A total of 1012 children (496 Boys) from all five educational zones were recruited. The children were categorized based on the educational zone and age. Table 1 shows the socio-demographic distribution of the population.
Table 1: Socio-demographic pattern of the study population
Socio demographic details
|
Number of Students (%)
|
Gender
|
Males
|
496 (49)
|
Females
|
516 (51)
|
Mean Age (Yrs) ±SD
|
Males
|
11.11±1.76
|
Females
|
11.13±1.88
|
Educational zones (%)
|
Jaffna
|
320 (31.6)
|
Vadamaradchi
|
234 (23.1)
|
Thenmaradchi
|
204 (20.2)
|
Valikamam
|
103 (10.1)
|
Islands
|
151 (15.0)
|
Maternal Age (years)
|
<20
|
54 (5.3)
|
20-29
|
297 (29.3)
|
30-39
|
355 (35)
|
40-49
|
234 (23.1)
|
>50
|
72 (7.1)
|
Household income a
|
Low
|
320 (31.6)
|
Middle
|
446 (44)
|
High
|
246 (24.3)
|
Maternal Educational Level
|
Nil
|
10 (1)
|
Incomplete primary
|
24 (2.4)
|
Complete primary
|
176 (17.4)
|
Incomplete secondary
|
402 (39.7)
|
Complete Secondary
|
340 (33.6)
|
Higher degree
|
60 (5.9)
|
a Household equivalent income (HEI): low (LKR<15,000), middle (LKR 15,000–<50,000), or high (LKR ≥50,000).
Mean heights of girls 9 through 13 years were higher than that of same age boys, which could be due to the pubertal growth spurt, occurring in girls earlier than boys. Similarly, the 9-13-year-old girls were slightly heavier than the boys and it reverses after the age of 14 years. Table 2 gives the mean height, weight, and BMI along with the Z scores for both boys and girls. One-way ANOVA showed the differences in the means between boys and girls was not significant (Table 2). Significant difference was not seen when the anthropometric parameters were segregated according to educational zones. The mean Z scores for the height was below the median except for 8year old girls and boys. The mean Z scores for the weight and BMI of all ages in both gender groups were below the median. (Table 2)
Table 2: Mean height, weight and BMI the children according to the age and sex
Age
(yrs)
|
N
|
a Height
|
b Weight
|
c BMI
|
Mean±SD (cm)
|
Mean Z score ±SD
|
Mean±SD (kg)
|
Mean Z score ±SD
|
Mean±SD (kgm-2)
|
Mean Z score ±SD
|
|
|
|
|
|
|
|
|
|
|
Male
|
Female
|
Male
|
Female
|
Male
|
Female
|
Male
|
Female
|
Male
|
Female
|
Male
|
Female
|
Male
|
Female
|
6
|
20
|
21
|
110.9±3.7
|
109.6±2.8
|
-1.0 ±0.7
|
-1.1±0.5
|
17.2±2.9
|
15.9±1.2
|
-0.2±1.2
|
-0.4±1.1
|
13.9±1.5
|
13.2±0.9
|
-1.2±1.1
|
-1.5±0.8
|
7
|
17
|
17
|
116.7±5.4
|
114.9±5.6
|
-0.9±1.0
|
-1.08±1.0
|
18.9±3.0
|
17.9±3.1
|
-0.7±1.5
|
-0.4±1.1
|
13.9±2.8
|
13.5±1.9
|
-1.5±1.8
|
-1.5±1.5
|
8
|
30
|
31
|
126.7±6.5
|
125.2±5.9
|
0.9±1.1
|
-0.21±1.0
|
22.6±3.9
|
21.5±3.8
|
0.7±0.9
|
-0.3±1.0
|
14.0±1.4
|
13.6±1.6
|
-1.4±1.1
|
-1.5±1.3
|
9
|
40
|
42
|
128.1±6.3
|
125.9±19.3
|
-0.7±1.0
|
-0.6±1.01
|
23.2±4.8
|
23.9±6.3
|
0.4±0.7
|
0.2±0.9
|
14.0±2.02
|
14.6±2.5
|
-1.7±1.4
|
-1.1±1.5
|
10
|
47
|
49
|
134.6±6.4
|
135.4±8.7
|
-0.5±1.0
|
-0.5±1.3
|
28.5±7.2
|
28.8±10.
