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Letters to the Editor |
Indian Pediatrics 2000;37: 114-115 |
| Nutritional Status of Adolescent School Children in Rural North India: A Study with Questionable Methodology |
I have serious reservations regarding the precision of data gathered by authors of a recently published article(1) by using techniques which cannot be considered acceptable for any nutritional or anthropometric research. How far is it correct and justifiable to measure height by `marking on the wall in the school with the help of a measuring tape' and recording of body weight with a `bath-room scale' that too by medical students who according to authors were undertaking `their practical exercise in epidemiology'? To my mind adhering to such techniques/devices not only generates imprecise and questionable sets of anthropometric data but also compromises the quality of training being imparted to medical undergraduates or others in the field of anthropometry which according to WHO(2) is a valuable tool for guiding public health policy and clinical decisions. The use of several medical undergraudates without paying attention to elimination/quantification of inter-observer error concerning weight and height measurements is another serious flaw in the study. Since many policies of the government are based on data gathered from similar surveys, the scientific community owes it to itself to present data using acceptable methodology so that the data so gathered are precise, accurate and reflect true situation, particularly, in country like ours where magnitude of nutrition and growth related deficit is enormous. A.K. Bhalla, References 1. Anand K, Kant S, Kapoor SK. Nutritional status of adolescent school children in rural north India. Indian Pediatr 1999; 36: 810-815. 2. World Health Organization. Physical Status: The Use and Interpretaton of Anthropometry. Technical Report Series 854, Geneva, World Health Organization, 1995; p 454. Reply Two main issues have been raised by Dr. Bhalla. The first issue pertains to scientific validity of the study and a second more serious one on undergraduate teaching. Regarding the first, we have clearly stated what methods were used. The manuscript passed through the peer review process wherein this issue was also raised. Based on their suggestion, we had included the limitation of the method in the discussion. Dr. Bhalla agrees that the nutritional situation in the country is of great concern and the scientific community should address it. Lack of information from rural community about adolescent nutrition clearly shows that this area requires focus. Some data is better than no data. Users of the data are expected to be trained in epidemiology so that they can judge the quality of each study. The literature review by the students showed that the results of the study was comparable to the other studies. On the second more serious issue we would like to comment in some detail. Dr. Bhalla assumes that the issues of standardization and interobserver errors were not discussed with the students. The study was done in a school and the measurement was done by only two students to minimize this error. A major part of pre-study discussion (one week) is spent with each batch to help them deal with the issues of specification of objectives and standardization of not only measurement scales but also method of asking questions and grading responses. At the end of the study, they are also asked to discuss the limitations of the study which in this case would include the method of measurement. Dr. Bhalla is requested to go through our paper which details the training in epidemiology which is given to medical students during their posting at Ballabgarh(1). Finally, we have also demonstrated the trait of intellectual honesty to the students which we feel is very important. In the end, though we share the concerns of Dr. Bhalla, we feel that they are misplaced in this instant. K. Anand, Reference 1. Goswami K, Anand K, Lobo J, Kapoor SK. Community based learning of medicine at AIIMS, India. Education for Health 1998; 11: 327-335. |
