Nutritional Status and Related Factors among Primary School Children, at Mangalore

 

Mrs. Savitha1, Dr. C. Anitha2, Dr. Larissa Martha Sams3

1M.Sc (N) Department of Medical Surgical Nursing, M.Sc (CND) Department of Studies in Food Science and Nutrition, Karnataka State Open University, Mukthagangothri, Mysore, Karnataka. India.

2Professor, Department of studies in Food Science and Nutrition, Karnataka State Open University, Mukthagangothri, Mysore, Karnataka. India.

3Professor & Principal, Department of Medical Surgical Nursing, Laxmi Memorial College of Nursing,

A.J. Towers, Balmatta, Mangalore, Karnataka. India.

*Corresponding Author E-mail: ssswtsavi09@gmail.com

 

ABSTRACT:

Malnutrition is major public health problem in developing countries causing higher morbidity and mortality among children. The present study described nutritional status and related factors among primary school children in Mangalore so as to plan and provide basis to health care providers and policy makers to develop strategy and prevent malnutrition. This study included a total of 110 school children from class 5, 6 and 7 from the primary school situated in Mangalore City. The students were assessed for knowledge, attitude, enabling factors and reinforcing factors towards the nutrition through a questionnaire. Nutritional status of the children was determined by anthropometric Measurements and classified according to the degree of malnutrition based on Gomez standard of classification (weight- for- age) and Water low’s classification (height- for- age). Majority of the children were malnourished (82.73%) and most of the children were moderately malnourished (43.64%). Only 20% of the children had adequate nutritional knowledge and good attitude was observed only in 13.64% of the children. Boys constituted 51.82% of the study population and boy to girl ratio was 1.07:1. Most of the children were aged 11 years (34.55%) and the mean age was 11 ± 1 years. First birth order was noted among 34.55% of the children. The money spent for snacking was between one to five rupees in 54.55% and 38.18% of the children had two times snacking a day. Majority of the children lived with their parents (93.64%). With regard to parents educations and occupation, 57.27% of the parents (both father and mother) were educated upto elementary school and were labours (Father 78.18% and mother 75.45%). The average monthly income was between Rs. 1,000 to 5,000 in 47.27% of the children Majority of the children (69.09%) had > 5 family members and 39.09% of the children had no siblings Almost all the children (99.09%) were aware about health awareness programme and 97.27% were aware about food supplementary support programme in schools. Positive association was found between nutritional status and attitude towards the nutrition (p=0.004), age (p<0.001), mothers education (p=0.002) and father’s education (p=0.016). There is high prevalence of malnutrition among the school children of study area aged between 9 to 13 years. Initiatives towards the increasing awareness of nutrition in children may help to reduce the burden of malnutrition among these children.

 

KEYWORDS: Awareness about nutrition, Knowledge about nutrition, Malnutrition, Nutritional status.

 

 

INTRODUCTION:

Children are the wealth of any nation as they constitute one of the important segments of the population. Children in the age group of 5-14 years are often considered as school age. It is recorded that in India one fifth population comprises of children between 5-14 years, the age group covering primary and secondary school age.1

 

The health well-being of children is a fundamental issue in education. The level of concern is illustrated by the fact that World Health Organization has set up a global school health initiative. In countries around the world, the issue is being addressed through school health services, health education and school meals programmers.2

 

Good nutrition is important throughout childhood because under nutrition during the first few years of life decreases adult body size and physical output when the growth rate is high. The middle childhood, 6 to 12 years old, is a period of steady physical growth. The average gain in weight during this period is about 3 to 3.5 kg per year and in height approximately 6 cm added each year.3 This age is also the period of major cognitive development.

