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Indian Journal of Community Medicine

Health Status of School Children in Ludhiana City

Author(s): P. Panda, A.I. Benjamin, Shavinder Singh, P. Zachariah

Vol. 25, No. 4 (2000-10 - 2000-12)

Deptt. of Social & Preventive Medicine, Christian Medical College, Ludhiana-141008, Punjab

Abstract:

Research question: What is the health and nutritional status of school children in Ludhiana?

Objectives: To assess the health and nutritional status of school children in the age group of 5-16 years and to find out their morbidity pattern.

Study design: Descriptive study.

Setting: A secondary school of Ludhiana city.

Participants: 776 students of both sexes, 462 boys and 314 girls.

Study variables: Height, weight, medical history and general physical examination.

Statistical analysis: Proportions.

Results: Girls of all ages except the 14 years old had lower mean weight for age in comparison to mean height, as compared to expected weight for age as per ICMR standards. The expected height for age as per ICMR standards, was also less in both boys and girls of all ages except the 15 and 16 year old. The prevalence of wasting and stunting in these children was high (52.2% wasted and 26.3% stunted), with boys and girls suffering almost equally. The 11-15 years old were affected most. 72.4% children were found to be suffering from some sickness at the time of examination. 26% had anaemia, with girls suffering more (30.5%) than the boys (22.9%).

Conclusions: The study reveals the poor nutritional and health status of school children under study, identifying this group for targeted services aimed at improvement of their health and nutritional status.

Keywords: School health, nutritional status, anaemia

Introduction:

Whereas there are concerted efforts to provide care to the under six year old children through various national maternal and child health programmes (e.g., ICDS, RCH programmes), the 5-16 years age group remains a neglected lot. The 1991 census shows that 25% of the population of India comprises of children aged 5-14 years1. School children constitute a large pool of children of this age group. The beginning of school health services in India dates back to 1909 when, for the first time medical examination of school children was carried out in Baroda city2. Since then, various types of government sponsored school health programmes have been launched from time to time, but progress and achievements are very slow and incomplete and very often limited to the urban and few favoured schools. In addition, school health services are irregular and intermittent, without follow-up or accountability. The 5-16 years old children are on the threshold of adulthood. If they are to reach adulthood in a healthy state, then it is necessary to provide targeted and concerted services to improve their health status.

The present study was carried out to find out the health status of school children in Ludhiana city.

Material and Methods:

All students, in the age group 5-16 years, of a secondary school in Ludhiana were examined by a health team consisting of medical students (final years), interns and faculty of the department of SPM, Christian Medical College, Ludhiana.

Observations:

Table I: Distribution of the children by age & sex.

Age (in years) Boys No. (%) Girls  Total
No. (%) No. (%)
4+ 39 (63.9) 22 (36.1) 61
5+ 48 (59.3) 33 (40.7) 81
6+ 53 (77.9) 15 (22.1) 68
7+ 51 (54.8) 42 (45.2) 93
8+ 50 (60.2) 33 (39.8) 83
9+ 45 (53.6) 39 (46.4) 84
10+ 24 (61.5) 15 (38.5) 39
11+ 32 (65.3) 17 (34.7) 49
12+ 23 (65.7) 12 (34.3) 35
13+ 13 (56.5) 10 (43.5) 23
14+ 27 (60.0) 18 (40.0) 45
15+ 40 (53.3) 35 (46.7) 75
16+ 17 (42.5) 23 (57.5) 40
Total 462 (59.5) 314 (40.5) 776

A total of 776 students of both sexes (462 boys and 314 girls), in the age groups of 5 years to 16 years, were examined.

Physical examination of all children was carried out, and their height (to the nearest 0.5 cms) and weight (in kgs., to the nearest 100 gms) were recorded. Anaemia was diagnosed from clinical signs such as pallor of the conjunctiva/tongue. The mean weight and height of the children according to age and sex were compared with the median weight for age and height for age as per ICMR standards3. Nutritional status of the studied children was assessed through weight for age (wasting) and height for age (stunting) according to waterlow classification.

Table II: Distribution of children as per their mean height (in cm).

