Indian 07. Pediatr. 44 : ,301, 1977

N U T R I T I O N A L STATUS OF SCHOOL CHILDREN IN R U R A L AND URBAN AREAS OF BIKANER, WEST R A J A S T H A N *

VEENA GUPTA** AND S. SAXENA***

Bikaner

Nutritional studies of individual and

population groups have been carried out

over a period of years in Western Europe

and North America. It was largely on

the recommendation of the Nutrition

Advisory Committee that such a study was

started in India in 1936 (Rao et al. 1958).

In Rajasthan, particularly in the western part of the state, such data are scanty and

therefore it was planned to carry out a

survey of school children in order to assess their nutritional status and growth.

Mater ia l and M e t h o d G r o w t h

In this study conducted on 1000 rural and 1000 urban school children fi'om Bikaner District of West Rajasthan, children from

6-12 years of age attending primary, secon-

dary and higher secondary schools were

included. The randomizat ion technique

was followed tbr the selection of schools.

A questionnaire was sent to the parents

of the children in order to obtain intorma-

tion regarding total number of members

in the family and their age, the monthly

income of earning members and their

occupation, and dietary habits. The ques-

tionnaire of the eating habits included

*From the Department of Paediatrics, S.P. Medical College, Bikaner.

**Department of Paediatrics, G.S.V.M. Medical College, Kanpur.

***Department of Paediatries, S.M.S. Medical College, Jaipur. Received on June 20, 1977.

information on the average consumption

of cereals, proteins, fats and vegetables

per 24 hours for the family. The age of

the child was taken from the records of the

child in the school and was approximated

to the next birth day.

The height and weight were recorded

on an U N I C E F beam balance cure height measuring scale. A detailed clinical exa-

mination was done in all the cases and

nutritional deficiency signs were carefully

recorded.

O b s e r v a t i o n s

The preponderance of males over

females in the rural area (54.6% boys and

45.4% girls) and fl males over males in the

urban area (45.2% boys and 54.8% girls)

was significant. The maximum number

of students were in the age group of 10

years in both the areas a n d the minimum

in the age group of 6 years in the rural and 8 years in the urban area.

Prevale~,ce of nutritional deficiency signs (TableJ 1 al;d 2)

All the nutritional deficiency diseases

were more prevalent in rural school children

(33%) than urban school children (18.5%)

and also they were more common in male

students in either areas except vitamin B

complex deficiency which was higher in female students of urban areas. In order of occuri:ence vitamin A deficiency was

recorded as first, anaemia second and

vitamin B complex deficiency third.

3 0 2 INDIAN JOURNAL OF PEDIATRICS

T a b l e 1. Incidence of nutritional defidency

VOL. 44, No. 357

Number of nutrient deficiencies

Rural Students Urban Students

Male Female Total Male Female Total

No. O//o No. % No. % No. % No. O//o No. %

None 313 57.14 358 78.86 670 67 352 77.87 463 84.49 815 81.50

One 215 39.38 90 19.82 305 30.5 97 21.46 84 15.33 181 18.1

Two 17 3.11 6 1.32 23 2.8 3 0.67 1 0.18 4 0.4

Three 2 0.37 -- -- 2 0.2 . . . . . .

Total num- 234 42.86 ber with nutritional deficiency

96 21.14 330 33.0 100 22.13 85 15.51 185 18.50

T a b l e 2. P~rcentage of various nutritional deficiency diseases, in male and female students of rural and urban areas.

Rural Students Urban Students

Nutrit ional deficiency Male Female Total Male Female Total

No. % No.

157 28.75 45

18 3.29

% No. % No. % No. % No. %

m l m l m m mmm

9.91 202 20.2 66 14.38 55 10,03 120 12.0

5 1.10 23 2.3 7 1.55 10 1.82 17 1.7

Vit. A

Vit. B complex

Vit. C

Vit. D

Anaemia

Total

13 2.38 7 1.54 20 2 9 1.99 9 1.64 18 1.8

14 2.56 7 1.54 21 2.1 7 1.55 5 0.91 12 1.2

52 9.52 38 8.38 90 9 15 3.32 7 1.28 22 2.2

255 46.70 102 22.46 357 35.70 103 22.79 86 15.69 189 18.9

GUPTA AND SAXENA--NUTRITIONAL STATUS OF SCHOOL CHILDREN ~03

Clinical manifestations cf vitamins deficiency (Table 3)

Among vi tamin A deficiency signs xerosis was more prevalent than Bitot's spots and phrynoderma, while in B complex

deficiency angular stomatitls was the most common sign. The st igmata of healed rickets were noticed in the form of bossing of the forehead, pigeon-shaped chest, Harrison's suIcus and bowing of the limbs in 2.1% rural and 1.2~o urban students.

