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NUTRITIONAL ASSESSMENT OF CHILDREN ATTENDING

MID DAY MEAL IN GOVERNMENT SCHOOLS

Chetna Jantwal* and Chhavi Arya**

*Research Scholar
Department of Home Science
D.S.B Campus, Kumaun University
Nainital, Uttarakhand
**Assistant Professor
Department of Home Science
D.S.B Campus, Kumaun University
Nainital, Uttarakhand
International Journal of Family and Home Science, Vol.14 (2) (May-Aug., 2018) (197-205)

Abstract
A cross sectional study of 120 children(68 girls and 52 boys) of 6-14 years years from
6 schools of Bhimtal block, district Nainital, Uttarakhand was undertaken to assess
the nutritional status of children who are benificiaries of mid day meal programme.
Anthropometric measurements were taken by measuring height, weight, mid upper
arm circumference through standard techniques.BMI Z score was used to classify
the nutritional status of the children. The clinical examination was carried out as an
indicator of deficiency symptoms of diseases. In the present study it was observed that
the mean BMI combining all ages for girls and boys was18.66±2.85 and 19.06±2.50
kg/m2, respectively. According to BMI Z score it was revealed that 57.69% boys and
70.58% girls were normal. The per cent of moderate and severe undernutrition was
26.92 % and 9.61% for boys and 22.05% and 2.94% for girls, respectively. The per
cent of overweight among girls was 4.41 per cent which was slightly lower than the
boys. The clinical examination of children revealed that 42.5 per cent of children
have cavity whereas 14.16 per cent of children have mottled teeth. 4.16 per cent
children have swollen and bleeding gums. Only 1.66 per cent children have cheilosis.
14.16 per cent children had pale eyes. Skin of 18.33 per cent children was dry. The
hairs of 9.16 per cent children were dull and dry whereas 10 per cent children had
pigmented hairs. The present study reveals different grades of malnutrition among
children and various nutrient deficiency. All the observation revealed that the
children who are benificiaries of mid day meal programme need better nutrition to
combat malnutrition and various deficiencies.

Keywords: Nutritional assessment, Clinical examination, BMI Z score

and Mid day meal.
198 Nutritional Assessment of Children Attending Mid Day Meal in Government...

Introduction

S chool going children are the most vulnerable population as they

suffer from malnutrition and various nutritional deficiencies. This
age group is a dynamic period of growth and development as children
undergo physical, mental, emotional and social changes (Byadagi 2015).
In developing countries like India malnutrition is the major problem
among school going children. According to WHO malnutrition
continues to be a major health problem in South East Asia. Studies have
reported that a large section of children especially the urban and rural
poor in India are suffering from varying grades of malnutrition (Alim
et al., 2012).
The nutritional status of school going children is as issue of vital
concern. The nutritional problems faced by school children are growth
retardation, stunting, underweight, iodine deficiency disorder, anemia
and vitamin A deficiency. Children s are the future of a country, they
should reach adulthood at a healthy state. Malnutrition affects children
chances of survival, increase their susceptibility to illness, reduce
their ability to learn and increase their chances of dropping out early
from school.
Hence the government of India had started mid day meal programme,
it is a multi faceted programme of the government which involves
provision of free lunch on working days for children in primary and
upper primary classes in various schools run by the government. The
National programme of nutritional support to primary education
(NP‑NSPE) commonly known as mid day meal scheme was launched
as a centrally sponsored scheme on 15 august 1995 in 2,408 blocks as a
dry ration scheme with the objectives of improving nutritional status
of children, encouraging poor children, belonging to disadvantaged
sections, to attend school more regularly and help them concentrate on
classroom activities, thereby increasing the enrollment, retention and
attendance rates. The hot cooked meal was served in the elementary
classes from 2004. The children of upper primary classes were covered
under mid day meal scheme from 2008-2009. Mid day meal scheme
have major impact on abolition of classroom hunger, promoting school
attendance, enhancing gender equity and facilitating the healthy
growth of children.
Nutrition has a direct impact on health and nutritional status. It is well
established that nutritional assessment is a major determinant of the
International Journal of Family and Home Science 199

health and well-being among children. Nutritional assessment is the

interpretation of anthropometric, biochemical, clinical and dietary data
to determine the nutritional status.
Uttarakhand is a hilly state with little information on the nutritional
status of the children consuming mid day meal. Few studies have been
attempted to evaluate the nutritional status of the children receiving
mid day meal in Primary and Upper primary schools.
Earlier few studies have been attempted to evaluate the nutritional
status of the children receiving mid day meal in the tarai region of
Uttarakhand. However studies on the nutritional status of children
receiving mid day meal in the hilly region of kumaun is scanty.
Keeping these facts in consideration, the present study has been
undertaken with the following objectives:
• To evaluate the nutritional status of the children consuming mid
day meal.
• To evaluate nutrients deficiency by clinical examination of the
children attending mid day meal.
Materials and Methods
Sampling Design: The study was cross sectional in nature and the
subjects were selected through random sampling technique.
Subjects: A sample of 120 school children who are benificiaries of
mid day meal (girls=68 and boys=52) of 6-14 years were selected from
6 schools of Bhimtal block, district Nainital, Uttarakhand.
Study Period: The study was conducted during a period of two months
from October 2016 to November 2016.
Method of data collection: Anthropometric measurements such as
height, weight, mid upper arm circumference were recorded using
standardized methodology (Gibson, 1990). Body mass index (BMI) was
calculated. BMI Z-score (WHO, 2007) was used to assess the nutritional
status of adolescents.
Clinical examination is the best indicator of deficiency symptoms of
micronutrients. The clinical examination of deficiency disease was
carried out as prescribed by Jelliffe (1966).
Statistical analysis: Mean, Standard deviation, percentage were used
for analysis of the data.
 Table 1: Anthropometric characteristics as per age and gender among children
200
Age
N Height(Cm) Weight(Kg) BMI(wt/ht2) MUAC(cm)
(yrs)
Boys Girls Boys Girls Boys Girls Boys Girls Boys Girls
6 4 5 113.5±2.65 113.20±1.48 16.00±0.82 15.00±0.71 16.00±0.82 15.00±0.71 16.25±1.19 15.3±1.30
7 7 8 116±5.58 115.75±10.24 18.29±2.12 18.25±3.01 18.29±2.12 18.25±3.01 16.28±0.69 15.81±0.79
8 5 7 118.60±6.58 119±4.68 18.80±1.79 19.57±1.27 18.80±1.79 19.57±1.27 16.8±0.57 16.21±1.65
9 6 6 125.67±7.17 123.50±4.28 22.00±2.90 21.17±0.98 22.00±2.90 21.17±0.98 17.33±0.51 16.25±0.82
10 6 6 130.5±10.56 131.17±5.74 22.00±1.67 24.00±2.00 22.00±1.67 22.83±3.87 17.91±1.46 18.25±1.60
11 6 7 133.33± 6.38 135.00±2.45 24.17±3.19 26.29±1.25 13.56±1.08 15.77±2.12 17.08±1.56 16.42±0.34
12 7 15 142.35±2.28 144.6±3.9 32.35±5.00 36.30±5.51 18.05±2.22 19.77±2.64 16.92±0.62 16.8±0.97
13 6 8 149.17±2.07 151.13±2.10 40.29±2.84 39.31±3.03 21.59±2.71 20.60±2.25 18.5±1.94 17.12±1.48
14 5 6 152.6±1.81 149.42±3.85 45.40±1.14 41.33±1.08 19.48±1.61 18.56±0.45 17.5±0.79 17.5±0.54
Pooled
52 68 131.30±14.33 131.42±14.55 26.59±10.39 26.80±9.76 18.66±2.85 19.06±2.50 17.17±0.73 16.63±0.90
Nutritional Assessment of Children Attending Mid Day Meal in Government...
International Journal of Family and Home Science 201

Result and Discussion

A total of 120 children (68 girls and 52 boys) of government school were
taken for the study. Various anthropometric parameters and clinical
examination were used for the nutritional assessment of the children
who are the beneficiaries of the mid day meal programme.
Table 1 represents the mean and standard deviation (SD) values of
height, weight, mid upper arm circumference (MUAC) and body mass
Index (BMI) of school children. Both boys and girls mean height and
weight follows a linear increasing trend. The mean height range from
113.50±2.65 cm to 152.6± 1.81 cm among boys and from 113.20 ± 1.48 to
149.42±3.85 cm among girls, respectively. Similar increasing trend has
been observed in mean weight. The mean weight of boys increased
progressively from16.00±0.82 to 45.40±1.14 kg for boys and from 15.00
± 0.71 to 41.33±1.08 kg for girls. The values of mean height and weight
observed for boys and girls (6-14years) was less than the ICMR(1990)
reference values. A study done by Joglekar (2015) also found that the
mean height and weight of school children in Chattisgargh who are
attending mid day meal was lower than the Indian and International
standards. According to the report of VIth joint review mission
Uttarakhand the mean height range from 111.11±6.49 cm to 150.99±10.67
cm for boys and 108.9±7.0 to 149.22± 5.84 cm for girls respectively and
the mean weight range from 16.16±2.25kg to 38.04±7.23kg for boys and
16.06±1.85kg to 38.03±5.28 kg for girls which is almost in line with the
present study.
Till age 10 years both girls and boys have almost the same height but
after 11 years of age girls height increases more rapidly till 13 years
because girls attain puberty at an earlier age around 10 years whereas
the boys attain puberty around 14 years of age.
MUAC is a measurement that allows to determine the malnutrition in
the subjects. Table 1 indicates that the MUAC of primary school boys
range from 16.25 ± 1.19 cm to 17.50±0.79 cm whereas for girls it range
from 15.30±1.30 to 17.5±0.54cm.Body mass Index is calculated by height
and weight. BMI for boys range from 16.00±0.82 kg/m2 to 19.48±1.61 kg/
m2 and 15.00±0.71 kg/m2 to 18.56±0.45kg/m2 among girls.
Table 2 indicates that according to BMI Z scores (WHO, 2007) 57.69
per cent boys and 70.58 per cent girls in schools who were consuming
mid day meal were normal, 26.92 per cent boys and 22.05 per cent girls
 Table 2: Nutritional status of children as per BMI Z-Score
202
Severe
Normal Moderate undernutrition Overweight
Age N undernutrition
n(%) n(%) n(%)
(yrs) n(%)
Boys Girls Boys Girls Boys Girls Boys Girls Boys Girls
6 4 5 2 2 2 2 - 1 - -
7 7 8 4 5 2 2 1 1 - -
8 5 7 4 6 1 1 1 - - -
9 6 6 2 4 3 2 1 - - -
10 6 6 3 4 1 2 2 -
11 6 7 3 6 3 1 - -
12 7 15 5 10 1 4 - - 1 1
13 6 8 4 6 - - - - 2 2
14 5 6 3 5 2 1 - -
Total 52 68 30(57.69) 48(70.58) 14(26.92) 15(22.05) 5(9.61) 2(2.94) 3(5.76) 3(4.41)
Nutritional Assessment of Children Attending Mid Day Meal in Government...
International Journal of Family and Home Science 203

