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Indian Journal of Community Medicine

A Study of the Morbidity Status of Children in Social Welfare Hostels in Tirupati Town

Author(s): K Srinivasan, G R< Prabhu

Vol. 31, No. 3 (2006-07 - 2006-09)

K Srinivasan1, G R Prabhu2

Abstract

Research Question: What is the prevalence and incidence of morbidity among children residing in social welfare hostels? Objective: To find out the morbidity pattern among hostel children by sex. Study Design: Cross sectional & longitudinal study. Setting: Social Welfare hostels in Tirupati town of Andhra Pradesh. Participants: 598 children (341 boys and 257 girls). Statistical Analysis: Proportions and Chi-square test. Results: The common prevalent morbid conditions found were skin disorders (25.7%), dental caries (21.5%), history of passing worms in stool (21.6%), Vit. B deficiency (3.2%), ARI (1.7%) and diarrhoea (1.2%). The prevalence of anaemia and helminthiasis in a 20% sub-sample based on laboratory findings were found to be 79.6% and 39.3% respectively. Significantly higher prevalence of anaemia and helminthiais was found among boys. In the follow up study, the major health problems reported were ARI, skin diseases, injuries, Vit. B complex deficiency, diarrhoea and eye diseases.

Keywords: Morbidity Pattern, Hostel Children, Anaemia & Helminthiases, Sub-Sample

Introduction

Provision of hostels for the children hailing from oppressed sections of the community like scheduled castes, scheduled tribes and other backward classes is an important social welfare measure. The role of these hostels in their education advancement is considerable1. To achieve this objective, the Government of Andhra Pradesh has started a large number of social welfare hostels and at present, there are 2210 hostels functioning in the state with scheduled caste children comprising 70%, of the hostel inmates.

Health care of these hostel children is of utmost importance as they are in a period of growth and development and need an optimum health & nutrition care. The data regarding morbidity status of these children is sparse despite the usefulness of such information in the management of these hostels and upliftment of these groups. In this context, the present study was taken up among children residing in social welfare hostels for scheduled castes in Tirupati town of Andhra Pradesh. This study focuses on morbidity status of children.

Methodology

The study was conducted from July 1999 to April 2000 among children residing in five social welfare hostels for scheduled castes, three for boys and two for girls in Tirupati. A total of 598 children formed the study subjects of whom 341 were males and 257 were females. Permission from the Deputy Director of Social Welfare was obtained for conducting the study. The wardens were interviewed and, hostel registers were looked into to secure information regarding the number of residential children.

The study comprised of an initial cross sectional study to find out the morbidity pattern and a longitudinal study for a period of 8 months to find out the incidence of illnesses among the children. Data regarding morbidity status was collected using a pre-tested proforma. At the first visit during July 1999, every child was examined physically from head to toe and deviations from normal, if any, were recorded. Then, periodic monthly visits were made over a period eight months from september 1999 to April 2000 and during each visit, enquiry was made about the occurrence of any ailment during the previous month and physical examination was done to detect any illness present. For testing of vision, Snellen’s chart was used.

In a sub sample of children (comprising 20% of total) drawn by systematic random sampling design, haemoglobin estimation was done by Sahli’s method. The WHO guidelines were adopted for classification of anaemia. Same children were also subjected to stool examination to know the prevalence of parasitic infestations. The students were asked to collect stool samples in clean bottles supplied to them and the samples were examined by a qualified laboratory technician on the same day. The results were analyzed using proportions and chi-square test.

Results

Majority of the children (61.4%) were in the age group of 10-14 years; scheduled caste children constituted a large proportion (70%). In general, 84.3% of children were found to have one or more morbid conditions. The major prevalent morbid conditions among boys were skin disorders (29.9%), dental caries (23.5%), history of passing worms in the stool (23.2%) pediculosis (20.2%) and ENT disorders (15.8%). The prevalence of clinical anaemia was 8.5% and that of defective vision was 4.4%. On the whole, 77.7% of the boys were found to have one or more morbid conditions. The skin disorders included ulcers, eczema, scabies, Hansen’s disease and tinea versicolor while the ENT conditions noted were history of epistaxis, nasal discharge, chronic suppurative otitis media, bleeding gums and vestibulitis (Table I).

