Assessment of the nutritional status and identification of health risk factors of older people in Khartoum State.

Abbas, M. Muna ; Abdel Magied, Ahmed ; Salih, Osama 等

Abstract

This study aims to assess the nutritional status and identify the health risk factors that face older Sudanese people of both sexes living in Khartoum Sate. Three groups were studied: the first group represented older people (women and men) living in older people's homes of Alsagana and Bahri in Khartoum State ;the second group represented older people of low socio-economic status and the third group represented people of high socio-economic status; both were in Khartoum State.

Data was collected by using questionnaires for respondents in general and focus group discussions were also carried out with the staff of the older people's homes. In addition, anthropometric measurements using BMI, were used to assess the nutritional status of the respondents.

The major findings of the study have shown that, most of inmates in Alsagana and Bahri older homes were mal-nourished. This was attributed to insufficient services; especially nutritional services, which suffer from insufficient funds provided by the Ministry of Social Welfare. Also, lack of qualified staff and lack of clear strategies and policies for the administration of the homes. Insignificant correlations were found between nutrition status and diseases ([X.sup.2]=12.03, P=0.149), nutrition status and number of meals ([X.sup.2]=4.13, P=0.38) and nutrition status and educational level ([X.sup.2]=10.66, P=0.55).

A high percentage of over weight respondents was found for the high socio-economic group (56% males and 66.7% females). Moreover, an overall percentage of malnutrition (over and under weight) among this group (70% males and 74.4% females) was observed. This is explained by the relationship between nutrition status and identified risk factors, of this studied group. There was a high significant correlation ([X.sup.2]=21.86, P=0.002) between the nutrition status and the number of meals taken per day; there was an insignificant correlation between the nutrition status and educational level ([X.sup.2]=2.99, P=0.08); also there was an insignificant correlation between nutrition status and diseases ([X.sup.2]=17.90, P=0.05). However, the main cause of the problem was not affordability but the lack of nutrition awareness.

Whereas, for the low socio-economic group the percentages of malnutrition found among the males and females were 20% and 23.3% respectively; the same percentage was registered for over weight. This situation will give an overall percentage of malnutrition among this group of 40% in males and 46.6% females. There was a relationship between nutrition status and identified risk factors of this group.

Also there was a insignificant correlation between nutrition status and educational level ([X.sup.2]=4.89, P=0.84) and between the nutrition status and diseases ([X.sup.2]=13.42, P=0.14), but a high significant correlation between psychological and nutrition status was found ([X.sup.2]=36.02, P=0.0) Although, the availability was of importance as a factor behind the above situation, but lack of nutrition awareness would rank high as the major factor behind the above situation. Relevant recommendations to the situation were made.

Introduction

In most African countries there are no special arrangements to meet the health needs of older people. There are no separate wards for the elderly in hospitals; there are also no geriatric units, even in technical hospitals.

Africans are suffering from poverty, diseases and inadequate health care, which directly lead to malnutrition. The latter is a major problem that results from poor economy, poor agricultural infrastructures, weather and insufficient knowledge on nutrition demand (Gregory and Peachy, 1997). Nevertheless, older persons (60and above) constitute a group of people who are considered at risk of poor dietary intake and nutritional problems. Whereas, the majority of poor older people in developing countries enter age after a lifetime of poverty and deprivation, poor access to health care and a diet that is usually inadequate in quality and quantity. Moreover, the relatively higher incidence of chronic diseases and reduced mobility among the elderly require greater health expenditures for these age groups (WHO, 1999).

For most of these older persons, retirement is not an option. Poverty, lack of pensions, complex emergencies such as war, displacement, drought, flooding, and rural to urban migration of younger people are among the factors that compel older persons to continue working. Adequate nutrition, healthy ageing, and the ability to function independently are thus essential components of a good quality of life. Therefore, there is a need to provide appropriate social and health care services to emerging elderly populations within the context of comprehensive national policies (WHO, 1994).

Although ageing is not considered a priority issue in the Arab region, the absolute number of people aged 65 and above has doubled from 5.7million in 1980 to 10.4 million in 2000 and is expected to increase to 14 million by 2010 and 21.3 million by 2020 (UN,2002).

Older Persons in Sudan

Sudan is the largest country in Africa and one of the poorest in the world. Its population is estimated at around, 40 million (Sudan Ministry of Heath et al, 2006).

