Assessment of Nutritional Deficiency Diseases in Rural School Children s of Anantapuramu District S. Pradeep Kumar Reddy 1*, G.

Transcription

1 Saudi Journal of Medical and Pharmaceutical Sciences Scholars Middle East Publishers Dubai, United Arab Emirates Website: ISSN (Print) ISSN (Online) Assessment of Nutritional Deficiency Diseases in Rural School Children s of Anantapuramu District S. Pradeep Kumar Reddy 1*, G.V Nagaraju 2 1 Assistant Professor, Dept. of Pharmacy Practice, Koringa College of Pharmacy, Korangi , Kakinada, A.P, India 2 Assistant Professor, Dept. of Pharmacy Practice, Koringa College of Pharmacy, Korangi , Kakinada, A.P, India Original Research Article *Corresponding author S. Pradeep Kumar Reddy Article History Received: Accepted: Published: DOI: /sjmps Abstract: In an attempt our study was to enlist the common nutritional deficiencies in rural areas of school children s of Anantapuramu district, we also aimed to Creating awareness and increasing knowledge of the students, parents and teachers about diet and nutrition providing of patient information leaf let about importance of nutrition. National Rural Health Mission (NRHM) also stated that nutritional disease account about 40 % childhood deaths and as a challenge in the under developing countries like India. Over six months period, assessment of nutritional deficiency diseases was carried out in school children s studying in Anantapuramu district. Nutritional assessment was done by direct interviewing of school children s, also by considering from the children s health book. In this 6 months interventional study There were 1472 participants of those 859 were boy s participants and 613 were girl s participants. We are strictly following the inclusion and exclusion criteria and the data was evaluated by the using of Microsoft Excel All study participants from 6-15 years of age are included in the study. Our study says that most of the nutritional deficiency disorders diseases can be prevented by creating awareness on nutrition and deficiency diseases. Nutritional deficiency disorders can be possible in different ways like inadequate taking of diet by an individual and pregnant woman during the pregnancy which makes the child as high risk to nutritional deficiency disorders. Keywords: Rural school children s, Nutrition deficiency diseases, Intervention, Six Months, Epidemiology study. INTRODUCTION Nutrients Nutrients are considered to be most vital for the existence of human life. Every nutrient has got its specific physiological role to play for the maintenance, growth and development of the body. Our diet should be adequate in all these nutrients. If the diet does not provide these in adequate amounts dietary deficiencies and diseases are bound to occur [1]. Nutrition is coming to the fore as a major modifiable determinant of chronic disease, with scientific evidence increasingly supporting the view that alterations in diet have strong effects, both positive and negative, on health throughout life [2]. Most importantly, dietary adjustments may not only influence present health, but may determine whether or not an individual will develop such diseases as cancer, cardiovascular disease and diabetes much later in life [3]. Health and nutrition are the most important contributory factors for human resource development in the country. India has been classified by the World Bank as a country with a low income economy, with per capita GNP of US $ 950. It ranks 160 in terms of human development among 209 countries [3]. Among the Indian population, about 28% in the rural and 26% in the urban areas are estimated to be below the poverty line which is defined as the expenditure needed to obtain, on an average, 2400 Kcal per capita per day in the rural areas and 2100 Kcal in urban areas [2]. Longterm malnutrition (under and over) leads to stunting and wasting, non communicable chronic diet related disorders, increased morbidity and mortality and reduced physical work output. It is a great economic loss to the country and undermines development. AIMS AND OBJECTIVES Aims We aimed to assess the nutritional deficiency disorders in rural school children s of Anantapuramu district. OBJECTIVES To enlist the common nutritional deficiencies in rural areas of school children s of Anantapuramu district. Creating awareness and increasing knowledge of the students, parents and teachers about diet and Available online:

2 nutrition providing of patient information leaf let about importance of nutrition. Improving the health and nutrition of schoolchildren through school-based programs. Offer a more cost-effective route for delivery of simple health interventions and health promotion. Discuss measures of prevention & treatment for these nutrition deficiency diseases MATERIALS AND METHODS Study design: A Prospective interventional study. Data analysis The data obtained from the questionnaires was analyzed in Microsoft excel 2013 (Microsoft Corporation). Data sources Data is collected by direct interviewing of school children s, also from the children s health book and the forms like nutrition assessment form, nutritional knowledge assessment form, nutritional survey general clinical examination form were used to collect the data Study site The study was carried out at rural government ZPHS schools in Anantapuramu district ; it is a rural setup, government ZPHS school in Bathalapalli (BOYS), ZPHS school in Bathalapalli(GIRLS), ZPHS school in Mudiguba (BOYS), ZPHS school in Mudiguppa (GIRLS. Located near Bathalapalli, Anantapuramu (District), Andhra Pradesh (state), and India. Study size: Study size of the study was 1472 in which boys and girls were involved in the study. Study period: Six months from July 2012 to January 2013 Data collection: Collected by direct interviewing of school children s and from the children s health book maintained by the schools. Study criteria Inclusion criteria Students studying in rural government ZPHS schools of Anantapuramu district. Children s aged from 5 to 15 years Children s suffering from nutritional deficiency diseases Children s who has experienced the signs and symptoms of nutritional deficiency diseases at present and past Exclusion criteria Private school study children s. Children are with congenital disorder. Children s not willing to participate in study Follow-up methods For follow-up of children s, regular visiting s to the schools daily and enquiring about their health status and frequency of nutritional deficiency disease signs and symptoms and by data from children health book. Variables Outcomes: BMI, BMR, Weight, Height, Wt/age, Ht/age, Ht/wt%. Potential confounders Co-morbidities which mimic the nutritional deficiency diseases symptomatically. Awareness about their nutritional status. Awareness about their health status. RESULTS AND DISCUSSION Distribution of Age Verses Sex Ratio of Study Participants Nutritional deficiency diseases assessment in rural school children was made from July 2012 to January 2013 in rural government ZPHS schools of Anantapuramu district there were 1472 participants of those 859 were boy s participants and 613 were girl s participants. All study participants from 6-15 years of age are included in the study. Most of the patients lie in the range of 12 to 15 years of age. Out of all the 859 boys study participants around 242 boys lie between 6 to 8 years and 232 lie in 9 to 11 years age group and remaining 385 boys participants were in between 12 to 15 years of age. Out of all the 613 girls participants around 137 girls lie between 6 to 8 years and 193 girls lie in 9 to 11 years age group and remaining 283 girls participants were in between 12 to 15 years of age. Number of study participants in age groups of 6 to 8, 9 to 11 and 12 to 15 are 379, 425 and 668. Table-1: Distribution of Age Verses Sex Ratio of Study Participants S.No Age group(yrs) Sex No. of study participants (N %) Boys 242(16.44 %) Girls 137(9.30%) Boys 232(15.76 %) Girls 193(13.11 %) Boys 385(26.15 %) Girls 283(19.22 %) Total 1472(100 %) Available online:

3 Graph-1: Distribution of Age Verses Sex Ratio of Study Participants Trends of Malnutrition among Study Participants According To WHO Child Growth Standards Malnutrition of boys study participants according to WHO Child Growth Standards were as follows stunted (n=157), wasted (n=348), under weight (n=251), normal (n=103). Malnutrition of girls study participants according to WHO Child Growth Standards were as follows stunted (n=98) and wasted (n=209) and under weight (n=261) and normal (n=45). Malnutrition of total study participants according to WHO Child Growth Standards were as follows stunted (n=255) and wasted (n=557) and under weight (n=512) and normal (n=148). Comparatively less frequent study participants were normal according to WHO Child Growth Standards. Table-2: Trends of Malnutrition among Study Participants According To WHO Child Growth Standards S.No Nutritional Status Boys Girls Total N (%) 1 Stunted 216(22.14%) 143 (23.32 %) 359 (24.38 %) 2 Wasted 391(45.51%) 209 (34.09 %) 600 (40.76 %) 3 Under weight 251(29.22%) 261 (42.57 %) 512 (34.78 %) Graph-2: Trends of Malnutrition among Study Participants According To WHO Child Growth Standards Trends of Malnutrition among Study Participants According To WHO Child Growth Standards Trends of dietary habits of boys study participants as per NIN daily recommended intake was as follows; vegetables (n=213),fruits(n=209),meat products(n=123),milk products (n=106),bread products(n=145),other products(n=63).trends of dietary habits of girls study participants as per NIN daily recommended intake was as follows; vegetables (n=143),fruits(n=207),meat products(n=98),milk products(n=84),bread products(n=63),other products(n=18).trends of dietary habits of boys study participants as per NIN daily recommended intake was as follows; vegetables (n=356),fruits(n=416),meat products(n=221), milk products(n=190),bread products(n=208),other products(n=81).comparatively less no. of study participants were taking as recommended daily intakes of vegetables, fruits, meat products bread products, according to NIN recommended daily intakes. Available online:

4 Table-3: Trends of Dietary Habits of Study Participants as Per NIN Daily Recommended Intakes S.No Daily Dietary habits Boys Girls Total N (%) 1 Vegetables 213(24.79 %) 143(23.32 %) 356 (24.18 %) 2 Fruits 209(24.33 %) 207(33.76 %) 416 (28.26 %) 3 Meat 123(14.31 %) 98(15.98 %) 221 (15.01 %) 4 Milk products 106(12.33 %) 84(13.70 %) 190 (12.90 %) 5 Bread product 145(16.88 %) 63(10.27 %) 208 (14.13 %) 6 Others Products 63(7.33 %) 18(02.93 %) 81 (05.50 %) Graph-3: Trends of Dietary Habits of Study Participants as Per NIN Daily Recommended Intakes Trends of Daily Nutrients Intake of Study Participants as Per NIN Daily Recommended Intakes Trends of daily nutrients intake of boys study participants as per NIN daily recommended daily nutrients intake was as follows vitamins (n=213), proteins (n=345), carbohydrates (n=467), mineral (n=234). Trends of daily nutrients intake of boys study participants as per NIN daily recommended daily nutrients intake was as follows vitamins (n=434), proteins (n=238), carbohydrates (n=345), mineral (n=123). Trends of daily nutrients intake of total study participants as per NIN daily recommended daily nutrients intake was as follows vitamins (n=647), proteins (n=583), carbohydrates (n=812), mineral (n=357). Comparatively less no. of study participants were taking as recommended daily intakes of vitamins, proteins, carbohydrates.mineral, according to NIN recommended daily nutrients intakes. Table-4: Trends of Daily Nutrients Intake of Study Participants as Per NIN Daily Recommended Intakes S.No Daily nutrients intake Boys Girls Total N (%) 1 Vitamins 213(24.88 %) 434(70.79 %) 647 (43.95%) 2 Proteins 345(40.16 %) 238(38.82 %) 583 (39.60 %) 3 Carbohydrates 467(54.36 %) 345(56.28 %) 812 (55.16 %) 4 Minerals 234(27.24 %) 123(20.06 %) 357(24.25 %) Graph-4: Trends of Daily Nutrients Intake of Study Participants as Per NIN Daily Recommended Intakes Available online:

5 Trends on Anaemia Status among Study Participants before Intervention Trends of anaemia status among boys study participants were as follows Severe anaemia 2.67 % (n=23), Mild anaemia 0.58 % (n=05), Moderate anaemia % (n=197), and remaining are Not anaemic % (n=634). Trends of anaemia status among girls study participants were as follows Severe anaemia 2.58 % (n=38), Mild anaemia 2.77 % (n=17), Moderate anaemia % (n=72), and remaining are Not anaemic % (n=486). Trends of anaemia status among total study participants were as follows Severe anaemia 4.14 % (n=61), Mild anaemia 1.49 % (n=22), Moderate anaemia % (n=269), and remaining are Not anaemic % (n=1120). Table-5: Anaemia Status among Study Participants before Intervention S.No Anaemia status Boys Girls Total N (%) 1 Severe 23(2.67%) 38(2.58 %) 61 (4.14%) 2 Mild 05(0.58 %) 17(2.77 %) 22 (1.49 %) 3 Moderate 197(22.93 %) 72(11.74%) 269(18.27 %) 4 Not anaemic 634(73.80% ) 486(79.28% ) 1120(76.08%) Graph-5: Anaemia status among study participants Distribution of BMI Values among Study Participants before Intervention Trends of Distribution of BMI values among boys study participants were as follows Obese 6.05 % (n=52), Overweight 10.12% (n=87), Normal % (n=233), and Underweight 45.28% (n=389) and remaining are Severe underweight % (n=98). Trends of Distribution of BMI values among girls study participants were as follows Obese 2.12 % (n=13), Overweight 5.54 % (n=34), Normal % (n=298), and Underweight % (n=245) and remaining are Severe underweight 3.75 % (n=23). Trends of Distribution of BMI values among total study participants were as follows Obese 4.41 % (n=65), Overweight 8.22 % (n=121), Normal % (n=531), and Underweight % (n=634) and remaining are Severe underweight 8.22 % (n=121). Table-6: Distribution of BMI Values among Study Participants Before intervention S. No BMI Distribution Boys Girls Total N (%) 1 Obese 52(6.05 % ) 13(2.12% ) 65 2 Over weight 87(10.12 % ) 34(5.54% ) 121 (8.22 %) 3 Normal 233(27.12 % ) 298(48.61% ) 531 (36.07 %) 4 Under weight 389(45.28 % ) 245(39.96% ) 634 (43.70 %) 5 Severe under weight 98(11.40 % ) 23(3.75% ) 121 (8.22 %) Available online:

6 Graph-6: Distribution of BMI Values among Study Participants Distribution of Muscle Mass among Study Participants Distribution of Muscle mass among boys study participants was as follows; % (n=87) were having 14 to 18 mm Muscle mass reading, % (n=472) were having 19 to 25 mm Muscle mass reading remaining % (n=362) were having26 to 30 mm Muscle mass reading. Distribution of Muscle mass among girls study participants was as follows; 4.89 % (n=30) were having 14 to 18 mm of Muscle mass reading, % (n=358) were having 19 to 25 mm of Muscle mass reading remaining % (n=162) were having26 to 30 mm of Muscle mass reading. Distribution of Muscle mass among total study participants was as follows; 7.94 % (n=117) were having 14 to 18 mm of Muscle mass reading, % (n=830) were having 19 to 25 mm of Muscle mass reading remaining % (n=524) were having26 to 30 mm of Muscle mass reading. Table-7: Distribution of Muscle Mass among Study Participants. S. No Distribution of Muscle mass Boys Girls Total N (%) mm 87(10.12 % ) 30(4.89 % ) 117(7.94 % ) mm 472(54.94 % ) 358(58.40 % ) 830(56.38 % ) mm 362(42.14 % ) 162(26.42 % ) 524(35.59 % ) Graph-7: Distribution of Muscle Mass Values among Study Participants Distribution of Nutritional Knowledge among Study Participants before Intervention Distribution of levels of Nutritional knowledge among boys study participants before intervention was as follows; 24.79% (n=213) has Average levels of Nutritional knowledge, 38.88% (n=334) has Above Average levels of Nutritional knowledge, and10.36% (n=89) has Nil levels of Nutritional knowledge, 25.96% (n=223) has Excellent levels of Nutritional knowledge. Distribution of levels of Nutritional knowledge among girls study participants before intervention was as follows; 50.89% (n=312) has Average levels of Nutritional knowledge, 34.58% (n=212) has Above Average levels of Nutritional knowledge, and 4.24% (n=26) has Nil levels of Nutritional knowledge, 10.27% (n=63) has Excellent levels of Nutritional knowledge. Distribution of levels of Nutritional knowledge among total study participants before intervention was as follows; % (n=525) has Average levels of Nutritional knowledge, % (n=546) has Above Average levels of Nutritional knowledge, and 7.81 % (n=115) has Nil levels of Nutritional knowledge, % (n=286) has Excellent levels of Nutritional knowledge. Available online:

7 Table-8: Distribution of Nutritional Knowledge among Study Participants before Intervention S.No Nutritional Knowledge Boys Girls Total (N%) 1 Average 213(24.79%) 312(50.89%) 525 (35.66 %) 2 Above Average 334(38.88%6) 212(34.58%) 546 (37.09 %) 3 Nill 89(10.36%) 26(4.24%) 115 (7.81 %) 4 Excellent 223(25.96%) 63(10.27%) 286 (19.42 % ) Graph-8: Distribution of Levels of Nutritional Knowledge among Study Participants Prevalence of Positive Signs and Symptoms of Nutritional Deficiency Diseases among Study Participants before Intervention Prevalence of positive signs and symptoms of nutritional deficiency diseases among boys study participants before intervention was as follows; 13.62% (n=117) has Blindness, 0.93% (n=08) has Bleeding gums, 1.51% (n=13) has Glositis, 2.67 % (n=23) has Coiled hair, 6.63% (n=57) has Conjunctivitis, 4.42% (n=38) has Spoon nails, 5.93% (n=51) has Pallor skin, 13.15% (n=123) has Sore tongue, 18.39% (n=157) has Dry scaly skin, 8.49 % (n=73) has Sparse thin hair, 0.81% (n=07) has Parotid enlargement, 2.79 % (n=24) has Goitre, 7.91% (n=68) has Delayed wound healing and remaining 12.68%(n=109) has No signs and symptoms. Prevalence of positive signs and symptoms of nutritional deficiency diseases among girls study participants before intervention was as follows; 20.22%(n=124) has Blindness, 0.48% (n=03) has Bleeding gums, 2.93% (n=18) has Glositis, 3.42% (n=21) has Coiled hair, 7.01% (n=43) has Conjunctivitis, 16.47% (n=29) has Spoon nails, 16.15% (n=43) has Pallor skin, 14.51% (n=89) has Sore tongue, 18.27% (n=99) has Dry scaly skin, 8.49 % (n=59) has Sparse thin hair, 0.48% (n=03) has Parotid enlargement, 0.65% (n=04) has Goitre, 3.91% (n=24) has Delayed wound healing and remaining 8.80% (n=54) has No signs and symptoms. Table-9: Prevalence of Positive Signs and Symptoms of Nutritional Deficiency Diseases among Study Participants before Intervention S. No Nutritional Deficiency signs Boys Girls Total (N %) 1 Blindness 117(13.62%) 124(20.22%) Bleeding gums 08(0.93%) 03(0.48%) 11 3 Glositis 13(1.51%) 18(2.93%) 31 4 Coiled hair 23(2.677%) 21(3.42%) 44 5 Conjunctivitis 57(6.63%) 43(7.01%) 100(6.79%) 6 Spoon nails 38(4.42%) 29(4.73%) 67 7 Pallor skin 51(5.93%) 43(7.01%) 94 8 Sore tongue 113(13.15%) 89(14.51%) Dry scaly skin 158(18.39%) 99(16.15%) Sparse thin hair 73(8.49%) 59(9.62%) 132 (8.96%) 11 Parotid enlargement 07(0.81%) 03(0.48%) Goitre 24(2.79%) 04(0.65%) Delayed wound healing 68(7.91%) 24(3.91%) No signs and symptoms 109(12.68%) 54(8.80) 163(11.07%) Prevalence of positive signs and symptoms of nutritional deficiency diseases among total study participants before intervention was as follows; 16.57% (n=244) has Blindness, 0.74% (n=11) has Bleeding Available online:

8 gums, 2.10% (n=31) has Glositis, 2.98% (n=44) has Coiled hair, 6.79% (n=100) has Conjunctivitis, 4.55% (n=67) has Spoon nails,6.38% (n=94) has Pallor skin, 13.72% (n=202) has Sore tongue, 17.45% (n=257) has Dry scaly skin, 8.96 % (n=132) has Sparse thin hair, 0.67% (n=10) has Parotid enlargement, 1.90% (n=28) has Goitre, 6.25% (n=92) has Delayed wound healing and remaining 11.07% (n=54) has No signs and symptoms. Graph-9: Prevalence of Positive Signs and Symptoms of Nutritional Deficiency Diseases among Study Participants Trends of Nutritional Deficiencies among Study Participants before Intervention Trends of Nutrients deficiency among boys study participants before intervention was as follows; n=8(0.93%) had Protein deficiency, n=168(19.55%) had Vitamin -A deficiency, n=13(1.51%) had Vitamin- D deficiency, n=23(2.67%) had Vitamin-E deficiency, n=57(6.63 %) had Vitamin-K deficiency, n=38(4.42%) had Vitamin-B1 deficiency, n= 51(5.93%) had Vitamin- B2 deficiency, n= 123(14.31%) had Vitamin-B6 deficiency, n=157(18.27%) had Vitamin-B 12 deficiency, n=73(8.49 %) had Folic acid deficiency, n=7(0.81%) had Vitamin-C deficiency, n=68(7.91%) had Iron deficiency, n=29(3.37%) had Iodine deficiency, and remaining n= 44(5.12 %) had No Nutrients deficiencies. Trends of Nutrients deficiency among girls study participants before intervention was as follows; n=3(0.48%) had Protein deficiency, n=134(21.85%) had Vitamin A Deficiency, n=18(2.93%) had Vitamin-D deficiency, n= 21(3.42%) had Vitamin-E deficiency, n=43(7.01%) had Vitamin-K deficiency, n= 29(4.73%) had Vitamin-B1 deficiency, n= 43(7.01%) had Vitamin-B2 deficiency, n= 101(16.47%)had Vitamin B6 deficiency, n=99(16.15 %)had Vitamin-B 12 deficiency, n=59(9.62 %)had Folic acid deficiency, n=3(0.48 %)had Vitamin-C deficiency, n=28(4.56 %)had Iron deficiency, n=11(1.79 %)had Iodine deficiency, and remaining n= 21(3.42%) had No Nutrients deficiencies. Table-10: Trends of Nutritional Deficiencies among Study Participants before Intervention S. No Deficiency of Nutrients Boys Girls Total (N %) 1 Protein deficiency 8(0.93%) 3(0.48%) 11(0.74 %) 2 Vitamin -A deficiency 168(19.55%) 134(21.85%) 302(20.51 %) 3 Vitamin-D deficiency 13(1.51%) 18(2.93%) 31(2.10%) 4 Vitamin-E deficiency 23(2.67%) 21(3.42%) 44(2.98 %) 5 Vitamin-K deficiency 57(6.63 %) 43(7.01%) 100(6.79%) 6 Vitamin-B1 deficiency 38(4.42%) 29(4.73%) 67(4.55%) 7 Vitamin-B2 deficiency 51(5.93%) 43(7.01%) 94(6.38 %) 8 Vitamin-B6 deficiency 123(14.31%) 101(16.47%) 224(15.21%) 9 Vitamin-B 12 deficiency 157(18.27%) 99(16.15 %) 256(17.39 %) 10 Folic acid deficiency 73(8.49 %) 59(9.62 %) 132(8.96 %) 11 Vitamin-C deficiency 7(0.81%) 3(0.48 %) 10(0.67 %) 12 Iron deficiency 68(7.91%) 28(4.56 %) 96(6.52%) 13 Iodine deficiency 29(3.37%) 11(1.79 %) 40(2.71%) 14 No deficiency 44(5.12 %) 21(3.42%) 65(4.41%) Available online:

9 Trends of Nutrients deficiency among total study participants before intervention was as follows; n=11(0.74 %)had Protein deficiency, n=302(20.51 %) had Vitamin -A deficiency, n=31(2.10%) had Vitamin- D deficiency, n= 44(2.98 %)had Vitamin-E deficiency, n=100(6.79%) had Vitamin-K deficiency, n=67(4.55%) had Vitamin-B1 deficiency, n=94(6.38 %) had Vitamin- B2 deficiency, n= 224(15.21%)had Vitamin-B6 deficiency, n=256(17.39 %)had Vitamin-B 12 deficiency, n=132(8.96 %) had Folic acid deficiency, n=10(0.67 %) had Vitamin-C deficiency, n=96(6.52%) had Iron deficiency, n=40(2.71%) had Iodine deficiency, and remaining n= 65(4.41%) had No Nutrients deficiencies. Fig-10: Trends of Nutritional Deficiencies among Study Participants Trends of Variations in BMI Distribution among Study Participants before Intervention and After Intervention Trends of variations in BMI distribution among boys study participants before and after intervention are as follows; 52(6.05 %) were Obese before intervention and after intervention was also 52(6.05 %), 87(10.12 %) were Over Weight before intervention and after intervention was also 87(10.12 %), 233(27.12 %) were Normal before intervention and after intervention was also 255(29.68%), 389(45.28 %) were Underweight before intervention and after intervention was also 350(40.74% ), 98(11.40 % ) were Severe underweight before intervention and after intervention was also 63(7.33 % ).Trends of variations in BMI distribution among girls study participants before and after intervention are as follows; 13(2.12% )were Obese before intervention and after intervention was also 13(2.12% ), 34(5.54% )were Over Weight before intervention and after intervention was also 24(3.91% ), 298(48.61% ) were Normal before intervention and after intervention was also 322(52.52% ), 245(39.96% )were Underweight before intervention and after intervention was also 220(35.88%), 23(3.75% )were Severe underweight before intervention and after intervention was also 17(2.77%). Table-11: Trends of Variations in BMI Distribution among Study Participants before Intervention and After Intervention S. No BMI Distribution Boys(before) Boys(after) Girls(before) Girls(after) 1 Obese 52(6.05 % ) 52(6.05 % ) 13(2.12% ) 13(2.12% ) 2 Over weight 87(10.12 % ) 87(10.12% ) 34(5.54% ) 24(3.91% ) 3 Normal 233(27.12 % ) 255(29.68% ) 298(48.61% ) 322(52.52%) 4 Under weight 389(45.28 % ) 350(40.74% ) 245(39.96% ) 220(35.88%) 5 Severe under weight 98(11.40 % ) 63(7.33 % ) 23(3.75% ) 17(2.77% ) Trends of Variations in Distribution Levels of Nutritional Knowledge among Study Participants before Intervention and After Intervention Trends of variations in levels of Nutritional knowledge among boys study participants before and after intervention are as follows; 213(24.79%) were Average before intervention and after intervention was 178(20.72 %), 334(38.88 %) were Above average before intervention and after intervention was 369(42.95 %), 89(10.36 %) were nil before intervention and after intervention was 33(3.84 %), 223(36.37%) were Excellent before intervention and after intervention was 279(32.47%). Trends of variations in levels of Nutritional knowledge among boys study participants before and after intervention are as follows; 312(50.89 % )were Average before intervention and after intervention was 248(40.45 % ), 212(34.58 % )were Above average before intervention and after intervention was 276(45.02 % ), 26(4.24% ) were nil before intervention and after intervention was 18(2.93 % ), 63(10.27 % )were Excellent before intervention and after intervention was 71(11.58%). Available online:

10 Graph-11: Trends of Variations in BMI Distribution among Study Participants before Intervention and After Intervention Table-12: Trends of Variations in Distribution Levels of Nutritional Knowledge Among Study Participants Before Intervention And After Intervention S.No Nutritional Knowledge Boys(before) Boys(after) Girls(before) Girls(after) 1 Average 213(24.79%) 178(20.72 %) 312(50.89 % ) 248(40.45 % ) 2 Above average 334(38.88 % ) 369(42.95 %) 212(34.58 % ) 276(45.02 % ) 3 Nil 89(10.36 % ) 33(3.84 % ) 26(4.24% ) 18(2.93 % ) 4 Excellent 223(36.37% ) 279(32.47 %) 63(10.27 % ) 71(11.58 % ) Graph-12: Trends of Variations in Distribution Levels of Nutritional Knowledge among Study Participants before Intervention and After Intervention Trends of Variations in Distribution of Nutritional Deficiencies among Study Participants before Intervention and After Intervention Trends of Nutrients deficiency among boys study participants before and after intervention was as follows; n=8(0.93%) had Protein deficiency before intervention and after intervention was 7(0.81 %), n=168(19.55%)had Vitamin -A deficiency before intervention and after intervention was 162(18.85 %), n=13(1.51%)had Vitamin-D deficiency before intervention and after intervention was 11(1.28% ), n= 23(2.67%)had Vitamin-E deficiency before intervention and after intervention was 19(2.21 %), n=57(6.63 %) had Vitamin-K deficiency before intervention and after intervention was 55(6.40 % ), n=38(4.42%)had Vitamin-B1 deficiency before intervention and after intervention was 38(4.47%), n=51(5.93%) had Vitamin- B2 deficiency before intervention and after intervention was 48(5.58 %), n=123(14.31%) had Vitamin-B6 deficiency before intervention and after intervention was 86(10.01 %), n=157(18.27%) had Vitamin-B 12 deficiency before intervention and after intervention was123(14.31 % ), n=73(8.49 %)had Folic acid deficiency before intervention and after intervention was 67(7.79 % ), n=7(0.81%)had Vitamin-C deficiency before intervention and after intervention was 4(0.46 % ), n=68(7.91%)had Iron deficiency before intervention and after intervention was 65(7.56 % ), n=29(3.37%)had Iodine deficiency before intervention and after intervention was 23(2.67 % ), and remaining Available online:

11 n= 44(5.12 %) had No Nutrients deficiencies before intervention and after intervention was 76(8.84 % ). Trends of Nutrients deficiency among girls study participants before and after intervention was as follows; n=3(0.48%)had Protein deficiency before intervention and after intervention was 3(0.48 %), n=134(21.85%)had Vitamin -A deficiency before intervention and after intervention was 126(20.55 %), n=18(2.93%) had Vitamin-D deficiency before intervention and after intervention was 17(2.77 % ), n= 21(3.42%)had Vitamin-E deficiency before intervention and after intervention was 22(3.58 % ), n=43(7.01%) had Vitamin-K deficiency before intervention and after intervention was 41(6.68 % ), n=29(4.73%)had Vitamin-B1 deficiency before intervention and after intervention was 24(3.91 % ), n=43(7.01%)had Vitamin-B2 deficiency before intervention and after intervention was 39(6.36 %), n=101(16.47%) had Vitamin-B6 deficiency before intervention and after intervention was 93(15.17 %), n=99(16.15%) had Vitamin-B 12 deficiency before intervention and after intervention was 91(14.84 % ), n=59(9.62 %) had Folic acid deficiency before intervention and after intervention was 53(8.64 % ), n=3(0.48 %) had Vitamin-C deficiency before intervention and after intervention was 2(0.32 % ), n=28(4.56 %)had Iron deficiency before intervention and after intervention was 65(7.56 % ), n=11(1.79 %)had Iodine deficiency before intervention and after intervention was 8(1.30% ), and remaining n= 21(3.42%)had No Nutrients deficiencies before intervention and after intervention was 67(10.92 % ). Table-13: Trends of Variations in Distribution of Nutritional Deficiencies among Study Participants before Intervention and After Intervention S.No Nutrient deficiency Boys(before) Boys(after) Girls(before) Girls(after) 1 Protein 8(0.93%) 7(0.81 % ) 3(0.48%) 3(0.48 % ) 2 Vitamin-A 168(19.55%) 162(18.85 % ) 134(21.85%) 126(20.55 % ) 3 Vitamin-D 13(1.51%) 11(1.28% ) 18(2.93%) 17(2.77 % ) 4 Vitamin-E 23(2.67%) 19(2.21 % ) 21(3.42%) 22(3.58 % ) 5 Vitamin-K 57(6.63 %) 55(6.40 % ) 43(7.01%) 41(6.68 % ) 6 Vitamin-B1 38(4.42%) 38(4.47% ) 29(4.73%) 24(3.91 % ) 7 Vitamin-B2 51(5.93%) 48(5.58 % ) 43(7.01%) 39(6.36 % ) 8 Vitamin-B6 123(14.31%) 86(10.01 % ) 101(16.47%) 93(15.17 % ) 9 Vitamin-B (18.27%) 123(14.31 % ) 99(16.15 %) 91(14.84 % ) 10 Folic acid 73(8.49 %) 67(7.79 % ) 59(9.62 %) 53(8.64 % ) 11 Vitamin-C 7(0.81%) 4(0.46 % ) 3(0.48 %) 2(0.32 % ) 12 Iron 68(7.91%) 65(7.56 % ) 28(4.56 %) 25(4.07 % ) 13 Iodine 29(3.37%) 23(2.67 % ) 11(1.79 %) 8(1.30% ) 14 No deficiency 44(5.12 %) 76(8.84 % ) 21(3.42%) 67(10.92 % ) Graph-13: Trends of Variations in Distribution of Nutritional Deficiencies among Study Participants before Intervention and After Intervention Available online:

12 Trends of Variations in Prevalence of Positive Signs and Symptoms of Nutritional Deficiency Diseases among Study Participants before Intervention and After Intervention Trends of prevalence of Nutritional deficiency signs and symptoms among boys study participants before and after intervention was as follows; n=117(13.62%)had Blindness before intervention and after intervention was 112(13.03 % ), n=08 (0.93%)had Bleeding gums before intervention and after intervention was 06(0.69 % ), n=13(1.51%)had Glositis before intervention and after intervention was 12(1.39 % ), n= 23(2.67%)had Coiled hair before intervention and after intervention was 21(2.44%), n=57(6.63 %) had Conjunctivitis before intervention and after intervention was 49(5.70 % ), n=38(4.42%)had Spoon nails before intervention and after intervention was 36(4.19 % ), n=51(5.93%)had Pallor skin before intervention and after intervention was 48(5.58 % ), n=113(13.15%)had Sore tongue before intervention and after intervention was 96(11.17 % ), n=158(18.39%)had Dry scaly skin before intervention and after intervention was153(17.81 % ), n=73(8.49 %)had Sparse thin hair before intervention and after intervention was 69(8.03 % ), n=7(0.81%)had Parotid enlargement before intervention and after intervention was 6(0.69 % ), n=24(2.79%)had Goitre before intervention and after intervention was 23(2.67 % ), n=68(7.91%)had Delayed wound healing before intervention and after intervention was 61(7.10 % ), and remaining n= 109(12.68%) had No Signs & Symptoms before intervention and after intervention was 167(19.44 % ). Trends of prevalence of Nutritional deficiency signs and symptoms among girls study participants before and after intervention was as follows; n=124(20.22%)had Blindness before intervention and after intervention was 119(19.41 % ), n=03(0.48%)had Bleeding gums before intervention and after intervention was 01(0.16 % ), n=18(2.93%)had Glositis before intervention and after intervention was 12(1.95 % ), n= 21(3.42%)had Coiled hair before intervention and after intervention was 19(3.09 % ), n=43(7.01%) had Conjunctivitis before intervention and after intervention was 41(6.68% ), n=29(4.73%)had Spoon nails before intervention and after intervention was 23(3.75 % ), n=43(7.01%)had Pallor skin before intervention and after intervention was 41(6.68 % ), n=89(14.51%)had Sore tongue before intervention and after intervention was 63(10.27 % ), n=99(16.15%)had Dry scaly skin before intervention and after intervention was 92(15.00 % ), n=59(9.62%)had Sparse thin hair before intervention and after intervention was 57(9.29 % ), n=03(0.48%)had Parotid enlargement before intervention and after intervention was 02(0.32 % ), n=04(0.65%)had Goitre before intervention and after intervention was 02(0.32 % ), n=24(3.91%)had Delayed wound healing before intervention and after intervention was 21(3.42% ), and remaining n= 54(8.80%) had No Signs & Symptoms before intervention and after intervention was 79(12.88 % ). Table-14: Trends of Variations in Prevalence of Positive Signs and Symptoms of Nutritional Deficiency Diseases among Study Participants before Intervention and After Intervention S.No Positive nutritional deficiency signs Boys(before) Boys(after) Girls(before) Girls(after) 1 Blindness 117(13.62%) 112(13.03 % ) 124(20.22%) 119(19.41 % ) 2 Bleeding gums 08(0.93%) 06(0.69 % ) 03(0.48%) 01(0.16 % ) 3 Glositis 13(1.51%) 12(1.39 % ) 18(2.93%) 12(1.95 % ) 4 Coiled hair 23(2.677%) 21(2.44 % ) 21(3.42%) 19(3.09 % ) 5 Conjunctivitis 57(6.63%) 49(5.70 % ) 43(7.01%) 41(6.68 % ) 6 Spoon nails 38(4.42%) 36(4.19 % ) 29(4.73%) 23(3.75 % ) 7 Pallor skin 51(5.93%) 48(5.58 % ) 43(7.01%) 41(6.68 % ) 8 Sore tongue 113(13.15%) 96(11.17 % ) 89(14.51%) 63(10.27 % ) 9 Dry scaly skin 158(18.39) 153(17.81 % ) 99(16.15%) 92(15.00 % ) 10 Sparse thin hair 73(8.49%) 69(8.03 % ) 59(9.62%) 57(9.29 % ) 11 Parotid enlargement 07(0.81%) 6(0.69 % ) 03(0.48%) 2(0.32 % ) 12 Goitre 24(2.79%) 23(2.67 % ) 04(0.65%) 2(0.32 % ) 13 Delayed wound healing 68(7.91%) 61(7.10 % ) 24(3.91%) 21(3.42% ) 14 No Signs & Symptoms 109(12.68) 167(19.44 %) 54(8.80) 79(12.88 % ) Available online:

13 Graph-14: Trends of Variations in Prevalence of Positive Signs and Symptoms of Nutritional Deficiency Diseases among Study Participants before Intervention and After Intervention Trends of Variations in Nutrients Intake among Study Participants before Intervention and After Intervention Trends of variations in Nutrients intake among boys study participants before and after intervention are as follows; n=213(24.88%) were taking daily vitamins as per NIN recommendations before intervention and after intervention was n=285(33.17 %), n=345(40.16 %) were taking daily proteins as per NIN recommendations before intervention and after intervention was n=398(46.33 %), n=467(54.36%) were taking daily carbohydrates as per NIN recommendations before intervention and after Intervention was n=523(60.88 %), n=234(27.24 %) were taking daily minerals as per NIN recommendations before intervention and after intervention was n=258(30.03 %). Trends of variations in Nutrients intake among girls study participants before and after intervention are as follows; n=434(70.79% ) were taking daily vitamins as per NIN recommendations before intervention and after intervention was n=478(77.97 % ), n=238(38.82 %) were taking daily proteins as per NIN recommendations before intervention and after intervention was n=263(42.90 % ), n=345(56.28%) were taking daily carbohydrates as per NIN recommendations before intervention and after intervention was n=358(58.40 % ), n=123(20.06 %) were taking daily minerals as per NIN recommendations before intervention and after intervention was n=168(27.40 % ). Table-15: Trends of Variations In Nutrients Intake Among Study Participants Before Intervention And After Intervention S.No Nutrients intake Boys(before) Boys(after) Girls(before) Girls(after) 1 Vitamins 213(24.88 %) 285(33.17 % ) 434(70.79 %) 478(77.97 % ) 2 Proteins 345(40.16 %) 398(46.33 % ) 238(38.82 %) 263(42.90 % ) 3 Carbohydrates 467(54.36 %) 523(60.88 % ) 345(56.28 %) 358(58.40 % ) 4 Minerals 234(27.24 %) 258(30.03 % ) 123(20.06 %) 168(27.40 % ) Graph-15: Trends of Variations in Nutrients Intake among Study Participants before Intervention and After Intervention Available online:

14 CONCLUSION We concluded that the prevalence of nutritional deficiency disorders in hospitalized patients is approximately 20%-40%. Nutritional deficiency is associated with poor wound healing, longer length of hospital stay increases the morbidity and mortality rate. Our study was carried out on 1472 rural school children s among Anantapuramu district of those 859 were boy s participants and 613 were girl s participants. Our study says that most of the nutritional deficiency disorders diseases can be prevented by creating awareness on nutrition and deficiency diseases. Nutritional deficiency disorders can be possible in different ways like inadequate taking of diet by an individual and pregnant woman during the pregnancy which makes the child as high risk to nutritional deficiency disorders. So we recommended that to create awareness to pregnant women among rural and urban areas. So for the prevention of nutritional deficiency in children s government has to take some measures to implement and to enact policies to control the nutritional deficiency disorders diseases in rural areas. Clinical pharmacist and scientific experts has to take the leading role for creating awareness among rural population by conducting educational programs in order to improve the human development index of the our nation. ACKNOWLEDGEMENT The authors specially thank Late.Vincente Ferrer founder of Rural Development Hospital (RDT) for providing an opportunity to carry out the research work. List of Abbreviations 1. NDD-Nutritional Deficiency Disorder. 2. RDAs- Recommended dietary allowances. 3. CMR-Child Mortality Rate. 4. HDI-Human development index. 5. ICDS-Integrated Child Development Services Program (India) REFERENCES 1. Rema, N., & Vasanthamani, G. (2011). Prevalence of nutritional and lifestyle disorders among school going children in urban and rural areas of Coimbatore in Tamil Nadu, India. Indian Journal of Science and Technology, 4(2), World Health Organization. (1990). Diet, nutrition and the prevention of chronic diseases. who. int/trs/who_trs_916. pdf. 3. Stephen, J. M. (2008). Nutritional Requirements disorders; Current Medical Diagnosis & Treatment the McGraw-Hill Companies, 354. Available online: