|Year : 2016 | Volume
| Issue : 1 | Page : 31-35
Health status of school children in rural area of coastal Karnataka
Muralidhar M Kulkarni1, N Varun2, Priya Rathi2, K Eshwari1, K Ashok1, Veena G Kamath1
1 Department of Community Medicine, Kasturba Medical College, Manipal University, Manipal, Karnataka, India
2 Department of Community Medicine,Yenepoya Medical College, Yenepoya University, Mangalore, Karnataka, India
|Date of Web Publication||22-Dec-2015|
Muralidhar M Kulkarni
Department of Community Medicine, Kasturba Medical College, Manipal University, Manipal
Source of Support: None, Conflict of Interest: None
Introduction: Children are the foundation of a strong and healthy nation. Morbidity among school-going children adversely affects their normal growth and development and hence is a major public health concern. School health program was started as an important component of total health care delivery system in the country with a purpose of addressing the health needs of children. Aim: To assess the morbidity pattern and nutritional status among school children. Materials and Methods: Study design: A cross-sectional study. Study period: 1-year from 1 st July 2012 to 30 th June 2013. Study setting: 14 schools with a total strength of 909 children in a rural area of coastal Karnataka. Data collection: Health examination of the school children was carried out by a trained team. Data regarding anthropometric measurements, refractory error, medical problems and minor ailments were collected using a predesigned proforma. Results: A total of 797 children were examined. Dental caries was the most common ailment observed in 31.86% of children 43.32% of the children were underweight, 53.03% were normal, and 3.65% were overweight for age. Conclusion: The school health program provides a good opportunity to screen, identify and impart education regarding health related issues. The common morbidities found were dental caries, pallor, upper respiratory tract infection and refractory error. Overweight was also observed in the school children and needs to be addressed. There is a scope of providing comprehensive school health services by incorporating dental care.
Keywords: Body mass index, children, health status, school health program
|How to cite this article:|
Kulkarni MM, Varun N, Rathi P, Eshwari K, Ashok K, Kamath VG. Health status of school children in rural area of coastal Karnataka. Med J DY Patil Univ 2016;9:31-5
|How to cite this URL:|
Kulkarni MM, Varun N, Rathi P, Eshwari K, Ashok K, Kamath VG. Health status of school children in rural area of coastal Karnataka. Med J DY Patil Univ [serial online] 2016 [cited 2020 Jul 12];9:31-5. Available from: http://www.mjdrdypu.org/text.asp?2016/9/1/31/172424
| Introduction|| |
School, a convergence center for health and education, is a setting that plays an important role in physical, social, mental and emotional development of children. School health program is an important component of total health care delivery system in the country started with a purpose of addressing the health needs of children, both physical and mental and in addition, provide for nutritional interventions, yoga facilities and counseling.  This program promotes screening of school children for various health problems and raises awareness about health issues in children and their families. , The important services include general health examination, anthropometry, treating minor ailments, referral and health education. School health program also caters to adolescents who represent around 25% of the world's population and around 59% of developing countries.  Morbidity among school-going children adversely affects their normal growth and development and hence it is a major public health concern. The common ailments seen in this age group are malnutrition, Vitamin A deficiency,  dental caries,  upper respiratory tract infection (URTI) and anemia. ,, Malnutrition due to deficiency or excess or imbalance of nutrients can put children at high risk of early development of chronic diseases particularly if combined with other adverse lifestyle behaviors. ,
Therefore, it is imperative that these morbidity patterns and nutritional status deficiencies are detected and controlled to get a healthy and economically productive future generation.
| Materials and Methods|| |
A cross-sectional study was conducted from 1 st July 2012 to 30 th June 2013. The Department of Community Medicine, Kasturba Medical College, Manipal University, Manipal collaborates with the government health authorities in carrying out the school health program. In the year 2012, the department conducted health examination in 14 schools with a total strength of 909 children over a period of 2 months from 1 st July to 31 st August 2012. A proper line listing of schools including its strength was made before the commencement. School teachers were briefed beforehand about the conduct of health check-up.
All the students enrolled in the school were included in the study. The students who were not available even after two visits to the school were excluded.
The team comprising of Faculty, Postgraduates, Interns, Medico-Social Workers and Optometrist visited schools for conducting health check-up and imparting health education to the students. The topics for health education constituted locally endemic diseases, reproductive health and personal hygiene.
Prior training was provided to interns regarding anthropometric measurements and clinical examination.
The health card of the students issued by the department of education was taken as a standard proforma. Age of children was ascertained by school records. Anthropometric measurements like height and weight were measured; body mass index (BMI) was calculated which was followed by detailed general and systemic examination. Visual acuity was assessed by an Optometrist from the Optometry Department of School of Allied Health Sciences, Manipal. Each of the tasks was assigned to one person throughout the program to avoid inter-observer variation. Any child requiring specialized medical care was referred to a secondary care hospital. Treatment for minor ailments was prescribed, and drugs were dispensed at the school with the help of respective primary health centers. Children aged 10 years and 16 years were immunized with tetanus toxoid vaccine by auxiliary nurse midwife as a part of universal immunization program in India.  A second visit was planned for the schools to contact children who were missed in the first visit. The children who could not be traced in the second visit were excluded from the study.
