International Journal of Medicine and Medical Sciences, ISSN: 2051-5731, Vol.46, Issue.3
1299
Prevalence of Scoliosis in Standard 6 Female Primary School Students in Marang District, Terengganu Kyin Htwe Faculty of Medicine and Health Sciences, UCSI University Terengganu Campus, PT. 11065, MukimRusila, 21600, Marang, Terengganu, Malaysia, Email:
[email protected]
Ahmad Tajuddin bin Abdullah Department of Orthopaedic and Traumatology, Hospital SultanahNurZahirah, Kuala Terengganu, Jalan Sultan Mahmud, 20400 Kuala Terengganu, Malaysia.,Email:
[email protected]
Azlin binti Amat KlinikKesihatan Kuala Berang, 21700, Hulu Terengganu, Terengganu, Malaysia, (Kementerian Kesihatan Malaysia)., Email:
[email protected]
Anisah binti Jalaluddin Faculty of Medicine and Health Sciences, UCSI University Terengganu Campus, PT. 11065, MukimRusila, 21600, Marang, Terengganu, Malaysia., Email:
[email protected]
Myat Moe Thwe Aung UniSZA, Kampus Kota, Jalan Sultan Mahmud, 20400, Kuala Terengganu, Malaysia., Email:
[email protected]
Min Swe Zaw Faculty of Medicine and Health Sciences, UCSI University Terengganu Campus, PT. 11065, MukimRusila, 21600, Marang, Terengganu, Malaysia., Email:
[email protected]
San Thitsa Aung Faculty of Medicine and Health Sciences, UCSI University Terengganu Campus, PT. 11065, MukimRusila, 21600, Marang, Terengganu, Malaysia.,Email:
[email protected]
San San Oo Faculty of Medicine and Health Sciences, UCSI University Terengganu Campus, PT. 11065, MukimRusila, 21600, Marang, Terengganu, Malaysia.,Email:
[email protected]
Aini bt Abu Bakar Faculty of Medicine and Health Sciences, UCSI University Terengganu Campus, PT. 11065, MukimRusila, 21600, Marang, Terengganu, Malaysia.,Email:
[email protected]
Asiah binty Wayakutty Faculty of Medicine and Health Sciences, UCSI University Terengganu Campus, PT. 11065, MukimRusila, 21600, Marang, Terengganu, Malaysia., Email:
[email protected]
ABSTRACT To determine the prevalence and associated risk factors of scoliosis, a cross-sectional study was conducted by using scoliometer, weighing machine and measuring tape. A structured questionnaire was given to 1001 standard 6 female students in 29 primary schools in Marang, Terengganu, Malaysia. Scoliosis screening was done by measuring Angle of Trunk Rotation (ATR) with scoliometer in 832 respondents from February to May 2013. Majority were Malay (98.8%) and 99.4% were 12 years old. Only 1% had family history. Prevalence of scoliosis identified by ATR ≥7˚ on screening was 2.0% and confirmed by Cobb’s angle in standing radiograph ≥10˚was 0.60%. ATR and age distribution, ethnics group and family history of scoliosis were not statistically correlated due to gross unequal distribution of variables. Only 32.6 % of students had menarche that was not correlated with ATR and Cobb’s angle. Weight and height was statistically correlated with ATR readings but not with Cobb’s angle. Girls in age of 12 years still have growth potential and risk of curve
progression. Further observation is needed in students with Cobb’s angle ≤10˚and ATR 5-6˚ group. Scoliometer is a reliable screening tool because of significant correlation between ATR and Cobb’s angle statistically. Scoliosis screening with scoliometer is recommended to implement in School Health Services for early detection of scoliosis before progression of curve in high risked standard 6 female primary school students.
Keywords-Scoliosis, Screening, Angle of trunk rotation, Cobb’s angle
1. INTRODUCTION Scoliosis Research Society (SRS) has defined scoliosis as a lateral curvature of the spine ≥10 degrees as measured Cobb’s Angle on a standing radiograph [1]. Eighty per cent of scoliosis is idiopathic. Adolescent idiopathic scoliosis (AIS) is the commonest type and it constitutes 90% of all cases. It is found between age 10 and 18 years
©RECENT SCIENCE PUBLICATIONS ARCHIVES| August 2013|$25.00 | 27702748 | *This article is authorized for use only by Recent Science Journal Authors, Subscribers and Partnering Institutions*
International Journal of Medicine and Medical Sciences, ISSN: 2051-5731, Vol.46, Issue.3
during skeletal maturity [1], [2]. The prevalence was increased significantly in 12 years old children, mostly in girls [3], [4]. In Malaysia, this age group is in standard 6, primary school [5]. School scoliosis screening was first conducted in Delaware in 1962 and wide spread in the United States and Canada. But routine screening in school has become a matter of controversy since 1996. Although school scoliosis screening has continued in many countries, Japan is the only one where nationwide scoliosis screening in school is mandated by law. In Singapore, it has been an effective screening program to detect scoliosis in schools since 1981. In Malaysia routine School Health Services cover children in Standard 1, 6 and Form 3 students, but scoliosis screening has not been part of it yet [5], [6]. Late presentation of large curves would be due to failure of early detection in the absence of screening program [7]. The incidence of scoliosis is more in girls than boys [2], [5], [8], [9]. Curves progression is also more in girls leading to disabling spine deformities and complications. Therefore girls are more commonly required monitoring and early intervention or treatments. To prevent such complications, early detection before curve progression is needed in 12 year-old girls [5], [7]. According to a study in Kuala Terengganu in 2004, the prevalence of scoliosis by screening with scoliometer in both girls and boys at age 12 years was 2.68%. Prevalence confirmed by Cobb’s angle was 0.53% [9]. Abnormal spinal curves are unlikely to be detected at an early stage unless scoliosis screening is implemented in School Health Services. For those reasons, scoliosis screening is recommended in standard 6, female, primary school students who are at risk [5], [9].