 

School children is one of vulnerable groups to malnutrition and health problems related with nutrient deficiencies. Improving the health of school children become a policy priority in international health School feeding program is one of the way because if they have malnutrition its can be influence in concentration of study and can decrease of ability in success of study.4 Malnutrition is “a man-made disease which often starts in the womb and ends in the tomb”.5 Adequate nutritional status is an essential requirement for children’s growth and development. Malnutrition and growth failure in children are associated with increased morbidity and can affect their response to illness.6,7 It is an invisible emergency, an iceberg whose deadly menace lies mainly hidden from the view.8

 

Depending on the definition used to classify malnutrition, the reported prevalence of acute malnutrition in infants and children admitted to hospitals from different countries ranges from 6.1 to In children with an underlying disease, a higher prevalence of chronic malnutrition (44-64%) was reported in several studies.9 Nutritional status, therefore, should be monitored regularly in children. Nutritional assessment goals are to evaluate the child’s nutritional status, risk of undernutrition or overweight and to provide guidelines for therapy and monitoring.10

 

STATEMENT OF THE PROBLEM:

Nutritional status and related factors among primary school children in Mangalore.

 

OBJECTIVES:

1.     To identify nutritional status and related factors among primary school children in Mangalore.

2.     To determine the nutritional status among primary school children.

3.      To analyze food habits of children.

4.      To find factors affecting nutritional status of children.

 

MATERIALS AND METHODS:

Research design:

The study design was descriptive cross-sectional study.

Research setting:

This study was conducted among the Primary School Children of Guardian Angels Higher Primary School, Government Higher Primary School and Adarsha Higher Primary School Mangalore.

Population:

In this study, Primary School Children attending fifth, sixth and seventh class of above mentioned Schools in Mangalore were enrolled.

Sample:

The sample would comprise of 110 primary school children.

 Sampling technique:

The Sample selection by statistical random sampling of children from 3 primary school at Mangalore.

 

Tools of study:

·       For study purpose Semi-structured interview schedule is used. The interview schedule consists of questionnaires to determine the associated factors among primary school children.

·       Nutritional status of children in this study is measured through anthropometric Measurements.

Children were classified according to the degree of malnutrition using Gomez standard of classification (weight- for- age) and Water low’s classification (height- for- age).

 

Plan for data analysis: 

The categorical data was expressed in terms of rates, ratios and percentages and continuous data was expressed as mean ± standard deviation. The association between various factors was determined using either chi-square test or Fisher’s exact test. A probability value of less than or equal to 0.05 was considered as statistically significant.

 

RESULTS:

Descriptive statistics were used to describe different variables such as gender, age, birth order, grade of the class, money for snacking, snacking Habit, knowledge, attitude, occupation of parents, education of parents, family income, family size, siblings below 10years and etc. Chi-square test was used to find out the association between the Predisposing Factors, Enabling factors, Reinforcing factors (independent variables) and the nutritional status (dependent variable) of Primary school children. A probability value of less than or equal to 0.05 was considered as statistically significant.

1.    Description of Nutritional Status:

In this study majority of the children that is, 82.73% were found to be malnourished the rate of moderate malnutrition was 43.64% while 20% and 19% had severe and mild malnutrition respectively.

2.     Description and association of predisposing factors:

The descriptive statistics of predisposing factors included nutritional knowledge, Attitude towards nutrition and socio demographic factors were presented. The association between predisposing factors and nutritional status of students were presented.

 

Table 1. Knowledge and nutritional status

Knowledge

Normal

Mild

Moderate

Severe

Total

No

%

No

%

No

%

No

%

No

%

Good

4

18

3

14

9

41

6

27

22

20

Fair

8

18

7

16

19

43

10

23

44

40

Poor

7

16

11

25

20

45

6

14

44

40

 p = 0.268

 

In this study maximum (94) students answered correctly for 11th question that is, which food item is good for vision and Maximum (92) students given wrong answer to 3rd question that is, example for carbohydrate rich food. Based on these answers coupled with answer to other questions, good nutritional knowledge was noted in 20% of the children and 40% each had fair and poor nutritional knowledge. However, no association was found between nutritional knowledge and nutritional status (p=0.268). These findings suggest that, majority of the children (80%) lacked knowledge about the nutrition. Further, the higher rate of malnutrition observed in the present study could be explained the higher rate of children who did not had adequate knowledge about the nutrition.

