Estimation of Various Nutritional Deficiencies in School Going Children of district Peshawar, Pakistan

Background: The aims of the study are to estimate gender wise and age wise nutritional status of school children of aged 4 to 15 years, in the local area of district Peshawar. Method: Institutional based cross-sectional study design was used. In the current research work a total of 500 samples were isolated from school-going children. In which 150(30%) were found positive for nutritional deficiency. The samples collected from male and females students of age 4-15 years. Result: Among the all samples nutritional anemia was found more frequent 60(12%), leading by malnutrition 50 (10%), moderate prevalence were shows by underweight 20(4%) and stunting 16 (3.2%) prevalence rate. while very low frequency was shows by wasting 4 (0.8%) respectively. Out of 500 children the number of male was slightly higher than females. The incidence of malnutrition, underweight and nutritional Anemia among the study population varied with gender and with age. Although the prevalence of nutritional anemia was higher in both age groups. Conclusion: Over all ratio of underweight and stunting were found moderate among all ages and gender wise distribution of nutritional sates

A study was conducted on depression, anxiety and stress level of female school teachers according to the study teaching not only affect physically but also mentally because a lot of energy is used in the class rooms ,in family commitments, which is a source of stress and depression..In Egypt primary teachers take 24classes per week, while secondary level teachers took 18 hours per week.The study indicated that 61.3% had teaching experience more than 10 years while 91% teachers were not satisfied with their pay scale.The prevalence of severe, moderate and mild depression were (0.7%, 2.8%and 19.7%), while the prevalence of extremely severe, moderate and mild anxiety level was (19.7%, 7.0% and 23.2%).These results showed that there is need to bring interventions to overcome such issues and order to prevent teachers from increasing psychological issues which would affect mentally and physically on nutritional status of teachers (Allam2017).

METHODOLOGY
This observational, cross sectional study was conducted in local area of District Peshawar from June 2023 to November 2023.After ethical approval, students of 4-15 years were selected from the Govt schools located in this area.Demographic information along with weight and height of the selected children were taken and plotted to gender specific, growth charts.The age of the children was determined using school records.In the schools nutritional status of children were assessed as follows: Weight: Measured using equipment and procedure.The measurements were taken to the nearest .5KgHeight: well taken using a measuring tape applied to the wall.The measurements were taken with children barefoot with their back of heels, buttocks and head touching the wall.Readings well be taken to the nearest .5cm.WHO-score system was used to classify the nutritional status of children.

Study Area and Period
The study was conducted in local area of district Peshawar, which is located Khyber Pakhtunkhwa.

Study Design
Institutional based cross-sectional study design were used.

Study Population
All secondary and primary school students (age group wise the source population, whereas sampled or selected students were the study population of this study.

Sample Size Determination
A Total of 500 children between the ages of 4-15 years were studied.A systematic random sampling technique was applied for sample collection.Lab investigations and Tests: All patients were subjected to: Complete Blood count and reticulocyte count.Patients with microcytosis underwent the following:

Serum Iron and ferritin
An automatic hematological analyzer and Biochemistry analyzer were used for clinical examination

Routine blood tests
This is done to assess anemia and other vitamin and mineral deficiencies.There may be dehydration, low blood sugar and signs of severe infection as is evident by raised level of blood cell counts.

Diagnosis of malnutrition in children
In children weight and height is measured and compared with the charts showing the expected average height and weight for a child of that age.Some children are persistently smaller for age and may be genetically so.

Blood tests in children
Routine blood tests in children include those for blood glucose, blood counts, urine for routine examination.Levels of iron in blood, folic acid and vitamin B 12 are also done.For protein estimation other tests including Normal ranges of ferritin 10 to 150 ng/mL for children 4 th years to 15 years.MCV normal range is 80 to 95 for children

 Analysis and Interpretation of data
Data will analyzed and interpret by using M word, Origin 16 and Excel.Frequency and Percentage were calculated for all quantitative variables.5. ETHICAL CONSIDERATION  The subjects were briefed about the study. Consent was taken from the subjects after explaining the purpose of study for the collection of data.

RESULTS
In the current research work a total of 500 samples were isolated from school-going children.In which 150(30%) were found positive.The samples collected from male and females students of age 4-15 years.Among the all samples nutritional anemia was found more frequent 60(12%), leading by malnutrition 50(10%), moderate prevalence were shows by underweight 20(4%) and stunting 16(3.2%)prevalence rate.while very low frequency was shows by wasting 4(0.8%) respectively.Out of 500 children the number of male was slightly higher than females.The prevalence of Nutritional Anemia among the study population varied with age.Children of high aged group had a significantly high incidence of nutritional Anemia compared with the lower age group "Table 1".Over all ratio of underweight and stunting were found moderate among all ages and gender wise distribution of nutritional status.A large number of males were anemic 32 (6.4%), malnourished 28 (5.6%), underweight 12 (2.4%),stunted 4 (1.6%) when compared with females nutritional anemia 14 (5.6%), malnutrition 11 (4.4%), underweight 4 (1.6), stunting 4 (1.6%) while wasting with zero prevalence rate 0 (0%).The males having a higher prevalence than the females.Age wise nutritional status in male shows that the high prevalence rates were found between \4-7 years of children.In which nutritional anemia 12 (4.8%)leading by Malnutrition 10 (4%) less prevalence were seen in Underweight 5 (2%) Stunting 5 (2%) while some prevalence was seen for wasting 2 (0.8% Age wise nutritional status in male shows that the high prevalence rates were found between 4-7 years of children.In which nutritional anemia 8 (3.2%) leading by Malnutrition 6 (2.4%) less prevalence were seen in Underweight 4 (1.6%)Stunting 2 (0.8%) while some prevalence was seen for wasting 2 (0.8%).Between the age group 8-11 the prevalence ratio were nutritional anemia 5 (2%) leading by Malnutrition 4 (1.6%) less prevalence were seen in Underweight 2 (0.8%) Stunting 2 (0.8%) while no prevalence was seen for wasting.Very low prevalence rate were seen between 12-15 age group Table .5Age wise nutritional status in female shows that the high prevalence rates were found between 4-7 years of children.In which nutritional anemia 7 (2.8%) leading by Malnutrition 5 (2%) less prevalence were seen in Underweight 2 (0.8%) Stunting 3 (1.2%)while no prevalence was seen for wasting.Between the age group 8-11 the prevalence ratio were nutritional anemia 5 (2%) leading by Malnutrition 4 (1.6%) less prevalence were seen in Underweight 2 (0.8%) Stunting 1 (0.4%) while no prevalence was seen for wasting Table .5

