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Original Article
Nutritional status assessment of school children in Bellary district, Karnataka Ramachandra Kamath, Ravi Prasad Jakkula, Saurabh Kumar Department of Public Health, Manipal University, Manipal, Karnataka, India
ABSTRACT Background: Malnutrition continues to be a primary cause of ill-health and morality among children in developing countries. It is a major public health problem and accounts about half of the deaths worldwide. About 150 million children in developing countries are still malnourished and more than half of underweight children live in South East Asia region. The high levels of under-nutrition in south Asia pose major challenge for child development. There are other factors that affect the nutritional status of children. Aims and Objectives: To assess the Nutritional Status of School Children in Bellary district. Materials and Methods: A total 27,544 students from 169 schools were enrolled for the study. Sample size was calculated by taking 20% of total enrolled school children in Bellary district. Statistical Analysis: The body mass index, Z score and World Health Organization Multicenter Growth Reference Study growth charts was used for analysis. Results: The study population of 27,544 students comprised of which 13,519 (49.1%) male and 14,025 (50.9%) female. On the analysis, 4447 (16.1%) found to be undernourished. More male students were found to be undernourished 2237 (16.9%), but obesity was common in females 1723 (12.3%). Conclusions: The nutritional status of the students in our study has been found better than other studies, but there are cases of undernourished that need attention and there is a need to deal with obesity and overweight in the school in order to prevent the epidemic of noncommunicable diseases. Key words: Bellary, obesity, schoolchildren, undernourished
INTRODUCTION Malnutrition continues to be a primary cause of ill-health and morality among children in developing countries. It is a major public health problem and accounts for about half of the death worldwide. [1] About 150 million children in developing countries are still malnourished, and more than half of Address for correspondence: Dr. Ravi Prasad Jakkula, State Program Manager, Swiss Emmaus, India. E-mail:
[email protected] Access this article online Quick Response Code: Website: www.jdrntruhs.org DOI: 10.4103/2277-8632.153300
Journal of Dr. NTR University of Health Sciences 2015;4(1) 13-16
underweight children live in South East Asia region. The high levels of under-nutrition in children in South Asia pose a major challenge for child survival and development.[2] There are other factors that directly or indirectly affect the nutritional status of children. The best global indicator of children wellbeing is growth and poor growth is attributable to a range of factor closely linked to overall standards of living and ability of population to meet their basic needs such as access to food, housing and health care.[3]
AIMS AND OBJECTIVES Today’s children are the citizens of tomorrow’s world, their survival protection and development are the prerequisite for the future development.[4] Without ensuring, optimal child growth and development efforts to accelerate economic development significantly will be unsuccessful. [5] A childhood 13
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Kamath, et al.: Nutritional status assessment of school children
period is of rapid growth and nutrition is one of the influencing factors in this period. Good nutrition is a basic requirement for good health. There is increasing evidence that the high level of nutritional deprivation is combined with the heavy burden of disease in the children. It has negative consequences for a child’s long-term overall development.[6] This has prompted an increased focus on the diverse needs of the school children nutrition and health status.[7] There are very few studies done in Bellary district, and no studies have been conducted in a comprehensive manner to assess the nutritional and health status.
MATERIALS AND METHODS The aim was to assess the nutritional status of school. This school-based cross-sectional study was conducted among schoolchildren in Bellary district. A total of 133,384 students are provided with a mid-day meal from the Akshaya Patra Foundation. Total of 20% of the beneficiaries (26,677) of mid-day Meal were selected for the study, but 27,544 students were assessed. The assessment among school children in Bellary district involved a total of 169 randomly selected schools; all students from class 3rd to class 7th present on the day of our visit were enrolled for the study. The schools were informed well in advance and were provided with all the information about the study and consent was taken from the respective school headmasters and the parents of the children. Weight was measured using a Seca™ 703 electronic scale accurate to ± 15%/±100 g, and height was recorded using measuring rod with 1-mm graduations. For the analysis the Statistical Package for the Social Sciences (SPSS® 16.0, SPSS Inc., 233 South Wacker Drive, 11 th Floor, Chicago, IL 60606-6412. Patent No. 7,023,453) and World Health Organization (WHO) multicenter growth reference study (MGRS) growth charts were used. Data was entered into SPSS and body mass index (BMI) was calculated then Z-scores were calculated for each individual, using the formula:
RESULTS A total of 27,544 school children were assessed in this study in 169 schools of Bellary district among which 13,519 (49.1) were males and 14,025 (50.9%) were females [Table 1]. Total students of 4447 (16.1%) found to be undernourished. About 2237 (16.9%) male students were found to be undernourished. 1723 (12.3%) of female students were found to be obese [Table 2]. Undernutritional was observed more in the 8 years of age (847, 25.2%) whereas obesity was seen more in the 15 years of age (6, 31.6%) [Table 3] and undernourished students were found more in class 3 (1177, 24.3%) and obesity was found to be more in class 7 (1126, 18.9%) [Table 4].
