Assessment of Nutritional Status and Morbidity Pattern among School Children of Rural Puducherry

Suba Joice,a Velavan A,b Natesan M,b Singh Z,b Purty AJ,b Hector Hc

a. Department of Community Medicine, Dr. Somervell Memorial Medical College, Karakonam, Thiruvananthapuram; b. Department of Community Medicine, Pondicherry Institute of Medical Sciences, Puducherry; c. Kanyakumari Medical Mission, CSI Hospital, Neyyoor

Abstract

Introduction: School health has been considered as an important tool in the assessment and promotion of health among children. Inspite of several health programmes in existence, malnutrition continues to remain a threat, leading to morbidities among school children.

Objective: To assess the nutritional status and morbidity pattern among school children in rural Puducherry.

Methodology: A descriptive study was conducted among children studying in a rural school of Puducherry during January 2009. A total of 548 students from age group 6 -17 years were examined.  A pre-designed and pre-tested questionnaire was used to collect information regarding demographic characteristics, anthropometric data and morbidity pattern of the children.  All quantitative variables were analyzed using mean and standard deviation and all qualitative variables were analysed for proportions.  To look for differences between the Mean Body Mass Index (BMI) of each age group of boys and girls with that of the reference BMI values, Students unpaired t- test was used and a p value < 0.05 was considered statistically significant.

Results: Among 261 boys and 285 girls in the study population, majority belonged to the age group 6-9 years.  The mean BMI for boys and girls were 15.99 ± 3.64 and 16.81 ± 3.38 respectively.  Among both boys and girls from the age group of 6 to 14 years the mean BMI was found to be lesser than the reference values and this difference observed was found to be statistically significant.  About 40.3% of children showed morbidities of various kinds related to nutrition, 20.9% children had refractive errors, 30.9% had dental problems, 6.2% had skin disorders, 14.5% children had pediculosis and 3.9% had history of worm infestations.

Conclusion: The study concluded that the most common morbidities among school children were related to nutrition and personal hygiene. Regular school health programmes should focus to educate and promote health among children.  There is a definite need to explore the gap between various national health programmes and health status of children.

Keywords: , , ,

Introduction

School health has been considered as an important tool in the assessment and promotion of health among children.  Health is a key factor in entering, continuing and performing in school.1  To attain effective learning children need to have good health.  School is acknowledged as the place where children gain knowledge from health education sessions on various aspects of personal hygiene, sanitation and social customs.   School health services are considered to be an ideal platform to detect earlier the health problems among children. Early identification of childhood illnesses through regular school health check-ups help prevent complications.2   School health services focus more attention on nutritional support, clinical assessment and personal hygiene.  These factors are considered to be important especially in a developing country like India.  

Inadequate nutrition in children can put them at high risk of chronic diseases particularly if combined with other adverse lifestyle behaviours.3  Children from rural areas and urban slums are found to suffer from poor quality of life.  Research indicates that malnutrition and poor health are among the most common causes of low school enrolment, high absenteeism, early dropout and poor classroom performance.  The important morbidities found among school children are malnourishment, communicable diseases, ailments of skin, eye and ear and dental problems.   With this background the present study was conducted to assess the morbidity pattern and nutritional status of the children of 6 to17 years age group in a rural school of Puducherry falling under the field practice area of Dept. of Community Medicine, Pondicherry Institute of Medical Sciences.

Materials and Methods

Table 1. Age and Sex Distribution of the Children

Table 1. Age and Sex Distribution of the Children

The present study was conducted in a rural school of Puducherry at Kalapet during January 2009.  All the children in the age group of 6 -17 years who were present at school during the school health survey were considered as the study subjects.  The purpose of the study was informed and consent was obtained from the Head of the Institution.  Parents were also informed of the school health survey by the school authorities.  A predesigned and pretested questionnaire was used to collect information regarding demographic characteristics and any present health problems or in the recent past by one to one interview method.  All the students were subjected to anthropometric measurements.  Body weight was measured (to the nearest kg) with the subject standing on the weighing scale as per WHO guidelines.  Height was measured (to the nearest cm) with the subject standing in erect position against a stadiometer.  General examination was done for all students by trained interns.  Specific examinations of skin, eyes, ear, nose, throat, tooth, CVS, Chest, Abdomen and CNS were also done. Nutritional status of the children was assessed by calculating BMI. The mean value of BMI at different age points were compared with the corresponding reference values of National Health and Statistics Report.4  Whenever a health problem was detected, the teachers were informed about the problem and guided regarding the course of action.  Data collected was entered and analysed using SPSS 16.0 version.  All quantitative variables were analyzed using mean and standard deviation and all qualitative variables were analysed for proportions.  To look for differences between the mean BMI of each age group of boys and girls with that of the reference BMI values, unpaired Student’s t- test was used and a p value < 0.05 was considered statistically significant.  

Results

Table 2. BMI of boys according to age and its comparison with reference value (n=261)

Table 2. BMI of boys according to age and its comparison with reference value (n=261)

The age-sex distribution of the study subjects (Table1) showed that overall there were 261(47.8%) boys and 285(52.2%) girls.  More children belonged to the lower age groups from 6 to 9 years.  The BMI of the boys and girls in the study are shown in Tables 2 and 3, which is found lower for all age groups in comparison to the reference value according to National Health and Nutritional Survey 2003-2006 conducted by CDC, National Centre For Health statistics,3 suggestive of malnutrition in all age groups and this difference observed was found to be highly statistically significant (p<0.001).  The Mean Body Mass Index for boys and girls were 15.99 ± 3.64 and 16.81 ± 3.38 respectively.  Among both boys and girls the difference in the mean BMI was observed to increase as age advanced.  The highest difference for boys was observed as 6.71 (p<0.05) in the age of 15 years and the same for girls was found to be 4.77 (p<0.005) in 17 years of age.  This shows that significant malnutrition existed among both sexes with predominance among males of adolescent age.

