CHAPTER - I

INTRODUCTION

BACK GROUND OF THE STUDY

In india there are about 60 million malnourished children and every month about one
lack children die due to effects of malnutrition about 2.5 million children of our
country are threatened by blindness in early childhood because of lack of vitamin and
about 1200- 1400 go blind every year because of this deficiency which is eminently
curable .

About 75- 80 of the hospitalized children suffer from some degree 25%
pediatric beds are occupied by patient whose major problem is malnutrition is
indirectly responsible for hospitalization .Children are mankind seeds for the future .
A god given gift hope they deserve the utmost care from us for they are like wet clay
in the hands of a potter . The way we mound of them the way the pot of the future
will be .Children growth rate reflects accurately the state of a nation public health and
average nutritional status of its citizens .

A study done reported that the nutritional status of slum children was worst
amongst all urban groups and was even poorer than the rural average most common
couses of malnutrition include faulty infant feeding practices due to infection and
heath security poor environmental condition and lack of proper child care practices
.Under five children constitute the most vulnerable segment of any community. Their
nutritional status is a sensitive indicator of child health .

We compared data obtained during this survey with data from a nutritional
survey conducted in 2005 in the same will age before the start of the KEMRI \CDE
surveillance activities.

NEED FOR THE STUDY :

Under nutrition is widely recognized as a major health problem in the developing

countries of the world severe protein energy malnutrition often associated with

1
infection contributes to high child mortality in under privileged community .Cases
with mild to moderate under nutrition are likely to remain unrecognized because
clinical criteria for their diagnosis are imprecise and difficult to interpret accurately .

Anthropometric that in the 20 century differences between socioeconomic

classes cousad greater differences between growth of children then differences due to
ethnic factors across countries .The more deprived the population in terms of access t
nutrients infection loads hygiene and even care and attention the lower were weight
and height out comes .

A study done found that severe degree of malnutrition had highest prevalence
under two years of age ,sex , religion , literacy status of parents and morbidity of the
children were significantly associated with malnutrition A study done evidenced
that prevalence of severe malnutrition was noted to be there times higher in females
[24.76%] then males [8.45%] and among families it increased in direct proportion to
birth rate and inverse proportion to birth interval moreover , children of illiterate
parents and non working mothers had a higher incidence of severe protein energy
malnutrition .

PROBLEM STATEMENT :

A study to assess the effectiveness of planned teaching programme on the knowledge

regarding malnutrition among the mother of under five children in a selected area of
Jabalpur

OBJECTIVES OF THE STUDY :

To assess the pre test knowledge score regarding mothers of under five
children in a selected area in Jabalpur .
To assess the effectiveness of planned teaching programme on knowledge
regarding malnutrition among mother of under five year children in a selected
area of Jabalpur .
To assess the post test knowledge regarding malnutrition among mother of
under five children in a selected area in Jabalpur .

2
OPERATIONAL DEFINITION :

ASSESS - Assess means to judge the knowledge of any subject

EFFECTIVENESS Refers to gain in knowledge as determined difference in

pre test and post test knowledge scores. by significant

STRUCTURED TEACHING PROGRAMME It refers to the

systematically organized and developed instruction and teaching aids designed for the
group of the mothers of under five children regarding malnutrition .

KNOWLEDGE Refers to level of understanding .

MOTHERS OF UNDER FIVE - It refers to the mothers of children from 1to

5 years residing in a selected community .

MALNUTRITION ( POOR NOURISHMENT ) impairment of health

resulting from a deficiency nutrients .

HYPOTHESES -:

H1 There will not be a significant difference between the pre test and post test level
of knowledge of mothers of under five children .

H2- There will not be a significant association of level of knowledge among mothers
of under five children with selected demographic variables .

CONCEPTUAL FRAMEWORK :

The conceptual frame work of this study can be derived from Imogene kings goal
attainment theory . this in under five children with interaction , transaction and good
communicating by taking up health teaching for mother of under five children which
is necessary to malnutrition in under five prevention of malnutrition by administrating
the structured teaching programme can be obtained by adopting this theory .

3
 ASSUMPTION :

Malnutrition may affect the under five children when children are deprived of
adequate protein and calories .
under five children are more vulnerable for malnutrition .
Health education focused on mothers will help in the under five year
children

LIMITATIONS OF STUDY :

The study is delimited to 40 mothers of under five children .

The study is delimited to mothers of children residing in a selected area of
Jabalpur .

SUMMARY :

This chapter deals with introduction in which the back ground of the study , need of
study , statement of the problem , objectives of study , operational definition ,
assumption , hypothesis , conceptual framework of the study and limitation of the
study .

THROUGHPUT OUTPUT
INPUT PROCESS

Definition of malnutrition Assess of knowledge of mothers of Gain

knowledge
Types of malnutrition under five years children regarding

4
 Causes of malnutrition malnutrition
Symptoms of malnutrition
Diagnosis of malnutrition
Treatment of malnutrition
Complication of malnutrition

Feedback

Fig. (a) Open system with a feedback as mechanism

system

5
 CHAPTER -2

REVIEW OF LITERATURE

Review of literature is an essential components of the research process . The review

of literature help to ascertain what is already known in relation to a problem of
interest .It provides a basis for future investigation.

The review should comprehensive evaluative. based on the objectives the

review of literature has been organized and presented under the following heading .

LITERATURE RELATED

Literature related to malnutrition .

Literature related to demographic variables 3- related to planned teaching

programme .

A.K. SINGH , ET AL (2012) conducted a cross section study where house

survey was done covering 406 children ( 1-6) from the sub centre villages of
additional PHC Amarpur in Meerut district to study the prevalence of PEM and its
various socio demographic correlates in children . a multi stage random sampling
technique was used for samples and result showed that the prevalence of
underweight was 57.4% according to IAP classification with the proportion of grade
I , II and III under nutrition being 68.2% , 29. 2% and 2.6% and none of the children
in grade IV under nutrition . the prevalence of underweight was significantly higher
in 3-6 year children ( 47.6% ) and there was no significantly difference in the sex
and caste . prevalence of underweight was significantly higher in children belonging
to nuclear families . there was direct association of underweight with poor housing
and environmental sanitation and low standard of living index . the prevalence of
underweight was low in children of literate mother . The investigator observed that
protein energy malnutrition is one of the silent emergency seen in children of 1-5
years of age , so based on the field experience in the community and literature
review, the investigator felt the need to conduct the study on protein energy
malnutrition among 1 to 5 year children and its associated factors . it would help to

6
create awareness among health professionals and people about malnutrition the
factors that leads to malnutrition in the community .
5
CHILDREN IN INDIA 2012 ASTATISTICAL APPRAISAL -children of
today are citizens of tomorrow , which is why is it is extremely important to
ensure proper health care facilities as well as adequate on nutritional intake for
them . there is urgent need to focus on the nutrition and overall development
needs of children .