DISCUSSION In the study, a total of 27,544 students were assessed in 169 schools of Bellary district [Table 5] among which 13,519 (49.1%) and 14,025 (50.9%) female. After analysis 4447 (16.1%) of children were found to be malnourished and out of which 865 (3.1%) students were under the category of severe thinness and 3582 students were under thinness category. Overweight TABLE 1: WHO STANDARDS FOR NUTRITIONAL STATUS Nutritional status
14
Value
95 95 95 95 95
−2SD to +1SD −2SD to –3SD Less than −3SD More than +1SD More than +2SD
WHO = World Health Organization; SD = Standard deviation
TABLE 2: SEX DISTRIBUTION OF SCHOOL CHILDREN, (N = 27,544) Gender
n
Percentage
Male Female Total
13,519 14,025 27,544
49.1 50.9 100
TABLE 3: SEX DISTRIBUTION OF NUTRITIONAL STATUS OF SCHOOL CHILDREN (N = 27,544) Nutritional status
The median BMI used in the above formula was taken from the WHO 2007 MGRS Charts. Nutritional grading was done using percentages.
Confidence interval %
Normal Thinness Severe thinness Overweight Obese
Normal Thinness Severe thinness Overweight Obese Total
Male (%)
Female (%)
Total (%)
9411 (69.6) 1818 (13.4) 419 (3.5) 922 (6.8) 949 (7.0) 13,519 (49.1)
8897 (63.4) 1764 (12.6) 446 (3.2) 1195 (8.5) 1723 (12.3) 14,025 (50.9)
18,308 (66.5) 3582 (13.0) 865 (3.1) 2117 (7.7) 2672 (9.7) 27,544 (100)
Journal of Dr. NTR University of Health Sciences 2015;4(1)
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Kamath, et al.: Nutritional status assessment of school children
TABLE 4: AGE DISTRIBUTION OF NUTRITIONAL STATUS OF SCHOOL CHILDREN (N = 27,544) Age
Normal (%)
Thinness (%)
Severe thinness (%)
overweight (%)
Obese (%)
Total (%)
7 8 9 10 11 12 13 14 15 16 Total
197 (76.7) 2349 (69.8) 3065 (70.8) 3758 (68.2) 4068 (66.7) 3461 (62.8) 1200 (57.3) 200 (55.2) 10 (52.6) 0 (.0) 18,308 (66.5)
32 (12.5) 682 (20.3) 786 (18.2) 838 (15.2) 690 (11.3) 419 (7.6) 118 (5.6) 16 (4.4) 1 (5.3) 0 (.0) 3582 (13)
6 (2.3) 165 (4.9) 163 (3.8) 202 (3.7) 169 (2.8) 115 (2.1) 43 (2.1) 2 (.6) 0 (.0) 0 (.0) 865 (3.1)
17 (6.6) 92 (2.7) 164 (3.8) 344 (6.2) 531 (8.7) 611 (11.1) 304 (14.5) 52 (14.4) 2 (10.5) 0 (.0) 2117 (7.7)
5 (1.9) 75 (2.2) 149 (3.4) 370 (6.7) 637 (10.5) 909 (16.5) 428 (20.4) 92 (25.4) 6 (31.6) 1 (100) 2672 (9.7)
257 (100) 3363 (100) 4327 (100) 5512 (100) 6095 (100) 5515 (100) 2093 (100) 362 (100) 19 (100) 1 (100) 27,544 (100)
TABLE 5: CLASS DISTRIBUTION OF NUTRITIONAL STATUS OF SCHOOL CHILDREN (N = 27,544) Class
Normal (%)
Thinness (%)
3 4 5 6 7 Total
3398 (70.3) 3668 (69.8) 3888 (68.9) 3774 (64.4) 3580 (60.2) 18,308 (66.5)
958 (19.8) 909 (17.3) 756 (13.4) 594 (10.1) 365 (6.1) 3582 (13)
Severe thinness (%) 219 221 164 160 101 865
(4.5) (4.2) (2.9) (2.7) (1.7) (3.1)
was seen in 2117 (7.7%) students whereas 2672 (9.7%) were found to be obese.
