Introduction:
The origin of the word adolescence is from Latin word ‘adolescere’ which means ‘to grow’ or ‘to grow to maturity.(1) Adolescents are the individuals in the age group of 10-19 years. It is a significant period of human growth and maturation; unique changes occur during this period and many adult patterns are established. The proximity of adolescence to biological maturity and adulthood may provide final opportunities to implement certain activities designed to prevent adult health problems.(2) The importance of health of adolescence has started to receive increasing recognition particularly in developing countries where four out of five world’s young population live and where more than half the population is under the age of 25 years.(3)
Nutritional status is now recognized to be a prime indicator of the health of individuals. The World Health Organization (WHO) believes that the ultimate objective of nutritional assessments is the improvement of human health.(4) In India, one of the important aims of nutritional research is to focus on the prevalence of undernutrition among adolescents. The nutritional status of adolescents needs to be monitored closely as they constitute the next generation of parents. The nutritional status of the adolescent girls, the future mothers, bear special significance.(5) There is also a need to develop a database on the nutritional status of adolescents from different parts of the country. This will enable the government and nongovernmental agencies to formulate policies and initiate strategies for well-being of the adolescents. Such a database is lacking at the moment.
Several factors affect the nutritional status of adolescents. Among these, socio-economic and demographic factors are associated with worldwide pattern of stunting and thinness. It has also been seen that the variability among nations and regions was substantial in comparison with variability among individuals within provinces.
In view of the above, the present study was carried out to assess the nutritional status among the adolescents in the age group of 10-15 years from the rural area of Karad Taluka.
Materials and Methods
A cross-sectional, school based study was carried out in Karad Taluka from the Satara district which is situated in the western belt of Maharashtra State. Study population included all schools catering to adolescents aged 10-15 years. An updated list of all schools (5th -10th standard) situated in rural area of Karad Taluka was used as the sampling frame. A study carried out in South India had reported that prevalence of stunting was 25.5 – 51% and prevalence of thinning was 42-75.4%.(6) Another study, which was carried out in Wardha, Maharashtra reported that prevalence of stunting was 34.5%.(7) Assuming proportion of stunting (p) to be 50%, 95% confidence level (1- α) and allowable error is 10%, sample size = 4 pq / d2 = (4 x 50 x 50) /102 =100.
Thus sample size was minimum 100 boys and 100 girls of age group 10-15 years. The study was conducted in randomly selected schools from rural area of Karad taluka from June 2014 to October 2014. Total 321 adolescents (178 boys and 143 girls) were included in the study.
The purpose and the process of the study were explained to the school principal and teachers. Informed Consent was obtained from participating adolescents. Complete clinical examinations as well as anthropometric measurements were performed. Data was collected in pre-tested proforma. Height and weight of each subject were measured using standard techniques.(2) Height and weight were measured to the nearest 0.1 cm and 0.5 Kg. Body mass index (BMI) was calculated as weight in Kg divided by square of height in meters.
The cut off value for stunting was <3rd percentile of the WHO 2007 norms - height for age and for thinness, <5th percentile of WHO 2007 norms-BMI for age.(8) Anaemia was diagnosed from clinical signs such as presence of pallor on the conjunctiva, tongue and palm.
Ethical clearance: The study was approved by the Ethical committee of the Krishna Institute of Medical Sciences Deemed University, Karad, Maharashtra.
Statistical analysis: Statistical analysis was carried out using windows version of SPSS-16. Mean, standard deviation, and percentile values were calculated. In order to test the significance of the difference, various statistical tests such unpaired t test, chi square test were used wherever necessary.
Results
For the present study data was collected from a total of 321 adolescents from a school for 5th to 10th standards, therefore the age variation observed in the studied children was between 10-15 years. This school is situated in rural area of Karad taluka from Satara district, which is situated in the western belt of Maharashtra state.
