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A study of the health status of early adolescent girls residing in social welfare hostels in Vizianagaram district of Andhra Pradesh State, India.

Introduction/Background

Adolescent girls form an important vulnerable sector of population that constitute about one-tenth of Indian population [1]. Under-nutrition among adolescents is a serious public health problem internationally, especially in developing countries [2]. Early adolescence after the first year of life is the critical period of rapid physical growth and changes in body composition, physiology and endocrine [3]. The Ministry of Women and Child Development is significantly involved in the issues of nutrition and development of children, particularly girl children. The scheduled castes and scheduled tribes have been identified as two most disadvantaged groups of Indian society needing special attention [4]. Empowerment of the hostel Girl is necessary to help her cope with the changes and promote awareness of health particularly nutrition and reproductive health, so as to break the intergenerational life cycle of nutritional and gender disadvantage and provide an enabling and supporting environment for self-development [5]. Social welfare department, with respect to the socioeconomic status of Scheduled Caste population and socio academic profile of the scheduled caste children, has been maintaining hostels as a pro-educational measure. These hostels serve as homes away from homes at places where schooling facilities are available. The girls stay more than 8 years in these hostels. Health care of these girls in the hostels is of utmost importance because the children in the school age (10-15 years) are in a period of growth and development when optimum nutritional and health care is essential. Adolescent girls health covers nutritional status, morbidity, and reproductive health. During the period of adolescence the nutrient needs are the greatest [6]. The girls are usually physically stunted a manifestation of chronic protein energy malnutrition. A large proportion of adolescent girls suffer from various gynecological problems, particularly menstrual irregularities such as menorrhagia, polymenorrhea, oligomenorrhea, and dysmenorrhea. In Andhra Pradesh, the welfare Programmes for the Scheduled Castes are looked after by the Education and Social welfare department. These institutions run on par with hostels and are being run in summer vacation also [7]. The role of these hostels in their education advancement is considerable [8]. To achieve this objective, the Government of Andhra Pradesh has started a large number of social welfare hostels and at present, there are 2313 hostels functioning in the A.P state with scheduled caste children comprising 70% of the hostel inmates [9]. Various base- line surveys also revealed that the health, nutritional and educational status of adolescent girls are at sub-optimal level [5]. The data regarding the nutritional status & morbidity status of the early adolescent girls in social welfare hostels are sparse, despite the usefulness of such information in the management of hostels and upliftment of these groups [10]. In this context, the present study was taken up among early adolescent girls residing in the social welfare hostels in urban area of Vizianagaram District. This study focuses on nutritional & reproductive status of early adolescent girls.

Aim and Objectives

1. To study the health status of early adolescent girls residing in social welfare hostels of Vizianagaram city, A.P.

2. To assess the Nutritional status of the early adolescent girls residing in the hostel.

3. To study the Morbidity pattern among the early adolescent girls in the social welfare hostels.

Methods/Study Design

Study design, study population and Sample size:

Cross sectional study was conducted from June 2010 to September 2010 among Children residing in two social welfare hostels for scheduled Caste girls. It is a field practice area of Department of Community Medicine, Maharajaha; Institute of Medical Sciences, Vizianagaram. A total of 420 girl's children formed the study subjects. Permission from the Deputy Director of Social Welfare was obtained for conducting the study. The wardens were interviewed and, hostel registers were looked into to secure information regarding the number of residential children. The medical officer along with house surgeons of the urban Health centre provides medical checkup and treatment for children once in a month. Those requiring specialist treatments will be referred to district hospital. Data regarding morbidity status was collected using a pre-tested proforma. At the first visit during June 2010, every child was examined physically from head to toe and deviations from normal, if any, were recorded. Enquiry was made about the health ,reproductive problems and occurrence of any ailment during previous two weeks.

Nutritional Status [right arrow] Nutritional status of girls was assessed by Anthropometric measurements viz height, weight, BMI.

Anthropometry Height--Stadiometer (measuring rod) capable of measuring to an accuracy of 0.1 cm was used to assess height of the subjects. The subject was made to stand without foot wear with the feet parallel and with heels, buttocks, shoulders, and occiput touching the measuring rod, hands hanging by the sides. The head was held comfortably upright with the top the head making firm contact with the horizontal head piece.

Weight--A portable weighing machine with an accuracy of 100gms was used to record the weight of the girls. Checking the scale with a known weight was done frequently and adjustment to zero was done every time for accurate reading. A girl were instructed to stand on the weighing machine with light clothing and without footwear and with feet apart and looking straight and weight was recorded to the nearest value.

Body Mass Index (BMI)--BMI was calculated using the formula (BMI =Weight in kg/height in [m.sup.2]). The girls were categorized into Various grade based on BMI according to WHO International Standard [11,12,13]. Hat is, Grade 3 thinness (BMI < 16 kg/[m.sup.2]), Grade 2 thinness (BMI 16-16.9 kg/[m.sup.2]), Grade 1 thinness (BMI 17-18.49 kg/[m.sup.2]), Normal (BMI 18.5-24.99 kg/[m.sup.2]), Overweight (BMI 25--29.99 kg/[m.sup.2]) and Obese (BMI >30 kg/[m.sup.2]) [14]. The girls were categorized into Various grade based on BMI according to National Standard [15], undernutrition (BMI<18.5 kg/[m.sup.2]), Normal (BMI 18.5-23.5 kg/[m.sup.2]), and Overweight (BMI >23.5 kg/[m.sup.2]).

Data Analysis: Data collected was entered in Microsoft Office Excel and analysed by using SPSS Version 16.0.

Study instruments: Pre-designed, pre-tested, semi-structured questionnaire, stethoscope, Weighing machine, measuring tape etc.

Results / Findings

A total 420 girls were studied. Of that 37.4% (157) were in the age group 13 years. Followed by 26.9% were in age group 14 years, 18.6% were in age group 12 years, 9.8% were in age group 15 years and very few that is 5% and 2.4% in the age group 11 and 10 years. (Table -I)

In the present study according to WHO reference standards, 56.4% (237/420) girls were under-nourished (BMI [less than or equal to] 18.5). The Girls suffering from chronic energy deficiency grade I, II and III were 25.2%, 15.2% and 16 % respectively. 12 (2.9%) was found to be overweight and none of the girls was found to be obese. According to the new guidelines by the Government of India as per the dianostic cut-off values the 56.4 % was found to be undernourished while 5.8 % was found to be Overweight (BMI >23.5 kg/[m.sup.2]). (Table-II) 126 out of 420 (30%) were showed clinical anaemia, 114/420 (27.1%) were having dental caries, 70/420 (16.7) were having reproductive problem (dysmenorrhoea), 67/420 ( 16% ) were skin problem, 4 % Eye problem( defective vision & refractive errors), 2.4 % were having URTI and 2.1 % ENT problem. (Table III)

Discussion

Undernutrition is documented public health problem contributing substantially to children's survival. There is scanty information on the nutritional status of girls residing in social welfare hostels. Therefore, there is a need to study the health problems among these girls and to develop a database from different parts of the country.

The results of the study are discussed below. The underfed still outnumber the overfed in the developing world among Asian, African and Latin American populations. In spite of the economic development in the region, undernutrition remains an important public problem in many Asian countries [16]. Undernutrition is a significant problem and continues to be a cause of morbidity and mortality among children in developing countries like India [17, 18]. The recent study of Cole et al [13] has stated that undernutrition is better assessed as thinness (low body mass index for age) than as wasting (low weight for height). Prior to this report, there were no suitable thinness and overweight/obesity cutoffs for 2-18 years age group [12, 13]. The uses of these new cut-off points are suggested to encourage direct comparison of trends in childhood thinness and overweight/obesity worldwide. Moreover, these cut-offs provide a classification of thinness and overweight/obesity for public health purposes at the National and International level.

