These 400 Children Will Be Selected by Simple Random Sampling Method
6.1 Need for the study :
Nutritional anemia is a major world wide public health problem. Iron deficiency is the most common cause of nutritional anemia in the world. Iron deficiency anemia is a major nutritional problem in India and is widely prevalent among special groups in the community such as under five’s, women in reproductive age and elderly people. These special groups are given much importance for the implementation of the services under appropriate National Health Programmes. Nutritional anemia is also common in school children of 5-15 years where less importance is given.
During school years a child has to develop physical, motor and mental abilities to cope up for adolescent and adult life. IDA impairs these abilities which are required for the learning achievements for example examination performance and school attendance of children in the school.1,2 Various nutritional deficiencies and parasitic infections in children can also cause IDA.3 Studies by various authors have been reported on prevalence of anemia and its consequences among school children.4,5
To understand the phenomenon of anemia and its relation to learning achievements, morbidity patterns and absenteeism among school children, the current study titled “Prevalence of Anemia, Morbidity, School Absenteeism and examination performance among lower primary school children in Davangere city has been undertaken with the following hypothesis :
Hypothesis :
Prevalence of anemia among lower primary school children predispose to frequent morbidities and this in turn increases school absenteeism and decreases exam (academic) performance.
Null Hypothesis :
Prevalence of Anemia among Lower Primary School children do not predispose to frequent morbidities and do not affect in turn their school absenteeism and exam performance.
Alternate hypothesis :
Prevalence of anemia among Lower Primary School children affects their health and in turn increase morbidities, school absenteeism and decrease exam performance.
6.2. Review of Literature
In developing regions of the world, the prevalence of anemia in 5-12 years old children is estimated to be 46% with the highest rates found in Africa (49%) and South Asia a 50%.3
7. / Material And Methodology :
7.1 Source of data :
Lower primary school children studying in 1st to 5th Std. in Davangere city.
Materials :
1) Prestructured, pretested proforma consisting of protocol for collection of information on school and child, details of parents, family composition, socioeconomic status be used. Nutritional assessment schedule10 (modified version) physical examination, system examination, anthropometric measures with reference to height and weight, Hb estimation, history of morbidity, school absenteeism and learning achievements (i.e., exam performance) as per annual exam marks card will be recorded.
2) Kit containing pediatric stethoscope, measuring tape, pen torch.
3) Sahli’s haemoglobinometer.
4) Krups portable weighing machine.
7.2 Method of collection of data (including sample procedure if any) Sampling procedure :
1) For the current study the required sample size of LPS children to be screened for prevalence of anemia has been calculated and school visit will be given for Hb estimation and morbidities during Dec 2007 and Jan 2008. For school absenteeism the preceding 3 months of attendance will be checked from register and for exam performance marks card will be followed as per the severity of anemia.
2) Study design : Cross sectional
3) Sampling techniques : Stratified, simple random sampling
a) Sampling size :
Davangere city has a total of 93 lower primary schools (1st to 5th Std.) of which 49 are Government schools and 44 private schools. Total lower primary school children population is 19249. Of which 9323 is Government and private in 9926.
To estimate the prevalence of anemia :
10% of LPS population i.e. 1929 children will be investigated for Hb levels. To obtain this sample size 10% of the total 93 schools, i.e. 10 schools (6 Government, 4 private) will be selected.
Six government schools will be selected by taking every 8th government school from the list.
Four private schools will be selected by taking every 10th private school from the list.
b) Selection of sub sample for study of morbidity, absenteeism and exam performance :
The sub sample is calculated a follows
2 = Chisquare value for 1 degree of freedom
at some desired probability level. This is
3.84 at 0.05 level
N = Population size 19249
P = 50% (0.5) prevalence of anemia lowest in studies
C = confidence interval of one choice (95% CI) = 0.05
= 400
- These 400 children will be selected by simple random sampling method.
- Every student in a standard has an equal chance for selection.
c) Procedures :
1) Height measurement : One of the walls of the class room will be calibrated using a metallic tape. The child will be made to stand against the wall after removing the footwear with the heels and buttocks touching the wall with the child looking straight height will be measured to the nearest 0.5cm.
2) Weight measurement : portable platform type of weighing machine will be used and weight will be recorded to the nearest 0.5 kg after making the child to stand erect on the weighing machine without the footwear.
3) Estimation of haemoglobin (Sahli’s method) : using aseptic precautions tip of the ring finger will be pricked and 20 cumm (i.e., 0.02ml) of blood will be drawn into the haemoglobinometer pipette and will be transferred into the N/10 HCl graduated haemoglobinometer tube. The contents will be mixed thoroughly and allowed to stand for 10 minutes for the maximum conversion of haemoglobin in blood to acid haematin. This will be diluted by adding distilled water in drops till the colour matches with that of the standard. The readings of the meniscus from the scale on the haemoglobinometer will be read and haemoglobin will be expressed as grams per 100 ml of blood. Diagnosis of Anaemia will be made as per WHO standard.11
4) Morbidity by present and past history
5) Nutritional morbidity will be assessed by physical examination.
6) For assessing learning achievements of school children only annual exam performance will be taken among other parameters of learning achievements.
d) Analysis :
The collected information will be compiled, tabulated and analysed by applying tests of significance such as proportions, dispersion and correlation.
8. / LIST OF REFERENCES:
- W.H.O. Promoting Health through Schools. Technical Report Series. No. 1997;870:68-69.
- Draper A. Child development and Iron deficiency. The Oxford Brief. Reports of meeting in Oxford University. Sep 1996.
- Stoltzfus J, Mchwaya H, James MT, Kerry J, Albonico M, Saviolirenzo. Epidemiology of Iron deficiency Anemia in Zanzibari school children, the importance of hookworms. Am J Clin Nutr 1997;65:153-159.
- Satyanarayana K, Pradhan RD, Ramnath T, Rao NP. Anemia and physical fitness of school children of rural Hyderabad. Indian Pediatr 1990;27:715-721.
- Agarwal DK, Upadhyay SK, Agarwal KN, Singh RD, Tripati AM. Anemia and mental functions in rural primary school children. Annals Tropical Pediatrics Dec 1989;4:194-198.
- Toleja GS, Singh P. Micronutrient profile of Indian population. Indian council of medical research New Delhi 2004;26.
- Verma M, Chhatwal J, Kaur G. Prevalence of anemia among urban school children of Punjab. Indian Pediatr 1998;35:1181-1186.
- Sahu T, Shahani NC, Patrick L. Childhood anemia – A study in tribal area of Mohana block in Orrissa. Indian J Commun Med 2007;32(1):43-45.
- Aswathi S, Sharma A. Survey of school health and absenteeism in Lucknow. Indian Pediatr 2004;41:518.
- Park K. Park’s Textbook of Preventive and Social medicine. 19th Edn. Jabalpur M/s Banarsidas Bhanot Publisher 2007;p.529.
- Demaeyer EM. Preventing and Controlling Iron Deficiency Anemia through Primary Health care. Geneva, World Health Organization 1989.