 

Table 2. Attitude and nutritional status:

Attitude

Normal

Mild

Moderate

Severe

Total

No

%

No

%

No

%

No

%

No

%

Good

1

7

0

0

8

53

6

40

15

14

Fair

4

9

13

30

16

36

11

25

44

40

Poor

14

27

8

16

24

47

5

10

51

46

p = 0.004

 

Table 3 shows the response of children for the assessment of attitude towards nutrition and graph 3 shows attitude levels. Maximum (100) students responded correctly for the statement “I make conscious effort to try drinking milk” while maximum (94) students responded wrongly for the statement “we can eat instant noodle every day and can be healthy”. Based on these and other responses, poor attitude was noted in 46.36% of the children and 40% of the children had fair attitude. The good nutritional attitude was noted in 13.64% of the children. Of the 44 children with fair attitude, 30% had mild, 36% had moderate and 25% had severe malnutrition and this difference was statistically significant (p=0.004). These findings suggest that majority of the children (86.36%) had poor / fair attitude about the nutrition which would have resulted in higher prevalence of malnutrition.

 

Socio Demographic Factors:

The descriptive statistics of socio demographic factors included gender, age, grade of school, birth order, money spent on snacking, frequency of snacking were presented. The association between socio demographic factors and nutritional status of students were presented.

 

Table 3. Sex and nutritional status:

Sex

Normal

Mild

Moderate

Severe

No

%

No

%

No

%

No

%

Boys

12

21

10

18

25

44

10

18

Girls

7

13

11

21

23

43

12

23

p = 0.686

 

In the present study 51.82% were boys and 48.18% were girls. The boy to girl ratio was 1.07:1. The sex distribution pattern observed in the present study was comparable with several other studies.11,12,13 The evidence suggests that boys are more likely to be stunted and underweight than girls, and in some countries, more likely to be wasted than girls.14 In this study among boys, 21% had normal nutritional status compared to 13% of the girls.

 

Table 4. Age and nutritional status

Age

(Years)

Normal

Mild

Moderate

Severe

Total

 

No

%

No

%

No

%

No

%

No

%

9

0

0

1

4

13

52

11

44

25

23

10

1

5

4

21

10

53

4

21

19

17

10

1

5

4

21

10

53

4

21

19

17

12

7

28

10

40

7

28

1

4

25

23

13

2

100

0

0

0

0

0

0

2

2

14

1

100

0

0

0

0

0

0

1

1

p < 0.001

 

In the present study most of the children were aged 11 years (34.55%) followed by 9 years (22.73%) and 12 years (22.73%). The mean age was 11 ± 1 years. Maximum children were enrolled from class 7 (39.09%) compared to class 6 (30%) and class 5 (30.91%). The higher prevalence of severe malnutrition was noted (44%) in children who were aged 9 years compared to none of the child with 13 and 14 years, 4% with 12 years, 16% with 11 years and 21% with 10 years of age. This difference was statistically significant (p<0.001).

 

Grade of school: Maximum children were enrolled from class 7 (39.09%) compared to class 6 (30%) and class 5 (30.91%).

 

 


Table 5. Birth order and nutritional status

Birth order

 

Normal

Mild

Moderate

Severe

Total

No

%

No

%

No

%

No

%

No

%

First

10

26

8

21

14

37

6

16

38

35

Second

5

15

9

26

14

41

6

18

34

31

Third

3

21

0

0

7

50

4

29

14

13

Fourth

1

4

4

17

13

54

6

25

24

22

p = 0.240

 


In the present study first, second, third and fourth birth order was noted in 34.55%, 30.91%, 12.73% and 21.82% respectively. Of the 35 children with first birth order, 21% had mild, 37% had moderate and 16% had severe malnutrition. No statistically significant association was found between birth order and nutritional status (p=0.240).

 

Table 6. Money spent for snacking and nutritional status

Money spent

(Rs.)

Normal

Mild

Moderate

Severe

Total

No

%

No

%

No

%

No

%

No

%

> 15

0

0

1

100

0

0

0

0

1

1

11 to 15

0

0

2

50

1

25

1

25

4

4

6 to 10

3

27

2

18

5

45

1

9

11

10

1 to 5

6

10

8

13

32

53

14

23

60

55

Nil

10

29

8

24

10

29

6

18

34

31

p = 0.073

 

In this study 54.55% of the children spent between one to five rupees for snacking. Among them, 10% were normal, 13% had mild, 53% had moderate and 23% had severe malnutrition. However this difference was statistically not significant (p=0.073).

