Health and nutritional profile of adolescent girls from underprivileged communities residing in Kasturba Gandhi Balika Vidyalaya in Rajasthan

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1 Asian J. Dairy & Food Res, 37(3) 2018: Print ISSN: / Online ISSN: AGRICULTURAL RESEARCH COMMUNICATION CENTRE Health and nutritional profile of adolescent girls from underprivileged communities residing in Kasturba Gandhi Balika Vidyalaya in Rajasthan Mukta Agrawal* 1, Priyanka Nagar 2 and Divya Jain 1 Department of Home Science, University of Jaipur, Jaipur , Rajasthan, India. Received: Accepted: DOI: /ajdfr.DR-1370 ABSTRACT Kasturba Gandhi Balika Vidyalayas (KGBVs) for adolescent girls from backward society is one of the initiatives of Government of India to enhance educational status and quality of life among adolescent girls of underprivileged communities. In these institutes free education, food, clothes, books and free residential facilities are provided to adolescent girls. The present study was an attempt to assess the nutritional status of adolescent girls residing in KGBVs of two districts of Rajasthan i.e. Jaipur and Tonk. Nutritional anthropometry and dietary survey (food inventory method and 24 hour dietary recall) were carried out on 457 girls. The respondents were in the age group of 9-18 years belonging to Schedule Caste (28.2 per cent), Schedule Tribe (31.7 percent), Other Backward Caste (36.76 percent) and General (3.2 percent) category. Energy deficiency was found among the percent girls while stunting (height for age <- 2SD of WHO Z score) among percent girls. Energy deficiency as well as stunting was observed higher among girls studying in class 6 th as compared to class 8 th. The food provided at KGBVs was basically cereal based. All food groups except cereals were available in inadequate quantities. Availability as well as intake of energy was adequate while that of micronutrients was below Recommend Dietary Allowances. A huge gap was observed between availability and intake of nutrients as well as food groups indicating possibility of pilferage of food stuffs. Key words: Adolescent girls, Food, KGBV, Malnutrition, Underprivileged. INTRODUCTION Adolescence is a special stage in the development of one s life and is termed as period of stress and storm with vulnerability and opportunity. Due to rapid development the nutritional demands also increase. This age is important for girls as they have to shoulder the responsibility of reproductivity and that of nurturing the future generation. Adolescence is the formative phase of life (Choudhary et al. 2016) and a period of physical and psychological transition from childhood to adulthood. The learning and deep impressions created during adolescence last a lifetime. Considering it as second window of opportunity good nutritional care will boost the physical, mental and psychological development and enhance the quality of life of adolescent girls. In India child marriage is still a major problem. Percentage of child marriage in India is 26.8 (NFHS ). According to Census of India 2001, 16.3 per cent girls aged years were pregnant at the time of survey indicating adolescent pregnancies. Rajasthan is one of the states with low basic indicators. Nutritional problems such as stunting, thinness *Corresponding author s muktahsc@gmail.com 1 Department of Home Science, University of Rajasthan, Jaipur , Rajasthan, India. 2 Design Innovation Centre, University of Rajasthan, Jaipur , Rajasthan, India. and anaemia are high among adolescent girls in Rajasthan. The rate of child marriages (35.4 percent) and adolescent pregnancies are high. Apart from these development indictors for adolescent girls with regard to health, education and life skills are also not favorable and socio-cultural expectations and economic pressure working on adolescent girls and boys are different. Programs focusing on health, education and development of adolescent girls are perhaps very important interventions which can bring positive results. Under nutrition during adolescence, confounded by childhood marriages, leads to higher mortality and morbidity among women (Anonymous 2018) and young children, thus perpetuating the vicious cycle of under nutrition. It is rather unfortunate but true that in the majority of girl child in India, there is no period of Adolescence as they shift from childhood to adulthood and soon become pregnant adult. The adolescent pregnancies results in weak premature infants and high mortality among mothers and infants. Thirteen percent deaths of females below the age of 24 years are related to pregnancy and child birth cause. Looking into this scenario one needs to pay attention to the adolescent girls. It is imperative to empower adolescent girls with adequate information and skills.

