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Original Article
Assessment of Nutritional Status among Adolescent

Garo in Sherpur District, Bangladesh 

Tamanna S1, Rana MM2, Ferdoushi A3, Ishtiyaq Ahmad SA4, Rahman M5, Rahman A6

Abstract:
Background: Garo is one of the largest indigenous communities of Bangladesh. Adolescence is a gold-
en period of time for nutritional promotion. Adolescent nutrition did not receive adequate attention in
Bangladesh. Tribal people like the Garo are even more unaware about the importance of adolescent
nutrition. Objectives: To find out physical growth as well as nutritional status among adolescent Garo
children in Sherpur district on the basis of anthropometric indices. Methods and materials: This cross
sectional descriptive study was conducted among 384 adolescent Garo children (boys and girls) aged 10-
18 years. A structured pre-tested questionnaire and a checklist were used to collect data through inter-
view. Anthropometric survey of randomly selected adolescent was carried out and compared against the
NCHS/WHO reference indicators such as BMI-for-age, Height-for-age and Weight-for-age. Standard
methods were applied to measure the height and weight of the adolescent and BMI was calculated.
Associations of nutritional status with socio-economic status, maternal working status, family type and
family size were determined. Results: In most of the age groups it is notable that the mean height and
weight of both boys and girls were lower than the WHO/NCHS standards. The prevalence of thinness,
stunting and underweighting was 49.74%, 15.1% and 7.29% respectively. Conclusions: Significant
association between malnutrition and socio-economic parameters was observed. So socio-economic sta-
tus, maternal working status, family type and family size are important determinants of nutritional sta-
tus of adolescent. Therefore, comprehensive programmes are required to be undertaken for the overall
nutritional development of the Garo population with special focus on the adolescents. 

Kew words: Nutritional status, Adolescence, Anthropometry, Garo, Bangladesh.

Introduction:
Adolescents constitute a core resource of a nation
for national rejuvenation and augmentation. They
are a large and growing segment of the global pop-
ulation. Adolescence is a period in life when tran-
sition from childhood to adulthood takes place and

behaviours and life styles are shaped
1
. According

to the World Health Organization people aged
between 10-19 years are considered as adoles-

cence
2
. They form a distinct group in the society,

which is clearly different from children and the

adults. They need a special support, care and

require special health services
3
. Proper nutrition

during adolescence period can be an important link
in nutrition throughout lifespan. To invest in the
health and development of the adolescents is to
invest in the greater well-being of the country.
United Nations estimated that about 1/5th of the

total population of the world are adolescents
4
.

Again, among the total adolescents of the world,

about one-fifth (19%) live in Asia
5
. Bangladesh is

one of the world's most densely populated coun-

Corresponds to: Aysha Ferdoushi, Lecturer, Department of Biotechnology and Genetic Engineering,
Mawlana Bhashani Science and Technology University, Bangladesh. E-mail: nupur_bmb@yahoo.com

1. Sonia Tamanna, Department of Biochemistry and Molecular Biology, University of Dhaka, Bangladesh.
2. Md. Masud Rana, Department of Biotechnology and Genetic Engineering, Mawlana Bhashani Science

and Technology University, Bangladesh. 
3. Aysha Ferdoushi, Department of Biotechnology and Genetic Engineering, Mawlana Bhashani Science and

Technology University, Bangladesh. 
4. Shah Adil Ishtiyaq Ahmad, Department of Biotechnology and Genetic Engineering, Mawlana Bhashani

Science and Technology University, Bangladesh. 
5. Mustafizur Rahman , Department of Biochemistry and Molecular Biology, University of Dhaka,

Bangladesh.
6. Atiqur Rahman, Department of Biochemistry and Molecular Biology, University of Dhaka, Bangladesh.

Bangladesh Journal of Medical Science Vol. 12 No. 03 July’13

269



tries facing major health and economic challenges.
Rates of malnutrition in Bangladesh are among the

highest in the world
6
. Malnourished children are

more probable to grow into malnourished adults

who face heightened risks of diseases and death
7
.

