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Year : 2012  |  Volume : 2  |  Issue : 2  |  Page : 142-146

A study of protein energy malnutrition in the school girls of a rural population

Department of Biochemistry, Vivekanandha College of Arts and Sciences for Women, Elayampalayam, Thiruchengode - 637 205, Tamil Nadu, India

Date of Submission07-Feb-2011
Date of Acceptance18-Mar-2011
Date of Web Publication9-May-2012

Correspondence Address:
Manikandan Krishnan
Department of Biochemistry, Vivekanandha College of Arts and Sciences for Women, Elayampalayam, Thiruchengode - 637 205, Tamil Nadu
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/2231-0738.95985

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India has shown remarkable progress and has a number of nutrition intervention programs, but malnutrition remains highly prevalent in the poor states of the country. Malnutrition results due to imbalance between the needs of the body and the intake of nutrients. In India, gender inequality in nutrition is present from infants to adulthood. Women and girls never reach their full growth potential due to nutritional deprivation. It may be due to poverty, lack of awareness and illiteracy. In the present study, Protein Energy Malnutrition (PEM) in the school girls from rural areas was measured. Moderate and severe malnutrition was observed in the 11-13 and 13-15 age groups of girls. Anemia was found to be higher in the 17-19 age groups of girls. In additional the illiteracy of the mothers and the occupation of fathers of the girls analyzed were studied and it was found that these conditions may be the main reason for the PEM and anemic condition. A wide variety of development actions are needed to improve the food security and nutrition of women. Prevalence of malnutrition along with anemia, and common ailments in an urban slum of India's modern city highlights the significance of developing integrated child illness management programs for the urban poor and strengthening nutrition intervention programs.

Keywords: Anemia, malnutrition, protein energy malnutrition

How to cite this article:
Krishnan M, Rajalakshmi P V, Kalaiselvi K. A study of protein energy malnutrition in the school girls of a rural population. Int J Nutr Pharmacol Neurol Dis 2012;2:142-6

How to cite this URL:
Krishnan M, Rajalakshmi P V, Kalaiselvi K. A study of protein energy malnutrition in the school girls of a rural population. Int J Nutr Pharmacol Neurol Dis [serial online] 2012 [cited 2023 Jan 26];2:142-6. Available from:

   Introduction Top

Nutritional problems in India have their roots in poverty and inequality. Poverty which restrains an individual or family to establish command over "Commodity Bundles with Enough Food", and inequality among other things places a disproportionate burden of ill health and under-nutrition on women and children. [1] Malnutrition and its associated disease conditions can be caused by eating too little, eating too much, or eating an unbalanced diet that lacks necessary nutrients. Under-nutrition is defined as failure to consume adequate energy, protein, and micronutrients to meet the basic requirements for body maintenance, growth, and development. Malnutrition is one of the most devastating problems worldwide and is inextricably linked with poverty. The scale of under-nutrition has also been studied among other populations and age groups, such as pregnant and lactating women. [2] This paper mainly focuses on the malnutrition and health status of school girls. The oppression of women socially and culturally means they have less access to everything, including food, resources, healthcare, community support and information.

The problems arising from cultural, political and economic realities must be addressed in tandem. However, significant steps should be taken to educate and to make them aware against the terrible problems of malnutrition. Malnutrition among women has long been recognized as a serious problem in India, but national-level data on levels and causes of malnutrition have been scarce. [3] A sign of nutritional deprivation is failure in growth and development. To evaluate the nutritional status up to the age of maturity, sex- and age-based assessment of growth and development is necessary. Any nutritional disorder or deficiency leads to mental and growth failure and low activities. [4] Therefore, to estimate the prevalence of stunting, wasting of muscles and underweight, we assessed anthropometric indices for school girls in the rural areas of Namakkal district, Tamilnadu, India.

   Materials and Methods Top


The present study was undertaken for girls aged between 11-19 from the schools of rural areas in the Namakkal district, Tamil Nadu, India. On the basis of the World Health Organization (WHO) criteria for body mass index (BMI) categories, malnutrition among subjects was calculated based on 15% predicted prevalence of underweight, 95% confidence interval and ±3% error and using the formula

The sample size was determined as 544 cases. Five schools were selected randomly and based on the population ratio the samples were selected systematically.

