RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES
BANGALORE, KARNATAKA
ANNEXURE – II
Proforma for Registration of Subjects for Dissertation
1. / NAME OF THE CANDIDATE AND ADDRESS / : / DR. KAREN JANICE MORASPOST GRADUATE IN PEDIATRICS,
VISHRANTHI DHAMA ,BANGALORE
2. / NAME OF THE INSTITUTION / : / BANGALORE MEDICAL COLLEGE AND RESEARCH INSTITUTE, BANGALORE.
3. / COURSE OF STUDY AND SUBJECT / : / M.D. IN PEDIATRICS.
4. / DATE OF ADMISSION TO THE COURSE / : / 01-06-2012
5. / TITLE OF THE TOPIC / : / COMPARATIVE STUDY OF IMPACT OF INFANT & YOUNG CHILD FEEDING(IYCF) COUNSELLING SERVICES ON NUTRITIONAL STATUS OF CHILDREN (BETWEEN 0-24 MONTHS )
6. BRIEF RESUME OF THE INTENDED WORK:
6.1 NEED FOR THE STUDY:
Malnutrition has been responsible directly or indirectly for 60% of 10.9 million deaths annually among children under five worldwide with over two-thirds of these deaths often being associated with inappropriate feeding practices in first year of life.1
Malnutrition among children occurs almost entirely during the first two years of life and virtually irreversible after that. The critical period of brain growth being first two years, emphasizes the importance of nutrition in first two years of life. The most immediate consequence of undernutrition is premature death2.
Acute Malnutrition is defined as weight for height <-2 Z scores or < 80% of the reference median and/or bilateral pedal oedema3.
The incidence of stunting is highest in first two years of life especially after first 6 months of life when exclusive breastfeeding alone cannot fulfil the energy needs of a rapidly growing child4.Exclusive breastfeeding is the single most effective intervention which could prevent 13-16% of childhood deaths. Adequate complementary feeding between 6-24 months could prevent additional 6% of all such deaths5.
Several strategies have been employed to improve complementary feeding practices. These include nutritional counselling to mothers designed to promote healthy feeding practices, provision of complementary foods and supplementation with foods with multiple micronutrients or with increased energy density6.
In many community settings access & utilisation of health facilities are poor & the available services are often curative and overstretched. There is a need for one to one Infant and Young Child Feeding counselling to break the vicious cycle of malnutrition. There is lot of wrong beliefs regarding diet during childhood illness and also surprisingly during health7.
Hence the present study was undertaken to evaluate the impact of Infant and Young child Feeding counselling services in OPD attached to a medical college hospital.
6.2 REVIEW OF LITERATURE:
Bhutta AZ et al. in their study “ What works? Interventions for Maternal And Child undernutrition and Survival” a study done in 36 countries, used a cohort model to assess the effect of education on complementary feeding and concluded that education about complementary feeding increased height for age by 0.25 (95% CI 0.01-0.49) in children between 1- 24 months 8.
Saha KK et al. in their prospective cohort study “Appropriate infant feeding Practices result in better growth of Infants and young children in rural Bangladesh ”with a sample size of 1343 infants found that more appropriate Infant feeding practices were associated with greater gain in weight for length(p<0.05) during infancy 9.
Roy SK et al. in their study “Intensive Nutrition Education with or without Supplementary Feeding Improves the Nutritional Status of Moderately –Malnourished Children in Bangladesh” which included 282 moderately malnourished children between 6-24 months, with a follow up period of 6 months concluded that using intensive nutritional education alone, 59% of moderately malnourished children improved to mild malnutrition as compared to 30% in non interventional group (p<0.001) 10.
Kilaru A et al. in their study “ Community based Nutrition Education for improving Infant growth in Rural Karnataka” which included 242 infants with 173 in interventional & 69 in non-interventional group states that nutritional education and counselling was significantly associated with increased weight for age by 33% in interventional group compared to 4 % in non- interventional groups 11.
Bhandari N et al. in their study “An educational intervention to promote appropriate Complementary Feeding Practices and Physical Growth in Infants and Young Children in Rural Haryana, India” with a sample size of 900 infants (95%CI) found 250g difference in weight between intervention and control groups and a 1cm difference in length at 12 months of age between intervention and control group. The study concluded that educational interventions had a positive effect on weight for age 12.
6.3 AIMS AND OBJECTIVES OF THE STUDY:
AIM: Providing IYCF(Infant and Young Child Feeding) counselling services to mothers/caregivers of children below 24 months on OPD basis
OBJECTIVES:
· Impact of Infant and Young Child Feeding counselling services intervention on the mothers’ knowledge on childs’ nutrition
· Impact of counselling will be assessed using established WHO indicators for assessing infant and young child feeding practices
· Growth monitoring of the child on the WHO growth standards in the intervention and the non intervention group
7. MATERIALS AND METHODS:
Study Design: Hospital based prospective case -control study.
7.1 SOURCE OF DATA:-
Children 0-24 months attending Outpatient department of Vanivilas Children hospital attached to Bangalore Medical College and Research institute will be enrolled for the study purpose. Mothers’/caregivers of these children will be evaluated on their knowledge on Infant and Young Child Feeding on a pre-structured, predesigned pretested proforma. The study will be conducted from November 2012 to November 2014.
7.2 METHOD OF COLLECTION OF DATA:-
After obtaining informed consent, children will be enrolled for the study.
Children between 0-24 months of age attending OPD services(including immunisation) will be enrolled for the study .Their growth will be monitored on WHO growth standards
Children are randomized into two groups ,group A and group B
Group A: Intervention provided. Infant and Young Child Feeding counselling services provided to the mother/caregiver with the assistance of staff nurse and nutritionist from Nutritional Rehabilitation Centre
Group B:Intervention not provided.
