Download rajiv gandhi university of health sciences bangalore, karnataka

RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES
BANGALORE, KARNATAKA.
PROFORMA FOR REGISTRATION OF SUBJECTS FOR
DISSERTATION.
1
NAME OF THE
CANDIDATE AND
ADDRESS
Mr. FABIN JOSE
1st YEAR MSc. NURSING STUDENT,
N.D.R.K. COLLEGE OF NURSING
B.M. ROAD HASSAN, KARNATAKA.
2
3
NAME OF THE
N.D.R.K. COLLEGE OF NURSING, B.M. ROAD, HASSAN,
INSTITUTION
KARNATAKA.
COURSE OF STUDY
MASTER OF SCIENCE IN NURSING
AND SUBJECT
4
DATE OF
(COMMUNITY HEALTH NURSING)
15.06.2010
ADMISSION TO THE
COURSE
5
TITLE OF THE
TOPIC
“EFFECTIVNESS
PROGRAMME
ON
OF
STRUCTRUED
KNOWLEDGE
OF
TEACHING
SCHOOL
TEACHERS REGARDING VITAMIN A AND D DEFICIENY
AMONG
SCHOOL
CHILDREN
IN
SELECTED
L.P
SCHOOLS, HASSAN”.
5.1
STATEMENT OF
THE PROBLEM
“A STUDY TO EVALUATE THE EFFECTIVENESS OF
STRUCTURED
TEACHING
PROGRAMME
ON
KNOWLEDGE OF SCHOOL TEACHERS REGARDING
VITAMIN A AND D DEFICIENY AMONG SCHOOL
CHILDREN IN SELECTED L.P SCHOOLS, HASSAN”.
6. BRIEF RESUME OF THE INTENDED WORK
6.1 INTRODUCTION
“I like a teacher who gives you something to take home to think about
besides homework”.
~Lily Tomlin as "Edith.1
Vitamin A, identified in 1913, was the first fat soluble vitamin to be discovered. A light
yellow crystalline compound, vitamin A is also known as retinol, a name given in reference to the
participation of the retina of the eye. Vitamin A has also been called the anti-infective vitamin due
to its role in supporting the activities of immune system.2
A tell-tale sign of vitamin A deficiency is hyperkeratosis, a goose bump-like appearance of
the skin caused by excessive production of keratin (a protein found in skin) that blocks hair
follicles. In initial stages, hyperkeratosis is found on the forearms and thighs, where the skin
becomes dry, scaly, and rough. In advances stages, hyperkeratosis affects the whole body, causing
hair loss. 3
Due to the important role of vitamin A in supporting the functions of the immune system,
individuals with insufficient intake of this vitamin often experience increased susceptibility to viral
infections, most notably Measles, Chicken pox, Pneumonia, and Respiratory Syncytial virus
(RSV). Prolonged vitamin A deficiency can lead to night blindness, due to impaired production of
rhodopsin, the compound in the retina responsible for detecting small amounts of light.
Xerophthalmia, a condition characterized by changes to the conjunctiva and cornea of the eye, also
results from prolonged vitamin A deficiency, and is a major cause of blindness in developing
nations. 4
Retinol is found in foods that come from animals such as whole eggs, milk, and liver.
Most fat-free milk and dried nonfat milk solids sold in the United States are fortified with vitamin
A to replace the amount lost when the fat is removed. Fortified foods such as fortified breakfast
cereals also provide vitamin A. Provitamin A carotenoids are abundant in darkly colored fruits and
vegetables. The 2000 National Health and Nutrition Examination Survey (NHANES) indicated
2
that major dietary contributors of retinol are milk, margarine, eggs, beef liver and fortified
breakfast cereals, whereas major contributors of provitamin A carotenoids are carrots, cantaloupes,
spinach. 5
Vitamin D is a fat soluble vitamin that is naturally present in very few foods, added to
others and available as dietary supplement. Vitamin D is also known as the “sunshine” vitamin
because the body manufactures the vitamin after being exposed to sunshine. 10 to 15 minutes of
sunshine 3 times weekly is enough to produce the body requirement of vitamin D. 6
It is also produced endogenously when ultraviolet rays from sunlight strike the skin and
trigger vitamin D synthesis. Vitamin D obtained from sun exposure, food, and supplements is
biologically inert and must undergo two hydroxylations in the body for activation. The first occurs
in the liver and converts vitamin D to 25-hydroxyvitamin D, also known as calcidiol. The second
occurs primarily in the kidney and forms the physiologically active 1,25-dihydroxyvitamin D, also
known as calcitriol. 7
Vitamin D is essential for promoting calcium absorption in the gut and maintaining
adequate serum calcium and phosphate concentrations to enable normal mineralization of bone and
prevent hypocalcemic tetany. It is also needed for bone growth and bone remodeling by osteoblasts
and Osteoclasts. Without sufficient vitamin D, bones can become thin, brittle, or misshapen.