Dr Sohail Ally reported that the adolescent popu-

lation in Bangladesh is 29.5 million
8
. Adolescent

growth spurt is delayed, extended, and less intense
in the Bangladeshi females than in their western

counterparts
8. Chronic energy deficiency, protein

energy malnutrition, low birth weight, micronutri-
ent deficiency are all serious problems in
Bangladesh. Although it affects people of all ages,
the children, women and the female adolescents

are mostly affected
9
. Again chronic under-nutrition

is considered to be the primary cause of ill health
and premature mortality among children in devel-

oping countries
10
.

In Bangladesh there are indigenous groups, approx-
imately 1.2 million and 1.13% of the total popula-

tion 
9, 11

. Among them the Garo is one of the largest
indigenous communities. According to the histori-
ans of this continent, the Garo tribe colonized
Bangladesh in the first century. They were
refugees from Mongolia and came to this region
through Tibet. Recent estimates suggest that in
total there are 97,695 Garo people. They live in
the north-eastern parts of the country especially in
Gajipur, Mymensingh, Netrakona, Tangail,
Sherpur, Jamalpur and some in Syllet districts

close to the Indian border
12
. The Garo tribe, like

every other indigenous community has its own cul-
ture. Their dresses, food habits and celebration
styles can be easily distinguished from the native
people and other tribes. Compared to the other
tribal groups, the Garo tribe is little advanced in
education and social activities. The problem of
food security is common in all the ethnic groups.
Being part of a developing country, the Garo com-
munity also suffers from poverty. Children belong-
ing to socially rearward groups like scheduled

castes
13

and tribes
14

are very much prone to malnu-
trition. In general, the tribal population is at a
higher risk of malnutrition, because of the socio-
cultural, socio-economic and environmental factors
influencing the food intake and health seeking

behaviour
15
. However, nutrition-related data of

adolescents in the Region is very scarce
16
. This

area obviously needs more focus. To protect Garo
adolescents from health risks and make healthy
choices, complete and disaggregated data (by age
and sex) must be collected. The objective of the
present study is to evaluate the nutritional status of
the Garo children aged 10-18 years using anthro-
pometric indices. The subjects for the present
cross-sectional study were selected from Jhenaigati
Upazila in Sherpur District, a hilly district of
Bangladesh that has a significant number (about
16232) of tribal people. 

Methods and materials:
This cross sectional study was conducted among
384 adolescent Garo children in Sherpur district,
Dhaka, Bangladesh. Among the 384 adolescent
children 209 (54.43%) were males and 175
(45.57%) were females. The study subject was
chosen following simple random sampling method.
Samples were collected from the place of residence
and schools.
The sample size (n) was calculated by the follow-

ing formula17:-

N=z
2
pq/d

2
=384

Where,
N= desired sample size
Z=normal standard deviation confidence level of
set will be 95%, which corresponds to 1.96
P=the estimated prevalence (assume 0.5 or 0.05)
Q= 1-p=1-0.5=0.5
D=degree of accuracy desired usually set at 5 %
(0.05)
A well structured questionnaire was developed to
obtain relevant information on anthropometric and
socioeconomic condition of the Garo adolescents.
All questions were customized and resettled to
obtain and record information easily. Nutritional
status was assessed by anthropometric measure-
ments such as height, weight, BMI using standard-

ized methodology
18
. Age of the subjects under study

was determined by interrogation and confirmed
through probing if the birth certificate were unavail-
able. The weight was measured by using digital
scale to the nearest 0.1 kg and height was measured
using anthropometer to the nearest of 0.1cm. BMI
was computed using the standard equation: BMI =
Weight (kg) / height (m2). Two nutritional indices
such as “weight for age z score” (WAZ), “height
forage z score” (HAZ) were calculated using World
Health Organization (WHO) standard (WHO,
2000). Z- Scores <-2 SD of the above indices were

Assessment of Nutritional Status among Adolescent Garo in Sherpur District, Bangladesh

270



considered as underweight (WAZ) and stunting
(HAZ). Data were analyzed by using SPSS Version
14.0. P-values of less than 0.05 were considered to
Local ethical approval was taken before study.

Results and Discussions:
Malnutrition continues to be a serious public health
problem in Bangladesh. Consecutive national nutri-
tion surveys reported high prevalence of malnutri-

tion in our country
19, 20. The nutritional status of

adolescent contributes significantly to the nutrition-
al status of the community. As adolescent is a crit-
ical period of growth and development, any pro-
gramme for a long-term effect on health should
have a focus on this period of life. The present
study was carried out among the Garo children
aged 10-18 years in Sherpur district to find out
their physical growth as well as nutritional status
on the basis of anthropometric indices.
Anthropometry is widely recognized as one of the
useful techniques for nutritional assessment
because it is highly sensitive to detect under-nutri-

tion
21
. It can be used to verify the existence of

nutritional problem in a population and to assess its
magnitude. These types of measurements are non-

expensive, need minimal training and readings are
reproducible.