Out of 321 study subjects included in the study 178 (55.5%) were boys and 143(44.5%) were girls. Maximum 73(22.7%) adolescents were present in the 10years age group followed by 71(22.1%) in 14years age group. Maximum 52(16.2%) males were present in 10 years age group and maximum 39(12.1%) females were present in 14 years age group (Figure 1). There was statistically significant difference in age-gender distribution of studied population (Χ2=11.702;df=5;p<0.05).
 |
Figure 1: Age and gender distribution of study population |
The height correlated positively with age and increased with the increase in age in boys and girls. In boys, mean height from its minimum 138 ± 5 cm in 10 years of age increased to the maximum 156 ± 7 cm in 15 years age. Total gain in height during 10-15 years was 18Cms. In girls gain in height during 10-15 years was 17cms. Mean height in girls is more than boys in all age groups except at 15 years where mean height for boys was higher than girls. Combining all ages, the mean height for boys was 146 ± 10 cm and for girls it was 149 ± 9 cm. An independent sample test showed that mean height in girls was significantly higher than boys, (t= 3.054; p<0.05) (Table 1) Combining all ages, the mean BMI for boys was 16 ± 3 kg/m2 and for girls it was 17±3Kg/m2. An independent sample T test showed that mean BMI in girls was significantly higher than boys.(t= 3.912; p<0.050) (Table 2)
In boys prevalence of stunting was 16.9%. The prevalence of stunting was 1.9% at 10 years and increased with increasing age. It was 35% at 15 years age. In girls prevalence of stunting was 6.3%. Agewise, there was no clear trend; it was 9.5% at age 10 years and 13.6% at age 15 years (Table 1). Prevalence of stunting in girls was significantly lower than boys (p<0.05).
Table 1: Distribution of adolescents according to prevalence of stunting |
| Age(Years) |
Boys |
Girls |
N |
Mean and SD of height(cm) |
Percent of adolescents in <3rd percentile of WHO 2007 |
N |
Mean and SD of height(cm) |
Percent of adolescents in < 3rd percentile of WHO 2007 |
10 |
52 |
138 ± 5 |
1.9 |
21 |
138±7 |
9.5 |
11 |
26 |
139±6 |
11.5 |
20 |
141±7 |
0 |
12 |
25 |
146±9 |
20.0 |
20 |
151±5 |
0 |
13 |
23 |
150±8 |
21.7 |
21 |
150±6 |
14.3 |
14 |
32 |
154±9 |
28.1 |
39 |
154±6 |
2.6 |
15 |
20 |
156±7 |
35.0 |
22 |
155±6 |
13.6 |
Total |
178 |
146±10 |
16.9 |
143 |
149±9 |
6.3 |
In boys the prevalence of thinness was 41.6% and varied between 28.1% to 55% without any clear trend. In girls, prevalence of thinness was 28.1% which varied between 10% and 40% (Table 2). The prevalence of thinness was significantly lower in girls than boys (p<0.05).
Table 2: Distribution of adolescents according to prevalence of thinness |
| Age(Years) |
Boys |
Girls |
N |
Mean and SD of BMI |
Percent of adolescents in <5th percentile of WHO 2007 |
N |
Mean and SD of BMI |
Percent of adolescents in < 5th percentile of WHO 2007 |
10 |
52 |
15±2 |
40.4 |
21 |
15±2 |
28.6 |
11 |
26 |
15±2 |
46.2 |
20 |
16±3 |
40.0 |
12 |
25 |
17±4 |
48.0 |
20 |
18±3 |
10.0 |
13 |
23 |
17±3 |
39.1 |
21 |
18±4 |
33.3 |
14 |
32 |
17±3 |
28.1 |
39 |
18±3 |
25.6 |
15 |
20 |
17±2 |
55.0 |
22 |
18±3 |
31.8 |
Total |
178 |
16±3 |
41.6 |
143 |
17±3 |
28.1 |
There was statistically no significant association between prevalence of stunting and religion, education of father, education of mother, occupation of father, and occupation of mother. There was statistically highly significant association between socioeconomic status and prevalence of stunting (p<0.001) (Table 3).
Table 3: Association between sociodemographic factors and stunting (%) |
| Sociodemographic factor |
Percentage of stunting |
χ2 |
P value |
Religion |
Hindu |
13 |
1.358 |
> 0.05 |
Muslim |
6.9 |
others |
6.7 |
Education of father |
Up to high school |
14.4 |
2.080 |
> 0.05 |
Intermediate, and above |
9.0 |
Education of mother |
Up to high school |
12.3 |
0.032 |
> 0.05 |
Intermediate, and above |
11.5 |
Occupation of father |
Professional,semiprofessional,clerical and skilled worker |
10.3 |
4.542 |
> 0.05 |
Semiskilled ,unskilled and unemployed |
20.3 |
Occupation of mother |
Professional, semiprofessional, clerical and skilled worker |
18.5 |
7.406 |
> 0.05 |
Semiskilled, unskilled and unemployed |
25.0 |
Socioeconomic status |
I |
7.1 |
12.417 |
< 0.001 |
II |
7.8 |
III |
11.7 |
IV |
16.7 |
V |
27.5 |
There was statistically no significant association between prevalence of thinness and religion, education of father, education of mother, occupation of father, and occupation of mother. There was statistically highly significant association between socioeconomic status and prevalence of thinness (p<0.001) (Table 4).
Table 4: Association between sociodemographic factors and thinness (%) |
| Sociodemographic factor |
Percentage of stunting |
χ2 |
P value |
Religion |
Hindu |
35.7 |
0.051 |
> 0.05 |
Muslim |
34.5 |
others |
33.3 |
Education of father |
Up to high school |
31.9 |
2.566 |
> 0.05 |
Intermediate, and above |
40.6 |
Education of mother |
Up to high school |
33.5 |
2.517 |
> 0.05 |
Intermediate, and above |
44.3 |
Occupation of father |
Professional, semiprofessional, clerical and skilled worker |
35.1 |
0.099 |
> 0.05 |
Semiskilled, unskilled and unemployed |
37.3 |
Occupation of mother |
Professional, semiprofessional, clerical and skilled worker |
40.7 |
1.097 |
> 0.05 |
Semiskilled, unskilled and unemployed |
29.2 |
Housewife |
35.0 |
Socioeconomic status |
I |
14.3 |
1.355 |
< 0.001 |
II |
10.9 |
III |
34.0 |
IV |
90.0 |
V |
92.5 |
In the present study prevalence of anemia was 19%.
Discussion
Our study was done in the schools for 5th to 10th standard; therefore, the age variation observed in the studied children was between 10-15 years. Out of 321 study subjects, 178 (55.5%) were boys and 143(44.5%) were girls. In the present study, total gain in height during 10-15 years was 18Cms, 17Cms in boys and girls respectively. Mean height in girls was more than boys in all age groups except at 15 years where mean height for boys was higher than girls. Combining all ages, mean height in girls was significantly higher than boys. Also combining all ages, the mean BMI in girls was significantly higher than boys.(Table 1& 2) As adolescent growth spurt occurs earlier in girls than boys that might be the reason for this. A study carried out among affluent adolescents also reported similar finding.(9) A comparative study carried out in adolescents from south India and UAE (6) showed that combining all ages, the mean height for south Indian girls was 145.7 ± 10 cms and for boys it was 146.9 ± 12.4 cms. The mean BMI for south Indian girls was 15.8 ± 2.7 and for boys it was 15.54 ± 2.4. The mean height for UAE girls was 151.3 ± 9 cms and for boys it was 154.8 ±11.5 cms. The mean BMI for UAE girls was 20.5 ± 4 and for boys it was20.2 ± 2.2 cm/kg2.
