Nutritional Status of Children Attending First Year Primary School in Derna, Libya in 2007 Foad Al Magri*, Samia S. Aziz,** and Omar El Shourbagy,*
Abstract: Background: School-age children attempt to develop personal independence and establish a scale of values. Individual variations in children become more noticeable in such areas as rates of growth, activity patterns, nutrient requirements, personality development and food intakes. Malnutrition is one of the leading causes of disease. Globally, under nutrition is an underlying or associated cause in at least half of all childhood deaths. This makes prevention of under nutrition in children one of the top priorities in efforts to reduce childhood mortality. The effects of malnutrition on children are not limited to physical health, but extend to mental, social and spiritual wellbeing. Objectives: To assess the nutritional status among children attending first year primary school at Derna (2007). Methodology: The study was conducted between (15/7/2007 and 15/11/2007) which was the time for children to have the clinical examination and vaccination for school registration. The total number of children entered first year primary school in 2007 was 1765 (900 males and 865 females). The health records consist of three parts. Part 1, contains socio-demographic information about the child, and his/her parents. Part 2, contains the medical history of the child (congenital anomalies, diabetes, bronchial asthma, epilepsy, nocturnal enuresis, presence of parasites in stool, or any other health problems). Part 3 covers clinical examination of the child. The vaccination was checked. Clinical examination was done, including: height and weight using standard techniques and general examination of the body. Weight, height, and age data were used to calculate z-scores of the nutritional indicators in comparison to the newly published WHO growth curve. Data were analyzed using WHO Anthro 2005 software and SPSS version 13. Prevalence rates of underweight, wasting, stunting, and overweight were determined using standard definitions in reference to newly established WHO growth charts Results: Tables and figures of the study revealed that in boys, the mean value of weight was 21.3+3.3 k.gs, height was 115.7+5.4 cm, and BMI was 16.1+3.1. In girls, the mean value of weight was 20.6+3.4 kgs, height was 115.9+5.6 cm, and BMI was 15.6+3.5. Out of 1765 children, 320 (18.1%) were underweight, 57 (3.2%) were overweight and 24 (1.4 %) were obese. Out of 1765, 1364 (77.3%) had normal weight. Under nutrition was more likely to be found in males (19.6%) than in females (16.7%) (OR=1.22, CI=0.95-1.56). Overweight was found slightly more in males (3.3%) than in females (3.1%). Obesity was found in males (0.7%) and also the same rate in females (0.7%). Discussion: The aspects of school health service include health appraisal of school children and school personnel, remedial measures and follow-up, prevention of communicable diseases, healthful school environment, nutritional services, first aid and emergency care, mental health, dental health, eye health, health education, education of handicapped children, proper maintenance and use of school health records. The prevalence of obesity in some developing countries has reached even higher levels than in many industrialized nations. Stunting can coexist with underweight or with overweight/obesity. The WHO recommends that developing countries monitor the coexistence of stunting and overweight in children, because these are risk factors for chronic disease in adulthood. Derna was considered as a high prevalence area for underweight. Currently, using the newly published WHO standards, we found that 77.3 % of children had normal weight, 18.1 % were underweight, 3.2% overweight and 1.4 % obese. Conclusion: Further studies are needed to verify possible regional differences. Combined overweight and stunting is more likely to be associated with central obesity and its metabolic effects. Similar surveys are needed to verify trends of nutritional problems. Keywords: Children, Body Mass Index, Nutritional status, Anthropometry.
*) Pediatric and Community Dept. Derna Faculty of Medicine, Omar Almukhtar University, Libya. **) Medical Studies Dept. Institute of Postgraduate Childhood Studies, Ain Shams University, Egypt. 3
Sebha Medical Journal, Vol. 6(2), 2007.