Table I: Detail age and sex wise distribution of
the study sample

The age and sex distribution of the studied children
are given in Table I. A total of 384 adolescent
were studied.  Among them 209 (54.43%) were
male and 175 (45.57%) were female. Of them
11.19%, 8.07%, 25%, 11.46%, 14.58%, 16.14%,
7.55%, 2.86% and 3.12% children were in age
group 10, 11, 12, 13, 14, 15, 16, 17 and 18 years
respectively. 

Tamanna S, Rana MM, Ferdoushi A, Ishtiyaq Ahmad SA, Rahman M, Rahman A

271

Frequency Age in 
Years Male Female Total 

10 21(48.8) 22(51.2) 43(100) 
11 17(54.83) 14(45.17) 31(100) 
12 48(50) 48(50) 96(100) 
13 23(52.27) 21(47.73) 44(100) 
14 29(51.79) 27(48.21) 56(100) 
15 39(62.9) 23(37.1) 62(100) 
16 21(72.41) 8(27.59) 29(100) 
17 5(45.46) 6(54.54) 11(100) 
18 6(50) 6(50) 12(100) 

Total 209(54.43) 175(45.57) 384(100) 

Boys Girls 
Number 
examined 

Mean 
weight 
(kg) 

SD WHO/NCHS 
standard 
weight (kg) 

Number 
examined 

Mean 
weight 
(kg) 

SD WHO/NCHS 
standard 
weight (kg) 

p-
value 

21 27.36 3.37 31.4 22 28.18 4.21 32.5 0.481 
17 29.70 6.07 32.2 14 30.71 6.37 33.7 0.658 
48 36.12 6.78 37.0 48 37.06 6.69 38.7 0.519 
23 46.0 7.05 40.9 21 42.81 5.06 44.0 0.091 
29 46.24 5.53 47.0 27 43.26 5.53 48.0 0.049 
39 50.74 6.34 52.6 23 47.43 3.75 51.5 0.027 
21 53.19 7.18 58.0 8 45.13 5.35 53.0 0.008 
5 57.4 6.06 62.7 6 45.00 3.16 54.0 0.002 
6 57.84 4.66 65.0 6 45.5 2.66 54.4 0.000 

Table II: Comparison of mean weight of boys and girls

SD= Standard Deviation
Table II focused the mean weights of boys and girls of the study group. The mean weight of girls was
more than the boys till twelve years of age, there after the boys weighed more. In age group 16 to 18
there was statistically significant difference in the mean weight of the boys and girls. On comparison
with the WHO/NCHS standard the mean weight of boys and girls was found to be lower in most of the
age groups. Only thirteen years old boys weighted more than the standard value. It is noticeable that
the mean weight of girls was found to be much lower compared to WHO/NCHS standard.



Table III: Comparison of mean height of the study population

Height may be considered most representative characteristic of overall growth and development. Table
III represents the mean height of boys and girls. No significant mean height difference was found in 10,
11 and 12 aged adolescents but thereafter the boys were taller than the girls. In most of the age groups
it was notable that the mean height of both boys and girls was lower than the WHO/NCHS standards.
Only the boys aged thirteen years were taller than the standard height.

Table IV: Nutritional Status of Study population according to WHO International Classification of
underweight, overweight and obesity based on BMI

In the current study (presented in table IV) according to WHO reference standard 49.47% adolescents
were normal (BMI 18.5-24.99), 49.74% adolescents were undernourished (BMI<18.5) and rest 0.79%
were overweight and none of the adolescent was found to be obese. Boys suffering from chronic energy
deficiency grade I, II and III were 25.36%, 17.22% and 7.65 % respectively and for girls it was 71%,
16% and 7.03 % respectively. So girls were more undernourished than boys. 