Health education was another important component of school health program. It was provided by an experienced and qualified health educator. Audio-visual demonstrations and role plays were used to make it interesting. Question and answer session was conducted to address their queries. The topics for providing health education were chosen according to the age of children and were of current and local relevance. It included session on personal hygiene, malnutrition and malaria to students of the first standard to fourth standard. The students of fifth to tenth standard were educated regarding adolescent personal hygiene, malaria, malnutrition and HIV/AIDS. Sessions related to sensitive topics like reproductive hygiene/menstrual hygiene and HIV/AIDS were taken by a female health educator separately for girls.
The data were entered using Statistical Package for the Social Sciences version 15.0 (SPSS Inc.) and results were expressed as a proportion. Test of significance applied was Chi-square test and P < 0.05 was taken as statistically significant.
Measurements and examination details
Weight was recorded using standard weighing scale, after adjusting it to zero, children were asked to step on it and stand still for equal distribution of weight. Weight was recorded to the nearest 100 g. 
Height was taken using the wall mounted stadiometer. It was taken after removing the footwear, subject standing erect with feet parallel; heel, shoulders and occiput touching the upright rod, position of head being comfortably erect with the lower border of orbit of the eye in the horizontal plane and measurement was recorded to the nearest 1 cm. 
The BMI for a person was calculated as the weight (in kilograms) divided by the square of their height (in meters).
World Health Organization BMI for age graphs was used to classify a child as normal, underweight and overweight. 
General examination included overall general appearance of the children including gait, pallor, icterus, cyanosis, clubbing, lymphadenopathy, ear examination and dental examination. This was followed by examination of the respiratory, cardiovascular and gastrointestinal systems.
Visual acuity was assessed using Snellens' chart for far vision and Jaegers' chart for near vision. Once a child was found to have diminution of vision, complete examination under dilatation was done at the school itself before prescribing visual aids. 
- Pallor: Color of the anterior rim of the lower palpebral conjunctiva was same as that of the posterior pale rim when examined in sunlight. 
- Icterus: Yellowish discoloration of sclera under sunlight. 
- Cyanosis: Bluish discoloration of mucous membranes and/or skin. 
- Clubbing: Bulbous enlargement of the ends of one or more fingers or toes. 
- Lymphadenopathy: Any abnormally enlarged lymph node, with or without signs of inflammation. 
- Refractory error: Visual acuity <6/18 and equal to or better than 3/60 in the better eye with best correction was taken as diminution of vision for prescribing visual aids. 
| Results|| |
A total of 14 Government Schools were covered in the field practice area of Department of Community Medicine, comprising of 909 children. Among them, 797 (87.7%) children were enrolled into the study of which 407 (51.1%) were males.
All school children were categorized according to the academic section for the purpose of analysis. Hence, the age groups included 7-11 years, 12-14 years and 15-16 years which represent primary, middle and high school children respectively [Figure 1] and [Figure 2].
The most common ailments seen in the school children were as shown in [Table 1]. Out of total 797 students examined, 9 (1.13%) were already diagnosed cases of mental retardation, learning disability, deaf and dumb, attention deficit hyperactivity disorder, seizure disorders and asthma and were on appropriate management as recommended by the respective specialists.
|Table 1: The section-wise distribution of minor ailments among school children|
Click here to view
| Discussion|| |
"School-age" is very crucial for the development of healthy habits, lifestyle and behavior. School health program is, therefore, an important joint venture of Departments of Education and Health providing an opportunity to implement primary and secondary prevention at the same time to a large number of children. Many studies have been done in various parts of India to ascertain the health status of school children and to find the pattern of growth and development, including the prevalence of minor illnesses. ,,
In the present study [Table 1], dental caries was the most common morbidity, affecting 31.86% of children. A subgroup analysis revealed a statistically significant reduction (P < 0.0001) in the prevalence of dental caries from primary to secondary sections similar to the study by Dambhare et al.  in Sewagram Maharashtra that reported 35.3% of the students to be suffering from dental caries and Panda et al.  from Ludhiana reported that 23.2% suffered from the condition reinforcing the fact that improving the oral health needs to be emphasized among the school-going children.
Jain and Jain,  Panda et al.  and Dambhare et al.  reported anemia (clinical pallor) in 42%, 26% and 28.45% respectively, which was higher than the finding of 15.8% reported in the present study. The lower prevalence seen in this study could be due to the effective implementation of supplementary nutritional program and provision of iron and folic acid supplementation at school, in this part of the country.
Upper respiratory tract infection was found in 14.3% of children in the present study and was similar to that seen in the study done by Panda et al.  (14.4%); however, Dambhare et al.  reported a higher percentage of 25.1%. This high prevalence found in all the studies show that URTI is one of the important causes of morbidity and needs to be addressed effectively at the primary health care settings.