Height percentiles showed increments for both boys and girls with age.(9,10) Pereira et al reported that girls gained 17.5 Cms during the age interval of 10-15 years.(11) Another study carried out in Surat reported that boys gained 19.9 Cms and girls gained 17.2 Cms during the age interval of 10-15 years.(12) Sathyavathi et al reported 17.5 and 15 cm gain for urban and rural girls’ respectively.(13)
In present study the prevalence of stunting in 10-15 years age group was 16.9% among boys and 6.3% in girls with an overall prevalence of 11.6%. Thus in girls prevalence of stunting was lower than boys (Table 1). Hence the prevalence of stunting in this study was comparatively less than other Indian studies.(5,7,14) A study (5) which was carried out in rural areas of nine states reported the extent of stunting was 39%. Study carried out in Wardha (7) reported the prevalence of 34.5%. Another study which was carried out in a rural area of North India (14) reported that the overall prevalence was 38.5%. A high prevalence of stunting has been previously reported from India. The report on regional WHO consultation on nutritional status of adolescent girls reported 45% prevalence of stunting among girls and 20% among boys with an average of 32% in both sexes.(15) A similarity in prevalence of stunting in boys and girls from developing countries has also been found by other worker.(16) The percentage of stunting increased with increased age in boys from 34.7% at 10 years to 59.77% at 17 years. In case of girls, the percentage of stunting increased with increasing age (32.5-46.7%) up to 13 years, after which it decreased to 37.2% at the age of 17 years.(5) In a study carried out in government and public schools of Delhi the prevalence of stunting was 9.9% in upper socioeconomic class girls and 35.3% in lower middle class girls.(17)
In the present study the prevalence of thinness was 41.6% in boys and 28.1% in girls, with overall prevalence of 34.8 %( Table 2). This prevalence is comparable to other Indian studies.(5,14) A study carried out in rural area reported that prevalence of thinness among boys varied between 31-52% without clear trend. In girls, it varied between 4%-59% and the prevalence of thinness in girls was lower than boys.(14) Yet another study reported that the prevalence of thinness ranged from 77.6% at 11 years to 44% at 17 years, while in case of girls, the extent of thinness was considerably less in each age group than their male counterparts. The prevalence of stunting and thinness were on an increasing trend, as age increased from 10-17 years.(5) In general, overall rate of under nutrition was 36.49%. The frequency of under nutrition (combining all ages) varied between boys (41.08%) and girls (30.61%) irrespective of sex, the rate of under nutrition progressively increased from 31.88% to 39.80% with the advancement of age.(18)
In the present study there was no significant association between prevalence of stunting and thinness with religion, education of father, education of mother, occupation of father, and occupation of mother. There was statistically highly significant association between socioeconomic status and prevalence of stunting and thinness. (Table 3 & 4).
All the demographic and socioeconomic factors, except family size and possession of own house, were significantly (p< 0.05) associated with the stunting of adolescents. The extent of stunting was higher (42.7%) among adolescents belonging to the scheduled caste community. The adolescents belonging to extended families had a lower prevalence of stunting (34.6%) as compared to those belonging to joint families(42.0%). The percentage of stunting among adolescents was higher in those living in kutcha houses(40.5%) and families of labourers (40.3%). The extent of stunting decreased with increasing size of land holdings and increase in per capita income. The prevalence of underweight as assessed by weight/age was significantly associated with all variables (p <0.05) except with ownership of house. There was significant (p< 0.05) association between CED (BMI < 5th percentile of NHANES) and religion, community, family size, type of house, occupation and per capita income.(5)
In the present study, the prevalence of anaemia was 19%. A study carried out in rural area of North India (14) reported the prevalence of anemia at 48%. Vasanti et al assessed the iron nutritional status among 312 rural school girls of Delhi. The prevalence of anaemia (Hb <12 gm/dl) was 28% in girls who had attained menarche and 22% in girls who had not attained menarche.(19) In another study among 1500 rural girls (10-19 years) from 10 villages in Gujrat, the prevalence of anaemia was reported to be 60%.(17) A study carried out in peri urban area of Maharashtra (7) reported the prevalence of 28.45% with girls suffering significantly more 38.89% as compared to boys 23.75%.