2 238 ASIAN JOURNAL OF DAIRY AND FOOD RESEARCH Adolescent girls from underprivileged communities are at higher risk of malnutrition. They have poor availability of food and nutrients. Girls studying in Kasturba Gandhi Balika Vidhyalaya from Schedule Caste and Schedule Tribes categories have access to proper food at free of cost. Therefore, an attempt was made to study the food and nutrient intake among the girls of Kasturba Gandhi Balika Vidhyalayas (KGBVs) of Jaipur and Tonk districts of Rajasthan. MATERIALS AND METHODS Demographic profile, clinical examination, anthropometric measurements, dietary survey was carried out among 457 adolescent girls of age 9-16 years residing in 9 Kasturba Gandhi Balika Vidhayalayas of Jaipur and Tonk Districts of Rajasthan. In the present study age, height, weights were recorded. The weight of the girls was recorded using platform weighing balance as it is portable and convenient to use in the field. The height was measured using stature meter up to the nearest 0.1 cm. Body Mass Index is expressed as a ratio of weight in Kg and height in m 2. WHO Z scores were used as standard of reference. The data were interpreted using height for age and BMI for age indices. BMI for age less than -2 SD was considered as energy deficient or thinness while that of -3 SD was consider severely undernourished. A girl was considered as stunted if height of age was less than -2 SD of WHO Z score while severe stunting was considered at below -3 SD. Diet and nutrient assessment was done using food inventory method and 24 hours dietary recall method (Bamji 2017). Iodine levels in salt were measured in the field using rapid test kit. Prevalence of anemia was assessed by examination of clinical symptoms such as paleness of skin, pale conjunctiva, pale nails, koilonychias, atrophic lingual papillae, general weakness, tiredness, shortness of breath and irritability. RESULTS AND DISCUSSION The study was carried out on 457 girls (240 and 217 from Jaipur and Tonk District respectively) from 9 Kasturba Gandhi Balika Vidhayalayas. Class wise break up indicated that 35 percent were studying in class VI, 45 percent in class VII and rest 20 percent in class VIII. The caste wise break up (Table 1) of subjects indicated that overall 28.2 percent girls were from scheduled caste, 31.7 percent were from scheduled tribe and per cent were from Other Backward Caste category. The mean age at menarche was years. The mean weight, height and Body Mass Index is presented in Table 2.The mean height of girls of 9 and 10 years was more than median value of WHO standards. The average height of girls in age 11 years and above was found lower than median value of WHO standards. The average Body Mass Index was also found lower than median value of Body Mass Index for International reference population in girls of 11 years and above. The data clearly indicates that the growth of adolescent girls leg behind the growth of reference population. Interpretation of data using Body Mass Index for age index indicated that 15.3 percent of girls were found energy deficient (having Body Mass Index for age less than 2SD of median of WHO Z scores) while 3.05 percent girls were severely energy deficient (Body Mass Index for age below-3 SD Z score). The prevalence of chronic energy deficiency was higher in girls from KGBVs of Jaipur as compared to Tonk district. The class wise break up for malnutrition indicated that the prevalence of chronic energy deficiency was high in girls studying in class VII as compared to VI and VIII class. The caste wise break of girls indicated that the prevalence of chronic energy deficiency was higher among girls of Other Backward Caste category (23.80 percent) followed by Schedule Caste (16.28 percent), general (13.33 percent) and Schedule Tribes (12.41 percent). Stunting was found in percent of girls while 2.2 percent girls were found severely stunted. The percentage of stunted as well as severely stunted girls was high in KGBVs of Jaipur district as compared to Tonk district. The prevalence of stunting was high in girls studying in class VI and VII as compared to class VIII. The caste wise break up of prevalence of stunting indicated that the percentage of stunted girls was highest in Other Backward Caste (23.80 percent) followed by Schedule Tribes (12.41 percent), Schedule Caste (16.28 percent) and general (13.33 percent) (Table 3) category. According to NNMB (2017) the Table 1: Distribution of adolescent girls according to caste. Caste Districts Jaipur(N=240) Tonk(N=217) Total (N=457) SC 33.8 (81) (48) 28.2 (129) ST 22.1 (53) 42.4 (92) 31.7 (145) OBC 41.7 (100) (68) (168) Gen 2.5 (6) 4.15 (9) 3.2 (15) Figures in parenthesis are frequencies. Table 2: Anthropometric Parameters of Adolescent Girls according to their Age. Age (years) Height (cm) Weight (kg) BMI (kg/m2) Mean±S.D Mean±S.D Mean±S.D ± ± ± ±7 35.3± ± ± ± ± ± ± ± ± ± ± ± ± ± ± ± ± ± ± ±1.42 Mean ± ± ±0.11

3 Table 3: Nutritional status of adolescent girls. Volume 37 Issue 3 (September 2018) 239 Energy deficiency (BMI for age) Stunting (Height for age) Percentage-3 SD Percentage -2 SD Percentage-3 SD Percentage -2 SD DISTRICT Jaipur (N=240) Tonk (N=217) Total (N=457) CLASS 6 (N=161) (N=205) (N=9) CASTE SC (N=129) ST (N=145) OBC (N=168) General (N=15) Table 4: Average availability of various food to adolescent girls per day as assessed by food inventory method. Food groups Jaipur Tonk Total Mean intake (g) per day Mean intake (g) per day Cereals and millets 434 ± ± Pulses and legumes 34.4 ± ± Green leafy vegetable 17 ± Other vegetables 50 ± ± Roots and tubers 59.4 ± ± Fruits Milk and milk products ± ± Fats and oil 25.4 ± ± Sugar and jaggery 25.8 ± ± Table 5: Average intake of various foods to adolescent girls per day as assessed by 24 hours dietary recall method. Food groups Jaipur Tonk Total Mean intake (g) per day Mean intake (g) per day Intake g/day Cereals and millets ± ± Pulses and legumes 24.70±7.3 43± Green leafy vegetable Other vegetables 63.87± ± Roots and tubers 61.51± ± Milk and milk products 91.4± ± Fats and oil 16.69± ± Sugar and jaggery 10.6± ± prevalence of thinness among adolescent girls was 20 percent among years and 14 percent among years. The findings of present study are comparable to NNMB data. The mean food available to girls is presented in Table 4. Results on food availability indicated that except cereals all other food stuffs were available in low amount as compared to the suggested food intake values by Indian Council of Medical Research (ICMR 2010). Consumption of leafy vegetables, milk and milk products and fruits were very low. Intake of pulse although was on a regular basis but the amounts available were low. There was a huge gap between food availability as calculated by food inventory method and 24 hours dietary recall method (Table 5). The mean nutrient availability and mean food intake by adolescent girls are presented in Table 6 and 7. The results of 24hour dietary recall method indicated poor intake of protein, calcium, iron, beta carotene, vitamin C, thiamine, riboflavin and niacin. Only intake of energy was comparable to that of RDA. The mean intake of all the nutrients was found lower than nutrients available as assessed by food inventory method. Only edible portion of food is taken into account in 24 hours dietary recall method where as in Food inventory method whole food stuffs are taken into account. Lower intake of foods as well as nutrients may also be due to individual variation in food intake.

