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Nutritional Status of Tribal Children and Adolescents in Rural South India: The Effect of an NGO Delivered Nutritional Programme

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Abstract

To investigate the prevalence of malnutrition using anthropometric measures in a cohort of tribal students attending a school in rural south India. Children attending the school were offered three meals a day during attendance. Analysis of anthropometric data obtained aimed to determine the nutritional effect of the food provided. The nutritional status of 409 students were assessed by comparing anthropometric measurements to reference values according to WHO/NCHS guidelines. Height for age <3rd percentile was defined as stunting. BMI for age <5th percentile was defined as thinness. 'New' students were defined as attending the school for <1 y. 'Old' students were defined as being in attendance for ≥1 y. Comparison of thinness and stunting prevalence in these groups enabled evaluation of the meals provided by the organisation. Four hundred and nine students were included for analysis in the study. The prevalence of thinness was 39.4 %. 59.5 % of 'new' and 52.9 % of 'old' students at the school demonstrated thinness. 59.4 % of students were classified as stunted. 73.8 % of 'new' students and 52.9 % of 'old' students demonstrated stunting (p 0.091). Significantly (p 0.010) more 'new' female students had stunted growth. Acute and chronic measures of malnutrition were high amongst adolescent students attending the school. Comparison of 'new' and 'old' adolescent pupils at the school hints that the 'old' students were less malnourished than their 'new' counterparts. This study demonstrates the importance for NGOs to develop their nutritional programmes with a special focus on adolescents.

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... This is similar with the report of Thomas. R.et al., [26], which explains that cafeteria system and availability of junk food may compromise the health of adolescents. Most of the parents in the study were civil servants, farmers, or self-employed, so they had money to give their children to eat at school. ...
... This agrees with the study of Thomas. R.et al., [26] which stated the increase income may lead to increase in food accessibility. Socio-economic background of parents, lack of time to prepare food, tiredness from school, culture, and availability of food were the factors influencing the feeding habits of adolescents in the study. ...
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The study has assessed the feeding habits and nutritional status of adolescents in Bamenda II Municipality. Multi-stage sampling technique was used to select four private non boarding secondary schools in Bamenda II Municipality. Systematic sampling was used to select the respondents from form one to lower-sixth and consent forms were signed. Structured Original Research Article Ange et al.; Asian Food Sci. 59 questionnaires were administered to 200 adolescents (11-19years). Dietary assessments were also carried out using food frequency questionnaires and 24hr dietary recall. The weight and height of students were taken to determine their body mass indices. The weights and heights of both sexes were taken and the readings were analyzed using standard deviation scores where > median-2SD to + < 1SD= Normal, Median<-2SD to >-3SD = moderate of under nutrition, < Median-3SD = severe under nutrition, + 1SD to < + 3SD= overweight, and greater than + 3SD = obesity. Using BMI-for age boys/girls (Z-score) for assessing nutritional status of adolescents in this study, majority of them were within the normal range. Few were underweight, overweight and obese. For age group 11-14 years, 83.3 % were normal, 16.7% were obese, and 0% for underweight and overweight. For age group 15-17 years, 22.7 % were normal ,25.9 % were obese, 23.5% were under weight and 28.2% were overweight A significant difference (p<0.05) was observed between males and females(15-17 years). For age group 18 and 19 years, 40% were normal ,0 % were obese,14.1 % were under weight and 32.9 % were overweight. A significant difference (X 2 =8.0, d,f=3, p=0.040) was observed between males and females(18 and 19 years) .With respect to waist circumference, a percentage of the respondents fell within the normal range. for males and females. The respondents generally ate twice a day. Forty-one (41%) of the respondents said they consume tubers twice a week, 31.5% consume cereals and their products more than four times a week, 12.5% consume pulses, legumes and products twice a week, 32.5% consume animal products once a week, 36.5% consume eggs and dairy products twice a week and 25% consume fruits and vegetables twice a week. The 24hr dietary recall revealed that the diets were monotonous. Peer group influence affects their food choices, feeding habits and nutritional status.