T a b l e 3. 61inical manifestations.

Nature of manifes ta t ion

Rura l Students

MalQ Female

Urban Students

Tota l Male Female Total

No. % No.

Vit. A dgeiency

Xerosis

Bitot's spots

Phrynoderma

Dry Pig- mented con- junct iva

Vii. B complex deficiency

%

88 16.11 23 5.06

47 8.61 12 2.f4

10 1.83 7 1.54

12 2.19 3 0.66

Angular 9 1.65 2 0.44 stomatitis

Cheilosls 3 0.55 I 0.22

Stomatit is , 5 0.91 1 0.22 glossltls

Others 1 0.18 1 0.22 ,

Vit. C 13 2,37 7 1,54

Vd. D 14 2.56 7 1.54

Total 202 37 64 14.08

No. % No. % No. % No. %

m e

111 l l .1 44 9.73 41 7.48 88 8.8

59 5,9 11 2.43 7 1.28 18 1.8

17 1.7 8 1.77 5 0.91 13 1.3

15 1.5 2 0.44 2 0.36 4 0.4

11 1.1 3 0.66 4 0.63 7 0.7

4 0.4 2 0.44 3 0.55 5 0.5

6 0.6 2 0.44 3 0.55 5 0.5

2 0.2 . . . . . .

20 2.0 9 t.99 9 1.64 I8 1.8

21 2.1 7 1.55 5 0.91 12 1.2

266 26.6 88 19.47 79 14.42 167 16.7

304 INDIAN JOURNAL OF PEDIATRICS

J~ul~itio~zaI disease and dietary habits in urban areas (Table 4)

The incidence of nutritional deficiency

diseases was higher in vegetarian than non- vegetarian students (i.e, 23.67% and 6.73% respectively) in urban areas. No such comment could be made for rural students

because of the very small number of non- vegetarian students i.e. only 10 non-vege-

tarians as compared to 990 vegetarians.

Family size The average size of families in rural

areas was 5.20 with a variation of 3 to 31, corresponding figures for urban families

were 4.08 with a variation of 3 to 34.

95.44% families were single in the rural area and 97.47% in the urban area.

Nutritional disea,ws in relation to socioeconomic statur

The socioeconomic status of the parents

of students have been divided into seven

main groups on the basis of their per capita

income. The relation of deficiency diseases

VOL. 44, No. 357

with socioeconomic status is tabulated in

Table 5. The highest incidence of deficiency

diseases was seen among the 7th socio,

economic group whose per capita income

was less than Rs. 50[- per year. Thus a reciprocal relation between socioeconomic

status and deficiency diseases has been

established.

Nutritional anthropomctry. Height, weight and head circumference were recorded in

all the children (Tables 6, 7 and 8).

Weight. The mean weight of urban boys and girls was higher than the mean weight of rural boTs and girls in all the age

groups (Table 6).

Height. Urban male and female stu-

dents were found to be taller than rural

male and female students. The average

height of girls was less than that of boys

upto 10 years of age. A sudden spurt of height at 10-12 years of age in female

students of both the areas was also noticed.

T a b l e 4. Percentage of nutritional deficiency disease in relation to dietary habits in rural areas.

Vegetarians

Nutrit ional Male Female Total disease

No. % No. % No. %

Vitamin de~ciencies

Anaemia

Total

80 25.98 72 17.56 152 21.17

12 3.69 6 1.46 18 2.50

92 29.87 78 19.02 170 23.67

Non-Vegetar ians

Male FemaIe Total

No. % No. % No.

8 5.55 7 5.07 15

3 2.08 1 0.73 4

l l 7,63 8 5.80 19

%

5.32

1.41

6.73

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~0~ INDIAN JOURNAL OF PEDIATRICS

T a b l e 6, Age, sex and average weight.

VoL. 44, No. 357

Age in years

Rural Students

Male

No.

Female

Mean weight in kg.

No.

6 40 15.50 60

7 62 17.55 68

8 100 19.4 36

9 54 21.00 60

I0 102 24.5 128

11 74 26.35 54

12 114 30.23 48

Urban Students

Male Female

Mean Mean Mean weight No. weight No. weight in kg. in kg. in kg.

14.67 74 17.14 66 17.14

17.50 60 20.39 56 17.64

18.76 50 22.50 40 19.21

19.67 94 24.53 80 21.18

22.30 112 25.~3 86 25.07

24.15 20 29.40 108 27.70

30.20 42 30.86 112 32.12

T a b l e 7. Age, sex and average height.

