Socioeconomic Disparities in Adolescent Growth: an Anthropometric Study of Nigerian School Children in Lagos

doi:10.21203/rs.3.rs-5147087/v1

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Socioeconomic Disparities in Adolescent Growth: an Anthropometric Study of Nigerian School Children in Lagos

https://doi.org/10.21203/rs.3.rs-5147087/v1

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Background

The dearth of literature on studies investigating the influence of various factors impacting adolescent growth patterns in African populations remain a major challenge in growth research. The aim of the current study was to assess the variation in anthropometric dimensions estimated from stature and limb parameters of adolescent Nigerian school children based on socio-economic backgrounds in Lagos, using school type as an indicator.

Methods

Ethical clearance was sought and obtained, and upon full consent of the participants, anthropometric measurements of stature, arm span, thigh, percutaneous tibial, arm, forearm, hand and foot lengths were taken from 640 adolescent school children (320 males and 320 females), aged 10–17 years, selected from public and private schools in Lagos using a systematic random method. The anthropometric protocol adopted were those recommended by the International Society for the Advancement of Kinanthropometry (ISAK); and the data collated was analyzed using SPSS version 20.

Results

We observed statistically significant differences in the mean of measured anthropometric dimensions between age matched private and public-school boys {Stature (167.69:160.33; p = 0.000*), Thigh length (45.92:42.66; p = 0.000*), Percutaneous tibial length (37.73:34.55; p = 0.000*), Arm length (28.89:26.81; p = 0.000*), Forearm length(26.14:23.65; p = 0.000*), Hand length (18.26:17.66;p = 0.004*), Foot length(25.07:24.08; p = 0.000*), Arm span (165.73:152.27; p = 0.000*)}, and girls {Stature (166.29:161.61; p = 0.000*), Thigh length (47.98:43.95; p = 0.000*), Percutaneous tibial length (37.43:35.35; p = 0.000*), Arm length(28.76:27.35; p = 0.000*), Forearm length (25.52:24.53; p = 0.002*), Hand length (18.07:17.76;p = 0.000*), Foot length(24.21:23.89; p = 0.023*), Arm span (164.19:154.25; p = 0.000*)}, showing that school types are indicative of socio-economic status. Additionally, significant male-female differences in anthropometric dimensions were greater in public than private schools, with the females exhibiting higher values than the males in the public schools, and the males recording higher values than the females in the private schools.

Conclusion

The observed variations in anthropometric dimensions among the study population may reflect a complex interaction between growth and socio-economic status, as these factors have been found to influence adolescent growth patterns.

Adolescent

Males

Females

Lagos

Anthropometric dimensions

Adolescents experience a critical transition from childhood to adulthood, which is characterized by rapid physical growth, psychological development and social changes (1). During this developmental period, the relatively uniform growth in childhood is suddenly altered by an increase in growth velocity, a sudden spurt which is influenced by gender, genetic, socio-economic, environmental and psychological factors(2, 3) A myriad of biological changes occur during adolescence which include sexual maturation, increase in height and weight, completion of skeletal growth accompanied by a marked increase in skeletal mass and changes in body composition. The succession of these events is consistent among adolescents. However, there may be a great deal of deviation in the age of onset, duration, and tempo of these events between and within individuals. For this reason, adolescents of the same chronological age can vary greatly in physical appearance. This has direct relevance for the nutrition requirements of adolescents (4). The socioeconomic background and lifestyle factors that often influence patterns of nutritional intake, physical activity and other environmental stresses that affect the development of anthropometric dimensions appear to manifest significantly during the adolescent growth period(5). These elements probably combine to mask the underlying growth pattern, thus; the widening margin of the inequalities between the poor and the better-off appears to be manifesting in the varying patterns of physical growth(6–10). During childhood and adolescence, sexual dimorphism usually results from different growth velocities in both sexes. In comparison to the males, the females grow faster. The latter follow the typical human growth curve with a higher tempo and finish their length growth earlier. After the adolescent growth spurt, the growth velocity decelerates but not in all dimensions, hence, males show clear growth advantage in adulthood because of their later and longer lasting growth spurt i.e., more years of physical growth (11, 12).