Anthropometric indices

Anthropometric measurements for the school girls were performed with the help of trained investigators and medical officer. Body weights were measured without shoes and with light clothing to the nearest 0.1 kg on a weight scale. Two readings with a 5-min interval were obtained, and the average constituted the final weight reading. Standing height was measured without headgear using a stadiometer to the nearest 0.1 cm. The sensitivity of the scales was checked and adjusted by health officials after the assessment of every 25 subjects. [5] BMI was calculated as weight (kg) divided by height (m) squared (kg/m2). According to the United Nations (UN) classification, BMI < 18 is considered severely malnourished, 18-20 is moderately malnourished, 21-24 is normal, 25-27 is overweight and > 27 is obese. [6] The BMI is a useful tool in both clinical and public health practice for assessing the nutritional status.

Hemoglobin measurement

Hemoglobin was measured with a portable photometer (Hemocue), which uses disposable sample microcuvettes with a dry reagent (sodium azide) into which one drop of capillary blood from a finger prick is drawn and then it is placed into the instrument for automatic hemoglobin (cyanmethemoglobin) measurement. Results are given in 1-2 min. This method is highly comparable to laboratory hemoglobin methods in terms of precision. [7]

Statistical analysis

Mean value and standard deviation were calculated using the software package SAS Version 8. Duncan's multiple range test was used to identify statistically significant differences. Data were considered significant for P <0.05 at 95% confidence interval. [8]

   Results Top

The Protein Energy Malnutrition (PEM) level was measured in the 11-19 age groups of girls. The prevalence of PEM was found to be increased with increase in the age group of girls [Table 1]. Family size (mean value) in the study group was found to be five to seven members. The highest percentage (46.3%) was observed in moderate malnutrition stage in the age group of 13-15, followed by severe malnutrition (35.9%) in the age group of 11-13. Overweight and obese personalities were observed at very low levels.
Table 1: Evaluation of protein energy malnutrition in the school girls from rural areas

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Hemoglobin (Hb) level was measured to detect the anemic stage in the school girls [Table 2]. Low level of Hb was observed in the 17-19 age group of girls followed by the 11-13 age group of girls. Normal level of Hb was found in the 13-15 and 15-17 age groups of girls. Education status in mothers was investigated in which illiterate level was found to be higher followed by primary, middle and higher secondary school education [Figure 1]. The employment status of the fathers of the school girls was analyzed in which labor was found to be the highest [Figure 2] and service was found to be the lowest.
Figure 1: Education status of mothers in relation to prevelance of protein energy malnutrition

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Figure 2: Occupation status of fathers in relation to prevelance of protein energy malnutrition

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Table 2: Detection of hemoglobin level in the school girls from rural areas

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   Discussion Top

Low height for age, namely stunting, usually originates from economic and health problems and also is called chronic malnutrition. Low weight for age that is referred to underweight is indicator of low height, low body mass or both, while low weight for height is indicator of low body mass. Low weight for height that is called wasting is usually due to acute diseases or food shortage during the same period. [9],[10] Growth assessment is the single measurement that best defines the health and nutritional status of children, because disturbances in health and nutrition, regardless of their etiology, invariably affect child growth. Health and nutrition problems during childhood are the result of a wide range of factors, most of which - particularly in underprivileged populations - relate to unsatisfactory food intake or severe and repeated infections, or a combination of the two. These conditions, in turn, are closely linked to the general standard of living and whether a population is able to meet its basic needs such as food, housing, and healthcare.