UNICEF INDIA , 2014 according to UNICEF malnutrition is more

common in India then in sub Saharan Africa , one in every three malnourished
children in the world live in India . Malnutrition in the children is not affected
by food intake alone, it is also influences to health services, quality of care for
child and pregnant mother as well as good hygienic practices.

A CROSS section descriptive survey study done to assess the nutrition

status of young children . they evidenced that greater risk for chronic
malnutrition was associated with families more them five people mother low
educational level children who were breastfed for more than a year .

A STUDY CORDUCTED ON PROTEIN energy malnutrition among

preschool children in among and found that the prevalence rates of wasting ,
stunting and underweight were 7.0% ,10. 6% and 17. 9% respectively at the
national level . There were no sex difference .

A study done to evaluate the prevalence of protein energy malnutrition

children under five year in three randomly selected state operated foster care
institution in Sri Lanka 52 samples were selected . The prevalence of protein
energy malnutrition was ( 51.9% ) under weight malnutrition ( 63. 5% ) and
wasting ( 25. 0% ) which was found to be considerably higher than the
national prevalence ( 13. 5% , 29. 4% , 14 . 0% respectively )

A study conducted on nutritional status of 406 preschool children residing in

urban slums at Delhi by making domiciliary visits. The overall prevalence of

7
 protein energy malnutrition was found to be 01 .0% while 31 . 8, 44. 1 5. 7 and
0.2 of children had grades I, II , III and IVPEM respectively age ,sex and
education had a significant association with PEM .

A study conducted to determine the growth of upper arm muscle area (

UAMA) upper arm fat area (UAFA ) and upper arm muscle area by height (
UAMAH ) and assessment of magnitude of under nutrition on the basis of
these parameters in santal children . The y evidenced that growth curves of
UAFA for age and UAMA by height were good indicator of nutritional status
in santal children . They recommended for approach to indentify the truly
under nourished children.

A cross sectional study done from randomly selected angan wadi to estimate
the pre-valence. Of and identify risk factors for xerophthalmia in children a
ged 6-71 Months living in slums in pune , india in 2003. at suggested the
importance of female education and indicated that vitamin a supplementation
and other .Approaches in children. Living in deprived areas like urban sluons.

A descriptive and prospective study of 335 children under the age of 6 admitted and
cared by clinicians and medical staff trained under world health organization
guidelines .

A study to compare prescription and delivery of nutrition to predefined nutritional

targets and identify risk factors associated with nutritional intake . they recommended
that nutritional therapy should be started in including adequate supply of protein and
in order to prevent deficits to accumulate nutrition should be needs cannot be met by
entreat nutrition .

A study reported that diet plays crucial role in the management of a case of protein
energy malnutrition severs malnutrition was best manged in the hospital as such cases
usually have life threatening complication . He suggested that when the child was
critically a caution approach to feeding was vital . By the end of the first week the
acute problems were overcome and oral feeds was introduced .In the rehabilitation
phase the emphasis was on weight gain and so a more vigorous approach was needed
.

8
 A study done to found that ready to use therapeutic food was important recent
advance in the dietary management of malnutrition in ambulatory setting , allowing
more effective prevention programmers and earlies discharge from hospital were
community follow up was available , which could be included in future protocols .
there was very good evidence on the use of micronutrients such as zone and that
smaller doses of daily large on admission for severe malnutrition SWEENEY et al .
1969 suggested an association between infection disease in the first 35 days of life
and EH of primary teeth using their data we have computer an odds ratio or for EH of
3.3 9 (c l 1.05,10.5) for those children with an infection in slightly 2.9 when
controlled for birth prematurity . This finding suggests either a direct effect of
infection on EH , possibly through febrile responses or an indirect effects , i e ,
infection being markers for malnutrition rather than an etiological risk factor for EH .

ALVAREZ e t al , 1993 , 1995 This study provides the sole evidence of a

relationship between early childhood PEM and permanent dentition caries .

Li et al , 1996 - A longitudinal study in per , adjusting for delayed eruption through

the comparison of peak caries levels , suggested that a single , prolonged ,
malnutrition episode in the first , year of life may result in liger primary dentition
caries rates , an increase in permanent dentition caries of that the caries risk may be
mediated by means other than enamel hyperplasia .

RUGY GUNN et al , 1998 - Found concurrent malnutrition in 2 to 6 year old Saudi

males with both case definitions of associated EH ( structural and opacities ) . While
controlling for a variety of potential confounders .

SEOW 1998 - In order to consider oral comes possibly associated with

PEM a brief , based on the excellent review is presented biological factors of caries
are

{1} Cryogenic bacteria in complex ecological system ( plaque ) .

{2} Fermentable carbohydrates .

{3} Host factors cryogenic bacteria acid using fermentable carbohydrates that
dematerializes that tooth base producing bacteria and rematerializing activity may

9
modify or counter the produced acid effects however , more pertinent in terms of
PEM

Are the host factors associated with caries , specifically tooth defects and the salivary
system . Tooth defects of interest are external structural defects ( hyperplasia ) that
can provide a more Cryogenic environmental niche and less protective enamel and
defects that include hypo mineralization and might increase susceptibility to
demineralization .

Salivary flow rates are related to caries directly through oral clearance and in terms
of buffering capacity and antimicrobial components . Salivary buffering is medicated
by the carbonate bicarbonate system as well as phosphate and protein system .

BOWMAN et al , 1998 Reports of underweight and stunted children a result of

range from 3.3 through 21 for various US regions and populations .