Those alder persons are also exposed to many risk factors (Ismail and Manadhan, 1998; Help Age International, 2008).

The elderly in Sudan constitute a relatively high proportion of the proportion similar to Lebanon, Morocco, and Tunisia compared to the other countries of the region, and is increasingly forming a larger proportion of the total population. Despite the many threats to health in Sudan, the population is ageing; people nowadays tend to survive to a more advanced age than did the previous generations. Yet there is evidence that the health system falls a long way short of addressing the health problems of elderly people (Ahmed, 2006).

In the Sudan, although there is available literature on the nutritional status and health risk factors of older people from both sexes ,there is hardly any of this literature in the published form .Neither on free living Sudanese older persons nor, particularly, on inmates living in older people's homes. However, there are only three research notes that have recently been published in The Ahfad Journal (Ali and Abdel Magied, 2005; Saad and Abdel Magied, 2005; Abdel Magied and Elrefaie, 2006).

Methodology

This was a cross sectional descriptive investigation. Quantitative and qualitative methodologies were employed for the data collation.

Quantitative data were colleted by a special questionnaire that was designed for the inmates of Alsagana and Bahri older people's homes.

A special questionnaire was also designed for the two free living groups of older persons from low and high socio-economic strata.

Qualitative data were colleted from the staff of the two older people's homes through focus discussion groups. The infrastructures of the two homes were monitored by personal observations. The nutritional status of the inmates and the two groups of free living older persons was assessed by measuring the body mass index (BMI) according to the following formula: BMI=weight/height (kg/[m.sup.2]) with the following interpretations:

BMI <16 Severe malnutrition
BMI = 16-16.99 Moderate malnutrition
BMI = 17-18.49 Mild malnutrition
BMI = 18.5-24.99 Normal
BMI >25=over weight (WHO, 1999).

Quantitative data were analysed using the computer package SPSS and results were presented in tables of frequency or frequency and percentage. Chi-square was used for cross tabulation for association of nutritional status with other variables at 95% confidence limits (P<0.5).

Results

Section 1:

Female and male older persons living in Alsagana and Bahri older people homes

The above table shows the personal data of both male and female inmates from Alsagana and Bahri older people's homes.

Of the 16 inmates of the two homes, there was only one Christian and 15 Muslims and none of them had personal or any other source of income. Of the 16 inmates, only 3 were females.

All (8) respondents from Alsagana home did not have regular medical check up, while all (8) those from Bahri home had regular medical check up.

Inmates of Alsagana home took two meals per day, while those of Bahri home took three meals per day. No special meals were provided to the inmates of the two homes. All (16) inmates of the two homes felt isolated.

Outcome of the focus group dissension with staff of Alsagana older people's home:

* All staff agreed upon that the services needed by inmates inside the homes were provided in accordance with the standard of life of any ordinary person, which include health, social and nutrition services.

* Unavailability of persons to look after them was the reason of admission the inmates to the home.

* Isolation was the main complain of many inmates, others were not satisfied with the provided food items in spite of the variety.

* Problems focused on by the staff included inadequacy of budget for provision of the necessary food supply, lack of qualified staff (e.g. nutritionist).

* Entertainment facilities (e.g. radio, TV) were available.

Main outcome of the focus group discussion with staff of Bahri older people's home:

* As stated by the staff, nutritional and health services were provided. Social activities were also available.

* Unavailability of a person to look after the inmate was the reason for his/her admission to the home.

* The main complain was form isolation.

* Lack of adequate financial resources and qualified staff were the main problems.

* Entertainment facilities (e.g. radio, TV) were available.

Personal observations:

Alsagana older people's home:

The home is spacious enough, the rooms are well ventilated, the Kitchen is clean, all necessary utensils are available including a refrigerator, nutritionist not available and no resident health worker. Meals were not prepared according to the scientific way. The building is spacious enough for (36) inmates.

Bahri older people's home:

Similar to Alsagana home in details, except for the advantage of availability of medical care.

Section 2:

Older people of high socio-economic status.

All (60) male and female respondents were staying with their families. Their children visit them on frequent and regular bases, but about 30% of them felt isolated.

All respondents (60) did regular medical check up and most of the respondents took two to three meals per day. All of females and most of the males were provided with special meals.

Section 3:

Older people of low socio-economic status.

All (60) male and female respondents were staying with their families. Their children visit them on frequent and regular bases, but about 30% of them felt isolated.