Growth assessment thus serves as a means for evaluating the health and nutritional status of children, just as it also provides an indirect measurement of the quality of life of an entire population. Of the various anthropometric indices that can be used to assess child growth status, the following provide a comprehensive description: height-for-age portrays performance in terms of linear growth, and essentially measures long-term growth faltering; weight-for-height reflects body proportion, or the harmony of growth, and is particularly sensitive to acute growth disturbances; and weight-for-age represents a convenient synthesis of both linear growth and body proportion. [10] Food intake is a crucial input for child development. The interaction of an inadequate diet with infection is the principal cause of under-nutrition. One of the most comprehensive reviews of studies of gender and age differences in food allocation was completed. [11] The accurate measurement of a child's representative food intake is a much tougher proposition than the assessment of immunization status, treatment for diarrhea or Acute Respiratory Infections, measures of stunting and wasting, or school enrollment. [11]

It was observed [12] that analysis of a subset of the data compared anemic and non-anemic girls within the well-nourished group, and similarly within the undernourished groups, under-nutrition being defined by BMI. This was done to control the confounding influence of under-nutrition.

It was reported that with increasing severity of under-nutrition, the number of steps completed in the step test became fewer and the recovery time was prolonged. Similarly, verbal and performance IQ scores progressively decreased with fall in Hb levels. The differences were significant for digit span test between non-anemic and severely anemic children in both the sexes. [13] reported that malnutrition is a common health problem in children. Illiteracy, poverty and lack of infrastructure are the most important risk factors involved in anemia in preschool children. [14] That anemia remains a major public health concern in preschool children and pregnant women in the developing world. While many studies have examined these two at-risk groups, there is a paucity of data on anemia in adolescents living in developing countries in the complex ecologic context of poverty, parasitism and malnutrition. In India, the problems of malnutrition and anemia exist in a greater dimension among the young children CSSM. [15],[16] The children of tribal communities, due to their low socioeconomic status and social isolation, become highly vulnerable in this regard.

Unicef reported that the prevalence of malnutrition in Bangladesh is among the highest in the world. Millions of children and women suffer from one or more forms of malnutrition including low birth weight, wasting, stunting, underweight, Vitamin A deficiencies, iodine deficiency disorders and anemia. Today malnutrition not only affects individuals but its effects are passed from one generation to the next as malnourished mothers give birth to infants who struggle to develop and thrive. If these children are girls, they often grow up to become malnourished mothers themselves. Globally, malnutrition is attributed to almost one-half of all child deaths. Survivors are left vulnerable to illnesses, stunted growth and intellectual impairment.

While malnutrition in India is prevalent among all segments of the population poor nutrition among women begins in infancy and continues throughout their lifetimes. Women and girls are typically the last to eat in a family; thus, if there is not enough food they are the ones to suffer most. Children of illiterate mothers are three times as likely to be severely undernourished as children of mothers with at least a high school education. [17],[18] The BMI can also be applied to define chronic energy deficiency(CED)/ underweight and overweight/obesity. [19],[20] Underweight/CED is usually indicated by a BMI of less than 18.5 kg/m 2 and overweight and obese is indicated by a BMI of more than 25.0 kg/m 2 .

There are several studies on nutrition transition in Asia and the Pacific, as well as in the developing world in general. [21] In India, which is typically known for a large incidence of under-nutrition, significant proportions of overweight and obese now coexist with the undernourished [22] and there is some evidence of emerging nutrition transition also. [19] Traditional foods meant for children, pregnant and lactating mothers are being forgotten and biscuits, bread, noodles, instant infant foods of very high cost are getting more popular. The value of traditional foods including coarse grains, fruits and green leafy vegetables, etc. need to be revived. These foods contribute fiber, antioxidant vitamins, beta carotene, vitamin C and folic acid, which help in preventing diet-related chronic disorders like diabetes, hypertension and cancer etc. [23]

   Conclusions Top

The causes of growth retardation are deeply rooted in poverty and lack of education. The extent of malnutrition can be countered by educating the parents with respect to the basic nutritional requirements of their children and encouraging them to consume locally available low-cost nutritious foods. The findings of this study suggest that school-going girls in the rural areas were found to be severely anemic, and necessary action should be taken to prevent future complications.