Table V: Prevalence of stunting and underweight in study group according to WHO/NCHS standards

According to WHO/NCHS standards, 58 (15.1%) out of 384 adolescent were stunted, with 9 (2.34%)
adolescent showing severe grade of stunting (Table V). Among them girls (17.71%) were more stunted
compared to boys (12.91 %). However 28 (7.29%) adolescent were underweight with 1.56% showing
severe grade of underweight. Among them girls (10.86%) were more underweight than boys (4.3%).

Assessment of Nutritional Status among Adolescent Garo in Sherpur District, Bangladesh

272

Boys Girls 

Number 
examined  

Mean 
height 
(cm) 

SD 
WHO/NCHS 

standard 
height (cm) 

Number 
examined 

Mean 
height 
(cm) 

SD 
WHO/NCHS 

standard 
height (cm) 

p-
value 

21 132.14 7.82 137.5 22 132.32 6.05 138.3 0.79 
17 135.24 9.56 140.0 14 137.29 6.71 142.0 0.49 
48 143.94 8.87 147.0 48 140.16 6.68 148.0 0.64 
23 155.57 8.08 153.0 21 148.61 5.74 150.0 0.002 
29 154.62 5.77 160.0 27 149.19 5.91 155.0 0.001 
39 158.05 6.36 166.0 23 152.17 4.83 161.0 0.000 
21 161.76 5.88 171.0 8 149.13 4.73 162.0 0.000 
5 164.20 2.58 175.0 6 151.5 4.13 163.0 0.000 
6 163.67 1.96 177.0 6 149.67 3.07 164.0 0.000 

Age

10
11
12
13
14
15
16
17
18

Grade of Under 
nutrition 

BMI Cut off 
Value Kg/m2 

No. of adolescent 
boys (%) 

No. of adolescent 
girls (%) 

No. of total 
adolescent (%) 

Grade 3 Thinness < 16 16(7.65) 27(7.03) 43(11.20) 
Grade 2 Thinness 16.0-16.99 36(17.22) 28(16) 64(16.67) 
Grade 1 Thinness 17-18.49 53(25.36) 31(17.71) 84(21.87) 

Normal 18.5-24.99 103(49.28) 87(49.71) 190(49.47) 
Overweight 25-29.99 1(0.47) 2(1.14) 3(0.79) 

Obese >30 0 0 0 

Stunted Underweight 
 

Severe (%) Moderate (%) Total (%) Severe (%) Moderate (%) Total (%) 
Boys 

(n=209) 
3(1.43) 24(11.48) 27(12.91) 1(0.47) 8(3.83) 9(4.3) 

Girls 
(n=175) 

6(3.42) 25(14.28) 31(17.71) 5(2.85) 14(8) 19(10.86) 

Total  
(n=384) 

9(2.34) 49(12.76) 58(15.1) 6(1.56) 22(5.73) 28(7.29) 



Table VI: Prevalence of stunting and underweight in study group according to mothers’ working status

Table VI executed that the prevalence of stunting and underweight was higher among adolescent whose
mothers were housewives than those who are involved in different types of working. Similar study car-
ried out by Mukherjee et. al also found the parallel result.

Table VII: Prevalence of stunting and underweight with respect to socioeconomic status

Table VII represents that out of 384 study population 244 (63.54%) belongs to the family of farmer, 61
(15.89%) belong to day labourer, 47 (12.24%) belong to employee, 7 (1.82%) belong to small busi-
nessman and rest 25 (6.51%) from other category. Majority of the mothers 331(86.2%) were housewives
and most of them were illiterate. From this table it is revealed that of the 384 adolescent whose father
are day labour were more stunted (24.59%) and underweighted (21.31%) than those whose father are
employee, while the lowest prevalence of stunning(4.25%) and underweight (2.13%) were observed in
the adolescents whose father are employee. So, these figures suggest that socioeconomic conditions are
closely associated with nutritional status of the adolescents.

Table VIII: Prevalence of stunting and underweight in study group according to family type

Significant association was also observed between stunting, underweight and socio economic indicators
such as type of family (Table VIII). Prevalance of stunning and underweight was observed to be much
higher in the joint families compared to the nuclear families.

