Nutritional Status, Hygiene Level, Morbidity Profile, and Their Effect on Scholastic Performance among School Children in Two Subcenter Areas of a PHC in Anekal Taluk, Karnataka, India.

BACKGROUND: Various factors such as age, sex, nutrition, hygiene, and morbidity impact the scholastic performance of schoolchildren.
OBJECTIVES: (1) The objective of the study is to assess the hygiene level, nutritional status, morbidity profile, and scholastic performance of children attending government schools in two select subcenter areas of Karnataka and (2) to study the association of hygiene level, nutritional status, and morbidity profile with scholastic performance.
METHODOLOGY: A cross-sectional study was done from July to August 2017 among children studying in the government schools of Mugalur and Kuthganahalli subcenters under Sarjapur PHC, Anekal Taluk, Bengaluru urban district. After obtaining permissions, general checkup of the students was done for morbidity pattern, and their anthropometric measurements were documented. Hygiene levels of the students were observed with a checklist to obtain scores that were grouped into good and poor. Attendance and grades were obtained from the class teacher to assess the scholastic performance.
RESULTS: Of a total 403 students studied, the mean age was 10.2 years (standard deviation: 2.87) with 51.1% girls. Nutrition status was good in 236 (58.6%) students and 262 (65%) had good hygiene. At the time of examination, 211 (53%) had at least one morbidity, with most common being dental caries (16.3%). Logistic regression showed that odds of girls having better grades is 2.4 times more when compared to boys and 2.1 times more likely in students with good hygiene. Students with good hygiene are 2.1 times more likely to have good attendance.
CONCLUSION: Hygiene status impacts the attendance and grades of the students. Girl students had significantly better grades than the boys.

INTRODUCTION

In India, a child is defined as a person below 18 years of age. Data from census of India 2011 show that children constitute 41% of India's population.[1] In Karnataka, the schoolchildren (below 16 years) constitute 24.4% of the population.[2] Nutrition is concerned primarily with the part played by nutrients in body growth, development, and maintenance.[3] Malnutrition refers to deficiencies, excesses, or imbalances in a person's intake of energy and/or nutrients.[4] Hygiene refers to conditions and practices that help to maintain health and prevent the spread of diseases.[5] A healthy childhood will lead to an equally healthy adulthood, provided the children are well taken care of in terms of nutrition and hygiene.[6] In most parts of the country, the children in the rural areas are nutritionally deprived and are more prone to illnesses. Added to this dire situation, there is less understanding about the importance of practicing good hygiene.[7] A child who is undernourished owing to socioeconomic or other reasons and not having good hygienic practices is prone to get diseases which are easily communicable.[8] A child with repeated illnesses misses classes and therefore may not perform well in the examinations. Schools are the best place to start training the children about good hygiene practices, and the importance of nutrition because the uncluttered minds will more readily grasp the suggestions in respect to health.

The present study was done with the following objectives:

To assess the hygiene level, nutritional status, morbidity profile, and scholastic performance of children attending government schools in two select subcenter areas of Karnataka

To study the association of hygiene level, nutritional status, and morbidity profile with scholastic performance.

Materials used

This was a school-based cross-sectional study done in Mugalur and Kuthganahalli subcenters under Sarjapur PHC in Anekal Taluk of Bengaluru urban district, Karnataka, for a period of 2 months. We included all the school students in the government schools of the villages under the two subcenters from Class 1 to 10. The tools used are measuring tape, weighing scales, and WHO Child Growth Standard Charts for body mass index (BMI) for age, Snellen's chart, and Hygiene score chart.

METHODOLOGY

Permissions were obtained from the Block Education Officer and the school authorities. All the children enrolled in 14 schools (in 13 villages) coming under the two subcenters were included in the study. A structured questionnaire was used to study the basic sociodemographic details of the schoolchildren. Hygiene scoring sheet was made with nine parameters. Hygiene level was studied using a scoring sheet on a visual observation basis. Hygiene was scored under nine different parameters such as hair, ears, nose, oral cavity and teeth, palms, fingernails, feet, toenails, and the dress. Each was scored as “0” for poor, “1” for average, and “2” for good hygiene with the maximum and minimum scores being 18 and 0, respectively. A score 13 and above was taken to indicate good hygiene.

After an informed verbal consent from parents and assent from the child, height and weight of the student were measured, and BMI was calculated and compared with the WHO Child Growth Standard Charts for BMI for age and gender. Vision was tested with Snellen's chart. A general checkup was done for all children, and their current morbidity on the day of the examination was documented. The school attendance of the child in the past 2 months along with the marks of the recent assessment was obtained from school records. Children who were absent on the day of the examination were excluded from the study. Attendance was converted into percentages, and anything more than 85% attendance was considered as good. Marks were converted into grades more than 90% recorded as “A,” 70%–89% as “B,” 50%–69% as “C,” and <50% as “D.”

A total of 439 students were present on the days of our school visits. Among these, there were 36 new joiners and did not have complete details of attendance and test marks. These children were excluded, and finally, 403 students were included in the study of whom we had complete details [Figure 1].

Figure 1

Flowchart on how the students were recruited

Statistical analysis

Data were entered in Microsoft Excel and analyzed using SPSS version 16.0. Descriptive statistics such as percentages and proportions were used to describe the sociodemographic details of the study sample. Chi-square tests and Fisher's exact test were used as applicable to study the association between hygiene level, nutritional status, morbidity profile, and scholastic performance. All variables that showed a statistically significant association with scholastic performance were put into a multiple logistic regression model with scholastic performance as the dependent variable and age and hygiene levels, as covariates. P < 0.05 was considered statistically significant for all analyses.

