|Year : 2014 | Volume
| Issue : 3 | Page : 164-169
A comparative study of nutritional status between government and private primary school children of Mysore city
NC Ashok, HS Kavitha, Praveen Kulkarni
Department of Community Medicine, JSS Medical College, SS Nagar, Mysore, Karnataka, India
|Date of Web Publication||13-Aug-2014|
H S Kavitha
Department of Community Medicine, JSS Medical College, Mysore, Karnataka
Source of Support: None, Conflict of Interest: None
Background: School health has been acknowledged as important since the beginning of 20 th century. Nutritional status is a major component of school health services. This study was undertaken to assess the nutritional status of government and private primary school children of Mysore city. Materials and Methods: Cross-sectional study design was adopted. One private and one government school were selected using multistage stratified random sampling method. A total of 1566 school children aged 6-12 years were measured for height and weight. Data on demographic details, dietary habits, and physical activity of child and education status, occupation, monthly income of their parents were collected. Results: Of 1566 children, 385 (24.5%) were underweight, 132 (8.4%) were overweight, and 65 (4.1%) were obese. Majority of underweight children 226 (32.5%) were found in government school. Except for two overweight children in government school, all overweight and obese children were found in private schools. Socioeconomic status, dietary habits, and physical activity of the child were found to be the determinants of their nutritional status. Conclusion: This study attempt to highlight the dual nutritional problem, under-nutrition among the lower socioeconomic class on one hand and growing epidemic of obesity among the affluent on the other.
Keywords: Diet, obesity, overweight, school children, underweight
|How to cite this article:|
Ashok N C, Kavitha H S, Kulkarni P. A comparative study of nutritional status between government and private primary school children of Mysore city. Int J Health Allied Sci 2014;3:164-9
|How to cite this URL:|
Ashok N C, Kavitha H S, Kulkarni P. A comparative study of nutritional status between government and private primary school children of Mysore city. Int J Health Allied Sci [serial online] 2014 [cited 2020 Jan 17];3:164-9. Available from: http://www.ijhas.in/text.asp?2014/3/3/164/138596
| Introduction|| |
The health of children and youth is of fundamental importance. Over one-fifth of our population comprises of children aged 5-14 years that is, the group covering primary and secondary education. As today's children are the citizens of tomorrow's world, their survival, protection, and development are the prerequisite for the future development of humanity. Without ensuring optimal child growth and development, efforts to accelerate economic development significantly will be unsuccessful.
Malnutrition implies to both extremes, under-nutrition on one side and over-nutrition on the other, causes a great deal of physical and emotional suffering and it is a violation of a child's human rights. They both increase the vulnerability of a child to a variety of diseases in later life. Health of children is of great importance as rapid growth occurs during this period. Good nutrition is a basic requirement for good health and a living organism is a product of nutrition. 
It is widely accepted that, for practical purposes, anthropometry is the most useful tool for assessing the nutritional status of children. There are many anthropometric indicators in use, such as mid upper arm circumference, weight for age, height for age, weight for height, and body mass index of Quetlet. Most of these indicators need to be used along with specific reference tables, e.g. National Center for Health Statistics tables, for interpreting data.
The principal aim of the nutritional assessment of a community is to map out the magnitude and geographical distribution of both under and over nutrition as a public health problem, to discover and analyze the ecological factors that are directly or indirectly responsible and where possible to suggest appropriate corrective measures, preferably capable of being applied with continuing community participation. With this recommendation in mind, assessment of the nutritional status of children of both government and private primary schools of Mysore city was carried out. The objective of the study was to compare the nutritional status of the students from government and private schools and to identify the factors influencing their nutritional status.
- To compare the nutritional status of government and private primary school children in Mysore city
- To assess the factors associated with the nutritional status.
| Materials and methods|| |
A cross-sectional study was conducted during the period of May 2011-November 2011, among the primary school children of private and government schools of Mysore city. The list of schools with its strength was obtained from BEO (North and South) of Mysore city. Multistage stratified random sampling method was used to select the schools. In first stage, the schools were divided into two strata, government schools, and private schools. Out of each stratum, one private school, and one government school were selected. Sample size was calculated using the formula:
n = 4pq/l2
Prevalence of obesity (p) was taken as 6% and relative allowable error (l) as 20% of p, 1566 primary school children constituted the study population. All students aged between 6 and 12 years from each selected school, were included in the study.
Approval for the study was obtained from the Ethical Committee of the institution. A prior consent for the study was taken from the school administration. At the time of initiating the study, parents of each participant were informed about the study protocol and written consent was obtained for their child's participation. Children whose parents did not provide consent and whose exact birth date was not available were excluded from the study.