Nutritional Status of Children …… Foad Al Magri, et al. Introduction: School-age children attempt to develop personal independence and establish a scale of values. Individual variations in children become more noticeable in such areas as rates of growth, activity patterns, nutrient requirements, personality development and food intake. Malnutrition is one of the leading causes of disease.1 Globally, Under nutrition is an underlying or associated cause in at least half of all childhood deaths. This makes prevention of under nutrition in children one of the top priorities in efforts to reduce childhood mortality.2 The effects of malnutrition on children are not limited to physical health, but extend to mental, social and spiritual well-being. The term malnutrition refers not only to deficiency states, but also to excess or imbalance in the intake of calories, proteins and/or other nutrients.3 Obesity is now considered by WHO as the biggest unrecognized public health problem. The prevalence of obesity in some developing countries has reached even higher levels than in many industrialized nations. Stunting can coexist with underweight or with overweight/obesity.4 The WHO recommends that developing countries monitor the coexistence of stunting and overweight in children, because these are risk factors for chronic disease in adulthood. Management of many chronic diseases that may develop due to the increased incidence of obesity would be beyond the capacity of many nations.5,6 Objectives: To assess the current health and nutritional status among children attending first year primary school at Derna (2007). Subjects and Methods: The study was conducted between (15/7/2007 and 15/11/2007) which was the time for children to have the clinical examination and vaccination for school registration. The total number of children entered first year primary school in 2007 was 1765 (900 males
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and 865 females). Their health records consisted of three parts. Part (1) contains socio-demographic information about the child, and his/her parents. Part (2) contains the medical history of the child (any congenital anomalies, diabetes, bronchial asthma, epilepsy, nocturnal enuresis, presence of parasites in stool, or any other health problems). Part (3) covers clinical examination of the child. The vaccination card was checked. Clinical examination was done including anthropometric measurement of height and weight using standard techniques and general examination and assessment of the body. Weight, height, and age data were used to calculate z-scores of the different nutritional indicators in comparison to the newly published WHO growth curve. Body Mass Index (BMI) is a number calculated from a child’s weight and height. BMI is a reliable indicator of body fatness for most children and teens. BMI does not measure body fat directly, but research has shown that BMI correlates to direct measures of body fat, such as underwater weighing and dual energy x-ray absorptiometry (DXA). BMI can be considered an alternative for direct measures of body fat. Additionally, BMI is an inexpensive and easy-to-perform method of screening for weight categories that may lead to health problems. For children and teens, BMI is age- and sexspecific, which is often referred to as BMI-forage. After BMI is calculated for children and teens, the BMI number is plotted on the BMIfor-age growth charts (for either girls or boys) to obtain a percentile ranking. Percentiles are the most commonly used indicator to assess the size and growth patterns of individual children. The percentile indicates the relative position of the child’s BMI number among children of the same sex and age. The growth charts show the weight status categories used with children and teens (underweight, healthy weight, at risk of overweight, and overweight). BMI-for-age weight status categories and the corresponding percentiles are shown in the following table.
Nutritional Status of Children …… Foad Al Magri, et al.
Weight Status Category Underweight Healthy weight At risk of overweight Overweight
Percentile Range Less than the 5th percentile 5th percentile to less than the 85th percentile 85th to less than the 95th percentile Equal to or greater than the 95 th percentile
Data were analyzed using WHO Anthro 2005 software (WHO, Geneva, Switzerland), and SPSS version 13. Prevalence rates of underweight, wasting, stunting, and overweight were determined using standard definitions in reference to newly established WHO growth charts.7
Results: Table (1) and figure (1) show anthropometric measurements of studied children (males and females). In boys, the mean value of weight was 21.3+3.3 k.gs, height was 115.7+5.4 cm, and BMI was 16.1+3.1. In girls, the mean value of weight was 20.6+3.4 k.gs, height was 115.9+5.6 cm, and BMI was 15.6+3.5.
Table (1): Anthropometric measurements of studied children (males and females) Anthropometric Measurement Weight/ kg Height/ cm BMI
Males Mean 21.3 115.7 16.1
+ SD 3.3 5.4 3.1
Mean 20.6 115.9 15.6
Females + SD 3.4 5.6 3.5
120 100 80
Weight/ kg
60
Height/ cm
40
BMI
20 0 MALES
Females Figure (1): Anthropometric measurements of studied children (males and females).
Table (2) and figure (2) show that 320 (18.1%) of children were underweight, 57 (3.2%) were overweight and 24 (1.4 %) were obese. Out of 1765, 1364 (77.3%) had normal weight. Under nutrition was more likely to be found in males
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(19.6%) than in females (16.7%) (OR=1.22, CI=0.95-1.56). Overweight was found slightly more in males (3.3%) than in females (3.1%). Obesity was found in males (0.7%) and also the same rate in females (0.7%).
