In the previous chapter, I examined the overall nutritional health of Marshallese school children. Compared to the World Health Organization (WHO) 2007 reference values, I found that Marshallese boys and girls in our sample were statistically significantly lower in average height at every age category. Both males and females were lower, on average, in weight-for- age across all age groups as well. Clinically speaking, the prevalence of stunting, classified as -2 standard deviations below the 2007 WHO reference means for each age group, was 31% and 38.7% for males and females, respectively, in our sample. Yet, surprisingly, none of the
Marshallese males or females in our sample was classified as “Severely Thin” and only three of the Marshallese males were considered “Thin” according to their body mass index. What this suggests is that although Marshallese males and females have considerably shorter heights compared to the reference, the extent of lower weights compared to the reference is not as severe. The disproportionate relationship leads to higher ratios in their body mass indices. This finding results in the calculation of “average” body mass indices for a majority of the sample compared to the 2007 WHO reference. In fact, body mass index actually revealed prevalent rates of overweight children, and to a lesser degree, obesity. Although this finding may reflect a secular trend in growth data, the results from the height-for-age and weight-for-age indices give pause.
As stated in the introductory chapter, this project began due to a pilot study developed in 2006 by a local committee of young professionals and government workers to investigate claims that private school children were outperforming public school children in growth and
academics. The pilot study revealed statistically significantly lower averages in height and weight among public school children when compared to private school children. Test scores and attendance were also found to be higher among private school children in that pilot study. As was tested in the previous chapter, the validity of the results of this pilot study were
unfortunately found to be suspect due to the inclusion of self-reported data (e.g., age), the absence of standardized anthropometric techniques, and a lack of repeated measures to determine the precision and reliability of the measurements taken.
Two of the original goals of the committee’s pilot study were to get an idea of the prevalence of undernourishment in children living on Majuro and then to compare children in public schools (who receive no school lunch or breakfast) with those in private schools (who do receive a school lunch and/or breakfast). The previous chapter met the first goal by identifying the prevalence of undernutrition of all sampled children attending school on Majuro Atoll. With the prior methodological errors addressed in the present study, I now approach the comparison of growth measures between the public and private school children.
The pilot study had two testable hypotheses and I will propose them again here. Of course, the 2006 pilot study utilized the CDC 2000 growth reference due to the absence of the WHO 2007 growth reference, published in 2007. Therefore, the following hypotheses are adjusted to reflect this dissertation’s current and appropriate methodology:
Hypothesis 1: There are no significant differences between the average height-for-age, weight-for-age, and BMI-for-age z-scores when comparing students attending Majuro primary public and private schools. Body composition measurement z-scores will reveal no significant differences between the two groups as well.
Hypothesis 2: Each of the groups sampled, public and primary school children, will not statistically significantly differ in their average attained growth measure z-scores when compared to the WHO 2007 reference population (deOnis 2007).
Additional Methodology
This comparison will use 308 males and 262 females (570 total) ranging from 5 to 14 years of age. This reduction in sample size from 588 to 570 Marshallese children was the result of missing birth certificates at the child’s school and the inability to confirm the child’s actual age. Another reduction occurred due to the small sample size of children in the age categories of four and fifteen years.
The children were divided into two categories to test my hypotheses; these categories were attendance at public versus private schools on Majuro. Our sample included 513 children attending public schools and 57 children attending private schools on Majuro Atoll. This sample configuration requires the combination of the age and sex groups because the division of the private school children into different age and sex categories would not yield a large enough sample for statistical analysis. The z-scores calculated for each anthropometric measurement allows me to combine the age and sex categories for public and private school children. The z- scores are representations of the number of standard deviations away from the reference mean and this calculation takes age and sex of the child into account. Therefore, it allows me to look at total data trends for all children attending either a private or public school while
Public vs. Private School Sample Composition
On first glance, the sampling of private school children appears very disproportionate to the public school children in our sample. Table 5.1 displays the distribution of children sampled from Majuro schools. Each potential school available for sampling is listed in the table as well. One can see the number of children sampled from each school and the percentage our sample represents from each school. Our sample shows approximately a 90/10 percent split between public and private school children.
Only one public school, Ajeltake Elementary, was not sampled and this occurred because multiple parent-teacher association (PTA) meetings were cancelled during the study period. The investigator was not able to present the project to parents or the teachers and so informed consent could not be delivered to parents. Delap Elementary represents just over a third of our sample of public school children. Rita, Uliga, and Delap elementary are located in the “urban” or most populated areas of the atoll. Together, they represent over 58 percent of the elementary school children sampled.
The definition of “urban” or “rural” communities on Majuro is a novel concept
introduced here. Gittelsohn (1998) defined all of the communities on Majuro as “urban”, but this study accepts that there are individual differences among the communities on Majuro. This concept will come into further focus later in this chapter as well as in later chapters. A point of admission will be made though, that these schools, especially Delap, may have been
oversampled. This potential oversampling was not by design. As stated in the methodology chapter, some schools were very open about participation in the study and I was allowed to visit these schools a number of days. Other school principals only allowed for fixed days to