... Among the publications that include an intervention component, supplementation was the most prevalent type of intervention, using food fortification in six publications and capsules in five. In addition, there was one school feeding program which provided daily balanced meals to a cohort of tribal students attending a school in rural south India (37) .The authors of this publication classified the students according to attendance: 'new' students less than 1 year and 'old' students more than 1 year of attendance. Comparison of thinness prevalence in these groups showed that 50% of 'new' and 37·5% of 'old' students were thin; however, the difference was not significantly different between the two groups. ...
... Recommendations from these publications can be inferred. The authors of the school feeding program (37) suggested that noting the exact length of attendance time to the program and quantifying meal intake by each student could be key to examining more accurately the nutritional benefits of school meals and developing detailed nutritional school programs. Recommendations resulting from the supplementation programs highlighted the need to explore long-term efficacy, dose and intake frequency of supplements to enhance adolescent micronutrient status. ...
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Undernutrition is a growing public health challenge affecting growth and development during adolescence in many low- and middle-income countries. This scoping review maps the evidence on adolescent undernutrition (stunting, thinness and micronutrient deficiencies) in South Asia and highlights gaps in knowledge. Using Arksey and O’Malley’s framework and the Joanna Briggs Institute Reviewers’ Manual, the search included electronic bibliographic databases (Medline (OVID), Embase, Cochrane Library, Web of Science, CINAHL, PsycInfo, and Scopus) as well as various grey literature sources published up to March 2019. In total, 131 publications met the inclusion criteria of this review. All the included evidence used quantitative data and 115 publications used a cross-sectional design. Nearly 70% (n=86) of the included publications were conducted in India. Prevalence of undernutrition was reported based on different growth references and cut-offs. Evidence is divided into publications that included an intervention component (n=12) and publications that did not include an intervention component (n=116), and presented in a narrative synthesis. This scoping review provides a wide range of publications on adolescent undernutrition in South Asia and identifies future research priorities in the field.
... In Asia the predominant predictor for pre-school and school-going underweight children is low birth weight babies. There are about 60 million underweight children in India with more percentage of them based in rural areas 6 . Prolonged chronic infections and an imbalance between nutritional consumption and work load are its prime determinants 7 . ...
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Objective: To determine the frequency of underweight and socio-demographic factors associated with it among school going children. Methods: A cross-sectional study with convenient sampling technique was carried out at Shalamar Medical and Dental College. Children from public and private schools of Lahore, were included in the study. Assent was taken from the participants after the consent was granted from their parents. Data was recorded on a questionnaire. Body weight and height were recorded and Body Mass Index (BMI) calculated. Children were classified as underweight and normal weight according to BMI. Student "t" test, "One way ANOVA" and "Chi-square" tests were applied to analyze the data through SPSS version 21. Results: The mean age of the participants was 12 years, 17% of school children were found to be underweight. Among underweight children, 74% belonged to middle and 20% to low socioeconomic class, and 50% had illiterate parents. There was significantly greater prevalence of underweight among girls (78%) than boys. Children belonging to pre-adolescent age group (6-11 years), low socioeconomic status, taking 1-2 meals per day, having illiterate parents and sleeping for >10 hours per day had significantly (p<0.05) less BMI were underweight. Significant association was also observed with age, gender, parent's education, and sleeping hours in underweight school children. Conclusion: Frequency of underweight school children in Lahore was 17%. Female sex, parent's education, and more sleeping hours were significantly associated with underweight.
... Studies conducted in other developing countries showed that NGOs could provide structural services such as building hospitals and providing medical equipment (15, [28][29][30]. Other evidence showed that NGOs could improve and promote the health of their communities through the establishment of primary healthcare centers, providing laboratory services, training community health workers to screen for and manage chronic hypertension, providing maternal and new-born health services, providing medical services for children with cancers, providing mental health services through community-based rehabilitation, prevention and treatment groups received growth monitoring, referrals to public health facilities, home-based counseling, and providing mid-day meals for primary school students and adolescents (31)(32)(33)(34)(35)(36)(37)(38)(39)(40). In many countries, the poor still have limited access to primary healthcare, and NGOs can increase access to health services because of their ability to design populationbased projects. ...