Previous studies have reported the status of frame size variation on adolescent male(13) and female(14) in Nigerian school children in Lagos. Similar studies on the growth pattern of adolescent male Nigerian school children(15) and the anthropometric evaluation of growth variation of adolescent females in urban Lagos(16) have also been reported. However, studies investigating the patterns of growth variation based on the anthropometric evaluation of stature and limb dimensions in adolescent Nigerian school children are rather scanty in the literature. Therefore, the present study sought to characterize the growth patterns of anthropometric parameters in adolescent Nigerian school children using stature and limb dimensions as indicators, to investigate the possible influence of socioeconomic status (SES) and to ascertain if there exist gender differences in the anthropometric variations among the participants.

Study design

Cross-sectional study design was used to investigate the variation in anthropometric dimensions estimated from stature and limb parameters of adolescent Nigerian school children based on socio-economic backgrounds in Lagos, using school type as an indicator.

Study population

This cross-sectional study comprised 640 adolescent Nigerian school children (320 males and 320 females), aged 10-17 years who volunteered and satisfied the eligibility criteria. The participants were selected by multistage stratified random sampling from two secondary schools, the University of Lagos Secondary School (constituting the middle to high income SES group) and Oduduwa Secondary School, Mushin (constituting the low-income SES group). The University of Lagos and Oduduwa Secondary Schools both involved 320 subjects each (160 males and 160 females), uniformly represented by 20 subjects for each of the 8 age groups cutting across the selected age range in the study (10-17 years). The SES classification protocol employed in this study was modified from previous studies (17,18). To ensure widespread of parental roots, various Nigerian ethnic nationalities were represented in the study and they include the Yoruba, Igbo, Hausa-Fulani, Edo, Ijaw, Ibibio, Efik, Igala, Nupe, Idoma, Tiv and Annang. Thus, allowing transmission of genetic traits from parent to offspring in a Mendelian heterogeneous manner.

Ethical approval and consent to participate

Ethical clearance to conduct this study was sought and obtained from Health Research Ethics Committee, College of medicine of the University of Lagos. Written approval obtained from the

authorities at the Mushin Local Education District of the Lagos State Universal Basic Education Board (SUBEB) and from the authorities at the University of Lagos International School enabled access to the study participants. Written informed consents were given by the participants before measurements were taken, which required the appendage of the signature of their parents/guardians on the consent forms as the prerequisite for the commencement of measurement. The right to withdraw, if so desired at any stage of the study was also clearly stated to the participants.

Eligibility criteria

This required the participants to be within the age range and have both parents of Nigerian ancestry as confirmed from the school records. Excluded from the study were the obese, acutely-ill and physically challenged children with poor health conditions that manifested with overt signs of stunted growth. Also excluded were those who presented apparent symptomatic musculoskeletal, dermatological or congenital deformity that might affect the anthropometric measurements.

Anthropometric data collection

Materials

a) Stadiometer: Alpha 220, SECA^TM Stadiometer (Germany), with a measuring range of 60-200 cm. For this study, it was used for stature measurement.

b) Segmometer:This custom-made instrument was manufactured from a steel tape 100cm long and at least 15mm wide which has attached two straight branches, each approximately 7-8 cm in length. For the present study, the segmometer was used to measure thigh, percutaneous tibial, arm, forearm and hand lengths.

c) Large sliding caliper: A Rosscraft^TM Campbell Anthropometry kit caliper 20 (Rosscraft, Canada) with two straight branches that allow measurement of large bone breadths. For the present study, the large sliding caliper was used for foot length measurement.

d) Lufkin steel tape: A Lufkin W606PM flexible steel tape, non-extensible, no wider than 7mm and have a stub of at least 4 cm before the zero line. For this study, it was used to measure the arm span.

Methods

The anthropometric parameters measured include stature, thigh length, percutaneous tibial length, arm length, forearm length, hand length, foot length and arm span, which were according to the anthropometric protocols recommended by the International Society for the Advancement of (19), with the measuring instruments read and recorded to the nearest 0.1cm for all the measurements.

a) Stature: The subject was required to stand with the feet together, with the heels, buttocks and the upper part of the back touching the scale of the stadiometer. The head was held in the Frankfort plane and this was achieved when the Orbitale (lower edge of eye socket) was in the same horizontal plane as the tragion (the notch superior to the tragus of the ear). With the hands of the measurer placed far enough along the line of the jaw of the subject to ensure that upward pressure is transferred through the mastoid process, the subject was instructed to take and hold a deep breath. The head board of the stadiometer was then placed firmly down on the vertex.

b) Thigh length: With one branch of the segmometer placed on the marked Trochanterion site, and the other end placed on the marked Tibiale laterale site, the thigh length was measured as the distance between the marked anatomical landmarks.

c) Percutaneous tibial length: One branch of the segmometer was placed on the marked Tibiale mediale site and the other is positioned on the marked Sphyrion site. The distance between the two landmarks was measured and this represents the tibial length.

d) Arm length: One branch of the segmometer was held on the marked Acromiale site, while the other was placed on the marked Radiale site. The distance between the two landmarks was measured and this represents the arm length.

e) Forearm length: With one branch of the segmometer held against the Radiale site and the other branch placed on the Sphyrion landmark, the distance between the two landmarks was measured and this represents the forearm length.

f) Hand length: Using the segmometer, this measurement was taken as the shortest distance from the marked Midstylion line to the Dactylion.

g) Foot length: Using a large sliding caliper, the distance between the Akropodian and the Pternion was measured and this represents the length of the foot.

h) Arm span: It was ensured that the participant’s head was in the Frankfort horizontal plane and the arms were outstretched at right angles to the body with palms facing forward. The length from the tip of the middle fingers of the left and right hands when raised parallel to the ground at shoulder height at a one-hundred-and-eighty-degree angle was then measured with a Lufkin steel tape.

Quality Control

Tester / Measurer Preparation

Preparations for the anthropometric measurements included the training of the measurer in anthropometric techniques consistent with the competence level of anthropometry technician Level 1 according to the protocol recommended by the International Society for the Advancement of Kinanthropometry (ISAK). This training was undertaken by the second author, who is an ISAK-certified Anthropometry Technician Level 2. The measurer and assistant were post-graduate students in the Department of Anatomy, College of Medicine of the University of Lagos. The measurer had reliability testing as part of the training, aimed to achieve technical errors within internationally accepted limits. All measurements were taken by the trained tester/measurer.

Measurement Error

To determine measurement error intrinsic to this study, technical error of measurement (intratester and intertester) was employed as a measure of validity. The subjects, variables and measurement procedures used for the two types of TEM were the same but the tests had to be carried out independently. Since one of the testers is a certified anthropometrist, the intertester TEM was used as a measure of accuracy. The TEM provides an estimate of the measurement error in the units of measurement of the variable. This value indicates that two thirds of the time a measurement should come within +/- of the TEM.

Statistical analysis

The data collated was analyzed using Statistical Package for the Social Sciences (SPSS) for windows, version 20.0, Armonk, New York: IBM Corporation. Kolmogorov-Smirnov test was employed to test the normality of the sample. All the data were analyzed for mean and standard deviation. The student t test was used to analyze the differences between independent groups at 95% confidence interval (P <0.05).

The results obtained were summarized using the tables. The Kolmogorov-Smirnov test revealed normal data distribution, with the test statistics found not to be statistically significant (P > 0.05) for all the parameters employed in the study.

Table 1 presents summary of the descriptive statistics and gender differences of anthropometric parameters for the Private school boys and girls. From the table, it can be observed that the Private school boys exhibited greater values for the anthropometric dimensions than the Private school girls, except for thigh length. However, the differences were statistically significant only for forearm length and foot length, with P values of 0.016 and 0.000 respectively. The Private school girls recorded greater thigh length value than the Private school boys, with t and P values of -4.46 and 0.000 respectively. The differences are statistically significant at P < 0.05.

Table 2 shows summary of the descriptive statistics and gender differences of anthropometric parameters for the Public school boys and girls. From the table, it can be observed that the Public school girls recorded higher values in the anthropometric parameters than the Public school boys, except for foot length. However, the differences were statistically significant for thigh, percutaneous tibial, arm and forearm lengths, with P values of 0.016, 0.047, 0.048 and 0.002 respectively. The differences are statistically significant at P < 0.05.

Table 3 shows differences in anthropometric parameters of the public and private school boys as an indicator of socio-economic status. From the table, it can be observed that there exist highly statistically significant differences in the anthropometric dimensions of the Private and Public school boys, with the Private school boys exhibiting predominantly greater values in all the parameters considered in this study.

Table 4 shows differences in anthropometric parameters of the public and private school girls as an indicator of socio-economic status. Here, it can be seen that the Private school girls recorded predominantly higher values in the anthropometric dimensions than the Public school girls. It can also be observed that the differences were all significant statistically, at 95% confidence interval. This indicates that school type in this context is an indicator of socio-economic status, as shown by the statistically significant differences in body dimensions of the age-matched school children.

Table 1

Summary of the descriptive statistics and gender differences of anthropometric parameters for the private school boys and girls.
DESCRIPTIVE STATISTICS					GENDER DIFFERENCES
Measurements (cm)	Private school boys (n = 160)		Private school girls (n = 160)		t - value	P - value
Measurements (cm)	Mean	± SD	Mean	± SD	t - value	P - value
Stature	167.69	12.68	166.29	7.82	1.11	0.268
Thigh length	45.92	3.99	47.98	3.73	-4.46*	0.000
Percutaneous tibial length	37.73	3.18	37.43	3.25	0.77	0.442
Arm length	28.89	2.86	28.76	2.04	0.43	0.662
Forearm length	26.14	2.50	25.52	1.70	2.43*	0.016
Hand length	18.26	1.53	18.07	1.04	0.93	0.350
Foot length	25.07	1.82	24.21	1.50	4.31*	0.000
Arm span	165.73	15.12	164.19	9.76	1.01	0.312

Differences significant at (P < 0.05) *, SD = Standard deviation.

Table 2

Summary of the descriptive statistics and gender differences of anthropometric parameters for the public school boys and girls.
DESCRIPTIVE STATISTICS					GENDER DIFFERENCES
Measurements (cm)	Public school boys (n = 160)		Public school girls (n = 160)		t - value	P - value
Measurements (cm)	Mean	± SD	Mean	± SD	t - value	P - value
Stature	160.33	13.91	161.61	12.03	-0.82	0.408
Thigh length	42.66	4.26	43.95	4.66	-2.41*	0.016
Percutaneous tibial length	34.55	3.62	35.35	3.06	-1.99*	0.047
Arm length	26.81	2.50	27.35	2.07	-1.99*	0.048
Forearm length	23.65	2.22	24.53	2.48	-3.12*	0.002
Hand length	17.66	1.65	17.76	1.24	-0.55	0.582
Foot length	24.08	1.82	23.89	1.74	0.89	0.371
Arm span	152.27	12.43	154.25	10.74	-1.42	0.154

Differences significant at (P < 0.05) *, SD = Standard deviation.

