RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES

KARNATAKA BANGLORE

PROFORMA FOR REGISTRATION OF SUBJECT FOR

DISSERTATION

SUBMITTED BY:

Ms.PRANITA SHARMA

1st YEAR M.SC.(NURSING)

COMMUNITY HEALTH NURSING,

BATCH 2010-2011

CHIKKABANVARA

R.R COLLEGE OF NURSING,

BANGLORE-560090

RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES,

KARNATAKA,BANGLORE

PROFORMA FOR REGISTRATION OF SUBJECT FOR DISSERTATION

1. / NAME OF THE CANDIDATE / Ms. PRANITA SHARMA
1st YEAR M.SC(NURSING)
R.R COLLEGE OF NURSING,
RAJA REDDY LAYOUT, CHIKKABANAVARA,
BANGLORE-560090
2. / NAME OF THE INSTITUTION / R.R COLLEGE OF NURSING
BANGLORE-560090
3. / COURSE OF THE STUDY AND SUBJECT / 1st YEAR M.SC.NURSING
COMMUNITY HEALTH NURSING
4. / DATE OF ADMISSION TO THE COURSE / 15-04-2010
5. / TITLE OF THE TOPIC / A STUDY TO ASSESS THE EFFECTIVENESS OF STRUCTURED TEACHING PROGRAM ON KNOWLEDGE REGARDING PROTEIN ENERGY MALNUTRITION AND ITS PREVENTION AMONG THE MOTHERS OF PRE-SCHOOL CHILDREN AT SELECTED RURAL AREAS OF BANGALORE.

BRIEF RESUME OF THE INTENDED WORK

INTRODUCTION

“The childhood shows the man as morning shows the day”- John Milton

Children are an embodiment of our dreams and hopes for the future. They are wet clay in potters’ hands; handled with care they become something beautiful else they break and become discarded. They are the most vulnerable group in the society.1

The concept that has emerged in the recent years is that nutrition is the cornerstone of socio-economic development and the nutritional problems are not just medical problems but are multifactorial with roots in various sectors of development such as education, demography, agriculture and rural development.

Considering the global problems being faced by the people like poverty, Injustice, unemployment, malnutrition, population explosion etc. Nutritional problem is one of the major problem which needs early intervention as it affects the vulnerable group of our society that is, children, pregnant women, lactating mothers and elderly population to a large extent.

Among the various nutritional problems which affects the vast segment of our population like, low birth weight ,Protein Energy malnutrition, Xeropthalmia. nutritional anemia etc. Protein Energy Malnutrition is the second most common nutritional problem which affects the pre-school children to a great extent.2

The preschooler's growth is slower than that of an infant. An average child age 2 through 5 will grow about 2 1/2 inches and gain 4 or 5 pounds each year. Because growth rate is slower, appetites may decrease. The preschool period is an excellent time to help your child become familiar with the idea that eating a proper diet is part of a healthy lifestyle. Attitudes and habits formed during preschool years are likely to be carried into the future. Over time, the preschooler will take inadequate nutrients when allowed to choose from a variety of healthy foods compared to their activity level.3

Protein Energy Malnutrition in children contributes to 1-2% incidence in India. At present in India 65% of under five children are malnourished and it contributes to 30% deaths among the under five children.2

There is no simple solution to the problem of Protein Energy Malnutrition ,many interventions are necessary of which, educating mothers is one of the important aspect, which promotes health, enables specific protection, and early diagnosis and treatment of Protein Energy Malnutrition.

6.1 NEED FOR THE STUDY

Food is necessary for survival but, of the right kind and right quality should be eaten in the right proportion to avoid food related disorders. When a diet is made up of right kinds of foods in the right proportions is called balanced diet. When a diet is composed of all nutrients and vitamins, it decreases the risk of contracting chronic diseases like Coronary Artery Disease, Hypertension, and nutritional deficiency disorders etc.4

The world’s demand for food is becoming greater than ever. The current world population of 6 billion will exceed 8 billion in2025 and new innovations are needed to meet the growing challenges of the poor and hungry world.

