RAJIVGANDHI UNIVERSITY OF HEALTH SCIENCES BANGALORE, KARNATAKA PROFORMA FOR REGISTRATION OF SUBJECT FOR DISSERTATION

1 / NAME OF THE CANDIDATE AND ADDRESS / MR. MALLAYYA 1ST YEAR M.Sc. NURSING,BHARTHI COLLEGE OF NURSING,4TH CROSS,K.R EXTENSION,TUMKUR-572101
2 / NAME OF THE INSTITUTION / BHARTHI COLLEGE OF NURSING,4TH CROSS, K.R EXTENSION,TUMKUR-572101
3 / COURSE OF THE STUDY AND SUBJECT / MASTER OF SCIENCES IN NURSING CHILD HEALTH NURSING.
4 / DATE OF ADMISSION TO THE COURSE / 06.08.2012
5 / TITTLE OF THE STUDY / GROWTH ASSESSMENT OF PRIMARY SCHOOL CHILDREN BASED ON BMI IN SELECTED RURAL SCHOOLS OF TUMKUR DISTRICT, KARNATAKA
5.1 / STATEMENT OF THE PROBLEM / “A CROSS SECTIONAL STUDY ON GROWTH ASSESSMENT OF PRIMARY SCHOOL CHILDREN BASED ON BMI IN SELECTED RURAL SCHOOLS OF TUMKUR DISTRICT, KARNATAKA.”

6.1INTRODUCTION

“There is hunger and surely already malnutrition.” - Christiane Berthiaume

Food, cloth and shelter are the basic component for leading the life. The first essential component of social justice is adequate food for all mankind. Food is the moral right of all who are born into this world. Providing good nutritious food to the child not only helps for the physical growth of the body and also helps in the intellectual, social and moral devolpment of the child. The period of growth and development extends throughout the life cycle; however, the period in which the principal changes occur is from conception to the end ofadolescence. As children grow older, they learn new things every day, start understanding and expressing things more clearly and do more complex and do more and more complex actions. All of this constitutes physical, mental and emotional growth of the child.1

Growthrefers to increase in the physical size of the body .it measure of physical maturities, signifies it’s an increase in size of the body and its various organs thus, it can measured in terms of centimeter (height) and kilograms (weight).2

Growth assessment is the single most useful tool for defining health and nutritional status at both the individual and population level. This is because disturbances in health and nutrition, regardless of their etiology, almost always affect growth. Growth monitoring strives to improve nutrition, reduce the risk of malnutrition, and produce early detection and referral for conditions manifested by growth disorders. At the population health level, cross-sectional study on growth assessment helps to define health and the nutritional status for purposes of program planning, implementation and evaluation. Growth monitoring is also used in all settings to assess the response to intervention.3

School age children are children in the age group of 6-12 years. Because of their rapid growth rate school age children requires proportionately more energy for each kilogram of body weight than the adults. A school age child requires 1690-2190 kcal of energy and 36-43 grams of protein per day on ICMR standard4.

A problem that arise deficiency in the intake of required calories and protein result in malnutrition and nutritional disorders in children.Malnutrition is more common in India. One in every three malnourished children in the world lives in India. About 50 per cent of all childhood deaths are attributed to malnourished In India.The prevalence of malnutrition varies across states, with Madhya Pradesh recording the highest rate (55%) and Kerala among the lowest (27%)In Karnataka state, 37.6% of children areunderweight, 28.1% of the population is undernourished and 5.5% of children who die under the age of 5 die from hunger.5.

BMI = weight (kg) / height (m) ²

Body Mass Index (BMI) is an anthropometricindex of weight and height that is defined as body weight in kilograms divided by height in meters squared.

Thebody mass index(BMI), orQuetelet index, is used for estimating humangrowthbased on an individual's weight and height. It was devised between 1830 and 1850 by theBelgianpolymathAdolphe Queteletduring the course of developing "social physics".Body mass index is defined as the individual's body mass divided by the square of his or her height. The formulae universally used in medicine produce aunit of measureof kg/m2. BMI can also be determined using a BMI chart.