In the present study according to WHO reference standards [11]. 56.4% girls were under-nourished (BMI [less than or equal to] 18.5 kg/[m.sup.2]). Girls with thinness grade I, II and III were 25.2%, 15.2% and 16 % respectively. Out of the total 420 girls, 12 (2.9%) was found to be overweight and none of the girls was found to be obese. According to the new guidelines by the Government of India (ICMR) [15] as per the diagnostic cut-off values the 237/420 (56.4%) was found to be undernourished while 5.8 % was found to be Overweight. In a study conducted by Kapil et al. [19] 8.1% were CED grade I, 6.65% were CED grade II and 78.8% were CED grade III. In a study by Raheena Begum [20] in Kerala, 53% in 14 years age group and 33% in 15 years age group were having BMI <18.5 kg/[m.sup.2]. In a study by Deshmukh et al. [21] CED was found to be 75.3%. In a study by Meenakshi Kalhan, 80% of the girls were under-nourished (BMI <18.5 kg/[m.sup.2]) [22]. The study of urban slum girls in Dhaka reported prevalence of thinness 17% [23]. Various authors have reported the prevalence of thinness among adolescent girls to be 14.7% [23], 30.1% [24], 41.3% [25] and 59% [26]. In a study among adolescent girls in Rajasthan, 6.5% of the girls were found to have a BMI of more than 18.5 [27]. Nurul Alam et al. found out that 26% of the girls were thin, with body mass index (BMI)-forage <15th percentile), 0.3% obese (BMI-forage >95th percentile), and 32% stunted (height-for-age [less than or equal to] 2 SD) [28]. According to Lazzeri G et al., the prevalence of thinness declined from 9.8% to 8.7%, and the prevalence of normal weight from 77.0% to 71.6%, while the prevalence of overweight rose from 13.3% to 19.7% [29]. In a study by Pascal Bovet et al. prevalence of thinness was 21.4%, 6.4% and 2.0% based on the three IS cut-offs and 27.7%, 6.7% and 1.2% based on the WHO cut-offs [30]. Saxena Y et al. prevalence of thinness was 56.25% [31]. Study conducted by Shivaramakrishna, 73.3% girls were under-nourished (BMI< 18.5). The prevalence of chronic energy deficiency based on BMI(grade I, II and III) were 23.0%,28.3%, and 22.2 % respectively.[32] Study by X Du H Greenland et al Using a modified Chinese reference, the rate of low body weight (BMI<18) was 32.2% [33]. Yustina Anie Indriastuti Kurniawan et al. about 50% were underweight and stunted indicating the presence of acute and chronic malnutrition. [34] Reports from India, Bangladesh, Nepal and Myanmar show that 32%, 48%, 47% and 39% adolescents respectively are stunted, and 53%, 67%, 36%, and 32% adolescents from these countries are thin.[35]

In the study by Renuka Jayatissa et al., it was observed that the prevalence of overweight, thinness and stunting among the adolescent school girls in Sri Lanka were 4.0%, 22.1% and 18.1% respectively [36]. In a study by Garba and Mbofung, the severe malnutrition was higher in girls (23.8%) than in boys (22.3%), while moderate malnutrition was higher in boys (93.1%) than in girls (86.7%) [37]. Mital Prajapati et al. also found out that the prevalence of thinness was equal to 41.3% [38]. The comparison of prevalence of undernutrition among the adolescents in India and other countries is presented in Table IV. Most of the studies reported lower prevalence of undernutrition than present study [28,29,30,33,36,38,45]. On the other hand, some other studies had almost similar prevalence of undernutrition [44,34,32], wheras some other studies showed a higher prevalence than present study [32,37].