At present the global scenario of hunger is; 925 million people do not have enough to eat, of which 98% of the world’s hungry people live in developing countries. Out of 925 million hungry people 146 million are under five children, so it can be concluded that hunger is leading to “food gap” and ultimately malnutrition.5

10.9 million children under five years of age die in developing countries each year. Malnutrition and hunger related diseases cause 60% of deaths .One out of every four children in developing countries are underweight. A childhood mortality study in the Americans showed that no less than57% of the children who die before the age of 5 years were found to have malnutrition.

During 1996-2004, more than 26% of the world’s children under the age of 5 years were under weight for their age. The proportion ranged from 1% of children in developed countries to 27% in developing countries.

At present in India 65% children under 5 years of age are under weight .This includes 47% moderate to severe cases,18% severe, of these 16% have moderate to severe wasting and 46% moderate to severe stunting, which is eventually affecting the Nation’s growth and development.2

During my experience in the Community I have observed that the mothers of under five children do not have adequate knowledge about Protein Energy Malnutrition and its prevention. They are unaware about the locally available low cost protein rich diet which is readily available in their locality. So, this study will be an assessment tool to identify their knowledge about Protein Energy Malnutrition and provide structured teaching program to enhance adequate knowledge about it. Therefore, I selected this study to educate the mothers of pre-school children regarding Protein Energy Malnutrition and its prevention.

6.2 REVIEW OF LITERATURE

Review of Literature is a key step in research process. The typical purpose of reviewing the existing literature is to generate research questions to identify what is not known about the topic. The major goal of the review of literature is to develop strong knowledge based to carry out research and other non research scholarly activities.6

Studies related to knowledge of mothers regarding PEM:

A cognitive analysis study conducted by Malothi S. and Vimal .L.Patel(2002),to assess the reasoning of mothers about childhood nutritional deficiencies in rural India. The study was conducted among 108 mothers in rural south India. The mothers were interviewed and their explanations verbally recorded, transcribed and then analyzed using cognitive methods of analysis. The result of the study showed that knowledge and practices associated with traditional system of Indian Medicine greatly influenced the mothers’ reasoning.7

A case controlled study was conducted by Saito.K, Korzenik J.R, Jekel J.F(1993) in a rural area in Tamil Nadu ,to assess the maternal knowledge of malnutrition and health seeking attitudes.34 cases and 34 controls were selected from the population of approximately 97,000.The result of the study showed poor nutritional status associated with socio-economic variables. The two groups showed a significant difference in nutrition related knowledge .Mothers believed that medical care was not an appropriate intervention for childhood illness such as malnutrition.8

A cognitive analysis study conducted by Anita Khokar, S.Singh, R Talwar, NewDelhi (2003), among 1661 children aged 6 months to 2 years.To assess the cause of malnutrition. The data was collected using a pre-tested and pre-structured questionnaire. The result of the study showed that among 1661 subjects 1009 were malnourished and the identified causes were, practice of discarding the colostrums, not exclusively breastfeeding the child till 6 months of age, delayed weaning, dilution of milk and use of bottle and nipple for feeding.9

A descriptive study conducted by A.Mittal and J.Singh (2007) among 482 children aged 1-5 years of urban slums of Tripuri Town ,Punjab, to assess the effect of various maternal factors on the prevalence of underweight and stunting among 1-5 year old children. The result of the study showed that out of 482 children, 185(38.38%) had low weight for age whereas 222(46.06%) had low height for age. Prevalence of malnutrition was more where mother’s age was less than 20 years; children of educated mothers were better nourished as compared to illiterate ones.10

Studies related to prevalence of PEM:

A comparative study done by Jevaseelan L.L.M of Biostatistics Department, CMC, Vellore (1993)focused on risk factors for malnutrition in South Indian children, the study investigated the impact of hygiene, housing and socio-demographic variables on acute malnutrition among 500 children aged 5-7 years living in Urban and rural .The result showed that children living in rural areas were more susceptible to malnutrition compared to those living in urban areas. 11

A comparative study done by M.S.Swaminathan, Research Foundation in China Sub-Saharan Africans and Indians (1996), among 650 under five children. The study showed that child nutrition is prevalent in7% of children under the age of 5 years in China and 28% in Sub-Saharan Africans compared to a prevalence of 43% in Indians. The study concluded that malnutrition is found mostly in rural areas and is concentrated in 10% of villages and districts accounting for 27-28% of all underweight children.12

