Nutritional Status of Adolescents in Semi-urban Community in Dukuchhap Village of Lalitpur , Nepal

Methodology A community based descrip ve cross-sec onal study was carried out by medical students during their field placement for nd community diagnosis in Dukuchhap Village of Lalitpur from 22 th November19 December 2017. All 10-19 years adolescent popula on was included in the study. Among the total popula on (2545) study, 474 were adolescent. The data were collected using semi-structured ques onnaire. Physical and anthropometric measurement were done. Data were analyzed using of WHO Z-scores criteria and cut offs points. All the findings were compared with Nepal Demographic and Health Survey, 2011 and other researches published in different journals on related topic. Excel version 2010 and SPSS version 13.0 were used to enter and analyze data.


Objec ve
To assess the nutri onal status of adolescents (10-19 years) in Dukuchhap Viillage of Lalitpur, Nepal

Methodology
A community based descrip ve cross-sec onal study was carried out by medical students during their field placement for nd community diagnosis in Dukuchhap Village of Lalitpur from 22 th November-19 December 2017.All 10-19 years adolescent popula on was included in the study.Among the total popula on (2545) study, 474 were adolescent.The data were collected using semi-structured ques onnaire.Physical and anthropometric measurement were done.Data were analyzed using of WHO Z-scores criteria and cut offs points.All the findings were compared with Nepal Demographic and Health Survey, 2011 and other researches published in different journals on related topic.Excel version 2010 and SPSS version 13.0 were used to enter and analyze data.

Results
The prevalence of stun ng was found out to be 36.28%.More males (16.51%) than females (12.60%) were severely stunted and 21.70% of male and 22.14% of female were moderately stunted.Among total respondents, 14.4% were severely stunted and 21.9% were moderately stunted.More numbers of male (38.2%) were stunted than female (34.7%).

Conclusion
Prevalence of malnutri on among adolescent was more in 10-12 years age group.The prevalence of moderate stun ng was slightly high in females than males.Adolescents with extended family type, increasing number of family members & agriculture, labourer and local business as main family occupa on are more prone to suffer from malnutri on.

ORA 17 INTRODUCTION
World Health Organiza on (WHO) defines adolescence as 1 the age group between 10 and 19 years .Inadequate nutri on during adolescence can retard growth and sexual matura on, and increase the risk of adult lifestyle diseases.The prevalence of malnutri on among adolescents is high in 2 developing countries.
Li le less research has been done on adolescent nutri onal status in Nepal.Though Indian studies are not directly applicable to Nepali popula ons, some comparisons might be useful A study in Karnataka state of India of the 13-19 age .group revealed that in rural areas more than one-third (36%) of boys and nearly a half (45.2%) of girls were stunted, while in urban areas about one-fourth (21.7%) of boys and girls 3 (26.5%)were stunted.The same study found that nearly half (48.4% in rural and 43.5% in urban) of adolescent boys and one fi h (19.4% in rural and 21.1% in urban) of adolescent girls were energy deficient, but only a very few (2.3% of rural and 5.4% of urban girl) were considered chronically energy deficient, however, the percentage were li le higher (18.8% in rural and 17.4% in urban boys) in case of boys.Energy deficient refers to the BMI for-age Z-score below -2SD i.e., the energy requirement is not sufficient A study on .Nutri onal Status of Adolescent Girls from an Urban Slum Area in South India concluded that there is a high prevalence of stun ng (47%), of underweight (42.6%) and of thinness 4 (20.6%)among adolescent girls in this slum community.
The study aimed to assess the demographic and health status focusing on nutri onal status of the VDC and also to evaluate health resources, services, and systems of care.The specific objec ves of the study were: assess nutri onal status of adolescents; analyze the distribu on of weight-forage, height-for-age between ethnic groups, and es mate the prevalence of malnutri on in each group.Poudel S et al

Prevalence of Stun ng
Out of 474 adolescents, 14.4% of them were severely stunted and 21.9% of them were moderately stunted.However, the prevalence of stun ng was slightly more in male (38.2%) than in female (34.7%).The prevalence of moderate stun ng was

DISCUSSION
Weight, Height and BMI of girls and boys of various ethnic groups Income, lifestyle, health, dominant posi on in society and many other factors vary widely between ethnic groups.So, we tried to assess the differences in nutri onal status between ethnic groups.The five main castes in Dukuchhap were Danuwar, Tamang, Chhetri, Brahmin and Newar.
As per Body weight (Table 2), Chhetri girls were on the lowest average with 39.Likewise when ethnic groups were compared on their heights Newar girls were of the shortest average stature with142 cm.In contrast, Brahmin girls were on the highest average body height with 151.9cm and have the highest BMI with 22.8 kg/m2 among all of them.Similarly for height of Boys, Newar boys do have the lowest average height with 132.6 cm.The Newar, Danuwar and Brahmin boys fall under the thinness category but the Danuwar boys have the lowest BMI due to the wider dispersion both in body weight and height.
As per the body mass index, firstly, girls were be er compared to their male counterparts except of the Chhetri girls which is opposite of what is expected of the community in Nepal where the society is predominantly dominated by male.Secondly, BMI of both Tamang girls and Tamang boys were be er amongst all other ethnic group only because in Tamang community there is no discrimina on between male child and female child, however, this ethnic group have the widest variability in their weight and height.

Prevalence of underweight
Out of 474 adolescents, 464 (97.9%) of them were found to be in normal weight indica ng that this community lies in food secure area in Nepal.However, the prevalence of underweight was slightly more in male (2.4%) than in female (1.9%).There was no case of severely underweight adolescent.However, 21.9% (104/474) of them were in chronic energy deficient condi on with BMI <16.

Prevalence of Stun ng
The prevalence of stun ng in the adolescent popula on was 172 (36.3%) of whom girls were 52.90% and boys 47.1% respec vely.The stun ng percentage of boys was lowest 25% (6/24) at age 14 which coincide with the growth spurt for boys.Similarly, in case of female the lowest stun ng percentage was 21% (7/34) at age 12 which also coincide with the growth spurt for girls.The prevalence of stun ng was found to be 36.28%and this is an improvement over similar 8. studies in Nepal, where 47% stun ng was reported in 1994 While not comparable, a study done in Darjeeling district, 9 India revealed stun ng prevalence to be 46.6 % .A 2005 study done in West Bengal, India revealed the prevalence of 10 stun ng to be 37.8%.This shows the prevalence of stun ng is decreasing in Nepal but it is s ll a great issue of concern to be solved.
A recent study of 2013 conducted in Chiro town, Ethiopia has revealed the prevalence of stun ng was higher in early Original Research Article adolescence (7.8%) than late adolescence (6.8%), which is 11 very lower than to our findings.

Prevalence of Malnutri on Main Family Occupa on, Family type and family size
Gender, types of residence, family size, family income, and ethnicity are all contribu ng factors in malnutri on.This study shows that there is a higher prevalence of malnutri on among adolescents whose families engage in agriculture, general labor, or local business as their main family occupa on.This study also discloses the prevalence of malnutri on to be more in extended family type than in nuclear type and increased malnutri on prevalence with increase in family size.This finding is new to Nepal but a recent study in Iran found a similar associa on between 12 larger family size and malnutri on.This supports our finding on effects of different demographic factors on nutri onal status.

CONCLUSION
The prevalence of stun ng was found to be 36.28%among the study popula on.Prevalence of stun ng shows decreasing trend and was more prevalent in girls than in boys (52.90% vs. 47.1%).Lower stun ng percentage at 14 years in boys and in 12 years in girls coincides with the growth spurt for boys & girls.
The prevalence of underweight was slightly more in male (2.36%) than in female (1.91%) and approximately twenty two percent of the adolescents were chronic energy deficient.
Adolescents of families having agriculture, laborer, and local business as their main family occupa on are more prone to suffer from malnutri on.The prevalence of malnutri on is higher in extended families, and malnutri on increases in prevalence as the numbers of family member increases.
-2 Z score = Normal, -2 to -3 Z score = Moderate, ≥ -3 Z score = severely Underweight 3 kg and had the lowest Body Mass Index with 18.2 falling in the thinness category whereas remaining other girls from different ethnicity all had normal BMI.However, Brahmin girls were on the highest average body weight with 47.1 kg and correspondingly the highest BMI among all other ethnic girls.Similarly for body weight of

Table 1 : Age and gender wise distribu on of adolescents at Dukuchhap, Lalitpur Weight, Height and BMI of girls and boys of various ethnic groups
The main ethnic group was Danuwar, consis ng 31.0% of the total adolescent popula on and the other ethnic groups were Tamang (30.4%),Chhetri (28.3%),Brahmin (4.4%), Newar (4.4%) and others i.e.Dalit, Magar and Limbu.
to minimize the error.Height was measured to the nearest 1 cm.using a portable s ck fi ed 1 with measuring tape.WHO Z-scores criteria and cut offs points were used to es mate the prevalence of underweight, thinness, stun ng and was ng and of different grades of malnutri on amongst adolescents based on gender and different ethnic groups were calculated.All the findings were compared with standard data from Nepal Demographic and 6 Health Survey 2011.Excel version 2010 and SPSS version 13.0 were used to enter and analyze data.RESULTSAmong 2545 studied popula on of Dukuchhap village of Lalitpur district in Nepal, 18.6% of them were adolescents.Out of the adolescents, 55.3% of them were females and 44.7% of them were males.The total number of female and male adolescents of different age group is shown in Table1.

Table 6 :
Prevalence and socio-demographic correlates of BMI amongst adolescents

Table 6 : Prevalence and socio-demographic correlates of BMI amongst adolescents
Newar boys had the lowest average with 32.3kg and unlike Chhetri girls, the Chhetri boys had the highest average body weight with 44.7kg.