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T.M.Maximova, E.P.Kakorina, E.V.Orlova

N.A.Semashko Institute for Research on Social Hygiene, Public Health, Economics and Management of the Russian Academy of Medical Sciences

Evaluation of children physical development as one of the population health status indices

Physical development indices that can react to many social, economic and ecological changes in the regions are one of the main criteria of rising generation health status.

Under present conditions when all vital capacity providing system is reorganized the society must regularly made physical development trends evaluations and in proper time provide support to children physical development that is a rising generations health foundation.

Both growth peculiarities and the forming of any physical development deviations reflect present economic situation, living conditions and life style of different population groups.

Children grow up in the worst conditions are really distinguished by rates of development process. Thus in the worse conditions the share of children with outstripping in height is less and that with backwardness in height and with deficit of body mass is larger (Table 1).

Table 1

Peculiarities of physical development in children at the age of 3-14 brought up under different conditions (‰)

Kemerovo

Salavat

Moscow

Peculiarities of physical development

1*

2**

1

2

1

2

with excessive height

34,0

16,5

20,0

16,7

29,2

22,6

with deficit of height

1,0

8,0

2,8

6,3

4,2

9,4

with deficit of weight

0,2

14,8

***

18,9

3,8

11,9

*1 - better conditions (good health status of matter, good nutrition and daily timetable)

**2 - worse conditions (opposite)

*** - not be meeting in our materials

In families of employees a share of children with accelerated height is considerably larger (20,6%) than in those of workers (12,3%). The same trend is observed in families with different incomes. Thus among children from families with high income the share of persons with outstripping in height is larger than among children from families with low income.

According to the data of foreign investigators a high height in boys and girls is noted in families with high income and private house. Several scientists consider a high height in adults as an indication of wellbeing in childhood.

Those biological growing processes in childhood are more accelerated in the better social environment.

Under the conditions of environmental changes it is observed how different doses of chemical substances influence metabolic and hormonal processes in organism provoking different changes of children height, weight and body mass. The small doses stimulate and the great doses depress this influence. A number of investigators note high indices of children physical development in regions with chemical composition of atmospheric air unfavorable for health. The scientists suppose that air pollution can result in partial acceleration of children growing and biological development following by health status worsening.

Those effects are observed more often when there are chemical factors of small intensity. When there is high level of air pollution one records more often a backwardness of physical development.

A number of researchers reveal that children physical development indices in the region with air pollution are lower than in those without it.

There is also information on the absence of air pollution influence on children physical development.

Thus though the research results are contradictory at times they undoubtedly indicate that it is necessary to study influence of pollute natural environment on children health status.

Results of our study revealed the dependence existing between children body parameters and the numbers of city population that to a certain extent define the peculiarities of child population living conditions and life style in settlements of different kinds.

Many deviations of physical development are recorded more often in children with chronic pathology. There are more healthy children among those who overtake in physical development the others at the same age than among those who backward the peers. A surplus or a deficit of the body mass is more rare in healthy persons, than normal weight. There is also the information indicated that physical activity influence frequency of chronic pathology in children (Table 2).

Table 2

Distribution of children without chronic diseases among persons with different evaluations of physical activity and body mass peculiarities (‰)

Territories

Number of children without chronic diseases

Physical activity

Body mass

Over a norm

Under a norm

Norm

Surplus

Deficit

Moscow

73,6

44,7

63,7

43,2

44,9

Kineshma

81,0

48,9

76,8

73,0

65,2

Vologda

66,2

34,3

71,9

55,3

62,1

Republic of Mary El (rural population)

77,8

60,7

80,1

36,4

63,0

Region of Saratov

72,2

10,0

69,7

55,6

38,9

In the city of Salavat diseases of nervous system and organs of senses was recorded in children more often in general in connection with anomaly of refraction and accommodation. They were recorded in 89,4 cases per 1000 in harmonically developed children and in 190 cases per 1000 in children with excessive weight at the age 0 - 14 years.

At the same time the children with insufficient weight more often had diseases of digestive system (139,5%.) than these ones with normal weight (36,4%.) and with excessive weight (95,2%.).

In the Khvalynsky district of the region of Saratov that has an iodine deficit the study of children physical development revealed a number of peculiarities. Thus mental disorders, genetic anomalies and diseases of nervous system and sense organs are recorded more often in the group with body mass deficit, but diseases of skin and hypodermic cellulose are recorded more often in children with excessive weight and height deficit.

In the group of risk for drug dependence and toxicomany the share of the persons with accelerated physical development is larger (22,6% for boys and 21,2% for girls) than that of the persons with underdevelopment (6,4% for boys and 5,3% for girls).

This indicates that it is necessary to evaluate the physical development more early and to make regular monitoring and opportune corrections of detected deviation.

The variety of physical development indices in different regions and population groups of our country is a result of interaction of organisms (their endogenous characteristics) and exogenous factors acting in different directions and over different period of children development and reflecting the adaptation of population to local circumstances, including environment toxic pollution.

Our analyze of the main physical development indices of children at the school age revealed that the data on existing sex differences in average rates of development are not statistically authentic for all age groups, although during the pubescence the girls overtake the boys in height and in many cases in weight also.

The problems of physical development acceleration, the evaluation of its paces in present time, its territorial peculiarities and genesis take an particular place in studying of the physical development patterns. Over the last years the new term "deceleration" appeared, that indicates on the complicated biological changing of the modern population.

We made an attempt to compare the levels of the morphologic development in children of different generations. The comparison of children body dimensions in Moscow in 1969-70,1979-81, 1993 revealed no change in the body length in these years (Table 3). N.A.Matveev and joint authors in the city of Nijny Novgorod (1988) received similar results.

Table 3

Dynamics of main indices of children physical development in city of Moscow

Age in

years

Boys

Girls

1969-70

1979-81

1993

1969-70

1979-81

1993

Length of body (cm)

6

115,9

117,8

118,6

115,7

117,3

118,1

7

123,9

124,0

122,2

123,5

123,3

122,6

8

129,7

128,2

129,0

129,0

127,5

127,1

9

131,6

134,4

134,7

133,9

133,7

134,3

10

140,3

139,9

141,3

140,3

138,4

140,3

11

143,4

144,6

144,5

144,6

143,8

144,5

12

150,0

149,1

151,0

152,8

151,4

152,1

13

156,7

155,5

157,5

156,8

157,2

159,1

14

162,2

162,3

164,7

160,9

159,2

162,3

15

166,7

168,6

167,9

161,9

160,6

162,4

Body mass (kg)

6

21,9

22,7

21,8

21,3

22,3

21,0

7

24,9

25,4

24,0

24,7

25,0

23,3

8

27,9

27,9

25,6

27,5

27,4

24,5

9

30,6

31,6

29,8

31,0

31,3

28,8

10

33,8

34,6

32,8

34,3

34,6

31,7

11

36,4

38,9

34,3

37,4

39,0

34,0

12

41,3

42,4

39,1

44,1

44,8

39,9

13

45,9

47,0

41,6

48,7

49,0

44,7

14

51,2

52,1

50,3

51,3

53,7

49,4

15

56,4

59,4

54,2

54,6

56,6

51,6

As for body mass there is its considerable decrease in all age groups of the Moscow population. This can be connected with the difficulties of children nutrition under modern conditions.

Our interview survey in the city of Kineshma revealed that more than half of physicians make limitations in food for their children. Study of T.K.Bekbosnov and joint authors (1992) indicated that deficit of protein in ration leads to decrease in paces of the muscular mass increasing.

According to the data of Ju.A.Jampolskaja and joint authors (1991) over the last years the clear trend to the increase of share of children with relative deficit of body mass and height is noted in the city of Moscow and the decrease of paces of children growth and development.