Nutritional Status of Children …… Foad Al Magri, et al. Table (2): Nutritional status of studied children (males and females) Nut. Status Normal Underweight Overweight Obese Total
80
75.8
78.8
Males No. % 682 75.8 176 19.6 30 3.3 12 1.3 900 100
Females No. % 682 78.8 144 16.7 27 3.1 12 1.4 865 100
Total No. 1364 320 57 24 1765
% 77.3 18.1 3.2 1.4 100
77.3
70 60 50
Normal
40
Underweight
30 20
19.6
Overweight
16.7
18.1
Obese
10 0 MALES
FEMALES
TOTAL
Figure (2): Nutritional status of studied children (males and females) Discussion: The aspects of school health service include health appraisal of school children and school personnel, remedial measures and follow-up, prevention of communicable diseases, healthful school environment, nutritional services, first aid and emergency care, mental health, dental health, eye health, and health education, education of handicapped children, proper maintenance and use of school health records.8 Derna was considered as a high prevalence area for underweight. Currently, using the newly published WHO standards, we found that 320 (18.1%) of children were underweight, 57 (3.2%) were overweight and 24 (1.4 %) were obese. Out of 1765, 1364 (77.3%) had normal weight. Under nutrition was more likely to be found in males (19.6%) than in females (16.7%) (OR=1.22, CI=0.951.56). Overweight was found slightly more in males (3.3%) than in females (3.1%). Obesity was found in males (0.7%) and also the same rate in females (0.7%).
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Knowing the prevalence rates of underweight, wasting, and stunting is important for determining the overall health of the community and for monitoring achievements toward mid-decade goals for nutrition and child health set by international organizations.9 In a survey done in Libya, it was found that 70% of children had normal weight, 4.3% were underweight, 3.7% were wasted, 20.7% were stunted, and 16.2% were overweight. The 20.7% prevalence rate of stunting classifies the country as a moderate prevalence area rather than a low prevalence area. When the data were collected in 1995, almost half of the children in the disadvantaged parts of the world were underweight and/or moderately or severely stunted. In the same year, the average prevalence of overweight children in the developing countries, as revealed by weight for height in reference to NCHC/WHO standards, was 3.3% (0.1%-14.4%). In developing countries and marginalized groups in affluent societies, under nutrition is increasing as a result of the debt crisis and consequent economic adjustment policies.10,11
Nutritional Status of Children …… Foad Al Magri, et al.
The rapid growth of some economies and changes in lifestyle, including diet and physical activity patterns, contribute to other malnutrition problems.
References: 1. Ezzati M, Lopez AD, Rodgers A, Vander Hoorn S, Murray CJ. Selected major risk factors and global and regional burden of disease. Lancet 2002; 360:1347-60. 2. De Onis M, Blossner M, Borghi E, Frongillo EA, Morris R. Estimates of global prevalence of childhood underweight in 1990 and 2015. Jama 2004; 291:2600-6. 3. Caulfield E, de Onis M, Blossner M, Black E. Undernutrition as an underlying cause of child deaths. Am J Clin Nutr 2004; 80:1938. 4. Child Growth Standards. World Health Organization. [http://who.int/childgrowth]; 2006. 5. James PT, Leach R, Kalamara E, Shayeghi M. The worldwide obesity epidemic. Obes Res 2001; 9 Suppl 4:228S-233S. 6. Child Growth Standards. World Health Organization. [http://who.int/childgrowth]; 2006. 7. MGRS. Enrolment and baseline characteristics in the WHO Multicentre Growth
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Conclusion: Further studies are needed to verify possible regional differences. Combined overweight and stunting is more likely to be associated with central obesity and its metabolic effects. Similar surveys are needed to verify trends of nutritional problems.
Reference Study. Acta Paediatr Suppl 2006; 450:7-15. 8. Uauy R, Kain J. The epidemiological transition: need to incorporate obesity prevention into nutrition programmes. Public Health Nutr 2002; 5:223-9. 9. Hameida J, Billot L, Deschamps JP. Growth of preschool children in the Libyan Arab Jamahiriya: regional and sociodemographic differences. East Medirr Health J 2002; 8:458-69. 10. Arab Maternal and Child Health Survey. League of Arab States. The Pan Arab Project for Child Development (PAPChild). League of Arab States. Last accessed 28 august, 2007. 11. Sabei L and Abusnena O. Physical health status of children entering the first year primary school in Tripoli in 2004: The need for more strengthening. JMJ, Vol. 6, No.2 (2006): 107-111.
