RESEARCH ARTICLE Science Technology · There is a growing concern over the child health all over the world with rapid economic growth and social changes. Major determinant of health

Md. Ashrafuzzaman Zahid et al.Assessment of nutritional status, dietary patterns and knowledge perceptions of school age children: A cross sectional study in Jessore, Bangladesh,Science & Technology, 2017, 3(10), 109-119,www.discoveryjournals.com © 2017 Discovery Publication. All Rights Reserved

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Md. Ashrafuzzaman Zahid☼, Joyosree Roy Chowdhury, Suvasish Das Shuvo, RashidaParvin

Department of Nutrition and Food Technology, Jessore University of Science andTechnology, Jessore, Bangladesh

☼Correspondence Author:Md. Ashrafuzzaman Zahid, Assistant Professor, Department of Nutrition and Food Technology, Jessore University of Science andTechnology, Jessore, Bangladesh. Email:[email protected]

Publication HistoryReceived: 11 January 2017Accepted: 12 February 2017Published: April- June 2017

CitationMd. Ashrafuzzaman Zahid, Joyosree Roy Chowdhury, Suvasish Das Shuvo, Rashida Parvin. Assessment of nutritional status, dietarypatterns and knowledge perceptions of school age children: A cross sectional study in Jessore, Bangladesh. Science & Technology,2017, 3(10), 109-119

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ABSTRACTBangladesh is still struggling with the problem of under nutrition among children. Malnutrition, the condition resulting from faultynutrition, weakens the immune system and causes significant growth and cognitive delay. Growth assessment is the measurement

Science & Technology, Vol. 3, No. 10, April-June, 2017 RESEARCH

Science & Technology

Assessment of nutritional status, dietary patterns and knowledgeperceptions of school age children: A cross sectional studyin Jessore, Bangladesh

ISSN2394–3750

EISSN2394–3769

An International Journal


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Publication License


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ISSN2394–3750

EISSN2394–3769



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that best defines the health and nutritional status of children, while also providing an indirect measurement of well-being for theentire population.A cross-sectional study, in which we explored nutritional status in school-age children and analyze factorsassociated with malnutrition with the help of a pre-designed and pre-tested questionnaire, anthropometric measurements andclinical examination from Jessore, Bangladesh. About 200 students (51% and 49% girls) from class three and four were assessedduring the six school visit. Percentages of girls were found more underweight and stunted compared to boys. About 16% studentswere found underweight (male 32.1% and female 28.9%) and15% were found stunted. Thinness was prevalent among 30% studentsand girls were found thinner than boys (38.8% vs. 21.6%). The prevalence of malnutrition is more severe among girls than boys ofthe same age’s groups. About 85% used tube well water for drinking and 73% used sanitary latrine. Only 16% were found toconsume food from vegetables, fruits, milk and protein group along with cereals. Both underweight and overweight equally existedin the students and dietary diversity was not adequate. Emphasis should be given towards nutrition education, personal hygieneeducation health education collaboratively to health and nutrition and promoting dietary diversity, in order to improve the welfareof urban children of Jessore district.

Keywords: Growth monitoring, Malnutrition, School-age Children, Stunting, Wasting

1. INTRODUCTION

Primary school age is a dynamic period of physical growth as well as of mental development of the child [1, 2]. There is a growing