All (60) respondents did not do regular medical check up. Most of the respondents took two to three meals per day, and all respondents were not provided by special meals.

Discussion, Conclusions and Recommendations

Although there are thousands of homeless older people in Khartoum, the extremely low number of inmates (16 in two homes with capacity of 72) is a situation that shows that there is no Government's policy and relevant interventions to care for the very poor or below the poverty line older people.

As a natural result of ageing, the majority of respondents in Alsagana home, were suffering from mobility problems. While the majority in Bahri home were suffering from week vision. In conformity to what was mentioned by Ismail and Manadhar (1998), the older people's deteriorating health status was perhaps a result of complex factors.

All of the respondents in both homes felt isolated in spite of the different types of entertainment facilities. A situation that most probably imposed a negative psychological impact on the inmates.

The diet in both homes (Alsagana and Bahri) was most probably unbalanced and the necessary nutritive balanced meals needed at their age were not provided. From both homes, 37.5% of the respondents were severely real-nourished. In Alsagana and Bahri older homes, 12.5% and 20% respectively were mildly mal-nourished, 12.5% in Bahri were moderately real-nourished and 50% were within normal level of nutritional status in Alsagana older home. While 12.5% in Bahri older home and 12.5% where over weight. This situation shows that there was not enough attention and care to monitor their nutritional status that would have prevented this status of mal-nourishment of the inmates.

For the inmates of both older people homes, correlation between the nutrition status and some risk factors (education, number of meals and diseases)had proven not significant (n = 16) due to: the small sample studied, receiving standardized food and sharing identical living conditions.

The focus group discussion in Alsagana older people home claimed that all services needed by inmates were provided, to live within the standard of life of an ordinary person. In spite of the available services (health, social and nutritional services)the group stated that the majority of inmates complained from isolation and the poor quality and insufficient quantity of food presented. This was attributed by the group, to lack of nutritionist and health personnel.

Personal observations showed that the home size was suitable for the number of admitted inmates, in addition to the obvious cleanliness of the inmates rooms, bathrooms and the kitchen. Each inmate had a separate cup and plate. In spite of the above positive sides of the home, yet many problems impeding the improvement of the home were encountered.

These comments were shared by the staff, who pinpointed the problems included: insufficient budgets provided for the food, other activities, and lack of nutritionist and health personnel.

Regarding Bahri older people home, the group stated that the financial resource, lack of trained staff and the way of administration of the home were the main problems facing Bahri older people' home. In an attempt to find solution to the four mentioned problems, the group agreed that this should come from the Ministry of Social Welfare by increasing the financial share and employ more qualified workers. In Bahri home, the rooms available were clean, but the ventilation is not as good as that of Alsagana older people' home.

In both homes the bathrooms are clean, but unfortunately are situated far away from the living area, which constitutes a problem for an older person who might be suffering from mobility problem. In both homes clean and organized kitchens were available, with clean utensils for cooking and a separate cup and plate for each inmate.

Regarding the high socio-economic status group, the majority of older people (males and females) were married. All of the respondents were still living with their families. This indicates stability for older people life, which is a main factor in maintaining their psychological, mental, social and nutritional health.

In spite of the fact that there is a direct correlation between income and the nutritional status of an individual (Ismail and Manadhar, 1998), in this study it was found that the relation between nutrition status and income was insignificant ([X.sup.2] = 0.99, P = 0.60). This could be explained by lack of nutrition awareness and knowledge and proper distribution of the income as far as nutritional priorities are concerned.

It is generally agreed that educated people have good nutrition status (Ismail and Manadhar 1998). However, this study has revealed that there was an obvious mismatch and lack of correspondence between educational level and nutrition status ([X.sup.2] = 2.88, P = 0.08). This apparent discrepancy can be attributed to the fact that, Sudanese people do not care much about the details of the nutritional components of their food intake, irrespective of the high educational level.

The majority of male and female respondents (33.3% and 43.4 respectively) had mobility problem. Nonetheless, they sought regular medical check-up and their health condition was controlled. Weak vision, deafness and mobility problems are normally not directly related to nutritional status but there are some diseases e.g. hypertension and diabetes which are affected by the nutritional status (David and Passmore, 1975).The study showed that insignificant correlation( [X.sup.2] = 17.90, P = 0.05) existed between nutrition status and diseases for this group. This might be attributed to the fact that the exact start of the diseases was not defined.

