A Study on the Morbidity Pattern of School Children in Doiwala Block, Dehradun S. KISHORE, J. SEMWAL AND K. MUZAMMIL H ealth is very important for the development of any nation. No doubt, it is linked to educational status, quality of life, standard of living and economic productivity. By acquiring health related knowledge, values, skills and practices, one can be empowered to pursue a healthy life and to work as agents of change for the health of their communities in which they live. 1 Research indicates that nutritional deficiencies and poor health in primary school children are among the important causes of low school enrolment, high absenteeism, early dropouts and poor classroom performance and ultimately failure to do well in the examinations. Health is therefore considered to be the important key factor in school entry as well as continued participation and attainment in school. 3, 4 According to a study, about 40% of the school children are found to be reasonably healthy and free from defects or morbidities. 5 Poor nutrition greatly affects the achievements in the educational field as well as in the sports performance. The relationship between the scholastic performance and nutritional status of the children has already been established. 6 School children are easily accessible and adoptable section of the population. They can contribute much towards attack on community health problems. They transmit all the health related advices learned in the school to their parents, family members, friends, relatives and neighbors. Actually in this way children act as health leaders in the family/ society. 7 This child to child approach is very helpful in mobilizing the people towards healthy life and generating awareness on personal hygiene and reduction of unhealthy practices. Keeping in view of the above facts, it was planned to identify the morbidity status of school children, to prevent them from deceased condition, to promote their health through regular health education and annual medical examination. The minor ailments were treated in time and high-risk children were screened out and referred early to higher center/HIMS for better management. Key words : Anemia, Dental caries, Worm infestation, Tobacco use, BMI. ABSTRACT Background: Research indicates that nutritional deficiencies and poor health in primary school children are among the important causes of low school enrolment, high absenteeism, early dropouts and poor classroom and exam performance. So the present study was conducted. Objective: To find out the morbidity pattern of the primary school children. Methods: A cross sectional survey to find out the morbidity pattern was conducted on 596 school children (246 boys and 350 girls), aged 5-16 years studying in class I-VIII in six different schools of Doiwala Block, Dehradun. The morbidity survey was conducted by a health team and the children were approached in their respective schools after taking due permission of the school principal. Preliminary information was recorded on the survey register. A detailed history taking and clinical examination was done with special attention on those systems which were affected most. Data thus collected was entered and analyzed by using Epi Info Statistical Software Package. Results: A total of 596 school children were included in the study, out of which 246 (41.27%) were boys and 350 (58.72%) were girls. The most common chewing habit was Supari chewing and was found in 22 (3.69%) children followed by Tobacco chewing in 7 (1.17%) children. Morbidity related to oral cavity was higher in boys, 131 (53.25%). Anemia was present in 162 (27.18%) children. Worm infestation was significantly higher in boys, 71 (28.86%). Watering of eyes (2.68%) was the commonest finding. Mean BMI in our study was found to be significantly lower as compared to ICMR and NCHS data. Conclusions: The spectrum of morbidity reported in this study is largely dependent on hygiene and calorie intake. In spite of regular mid day meal program at schools, our children are still undernourished that means the calorie intake at home is not adequate. There is a strong need for a regular health check-up and follow up services at school level. Accepted : May, 2009 HIND MEDICAL RESEARCH INSTITUTEInternational Journal of Medical Sciences (October, 2009 to March, 2010) Vol. 2 Issue 2 : 96-100 RESEARCH PAPER See end of the article for authors’ affiliation K. MUZAMMIL Department of Community Medicine, Muzaffarnagar Medical College, MUZAFFARNAGAR (U.P.) INDIA
Transcript
A Study on the Morbidity Pattern of School Children in Doiwala Block, DehradunS. KISHORE, J. SEMWAL AND K. MUZAMMIL
Health is very important for the developmentof any nation. No doubt, it is linked to
educational status, quality of life, standard ofliving and economic productivity. By acquiringhealth related knowledge, values, skills andpractices, one can be empowered to pursue ahealthy life and to work as agents of changefor the health of their communities in whichthey live. 1
Research indicates that nutritionaldeficiencies and poor health in primary schoolchildren are among the important causes of lowschool enrolment, high absenteeism, earlydropouts and poor classroom performance andultimately failure to do well in the examinations.Health is therefore considered to be theimportant key factor in school entry as well ascontinued participation and attainment in school.3, 4 According to a study, about 40% of theschool children are found to be reasonablyhealthy and free from defects or morbidities.5
Poor nutrition greatly affects theachievements in the educational field as wellas in the sports performance. The relationship
between the scholastic performance andnutritional status of the children has already beenestablished. 6 School children are easilyaccessible and adoptable section of thepopulation. They can contribute much towardsattack on community health problems. Theytransmit all the health related advices learnedin the school to their parents, family members,friends, relatives and neighbors. Actually in thisway children act as health leaders in the family/society. 7 This child to child approach is veryhelpful in mobilizing the people towards healthylife and generating awareness on personalhygiene and reduction of unhealthy practices.
Keeping in view of the above facts, it wasplanned to identify the morbidity status of schoolchildren, to prevent them from deceasedcondition, to promote their health throughregular health education and annual medicalexamination. The minor ailments were treatedin time and high-risk children were screenedout and referred early to higher center/HIMSfor better management.
Key words :Anemia, Dentalcaries, Worminfestation,Tobacco use,BMI.
ABSTRACTBackground: Research indicates that nutritional deficiencies and poor health in primary school children areamong the important causes of low school enrolment, high absenteeism, early dropouts and poor classroomand exam performance. So the present study was conducted.Objective: To find out the morbidity pattern of the primary school children.Methods: A cross sectional survey to find out the morbidity pattern was conducted on 596 school children (246boys and 350 girls), aged 5-16 years studying in class I-VIII in six different schools of Doiwala Block,Dehradun. The morbidity survey was conducted by a health team and the children were approached in theirrespective schools after taking due permission of the school principal. Preliminary information was recordedon the survey register. A detailed history taking and clinical examination was done with special attention onthose systems which were affected most. Data thus collected was entered and analyzed by using Epi InfoStatistical Software Package.Results: A total of 596 school children were included in the study, out of which 246 (41.27%) were boys and 350(58.72%) were girls. The most common chewing habit was Supari chewing and was found in 22 (3.69%)children followed by Tobacco chewing in 7 (1.17%) children. Morbidity related to oral cavity was higher inboys, 131 (53.25%). Anemia was present in 162 (27.18%) children. Worm infestation was significantly higherin boys, 71 (28.86%). Watering of eyes (2.68%) was the commonest finding. Mean BMI in our study was foundto be significantly lower as compared to ICMR and NCHS data.Conclusions: The spectrum of morbidity reported in this study is largely dependent on hygiene and calorieintake. In spite of regular mid day meal program at schools, our children are still undernourished thatmeans the calorie intake at home is not adequate. There is a strong need for a regular health check-up andfollow up services at school level.
Accepted :May, 2009
HIND MEDICAL RESEARCH INSTITUTE
International Journal of Medical Sciences (October, 2009 to March, 2010) Vol. 2 Issue 2 : 96-100RESEARCH PAPER
See end of the article forauthors’ affiliation
K. MUZAMMILDepartment ofCommunity Medicine,Muzaffarnagar MedicalCollege,MUZAFFARNAGAR(U.P.) INDIA
97
HIND MEDICAL RESEARCH INSTITUTEInternat. J. Med. Sci., Oct.., 2009-March, 2010, 2(2)
MATERIALS AND METHODS
A cross sectional survey was conducted on 596school children (246 boys and 350 girls), aged 5-16 yearsstudying in class I-VIII in six different schools of Doiwala,Dehradun to find out the morbidity pattern. The morbiditysurvey was conducted by a health team comprised ofMSWs, Interns, PGs and a faculty member under thedirect supervision of the Head of the Department ofCommunity Medicine, HIMS, Swami Ram Nagar,Doiwala, Dehradun. The children were approached intheir respective schools during the school hours aftertaking the due permission of the Head or principal/ IC ofthe school.
Preliminary information of the students like theirname, age, sex, religion and caste was obtained andrecorded on the survey register. A detailed clinicalexamination was done with special attention on thosesystems which were affected most. Weight of the childrenwas measured with minimum clothing with the help ofweighing machine (Bathroom Scale) assuring an error of± 0.5 Kg. Height was measured with the help of calibratedmetallic tape fixed to the wall, with child standing erectagainst the wall (barefoot). An error of ± 0.5 cm wasconsidered while measuring the height.
Worm infestation and tobacco consumption werediagnosed on the basis of history and asking questions.Otoscope was used to diagnose ear problems. Hearingwas assessed by Rinne’s test using Tuning Fork. Snellen’schart was used to assess the visual acuity. Anemia wasdiagnosed clinically. Detailed systemic examination wascarried out on all the children.
Abdominal problems/ diseases were diagnosed withthe help of signs and symptoms viz., abdominal distension,pain abdomen, hepato-spleenomegaly and character ofbowel sounds. Cough, dyspnoea, breathing pattern,respiratory distress, air entry, breath sounds andaccompaniments were considered to establish diseasesrelated to respiratory system. Pulse rate and character,heart sounds and murmur were observed for establishingcardiovascular diseases. CNS examination includeddetailed history of headache, head injury, developmentalmilestones, abnormal movements and by seeing muscletone, reflexes and any sensory or motor deficit.
Oral cavity was examined for any abnormalpigmentation of teeth, caries, cavities, glossitis and ulcersof mouth or tongue. The criteria followed for diagnosisof vitamin deficiencies were as per WHO guidelines.
During the study period, all the children and teacherswere given single dose of Tab. Albendazole. A brief healthtalk session was conducted with teachers and children to
discuss the importance of various aspects of personalhygiene, nutrition and environmental sanitation.
Data collected and recorded on the survey registerwas analyzed by interns under the supervision of thefaculty member/ PG. It was subjected to be tested forstatistical significance.
Definitions used:For the purpose of the present study, following
definitions were taken into account.
Morbidity of the child:This was defined as average number of morbidity in
the child and was calculated by dividing the total morbidityby total number of morbid children.
Chewing habit:This was defined as consumption of Supari
andTobacco for at least thee days a week. Alcoholconsumption was included in this category because onlyone child was found consuming alcohol and that toooccasionally.
RESULTS AND DISCUSSION
A total of 596 school children were included in thestudy, out of which 246 (41.27%) were boys and 350(58.72%) were girls (Table 1). 86 (35%) boys and 182(52%) girls were Hindu while 160 (65%) boys and 168(48%) girls were from Muslim community. 30 (5.03%)children were found to be addicted. The most commonchewing habit was Supari chewing and was found in 22(3.69%) children followed by Tobacco chewing in 7(1.17%) children. This was significantly higher in boys(2.43%) as compared to girls (0.28%).
Morbidity related to oral cavity was higher in boys,131 (53.25%) as compared to 135 (38.57%) in girls and itwas found to be statistically significant. Most commondental problems was dental caries and was found in 76(30.89%) boys and 68 (19.42%) girls, followed by dentalplaque, in 119 (19.96%) children. Some other ailmentsrelated to oral cavity like gum swelling, broken teeth andabnormal denture were found in 3 boys and 1 girl only.
Anemia was present in 162 (27.18%) children, ofwhich 64 (26.01%0 were boys and 98 (28%) were girls.Worm infestation was found in 152 (25.5%) and it wassignificantly higher in boys, 71 (28.86%) as compared togirls, 81 (23.14%).
Morbidity related to eyes was found in 26 (4.36%)children, out of which 8 (3.25%) were boys and 18(5.14%) were girls. Watering of eyes (2.68%) was the
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commonest finding followed by refractory errors (1%).Other eye related problems like squint was present inonly 1 child, stye and phlebitis in 3 children.
Ear diseases were found in 41 (6.87%) children ofwhom 20 (8.13%) were boys and 21 (6%) were girls. Itwas significantly higher in boys as compared to girls.Wax/ ear pain and ear discharge were found in 14 (2.34%)and 15 (2.51%) children respectively and were thecommonest problem. Hearing loss was present in 11(1.84%) children. Only one case of congenitally abnormalpinna was found.
Skin ailments were found in 24 (4.02%) children,out of which 10 (4.06%) were boys and 14 (4%) weregirls. Fungal infections were the commonest finding 12(201%) followed by furunculosis/ impetigo 5 (0.83%),scabies/ pediculosis 4 (0.67%) and white spots 3 (0.5%).Statistically significant difference was found in boys andgirls.
Symptoms pertaining to abdomen (mainly lose stools,vague/ ill defined pain abdomen) were present in 46(7.71%) children of which 21 (8.53%) were boys and 25(7.14%) were girls. Morbidity related to respiratorysystem was found in 23 (3.85%) children, of whom 8(3.25%) were boys and 15 (4.28%) were girls. URTIwas found in 14 (2.34%) children (6 boys and 8 girls)while LRTI was found in 9 (1.51%) children (3 boys and6 girls). Clinically UTI (urinary tract infection) was foundin 6 (1%) children, of which 2 were boys and 4 weregirls.
Other morbidities found were one girl suffering fromRheumatic Heart Disease, a boy and a girl were found tohave musculoskeletal deformities ( in the form of fractureand post-fracture contracture). 3 (0.5%) children (1 boyand 2 girls were of Seizure disorder and were presentlyon ACT (Anti-convulsion therapy).
In the study as presented in the Table 2 mean BMIwas found to be significantly lower as compared to ICMRand NCHS data.
Table 1 : Morbidity pattern among school children: sex-wiseTraits Males
P < 0.5, df = 4(Figures in parentheses denote percentages)
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Only dental problems and ear problems varysignificantly with age (Table 3).
The pattern of morbidity in the present study revealsthat the average morbidity per child is less than that ofAnanthakrishnan et al. (2001) reported it to be 2.5 8.Most of the morbidity group studied were found to bestatistically significant I relation to sex.
Chewing habits were found in 7.72% boys ascompared to 3.14% girls reason being the involvement inthe outdoor activities and pressure of peers, which iscomparatively more in boys. Only 1 child was foundconsuming alcohol occasionally. In our study oral hygienewas found significantly better in girls as compared to boys,which may be due to better personal care taken by them.
Dental caries was present in 25% children which iscomparable to 23.1% as reported by Panda et al. (2000)and 27.9% as reported by Ananthakrishnan et al. (2001).Anemia was reported in 27.18% of children, which isapproximately similar as reported by Panda et al. (26%)in their study based at Ludhiana City. In spite of lowerworm infestation in girls, greater number of girls werehaving anemia, which could be due to attainment ofmenarche in few of the girls. Anemia reported byAnanthakrishnan et al.(2001) was much higher (57.1%)than our study (27.18%), reason could be higher load ofworm infestation they have reported in their study.
Eye infections were reported in two cases (0.81%)only, which is much less than as reported byAnanthakrishnan et al. (2001) (2.7%). Ear morbidity was
Fig. 2 : Mean BMI according to age and overall sexTraits Number (%) Mean BMI SD
Sex
Male 246 (41.27) 14.99 3.17
Female 350 (58.72) 15.87 3.50
Age (Yrs)
5 4 13.06 1.07
6 56 14.35 2.46
7 69 14.31 1.34
8 92 14.53 2.33
9 78 14.75 2.13
10 69 15.21 3.20
11 61 16.43 4.63
12 59 15.81 2.43
13 52 17.75 3.74
14 42 18.08 3.69
15 12 18.99 1.70
16 2 19.21 3.63
Total 596 15.52 3.19
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found to be significantly higher in boys as compared togirls. Ear infection/ ear discharge was reported in 2.51%cases while Ananthakrishnan et al. (2001) reported it tobe 3.1%. Skin related diseases were significantly higherin boys as compared to girls, which may be due to thenegligence in personal hygiene by boys.
Skin infections were reported in 2.51% of childrenwhile Ananthakrishnan et al. (2001) reported it to be8.7%, which could be due to various geographicalvariations like humidity, rain etc. Respiratory tractinfections were reported in 3.85% of children, whileAnanthkrishnan et al. (2001) reported it to be 6% in theirstudy. Seizure disorder was reported in 0.5% cases, thisis high as compared to 0.2% reported by Anantharishanet al. (2001).
In this study and that of Panda et al. (2001) no caseof clinical Vitamin –A deficiency was found. Vitamin-Adoses are regularly administered to children visiting healthpost in this area. Cases of other Vitamin deficiencies werealso not found I our study, which could be due to adequateintake of seasonal green vegetables in this area as theseare cheap and easily available.
Nutritional status of both boys and girls was lowerthan that of NCHS and ICMR standards. The overalllower BMI was due to poor calorie intake, poverty andlarge family size and genetically determined to someextent. The nutritional status of girls was significantlybetter than boys. This might be so because I this studythe number of girls was more in class VI-VIII. It couldalso be due to early hormonal changes leading to betterphysical development in them as compared to boys.
Conclusion:The spectrum of morbidity reported in this study is
largely dependent on hygiene and calorie intake. In spiteof regular mid day meal program at schools, children werestill undernourished that means the calorie intake at homewas not adequate. Moreover, the mid day meals servedat schools were rarely as per recommendations. Ironically,Vitamin deficiency was not reported, although childrenwere nourished.
The importance of personal hygiene, regular intakeof calorie rich diet has to be emphasized through regularinteractive session with community attending the every
health post. Education sessions should form an essentialpart of every health worker’s job. Health, diet andnutritional education should necessarily be included inschool curriculum. Children need to be sensitized aboutpersonal hygiene during school hours as well as at home.
Moreover there is a strong need for a regular healthcheck-up and follow up services at school level will leadto formation of healthy child and adolescent whichconstitute the future of our country.
Authors’ affiliations:S. KISHORE AND JAYANTI SEMWAL, Departmentof Community Medicine, Himalayan Institute of MedicalScience, Jolly Grant, Doiwala, DEHRADUN(UTTARAKHAND) INDIA
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WHO Expert Committee on School Health Services. Reporton the First Session (1950). Geneva, World Health Organization,(WHO Technical Series, No.30).
Pollitt, E. (1990). Malnutrition and infection in the classroom.Paris, UNESCO.
Levinger, B. (1994). Nutrition, health and education for all.Newton, MA, Education Development Centre and UnitedNations Development Programme, 1994.
Govt. of India, Ministry of Health & Family welfare (1982). Reportof the task force on school health services. Mimeographeddocument P.I.
Van Resenbreg, S. (1977). Afr. Med. J., 52 : 644.
Bhalerao, V.R. (1981). World Health Forum, 2 (2) : 209-210.
Ananthakrihnan,,S., Pani, S.P. and Nalini, P. (2001). Acomparative study of morbidity in school in school age children;J. Indian Paediatrics, (38) : 1009-1016.
Panda, P. , Benjamin, A.I., Shavinder Singh and Zachariah, P.(2000). Health status of school children in Ludhiana City. IJCM,25 (4).
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A STUDY ON THE MORBIDITY PATTERN OF SCHOOL CHILDREN IN DOIWALA BLOCK, DEHRADUN