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Background Delivering essential health services through non-governmental organizations (NGOs) could facilitate moving toward universal health coverage (UHC), especially in low- and middle-income countries. This study investigates the viewpoints of Iranian health system experts and executive stakeholders on the role of NGOs in moving toward UHC. Method We conducted 33 semi-structured interviews with health policymakers, NGO representatives at the national and provincial level, and other key informants and analyzed using content analyses methods, using MAXQDA 12. The inductive-deductive approach was used for qualitative data analyses. Result Based on the thematic analysis of interviews and document reviews, nine main themes and one hundred and five sub-themes were identified. Each theme was categorized based on NGO-, society-, and government-related factors. Conclusion Recognizing the critical role of NGOs and their contribution in moving toward UHC is essential, particularly in the local context. Collaboration between NGO stakeholders and the government could facilitate moving toward UHC.
... For example, it was shown that the decision-making, organisational vision, mission and strategy, skills and abilities of NGOs staff positively affect NGOs' productivity in providing health services [28,31,103,104]. NGOs have improved and promoted the health of their communities through the establishment of primary health centres, laboratory service, training community health workers to screen for and manage chronic hypertension, providing maternal and newborn health services, providing medical services for children with cancers, providing mental health services through community-based rehabilitation, prevention and treatment groups received growth monitoring, referrals to public health facilities, home-based counselling and providing mid-day meals for primary school students and adolescents [34,51,70,71,74,91,93,95,96,99]. For example, in Bangladesh, NGOs provided clinical education, vaccination, reproductive health (antenatal and postnatal care, skilled birth attendance, breastfeeding prevalence, contraceptive prevalence, sexually transmitted [29,35,36,47]. ...
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Background Developing essential health services through non-governmental organisations (NGOs) is an important strategy for progressing towards Universal Health Coverage (UHC), especially in low- and middle-income countries. It is crucial to understand NGOs’ role in reaching UHC and the best way to engage them. Objective This study reviewed the role of NGOs and their engagement strategies in progress toward UHC. Method We systematically reviewed studies from five databases (PubMed, Web of Science (ISI), ProQuest, EMBASE and Scopus) that investigated NGOs interventions in public health-related activities. The quality of the selected studies was assessed using the mixed methods appraisal tool. PRISMA reporting guidelines were followed. Findings Seventy-eight studies met the eligibility criteria. NGOs main activities related to service and population coverage and used different strategies to progress towards UHC. To ensure services coverage, NGOs provided adequate and competent human resources, necessary health equipment and facilities, and provided public health and health care services strategies. To achieve population coverage, they provided services to vulnerable groups through community participation. Most studies were conducted in middle-income countries. Overall, the quality of the reported evidence was good. The main funding sources of NGOs were self-financing and grants from the government, international organisations, and donors. Conclusion NGOs can play a significant role in the country’s progress towards UHC along with the government and other key health players. The government should use strategies and interventions in supporting NGOs, accelerating their movement toward UHC.
... Incidence of thinness was higher among boys (59.5%) than girls (41.3%) counterparts (Medhi, Hazarika, & Mahanta, 2007). A research done to examine the commonness of malnutrition using anthropometric methods in tribal students appearing a school in rural south India proved that 59.4% students were stunted (Thomas, Srinivasan, & Sudarshan, 2013). A study found out that in rural Goa among adolescents (10-19 years) found out that 37.8% boys and 27.5% girls who joined the health camps were malnourished. ...
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Background. Malnutrition is a major health problem in India. It mostly affects children of school going age with serious health problems putting them at an increased risk for developing chronic diseases later in life. This study aims to study the prevalence of malnutrition (overweight and underweight) in children aged 10-13 years in schools in Manipal and Utopia, Karnataka. Materials and Methods. In this study, a total 400 students were studied. Their anthropometric measurements like height, weight, BMI and MUAC, dietary pattern, physical activity level, and child eating behavior. Questionnaire was used to note the student’s information. The data collected was subjected to statistical analysis using SPSS version 21, Diet Cal, and Anthroplus1.0.4. Results. It was observed that in the childhood category 10-13 years there were 222 (55.5%) male and 178(44.5%) female. According to the BMI for age 53.4% of them falls under the normal category; 22.3% falls under the mild wasting category; About 18.3% falls under the obese category and 8% falls under the moderate wasting category. There is no students falling under the severe wasting and overweight category according to the BAZ classification. When the height for age was done for all the children, about 36.3% falls under normal height; About 35.5% falls under mild stunting; 19.3% falls under the moderate stunting; 8.3% falls under the severe stunting category; and 1% falls under tall category according to the HAZ classification. Conclusions. In conclusion, mild stunting and wasting was observed among children. There are no students falling under the severe wasting and overweight category according to the BAZ classification.