BMI is the commonly accepted index for classifying adiposity in adults and it is recommended for use with children and adolescents. The Body Mass Index (BMI)-for-age charts for boys and girls aged 2 to 20 years are a majoraddition to the new Pediatric Growth Charts. For the first time there is a screening toolto assess risk of overweight and underweight in children and adolescents. For school-aged children (6 to 11 and 12 to 19 age groups), BMI-for-age was slightly better than weight-for-stature in predicting underweight and overweight.6

TheWHOregards a BMI of less than 18.5 as underweight and may indicatemalnutrition, aneating disorder, or other health problems, while a BMI greater than 25 is considered overweight and above 30 is consideredobese. These ranges of BMI values are valid only as statistical categories.7

BODY MASS INDEX TABLE
BMI / UNDER WEIGHT / NORMAL / OVERWEIGHT / OBESE
VALUE / >18.5 / 18.5-24.9 / 25.0-29.9 / <30

6.2NEED FOR THE STUDY

In 2011, UNICEF-WHO-The World Bank joint estimateschild malnutrition shows 165 million children under five years of age worldwide were stunted (i.e., low height-for-age), a decrease from an estimated 253 million similar children in 1990. High prevalence levels of stunting among children in Africa (36% in 2011) and Asia (27% in 2011) remain a public health problem.9

According the U.S global health policy data the prevalence of child malnutrition is about 16.2% and India is ranked 2nd in the world of the number of children suffering from malnutrition about 43.7%.10

Malnutrition is more common in India than in Sub-Saharan Africa. One in every three malnourished children in the world lives in India. About 50 per cent of all childhood deaths are attributed to malnutrition. In India, around 46 per cent of all children below the age of three are too small for their age, 47 per cent are underweight and at least 16 per cent are wasted. Many of these children are severely malnourished. The prevalence of malnutrition varies across states, with Madhya Pradesh recording the highest rate (55 per cent) and Kerala among the lowest (27 per cent).5

report by the Naandi Foundationbased on a survey of the height and weight of more than one lakh children across six States has found that as many as 42 per cent of under-fives are severely or moderately underweight and that 59 per cent of them suffer from moderate to severe stunting, meaning their height is much lower than the median height-for-age of the reference population.11

As per data provided by women and child welfare departmentKarnataka, Over 2,600 children under the age of 6 years have died of malnutrition in Raichur district of Karnataka of which 811 died in 2009 while the number went up to 1,233 in 2010. As many as 645 such deaths have been recorded till August 2011. Malnourishment among kids is so acute in Raichur - which is at the bottom of the 30 districts of the state in terms of human development index - that such deaths have become common to every household in the district. Malledevara Gudde, Nagada Dinne, Markam Dinne, Magol, Kydigera, Ganadhal and Jagirujagil Dinne villages are the worst affected.The Data also shows that 78,366 children are malnourished in the district, of which 639 are severely malnourished (grade III and grade IV).12

Cross sectional study was conducted to identifying the prevalence of malnutrition among 500 children of govt schools of Azad Nagar, Bangalore south Asia. The study was focused on children aged 8-14 years. Anthropometric data and eating practices of children were collected with the help of a pretested questionnaire and food intake diary. Their Body Mass Index (B.M.I) for age was calculated and compared with WHO (2007) standards. The prevalence of malnutrition was 68%, males recorded a relatively high rate of malnutrition 57.94% (197) than females 42.06% (143). The study reveals that the averages of govt school children in Azad Nagar are underweighted.13

Above stated data and statistics reveals that malnutrition is more common in pre-school and school going children than the other group of people and with past working experience in pediatrics ward and in my native district most of the children are suffered from malnutrition so I will take the above statement for my study.