Infant and Young Child Counselling Services would include:
From0-6months(interactive breastfeeding counselling):includes
Assistance &support at birth for starting breastfeeding within one hour
Providing information on benefits of exclusive breastfeeding, benefits of optimal feeding practices & skills like: positioning, attachment, expression of breastmilk ,preparation of complementary foods.
From 6-24 months(follow up counselling): Techniques in coping with breastfeeding problems & sustaining breastfeeding, and for adequate complementary feeding
Sample size: Subjects will be 250 children less than 24 months coming to the OPD , Vanivilas Childrens’ hospital.
7.3 INCLUSION CRITERIA: -
· Children below the age of 24 months born term and birth weight of more than 2.5 kgs
· Mothers/caregivers of these children who have given consent
7.4 EXCLUSION CRITERIA:-
· Hospitalised patients
· Preterm infants≤ 37 weeks.
· Low birth weight infants≤ 2.5kgs.
· Children with NICU admissions.
· HIV exposed/infected infants.
· Children with congenital abnormalities of the GIT, cardiac, renal system &CNS
7.5 Does the study require any investigation or interventions to be conducted on patients or other human beings or animals? If so please describe briefly? YES.
7.6 Has the ethical committee clearance been obtained for this study from your institution? YES
7.7 STATISTICAL ANALYSIS:
Statistical methods to be used for the analysis of the data collected include Mean Score Comparison using `z’ test or non parametric Mann-Whitney tests and other applicable methods.
8 LIST OF REFERENCES:
1. World health Organisation. Global Strategy for Infant and Young Child Feeding. Geneva, Switzerland: World health Organisation , 2003.
2. Kleigman RM, Stanton BF, Geme JWS, Schor NF, Behrman RE. Nutrition, Food Security and Health Chapter 43. In: Nelson’s textbook of Paediatrics. 19th edition Elsevier : 2011.170-178
3. United Nations Chidren’s Fund(2011),Final IYCF Programming Guide 2011;1:1-173.www.unicef.org/nutrition/files/ Final_ IYCF_ Programming_ guide_2011.
4. Imdad A, Yakoob MY, Bhutta ZA .Impact of maternal education about complementary feeding and provision of complementary foods on child growth in developing countries .Biomed Central Public Health;2011 April 13;11 Suppl3:S25
5. Jones G, Steketee RW, Black RE,Bhutta ZA, Morris SS. How many Child deaths can we prevent this year? Lancet 2003;362:65-71
6. Caulfield LE, Huffman SL, Piwoz EG. Interventions to improve intake of complementary foods by infants 6 to 12months of age in developing countries: impact on growth and on the prevalence of malnutrition and potential contribution to child survival. Food and Nutrition Bulletin 1999;20:183-200
7. Benakappa AD, Shivamoorthy P. Beliefs Regarding Diet during Childhood illness.2012;37(1):20-24.
8. Bhutta ZA, Ahmed T, Black RE, Cousens S, Dewey K, Giugliani E, Haider BA et al. What works? Interventions for Maternal And Child Undernutrition and Survival.Lancet.2008;371(9610):417-440
9. Saha KK, Frongillo EA, Alam DS, Arifeen SE, Persson LA, Rasmussen KM. Appropriate infant feeding Practices result in better growth of Infants and young children in rural Bangladesh American Journal of Clinical Nutrition. 2008;87:1852-59
10. Roy SK, Fuchs GJ, Mahmud Z, Ara G,Islam S,Shafique S et al. Intensive Nutrition Education with or without Supplementary Feeding Improves the Nutritional Status of Moderately –Malnourished Children in Bangladesh Journal of Health Population Nutrition2005 Dec;23(4):320-330
11. Kilaru A, Griffiths PL, Ganapathy S, Ghosh S. Community Based Nutrition Education for improving Infant Growth in Rural Karnataka. Indian Pediatrics 2005;42:425-3
12. Bhandari N, Mazumder S,Bahl R,Martines J,Black RE, Bhan MK..An Educational Intervention to promote Appropriate Complementary Feeding Practices and Physical Growth in Infants and Young Children in Rural Haryana , India .The Journal of Nutrition 2004 Sept;134(9):2342-8.
9. / SIGNATURE OF THE CANDIDATE / : / DR.KAREN JANICE MORAS10. / REMARKS OF THE GUIDE / : / Severe Acute Malnutrition has become a major problem in children under 5 years of age, with high morbidity and mortality. Intervention aimed after brain growth is completed will not reverse the permanent brain damage. Hence early intervention like IYCF Counselling services should be established in Paediatric OPDs at no cost, to prevent the malnutrition malady and its tragic consequences.
11. / NAME & DESIGNATION OF GUIDE
11.1 / GUIDE / : / DR. ASHA BENAKAPPA,
PROFESSOR,
DEPARTMENT OF PEDIATRICS,
VANIVILAS HOSPITAL,
BANGALORE MEDICAL COLLEGE & RESEARCH INSTITUTE, BANGALORE
11.2 / SIGNATURE / :
11.3 / CO-GUIDE / :
11.4 / SIGNATURE / :
11.5 / HEAD OF THE DEPARTMENT / : / DR. GANGADHAR B. BELAVADI,
PROF. AND HOD,
DEPARTMENT OF PEDIATRICS,
VANIVILAS HOSPITAL,
BANGALORE MEDICAL COLLEGE & RESEARCH INSTITUTE, BANGALORE
11.6 / SIGNATURE / :
12.1 / REMARKS OF THE CHAIRMAN & DEAN / :
12.2 /
SIGNATURE
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