... Prevalence of overweight is slightly higher in Chakma tribal girls than Bengal girls. From earlier papers it is established and widely accepted that in India a majority of children and adolescent of tribal community suffer from malnutrition (Khongsdier and Mukherjee2003;Chakraborty et al. 2008;Thomas et al. 2013;Basu et al. 2014;Mondol 2014;Sukhdas et al. 2014). The recent investigation showed that, the nutritional status of Chakma tribal girls is slightly worse or weak than the Tripuri and Sonowal Kachari children of Tripura (Sil et al. 2011) and Assam (Singh and Mondal 2013) respectively but is better than that of other tribal children of northeast India (Gaur and Singh 1995;Khongsdier and Mukherjee 2003;Singh and Sengupta 2007;Mondol 2014;Sukhdas et al. 2014). ...
... Prevalence of thinness and overweight are slightly higher in girls than in boys. From earlier papers it is established and widely accepted that in India a majority of children and adolescent of tribal community in India suffer from malnutrition (Khongsdier 2003;Chakraborty et al. 2008;Thomas et al. 2013;Basu et al. 2014;Mondol 2014;Sukhdas et al. 2014). The recent investigation showed that, the nutritional status of Chakma children is slightly worse or week than the Tripuri and Sonowal Kachari children of Tripura (Sil 2011) and Assam (Singh and Mondal 2013) respectively but is better than that of other tribal children of northeast India (Gaur 1995;Khongsdier 2003;Singh and Sengupta 2007;Mondol 2014;Sukhdas et al. 2014). ...
Article
The present cross-sectional data was collected on 710 Chakma tribal children (539 boys and 513 girls) aged 6 to 16 years from North District of Tripura. This study was conducted to determine the physical growth and the nutritional status of randomly selected school going Chakma children of Tripura. The nutritional status in terms of stunting (Height >3 rd percentile), thinness (BMI> 5 th percentile) and overweight (BMI< 85 th percentile) were measured by the classification of World Health Organization, using the WHO growth reference data of 2007. Socioeconomic status was measured using the updated Kuppusswami scale. The overall prevalence of stunting, thinness and overweight were found 38.31 percent, 10.56 percent and 2.68 percent respectively. It wa s also noticed that prevalence of undernutrition is slightly greater in boys than girls. This study indicated that both under nutrition and over nutrition coexisted among the Chakma tribal children of Tripura, although the number of overweight children is negligible.
... The National Nutrition Monitoring Bureau (NNMB) (2012) reported that among children under five from the tribes, 54% were underweight, 54% were stunted, and 29% were wasted. Further, literature suggests that the prevalence of thinness among tribal adolescents ranged from 38% to 81% (Dhingra 2011;Maiti, Ghosh, and Paul 2012;Sarkar et al. 2012;Thomas, Srinivasan, and Sudarshan 2013). Besides thinness, anemia is an issue of public health concern. ...
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We examined the influence of nutritional status, body fat, and anemia on the physical fitness (PFI) of tribal adolescents. Weight, height, skinfold thickness, PFI, and hemoglobin levels of 147 adolescents (11 to 16 years) were measured. The experience of cycling was recorded. Overall, 31.3% were mildly, 12.9% were moderately, and 10.9% were severely thin. The majority (81.6%) were nonanemic. All had “poor” PFI scores. Hemoglobin levels were significantly associated with PFI scores in boys and girls. Experience of cycling also predicted PFI in girls. Nutritional status, hemoglobin level, and physical activity were associated with the fitness levels of these adolescents.
... The nutritional status of tribal children in India was explored on nationwide studies conducted by National Nutrition Monitoring Bureau (NNMB), National Family Health Surveys (NFHS) and also in some tribe specific studies [5][6][7][8][9]. The NNMB in its first repeat survey has reported the prevalence of 96 % underweight among tribal children studied [10] and as per India's National Family Health Surveys-3, 54.3 % of tribal children were underweight [6]. ...
