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Year : 2022  |  Volume : 15  |  Issue : 4  |  Page : 529-533  

Health profile and nutritional status of rural primary school children in Western Maharashtra. Is school absenteeism associated with undernutrition?

Department of Community Medicine, Armed Forces Medical College, Pune, Maharashtra, India

Date of Submission09-Nov-2020
Date of Decision02-Jun-2021
Date of Acceptance02-Jun-2021
Date of Web Publication01-Mar-2022

Correspondence Address:
Arun Kumar Yadav
Department of Community Medicine, Armed Forces Medical College, Pune - 411 040, Maharashtra
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/mjdrdypu.mjdrdypu_620_20

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Background: Healthy adulthood thrives on the foundation of a healthy childhood. Earlier studies show different morbidity patterns and prevalence of under-nutrition in children studying in Government primary schools. The present study was undertaken to explore the morbidity pattern and nutritional status of children studying in a government primary school in the field practice area of Rural Health Training Centre of a medical college in Pune, Western Maharashtra. Methodology: A cross-sectional study was done in a Government Primary School during January–February 2019. A total of 134 school children studying in classes 1st to 7th underwent anthropometric measurements, medical examination, dental examination, and haemoglobin estimation to bring out the common morbidities present in children of school-going age. School records of the past 6 months of the academic year 2018–19 were used to know the prevalence of absenteeism among the subjects studied, and an attempt was made to find any association between absenteeism and under-nutrition among school children. Results: Out of 134 children, 26 (19.4%) were stunted, 51 (38.64%) were underweight, and 2 (1.49%) were found to be obese. Dental caries was found in 73 (54.48%) pupils, and it was the commonest morbidity found. Eighty-six (64.18%) of the examined school children were anemic. Thirty-five (26.12%) had ear problems, skin problems were found in 35 (26.12%), 6 (4.48%) had refractive errors, and 2 (1.49%) were having Tachycardia. An association was found between abesentism and underweight (P = 0.02). Conclusions: The present study found that under-nutrition is present among children studying in a rural Government school despite the mid-day meal programme being implemented in the school. Targeted interventions may be planned for undernourished children to improve their nutritional status, and more studies are required to assess their health needs and problems.

Keywords: Absenteeism, health profile, nutritional status, primary school

How to cite this article:
Singh B, Kansara NK, Bansal A, Teli P, Yadav AK. Health profile and nutritional status of rural primary school children in Western Maharashtra. Is school absenteeism associated with undernutrition?. Med J DY Patil Vidyapeeth 2022;15:529-33

How to cite this URL:
Singh B, Kansara NK, Bansal A, Teli P, Yadav AK. Health profile and nutritional status of rural primary school children in Western Maharashtra. Is school absenteeism associated with undernutrition?. Med J DY Patil Vidyapeeth [serial online] 2022 [cited 2022 Jul 5];15:529-33. Available from: https://www.mjdrdypv.org/text.asp?2022/15/4/529/338913

  Introduction Top

Healthy adulthood thrives on the foundation of a healthy childhood. Healthy children are less likely to indulge in absenteeism and school dropouts. Health activities in schools contribute to desirable attitudes about health, leading to a healthy lifestyle for school-going children.[1]

School health though important, is not in the priority list of many government across the globe.[2] There is a high prevalence of malnutrition among school-going children in low- and middle-income countries, affecting mainly the under-5 children.[3] Nutritional deprivation is widespread in school-going children, particularly primary school children, ranging from 20% to 80% in various studies conducted previously across India.[4],[5],[6],[7],[8],[9]

The National Family Health Survey (NFHS)-4 data of 2015–16 indicates that the prevalence of stunting (low height-for-age) is higher in rural areas (41.2%) as compared to urban areas (31.0%). All the states have seen a decline in stunting among children under 5 years between NFHS-3 and NFHS-4. NFHS-4 data also indicate that the proportion of underweight (low weight-for-age) children has been higher in rural regions (38.3%) as compared to the urban areas (29.1%) in children of the same age group.[10]

Children in the age group of 6–14 years are relatively neglected at the national level, and only mid-day meal scheme covers them. Mid-day meal scheme provides 450 calories of energy and 12 g of proteins daily to children of primary classes (I to V). Children studying in upper primary classes (VI to VIII) are provided with 700 calories of energy and 20 g of proteins per day. They are provided nutrition 300 days in the year.[11] However, absenteeism may affect the implementation of the programme. Moreover, the available literature on the nutritional status of school children in rural areas is relatively scarce. With this background, the present study was undertaken to explore the morbidity pattern and nutritional status of children studying in a government primary school.