Vitamin D sufficiency prevents rickets in children and Osteomalacia in adults. Together with
calcium, vitamin D also helps protect older adults from Osteoporosis. 8
Vitamin D has other roles in human health, including modulation of neuromuscular and
immune function and reduction of inflammation. Many genes encoding proteins that regulate cell
proliferation, differentiation, and apoptosis are modulated in part by vitamin D. Many laboratorycultured human cells have vitamin D receptors. It remains to be determined whether cells with
vitamin D receptors in the intact human carry out this conversion. 9
Very few foods in nature contain vitamin D. The flesh of fish (such as salmon, tuna, and
mackerel) and fish liver oils are among the best sources. Small amounts of vitamin D are found in
beef liver, cheese, and egg yolks. Vitamin D in these foods is primarily in the form of vitamin D3
(cholecalciferol) and its metabolite. Some mushrooms provide vitamin D2 (ergocalciferol) in
3
variable amounts. Mushrooms with enhanced levels of vitamin D2 from being exposed to
ultraviolet light under controlled conditions are also available.10
Vitamins are important micronutrient for maintaining normal growth, regulating cellular
proliferation and differentiation, controlling development and maintaining and reproductive
function. It is essential for children because vitamin promotes growth and development both
physical and mentally. Child spends most of their life time with the teachers. So teachers can
easily identify disability during their growth and developmental period.
6.2. NEED FOR THE STUDY
Dietary deficiency of vitamin A and D is quite common in developing countries and is
associated with the high incidence of blindness, viral infections, growth retardation and child
mortality that occurs in impoverished populations.
The census of India for the second time during post independence period at country level
has provided very useful statistics on various disabilities. The various types of disabilities that are
considered are: disabled in seeing, hearing, speech, movement and mental. As per present census
analysis in India in all there are 21.9 million, 2.1% persons in Karnataka are disabled one. One the
basis of statistical scores method the disabled person of Dashina Kannada, Kodagu, and
Chinkamangalor visual and movement disabilities are more predominant. Main causes are vitamin
A and D deficiency. 11
Approximately 250,000 to 500,000 malnourished children in the developing world become
blind each year from the deficiency of vitamin A. Rickets is the classical diseases in children due
to deficiency of vitamin D. Vitamin D is essential for absorption of calcium from gut, maintaining
adequate serum calcium concentration enables normal mineralization of bone and prevent
hypocalicemic tetany in children. There is increased interest in early forms of vitamin A
deficiency, described as low storage levels of vitamin A that do not cause obvious deficiency
symptom. This mild degree of vitamin A deficiency may increase children's risk of developing
respiratory and diarrheol infections, decrease growth rate, slow bone development, and decrease
4
likelihood of survival from serious illness. Children who are considered to be at increased risk for
sub clinical vitamin A deficiency include:

toddlers and preschool age children;

children living at or below the poverty level;

children with inadequate health care or immunizations;

children living in areas with known nutritional deficiencies;

recent immigrants or refugees from developing countries with high incidence of vitamin A
deficiency or measles.
Vitamin A deficiency rarely occurs in the United States, but the World Health Organization
(WHO) and the United Nations Children's Fund (UNICEF) recommend vitamin A administration
for all children diagnosed with measles in communities where vitamin A deficiency is a serious
problem and where death from measles is greater than 1%. In 1994, the American Academy of
Pediatrics recommended vitamin A supplements for two subgroups of children likely to be at high
risk for sub clinical vitamin A deficiency: children aged 6 months to 24 months who are
hospitalized with measles, and hospitalized children older than 6 month. 12
Fat Malabsorption can result in diarrhea and prevent normal absorption of vitamin A.
Over time this may result in vitamin A deficiency. Vegetarians who do not consume eggs and
dairy foods need provitamin A carotenoids to meet their need for vitamin A. They should include a
minimum of five servings of fruits and vegetables in their daily diet and regularly choose dark
green leafy vegetables and orange and yellow fruits to consume recommended amounts of vitamin
A. 13
Nutrient deficiencies are usually the result of dietary inadequacy, impaired absorption and
use, increased requirement, or increased excretion. A vitamin D deficiency can occur when usual
intake is lower than recommended levels over time, exposure to sunlight is limited, the kidneys
cannot convert vitamin D to its active form, or absorption of vitamin D from the digestive tract is
inadequate. Vitamin D-deficient diets are associated with milk allergy, lactose intolerance, and
strict vegetarianism. 14
5
Rickets and Osteomalacia are the classical vitamin D deficiency diseases. In children,
vitamin D deficiency causes rickets, a disease characterized by a failure of bone tissue to properly
mineralize, resulting in soft bones and skeletal deformities. Rickets was first described in the mid17th century by British researcher. In the late 19th and early 20th centuries, German physicians
noted that consuming 1-3 teaspoons of cod liver oil per day could reverse rickets. In the 1920s and
prior to identification of the structure of vitamin D and its metabolites, biochemist Harry
Steenbock patented a process to impart antirachitic activity to foods. The process involved the
addition of what turned out to be precursor forms of vitamin D followed by exposure to UV
radiation. 15
Prolonged
exclusive
breastfeeding
without
the
AAP-recommended
vitamin
D
supplementation is a significant cause of rickets, particularly in dark-skinned infant’s breastfed by
mothers who are not vitamin D replete. Additional causes of rickets include extensive use of
sunscreens and placement of children in daycare programs, where they often have less outdoor
activity and sun exposure. Rickets is also more prevalent among immigrants from Asia, Africa,
and the Middle East, possibly because of genetic differences in vitamin D metabolism and
behavioral differences that lead to less sun exposure. 16
Vitamin D requirements cannot be met by human milk alone, which provides only about 25
IU/L. A recent review of reports of nutritional rickets found that a majority of cases occurred
among young, breastfed African Americans. The sun is a potential source of vitamin D, but AAP
advises keeping infants out of direct sunlight and having them wear protective clothing and
sunscreen. As noted earlier, AAP recommends that exclusively and partially breastfed infants be
supplemented with 400 IU of vitamin D per day. Homebound individuals, people living in
northern latitudes (such as New England and Alaska), women who wear long robes and head
coverings for religious reasons, and people with occupations that prevent sun exposure are unlikely
to obtain adequate vitamin D from sunlight. 17
This study is to assess the effectiveness of structured teaching programme on knowledge
of school teachers regarding vitamin A and D deficiency among L.P school students. Today’s
children are the citizens of future, so we have to safe guard children by early identification and its
prophylactic management.
6
6.3 STATEMENT OF PROBLEM
“A study to evaluate the effectiveness of Structured Teaching Program on Knowledge
of school teachers regarding vitamin A and D deficiency among the school children in
selected L.P Schools, Hassan”
6.4 OBJECTIVES OF THE STUDY
1.
To assess the knowledge of school teachers in Experimental & Control group of selected
L.P schools regarding vitamin A and D deficiency among the school children before the
administration of Structured Teaching Programme.
2.
To Develop and administer Structured Teaching Programme regarding vitamin A and D
deficiency to the school teachers in the Experimental group of selected L.P schools,
Hassan.
3.
To assess the knowledge of school teachers in Experimental & Control group regarding
vitamin A and D deficiency among the school children after the administration of
Structured Teaching Programme.
4.
To evaluate the effectiveness of Structured Teaching Program regarding vitamin A and D
deficiency among the school children in selected L.P schools, Hassan.
5.
To associate the pre & post test knowledge score of Experimental & Control group of L.P
school teachers with selected socio – demographic data.(age, sex, education, experience in
teaching field, health team member at home, exposure to media, number of children in
home, living area).
7
6.5 HYPOTHESIS
1. Null hypothesis:
H1: There will not be a significant difference between pre test and post test knowledge scores
regarding vitamin A and D deficiency among the Experimental group.
2. Research hypothesis:
H2: There will be a significant difference between pre test and post test knowledge scores
regarding vitamin A and D deficiency among the Experimental group.
H3: There will be significant association between the pre test knowledge scores & the
demographic variables.
6.6 ASSUMPTIONS:1.
The teachers will be having some knowledge about vitamin A & D deficiency.
2.
This study will improve the knowledge of Lower Primary school teachers regarding early
identification of vitamin A and D deficiency and thus the reduction of occurrence of
malnutrition in children.
6.7 OPERATIONAL DEFINITIONS
1. EVALUATE
It refers to judge or determine the significant worth or quality of Structured Teaching
Programme on knowledge regarding vitamin A and D deficiency among L.P school teachers, from
the response of pre test & post test.
8
2. EFFECTIVNESS
It refers to significant increase in the level of knowledge of L.P school teachers regarding
vitamin A and D deficiency from the response of pre-test, Structured Teaching Programme.
3. STRUCTURED TEACHING PROGRAMM
It refers to systematically organized instruction on knowledge regarding vitamin A and D
deficiency among L.P school teachers & the Structured Teaching Programme is in the form of
power point presentation.
4. KNOWLEDGE
It refers to the understanding of or information regarding vitamin A and D deficiency
among L.P school teachers, for the study purpose the knowledge areas will be introduction, causes,
signs & symptoms in details, dietary management & prevention.
5. VITAMIN A AND D
Vitamin A is a fat soluble vitamin that plays an important role in vision, bone growth,
reproduction, cell division, and cell differentiation (in which a cell becomes part of the brain,
muscle, lungs, blood, or other specialized tissue). Vitamin A helps regulate the immune system,
which helps prevent or fight off infections by making white blood cells that destroy harmful
bacteria and viruses.
Vitamin D is a fat soluble vitamin essential for promoting calcium absorption in the gut and
maintaining adequate serum calcium and phosphate concentrations to enable normal
mineralization of bone and prevent hypocalcemic tetany. It is also needed for bone growth and
bone remodeling by osteoblasts and osteoclasts, it also prevent rickets.
6. SCHOOL CHILDREN
It refers to those who are all attending the school, for the reference of the study, school
children are defined as those who are studying 1-5th standard at selected schools, Hassan.
9
7. LOWER PRIMARY SCHOOL TEACHERS
It refers to those who are teaching the school children & for the study it refers to the
teachers those who are teaching for the school students between 1-5th standards at selected schools,
Hassan.
8. DEFICIENCY
It refers to a condition resulting from the lack of one or more essential nutrients in the diet,
from the metabolic dysfunction, or from impaired digestion or absorption, excessive excretion or
increased biologic requirements. For the study purpose it refers to the lack or insufficiency of
vitamin A and D.
6.8 CRITERIA FOR SAMPLE SELECTION
Inclusion criteria
1. Teachers who are teaching in L.P class (1-5 standards) at selected schools, Hassan.
2. Teachers of L.P class who are present at the time of data collection.
Exclusion criteria
1. Teachers those who are teaching in higher primary class of selected school, Hassan
2. Teachers not present at the time of study.
6.9 LIMITATIONS OF THE STUDY
Study is limited to:
1. 80 lower primary school teachers of selected school, Hassan.
2. A period of 4 -6 weeks.
10
6.10 SIGNIFICANCE OF THE STUDY
Prevalence of vitamin A deficiency in India highest among the world. In India 30,000
children per year deaths, main cause is vitamin A and D deficiency. So I hope that my study will
improve the knowledge of school teachers to identify vitamin A and D deficiency in children. High
morbidity & mortality rate of children due to vitamin A & D deficiency can be reduced only by
early diagnosis & primordial function. This can be done by teacher & parents as because they are
the most related persons with student. This study signifies the importance of Structured Teaching
Program on identification of vitamin A and D deficiency in lower primary school children. The
study will help the teacher’s in early identification of vitamin A and D deficiency and they may
teach the parents about importance of vitamin A and D in younger age.
6.11 CONCEPTUAL FRAME WORK
Pender’s health promotion model
6.12 REVIEW OF LITERATURE
Review of literature is a key step in research process. Review of literature refers to an
extensive, exhaustive and systematic examination of publications relevant to the research project
.Before any research can be started whether it is a single study or an extended project, literature
reviews of previous studies and experiences related to proposed investigations should be done.
One of the most satisfying aspects of the literature review is the contribution it makes to the new
knowledge, insight and general scholarship of the researcher. 18
A multicentre study to assess vitamin A deficiency disorders (Bitot’s spot and corneal
scars) in 1,64,512 children (< 6 years) and night blindness among 1,13,202 children (24–71
months) from 16 districts of 11 states was carried out during 1997–2000. The prevalence of night
blindness among 6,633 pre scholars from 15 districts was also assessed. The sampling
methodology followed was a “30 cluster survey”. The highest prevalence of Bitot’s spot (4.71%),
11
corneal scar (0.5%) and night blindness (5.17%) in children was found in Gaya district whereas the
highest prevalence of night blindness (19.62%). 19
A study conducted in 2007 issued in India journal of pediatrics, a theme issue of magnitude
of vitamin A deficiency in primary school children of Sirur shows that nutritional assessment of
293 children from primary school children in a drought affected area revealed vitamin A
deficiency in 56% of them, which is highest reported so far in India. Extension of prophylactic
massive doses to primary school children for such areas is suggested. 20
A cross-sectional study conducted at Pediatric department of Civil Hospital Karachi from
January 2007 to December 2008. Patients aged 6 to 60 months, admitted in the ward were assessed
for nutritional status and stunting according to the WHO classification of malnutrition, mild
moderate and severe malnourished children were included in the study. A total of 150 patients
were enrolled in this study. Of all, 44% patients were severely stunted, 29% had moderate stunting,
18% had mild stunting while only 10.7% had normal stature. Severely malnourished were 79%
patients, 20% patients had moderate malnutrition. Forty two percent severely malnourished
children also had severe stunting. Anemia was the most common micronutrient deficiency seen in
78% patients, out of these 88% had iron deficiency anemia, Rickets was found in 36% patients.
Vitamin A deficiency was present in 14% cases. 21
A epidemologic study identified prevalence of vitamin A deficiency among Indian
preschool-aged children, Department of Community Medicine, Sikkim-Manipal Institute of
Medical Sciences. Study based on a broad criterion of vitamin A deficiency among Indian
preschool-aged children was developed on information provided in the WHO publication.
Secondly, 'Night Blindness (XN)' among preschool-age children along with Corneal Xerosis
associated with Bitot's spot (X1B) was considered as positive clinical signs. The total number of
children in this study population was 208379 and the number of children suffering from Vitamin A
deficiency disorders was 12510. The median prevalence was 7.0% and Inter-Quartile Range 3.3%
- 9.3%. 22
A cross sectional study conducted by PSM institute of medical science & published in
Indian journal of community medicine regarding nutrition status & dietary intake of preschool
children in urban slum of Varanasi, the study design was cross sectional the sample size is 520 pre
12
school children, the result shows that about 75% of preschool children was malnourished with 20%
of suffering from severe malnutrition. Although intake of protein comparatively better but vitamin
A was not enough. In 20% malnourished preschool children main disorders are night blindness &
growth retardation. 23
A cross sectional study was under taken on 135 Jenukuruba tribal children in Mysore,
Karnataka belonging 4 -13 age groups through purposive sampling method revealed that high
prevalence of mild 41%, severe 6.7% stunting, under weight was 45.2% & 14.8% severity shows
high prevalence of lack of luster & sparseness in hair, conjunctiva Xerosis are noted. 24
A hospital based study revealed that the prevalence of clinical evidence of vitamin D
deficiency in 5-15 yr old children has been shown to be 0.19 per cent though objective diagnostic
criteria were not mentioned (14). In children of Indian origin residing in South Africa, the
prevalence of knock knees and bow legs with gaps of 2.5 cm or more was 6.1-19.4 per cent (15).
In Asian migrants in the United Kingdom, the prevalence of clinical vitamin D deficiency in
children and adolescents was shown to be 5 to 30 per cent (16-19), while in studies using
biochemical and radiological variables, prevalence was 12.5 to 66 per cent. 25
A study performed by Ministry of Health in 1998; the study aimed to investigate the
prevalence of VDDR in children aged between 0–3 years. Between March 2007 and February
2008, 39,133 children aged between 0–3 years who were brought to different pediatric outpatient
clinics in Erzurum, Turkey, were examined for VDDR. VDDR diagnosis was made by radiological
and biochemical findings in the cases who were initially suspected of having clinical VDDR.
