|Year : 2015 | Volume
| Issue : 1 | Page : 10-15
Nutritional status and morbidity profile of school-going adolescents in a district of West Bengal
Abantika Bhattacharya1, Mausumi Basu2, Supantha Chatterjee3, Raghu Nath Misra2, Gagori Chowdhury4
1 Department of Community Medicine, Midnapore Medical College, Paschim Medinipur, India
2 Department of Community Medicine, Institute of Post-Graduate Medical Education and Research (IPGMER), Kolkata, West Bengal, India
3 Department of Medical Education, Health and Family Welfare, Government of West Bengal, Swasthya Bhavan, Kolkata, West Bengal, India
4 Department of Bio-Informatics and Bio-Physics, University of Calcutta, Kolkata, West Bengal, India
|Date of Web Publication||8-Dec-2014|
Department of Community Medicine, Institute of Post-Graduate Medical Education and Research (IPGMER), Kolkata, West Bengal
Source of Support: We declare that no funding, direct or indirect, for
our study was received, Conflict of Interest: There are no potential,
perceived, or real competing and/or confl icts of interest among authors
regarding the article.
our study was received
Background: In India, adolescent age group (10-19 years) constitutes 21.4% of the total population. The health and nutritional status of the adolescents is an index of its future manpower. It is well recognized worldwide that anthropometric measurements are indispensable in diagnosing undernutrition. Objective: To assess the nutritional status and morbidity pattern among school-going adolescents. Materials and Methods: A descriptive cross-sectional study was carried out in three randomly selected co-educational schools of Burdwan District of West Bengal in May 2013 among 424 adolescents in the age group of 10-19 years from class V to class XI (except class X), using a predesigned pretested proforma. Results: The prevalence of underweight and stunting were 53.31% and 47.41%, respectively, which was significantly higher in early adolescence than in late adolescence and more in boys than in girls. About 55.18% had pallor, 40.33% had dental caries, 33.49% were suffering from refractive errors, 23.11% had history of worm infestation, 38.90% had skin problems, and 68.61% adolescents had ENT problems. Conclusion: The health and nutritional status among the school-going adolescents was found to be poor.
Keywords: Adolescence, morbidity, nutrition
|How to cite this article:|
Bhattacharya A, Basu M, Chatterjee S, Misra RN, Chowdhury G. Nutritional status and morbidity profile of school-going adolescents in a district of West Bengal. Muller J Med Sci Res 2015;6:10-5
|How to cite this URL:|
Bhattacharya A, Basu M, Chatterjee S, Misra RN, Chowdhury G. Nutritional status and morbidity profile of school-going adolescents in a district of West Bengal. Muller J Med Sci Res [serial online] 2015 [cited 2019 Jun 20];6:10-5. Available from: http://www.mjmsr.net/text.asp?2015/6/1/10/146414
| Introduction|| |
The word "adolescence" is coined from the Latin verb "adolescere" that implies "to grow into maturity." Adolescence can be viewed as a tunnel, very long and much darker in some people than in others, but through which all must pass. The World Health Organization (WHO) defines adolescence as the period from 10 to 19 years of age, characterized by physical, psychological, and social changes, and is classified into two: early adolescence between 10 and 14 years and late adolescence between 15 and 19 years. Adolescent, on the other hand, is defined by the WHO as a person aged between 10 and 19 years, while adolescence period is a period of transition from childhood to adulthood. 
Adolescents account for more than one-fifth of the world's population. In India, this age group constitutes 21.4% of the total population, comprising one-fifth of the total population.  Adolescence is the second most critical period of physical growth after the first year. Twenty-five% of adult height and 50% of adult weight are attained during adolescence. It is also an intense anabolic period when requirements for all nutrients increase. 
The health and nutritional status of adolescents is an index of their future manpower. Inadequate nutrition during adolescence can have serious consequences throughout reproductive years and beyond. For example, short stature in adolescents resulting from chronic malnutrition is associated with lean body mass and deficiencies in muscular strength and working capacity. 
According to the WHO, the ultimate intention of nutritional assessment is to improve human health.  It is well recognized worldwide that anthropometric measurements are indispensable in diagnosing undernutrition. 
Anthropometry is the single most universally applicable, inexpensive, and noninvasive technique available to researchers for the assessment of body size and proportion. 
Surprisingly, information regarding the nutritional status of adolescents from the developing world was lacking for a long time. One of the reasons for the lack of information has been the difficulty of interpreting anthropometric data in these age groups. 
The adolescent group also includes the school-going group. The important morbidities found among school children are malnourishment, communicable diseases, nutritional disorders, and skin, eye, ENT, or dental problems. School health services have been considered as an ideal platform for early detection of the health problems among children. Early identification of childhood illnesses through regular school health check-ups helps prevent complications.  Research indicates that malnutrition and poor health are among the most common causes of low school enrollment, high absenteeism, early dropout, and poor classroom performance.
Several recent studies have investigated the nutritional and morbidity status of adolescents from different parts of India. Still there is a need to develop a database on the nutritional and morbidity status of these groups from different parts of the country that would help in formulating policies and initiating strategies for the well-being of adolescent children.
With this background, this study was carried out with the objective of assessing the nutritional status and morbidity pattern among school-going adolescents in government schools of Burdwan district, West Bengal.
| Materials and Methods|| |
Study Design and Study Population
A school-based observational, descriptive study, cross-sectional in design, was carried out in three randomly selected schools of Burdwan district in West Bengal of eastern India, in the month of May 2013. Adolescents of these three schools, in the age group of 10-19 years from class V to class XI (except class X), formed the study population.
Students of both sexes, studying in class V, VI, VII, VIII, IX, and XI, between 10 and 19 years of age, who were not seriously ill and were present during the day of study, and whose parents gave informed written consent were included in the study.
Students above or below 10-19 years of age, who were seriously ill or absent during the study day, and whose parents did not give informed written consent were excluded from the study.
A predesigned and pretested semi-structured proforma (prepared in consultation with experts of community medicine, pretested on 50 adolescents of a nearby school other than the ones selected for the study, modified and validated by another three experienced persons of community medicine), weighing scale, height measuring machine, torch, and Snellen's eye testing chart were the study tools. The schedule had two parts. Part I consisted of information on the socio-demographic status, i.e. age, sex, religion, type of family, and per capita monthly income (PCMI). Part II consisted of study participants' anthropometric measurements and clinical signs and symptoms.
Age, sex, religion, type of family, PCMI, anthropometric measurements (height, weight), clinical signs and symptoms were the study variables.
The sample size was calculated using the formula, n = Z 2 (1-α/2) pq/d2 (where Z(1-α/2) = 1.96 at 95% confidence level, p = prevalence of morbidity, q = 1-p, and d = allowable error). For this study, we assumed 50% prevalence of morbidity; hence, p = 0.5, q = 0.5, and d = 5%. Thus, the sample size obtained was 385.  Taking into account 10% as nonrespondents, the total number came out to be 424.
Adolescents numbering 144 from each of two schools (144 × 2 = 288 from two schools) and 136 from the other school were studied (totally 424 students were included). Twenty-four from each class from the first two schools (classes V-XI, except class X) in the age group of 10-19 years and 23 students from each class from the third school were selected by simple random sampling and examined by a team comprising doctors through scheduled visits. Informed consent of the head of the institutions was taken before conducting the study.
Burdwan district is divided into urban and rural areas. From this, an urban area was selected by simple random technique.
At the second stage, three senior secondary co-educational schools were selected randomly from the listed senior secondary schools of Burdwan municipality.
At the third stage, one section from each class (i.e. from class V to XI, except class X) was selected by lottery method. Students from the class were selected through random sampling. School record was used for getting reasonable accuracy in age assessment. Students who were present on the day of survey with the above-mentioned age were included in the study. In case of absence, the next roll number was taken into study. This process was repeated for each of the three schools till the sample size of 424 was met.
After obtaining clearance from the Institutional Ethics Committee (IEC), permission was obtained from the school authorities. The informed written consent of the parents of the study population was obtained after explaining the purpose and nature of the study to them. The study population was assured about confidentiality of the information and anonymity of the participants.
A separate room in each school was used for examination purpose. All the registered students were subjected to anthropometric measurements. The weight was measured in kilograms without shoes using a standing weighing machine having a precision of 0.5 kg. Checks on the scale were made routinely before recording the weight of each student and the pointer was adjusted to zero using the screw provided. The height was taken barefooted in centimeters using standard measuring tape. A vertical tape fixed perpendicular to the ground on the wall was used as the scale. This tape was non-stretchable. It was fixed with a transparent adhesive tape and care was taken to see that there was no fold or tilting to any side. During the examination, the scale was repeatedly checked for loosening of adhesive tapes or tilting of the scale. Height was recorded to the nearest 1 cm. The level of stunting (height-for-age z-scores), which is an indicator of chronic malnutrition, and underweight (weight-for-age z-scores), which is another indicator of malnutrition, were calculated using the WHO AnthroPlus software.  Thus, those below −2 standard deviations of the National Center for Health Statistics( NCHS) median reference for height-for-age and weight-for-age were defined as stunting and underweight, respectively.
General clinical examination of all the students was carried out in natural light. Every student was examined physically from head to toe for any signs of illness. Information was collected regarding history of worm expulsion during last 3 months. Anemia was diagnosed from clinical signs such as presence of pallor on the conjunctiva, tongue, and palm. Wherever any health problem was detected, the doctors prescribed necessary medications. Referral was made for further management. Social class was calculated using modified BG Prasad scale 2013. 
Data were entered in Microsoft Office Excel and analyzed with Statistical Package for the Social Sciences SPSS Inc. Released 2007. SPSS for Windows, Version 16.0. Chicago, SPSS Inc (SPSS) version 16.0. Data were analyzed using percentages and Pearson's Chi-square test for normal distribution. P values less than 0.05 were considered significant.
| Results|| |
A total of 424 adolescents participated in the study. Out of them, 262 (61.79%) were boys and the remaining 162 (38.21%) were girls, and were aged between 10 and 19 years. Mean age of the adolescents was 14.2 ± 1.9 years. Almost half [214 (50.47%)] of them were early adolescents and the remaining [210 (49.53%)] were late adolescents. Majority of them were Hindus (78.30%) and from nuclear families (82.31%). With regards to socio-economic status, 41.30% belonged to class V followed by class IV (32.05%) according to modified BG Prasad's classification 2013.
About 46.69% of the adolescents were found to be normal and 53.31% were undernourished as per their weight-for-age criteria. Boys suffered more (61.45%) than girls (40.13%), which was statistically significant (P < 0.05). Early adolescents (10-15 years), in whom the growth spurt takes place, were observed to be at the highest risk of being underweight (58.88%), which was also found to be statistically significant (P < 0.05) as compared to late adolescents (16-19 years) (47.62%). The prevalence rate of underweight was significantly associated with the type of family and socio-economic status (P < 0.05), but not with religion of the study population (P > 0.05) [Table 1].
|Table 1: Distribution of adolescents according to their nutritional status (underweight) as per age and sex (N = 424)|
Click here to view
[Table 2] reveals that overall, 47.41% of the adolescents were stunted with boys outnumbering girls (51.91% vs. 40.13%) and this sex difference was statistically significant (P < 0.05). Similarly, early adolescents were more stunted (54.21%) as compared to late adolescents (40.48%), which was also statistically significant (P < 0.05). Again, the prevalence rate of stunting was significantly associated with the type of family and socio-economic status (P < 0.05), but not with religion (P > 0.05).
|Table 2: Distribution of adolescents according to stunting as per age and sex (N = 424)|
Click here to view
Various disorders observed among the adolescents are shown in [Table 3]. About 88.2% adolescents were suffering from one or more illnesses at the time of examination. As high as 55.18% of the school-going adolescents had pallor, with girls suffering more than boys. About 40.33% adolescents had dental caries, 33.49% adolescents were found to be suffering from refractive errors, 23.11% adolescents had history of worm infestation, 38.90% adolescents had skin problems, and 68.61% adolescents had one or the other ENT problem. The prevalence of vitamin A deficiency, worm expulsion, refractive errors, skin infestations, and ENT problem was more among boys than girls. However, pallor, vitamin B complex deficiency, iodine deficiency disorders, and dental caries were found to be more among girls.
| Discussion|| |
In the present study it was found that the prevalence rates of underweight and stunting were 53.31% and 47.41%, respectively, which were similar to the values reported in some previous studies. ,,,,,,, A study conducted at Wardha by Dambhare et al.,  revealed that 51.7% of adolescents were underweight and 34.5% were stunted. A similar study performed at Wardha by Deshmukh et al.,  showed that overall, 53.8% of the adolescents were undernourished. A study from Puducherry by Joice et al.,  also described that significant malnutrition existed among both sexes. The study carried out by Thekdi et al.,  at Gujarat demonstrated similar results revealing frank undernutrition among school children. The prevalence of stunting and underweight among adolescents in the study carried out in Bangladesh by Rahman et al.,  was estimated to be 46.6% and 42.4%, respectively. The corresponding figures of stunting and underweight in a study conducted by Ghosh et al.,  in Nepal were 44.5% and 49.5%, respectively, and another study from Assam by Medhi et al.,  reported rates of 50.4% and 49.5%, respectively. According to a study conducted at Puducherry by Ananthakrishnan et al.,  57.6% had undernutrition.