RESULTS

The age range of the children was between 6 and 17 years with the maximum number of children in the age group of 6–10 years (54.09%). Of all the 403 children in 14 schools, 206 (51.1%) were girls and 197 (48.9%) were boys. Most children belonged to the Hindu religion. The class distribution was 183 (45%) belonging to lower primary, 133 (35%) to upper primary, and 85 (21%) in high school. Based on the WHO BMI charts, 236 (58.6%) children had normal nutrition, 80 (19.9%) were thin, and 73 (18.1%) were severely thin with more boys being severely undernourished. The other end of the spectrum included 12 (3%) overweight and 2 (0.5%) obese children. The general health status among schoolchildren was low with 211 (52%) having some disease present with boys and girls equally affected. The most common illness noticed was dental caries with 66 (16.3%) children suffering from it. The other common illnesses encountered were impacted ear wax (15.6%), upper respiratory tract infections (6.4%), and refractive errors (4.7%).

One-third of the students (262, 65%) scored good on the hygiene score. Of the 141 (35%) students who had poor hygiene, 92 (23%) were boys and 49 (12%) were girls. The main areas of concern in hygiene were oral cavity, ears, and fingernails [Figure 2].

Figure 2

The number of students who scored good, average, and poor in the hygiene scoring on visual inspection

The scholastic performance of students was graded; 130 students obtained Grade “A” with girls constituting 67%; and 189%, 71%, and 13% students securing Grades “B,” “C,” and “D,” respectively. Grades “A” and “B” were taken as good academic performance, and Grades “C” and “D” were taken to be poor performance. Academically, 319 (79%) had good grades and 84 (21%) performed poorly out of which 14% were boys.

On univariate analysis, hygiene status (P = 0.008) and age category (P = 0.003) were significantly associated with the attendance. On doing a multivariate analysis [Table 1], it was found that students with good hygiene status had 2.1 times chances of having better attendance as compared to students with poor hygiene and students in the age category of more than or equal to 11 years were 2.6 times more likely to get better attendance as compared to the students who were <10 years old. Similarly, gender (P < 0.001), hygiene status (P < 0.001), and age category (P = 0.001) were significantly associated with grades. Multivariate analysis [Table 2] showed that girls are 2.4 times more likely to get better grades when compared to boys and students who are 11 years and above have 2.6 times higher chances of getting better grades as compared to students who are 10 years and younger. Furthermore, students with good hygiene are 2.1 times more likely to get better grades than those with poor hygiene.

Table 1

Multivariate analysis of factors associated with attendance

	Factor	OR	95% CI	Significance (P)
Attendance	Hygiene
	Poor	-	-	0.010
	Good	2.173	1.209-3.907
	Age
	6-10	-	-	0.005
	>11	2.648	1.352-5.184

OR: Odds ratio, CI: Confidence interval

Table 2

Multivariate analysis of factors associated with grades

	Factor	OR	95% CI	Significance (P)
Grades	Gender
	Male	-	-	0.001
	Female	2.435	1.433-4.136
	Age category
	6-10	-	-	<0.001
	>11	2.676	1.543-4.639
	Hygiene status
	Poor	-	-	0.004
	Good	2.117	1.264-3.543

OR: Odds ratio, CI: Confidence interval

DISCUSSION

Although the boys and girls were almost equally distributed in nutrition status and morbidity, girls had better hygiene, attendance, and grades. Our study found significant association between gender and grades proving that girls who had better hygiene had better attendance and performed well. The students who had poor hygiene were more prone to diseases and missed classes and could not perform adequately. The nutrition was not adequate in the study area with 38% being undernourished.

Most children were from poor socioeconomic status and could not afford a balanced diet. The milk and lunch under the mid-day meal program were the only source of proteins for most of them. Possible reason for the dearth in hygiene in the students is lack of awareness among parents also, about the knowledge and practices of good personal hygiene. Furthermore, the teachers cannot check for the proper personal hygiene for all the children. Lack of facilities for washing at school may also be a contributing factor.

A study done by Rashmi et al.[9] in the private schools of Bengaluru urban district showed that there is a positive correlation between anthropometry and school performance, but in our study, there was no significant association between the two. Another study by Asghar et al.[10] in a primary school in Lucknow showed that dental caries was the most common morbidity with a prevalence of 37.07%, and our study corroborates the same with dental caries being most common with a prevalence of 16.3%. A study done by Deb et al.[8] found that hygiene was better in girls and 70% of students had some morbidity. Our study too has found that girls have better hygiene and 52% of the students had some morbidity.

Morbidity was taken on the day of the school visit which is not indicative of the complete picture. The attendance taken for the study may include absenteeism in the past for other illnesses which may have an association. Moreover, the absenteeism may not necessarily be due to illness alone. The children who were excluded because of them being absent on the day of the study may actually be sick. These were our limitations in our study.

CONCLUSION

The nutrition status, morbidity profile, and hygiene levels were adequate in half of the total children, and girls outdid boys in hygiene, grades, and attendance, thus proving the association of hygiene with both attendance and grades.

Changing behavior and teaching important messages of life in childhood goes a long way in shaping the life and health of the individual even as an adult. Apart from teaching them about nutrition and hygiene, they should also be taught to tell when there is something wrong with them such as headaches and difficulty in seeing the blackboard which are difficult to pick up by teachers and parents. Health education is the way forward, not only to the students but also to the parents and teachers.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.