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Relationship between life style, general health status and academic achievement of nursing students

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https://www.eduzhai.net Public Health Research 2013, 3(3): 54-70 DOI: 10.5923/j.phr.20130303.05 The Relationship between Lifestyle, General Health & Academic Scores of Nursing Students Marwa Omar Abd El-Kade r1, Fathia Attia Mohammad2,* 1Physician ,M inistry of Health (Egypt), Applied M edical Science Collage , KKU. (KSA.) 2Lecturer of M edical- Surgical Nursing faculty of Nursing, Zagazig University Egypt Abstract Background : Unhealthy behaviors and educational challenges may influence each other, or have common root causes. Health is an excellent indicator for the academic success of students that is an excellent indicator for the overall wellbeing of youth. Design: cross-sectional study. Aims: were to assess healthy & unhealthy habits among the nursing students, assess the impact of unhealthy habits on student general health & assess the impact of student general health on their academic scores. Tools: A designed questionnaire as well as anthropometric measurement was used to collect data. The results of the study revealed to The majo rity of participants were taking drugs without prescribed , didn’t practice exercise &medical checkup, & eat mo re spicy diet. The majo r health problems were abdo minal, pain, menstrual pain fell of tiredness& headache. In conclusion, the findings from this study revealed to: there were a positive relationship between health status, health habits, and academic score &unhealthy lifestyle behaviors' have impacts in students health & academic score. Reco mmendation : Universit ies need to pay attention to students health and wellbeing& a national program must be conduct to all students for improve healthy lifestyle awareness regarding healthy diet, importance o f exercise, and periodic medical checkup, as well as personnel hygiene and avoiding drugs abuse & its impacts in general health and success . Keywords Lifestyle, Healthy and Unhealthy Lifestyle General Health, Un iversity Students, Student Achievement 1. Introduction Lifestyle defined as it is a way of life or style of liv ing that reflects the attitudes and values of a person or group.[1&2] . A healthy lifestyle leaves you fit, energetic and at reduced risk for disease, based on the choices you make about your daily habits. Good nutrition, daily exercise and adequate sleep are the foundations for continuing good health.[3& 4]. A healthy lifestyle includes healthy habits. This means protecting your skin fro m the sun, practicing safe sex, getting regular health check-ups and avoiding substance abuse. Otherwise, healthy lifestyle habits include getting enough sleep, avoiding wo rk place accidents, and good oral hygiene . Moreovero, a healthy lifestyle is made up of a healthy balanced diet, regular exercise, good work-life balance and sleep with the absence of harmful drugs, alcohol, tobacco, illness and stress.[5&6] . The wo rd 'healthy' has several distinct senses or meanings: 1: having or indicating good health in body or mind; free fro m infirmity or disease; 2: exercising or showing good judgment, eating a variety of fo o d s [7]. Research shows that students have the best chance to succeed when they are healthy. “Health” in this context * Corresponding author: dr.fathia@yahoo.com (Fathia Attia Mohammad) Published online at https://www.eduzhai.net Copyright © 2013 Scientific & Academic Publishing. All Rights Reserved includes a nutritious diet, physical activity, emot ional well-being, safety and a sense of security, absence of chronic conditions such as asthma or diabetes, and access to physical/ mental health services. In the long run, unhealthy behavior interferes with a student's education and an individual's quality of life[8]. Health &wellbeing wellbeing have direct impact on success rates, attendance & academic performance.[9]. Previous studies clearly indicate that premature mo rbidity and mortality are primarily the result of unhealthy lifestyle behaviors[10, 11&12]. These studies focus to a large extent on lifestyle behaviors such as tobacco use[12], physical inactivity[13; 14; 15; 12], unhealthy diet[12,13, 14& 15] and use of alcohol[15; 16]. Despite the fact that benefits of modify ing lifestyle are increasingly demonstrated in clin ical and general populations, assessment of lifestyle and therapeutic lifestyle changes is neglected in practice behaviors relevant to health include physical activities, d iet, sleeping, s moking, drin king and drug consumption[17]. The high prevalence of sedentary behaviors, physical inactivity and unhealthy dietary habits among Saudi adolescents is a major public health concern, there is an urgent need for national policy pro moting active liv ing and healthy eating while reducing sedentary behaviors among Saudi children and adolescents[18]. Consumption of alcohol or other addictive substances is considered as "illegal" in Saudi Arab ia, as the law is based on Islamic Sharia rules, which forb id consumption of any Public Health Research 2013, 3(3): 54-70 55 amount of alcohol and other forms of substances. Therefore, for religious and legal reasons, any use of alcohol is considered as abuse by Saudi general public[16]. Drug abuse negatively impacts education in several ways: 1-Impaired Short Term Memory, even students who use marijuana, which is considered a mild drug, is doing those selves a disservice. Marijuana limits the brain's ab ility to retain informat ion. 2-Inability to Focus, drug abusers find it difficult to focus, particularly on tasks that require mental effort. A lack of focus generally leads to poor performance on schoolwork. 3-Vicious Cycle, the United Nations International Drug Control Program suggests that when students' educational performance goes down, their self-esteem suffers. This can cause a cycle of even lower academic performance and lower self-esteem that often drives students toward further drug use[19]. Studies have also shown that university students suffer fro m eating disorders and skipping meals is a co mmon habit . Eating habits affect the academic performance of students because study schedules or workload keep vary ing within and between semesters[20; &21]. Healthy diets help students focus longer, assist in brain development, and help instill an anxiety-free attitude to enhance learning[22]. Research shows students learn better when they're well nourished. Healthy eating has been linked to higher grades, better memory, more alertness, faster information processing and improved health leading to better school attendance, Conversely, unhealthy eating habits can negatively affect learning. Without proper nutrition and adequate calories, students often don't have enough energy to power the brain, resulting in fatigue and learning problems. Measurement of lifestyle behaviors is necessary for the identification of causal associations between unhealthy lifestyle and health outcomes However, despite considerable evidence for the importance of the assessment of lifestyle and therapeutic lifestyle changes in both clinical and normal populations, it still is underutilized[23]. Optimal sleep is an essential co mponent of healthy lifestyle. In general, college students do not get the required 9 hours of sleep for optimal alertness[24] The students who engaged in moderate physical activity were found to a have higher grade point average[25]. Ho wever students who exercised for an average of seven or more hours a week showed signs of addiction towards exercise and had relatively lo wer g rades[26]. It has been argued that health is an important factor for academic achievement in higher education[27]. Pro moting the health and well-being of all members means promoting effective learning[28]. It is widely accepted that health and well-being are essential elements for effect ive learn ing[29]. Education is a strong predictor of lifelong health and quality of life in d ifferent populations, settings, and time[30]. Many factors are associated with academic outcomes[31]. Adolescents who use alcohol, tobacco or other drugs achieved lower grades, had more negative attitudes toward school, and exh ibited increased absenteeism[32]. Furthermore, exercise seems associated with imp roved academic outcomes[33], and malnutrition additionally p lays an important role in academic performance[34]. Health and education may interact in three not mutually exclusive ways: 1) education may determine health; 2) one or more other factors may determine both health and education simultaneously; and 3) health may determine education[35]. Education and health are linked; unhealthy behaviors and educational challenges may influence each other. Health is an excellent indicator for the academic success of students. Enhancing student wellbeing and its pathways can increase academic achievement. The four main mechanis ms by which the enhancement of student wellbeing and its pathways can indirectly improve academic ach ievement are: By increasing student motivation to participate and achieve; By increasing student engagement with, and participation in, learn ing; By increasing student attendance and hence increasing school complet ion; and By decreasing problem behavior at school and hence decreasing levels of suspension and exclusion fro m school[36]. The majority of un iversity students are aged between 18 and 21 when entering university, a t ransition age to adulthood which is a time characterized by dramat ic changes in life. During university time they consequently adopt new health behaviors and there may be a risk that they continue with unhealthy lifestyle choices that were established during their university years, which makes them a risk group not only during these years but for the rest of their lives.[37]. A college student’s life contains many important factors that may hinder or imp rove it. These factors includes student’s living situation, health and of course academic performance. Academic achievement is extremely important for college students, as it is a main determinant of their future[38]. There is no study has yet been published on e.g., nursing students’ health promoting lifestyle p rofiles, particularly examining their relat ionship with academic performance and nursing courses[39]. 2. Subjects and Methods 2.1. Research Objecti ves 1- Assess the impact of unhealthy habits on student general health 2-Assess healthy & unhealthy habits among the nursing s tud en ts 3- Assess the impact of student general health on their academic scores 2.2. Methods 2.2.1. Design A cross-sectional designs was conduct to fulfill the goals of study 2.2.2. Sitt ing and Subjects 56 M arwa Omar Abd El-Kader et al.: The Relationship between Lifestyle, General Health &Academic Scores of Nursing Students One hundred & fifty undergraduate students from Applied Medical Science Collage, king Khalid University were participating in the study. The participants were eighteen years of age and older 2.2.3. Tool of the Study A self admin istered questionnaire sheet was developed by the researcher researchers after review related literature [40-47] in Arabic and distributed between students. Questionnaire sheet consists of 57 questions. The types of questions include mult iple choices, and true & false questions & it included 4 sections. The first one was regarding student & their family demographic characteristics (Q1 –Q7) e.g. age, ma rita l state, academic scores gained in next semester, family nu mber, & income & history for chronic illness. The second one cover student's lifestyle (Q8-Q48), wh ich includes alcohol &tobacco use, drug history, nutritional habits, sleep& exercise, & personnel hygiene. The third one covered general health condition (Q49) includes 63 sub questions cover major signs & sy mptoms of body system health problems . The fourth one covered Anthropometric measures (Q50-Q57) e.g. height, weight, body mass index, pulse, blood pressure, oxygen saturation, fasting blood sugar & hemoglobin. The coded data were input on Excel spread sheets and converted to SPSS for statistical analysis. Responses are coded as “yes = 1” and “no = 0,” which y ields a score range of 0 to 24, the negative impact questions were revised its score. For mu ltip le question scores range fro m 1- 5 (3 9q u es tio n ). 2.2.4. Imp lementation Strategy 2.2.4.1. Preparat ion for the Work A review of past and current literature was done ,official permissions were obtained fro m the Dean of collage. Pilot study was carried up on 5 students after the development of tools and before data collection. All needed equip ment were bought and agreement fro m hospital to sent blood sample in specific t ime was obtained. Researchers went to classes and students classified to 6 groups according to their academic schedule and informing each group for time of attendance to be sharing in the research. 2.2.4.2. Data Collection Procedures The data collect ion began in November 2011 till the end of January 2012. The data was collected fro m students during work hours of the college; all students were asked to answer each question at the same time with a pause between the questions to maintain unifo rmity of instructions or response to queries on any particular question. This also helped to minimize non-response on questions. The length of time needed for comp leting the questionnaire was ranged fro m hour to half past hour When participants arrived fo r the setting , they were seated with sufficient space between each person and informed about the nature, purpose, and benefits of the study, her participation is voluntary, also provided with basic instructions on how to complete the questionnaire. Participants are asked to respond to each question according to their typical performance during the past 3 months ,after completed questionnaire, give it fo r researchers and she becomes ready to take her anthropometric measures including height, weight, pulse, b lood pressure, o xygen saturation blood glucose test and taking blood samp le for hemoglobin analysis. The academic score for each student was printed to ensure its validity. Body mass index (BMI) was retrieved by using a formula dividing the individual’s body weight in kilograms by the square of their height. An index <20 is classified as underweight, 20-25 is rated norma l or optima l weight and an index >25 is considered overweight. Pulse, O2 saturation & blood pressure were measured by using electronic vital signs machine as well as measured blood sugars by using electronic glucose test apparatus. Hemoglobin level was test by taking2cc blood sample fro m each student & sends for private laboratory investigation to test (Hammed hospital), due to the apparatus of Hemoglobin was too expensive to buy it. Plas ma glucose level classified according to A merican diabetic association to normal who had Fasting plas ma glucose of 70-110 mg/dl , prediabetic that who had fasting plasma glucose 111-125mg\dl & diabetic who had fasting plasma glucose >126 mg\dl . According to result of hemoglobin test , participants were classified to mild, moderate or severe anemic according to WHO. M ild anemia corresponds to a level of hemoglobin concentration of 10.0-10.9 g/dl; moderate anemia corresponds to a level of 7.0-9.9 g/dl, while severe anemia corresponds to a level less than 7.0 g/dl. O2 saturation: measure of amount of O2 bound to hg are assessed by pulse oximeter (SpO2) its normal is >95% on room air. The American Heart Association identifies the following categories in persons not receiving antihypertensive med ications: Normal 120\80, High normal (pre hypertension) 120–139 \ 80–89,Stage I HTN 140–159\ 90–99 & Stage II HTN 160 \ 100[48] . 2.2.5. Eth ical Considerations The Ethics and Research Co mmittee in KKU was approved the study protocol. Confidentiality of the subjects were a lso assured through coding of all data. The researcher assured that the data collected and informat ion will be confidential and would be used only to imp rove their health and for the purpose of the study. Statistical Anal ysis The statistical analysis of data done by using excel program for figures and SPSS (SPSS, Inc, Chicago, IL) program statistical package for social science version 16. The description of the data done in form of mean (+/-) SD for quantitative data ,Frequency & proportion for Qualitative data .The analysis of the data was done to test statistical significant difference between groups. Chi-Square test was Public Health Research 2013, 3(3): 54-70 57 used to compare qualitative data. Spearman correlation test was used to test association between variables N.B: P is significant if < or = 0.05 at confidence interval 95% . 3. Result The majority of participants were aged 20years old, virgin (92% & 93.4% respectively). About three quarter their Academic score were ranged between 2.5to 4,(74.7%). Among participants weight, 70.7% had change in their weight in past 6 months, 62.3% out of them had increased in weight & only 17.3% taken some things to deceased her weight. On the other hand , 70.7% think that had an ideal weight. Also table indicates to majority of participants had family h istory to health problems, & & mo re than half had family s moking history &had sufficient family income(83.3, 52.7, &52.7% respectively). Table(1). The majo r health problems as reported by participants were hypertension followed by diabetes & anemia ( fig.1). Table 1. Demographic characteristics' of participants (N=150) Items No % Age 1.18-20 12 8 2.>20 138 92 Marital state 1.married 5 3.3 2. never married 140 93.4 3.divorce 5 3.3 Family health problems 1.yes 125 83.3 2.no 25 16.7 Family income 1. in sufficient 19 12.7 2. sufficient 79 52.7 3. sufficient& more 25 34.6 Academic score 1.<2.5 24 16 2.2.5-4 112 74.7 3.>4 14 9.3 family smokers 1.yes 79 52.7 2.no 71 47.3 Wt. change past 6 month 1.yes 106 70.7 2.no 39 26 3.didn’t know 5 3.3 Wt changes was 1. Increase 66 62.2 2. decrease 40 58.7 Are taken some thing to inc\ de. your Wt 1. Yes 26 17.3 2.no 124 82.7 If yes, What you taken 1.dietary program 20 13.3 2. herbs 6 4 3.nothing 124 82.7 61 DM 21 Anemia Liver 5 25 Non 87 HTN Figure 1. Percentage Distribution of family history to chronic illness 58 M arwa Omar Abd El-Kader et al.: The Relationship between Lifestyle, General Health &Academic Scores of Nursing Students 60% of participants hadn’t feels hunger past 6 months, nearly tow third had taken meals at their house(64%) , wh ile only 58.7% were maintained on taking healthy foods & all participants were used plenty oil & majority of them were taken snack between meals , (94%) represent in chips, juice, biscuit & hazels (59.3%, 39.3%, 20.7%, 16% respect.),they taken for 1-2 time\day(39.3% ), 3-5time\day (31.3% ) & more than 5time \day( 23.3%).More ever, 62% hadn’t source of drin king water at ho me, majority of hadn’t source of drinking water at home were used bottles (93.5%) & nearly half of part icipant were d rin king 4-6 moderate coup of water per 24 hours(47.3%) (Table,2 & figure 4). Regarding to participants sleeping & exercise, there were only 22.7% practice exercise regularly, 61.7% out of them were pract ice walking exercise for tree t ime per week for more than one hour per time .70.7% didn’t practice exercise due to hadn’t time wh ile , majo rity were wanting in sharing in exercise program(84%). Regarding sleeping , as reported by participants , more than half were slept for 4-8 hour per day (54%), the same proportion had interrupted sleeping, more than tow third had difficult to get sleeping(68.7%) & majority needs day sleeping , didn’t taking alert or sleeping drugs(82.7, 78.7,&84.7% respectively) Tab le (3). Table 2. Assessment of part icipant s dietary Habit s (No =150) Items No % Fells hunger due to insufficient diet at house in past 6m. 1. never 91 60 2. 1-5 3. 6-10 4. >10 12 8 13 8.7 14 9.3 Taking meals at home 1. yes 96 64 2. no 54 36 If No why 1. Iam outside 75 50 2. better outside diet 4 2.7 3. for change 17 11.3 Maintain taking healthy food 1. yes 88 58.7 2. no 62 42.3 Oil used at home 1. planti 150 100 2. butter 0 0 Takes snake between meals 1. yes 2. no 141 94 9 6 Have healthy water source at home 1. yes 57 38 2. no 93 62 If no , source of drinking water at home 1. bottles 2. filter 78 93.5 15 16.5 Cups of water drinking \ day 1.1-3 2.4.6 50 33.3 71 47.3 3.>6 29 19.4 60 54 50 40 28 30 20 10 5 5 0 FATHER HUSBANDBROTHER OTHER FAMILY SMOKERS 47 16 16 1:5 6:10 10< SMOKING NUMBER 35 30 14 1:5 6:10 10< PERIOD OF SMOKING Figure 2. Percentage Distribution of family smoking history Public Health Research 2013, 3(3): 54-70 59 Table 3. Assessment of participants sleep & exercise ( No 150) Items - Practice exercise regularly - If not , why If yes, 1- types of exercise 2- frequency\w 3- time spent - Want to participate in exercise program - Sleeping hours \ day - Quality of sleeping - Difficulty to get in sleeping - difficulty to awaking - needs day sleeping - taking alert drug - Hours of sleeping at night - taking sleeping drugs 1.yes 2.no 1- Don’t like 2- No time 3- Weak health 1 - walking 2 - volley \ basket 1- one time 2- towtime 3- three time 1 - 30 min 2 - 31-60 min 3 - >60 min 1 - yes 2 - no 1- < 4h 2- 4-8h 3- >8h 1 - calm 2 - interrupted 1- never 2- sometime 3- usually 1- never 2- sometime 3- usually 1. yes 2. no 1. yes 2. no 1 - 10-11 2 - >11-12 3- >11-1 4- >1 1. yes 2. no No % 34 22.7 116 77.3 25 21.5 82 70.7 9 7.8 21 61.7 13 38.3 8 23.5 9 26.5 17 50 11 32.3 6 17.7 17 50 126 84 24 16 23 15.3 81 54 46 30.7 69 46 81 54 13 8.7 103 68.7 34 22.6 47 31.3 80 53.3 23 15.4 124 82.7 26 17.3 32 21.3 118 78.7 36 24 45 30 49 32.7 20 13.3 23 15.3 127 84.7 Table 4. Assessment of participants personnel hygiene (No =150) No of bath \ w Periodic checkup If no, why Items Hand washing Brushing teeth No of brushing teeth last week Brushing teeth after meals General health is 1 - one 2 -tow 3 – three 1. yes 2. no 1- haven't problems 2-haven't time 3- not important 4- expensive 1-before meals 2- after meals 3- before toilet 4- after toilet 1 – yes 1- 1-3 2- 4-6 3- daily 1- yes 2- no 1- poor 2- moderate 3- good 4-perfect No % 26 17.3 68 45.3 56 37.4 0 0 150 100 94 62.7 20 13.3 24 16 12 8 140 93.3 150 100 81 54 150 100 150 100 27 18 14 9.3 109 72.7 31 20.7 119 70.3 14 9.3 38 25.3 84 56 14 9.4 60 M arwa Omar Abd El-Kader et al.: The Relationship between Lifestyle, General Health &Academic Scores of Nursing Students Table 5. Correlation of Participants' Academic scores & Selected Demographic Characteristics Demographic Characteristics Age Family health problem Family income Family smoking General health Educational satisfaction Weight changes 18-20y >20y Yes No Un sufficient Sufficient Sufficient & safe Yes No poor Mo derat e Good P erfect Yes No Yes No Didn’t Know Academic scores <2.5 2.5-4 >4 tot al 6 6 0 12 18 106 14 138 19 92 14 125 5 20 0 25 0 19 0 19 19 51 9 79 5 42 5 52 14 62 2 78 10 50 12 72 0 14 0 14 5 9 0 14 5 33 0 38 14 56 14 84 20 64 9 93 4 48 5 57 15 82 9 106 9 30 0 39 0 0 5 5 *Significant Table 6. Correlat ion of P art icipant s' Academic scores & Major Habit s Life style habits <2 Used drugs Without order -Yes 24 -No 0 Taken meals at house -Yes 13 -No 11 Taken snakes -Yes 24 -No 0 Practice exercise -Yes 0 -No 24 Sleeping hours\d 1- < 4h 0 2- 4-8h 19 3- >8h 5 Sleep Quality - Quite 6 - Interrupted 18 *Significant Academic scores 2.5-4 >4 tot al 79 0 103 33 14 47 73 10 96 39 4 54 103 14 141 9 0 9 34 0 34 78 14 116 19 4 23 57 5 81 36 5 46 54 15 69 58 5 81 Chi-S qua re P value .003* .200 .013* .000* .003* .055 .000* Chi-Square P value .000* .494 .197 .001* .036* .002* Among participants personal hygiene & general health,45.3% had taken bath twice\week, 37.4 had taken bath three\week. All participants hadn’t applied periodic checkup(100%), 62.75 hadn’t applied periodic checkup because hadn’t health problems. Also, all part icipants were washing hands before handling meals & after using toilet ,& brush her teeth(100%), 72.7 out of them brush teeth three time per week. More than half view their health were good follo wed by quarter view their health were moderate(56, 25.3% respectively) ( table(4) There were a significant relat ionship between participants academic score & selected demographic characteristics among family income, s moker, participant age, general health, &weight changes ( P value < 0.05) ( table 5). There were a significant relationship between participants academic scores & major Hab its regarding drugs used past 6 months, practice exercise , sleeping hours & quality of sleeping ( P value < 0.05) ( table 6). There were a significant relat ionship between participants academic scores & meals habits among place of breakfast , time & place of both lunch & dinner ( P value < 0.05) (table 7). There were a significant relationship between participants academic scores & nutrients' Intakes past month regarding frequently taking meat, poultry, milk, eggs, fish, bean, vegetables, fruit, candy, salty & spicy diet, tea, coffee, soft drinking. Fresh juice &starchy diet( P value < 0.05) ( table 8). There were a significant relat ionship between participants academic scores &major health Problems & Anthropometric Measurements regarding who suffer fro m fainting, general weakness, Loss of appetite, abdominal pain, nausea,irregular menses , in concentration, tiredness, depression, joint pain, & all Anthropometric Measurements of BMI, Bp, B.G., & Hg. ( P value < 0.05) ( table 9).There were a significant relat ionship between participants AnthropometricMeasurements& their nutrients intakes ( table 10) Public Health Research 2013, 3(3): 54-70 61 120 113 Figure 3. Percentage Distribution of participantsto common drugs taken 100 80 65 60 40 40 29 59 47 35 20 6 9 0 CHIPSY BISCUIT JUICE HAZELS FRUITS NEVER 1:2 3:5 5 < EATING SNACKS TIMES Fi gure 4. P ercent age Distribut ion of part icipant s to common snackt aken Breakfast Lunch Dinner Table 7. Correlat ion of P art icipant s' Academic scores & Meals Habit s Meals Time 6-8 >8 Academic scores <2.5 2.5-4 >4 tot al 11 41 9 61 13 71 5 89 Place Out H In H Time No 1-3 >3 Place No Out H In H 24 86 0 26 0 16 24 65 0 31 0 16 0 10 24 86 5 115 9 35 5 21 9 98 0 31 5 21 0 10 9 119 Time No 9-11 >11 Place No Out H In H 0 15 15 81 9 16 0 15 6 6 18 91 0 15 14 110 0 25 0 15 1 13 13 122 Chi-Square P value .118 .000* .000* .010* .003* .006* *Significant 62 M arwa Omar Abd El-Kader et al.: The Relationship between Lifestyle, General Health &Academic Scores of Nursing Students Table 8. Correlat ion Bet ween P art icipant s Academic Scores & Nut rient s' Intakes Type of nutrients' Animal meat 1-5 6-15 >15 Poultry 1-5 6-15 >15 Milk 1-5 6-15 >15 Eggs 1-5 6-15 >15 Liver 1-5 6-15 >15 Fish 1-5 6-15 >15 1-5 bean 6-15 >15 1-5 Nut s 6-15 >15 1-5 Veget ables 6-15 >15 1-5 Fruit s 6-15 >15 1-5 Sugary 6-15 >15 1-5 Dat e 6-15 >15 1-5 Canned food 6-15 >15 Salty food 1-5 6-15 >15 Spicy 1-5 6-15 >15 Tea 1-5 6-15 >15 1-5 Coffee 6-15 >15 Soft drinks 1-5 6-15 >15 Juice 1-5 fresh 6-15 >15 St arch y 1-5 6-15 >15 *Significant <2.5 No % 0 .0 24 16.0 0 .0 4 2.7 4 10.7 16 2.7 4 .0 5 3.3 19 12.7 6 4.0 14 9.3 4 2.7 18 12.0 6 4.0 0 .0 5 3.3 15 10.0 4 2.7 0 .0 24 16.0 0 .0 5 3.3 11 7.3 8 5.3 0 .0 6 4.0 18 12.0 4 2.7 10 6.7 10 6.7 5 3.3 11 7.3 8 5.3 11 7.3 9 6.0 4 2.7 4 2.7 14 9.3 6 4.0 24 16.0 0 .0 0 .0 00 00 10 6.7 14 9.3 13 8.7 6 4.0 5 3.3 9 6.0 6 4.0 9 6.0 9 6.0 11 7.3 4 2.7 8 5.3 6 4.0 10 6.7 4 2.7 6 4.0 14 9.3% Academic Score % 2.5:4 >4 No % No % 36 24.0 0 .0 55 36.7 14 9.3 21 14.0 0 .0 16 10.7 0 .0 56 26.7 14 .0 40 37.3 0 9.3 5 6 0 .0 72 48.0 4 2.7 31 20.7 10 6.7 19 12.7 5 3.3 80 53.3 4 2.7 13 8.7 5 3.3 76 50.7 14 9.3 30 20. 0 .0 6 4.0 0 .0 65 43.3 10 6.7 41 27.3 4 2.7 6 4.0 0 .0 33 22.0 9 6.0 63 42.0 5 3.3 16 10.7 0 .0 30 20.0 4 2.7 60 40.0 10 6.7 22 14.7 0 .0 17 11.3 0 .0 61 40.7 9 6.0 34 22.7 5 3.3 22 14.7 0 .0 67 44.7 14 9.3 23 15.3 0 .0 11 7.3 0 .0 54 36.0 9 6.0 47 31.3 5 3.3 40 26.7 5 3.3 48 32.0 9 6.0 24 16.0 0 .0 20 13.3 0 .0 51 34.0 4 2.7 41 27.3 10 6.7 28 18.7 9 6.0 41 27.3 5 3.3 43 28.7 0 .0 00 00 00 00 31 20.7 9 6.0 81 54.0 5 3.3 41 27.3 0 .0 33 22.0 14 9.3 38 25.3 0 .0 21 14.0 0 .0 39 26.0 9 6.0 52 34.7 5 3.3 11 7.3 0 .0 37 24.7 5 3.3 64 42.7 9 6.0 26 17.3 0 .0 77 51.3 4 2.7 9 6.0 10 6.7 6 4.0 0 .0 49 32.7 0 .0 57 38.0% 14 9.3% Tot al No % 36 24.0 93 62.0 21 14.0 20 13.3 74 37.3 56 49.3 9 6 81 54.0 60 40.0 30 20.0 98 65.3 22 14.7 108 72.0 36 24.0 6 4.0 80 53.3 60 40.0 10 6.7 42 28.0 92 61.3 16 10.7 39 26.0 81 54.0 30 20.0 17 11.3 76 50.7 57 38.0 26 17.3 91 60.7 33 22.0 16 10.7 74 49.3 60 40.0 56 37.3 66 44.0 28 18.7 24 16.0 69 46.0 57 38.0 61 40.7 46 30.7 43 28.7 00 00 50 33.3 100 66.7 54 36.0 53 35.3 43 28.7 30 20.0 54 36.0 66 44.0 20 13.3 53 35.3 77 51.3 34 22.7 87 58.0 29 19.3 10 6.7 55 36.7 85 56.7% Chi-S quare P value .000* .000* .000* .024* .108 .005* .000* .175 .000* .004* .282 .263 .051* 000* .015* .000* .025* .000* .000* .001* Public Health Research 2013, 3(3): 54-70 63 Table 9. Correlation of Participants' academic Score with Major health Problems & Anthropometric Measurements Major Health problems & Anthropometric Measurement s <2.5 2.5-4 Faint in g Yes No Un cert ain 5 35 19 54 0 23 General weakness Yes No Un cert ain 5 39 0 29 19 44 Loss of appetit e Yes No Un cert ain 0 57 18 50 6 5 Abdominal Pain Yes No Un cert ain 6 47 18 65 0 0 Nausea Yes No Un cert ain 0 42 18 65 6 5 Recurrent headache Yes No Un cert ain 11 57 13 50 0 5 Menses pain Yes No Un cert ain 16 82 8 30 0 0 Menses irregularity Yes No Un cert ain 4 27 20 67 0 18 In concentration Yes No Un cert ain 0 39 24 67 0 6 Tiredness Yes No Un cert ain 5 82 19 30 0 0 Depression Yes No Un cert ain 0 39 24 68 0 5 Joint pain Yes No Un cert ain 5 39 19 67 0 6 BMI - <20 - 20:25 - >25 9 36 4 62 11 14 Bp - < 1oo\60 15 37 - 100\60- 140\80 4 60 - >140\80 6 14 Bl. Glucose - 70-125 ->125 20 92 4 20 Hb - <10 - >10 0 9 24 103 *Significant >4 Tot al Chi-S qua re P value 0 40 14 87 .000* 0 23 0 44 0 29 .000* 14 77 5 62 9 77 .000* 0 11 10 63 4 87 .020* 0 0 0 42 14 97 .000* 0 11 10 78 4 67 .378 0 5 9 107 5 43 .674 0 0 10 41 4 91 .000* 0 18 0 39 14 105 .000* 0 6 9 96 5 54 .000* 0 0 0 39 14 106 .000* 0 5 0 44 14 100 .021* 0 6 0 45 10 76 4 29 .000* 5 57 6 70 .003* 3 23 10 122 4 28 .030* 5 14 9 136 .000*

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