concern over the child health all over the world with rapid economic growth and social changes. Major determinant of health statusin an adult is their nutritional status in childhood. Protein Energy Malnutrition is the most important nutritional problem globallywhich is more severe in third world countries affecting children of under-five age category. 20‑80% of primary school children aresuffering from nutritional deprivation [3]. Bangladesh is an agro-economy based developing country in South Asia. As a developingcountry, the nutritional status in Bangladesh is not so developed. Major improvements are still needed to fully protect youngchildren from malnutrition, an underlying cause of child death. Among total Population (155 million) Under 18 population is 64million. Chronic malnutrition: stunting (moderate & severe) 41.3%, Acute malnutrition: wasting (moderate & severe) 15.6%,Underweight (moderate & severe) 36.4 %, Underweight (severe) 10.4%, overweight (moderate & severe) 1.5%. The percentage ofconsumers who used iodized salt for consumption was 82%. At Urban area in Bangladesh, UNICEF 2011 reported that the access toimproved drinking water sources 85.3% and access to improved sanitation facilities 55.3% [4].Malnutrition is an underlying cause ofover half of child deaths in many developing countries and affects the physical, mental, social wellbeing and child development.Anthropometric assessment provides the rapid measurement of growth, health and nutritional status of children [5].Researchindicates that health problems due to miserable nutritional status in primary school-age children are among the most commoncauses of low school enrolment, high absenteeism, early dropout and unsatisfactory classroom performance [6].Chronic undernutrition in childhood is linked to slower cognitive development and serious health impairments later in life that reduce the qualityof life of individuals. Nutritional status is an important index of this quality. Growth monitoring is universally used to assessnutritional status, health and development of individual children, and also to estimate overall nutritional status and health ofpopulations. Compared to other health assessment tools, measuring child growth is a relatively inexpensive, easy to perform andnon-invasive process [7]. Anthropometric examinationisan almost mandatory tool in any research to assess health and nutritionalcondition in childhood. Physical measurements like body weight, height, circumference of arm and calf, triceps skin fold of childrenhave been extensively used to define health and nutritional status of communities. Based on the age, body weight and height, anumber of indices such as height-for-age and weight-for-height have been suggested [8]. The children are classified using threecategories: ‘underweight’ (low weight-for-age), ‘stunting’ (low height-for-age) or‘wasting’ (low weight-for-height). Lowanthropometric values are those more than 2 SD away from the CDC 2000 (Centers for Disease Control and Prevention) standards[8-11].Now-a-days under nutrition of primary school children is the most important concern throughout the world. 842 millionpeople in the world do not have enough to eat [8-12].The present condition of nutritional status and health status of school-agechildren in Bangladesh is extremely unacceptable. About 48% of Bangladeshi children are malnourished and 1.5 million of them dieeach year from diarrhea that worsens and is worsened by malnutrition [13]. The prevalence of underweight ranged from 49.8% inKhulna to 64.0% in Sylhet which also showed the highest prevalence of stunting (61.4%) and wasting (20.9%).Barisal and Khulna


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have the lowest stunting and underweight rates as well as the lowest share of the total stunted children in Bangladesh [14,15]. Beinga division of Khulna district no study has reported the nutritional status of primary school children of Jessore district. According toUNICEF, in 2008-2012, percentage of stunting (moderate & severe) 41.3%, wasting (moderate & severe) 15.6%, Underweight(moderate & severe) 36.4 %, Underweight (severe) 10.4%, overweight (moderate & severe) 1.5%. The present scenario of nutritionalstatus in Jessore District of children is 30% underweight, 75 severely underweight, 39% stunted and 22% severely underweight [16,17].A review of the literature on hand hygiene suggests that hand washing with soap (HWWS) can reduce micro-organism levelsclose to zero, mainly through the mechanical action of rubbing and rinsing. Good hand washing practice should include water,washing agent such as soap and a drying phase [18, 19].

Nutritional status during school age is a major determinant of nutritional and health status in adult life. Health hazardsassociated with under nutrition and micro nutritional deficiencies remain major public health problems. The study was carried out inhigher primary schools of Gulbarga city. Out of 935 school children under study 51.23% were boys and 48.77% were girls. 50.05%children were below average weight for age showing undernourishment. 22.35% children had specific deficiency diseases in whichbitot’s spot in 48.80% children and anemia is10.05%. 91.44% school children had good personal hygiene [20, 21]. Different studiesalso showed that heights for age z-scores were positively associated with a mean score for pulses in countries and dairy products,beverages and fats. Higher BMI was associated with higher scores for cereals, fruits, vegetables, dairy products, mixed dishes,beverages, sweets and fats [22-24, 34, 35]. Despite the economic growth observed in developing countries, malnutrition is still highlyprevalent. The school age is a dynamic period of growth and development. Poor health and malnutrition may impair both thegrowth and cognitive development of primary school children. The aim of this study carried out the nutritional status and basichygiene practice among the primary school children in Dhaka city, Bangladesh [25, 33].

The overall objective of the study is to assess the nutritional status, diet pattern and knowledge and awareness of health,nutrition, sanitation and hygienic condition of 8-9 years old school going children at urban area in Jessore District.