A Study done by the expert in the food and nutrition department, Mohanram Chand of MS University in 2002 among the 6-14 years old children of the urban and rural areas of Vadodara district The study used anthropometrical surveys to calculate the numbers, focusing on BMI as the main indicator of nutrition. The study concluded that 75% of 3000 children in rural areas of this district were malnourished whereas 155 of the 23,000 children studied in the urban areas were overweight.13

According to the profile, in Karnataka (1996) was conducted on293 children under the age of 5years of rural, tribal and urban slums, the weight curves of boys of urban slums were better placed when compared to tribal and rural children. The mean weight of boys and girls were much below the standard in all three areas. The height curves of boys in tribal pre-school children were greater than those of urban slum and rural boys. Height curves of girls both in tribal and urban slum run almost together but at a higher level for rural girls. Meaan height for rural boys and girls in rural tribal and urban slums fall below the standard. Undernutrition among the tribal pre-school children is 73.5% followed by 67.8% in rural and lowest in urban slum which is 47.8%and lowest in urban slums that is 47.6%..The study of under nutrition occurring in different age groups reveals that it is lowest 33% in the age of0-6 months and almost doubles60% by the end of second year. It remains more or less stagnant from then onwards till the age of 5 years. 14

Studies related to risk factors of PEM:

A cross-sectional study conducted by Singh MB and Anand P.K (2003) among 914 children aged 0-5 years of Jodhpur district of Rajasthan, to assess the impact of drought on the nutritional status of the pre-school children facing drought condition very frequently using a nutritional status tool.The study concluded that the extent of malnutrition was significantly higher in girls than boys. Comparison of the present result with the earlier studies showed higher prevalence of PEM and higher dietary energy and protein deficiencies.15

A descriptive study conducted by Sally Grantham,Mc.Gregor,West Indies (1988) among 300 school age children, on the relationship between mental development and severe malnutrition, using WHO questionnaire. The study concluded that the school age children who suffered from early childhood malnutrition have generally been found to have poor intelligent quotient (IQ).16

A comparative study conducted by Chung L.Fung on Prevalence and correlation of malnutrition among 2019 children under the age of 7 years living in rural minority areas of China (1997).The result of the study reveled that prevalence of moderate and severe malnutrition was 15.8%and 3.1% for underweight children. And low socio-economic condition and poorer maternal child rearing behavior significantly increased the risk for stunting of children .17

A cohort study conducted by Russel Prophet and Samuel (1998),focused to examine whether exposure to early childhood Protein Energy Malnutrition is related to worsened periodontal status in the permanent dentition during adolescence. The study was conducted among 96 adolescents aged 12-19 living in rural Haiti using WHO diagnostic criteria. The study concluded that exposure to early childhood PEM was related to poorer periodontal status in the permanent dentition.18

A descriptive study conducted by S.V. Subramanian and George D.Smith ,investigated the effect of socio-economic status and nutrition in India(1998),the study was conducted among 77,220 women from different socio-economic status backgrounds and with varying body mass indices. The result of the study showed that socio-economic status has a positive proportional relationship with nourishment.19

Studies related to role of mother in prevention of malnutrition:

Christian and Alderman (2001) have measured child malnutrition in Ethoipa using height for Z –scores and identified that the gender of the child, household resources, parental education, food prices and maternal education are the key determinants of growth flattering in Ethopia.Further, they have also found out that strengthening of nutritional knowledge of the community through child growth monitoring or nutritional education program are important other than formal education.20

Raathnayke and Weerhewa(2003) studied the role of mothers income in alleviating calorie malnutrition in Srilanka, using calorie adequacy ratio (CAR) and Relative Calorie Allocation(RCA) .They used a sample of 183 low income household from urban, rural and statute sectors. They found that income of mothers, family size, children’s age, gender, birth order and the education level of mothers are important determinants of household and individual nutritional levels.21

STATEMENT OF THE PROBLEM

A study to assess the effectiveness of structured teaching program on knowledge regarding protein energy malnutrition(PEM) and its prevention among the mothers of pre-school children at the selected rural area ,Bangalore.

6.3 OBJECTIVES OF THE STUDY:

1. To assess the pre test knowledge scores regarding PEM and its prevention among the mothers of pre school children.

2. To develop structured teaching program on PEM and its prevention.

3. To assess the effectiveness of structured teaching program by comparing the pre test and the post test knowledge scores.

4. To determine the association between pre test knowledge score and the selected demographic variables.