Healthy School Going Research Articles

Impact of Customized oral health education module among Visual, Hearing impaired and Normal healthy children in Central India: A Longitudinal study.

Objective: To evaluate and compare the oral hygiene status of visual impaired, hearing impaired and normal healthy school going children in the age group of 5-18 years and to assess the impact of customized oral health education module on their oral hygiene status.

Spirometric Values of Healthy School Children in Three Rural Schools of Bangladesh

Background: The prevalence of asthma in Bangladesh is about 7%. The spirometric values in healthy children were obtained in a single urban school more than a decade ago. No rural data is available till date. The objective of this study is to determine the spirometric values of healthy school going children in three rural schools of Bangladesh. Materials and Methods: This cross-sectional study was carried out from July 2019 to June 2020 among 300 healthy children among both boys and girls aged 11 to 15 years in three rural schools. Among 350 approached students 332 students responded to the study, 18 students did not meet inclusion criteria and 14 students could not follow spirometry procedure. Informed written consent was taken from guardians. History regarding socio-demographic profile, passive smoking, concurrent or past respiratory illness and medication were taken and weight, height and BMI were measured of the children. Spirometry was done with spirometer and reports were generated by software installed in a laptop. Results: Boys showed higher FVC, FEV1 and PEFR but lower FEV1/FVC ratio than those of girls. Regression equations for lung function values were determined for boys and girls considering height as independent variable. Conclusions: Spirometric indices were higher in boys than those of girls and they tended to increase with height, except FEV1/FVC ratio that was higher in girls with a negative correlation with height. BANGLADESH J CHILD HEALTH 2023; VOL 47 (1) : 17-23

Problems Associated with Persisting Primitive Reflex in Healthy School-going Children

Introduction: Primitive reflexes, originating in the brainstem, develop in utero and vanish within six months post-birth, aiding infant motor milestones. Integration relies on cortical maturation inhibiting them via basal ganglia pathways. Persistence may indicate neurological issues lead to motor, balance, and learning difficulties. Aim: This scoping review explored the persistence of primitive reflexes and determined the problems associated with their persistence in healthy school-going children. Materials and Methods: A total of 3988 full-text published articles were identified from PubMed, Ovid-SP and Physiotherapy Evidence Database (PEDro) from 2004-2024 year. Only full text prevalence/ incidence and observational studies on children between 4-12 years are included. After duplicate deletion 3614 articles were left at abstract level, finally 63 full text articles related to research topic were further analysed and only nine articles were included in review for analysis. Results: Within group analysis for both experimental groups were found to be statistically significant for Rectus femoris and Vastus Lateralis muscles whereas between group analysis revealed general power training group to offer statistically significant improvement with p-value <0.05. Conclusion: Majority of articles show that persistence of ATNR (Asymmetrical Tonic Neck Reflex) reflex shows neurological impairments like attention and reading difficulties while persistence of spinal galant may lead to scoliosis. In articles assessing the persistence of all primitive reflexes like ATNR/STNR (Symmetrical Tonic Neck Reflex)/TLR (Tonic Labyrinthine Reflex) may cause gait impairments and development delay. Boys exhibit higher reflex activity and attention deficits, correlating with diminished reading proficiency, emphasising the link between neuromotor maturity and academic achievement. The prevalence of primary reflexes like ATNR and TLR in preschoolers, impact attention, neuromotor development and gait. Early detection of persisting primitive reflex, and managing them with reflex integration therapy in children can help mitigate neurological development delay

The consequence of deconditioning on the levels of physical fitness in healthy school going children

The consequence of deconditioning on the levels of physical fitness in healthy school going children

A cross-sectional study to validate neck circumference, waist circumference, wrist circumference and mid upper arm circumference as a screening tool for overweight in adolescents at school of Ahmedabad city

Obesity is a major health problem in children & adults. Due to physiological changes during growing up in children and adolescents, it is difficult to develop one simple index for measurement of overweight & obesity. So, this study was carried out to identify simple methods like neck, waist, wrist, and mid upper arm circumference used as screening tools for overweight & obesity.: To correlate neck, waist, wrist & mid upper arm circumference with BMI for prediction of overweight. This was a cross-sectional study done on healthy urban school going children in the age group of 9 -17 years old. After measuring height and weight, BMI (body mass index) was calculated and nutritional status was classified. BMI was compared to neck, waist, wrist & mid upper arm circumferences to find out correlation. Cut off values of all four parameters to predict overweight & obesity were obtained by analysing the ROC (receiver operating characteristics) curve.: Total 907 students of age group 9 to 17 years old were screened. Correlation of Neck circumference (NC), Waist circumference (WC), Wrist Circumference (WrC) and Mid Upper Arm Circumference (MUAC) with BMI by Pearson’s correlation coefficient were correlated positively. The bland Altman plots showed higher concentration of points at the 95% limit of agreement (±1.96 SD) and that the mean difference in Z-score of two tests was equal or close to zero. AUROC for NC was 0.81, for WC 0.9, for WrC 0.811 and for MUAC 0.893.Neck circumference, Waist circumference, Wrist circumference and Mid upper arm circumference can be used as a screening test for predicting overweight or obesity in adolescents.

Predictive regression equation and nomogram of peak expiratory flow rate in healthy school going children of Kolhapur, Maharashtra, India

The Journal is the primary organ of Continuing Paediatric Medical Education in Sri Lanka. The journal also has a website. Free full text access is available for all readers.The Sri Lanka Journal of Child Health is now indexed in SciVerse Scopus (Source Record ID 19900193609), Index Medicus for South-East Asia Region (IMSEAR), CABI (Centre for Agriculture and Bioscience International Global Health Database), DOAJ and is available in Google, as well as Google Scholar.The policies of the journal are modelled on the Committee on Publication Ethics (COPE) Guidelines on Principles of Transparency and Best Practice in Scholarly Publishing. Sri Lanka Journal of Child Health is recognised by the International Committee of Medical Journal Editors (ICMJE) as a publication following the ICMJE Recommendations.

Prevalence of Obesity and Hypertension among Rural School Adolescents: A School Based Pilot Study in Kerala, India

Aim: The prevalence of hypertension and obesity is increasing worldwide. Recent data on sustained hypertension and obesity among school-going children and adolescents from the state of Kerala, India are limited. The aim of the present study was to estimate the prevalence of obesity and hypertension among apparently healthy school going adolescents.
 Methodology: A cross-sectional survey was conducted among 252 school going adolescents aged 11-16 years (173 boys and 79 girls) selected from two private aided rural schools of Thrissur, District, Kerala, India. Measurements like height, weight, and blood pressure were done using standard guidelines. Guidelines of Indian Academy of Pediatrics and standard guidelines of blood pressure measurement using gender height specific blood pressure percentile charts were used to identify the overweight/obese and pre-hypertensive/ hypertensive adolescents respectively. Analysis was done using SPSS version 27.0. Gender wise differences were checked using chi-square and t-test.
 Results: Among 252 adolescents, 83 (20.7%) were either overweight or obese and pre-hypertensive or hypertensive. The overall prevalence of obesity and overweight was found to be 9.5% and 15.1% respectively. The overall prevalence of hypertension and prehypertension was found to be 15 (6.0%) and 24 (9.5%) respectively. Systolic blood pressure and diastolic blood pressure was found to be statistically lower (P<0.001) among those with normal BMI, than those with overweight or obesity. The mean systolic and diastolic BP was slightly more among boys than girls and it was not statistically significant.
 Conclusion: The high prevalence of hypertension, obesity and the strong association between obesity and high blood pressure seen among school-going adolescents necessitates immediate attention. Strategies should be designed and implemented for prevention, early identification, and treatment of pediatric obesity and hypertension in forestalling the morbidity/mortality from non communicable diseases and its complications.

Association of Heavy School Bags with Musculoskeletal Discomfort among Primary School Children of Islamabad, Pakistan

