Nutritional Status, Proteinuria and Glycosuria among Primary School Children in a rural community of Bangladesh

[Ibrahim Med. Coll. J. 2008; 2(1): 35-36]

To the Editor

Nutritional status of primary school children in rural Bangladesh has not been addressed in the past. Nor there was any published report on the prevalence of glycosuria and proteinuria in this group. Detection of proteinuria is an easy method to detect disease like glomerulonephritis in children. Glycosuria indicates several underlying pathological conditions like – diabetes mellitus and tubulo-interstitial disorders. This study was undertaken to determine the nutritional status amongst the primary school children in addition to screening for proteinuria and glycosuria.

This cross sectional study was conducted in the purposively selected four primary schools situated in 4 villages of Sreepur Thana. The villages were Satkhamair, Mulaid, Ansar Tapirbari and Tangra situated about 80 km off Dhaka City. All students of the primary schools were considered eligible for the investigation. The school teachers were contacted and the purpose of the study and procedural details were explained to them. We started interviewing the students one by one in a room provided by the school authority. The interviewing sessions included information on their socio-demographic characters like name, age, sex, housing, and the use of latrine and drinking water. The teachers helped us in assessing family income either by checking information from admission registry or personal impression. Then each student was examined for height, weight and mid-upper arm circumference (MAC) including signs of vit-A, vit-B, vit-C deficiency. The presence or absence of anemia and goiter as a sign of iron and iodine deficiency respectively were noted. Each student was provided with a test tube and instructions on how to collect his / her urine. Urine samples were examined for the presence of glucose with an enzyme (glucose oxidase) impregnated test-strip. Following the glucose-oxidase test, the urine was tested for the presence of protein in urine using salicylic sulfonic acid.

A total of 460 (M / F = 256 / 204) students of four primary schools in four different villages took part in the investigation. Almost all students had provision of safe drinking water (99.6%) and sanitary latrine (91.3%). More than 90% had tin shed living rooms.

The mean ± (SD) age was 8.5 (1.7) years. Their mean (SD) height, weight and MAC were 124.3 (10.2) cm, 21.0 (4.8) kg and 16.9 (1.7) cm, respectively. The estimated body mass index (BMI) was 13.5 (1.6) and body surface area (BSA) was 0.86 (0.13). The comparisons of age, height, weight, MUAC, BMI and BSA between male and female participants did not differ (data not shown). According to Gomez’ classification of nutritional status – only 13.8% was graded as “normal” and 7% as “3rd degree or severe malnutrition” [table 1].  The partial correlation as expected, the age was significantly (p<0.001 for all) correlated with height (r=0.79), weight (r=0.73) and MUAC (r=0.55). Similar correlations were also found with BMI and BSA (table not shown).

Table 1. Nutritional status of the school children of age 6-12 years (n=456): Gomez’ classification

The prevalence of anemia was found among 18.7% of the children. Regarding oral hygiene, 55% of them had dental caries and 23.7% reported gum-bleeding during brushing of teeth. Skin examination revealed that 2.8% had scabies and 2.4% had fungal infection. Although proteinuria was detected among 2.2% of the participants there was no case of glycosuria. As regards nutritional deficiency, sign(s) of Vitamin A deficiency was found in 11.7% and Vitamin B deficiency in 29.3%. Visible goiter was detected in 1.3% of the participants [table-2].

Table 2. General clinical features and diseases and signs of micronutrient deficiency.

Although the investigation was conducted on a small sample (n = 460) from four purposively selected village-schools, very few reports are seen for this group in Bangladesh. There are several reports on nutrition in Bangladesh and other countries but those are mostly in the under-fives1, 2. Very few studies address the nutritional status of children and adolescents in the rural community. As there was no other anthropometric study of this age group it was not possible to compare our anthropometric findings to that of the others. According to Gomez’ classification, not even one-fifth of the study subjects had a “normal” nutritional status. This finding indicates that more than 80% of the children of age 6 – 12 years suffer from mild to severe malnutrition and about 40% suffer from moderate to severe malnutrition.

Fatema Binte Rasul, Nandini Datta, Md. Juber Alam,

Malabika Bardhan, Afrina Shams Chowdhury,

Chowdhury Dilabiz Mahmood, Md. Saif Bin Mizan,

Rajib Bhadra Roni, Jhumur Ghosh, Rifat Imam Majumder,

Saad Ahmed Ferdous, Roksana Sherin, Mahadi Hassan,

Md. Mamunur Rashid –Ibrahim Medical College IM-3B

References

1.  Faruque AS, Khan AI, Malek MA, Huq S, Wahed MA, Salam MA, Fuchs GJ, Khaled MA. ICDDR,B: Center for Health and Population Research, Dhaka, Bangladesh. [email protected]

2.  de Onís M, Monteiro C, Akré J, Glugston G. The worldwide magnitude of protein-energy malnutrition: an overview from the WHO Global Database on Child Growth. Bull World Health Organ 1993; 71(6): 703