   References Top

1.Sen AK. Poveny and Famines - An Essay on Entitlement and Deprivation. Oxford: Oxford University Press; 1981.  Back to cited text no. 1
2.Rouse DJ. Potential Cost-Effectiveness of Nutrition Interventions to Prevent Adverse Pregnancy Outcomes in the Developing World. Journal of Nutrition 2003;133:1640S-4S.  Back to cited text no. 2
3.Dewan M. Malnutrition in Women. Stud Home Comm Sci 2008;2:7-10.  Back to cited text no. 3
4.Ghorbani J. Protein- Energy malnutrition prevalence in school children of Zanjan city. Sci J Med Uni Zanjan 1998;23:24-8.  Back to cited text no. 4
5.National Health and Nutrition Examination Survey III (NHNES). Body Measurements (Anthropometry) Westat, Rockville, Inc .; 1988  Back to cited text no. 5
6.United Nations Administrative Committee on Coordination/Subcommittee on Nutrition (UNACCSN). Second Report on the World Nutrition Situation. Vol. 1. Global and Regional Results. Geneva; United Nations Administrative Committee on Co-ordination/ Subcommittee on Nutrition; 1992.  Back to cited text no. 6
7.von Schenck H, Falkensson M, Lundberg B. Evaluation of "Hemocue" A New Device For Determining Haemoglobin. Clin Chem 1986;32:526-9.   Back to cited text no. 7
8.Duncan BD. Multiple range test for correlated and heteroscedastic means. Biometrics. 1957;13:359-64.  Back to cited text no. 8
9.WHO. Measuring change in nutritional status. Geneva: WHO; 1983.  Back to cited text no. 9
10.WHO Working Group. Use and interpretation of anthropometric indicators of nutritional status. Bull World Health Organ 1986;64:924-41.  Back to cited text no. 10
11.Haddad L, Hoddinott J. Does Female Income Share Influence Household Expenditures? Evidence from the Côte d'Ivoire. Oxf Bull Econ Stat 1995;57:77-96.  Back to cited text no. 11
12.Sen A, Kanani SJ. Deleterious Functional Impact of Anemia on Young Adolescent School Girls. Indian Pediatr 2006;43:219-26.  Back to cited text no. 12
13.Mohamed EH, Maryem F, Youssef. A, Ahmed Omar TA., Abdelali. A Nutr Ther Metab 2010;28:73-6.  Back to cited text no. 13
14.Kager PA, ter Kuile FO. Anemia in adolescent schoolgirls in western Kenya: Epidemiology and prevention. PhD Thesis University of Amsterdam, Tjalling Leenstra. 2003;1-3.16.   Back to cited text no. 14
15.CSSM review. Government of India, A Newsletter on Child Survival and Safe Motherhood Program, No.25, January 1995.  Back to cited text no. 15
16.Jyothi Lakshmi A, Begum K, Saraswathi G, Prakash J. Prevalence of anemia in Indian rural preschool children: Analysis of associative factors. Indian J Nutr Dietet 2001;38:182-90.  Back to cited text no. 16
17.Horowitz B, Kishwar M. Family Life-The Unequal Deal. In: Madhu Kishwar and Ruth Vanita (Eds.): In Search of Answers: India: Indian Women's Voices from Manushi; 1985.  Back to cited text no. 17
18.Chatterjee M. Indian Women: Their Health and Economic Productivity. Washington, DC: World Bank Discussion; 1990. p. 109.  Back to cited text no. 18
19.Shetty PS, James WP. Body Mass Index: A Measure of Chronic Energy Deficiency in Adults, Food and Agriculture Organization, Food and Nutrition. Rome: FAO; 1994. p. 56.  Back to cited text no. 19
20.Ferro-Luzzi A, Sette S, Franklin M. A Simplified Approach of Assessing Adult Chronic Energy Deficiency. Eur J Clin Nutr 1992;46:173-86.  Back to cited text no. 20
21.Popkin BM. The Nutrition Transition in Low income Countries: An Emerging Crisis. Nutr Rev. 1994;52:285-98.  Back to cited text no. 21
22.International Institute for Population Sciences and ORC Macro 2000. IIPS: Mumbai, India: National Family Health Survey (NFHS-2); 1998-99.   Back to cited text no. 22
23.Bansal RD, Mehra M. Malnutrition: A silent emergency. Indian J Public Health 1999;43:1-2.  Back to cited text no. 23


  [Figure 1], [Figure 2]

  [Table 1], [Table 2]

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