About 10.41% of children had refractory error in the present study whereas Panda et al.  reported only 5.6% of refractory error. It was also found that refractory error increases with higher sections in school (P < 0.05). Early recognition and correction of this condition are of crucial importance for overall growth and academic advancement.
Body mass index is considered as one of the accurate measures to assess nutritional status.  The present study showed that 43.32% of the children were underweight, 53.03% were normal and 3.65% were overweight. Navaneethan et al.  conducted a study in Tamil Nadu, which reported 83% as underweight, 16% as normal and the remaining 0.45% as overweight that showed contrasting results as compared to the result in this study. Kumar et al.  reported 5.74% of obesity from affluent schools in South India. This implies that obesity is also a matter of concern and is an emerging health problem that needs to be tackled by effective preventive measures like health and nutrition education and targeted intervention so as to reduce further comorbidities.
| Conclusion and Recommendations|| |
According to the present study, dental caries was the most commonly seen minor illness that has to be managed. Another area of concern is refractory error, for which correction and nutrition education should be advised. BMI calculation showed that in the present study overweight has emerged as a problem of major concern that if not addressed, can lead to various lifestyle diseases later in life. Therefore, continuous health education is the need of hour. All other morbidities were less prevalent as compared to other parts of India. Therefore, continuous monitoring with periodic health check-up may help to control these morbidities for better health of the future generation.
Laboratory tests to confirm the clinical diagnosis of anemia was not performed and the children referred to secondary care center could not be followed due to resource constrains.
| Acknowledgment|| |
The authors would like to thank the District Health Officer (DHO), Deputy Director of Public Instruction (DDPI) Udupi district, Udupi and all the teachers of the government schools for their cooperation. The author acknowledges the support of Department of Optometry, School of Allied Health Sciences in carrying out the school health program and Department of Community Medicine, Kasturba Medical College, Manipal University, Manipal.
| References|| |
Prasad KR. CME: School health. Indian J Community Med 2005;30:109.
Ananthakrishnan S, Pani SP, Nalini P. A comprehensive study of morbidity in school age children. Indian Pediatr 2001;38:1009-17.
Joshi N, Rajesh R, Sunitha M. Prevalence of dental caries among school children in Kulasekharam village: A correlated prevalence survey. J Indian Soc Pedod Prev Dent 2005;23:138-40.
Das P, Basu M, Dhar G, Mallik S, Pal R. Nutritional status and morbidity pattern of government primary school children in north Kolkata of West Bengal, India. South East Asia J Public Health 2012;2:13-7.
Deb S, Dutta S, Dasgupta A, Misra R. Relationship of personal hygiene with nutrition and morbidity profile: A study among primary school children in South Kolkata. Indian J Community Med 2010;35:280-4.
Mukhopadhyay A, Bhadra M, Bose K. Anthropometric assessment of nutritional status of adolescents of Kolkata, West Bengal. J Hum Ecol 2005;18:213-6.
Centre for Disease Control and Prevention. Body Mass Index for Age Percentiles (2-20years). Atlanta: National Centre for Health Statistics in Collaboration with the National Centre for Chronic Disease Prevention and Health Promotion. Available from: http://www.cdc.gov/growthcharts
. [Last updated on 2010 Sep 09; Last accessed on 2013 Oct 10].
World Health Organization. Training course on Child Growth Assessment. Geneva, Switzerland: WHO Press, World Health Organization; 2008. p. 37.
World Health Organization. Assessment of the Prevalence of Visual Impairment Attributable to Refractive Error or other Causes in School Children. Geneva Switzerland: WHO Press, World Health Organization; 2007. Available from: http://www.who.int/blindness/causes/RESCProtocol.pdf
. [Last accessed on 2013 Oct 11].
Walker HK, Hall WD, Hurst JW. Clinical Methods. 3 rd
edition. Atlanta, Georgia: Butterworth Publishers; 1990.
Dambhare DG, Bharambe MS, Mehendale AM, Garg BS. Nutritional status and morbidity among school-going adolescents in Wardha, a Peri-Urban area. Online J Health Allied Sci 2010;9:1-3.
Panda P, Benjamin AI, Singh S. Health status of school children in Ludhiana City. Indian J Community Med 2000;115:150-5.
Jain N, Jain VM. Prevalence of anemia in school children. Med Pract Rev 2012;3:1-4.
Navaneethan P, Kalaivani T, Rajasekaran C, Sunil N. Nutritional status of children in rural India: A case study from Tamil Nadu, first in the world to initiate the Mid-Day Meal scheme. Health 2011;3:647-55.
Kumar S, Mahabalaraju DK, Anuroopa MS. Prevalence of obesity and its inﬂuencing factor among afﬂuent school children of Davangere City. Indian J Community Med 2007;1:15-7.
[Figure 1], [Figure 2]