Background: Musculoskeletal disorders, an increasing concern among school going children, primarily affect muscles and tendons. They lead to secondary damage to nerves and joints in the neck, upper back, shoulders, arms, and hands, etc. The objective of this study was to determine the association of carrying heavy school bags with musculoskeletal discomfort among primary school children in government schools of Islamabad, Pakistan.
 Material and Methods: This cross-sectional survey was conducted in different government schools of Islamabad, Pakistan from June 2018 to November 2018. After an informed consent from parents, 377 healthy school going children aged 6-14 years were included in this study. Data was collected through Backpack Questionnaire. Chi square test was used to compare the frequency of musculoskeletal discomfort with demographic characteristics and backpack-related features. P-value less than .05 was considered statistically significant.
 Results: Mean age of the school children was 9.49 ± 1.53 years with 179 (46.9%) male and 203 (53.1%) female students. Majority of students (89.8%) were found with school bags more than 15% of their body weight. Shoulder pain was the most commonly reported complaint (67.3%). There was a significant association between pain and perceived backpack weight (P=.001), and between pain and self-perceived posture (P=.001). Leaning forward (66.2%) was the most commonly adopted posture followed by leaning sideways (15.4%) and stooping (2.9%), respectively. The association between pain and duration of carrying backpack from home to school was insignificant (P=.055) in contrast to pain and duration of carrying bag from school to home (P=.007), respectively.
 Conclusions: Musculoskeletal discomfort was found commonly among primary school children with shoulder pain being the most frequent, as maximum students were carrying heavy school bags.

Peak expiratory flow rate in normal school children (5-15 Years) of Vizianagaram district- A cross-sectional study

Introduction: PEFR is a simple bedside tool to assess the degree of airway obstruction in asthmatic children. As it is influenced by age, anthropometric data, racial and ethnic differences, region specific nomograms have been advocated for use. This study has been undertaken with a view to establish reference values for PEFR and develop nomograms in Vizianagaram district. Material and Methods: The present study was undertaken at MIMS medical college, Vizianagaram. The main aim of this school based, cross-sectional, descriptive study was to establish standard nomograms of PEFR for healthy school going children between 5-15 years age group. A total of 2684 students were included in the study after meeting the inclusion criteria. PEFR values were recorded with mini-Wright peak flow meter. Body surface area and body mass index were calculated from height and weight. Statistical analysis was carried out using R version 3.4.2. Results:PEFR showed high positive correlation with respect to Height, Weight, Age, Body Surface area and moderate positive correlation with BMI. Separate regression models were developed for boys and girls. Conclusions:PEFR had positive correlation with height, age, weight, BMI and BSA.PEFR values of children in Vizianagaram district were lesser than those of other south Indian, north Indian and western children. Keywords: PEFR, mini-Wright peak flow meter, linear regression equations, asthma morbidity, nomograms

Comparison of plasma adipocytokines & C-reactive protein levels in healthy schoolgoing adolescents from private & government-funded schools of Delhi, India.

Background & objectives:Obesity-mediated chronic inflammatory state is primarily governed by lifestyle and food habits in adolescents and marked by alterations in the level of various inflammatory markers. This cross-sectional study was aimed to compare the inflammatory status of healthy Indian adolescents vis-à-vis their obesity profile. The inflammatory state of urban adolescents attending private and government-funded schools, and the relationship between inflammatory marker levels and anthropometric indices in the study participants from both groups were examined.Methods:A total of 4438 study participants (10-17 yr) were chosen from various schools of Delhi, India, and their anthropometric parameters were measured. Plasma adipocytokines (adiponectin, leptin and resistin) of the study participants were measured by enzyme-linked immunosorbent assay, and plasma C-reactive protein (CRP) levels were assayed by a biochemical analyzer. Metabolic syndrome-related risk factors such as waist circumference, hip circumference (HC), fasting glucose, fasting insulin, Homeostatic Model Assessment of Insulin Resistance, total cholesterol, high-density lipoprotein-cholesterol, low-density lipoprotein-cholesterol and triglycerides of normal-weight adolescents were also evaluated.Results:The level of leptin and CRP increased with increasing adiposity, whereas adiponectin levels were found to be negatively related to obesity. All plasma cytokine levels (adiponectin, leptin and resistin) were significantly elevated in female than male adolescents. Age-based classification revealed a distinct trend of variability in the levels of all the inflammatory markers among adolescents of varying age groups. Significant differences were observed between private and government schoolgoing adolescents in terms of anthropometric and inflammatory parameters, with higher adiposity indices in the former group. The relationship of plasma adipokine and CRP levels with various adiposity indices was found to be distinctly different between private and government schoolgoing students.Interpretation & conclusions:Inflammatory markers were significantly elevated in overweight/obese adolescents. The socio-economic condition of urban Indian schoolgoing adolescents reflecting lifestyle transition has profound effects on their adiposity indices and inflammatory states. Longitudinal studies in different regions of the country need to be done to further confirm the findings.

Streptococcus anginosus Throat colonization in Healthy School going children

Background: Streptococcus anginosus was most commonly considered as commensals and closely related to Streptococcus pyogenes. Recovery of this bacteria from the throats has been reported to exceed that of S. pyogenes in regions where streptococcal disease is endemic. Infection with these bacteria may cause acute rheumatic fever (ARF) and its sequelae rheumatic heart disease (RHD) in susceptible individual. Molecular mimicry and autoimmunity probably play a crucial role in the pathogenesis. M protein in streptococci shares structural similarities with cardiac proteins such as myosin and the antibodies produced in patient cross-react with both M protein and heart tissue leading to RHD that causes significant morbidity and mortality in developing countries. The incidence of ARF peaks between 5-15years of age and high burden of RHD is seen in Asia. Strptococcus anginosus being the most common beta hemolytic group C streptococcus isolated from the human throat. The present study provides epidemiological clues of this bacteria which is necessary in developing preventive measures. Objective: To study the prevalence of Streptococcus anginosus in throat among healthy school children. Method: Throat swabs were collected after taking consent from 3, 416 children. The organism were isolated in sheep blood agar and beta hemolytic organisms were identified as Streptococcus anginosus by Vitek 2 compact, an automated system. Result: Out of 3416 throat samples only six samples had beta hemolytic Streptococcus anginosus. Conclusion: The present study showed the presence of beta hemolytic Streptococcus anginosus. Further study regarding M genes are required for knocking the virulence factors by developing suitable vaccines.

EPIDEMIOLOGY, ECOLOGY AND PREVALENCE OF SOIL TRANSMITTED HELMINTHS FROM KOSHI REGION OF NORTH BIHAR.

Prevalence of soil transmitted helminthes infections in apparently healthy school going children and other 528 people of different districts of Koshi regions of North Bihar were evaluated. Over all incidences of STHs infection was 39.39% during study. High incidence of STH was seen in the rainy season i.e., in the month of July and August, September, significantly higher (P<0.05) .The incidence of Ascaris lumbricoides was highest in the month of August (18.64%). The month of September was 15.25% followed by that of July (14.4%) and October with 10.16%. Also the incidence of hookworm registered the highest incidence in the month of June (19.27%) and lowest in the month of December (4.82%) during the study period. However prevalence of Trichuris trichiura was negligible and it was almost nil in the most of the months but was highest in month of September with 28.57% and lowest in October with 14.00% The climatic factors are responsible for soil transmitted helminthes which are temperature, rainfall and relative humidity. Ascariasis, Trichuriasis and Ancyclostomiasis (Hookworm infection) are found to be endemic in this region.

A pediatric echocardiographic Z-score nomogram for a developing country: Indian pediatric echocardiography study - The Z-score.

Background: Almost all presently available pediatric echocardiography Z-score nomograms are based on Western data. They may not be a suitable reference standard for assessing the sizes of cardiac structures of children from developing countries. Objective: This study's objective was to collect normative data of 21 commonly measured cardiovascular structures using M-mode and two-dimensional echocardiography in Indian children aged between 4 and 15 years and to derive Z-score nomograms for each. Subjects and Methods: The study was conducted at two centers in India . Ajmer, Rajasthan, and Mohali, Punjab. We studied a community-based sample involving healthy school going children. After excluding children with cardiovascular abnormalities on the screening echocardiogram, 746 children were included in the final analysis. Echocardiographic assessment was performed using a Philips iE33 system. Results and Analysis: For each parameter measured, seven models were evaluated to assess the relationship of that parameter with the body surface area and the one with the best fit was used to plot the Z-score chart for that parameter. Z score charts were thus derived. Conclusions: The Z-score nomograms derived by this study may be better alternatives to the Western nomograms for use in India and other developing countries for preprocedural decision making in the pediatric population. However, they will require validation in large-scale studies before they can become clinically applicable.

