Nutritional status of year-1 school girls in the Colombo Municipality

Method 4 schools were selected by random sampling. Stratified sampling was used to determine the number of students to be chosen from each class. Individual children were selected by systematic sampling. Students chronically ill, those whose parents were absent and those born preterm were excluded. An interview-based questionnaire was used to collect data from mothers. Weights and heights of children were measured. The statistical method used to establish significance was the standard normal deviate (Zscore). A Z-score <1.96 is not significant (p>0.05); 1.96-2.58 probably significant (p<0.05); >2.58 definitely significant (p<0,01).


Introduction
Nutritional status of a female is of paramount importance as she is the one capable of giving birth to a child.Nutritional status of a woman in her reproductive age reflects her nutritional level in childhood to a great extent.In Sri Lanka, 16% children <5 years of age are stunted and 30% are underweight 1 .This motivated us to look into the nutritional status of six year old girls in Sri Lanka.Various factors influence a child's nutrition.Exclusive breast feeding during the first 4 months of life is one such factor.The question has arisen, however, as to whether long duration breast feeding has a positive or negative influence on a child's nutrition 2,3 .Today a woman is often employed compelling her to be out of reach of the family for most of the day.This influences the nutritional status of her children.Studies conducted in Sri Lanka and outside have revealed the importance of socio-economic status, maternal education and birth order of child on nutrition 4,5,6 .Factors which might influence nutritional status, such as weaning, bottle feeding, gap between the previous child and index child, were also included in our study.

Objectives
• To estimate prevalence of malnutrition among year-1 school girls in Colombo Municipality.
• To compare nutritional status of year-1 school girls in 2 grades of schools in Colombo Municipality.
• To study factors which influence nutritional status of year-1 school girls.
• To identify ways in which mothers received nutritional advice.

Design
A descriptive cross-sectional study.
Setting 4 schools within Colombo Municipality.

Study population
100 year-1 school girls within Colombo Municipality.Grades A and C schools were taken as representative of 2 social classes and 50 girls from each grade were included in study.

Method
2 lists of names of schools falling under grades A and C were obtained from Education Ministry.2 schools from each list were selected by random sampling.The decided sample size from each grade of school was 50.Stratified sampling was used to decide the number of students to be chosen from each class.Selection of individual children was done using systematic sampling.Every fourth name in the attendance register of each class was marked and the child was included in the study after obtaining mother's consent.
Students who were chronically ill, students whose parents were absent and students who were born preterm were excluded.
Prior permission for data collection was obtained from school principals and dates of parent meetings were obtained from each school.An interviewbased questionnaire was used to collect data from mothers ensuring privacy during interviews.
Questions were asked about maternal age, level of maternal and paternal education, maternal occupation currently and during first year of child's life, family income, birth weight, number of children, gap with older child, duration of breast feeding and exclusive breast feeding, weaning, bottle feeding and modes of receiving nutritional advice.
Children were weighed, without shoes, in school uniform, using a bathroom scale which was calibrated accurately.The same person, using same scale weighed all children.After every 5th child the scale was calibrated to zero.
Height was measured bare footed using a metal tape attached to a straight wall.The same person, using the same tape, measured the height in all children.
Another person helped to ensure correct posture of the child.
The overall distribution, and distribution for each grade, of heights and weights in year-1 girls was tabulated and prevalence of malnutrition and stunting determined.
Distribution of heights and weights for each school grade was tabulated and prevalence of malnutrition and stunting determined.They were compared statistically.
Weights of the year-1 school girls were grouped as underweight (<2SD NCHS), normal and overweight (>2SD NCHS) and the values were tabulated for factors thought to influence nutritional status.

Results and analysis
Distribution of weight in year-1 school girls in the Colombo Municipality is shown in Table 1.The weights ranged from 11 to 31 kg with a mean weight of 18.9 kg.
Analysis of weight distribution in the year-1 school girls is shown in Table 2. 16% year-1 school girls were underweight (<2SD).
Distribution of heights of year-1 school girls is shown in Table 3. Heights of year-1 school girls ranged from 1.0 to 1.29 metres with a mean of 1.14 metres.
Analysis of height distribution in the year-1 school girls in Colombo Municipality is shown in Table 4.In grade C schools weights of year-1 school girls ranged from 11 to 31 kg with a mean of 17.7 kg and a SD of 4.7.
The mean weight in grade A schools was significantly greater than that in grade C schools (Z-score 2.82; p<0.01).
Analysis of weight distribution in the year-1 school girls of grade A schools is shown in Table 7.In grade C schools, heights of year-1 school girls ranged from 1.00 to 1.28 metres with a mean of 1.17 metres and a SD of 0.054.
The mean heights in grades A and C schools were identical.
Variation of nutritional status with maternal age is shown in Table 11.13% currently employed mothers had underweight year-1 school girls compared to 18% currently unemployed mothers (Z-score 0.69; p>0.05).
Variation of nutritional status with maternal occupation during first year is shown in Table 15.Variation of nutritional status with family income is shown in Table 16.19% year-1 school girls who had birth weights <2.5 kg and 12% with birth weights 2.5 kg or more were found to be underweight (Z-score 0.81; p>0.05).
Variation of nutritional status with number of children in family is shown in Table 18.10% year-1 school girls who had 3 or more siblings were underweight compared to 18% who had 2 or less siblings.(Z-score 1.03; p>0.05).
Variation of nutritional status with the gap with the older child is shown in Table 19.Variation of nutritional status with the duration of breast feeding is shown in Table 20.Variation of nutritional status with the duration of exclusive breast feeding is shown in Table 21.12% year-1 school girls, who were exclusively breast fed for 4 months or > were underweight compared to 21% exclusively breast fed for <4 months (Z-score 1.2; p>0.05).
Variation of nutritional status with the start of weaning is shown in Table 22.Variation of nutritional status with bottle feeding is shown in Table 23.

Discussion
In the demographic and health surveys conducted in 1987 and 1993 63% of children <5 years of age were found to have protein energy malnutrition while 72% of 5 year old children in Sri Lanka were found to be underweight 7 .
Weights of year-1 school girls in Colombo Municipality showed a normal distribution which was shifted 0.564 SD to the left from reference NCHS population.16% year-1 school girls were underweight (<2SD) compared to 30% in Sri Lanka 1 .
The heights of year-1 school girls in Colombo Municipality showed a normal distribution.There was no significant difference of height compared with the NCHS reference population.2% year-1 school girls were stunted (<2SD) compared to 16% in Sri Lanka 1 .
The weights of year-1 school girls in both grades A and C schools showed a normal distribution.The weight distribution curve of grade C schools showed a 1.05 SD shift to the left from the NCHS reference population.The mean weight in grade A schools was significantly greater than in grade C schools (Z-score 2.82; p<0.01).However the difference in nutritional status of grade A and C schools was not statistically significant (Z-score 1.66; p>0.05).
The heights of the year-1 school girls in grades A and C schools showed a normal distribution.The mean heights of year-1 school girls in grade A and C schools were identical.
The maternal age, maternal level of education, paternal level of education, current employment of the mother, maternal employment during the first year after delivery, family income, low birth weight, number of siblings, gap with older sibling, duration of exclusive breast feeding, prolonged breast feeding, time of weaning did not significantly influence the nutritional status of year-1 school girls in Colombo Municipality.

Conclusions
• 16% year-1 school girls in Colombo Municipality were underweight and 2% were stunted.
• There was no significant difference in the nutritional status of year-1 school girls in grades A and C schools in the Colombo Municipality.
• None of the factors studied significantly influenced the nutritional status of year-1 school girls in Colombo Municipality.
• 3 commonest modes of receiving nutritional advice were family health midwife, family practitioner and mass media.

Table 2
Analysis of weight distribution in the year-1 school girls in Colombo Municipality

Table 7
Analysis of weight distribution in the year-1 school girls in grade A schools Weight (kg)