|
-0.9±1.1
|
0.1±1.1
|
15.5±2.9
|
15.4±3.8
|
-0.9±1.7
|
-1.1±1.5
|
11
|
72
|
76
|
141.3±6.8
|
143.1±8.7
|
-0.2±1.0
|
-0.3±1.3
|
32.6±8.6
|
33.5±9.8
|
-0.5±1.3
|
-0.5±1.4
|
16.1±3.2
|
16.1±3.0
|
-0.9±1.7
|
-0.9±1.6
|
12
|
75
|
78
|
143.6±7.1
|
144.8±6.8
|
-0.7±1.0
|
-0.9±1.0
|
35.0±10.2
|
35.2±9.5
|
-0.5±1.6
|
-0.7±1.4
|
16.7±3.8
|
16.5±3.5
|
-0.9±1.8
|
-1.1±1.6
|
13
|
74
|
76
|
147.4±7.5
|
151.0±1.3
|
-1.1±1.0
|
-0.7±1.0
|
35.3±11.3
|
41.1±10.9
|
-1.2±1.4
|
-0.5±1.4
|
16.0±3.6
|
17.8±3.8
|
-1.7±1.6
|
-0.8±1.6
|
14
|
50
|
52
|
156.4±8.8
|
155.2±6.3
|
-0.8±1.1
|
-0.6±0.9
|
45.2±15.3
|
45.5±10.4
|
-0.7±1.7
|
-0.6±1.4
|
18.1±4.7
|
18.8±3.7
|
-1.0±2.1
|
-0.6±1.4
|
15
|
43
|
45
|
163.2±9.7
|
157.1±7.3
|
-0.7±1.2
|
-0.6±1.0
|
49.4±13.4
|
45.9±10.9
|
-0.7±1.4
|
-1.1±1.6
|
18.4±4.2
|
18.5±3.8
|
-1.1±1.8
|
-1.0±1.6
|
16
|
28
|
29
|
169.3±8.2
|
157.9±7.1
|
-0.4±1.1
|
-0.7±1.0
|
57.2±15.4
|
50.4±10.2
|
-0.2±1.5
|
-0.4±1.2
|
19.7±4.4
|
20.1±3.4
|
-0.7±1.8
|
-0.4±1.1
|
Total
|
496
|
516
|
143.0±16.2
|
142.3±15.8
|
-0.7±1.1
|
-0.6±1.1
|
34.8±14.6
|
34.9±13.2
|
-0.5±1.4
|
-0.5±1.3
|
16.3±3.8
|
16.6±3.7
|
-1.2±1.7
|
-0.9±1.5
|
a One way ANOVA F(1,22)=0.05 p=0.8, b F(1,22)=0.008 p=0.9, c F(1,22)=0.041 p=0.84
Prevalence of stunting was in 10.9% of boys and 11.8% of girls. Wasting was seen in 30.6% of boys and 29.1% of the girls (Table 3).
Table 3: Prevalence nutritional status according to age and sex
|
-
|
|
Height for age
|
BMI for Age
|
Age
|
No
|
|
Stunting
|
Wasting
|
Normal
|
Overweight
|
Obese a,b
|
|
Male
|
Female
|
Male
|
Female
|
Male
|
Female
|
Male
|
Female
|
Male
|
Female
|
Male
|
Female
|
|
|
|
N
|
%
|
N
|
%
|
N
|
%
|
N
|
%
|
N
|
%
|
N
|
%
|
N
|
%
|
N
|
%
|
N
|
%
|
N
|
%
|
|
6
|
20
|
21
|
2
|
10.0
|
2
|
9.5
|
07
|
35.0
|
13
|
62.0
|
12
|
60.0
|
7
|
33.3
|
1
|
5.0
|
1
|
4.7
|
0
|
0
|
0
|
0
|
|
7
|
17
|
17
|
2
|
11.7
|
3
|
17.6
|
07
|
41.2
|
8
|
47.0
|
09
|
53.0
|
6
|
35.3
|
0
|
0
|
2
|
11.8
|
1
|
5.9
|
1
|
5.9
|
|
8
|
30
|
31
|
1
|
3.3
|
1
|
3.2
|
09
|
30.0
|
10
|
32.3
|
17
|
56.7
|
19
|
61.3
|
2
|
6.7
|
1
|
3.2
|
2
|
6.7
|
1
|
3.2
|
|
9
|
40
|
42
|
5
|
12.5
|
7
|
16.7
|
10
|
25.0
|
13
|
31.0
|
22
|
55.0
|
25
|
59.5
|
4
|
10.0
|
3
|
7.1
|
4
|
10.0
|
1
|
2.4
|
|
10
|
47
|
49
|
6
|
12.8
|
6
|
12.2
|
14
|
29.8
|
12
|
24.5
|
23
|
49.0
|
31
|
63.3
|
5
|
10.6
|
5
|
10.2
|
5
|
10.6
|
1
|
2.0
|
|
11
|
72
|
76
|
1
|
1.4
|
4
|
5.3
|
26
|
36.1
|
20
|
26.3
|
34
|
47.2
|
46
|
60.5
|
8
|
11.1
|
8
|
10.5
|
4
|
5.5
|
2
|
2.6
|
|
12
|
75
|
78
|
9
|
12.0
|
6
|
2.6.0
|
27
|
36.0
|
22
|
28.2
|
37
|
49.3
|
47
|
60.3
|
7
|
9.3
|
7
|
9.0
|
4
|
5.3
|
2
|
2.6
|
|
13
|
74
|
76
|
10
|
13.5
|
10
|
13.1
|
20
|
27.0
|
21
|
27.6
|
35
|
47.3
|
42
|
55.3
|
8
|
10.8
|
10
|
13.2
|
11
|
14.9
|
3
|
3.9
|
|
14
|
50
|
52
|
8
|
16.0
|
5
|
9.6
|
15
|
30.0
|
13
|
25.0
|
23
|
46.0
|
28
|
53.8
|
7
|
14.0
|
9
|
17.3
|
5
|
10.0
|
2
|
3.8
|
|
15
|
43
|
45
|
5
|
11.6
|
11
|
24.4
|
11
|
25.6
|
11
|
24.4
|
22
|
51.1
|
24
|
53.3
|
6
|
13.9
|
7
|
15.5
|
4
|
9.3
|
3
|
6.6
|
|
16
|
28
|
29
|
5
|
17.9
|
6
|
20.7
|
06
|
21.4
|
7
|
24.1
|
11
|
39.3
|
14
|
48.3
|
8
|
28.6
|
3
|
10.3
|
3
|
10.7
|
5
|
17.2
|
|
Tot
|
496
|
516
|
54
|
10.9
|
61
|
11.8
|
152
|
30.6
|
150
|
29.1
|
245
|
49.4
|
289
|
56.0
|
56
|
11.3
|
56
|
10.7
|
43
|
8.7
|
21
|
4.1
|
|
a Boys were significantly obese than girls X2(1,1012)=9.03 p <0.002
b Older Boys (>10years) were significantly obese than younger boys (<10years) X2(1,496)=4.79 p<0.02
The prevalence of overweight was 11% and obesity was 6.3% of the population. Overweight was predominantly seen in 9-14-year-old girls and those were the most affected ages. Obesity was predominantly seen in boys (8.7 %) and it was significantly higher when compared to the girls (4.1%) (p <0.001). Older boys (>10 years) were significantly affected than the younger ones (p <0.02) (Table 3).