2. MATERIALS & METHODOLOGY2.1. Study AreaThe study was conducted in urban primary level school of Jessore District in Bangladesh. This study was conducted the six schools inJessore Sadarupazila namely Mentor School & College, Afortschool & college, Daudh Public School & College, BAF Shahin School& College, and Pulerhat Primary School.

2.2. Study DesignThis was a cross-sectional study, descriptive in nature that was sought to construct a profile of the nutritional status of 8-9 years oldchildren of Jessore. The data for the study were obtained from a school survey that was carried from 27-31 August. This studyrepresented the nutritional status of 8-9 years old children at urban areas in Jessore district. The main study components are-(a)Nutritional Status, (b)Socio-economic Information, (c)Dietary pattern, (d)Health awareness, Hygiene & Sanitation and(e)Anthropometry (BMI, Height, Weight and anthropometric indices’ Z values).

2.3. Study Population and Sample SizeThe targeted populations of this study were primary school going children of urban area aged between eight to nine years old fromclass three and four in Jessore, Bangladesh. A total of 200 students were randomly selected for this study from previously mentioned6 schools of Jessore districts. The sample was collected from a school visit and the students were from class three and four. We hadselected 30 students from each of the school but 5 more students were selected from Mentor School & College, and PulerhatPrimary School. Hence, totally 200 children were taken from primary school going children both boys and girls who were randomlyselected.

2.4. Development of Questionnaire and Study InstrumentA standard questionnaire was developed in accordance with the study objectives to obtain relevant information on socio-economic,dietary pattern, health, hygiene and sanitation, anthropometric data. The initial questionnaire was then pretested among theselected school.The data on different information were collected through interviews of the 8 & 9 children of the family, usingstructured questionnaire. Both qualitative & quantitative information were collected. The questionnaire was developed to obtain


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relevant information regarding Socio-economic status such as Educational status, Occupation, Family size etc.Dietary informationwas collected through the past day dietary recall method to estimate the average household food intake.

2.5. Data collectionThe procedures followed in taking anthropometric measurements are as described by World Health Organization and UnitedNations [26, 27]. Their corresponding deviation scores (Z-scores) were calculated with reference to the National Centre for HealthStatistics (NCHS) population, using the cut-off points recommended by the World Health Organization (WHO 2008). The weight wasrecorded to the nearest 0.1 kg. A measuring board with an accuracy of 0.1cm was used to take the children’s height.The height (incm) and weight (in kg) of 200 study children in the school visited were measured using an ‘Electronic body scale TCS 200-RT’. Thechildren were in minimal clothing and without footwear when measurements were taken. This was designed to fulfill the objectivesof profiling the nutritional status of 8-9 years old children and to test the overall nutritional status. Therefore, height, weight, BMImeasurements, age, sex, income, and, disease name and place had to be addressed. Anthropometric data used for this study wereheight and weight. From these data derived indices were calculated for assessing nutritional status. The derived indices were weightfor age Z scores, height for age Z scores and BMI for age Z scores. The three indices are used to identify three nutritional conditions:underweight, stunting and wasting, respectively.

Body Mass Index-for-age at children: BMI is a calculation that uses a child's height and weight to estimate how much body fat he orshe has.

Table 1 BMI for age percentile range chart for children 2 to 20 years age children

≤5 Percentiles curve from growth chart Underweight

>5 to 85 Percentiles curve from growth chart Normal

>85 to 95 Percentiles curve from growth chart At risk overweight

>95 Percentiles curve from growth chart Overweight.

Z-score: The Z-score or standard deviation unit (SD) is defined as the difference between the value for an individual and the medianvalue of the reference population for the same age or height, divided by the standard deviation of the reference population. This canbe written inEquation form as: ( ) = (Observed value) − (median reference value)Standard deviation of reference population2.6. Data AnalysisThe collected data were edited meticulously and responses were coded properly. The data were entered into the computer and usedanalytical technique. Data were edited, processed, and analyzed with the used of the Excel, SPSS 16 version; WHO Anthro plussoftware were used to calculate the different types of anthropometric indices.

2.7. Ethical issuesInitially explained the purpose and objective of the study to the Headmistress and permission was taken to conduct this study.Verbal consent was taken from mothers and as well as from children who were able to understand. This was a self-funding studyand no external fund was provided to carry out this study.