DISCUSSION
In the current research work, a total of 500 samples were isolated from school-going children.
The samples were collected from male and female students of age 4-15 years.Among the all samples nutritional anemia was found more frequent 60(12%), led by malnutrition at 50(10%), moderate prevalence was shown by underweight 20(4%), and stunting at 16(3.2%) prevalence rate.while very low frequency was shows by wasting4 (0.8%) respectively.Out of 500 children, the number of males was slightly higher than females.Nutritional Anemia and malnutrition were observed in the study population respectively.
The prevalence of nutritional Anemia among the study population varied with age.Children in the 12-15 years group had a significantly higher prevalence of nutritional Anemia compared with the lower age group.(Ahsan et al 2020) also conducted a study in which a total of 571 children, 348 (56.4%) were boys and 223 (43.6%) were girls.Nearly 89 (15.5%) children including 52 (10.5%) boys and 37(6.4%)girls had normal anthropometric indices.Stunting was the most frequent anthropometric failure (n=219, 38.3%) followed by wasting (n=163, 28.51%) and underweight (n=100, 17.5%) respectively.Gender disparity was observed in the distribution of malnutrition with boys having a higher frequency of stunting, wasting, and underweight than girls.
Although the prevalence of nutritional anemia was higher in both age groups and sexes, it was not significant.Nutritional Anemia prevalence was significantly higher among school going children.The difference between the age groups as well as nutritional status remained significant as risk factors of anemia were also the main relation.The ratio of underweight and stunting was found moderate among all ages and gender-wise distribution of nutritional status.The prevalence of malnutrition and stunting varied significantly within the age group with the lower age group having higher prevalence.More males were anemic 32 (6.4%), malnourished 28 (5.6%), underweight 12 (2.4%),stunted 8 (1.6%) when compared with females anemia 28 (5.6%), malnutrition 22 (4.4%), underweight 8 (1.6), stunting 8 (1.6%) while wasting with zero prevalence rate 0 (0%) respectively though the difference was not significant in malnutrition and stunting.The difference in prevalence of underweight among the sexes was significant with the males having a higher prevalence.Bivariate analysis revealed children of the 0-5 year age group were significantly at odds of being malnourished.Similar work was also performed by (Shakir Ullah et al 2023).
Conducted a study in which out of 1500 school-going students 600(40%) were found positive and 900(60%) were found normal according to age.Gender-wise analysis shows that in male students 210(35%) were found positive for stunting and 150 (25%) male students were underweight.In overall female students, 135(22.5%)were found stunting and 105 (17.5%) were found underweight.According to age group wise between 4 to 10 years 90 (10%) female students were found stunting and 60(6.6%) were found underweight.While in the age of 11 to 15 years 48 (5.3%) students were stunted and 42 (4.6%)students were underweighted.The difference in stunted and underweight showed more boys than girls.In the pre-nursery group, more boys were stunted than girls, the ratio being 70%:30%,on the contrary, underweight was more in boys than in girls, with a ratio of 57%:43%.In the Primary section, both stunting and underweight were more in boys as compared to girls.The ratios were 54.8%:45.2%and 82.9%:17% respectively.

RECOMMENDATION
There was a very high prevalence of anemia, underweight, stunting and wasting among male than in female children.The results of the present study will be useful for policy makers in their struggle to formulate various developmental and health care programs.Nutritional intervention is also necessary to upgrade the nutritional status among the children.
The results should be presented logically in the results section, highlighting critical information presented in tables and figures.The discussion section should highlight the significance of the findings in relation to the issues and theories raised in the introduction and set the new data in the perspective of previous pertinent r 1 Tables may have a footer.
Estimation of Various Nutritional Deficiencies in School Going Children of district Peshawar, Pakistan Therefor.theobjective of thise study estimates gender wise nutritional status of school children of distryct Peshawat.estimateage wise prevalence of the nutritional incidence of school aged children and find out Nutritional Anemia Stunting and Underweight school aged children OBJECTIVE  To estimate gender wise nutritional status of school children of district Peshawar.
 To estimate age wise prevalence of the nutritional incidence of school aged children.To find out Nutritional Anemia, Stunting and Underweight school aged children.

Table . 1
Over all nutritional status of school going children

Table . 2
Gender wise nutritional status of school going children

Table . 3
Age wise nutritional status of school going children

Table . 4
Age wise nutritional status of male school going children

Table . 5
Age wise nutritional status of female school going children