of its essential public health diet results in underweight, wasting and lowered package for cost effective health program, the nutrition resistance to infection, stunted growth and impaired and health of school- age children in the developing cognitive development and learning. world has received a little attention [1]. WHO in 1997, developed 10 recommendations for school health, and Under nutrition continues to be a primary initiated a global school health initiative in ten cause of ill-health and premature mortality among countries, of which 8 were developing countries [2]. children in developing countries [4]. Under nutrition Despite such initiatives, school health has not been among children is prevalent in almost all the states in focused on in India for many years and donor initiated India [5]. The children living in rural areas of India school health projects have come and gone sporadically disproportionately suffer from under nutrition compared over the decades. with their urban counterparts [6]. 379 Singh SP et al., Sch. J. App. Med. Sci., 2014; 2(1D):379-383 The best global indicator of children’s well Stunting is defined as a low height-for-age for being is growth. Poor growth is attributable to a range children, and it measures the past (chronic) child of factors closely linked to overall standards of living undernutrition. Children with z-scores < -2.00 are said and the ability of populations to meet their basic needs, to be stunted. such as access to food, housing and health care. Assessment of growth is the single measurement that Thinning is defined as low BMI-for-age for best defines the nutritional and health status of children, children, and it is a measure of current or acute and provides an indirect measurement of the quality of undernutrition. Children with z-scores < - 2.00 are said life of the entire population. to be thinned. According to modern concepts, school health Data compilation and analysis service is an economical and powerful means of raising Epi-info software 3.4.1 was used in the community health and more important in future analysis of the data with use of MS Excel. p value was generations. By simply doing periodic medical used to determine the relation between variables. Data examination and daily morning inspection of students, of the nutritional survey was assessed by using WHO we can detect many more problems and treat Anthro software for personal computers, version 3.1, accordingly. The health problems of students vary 2010 [11]. country to country. The most prevalent health problems are malnutrition, infectious disease, intestinal parasites, Criteria for age and diagnosis and diseases of skin, eye, ear and dental caries. Exact age of the child was established from birth certificate/ school identification card, Keeping this in view, this study was carried immunization card or recall method (to the nearest out with the objective to assess the nutritional status and month using calendar of local events). Diseases were morbidity pattern among school going children of accepted as such as diagnosed by pediatrician, skin Bareilly District, UP. This age group is on the threshold specialist and medical officer. of adulthood on whom the progress and welfare of the nation depends. Referral Services Those who were very sick requiring METHODOLOGY emergency treatment were referred to emergency unit A hospital based cross sectional study was of SRMS IMS Bareilly. carried out in the field practice area of rural health training centre (RHTC), Dhaura Tanda, Dept. of Inclusion criteria Community Medicine, SRMS Institute of medical Children of 5-18 year attending outpatient sciences, Bareilly. A minimum sample size of 561 department (OPD) school children (5-18 yrs) was selected for study. The study was conducted from month of July to September Exclusion criteria 2013.The methodology comprised of interview and Children who were seriously ill, too agitated & physical examination. Socio-economic status (SES) is unwilling for anthropometric measurements were determined by using Modified Prasad’s scale [7].The excluded from the study. information was collected on pre designed and pre tested proforma. RESULTS A total of 561 school age children participated WHO anthropometric classification was used for the in the study. Out of them 285 (50.80%) were boys and assessment of malnutrition. Based on the age, body 276 (49.20%) were girls between the age of 5 to 18 weight and height, a number of indices such as weight- years. Table 1 show that 41.00% children were for-age, height-for-age and BMI-for-age have been underweight, 23.88% children were stunted and 36.18% suggested8. The children are classified using three were thinned. Prevalence of malnutrition was categories: 'underweight' (low weight-for-age), comparatively more among boys than girls. 'stunting' (low height-for-age) or 'thinning' (low BMI- for-age). Low anthropometric values are those more Among malnourished children, males than 2 SD away from the CDC 2000 (Centers for dominate the females while the reverse in the case of Disease Control and Prevention) standards [8-10]. normal children. According to weight for age 44.56% boys and 37.32% girls were found to be Underweight is defined as low weight-for-age undernourished. As per their height for age, 26.32% and it reflects past (chronic) and present (acute) boys and 21.38% girls were stunted and as per BMI for undernutrition. Children with z-scores < -2.00 are said age, 38.25% boys and 34.07% girls were thinned. Here to be underweight. association of malnutrition with normal children was found statistically non-significant (p>0.05). 380 Singh SP et al., Sch. J. App. Med. Sci., 2014; 2(1D):379-383 Table 1: Percentage of underweight, normal weight and over weight in study population Weight/Age (%) Height/Age (%) BMI/Age (%) Boys Girls Total Boys Girls Total Boys Girls Total Perc entile (%) (%) (%) (%) (%) (%) (%) (%) (%) 127 103 230 75 59 134 109 94 203 <3 (44.56) (37.32) (41.00) (26.32) (21.38) (23.88)