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To find out the magnitude and epidemiological determinants of malnutrition among 0-6 y tribal children. A community based cross sectional study was done in the villages of Melghat in central India. The information of 540 children in the age group 0-6 y was collected. The newly developed WHO growth standards were used to calculate conventional indices of malnutrition (underweight, stunting and wasting) and composite index of anthropometric failure (CIAF). Univariate and multiple logistic regression analysis were used to find out the correlates of malnutrition. The prevalence of malnutrition among these tribal children in terms of underweight, stunting, and wasting were 60.9 %, 66.4 % and 18.8 % respectively. Malnutrition in terms of composite index of anthropometric failure (CIAF) was 76.3 %. The important correlates of malnutrition that emerged out of this study were the age of child, age of mother less than 20 y at her first pregnancy, practice of not feeding colostrum, calorie deficit diet, anemia and morbidities like diarrhea and acute respiratory illnesses. The prevalence of malnutrition was high in tribal children. The health care delivery at village level should be strengthened for early diagnosis and prompt treatment of anemia and other morbidities in children. The strategies are needed to delay the child bearing age in this community and improve breast feeding practices.
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Starting from an analysis of the health care levels in Indian scenario, the research project “Healthcare for All” developed a meta-project that considers all the current criticisms and the Indian customs through a flexible layout that responds to the healthcare needs of population of West Bengal. The innovation of the research work is to develop a design solution that considers hygienic aspects, hospital design and distribution issues, with the sub-division of paths. The choice of low cost and local technologies permits to promote the usage of natural materials, their maintenance and skills for creating a virtuous economic system.
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Nutritional status is the best indicator of the global well-being of children. In India every third child is underweight, whereas in the Garhwal Himalayas only one-fifth of the children are nutritionally normal. Information regarding the causes of such low nutritional status in children of Garhwal is lacking. The present study was designed to identify factors that may influence the nutritional status of the children of the Garhwal Himalayas. Stunting, signifying long-term irreversible chronic undernutrition, was studied, along with wasting, which signifies acute undernutrition among children. Forty families from one town and one village in each of the three major agroclimatic situations (high, middle, and low hills) were selected at random (total 240 families). The nutritional status of 353 children (0 to 12 years of age) was assessed by nutritional anthropometry and compared with tables of weight-for-age and height-for-age z-scores (WAZ and HAZ) identifying wasting and stunting, respectively, and compared with the World Health Organization (WHO) Growth Reference charts 2007. Chi-square test was applied to analyze the effects of age, sex, altitude, and area on the nutritional status of children. Of the 353 children studied, 38.2% belonged to the school-aged group, with 7% more girls than boys. Only 11.3% of the children had normal HAZ while 10.3% had normal WAZ. The largest percentages of children (31.8% HAZ and 29.1% WAZ) were clustered in the SD1 group, that is the severely stunted or wasted group. In every age group except the 9- to 12-year group, most of the children were found in the WAZ SD1 category. Gender appeared to influence the SD1 category significantly. There were 17.0% severely stunted girls (SD1), as compared to 14.8% boys; while the percentages of WAZ girls was 16.1% and boys was 13%. The situation in the urban areas was slightly better: 6.4% of the sample had normal HAZ and 7.1% had normal WAZ, compared with 4.4% and 4.6% of the rural children. In all three agroclimatic situations, the largest percentage of children fell in the HAZ SD1 (stunted) category (15.3% in the high hills, 7.3% in the middle hills, and 9.5% in the low hills). There is a significant effect of area (rural vs. urban) on stunting and wasting among children. The child's sex affects stunting only. The other two variables, altitude and age, do not show a significant relationship with stunting or wasting. The rate of malnutrition among children in the Garhwal is very high. The majority are severely stunted and wasted, indicating a high prevalence of both chronic and acute malnutrition. Only the area of residence (rural or urban) had an influence on a child's nutritional status.