During a one-year period, 39 (0.099%) of the 39,133 patients were diagnosed with VDDR. None
of the cases with rickets was taking vitamin D supplementation. The most frequent physical
findings were rachitic rosary, enlargement of the wrists, and craniotabes. 26
A study conducted on vitamin D & rickets, it shows that once foods were fortified with
vitamin D and rickets appeared to have been conquered, many health care professionals thought
the major health problems resulting from vitamin D deficiency had been resolved. However,
rickets can be considered the tip of the vitamin D–deficiency iceberg. In fact, vitamin D deficiency
remains common in children and adults. In utero and during childhood, vitamin D deficiency can
cause growth retardation and skeletal deformities and may increase the risk of hip fracture later in
13
life. Vitamin D deficiency in adults can precipitate or exacerbate Osteopenia and Osteoporosis,
cause Osteomalacia and muscle weakness, and increase.27
A cross-sectional study undertaken to know the vitamin D status in India, it revealed that
the vitamin D status of children is very low in both urban and rural population studied. Pregnant
women and their new born had low vitamin D status. The effect of short course of loading doses of
vitamin D doesn’t have a lasting effect and a maintenance dose is needed. Low 25(OH)D levels
has its implications of lower peak bone mass and lower BMD compared to west. There may be a
public health need to fortify Indian foods with vitamin D. 28
A study conducted about calcium intake, sun exposure, vitamin D in 24 children and 16
adolescents with rickets/Osteomalacia.They found that young children with rickets had lower
calcium intake compared with controls, but similar sun exposure and 25 hydroxyvitamin D. Thus
deficient calcium intake is universal among children and adolescents with rickets/Osteomalacia.
Inadequate sun exposure and vitamin D deficiency are important in the etiology of adolescent
Osteomalacia. 29
A cross-sectional study, relating vitamin D to biochemical variables in the homeostatic
pathway for vitamin D physiology (PTH, calcitriol, bone remodeling). Two recent randomized
interventional trials show that vitamin D supplementation increases accrual of bone mass in
younger girls, and this is partly explained by enhanced calcium absorption and bone
mineralization. 30
A study revealed that vitamin D deficiency was highly prevalent in Qatari adolescents (1116 years old; 61.6%), followed by the 5-10 year olds (28.9%) and those below 5 years old (9.5%).
Vitamin D deficiency increased with age and there was a significant difference between vitamin
D-deficient and normal children in their age groups. A family history of vitamin D deficiency was
more frequent in children with vitamin D deficiency (33.7%) than in normal children (24.5%).
Most of the vitamin D-deficient children had no physical activity (60.6%) and no exposure to
sunlight (57.5%). 31
14
A study conducted a nationwide food consumption and nutrition survey in Nigeria to help
formulate strategies to address VAD, among other deficiencies. The distribution of VA in children
<5 y old was 25.6% in the rural sector, 32.6% in the medium, and 25.9% in the urban sector (P <
0.05). In conclusion, VAD is a severe public health problem in Nigeria. Although the proportion of
children with low serum vitamin A levels varies agro ecologically and across sectors, it is an
important public health problem in all zones and sectors. 32
7. MATERIAL AND METHODS OF STUDY
7.1 SOURCES OF DATA
Data will be collected from the L.P school teacher (1-5 standards) of selected L.P schools,
Hassan.
7.2 METHOD OF DATA COLLECTION
1. Research design: - True experimental, Solomon 4 group design is planned for the research
study.
Experimental group ------- Pre-test -------- Intervention ------------- Post-test
School-1(20)
O1
X
O2
Control group -------------- Pre-test ------------------------------------- Post-test
RANDOM
SAMPLING
School-1(20)
O1
O2
Experimental group-------------------------- Intervention ------------- Post-test
School-2(20)
X
O3
Control group -------------------------------------------------------------- Post-test
School-2(20)
O3
15
O1= Assessment of pre-test knowledge of school-1(20) regarding vitamin A and D deficiency in
teachers, among L.P school children.
X = Structured Teaching Programme on vitamin A and D deficiency in teachers, among L.P school
children.
O2 = Assessment of school-1(20) post test knowledge regarding vitamin A and D deficiency in
teachers, among L.P school children.
O3= Assessment of school-2(20) post test knowledge regarding vitamin A and D deficiency in
teachers, among L.P school children.
2. Research setting: Selected L.P school, Hassan.
3. Population:

Accessible population: School teachers at Hassan.