Table 7. Frequency of snacking and nutritional status

Frequency

Normal

Mild

Moderate

Severe

Total

No

%

No

%

No

%

No

%

No

%

One time

8

23

7

20

14

40

6

17

35

32

Two times

3

7

6

14

22

52

11

26

42

38

≥ 3 times

8

24

8

24

12

36

5

15

33

30

p = 0.268

 

In the present study 38.18% had two times snacking while 31.82% has one time and 30% had more than or equal to three times in a day. In children with frequency of snacking two times (38%), 26% had severe and 52% had moderate malnutrition. However no statistically significant association was noted between frequency of snacking and nutritional status (p=0.268).

 

Description and association of Enabling factors :

The descriptive statistics of enabling factors included Accommodation Type, Occupation parents, Education parents, Number of Household member, Number of children in family. The association between enabling factors and nutritional status of students were presented.


 

Table 8. Accommodation type and nutritional status

Living with

Normal

Mild

Moderate

Severe

Total

No

%

No

%

No

%

No

%

No

%

Father & Mother

18

17

18

17

46

45

21

20

103

94

Grandfather & Grand mother

1

20

2

40

1

20

1

20

5

5

Uncle and aunt

0

0

1

100

0

0

0

0

1

1

In laws

0

0

0

0

1

100

0

0

1

1

p = 0.573

 

In this study nutritional status was comparable in children who were accompanied with parents, grandparents and relatives (p=0.537).

 

Table 9. Occupation of parents and nutritional status

Occupation

Normal

Mild

Moderate

Severe

Total

No

%

No

%

No

%

No

%

No

%

Father

 

 

 

 

 

 

 

 

 

 

Private /

 

 

 

 

 

 

 

 

 

 

company

0

0

0

0

4

67

2

33

6

5

employee

 

 

 

 

 

 

 

 

 

 

Labor

1

11

1

11

4

44

3

33

9

8

Vendor

16

19

18

21

36

42

16

19

86

78

Unemployed

1

20

1

20

2

40

1

20

5

5

Farmer

1

25

1

25

2

50

0

0

4

4

p=0.938

 

 

 

 

 

 

 

 

 

 

Mother

 

 

 

 

 

 

 

 

 

 

Government employee

0

0

0

0

3

60

2

40

5

5

Private /

 

 

 

 

 

 

 

 

 

 

company

1

33

0

0

2

67

0

0

3

3

employee

 

 

 

 

 

 

 

 

 

 

Labor

15

18

18

22

34

41

16

19

83

75

Unemployed

0

0

1

50

0

0

1

50

2

2

Farmer

3

18

2

12

9

53

3

18

17

15

p=0.699

Table 10. Education of parents and nutritional status

Education

Normal

Mild

Moderate

Severe

Total

No

%

No

%

No

%

No

%

No

%

Mother

 

 

 

 

 

 

 

 

 

 

Illiterate

3

14

8

36

9

41

2

9

22

20

Elementary school

8

13

8

13

30

48

17

27

63

57

Higher primary school

7

39

3

17

8

44

0

0

18

16

Bachelor degree

0

0

2

40

0

0

3

60

5

5

Diploma

1

50

0

0

1

50

0

0

2

2

p=0.938

Father

 

 

 

 

 

 

 

 

 

 

Illiterate

5

24

4

19

9

43

3

14

21

19

 

 

 

 

 

 

 

 

 

 

 

Elementary school

7

11

9

14

29

46

18

29

63

57

Higher primary school

5

24

6

29

10

48

0

0

21

19

Bachelor degree

1

25

2

50

0

0

1

25

4

4

Diploma

1

100

0

0

0

0

0

0

1

1

 p=0.016\\

 


In the present study no association was found between occupation of father (p=0.938) and mother with nutritional status of the children (p=0.699).

 

In the present study significantly higher number of children with severe malnutrition (60%) were noted whose mother had education up to graduation (p=0.002) and higher number of children with moderate malnutrition (48%) were noted whose father had education up to higher primary school (p=0.016). These findings propose a strong association between nutritional status of the children and education of the parents.