Morbidity profile: The health problems of adolescent girls vary from place to place and several studies conducted in India and abroad revealed that the main morbidity conditions include malnutrition, dental caries, and diseases of skin, problem of Eye & Ear and reproductive problems.

In the present study, the leading causes of morbidity were undernutrition 56.4%, dental caries (27.1%), skin diseases (16%), dysmenorrhoea (16.7%), defective vision (4%), URTI (2.4%), ENT (2.1%) and clinical anaemia (pallor) 30%.

In a study conducted by Srinivasan [10] (2000), in Tirupati in 598 children aged 6-17 years, the common morbid conditions found were skin disorders 25.7%, dental caries 21.5%, ARI 1.7% and diarrohea 1.2%.

In the present study, the morbidity due to skin diseases is 16%. In the study by Srinivasan [10], scabies accounted for 29.9%. In a study by Singh et al. [39] scabies accounted for 16.2%.

In the present study, the prevalence of dental caries is found to be 27.1%. In the study by Srinivasan dental caries was 21.5%. 13.33% of dental caries was seen in the study conducted by Choudhary et al [40] in adolescent girls of rural area of Varanasi. The high prevalence of dental caries in the present study may be due to poor oral hygiene.

In the present study defective vision was 4%, whereas in other studies [10, 39] the prevalence of defective vision was 4.7% and 4.5% respectively. This difference may be due to inadequate indoor lighting.

In the present study dysmenorrhea is present in 16% of study subjects. In a study conducted by Deo et al. [41] dysmenorrhea was present in 31.64%. In a study conducted by Srinivasan dysmenorrhea was noted in 3.5%. The low prevalence of dysmenorrhea in the other studies may be due to the reason the study subjects comprised of different age groups. In a study by Geetha et al [42] in rural south India, dysmenorrhea was noted in 21%. Study by N Rema found that common deficiency diseases prevalent among the school going children were anemia and skin infections 10.6% & 67%. The chief cause of anemia could be contributed to the lack of proper iron, vitamin B12 and folic acid in the diets of these children [43].

Conclusions

The following are the conclusions from the present study:

A total 420 girls were studied. Of that 37.4% were in the age group 13 years. According to WHO reference standards 56.4% girls were under-nourished (BMI [less than or equal to] 18.5). Girls suffering from chronic energy deficiency grade I, II and III were 25.2 %, 15.2 % and 16 % respectively. Out of the total 420 girls, 12 (2.9%) was found to be overweight and none of the girls was found to be obese. According to the new guidelines by the government of India as per the diagnostic cut-off values the 56.4% was found to be undernourished while 5.8 % was found to be Overweight (BMI >23.5 kg/[m.sup.2]). However 30% were showed clinical anaemia, 27.1% were having dental caries, 16.7% were having reproductive problem (dysmenorrhoea), 16% were skin problem, 4 % Eye problem (defective vision & refractive error), 2.4% were having URTI, and 2.1% ENT problem. In view of the high prevalence and incidence of morbidity among adolescent girls in the hostels, regular periodic medical examination and facilities for treatment on the spot at school hostels and referral services should be organized and monitored systematically. Health education programmes on hygiene and common diseases have to be carried out regularly in hostels in consultation with concern health authorities.

Ethical Considerations: The study protocol was submitted to the Institutional Ethical Committee and clearance was obtained. Written informed consent from the heads of the institutions and assent from the selected adolescents was also obtained, before initiation of the study in the respective Institutions.

Conflict of Interest: There does not exist any conflict of interest what so ever.

Role of Funding Source: There does not exist any role of funding source what so ever.

Acknowledgements

The Principals and the authorities of both the Hostels are thankfully acknowledged for their help during data collection. Our thanks go to the professors & head of Department of Community Medicine, and the staff of Urban Health Centre for their continuous support.

Also our appreciation is extended to Respected Dean of MIMS Medical College and Management for giving us permission to carry out study. Also we are sincerely indebted to all the participants who made this study possible.