Age in years

Rulal Students Urban Students

Male Female Male Female

Mean Mean Mean No. height No. height No. height No.

in cm. in cm. in cm.

6 40 101.52 60 106.43 74 110.65 66

7 62 113.71 68 112.71 60 119.20 56

8 100 120.00 36 117.6(} 50 124.24 40

9 54 127s t,0 126.70 94 129.89 80

10 102 128.00 128 127.40 112 131.98 86

11 74 129.00 54. i29.50 20 139.90 108

12 114 136.00 48 138.00 42 145.00 112

h iean height

i n cn l ,

110.23

116.46

120.34

127.60

130.87

140.72

147.00

G U P T A AND S A X E N A ~ N U T R I T I O N A L STATUS OF S C H O O L C H I L D R E N 307

T a b l e 8. Age, sex and mean head circumf e,ence.

Rural Students Urban Students

Age in years Male Female Male Female

Mean head Mean head Mean head Mean head No. circumference No. circumference No. circumference No. circumference

in cm. in cm. in cm. in cm.

6 40 50.2 60 49.7 74 50.3 66 49.8

7 62 51.1 68 50.2 60 51.2 56 50.3

8 100 51.6 36 51.0 50 51.7 40 51.2

9 54 52.2 60 51.8 94 52.4 80 51.5

10 102 52.4 128 52.8 112 52.5 86 51.9

11 74 52.6 54 52.2 20 52.8 108 52.3

12 114 53.1 48 52.5 42 53.3 112 52.7

Head circumference. Urban students had a

bigger head circumference than their

counterparts in rural area.

Dietary habits. Our questionnaire revealed that the eating habits of the low socioeconomic rural and urban stu-

dents were almost the same. The staple

diet being cereals, pulses and green leafy

vegetables. However, qnantitative estima-

tion of the diets were not done. Most of

the students in both the areas were vegeta-

rians. Only a few non-vegetarians were

noted in the rural area who used to take

non-vegetarian diet about once in a month.

10% of urban students were non-vegetarian

and used to take non-vegetarian diet

approximately twice a week.

D i s c u s s i o n

In the present study 33% of rural and

18.5~/o of urban students were found to

be undernourished, with preponderance

amongst males in both the areas. Manifes-

tations of malnutri t ion included avitami- nosis, particularly vitamin A deficiency

which constituted the largest group. Anaemia was next in order of prevalence.

The vegetarian students had more nutri-

tional deficiencies than the non-vegetarian.

A direct correlation between nutritional

deficiency diseases and poor socioeconomic

status has been established in the study.

A comparative study of the incidence of

various deficiency diseases in different areas

was done. I t was clear that there is a

308 INDIAN JOURNAL OF PEDIATRICS VOL. 44, No. 357

variation in nutritional deficiency diseases in different areas of the country. I n the

present study nutritional status was poor in

rural students as compared to u rban stu- dents probably due to poverty, ignorance and non-availabil i ty of eatables.

School health surveys provide not only

an opportunity to make a health appraisa l of school children but provide ample data to throw light on the nutritional status of

school children and to have our own

standards.

Summary rlhe height and weight of two thousand

urban and rural school children of Bikaner District have been estimated. Clinical

features of nutritional deficiency were common in both the areas (33% rural and 18.5% urban). Urban girls and boys were taller and weighed more than their rural

compatriots.

R e f e r e n c e s

Gill, P .S , Prasad, B.G. and Shrivastava, R.N. (1968). Nutritional status of primary school children in rural area of Lucknow. Indian ft. Pdiatr. 35, 414.

Ishwarchandra and Marwah, S.N. (1967). Health survey of school children in rural and urban areas of Jabalpur, M.P. ft. Indian Med. Assoc. 49, 577.

Katha], N.D. Health Status of School Child. ren in Rural Area of Harsola, District Indore. A thesis for M.D. University of Indore.

Mukerjee, P.S. and Sen Gupta, S.K. (1960). Health Status of School Children in urban West

Bengal. Indian ft. P~b. Hlth. 4, 184. Mukerjee. P.S. and Sen, P.C. (1962). Health

status of school children in rural West Bengal. ft. Indian M d . Assoc. 38, 421.

Rao, B.R.H., Klontz: C.H., Benjamin, V., Rao, P.S., Begum, Almas and Qum, M.G. (1961). Nutrition and health status survey of school children in Kani- jumbad Valley, North Arcot District and in Vellore

Town. lndian ff. Pediatr. 211, 203. Shah, P.M. and Udani, P.M. (1968). Medical

examination of rural school children in Palghar Taluk. Indian Pediatr. 5, 343.