The majority (66.7% and 70%) of both respondents (males and females) did not feel isolated. There seems to be a direct relation between the psychological status (isolation) and nutrition status i.e. the psychological status seems to affect the appetite positively ([X.sup.2] = 30.12, P = 0.0).

The majority (37.3%) of the male respondents took three meals, while 50% of female respondents took two meals. There was a high significant correlation ([X.sup.2] = 21.86, P = 0.0002) between the nutrition status of older people with high socio-economic status and the number of meals taken per day.

The majority (56.7 and 66.7%) of females and males, respectively suffered from over weight. This is considered to be a condition of malnutrition. This situation may be regarded as a consequence of ignorance of nutritional knowledge.

Regarding the group of low socio-economic status, the majority (66.6%) of both respondents were married, and all of respondents (males and females) were living with their families. This situation shows a strong kin relationship between the family members and thus more stable life. In spite of the fact that the educational level has a direct effect on the nutritional status (Suliman, 2000), this study showed that there was an insignificant correlation ([X.sup.2] = 4.89, P = 0.84). This may probably be attributed to ignorance of Sudanese people of nutritional knowledge. This is in-addition to the fact that this group cannot afford expensive food items, which are of high nutritive value.

All respondents had irregular medical check up. This might have led to high incidences of health problems, which are directly related to the nutrition status (Ismail and Manadhar, 1998). However, this study showed an insignificant relation ([X.sup.2] = 13.42, P = 0.14) between diseases and nutritional status. This might be attributed to the habitual type of food intake which might not change even if the person is sick; due to unaffordability.

The majority (66.7% males and 70% females) of both respondents did not feel isolated. This indicates as shown by this study that there is a highly significant correlation ([X.sup.2] = 36.02, P = 0.0) between the psychological status and nutrition status. The insignificant correlation([X.sup.2] = l.71, P = 0.63) between the nutrition status and income, may probably be attributed to the fact that lack of awareness could have affected the nutrition status irrespective of the income.

It was, there fore, thought pertinent to conclude:

The services provided to the older people in order to meet their problems are insufficient. Particularly, there is not enough homes for keeping the older people and the two homes available lack comprehensive good services and facilities as well as qualified staff. This is a consequence of low budget allocated by the Social Welfare Ministry as was pointed out by the focus group discussion. A high percentage of malnourished inmates were 50% at Alsagana older people's home and 75% in Bahri older people's home.

The studied group of high socio-economic status was found to be living a stable life within their families. They can afford means of entertainment, high quality and quantity of food items. But, they seem to lack adequate knowledge and awareness concerning their nutritional intake. This was observed through the high percentages of over weight 56.6% males and 66.7% females. Lack of nutritional knowledge was the most important risk factor facing this group and thus resulted in overweight.

Concerning the low socio-economic status group, in spite of the fact that they suffered from low income and affordability of needs, they were living in closely linked family interrelationship. This situation was of high significant impact ([X.sup.2] = 36.02, P = 0.0). Twenty percent of males in this group and 23.3% of females were over weight; which indicates lack of awareness and knowledge concerning their nutrition intake. On the other hand, approximately the Same percentage was found to be malnourished. This is a strong indication that older people of this group, in addition to the lack of awareness, cannot afford to meet their nutritional needs by taking a balanced diet. The main risk factors facing this group were lack of nutritional knowledge, un-affordability of their nutritional requirements and lastly lack of regular medical cheek-up.

Accordingly, the following recommendations were made:

* The Government should establish older people homes to accommodate the homeless ones.

* More attention should be dedicated to identify and look after the older who are homeless.

* Periodical surveys are to be conducted so as to monitor numbers of homeless older people.

* Services in the existing older people homes should be improved to meet the requirements of inmates.

* Employment of qualified staff so as to maintain a good quality services.

* Older people homes should open their doors for frequent visits of other older people living outside the homes so as to reduce the feeling of isolation among inmates.

* The Ministry of Social Welfare should provide appropriate funds to older people homes.

* Health and nutrition awareness should be provided through, television, radio, educational material and home visits by health providers to all older people in all socio-economic classes.

* The Government should increase the pensions of older people in low socio-economic classes and provide them with income generating activities that suit the health and age of older people.

* Strategies and policies within the health and Social Welfare system should be formulated to consider the older people as target group.

* Donors should be attracted to fund projects connected With the welfare of older people.