Table 3. BMI of boys according to age and its comparison with reference value (n=285)

Table 3. BMI of boys according to age and its comparison with reference value (n=285)

With regard to the morbidity pattern studied, about 40.3% of children showed morbidities related to nutrition.  Of this anaemia was the predominant morbidity observed among both boys and girls (Table 4).  About one fifth of the children (20.9%) had refractive errors and 30.9% children had dental problems.  Of the observed dental morbidities, a quarter of the children had dental caries. 6.2% children had skin disorders of which scabies was observed in 0.2% of children.  About 14.5% children had pediculosis and 3.9% had history of worm infestations. 55.3% and 6.8% of children had upper respiratory tract infection and diarrhoea respectively in the recent past which was considered to be in last three months from the time of data collection. 

Discussion

Table 4. Morbidity Pattern among the Children (n=546)

Table 4. Morbidity Pattern among the Children (n=546)

A study carried out by Komal Thekdi et al5 in Surendra Nagar district of Gujarat showed similar results with BMI values comparatively lower for all age groups suggesting frank under-nutrition among school children.  Nutrition related morbidities in the study was 59.2% whereas it was 40.3% in our study.  Anaemia was observed among 25% of study participants in the same study and 28.45% in the study by Dambhare et al,6 while it was 39.4% in our study. Similar to our study the most common morbidity observed among primary school children in a study by Soumya Deb et al7 in Kolkata was anaemia. This shows that nutritional anaemia continues to be a problem among our children which would definitely pose a threat to their cognitive development.  Refractive errors in Komal Thekdi et al5 study was 37% and was addressed as the most common morbidity among school children.  In contrast to this it was 20.9% in our study and 13.79% in the study by Dambhare et al.6  The prevalence of caries tooth was 35.34% in Dambhare et al6 study while it was 25% in our study.  The problem of worm infestation was found to be 13.2% in Komal Thekdi et al5 study while it was only 3.2% in our study.  The lesser prevalence of morbidities among school children in our study could be due to regular screening for health status of children and health education activities addressed in this school, increased literacy rate of the population of Puducherry and availability of better health facilities in Puducherry state.

Conclusion

The health and nutritional status among the school children was found to be low.  The mean BMI was low irrespective of the age group.  39.4% of children had pallor. Anaemia and under-nutrition make the children susceptible to various infections.  Though morbidities were less compared to other studies yet there are good numbers of children who suffer from the same.  The problem of anaemia needs to be corrected with routine anti-helmintic drugs, iron prophylaxis and treatment of other chronic infections.  Thus there is a definite need to focus on the periodical and regular health check up with intense efforts towards nutrition along with focused health education in schools to improve the health and nutritional status of the school going children.

References

  1. Kishore J. National Health Programs of India. New Delhi: 2nd ed. Century Publications; 2007. p.441-7.
  2. Panda   P,   Benjamin   AI,   Singh   S,   Zachariah   P. Health status of school children in Ludhiana city.  Indian  J   of   Community   Medicine. 2000 Oct – Dec;25(4):150–5.
  3. Body Mass Index for Age percentiles (2-20 years). Developed by National centre for Health statistics in collaboration with the National centre for chronic disease prevention and health promotion. [modified on 2000 oct 16; cited 2009 Oct 12]. Available from: http://www.cdc.gov/growth charts.
  4. McDowell MA, Fryar CD, Ogden CL, Flegal KM. National Health Statistics Reports, Anthropometric Reference Data for Children and Adults: (2003–2006). Vol 10. 2008. p. 17-24.
  5. Komal Thekdi,  Girija Kartha, Sunita S. Nagar  Assessment  of  nutritional  and  health  status  of  the school  students  of  5th  to  9th  standard  (11  to  15  years  age  group) of  Surendranagar  district,  Gujarat  state, India. Health line. July- Dec 2011;2(2):59-61.
  6. Dambhare   DG,   Bharambe   MS,   Mehendale   AM,   Garg   BS.  Nutritional   Status   and   Morbidity   among   School   going  Adolescents in Wardha, a Peri-Urban area. Online J Health Allied Scs. 2010;9(2):1-3.
  7. Soumya Deb, Sinjitha Dutta, Aparajita Dasgupta, Ragunath Misra. Relationship of personal hygiene with nutrition and morbidity profile: A study among primary school children in South kolkatta. Indian  J   of   Community   Medicine. 2010 April;35(2):280–4.

Author Information

  1. Joice. Y.S., Assistant Professor, Departnement of Community Medicine, Dr. Somervell Memorial Medical College, Karakonam
  2. Velavan A., Postgraduate student, Department of Community Medicine, Pondicherry Institute of Medical Sciences, Puducherry
  3. Natesan M., Assistant Professor, Department of Community Medicine, Pondicherry Institute of Medical Sciences, Puducherry
  4. Singh Z.,  Professor and Head Department of Community Medicine, Pondicherry Institute of Medical Sciences, Puducherry
  5. Purty. A.J., Professor, Department of Community Medicine, Pondicherry Institute of medical Sciences, Puducherry
  6. Hector H., Consultant Ophthalmologist, Kanyakumari Medical Mission, CSI Hospital, Neyyoor

Conflicts of Interest

None Declared

Acknowledgements

We are grateful to the school authorities, teachers and the students who have provided a great platform to conduct this study. The inspiration and help provided by the HOD, faculty and the non-teaching staff of Dept. of Community Medicine, PIMS are also duly acknowledged.

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