References

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Vinod Wasnik *, B. Sreenivas Rao, Devkinandan Rao

Department of Community Medicine, Maharaja Institute of Medical Sciences, Nellimarla, Vizianagaram District, Andhra Pradesh, India

* Corresponding Author
Table I: Details age wise distribution of study sample

Age in Years   Frequency   Percent

10                10         2.4
11                21        5. 0
12                78        18.6
13                157       37.4
14                113       26.9
15                41        9. 8
Total             420       100.0

Table II: Nutritional Status of Study population as per National
& International Classification of underweight, overweight and
obesity according to BMI

WHO standard * n = 420

                               BMI Cutoff      No. of
Grade of Undernutrition       Value Kg/m2    Girls n (%)

Grade 3 Thinness                  < 16         67 (16)
Grade 2 Thinness               16.0-16.99     64(15.2)
Grade 1 Thinness                17-18.49      106(25.2)
Normal                         18.5-24.99     171(40.7)
Overweight                      25-29.99       12(2.9)
Obese                             >30            Nil

Indian Standard **

Underweight                      < 18.5      237 (56.4)
Normal                         18.5-22.9     159( 37.8)
Overweight                    23 and Above    24( 5.8)

* WHO The International Classification of underweight,
overweight and obesity according to BMI.2004

** Indian Council of Medical Research, 2009

Table III: Morbidity status of hostel Girls

Morbidity Status   Frequency   Percent

URTI                  10         2.4
skin problems         67         16.0
Eye problems          17         4.0
ENT problems           9         2.1
Dental problems       114        27.1
Reproductive          70         16.7
NAD                    7         1.7
Anaemia               126        30.0
Total                 420       100.0

Table IV: Comparative Frequency of Thinness among
the adolescent girls of different countries

Reference Study                 Area Population      Sex

NurulAlam et al 2010               Bangladesh       Girls

Lazzeri G et al 2008             Tuscany,Italy      Both

Pascal Bovet et al June 2011       Seychelles       Both
                                (African Region)

Afework Mulugeta et al, 2009        Ethiopia        Girls

Saxena Y et al 2011             Dehradun, India     Girls

Shivaramakrishna et al 2011     Banglore, India     Girls

X Du et al 2003                      China          Girls

Yustina Anie Indriastuti           Indonesia        Girls
Kurniawan et al 2006

Renuka Jayatissa et al 1997        Sri Lanka        Girls

A. K. M. Shahabuddin               Bangladesh       Both

Bisai et al 2008               West Bengal, India   Both

CMG Garba et al 2010                Cameroon        Both

Mital Prajapati et al 2011       Gujarat India      Both

Vinod Wasnik 2011               (Present study)     Girls

Reference Study                 Date of Survey     Undernutrition

NurulAlam et al 2010               2003-2004            26%

Lazzeri G et al 2008               2002-2006           17.9%

Pascal Bovet et al June 2011       1998-2004           29.8%

Afework Mulugeta et al, 2009       2004-2005           58.3%

Saxena Y et al 2011                  2010              56.25%

Shivaramakrishna et al 2011      Jan-Feb 2009          73.5%

X Du et al 2003                      2001              32.2%

Yustina Anie Indriastuti             2005               50%
Kurniawan et al 2006

Renuka Jayatissa et al 1997        August to           22.1%
                                 December 1997

A. K. M. Shahabuddin             December 1996          67%
                               and January 1997

Bisai et al 2008               May 2008-March 09       44.5%

CMG Garba et al 2010                  --               86.7%

Mital Prajapati et al 2011        July 2008-           41.3%
                                 December 2008

Vinod Wasnik 2011                January 2010-         56.4%
                                  Augest 2010
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Author:Wasnik, Vinod; Rao, B. Sreenivas; Rao, Devkinandan
Publication:International Journal of Collaborative Research on Internal Medicine & Public Health (IJCRIMPH)
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Date:Jan 1, 2012
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