Assessment of nutritional status of school going adolescents in rural and urban area of north karnataka: A comparative study
Introduction
The word adolescence comes from the Latin word ‘adolescere’ meaning to grow and to mature. Adolescents are defined as the age group between 10-19 years according to WHO.1, 2 At present the population of adolescent is 1.2 billion globally forming 18% of the total population. Around 243 million are living in India and consists of about 21% of Indian population.3 Today, every 5th person in India is an adolescent.4 Adolescence may be divided into three developmental stages-early adolescence- 10 to 13 years, middle adolescence- 14 to 16 years, late adolescence- 17 to 19 years.4, 5, 6, 7
Adolescence is the transition period during which they gain up to 50% of their adult height and skeletal mass. Unmet nutritional needs lead to several public health problems such as stunted and retarded growth, impaired mental development, anaemia. In adolescent girls, short stature that carries on into adulthood is associated with many concurrent and future adverse health and pregnancy outcomes like obstructed labour, post-partum haemorrhage, genital infection etc. Global prevalence of underweight among children and adolescent is 8.4% in girls and 12.4% in boys according to worldwide pooled analysis of study published in Lancet in 2017.8 In India, it varies from 21.4% to 47.93% according to different studies conducted across the country.9 Poor nutrition can lead to underweight stunting and on the other hand increased risk of non-communicable diseases later in life. Most of the published literature focuses on nutritional status among adolescents, while there is a paucity of information of nutritional status of adolescents in both rural and urban area. Hence, the present study was designed to assess and compare the nutritional status and the factors affecting the nutritional status of school going adolescents in rural and urban area.
Material and Medhods
An observational study was conducted among the school going adolescents (10-19 years) studying in Government schools in rural and urban field practice area of Department of Community Medicine, BIMS, Belagavi during October 2019 to December 2019. There are 13 schools in Uchagoan and 9 schools in Kashbag. All the Government schools were included in the sampling frame. The calculated sample size was N=360 taking the prevalence of malnutrition 19.44% in a previous Indian study with absolute error 5%, 10% response failure and 95% confidence interval 10 A written permission from the authorities of all institutions was obtained prior to data collection. Students from standard six to ten were taken in the study and they were selected using simple random sampling technique.
Table 1