Table I: Morbidity Profile of Boys (N=351)

Morbidity condition Number
of
children
%
Skin disorders 102 (29.9)
Dental caries 80 (23.5)
History of passing worms in stool 79 (23.2)
Pediculosis 69 (20.2)
ENT conditions 54 (15.8)
Clinical anaemia 29 (8.5)
Defective vision 15 (4.4)
Vit. B-complex deficiency 12 (3.5)
Musculo-skeletal conditions 7 (2.1)
Acute Respiratory Infections 5 (1.5)
Diarrhoea 4 (1.2)
Others 5 (1.5)
Having one or more morbid conditions 265 (77.7)

Among the girls, the common morbidity conditions found were pediculosis (87.5%), skin disorders and dental caries (19.5% each), history of passing worms in stool (18.3%), ENT disorders (17.5%), clinical anaemia (5.8%) and defective vision (4.7%). On the whole, 94.5% girls had one or more morbid conditions. The skin disorders found were ulcers, warts, eczema, phrenoderma, scabies and Hansen’s disease while the ENT conditions mainly included history of epistaxis, chronic suppurative otitis media, nasal discharge and enlarged tonsils (Table II).

Table II- Morbidity Profile of Girls (N=257)

Morbidity condition Number
of
children
%
Pediculosis 225 (87.5)
Dental caries 50 (19.5)
Skin disorders 50 (19.5)
History of passing worms in stool 47 (18.3)
ENT conditions 45 (17.5)
Clinical anaemia 15 (5.8)
Defective vision 12 (4.7)
Dysmenorrohea 9 (3.5)
Musculo-skeletal conditions 8 (3.1)
Acute Respiratory Infections 5 (1.9)
Vit. B-complex deficiency 4 (1.6)
Others 3 (1.2)
Diarrhoea 3 (1.2)
Having one or more morbid conditions 243 (94.5)

The follow up study in boys revealed that the major incident disease (episodes per child year) were ARI (2.6), skin conditions (1.0), injuries (0.8), diarrhoeal episodes and eye diseases (0.4 each). Among the skin conditions, 93 cases of scabies accounted for 64.6% of new spells. The incidence of angular stomatitis is also worth noting (Table III) Among the girls, the major incident diseases (episodes per child year) found were ARI (3.1), skin conditions (0.4), diarrhoeal episodes, Vit B Complex deficiency and eye diseases (0.2 each) -Table IV.

Table III: Occurrence of New Spells of Sickness Among Boys (150 Child Years)

Morbid
condition
Number
of spells of
sickness
Episodes
per child
year
Acute Respiratory Infections 393 2.6
Skin conditions 144 1.0
Injuries 113 0.8
Diarrhoeal episodes 54 0.4
Eye diseases 54 0.4
Vit. B-complex deficiency 24 0.2
ENT conditions 17 0.1

Table IV: Occurrence of New Spells of Sickness Among Girls (130 Child Years)

Morbid
condition
Number
of spells of
sickness
Episodes
per child
year
Acute Respiratory Infections 396 3.1
Skin conditions 47 0.4
Diarrhoeal episodes 27 0.2
Vit. B-complex deficiency 25 0.2
Eye diseases 20 0.2
Anaemia 19 0.2
ENT conditions 19 0.2
Injuries 6 0.1

Table V: Prevalence of Anaemia in Children Based on Hb% Estimation

  Anaemia Total
Group present <12gm% Absent >12 gm%
Boys 50 (87.7) 7 (12.3) 57 (100.0)
Girls 36 (72.0) 14 (28.0) 50 (100.0)
Total 86 (80.4) 21 (19.7) 107 (100.0)
χ2=3.9; df=1; P <0.05

Table VI – Prevalence of Intestinal Parasitic Infestation by Stool Examination

  Anaemia Total
Group present <12gm% Absent >12 gm%
Boys 50 (87.7) 7 (12.3) 57 (100.0)
Girls 36 (72.0) 14 (28.0) 50 (100.0)
Total 86 (80.4) 21 (19.7) 107 (100.0)
χ2 =9.2; df =1; P < 0. 005

Regarding immunization status, it was observed that 49.8% of boys and 65.4% girls were not having BCG scar. A sub sample of 107 children was subjected to haemoglobin estimation for detecting anaemia and stool examination to find out the helminthic infestation. It was found that 80.4% of the children were anaemic. The prevalence of anaemia was noted to be significantly higher in boys (87.7%) compared to that among girls (72.0%) (Table V). Overall, 39.3% children were found to have intestinal helminthic infestation. Among the boys, the prevalence of infestation was found to be significantly higher (52.6%) than that among girls (24.0%) (Table VI).

