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Growth Studies

Physical Growth & Development in North East India : A Public Health Issue Anthropological Survey of India (AnSI) has been conducting research on physical growth and development of India’s children, for a long time. Now, it has been decided to re-orient the 10 th plan national project entitled “Physical Growth of Adolescents” as “Physical Growth and Development of Children in North East India: A Public Health Issue” with a massive sampling strategy has been undertaken. Therefore,. Under this project all the eight states of North East India will be explored. The study will be cross-sectional in nature and the sample size will be 200 individuals (per ethnic group) in each gender and age class following the WHO recommendation. There will be 19 age classes from birth to 18 years of age and thus, total target sample for each community will be 7600 individuals (200x19x2). In the first phase, 22 large communities representing all the eight states of North East India will be studied. Ultimately the aim is to study all the communities of North East India. More than 30 trained anthropologists will be involved in this project. In addition to anthropometrics and clinical measurements, a wide range of data on socio-cultural, demographic, reproductive history and other health aspects will be collected. Objectives of the Project Two fundamental objectives of the present research project are – To investigate the ethnic and the environmental sources of variability in physical growth and nutritional status of children from 0-18 years in North East India. To construct ethnic specific or pooled growth standards for the children of similar age ranges of both genders from this region. Output There is scanty information on growth and health status of various populations of North Eastern region of India. Therefore, there is an urgent need to develop a database of growth and developmental status of various ethnic groups of the North Eastern region of India. Considering this scenario, the present research project is unique in its nature and will provide pioneering findings that will have direct public health implications. Results of this project will enable the government and non-governmental organizations to formulate effective health promotion policies so as to improve the general health and nutritional status of children in the region. Physical Growth & Development of Children in North East India: A Public Health Issue FINDINGS THUS FAR: The national project ‘Physical Growth and Development of Children in North Ease India (0-21yrs): A Public Health Issue’ was initiated to investigate the ethnic and environmental sources of variability in the Physical Growth of the children in the North-East region and to construct ethnic specific or pooled growth references for the children of similar age ranges of both the sexes, to help the concerned authorities in the region. The Angami Naga of Nagaland are largely found in the Kohima district The project was launched with the Southern Angami, subsequently covering the Western Angami and presently the fieldwork is under progress among the Northern Angami. Anthropometric data collected up to September 30, 2007 covering birth to 21yrs age groups is 4950 (2510 male and 2440 female) of which the Western Angami is 1858 (948 male and 910 female) while the Southern Angami is 3092 (1562 male and 1530 female). For the present preliminary analysis, data collected from the Western Angami is utilized. Growth Curves: It is evident from the growth (distance) curves of height for Angami boys and girls (Fig – I) that is up to 8+ yrs; Angami boys are taller than girls except for the age group of 5+ yrs. where girls are taller than boys. Girls exceed the height of boys at 9+yrs and continue with that trend up to 13+ yrs. This is largely due to the earlier onset of adolescence among the girls. The height of girls increases up to 16yrs and there after the curve becomes flat. The height of boys surpassed that of girls at 14+yrs when the girls cease their adolescence and the boys attain the peak velocity of growth and continue up to 19+yrs and there after owing to the cessation of height, the curve gets flattened among the boys as well. In a way similar with height, the boys are heavier than the girls in most of the age groups except in the age groups 12+ to 14+ when girls get heavier than the boys due to earlier adolescence (Fig. 2). Girls continue to gain weight up to 18+yrs and there after the curve becomes flat. Both boys and girls show more or less similar weight in age groups 9+ to 12+yrs. Boys continue to gain weight up to 20+yrs and there after the growth curve gets flattened. Nutritional Status of Pre-School Angami Naga Children, following the Z- score Classification as recommended by the WHO, indicate that the percent distribution of pre-school children according to under nutrition, wasting and stunting has been computed using NCHS reference values. The under weight among the pre-school boys varies from 0 in 2+ yrs & 4+ yrs to 5.41% in below 1yr and over weight varies from 1.96% in 1+ yr to 3.13% in 2+ yr. And total under weight among the pre-school boys is 2.94% (moderate 2.45% + severe 0.49%), while the total over weight is 2.45%. Among pre-school girls, the under weight noted in the age group below one year is 5.72% (moderate 2.86%, + severe 2.86%) and 2+ yrs (4.17%). Severely wasting is absent. It has also been noted that about 13% of pre-school Angami children are stunted, but the frequency of stunting is higher among girls than that of boys. Body Mass Index (BMI) Body mass Index (weight (kg) / height (m) ²) is a good anthropometric index for classifying adiposity in adults and it is recommended for use both among the children and adolescents. BMI is a screening tool used to identify individuals who are underweight or overweight. For children, BMI is gender and age specific. BMI changes substantially as children get older. Recommended BMI percentiles for the age groups 2-18 yrs. (Cole et al, 2000): (< 5th percentile: Underweight; 5th to < 85th percentile: Normal Weight; 85th to < 95th percentile: Risk of Overweight; > 95th percentile: Overweight) Following above table for BMI centiles and WHO BMI values as reference, the nutritional status of Western Angami children reveals that out of 673 school going and adolescent boys, 51 (7.58%) are undernourished, 610 (90.64%) are normal, 7 (1.04 %) are prone to overweight and only 5 (0.74%) are overweight. In case of girls, out of 608 school going and adolescent girls, 60 (9.87%) are underweight, 531 (87.34%) are normal, 14 (2.30%) are prone to overweight while only 3 (0.49%) are overweight. Thus it is clear that among the Angami children, over weight varies inversely with age. It may be opined that the Angami Naga children are by and large well nourished. Present data for height and weight of Angami children compared with the ICMR (1990) data reveals that both height and weight of Angami children is slightly lower than that of ICMR satndards. The pattern of growth curves of Angami children shows more or less similar pattern with the ICMR data, but the reasons for lower height and weight among the Angami Naga children than of ICMR need to be found out. As per BMI percentile classification of WHO, 90.2% and 88.84% of Angami boys and girls respectively are normal. In general, it can be said that the nutritional status of Angami children is more or less similar with that of the Sekmai of Manipur and the Sonowal Kachari of Assam. Present study shows that about 6% of pre-school Angami children are undernourished, 15% are wasted, and 13% are stunted, indicating that the health of pre-school Angami children is much better than that of Nagaland in general, the nutritional status of Angami Naga children is between the affluent Indian children and that of the children of Nagaland. Training of Research Fellows at NIN, Hyderabad A 15 days training programme on the Nutritional Anthropometry (Diet Survey and Clinical signs of vitamin & other deficiencies) for the Research Fellows involved in the Project was arranged at the National Institute of Nutrition, Hyderabad, from 30th March to 13th April, 2008. All senior scientists including Dr. G.N.V.Brahmam, Scientist F & Deputy Director, Nutritional Anthropometry Division delivered lectures on various aspects of clinical signs of vitamin & other deficiencies in the pre-school children, along with practical demonstrations in the nearby schools. Methods of Diet Survey including fieldwork in the surrounding areas and an analysis of diet data were also demonstrated. Training was very much beneficial, with an added new dimension to the on going project. Dr V.R.Rao, DIC could make it to the valedictory session on the last day, when it was resolved that the family diet survey will be included in this on going project and NIN would help the researchers in the analysis of diet Survey data, including the estimation of nutrient values of uncommon food items of North-East India.

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