SHILS et al , 1999 protein energy malnutrition occurs when there are

deficiencies in protein , energy food or both , relative to a bodys needs , dietary
energy and protein deficiency usually occur together .

Main PEM has an acute course and has a main deficiency in energy , moderate PEM
is chronic in nature and has a main deficiency in protein while severe PEM is both
chronic and composed of deficiency in both protein and energy .

SEMBA and BLOEM 2001 However , PEM during the first 5 years of life
cannot be viewed solely in terms of nutritional in take malnutrition refers to the
syndrome of inadequate intakes of protein energy and micronutrients combined with
frequent infection over a third of the worlds children are affected by PEM .

CARVALHO et al , 2001 Thus , scientifically sound studies of malnutrition

and health outcomes , particularly those levels , have direct and immediate
applicability to the health of children worldwide .

10
RUSSELL SL et al , 2006 - Conducted a retrospective study on knowledge
about protein energy malnutrition among rural mother living in rural Haiti .

The sample size for this study was 96 mother . The overall result of this study was 57.
3% of the participant s having adequate knowledge regarding protein energy
malnutrition remaining of the participants having less knowledge about protein
energy malnutrition .

LISA HOSTI et al , 2009 Conducted a study about estimation of prevalence of

protein energy malnutrition with various anthropometric indices and examine its
correlates in a large of poor rural minority children among for children less than 5
year of age . The result of this study was prevalence of moderate and server protein
energy malnutrition was 15. 8 and 3.1% for and 9.2% for stunting and 0.9 and 0.5 %
for washing .

LIMA M ET AL , 2010 Conducted a study about malnutrition among children

of adolescent mother in a squatter community . Two groups of mothers were
distinguished via adolescent mothers with a mean ( S D) age it first delivery of 16 .7
year and older mothers with a mean (S D ) age at first delivery of 25 . The result were
the undernourished first born was the undernourished first born was 2. 5 times more
likely to have on adolescent mothers four times more likely to be in a household with
low income . 2 times likely to have illiterate mothers as compared to the first born
who remain well nourished .

N. KHADHA et al 2010 - Conducted a study to assess the relative importance

of socioeconomic and maternal determinants of the nutrition situation and maternal
determinants of the nutrition situation of fewer than 5 year of old in a urban African
area . The random sample of 1368 household by home visit and anthropometric
measurements were performed using standardized procedures on preschool children
(n- 2372 ) and their mothers (n 112) . The result of this was the influence of socio
economic factors on the nutrition status of children taking in to account adjustment
variables such as mother s age and sex was assessed .

11
OYELAMI OA et al , 2011- Conducted a study on assurance of kwashiorkor
before the establishment of training unit at Nigerian tertiary hospital . A retrospective
hospital based analytical study was under taken . The study setting was pediatric ward
, of Wesley Guide Hospital Nigeria ,. The result was 30. 4% reduction in the total
admission between there periods.
Reduction in number of Kwashiorkor case between groups was significantly related
to the reduced incidence of measles . The total number of Kwashiorkor case c r =
0.412 and 0.233 for group 1 and 10 .

A.K. SOOD , et al 2007 Conducted study on knowledge and practices among

rural mothers in Haryana . The conducted study on 108 rural mothers about child
hood diarrhea where determine by using pretested semistructure interview schedules
the common process are reported were eruption of teeth {67. 59 %} eating of mud
{51.85%} worn infestation {47. 22%} change of climate {35.18%} poor personal
hygiene {34.25%} and changes in diet {25.92%} majority {83.33%} of mothers
practice food restriction during diarrhea 77% consulted their mother in lows in the
first instance for treatment of diarrhea .

ONIS et al , 2001 - Which results in a lower resistance to diseases .

NILAMBARJH , et al , 2006 Conducted a study on knowledge , attitude and

practices of mothers regarding home management in hepal on 330 children on
Sunsari district . The time of home visit , after 24 houes ton know the improvement
in the child and also preparation the information about ors and also it usual names in
the management of dehydration due to diarrhea . Mothers gave ors to their children
{after each stool } with caret .

DEDUYS ROESSINGH AS , et al 2007 this study has conducted

in france in this study they reviewed the files of all children admitted to
hospital for the has between 1988 to 2000 . In a conclusion the research
determine and treatment needs among under five children with
gastrointestinal complication of rare but they need early surgery .

12
 CHAPTER 3
METHODOLOGY
Methodology is the most important part of research study , which
enables the researcher to form blueprint of the research undertaken .
Research methodology provides a brief description of the method
adopted by the investigator in the study . Research methodology
involves the systematic procedure by which the researcher starts from
the time of initial identification of the problems to its final conclusion
. The present study was aimed at assessing the effectiveness of
structured teaching programme on malnutrition among mother of
under five children selected area of Jabalpur.[M.P].

This chapter deals with different steps which were undertaken

by the investigator for gathering and organizing the data .It includes
the description of research approach , research design ,setting of the
study , population , sampling technique , criteria for selection of the
samples , samples size , limitations , and method of data collection ,
development and description of the tool , ethical consideration ,
validity , and development of structured teaching programme on
malnutrition , pilot study , reliability , data collection procedure and
plan for data analysis .

THE RESEARCH APPROACH

Research approach is the most important amd significant part
of any research. The appropriate choice of the research approach
depends upon the purpose of the research study which was
undertaken.

RESEARCH DESIGN

The selection of the research design is an important and

essential step in research as it is concerned with the overall frame
work of conducting the study by giving a plan , structure and
strategy of investigation .

13
 A one group test , post test pre experimental design straight
forward research design in which there is a treatment and were given
a post test . After considering the entire factors related to the selected
problem , the investigator has selected one group pre test , post test
pre experimental design for testing the effectiveness of structured
teaching programme on malnutrition among mother of under five
childrens in selective area of Jabalpur .

Target Population
Extraneous Mothers of under five years children
Variables slum areas of Jabalpur
Purposive
Age
Relation Accessible population
Type of family Mothers of under five years childrens who
Number of are living in slum areas of Jabalpur
children Random Sam
Education
Complete En
Income of
family Sample/ Sample size
40 mothers of under five years
children

Dependent Pre-Test
Variables

Knowledge Independent Variables Data Collec

on Implementation of structure d Teaching Structu
Malnutrition programme Question

Post- Test

Data analysis and interpretation

Descriptive and inferential statistics
Criterion m
Knowledg
Report writing
14
 Low Knowledge Average Hi
Knowledge

Fig.2 Schematic diagram of

research

VARIABLE UNDER STUDY

Variable is an attribute of a person or an object that varies that is taken different

values. In the present study they are given below.