4 240 ASIAN JOURNAL OF DAIRY AND FOOD RESEARCH Table 6: Mean nutrient availability to adolescent girls as assessed by food inventory method. Table 8: Signs and symptoms of anemia among adolescent girls. Signs and Symptoms District Jaipur(N = 240) TonkN = 217 Total N=457 Paleness of skin (106) 49.31(107) 46.6 (21.3) Pale conjunctiva (129) (97) (226) Pale nails 32.5 (78) (63) (141) Koilonychias 9.58 (23) 8.29 (18) 8.97 (41) Atrophic lingual papillae 4.17 (10) 0.92 (2) 2.63 (12) General weakness (51) (70) (121) Easy fatigability (28) (29) (57) Shortness of breath 4.17 (10) (34) 9.63 (44) Irritability 40 (96) (50) (146) Figures in parenthesis indicate the number of girls. (10-12 years) (13-15 years) (16-18 years) Jaipur Tonk Total Jaipur Tonk Total Jaipur Tonk Total Energy (kcal/d) AI %RDA Protein(g/d) MI %RDA Fat(g/d) MI %RDA Iron (mg/d) MI %RDA Calcium(mg/d) MI %RDA Carotene(µg/d) MI %RDA Thiamine(mg/d) MI %RDA Riboflavin(mg/d) MI %RDA Niacin (mg/d) MI %RDA Folic Acid(µg/d) MI %RDA Vitamin C(mg/d) MI %RDA Table 7: Mean nutrient intake of adolescent girls as assessed by 24 hour dietary recall method. Jaipur Tonk Total Nutrients RDA Average availability %RDA Average availability %RDA Average availability %RDA ±SD ±SD Energy ± ± Protein ± ± Fat ± ± Iron ± ± Calcium ± ± BetaCarotene ± ± Thiamine ± ± Riboflavin ± ± Niacin ± ± Folic Acid ± ± Vitamin C ± ±

5 The iodization level in salt was more than 15 ppm at all the KGBVs. Almost half of the girls had one or more sign and symptoms of anemia like paleness of skin (47 percent), pale conjunctiva (50 percent, pale nails (31 percent) (Table 8). CONCLUSION The adolescent girls lag behind the growth of International reference population. Stunting was found in percent of girls while severe stunting was found in 3.05 percent girls. Similarly 13.5 percent were energy deficient and 2.20 percent girls were severely energy deficient. The prevalence of chronic energy deficiency and stunting was high in Jaipur as compared to Tonk District. Volume 37 Issue 3 (September 2018) 241 Three meal pattern was followed by all KGBVs. As the diet provided were cereal based and cereals forming the major part of every meal, other foods including body building food as well as protective foods were found deficient. Consumption of low intake of milk and milk products, fruits and leafy vegetables reflected in low intake of calcium, vitamin A, iron and other micronutrients. It was observed that the nutritional status of girls studying in class VIII was better than those studying in lower class. This clearly reflects the positive influence of availability of food free of cost every day to girls for longer duration to class VIII studying than lower classes. REFERENCES Anonymous(2018). Cited on 19 April Bamji, M.S. (2017). Textbook of Human Nutrition (4th Edn.). Oxford & IBH, New Delhi. Census of India (2001). Age Structure and Marital Status Retrieved from and_marital_status.aspx Cited on 19 April Choudhary, S., Khichar, S., Dabi, D.,Parakh, M.,Dara, P. K., Parakh P.,Vyas, S. and Deopa B. (2016) Urban rural comparison of anthropometry and menarcheal status of adolescent school going girls of Jodhpur, Rajasthan, India. J Clin Diagn Res.10 (10): SC08 SC12. ICMR (2010) Nutrient Requirement and Recommended Dietary Allowances for Indians. Indian Council of Medical Research. National Institute of Nutrition, Hyderabad, India. National Family Health Survey (NFHS-4). Fact Sheet India and Rajasthan. International Institute of Population Sciences, Mumbai, India National Nutrition Monitoring Bureau (2017) (NNMB). Technical Report No. 27. National Institute of Nutrition, ICMR, Hyderabad, India World Health Organization (WHO). Child Growth Standards retrieved from