Children in the age group of 5-14 years are often considered as school-age. Since 1972, the United Nations Educational Scientific and Cultural Organization (UNESCO) considers 6-11 years as primary school age and 12-17 years as secondary school age for statistical purposes. In it is recorded that in India one fifth of the population consists of children between 5 and 14 years, which includes the primary and secondary school age. School age is considered as a dynamic period of growth and development because children undergo physical, mental, emotional and social changes. In other words the foundations of good health and sound mind are laid during the school age period. Hence the present study was formulated with the objective, to assess and find the major socio-economic correlates of nutritional status in school-age children.
The present study showed a growth lag in the basic parameters of height and weight as compared to the reference standards laid down by CDC 2000. Our findings are similar to that reported by other workers from India [7
]. Best C. et al. also reported that underweight and thinness were most prominent in populations from South-East Asia and Africa, whereas in Latin America, the prevalence of underweight or thinness was generally below 10% [9
Throughout the developing world, children fail to grow in length and weight in a remarkably similar age-specific pattern, despite vast differences in the prevalence of low weight (wt)/age and height (ht)/age between the regions [2
]. We analyzed the prevalence of stunting, wasting and underweight as markers of undernutrition and our findings were similar as in South Africa, where stunting and underweight remain a public health problem in children, with a prevalence of 20% stunting and almost 10% underweight [10
]. The anthropometric results of a study in Qwa Qwa also indicated that 2.8% of the total group of respondents was severely stunted, and that 11.3% were stunted [11
Thus the differences in the degree of growth failure in weight and height have implications for assessing the true prevalence of chronic malnutrition. This is also important for monitoring trends or evaluating the effects of interventions [12
]. There is a need to shift the focus from wt/age to ht/age and wt/ht for assessing malnutrition and identifying populations that could benefit from interventions.
The school children in the present study were found to be better nourished than the rural Punjab school children as reported in another recent study [13
], where the prevalence of malnutrition was 87.4%. However, the standards of nutrition among children in the present study were lower than those found in children in Delhi by Dhingra et al. [14
] and in urban school-age children in Tirupati as reported by Indirabai et al. [15
]. Goyal et al. [16
] found malnutrition among Ahmednagar school children to be 20% only, with 6.8% having severe malnutrition, which is much lower than rural school children of Punjab (37.6%) [13
] and amongst school children of Madras, as found by Sunderam et al. (32.6%) [17
]. These disparities in findings of different studies may be due to differences in study settings. The rate of undernutrition of the present study is quite similar to the findings of Medhi et al. [18
] who recorded a prevalence rate of undernutrition of 53.9% among school-age children in Assam-India.
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 [19
], but in the present study, undernutrition was significantly more prevalent in girls than boys. A number of studies in Africa suggest that rates of malnutrition among boys are consistently higher than among girls. Studies conducted in Ecuador [21
] and in Tanzania [22
] show that boys were more commonly affected than girls. One of the largest studies [20
] of anthropometric status of rural school children in low income countries (Ghana, Tanzania, Indonesia, Vietnam and India) found the overall prevalence of stunting and underweight to be high in all five countries, ranging from 48 to 56% for stunting and from 34 to 62% for underweight. Boys in most countries tended to be more stunted than girls and in all countries, boys were more underweight than girls. These disparities in findings are due to differences in study frame, family setups, gender bias and parental preferences for male children in the Indian society.
Anemia was detected in 37.5% of children in the present study, which was more than in the children of rural school children in Punjab (22.5%) [13
]. The prevalence of anemia in girls (42.8%) was significantly higher than in boys (33.7%). In our study diagnosis of anemia was exclusively based on clinical examination; no laboratory examination was done. Hence there is a possibility of underreporting of prevalence of anemia in this study population and this underreporting may be higher in boys. Prevalence of dental caries in the present study was higher than in rural Punjab school children (11.1%) [13
], almost equal to the findings in Tirupati (20.9%) [15
] and less than in Madras school children (38.6%) [17
]. Gender differences observed in the prevalence of dental caries were statistically not significant.
Women's educational and social status, food availability, and access to safe water are well reported important underlying determinants that directly or indirectly cause malnutrition among children [23
]. In our study mother's education was found to be a strong predictor of child nutritional status. Data analysis of National Family Health Survey (NFHS) 1 also showed that mother's education has a strong independent effect on a child's nutritional status even after controlling for the potentially confounding effects of other demographic and socioeconomic variables [24
Earlier studies using household-level data have found mother's education to be positively associated with a number of measures of child health and nutritional status [25
]. Results pointing to the importance of socioeconomic status indicators such as mother's education to children's nutritional status are consistent with findings in Yip et al. [32
Further improvement in nutritional status with maternal education has been reported by other authors [33
]. The pattern of declining incidence of stunting by mother's education in Cambodia is consistent with patterns observed in many other developing countries [37
]. The pattern for wasting concurs with arguments found in several other studies [38
] that wasting is influenced less by maternal characteristics than is stunting. One explanation is that mother's education has a limited effect on preventing illness such as diarrhea when there are widespread sources of infection.
Various studies have concluded that parental education, especially mothers' education, is a key element in improving children's nutritional status [40
In the present study family type was significantly associated with all three indices of malnutrition. Similar results have been reported by Gopaldas et al. [34
]. NFHS 1 survey also showed that children living in joint family setup were more likely to suffer chronic malnutrition than children from nuclear families. The results are different from a study by Singh [42
] on children of urban slums as in their study > 70% of the families were nuclear.
It was clearly shown that children who had never been breastfed were at much higher risk of poor nutritional status. Thus breastfeeding is positive health behavior in this population, and should be encouraged.
One of the strongest predictors of malnutrition in this analysis was mother's working status. Children of nonworking mothers have better nutritional status than children of working mothers, possibly due to more time for caring of children [34
]. Hence the busy time schedule of working mothers adversely affects the nutritional status of children. The NFHS II also observed a higher prevalence of these three indices of malnutrition in children of working mothers.
This study shows that maternal educational status, mother's working status and family type are important determinants of the nutritional status of the child. 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.