1.1 Justification of Conducting This Study Screening of scoliosis by using scoliometer in school students is simple, safe, non invasive, cost-effective [5], [10]-[12]. It can offer early referral for an appropriated treatment if the test is positive. This effort will hopefully increase the awareness of scoliosis to the students, parents and teachers. If it is incorporated nations’ wide in school health program, it can contribute early detection to prevent late presentation in students with risk of scoliosis.
2. METHOD
signed but not to consent and absent during data collection were excluded in this study. Respondents would be screened scoliosis by Scoliometer (MIZUH OSI, NP 1401 REV B, U. S. PATENTNO. 5,181,525). It is a tool to measure Angle of Trunk Rotation (ATR) in degree during Forward Bending Test (FBT). The students with ATR reading ≥7˚ would be referred to Spine Clinic in Hospital Sultanah Nur Zahirah, Kuala Terengganu for confirmation and further managements [10], [13], [14]. Scoliosis would be confirmed by measuring Cobb’s angle 10 degrees or more in standing spine radiograph [1]. Pearson’s chi-square, Simple logistic regression and Pearson’s correlation were applied in data analysis. The level of significance (α) of this study was set at 0.05.
3. RESULTS AND DISCUSSION Out of 1001 recruited, 832 students (83.1%) were included in this study. Dropout rate was 16.9%. Most of the respondents were Malay (98.8%) and the rest were Chinese (1.2%). Most of the students (99. 4%) are 12 years old. Only 1.0% of respondents were found to have family history of scoliosis. Mostly their siblings (50%) were affected the disease. Based on ATR ≥ 7 degrees, the prevalence of scoliosis by screening was 2.0%. Correlation between ATR reading and age of the respondents, race, menarche, positive family history of scoliosis were not significant due to gross unequal distribution of the variables.
3.1 Students with ATR ≥ 7 Degree Out of 832 respondents, 17 students (2.0%) with ATR ≥ 7˚ were referred to spine clinic for confirmation. Fourteen (82.35%) students followed up in spine clinic for radiological confirmation and further managements. Their Cobb’s angle ranged from 0 to 33 degrees (Figure 1). Students who had confirmed scoliosis by Cobb’s angle ≥ 10˚ were 5 (35.7%). Their Cobb’s angle ranged from 13˚ to 33˚. The prevalence of scoliosis confirmed by Cobb’s angle 10 degrees or more in standard 6 female primary school students was 0.60%.
Cross-sectional study was done among standard 6 female students attending 29 primary schools in the Marang District from February to May 2013. According to the schools' registry the total numbers of female population in study area is 1001. A questionnaire was structured to collect the information. It consisted of (a) students’ reference number, (b) name of school, (c) their completed year of age, (d) age of menarche, (e) race, (f) having family history of scoliosis and (g) the relationship with the respective student. The students who were with disability, failed to return questionnaires, without signed consent forms from parents or guardians, those whose parents or guardians
1300
Fig. 1 Scatter plots showing correlation between ATR degree and Cobb’s angle
©RECENT SCIENCE PUBLICATIONS ARCHIVES| August 2013|$25.00 | 27702748 | *This article is authorized for use only by Recent Science Journal Authors, Subscribers and Partnering Institutions*
International Journal of Medicine and Medical Sciences, ISSN: 2051-5731, Vol.46, Issue.3
Among 5 students who had confirmed to have scoliosis, 4 were Malay and 1 was Chinese girl. They were in 12 yearold. All of them had not attained menarche yet and did not have family history of scoliosis. The prevalence of scoliosis varied from 0.12% to 3.1% due to different age group and screening methods used [6], [14]-[17]. Other reason was the different degree of Cobb’s angle to confirm scoliosis [6], [15], [16], [18]. The prevalence of scoliosis in this study was comparable to the studies among 12 year-old students in Norway and Malaysia. In those studies ATR ≥7˚ was used as cut-off point for referral from screening. Referral rate was 1.5% in Norway and 2.68% in Malaysia. The point prevalence of scoliosis confirmed by Cobb’s angle ≥10˚ was 0.55% (0.40% in girl and 0.15% in boys) in Norway and 0.53% in Malaysia [8], [9]. Girls in age of 12 years still have growth potential and risk of curve progression. Further observation and close monitoring of curve progression by rescreening every 4-6 months is recommended in students with Cobb’s angle ≤ 10˚[19].
3.2 Students with ATR 5 - 6 Degrees and