Classification of BMI according to IAP guidelines. 11
BMI
|
Categories
|
<18.5
|
Underweight
|
18.5-23
|
Normal
|
23-27
|
Overweight
|
>27
|
Obese
|
Table 2
Socio-demographic distribution of the study participants. N=360
Socio-demographic characteristics
|
|
Rural N (%)
|
Urban N (%)
|
Total N (%)
|
Age (Adolescence phase)
|
Early
|
45(25.0%)
|
106 (58.89%)
|
151 (41.94%)
|
Middle
|
135(75.0%)
|
72(40.0%)
|
207(57.50%)
|
Late
|
0(0.00)
|
2(1.11%)
|
2(0.56%)
|
Total
|
180
|
180
|
360
|
Gender
|
Boys
|
73 (40.56%)
|
65 (36.11%)
|
138 (38.33%)
|
Girls
|
107 (59.44%)
|
115 (63.89%)
|
222 (61.67%)
|
Total
|
180
|
180
|
360
|
Standard (class)
|
6th
|
23 (12.78%)
|
48 (26.67%)
|
71(19.72%)
|
7th
|
22 (12.22%)
|
48 (26.67%)
|
70(19.44%)
|
8th
|
45 (25.0%)
|
42 (23.33%)
|
87(24.17%)
|
9th
|
45 (25.0%)
|
22 (12.22%)
|
67(18.61%)
|
10th
|
45 (25.0%)
|
20 (11.11%)
|
65(18.06%)
|
Total
|
180
|
180
|
360
|
Type of family
|
Nuclear
|
99 (55.0%)
|
111 (61.67%)
|
210(58.33%)
|
Joint
|
22 (12.22%)
|
26 (14.44%)
|
48(13.33%)
|
Three generation
|
59 (32.78%)
|
43 (23.89%)
|
102(28.33%)
|
Total
|
180
|
180
|
360
|
Religion
|
Hindu
|
172 (95.56%)
|
178 (98.89%)
|
350(97.22%)
|
Muslim
|
7 (3.89%)
|
1(0.56%)
|
8(2.22%)
|
Christian
|
1 (0.56%)
|
0(0.00)
|
1(0.28%)
|
Others
|
0(0.00)
|
1(0.56%)
|
1 (0.28%)
|
Total
|
180
|
180
|
360
|
Socio-Economic Status
|
Class I & II
|
6 (3.33%)
|
43 (23.89%)
|
49 (13.61%)
|
Class III
|
37 (20.56%)
|
40 (22.22%)
|
77 (21.39%)
|
Class IV
|
105 (58.33%)
|
71 (39.44%)
|
176 (48.89%)
|
Class V
|
32 (17.77%)
|
26 (14.44%)
|
58 (16.11%)
|
Total
|
180
|
180
|
360
|
Fathers Education
|
Illiterate
|
13 (7.22%)
|
9 (5.0%)
|
22 (6.11%)
|
Primary school
|
8(4.44%)
|
10 (5.56%)
|
18 (5.00%)
|
Middle school
|
46 (25.56%)
|
30 (16.67%)
|
76 (21.11%)
|
High school
|
80 (44.44%)
|
55 (30.56%)
|
135 (37.50%)
|
Pre-university
|
22 (12.22%)
|
40 (22.22%)
|
62 (17.22%)
|
Graduate and Higher
|
6(3.33%)
|
19 (10.56%)
|
25 (6.94%)
|
*Not Applicable
|
5 (2.78%)
|
17 (9.44%)
|
22 (6.11%)
|
Total
|
180
|
180
|
360
|
Mothers Education
|
Illiterate
|
13 (7.22%)
|
8 (4.44%)
|
21 (5.83%)
|
Primary school
|
2 (1.11%)
|
7 (3.89%)
|
9 (2.50%)
|
Middle school
|
51 (28.33%)
|
55 (30.56%)
|
106 (29.44%)
|
High school
|
95(52.78%)
|
68 (37.78%)
|
163 (45.28%)
|
Pre-university
|
19 (10.56%)
|
26 (14.44%)
|
45 (12.50%)
|
Graduate and Higher
|
0 (0.00)
|
13 (7.22%)
|
13 (3.61%)
|
*Not Applicable
|
0 (0.00)
|
3 (1.67%)
|
3 (0.83%)
|
Total
|
180
|
180
|
360
|
*Not Applicable: either not staying together or death
|
Table 3
Distribution of adolescents according to clinical assessment. N=360
Category
|
Clinical Sign (General appearance)
|
Rural N, (%)
|
Urban N, (%)
|
Z-statistic & p-value
|
Total N, (%)
|
Built & nourishment
|
Thin
|
29 (16.11%)
|
59 (32.77%)
|
3.74901 &<0.01*
|
88 (24.44%)
|
Obese
|
12 (6.67%)
|
10 (5.56%)
|
0.439607 &>0.05
|
22 (6.11%)
|
Normal
|
139 (77.22%)
|
111 (61.67%)
|
--
|
250 (69.44%)
|
Hair
|
Thin & sparse
|
12 (6.67%)
|
03(1.67%)
|
2.391639 &<0.05*
|
15 (4.17%)
|
Lack of lustre
|
05 (2.78%)
|
11 (6.11%)
|
1.53789 &>0.05
|
16 (4.44%)
|
Dyspigmentation
|
01(0.56%)
|
01 (0.56%)
|
0 &>0.05
|
02 (0.56%)
|
Normal
|
162 (90.0%)
|
165 (91.67%)
|
--
|
327 (90.83%)
|
Eyes
|
Pallor present
|
49 (27.22%)
|
35 (19.44%)
|
1.752571 &>0.05
|
84 (23.33%)
|
Pallor absent
|
131 (72.78%)
|
145 (80.56%)
|
--
|
276 (76.67%)
|
Ears
|
Discharge
|
01 (0.56%)
|
09 (05.0%)
|
2.58583 &<0.05*
|
10 (2.78%)
|
Hearing aid
|
0 (0.00)
|
02 (1.11%)
|
1.42142 &>0.05
|
02 (0.56%)
|
Normal
|
179 (99.44%)
|
169 (93.88%)
|
--
|
348 (96.67%)
|
Teeth
|
Caries
|
79 (43.88%)
|
81 (45.0%)
|
0.21384 &>0.05
|
160 (44.44%)
|
Enamel attrition
|
7 (3.88%)
|
5 (2.78%)
|
0.581902 &>0.05
|
12 (3.33%)
|
Normal
|
94 (52.22%)
|
94 (52.22%)
|
--
|
188 (52.22%)
|
Tongue
|
Pale
|
16 (8.89%)
|
03 (1.67%)
|
3.103517 &<0.01*
|
19 (5.27%)
|
Fissured
|
10 (5.56%)
|
05 (2.78%)
|
1.322512 &>0.05
|
15 (4.17%)
|
Normal
|
154 (85.56%)
|
172 (95.56%)
|
--
|
326 (90.56%)
|
Lips
|
Stomatitis & cheilosis
|
15 (8.33%)
|
08 (4.44%)
|
1.514246 &>0.05
|
23 (6.39%)
|
Normal
|
165 (91.67%)
|
172 (95.56%)
|
--
|
337 (93.61%)
|
Gums
|
Spongy
|
07 (3.89%)
|
0 (0.00)
|
2.699148 &<0.05*
|
07 (1.94%)
|
Bleeding
|
06 (3.33%)
|
03 (1.67%)
|
1.010117 &>0.05
|
09 (2.5%)
|
Normal
|
167 (92.78%)
|
177 (98.33%)
|
--
|
344 (95.56%)
|
Thyroid gland
|
Enlarged
|
0 (0.00)
|
06 (3.33%)
|
2.49008 &<0.05*
|
06 (1.67%)
|
Normal
|
180 (100%)
|
174 (96.67%)
|
--
|
354 (98.33%)
|
Skin
|
Dry & scaly
|
42 (23.33%)
|
13 (7.22%)
|
4.359025 &<0.01*
|
55 (15.28%)
|
Normal
|
138 (76.67%)
|
167 (92.78%)
|
--
|
305 (84.72%)
|
Nails
|
Flat
|
12 (6.67%)
|
03 (1.67%)
|
2.391639 &<0.05*
|
15 (4.17%)
|
Normal
|
168 (93.33%)
|
177 (98.33%)
|
--
|
345 (95.83%)
|
Table 4
Comparison of mean weight, height, BMI and WHR of rural and urban adolescents (Mean ± SD). N=360
Parameters
|
Boys
|
Test statistic & p-value
|
Girls
|
Test statistic & p-value
|
Rural (73)
|
Urban (65)
|
Rural (107)
|
Urban (115)
|
Weight (kg) Mean ± SD Median IQR
|
37.74 ±7.98 37 8.5
|
34.15±9.11 32 11.5
|
Z=3.061 & 0.002*
|
39.33±7.66 151 7
|
38.60±9.2 149 12
|
Z=1.299 & P=0.194
|
Height (cm) Mean ± SD Median IQR
|
151.33±10.86
|
146.15±9.11
|
t= 2.92 & p=0.003*
|
149.66±8.49 151 7
|
149.43±8.69 149 12
|
Z= 0.66 & P=0.508
|
BMI (kg/m2) Mean ± SD Median IQR
|
16.33±2.16 15.82 2.92
|
15.81±3.15 14.88 3.45
|
Z= 2.09 & P= 0.037*
|
17.50±2.86 17.1 3.89
|
17.18±3.27 16.44 4.26
|
Z=1.096 & P= 0.273
|
WHR Mean ± SD
|
0.79 ± 0.05
|
0.83±0.06
|
t= 4.073 & p <0.001*
|
0.77±0.05
|
0.80±0.04
|
t= 5.287 & p =0.007*
|
Z= MW U test has been applied as the data was not normal. t= t test has been applied
|
Table 5
Overall prevalence of malnutrition according to IAP-BMI cut off among school adolescents. N=360
Nutritional status
|
Rural
|
Urban
|
Total
|
Normal weight
|
44 (24.44%)
|
32 (17.7%)
|
76(21.11%)
|
Under weight
|
132 (73.33%)
|
137 (76.11%)
|
269 (74.72%)
|
Overweight
|
3 (1.67%)
|
9 (5.0%)
|
12(3.33%)
|
Obese
|
1 (0.56%)
|
2(1.11%)
|
3 (0.83%)
|
Table 6
Distribution of adolescents according to IAP- BMI cut off. N=360
BMI Cut off (kg/m2)
|
Boys
|
Girls
|
Total
|
Rural N (%)
|
Urban N (%)
|
Total N (%)
|
Rural N (%)
|
Urban N (%)
|
Total N (%)
|
Rural N (%)
|
Urban N (%)
|
Total N (%)
|
<18.5 Under- Weight
|
61 (83.56%)
|
55 (84.62%)
|
132 (73.33%)
|
71 (66.36%)
|
82 (71.30%)
|
137 (76.11%)
|
132 (73.33%)
|
137 (76.11%)
|
269 (74.72%)
|
18.5-23 Normal
|
12 (16.44%)
|
7 (10.77%)
|
44 (24.44%)
|
32 (29.91%)
|
25 (21.74%)
|
32 (17.78%)
|
44 (24.44%)
|
32 (17.78%)
|
76 (21.11%)
|
23-27 Over- Weight
|
0 (0.0)
|
2 (3.08%)
|
3 (1.67%)
|
3 (2.80%)
|
7 (6.09%)
|
9 (5.0%)
|
3 (1.67%)
|
9 (5.00%)
|
12 (3.33%)
|
>27 Obese
|
0 (0.0)
|
1 (1.54%)
|
1 (0.56%)
|
1 (0.93%)
|
1 (0.87%)
|
2 (1.11%)
|
1 (0.56%)
|
2 (1.11%)
|
3 (0.83%)
|
Total
|
73
|
65
|
180
|
107
|
115
|
180
|
180
|
180
|
360
|
Table 7
Age wise distribution of malnutrition among adolescents. (IAP-BMI cut off). N=360
Age in years
|
Rural N (%)
|
Urban N (%)
|
Under weight
|
Over- weight
|
Obesity
|
Under Weight
|
Over-weight
|
Obesity
|
Early adolescence
|
30 (22.72%)
|
2 (66.67%)
|
1 (100%)
|
90 (65.69%)
|
5 (55.56%)
|
0
|
Middle adolescence
|
102 (77.27%)
|
1 (33.33%)
|
0
|
45 (32.85%)
|
4 (44.44%)
|
2 (100%)
|
Late adolescence
|
0
|
0
|
0
|
2 (1.46%)
|
0
|
0
|
Total
|
132
|
3
|
1
|
137
|
9
|
2
|
Table 8
Association of nutritional status according to IAP BMI cut off with socio-demographic profile of rural adolescents. N=360
Parameter
|
Rural
|
Urban
|
Under weight
|
Over- weight & Obesity
|
Normal
|
Total
|
Under weight
|
Over- weight & Obesity
|
Normal
|
Total
|
Sex
|
|
|
|
|
|
|
|
|
Boys
|
61 (83.6%)
|
0 (0.0)
|
12 (16.4%)
|
73 (100%)
|
55 (84.6%)
|
3 (4.6%)
|
7 (10.8%)
|
65 (100%)
|
Girls
|
71 (66.4%)
|
4 (3.7%)
|
32 (29.9%)
|
107 (100%)
|
82 (71.3%)
|
8 (7.0%)
|
25 (21.7%)
|
115 (100%)
|
Total
|
132 (73.3%)
|
4 (2.2%)
|
44 (24.4%)
|
180 (100%)
|
137 (76.1%)
|
11 (6.1%)
|
32 (17.8%)
|
180 (100%)
|
Chi-square & p-value
|
7.701 & 0.021*
|
0.448 & 0.126
|
Religion
|
|
|
|
|
|
|
|
|
Hindu
|
127 (73.8%)
|
4 (2.3%)
|
41 (23.8%)
|
172 (100%)
|
137 (77.0%)
|
11 (6.2%)
|
30 (16.9%)
|
178 (100%)
|
Muslim
|
4 (57.1%)
|
0 (0.0)
|
3 (42.9%)
|
7 (100%)
|
0 (0.0)
|
0 (0.0)
|
1 (100%)
|
1 (100%)
|
Christian
|
1 (100%)
|
0 (0.0)
|
0 (0.0)
|
1 (100%)
|
0 (0.0)
|
0 (0.0)
|
0 (0.0)
|
0 (0.0)
|
Others
|
0 (0.0)
|
0 (0.0)
|
0 (0.0)
|
0 (0.0)
|
0 (0.0)
|
0 (0.0)
|
1 (100%)
|
1 (100%)
|
Total
|
132 (73.3%)
|
4 (2.2%)
|
44 (24.4%)
|
180 (100%)
|
137 (76.1%)
|
8 (6.1%)
|
172 (95.6%)
|
180 (100%)
|
Chi-square & p-value
|
1.780 & 0.776
|
9.354 & 0.053*
|
Type of family Nuclear
|
78 (78.8%)
|
0 (0.0)
|
21 (21.2%)
|
99 (100%)
|
81 (73.0%)
|
8 (7.2%)
|
22 (19.8%)
|
111 (100%)
|
Joint
|
15 (68.2%)
|
2 (9.1%)
|
5 (22.7%)
|
22 (100%)
|
19 (73.1%)
|
2 (7.7%)
|
5 (19.2%)
|
26 (100%)
|
3- Gen
|
39 (66.1%)
|
2 (3.4%)
|
18 (30.5%)
|
59 (100%)
|
37 (86.0%)
|
1 (78.8%)
|
5 (11.6%)
|
43 (100%)
|
Total
|
132 (73.3%)
|
4 (2.2%
|
44 (24.4%)
|
180 (100%)
|
137 (76.1%)
|
11 (6.1%)
|
322 (17.8%)
|
180 (100%)
|
Chi-square & p-value
|
9.471 & 0.050*
|
3.272 & 0.513
|
Education of father
|
|
|
|
|
|
|
|
|
Illiterate
|
11 (84.6%)
|
0 (0.0)
|
2 (15.4%)
|
13 (100%)
|
7 (77.8%)
|
0 (0.0)
|
2 (22.2%)
|
9 (100%)
|
Primary
|
4 (50.0%)
|
2 (25.0%)
|
2 (25.0%)
|
8 (100%)
|
7 (70.0%)
|
1 (10.0%)
|
2 (20.0%)
|
10 (100%)
|
Middle
|
35 (76.1%)
|
0 (0.0)
|
11(23.9%)
|
46 (100%)
|
20 (66.7%)
|
5 (16.7%)
|
5 (16.7%)
|
30 (100%)
|
High
|
59(73.8%)
|
1(1.3%)
|
20(25.0%)
|
80 (100%)
|
41 (74.5%)
|
1 (1.8%)
|
13 (23.6%)
|
55 (100%)
|
Pre-university
|
17 (77.3%)
|
0(0.0)
|
5(22.7%)
|
22(100%)
|
32(80.0%)
|
2(5.0%)
|
6(15.0%)
|
40(100%)
|
≥Graduate
|
2(33.3%)
|
1(16.7%)
|
3(50%)
|
6(100%)
|
16(84.2%)
|
0(0.0)
|
3(15.8%)
|
19(100%)
|
NA
|
4(80.0%)
|
0(0.0)
|
1(20.0%)
|
5(100%)
|
14(82.4%)
|
2(11.8%)
|
1(5.9%)
|
17(100%)
|
Total
|
132(73.3%)
|
4(2.2%)
|
44(24.4%)
|
180(100%)
|
137(76.1%)
|
11(6.1%)
|
32(17.8%)
|
180(100%)
|
Chi-square & p-value
|
30.940 & 0.002*
|
13.588 & 0.328
|
Education of mother
|
|
|
|
|
|
|
|
|
Illiterate
|
10(76.9%)
|
1(7.7%)
|
2(15.4%)
|
13(100%)
|
5(62.5%)
|
0(0.0)
|
3(37.5%)
|
8(100%)
|
Primary
|
1(50.0%)
|
0(0.0)
|
1(50.0%)
|
2 (100%)
|
6(85.7%)
|
1(14.3%)
|
0(0.0)
|
7(100%)
|
Middle
|
41(80.4%)
|
2(3.9%)
|
8(15.7%)
|
51(100%)
|
39(70.9%)
|
4(7.3%)
|
12 (21.8%)
|
55(100%
|
High
|
69(72.6%)
|
0(0.0)
|
26(27.4%)
|
95(100%)
|
52(76.5%)
|
5(7.4%)
|
11(16.2%)
|
68(100%)
|
Pre-university
|
11(57.9%)
|
1(5.3%)
|
7 (36.8%)
|
19 (100%)
|
24(92.3%)
|
0(0.0)
|
2(7.7%)
|
26(100%)
|
≥Graduate
|
0(0.0)
|
0(0.0)
|
0(0.0)
|
0(0.0)
|
9(69.2%)
|
1(7.7%)
|
3(23.1%)
|
13(100%)
|
NA
|
0(0.0)
|
0(0.0)
|
0(0.0)
|
0(0.0)
|
2(66.7%)
|
0(0.0)
|
1(33.3%)
|
3(100%)
|
Total
|
132 (73.3%)
|
4(2.2%)
|
44 (24.4%)
|
180(100%)
|
137(76.1%)
|
11(6.1%)
|
32 (17.8%)
|
180(100%)
|
Chi-square & p-value
|
10.599 & 0.225
|
10.560 & 0.567
|
A pre-designed semi-structured questionnaire was used to collect information regarding socio-demographic profile. Data was collected by using direct interview method. Detailed clinical examination including head to toe examination, anthropometry and systemic examination was done. Ethical clearance was obtained from institutional ethical committee of BIMS, Belagavi.