Discussion

The health problems of a school child vary from place to place and several studies conducted in India revealed that the main morbidity conditions include infectious diseases, malnutrition, helminthiases, diseases of the skin, eye & ear and dental caries.

The high prevalence of morbidity (77.7% in boys and 94.5 % in girls) found in the current study is disturbing as it will interfere with the physical and mental development of children and contribute to scholastic backwardness. The prevalence of skin disorders in the present study was 25.7%. Similar findings were reported in Ropar district of Punjab (23.2%)2 as well as in Delhi (36.7%)3. The high prevalence of skin disorders in the present study may be due to poor personal hygiene, lack of awareness regarding common diseases and overcrowding. The prevalence of dental caries in the present study (21.5%) is comparable to the findings in Orissa (33.2%)4, and Delhi (16.1%)3 but a lower prevalence was reported in Chittoor district of A.P. (6.9%)5. While the current study revealed a prevalence of 39.3% helminthiases, Udaipur study6 reported a higher figure of 45.5%. The prevalence of anaemia in the present study was 79.6% which was comparable to that reported in Hyderabad (68.0%)7 and in Gujarat (60.0%)8; a lower prevalence of 8.2% was found in Chittoor5. The proportion of angular stomatitis in the present study (3.2%) correlates well with Chittoor study (2.7%)5.

The current study has revealed the prevalence of ARI as 1.7% while higher prevalence of 4.8% in Chittoor5, 7.1 % in Western Uttar Pradesh9 and 22.1 % in Western Orissa10 were reported. The prevalence of diarrhoea in the present study was 1.2% which was comparable to 1% prevalence reported in Chittoor district survey5.

In view of the high prevalence and incidence of morbidity among children, periodic medical examination of the inmates and treatment facilities should be organized and Morbidity of Children in Welfare Hostels monitored systematically. Health education of children with regard to personal hygiene and common diseases along with provision of necessary materials like soaps and oils etc., under supervision by hostel staff will go a long way in controlling these infections. As a high prevalence of anaemia and helminthiasis was found among children, there should be regular iron and folic acid supplementation along with periodic deworming.

References

  1. Dubey SN, Murdia R. Administration of policy and programmes for backward classes in India. Sowmya Publications Private Limited, 1976, 53, 204-215.
  2. Gupta KB, Walia BNS. A longitudinal study of morbidity in children in a rural area of Punjab. Indian Journal of Paediatrics, 1980; 47:297-301.
  3. Chabbra P, Garg S, Sharma N, Bansal RD. Health and Nutritional status of boys aged 6-12 years in a children’s observation home. Indian Journal of Public Health, 1996;40; 126-129.
  4. Pandit K, Kannan AT, Sarma A and Agarwal K. Periodontal disease and dental caries in primary school children in rural areas of Delhi. Indian Journal of Paediatrics, 1986 ; 53 : 525- 529.
  5. Andhra Pradesh School Health Project: Special School Health check up programme, Chittoor district report, 1996
  6. Bhandari B, Gupta G and Mandowara SL. Prevalence of intestinal parasites in Udaipur. Indian Journal of Paediatrics, 1985;52;299-302.
  7. Padmaja P A, Lakshmi AV and Mahatab S B. Riboflavin and Haemoglobin status of Urban school boys: relationship with income, diet and anthropometry. Indian Journal ofPaediatrics, 1987; 54 : 529-533.
  8. Seshadri S. Weekly implementation of iron in Rural adolescent girls In: Malnutrition in South Asia-A regional profile, 1996, ROSA publications, S, 79. 9. Taneja MK, Sandel J, Shukla PL. Health status of urban school children in Western Uttar Pradesh. Indian Journal of Paediatrics, 1978; 45; 359-363
  9. Chopdar A, Mishra PK. Health status ofrural schoolchildren in Western Orissa. Indian Journal of Paedfatrics, 1980;47:203-206.

1 Deptt. of Community Medicine, Government Medical College, Anantapur, A P

2 Deptt. of Community Medicine, S V Medical College, Tirupti, AP

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