were moderately undernourished whereas 9.61 per cent boys and 2.94
per cent girls were severely undernourished and 5.76 per cent boys and
4.41 per cent girls were overweight.. The result shows that the more
per cent of girls are normal in comparison to boys. Similar results has
been observed by the VI joint review mission report (Uttarakhand)
on children attending mid day meal. In a study done by Alim et al.
(2012) on children attending mid day meal scheme in government
primary school in Aligarh city found that 13.04 per cent boys were
normal and 23.45 per cent girls were normal which was lower than the
present study.
A study done by Srivastava et al. (2013) on 392 adolescents found that
65.90 per cent boys and 71.60 per cent girls were normal which is higher
than the present study but show a similar trend that more per cent of
girls were normal in comparison of boys.
Clinical examination is the best indicator of deficiency symptoms of
nutrients. The results of clinical examination have been presented in
Table 3 which indicates that 42.5 per cent of children have dental cavity.
It was also found that 14.16 per cent of children have mottled teeth. The
cavities and mottled teeth occur due to calcium deficiency and poor
oral hygiene.4.16 per cent children have swollen and bleeding gums.
Only 1.66 per cent children have cheilosis which occurs due to Vitamin
B deficiency. Among the selected children 14.16 per cent children had
pale conjunctiva which occurs due to iron deficiency. Skin of 18.33 per
cent children was dry and hairs of 9.16 per cent children were dull and
dry whereas 10 per cent children had pigmented hairs. The dull and
pigmented hairs indicate protein deficiency among children The above
deficiency symptoms indicates the deficiency of various nutrients in
the children who are attending mid day meal.
According to a study done by Joglekar (2015) on clinical examination of
Primary School Children who are consuming mid day meal in the State
of Chhattisgarh, it was found that out of 400 students, about 42 percent
had dull and dry hair .Only 0.75 percent students had problem of
cheiliosis, The prominent clinical problem observed was teeth carries.
Out of 400 students 53.25 percent students were facing the problem
of teeth carries and pale eyes were found in 32.75 percent children. In
the present study dental cavity was also a prominent problem among
school children.
204 Nutritional Assessment of Children Attending Mid Day Meal in Government...

Table 3: Clinical Assessment of the children

No. of children
Details Particulars
n(%)
Teeth Mottled teeth 17.00(14.16)
Cavity 51(42.5)
Gums Swollen gums 5 (4.16)
Bleeding gums 5 (4.16)
Mouth Lesions 5 (4.16)
Cheilosis 2(1.66)
Eyes Pale conjunctiva 17.00(14.16)
Skin Dry skin 22(18.33)
Nails Chalky nails 16(13.33)
Hairs Dull and dry 11(9.16)
Pigmented 12(10)

Conclusion
The nutritional status of school going children is an issue of vital
concern. Children undergo physical, mental, emotional and social
changes. Malnutrition affects children chances of survival, increases
their susceptibility to illness. A malnourished child will become a
malnourished adult and will affect the future of our country. In the
present study only 57.69 per cent boys and 70.58 per cent girls were
normal whereas the remaining children suffer from malnutrition and
there is a need to overcome the malnutrition among children as they
are the future of our country. There is an urgent need to encourage
healthy eating habits and personal hygiene among children’s.
References
Gibson, R. S. (1990): Principles of Nutritional Assessment. Oxford University
Press. New York, pp. 153-195.
WHO. (2007): http://www.who.int/growthref/bmifa_girls_5_19years_z.
pdf?ua=1
WHO (2007): http://www.who.int/growthref/bmifa_boys_5_19years_z.
pdf?ua=1
Jelliffe, D.B. (1966): The Assessment of the Nutritional Status of the
Community. WHO Monograph Series No. 53, WHO Report of Working
Party of the Intervention Dietary Energy Consultation Group. Am J Clin
Nutr., 42: 969-981.
International Journal of Family and Home Science 205

Joglekar, A.R. (2015): Evaluation of a mid day meal program for primary school
children in the state of Chhattisgarh. Stud Home Com Sci., 9(1):45‑50.
Alim, F., Khalil, S., Mirz., I and Khan, Z. (2012): Impact of mid day meal scheme
on the nutritional status and academic achievement of school children in
Aligarh. Indian J. Sci.Res., 3(2):85-90.
Byadagi, S. (2015): Comparison of nutritional status of school children with
and without mid day meal program. Journal of Environment and Ecology.,
6(1): 69-75.
Joint Review Mission (2014): Joint Review Mission: Uttarakhand. Government
of India. Ministry of Human Resource Development. Department of
School Education and Literacy.

Received on 19.1.2018 and accepted on 29.1.2018

***