A Study to Assess the Knowledge and Practice Of

“A STUDY TO ASSESS THE KNOWLEDGE AND PRACTICE OF

MOTHERS REGARDING PREVENTION AND MANAGEMENT

OF MALNUTRITION AMONG THE UNDER FIVE

CHILDREN IN SELECTED HOSPITALS

AT TUMKUR"

PROFORMA FOR REGISTRATION OF SUBJECT FOR DISSERTATION

DIVYA SUSAN

CHILD HEALTH NURSING

ARUNA COLEEGE OF NURSING

RING ROAD,MARLUR, TUMKUR

2010-2011

RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES

BANGALORE, KARNATAKA.

PROFORMA FOR REGISTRATION OF SUBJECT FOR DISSERTATION

01. NAME OF THE CANDIDATE AND ADDRESS:DIVYA SUSAN

M. Sc. Nursing 1st year

ArunaCollege of Nursing,

Ring Road, maralur

Tumkur.

02. NAME OF THE INSTITUTION : Aruna College of Nursing

Tumkur.

03. COURSE OF STUDY AND SUBJECT:1ST Year M.Sc. Nursing

Child Health Nursing

04. DATE OF ADMISSION:18-02-2010

05. TITLE OF THE TOPIC:“A Study to assess knowledge and

Practice of mothers regarding prevention and management of malnutrition among the under five children inselected hospitals at Tumkur”.

6. BRIEF RESUME OF THE INTENDED WORK

INTRODUCTION

Malnutrition is the condition that results from taking an unbalanced diet in which certain nutrients are lacking, in excess (too high an intake), or in the wrong proportions. A number of different nutrition disorders may arise, depending on which nutrients are under or overabundant in the diet.

The World Health Organization cites malnutrition as the gravest single threat to the world's public health. Improving nutrition is widely regarded as the most effective form of aid.Emergency measures include providing deficient micronutrients through fortified sachet powders, such as peanut butter, or directly through supplements. The famine relief model increasingly used by aid groups calls for giving cash or cash vouchers to the hungry to pay local farmers instead of buying food from donor countries, often required by law, as it wastes money on transport costs1.

Major causes of malnutrition include poverty and food prices, dietary practices and agricultural productivity, with many individual cases being a mixture of several factors. Malnutrition can also be a consequence of other health issues such as diarrheal disease or chronic illness. especially the HIV/AIDS pandemicClinical malnutrition, such as in cachexia, is a major burden also in developed countries.1

As much as food shortages may be a contributing factor to malnutrition in countries with lack of technology, the FAO (Food and Agriculture Organization) has estimated that eighty percent of malnourished children living in the developing world live in countries that produce food surpluses. The economist Amartya Sen observed that, in recent decades, famine has always a problem of food distribution and/or poverty, as there has been sufficient food to feed the whole population of the world. He states that malnutrition and famine were more related to problems of food distribution and purchasing power.2

A lack of breastfeeding can lead to malnutrition in infants and children. Possible reasons for the lack in the developing world may be that the average family thinks bottle feeding is better. The WHO says mothers abandon it because they do not know how to get their baby to latch on properly or suffer pain and discomfort.

Many tend to think malnutrition only in terms of hunger, however, overeating is also a contributing factor as well. Many parts of the world have access to a surplus of non-nutritious food, in addition to increased sedentary lifestyles. In turn, this has created a universal epidemic of obesity. Yale psychologist Kelly Brownell calls this a "toxic food environment” where fat and sugar laden foods have taken precedent over healthy nutritious foods. Not only does obesity occur in developed countries, problems are also occurring in developing countries in areas where income is on the rise.3

6.1 NEED FOR THE STUDY

India is a third world war country. Since independence, one of the gravest problems India is confronting with is malnutrition among under-5 children. As in other developing nations, malnourishment is a burden on considerable percentage of population, the most vulnerable being the youngest group of the society. About two-third of the under-five children of our country is malnourished. Among them, 5-8% are severely malnourished while rest fall in the group of mild or moderate malnutrition. So it can be said that malnutrition is one of the most widespread conditions affecting child health. The 'germ' of malnutrition 'infects' a foetus in the intra-uterine life due to lack of sufficient antenatal care on part of the mother. The condition deteriorates further when after birth the infant is deprived of exclusive breast feeding or initiation of weaning is delayed. Weaning should be started after the age of 6 months and should contain energy rich semi-solid food.4

Malnutrition makes a child susceptible to infections and delays recovery, thus increasing mortality and morbidity. Every time an innocent child suffers the curse of malnutrition; the responsibility goes to the mother, the family and to the community due to their faulty or no knowledge regarding the harmful effects of prelacteal feeding, benefits of exclusive breast feeding and initiation of proper weaning at the correct time. It is to be realized that a million children die worldwide each year because they are not breast fed. Several millions who survive suffer from acute or chronic illness related to harmful effects of artificial feeding. These sufferings are unnecessary and are the preventable ones by discouraging bottle feeding and initiating efforts to bring back the breast feeding culture.5