Dependent variable

A pressured effect in referred to as the dependent variables. In the present

study it refers to the knowledge level of mother less than five year children regarding
protein energy malnutrition.

Independent variable

The pressured cause is referred to the independent variable in this study it

refers to the variables such as age experience qualification and department of
working.

SETTING OF THE STUDY

Setting are the more specific place where data collection will occur .

The setting of the present study was in Victoria hospital ,Jabalpur . Jabalpur is
situated in the heart of Madhya Pradesh. It is has an vast area of 10,160 km. sq with of
population of 2,167,469[2001 census].

POPULATION :-

Population is the entire aggregation of cases that most a deigned 0 criteria.

15
The population in the study is described in two forms.

TARGET POPULATION:-

The target population in the present study are mother of under five year
children .

ASSESSIBLE POPULATION

The assessable population are mother of five year children in selected area of
Jabalpur .

SAMPLE SIZE

A sample consists of a subject of the unit that composes the population . In the study
sample comprises of 40 mothers of five year children .

SAMPLING TECHNIQUE

Sampling is a process of selecting a portion of the population to represent the entire

population, convenient sampling is based on the convenience of a researches. In
this study convenient sampling has been done to select the sample. All mothers of five
years children who fulfilled the inclusion criteria and those who were available during
the data collection were selected for the study.

CRITERIA FOR SAMPLE SELECTION

INCLUSION CRITERIA

1. Mothers of five year children

2. Available at the time of data collection.
3. Willing to participate in the study.

EXCLUSION CRITERIA

1. Not willing to participate in the study.

2. Not available during data collection.

16
 LIMITATIONS

The study was limited to

1. W ho were available during data collection?
2. Who were willing to participate in the study?

METHOD OF DATA COLLECTION

Method of data collection includes development of tool, testing of validity and

reliability and data collection procedure.

A questionnaire is a self-reported instruments and contain questions that

respondents are asked to answer in writing . A self administered was selected
as a method of data collection for present study.

DEVELOPMENT OF THE TOOL:-

The following steps were adopted in the development of the tool .

Review Literature.
Discussion with rural experts.
Construction of a structured interview schedule.
Content validity.
Pre-testing of the tool.
Reliability.
Investigator is observations in the rural area.

DESCRIPTION OF THE TOOLS:

The final format of the structured questionnaire was comprised of two parts.

PART-A This section includes items seeking information on the demographic

data which include:-

I. Age
II. Religion
III. Type of family Experience etc.

17
 PART-B This section includes 20 questions seeking information regarding the
knowledge on malnutrition.

SCORING OF QUESTIONNAIRES:-

The maximum - 20

The minimum score - 00

For right answer - 01

For wrong answer - 00

The scoring is categorized as:-

Poor - 0-5

Average - 6-12

Good - 13-20

PILOT STUDY

Pilot study was conducted on 11th March 2016,to assess the feasibility and reliability
of the tool. Ten subjects were selected from the mothers of under five years childrens
in selected rural areas of Jabalpur.

The data was collected during the period of 11th March 2016. The samples
were considered for final study. The tool and structured teaching programmed was
found to be feasible through participants responses.

VALIDITY

Consent validity refers to the degree to which the items in instruments

adequately represent the universal content. The prepared tool and structured teaching
programme was validated by two teachers of nursing faculties. The expert were
requested to judge the items for their relatedness, clarity, content, simplicity and
appropriateness. Based on their suggestion, recommendations and the results of the
pilot study , the format of the tool was modified .

18
RELIABILITY

Reliability refers to accuracy or inaccuracy rate in measurement device. The

three main attribute of reliable scale are stability, homogeneity and equivalence.The
reliability of tool was tested by using test-retest method .The reported coefficient of
correlation was found to be highly significant. The tool was found to be highly
reliable and valid.

DATA COLLECTION PROCESS:-

Datas were collected on the investigators familiarized with the subject and
explained the purpose of the study method of data collection subjects were selected
from slum area Jabalpur by convenient sampling.

The subjects were first interviewed and their demographic and baseline
information were collected. Then their knowledge on malnutrition was assessed using
the structured questionnaire.

19
 CONTENT OF TEACHING

Subject : Pediatric nursing

Topic : Malnutrition

Group : Mothers of under fiver year children

Place : Ghamapur

Teaching method : Lecture cum discussion

Date and time : 18/3/2016

Duration : 1 hour

AV Aids : Flip chart, Posters , Pamphlets

Student teacher : Pramila Raidas , Priyanka yadav

Pooja kachhi , Pushpa singh

Guided by : Mrs. Rebecca Bethe (Lecturer)

20
 OBJECTIVES

General Objectives:
At the end of the teaching programme on the knowledge regarding malnutrition
among the mother of under five year children in selected area of Jabalpur.

Specific Objectives:
At the end the teaching programme mother of under five children will able to.

Introduce Malnutrition
Define Malnutrition
List out the types
List out the causes
List out the symptoms
List out the diagnosis
List out the treatment
List out the complication

21
22
S.No. Time Specific Content Teaching A.V Evolution
Object Learning Aids
Activity
1) 4)min Introduce the INTRODUCTION Flip chart
topic Malnutrition is due to in sufficient & imbalanced diet
Protein energy malnutrition is the major nutrition
problem malnutrition like LBW is global problem
during 1995, more than 28% of the worlds children
under the age of 5 years were under weight for their
age.
2) 2 min Define Impairment of health resulting from a deficiency Define Malnutrition
malnutrition nutrients
3) 10 min Types of 1: Protein energy Meelnutrition Flip chart Wheat are the type of
Malnutrition Merasmus malnutrition
Kwashiorkor
2:Micronutrients deficiency diseases
Night blindness
Beriberi
Pellagra
Scurvy
Rickets

4) 5 min Causes of Lack of food Wheat are the

malnutrition Loss of appetite causes of
Those with diarrhea or persistent Malnutrition
nausea & vomiting. Flip
Neglected children chart

23
 Infection diseases
Worm infestations
Socio-Economic factors
Cultural factors

(5) 10 min Symptoms of Weight loss

malnutrition B.M.
Weakness of muscles & fatigue
Lack of energy
Irritability & dizziness
Skin & hair becomes dry
Growth failure
Pain in the bones & joints
Anemia
Spoon shaped nuts
Bleeding gums

24
 BMI
Routine blood test
Mid-upper arm diameter
X-Ray
6) 5 Mint Diagnosis Stool test
Urine test Flip chart

Thyroid function test

Level of calcium, Phosphate , Zinc ,vita.