6.3 REVIEW OF LITURATURE

A cross sectional study was undertaken inMedinipur District,west Bengal. Of 119children aged 2-13 years, 59 boys and 60 girls were studied. Height and weight measurements were made by standard Techniques .the results shows the overall prevalence of underweight, stunting and wasting was 52.9%, 49.6% and 22.7%, respectively. About 16.0%, 24.4% and 1.7% of children were found to be severely underweight, stunted and wasted. By considering the above data the authors concludes the nutritional status of children in West Bengal is critical. Appropriate measures should be taken by the respective authorities to improve childhood health and nutritional status.14

The study was carried out to determine physical growth of children aged 10 to 13 years. 139 students both boys and girls were selected from two villages of Dharwad taluk during 2008-09. The results revealed that the mean height andweight of rural boys and girls were significantly below NCHS (50th percentile) and ICMR standards. In case of boys and girls, Greater gain in height was observed between 10-11 years as compared to 11-12 and 12-13 years and greater gain in weight was observed between 12-13 years as compared to 10-11 and 11-12 years. Further, age was significantly and positively relatedto height, weight and chest circumference at 0.01 levels.15

A cross-sectional study was undertaken on 135 Jenukuruba tribal children belonging to 6+ to 10+ age group through purposive sampling method. Anthropometric measurements and Clinical observation techniques were used to analyze the nutritional status. Assessment of nutritional status using WHO recommended anthropometric indicator and Z-score interpretation revealed, high prevalence of mild (41.5%) and severe (6.7%) stunting, more prevalence of mild (40%) and severe (3.7%) in wasting, and underweight was 45.2% moderate and 14.8% severity. The BMI value shows 69.6% were CED-III and only 2.2% were CED-I. Clinical assessment shows high prevalence of lack of luster and sparseness in hair, conjunctiva xerosis in eyes, angularstomatities in lips, scarlet and raw tongue, and dental flurosis in teeth and scabies in skin. Most of the children are mesomorphic in physical appearance.16

The cross sectional study was carried out on 4457 primary school going children to investigate the physical growth as well asnutritional status of Darjeeling and Jalpaiguri districts of West Bengal. Standard anthropometric methodswere applied to measure the height and weight of the children. The children were randomly selectedour study shows that average height of the girls was more than theboys. From the view of weight for age, nutritional status shows poorer when it was compared with the nutritional status fromthe light of height for age as per Waterlow’s classification. The weight of children was not increasing with the advancement ofage. Physical growth as well as nutritional status of boys was affected more than the girls. Children of higher age group weremore affected nutritionally. 17

A cross-sectional study was conducted to assess nutritional status in school-age slum children and analyze factors associated with malnutrition with the help of a pre-designed and pre-tested questionnaire, anthropometric measurements and clinical in urban slums of Bareilly, Uttar-Pradesh (UP), India. The result shows mean height and weight of boys and girls in the study group was lower than the CDC 2000 standards. Regarding nutritional status, prevalence of stunting and underweight was highest in age group 11 yrs to 13 yrs whereas prevalence of wasting was highest in age group 5 yrs to 7 yrs. The risk of malnutrition was significantly higher among children living in joint families, and less educated mother. The author suggests taking community based intervention against malnutrition and growthmonitoring.18

Study was conducted to assess the nutritional status of school aged children (6-17 years) in Makurdi, capital of Benue State-Nigeria. Compared to NCHS/WHO standard, mean BMI (body mass index) of school children in Makurdi was inferior at all ages. The prevalence rate of under nutrition was (50.66%) and schools located in the slum parts of Makurdi (C.A.C wadata and L.G.E.A Wurukum) recorded the highest rate of under nutrition with (78.33%) and (73.33%) respectively. Males recorded a relatively high rate of under nutrition 162 (57.44%) than females 142 (44.65%). The study reveals that the average of school child in Makurdi is undernourished. Poor nutrition of children do not only affects the cognitive development of children but also likely to reduce the work capacity in future.19

