A comparison of nutritional status of primary school children in two settlements in the Polonnaruwa District

This study was conducted to assess and compare the nutritional status of primary school children of a new (Mahaweli System "B") and an old settlement (Parakrama Samudraya) area in the Polonnaruwa dis­ trict. A total of 941 and 719 primary school children from the new and old settlements, respectively, were studied. Heights and weights of primary school chil­ dren were measured using standard techniques. Fin­ ger prick blood samples were obtained to measure haemoglobin concentrations using"ERMA AE-11N" photoelectric colorimeter. Weight-for-age, heightfor-age and weight-for-height z-scores were calcu­ lated using EPIINFO. The nutritional status of the primary school children of the new settlement were poorer than those in the old settlement in all three anthropometric indicators, namely stunting, wast­ ing and underweight. The prevalence of stunting among children from the new settlement (36.2% and 31.2% in males and females respectively) was sig­ nificantly higher than those of children in the old settlement (29.0% and 28.6% in males and females respectively). The prevalences of wasting among children from the new settlement (51.8% and 48.2% in males and females respectively) were significantly higher than that of children in the old settlement (27.3% and 23.2% in males and females respectively). The prevalence of underweight was 65 .4% and 62.4% in the new settlement and 47.2% and 38.3% in the old settlement, in male and female children, re­ spectively. More than 8 5 % of the children were anaemic with the prevalence being significantly higher among children from the new settlement (91.5%) as compared to those from the old settlement(72.3%).

Children were enrolled in the study after obtain ing informed consent from parents or guardians.
Children who were absent on the day of the sur vey, who did not cooperate or whose parents or guardians did not give consent were exuded from the study. Data on age, sex and the dates of birth were extracted from school registers. All the chil dren in these schools had birth certificates and the class teachers entered the dates of birth in the registers.
The weights of the children were measured to the nearest 100 grams using a "Detecto" adult weigh ing scale as recommended by the WHO (7). Haemoglobin concentrations were measured in 908 students from the new settlement and 369 stu dents from the old settlement. The haemoglobin concentrations of children in the new settle ment ranged from 6.74 g/dL to 15.04 g/dL while those of the old settlement ranged from 6.24 g/dL to 15.5 g/dL (Table 6) In this study it was observed that the prevalence of wasting (51.8 % and 48.2 %, for males and fe males, respectively) in the new settlement was higher than the prevalence of stunting (36.2 % and 31.2 % for males and females, respectively). Usually, in nutritional surveys, the prevalence of wasting is lower than the prevalence of stunting. This phenomenon demonstrates the degree of the present socio-economic strain on the nutritional status of primary school children of the new settle ment. In the old settlement the prevalence of wast ing was lower than that of stunting.
The prevalence of stunting among children of Polonnaruwa was approximately 32% in boys and 30% in girls. In a study of children of Talkote, a "purana" village near Sigiriya carried out in 1989, almost all children (100% of boys and 90% of girls) 5 to 14 years had a Body Mass Index(BMI) less than 18.5 (12). The BMI is an index of chronic dietary energy deficiency. Children in the present study appear to be better nourished than the chil dren resident in the "purana" village.

In a study of school children from different loca tions of the Colombo District reflecting different socio-economic strata of the population, Wikramanayake and Amarasinghe reported that the BMI of affluent children is higher than that of less affluent children and are comparable to that of children of Chinese descent in Hong Kong but markedly different from those of affluent Indian girls in New Delhi and Irish and American popula tions (13). The differences in nutritional status seen among school children resident even within close proximity, as was seen in this study between children of the old and new settlements, is a re flection of the significant impact of many socio economic factors on nutrition.
The results of this study indicate that anaemia is a major public health problem among these chil dren. The relatively better haemoglobin status coupled with the better anthropometric status among children of the old settlement as compared to children of the new settlement is a reflection of the poorer socio-economic status, in general, of the families of the new settlement. The most prob able cause of the anaemia is iron deficiency which may be due to poor dietary intake as well as pres ence of concomitant helminth infections. At the time of the study, the prevalence of hookworm infestation among children of the new settlement was 13% as compared to no infestation among children in the old settlement. The differences in the prevalence of anaemia between children of the 2 settlements may be due to differences in the prevalence of hookworm infection.
Another important finding of this study is the absence of a consistent difference between males and females in either of the two settlements with regard to anthropometric status and haemoglo bin concentrations.

The Ceylon Journal of Medical Science
The results of this study have far reaching implica tions. Firstly, the poor nutritional status of primary school children in rural communities needs to be addressed. Nutrition programmes should be de signed and implemented specifically for these com munities. In addition, adequate health care facili ties should be provided. Secondly, the poorer nu tritional status of primary school children of the new settlement as compared to those of the old settlement requires that these settler communities should be provided with adequate health care fa cilities and possibly other benefits such as food subsidies to mitigate effects of socio-economic fac tors that these communities may have to face. These facilities should be planned well in advance and implemented as soon as settlement is done. Not addressing these issues will only result in a failure of the entire settlement programme. In addition, as nutritional status has a significant impact on health and learning abilities in school, neglecting the nu tritional status of these children will only result in a waste of investments made in the educational sec tor. Focused nutrition interventions and provision of adequate health care to this age group will not only be of benefit to the target population per se, but will have a ripple effect on other segments of society as well, such as pregnant mothers, pre school children and adults. This will be of benefit for the communities as a whole to be more eco nomically productive.

*Comparison of prevalence of wasting among male children between new and old settlements N -Number of children
The Ceylon Journal of Medical Science