 

Table 11. Average monthly income and nutritional status

Average monthly income

Normal

Mild

Moderate

Severe

Total

No

%

No

%

No

%

No

%

No

%

> 20,000 Rupees

2

25

0

0

6

75

0

0

8

7

Rs. 10,001– 20,000

3

12

4

15

12

46

7

27

26

24

Rs. 5,001– 10,000

5

21

5

21

11

46

3

13

24

22

Rs. 1,000 Rupees

9

17

12

23

19

37

12

23

52

47

p = 0.514

 

In this study no association was found between average monthly income and nutritional status (p=0.514)

Table 12. Family member and nutritional status

Family members

Normal

Mild

Moderate

Severe

Total

No

%

No

%

No

%

No

%

No

%

3 Members

0

0

2

29

4

57

1

14

7

6

4 Members

3

11

6

22

14

52

4

15

27

25

≥ 5 Members

16

21

13

17

30

39

17

22

76

69

p = 0.633

 

In the present study nutritional status was not influenced by the number of family members (p=0.633).

 

Table 13. Siblings below 10 years and nutritional status

Sibling below

 10 years

Normal

Mild

Moderate

Severe

Total

No

%

No

%

No

%

No

%

No

%

0

8

19

7

16

18

42

10

23

43

39

1

6

21

7

24

13

45

3

10

29

26

2

2

12

3

18

6

35

6

35

17

15

3

2

17

2

17

7

58

1

8

12

11

> 3

1

11

2

22

4

44

2

22

9

8

p = 0.899

 

In this study no association was found between siblings below 10 years and nutritional status of the children (p=0.899).

 

Description and association of Reinforcing factors:

Table 14. Health awareness programme and nutritional status

Health awareness program

Normal

Mild

Moderate

Severe

Total

No

%

No

%

No

%

No

%

No

%

Yes

19

17

21

19

48

44

21

19

109

99

No

0

0

0

0

0

0

1

100

1

1

p = 0.564


In the present study health awareness programme offered by the school did not affect the nutritional status of the children (p=0.564).

 

Table 15. Food supplementary support in school and nutritional status

Supplementary support in school

Normal

Mild

Moderate

Severe

Total

No

%

No

%

No

%

No

%

No

%

1 time

0

0

0

0

1

50

1

50

2

2

2 times

0

0

1

100

0

0

0

0

1

1

3 times

19

18

20

19

47

44

21

20

107

97

p = 0.629

 

In this study no association was found between nutritional status of the children and snacking offered by the school (p=0.629).

 

DISCUSSION:

Overall the present study highlights the magnitude of malnutrition in children residing at Mangalore. Positive association was found between age, parents education and nutritional status. This provides a clue to the health policy makers that, malnutrition among children is a major public health problem. Further, efforts directed towards improvement of female literacy, women empowerment and restricting family size will have a positive impact on the nutritional status of school children. Besides education and age, there are other factors that directly or indirectly affect the nutritional status of children to plan for the initiatives such as increasing awareness in mother regarding the nutritional intake of the child, focus the attention of policy-makers on the nutritional status of children as one of the main indicators of development and as a precondition for the socioeconomic advancement of societies in the long term.

 

Limitations of Anthropometry

·       Relatively insensitive to short term nutritional status.

·       Cannot identify specific nutrient deficiencies.

·       Measurements like Skin-folds are difficult to carry out in obese people.

·       There may be ethnic differences in fat deposition.

 

Limitations of Clinical assessment

·       May not detect the early stages.

·       Malnutrition cannot be quantified on the basis of clinical signs.

·       Many deficiency signs are unaccompanied by physical signs.

·       Lack of specificity and subjective nature of most of the physical signs.

 

CONCLUSION:

Based on the findings of this study it may be concluded that, there is high prevalence of malnutrition among the school children aged between 9 to 13 years in Mangalore. Initiatives towards the increasing awareness of nutrition in children may help to reduce the burden of malnutrition among these children.

 

ACKNOWLEDGEMENT:

The investigator acknowledges the co-operation of children during data collection.

 

CONFLICTS OF INTEREST:

Nil

 

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Received on 28.11.2022         Modified on 17.12.2022

Accepted on 09.01.2023       ©A&V Publications All right reserved

A and V Pub J. of Nursing and Medical Res. 2023; 2(1):13-18.

DOI: 10.52711/jnmr.2023.05