This study was conducted to assess the growth and nutritional status of school age children (6-14 years) of teagarden workers of Assam. Compared to NCHS standard and affluent Indian children, the mean height and weight of tea gardenchildren was inferior at all ages. Assessment of nutritional status using WHO recommended anthropometric indicators revealed ahigh prevalence of malnutrition among tea garden school age children and malnutrition was both chronic and recent in nature. Prevalence of wasting, stunting and underweight was 21.2%, 47.4% and 51.7% respectively among the children in the age groupof 6-8 years. Prevalence of stunting and thinness was 53.6% and 53.9% respectively among the children in the age group of 9-14years age group.20

A study was conducted to assess the nutritional healthstatus of primary school children of rural and urban areas, byassessing their clinical health status and the quantity and quality offood intake by the children in both the areas of study. Four hundredchildren of 7-9 years of age were selected from the rural and urbanareas of Bareilly district. They were assessed for nutritional healthStatus by applying Clinical Nutrition Survey Chart; 24-hr recall methodand Food Frequency Questionnaire. The nutritional deficiency signsand symptoms were observed more in rural children than the urbanchildren. Nutrient intake and consumption frequency of the entire 6 foodgroup was more among the urban children compared to their ruralcounterparts.21

6.4 STATEMENT OF THE PROBLEM.

“A cross sectional study on growth assessmentofprimary school children based on BMI inselected rural schools of Tumkur district, Karnataka.”

6.5 OBJECTIVE OF THE STUDY.

  1. To assess the growth of school children based on Body mass index
  2. To compare the body mass index of primary school children with international standard (CDC 2000)
  3. To find out the association between BMI value with selected socio-demographic variables of primary school children.

6.6 HYPOTHESIS:

H0: There is no significant difference between BMI values of children with international standards

H1:There will be a significant difference between BMI values of children with international standards

H2: There will be a significant difference in BMI values of children’s with their demographic variables

6.7 ASSUMPTION.

  1. School going children have different BMI value as compared with international standards.
  2. Comparatively there is a poor growth or malnourishment in the government school children.
  3. Assessment of growth status indicates the health status of the child.

6.8 OPERATIONAL DEFNITION.

Growth:Growth refers to increase in the physical size of the body .it measure of physical maturities, signifies it’s an increase in size of the body and its various organs thus, it can measured in terms of centimeter (height) and kilograms (weight).

Assessment:It refers to standardized measurement of growth of the school going children

School going children: The children are those who are studying in the primary school children and falls in the age between 6 to 10years.

BMI (body mass index): It refers to the tool used in this study for growth assessment in terms of weight/height in meter square

6.9 CRITERIA FOR SELECTION OF SAMPLE.

INCLUSIVE CRITERIA:

  1. School going children between the age of 6-10years in rural areas.
  2. Student presented in school at the time of study
  3. Parents those who are agree to participate their children in this study.

EXCLUSIVE CRITERIA:

  1. Student who are suffering from congenital abnormalities and chronic illness
  2. School children who are below 6 year and above 10years of age group.
  3. Parents those who are not agree to participate their children in this study.

6.10 LIMITATION OF THE STUDY.

  1. Study is limited to primary school children (300 samples)of the selected rural schools of Tumkur district
  2. Study period limited to 4-6 weeks.

7. MATERIAL AND METHOD OF THE STUDY.

7.1 SOURCES OF DATA COLLECTION.

The data will be collected from the school going children in selected rural schools of Tumkur district.

7.2 METHOD OF COLLECTING DATA.

7.2.1 Research approach:

Descriptive Research

7.2.2 Research design:

Cross-sectional design

7.2.3 RESEARCH SETTING:

Study will be conducted at rural primary schools of Tumkur district

7.2.4 POPULATION:

Population of the study comprise of school going children.

7.2.5 SAMPLE SIZE:

The sample size of the study consists of 300 school going children in selected rural schools of Tumkur district.

7.2.6 SAMPLE TECHNIQUE:

Purposive sampling technique will be used to select the sample.