However, some other previous studies revealed somewhat lower prevalence of undernutrition. ,, The study conducted at Paschim Medinipur by Bose et al.,  showed that the overall prevalence of undernutrition was 35.3%. Also, a study conducted at Goa by Banerjee et al.,  demonstrated that the prevalence of underweight was 33.3%. According to Dey et al.,  40% adolescents were found to be undernourished in Darjeeling.
In the study from Goa,  the prevalence rates of being underweight across the school classes were: 33% (class V), 38.4% (class VI), 41% (class VII), 26.8% (class VIII), 33.1% (class IX), 27.6% (class X), 24.6% (class XI), and 40.6% (class XII).
In our study, the prevalence rates of underweight and stunting were significantly higher (58.88% and 54.21%, respectively) in early adolescence than in late adolescence (47.62% and 40.48%, respectively), corroborating with the findings by Dambhare et al.,  Deshmukh et al.,  and Bose et al. 
Similarly, the prevalence rates of underweight and stunting were significantly higher (61.45% and 51.91%, respectively) in boys than in girls (40.13% and 13%, respectively) in the present study, Wardha study,  Puducherry study,  Nepal study,  Assam study,  Paschim Medinipur study,  Goa study,  and Darjeeling study.  However, some other studies reported that girls suffered more as compared to boys. ,
Refractive errors in Thekdi et al.'s  study was 37% and was addressed as the most common morbidity among school children. In contrast to this, it was 33.49% in our study, 13.79% in Dambhare et al.'s  study, 20.9% in Joice et al.'s study,  2.7% in Ananthakrishnan et al.'s study,  and 22.5% in Kakkar et al.'s study. 
The problem of worm infestation was reported to have a prevalence of 7.76% by Dambhare et al.,  3.9% by Joice et al.,  13.2% by Thekdi et al.,  46.4% by Ananthakrishnan et al.,  and 60% by Kakkar et al.,  while it was 23.11% in our study.
Studies in Wardha  revealed that 28.45% of school-going adolescents had anemia, with girls suffering significantly more (38.89%) as compared to boys (23.75%). This finding is similar to the present study where 55.18% were found to have anemia and girls suffered more than boys, Dehradun study of Kakkar et al.,  where clinical anemia was higher in girls (46.7%) as compared to boys (34.1%), Puducherry study of Joice et al.  (39.4%), Gujarat study of Thekdi et al.  (25%), Puducherry study of Ananthakrishnan et al.  (57.1%), and Darjeeling study of Dey et al. (40%). 
The prevalence of caries tooth was 35.34% in Dambhare et al.'s  study, 25% in Joice et al.'s  study, 27.9% in Ananthakrishnan et al.'s  study, 15% in Dey et al.'s  study, and 53.1% in Kakkar et al.'s  study, while it was 40.33% in our study.
In Puducherry study,  about 40.3% of children showed morbidities related to nutrition (vitamin A deficiency and vitamin B complex deficiency). The corresponding figures were: 35.60% in the present study (vitamin A deficiency 8.01% and vitamin B deficiency in the form of glossitis and angular stomatitis 27.59%), 59.2% in Gujarat study,  34% in Puducherry study  (vitamin A deficiency 3.1%, riboflavin deficiency 32.9%), and 6% in Darjeeling study. 
The prevalence of skin disorders was 26.64% (ringworm and scabies) in this study, while it was 6.9% in Dambhare et al.'s  study, 6.2% in Joice et al.'s  study, 8.7% in Ananthakrishnan et al.'s  study, 13% in Dey et al.'s  study, and 16.3% in Kakkar et al.'s  study.
ENT problems were observed among 68.61% of the study participants in the present study. In contrast to this, it was only 5.14% in Wardha  study (2.59% had tonsillitis and 2.59% had wax in ear) and 3.1% in Puducherry  study.
Adolescence is a relatively healthier period in the life of an individual. Most of the nutritional deficiencies may be carried on from childhood itself. Therefore, a longitudinal study would be better describing the impact of diet and growth spurt during this period.
| Conclusion|| |
The health and nutritional status among the school-going adolescents were found to be poor. Anemia and undernutrition make the children susceptible to various infections. Morbidities were high compared to other studies. There is a definite need to focus on the periodical and regular health check-up with concerted efforts toward the nutrition of school-going adolescents, along with a need to have focused health education in schools to improve the health and nutritional status of them as they contribute significantly as our future torchbearers.
| Acknowledgment|| |
None were contributors except the authors.
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[Table 1], [Table 2], [Table 3]