Double burden of malnutrition among Indian schoolchildren and its measurement: a cross-sectional study in a single school.

OBJECTIVE: This cross-sectional study set in a single school on the outskirts of a large city aimed to document the extent of double burden of malnutrition (coexistence of overnutrition and undernutrition) among Indian schoolchildren from lower socioeconomic groups, and to determine if mid-upper arm circumference (MUAC) can be used as a proxy for body mass index (BMI). SUBJECTS: The total number of participants was 1444, comprising 424 girls and 1020 boys belonging to playgroups and grades 1 to 7. MEASUREMENTS: Anthropometric measurements, such as participants' MUAC, height and weight were measured using standard techniques. Descriptive statistics for BMI and MUAC were obtained based on gender; z-scores were computed using age-specific and sex-specific WHO reference data. The distribution of variables was calculated for three groups: girls, boys and all participants. Homogeneous subsets for BMI and MUAC were identified in the three groups. Age-wise comparisons of BMI and MUAC were conducted for each gender. MAIN OUTCOME MEASURES: (1) To know if MUAC and BMI are correlated among boys and girls. (2) To study BMI and MUAC z-score distribution among the participants. RESULTS: MUAC was positively correlated with BMI in both boys and girls. The following BMI z-score distribution was observed: severe acute malnutrition (SAM), 5 (0.3%); moderate acute malnutrition (MAM), 146 (10.1%) and undernourished, at risk of MAM/SAM, 141 (9.8%); obese, 21 (1.5%); overweight, 36 (2.5%) and pre-obese, 136 (9.4%). The distribution of categories of children based on MUAC z-scores was: SAM, 7 (0.5%); MAM, 181 (12.5%) and undernourished, at risk of MAM/SAM, 181 (12.5%); obese, 19 (1.3%); overweight, 178 (12.3%) and pre-obese, 135 (9.3%). CONCLUSIONS: SAM/MAM/undernourished states and obesity/overweight/pre-obese states, indicating undernutrition more than overweight, coexist among Indian schoolchildren from lower middle/lower socioeconomic categories. BMI and MUAC were significantly correlated. MUAC identifies both undernutrition and overnutrition by early detection of aberrant growth.

Out-of-pocket nonmedical expenses associated with out-patient treatment of common childhood illnesses.

BACKGROUND: Out-of-pocket expenses, medical and non-medical, have an impoverishing effect on the family. OBJECTIVE: Determine non-medical out-of-pocket expenses incurred during out-patient attendance for primary care services. METHODS: A descriptive survey was undertaken at a rural medical college using interviewer-administered questionnaire to parents of children <6 years over a period of 6 weeks. Seventy-six participants were interviewed for collecting demographic data and actual cost on travel and meals. RESULTS: Median expenditure for travel was Indian rupees (INR) 20 with inter-quartile range (IQR) 14-48 and on food it was INR 110 with IQR 40-155. Median total expenditure on the visit was INR 122 with IQR 61-220. Among those who travelled >5 km, 36% attendance was for respiratory complaints, 27% with fever and as many as 86% for vaccination. CONCLUSION: Families in rural India have substantial costs incurred in OPD attendance, most of which is for preventive health care such as immunization.

Teaching primary care in pediatric outpatient department in developing countries: a feasibility study.

We studied the feasibility of teaching primary care to undergraduate medical students in an outpatient department (OPD) using a specially developed teaching package. Teaching was conducted in four 30 min sessions during a 4 week rotation term, and a test was offered at the end. We concluded, on the basis of grades achieved in the test, that it is feasible to impart primary care knowledge through OPD teaching using structured teaching goals for teachers.