Table IX: Prevalence of stunting and underweight with respect to family size

Table IX represents that 114 (29.68%) adolescent children came from families consisting three-four mem-
bers, 199 (51.82%) were from families of five-six members and 71 (18.49%) were from families consist-
ing more than six members. Higher prevalence of stunning and underweight was observed in the families
having more than six members whereas lowest prevalence of stunning and underweight was seen in those
families having three-four members. Thus the present study implies that family size is significantly associ-

ated with nutritional status. Similar results have been reported by Gopaldas et al and Mukherjee et al. 
22,23

Tamanna S, Rana MM, Ferdoushi A, Ishtiyaq Ahmad SA, Rahman M, Rahman A

273

 thgiewrednU detnutSMaternal 
working status 

N (%) 
Stunted (%) Normal (%) Underweight (%) Normal (%) 

Working 53(100) 6(11.32) 47(88.68) 3(5.67) 50(94.33) 
Housewives 331(100) 52(15.71) 279(84.29) 25(7.55) 306(92.45) 
Total 384 58(15.10) 326 (84.9) 28(7.29) 356(92.71) 

 thgiewrednU detnutSSocioeconomic 
Status 

 
N Stunted (%) Normal (%) Underweight (%) Normal (%) 

Farmer 244 36(14.75) 208(85.25) 10(4.09) 234(95.91) 
Day  labour 61 15(24.59) 46(75.41) 13(21.31) 48(78.69) 
Employee 47 2(4.25) 45(95.75) 1(2.13) 46(97.87) 
Business 7 1(14.28) (85.72) 1(14.28) 6(85.72) 
Other 25 4(16) 21(84) 3(12) 22(88) 
Total 384 58(15.10) 326(84.9) 28(7.29) 356(92.71) 

 thgiewrednU detnutS
Type of family N (%) 

Stunted (%) Normal (%) Underweight (%) Normal (%) 

Nuclear family 347(100) 39(11.24) 308(88.76) 17(5.67) 330(94.33) 
Joint family 37(100) 14(51.35) 23(48.65) 11(29.72) 26(70.28) 
Total 384 58(15.10) 326 (84.9) 28(7.29) 356(92.71) 

Stunted Underweight Family  size 
(members) 

N 

Stunted (%) Normal (%) Underweight (%) Normal (%) 

3-4 members 114 13(11.4) 101(88.6) 5(4.38) 109(95.62) 
5-6 members 199 21(10.55) 178(89.45) 12(6.03) 187(93.97) 
Aove-6 members 71 24(33.81) 47(66.19) 11(15.49) 60(84.51) 
Total 384 58(15.1) 326(84.9) 28(7.29) 356(92.71) 



Figure I: Prevalence of stunted (a) and under-
weight (b) children with respect to different
socioeconomic parameters.
a.

b.

In Figure I, we have tried to summarize the find-
ings of the study with respect to the association of
different socioeconomic parameters with adoles-
cent nutrition of the subjected Garo tribe. From the
figure, we can see that the joint families, families
with more than 6 members and families of day
labourers are the worst in maintaining adolescent

nutrition. So, in order to improve the adolescent
health status we must give emphasis on these three
types of families.

Conclusion:
Adolescence is a golden period of time for nutri-
tional promotion as it is a vital phase of physical
growth and development in the lifespan. Another
proposition of adolescence in human life cycle lies
in its immediacy to later life. Thus, health and
nutritional status of adolescent children may have
great impact on the quality of the next generations.
According to UNICEF report there are 27.7 mil-
lion adolescents aged 10-19 years in Bangladesh –
13.7 million girls and 14 million boys – making up
about one fifth of the total population. Regardless
of all these important considerations, adolescent
nutrition did not receive adequate attention in
Bangladesh. Tribal people like the Garo are even
more unaware about the importance of adolescent
nutrition. The aim of this study was to prepare an
adolescent health profile for the adolescent Garo of
Jhenaigati upazila. The results of the present study
indicate that nutritional status of these children is
not satisfactory as more than half of the adoles-
cents are malnourished. This study also focuses on
some other contributing factors which may affect
adolescent nutrition like socio-economic status,
maternal working status, family type and family
size etc. There is much scope for the improvement
of their nutritional status. The economic status of
the parents must first be improved. Besides, the
parents must be cautious about the child health and
development. Children must be supplied with the
balanced diet.  Therefore valuable health and nutri-
tional endorsement programs can be started based
on the findings of this study with the eventual
objective of decreasing under nutrition and to
recover the health status of the adolescent.

Assessment of Nutritional Status among Adolescent Garo in Sherpur District, Bangladesh

274



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