  Methodology Top

A cross-sectional study was done in a Government Primary school during Janurary–Feburary 2019. The study was conducted in a Government primary school of Western Maharashtra during Janurary–Feburary 2019. The school is administered by the local Zilla Parishad Committee. A mid-day meal programme is running in the school since 2003 for primary classes and later extended up to the seventh standard in the year 2008. The study was undertaken amongst all present 134 children of the school (school strength was140) situated in the field practice area of Rural Health Training Centre of a medical college in Pune, Western Maharashtra. The study included all children studying in classes first to seventh of the school. Permission was taken from the administration of the school as well as the parents of the children for conducting the study. Verbal assent was also taken from children 7–12 years of age.

Anthropometric measurements, clinical and physical examination were undertaken in school premises by doctors who underwent training before starting the study for the standardization of the methods. A dentist carried out a detailed dental examination. Snellen's chart was used to test the visual acuity to diagnose refractive errors. An otoscope was used to check for ear diseases. A digital weighing machine was used to measure weight to the nearest 100 g. The recording of weight was done three times, and the average was taken as the final value. Height was taken to the nearest 0.5 cm. For anemia, hemoglobin was estimated using Sahli's method.[12]

For diagnosing anemia and assessing its severity, Hb concentration cut-off values were used as a reference as given by WHO's vitamin and mineral nutrition information system.[12] “Height-for-age” was graded as normal, mild to moderate stunting, and severe stunting based on 2007 WHO reference z-scores for 5–19 years of age for boys and a separate reference table for girls in the same age group. “Height-for-age'” <−3 standard deviation (SD) implies severe stunting and Height-for-age between-2SD and-3SD denotes mild to moderate stunting and >−2SD implies normal height for that age. “Weight-for-age” was graded as normal, mild to moderate underweight, and severe underweight as per simplified field tables of WHO (z-score tables) for girls aged 5–19 years and similarly for boys for the same age group.

School absenteeism of the each student was recorded from the school records of the past 6 months. For school absenteeism, only the absence of a complete day was counted as school absenteeism.

School authorities were apprised about the results through PowerPoint presentation regarding the children's health status and the need and benefits of having a fully functional school health service in their school. This study was approved by Institutional Ethical Committee, AFMC, Pune, with serial number IEC/2020/312.

Data were collated into a Microsoft Excel sheet and analyzed using IBM Corp. Released 2013. IBM SPSS Statistics for Windows, Version 22.0. (Armonk, NY: IBM Corp.). The continuous data are presented as mean and standard deviation, and the categorical data are presented as frequency and percentage. A P < 0.05 was taken as statistically significant.

  Results Top

A total of 26 (19.40%) children were found to be stunted, 51 (38.64%) were underweight, and 2 (1.49%) were found to be obese [Table 1].
Table 1: Nutritional status of school children as per who reference values (n=134)

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According to WHO z-scores, the overall prevalence of mild to moderately underweight children and severely underweight children was 48 (36.4%) and 3 (2.3%), respectively. The prevalence of mild to moderate and severe stunting was 22 (16.4%), and 4 (3%), respectively. Eighty-six (64.18%) of the school children were found to be anemic out of which mildly anemic were 33 (38.37%) and moderate anemia was found in 53 (61.63%) children. Girls (50 [79.4%]) had a higher prevalence of anemia among them as compared to boys (36 [50.7%]) (P = 0.001).

