Indian Pediatrics 1999; 36:75-78 

Health Status of School Girls from Affluent Population of Mumbai

Children of private schools are generally expected to enjoy good health due to better health awareness and lack of economic constraints. However, actual situations is not as satisfactory as expected in these 'well to do' children(1-3). The present study aims to assess the general health status of the girls from a convent school of metropolitan city of Mumbai.

Subjects and Methods

A total of 1,144 girls of 5-15 years age (630 of primary section and 514 of secondary section. were examined during a school health checkup camp, organized in February 1998. The school under study was selected as it mainly caters to the children of upper socia-economic strata.

Relevant medical history was obtained on a pre designed format by authors who also conducted clinical examination of each girl themselves. Anthropometry, blood pressure and visual acuity were recorded by pediatric residents. Diagnosis. of helminthiasis, bronchial asthma, tuberculosis; epilepsy, UTI, etc., was based on history, and review of medical records, if available.

Nutritional status was assessed by anthropometric parameters and compared to published standards(4). A child was labelled as hypertensive, only when three consecutive BP readings at 15 minutes intervals were more than 95th percentile. Visual acuity was screened on Snellen's chart. Dental caries was diagnosed as per WHO definition(5).

Behavioral problems Were assessed with the help of class teachers and co-students, who proved to be valuable informants of girl's behavior in the class. Sometimes, physical findings as in cases of nail biting or thumb sucking also provided indirect clues to the problem.

Results

Out of these 1144 girls, 397 (34.7%) did not show any significant identifiable abnormality on history or clinical examination. Rest all had at least one or more likely, multiple health problems. Twenty six per cent and 45.3% girls of primary and secondary sections were apparently healthy, respectively.

The commonest health problems noted in these girls were related to hygiene (62.2%). While. dental caries and helminthiasis were commoner in younger girls, pediculosis was most frequently seen in older girls of secondary section. Dental fillings were seen in 26.1 % girls with caries, mostly in secondary girls (Table I).

Nutritional disorders Were present in 29.0%. Undernutrition was commoner in younger girls of primary section, though stunting was more frequently seen in older girls. Pallor too, was relatively more common in older girls. Signs of vitamin A deficiency were limited to conjunctival xerosis or Bitot's spots and none had night blindness. Obesity was present in 3.3% girls (Table II).

Refractory errors (visual acuity >6/9) were seen in 564 (49.3%) girls, including 56.8% and 40.3% girls of primary and secondary sections respectively. Only 9.4% of total girls were actually using spectacles, including 4.4% of primary and 15.6% of secondary section girls.

Other important health problems included asthma (6.6%), hypertension (2.2%), otitis media (2.0%), splenomegaly (1.6%), ocular infections (1.5%), cervical lymphadenopathy (1.1 %), tuberculosis (0.8%), cardiac disease (0.5%), deafness (0.4%), epilepsy (0.4%) and UTI (0.4%). Among the six cardiac lesions, two were rheumatic in origin.

Grossly identifiable behavioral abnormalities were noted in 9.3% girls, as shown in Table IlI. Most 'of them had multiple problems or a history of switch-over from one to other manifestation.
 

TABLE I-  Hygiene Related Health Problems ill Study Girls,
 

* Primary v/s secondary section; NS = Not significant.
# Treated-Primary: 41 (26.1%): Secondary: 99 (65.1%); Total: 140 (26.1%).
 

TABLE II-Nutritional Health Problems in Study Girls.
 

# Anxiety neurosis (2); Truancy (1); Stealing (2); Hysteria (2).
* Primary vis secondary section; NS = Not significant

Discussion

School health surveys offer an excellent opportunity to screen a large size of pediatric population with minimum resources. The fact that only one third of the school girls from higher socia-economic strata of the society in present study as well as in a previous study(3) could be labelled as the 'apparently healthy' is an eye opener to all of us. Any deviation from normal health in this age group is likely to have adverse consequences in future.

Presence of dental caries in 61 % of younger girls and 29.6% of adolescents reflects poor status of dental hygiene in the study population. Dental caries has been re- ported in nearly half of the school children of Mumbai(6), more commonly in affluent school children(3). Girls seem to be more susceptible for tooth decay than boys, for un- explained reasons(7). It is not so common in rural or slum school girls(8). Worm infestation and scabies were also common in younger girls, as reported in earlier studies from different population subgroups(3,8).

Prevalence of scalp lice infestation in primary school girls has considerably declined to 10.5%, since in earlier study from the girls of same age group done in 1981, when it was seen in 46.6%(3). However, pediculosis was the commonest hygiene related problem in adolescent girls of secondary section.

Nutritional deficiencies are widely prevalent in rural and slum children due to poverty, ignorance and high incidence of infections(8,9). The present study shows that de- spite being from higher socia-economic status, undernutrition, anemia and vitamin A deficiency were common in the studied girls. Ignorance about the nutritive values of different foods and discrimination against the girl child may be important contributory factors for this observation(2,9).

Refractory errors were noticed in nearly half of the girls, more frequently than that re- ported by others(3,6). Our study reveals actual use of spectacles by nearly one tenth of the girls, more commonly in older ones. It is to be noted that refractory errors frequently remain uncorrected in younger girls.

The presence of bronchial asthma in 6.6% of subjects is not unexpected, as Mumbai has hot and humid climate with heavy pollution. Hypertension was seen in 2.2% girls and nearly half of them were obese. However, serial determinations of blood pressure could not be done which are necessary to confirm the diagnosis.

Behavioral problems in school children are common due to excessive stress, competitiveness, high parental expectations and consequent anxiety(10). In the present study, most of the problems seen, i.e., nail biting, vogue aches and pains, thumb sucking, etc. indirectly indicate highly stressful and anxiety related behavior. These problems were less frequently noted in older girls. Probably, in the absence of experienced psychiatrist, it was difficult to extract the hidden behavior of older children.

In conclusion, the present study demonstrates that, contrary to popular belief, even the children of upper socio-economic status have significant health problems and need attention.
 

 References