Measurement of peak expiratory flow rate values in healthy school going children between 6 and 12 years attending urban schools in Chennai

Background: Peak expiratory flow rate (PEFR) is an important tool in monitoring patient’s changes in asthma. Bronchial asthma is among the commonest disorders in childhood. Here authors planned to measure PEFR in healthy school going children between 6 and 12 years and correlate PEFR against various parameters such as height, weight, sex, age and chest circumference.Methods: The study was conducted from February 2005-August 2006 among healthy children between 6 and 12 years of age attending urban schools of both sexes in Chennai. The schools were selected randomly. Results: PEFR values were measured in a large number of children between 6 and 12 years and varied significantly between boys and girls in the age group 6 to 12 years. Among all the study variables, height had shown the maximum positive correlation to PEFR in both boys and girls. The co-efficient of regression derived for height was found to be highly statistically significant both in boys and girls.Conclusions: Significant correlations were found between PEFR and biological variables like age, weight, height and chest circumference. The correlation is more robust with regard to height. Boys have more PEFR values than girls across all age groups.

Correlates of peak expiratory flow rate and deriving the prediction equation in school going children of Lucknow

Background: Peak expiratory flow rate (PEFR) is an essential measure in the monitoring and evaluation of airway obstruction in asthmatic children. Studies on PEFR in children are limited. The objectives of the study were to evaluate PEFR in healthy school going children and its correlation with age, weight, height and Body Surface Area and to derive their prediction equations.Methods: We conducted a cross-sectional study in 1200 healthy school children age group of 5-15 years after approval from the institutional Ethical committee. All the analysis was carried out by using SPSS version 16.0. Pearson correlation coefficient was calculated to find the correlation between PEFR and anthropometric parameters among boys and girls. Results: PEFR was higher in boys than girls among all age groups except for 5 years of age. PEFR prediction equations were obtained both for boys and girls using multiple regression equations. For boys: 4.21* age in years2+0.68* height in cms – 2.48* weight in kg +322.85* BSA3 – 137.88 and for girls: 10.64* age in years1 +0.25* height in cms +0.09* weight in kg + 99.44* BSA -22.41 (1p=0.0001, 2p=0.001, 3p=0.007). Conclusions: We developed PEFR prediction equations in children using weight, height, and body surface area. This would be helpful in evaluation of children with airway diseases.

A Study of Correlation of Peak Expiratory Flow Rate with Body Mass Index in Healthy School Going Children

A Study of Correlation of Peak Expiratory Flow Rate with Body Mass Index in Healthy School Going Children

Prevalence of impaired glucose tolerance test and diabetes in overweight, obese and apparently healthy school going adolescents

Background: Adolescence is a period of transition from childhood to adulthood. It occupies a crucial position in the life of human beings characterized by an exceptionally rapid rate of growth in physical, mental, sexual, and psychological behavior etc. The present study was planned to study the prevalence of impaired glucose tolerance amongst overweight, obese and apparently healthy school going adolescents in the city of Jaipur, Rajasthan.Methods: The study has been conducted in the Department of Pediatrics of Mahatma Gandhi Medical College of Mahatma Gandhi University of Medical Sciences and Technology, Jaipur. The study was a cross sectional analytical study conducted in schools of Jaipur. This study was done from August 2011 to November 2011 and 180 patients of aged between 10 to 18 years of age were enrolled.Results: In this study, it was found that the prevalence of overweight to be 32.65 percent in males and 34.15 percent in females. It was seen that 33.67 percent males and 32.93 percent females belonged to the obese category. Out of 180 adolescents, 25 (13.89 percent) were found to have IGT and only 1 was found to have type 2 diabetes (0.5 percent). Out of 25 students with IGT, 15 were boys and 10 were girls. Among these 25 students with IGT, 9 were overweight and 16 were obese. 15 percent of overweight student and approximately 26 percent of obese students had IGT. The association of IGT and increased BMI was found to be highly significant.Conclusions: The present study highlights the fact that type 2 diabetes in children occurs in developing counties and there is an increase need to look for type 2 diabetes in overweight and obese children and adolescents in India. Therefore, it is recommended that all obese and overweight adolescents should be screened at least yearly for type 2 diabetes mellitus using OGTT so that timely intervention can be done.