Conclusions
In present study overall prevalence of stunting (11.6%) was comparatively less than other Indian studies carried out in different states. Whereas prevalence of thinness (34.8%) was comparable with other Indian studies. Sex wise comparison shows that prevalence of stunting and thinness was significantly lower in girls than boys. So regular health check-up with concerted effort towards nutrition along with focused health education can improve the health and nutritional status of these school going rural adolescents. Also growth is influenced by both genetic and environmental factors. If socio-economic status is improved there is full expression of the genetic potential.
Acknowledgement
This project is awarded by ICMR for STS scholarship. Authors are grateful to Principal, teachers and participants of school for their co-operation.
Conflict of interest: None.
References
- Agarwal K, Satyavathi NK. Review on adolescent growth studies part A: Physiological aspect and environmental factors. Indian J Peadiatr. 2004; 71(6):565-67.
- World Health Organization. Physical status-the use and interpretation of anthropometry. Report of the WHO Expert Committee. Technical Report Series No.854. World Health Organisation, Geneva, 1995. pp 263-311.
- Park’s Textbook of Preventive and Social Medicine, Banarsidas Bhanot Publishers. 22nd Ed.
- Beghin I, Cap M, Dujardin B. A Guide to Nutritional Assessment. World Health Organization, Geneva. 1988.
- Venkaiah K, Damayanti K, Nayak MU, Vijayaraghavan K. Diet and nutritional status of rural adolescents in India. Eur J Clin Nutr. 2002;56:1119-25.
- Haboubi GJ, Shaikh RB. A comparison of nutritional status of adolescents from selected schools of South India and UAE: A cross-sectional study. IJCM 2009;34(2):108-111.
- 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(2):3.
- Onis de M, Onyango AW, Borghi E, Siyam A, Nishida C, Siekmann J. Development of a WHO growth reference for school aged children and adolescents. Bulletein of the WHO. September 2007;85(9);660-667.
- Patil SS, Patil SR, Durgawale PM, Kakade SV, Kumar A. Study of physical growth standards of adolescents (10-15years) from Karad, Maharashtra. International Journal of Collaborative Research on Internal Medicine & Public Health 2013;5(1):10-18.
- Agarwal KN, Tripathi AM, Sen S, Kaliyar GP. Physical growth and adolescence. Indian Pediatr. 1974;11:93-97.
- Pereira. P, Mehta S, Khare BB, Katiyar GP, Agarwal DK, Tripathi AM, Agarwal KN. Physical growth characteristics of upper socio-economic adolescent girls of Varanasi. Indian J Med Res June 1983;77:839-844.
- Thakor GH, Kumar P, Desai VK, Srivastava RK. Physical Growth standards for urban adolescents (10-15 yrs) from South Gujrat. Indian J of Comm Med. 2000;25:86-92.
- Sathyavathi K, Agarwal KN, Khare BB, Agarwal DK. The growth pattern of weight and height during adolescence. Indian J Med Res. 1981;74:857.
- Anand K, Kant S, Kapoor SK. Nutritional status of adolescent school children in rural North India. Indian Pediatr. 1999;36(8):810-5.
- World Health Organization. Nutritional status of adolescents girls and women of reproductive age. Report of regional consultation. SEA/NUT/141. World Health organization, Geneva. 199. p 3.
- Kurz KM, Johnson-Welch C.The nutrition and lives of adolescents in developing countries: Findings from the nutrition of adolescent girls research program. International Center for Research on Women, Washington DC. 1994.
- Kapoor G, Aneja S. Nurtritional disorders in adolescent girls. Indian Pediatr 1992;29:969-973.
- Mukhopadhyay A, Bhadra M, Bose K. Anthropometric assessment of nutritional status of adolescents of Kolkata, West Bengal. J Hum. Ecol. 2005;18(3):213-216.
- Vasanti G, Pawashe AB, Susie H, Sujatha T, Raman L. Iron nutritional status of adolescent girls from rural area and urban slum. Indian Pediatr 1994;31:127-132.
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