DIETARG THERAPY

1.Bread-Rice , Potatoes & other starch food.

2.Milk and dry fruits.

3. Fruit & vegetables

7) 15 minte Treatment and
prevention of 4. Meat , Poultry , fish , eggs , beans. POSTERS
malnutrition

In children prevention of malnutrition includes

practicing exclusive breast feeding &adequate
nutrition of the mother.

PREGNANT WOMEN SHOULD TAKE

25
Pregnant women require more calories & nutrients
than non-pregnant women as their fetus grows.

Iron , folic acids &other vitamins and minerals

GOVERNMENT OF INDIAS NUTRITIONAL

PROGRAMMES

1. The supplementary feeding programme-

(1970)
Nutritional benefit of preschool children (6
month to 6 years)
Pregnant women and nursing mothers .
The supplementary food supplies 300 calories
of energy and 10-12 gms of protein per child
per day .

2. BALWADI NUTRITION PROGRAMME-

(1970-71)
Balwadi were established in rural areas fore
providing preparatory education to children in
the age of 3 to 6 year .

3. MID-DAY MEAL PROGRAMME (1960S)

Mid-day meal programme has an important
role in providing balanced diet to school
children.
Provide diet supplements to children.
In this programme one-third of the childs
daily requirement can be fulfilled.

26
 4. VITAMIN A PROPHYLAXIS
PROGRAMME (1970)
It is necessary to prevent disease due to
deficiency of vitamin A.
Children under 5 year of age are given vitamin
A containing 2,00,000 IU orally , every 6
months through this programme in India every
year.

5. ANEMIA CONTROL PROGRAMME.

This programme consists of distribution of

iron and folic acid tablets to pregnant women
and young children (1-12 years)

1. Fever >39.c
2. Jaundice
3. Bleeding tendencies
4. Very pale (sever-anemia)
5. Extensive skin lesion/infection.

8) 5 minutes Complication Flip chart

of
Malnutrition

27
CHAPTER - IV
DATA ANALYSIS AND INTERPRETATION
Objectives of the study:-

To assess the existing knowledge level of mothers of under five year

children.
To assess the effectiveness of Structured Teaching Programme on
malnutrition.
To find out the relationship between the selected socio demographic
variables of mothers of under five year children with their pre test
knowledge score on malnutrition.

According to the objectives of the study, the data were represented under
the following section:

Section I

It deals with analysis of the demographic data of the sample.

General information related to malnutrition.

Section II

It deals with analysis of the data according to grading of the knowledge.

Section III

It deals with analysis of the data in relation to mean and standard deviation
(SD).

Section IV

It deals with association between the demographic variables and knowledge

scores of mothers of under five years children on malnutrition

28
 SECTION- I
Socio-demographic data selected for analysis in the study were age, religion and
type of family.

Table no:-1

Demographic description of sample according to frequency &

percentage.

( N=40)
S.No Variables Frequency Percentage
.
1. Age
a) 20-21 years 13 32.5%
b) 22-23 years 11 27.5%
c) 24-25 years 9 22.5%
d) 26-27 years 7 17.5%

2. Number of the children

a) 1 4 10%
b) 2 13 32.5%
c) 3 7 17.5%
d) more than 3 16 40%

3. Religion
a) Hindu 24 60%
b) Muslim 9 22.5%
c) Christian 3 7.5%
d) others 4 10%

29
 4. Types of family
a) Nuclear 11 27.5%
b) Joint 29 72.5%

5. Education qualification
a) Illiterate 1 2.5%
b) primary class 12 30%30
c) high school 24 60%60
d) graduate 3 7.5%

6. Income of the family

a)1000-3000 5 12.5%
b)3000-5000 14 35%
c)5000-8000 17 42.5%
d) above 8000 4 10%

30
 17.5

32.5
20 to 21 years
22 to 23 years
24 to 25 years
22.5 26 to 27 years

27.5

Figure:1
PIE DIAGRAM SHOWING THE PERCENTAGE
DISTRIBUTION OF WOMEN ACCORDING TO
AGE .
Most of women32.5% women are in the age group of 20-21 years . 27.5% are in
the age 22-23 years .22.5% are in the age group of 24-25 years women and 17.5%
are in the age group of 26-27 years women .

31
 10

40

One
32.5
Two
Three
> Three

17.5

FIGURE :2
PIE DIAGRAM SHOWING THE PERCENTAGE
DISTRIBUTION OF CHILDREN ACCORDING TO
Number
Most of the women 40%are having more than 3 children 17.5% are having 3
children 32.5%are having 2 children and 10%are having 1 children.

32
 0
60

50

40

60
30

20

22.5
10
7.5 10

0
Hindu Muslim Christian Others

Figure:3
Pie diagram showing the percentages distribution of
religion according to parents.

Most of the women 60% are Hindu .22.5% are Muslim .7.5% are Christian. And
10% women are others.

33
 72.5
80

70

60

50

40
27.5

30

20

10

0
Nuclear Joint

Figure: 4
Pie diagrams showing the parentage distribution of
type of family according to parent.

72.5% women are in joint family and 27.5% in nuclear family.

34
 60

50

40

0 60
30

20

10
0
0
0
Illeterate Primary class High school Graduate

Figure:5
Pie diagrams showing the percentage distribution of
qualification according to parents .

Most of the women 60% are high school education and 30% are in primary
class education 7.5%are in graduated women and 2.5%are in illiterate women .

35
 Series 1

45
40
35
30
25
42.5
20 35
15
10
12.5 10
5
0
1000-3000 3000-5000 5000-8000 above 8000

Figure:6
Pie diagram showing the percentage distribution of
income of the family according to parent .

Among 40 sample 12.5%are having the monthly income status between Rs 1000-
3000. 35%are from Rs . 3000-5000 ,42.5%are Rs . 5000-8000 and rest status
10%are from above Rs . 8000

36
 70 65

60

50

40

30
20
20 15

10

0
GOOD AVERAGE POOR

Figure:7
Pre test knowledge of mothers of under five year
children
Table No -02
Assessment of pre-test knowledge of mothers of under five year
childrens

(N=40)

S. no category frequency percentage mean Sd

01 Good 6 15%

02 Average 8 20% 12.66 7.308

03 Poor 26 65%

37
The data presented in the table no 02 fulfill the objective (1) clearly indicates that
26 mothers have poor knowledge regarding malnutrition The mean & SD also
justify the knowledge of mothers.

38
80 75

70

60

50
GOOD
40
AVERAGE

30 POOR

20 15
10
10

0
GOOD AVERAGE POOR

FIGURE:8
Post test knowledge of mothers of under five year
children

Table No -03
Assessment of post knowledge of mothers of under five year children

(N=40)

S .no category frequency percentage mean Sd

01 Good 30 75%

Average 6 15% 13.33 10.284

02
Poor 4 10%
03

39
The data presented in the table no 03 fulfill the objective (1)clearly indicates that
30 mothers have good knowledge regarding malnutrition.The mean & SD justify
the knowledge of mothers.

Table No-04
Correlation between pre & post test knowledge of mothers of under
five year children regarding malnutrition.

S. No Description mean SD Correlation

01 Pre-test 12.66 7.308

knowledge
Post-test 13.33 10.284 20.05
02 knowledge

The Table no .04 fulfill the objective No.02. The comparison between pre and post
knowledge made by correlation. Correlation is the appropriate statistical method to
compare the pre &post test knowledge score . The result showed positive correlation.

Table No-05
Compare of pre & post test knowledge of mothers of under five year
childrens regarding malnutrition.

(N=40)

S.NO Description Mean SD T-Test

Pre-test 12.66 7.308

01 knowledge
02 Post- Test 13.33 10.284 0.898
knowledge

40
The Table No 05 fulfill the objective No-02 The comparison between pre and
post test knowledge made by T-test. The pre test and post test knowledge was
statistically tested by applying T-test methode.

41
 CHAPTER-V
DISCUSSION

The present study was undertaken to assess the effectiveness structured teaching
programme on the knowledge regarding malnutrition among mothers of under fiver
year children in selected slum area in Jabalpur the study adopted quantitative research
approach the population in 40 women from selected rural area in Jabalpur .

Objectives of the study :-

1. To assess the existing knowledge level of mothers of under five year

childrens on malnutrition.
2. To assess the effectiveness of structured teaching programme on malnutrition.
3. To find out the relationship between the selected socio demographic variables
of mothers of under five year children with their pre-test knowledge score on
malnutrition.

Summary:-

This chapter deals with the assessment of effectiveness of structured teaching

programme on the knowledge regarding malnutrition among mothers of under five
year childrens in selected slum area of Jabalpur.

The main aim of the study was to identity the knowledge level of mother
regarding malnutrition among mothers of under five year children in selected slum
area.

42
 CHAPTER -VI

MAJOR FINDING

1. Most of the women 32.5% women are in the age group of 20-21 year . 27.5%
are in the age 22-23 year. 22.5% are in the age group of 24-25 year women and
17.5%are in the age group of 26-27 year women.
2. Most of the women 40% are having more than 3 children 17.5% are having 3
children 32.5%are having2 children and 10% are having 1 children.
3. 72.5% women are in joint family and 27.5% in nuclear family .
4. Most of the women 60% are high school education and 30%are in primary class
education 7.5% are in graduated women and 2.5% are in illiterate women.
5. Among 40 sample 12.5% are having the monthly income status between Rs.
1000-3000 35% are from Rs. 3000-5000 ,42.55are Rs. 5000-8000 and rest status
10% are from above Rs. 8000.

LIMITATION

Study is limited to the Ghamapur.

SUMMARY

This chapter deals with back ground of the study and statement of the problem
objective assumption limitation operational definition.

The present study was undertaken to assess the effectiveness structured teaching
programme on the knowledge regarding malnutrition among mothers of under five
year children in selected slum area of Jabalpur.

CONCLUSION

The majority of the mothers have less knowledge regarding malnutrition. To

conclude the researchers would like to mention that present study helped to assess the

43
effectiveness structured teaching programme on the knowledge regarding
malnutrition.

44
 REFERENCES

BOOKS
1. Parul Datta text book of pediatric Nursing published by Jaypee Brothers
medical publi9shers (P) Ltd edition 2nd-2012 Page No. 206-209.

2. .Piyush Bianwzzo text book of breast feeding the newborn published by

A.P Jain & CO edition 1st-2011 Page No. 135.

3. Donna L.Wong texts book of pediatric nursing publisher by Whaley &

Wongs edition 8th edition 2007 page No. 345-346.

4. Pee Vee text book of child health nursing published by S.Vikas (medical
publishers) India edition 2013 Page No. 402-410

5. Shabhammasih text book of essentials food and nutrition published by

rajinder kapoor edition 1st 2006 Page No. 93-95.

6. Melly San and N.Gather text book by nutrition for nurses published by
Jaypee brothers 1st edition 2000 Page No. 22.

7. Pee Vee text book of nursing research and statistics published by S.Vikas
& Company (meical publishers) India Page No. 318.

8. Ghosh S. Nutrition and Child care : A practical guide 2nd ed. New Delhi :
Jaypee

9. Sen V. & Sharmah R. mid arm/ head circumference ration in the

assessment of malnutrition. The pediatric 1980; 47; 215-5.

10. Ghai OP. Essential pediatrics. 6th ed. New Delhi; CBS Publishers; 2005. P.
101-2.

11. National Family Health Survey (NFHS III) 2005-06. Vol. 1. Ministry of
Health and Family Welfare. Govt. of India Mumbai International Institute
for Population Sciences. P- 267-73.