* Geriatrics units should be established within hospitals to provide proper medical assessment and rehabilitation for older people.

References

(1-) Abdel Magied, Ahmed and E1 Refaie, hind (2006): Assessment of the Nutritional Status and Health Risk Factors of Older Women in Khartoum "2". The Ahfad Journal Val. 23, No. 1 (Research note).

(2-) Ahmed, Awad Mohamed (2006). Diabetes Care in Sudan: Emerging Issues and Acute Needs. Diabetes voices: Volume 51 issue.

(3-) Ali, B.F, Samia and Abdel Magied, Ahmed (2005): Nutrition Status, Health Rick Factors and Food Security of Older Persons Living in Kass Province (South Darfur State). Case Study: Shattaya Fur. The Ahfad Journal Val. 22, No. 2 (Research note).

(4-) David, R. and Pass more, G.H. (1986): Human Nutrition and Dietetics. Nutrition Requirements of Older People. Churchill Living Stone, Edinburgh, London and New York.

(5-) Gregory, Kale and Peachy, Karen (1997): Assessing the Nutrition Vulnerability of Older People in Developing Countries. Help Age International and London School of Hygiene and Tropical Medicine. Help Age International Publication.

(6-) Help Age International (2008): Aging and Risk Factors: http://www.WHO.org

(7-) Ismail, Suraiya and Manadhar, Mary (1998): Better Nutrition For Older People. WHO Publication.

(8-) Saad, Marim and Abdel Magied Ahmed (2005): Nutrional Vulnerability and Health Risk Factors of Older Persons Living in Southern Darfur State. Case Study: Tuluz Province. The Ahfad Journal Vol. 22, No. 2 (Research note).

(9-) Sudan Ministry of Health (2006): Sudan House Hold Survey (SHHS). Central Bearau of Statistics, Khartoum, Sudan.

(10-) Suliman, A. (2000): Paper on Plan of Action on Ageing. Meeting of Experts to Develop a Policy Frame. Work and Plan of Action on Ageing, HAl, Kampala, Uganda.

(11-) UN (2002).World Population Aging: Department of Economic and Social Affairs Population Division United Nations.

(12-) WHO, (1994). Regional Strategy of Health Care of the elderly in the Eastern Mediterranean Region: 1992-2001. Regional Advisory Panel on Health Care for the Elderly. Alexandria, World Health Organization, Regional Office for the Eastern Mediterranean.

(13-) WHO, (1999). The Elderly in the Eastern Mediterranean Region: An Over View in Ageing. Exploding the Myths, International Year of Older Persons. Alexandria, World Health Organization Regional Office for the Eastern Mediterranean.

(14-) WHO (1999): Management of Severe Malnutrition by Physicians and Other Senior Health Workers, WHO Publication.

Abbas, M. Muna; Abdel Magied, Ahmed; Salih, Osama (School of Health Sciences and NCTR, Ahfad University for Women)

Table 1: Distribution of Alsagana and Bahri homes inmates by sex,
age group, level of education and marital station:

 Alsagana Bahri
 older older
 persons persons
Sex Frequency Frequency

Male 8 5
Female 0 3
Total 8 8

Age groupin ears
6069 5 5
7079 2 1
80 and above 1 2
Total 8 8

 Alsagana Bahri
 older older
Level of persons persons
education Frequency Frequency

Illiterate 3 5
Khalwa/primary 4 3
Secondary 1 0
Total 8 8
Marital status
Single 2 5
Married 1 3
Divorced 5 0
Total 8 8

Table 2: Distribution of Alsagana and Bahri homes inmates by health
problems and food intake problems:

 Alsagana Bahri
Health home home
problem Frequency Frequency

Week vision 3 4
Hypertension 1 1
Mobility 4 3
Total 8 8

 Alsagana Bahri
Food intake home home
problem Frequency Frequency

Chronic diseases 1 4
Disability 2 3
Mastication 5 1
Total 8 8

Table 3: Distribution of Alsagana and Bahri homes inmates by
nutritional status according to their BMI classification (WHO, 1999):

Nutrition status of
Alsagana inmates Frequency

<16=sever malnutrition 3

16 - 16.99 = moderate 0
malnutrition

17-18.49 = mild 1
malnutrition

18.5 - 24.99 = normal 4

>25 = over weight 0

Nutrition status of Bahri
inmates Frequency

<16 = sever malnutrition 3

16 - 16.99 = moderate 0
malnutrition

17 - 18.49 = mild 3
malnutrition

18.5 - 24.99 = normal 1

>25 = over weight 1

Table 4: Distribution of respondents of high socio-economic status by
sex and age groups:

 Age
 group in
Sex Frequency % years Frequency %

Male 30 50% 60_69 26 86.7%
Female 30 50% 70_79 04 13.3%
Total 60 100% Total 30 100%

Table 5: Distribution of respondents of high socio-economic status by
educational level and marital status:

Educational Male Female
level Frequency % Frequency %

Illiterate 02 6.7% 05 16.7%
Khalwa/primary 02 6.7% 12 40%
Secondary 10 33.3% 08 26.6%
University 16 53.3% 05 16.7%
Total 30 100% 30 100%

Marital status Male Female
 Frequency % Frequency %

Single 00 0% 00 0%
Married 20 86.7% 20 66.6%
Divorced 00 0% 00 0%
Widowed 10 13.3% 10 33.3%
Total 30 100% 30 100%

Table 6: Distribution of respondents of high socio-economic status by
health and food intake problem:

Health problem Male Female
 Frequency % Frequency %

Week vision 04 13.3% 00 00%
Deafness 03 10% 00 00%
Hypertension 05 16.7% 04 13.3%
Diabetes 06 20% 03 10%
Mobility 10 33.3% 13 43.4%
None 02 6% 10 33.3%
Total 30 100% 30 100%

Food intake Male Female
Problem Frequency % Frequency %

Mastication 10 33.3% 12 40%
Chronic diseases 00 0% 04 13.3%
(Hypertension/
Diabetes)
Disabilit 10 33.3% 06 20%
Total blinders 01 3.4% 03 10%
None 09 30% 05 16.7%
Total 30 100% 30 100%

Table 7: Distribution of respondents of high socio-economic status
by nutritional status according to their BMI classification
(WHO, 1999):

Nutrition status Male Female
 Frequency % Frequency %

<16 = sever 00 0% 00 0%
malnutrition

16 - 16.99 = 00 0% 00 0%
moderate
malnutrition

17 - 18.49 = mild 04 13.3% 02 6.7%
malnutrition

18.5 - 24.99 = 09 30% 08 26.6%
normal

>25 = over weight 17 56.7% 20 66.7%

Total 30 100% 30 100%

Table 8: Distribution of respondents of low socio-economic status by
sex and age groups:

Sex Frequency %

Male 30 50%
Female 30 50%
Total 60 100%

Age
group in Male Female
years Frequency % Frequency

60_69 18 60% 20 66.7%
70_79 10 33.3 10 33.3%
80 and+ 2 6.7 0 0%
Total 30 100 30 10%

Table 9: Distribution of respondents of low socio-economic status by
educational level and marital status:

Educational Male Female
level Frequency % Frequency

Illiterate 10 33.4% 16 53.3%
Khalwa/primary 16 53.3% 14 36.7%
Secondary 4 13.3% 00 0%
Total 30 100% 30 100%

Marital status Male Female
 Frequency % Frequency

Single 05 16.7% 0 0%
Married 20 66.6% 20 66.6%
Widowed 05 16.7% 10 33.4%
Total 20 100% 30 100%

Table 10: Distribution of respondents of low socio-economic status by
health and food intake problems:

Health problem Male Female
 Frequency % Frequency %

Week vision 12 40% 10 33.3%
Hypertension 05 16.7% 05 16.7%
Diabetes 07 23.3% 05 16.7%
Mobility 06 20% 10 33.3%
Total 30 100% 30 100%

Food intake Male Female
Problem Frequency % Frequency %

Mastication 20 66.6% 16 53.4%
Chronic diseases 05 16.7% 10 33.3%
(HEP./Dias)
Disability 00 0% 04 13.3%
None 05 16.7% 00 0%
Total 30 100% 30 100%

Table 11: Distribution of respondents of low socio-economic status by
nutritional status according to their BMI classification (WHO,1999):

 Male Female
Nutrition status Frequency % Frequency %

<16=sever 00 00% 00 00%
malnutrition

16 - 16.99 = moderate 00 00% 02 6.7%
malnutrition

17 - 18.49 = mild 06 20% 05 16.7%
malnutrition

18.5 - 24.99 = normal 18 60% 16 53.3%

>25 = over weight 06 20% 07 23.3%

Total 30 100% 30 100%