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3. RESULTS3.1. Description of General Information and Family InformationTable 2 describes the number and percentage of general information: grade of class, gender and age. About 80% of the studentsfrom class tree whereas 20% of them from class four. All the respondents’ were categorized in eight and nine years group indifferent percentage (47% vs. 53%). The proportions of boys and girls respondents were 51% and 49%, respectively. Table 2describes the family status of the households from where the students were belongs to. The majority of family were middle class(64%) followed by poor. Among the middle class families boys families were found more in percentage that the girls families.

Table 2 Frequency Distribution of Students’ General Information

General Information

GenderTotal

Boys Girls

n (102) % (52) n (98) % (49) n (200) %

Grade of classClass three 86 43 74 37 160 80

Class four 16 8 24 12 40 20

AgeEight years 48 24 46 23 94 47

Nine years 54 27 52 26 106 53

Family status Poor 22 11 18 9 40 20

Middle Class 66 33 62 31 128 64

Rich 14 7 18 9 32 16

3.2. Description of Health & Medical InformationTable 3 shows the Health Expenditure at Month. There was about 40% respondents required health expenditure less than onethousand taka where girl’s families were expenditure 24% and boy’s family were 16% for their family (maximum result). About 37%respondents didn’t require any health expenditure at month.

Table 3 Frequency Distribution of Health Expenditure at Month

Health expenditureBoys Girls Total

n (102) % (51) n (98) % (49) n (200) %

<1000 32 16 48 24 80 40

>1000 24 12 22 11 46 23

Not required 46 23 28 14 74 37


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General Information

GenderTotal

Boys Girls

n (102) % (52) n (98) % (49) n (200) %


Class four 16 8 24 12 40 20


Nine years 54 27 52 26 106 53


Middle Class 66 33 62 31 128 64

Rich 14 7 18 9 32 16




n (102) % (51) n (98) % (49) n (200) %

<1000 32 16 48 24 80 40

>1000 24 12 22 11 46 23

Not required 46 23 28 14 74 37


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General Information

GenderTotal

Boys Girls

n (102) % (52) n (98) % (49) n (200) %


Class four 16 8 24 12 40 20


Nine years 54 27 52 26 106 53


Middle Class 66 33 62 31 128 64

Rich 14 7 18 9 32 16




n (102) % (51) n (98) % (49) n (200) %

<1000 32 16 48 24 80 40

>1000 24 12 22 11 46 23

Not required 46 23 28 14 74 37


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Table 4 describes the Health information of suffered disease at last month/week. About 55% respondents were suffered from adisease where most of them were female 29%. Among the respondents 45% were found not suffered from any disease. Types ofsuffered diseases are represented in figure 1. Common cold and fever were the most frequent causing symptoms among thestudents (Figure 1).

Table 4 Frequency Distribution of Health information of suffered disease at last month/week

ResponseBoys Girls Total

n (102) % (51) n (98) % (49) n (200) %

Yes 52 26 58 29 110 55No 50 25 40 20 90 45

Figure 1 Frequency distribution of Type of suffered disease at last month/week

3.3. Description of Hygiene & Sanitation Information

Table 5 describes that Source of Drinking water. Majority of the respondents (85%) used tube well water as source of drinkingwater. On the other hands rest of them used tape water for drinking. Only 1% female respondents used pond water.Around 32%respondents were found having deep tube well in their house and rest of them (68%) used water from other sources (Figure 2).Purification method of drinking water from unwanted sources presents in (Figure 3).

19%

7%

3%

Table 5 Frequency Distribution of Source of Drinking water

Source of drinking waterBoys Girls Total

n (102) % (51) n (98) % (49) n (200) %Tube well 86 43 84 42 170 85Tape water 16 8 12 6 28 14Pond 0 0 2 1 2 1Others 0 0 0 0 0 0


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n (102) % (51) n (98) % (49) n (200) %

Yes 52 26 58 29 110 55No 50 25 40 20 90 45




45%

20%

19%

7%

3%6% Not suffer disease

common cold

fever

stomachache

headache

others





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n (102) % (51) n (98) % (49) n (200) %

Yes 52 26 58 29 110 55No 50 25 40 20 90 45








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Color of the used tube well shows in figure 4. About 12% respondents had no tube well. Around 73% tube well’s color werefound green. And only 5% tube well had no sign (Figure 4). The figure-5 shows that use of hygienic latrine was higher in the sample.Maximum children were found practicing hygienic behavior such as washing hand before eating (95%), after using toilet (97%) anduse iodized salt (90%). All were found to brush their teeth regularly (100%) (Figure-6)

Figure 2 Availability of deep tube wells Figure 3 Purification method of drinking water fromunwanted source

Figure 4 Safety color of the tube well used for drinkingwater

Figure 5 Frequency distribution of type of toilet.