45
12. Kaur G. Singh KH. Singal P. Singh Nutritional status: Anthropometric
perspective of preschool children Anthropologist 2005;7(2):99-103.

13. Sharma JN. Bora P. Mid Arm circumference as an inhere of malnutrition

between 6 to 12 months of age. inc pediatric 1998; 35: 1005-8.

14. Robinow M. Jelliffee DB. The arm circumference as a public health inhere
of malnutrition of early childhood .J. Trop pediatric 1993;39:298-303.

15. Ball TM. Pust RE. Arm circumference vs Arm circumference/ Head
circumference ration in the assessment of malnutrition in rural Malawian
children . J Trop pediatric 1993;39:298-303.

16. Mandal GC. Bose K. , Bisai S. Ganguly S under nutrition among integrated
child development services (ICDS) Scheme children aged 2-6 years of
Aram bag , Hooghly District West Bengal, India : A Seriou Health Problem.
J of Pub. Health 2008:5(1): 28-33.

17. Mittal A. Singh J. Ahluwalia SK Effect of Maternal factors on nutritional

status of 1-5 years old children in urban slum population inc; J of com
Med 2007;32(4).

18. Saxena N. Nagar D. Kapil U. Prevalence of underweight wasting and

stunting. Inc; Pediatric 1996; 34: 627-37.

JOURNALS

Nursing Journal of India, Deficiency Protein & Prevention of Malnourished. Volume-

ii 2008.

WEBSITES

1. www.pubmed.com
2.www.midline.com
3. www.cinhals.com
4. www.wikipedia.com
5. Aje.oxfordjournals.com

46
 PART-I

Demographic Data
Demographic profiles of participants

Instructions
This will be confidential pleas tick mark the item that you considered appropriate .
Kindly do not miss any item .

1) Age group of the mother.

(a) 20 -21 years { }

(b) 22 -23 years { }

(c) 24 --25 years { }

(d) 26 -27 years { }

2) Number of children .

(a) 1 { }

(b) 2 { }

( c) 3 { }

(d) More than 3 { }

3) Religion

(a) Hindu { }

(b) Muslim { }

(c) Christian { }

(d) Any other, specify { }

4) Type of family

(a) Nuclear { }

(b) Joint { }

47
5) Education qualification .

(a) Illiterate { }

(b) Primary { }

( c) High School { }

(d) Graduate { }

6) Income of the family .

(a) Rs. 1000 Rs. 3000 { }

(b) Rs. 3000 Rs. 5000 { }

( c) Rs. 5000 RS. -8000 { }

(d) Above Rs.8000 { }

48
 PART-II

Structure knowledge questionnaires ,question regarding

malnutrition

INSTRUCTIONS
There are certain options to know your knowledge regarding malnutrition .

Kindly ( ) to the appropriate option according to you . The information you provide
will be kept confidential.

1. what is malnutrition ?

(a) Inadequate dietary intake { }

(b) Blood disorder { }

( c) Mental disorder { }

(d) None of these { }

2.what is nutrition ?

(a) Balance diet { }

(b) High fat diet { }

( c) Good food { }

(d) Spicy food { }

3.Which country is mostly effect by malnutrition ?

(a) Asia { }

(b) Australia { }

(c) India { }

(d) All of above { }

49
4. Which media is best for informing malnutrition ?

(a) Television { }

(b) Radio { }

( c) Health center { }

(d) All of above { }

5. What type of diet should be given to the malnutrition child?

(a) protein rich diet { }

(b) carbohydrate rich diet { }

( c) Mineral diet { }

(d) All of above { }

6. How can you educate the mother about knowledge & health services of
malnutrition ?

(a) Anganwadi { }

(b) Health worker { }

( c) Health center { }

(d) All of above { }

7. What are the problems related to malnutrition ?

(a) Obesity { }

(b) Balance diet { }

(c ) Smoking { }

(d) Infant mortality { }

8. How much body weight at time of birth ?

(a) 2.5 kg { }

50
(b) 4 kg { }

(c) 6 kg { }

(d) 8 kg { }

9. What are t5he risk factor of malnutrition ?

(a) Communicable disease { }

(b) Worms infection { }

( c) Socio economic factors { }

(d) All of above { }

10. What are the complication of malnutrition ?

(a) Hypoglycimia { }

(b) Hypothermia { }

( c) Infection { }

(d) All of above { }

11. How do you prevent malnutrition?

(a) Nutretional education { }

(b) Breast feeding teachniqes ? { }

( c) Infection { }

(d) None of these { }

12. What are the programme run by govt. of India for prevention of malnutrition ?

(a) Mid day meal programme { }

(b) Balwadi nutrition programme { }

( c) Samekit child programme { }

(d0 All of above { }

13.What are the symptoms of marasmus ?

(a) Anemia { }

(b) Pre-tearm baby { }

(c ) A or B both { }

51
(d) None of these { }

52
14. In which age of children has malnutrition been seen mostly?

(a) 1 to 5 year { }

(b) 6 to 10 year { }

( c) 15 to 17 year { }

(d) None of these { }

15. Which diet should be given under the five years childrens?

(a) Fatty food { }

(b) Spicy food { }

( c) balanced diet { }

(d) All of above { }

16. What are the symptoms of Ricketts ?

(a) Abdominal distention { }

(b) Bend leg &hand { }

( c) A & B Both { }

(d) All of above { }

17. How can 1 to 5 years children be saved from malnutrition ?

(a) Immunization { }

(b)Malnutrition education { }

( c) Breast feeding { }

(d) All of these { }

18. What are the symptoms of scarbe disease?

(a) Red and black spot in body { }

(b) Abdominal distention { }

( c) Sunkyen eye { }

(d) All of these { }

53
19. Which age child is taken under the mid day meal programme ?

(a) 1-5 years { }

(b) 18-20 years { }

( c) 5-14 years { }

(d) All of these { }

20 . What sort of face of child does it look due to kwashiorkor diseases?

(a) Abdominal distention { }

(b) Long hand { }

( c) A & b both { }

(d) none of these { }

54
Answer

QUESTION ANSWER QUESTION ANSWER

NO. NO. NO. NO.