Target population: Selected L.P school teachers at Hassan.
4. Sample: L.P School teachers (1-5 standards) of selected schools, Hassan.
5. Sample size- 80 L.P school teachers (1-5 standards) of selected schools, Hassan.
6. Sampling technique: Stratified random sampling technique will be used for the study.
7. Collection of data-Data will be collected by using questionnaires.
16
8. VARIABLES
Independent variable
Structured Teaching Program regarding vitamin A and D deficiency.
Dependent variable
Knowledge of L.P school teachers regarding vitamin A and D deficiency.
Extraneous variables
Age, sex, education, experience in teaching field, health team member at home, exposure to
media, number of children in home, living area.
9. PLAN FOR DATA ANALYSIS
Descriptive statistics
Descriptive statistics include percentage, frequency, mean and standard deviation
Inferential statistics
It include paired ‘t-test’ with chi- square test and “ANOVA” “f” test for the assessment of
Knowledge and to associate the socio demographic variable is planned .
10. PILOT STUDY
10% of sample size is planned for the pilot study.
17
11. ETHICAL CONSIDERATION
1. Does the study require any intervention to be conducted on lower primary school teachers?
Yes
2. Has ethical clearance will be obtained from your institution?
Yes
3. Has the consent will be taken from selected school?
Yes
18
12. LIST OF REFERENCES (VANCOUVER STYLE)
1. www.quotegarden.com
2. Institute of Medicine. Food and Nutrition Board. Dietary Reference Intakes for Vitamin A,
Vitamin K, Arsenic, Boron, Chromium, Copper, Iodine, Iron, Manganese, Molybdenum,
Nickel, Silicon, Vanadium, and Zinc. National Academy Press, Washington, DC, 2001.
3. 6.Gerster H. Vitamin A-functions, dietary requirements and safety in humans. Int J Vitam
Nutr Res 1997;67:71-90.
4. Ross AC, Gardner EM. The function of vitamin A in cellular growth and differentiation,
and its roles during pregnancy and lactation. Adv Exp Med Biol 1994;352:187-200.
5. Hinds TS, West WL, Knight EM. Carotenoids and retinoids: A review of research, clinical,
and public health applications. J Clin Pharmacol 1997;37:551-8.
6. Institute of Medicine, Food and Nutrition Board. Dietary Reference Intakes: Calcium,
Phosphorus, Magnesium, Vitamin D, and Fluoride. Washington, DC: National Academy
Press, 1997.
7. Cranney C, Horsely T, O'Donnell S, Weiler H, Ooi D, Atkinson S, et al. Effectiveness and
safety of vitamin D. Evidence Report/Technology Assessment No. 158 prepared by the
University of Ottawa Evidence-based Practice Center under Contract No. 290-02.0021.
AHRQ Publication No. 07-E013. Rockville, MD: Agency for Healthcare Research and
Quality, 2007. (PubMed abstract)
8. Goldring SR, Krane S, Avioli LV. Disorders of calcification: osteomalacia and rickets. In:
DeGroot LJ, Besser M, Burger HG, Jameson JL, Loriaux DL, Marshall JC, et al., eds.
Endocrinology. 3rd ed. Philadelphia: WB Saunders, 1995:1204-27.
9. Favus MJ, Christakos S. Primer on the Metabolic Bone Diseases and Disorders of Mineral
Metabolism. 3rd ed. Philadelphia, PA: Lippincott-Raven, 1996.
10. Holick MF. Evolution and function of vitamin D. Recent results. Cancer Res 2003;164:328. [PubMed abstract]
11. Hayes CE, Hashold FE, Spach KM, Pederson LB. The immunological functions of the
vitamin D endocrine system. Cell Mol Biol 2003;49:277-300. [PubMed abstract]
19
12. Ross AC. Vitamin A and retinoids. In: Modern Nutrition in Health and Disease. 9th Edition
(edited by Shils ME, Olson J, Shike M, Ross AC). Lippincott Williams and Wilkins, New
York, 1999, pp. 305-27.
13. Harbige LS. Nutrition and immunity with emphasis on infection and autoimmune disease.
Nutr Health 1996;10:285-312. [PubMed abstract]
14. Hollis BW. Editorial: the determination of circulating 25-hydroxyvitamin D: no easy task.
J. Clin Endocrinol Metab 2004;89:3149-3151.
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