Table 3

Differences in anthropometric parameters of the public and private school boys as an indicator of socioeconomic status.
DIFFERENCES BASED ON SOCIOECONOMIC STATUS OF THE SCHOOL BOYS
Measurements (cm)	Private school boys (n = 160)		Public school boys (n = 160)		t - value	P - value
Measurements (cm)	Mean	± SD	Mean	± SD	t - value	P - value
Stature	167.69	12.68	160.33	13.91	4.62*	0.000
Thigh length	45.92	3.99	42.66	4.26	6.60*	0.000
Percutaneous tibial length	37.73	3.18	34.55	3.62	7.79*	0.000
Arm length	28.89	2.86	26.81	2.50	6.49*	0.000
Forearm length	26.14	2.50	23.65	2.22	8.80*	0.000
Hand length	18.26	1.53	17.66	1.65	2.93*	0.004
Foot length	25.07	1.82	24.08	1.82	4.53*	0.000
Arm span	165.73	15.12	152.27	12.43	8.13*	0.000

Differences significant at (P < 0.05) *, SD = Standard deviation.

Table 4

Differences in anthropometric parameters of the public and private school girls as an indicator of socioeconomic status.
DIFFERENCES BASED ON SOCIOECONOMIC STATUS OF THE SCHOOL GIRLS
Measurements (cm)	Private school girls (n = 160)		Public school girls (n = 160)		t - value	P - value
Measurements (cm)	Mean	± SD	Mean	± SD	t - value	P - value
Stature	166.29	7.82	161.61	12.03	3.85*	0.000
Thigh length	47.98	3.73	43.95	4.66	7.98*	0.000
Percutaneous tibial length	37.43	3.25	35.35	3.06	5.52*	0.000
Arm length	28.76	2.04	27.35	2.07	5.73*	0.000
Forearm length	25.52	1.70	24.53	2.48	3.87*	0.002
Hand length	18.07	1.04	17.76	1.24	2.28*	0.000
Foot length	24.21	1.50	23.89	1.74	0.89*	0.023
Arm span	164.19	9.76	154.25	10.74	1.42*	0.000

Differences significant at (P < 0.05) *, SD = Standard deviation.

Social gradients as a basic category of variation in growth pattern(20–23) was demonstrated in the present study, as significant differences in body size and maturation rate were observed within a society between groups differing in some aspects of their socio-economic situations. According to(24) socio-economic status (SES) can be defined as a theoretical construct encompassing individual, household, and/or community access to resources. It is commonly conceptualized as a combination of economic, social and work status, measured by income or wealth, education, and occupation, respectively. SES has been linked to a wide range of health-related exposures and outcomes, including child undernutrition, chronic disease and infection(25–27).Ibeabuchi et al., (2015b) opined that the non-applicability of some of the traditional indices of SES to many developing countries has been highlighted (18), making it pertinent to adopt simpler and easily-verifiable criteria, and the employment of proxies for SES such as residence area and the type of school attended has been reported (14, 16, 28); as for the latter, economically advantaged families often prefer fee-paying private schools to minimal-fee-paying public schools because the former are better funded to provide superior educational facilities and a more positive learning environment (29).

From the present study, private school participants (boys and girls) exhibited consistently higher mean values than their public-school counterparts in all the anthropometric parameters, which include stature, thigh length, percutaneous tibial length, arm length, forearm length, hand length, foot length and arm span. This indicate that the differences in anthropometric dimensions based on SES is highly significant statistically, for all the measured variables. This is in consonance with the reports from previous similar growth studies on children(14, 16, 30–32) where the middle to high income group of the populace exhibited greater anthropometric values than the low-income groups. These findings further highlight the underlying effects of SES on growth, as it has been reported that low socio-economic factors such as poor food consumption pattern, illness, lack of sanitation, poor hygienic practices, inadequacy of parents’ education and other handicaps of poverty appear to be far more decisive than genetic predisposition in producing deviations from the normal reference growth patterns (33). The variations observed between the two socioeconomic backgrounds may reflect the disparity associated with the onset of the adolescent growth spurt which can be due to the influence of many exogenous factors relative to socio-economic background (14, 16).