Age (in years) Boys Girls ANOVA  p value
No. Mean height SD No. Mean height SD
4+ 39 99.42 5.35 22 99.63 4.32 0.14
5+ 48 107.47 6.25 33 105.57 5.87 0.00
6+ 53 112.22 4.66 15 113.20 7.06 0.11
7+ 51 117.43 5.41 42 117.97 6.45 0.72
8+ 50 123.76 5.79 33 123.72 5.39 0.40
9+ 45 127.60 5.54 39 128.41 8.74 0.32
10+ 24 139.04 12.71 15 134.46 5.89 0.18
11+ 32 138.12 6.13 17 139.00 10.46 0.31
12+ 23 142.39 7.70 12 144.16 5.28 0.27
13+ 13 145.84 7.77 10 147.60 6.62 0.45
14+ 27 155.03 10.76 18 152.00 4.48 0.21
15+ 40 163.10 7.29 35 152.54 4.93 0.00
16+ 17 163.87 6.10 23 152.90 4.44 0.00

SD = Standard deviation.

On an average the boys were found to be significantly taller than the girls at ages 5,15 and 16 (ANOVA p<0.05). At 4,6,7,9,11,12 and 13 years the girls were taller than the boys, but these differences were statistically not significant (ANOVA p>0.05).

Table III: Distribution of children as per their mean weight (in kg).

Age (in years) Boys Girls ANOVA p value
No. Mean height SD No. Mean height SD
4+ 39 14.98 1.96 22 14.81 1.47 0.25
5+ 48 17.10 2.81 33 16.28 2.93 0.004
6+ 53 18.17 2.62 15 18.33 3.33 0.003
7+ 51 20.12 2.86 42 20.72 3.76 0.20
8+ 50 24.00 4.22 33 23.78 3.47 0.93
9+ 45 26.62 4.47 39 26.93 6.28 0.64
10+ 24 32.65 7.63 15 28.86 4.06 0.13
11+ 32 32.65 7.63 17 33.64 9.21 0.64
12+ 23 34.47 6.06 12 37.91 7.85 0.14
13+ 13 34.15 5.87 10 41.50 7.93 0.002
14+ 27 42.94 10.39 18 48.38 8.69 0.007
15+ 40 50.40 8.03 35 46.38 8.30 0.001
16+ 17 54.30 9.50 23 46.95 8.60 0.004

SD = Standard deviation.

On an average the girls weighed significantly more than the boys at ages 6,13 and 14 (ANOVA p<0.05). At ages 7,9,11 and 12 also the girls weighed more than the boys, but these differences were statistically not significant (ANOVA p>0.05). The boys were significantly heavier than the girls at ages 5,15 and 16 (ANOVA p<0.05). At ages 4,8 and 10 also the boys weighed more than the girls, but the differences were statistically not significant (ANOVA p>0.05).

Table IV: Mean weight of girls as percentage of mean weight of boys of the same age.

Age (in years) Present study NCHS8 Kerala8
4+ 98.6 94.9 97.1
5+ 95.3 94.4 98.6
6+ 100.5 94.9 95.7
7+ 102.9 97.1 101.9
8+ 99.1 99.6 94.6
9+ 101.1 102.7 98.7
10+ 89.2 104.2 101.0
11+ 103.0 104.5 100.5
12+ 109.8 103.5 102.4
13+ 121.7 101.0 105.3
14+ 112.8 96.8 104.9
15+ 92.1 92.4 106.4
16+ 86.5 NA* NA*

*Not available.

Table V: Mean deficit from ICMR standards for weight and height of children.

Age (in years) Mean deficit from ICMR standards
Weight (Kg) Height (cm)
Boys Girls Boys Girls
4+ 2.0 1.9 2.2 1.7
5+ 2.8 2.4 0.9 1.6
6+ 1.4 2.4 2.4 2.5
7+ 2.6 2.2 2.2 2.8
8+ 2.7 1.5 2.7 1.3
9+ 3.9 2.8 4.7 3.1
10+ 4.0 4.6 0.5 1.1
11+ 5.2 2.9 6.0 3.9
12+ 6.1 4.7 7.9 8.1
13+ 5.4 2.9 7.2 10.2
14+ 3.1 -1.6 0.3 3.8
15+ 2.3 1.9 -7.5 -2.1
16+ 2.5 1.6 -9.5 -5.4

The weights of the girls as percentages of weights of boys of the same age is shown in Table IV. The standards of growth of female children were observed to be at par with NCHS standards except in the time of growth spurt (ages 9,10 and 11 years). It was also noted that the present standards were better than Kerala school girls except in the ages of 5 and 15 years4. Comparison of mean heights and weights of the children with the median height for age and weight for age as per ICMR standards (Table V) indicated that in all the age and sex groups it was less except for weight in 14 year old girls and for height in boys and girls at ages 15 and 16 years.

Nutritional status of the children is shown in Tables VI-IX.

Table VI: Nutritional status of children (wasting) as per age.

Age (in years) Nutritional status
No. Normal Wasted
Mild Mod. Severe
Upto5 142 55 (38.7) 56 (39.4) 24 (16.9) 7 (4.9)
6-10 367 168 (45.8) 113 (30.8) 67 (18.2) 19 (5.2)
11-15 152 68 (44.7) 27 (17.8) 30 (19.7) 27 (17.8)
15+ 115 80 (69.6) 24 (20.9) 11 (9.5) 0 0
Total 776 371 (47.8) 220 (28.4) 132 (17.0) 53 (6.8)

Figures in brackets are percentages; X2=51.6, d.f.=6 (For the Chi-square test, moderate and severe degrees of stunting were grouped together).

47.8% of children were found to be normal as per their weight for age, 52.2% were malnourished and 6.8% were in severe degree of wasting. The 11-15 years old children, the age group in which the growth spurt takes place, were observed to be at heighest risk of wasting.

Table VII: Nutritional status of children (wasting) as per sex.

Sex Nutritional status
No. Normal Wasted
Mild Mod. Severe
Boys 462 218 (47.2) 133 (28.8) 80 (17.3) 31 (6.7)
Girls 314 153 (48.7) 87 (27.7) 52 (16.5) 22 (7.0)
Total 776 371 (47.8) 220 (28.3) 132 (7.0) 53 (6.8)

Figures in brackets are percentages; X2=0.26, d.f.=3, p=0.968

Both boys and girls suffered almost equally (p=0.968).

Table VIII: Nutritional status of children (stunting) by age.

Age (in years) Nutritional status
No. Normal Stunted
Mild Mod. Severe
Up to 5 142 107 (75.3) 25 (17.6) 10 (7.0) 0 (0)
6-10 367 262 (71.4) 86 (23.4) 18 (4.9) 1 (0.3)
11-15 152 97 (63.8) 41 (27.0) 10 (6.6) 4 (2.6)
15+ 115 106 (92.2) 9 (7.8) 0 0 0 0
Total 776 572 (73.7) 161 (20.7) 38 (4.8) 5 (0.7)

Figures in brackets are percentages; X2=32.4, d.f.=6, p=0.0000 (For the Chi-square test, moderate and severe degree of stunting were grouped together.

20.7% children were in mild degree of stunting and 5.5% were in moderate/severe degrees of stunting. The 11-15 years old children were the most affected .

Table IX: Nutritional status of children (Stunting) in boys and girls.

Sex Nutritional status
No. Normal Stunting
Mild Mod. Severe
Boys 462 344 (74.4) 93 (20.1) 24 (5.2) 1 (0.2)
Girls 314 228 (72.6) 68 (21.6) 14 (4.5) 4 (1.2)
Total 776 572 (73.7) 161 (20.7) 38 (4.9) 5 (0.6)

Figures in brackets are percentages; X2=3.75, d.f.=3, p=0.29

Both boys and girls were suffering almost equally from stunting (p=0.29).

Table X: Morbidity pattern of children under study.

Sickness Boys (n=462) Girls (n=314) Total (n=776)
Anaemia* 106 (22.9) 96 (30.5) 202 (26.0)
Caries tooth** 110 (23.8) 70 (22.2) 180 (23.1)
Tonsillitis*** 71 (15.3) 41 (13.0) 112 (14.4)
Pharyngitis 2 (0.4) 4 (1.2) 6 (0.8)
CSOM 0 0 1 (0.3) 1 (0.1)
Nasal discharge 2 (0.4) 4 (1.2) 6 (0.8)
Refractive errors 30 (6.5) 14 (4.4) 44 (5.6)
Squint 2 (0.4) 0   2 (0.2)
Conjunctivitis 0 0 1 (0.3) 1 (0.1)
Skin diseases 5 (1.1) 3 (0.9) 8 (1.1)
Total 328 (71.0) 234 (74.5) 562 (72.4)

Figures in brackets are percentages

Gender differences in the prevalence of the three most common diseases suffered by the students:

*X2=5.6, d.f.=1, p<0.02; **X2=0.24, d.f.=1, p>0.60; ***X2=0.81, d.f.=1, p>0.30.