Anti streptolysin O (ASO) titers in normal healthy children aged between 5 to 15 years in Ujjain region

Introduction: Rheumatic fever is an inflammatory disease that may develop after an infection with Streptococcus pyogenes bacteria, believed to be caused by antibody cross reactivity that can involve heart, joints, skin and brain. Measurement of Anti Streptolysin O (ASO) antibodies to specific streptococcal antigens is therefore necessary for the diagnosis of the preceding Group A Streptococcal (GAS) infection. Aims and objectives: To determine the upper limit of the normal ASO titers in normal healthy school going children aged 5-15 years and to determined a baseline value to compare with when a single ASO titer is available. Material and method: A community based cross sectional study was done on normal healthy children aged 5-15 years divided into group 1 (5-10 years) and group 2 (11-15 years) after taking informed consent from parents. Blood sample were collected after thorough sterilization of the area. ASO testing from serum sample was done using TURBILYTE Antistreptolysin ‘O’ diagnostic reagent for quantitative in-vitro determination of ASO in serum on photometric systems. Results: Out of total 200 children included in the study, 100 were in group 1 and 100 in group 2, 118 (59%) were males and 82 (41%) were females. The mean ASO titer for group 1 was 105.69 IU and that of group 2 was 144.73 IU with a standard deviation of 3.675 and 5.823 respectively (P value <0.05). Out of total 200 students 160 were living in overcrowded conditions. The mean ASO titer of children with overcrowded living conditions was 131.41 IU with a standard deviation of 53.472, and those with non-overcrowded living condition was 100.42 IU with a standard deviation of 39.30 (P value < 0.05). Conclusion: The upper limit of normal (ULN) was greater in the children of Group 1 (P value <0.05, 200 Vs 135). No statistically significant difference was found in the ASO titer according to gender. Statistically significant high mean ASO titer (131.41 IU) was found in children living in overcrowded conditions as compared to those living under non-overcrowded conditions (100.41 IU).

Prevalence of Hypertension and its Risk Factors Among School Going Adolescents of Patna, India.

Hypertension (HT) has its origin in childhood and adolescent period but it goes undetected due to absence of sign and symptoms, unless specifically looked for during this period. It has been seen that one with raised blood pressure level in this period will also have raised Blood Pressure (BP) level in their adulthood and elderly period. The present study was conducted to estimate the prevalence of HT and its risk factor among apparently healthy school going adolescents of Patna district. A cross-sectional study among 2913 school going adolescents of eighth to 10th standard was conducted from April 2014 to August 2015 by adopting a two stage cluster sampling technique. The questions pertaining to risk behavior in relation to cardiovascular diseases from WHO's Global School based Student Health Survey were used for this study. The mean systolic and diastolic blood pressure of study population was 107.4 mm of Hg (95% C.I. 106.93-107.77) and 67.4 mm of Hg (95% C.I. 67.26-67.54), respectively. Prevalence of pre-HT and HT was 10.9% and 4.6% in school going adolescents while prevalence of overweight/obesity was 1.5%. Both systolic and diastolic blood pressures had positive and significant correlation with age, height and body mass index. The proportion of children who had ever taken tobacco was 5.3%, cigarette smoking 4.3%, alcohol consumption 2.1%, and excess salt intake 22.3%. Only 49.1% children were doing physical activity at least one hour a day in past seven days for maintenance of good health. The present study recommends that regular screening of blood pressure level must be initiated in adolescents so that remedial measure can be initiated as early as possible.

A pediatric echocardiographic Z-score nomogram for a developing country: Indian pediatric echocardiography study - The Z-score.

Background:Almost all presently available pediatric echocardiography Z-score nomograms are based on Western data. They may not be a suitable reference standard for assessing the sizes of cardiac structures of children from developing countries.Objective:This study's objective was to collect normative data of 21 commonly measured cardiovascular structures using M-mode and two-dimensional echocardiography in Indian children aged between 4 and 15 years and to derive Z-score nomograms for each.Subjects and Methods:The study was conducted at two centers in India - Ajmer, Rajasthan, and Mohali, Punjab. We studied a community-based sample involving healthy school going children. After excluding children with cardiovascular abnormalities on the screening echocardiogram, 746 children were included in the final analysis. Echocardiographic assessment was performed using a Philips iE33 system.Results and Analysis:For each parameter measured, seven models were evaluated to assess the relationship of that parameter with the body surface area and the one with the best fit was used to plot the Z-score chart for that parameter. Z score charts were thus derived.Conclusions:The Z-score nomograms derived by this study may be better alternatives to the Western nomograms for use in India and other developing countries for preprocedural decision making in the pediatric population. However, they will require validation in large-scale studies before they can become clinically applicable.