Abstract
Due to vulnerabilities resulting from disparities in socio-economic status (SES), most nutrition and health interventions are targeted at children in public schools. This study was conducted to investigate the determinants of malnutrition among pupils attending public and private schools in the Hohoe municipality, Ghana. School-based cross-sectional survey, which used a multi-stage random sampling technique to select 633 pupils, aged 3–12 years enrolled in 14 public and seven private schools. Data was collected through face-to-face interviews using semi-structured questionnaire. Type of school attended was used as proxy of SES of the pupils. Weight, height and mid upper-arm circumference were measured and used to generate underweight, stunting, thinness and obesity levels using WHO Antroplus and STATA 12.1. Mutually adjusted simple and multinomial logistic regressions were performed to determine associations between explanatory and dependent variables. Underweight (13 % vs. 2 %, p = <0.0001), stunting (12 % vs. 3 %, p = <0.0001) and thinness (8 % vs. 1.4 %, p < 0.0001) were higher among pupils attending public schools compared to their private schools counterparts. Public school pupils had increased likelihood for underweight (AOR = 7.5; 95 % CI = 2.4–23; p = 0.001) and an increase risk for thinness (RR = 4.7; 95 % CI = 1.5–21.2; p = 0.028) but had decrease risk for overweight (RR = 0.3; 95 % CI = 0.1–1; p = 0.043). Overweight (9 %) was higher among private schools pupils compared to public schools (3 %). Underweight (14 % vs. 6 %), stunting (14 % vs. 4 %) and thinness (8 % vs. 4 %) were higher among pupils in rural schools compared to urban dwellers. Rural schools children were twice likely to become stunted (AOR = 2.6; 95 % CI = 1.0–6.4; p = 0.043). However among pupils attending schools in urban areas, the prevalence of overweight was 7 % compare to 1 % in rural areas. Pupils who consumed only two meals per day were more likely to be underweight (AOR = 6.8; 95 % CI = 1.4–32.2; p = 0.016), stunted (AOR = 7.2; 95 % CI = 1.2–43.7; p = 0.033) and thin (RR = 9.4; 95 % CI = 2.0–47.8; p = 0.007) compared to those who had at least three square meals daily. Both under nutrition and over-nutrition were common among the school pupils but overweight appeared largely driven by high SES and urbanization while under nutrition was associated with low SES and rural residency. Interventions targeting school children should aim at reducing poverty and hunger as these factors remain as underlying causes of malnutrition in childhood.
Highlights
Due to vulnerabilities resulting from disparities in socio-economic status (SES), most nutrition and health interventions are targeted at children in public schools
The results of the study show that 65.9 % of the pupils attend public schools and 34.1 % attend private schools
On the whole the study revealed that both under nutrition and over nutrition are common among pupils in public and private schools but over nutrition appeared to be largely driven by improved socio-economic status and urbanization
Summary
Due to vulnerabilities resulting from disparities in socio-economic status (SES), most nutrition and health interventions are targeted at children in public schools. Malnutrition among children in developing countries is a major public health concern since it places a heavy burden on already disadvantaged communities [1]. Despite the economic growth observed in developing countries, Ghana, malnutrition and more importantly under nutrition is still highly prevalent in some parts of the country [4]. A growing prevalence of obesity and its related chronic diseases is being observed in these countries [5]. Obesity is already a major concern in developed countries for pre-school children [6] as well as schoolchildren [7]
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