ORIGINAL ARTICLE Year : 2020  Volume : 33  Issue : 3  Page : 868872 Assessment of growth and blood pressure measurements in Gharbia urban and rural primary school children Aml Y Mahmoud^{1}, Wafaa M Abo Elfotoh^{2}, Soheir S Abou El.Ella^{2}, ^{1} Neonatology Department, Ministry of Health, El Santa, Gharbeya, Egypt ^{2} Pediatrics Department, Faculty of Medicine, Menoufia University, Shebeen ElKom, Egypt Correspondence Address: Objective To assess the growth using anthropometric measurements and determine the prevalence of obesity, short stature, and hypertension among primary school children. Background Healthy growth for children is of great importance in the development of their physical and mental growth. Growth is influenced by many factors that act to modify a child's genetic growth. Patients and methods A crosssectional study was conducted on 1050 children aged 6 to less than 12 years, including 515 (49%) boys and 535 (51%) girls, who were recruited from primary schools in Zefta city, Gharbeya Governorate. All children were assessed for anthropometric measurements such as weight (kg), height (cm), BMI (kg/m^{2}), and arm span (cm). Moreover, blood pressure (BP) was measurement. Results The mean age was 8.50 + 1.70 years. The overall anthropometric values for boys were as follows: mean height was 134.55 ± 11.75 cm, mean weight was 32.38 ± 9.24 kg, and mean BMI was 17.47 ± 2.68 kg/m^{2}. The corresponding measurements for girls were 133.55 ± 12.38 cm for height, 32.68 ± 10.73 kg for weight, and 17.84 ± 3.096 kg/m^{2} for BMI. Prevalence of overweight and obesity in boys were 4.9 and 6.8% and in girls were 11.2 and 7.5%, respectively. Mean BP for male children was 102.53 and 61.59 mmHg for systolic BP and diastolic BP, respectively, and for girls was 102.42 and 61.48 mmHg for systolic BP and diastolic BP, respectively. Prevalence of prehypertension in boys was 7.7% and in girls was 11.2%. No cases of short stature were seen. Conclusion Most children have normal growth patterns. Obesity was positively associated with higher BP.
Introduction Growth is defined by an increase in physical dimensions (e.g., increase in height and weight) as well as various parts and organs of the body [1]. Growth is under the control of both genetic and environmental factors. There is a considerable variation across populations in height and weight, which is the result of genetic difference, exposure to many different environmental factors, and differences in socioeconomic status. A child's growth is an indicator of health and society's wellbeing [2]. The growth of children can be assessed through the anthropometric measurements. If children are assessed once, the growth status of children for age can be evaluated by comparing these data with the appropriate reference chart, and if the children are assessed more times, the children's growth rate data are important to detect any changes in growth [3]. Calculating the midparental height is important because most short or tall children have short or tall parents [4]. Obesity is defined by the BMI. BMI is measured by dividing the body weight to height (kg/m 2) [5]. Obesity is a multifactorial condition caused by genetic and nongenetic factors [6]. Complications related to childhood obesity include hypertension, type 2 diabetes mellitus, dyslipidemia, left ventricular hypertrophy, nonalcoholic steatohepatitis, obstructive sleep apnea, and orthopedic problems (such as slipped capital femoral epiphysis), as well as social and psychological problems [5]. Hypertension is a major public health problem, and it is the main cause of cardiovascular disease, heart failure, endstage renal disease, and mortality [7]. Hypertension is defined as blood pressure (BP) that is, on different visits, measured at or higher than the 95th percentile for age, sex, and height. Prehypertension is, at three or more visits, measured BP at or higher than the 90th percentile for age, sex, and height but less than the 95th percentile [8]. This study aimed to assess the growth parameters and detect the prevalence of obesity, hypertension, and short stature among primary school children. Patients and Methods Patients A crosssectional study was conducted on 1050 children aged 6 to less than 12 years, comprising 515 (49%) boys and 535 (51%) girls, who were recruited from primary schools in Zefta, Gharbeya Governorate, during the period from April 2017 to November 2017. The mean age was 8.50 ± 1.70 years. Children who participated in this study were apparently normal children of both sexes. We excluded children with known chronic diseases and endocrinal disorders, children having known genetic or chromosomal abnormalities, and those who were receiving drugs affecting their growth. They were classified into six groups according to age 6, 7, 8, 9, 10, and 11 years. The study was approved by Ethical Committee of Menoufia Faculty of Medicine. Informed consent was taken from the parents of children after full explanation of the study. Methods All children were subjected to full history with stress on nutritional history such as amount and type of food taken; family history of obesity, hypertension, or short stature; developmental history; and physical history. Clinical examination was done stressing on fat distribution such as presence of central, peripheral, or truncal obesity and looking for skin pigmentation. BP is measured by using a standard mercury sphygmomanometer. BP was measured twice at the same sitting. Normal BP is less than 90th percentile for normal systolic blood pressure (SBP) and DSP, prehypertension is at least 90th but less than 95th percentile for normal SBP and DSP, and hypertension is of at least 95th percentile for normal SBP and DSP [8]. Anthropometric measurements including height (cm) were measured using a wall chart. Standing height was measured once without shoes to the nearest 0.5 cm. Arm span (cm) and US/LS ratio was used to assess linear growth. Weight (kg) was measured using a digital floor scale to the nearest 0.1 kg, and BMI (kg/m 2) was calculated by the formula = weight (kg)/height squared (m). Height, weight, and BMI values were plotted on the corresponding percentile curves for age and sex. Underweight was BMI less than 5th percentile, healthy weight was BMI at least 5th and less than 85th percentile, overweight was BMI of at least 85th and less than 95th percentile, and obesity was BMI of at least 95th percentile [9]. Statistical analysis The data were coded, entered, and processed on a compatible IBM computer using the statistical package for the social sciences, 20th version (SPSS 20; SPSS. Inc., Chicago, Illinois, USA). The results were represented in tables and diagrammatic forms and then interpreted. Mean, SD, range, frequency, and percentage were used as descriptive statistics. Analytic statistics, for example, χ2, was used to study association between two qualitative variables. Student ttest is a test of significance used for comparison between two groups having quantitative parametric variables. Spearman's correlation was used in the correlation between two parametric parameters. P value indicates significance when less than 0.05. Results A total of 1050 (515 boys and 535 girls) children, who were aged 6 to less than 12 years old (mean age was 8.50 ± 1.70 years), were enrolled in the study [Table 1]. In this study, the overall anthropometric values for boys were as follows: mean height was 134.55 ± 11.75 cm, mean weight was 32.38 ± 9.24 kg, and mean BMI was 17.47 ± 2.68 kg/m 2. The corresponding measurements for girls were 133.55 ± 12.38 cm for height, 32.68 ± 10.73 kg for weight, and 17.84 ± 3.096 kg/m 2 for BMI.{Table 1} Mean height of girls was lower than that of the boys in all age groups. Mean weight of girls was higher than the boys, in most of the age groups. However, there also was no statistically significant difference in the mean weight and height between boys and girls in any of the age groups. BMI was found to increase with age. The older participants had the highest BMI values [Table 2]. In this study, most children have normal growth, with height percentile mostly ranging from more than 25th up to 75th in 53.3 and 60% in boys and girls, respectively. The weight percentiles also ranged mostly from more than 25th up to 75th in 68.7 and 61.1% in boys and girls, respectively. BMI percentiles also ranged from at least 5th to less than 85th in 85.4 and 78.5% in boys and girls, respectively [Table 3]. The overall prevalence of overweight was 4.9 and 11.2% and that of obesity was 6.8 and 7.5% in the boys and girls, respectively [Figure 1].{Table 2}{Table 3}{Figure 1} The findings of the present study revealed that mean BP for boys was 102.53 and 61.59 for SBP and diastolic blood pressure (DBP), respectively, and for girls was 102.42 and 61.48 for SBP and DBP, respectively. The rise in BP was directly proportional to the increase in age in both sexes. There was no significant difference between the SBP as well as DBP of the two sexes at various age groups. The prevalence of prehypertension is 7.7 and 11.2% for boys and girls, respectively [Table 3]. SBP and DBP pressures significantly correlated with age, body weight, height, and BMI [Table 4].