In our study, total prevalence of under nutrition was found to be 16.1% which is less as compared to the study by Saluja et al. (49.5%).[8] The under-nutrition in the study among male and female was 15.3% and 19.3% respectively which is less than when compared to Hassan and Zulkifle[9] study conducted in government school children in the field area of Azad Nagar Bangalore (male-57.94%, and female-42.06%). In current study prevalence of thinness is found to be 16.9% and 15.8% among boys and girls in a similar study conducted by Chakraborty and Bose[10] in three local primary schools of Nandigram areas of Purba Medinipur District. In the study, the prevalence of undernourished was found to be 16.1% that is less than that of a similar study conducted by Francis et al. [11] in Jos North Local Government Ares of Plateaus, Nigeria where he found prevalence of underweight, stunting and wasting was 10.3%, 11.1% and 2.4% respectively. Another study conducted by Chandra et al. [12] in villages of Dharward and Haliyal taluks had reported in our study. A study carried out among Jenukuruba tribal children by Prabhakar and Gangadhar[13] also Journal of Dr. NTR University of Health Sciences 2015;4(1)
Overweight (%)
Obese (%)
Total (%)
148 (3.1) 220 (4.2) 397 (7) 581 (9.9) 771 (13) 2117 (7.7)
108 (2.2) 235 (4.5) 450 (8) 753 (12.8) 1126 (18.9) 2672 (9.7)
4831 (100) 5253 (100) 5655 (100) 5862 (100) 5943 (100) 27,544 (100)
revealed high prevalence of mild (41.5%) and severe (6.7%) in stunting, more prevalence of mild (40%) and severe (3.7%) in wasting and underweight was 45.2% moderate and 14.8% severity, which is more than the prevalence of undernutrition seen in our study. In the study, the undernourishment was seen in 16.9% boys and 15.8% girls. Whereas in a similar study conducted by Chakraborty and Bose[10] In primary school of Nandigram area of Purba Medinipur District West Bengal Reported overall (age Combined) prevalence of thinness was 62.9% and 61.6% in boys and girls, respectively. Another study conducted by Banerjee et al.[14] in the mining region in North belt of rural Goa reported total number of underweight boys was 214 (37.8%) and the number of underweight girls was 124 (27.5%). A similar type of study done by Hassan and Zulkifle[9] among Government schools in Azad Nagar area of Bangalore reported the prevalence of malnutrition in males and females was 57.94% and 42.06%, respectively. In this study among the school children in Bellary district, the prevalence of thinness and severe thinness was observed 13% and 3.1% respectively whereas a similar study done by Bisai et al.[15] among Lodha Tribal children in the village of Paschim Medinipur reported 9.1%, 9.7% and 3.6% children were found
to be severely underweight, stunted and wasted respectively. 15
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Kamath, et al.: Nutritional status assessment of school children
CONCLUSION A total of 27,544 school children were assessed in this study in 169 schools of Bellary district among which 13,519 (49.1) comprised of male and 14,025 (50.9%) female. Total students of 4447 (16.1%) found to be undernourished. Male students were found to be undernourished 2237 (16.9%) but obesity were found to be common in females 1723 (12.3%) but there were cases of undernourished that needed attention and there is a need to deal with obesity and overweight in the school in order to prevent the epidemic of noncommunicable diseases.
LIMITATION Limitation of our study is that data on the socioeconomic status of the students were not collected in order to get details of the socioeconomic status a community-based study need to be done.
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How to cite this article: Kamath R, Jakkula RP, Kumar S. Nutritional status assessment of school children in Bellary district, Karnataka. J NTR Univ Health Sci 2015;4:13-6. Source of Support: Nil. Conflict of Interest: None declared.
Journal of Dr. NTR University of Health Sciences 2015;4(1)