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To study the current diet and nutritional status of rural adolescents in India. Cross-sectional study with household as the unit of randomization. National Nutrition Monitoring Bureau collected information in the rural areas of the nine States. In each State, 120 villages were selected from eight districts. From each of the selected villages, 20 households (HHs) were selected from five clusters. The information on socio-demographic profile was collected in all the 20 HHs, while anthropometric data such as weight, height and clinical signs of nutritional deficiency was collected on all the available adolescents in the selected households. In every fourth sampled household, ie five HHs, dietary information on all the members was collected using 24 h dietary recall. The outcome measures for nutritional status were proportion of underweight (<median -2 s.d. of NCHS standards of weight for age), stunted (<median -2 s.d. of NCHS standards of height for age) and body mass index. The nutrient intakes were compared with recommended dietary allowances (RDA). Anthropometric and socio-economic information on 12 124 adolescent boys and girls and dietary information on 2579 individuals in 1996-1997 was available for the analysis. The major occupation of the heads of the households surveyed was agriculture. More than a third (37.3%) of the families with adolescents did not possess any land. The per capita income per month was about Rs 250/- at 1996-1997 prices. About 23% of the adolescent girls were married before the age of 18 y. About a quarter of the married adolescent girls had short stature and 18.6% were underweight. They considered as 'at risk'. About 39% of the adolescents were stunted (<Median -2 s.d. of NCHS height for age) irrespective of sex. The prevalence of undernutrition (<median -2 s.d. of NCHS weight for age) is higher (53.1%) in boys than in girls (39.5%). The extent of stunting was higher (42.7%) among adolescents belonging to the scheduled caste community. In the case of girls, the extent of underweight was considerably less in each age group than their male counterparts. About 70% of adolescents consumed more than 70% of RDA for energy. The intakes of micronutrients such as vitamin A and riboflavin were woefully inadequate. The extent of undernutrition was high among adolescents and was higher among boys than girls. Adolescent girls in the rural areas could be at greater risk of nutritional stress because of early marriage and early conception before completion of their physical growth.
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Tribal population constitutes about 8% of the total population in India. They are particularly vulnerable to undernutrition, because of their geographical isolation, socio-economic disadvantage and inadequate health facilities. Recognizing the problem, Government of India launched different programmes for their welfare. Adolescence is a significant period of growth and maturation. The nutritional status of adolescent girls, the future mothers, contributes significantly to the nutritional status of the community. Therefore an attempt was made to assess the diet and nutritional status of adolescent population from the different tribal areas of India. The available database collected by National Nutrition Monitoring Bureau (1998-99) was utilized for this purpose. Data on a total of 12,789 adolescents (10-17 yrs) was included for the analysis. Four percent of the adolescent girls were married and less than 1% were either pregnant (0.4%) or lactating (0.7%) at the time of the survey. The mean intake of all the foodstuffs, especially the income elastic foods such as Pulses, Milk & Milk products, Oils & fats and Sugar & Jaggery were lower than the recommended levels of ICMR. The intake of all the foodstuffs except green leafy vegetables was lower than that of their rural counterparts. The intake of all the nutrients were below the recommended level, while that of micronutrients such as iron, vitamin A and riboflavin were grossly inadequate in all the age and sex groups. About 63% of adolescent boys and 42% of girls were undernourished (< 5th BMI age percentiles of NHANES). A significant association between undernutrition and socio-economic parameters like type of family, size of land holding and occupation of head of household was observed. Therefore, there is a need to evolve comprehensive programmes for the overall development of tribal population with special focus on adolescents.
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To construct growth curves for school-aged children and adolescents that accord with the WHO Child Growth Standards for preschool children and the body mass index (BMI) cut-offs for adults. Data from the 1977 National Center for Health Statistics (NCHS)/WHO growth reference (1-24 years) were merged with data from the under-fives growth standards' cross-sectional sample (18-71 months) to smooth the transition between the two samples. State-of-the-art statistical methods used to construct the WHO Child Growth Standards (0-5 years), i.e. the Box-Cox power exponential (BCPE) method with appropriate diagnostic tools for the selection of best models, were applied to this combined sample. The merged data sets resulted in a smooth transition at 5 years for height-for-age, weight-for-age and BMI-for-age. For BMI-for-age across all centiles the magnitude of the difference between the two curves at age 5 years is mostly 0.0 kg/m(2) to 0.1 kg/m(2). At 19 years, the new BMI values at +1 standard deviation (SD) are 25.4 kg/m(2) for boys and 25.0 kg/m(2) for girls. These values are equivalent to the overweight cut-off for adults (> or = 25.0 kg/m(2)). Similarly, the +2 SD value (29.7 kg/m(2) for both sexes) compares closely with the cut-off for obesity (> or = 30.0 kg/m(2)). The new curves are closely aligned with the WHO Child Growth Standards at 5 years, and the recommended adult cut-offs for overweight and obesity at 19 years. They fill the gap in growth curves and provide an appropriate reference for the 5 to 19 years age group.
