Nepalese Schoolchildren Research Articles

Different Risk Factors for Erosive Tooth Wear in Rural and Urban Nepal: A National Study.

Background: Erosive tooth wear (ETW) is of growing concern, but data on ETW among Nepalese children are scarce. The main aim of the study was to investigate the prevalence and severity of ETW among Nepalese schoolchildren. We also aimed to analyse the risk indicators for ETW according to location (rural/urban) and the role of obesity in the risk for ETW. Methods: This national study was conducted among 5–15-year-old Nepalese schoolchildren from different regions. Altogether, 1137 out of 1151 schoolchildren participated in both a clinical examination and a survey. ETW was recorded using the Basic Erosive Wear Examination. Results: The prevalence of ETW was 65%. One-fifth of the examined subjects were in need of preventive or restorative treatment. Living in an urban area and studying in a private school were protective factors for ETW, whereas consuming fruits frequently and using charcoal for tooth cleaning increased the odds for ETW. Central obesity was the strongest risk indicator for ETW among urban residents. Conclusions: ETW of low severity is common among Nepalese children and adolescents. Socio-demographic factors influence the prevalence of ETW in Nepal and there seems to be different factors that play a role in the ETW process according to location of residence.

Dietary Patterns Measured by Principal Component Analysis and its Association with Stunting among Nepalese Schoolchildren in Nepal

Background There is a gap of knowledge on the link of major dietary patterns with stunting among schoolchildren in Nepal.
 Objective To identify dietary patterns in rural Nepalese households in two districts and assess their association with stunting among schoolchildren.
 Method This cross-sectional study gathered data from 708 schoolchildren aged 8-16 years participating in the baseline survey in the Districts of Dolakha and Ramechhap, Nepal. We derived major dietary patterns from a principal component analysis of reported intake from a food frequency questionnaire completed through interviews with the caregivers. Statistical analysis was conducted using mixed logistic regression with random intercepts at the level of schools adjusting for socio-demographic and behavioural indicators.
 Result The diet of surveyed schoolchildren was mainly comprised of starchy staples and legumes. Five dietary patterns score were derived: mixed food, vegetables and lentils, milk and beverages, salty snacks, and processed food. The vegetables and lentils pattern scores were negatively associated with stunting (aOR 0.84; 95% CI: 0.66-1.08, p=0.17) after adjusting for regional differences, demographic and behavioural risk factors.
 Conclusion Our results suggest that adherence to dietary patterns high in vegetables and animal protein might be associated with reduced odds of being stunted among schoolchildren. Therefore, the promotion of dietary diversification strategies to improve schoolchildren’s food consumption is required in the study area.

Effectiveness of Systematic Echocardiographic Screening for Rheumatic Heart Disease in Nepalese Schoolchildren

Echocardiographic screening allows for early detection of subclinical stages of rheumatic heart disease among children in endemic regions. To investigate the effectiveness of systematic echocardiographic screening in combination with secondary antibiotic prophylaxis on the prevalence of rheumatic heart disease. This cluster randomized clinical trial included students 9 to 16 years of age attending public and private schools in urban and rural areas of the Sunsari district in Nepal that had been randomly selected on November 17, 2012. Echocardiographic follow-up was performed between January 7, 2016, and January 3, 2019. In the experimental group, children underwent systematic echocardiographic screening followed by secondary antibiotic prophylaxis in case they had echocardiographic evidence of latent rheumatic heart disease. In the control group, children underwent no echocardiographic screening. Prevalence of the composite of definite or borderline rheumatic heart disease according to the World Heart Federation criteria in experimental and control schools as assessed 4 years after intervention. A total of 35 schools were randomized to the experimental group (n = 19) or the control group (n = 16). After a median of 4.3 years (interquartile range [IQR], 4.0-4.5 years), 17 of 19 schools in the experimental group (2648 children; median age at follow-up, 12.1 years; IQR, 10.3-12.5 years; 1308 [49.4%] male) and 15 of 16 schools in the control group (1325 children; median age at follow-up, 10.6 years; IQR, 10.0-12.5 years; 682 [51.5%] male) underwent echocardiographic follow-up. The prevalence of definite or borderline rheumatic heart disease was 10.8 per 1000 children (95% CI, 4.7-24.7) in the control group and 3.8 per 1000 children (95% CI, 1.5-9.8) in the experimental group (odds ratio, 0.34; 95% CI, 0.11-1.07; P = .06). The prevalence in the experimental group at baseline had been 12.9 per 1000 children (95% CI, 9.2-18.1). In the experimental group, the odds ratio of definite or borderline rheumatic heart disease at follow-up vs baseline was 0.29 (95% CI, 0.13-0.65; P = .008). School-based echocardiographic screening in combination with secondary antibiotic prophylaxis in children with evidence of latent rheumatic heart disease may be an effective strategy to reduce the prevalence of definite or borderline rheumatic heart disease in endemic regions. ClinicalTrials.gov Identifier: NCT01550068.

Influence of dental caries on oral health-related quality of life, school absenteeism and school performance among Nepalese schoolchildren.

To evaluate the impact of untreated dental caries and its consequences on oral health-related quality of life (OHRQoL), school absenteeism and school performance in Nepal. This is a population-based, national cross-sectional study. This study was conducted among three WHO index age groups (5-6, 12- and 15-year-olds) of schoolchildren from 18/75 randomly selected districts of Nepal. Clinical findings on untreated dental caries lesions (decay in primary and permanent dentition, dt/DT) and its consequences (pufa/PUFA) were recorded, and the participants were graded into four categories based on the severity of untreated dental caries (GUDC). The Nepali version of Child-Oral Impacts on Daily Performances (C-OIDP) was used to assess the information on OHRQoL. Similarly, school-related information (school absenteeism and school performance) was collected from the school registry. Generalized linear mixed models with random effects were used to evaluate the association between dental caries and OHRQoL, school absenteeism and school performance. Among the study sample, the mean (SD) C-OIDP score was 2.4 (5.0). It was observed that the 15-year-olds, those belonging to the Newari ethnic group, and children with high GUDC grades had poor OHRQoL. After adjusting for confounding factors, high dt+DT or pufa+PUFA was associated with higher impact on OHRQoL. Similarly, lower grades of GUDC (Grade 1 and Grade 2) also had less impact on OHRQoL than the most severe Grade 4. High dt+DT or pufa+PUFA were associated with maximum school absenteeism. Furthermore, high C-OIDP and a grade of GUDC ≥2 score were associated with poor school performance. Untreated dental caries and its consequences have a considerable impact on OHRQoL. These conditions may contribute to high school absenteeism and poor school performance.

Body mass index and dental caries experience in Nepalese schoolchildren.

The aim was to investigate the severity of untreated dental caries among Nepalese schoolchildren and its association with their body mass index (BMI) using IOTF, WHO and Nepalese growth reference systems. This school-based clinical cross-sectional study was conducted with three WHO index age groups (5- to 6-, 12- and 15-year-olds) in 18 out of 75 districts of Nepal, selected using stratified random sampling. A total of 1135 schoolchildren were included in the study. A validated structured questionnaire was used to assess the children's oral hygiene practices and dietary habits. Clinical oral examinations investigated the status of untreated dental caries in primary and permanent teeth (dt/DT) along with its consequences (pufa/PUFA). Later, the grade of severity of untreated dental caries (GUDC) was determined using both dt/DT and pufa/PUFA. Height (cm), weight (kg), waist circumference (cm) and hip circumference (cm) were measured, and the body mass index (BMI), waist-to-hip ratio (WHR) and waist-to-height ratio (WHtR) were calculated. The findings were presented as proportions, and the chi-square test was performed to compare differences between groups. Generalized linear mixed models with random effects assessed the association between the severity of untreated dental caries and the BMI. According to the IOTF, WHO and Nepalese growth reference systems, the overall proportions of children with a low BMI were 38.6%, 15.4% and 12.8%, and those with a high BMI were 7.9%, 4.6% and 8.4%, respectively. Untreated dental caries was common among the youngest age group and those with infrequent tooth brushing habits or frequent consumption of sweet bakery products, sweets or candy, or tea with sugar. Neither a low nor a high BMI was associated either with dt + DT or with pufa + PUFA, after adjusting for confounders. However, both a low and a high BMI (all three references) were associated with the severity of dental caries or GUDC. Regardless of the growth reference system used, children with either low or high BMI may be at risk of developing untreated dental caries lesions and related consequences. Both underweight and overweight/obese and dental caries share common risk factors, mostly dietary. Preventive and intervention approaches/strategies such as behavioural and dietary modifications should be implemented to improve both children's oral health and their nutrition in Nepal.

Nepalese Schoolchildren as Research Participants: Challenges in Qualitative Research

The present research explores the potential methodological challenges in conducting qualitative fieldwork using schoolgirls in Nepal as participants. It particularly focuses on the logistic, academic, and social challenges that impact on the scholarly inquiry into aspects of schooling and the wider society in rural Nepal. The participants in this study were schoolgirls, and school drop-outs girls (12 - 16 years old), from Dalit community in Nepal. Schoolchildren, both in school and school drop-outs particularly girls, are an invaluable source of information on society and schooling. Although school-aged girls have the right to express their views, perceptions, opinions, and competencies, as much as adults do. However, their participation in research activities has been very rare in Nepal. This research applies various methodological tools to carry out this qualitative study in the school setting in Nepal and highlights the challenges associated with these methodologies, particularly the challenges related to confidentiality and interactions when using children as research participants.

Anemia, Iron Deficiency and Iodine Deficiency among Nepalese School Children.

To assess iodine and iron nutritional status among Nepalese school children. A cross-sectional, community based study was conducted in the two districts, Ilam (hilly region) and Udayapur (plain region) of eastern Nepal. A total of 759 school children aged 6-13 y from different schools within the study areas were randomly enrolled. A total of 759 urine samples and 316 blood samples were collected. Blood hemoglobin level, serum iron, total iron binding capacity and urinary iodine concentration was measured. Percentage of transferrin saturation was calculated using serum iron and total iron binding capacity values. The mean level of hemoglobin, serum iron, total iron binding capacity, transferrin saturation and median urinary iodine excretion were 12.29±1.85g/dl, 70.45±34.46μg/dl,386.48±62.48μg/dl, 19.94±12.07% and 274.67μg/L respectively. Anemia, iron deficiency and iodine deficiency (urinary iodine excretion <100μg/L) were present in 34.5%, 43.4% and 12.6% children respectively. Insufficient urinary iodine excretion (urinary iodine excretion <100μg/L) was common in anemic and iron deficient children. Iron deficiency and anemia are common in Nepalese children, whereas, iodine nutrition is more than adequate. Low urinary iodine excretion was common in iron deficiency and anemia.

Urinary Iodine Excretion among Nepalese School Children in Terai Region.

To assess the current iodine status among school children in Terai region of Nepal. A cross sectional study was conducted in 2012 among the school children aged 6-12y in three Terai districts (Siraha, Saptari and Jhapa) of eastern Nepal. A total of 1105 casual urine samples were collected from children of different schools of above districts. Urinary iodine excretion was estimated using ammonium persulphate digestion method. The median urinary iodine excretion in school children was 226.33μg/L (234.16μg/L, 229.25μg/L and 210.67μg/L in Siraha, Saptari and Jhapa districts respectively). About 12.7% (n = 140) children were found to be iodine deficient and 34.2% (n = 378) children had excessive iodine nutrition. There was good improvement in iodine nutrition among children in Terai region, with a large part of population showing excessive iodine nutrition.

Corporal Punishment in Nepalese School Children: Facts, Legalities and Implications

While the Convention on the Rights of the Child (CRC) demands that children be respected as humanbeings with the right to dignity and physical integrity, in Nepal corporal punishment is often considerednecessary to children’s upbringing, to facilitate learning and to instill discipline in the children. Theexistence of this cruel practice towards children is attributed to the weak national policy, unhealthyacademic competition among the schools, poorly trained teachers, superstitious traditional beliefs andhierarchical social structure. Consequently, the children are doomed to suffer this practice resulting innegative physical, mental and social welfare. Besides corporal punishment, sexual abuse in schoolgoing children seems to be frequent but mostly unreported. This is high time we eliminated this violenceagainst children in schools and it calls for holistic approach. For this, it is necessary to pursue a set codeof conduct and raise awareness among the teachers for the child rights in order to stop undignified,inhuman and undisciplined tradition. The awareness and capacity of the health professionals to deal withcomplexities of the child abuse also needs to be promoted. Furthermore, the need of improvements inthe national laws and their proper implementation is a longstanding challenge for the governmental andnongovernmental organizations.Key words: child abuse; child rights; corporal punishment; psychologicalDOI: 10.3126/jnps.v30i2.2929J. Nepal Paediatr. Soc. May-August, 2010 Vol 30(2) 98-109

Salivary cortisol and heart rate in stunted and nonstunted Nepalese school children.

To test the hypothesis that stunted Nepalese children have an altered stress response system when compared with matched nonstunted children in response to a battery of psychological tests. Case-control study. Poor urban areas of Kathmandu, Nepal. A total of 64 stunted (less than -2 s.d. height-for-age) children compared with 64 nonstunted (> -1s.d. height-for-age) schoolchildren between 8 and 10 y old matched for school and sex. A psychological test session was administered, which included mental arithmetic and two tests of working memory. Salivary cortisol samples were obtained at five points during testing, and heart rate was measured during testing and also at baseline. Salivary cortisol samples were also obtained once early in the morning. Hemoglobin was assessed at the testing session, and extensive data were obtained on the social background of the children's families. Stunted Nepalese children showed a blunted physiologic response (salivary cortisol and heart rate) to psychological stressors (P<0.05) when compared with nonstunted children, but were not different from the nonstunted children in baseline measures, when controlling for social background. The two groups were not different in terms of social background. These findings suggest that childhood growth retardation may be associated with changes in physiological arousal, and that stunting could be associated with hyporesponsivity in response to psychological stress.

PREVALENCE OF STREPTOCOCCAL PHARYNGITIS AMONG SCHOOL CHILDREN OF POKHARA VALLEY, NEPAL

Group A Beta Haemolytic Streptococcal (GABHS) infections and their sequelaeRheumatic fever (RF) and Glomerulonephritis (GN) have a world wide distributionand pose an important health problem. Present study intended to find out the prevalenceofGABHS pharyngitis among school children in the Pokhara Valley, Nepal. It was across sectional, observational study. During 7 months period total 750 children wereexamined from six government primary schools. 25.3% were found to have symptomsof clinical pharyngitis and the prevalence of GABHS pharyngitis was 7.2% amongthese school children. GABHS pharyngitis found more among male and in the agegroup of 3-10 years. This study was undertaken to highlight the problems of GABHSthroat infections in Nepalese school children and also to stress on the urgent need forcontrol programme for streptococcal disease complex.Key Words: Prevalence, Streptococcal pharyngitis, School children.

SIGNIFICANT OTHERS OF RURAL AND URBAN NEPALESE CHILDREN

The significant others of 641 Nepalese secondary school children are reported according to gender and school grade level and location (rural or urban). Unlike findings from other cultures ‘father’ was of similar salience to ‘mother’, and ‘teacher’ was of importance to about half the sample. These trends were stronger in the rural areas where traditional Hindu values are strongest.

Participation in Sport: A Nepalese Investigation

In this investigation with 398 Nepalese secondary school children, participation in sport was a function not only of sex but also of nonacademic self-esteem and family status as measured by parental education.

Asymptomatic throat carriage rate and antimicrobial resistance pattern of &lt;i&gt;Streptococcus pyogenes&lt;/i&gt; in Nepalese school children

Streptococcus pyogenes or Group A streptococcus (GAS) causes several suppurative and non suppurative infections. In addition to pharyngitis and skin infections, GAS are also the causative agent of post-streptococcal infection syndromes such as acute rheumatic fever (ARF) and post-streptococcal glumerulonephritis (PSG). GAS frequently colonises in the throat of an asymptomatic person. Pharyngeal carriage rates of GAS among healthy school children vary with geographical location and seasons. We carried out this preliminary study to determine the throat carriage rate and antimicrobial resistance trend of Streptococcus pyogenes or Group A streptococcus (GAS) among the Nepalese school children. Four schools situated at different locations of Kathmandu valley were included in the study. Throat swabs from 350 students of age group 5-15 years were collected, immediately transported to the laboratory and were processed for S. pyogenes following standard microbiological procedures. Antimicrobial susceptibility testing of the isolates was performed by Kirby Bauer disc diffusion method following CLSI guidelines. S. pyogenes was isolated from 10.9% (38/350) of the screened children. The GAS colonisation rate was statistically insignificant (P>0.05) with sex and age sub-groups, although the rate was slightly higher among girls and age sub-group 9-12 years. No significant difference in carrier rate was observed among different schools (P>0.05). All isolates were susceptible to azithromycin. No resistance was detected for penicillin and its derivative antibiotic ampicillin. Highest resistance rate was observed for cotrimoxazole (71.0%) followed by chloramphenicol (7.8%), ciprofloxacin (5.2%) and erythromycin (5.2%). Antibiotic resistant GAS isolated from asymptomatic Nepalese school children is a public health concern. When screened and appropriately treated with antibiotics, carriers can be prevented from spreading of streptococcal infections in the school environment and the community. Preventing cross infections would ultimately reduce the incidence of life-threatening sequelae which are debilitating and difficult to treat. It is recommended to conduct regular screening and GAS surveillance in schools, and maintain rational use of antibiotics to minimise GAS carriage/infections and resistance.

NEPALESE CHILDREN'S COGNITIVE DEVELOPMENT AS REVEALED BY DRAWINGS OF MAN, WOMAN, AND SELF

Drawings of Man, Woman, and Self were collected from 807 Nepalese schoolchildren. On American norms, Goodenough IQ's averaged 100 at age 6, but dropped to 75 by age 13. Scores were lower in more isolated regions. Results seem related to lack of stimulation and training in perceptual differentiation. Sex and caste differences were not significant. A number of comparisons of form and content showed cultural influences. Some content can be directly related to Nepalese costumes and religious practices, but the reasons for other widespread characteristics are unclear. Nepalese and American ways of portraying sex differences were explored. Examples of several drawings illustrate the richness and diversity of these Nepalese drawings. Children's drawings are important indicators of personal development and individuality. Considerable research evidence shows the relation of mental age progression to the stages of drawing development from scribbling to representational form. Such stages appear to be consistent in di