Comparative Assessment of Nutritional Status of School Children Aged 6-8 Years in Selected Urban and Rural Schools of Belagavi – A Pilot Study

Introduction

Malnutrition impedes national development and thus can be a national issue. There are various conditions referred to as malnutrition, each having a specific aetiology associated with lack of one or more nutrients.

Malnutrition in this context is defined in terms of ‘Protein Energy Malnutrition’ which is characterized by an imbalance between the amount of protein and energy available and what the body needs to maintain healthy growth and function. Children who are malnourished suffer grave repercussions, including delay in physical maturation, intellectual growth, and resistance to infection. The health of a person is impacted by their food intake and utilization by their body.¹ Pertaining to a child's growth and development, the school days are the most critical.

According to the NFHS-5 (National Family Health Survey), 35.8% of children under the age of five are underweight and nearly 38.4% are stunted. According to the Global Nutritional Report 2019, in India, between 2019 and 2021, stunting rates among children under the age of five decreased from 48% to 38.4%. However, the prevalence of undernutrition in children is still high.²

Although diet has a direct impact on a child's development and health, indirect factors such as food, security, socioeconomic status, environmental conditions, and the availability of resources also have a significant impact.³ In emerging nations like India, where poverty is still pervasive, majority of poor rural households lack land and these people migrate to metropolitan regions in quest of employment. The local population's means of subsistence has drastically changed as a result of increased urbanization of rural areas.

Aim

To evaluate and compare the nutritional condition of children in rural and urban schools.

Objectives

1. To conduct anthropometric evaluation of the nutritional status of Belagavi school children.

2. To compare the nutritional status of children in urban and rural schools of Belagavi.

Materials and Methods

Source of data: The subjects were selected from primary high schools in Belgaum's rural (Belagundi) and urban (Ramnagar) districts. 

The following criteria were used in the data collection.

Study design: Prospective study Type of research: Observational pilot study

Selection criteria: Subjects of both sexes between the ages of 6 and 8 years fulfilling inclusion and exclusion criteria

Sample size: 120 students (60 urban and 60 rural)

Duration of study: Three months (01/05/2022 to 31/07/2022)

Tools used in the study: Waterlow’s and Gomez's classifications of malnutrition were used to determine the nutritional status of children using three anthropometric indices⁴ , including height for age, weight for age, and weight for height.⁵

Waterlow’s Classification of Malnutrition

Gomez’s Classification of Malnutrition

Formula for calculations

% Weight for height = (weight of subject)/(weight of a normal child of the same height)×100

% Height for age = (height of subject)/(height of a normal child of the same age)×100

% Weight for age = (patient weight)/(weight of normal child of same age)×100

Inclusion criteria

Children between the ages of 6 and 8 years were identified using three anthropometric indices, including height for age, weight for age, and weight for height, according to Waterlow's and Gomez's classifications of malnutrition.

Exclusion criteria

• Congenital conditions such as cleft palate, atrial septal defect, and ventricular septal defect are examples of secondary malnutrition.

• Malabsorption syndrome included inborn errors of metabolism, chronic renal failure, renal tubular acidosis, and cystitis fibrosis as well as celiac disease, lactose intolerance, giardiasis, and cystitis fibrosis.

The SPSS software version 17.0 was used to analyze the data, which were entered into an MS Excel sheet.

Results

In the present study, 120 children were included among which 60 were from urban area and 60 were from rural. According to the analysis of Waterlow's classification of malnourished, weight for height in urban children was found to be mild in 30%, moderate in 13.3% and normal in 56.7%, while in rural children, it was mild in 33.3%, moderate in 33.3%, severe in 5% and normal in 28.33% (Table 1). The analysis of Waterlow’s classification of malnutrition based on height for age was as followsin urban children, mild (28.33%), moderate (33.33%) and normal (68.33%); in rural children, mild (30%), moderate (6.6%), severe (1.6%) and normal (61.66%) (Table 2). Weight for age according to Gomez’s classification of malnutrition showed mild malnutrition in 28.33%, moderate malnutrition in 8.3% and normal in 63.33% of urban children. Among rural children, mild malnutrition was noted in 55%, moderate malnutrition in 10%, severe malnutrition in 1.66% and was normal in 33.33% (Table 3). Stunting impacted 19 (31.66%) urban and 23 (38.33%) rural children, whereas wasting affected 26 (43.33%) urban and 40 (66.66%) children from rural areas. Under nourishment affected 22 (36.66%) urban and 43 (71.66%) rural children (Table 4). In accordance with a study, wasting was found to be more in rural school children than urban school children.

Discussion

It is clear from the current survey that the rural primary school students in Belagundi in the age group of 6-8 years are more likely to be malnourished than their urban counterparts.

Stunting was found to occur 31.66% more frequently in rural primary school children compared to urban students. Around 66.66% of students in rural schools showed wasting which is far greater than 26% observed in metropolitan school children. Compared to 36.66% children in urban schools, 71.66% of rural school children were found to be underweight.

Children in rural areas exhibited the highest levels of undernutrition. In general, it was observed to be higher in rural children and lower among urban children. In all three nutritional status measures, malnutrition affected male children more compared to female children.

The level of malnutrition varied more dramatically for people from different backgrounds, and it typically decreased with rise in mothers' education levels, where the nutritional status of the children improved, and their children were born larger.

The fact that rural school children showed a higher overall frequency of malnutrition than urban school children may be related to the parents' economic situation and lack of nutritional importance.

Limitations

• Sample size was very small.

• Age group included in the study was limited.

• The survey was conducted involving only two schools.

Recommendation for further studies

The current investigation was an observational study that evaluated the nutritional status of school-age children in Belagavi's rural and urban areas. Administration of homoeopathic drugs to improve nutritional status can be the focus of future homoeopathic interventional studies.

Conclusion

Despite the fact that numerous government health programs have been implemented, malnutrition is becoming more difficult to treat. Malnutrition classifications developed by Waterlow and Gomez were used to conduct anthropomorphic investigations. According to the report, children attending rural schools in Belagavi showed malnutrition more frequently than those attending urban schools. According to the present study, malnutrition affected school children, but more so in rural than urban settings.

Conflicts of Interest

None

Acknowledgement

We are very grateful to the school staff and schools that have allowed us and helped us during this study. We are also grateful to the department of homoeopathic Materia Medica which allowed us to conduct the camp.