A pilot study was carried out on 150 school children in a randomly selected private and government schools other than that included in the study, to check the feasibility of the questionnaire. A semi-structured questionnaire was distributed to the study subjects in the classroom after explaining them about the study. All students were instructed to take the questionnaire home and get it filled by their parents/guardians, which were collected back the next day. Simultaneously, height and weight of the children was measured using standardized instruments and techniques. Variables such as age, sex, religion, type of diet, frequency of consumption of junk food, and bakery products such as biscuits, cake and chips, etc., habits of child-like physical aerobic exercise and outdoor games, duration of watching TV and time spent in front of the computers were recorded and education status, occupation, monthly income of their parents were included in the questionnaire to assess the socioeconomic status of the family. Socioeconomic status of the family was assessed using modified Kuppuswamy's method of socioeconomic scale. ,
One-day diet history was collected using 24 h recall method. The nutrients intake of randomly selected 100 underweight, 100 normal weight, and 100 overweight/obese children were computed to derive the energy, protein and fat consumption using standard conversion tables. The values of energy, protein and fat consumed were assessed for excess, adequate and deficient by comparing it with the recommended daily allowance (RDA) for Indian children.
Height was measured by asking the child to stand upright without footwear with gaze horizontal and with the heels, the buttocks and the shoulders touching the wall on which the scale was marked with the measuring tape. It was recorded in centimeters to the nearest 0.5 cm and then converted to meter for calculating body mass index (BMI). Weight was recorded in kilogram to the nearest measure of 0.5 kg using the standard weighing machine. The students were asked to stand upright, bare footed on the weighing machine looking straight, while the measurement was read. The scale was zeroed before each session. BMI was calculated using the formula:
According to Center For Disease Control And Prevention BMI for age percentile chart, which is considered to provide an appropriate reference curves for the world population aged 2-20 years,  children were categorized into four groups: ≥95 th percentile as obese, >85 th percentile as overweight, 5-85 th percentile as normal and <5 th percentile as underweight. Data were compiled using Data was compiled using Microsoft Excel software and analyzed using Epi-Info software. Proportion and Chi-square tests are carried out in this study. For all statistical tests applied, P < 0.05 was considered as the significant level.
| Results|| |
Among 1566 children, aged 6-12 years, 695 (44.3%) were from government school and 871 (55.6%) were from private school. Sex wise, 341 (49.0%) were girls and 354 (50.9%) were boys in government school and 453 (52.0%) were girls and 418 (47.9%) were boys in private school. Majority of children in government school were in the age group of 6-7 years (31%) and in private school were in the age group of 10-11 years (25%). In this study, 483 (69%) government school children belonged to Classes IV and V and 676 (78%) private school children belonged to Classes I and II socioeconomic group.
The overall prevalence of underweight, overweight and obesity among primary school children of Mysore city was 385 (24.5%), 132 (8.4%), and 65 (4.1%), respectively. No obese child was found in government school, whereas underweight prevalence was more in government school (32.5%) when compared with private school (18.2%). The overweight prevalence was more in private school (14.9%) than government school (0.2%).
Underweight prevalence was high among 6-7 years of age group in both government (40.2%) and private (43.3%) school and was more among girls (36.3% in government, 19.6% in private) than boys (28.8% in government, 16.7% in private). The prevalence of overweight and obesity showed an increasing trend with the age of private school children. Overweight prevalence was more in boys (18.6%), whereas obesity prevalence was more in girls (8.6%).
Classes IV and V economic group children (90.2%) of government school showed higher prevalence of underweight than Classes II and III (9.7%) economic group (χ2 - 20.8, P = 0.01). Significant association of high socioeconomic status was seen with prevalence of overweight (χ2 - 20.8, P = 0.0001) and obesity (χ2 - 14.6, P = 0.0001) and low socioeconomic status with underweight prevalence (χ2 - 121.3, P = 0.01) in private school [Table 1],[Table 2]a nd [Table 3].
|Table 2: Nutritional status of government school children in relation to their sociodemographic characters|
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|Table 3: Nutritional status of private school children in relation to their socio-demographic characters|
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Increased consumption of bakery food items such as cakes, chips, biscuits, chocolates, etc., significantly increased the prevalence of overweight (χ2 - 52.4, P = 0.001] and obesity (χ2 - 14.3, P = 0.002), but was not associated with underweight prevalence (χ2 - 4.26, P = 0.23).
Private school children with regular aerobic exercise habit showed lower BMI status (χ2 - 21.5, P = 0.0001). Playing outdoor games more than an hour/day reduced the prevalence of overweight (χ2 - 35.8, P = 0.0001) and obesity (χ2 - 14.8, P = 0.002) significantly in private school, whereas raised the underweight prevalence (χ2 - 36.4, P = 0.0001) in government school.
Watching television more than an hour/day was significantly associated with the high prevalence of overweight (χ2 -72.2, P = 0.0001) and obesity (χ2 -41.4, P = 0.0001). Time spent in front of computer was also significantly associated with high prevalence of overweight (χ2 -10.2, P = 0.001) and obesity (χ2 -5.11, P = 0.02) in private school [Table 4] and [Table 5].
|Table 4: Nutritional status of government school children in relation to their dietary habits and physical activity|
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|Table 5: Nutritional status of private school children in relation to their dietary habits and physical activity|
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For assessing the dietary adequacy100 underweight, 100 normal weight and 100 overweight/obese children were randomly selected. Maximum number of underweight children consumed less than RDA of calorie (56), protein (52) and fat (49) per day, whereas maximum obese children consumed more than RDA of calorie (65) and fat (59) daily [Table 6].
|Table 6: Distribution of underweight, normal weight and overweight/obese children according to their dietary adequacy|
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| Discussion|| |
The overall prevalence of overweight and obesity seen in this study was similar to the findings in studies by Saraswathi et al.,  among children aged 13-17 years at Mysore (8.75%) and by Kumari and Krishna,  in Guntur (8.4%). However, studies done by Chhatwal et al.,  in Punjab and Sharma et al.,  in Delhi have reported higher prevalence of 14% and 22%, respectively. This difference in prevalence indicates a strong influence of nutritional habits and lifestyle pattern on overweight and obesity found in children. The prevalence of under nutrition in government schools of Bangalore as reported by Hasan et al.,  was 58.2%, which was more than this study.
Children of private schools who belonged to high socioeconomic class were better nourished compared to Government school students who belonged to low socioeconomic class. Studies by Ramesh,  in Kerala and Thekdi  in Gujarat also stated the same. Being financially sound may allow the children to indulge in practice of purchasing calorie dense fast foods and a lifestyle involving less of physical activity and more in-door activities like playing games on computer, watching television, etc., As the majority of youth are not in the workforce, the indicators of socioeconomic status used in the studies on youth population are based on those of their parents.
Snacks and junk foods consumed at home and outside home is one of the main risk factor for overweight and obesity. Snacks and junk foods are more energy dense and higher in fat content. The prevalence of overweight/obesity raised in children with increased frequency of consumption of high energy food. This positive association of high calorie/fat rich foods with body weight has been proved by various research studies. ,,, Under nutrition prevalence was not related to junk food in our study, but Bangalore study  showed that bakeries items also predispose to malnutrition as maximum of them provide only energy and are deficient in both macro- and micro-nutrients. In the past 10 years in Mysore, there has been a tremendous growth in the number of fast food joints and bakeries and the frequency of children eating out has also gone up, coupled with the increased number of children with pocket money. All this has changed the diet to a high fat, high sugar low fiber diet and resulted in increase of prevalence of malnutrition.
Lack of outdoor game activity and inadequate aerobic exercise were significantly associated with obese private school children. Similar finding was reported by Kotian et al.,  in Mangalore, which showed higher risk among those participating <2 h/week in any type of physical activity, whereas higher level of physical activity with poor nutrition led most of the government school children toward undernourishment.
Several studies by Laxmaiah et al.,  Dietz,  Goyal et al.,  Crespo et al.,  have found a positive association between the time spent on watching television/playing computers (≥3 h/day) and increased prevalence of overweight in children, similar to this study. Watching television/playing computer displace the time that children spend in physical activities, contribute to increased energy consumption through excessive snacking and eating meals in front of the TV, influence children to make unhealthy food choices through exposure to food advertisements and it lowers children's metabolic rate.
Higher economic class children, who go to private school, follow sedentary lifestyle and have higher risk of becoming overweight/obese which leads them toward non communicable diseases. Lower economic class children who go to government schools are more prone for under nutrition.
| Conclusion|| |
This study highlights that overweight and obesity are the problems prevalent in affluent communities where sedentary lifestyle is followed. Physical inactivity and high calorie diet increases the risk of being overweight. This arises the need to devise meaningful measures to develop a healthy lifestyle among school children by creating awareness about balanced diet and recommended level of physical activity.
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[Table 1], [Table 2], [Table 3], [Table 4], [Table 5], [Table 6]