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Pubertal delay can be a manifestation of a wide variety of diseases, the proportions of which may vary between developing and industrialised countries. A retrospective study was undertaken to investigate the aetiology of delayed puberty in northern India. Follow-up records of patients with delayed puberty presenting to the endocrine clinic between 2003 and 2007 were analysed. Forty-two patients (19 boys, 23 girls, age range 14-27 y) of 46 who initially presented had complete evaluation. The main causes of pubertal delay were chronic systemic illnesses (16), e.g. malnutrition, anaemia and chronic infections, hormone deficiencies (11), hypergonadotrophic hypogonadism (7) and constitutional delay (6). While the majority of girls (11/23) were found to have underlying systemic disorders, endocrinopathies (6/19) were the major causes of pubertal delay in boys. Chronic systemic illnesses are the major cause of pubertal delay in developing countries. Social awareness and education leading to early detection and treatment can prevent pubertal delay in a large proportion of cases.
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Delayed puberty can be defined as the lack of pubertal development at an age of 2 SD above the mean, which corresponds to an age of approximately 14 years for males and 13 years for females, taking both sex and ethnic origin into consideration. Its incidence associated with chronic illnesses is unknown; however, its clinical importance is relevant due to the larger percentage of patients with chronic disorders surviving until the age of puberty. Virtually every child with any chronic disease could present with delayed puberty (due to recurrent infections, immunodeficiency, gastrointestinal disease, renal disturbances, respiratory illnesses, chronic anaemia, endocrine disease, eating disorders, exercise and a number of miscellaneous abnormalities). Pubertal delay associated with chronic illness is accompanied by a delay in growth and the pubertal growth spurt. The degree to which growth and pubertal development are affected in chronic illness depends upon the type of disease and individual factors, as well as on the age at illness onset, its duration and severity. The earlier its onset and the longer and more severe the illness, the greater the repercussions on growth and pubertal development. The mechanism that trigger the start of physiological puberty remain unknown. Although malnutrition is probably the most important mechanism responsible for delayed puberty, emotional deprivation, toxic substances, stress and the side effects of chronic therapy, among others, have been implicated in the pathophysiology of delayed puberty. Therefore, early diagnosis is essential and appropriate and specific therapy fundamental.
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In developing countries, children of 0-5 years of age form a large as well as "high risk" group. Malnutrition poses a grave risk to the health of these children. The main objectives of this study were to assess the health & nutritional status of children of 0-5 years of age group & to study the influence of various epidemiological factors on health & nutritional status of children on 0-5 years of age group. It is a community based cross sectional study done in randomly selected three wards of Petlad town, district Anand in Gujarat state. 300 children of age group 0-5 years selected by systematic sampling method. Mother of each child included in the study was subjected to personal interview in her own house followed by clinical examination & anthropometric measurements of the child. The three indices of nutritional status namely, weight for age, height for age, & weight for height were expressed in standard deviation units from the median for the international reference populations as per WHONCHS standards & were compared with WHONCHS growth reference data. The prevalence of under weight (wt. for age below 2SD) was 43.67%. 50.3% children were found stunted (ht. 1br age below -2 SID) with higher prevalence in 2nd and 5th year of life. Prevalence of wasting (wt. for ht. below 2SD) was comparatively low (23.2% with a peak in 3rd year of life). These nutritional parameters showed a significant association with parental education, socio-economic status, family size, environmental conditions (safe drink water, sanitary waste disposal & overcrowding), & episodes of common diseases.
NNMB Report on diet & nutritional status of adolescents. India: National Institute of Nutrition
  • K Vijayaraghavan
  • K Venkaiah
  • K Damayanthi
  • M U Nayak
Turning the tide of malnutrition: responding to the challenge of the 21st century
  • Who
Adolescent Nutrition: A Review of the Situation in Selected South-East Asian Countries World Health Organisation: Regional Office for South-East Asia ‘new’ Delhi Available online at
  • R Haider
  • S Bhatia
Adolescent Nutrition: A Review of the Situation in Selected South-East Asian Countries. World Health Organisation: Regional Office for
  • R Haider
  • S Bhatia