The illnesses suffered by the children is reflected in Table X. A total number of 562(72.4%) children were suffering from one or more illness. 26% had anaemia, 23.1% had dental caries, 14.4% had tonsillitis and 5.6% suffered from refractive errors. The prevalence of anaemia was significantly higher in girls (30.5%) than in boys (22.9%). 1.1% of the children were found to be suffering from skin diseases. No child had clinical vit-A deficiency.

The school children in the present study were found to be nutritionally better than the rural Punjab school children as reported in another recent study5, where the prevalence of malnutrition was 87.4%. However, the standards of nutrition among school children in the present study were lower than those found in Delhi corporation school by Dhingra et al6 and in urban school children in Tirupati as reported by Indirabai et al7, who found prevalence of malnutrition in their studies to be 50% and 47% respectively. Gangadharan et al8 also reported prevalence of malnutrition up to 34.20% in Kerala school children. Goyal et al9 found malnutrition among Ahmednagar school children to be 20% only, with 6.8% having severe malnutrition, which is much lower than rural school children of Punjab (37.6%)5 and amongst school children of Madras as found by Sunderam et al (32.6%)10.

Anaemia was detected in 26% of children in the present study, which is a little more than that (22.5%) found in the children of rural school children in Punjab5 and almost equal to findings (25.25%) amongst school children in Kerala8. Merchant et al4 also observed the same results for anaemia (25.7%) among Bombay school children. The prevalence of anaemia in girls (30.5%) was significantly higher (p<0.02) than in the boys (22.9%). Dental caries was found in 23.1% children in the present study and this is more than that found in the rural Punjab school children (11.1%)5, Tirupati (20.9%)7 and Madras school children (38.6%)10. The gender differences observed in the prevalence of dental caries was statistically not significant.

Conclusions:

The health and nutritional standards of the school children under study are found to be low, more so in girls than in boys. The extent of malnutrition in this group is high, with the children in nearly all ages, both boys and girls, being deficient in both weight and height as compared to the ICMR standards. The prevalence of wasting and stunting in these children is high (52.2% wasted and 26.3% stunted), with boys and girls suffering almost equally. The prevalence of anaemia is high in both sexes, though significantly more so in the girls (30.5%) than in the boys (22.9%). Malnutrition and anaemia make the children more susceptible to infection.

The study reveals the poor nutritional status of school children in a highly developed and economically well off part of Punjab, the granary of India, highlighting the need for increased, concerted efforts towards improvement of their nutrition.

References:

  1. Government of India, Ministry of Health and Family Welfare, Department of Family Welfare: Family Welfare Programme in India, Year Book 1995-96; Table A-4: 24.
  2. Park JE and Park K: Textbook of Preventive and Social Medicine, 10th edition (1985), Publ. Banarsidas Bhanot, Jabalpur; pp 446-7.
  3. ICMR (1972): Growth and physical development of Indian infants and children. Technical Report Series No.10.
  4. Gopalan C and Harvinder Kaur. Towards Better Nutrition - Problems and Policies. Nutrition Foundation of India, Special Publication Series, 1993; No.9, 70-8.
  5. Panda P, Benjamin AI, Zachariah P: Growth and morbidity patterns among rural school children in Ludhiana, Punjab. Health and Population: Perspectives and Issues, 1997; Vol 20, No.1: 20-8.
  6. Dhingra DC, Anand NK, Gupta S: Health status of school children of various socio-economic groups. Indian Pediatrics 1977; Vol. 14, No. 3: 243-6.
  7. Indirabai K, Ratna Malika DPNM: School Health Service Programme, A comprehensive study of school children of Tirupati city, Andhra Pradesh. Indian Pediatrics 1976; Vol. 13, No.10: 751-8.
  8. Gangadharan M: School health service programme in Kerala, A rural study. Indian Pediatrics 1977; Vol 14,
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