68%

32%

0

20

40

60

80

not yet green red no sign

12

73

10


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yes

no

0%

81%

14%

4% 1%

no sign

5sanitary

73%

unhygienic

27%


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Perrcent

Not need

Boiling

Filtering

None of them

sanitary73%


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Figure 6 Percentage of children practicing some hygienic behavior

3.4. Description of Nutritional StatusNutritional status of students was determined by measuring different type of anthropometric indices, weight for age Z scores (WAZ),height for age Z scores (HAZ), and BMI for age Z scores (BAZ). Percentile was categorize as Underweight (≤5 Percentiles), Normal(>5 to 85 Percentiles), at risk overweight (>85 to 95 Percentiles), and Overweight (>95 Percentiles). Table 6 shows the nutritionalstatus of the students based on different nutritional indices. Nutritional indices such as weight for age (WAZ), height for age (HAZ),and BMI for age (BAZ) were found significantly (p<0.05) different between boys and girls. Girls were found worse in all thenutritional indices compared to boys.

Table 7 describes the nutritional status of children based on different nutritional indices. Among the total sample (n=200) about16% were found underweight where boys shared 11.8% and girls were 20.4%, based on weight for age Z scores. Significantly(p=0.146) male students were found more Normal (74.5%) than female students (71.4%). Similarly male students (13.7%) were foundsignificantly more overweight than female students (8.2%). Table 7 Shows the nutritional status based on height for age Z scores.School age is considered as an active period of growth and development because in this age period children go through physical,mental, emotional and social changes. Among the total sample (n=200), about 85% were normal where the boys were 88.2% andgirls were 81.6%, based on height for age Z scores. Significantly (p=0.356) female students were found more mildly stunted thanmale students (10.2% vs. 7.8%), based on the rangemildly stunted (-1≤HAZ≤2). Similarly female students were found significantlymore moderately stunted than male students (8.2% vs. 3.9%), based on the range moderately stunted (-1≤HAZ≤2).

90

Using iodized salt

Table 6 Nutritional status based on different type of anthropometric indices

Indices Boys (n=102) Girls (n=98) Total (n=200) p-value*

Weight for age (WAZ)¥ 0.58±1.33 -0.04±1.44 0.27±1.41 0.002

Height for age (HAZ)¥ 1.03±1.56 0.40±1.59 0.72±1.61 0.006

BMI for age (BAZ)¥ -0.01±1.52 -0.42±1.41 -0.21±1.48 0.045

*significant at p<0.05 and student t-test was performed; ¥mean ± SD value is given


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9597

100

Using iodized salt washing hand(before eating)

washing hand(after defecation)

brushing teeth

percent





BMI for age (BAZ)¥ -0.01±1.52 -0.42±1.41 -0.21±1.48 0.045



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BMI for age (BAZ)¥ -0.01±1.52 -0.42±1.41 -0.21±1.48 0.045



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Table 7 Percent distribution of nutritional status based on weight for age Z scores (WAZ)

Nutritional status Boys (n=102) Girls (n=98) Total (n=200) p-value

weight for age Zscores (WAZ)

Underweight1 11.8 20.4 16.0

0.146Normal2 74.5 71.4 73.0

Overweight3 13.7 8.2 11.0

height for age Zscores (HAZ)

Mildly stunteda 7.8 10.2 9.0 0.356

Moderately stuntedb 3.9 8.2 6.0

Normalc 88.2 81.6 85.0

BMI for age Zscores (BAZ)

Thinness1* 21.6 38.8 30.0 0.029

Normal2* 58.8 46.9 53.0

Overweight3* 19.6 14.3 17.0

1 underweight (WAZ<-1); 2 normal (-1≤WAZ≤2); 3overweight (WAZ>2); 1 Mildly stunted (-2≤HAZ<-1); 2 Moderatelystunted (HAZ<-2); 3Normal (-1≤HAZ≤2); *significant at p<0.05; 1* underweight (BAZ<-1); 2* normal (-1≤BAZ≤2);3*overweight (BAZ>2)

Regarding the percent distribution of nutritional status based on BMI percentile in Table-7, most of respondents 53% werenormal. Where the boys were 58.8% and girls were 46.9%, based on the rangeNormal (-1≤BAZ≤2). Significantly (p=0.029) femalestudents were found more Underweight than male students (38.8% vs. 21.6%), based on the rangeUnderweight (BAZ<-1). On theother hand male students were found significantly more Overweight than female students (19.6% vs. 14.3%), based on therangemoderately stunted (BAZ>2).

Maximum respondents were within range of -2 to +2 SD values which indicates normal nutritional status (Figure 7). Whereassome of the respondents were below the standard range, indicates malnourished condition. Similarly few respondents were abovethan standard range, indicates over weight. And the obtain curve was comparatively flat than the bell shaped Reference Curve(Figure 7).

Figure 7 Distribution of the BMI for age Z-score compared to WHO international reference


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0.146Normal2 74.5 71.4 73.0





Normalc 88.2 81.6 85.0


Thinness1* 21.6 38.8 30.0 0.029

Normal2* 58.8 46.9 53.0

Overweight3* 19.6 14.3 17.0


Regarding the percent distribution of nutritional status based on BMI percentile in Table-7, most of respondents 53% werenormal. Where the boys were 58.8% and girls were 46.9%, based on the rangeNormal (-1≤BAZ≤2) . Significantly (p=0.029) femalestudents were found more Underweight than male students (38.8% vs. 21.6%), based on the rangeUnderweight (BAZ<-1). On theother hand male students were found significantly more Overweight than female students (19.6% vs. 14.3%), based on therangemoderately stunted (BAZ>2).




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0.146Normal2 74.5 71.4 73.0





Normalc 88.2 81.6 85.0


Thinness1* 21.6 38.8 30.0 0.029

Normal2* 58.8 46.9 53.0

Overweight3* 19.6 14.3 17.0


Regarding the percent distribution of nutritional status based on BMI percentile in Table-7, most of respondents 53% werenormal. Where the boys were 58.8% and girls were 46.9%, based on the rangeNormal (-1≤BAZ≤2). Significantly (p=0.029) femalestudents were found more Underweight than male students (38.8% vs. 21.6%), based on the rangeUnderweight (BAZ<-1). On theother hand male students were found significantly more Overweight than female students (19.6% vs. 14.3%), based on therangemoderately stunted (BAZ>2).




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3.5. Description of Individual Dietary Record MethodEating pattern has a great impact on nutritional status of different stages of life from neonate to adult. Lack of proper nutrients inbody has resulted in a negative impact on our health. Low or high intake of food creates an imbalance condition. Proper intake ofnutritious and safe food helps to maintain a healthy body.

Figure 8 depicts the percent share of different combination of food groups consumed by the students in the recalled day. Itshowed that about 33% children consumed combination of Cereal, vegetables, animal protein, and fruits followed by 28% threegroups consumer. Only 10% of the children consumed foods from only two groups: cereal and vegetables. Five food groupsconsumer were only 16%. Figure 8 which could make it easy to understand and compare the different combination of food groupsconsumed by the students per day.

Figure 8 Individual dietary record method

C= cereals, V= Vegetables, AP= Animal Protein, F= Fruits, M= Milk & Dairy Products.

4. DISCUSSIONThis study was conducted among primary school-age children with the age range of 8-9 years. In our study nutritional status of thestudents was assessed by measuring different type of anthropometric indices such as weight for age Z scores (WAZ), height for ageZ scores (HAZ), and BMI for age Z scores (BAZ). All the indices were found significantly (p<0.05) different between boys and girls.Girls were found worse off in all the nutritional indices compared to boys. About 17% were found underweight where boys shared11.8% and girls were 20.4%, based on weight for age Z scores. Significantly (p=0.146) male students were found more normal thanfemale students. Similarly male students were found significantly more overweight than female students. Based on height for age Zscores, about 85% were normal where the boys were 88.2% and girls were 81.6%, significantly (p=0.356) female students were foundmore mildly stunted than male students, similarly female students were found significantly more moderately stunted than malestudents. Nutritional status based on BMI for age, most of respondents 53% were normal, significantly (p=0.029) female studentswere found more underweight than male students. On the other hand male students were found significantly more overweight thanfemale students. In this study the prevalence of underweight, stunted and overweight were 73%, 15% and 17% respectively. In 2014a study conducted by Haqueet al. found that WAZ was higher boys and HAZ scores were lower in boys of primary school children.This study had reported the nutritional status and hygienic practices of the primary school children. Among respondents 66.40% (73)were boys and 33.60% (37) were girls. The study reported, in case of WAZ, 19.10% were below normal, 79.10% were normal and1.80% was above normal. In case of HAZ, 11.80% were below normal, 80% were normal and 2.70% were above normal. In case ofWHZ 18.20% were below normal, 55.50% were normal and 1.80% were above normal [28].