Q 1. A Q 11. C

Q 2. A Q 12. D

Q 3. A Q 13. C

Q 4. D Q 14. A

Q 5. D Q 15. C

Q 6. D Q 16. C

Q 7. D Q 17. D

Q 8. A Q 18 D

Q 9. D Q 19. C

Q 10. D Q 20. C

55
 [k.M+ v
Lkkekftd tulkaf[;dh; vakdMs+

iz- 1 ek dh vk;q
v 20 ls 21 lky
c 22 ls 23 lky
l 24 ls 25 lky
n 26 ls 27 lky

iz- 2 cPpks dh la[;k

v 1
c 2
l 3
n 3 ls vf/kd

iz- 3 /keZ
v fgUnq
c eqfLye
l ffp;u

56
 n vU;

iz- 4 ifjokj ds izdkj

v ,dy ifjokj
c la;qDr ifjokj

iz- 5 kS{kf.kd ;ksX;rk

v vui<+
c izkFkfed
l gkbZLdwy
n Lukrd

iz- 6 ifjokj dh vk;

v 1000 :- 3000 :-
c 3000 :- 5000 :-
l 5000 :- 8000 :-
n 8000 :- ls vf/kd

57
 [k.M+ c
iz- 1 dikqsi.k D;k gSa \
v vi;kZIr vkgkj dk lsou
c jDr fodkj
l euksfodkj
n buesa ls dksbZ ugh
iz- 2 iksi.k D;k gSa \
v larqfyr vkgkj
c vf/kd olk ;qDr Hkksstu
l vPNk Hkkstu
n elkysnkj Hkkstu
iz- 3 fdl nsk esa dqiksi.k lcls T;knk
ns[kk x;k gSa \
v ,fk;k
c vkLVsfy;k
l Hkkjr
n buesa ls dksbZ ugh
iz- 4 fdlds izpkj ds }kjk dqiksi.k ds ckjs
esa lcls T;knk tkudkjh feyrh gSa \
v Vsyhfotu
c LokLF; dsUnz

58
 l jsfM+;ks
n buesa ls lHkh

iz- 5 dqiksfir cPpks dks fdl rjg dk

vkgkj fn;k tk ldrk gSa \
v izksVhu ;qDr vkgkj
c dkcksZgkbMsV ;qDr vkgkj
l [kfut ;qDr vkgkj
n buesa ls lHkh
iz- 6 vfkf{kr ekrkvks dks dqiksi.k ds
ckjs esa dSls tkudkjh nh tk ldrh gSa \
v vkaxuckM+h ds }kjk
c LokLF; dk;ZdkkZvks ds }kjk
l LokLF; dsUnz ds }kjk
n bueas ls lHkh
iz- 7 dqiksi.k ls lacf/kr leL;k, dkSu
&dkSu lh gSa \
v eksVkik
c larqfyr vkgkj
l /kweziku
n fkkq e`R;`

59
iz- 8 tUe ds le; cPps dks otu fdruk
gksuk pkfg, \
v 2-5 fdyksxzke
c 4 fdyksxzke
l 6 fdyksxzke
n 8 fdyksxzke

iz- 9 dqiksi.k ds fy, ftEesnkj dkjd dkSu &

dkSu ls gSa \
v laked jksx
c d`fe jksx
l lkekftd vkfFkZd dkjd
n buesa ls lHkh
iz- 10 dqiksi.k ls dkSu &dkSu lh tfVyrka,
gks ldrh gSa \
v kdZjkU;urk
c riU;wurk
l ladze.k
n buesa ls lHkh
iz- 11 dqiksi.k dh jksdFkke dSls dh tk
ldrh gSa \
v iksi.k fk{kk
60
 c Lruiku dh rduhd
l v vkSj c nksuks
n buesa ls dksbZ ugh
iz- 12 Hkkjr ljdkj us dqiksi.k ls cpkus ds fy,
dkSu &dkSu ls izksxzke pyk;k gSa \

v e/;kUg Hkkstu
c ckyckM+h iksk.k dk;Ze
l lesfdr cky fodkl ;kstuk
n buesa ls lHkh

iz- 13 dqiksi.k dh igpku ds fy, dkSu&

dkSu lh tkp djokuk pkfg, \
v [kwu dh tkp
c iskkc
l ,Dl & js
n mi;qDr lHkh
iz- 14 dqiksi.k fdl mez ds cPpks esa lcls
T;knk ns[kk x;k gSa \
v 1 ls 5 lky
c 6 ls 10 lky
61
 l 15 ls 17 lky
n buesa ls dksbZ ugh
iz- 15 ,d ls ikp okZ rd ds cPpks dks
dkSu & lk vkgkj nsuk pkfg, \
v olk;qDr

-
c elkysnkj Hkkstu
l larqfyr vkgkj
n buesa ls dksbZ ugh
iz- 16 fjdsV~l jksx ds D;k y{k.k gSa \
v isV Qwyk
c gkFk vkSj iSj nksuks eqM+s
l v vkSj c nksuks
n buesa ls dksbZ ugh

62
iz- 17 ,d ls ikp lky rd ds cPpks dks
dqiksi.k ls dSls cpk;k tk ldrk gSa \
v Vhdks }kjk
c dqiksk.k fk{kk
l Lruiku
n buesa ls lHkh
iz- 18 LdohZ jksx ds D;k & D;k dkj.k
gSa \
v kjhj esa yky dkys pdrs
c isV Qwyk gqvk
l vk[ks /klh gqbZ
n buesa ls lHkh
iz- 19 ek/;kUg Hkkstu dk;Ze ls fdl
mez ds cPpks dks kkfey fd;k tkrk gSa
\
v 1 ls 5
c 18 ls 20
l 5 ls 14
n buesa ls lHkh
iz- 20 Dokfkdksj jksx esa cPps dk
kjhj fdl vkdkj dk fn[krk gSa \
v isV Qwyk

63
c yEck gkFk
l gkFk iSj eqM+s
n buesa ls lHkh

64
 mRrjekGk

Izku mRrj
Lka[;k

1 v
2 v
3 v
4 n
5 n
6 n
7 n
8 v
9 n
10 n
11 l
12 n
13 n
14 v
15 l
16 l
17 n
18 n
19 l
20 n

65
66