Inclusion criteria
Students of both sexes between 10-19 years age group
Willing to participate in the study
Exclusion criteria
Students who did not give informed written consent
Body weight of the study participants was measured to nearest 0.1 kilogram with portable machine with scale adjusted to zero before each session.Height was measuredwithout footwear using a stadiometerto nearest 0.5 centimetre. Hip and waist circumference was measured using non-stretchable tape to the nearest 0.1cm. Body Mass Index (BMI) classification is made according to IAP guidelines.
Statistical Analysis
Data entry was done in MS Excel and it was analysed using SPSS and MS Excel. Categorical variable was appropriately coded for data entry. Numerical data like age, weight, height, waist and hip circumference were entered as such. Statistical measures used were mean, median, standard deviation, percentage. Z-statistic, t-test, Mann Whitney U test and chi square test were applied as test of significance. The statistical significance was evaluated at 95% confidence level (p<0.05). Result was represented in tables.
Results
360 adolescents participated in the study i.e., 180 from rural and urban area respectively. Maximum participants 207(57.50%) were in middle adolescence phase (75.0%from rural and 40.0% from urban).55.0% from rural and 61.67% urban area belonged to nuclear family. As per modified B.G Prasad classification (January 2020) scale, majority of adolescents in rural area (58.33%) belonged to class IV compared to urban 39.44%. [Table 2 ]
Discussion
In Premkumar S et al. study in the rural area, the prevalence of overweight/obesity was 16.2% and 24%in the urban school going adolescents which was higher compared to our study.2 In our study, skin appeared dry and scaly in 23.33% rural compared to 7.22% urban which was significant (p-value <0.01) and was higher compared to Karak P et al. study (17% rural and 3% in urban).5 Prevalence underweight(74.72%) was higher in our study compared to Rahman F et al. in Kanpur (52.09%). Nearly 73.33% of rural and 76.11% urban adolescents were underweight whereas in Rahman F et al. 45.51% and 50.8% were undernourished in urban and rural areas respectively.8, 12 In Rajaretnam T et al. study in Karnataka weight among boys was 42.3±8.7 in rural 46.0±10.4 among urban whereas in girls 39.8±6.1 in rural and 42.3±7.7 in urban which was higher compared to our study.13 Eyes were pale in 25.4% and 11.8% had flat nails in Shivaprakash and Joseph study in urban area which was higher compared to our study where 19.44% of urban adolescent eyes were pale and 1.67% had flat nails.11, 10
Underweight finding inour study was similar to Deshmukh PR et al. (75.3%), less compared to Srinivasan K et al. (78.4%), whereas higher than Rao V G et (61.7%) and Pal A et al. (48.78%).14, 9, 15, 6
Conclusion
Prevalence of malnutrition (underweight, overweight and obesity) was more in urban area (76.11%) compared to rural area (73.33%) based on IAP-BMI criteria. Underweight was prevalent maximum in middle adolescence phase (77.27%) in rural and urban early adolescence phase (65.69%). Overweight (66.67%) was more in early adolescence phase in rural and compared to urban in middle adolescence phase (55.56%).
Recommendations
Adolescents must be educated at school level about the importance of regular intake of healthy nutritious food and harmful effects of non-nutritious food. Awareness campaigns in school highlighting nutritional status as a major risk factor that causes both physical and mental growth retardation.
Limitations
The present study included only government schools. The results whatever obtained cannot be generalized to entire adolescent population of Khasbag and Uchagaon.
Conflict of Interest
None.
Acknowledgements
Authors gratefully acknowledge the participants, coordinators and Dr R. G. Viveki, Head of the department of Community Medicine, BIMS, Belagavi for assistance and support.
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