Nutritional status among primary school children in rural Sri Lanka; a public health challenge for a country with high child health standards

Abstract

BackgroundNutritional status of pre adolescent children is not widely studied in Sri Lanka. The purpose of this study was to determine the nutritional status among pre-adolescent school children in a rural province of Sri Lanka.MethodsA school based cross sectional study was carried out in North Central Province in 100 rural schools, selected using multi stage cluster sampling with probability proportionate to size. Children in grade one to five were enrolled with a maximum cluster size of fifty. Anthropometric measurements were done by trained data collectors and venesection was done at site by trained nurses. WHO AnthoPlus was used to calculate the BMI, height for age and weight for age Z scores. Survey design adjusted prevalence estimates with linearized standard errors were generated using svy function of STATA. Mean haemoglobin concentration (Hb) was calculated using methaeamoglobin method. Screening for iron deficiency and thalassemia trait was done using peripheral blood films.ResultsHeight and weight measurements were done for 4469 of children and the Hb data was available for 4398 children. Based on the survey design adjusted estimates, prevalence of severe thinness, thinness, overweight and obesity in this population was 8.60% (SE 0.94), 2.91%(SE 0.74), 2.95%(0.26) and 2.43%(SE 0.92) respectively. Similarly, survey design adjusted prevalence of underweight and stunting were, 25.93% (95% CI 24.07–27.89%) and 43.92%(95% CI 40.55–47.56%). Adjusted mean estimates for hemoglobin was 12.20 (95% CI 12.16–12.24) g/dL. Prevalence of anemia was 17.3% (n = 749). Prevalence of mild and moderate anemia was 9.4 and 7.6% respectively.ConclusionThis study confirms that malnutrition is still a major problem in North Central Province, Sri Lanka.

Factors associated with anemia among Sri Lankan primary school children in rural North Central Province

“…Detailed methodology of the original study is published elsewhere [35]. A summary is presented here.…”

“…Investigation reports were obtained from a commercial diagnostic laboratory with external quality control procedures. Further details on study design, including study setting, study population, sampling method, data collection tools and data collection are described in the previous paper [35]. …”

“…We previously reported that anemia prevalence among rural primary school children in North Central Province (NCP), Sri Lanka was 17.1% and mean hemoglobin level is 12.2 g/dl (SD = 0.89) [35]. Hemoglobin level less than 11.5 g/dl was used as the cut off; as recommended by the WHO for 5–11 years old children living at altitudes of less than 1000 m [36].…”

“…Hemoglobin level less than 11.5 g/dl was used as the cut off; as recommended by the WHO for 5–11 years old children living at altitudes of less than 1000 m [36]. Initial analysis has shown that the prevalence declined with age in both sexes [35]. Purpose of the present paper is to determine modifiable factors associated with childhood anemia in NCP in order to plan evidence based public health interventions.…”

Iron status and prevalence of anaemia among school children in the Jaffna district

“…There was a significant difference in the iron deficient status between males (48.2%) and females (54.8%) in this study (p=0.024), A survey done in the Galle district in 2003 among school children of 12-16 years old also showed a significantly increased prevalence of anaemia in females compared with males (p=0.004). The same study found iron deficiency in 30.2% males and 47.8% females 14 . Nutrition and Food Security Assessment in Sri Lanka, 2009 showed 33.9% of females aged less than 20 were anaemic 15 .…”