7.2.7 COLLECTION OF DATA:

Data will collect from sample by using check list

7.2.8 RESEARCH VARIABLES:

Research variables are growth assessment and BMI

8. DATA ANALYSIS METHOD:

The data analysis planned for the descriptive statistics and inferential statistics. The descriptive statistics plan to use in data analysis are the percentage, mean and standard deviation and inferential statistics are paired‘t’ test and chi square test

9. PILOT STUDY.

10% of the total population

10. ETHICAL COSIDERATION.

  1. Has ethical clearance being obtained from your college?

Yes… Ethical clearance will be obtained at the time of study.

  1. Has the consent been taken from the respondent?

Yes… Informed consent will be taken from respondents.

11. LIST OF REFERENCES.

  1. Marlow R Dorothy. Redding A Barbara. Text book of pediatric nursing, 6th edition

WB Saunders Company. New Delhi. Page no-163.

  1. B.T.Basavantappa, community health nursing second edition, jaypee brother’s medical publishers (P) ltd. Page No-539
  2. Canadian Paediatric Society, Use of growth charts for assessing and monitoring growth in Canadian infants and children: Executive summary, Paediatric Child Health.2004 March;9(3): 171–173.
  3. K.Park, Preventive and social medicine, JabalpurJ.P.Publications,M/S banarsidas Bhanot18th edition, January 2005.page no-585
  4. Using the BMI for age growth chart cited on
  5. En.wikipedia.org/wiki/body_mass_index
  6. K.Park, Preventive and social medicine, Jabalpur J.P.Publications,M/S banarsidas Bhanot18th edition, January 2005.page no-483 and 506
  7. Information sheet -UNICEF-WHO-The World Bank joint child malnutrition estimates. Available on

10.U.S global health policy, Prevalence of Child Malnutrition (Percent Underweight under Age Five) 2005-2011.Available on

11.42 per cent of Indian children are underweight The Hindu, news/national new Delhi-January 10-2012 cited on

  1. Karnataka: Gold mine town Raichur tops malnutrition death chart cited on indiatoday.intoday.in/story/malnutrition-death-in-karnataka-kids-die/1/153489.html

13.Izhar Hasan,A Study of prevalence of malnutrition in government School children in the field area of Azad nagar Bangalore, India

  1. Samiran Bisai, Chhanda Mallick, Prevalence of under nutrition among Kora-Mudi childrenaged 2-13 years in Paschim Medinipur District, West Bengal, India World J Pediatric, and Vol 7 No 1. February 15, 2011
  2. Saraswati c. Hunshal, Lata pujar and Netravati, Physical growth status of school going children-Karnataka J. Agric. Sci.,23 (4) : (625-627) 2010
  3. S.C. Jai Prabhakar and M.R. Gangadhar, Nutritional Status of Jenukuruba Tribal Children in Mysore District, Karnataka Anthropologist, 11(2): 83-88 (2009)
  4. Prabir Kumar Manna, Debasis De, Tushar Kanti Bera, Anthropometric Assessment of Physical Growth and Nutritional Status among School Children of North Bengal Anthropologist, 13(4): 299-305 (2011)
  5. Anurag Srivastava,Syed E Mahmood,Payal M Srivastava, Nutritional status of school-age children - A scenario of urban slums in India.Arch Public Health.2012;70(1): 8.
  6. Amuta, Elizabeth Une, Houmsou and Robert Soumay, 2009. Assessment of Nutritional Status of School Children in Makurdi, Benue State. Pakistan Journal of Nutrition, 8: 691-694.
  7. G.K.Medhi, A. Barua2 and J.Mahanta, Growth and Nutritional Status of School Age Children (6-14 Years) of Tea Garden Worker of Assam, J. Hum. Ecol., 19(2): 83-85 (2006)
  8. Mehrotra Monika, Arora santosh, and Nagar veenu, Nutritional Health Status of Primary School Children A study in Bareilly District, Indian Educational Review, Vol. 48, No.1, January 2011

11. SIGNATURE OF THE CANDIDATE: