الفهرس 
physical growthOnly 14 pages are availabe for public view
 |  | from | 244 |  |  |
| | | from | 244 | | |
Abstract
In the field of assessment of growth and development, there is no international reference population suitable for use as a target in all countries due to differences in genetic and invronmental factors between them. In other words, standards of growth should be society specific.
This work aimed at providing paediatricians and health supervisors with standards for some antheropometric parameters (weight, height and sitting height) and bone age, suitable for evaluation of growth of rural and urban Egyptian school children. Also to comparing them with those in developed countries and studying the effect of sex and residence on the previous items.
To achieve this aim, a cross sectional study was carried out upon 400 healthy school children divided into 200 males and 200 females. They were chosen by random sample from urban and rural areas. The age of children ranged between (6-9) years, divided into (4) age groups, with one year intervals.
Each child in studied groups was subjected to the following examination:
5
— 150 -
I—Clinical examination: To exclude any child suffering from any skeletal deformity or any detectable chronic disease (such as, chronic heart, chronic asthma, chronic liver and renal
diseases)•
II—Assessmeent of growth and developement:
(A)Physical measurements of the parameters related to growth such as weight, height and sitting height.
(B)Skeletal maturation:
The right hand and wrist, used to be x—rayed, for skeletal examination and the assessment of skeletal maturity of children was done according to Tanner—Whitehouse method.
It was observed that, there was no statistical significance of differences neither between males and females nor between rural and urban mean chronological age in all age groups except one age group of 6 year.; between rural and urban.
On the other hand, the skeletal growth and maturation represented by skeletal age more advanced in tamales than males in all age groups. This sex differences increases with age especially in the PUS bone age (epiphyseal bones)• Also the sex difference is more pronounced for epiphyseal bones (RUS bone age) than for 20—bones and carpal, where it was statistically
significant in 4 age groups for RUS, while, it was
— 151 —
statitstically significant in one age group only for each 20—bones and carpal.
Also, we observed that, the skeletal maturation of the urban children more advanced than rural children in all age groups (for PUS, 20—bones and carpal bone age), and the difference was statistically significant in one age group only (6 years female) for both 20—bones and carpal bones.
It was to be noticed that, the mean PUS bone age for rural males was less than the mean chronological age in all age groups from 6-9 years, while, in advance of the chronological age in both urban males and females (urban and rural).
Also, the mean bone age of both (20—bones and carpal) for males (rural and urban) and for rural female was less than the chronological agei while, the mean bone age of both (20—bones and carpal) for urban female was advanced than the chronological age from 6 to 9 years.
Also, it was observed that, the difference between skeletal age and chronological age varied from age to age.
In comparison of our children mean (20—bones) bone age and that of Japanese children in Sappore, we observed that our
— 152—
children more advanced than that of the Japanese children.
But, in comparison of the skeletal maturity (bone age) of our children with the British children (standard), we observed that, in the standard films of our children, 79.2% of the male percentile of the bone age lies below the 50th percentile of the British standard (41.7 rural and 37.5 urban), while, 75% of the females lies above the 50th percentile of the British standard (29.2% rural and 45.8% urban).
Also, as regard to the percentils of the mean bone age of our children, we observed that, 62.5% of males of our children lies below the 50th percentile of the British children (45.8% rural and 16.7% urban), while 79.2 of females percentile lies above 5oth percentile (29.2% rural and 50% urban).
But, as regard to the median bone age (50th percentile) of our children, we noticed that, the median of RUS bone age of our males children (rural and urban) lies below the 50th percentile of the standard except age groups 8 and 9 years urban. While all females (rural and urban) 50th percentile lies above the 50th percentile of the standard.
— 153 —
Also, the median of 20—bones, bone age for our males children (rural and urban), lies below the 50th percentile of standard, while females (rural and urban) 50th percentile lies above the 50th percentile except the age groups 6 and 9 years rural.
While, as regard to the median carpal bone age for our children, we observed that, the median carpal bone age for our males children (rural and urban) and rural females lie,’ below the 50th percentile of the British standard, while all the urban females lies above the 50th percentile of the British children.
So, in general, we can say that our males children (rural and urban) are retarded than the British children as regard to skeletal maturation, while our females children are advanced than the British children.
It was to be noticed that, we could not compare our results with those in other Egyptian localities due to differences in the methods applied in the assessment of the skeletal maturation and the mariner of calculated chronological age.
1— Weights
As regard to the weight in the present study, we noticed that, males were heavier than females in general, especially the rural, but the difference of weight between males and females was
— 154 — not marked (less than 1 kgm) except in age group 9 years rural which is statistically significant, and sometimes, females weight even may very slightly exceed males especially in urban children.
Also, we found that, the urban children more heavier than rural children especially the females, and these differences were not statistically significant except in age group 9 years females, and sometimes rural children even may very slightly exceed urban children especially in males.
Also, we found that, the mean weight at the age of 6 and 9 years and the average increase of weight/years for rural males were higher than that of rural females. While, the mean weight at the age of 6 and 9 years and the average increase of weight/years for urban males were less than that of urban females.
Also, we found that, the mean weight of rural males at 6 and 9 years and the average increase of weight/year were higher than that of urban males, while againest these results in females.
In comparison of our children with the American standard (NCHS) for the weight, we observed that, the median weight (50th percentile) of our children lies below the 50th percentile of the
— 155 —
standard except in one age group (6 years female urban), which lies above the 50th percentile.
2— Stature (height)g
As regard to stature (height) in the present study, we observed that, males were taller than females in general, but these differences were not statistically significant except in age group 9 years rural.
Also, we observed that, the mean height at the age of 6 and 9 years in males (rural and urban) were higher than that of females (rural and urban) except at the age group 6 years urban.
Also, the average increase of height in males was higher than that of females.
It was to be noticed that, although during the period of age 6 to 9 years, the average increase in height in rural children (males and females) higher than urban children (males and females), but the mean height in urban children was higher than in rural children in• all age groups, and this difference was statistically significant in 5 groups.
— 156 —
In comparison of our children (males and females) with the American standards for the height (NCHS), we found that the urban 50th percentile for males and females lies below the (NCHS) standard, and the rural 5oth percentile for males and females lies relatively far lower from the (NCHS) standard, especially in the age groups 6 and 7 years.
But in comparison of our urban children (which belonged to a middle socioeconomic class) with the Japanese children in Sapporo, we found that, the mean height of the Egyptian children (males and females) was advanced than that of Japanese children (males and females) from the age group 6 to 9 years.
3— Sitting—heights
As regard to the sitting height in the present study, we observed that, the males were advanced than females in 4 age groups especially in urban children and these differences were statistically significant in two groups, and the females were advanced than males in other 4 age groups, especially in rural children but these differences were not statistically
significant.
Also, we observed that, the mean sitting height of urban
children more advanced than rural children in all age groups and
- 157 -
the differences were statistically significant in all age groups except one (age group 6 years male).
(C) Correlation between skeletal maturity and some anthropometeric measurements!
1-Weight:
We observed that there is positive correlation between skeletal age (RUE, 20-bones and carpal) and the weight in all age groups except in age group 6 years.
2-Height (stature):
We noticed that, there is positive correlation between skeletal age (RUS, 20-bones and carpal) and stature (height) in all age groups except in age group 6 years for RUS bone age only.
3-Sitting-Height:
We observed that, there is no constant positive
correlation between skeletal age (RUE, 20-bones and carpal) and sitting-height. There is positive correlation for RUS bone age in age group 7 years only, and for 20-bones in age groups 7, 8 and 9 years, but for carpal bone age, in age ’ groups 7 and 8 years.
— 158 —
RECOMENDATIONS
Lastly we recommend the following:
1—Dependence on the standards of developed countries to evaluate the physical and skeletal growth and development of the Egyptian children is unfair, due to differences exist in the genetic and environmental factors, so, there—is a need for local Egyptian standards for both physical and skeletal growth and development for the different age groups.
2—Prospective large scaled studies on physical and skeletal growth and development are required to clarify the issue of any significant difference between males and females or between rural and urban areas, and for estimating the mean bone age and the mean of different anthropometeric measurements at different age groups.
3—The most valid and reliable method for the assessment of skeletal maturity is the method adopted in this study, this will be of great help in comparison of different studies, in the fields of anatomy, pediatrics, and public health.
4—We hope to add a guide line for preparation of a special standards for the different localities in Egypt to be the base for a national collective Egyptian standard, according to update techniques.