COMPARATIVE STUDY ON NUTRITIONAL STATUS OF PRIMARY LEVEL SCHOOL CHILDREN STUDYING IN PRIVATE AND PUBLIC SCHOOLS OF BABIYA VDC, SUNSARI by Sukriti Koirala Roll No.: 80092 TU Regd. No.: 5-2-0008-0097-2012 Department of Nutrition & Dietetics Central Campus of Technology Institute of Science and Technology Tribhuvan University, Nepal 2018 i COMPARATIVE STUDY ON NUTRITIONAL STATUS OF PRIMARY LEVEL SCHOOL CHILDREN STUDYING IN PRIVATE AND PUBLIC SCHOOLS OF BABIYA VDC, SUNSARI A dissertation submitted to the Department of Nutrition and Dietetics, Central Campus of Technology, Tribhuvan University, in the partial fulfillment of the requirements for the degree of B.Sc. Nutrition and Dietetics. by Sukriti Koirala Department of Nutrition & Dietetics Central Campus of Technology Institute of Science and Technology Tribhuvan University, Nepal February , 2018 ii Tribhuvan University Institute of Science and Technology Department of Nutrition & Dietetics Central Campus of Technology, Dharan Approval Letter This dissertation entitled Comparative Study on Nutritional Status of School Children Studying in Private and Public Schools of Babiya VDC, Sunsari presented by Sukriti Koirala has been accepted as the partial fulfillment of the requirements for the degree of Bachelor of Science in Nutrition and Dietetics. Dissertation Committee 1. Head of department (Mr. Dambar B. Khadka, Lecturer) 2. External Examiner (Mr. Birendra Kumar Yadav, Associate Professor) 3. Supervisor (Mr. Kabindra Bhattarai, Teaching Assistant) 4. Internal Examiner (Mrs. Richa Bhattarai, Teaching Assistant) Date: February 27, 2018 iii Acknowledgements First and foremost, I would like to show gratitude to my research supervisor Mr. Kabindra Bhattarai; Teaching Assistant of Central Campus of Technology, who despite his busy schedule, always had time to guide and correct me during the entire period of this study. I also owe special thanks to the research co-supervisor Mr. Dinesh Shrestha; Teaching Assistant, for his support whenever I needed any help. Without their assistance and dedicated involvement in every step throughout the process, this paper would have never been accomplished. I am forever grateful to Central Campus of Technology for giving me the identity. I would like to thank Prof. Dr. Dhan Bdr Karki; Campus Chief, for his enormous support. I also express my sincere thanks to Mr. Dambar B. Khadka, Head of Nutrition and Dietetics Department, for his valuable suggestions and guidance and also for providing me with all the necessary facilities for the research. Getting through my dissertation required more than academic support, and I have many people to thank for listening to and, at times, having to tolerate me. I would like to express my gratitude and appreciation to my friends Ms. Bheesma Rai and Ms. Kushma Gautam who tirelessly co-operated and participated in data collection during research work. I would also like to thank Ms. Anushka Lamichhane and Mr. Mohan Khadka for their helping hands. I take this opportunity to express my deepest gratitude towards my teachers, all seniors, juniors and staffs of library of CCT for their direct and indirect co-operations and suggestions. I also express my sincere thanks to all the teachers of schools in Babiya VDC, mothers and care takers of children for providing their valuable time and information. Most importantly, none of this could have happened without my family. I would like to thank my parents, sister and brother for their patience, guidance, motivation and everlasting support during my study. I also place on record, my sense of gratitude to everyone who directly or indirectly helped me to complete this work. Date of submission: February 27, 2018 (Sukriti Koirala) iv Abstract The nutritional status of school children influences their health, intellect, and subsequently their educational achievement. Yet, school children are not usually included in health and nutrition surveys. A descriptive cross-sectional study was conducted among 274 students; 137 students from each private and public schools in Babiya VDC, Sunsari to assess and compare the nutritional status of primary level school children and to determine the associated factors. Weight and height of students were measured using standard instruments and semi-structured questionnaires were administered to parents or care takers to assess the factors affecting nutritional status of children. Information about food consumption was collected by 24 hour dietary recall method. Prevalence of malnutrition was determined based on WHO classification and food composition table was used to calculate the nutrients contents. The survey data were analyzed using WHO Anthro Plus version 1.0.4 and SPSS 20.0. Chi-square test was used to identify the associated factors of malnutrition. In private schools, 10.2% children were stunted (2.2% severely stunted and 8.0% moderately stunted) and 28.4% were thinned (5.1% severely thinned and 23.3% moderately thinned). In public schools, 27% children were stunted (2.9% severely stunted and 24.1% moderately stunted) and 26.3% were thinned (6.6% severely thinned and 19.7% moderately thinned). The prevalence of stunting was higher in female students in both private and public schools. Thinness was more prevalent in male students of private schools whereas its prevalence was equal in both genders in public schools. Gender (p=0.013), adequacy of protein (p=0.000), adequacy of calorie (p=0.037) and age of mother (p=0.007) of private school children were significantly associated with stunting. While in public schools, birth weight of children (p=0.013) and knowledge of mother about malnutrition (p=0.014) were significantly associated with stunting. Knowledge about malnutrition of mothers (p=0.012) was found to be significantly associated with thinness in private school children whereas caste (p=0.01) was found to be significantly associated with thinness in public school children. v Contents Approval Letter .............................................................................................................. iii Acknowledgements ......................................................................................................... iv Abstract ............................................................................................................................ v List of Tables .................................................................................................................... x List of Figures ................................................................................................................. xi List of Abbreviations .................................................................................................... xiii 1 Introduction ........................................................................................................... 1-4 1.1 Background .......................................................................................................... 1 1.2 Statement of problem ........................................................................................... 2 1.3 Objectives ............................................................................................................ 3 1.3.1 General objective........................................................................................... 3 1.3.2 Specific objectives......................................................................................... 3 1.4 Research questions ............................................................................................... 4 1.5 Significance of the study ...................................................................................... 4 1.6 Limitations ........................................................................................................... 4 1.7 Assumptions ......................................................................................................... 4 2 Literature review ................................................................................................. 5-21 2.1 Nutrition ............................................................................................................... 5 2.2 Malnutrition ......................................................................................................... 5 2.3 Forms of malnutrition .......................................................................................... 5 2.4 Causes of malnutrition ......................................................................................... 6 2.5 Malnutrition and infection cycle .......................................................................... 8 2.6 Nutritional status .................................................................................................. 9 2.6.1 Factors affecting nutritional status ................................................................ 9 vi 2.6.2 Nutritional requirements ............................................................................. 12 2.6.3 Methods of assessment of nutritional status ................................................ 13 2.6.4 Nutritional status indicators ........................................................................ 15 2.7 Nutritional status of Nepal ................................................................................. 17 2.8 Causes of low nutritional status in school children in developing countries ..... 17 2.9 Literature review from previous studies ............................................................ 18 3 Methods and