As children growth and development are indices of the nation health it is necessary to keep these indices under a dynamic surveillance using the appropriate instruments. "Interregional standards for evaluation of children length and body mass" can be using as such instrument. These standards are developed by the collective of authors on the base of the regularities of children growth and development and they make it possible to evaluate the physical development of every child regardless of his age, sex, nationality and place of residence.

For evaluation of children development we use a conventional scheme taking as a basis our methods and including 5 groups of children physical development evaluation.

The evaluation of children physical development in different regions of Russia by using unified comparable methods revealed both general and local problems of physical development evaluation in children of the different age groups. These data can be using in future for evaluation of dynamic changes in the health characteristics.

As to the children at the early age more than a half of them have a normal physical development in most territories. And in some regions the signified share of children (15-20%) has excessive body mass. With age the share of children having excessive body mass decrease and share of children with deficit of weight increase. The weight deficit has the greatest prevalence among the children at the school age.

Thus the problem of the great share of children at the early age with excessive weight is general for all territories. I.M.Vorontsova supposes that it can be connected with deviations in nutrition of children at such age, namely with excessive consumption of mealy food and deficit of vegetables and fruits. As a reasons for disharmonious development can be considered also the other factors including ecological and geochemical factors.

According to the evaluation using "Interregional standards" and indicated scheme among the children at the school age 68-70% have a normal physical development, 5-10% have a deficit of weight, 5-7% have a high height and 3-5% have a small height. But each territory has its own peculiarities. The share of children with a normal physical development is approximately the same in all compared territories (68-70%) excluding of Moscow where this share is considerably lower (64,6%) and of the city of Kaluga where the situation is more favorable (76% of children have a normal physical development, t > 2,0) (Table 4).

Table 4

Distribution of children at the age of 6-14 years in conformity with levels of their physical development in different regions of the country, 1992-1993 ().

Level of physical development

Moscow

Kaluga

Kineshma

Vologda

Nijny Novgorod

Vladivostok

Region of Saratov

Normal

64,6

76,0

69,5

68,6

69,7

67,8

70,2

Surplus of weight

11,4

6,8

13,9

7,0

6,5

7,1

14,2

Deficit of weight

10,9

8,0

4,8

12,4

15,5

10,9

3,8

Low height

2,8

2,2

7,5

6,0

2,5

2,7

4,7

High height

10,3

6,9

4,4

6,1

6,8

12,4

7,2

The different deviations of children physical development in the compared territories are also similar that indicates general mechanisms for the regulation of these conditions and maybe reflects the spectrum of morphologic and functional peculiarities of the rising generation. But in some territories the specific deviations are so great that they can be considered as situations called for profound study of local reasons for their forming.

First of all it is the large share of children with deficit of weight in the cities of Vologda (12,4%) and of Novgorod (15,5%) and the large share of children with low height in the cities of Kineshma and Vologda. There is the great share of children with high height in the city of Vladivostok, what is noted also in the other studies and can indicate the long action some local factors. According to the number of children having excessive weight the territories can be divided to two groups, the first group have the rate 7% (the cities of Kaluga, Vologda, Nijny Novgorod, Vladivostok), the second - 12-14% (the cities of Moscow and Kineshma and region of Saratov).

The analysis of spectrum of children physical development deviations in the city of Moscow calls for a specific attention. There is the comparatively small share of children with normal physical development and many children have the high rates of many other parameters there. One of hypotheses to explain this phenomenon can be the disbalanced influence of complicated social and ecological environment of the big city on different systems of organisms.

So the using of the unified methods for study of population physical development gives the possibility for the rightful comparison of data, for revealing not only general regularities but also local peculiarities of health characteristics and for evaluation of dynamic changes direction development.

Detected local peculiarities of physical development can be a foundation for making hypotheses on mechanisms of its deviations. The dynamic evaluation of children physical development is necessary for orientation of administrative organs in regions and territories on problems of efficiency of vital capacity providing system and on planification of the strategy for preventive work in treatment-and-protective institutions.

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