A study was conducted to evaluate factors contributing to the nutritional status of mother and young children in Guatemala thatstudied by satchel et al. (2005) described that some factors were related with nutritional status of children [29]. The Guatemala studyreported 52.6% were underweight and 9.2% were stunted which was higher than what we found in our study. Educational status ofthe parents was found to be significantly associated with nutritional status of primary school children but in our study we had not

0

C+V

C+V+AP

C+V+AP+F

C+V+AP+F+M

C+V+AP+M


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0 10 20 30 40

Percent


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Percent


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assessed the relationship between children nutritional status with mother’s education [30]. A very recent similar type of study wasconducted by Assefa et al. (2015) in South-east Ethiopia where the Socio-demographic characteristics and nutritional status ofadolescents were assessed in Jimma zone, South West Ethiopia, in 2011. It showed that most of the underweight adolescents werefemales (53.20%), adolescent father`s education had primary (42.45%) and adolescent mother`s education had no education(55.45%). And most of the stunted adolescents were males (67%), adolescent father`s education had no education (61%) andadolescent mother`s education had primary (45%) [31].

In our study, from the part of hygiene and sanitation status, about 85% respondents were consumed deep tube well water andaround 68% respondents had deep tube facility of which only 73% tube well had green color and 5% had no sign, 73% used sanitarylatrine, About all the students used to wash hand after defecation and before eating and 90% family used iodized salt. All therespondents were found to brush their teeth every day. Haque et al. (2014) found showed that in case of basic hygiene practice, allrespondents washed hand before and after meal, washed hand after coming home from outside area. For brushing teeth, 34.2%,57.5% and 8.2% boys brushed teeth one, two and three times every day respectively [28].Only 16% respondents were consumedfood from five groups (cereals, vegetables, and protein, fruit and milk & dairy products) at their past day. Majority (33%) wasconsumed food from four groups (cereals, vegetables, protein and fruit) and only 10% was consumed cereals and vegetables.Hosma and et al. (2013) showed the relationship between dietary intake and nutritional status of urban primary school children fromIran and India. The result was that total dietary diversity scores were significantly higher for Indian children who had normal weightor who were overweight (F=32.197, p=0.000) and lowest for underweight children. Similar trends were observed for the childrenfrom Iran (F=9.345, p=0.000). In Iran, mean scores for vegetables, beverages, sweets and fats increased with increasing weight.Heights for age z-scores were positively associated with a mean score for pulses in countries and dairy products, beverages and fats.Higher BMI was associated with higher scores for cereals, fruits, vegetables, dairy products, mixed dishes, beverages, sweets and fats[32].

5. CONCLUSIONMalnutrition is a significant problem throughout the world, but specifically in developing and under-developed countries likeBangladesh. This cross-sectional study was sought to construct a profile of the nutritional status of 8-9 years old children of Jessoreurban. It is important to examine the nutritional status of this age group because children these ages have the potential to “catchup” physically and mentally if their nutritional situation improves. This assessment takes into account all aspects of the socio-demographic factors, health status, sanitation, nutritional knowledge, hygiene practice and dietary pattern which contributing tomalnutrition. To reduce the ill effects of malnutrition the government needs to take necessary steps to reduce prevalence ofmalnutrition. Family members should be concerned about their child to rare up so that they could be capable to overcome theentire nutritional problem. Both nutrition specific and nutrition sensitive intervention need to initiate to reduce double burden ofmalnutrition. Hygiene practices could have been over reported as is common with self-reported hygiene practices. Educational leveland socio economic status of the children’s parents could represent a source of bias.

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