The most common morbidity found was dental caries in 73 (54.48%; 95% confidence interval [CI]: 53.59–55.45) students followed by Pallor in 61 (45.5%; 95% CI 44.54–46.49). 35 (26.12%; 95% CI: 25.26–26.98) school children were found to have Ear problems, and the same proportion of schoolchildren had skin problems (Ringworm−21 [15.67%] and Scabies-14 [10.45%]). Refractory errors were found in 6 (4.48%; 95% CI: 4.07–4.89) children and 1 (0.75%) of the subject had lateral gaze palsy in one eye. Two (1.49%) cases of tachycardia were identified, and 1 had chronic headache [Figure 1]. A total of 32 (23.88%: 95% CI 16.9–32.1) students were maintaining poor nail and personal hygiene.

A total of 32 (23.9%) students were having <90% attendance. We found an association between underweight and absenteeism (P = 0.02). The prevalence of stunting was also more among children who had <90% attendance, however the same was not statistically significant (P = 0.46) [Table 2].
Figure 1: Morbidity pattern of the school

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Table 2: Association of absenteeism with underweight and stunting

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  Discussion Top

In the present study, the prevalence of underweight and stunting was 38.64% and 19.4% respectively. As per NFHS-4 data of 2015–16, the prevalence of underweight and stunting among children under 5 years of age in rural areas of Maharashtra stood at 40% and 38.4% respectively.[10] Kakeri et al. conducted a study in 2018 in Palghar district of Western Maharashtra among 400 students (200 students from government school and private school each) and found the prevalence of underweight at 15.2% and stunting at 20.5%.[4] A study by Pise et al. revealed the stunting rate of 8.9% among institutionalised children in a Mumbai slum.[6] In another study by Abraham et al. conducted in South India among 714 students found that the prevalence of underweight and stunting was 30.7% and 10.4% respectively.[7]

A study conducted in an urban region of Guntur on schoolchildren aged 5–15 years by Madhavi and Kumar pointed out that malnutrition was significantly more in boys compared to girls.[8] The study conducted in South found that girls have more undernutrition than boys.[7] In our study, we found that there is no difference for undernutrition between boys and girls.

In the present study, dental caries stood at 73 (54.5%) followed by Pallor at 61 (45.5%). The prevalence of dental caries among institutionalised children in Mumbai slum stood at 44.4% in a study by Pise et al.[6] The study by Kakeri et al. also saw the prevalence of Dental caries as high as 63% in Government school children.[4] In our research, caries was almost equally distributed among boys and girls.

NFHS-4 data show anemia prevalence in rural areas in children under 5 at 54%.[7] Overall prevalence of anemia in our study stood at 64.18%. Girls (79.4%) suffered more as compared to boys (50.7%). The studies conducted by Gokhale et al. and Abraham et al. also reported that higher number of girls had anemia as compared to boys.[7],[9]

The mid-day meal scheme was implemented in 2002 in 15 tribal districts across Maharashtra and later extended to all districts in January 2003. Following the Government of India Guidelines, the mid-day meal scheme in Maharashtra was extended to cover children in upper primary (VI-VIII) classes. Initially, only 43 educationally backward blocks in 10 districts of Maharashtra were covered in January 2008, and the scheme has been extended across the state from September 2008.[13]

We also studied the association between absenteeism and undernutrition. Only 32 (23.9%; 95% CI 16.9–32) were found to have attendance <90%. The prevalence of undernutrition differs between the two groups, and it was found that higher attendance is associated with less prevalence of underweight and stunting. Interestingly underweight which reflects recent undernutrition was found statistically significant associated with absenteeism. Similar findings were observed in a study done among rural children in 785 students in Spain.[14] As a public health point of view, administration and teachers should encourage 100% attendance of the children so that the maximum number of children are benefitted the maximum number of days of the mid-day meals scheme of the children. Furthermore, this would help in targeted interventions to be delivered among school children like extra diet or take away home rations for children suffering from malnutrition.[15]

The study was conducted in a single government primary school. The generalizability of findings of the study may be limited. The study needs to be replicated with a larger sample size and multiple schools. The study may be used as a template for the larger studies. Another limitation of the study was that the association between absenteeism and underweight may be affected by confounders like socioeconomic condition, number of family members etc.