The present study also recorded gender differences in the anthropometric parameters of the private and public school sample. It was observed that statistically significant sexual dimorphism was more dominant in the public than the private school. The female sample in the public school recorded consistently higher values than their male counterparts for all the parameters except the foot length. When compared with the trend for sexual dimorphism in adult samples (> 18 years), it can be observed that anthropometric studies on adult populations in different climes usually report dominantly higher values for the males than the females. These previous reports on gender differences in stature(34), thigh length (35), percutaneous tibial length (36), arm length (37), forearm length(38), hand length (39), foot length(40) and arm span(41); and a plethora of other similar studies have all reported significantly higher values for the males than the females; showing a pattern different from the adolescent sample of the public school considered in the present study. This variation in trend, hence the equality or less significant gender differences, or even greater adolescent female anthropometric values than the males can be explained on the basis that during childhood and adolescence, sexual dimorphism usually result from different growth velocities in both sexes. In comparison to the males, the females grow faster. The latter follow the typical human growth curve with a higher tempo and finish their length growth earlier. After the adolescent growth spurt, the growth velocity decelerates but not in all dimensions, hence males show clear growth advantage in adulthood because of their later and longer lasting growth spurt i.e., more years of physical growth(12, 34, 42).

This study has reported the variation in stature and anthropometric limb dimensions of adolescent Nigerian school children on the basis of gender and SES using school type as indicator in Lagos. As there exist limited literature for anthropometric variation in adolescents due to the impacting factors on growth employed in this study, the findings could serve as useful reference data in growth research, nutrition assessment, secular trends in growth pattern and general clinical practice.

SES Socio-Economic Status

SPSS Statistical Package for the Social Sciences

ISAK: International Society for the Advancement of Kinanthropometry

SUBEB State Universal Basic Education Board

TEM Technical Error of Measurement

SD Standard Deviation

ACKNOWLEDGEMENT

The authors wish to express sincere gratitude to all the Principals and Head Teachers of the schools that participated in the research. We appreciate the assistance rendered by various form masters/mistresses, teaching staff and class coordinators who assisted us in the collection of data. This appreciation would not be complete without our thanking the pupils and students who graciously made themselves available for and participated in the study.

AUTHORS’ CONTRIBUTIONS

SIM & MNI designed the study and developed the methodology; SIM collected the data. SIM, NPO, EAO wrote the first draft of the manuscript; NP and IOA analyzed the data. VCE supported in the manuscript review. All authors approved the final draft of the manuscript.

FUNDING

This work was not funded by any organization or body.

AVAILABILITY OF DATA AND MATERIALS

The data presented in this study are available on request from the first author ([email protected])

Ethics approval and consent to participate

Ethical clearance to conduct this study was sought and obtained from the Health Research Ethics Committee, College of Medicine of the University of Lagos. Written approval obtained from the authorities at the Mushin Local Education District of the Lagos State Universal Basic Education Board (SUBEB) and the authorities at the University of Lagos International School enabled access to the study participants. This study was conducted following the ethical principles outlined in the Declaration of Helsinki. The research protocol was designed to ensure the protection of the rights, safety, and well-being of the participants. Informed consent was obtained from all participants, and their confidentiality was maintained throughout the study. The right to withdraw, if so desired at any stage of the study was also clearly stated to the participants.

Consent for publication

Not applicable.

Competing interests

The authors declare no competing interests.

Author details

¹Department of Anatomy, Faculty of Basic Medical Sciences, Nnamdi Azikiwe University, Nigeria. ²Department of Anatomy, School of Basic Medical Sciences, Faculty of Basic Medical Sciences, University of Benin, Benin City, Nigeria. ³Department of Anatomy,College of Medicine, University of Lagos,Lagos, Nigeria. ⁴Developmental Neurobiology and Forensic Anatomy Unit, Department of Anatomy, University of Ibadan, Ibadan 200212, Nigeria.

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The authors declare no competing interests.

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Socioeconomic Disparities in Adolescent Growth: an Anthropometric Study of Nigerian School Children in Lagos

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