The prevalence of the types of malnutrition in the different educational zones suggested that Thenmaradchi zone had a significantly higher prevalence of stunting (p<0.001) and obesity and overweight were more prevalent in the Jaffna zone (p<0.001) (Table 4). The islands and Thenmaradchi zones had very minimal prevalence of obesity and overweight.
Table 4: Prevalence of malnutrition according to educational zones
Educational Zones
|
N
|
Stunting
N (%)a
|
Wasting
N (%)b
|
Overweight
N (%)c
|
Obese
N (%) c
|
Jaffna
|
320
|
23 (20)
|
81 (26.8)
|
38 (34)
|
22 (34.4)
|
Vadamaradchi
|
234
|
19 (16.5)
|
45 (14.9)
|
28 (25)
|
16 (25)
|
Thenmaradchi
|
204
|
34 (29.5)
|
88 (29.1)
|
10 (8.9)
|
08 (12.5)
|
Valikamam
|
103
|
23 (20)
|
54 (17.9)
|
22 (2.0)
|
12 (18.8)
|
Islands
|
151
|
16 (14)
|
34 (11.3)
|
14 (12.5)
|
06 (9.4)
|
Total
|
1012
|
115 (11.3)
|
302 (29.8)
|
112 (11.1)
|
64 (6.3)
|
Prevalence of malnutrition within the zones X2(12, 1012) =31.95 p<0.001
a Stunting X2(4,1012) =26.07 p<0.001, bWasting X2(4,1012)=61.9 p<0.0001, Overweight and obesity X2(4,1012)=30.45 p<0.0001
Maternal Education and Family income had a significant impact on the prevalence of stunting, wasting, overweight and obesity (p<0.001). Family size had a significant impact on the wasting, overweight and obesity. The residential area had a significant impact on the stunting but not in wasting, overweight and obesity. Table 5 shows the comparative date on the nutritional problems and the socio-demographic factors.
Table 5: Association of socio-demographic factors to nutritional problems
Socio-economic factors
|
Stunting
|
Wasting
|
Overweight and obesity
|
Yes (%)
|
No (%)
|
OR (95%CI)
P Value
|
Yes (%)
|
No (%)
|
OR (95%CI)
P Value
|
Yes (%)
|
No (%)
|
OR (95%CI)
P Value
|
Education level of the mother
Low
Good
|
62 (54)
53 (46)
|
117 (13)
780 (87)
|
7.79
(5.15-11.8)
<0.001
|
79 (26)
223 (74)
|
70 (10)
640 (90)
|
3.23
(2.26-4.62)
<0.001
|
51(29)
125 (71)
|
104 (12)
732 (88)
|
2.87
(1.95-4.33)
<0.0001
|
Family Income
Low
Adequate
|
103(89)
12 (11)
|
110 (12)
787 (88)
|
61.4
(32.69-115-3)
<0.0001
|
245(81)
57 (19)
|
113 (16)
597 (84)
|
22.71
(15.97-32.27)
<0.001
|
124 (70)
52 (30)
|
108 (13)
728 (87)
|
16.07
(10.97-23.54)
<0.0001
|
Family Size
<5
>5
|
105(91)
10 (9)
|
839 (94)
58 (6)
|
0.72
(0.36-1.4)
= 0.3
|
194 (64)
108 (36)
|
584 (82)
126 (18)
|
0.38
(0.28-0.52)
<0.0001
|
102 (58)
74 (42)
|
738 (88)
98 (12)
|
0.18
(0.12-0.26)
<0.0001
|
Residential Area
Rural
Urban
|
75 (65)
40 (35)
|
429 (48)
468 (52)
|
2.4
(1.36-3.06)
= 0.0005
|
109 (36)
193 (64)
|
290 (41)
420 (59)
|
0.87
(0.62-1.08)
= 0.15
|
59 (34)
117 (66)
|
313 (37)
523 (63)
|
0.84
(0.59-1.18)
= 0.3
|
a Low was no education, incomplete and complete primary. Adequate was incomplete secondary, secondary and higher degree
b Household equivalent income (HEI): low less than LKR 15,000, adequate more than LKR 15,000