Introduction

Children are not only divine gifts but also the mirror of a nation and hope of the world. They are the countries biggest human investment for development. It is rather unfortunate that even after 60 years of Independence, our country had made little progress in improving the health condition of our school children when compared to the developed countries. Quality of life of school children, by all standards continues to be poor more so in rural areas and urban slums.

The World Health Organization’s Expert Committee on School Health Services noted as long as 1950 that “to learn effectively, children need good health”.¹ Research indicates that nutritional deficiencies and poor health in primary school age children are among the causes of low school enrolment, high absenteeism, early dropout and poor classroom performance.

The present position with regard to the health and nutritional status of the children in our country is very unsatisfactory. Mortality in this age bracket is low but morbidity and physical defects constitute heavy burden. Extensive surveys have been carried out in different parts of the country and the findings show that sickness, morbidity and mortality rates in India are among the highest in the world.² Health problems of school children vary from one place to another. Surveys carried out indicate that the main emphasis will fall in malnutrition, infectious diseases, intestinal parasites, diseases of skin, eye and ear and dental caries.³ These health problems can make learning difficult and may seriously hamper the educational process and the child’s intellectual growth and may also handicap the child for life. Keeping all the se facts in view, a need was felt to carry out a survey of the health status of primary school children in various schools of Meerut city with the following objectives-

1. To find out the overall prevalence of morbidity in primary school children. 2. To study the pattern of morbidity in primary school children (5-11 years) in urban Meerut.

Material and methods

The present cross-sectional study was carried out from March 2007 to October 2007 in urban area of Meerut. The study subjects were school going children (5-11 years). For the purpose of study, the urban area of Meerut district was divided into four zones. A list of all government primary schools was taken and arranged according to the zones. Equal numbers of students were examined from the randomly selected school/ schools from each zone. For calculating the sample size, the prevalence of malnutrition was considered as the most common health problem in primary school age children. Therefore, by taking prevalence of malnutrition as 50% for confidence level 95% with a relative precision of 10%, an optimum sample size for study was obtained by applying the formula n= 3.84 pq/SE² . This sample size was doubled in order to cover both boys and girls, & thus a total of 800 students (426 boys and 374 girls) were interviewed and examined. They were interviewed through oral questionnaire method and desired information was collected on pre-designed and pre-tested proforma. A thorough clinical examination was made along with anthropometric measurements which was carried out at school premises in one room made available for this purpose. Different morbidities were classified according to ICD-10 classification⁴ The nutritional status of the children was assessed by the quantitative classification given by Nutrition Sub-Committee of Indian Academy of Paediatrics (1972)⁵.For detecting anemia Haemoglobin estimation was done by Sahli’s haemoglobinometer. Cut off level of Hb (g/dl) for anaemia in children was taken as 12g/dl.⁶ For screening the hearing ability of the children the “Wisper Test”⁷ was used. Vision was tested by means of Snellen’s chart test⁸.

Results

The maximum number of children (23.6%) studied were in the age group of 9 years and minimum (4.3%) in the age group of 5 years. The same was the case in boys and girls distribution (Table 1)

Figure 1

Table 1-Age and sex wise distribution of children

In all 542 (67.8%) children were found to be suffering with one or more morbid conditions accounting for the sickness rate of 67.8% children as shown in Table-2.

Figure 2

Table 2-Distribution of children according to morbidity

A total of 2532 morbidities were found to be present in 542 sick children accounting for 4.6 morbidities per sick child. Maximum children (93.4%) were having morbidity related to nutritional deficiencies followed by diseases of the oral cavity (92.3%), malnutrition (73.1%), skin diseases (59%), behavioural problems (38.2%) and diseases of blood forming organs (35.8%) (Table 3).

Figure 3

Table 3- Distribution of children according to various morbidities (Multiple response)

Table-4 shows the prevalence of various diseases in children. The morbidity was maximum due to malnutrition (495/1000). Next in order were morbidity due Vitamin B deficiency (301.3/1000), nutritional anaemia (242.5/1000), dental caries (227.5/1000), other disorders of the teeth (220/1000), Vitamin C deficiency (186.3/1000), other skin changes like dry skin and petechiae (183.8/1000), nail biting and thumb sucking (153.8/1000), Pediculosis (143.8/1000) and acute upper respiratory infections (140/1000).

Figure 4

Table 4- Distribution of children according to types of morbidities

Discussion

In our study, 67.8% children (70.0% boys and 65.2% girls) were found to be suffering with one or more morbid conditions accounting for the sickness rate of 67.8% children with 4.6 morbidities per sick child. The findings in our study were found to be lower as compared to a similar study conducted in Ludhiana by Panda et al⁹ who observed 72.4% children suffering from one or more illnesses of which 71% were boys and 74.5% were girls. While Ananthakrishnan et al¹⁰ reported morbidity in 97% children with undernutrition (57.6%), anaemia (57.1%), worm infestation (46.4%), riboflavin deficiency (32.9%) and dental caries (27.9%) as the most common causes of morbidity, Hassan et al¹¹ in a similar study among school children of Aligarh found 82% children suffering from some sickness at the time of examination of which dental problems (25%) and anaemia (24.8%) were found to be the most common causes of morbidity. Similarly Karikatti et al¹² observed 50.42% children suffering from one or the other health problems and the common disorders found were malnutrition (33-79%), dental caries (40.25%) parasitic infestation (40.25%), nutritional deficiencies (20.11%) and respiratory disorders (22.57%). In our study the prevalence of morbidity was maximum due to malnutrition followed by Vitamin B deficiency , nutritional anaemia and dental caries.We noted malnutrition in 49.5% children and these findings are lower than the findings of Panda et al⁹ (52.2%), Ananthakrishnan et al¹⁰ (57.6%), Semwal et al¹³ (52.6%), and Shakya et al¹⁴ (51%) and almost equal to the findings of Prakash et al¹⁵ . In the present study, anaemia was detected in 37.7% (30.6% in boys and 45.2% in girls) children which is more than that found by Panda et al⁹ , Semwal et al¹³, Hassan et al¹¹ and Chandra et al¹⁶ in their studies ( 26%, 28.4%, 24.8% and 25.5% respectively) and almost equal to findings (37.48%) of Mullick⁷ amongst school children in Jhansi. In all these studies girls were found to be more anaemic than boys which is similar to the findings in the present study. In our study, 22.8% children (13.1% boys and 9.6% girls) were found to be suffering from dental caries which is higher than that observed by Shakya et al¹⁴ (19.8%) and Pandey et al¹⁷ (13.56%) and almost similar to the findings of Panda et al⁹ who also reported dental caries in 23.1% children.

Conclusion

Health is a key factor in school entry, as well as continued participation and attainment in school. Most of the defects and diseases that are seen among the school children are preventable and the health of the child can be preserved and improved, provided that the defect or disease is detected and remedied early by a well organized school health programme.