Download rajiv gandhi university of health sciences

RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES
BANGALORE, KARNATAKA
PERFORMA FOR REGISTRATION OF SUBJECTS FOR DISSERTATION
1
NAME OF THE CANDIDATE MRS. JASPREET KAUR,
AND ADDRESS
H.NO.230-C, RATTAN NAGAR, TRIPRI,
PATIALA, PUNJAB.
2
NAME OF THE INSTITUTE
NOOR COLLEGE OF NURSING,
NO.5, NOOR BUILDING, RMV 2nd STAGE,
BHOOPASANDRA MAIN ROAD,
BANGALORE-94.
3
4
5
COURSE OF STUDY &
M.SC., NURSING 1ST YEAR, PAEDIATRIC
SUBJECT
NURSING.
DATE OF ADMISSION
01st JUNE 2010.
TITLE OF THE TOPIC
“A STUDY TO ASSESS THE KNOWLEDGE
REGARDING IMPORTANCE OF PROTEIN
INTAKE AMONG
FIVE
MOTHERS OF UNDER
CHILDREN
PAEDIATRIC
WARD
ADMITTED
OF
IN
SELECTED
HOSPITAL AT BANGALORE WITH A VIEW
TO
DEVELOP
MODULE.”
1
SELF
INSTRUCTIONAL
6. BRIEF RESUME OF THE INTENDED WORK
INTRODUCTION
Child health is the foundation of the family and wealth of a nation. Good nutrition is
the basic component of growth and development for maintenance of health throughout life.
“Nutrition is defined as combination of dynamic process by which the consumed food is
utilized for nourishment, structural and
functional efficiency of every cell of the
body.” Under five children require balanced nutrition to become healthy for national growth
and economic development1.
Nutrition in early childhood can have lifelong implications. It is important to develop
healthy eating practices in childhood to prevent or delay the development of lifestyle related
diseases. Caregivers of this age must receive the best information and resources available.
The health and nutrition of the children need protection in order to ensure sound foundation
and secure the future of any society. In India, there are 53% of under five children in which
67% million – live without basic healthcare facilities. This means that India alone accounts
for about one-third of all children in the world aged below five who don’t have basic health
care2.
Protein comes from the Greek word meaning “ To take first place.” Proteins are the
chief substances in the cells of the body, they are composed of carbon, hydrogen, oxygen and
nitrogen. Some proteins also contain sulphur, phosphorus and other elements. Proteins are
made up to simpler substances called amino acids classified as essential and non-essential
amino acids Amino acids are essential for building of body tissues for growth, maintenance
and repair3.
Weaning is gradual process started at 4-5 months of age. If supplemented by suitable
foods rick in protein and other nutrient can improve the immunity, help in growth and
2
development. By the age of one year, the child should receive solid foods consisting of
cereals, pulses, vegetables and fruits.4
Growth faltering and malnutrition are highly prevalent in most south Asian countries.
Among the serious consequences, malnutrition is increased in risks of morbidity and
mortality in children as well as deficits in physical stature and lowered cognitive measures.
Protein malnutrition in poor households has been well documented in India, with the highest
rates observed in those aged 12-23 months. Countrywide national Family Health Survey II
data show mean underweight prevalence increases from 11.9% below 6 months infants to
58.4% at 12-23 months of age. The intervention group as a whole has improved feeding
practices.
Global hunger Index, South Asia, Shows that the highest child malnutrition rate is
about 5.6 million leading to child mortality. The 2006 report mentioned the low status of
women and lack of nutritional knowledge are important determinants of high prevalence of
under weight children in the specific region. U.S. Census Bureau and Agriculture department
2007 shows estimated 3.5 million children under the age of five are at risk of hunger and
protein malnutrition. The reason behind in under utilization of existing programmes as free
distribution of food stamps and school meals. 5
The most recent estimate in October 2010 by FAO says that 925 billion people are
undernourished. And the estimated proportions of deaths
in which malnutrition is the
underlying cause are roughly similar for diarrhea 61% malaria 57% pneumonia 56% and
measles 45%.4 WHO estimates that more then 300 million children suffer from protein
deficiency only and mortality rate is an high as 40% in under five children. ‘The Lancet’
says protein malnutrition in first two years is irreversible. Protein deficient children grow up
to worse health and lower educational achievements.6
3
The Health status of under five children in 2001 census of Karnataka reported that
under five mortality rate is 69/1000 live births. The census also included that there are about
6.2% of children with severe under nutrition, 45.4% with moderate under nutrition,
39.0%and only 9.4% are normal. Thus, from these data, it is evident that nutritional status of
the under five children in Karnataka is poor.7
A National family Health Survey report shows that 4 out of every 10 children in the
Karnataka stage are undernourished, born stunted or too short for their age. About 70% of the
children in the state in the age group of 6 to 59 months are anaemic. The national Nutrition
Monitoring Bureau report shows the consumption of green leafy vegetables, roots and tubers,
milk and milk related products, fats and oils is low in Karnataka. Considering that some
state-run programmes, like the integrated child Development Scheme ( ICDS), have been on
since 1975, it is surprising that the state is still unable to address the issue of malnutrition.
The ICDS programme is on in 54, 260 anganwadis in the state.
Around 44 Lakhs
beneficiaries, including pregnant women, lactating mothers and anganwadi workers are
availing of the benefits. “With Rs.2 per beneficiary, it will take time to achieve complete
control on malnutrition and the government is planning to increase the amount to Rs.4 per
child beneficiary”.9
Protein deficiency constitutes a major health problem in India and other countries of
the developing world.
In infants and children every year over 50%
of children are
undernourished. The most vulnerable period of malnutrition is first five years. And it is
basically the result of poor knowledge on part of the mothers regarding nutritional
requirements.
4
6.1 NEED FOR THE STUDY
“How wonderful it is that nobody need wait a single moment
before starting to improve the world.”
-
Anne Frank.
Today’s healthy child is tomorrow’s better citizen. Development of healthy child is
influenced by many factors. Under five children are the most vulnerable groups who are
prone to many infective disease and nutritional deficiencies. Proteins are very important for
growth and development, wear and tear of tissue repair and maintenance, formation of
immune bodies, enzymes and harmones. Proteins also act as sources of energy when
consumed in excess of body need. Protein sources are basically classified as animal source
(eg : Cheese, Milk, liver, Fish, meat and eggs) Plant sources (eg: pulses, nuts, beans and soya
beans). Conventional sources (eg: oil seeds, cakes, sea weeds).10
The protein requirement depends upon the age, sex, physical, physiological and other
factors. ICMR 1981 recommended 1.83 gm per kg of body weight of protein up to 1-3 years
and 1.56 gm per kg of body weight of upto-4-5 years, i.e 22 gm and 29 gm of total
requirement respectively. For infants 2.3gm per kg up to 3 months, 1.8gm per kg up to 3-9
months, 1.5 gm upto 9-12 months is the daily recommended protein allowance. The mental
and social development of the child is dependent on the mother. The mother is the first
teacher of the child, and that is why the mother and child are treated as one unit.
A study conducted to find out the Effect of maternal factors on nutritional status of 15 year old children in urban slum population among 482 children in Punjab reported that
education of mother significantly influenced the nutritional status of under fives as the
prevalence of under nutrition was 60.9% where mother was illiterate and it was only 21.2%
where education level was more than high school. Mother’s age showed highly significant
5
(p=0.001) effect on the prevalence of under nutrition. That is where mother’s age was less
than 20 years; the prevalence was 75.0% as compared to 32.2% where mother’s age was
more than 30 years.12
A vast majority of the children suffering from mild to moderate forms of malnutrition
remain hidden in the community. PEM results from the interaction of several factors among
which two are more as less directly responsible for the disease.
First quantitatively
insufficient and qualitatively inadequate dietary intake, second infections processes such as
gastrointestinal and respiratory infections and other infections diseases of childhood.
Infections experienced by children during first year of life represent the major factor in
protein energy malnutrition. In child hood infections especially measles were traced in more
then half of the children. Similar observation concerning of precipitating effect of infections
processes such as measles, Germen measles, whooping cough, primary tuberculosis and
malaria have been seen.13
Insufficiency of food the so-called “food –gap” and lack of awareness are chief cause
of protein energy malnutrition, which is a major health problem particularly in first years of
life. The majority of cases of protein energy malnutrition were nearly 30% are mild and
moderate cases. The incidence of protein energy malnutrition is more in preschool children.
This problem exists in all the states and the nutritional marasmus is more frequent than
kwashiorkor. 15
An cross sectional study was conducted to examine the nutritional status of children
(aged 1-5 years) who lived in the Klong Taey slum Bangkok. Anthropometric measurements
were made for 232 children; socio economic background information was obtained by
interviewing their mothers using a structured questionnaire. The results showed that family
income, maternal housewifely or unemployment food practice and a maternal education level
6
lower than primary school were associated with low nutritional status of under five children.
Findings implied that protein nutrition is remains as threat to the health of urban poor in
Bangkok. The finding should not be over looked countermeasures or indicated.
A study was conducted to determine the prevalence of PEM and its associated with
soil transmitted in Orang Aslu children Malaysia. The study result obtained from 368
children aged 2-15 years showed that the overall prevalence of mild and significant under
weight was 32.1 % and 56.5% respectively. The present study vividly showed that stunting
and under weight are highly prevalent among Orong Aslu children.17
Infants and children under five are the most vulnerable group. They are seriously
affected by deficiency of protein.
Serious
complications of advanced Protein energy
malnutrition(PEM) can happen leading to superadded overt and hidden infections like
septicemia, pneumonia, diarrhea, pyoderma, scabies, U.T.I, tuberculosis infection. Mothers
are the most wondrous care givers who nurture their kids. Thus they play a prime role in
providing nutrition. So they should have adequate knowledge of protein’s significance in
diet of under five children.
The nurse plays an important role in educating the mothers of under five children
about significance of protein in daily diet. Ongoing health education and reinforcement while
monitoring to reduce protein deficiency is an important challenge for nurses. Education of
mothers is the process of
assistance to learn and incorporate healthy eating behaviors in
every day life. Providing sound and sincere advice regarding the measures to take adequate
protein will provide health promotion positively. Hence the investigator found need to assess
the knowledge of giving protein diet to the under five children among mothers.
7
6.2 REVIEW OF LITERATURE
The review of literature is defined as broad, comprehensive in depth, systematic and
critical view of scholarly publications, unpublished scholarly print material, audio-visual
materials and personal communications.
Review of literature provides the basis for future investigation, feasibility of study
and indicates constraints of data collection. Review of literature is extensive, exhaustive
examination of publication relevant to research project. It is under taken to establish the
need for the study methodology , development of a tool and structured teaching programme.
The review of literature in this chapter is presented under as follows.
 Literature related to protein sources
 Literature related to feeding practices among under Five children
 Literature related to demographic variables of protein malnutrition
 Literature related to knowledge of mothers of under five children regarding protein
energy malnutrition
Literature related to protein sources
An experimental study was conducted in among 3-5 years children living in rural area
who were below the 90th percentile of standard weight for age to compared the nutritional
status with serum protein and lipid to determine the effect of protein source egg on them.
The result shows that because of addition of three eggs per week, total cholesterol HDL level
has decreased and albumin prealbumin and HDL levels demonstrated significant increasing
levels so in conclusion three eggs for week can provide adequate protein for children of 3-5
years of age. 18
An Article stated for children 1-3 years the average daily intake of cereals and millets
among 1-2 years children was 136 g forming 78% of RDI. The intake of cereals of millets
8
was lower than the RDI in all the states except in Madhya Pradesh (106% of RDI). The
extent of deficit was the highest in Kerala and Gujarat (36%), followed by Tamil Nadu and
Maharashtra (33%), Karnataka, Orrisa West Bengal (20%)and Andra Pradesh(10%). The
mean intake of pulses of legumes(12g) was about a third of the RDI (35g). the consumption
of green leafy vegetables, a rich source of B carotene, was negligible(6g).19
A study was conducted to measures the levels of proteins in different vegetarian
sources by The Ralston Purina Company of St. Louis. The study revealed that soyabeans
contains 42% protein 33% carbohydrates, 20% oil, 5% hulls. It is clear from the study that
10-15% of babies in U.S. are raised on soy-based formula and almost 60% of their favourite
food supplements contain soy protein . Study concluded that soy a or bean protein is best out
of vegetarian sources of protein. 20
The study was conducted at Harvard University to assess the level of proteins in
vegetarian diets. Results showed that dairy and egg products are the complete sources for
lacto -ovo vegetarians only vegetable sources contain significant amounts of all eight types
of essential amino acids. It further concluded that essential amino acids can be obtained by
eating a variety of plant sources. 21
Literature related to feeding practices of under Five children
An article on “ Additional Reasons For a Vegetarian Diet” Stated that various
ethical reasons for choosing vegetarianism. Jainism teaches vegetarianism as a moral
conduct, so prohibit meat eating. Hinduism hold vegetarianism as an ideal and have
conviction that non-vegetarian food is detrimental for the mind and spiritual development.
In Buddhism there are several Sanskrit texts where Buddha instructs his followers to avoid
meat.
The Sikhism prohibits Sikhs to eat meat and eggs. The article showed there is
definitely a concern of vegetarianism with protein deficiency. 22
9
A study was conducted to assess the nutritional status of 100 pre-schoolers from
anganwadi centers in slum areas of Udaipur city. Interview schedule containing questions on
background information about the family was used. Detailed information was also collected
from records of Anganwadi survey and beneficiary survey register. The assessment of
nutritional status of the subjects was based on weight for age. The study result reveals that
more than 50% of these pre-schoolers showed symptoms of protein energy malnutrition and
anemia, while 22% had pigeon chest deformity due to vitamin D and calcium deficiency.
Classifications for degree of malnutrition as per IAP showed that majority of these subjects
(66%) were under weight (Grade I and II). Water low’s classifications revealed that majority
of these preschoolers were wasted (30%) or wasted and stunted (42%).23
A study was conducted to examine the association between complementary feeding
practices and mother’s education status in Islamabad among mothers of 500 infants attending
the Pediatric Outpatient department.
The study results showed a positive relationship
between the nutritional status of infants and educational status of mothers (P<0.001). A
similar relationship was observed between the educational status of respondents and the
introduction of complementary foods at an appropriate age (six months) on infants
(p<0.001).24
A study was conducted on physicochemical properties and nutritional traits of milletbased weaning food suitable for infants in Kumaon hills, northern India. A weaning food
based on malted foxtail millet flour (30%), malted barnyard millet flour (30%), roasted
soybean flour (25%) and skin milk powder (15%) was prepared. The mix contained 18.37
grams proteins and 398 kcal energy per 100 grms, The nutrient composition of this fortified
weaning mix met the prevention of food adulteration standards. So, this met the
acceptability of criteria for weaning food.
10
A Study wad conducted on early in weaning increase infants’ acceptance of new
foods for up to two months at Nestle Research Center, Switzerland. Infants receiving their
first vegetable(carrot puree) and over the next 9 days either carrots every day, 3 vegetables
changed for every 3 days or 3 vegetables changed daily. On the 12th and 23rd days receive
new vegetable purees, tomato then peas. Several weeks later, they received 2 more new
foods, meat and fish. Results showed that variety in weaning increased new food acceptance.
Frequency of change was more effective than number of vegetables fed. They concluded that
these interventions correspond to differences in milk and vegetable feeding have practical
consequences for acceptance of new foods.
The findings of the study on the influence of infant feeding practices on nutritional
status of under five children in selected four Anganwadi areas of urban Allahbad showed
that among all under five children surveyed, 36.4% underweight, 51.6% stunted and 10.6%
wasted. The result also revealed that initiation of breast feeding after six hours of birth,
deprivation from colostrums and improper complementary feeding were found significant
(P<0.05) risk factor for underweight.25
A study was conducted to assess the nutritional status and feeding practices of underfive children in Tanzania.
Face –to-face interviews with the sampled mothers were
conducted using a semi-structured questionnaire. Anthropometric measurements using
weight-for-age criterion were employed to assess the nutritional status. The study showed
that 31% of the children were undernourished, some (6%) of them severely. Breast feeding
duration of more than one year was common among the mothers. Fifty-four percent of the
weaned their children as early as two months after birth. The most common type of weaning
food was maize porridge mixed with cow’s milk (46%). An educated mother was less likely
11
to have an undernourished child, while a child from a teenage mother was more likely to be
undernourished.26
Literature related to demographic variables of protein malnutrition.
A descriptive study was conducted to find underlying causes of protein malnutrition
in under five children on Nigeria. It was found using modified Wellcome classification that
prevalence of PEM was 27% in rural Nigerian community. It also concluded poverty,
inadequate food production, ignorance and uneven distribution of food are also the
underlying causes of malnutrition in under five children. 27
A case controlled study was conducted to determine the socio-economic factors
predisposing under five children to severe protein malnutrition in 66 children age 3-36
months attending out patient department Moi Teaching and Referral Hospital in Eldoret,
Kenya. The result showed social rick factors were single mothers (OR 14.93), young
mothers (OR 3.95), living in temporary house (OR 3.627), caretaker who was not married to
child’s parent (OR 0.10). It conclude that socio –economic for protein malnutrition are single
mothers, poverty, social conditions, sex of the child and incomplete immunization. 28
A study was undertaken to assess the impact of drought on childhood illnesses and
nutrition among 914 under five children of rural population using three stage sampling
design in Rajasthan. The findings of the study revealed that children suffered from recent
and long term malnutrition were 39% and 26% respectively as per National Centre for Health
Statistics (NCHS) standards. The extent of malnutrition was significantly higher in females
than in males (P<0.01).
Vitamin A & B complex deficiencies were 0.7% and 3%
respectively. The protein energy malnutrition (PEM) was observed in 44.4%. Overall mean
calorie and protein intake deficit was observed to be very high (76.0 & 54.0%). The
12
comparison of present drought results with earlier studies in normal and drought conditions
showed higher prevalence of PEM and deficiencies of calories & proteins in their diet.29
A survey was conducted to examine how economic inequality was associated with
chronic childhood PEM, Information was collected on 32-35 children aged 0-59 month.
Household wealth status was measured by an index based on household ownership of durable
assets. The results of this study indicated that children in poorest 20% household were more
than twice as likely to suffer from stunting as children in richest 20% households. The study
concluded the wealth inequality is associated with chronic childhood under nutrition and
emphasizes that reducing poverty and making
services accessible to poor will be key to improve nutritional status of under five children in
Combodia. 30
A repeated cross sectional study was conducted to measure rates of hunger and food
insecurity among young U.S born Latino
children with Mexican immigrant parents
compared with a non-immigrant non-latino in a low income clinic population. A survey was
done on 4278 caregivers of children <3 years of age in a pediatric clinic for 5 years period.
The results showed young Latino children has higher rates of child hunger than non-Latinos
6.8 vessus 0. 5% It concluded that young children in Mexican immigrant families are
especially high rick for hunger, household in security and in turn malnutrition. 31
A study was conducted among 90 mothers of weaning age children on infant feeding
practices of Pakistani mothers in England and Pakistan. 45 were in England and 45 in
Pakistan. A questionnaire available in English and Urdu was used to find out about general
beliefs about weaning. Result showed that mothers in both groups commence weaning
between 3-4 months, common weaning foods included rice, cereals and eggs with
progression to fruit and vegetables and family food in Pakistan, and fruit, Vegetables, meat
13
and convenience foods( especially sweet options) in England. Both groups of mothers
wanted more information about infant feeding practices. It was concluded that mothers in
Pakistan demonstrated more confidence in weaning practices than in England because of
experiences with other siblings and advice from
relatives. More advice from health
professionals was requested and is needed by all mothers in order to improve weaning
practices of the infants. 32
A cross- sectioned study was conducted to determine the prevalence and to identify
risk factors associated with protein-energy malnutrition (PEM) in 798 children under five
years of age in Luangprabang province, Laos. Anthropometric measurements of children
were done and data were transformed into height-for-age, weight-for-age and weight-forheight ratios. Mothers were also interviewed with a semi-structured questionnaire. The
findings reveled that there was a high prevalence of stunting, underweight and wasting,
which is, 54.6%, 35%, and 6% respectively. It was also noted that children aged 12-23
months and Khmu ethnic children had a higher prevalence of stunting (65% and 66%) and
underweight (45% and 40%), respectively. However, it was also found that boys were more
prone to be stunted and underweight. Furthermore, restricted intake of meats, vegetables
during illness, and low maternal education were main risk factors for child malnutrition in
the study area.33
A study was conducted to examine the factors causing Malnutrition in Bangladesh
among 560 under Five Children. The analyses revealed that 45 percent of the children under
age five were suffering from chronic malnutrition, 10.5 percent were acutely malnourished
and 48 percent had under-weight problem. The main contributing factors for under five
malnutrition were found to be previous birth interval, size at birth, mother’s body mass index
at birth and parent’s education.34
14
Literature related to knowledge of mothers of under five children
regarding protein energy malnutrition
A study was conducted on intensive nutritional education with or without
supplementary feeding improves the nutritional status of moderately malnourished children
in rural Bangladesh. About 282 moderately malnourished children aged 6-24 months were
considered. Mother of them were divided in two groups; one with intensive nutrition
education group and other with both intensive nutrition education, and their children received
additional supplementary feeding. Ability of mothers to identify malnutrition improved from
15% to 99% in the intensive nutrition education group and from15% 0 100% in the intensive
nutrition education and supplementary feeding. It was concluded the study that intensive
nutrition education improves the status of children with or without supplementary feeding. 35
A study was conducted to find the relationship between the maternal nutritional
knowledge and nutritional status in Ghana.
The data were collected from 55 well
nourished and 55 malnourished mothers – child pairs. A questionnaire designed to collect
data on mother’s knowledge and practices related to child care and nutrition was
administered to the mothers.
The data on mother’ demographic and socioeconomic
characteristics as well as child anthropometric data were also collected.
Maternal
education on the other hand was not found to be independently associated with nutritional
status. These results imply that mother’s practical knowledge about nutrition may be more
important than formal maternal education for child nutrition outcome.36
A cross-sectional study conducted on Evaluation of nutritional knowledge of thirty
mothers (house wives) about their children in Pakistan revealed that early weaning was noted
in 12 (11.4%) infants, 41 (39%) infants were weaned in 4-6 months and delayed weaning
was noted in 52 (49.5%) infants. Boiled water was used by 14(46.6%) mothers and filtered
15
water by 4(13.3%) while 12 (40%) mothers used tap water. 80(76.19%) infants received
Gutti as first feed while colostrums was given to 25(23.80%) . 28(93.3%) mothers did breast
feeding, 10(33.3%) gave cow’s milk along with breast milk and 11(36.6%) formula milk
along with breast milk.37
A case control study was conducted to find out maternal knowledge of malnutrition
and health care seeking attitudes of 68 mothers in rural Tamil Nadu. The study reported
that 34 mothers of well nourished children have more knowledge (59%) regarding role of
lack of food or nutrition in mild marasmus – kwashiorkor mixed malnutrition compared to
the 34 mother of severely malnourished children (35%). There were 67.6% of poor and
illiterate mothers out of 68 mothers. The study also reported that only 28% of mothers
would seek medical care for malnutrition.40
6.3 STATEMENT OF THE PROBLEM
“A Study To Assess the knowledge regarding importance of protein intake
among mothers of under five children admitted in peadiatric ward of selected hospital
at Bangalore with a view to develop self instructional module”.
6.4 OBJECTIVES OF THE STUDY
 To assess the level of knowledge regarding importance of protein intake among
mothers of under five children.
 To find out association between level of knowledge among mothers of under five
children with their selected demographic variable.
 To prepare Self instructional module (SIM) regarding importance of protein intake.
6.5 OPERATIONAL DEFINITIONS
 Assess: It is the statistical measurement of level of knowledge regarding
importance of protein intake among mothers of under five children observed by
16
structured knowledge questionnaire.
 Knowledge : It refers to the verbal responses given by mothers of under five
children regarding importance of protein intake.
 Mothers : In this study it refers to the mothers who have children below
five years of age and taking care of them.
 Under five Children : In this study it refers to the children who were below the
age group of five years.
 Protein intake: Protein is the chemical compound composed of carbon, oxygen
and nitrogen. It is needed for growth and development of children.
 Self instructional module : It refers to the informational booklet which include the
definition, meaning of protein, sources of protein, functions, importance/ need of
protein intake and deficiency problems with management and preventive measures
of protein.
6.6 ASSUMPTIONS
 Mothers of under five children possess some knowledge regarding importance of
protein intake.
 Self instructional module regarding importance of protein intake will help them to
enhance their knowledge to follow during practice.
6.7 DELIMITATIONS
The Study is Limited to
 Mothers of under five children
 Pediatric wards of selected hospitals at Bangalore.
 The study is limited to 6 weeks.
17
7 MATERIAL AND METHOD
7.1 Primary source : Mothers who are having under five children admitted in Peadiatric
ward of selected hospital at Bangalore.
7.2 Research Approach : Descriptive approach
7.3 Research Design : Descriptive design.
7.4
Settings of the Study: The study will be conducted in Mediscope, Republic, Green
View Hospital of Peadiatric ward at Bangalore. These hospitals approximately 5 to 10
Kms away from Noor College of Nursing.
7.6 Population : Mothers of under five children who are admitted in peadiatric ward of
selected hospital at Bangalore.
7.7
Sample : In this study mothers those who all are having under five children admitted
in peadiatric ward of selected hospital at Bangalore.
7.8 Sample Size : The sample size of this study is 60.
7.9 The Sampling Technique : Non Probability Convenience sampling.
7.10 SAMPLING CRITERIA
(i)
INCLUSION CRITERIA : The mothers
 Who have under five children.
 Who all are having either male or female babies.
 Who are willing to participate in the study
 Who can read and write English or Kannada.
(ii)
EXCLUSION CRITERIA : The mothers
 Who have children more than the age of five years.
 Who are not willing to participate in study
 Who don’t know Kannada or English.
18
8 DESCRIPTION OF VARIABLES
The study variable is knowledge of mothers of under five children regarding protein
in take.
9 METHOD OF DATA COLLECTION
Prior to data collection, permission will be obtained from the concerned authority for
conduction of study. After obtaining consent from the subject, the investigator will
explain the purpose of the study and the structured knowledge questionnaire will be
administered to collect the data, followed by self instructional module regarding importance
of Protein in take will be provided. The study period is 4-6 weeks.
10 DESCRIPTION OF TOOL
As per expert opinion structured knowledge and occupation of mother questionnaire
will be prepared. It will consist of :
 Demographic variables like age and sex of child, education of mother, occupation,
religion and residential area etc.
 Structured knowledge questionnaire regarding importance of protein intake among
under five children’s mothers.
11 STATISTICAL ANALYSIS
Data obtained will be assessed in terms of objectives of the study by using descriptive
and inferential statistics.
Descriptive statistics
 Frequency and percentage distribution will be used to analyse the demographic data
of mothers of under five children.
 Mean and standard deviation will be used to assess the level of knowledge regarding
importance of protein intake among mothers of under five children.
19
Inferential Statistics
 Chi square (x2) will be used to find out the association between the knowledge score
of mothers of under five children with their selected demographic variable.
12.
DOES THE STUDY REQUIRE ANY INVESTIGATION OR INTERVENTION
ON PATIENT OR OTHER HUMAN BEINGS ANIMALS. IF SO PLEASE
DESCRIBE:
Yes, SIM will be administered and level of knowledge will be assessed.
13. ETHICAL CONSIDERATIONS TOWARDS SAMPLE RELATED TO STUDY
YES
Permission will be obtained from concerned authority in the selected pediatric
hospital to conduct the study. A written consent will be obtained from the participants of this
study
20
14. LIST OF REFERENCES
1) Mrs.Vasundra, Community health nursing 1994, 2nd edition, JP Brothers P135.
2) Park. K, Text Book of Preventive and Social Medicine 200, 18th edition,
Banarasidas Bhanot Publishers. P 432, 435, 654.
3) http://e b health care . com / http://: goggle.com
4) http://iresearch. World bank .org/Povcal Net. Life Style lounge. http//i love india
com.
5) Tada Y, Keiwkarnaka B, Pancharuniti N, Chamroonsawasdi K. Nurtritional status
of the preschool children of the klong Toey slum Bangkok. Southeast Asian J Trop
Med Public Health.2002 Sep;33:628-37.
6) Nirmala M Nagaraj. Nutrition still a distant dream. 4 out of 10 kids in Karnataka are
under nourished. The Times of India, Bangalore 2008 Dec 2; Times city(col.7).
7) Karnataka’s Health Action 2001 Aug: 36-39.
8) Suraj Gupta, the short Text Book of Pediatrics, 2009, 11th edition Jaypee Brothers
Medical Publishers P. Ltd P146.
9) Ghai OP Essential pediatrics, 1996, 4th edition, Inter print Publishers New Delhi
P47-48.
10) Iqbal Hossain M, Yasmin R, Kabir I, Nutritional and immunization status, weaning
practices and socio-economic conditions of under five children in three villages of
Bangladesh. Indian J Public Health.1999 Jan-Mar;43(1):37-41.
11) Dorothy R. Marlow, Barbara A, Redding Text Book of Pediatric Nursing 2001 6 th
edition Philadelphia W.B. Saunders Company. 675-677.
21
12) Al-Mekhlafi HM, Azlim M, Aini UN, Shaik A, Saiah A, etal, Protein energy
malnutrition and soiled-transmitted helminthiasis among orang Asli children in
Malaysia Asia Pac J Clin Nutr.2005;14(2): 188-94
13) Mayurasakorn
K,
Supplement
of
three
eggs
per
week,
BMJ
1998,
Nov;326(8112):1122-1125.
14) Shanthi Ghosh Nutrition and Child Care A Practical Guide 2nd edition JP publisher
p35.
15) http://made in atlantis : com /life/bean protein.
16) http:en.Wikipedia.org.wiki/vegetarianism.
17) Igbedish S.O. Articles from BMJ 249K.
18) East Afr. Med J. 2004 Aug;(8):415-21.
19) Hong R, Mishra V. Effect of wealth inequality on chronic under-nutrition in
Cambodian children. J Health Popul Nutr.2006 Mar;24(1):89-99.
20) Kersy M. Geppert. J Getts DB. Hunger in young children. Public Health Nutr.2007
April;10(4):390-5.
21) Sarwar T. infant feeding practices. Journal of Human Nutrition Diet 2002
Dec:15(6):419-28.
22) Ray SK, Fuchs GJ, Mahmub A, et al. intensive education with out supplementary
feeding improves the nutritional status of moderately-malnourished children in
Bangladesh. J Health Popul Nutr.2005 Dec; 23(4):320-30.
23) Thathola A, Srivastava.S. Physicochemical Properties and nutritional traits of
millet-based weaning food suitable for infants. Asian pediatric Journal of clinical
nutrition 2002.Mr;11(1):28-32.
22
24) Maier As, Chabanet C, Schaal B, Leathwood PD, Issanchou SN. Early in weaning
increase infants acceptance of new foods for upto two months. Clinical nutrition
2008 Oct, 5.
25) Uuder five nutrition.Avialable from http:// mother child nutrition .Org/news
/index.html(Accessed on (23-09-2009).
26) Khattak AM, gul S, Mustaba ST, jamaluddin. Evaluation of Nutrional knowledge
of mother about their children.Gomal journal of medical science 2007; 5(1): 17
27) Mittal A, Singh j, Abluwalia. Effect of Maternal factor on Nutritional status of 1 – 5
year old children in urban slum population. Indian journal of Community Medicine
2007;32(4): 264 – 267
28) Tripati MS, Sharms V.Assessment of nutritional status of preschoolers in slum
areas of Udaipur city. Indian journal of public health 2006 Jan –mar ;50(1):33-4
29) Singh MB, Lakshminarayana j, Fotedar R, Anand PK.Childwood Illness and
malnutrition in under five children in drought affected desert area of western
Rajasthan , India Indian journal of communicable diseases 2006 Mar;38(8) 88-89
30) Saito K, Korzenik A case control study of maternal knowledge of malnutrition
and health seeking attitudes in rural south india. Yale Journal Biological Medicine
1997 Mar-Apr: 70(2): 149-60.
31) Liagat P, Rizvi MA, Qayyum A, Ahmed H. Association between complementary
feeding practices and mothers education status in Islamabad. Journal of Hum
Nutrition and Dietics. 2007 Aug; 20(4): 340-4.
23
32) Taneja DK, et.al, A study of infant feeding practices and the underlying factors in a
rural area of Delhi. Indian Journal of community medicine 2003 Jul-sep; 28(3):
107-11.
33) Setwe G. Prevalance and risk factors for malnutrition among children aged 5 years
and less in the Lefaragatlha village of Bophuthatswana. Curationis 1994 Aug;
17(3): 33-5.
34) Kumar D, Goel Nk, et.al, Influence of infant feeding practices on nutritional status
of under five children. Indian journal of Peadiatrics 2003 May;73(5):417 – 21.
35) Nyaruhucha Cn, Msuya JM, Mamiro PS, Kerengi AJ. Nutritional staus and feeding
practices of under five children in simanjiro District, Tanzania. Tanzan Health Res
Bull 2006 Sep; Sep 8(3) 162-07.
36) Risk Factors for protein-energy malnutrition in children under 5 years: study from
Luangprabang
province
Lao.
Available
from
http://www.find-health-
articles.com/rec pub 1744505 risk-factors-protein-energy-malnutrition-children-5years-study,htm (accessed on 21.10.2009).
37) Rayhan IM, et.al, Factors causing Malnutrition among under five Children in
Bangladesh. Pakistan Journal of Nutrition 2006; 5 (6): 558-562.
38) Yaa.L, et.al, Maternal nutrition knowledge and child nutritional status in the Volta
region of Ghana. Maternal and Child Nutrition 2005 Apr;1(2): 100-110.
39) Robert C, Bruke S.A Quantitative and Qualitative Approach. London: Jones and
Barett Publishers; 1989.
40) Abdullah F, Levine S. Better Nursing care Through Nursing Research. 3rd ed.Lodon
Mc Millan Company; 1986.
24
15. SIGNTURE OF THE CANDIDATE
16
REMARKS OF THE GUIDE
17
17.1 NAME AND DESIGNATION
OF THE GUIDE
17.2 SIGNATURE
17.3 CO-GUIDE
17.4 SIGNATURE:
17.5 HEAD OF THE
DEPARTMENT
17.6 SIGNATURE
18
18.1 REMARKS OF THE
CHAIRMAN AND
PRINCIPAL
18.2 SIGNATURE
25