Introduction
The word ‘adolescence’ is derived from the Latin verb ‘adolescere’, which means “grow to maturity.” Adolescence is a grey area in the spectrum of life falling between childhood and adulthood. It is an age of transition when an individual experiences rapid growth and development, both physical and psychological and changes from being a child to an adult.
The World Health Organization (WHO) defines adolescents as young people aged 10-19 years. Four out of five adolescents live in developing countries, the vast majority of adolescents (90%) live in low- or middle-income countries. Some 1.2 billion adolescents (10−19 years old) today make up 18 per cent of the world’s Population. More than half of all adolescents live in Asia. In absolute numbers, India is home to more adolescents – around 243 million – than any other country. It is followed by China, with around 200 million adolescents. The adolescent population of either of these countries’ dwarfs that of any other country.1 According to WHO (2002) number of world’s adolescent population, between 10 to 19 years of age, is 1200 million, and out of which 19% faces a series of nutritional challenges. Such nutritional challenges not only affect their growth and development but also their livelihood. Nevertheless, the adolescent population remains largely neglected, as they seem difficult to measure, and hard to reach, in which the need of adolescent girls in particular are often ignored.2 As per UNICEF (2012) the prevalence of underweight among 15-19 years old in some countries is very high. In India 47% of adolescent girls are underweight.1
Dual burden of malnutrition is a cause of concern among adolescents in low- and middle-income countries. Nearly 50 per cent of adolescent girls aged 15–19 in India are underweight, with a body mass index of less than 18.5, and more than one quarter are underweigh in 10 other countries. Such undernutrition renders adolescents vulnerable to disease and early death and has lifelong health consequences. In adolescent mothers, undernutrition is related to slow fetal growth and low birth weight. From the data base of NFHS 3 and NFHS 4, it was highlighted that prevalence of chronic energy deficiency (CED) in 15-49 years of decreased from NFHS 3 to NFHS 4 but still it is 22.9%. It was found to be higher in rural women as compared to urban women.3
RSOC (2013-14) also highlighted the dual burden of malnutrition among adolescent girls. it showed that 44 percent of the adolescent girls aged 10-18 were severely thin and additional 19 percent were moderately thin or under-nourished, so in all 63 percent of the girls were thin or undernourished. A small proportion of the girls were either overweight 2% or obese 1%. Only about one-third 34% of the adolescent girls were neither underweight nor overweight. The percentage of undernutrition was relatively higher among girls from rural areas 64% than those from the urban areas 59%.4, 5 NFHS 5 Gujarat factsheet revealed that in Gujarat also nutritional status of women in reproductive age group is also a care of concern. Twenty five percent women (15-49 years) showed CED and proportion of such women was higher in rural area as compare to urban area.6, 7, 8, 9, 5, 10
According to RSOC (2013-14) Gujarat data, 52.6% of girls in the age range of 15-18 showed chronic energy deficient.4
Materials and Methods
Under Vadodara Mahanagar Seva Sadan there are four zones i.e. East, West, North and South Zones. Out of four zones one zone i.e. East Zone was purposively selected and from that one UHC Sawad was Purposively selected. Under Sawad UHC there are 12 AWCs from that 7 AWCs were randomly selected after obtaining necessary permission from Vadodara Mahanagar Seva Sadan. The study was approved under the Department of Medical Ethics Committee (No. IECHR/2017/18). The Maharaja Sayaji Rao University of Baroda,Vadodara.
School going (195) and out of school (95) unmarried adolescent girls who gave written consent and Assent were enrolled for the study. Data on Socio-Economic background (SES) for enrolled girls families, Weight, Height was collected using pre- tested semi structure questionnaire. Nutritional status was assessed in terms of thinness and stunting using WHO growth standard 2007.
Criteria for identification of anthropometry based nutritional status
Thinness is defined as low BMI for age(5-19Y). Stunting is defined as low height for age.
Table 1
Socio-demographic profile of the adolescent girls.
Table 2
Educational background of adolescent girls.
|
Category |
N=250 |
% |
|
School going |
155 |
62.0 |
|
Out of school |
95 |
38.00 |
Table 3
Prevalence of malnutrition (Z-scores) among school going and out of school adolescent girls (N, %)
Results
Socio economic background of the enrolled unmarried adolescent girls
In all 250 unmarried adolescent girls in the age of 15-19 years were enrolled for the study. General information like age of AGs, education, occupation, religion, income level and type of family was elicited from 250 enrolled girls for the study. Highlights of the socio-economic profile of girls is presented in Table 1.
It was found that mean age of girls was 16.3±1.25 years. Nearly 51 % of the adolescent girls had studied up to secondary level. With regards to occupation of the adolescent girls, 13.2% of the girls were only engaged in earning. 62% of the adolescent girls were attending school. Almost all the subjects were Hindu (99.2%). Seventy percentage of the enrolled girls were from reserved category like SC/ST/OBC. 41.2% enrolled girls belonged to BPL category. Nearly 46% of the families had monthly family income in the range of Rs.6000-10000. Seventy-five percentage of the families were nuclear and average family size of the family was 5.4.
From total 250 adolescent girls, 62% were school-going and 38.0% were out of school. Eighty -seven percentage of the OSG had studied up to Primary/Secondary level.Table 2.
Prevalence of Thinness and Stunting
Prevalence of anthropometry based undernutrition was assessed based on WHO growth std. (2007) using BMI for age and Height for age. Data is presented in Table 3 It was found that 15.2 % and 6.4% of the girls were moderately and severely thin respectively. Moderately stunting was found to be 19.6%. Severe stunting was found in 4% of thegirls. In both indices, prevalence of moderate thinness and stunting was higher in school going girls as compared to out of school going girls.
Conclusion
From the findings, it can be concluded that prevalence of thinness and stunting is acause of concern for urban unmarried adolescent girls (15-19Y). Various government national programmes like RKSK, School health and wellness programm under Ayushman Bharat needs to be familiarised among adolescent girls for improving nutritional status of adolescent girls. Data from Comprehensive National nutrition Survey-CNNS (2016-18) Gujarat data also reports similar results.
Discussion
The findings of present study revealed that there is acause of concern for thinness and stunting among adolescent girls. only 13.2% of girls had normal BMI for their age and 19.2% of girls had normal cutoffs for Height for age. School girls were slightly better as compared to out of school girls. Thirty eight % of girls (15-19Y) are found to be out of school There is a need to counsel these girls for readmission in the schools under Sarve Shiksha Abhiyan.