All the examined school children and teachers were issued school health record cards at the end of their health examination. All those study subjects who were found having any of the medical problems requiring specialist attention were referred to respective out-patient services of a tertiary care centre at Pune. The dentist who conducted the dental examination also demonstrated good oral hygiene techniques. The demonstration was organized class-wise so that children learn about the ideal method of brushing their teeth. The researchers plan to assess the nutritional status of the families of the school children who were found to be undernourished (both stunted and underweight) by studying their dietary patterns and staple food practices.

  Conclusions Top

The key findings of this study are the high prevalence of anemia and undernutrition among school children attending a government school despite the implementation of the mid-day meal scheme. This study also highlights the requirement of health education and awareness among children, teachers, and parents alike concerning personal hygiene, environmental sanitation, and common diseases. Students should be encouraged to attend school, and absenteeism may be reduced so that benefits may reach the maximum number of children on the maximum number of days.

Financial support and sponsorship


Conflicts of interest

There are no conflicts of interest.

  References Top

Day RE, Sahota P, Christian MS. Effective implementation of primary school-based healthy lifestyle programmes: A qualitative study of views of school staff. BMC Public Health 2019;19:1239.  Back to cited text no. 1
Organization WH. Improving Health through Schools: National and International Strategies; 2000. Available from: https://apps.who.int/iris/handle/10665/66314. [Last accessed on 2021 May 17].  Back to cited text no. 2
Galloway R. Global nutrition outcomes at ages 5 to 19. In: Bundy DAP, Silva N de, Horton S, Jamison DT, Patton GC, editors. Child and Adolescent Health and Development. Washington (DC): The International Bank for Reconstruction and Development/The World Bank; 2017.  Back to cited text no. 3
Kakeri M, Howal PV, Chaudhari YF. Health profile of school children of two schools in Palghar district, western Maharashtra, India. Int J Community Med Public Health 2018;5:4746-50.  Back to cited text no. 4
Dimmala C, Burra K. A study on nutritional status and environmental conditions of school children residing in social welfare hostels in urban area of a South Indian city. Int J Community Med Public Health 2019;6:3694-8.  Back to cited text no. 5
Pise K, PA G, Sankarnarayanan S. Nutritional status and morbidity profile of institutionalized children in an urban slum of Mumbai city. Asian J Med Res 2012;1:74-8.  Back to cited text no. 6
Abraham SB, Chauhan RC, Rajesh M, Purty AJ, Singh Z. Nutritional status and various morbidities among school children of a coastal area in South India. Int J Res Med Sci 2017;3:718-22.  Back to cited text no. 7
Madhavi K, Kumar B. A study on morbidity pattern of school children aged 5-15 yrs in an urban area of Guntur. J Evol Med Dental Sci 2013;2:6566-72.  Back to cited text no. 8
Gokhale CN, Borgaonkar CA, Shanbhag SS, Solanki MJ, Rasal MM. Morbidity pattern among primary school children in a tribal area of Maharashtra. Int J Community Med Public Health 2017;5:165-9.  Back to cited text no. 9
National Family Health Survey. Available from: http://rchiips.org/nfhs/factsheet_nfhs-4.shtml. [Last accessed on 2021 May 17].  Back to cited text no. 10
School Education | Government of India, Ministry of Education. Available from: https://www.education.gov.in/en/mid-day-meal. [Last accessed on 2021 May 17].  Back to cited text no. 11
WHO | Haemoglobin Concentrations for the Diagnosis of Anaemia and Assessment of Severity. WHO. Available from: http://www.who.int/vmnis/indicators/haemoglobin/en/. [Last accessed on 2021 May 17].  Back to cited text no. 12
Mid Day Meal. Available from: https://education.maharashtra.gov.in/mdm/mdms/register/language: eng. [Last accessed on 2021 May 21].  Back to cited text no. 13
Rodríguez-Escobar G, Vargas-Cruz SL, Ibáñez-Pinilla E, Matiz-Salazar MI, Jörgen-Overgaard H. Relationship between nutritional status and school absenteeism among students in rural schools. Rev Salud Publica (Bogota) 2015;17:861-73.  Back to cited text no. 14
Muhammad GM, Ganesan S, Chacko TV. Effectiveness of multi-strategic health screening cum educational intervention model in promoting health of school children in rural Coimbatore. Indian J Public Health 2019;63:133-8.  Back to cited text no. 15
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