{Table 4} Discussion Growth is influenced by several factors that act independently and in concert to modify a child's genetic growth potential [10]. Growth monitoring of apparently healthy children is an important matter in healthcare, as it can detect serious health conditions at an early stage. It requires both clinical experience and algorithms that detect abnormal growth [11]. In this study, the overall anthropometric values for boys were as follows: mean height was 134.55 ± 11.75 cm, mean weight was 32.38 ± 9.24 kg, and mean BMI was 17.47 ± 2.68 kg/m 2. The corresponding measurements for girls were 133.55 ± 12.38 cm for height, 32.68 ± 10.73 kg for weight, and 17.84 ± 3.096 kg/m 2 for BMI. Eze et al. [12] showed the anthropometric measurements among Nigerian school children, aged 6–12 years. For boys, the overall anthropometric values were as follows: mean height was 136.2 ± 9.8 cm, mean weight was 29.2 ± 7.0 kg, and mean BMI was 15.6 ± 2.2 kg/m 2. The corresponding measurements for girls were 137.0 ± 10.7 cm for height, 30.2 ± 8.4 kg for weight, and 15.9 ± 2.7 kg/m 2 for BMI. In this study, the mean height of girls was lower than that of the boys in all age groups, but the mean weight of girls was higher than the boys, in most of the age groups. However, there was no statistically significant difference in the mean weight and height of boys and girls in any of the age groups. Srivastava et al. [13] reported similar finding in their study, which enrolled 512 school children aged 5–15 years from urban slums of Bareilly, India. In this study, most children have normal growth, with height percentile mostly ranging from more than 25th up to 75th, as seen in 53.3 and 60% in girls and boys, respectively. The weight percentiles also ranged mostly from more than 25th up to 75th, as seen in 68.7 and 61.1% in boys and girls, respectively. BMI percentiles also ranged from at least 5th to less than 85th in 85.4 and 78.5% in boys and girls, respectively. Moreover, Eze et al. [12] found that most studied children were following normal growth paths. Girls had a higher mean BMI. The mean values of BMI in our study were 17.47 ± 2.68 kg/m 2 in boys and 17.84 ± 3.09 kg/m 2 in girls. Moreover, Nwaiwu and Ibe [14] found similar results in their study, where the mean BMI for boys was 16.09 ± 2.07 kg/m 2 and for girls was 16.47 ± 2.52 kg/m 2. Eze et al. [12] found also found that girls had a higher BMI than boys, where the mean BMI for boys was 15.6 ± 2.2 kg/m 2 and for girls was 15.9 ± 2.7 kg/m 2. In this study, the overall prevalence of overweight was 4.9 and 11.2% and that of obesity was 6.8 and 7.5% in the boys and girls, respectively. ElHazmi and Warsy [15] reported in the study carried on 12 701 (6281 boys and 6420 girls) Saudi Arabian children with ages ranging from 1 to 18 years that the overall prevalence of overweight was 10.68 and 12.7% and that of obesity was 5.98 and 6.74% in the boys and girls, respectively. Zephier et al. [16] reported that the prevalence of overweight (BMI, ≥85th percentile) among the American Indian children aged 5–17 years during 2002–2003 was 48.1% in boys and 46.3% in girls, whereas the prevalence for obesity (BMI, ≥95th percentile) was 29.4 and 26.1% for boys and girls, respectively. The high prevalence of overweight/obesity among schoolaged children might be because of less physical activity and higher consumption of more unhealthy, highfat foods, sweetened beverages, and salty snacks and less milk, fruits, and vegetables than recommended. Obese children should be routinely screened for BP and other coexisting cardiovascular risk factors including lipid profile [17]. Our results revealed that anthropometric measures (weight, height, and BMI) among children with prehypertension were significantly higher than those among children with normal BP. SBP and DBP pressures significantly correlate with age, body weight, height, and BMI. Adiele and Morgan [18] also found similar results in their study which involved 480 (230 boys and 250 girls) primary school children aged 5–11 years. In this study, the prevalence of prehypertension is 7.7 and 11.2% for boys and girls, respectively. This study detected no cases of short stature among the studied children. This may be owing to relatively small sample size. This disagrees with Zayed et al.[19], who conducted a crosssectional study on 2702 children aged 6–12 years and found that the prevalence of short stature was 4.9%. Any child with an abnormally slow growth rate, height below third percentile, or height considerably below the genetic potential deserves further evaluation. An assessment of growth requires reliable growth measurements, with data plotted on suitable growth charts [20]. Conclusion Most of the growth parameters in children in this study had normal pattern and correspond to the increase in the age of the participants of both sexes. The increase in BMI corresponds to the adolescent spurt growth. Obesity among school children was positively associated with higher BP. Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest. References