According to the World Health Organization, malnutrition is by far the biggest contributor to child mortality, present in half of all cases. Underweight births and inter-uterine growth restrictions cause 2.2 million child deaths a year. Poor or non-existent breastfeeding causes another 1.4 million. Other deficiencies, such as lack of vitamin A or zinc, for example, account for 1 million. Malnutrition in the first two years is irreversible. Malnourished children grow up with worse health and lower educational achievements. Their own children also tend to be smaller.6 Malnutrition was previously seen as something that exacerbates the problems of diseases as measles, pneumonia and diarrhea. But malnutrition actually causes diseases as well, and can be fatal in its own right.7

6.2 REVIEW OF LITERATURE

According to Polit and Hungler a through literature review provides a foundation upon which to base a knowledge and generally is well conducted before any data are collected in any study.

A study conducted on Malnutrition, With Its 2 Constituents of protein–energymalnutrition and micronutrient deficiencies, continues to bea major health burden in developing countries. It is globallythe most important risk factor for illness and death, with hundredsof millions of pregnant women and young children particularlyaffected. Apart from marasmus and kwashiorkor (the 2 forms ofprotein– energy malnutrition), deficiencies in iron, iodine,vitamin A and zinc are the main manifestations of malnutritionin developing countries. In these communities, a high prevalenceof poor diet and infectious disease regularly unites into avicious circle. Interventions to preventprotein– energy malnutrition range from promoting breast-feedingto food supplementation schemes, whereas micronutrient deficiencieswould best be addressed through food-based strategies such asdietary diversification through home gardens and small livestock.The fortification of salt with iodine has been a global successstory, but other micronutrient supplementation schemes haveyet to reach vulnerable populations sufficiently. To be effective,all such interventions require accompanying nutrition-educationcampaigns and health interventions. To achieve the hunger- andmalnutrition-related Millennium Development Goals, we need toaddress poverty, which is clearly associated with the insecuresupply of food and nutrition.9

A study was conducted on Approximately 70.0% of the world's malnourished children live in Asia, resulting in the region having the highest concentration of childhood malnutrition. About half of the preschool children are malnourished ranging from 16.0% in the People's Republic of China to 64.0% in Bangladesh. Besides protein-energy malnutrition, Asian children also suffer from micronutrient deficiency. Another major micronutrient problem in the region is iodine deficiency disorders, which result in high goiter rates as manifested in India, The etiology of childhood malnutrition is complex involving interactions of multiple determinants that include biological, cultural and socio-economic influences. Protein-energy malnutrition and micronutrient deficiency leading to early growth failure often can be traced to poor maternal nutritional and health care before and during pregnancy, resulting in intrauterine growth retardation and children born with low birth weight. While significant progress has been achieved over the past 30 years in reducing the proportion of malnourished children in developing countries, nonetheless, malnutrition persists affecting large numbers of children.10

A study was conducted on In India, approximately 20 percent of children under the age of four suffer from severe malnutrition, while half of all the children suffer from undernutrition. The contributions of knowledge and attitudes of nutrition-conscious behaviors of the mothers to childhood malnutrition has been unclear. The purpose of this study was to explore maternal knowledge of the causes of malnutrition, health-care-seeking attitudes and socioeconomic risk factors in relation to children's nutritional status in rural south India. Thirty-four cases and 34 controls were selected from the population of approximately 97,000 by using the local hospital's list of young children.Severe malnutrition was defined as having less than 60 percent of expected median weight-for-age. Interviews obtained: (1) socioeconomic information on the family, (2) knowledge of the cause of malnutrition and (3) health-care-seeking attitudes for common childhood illnesses, including malnutrition. Poor nutritional status was associated with socioeconomic variables such as sex of the child and father's occupation. The father's occupation was a more accurate indicator for malnutrition than household income. These results suggest a need for intensive nutritional programs targeted toward poor female children and their mothers.11

This study examines reasoning about the cause and treatment of three types of childhood protein energy malnutrition (PEM) by 108 mothers in rural South India. The mothers were interviewed and their explanations of the childhood nutritional problems were verbally recorded, transcribed and then analyzed using cognitive methods of analysis. The results indicated that knowledge and practices associated with traditional systems of Indian medicine prevalent in rural areas greatly influenced the mothers' reasoning. Their explanations were shown to have story-like structures, with sequences of events linked by strong causal explanations. Mothers with higher levels of formal education showed greater verbal use of concepts related to biomedical theories of nutritional disorders. However, their interpretations of these concepts were still based on the traditional theory. The study revealed both positive and negative aspects of traditional knowledge and beliefs for adequate child nutrition and health. The development of improved instructional strategies for nutrition and health education in relation to knowledge organization is discussed in the context of rural India.12

A study conducted on A project was conducted in a rural area in September 1994 with the aim of decreasing the incidence of protein-energy malnutrition among children under 5 years, by nutritional intervention through the primary health care system. An initial situation analysis revealed the region's resources and causes of malnutrition. Practical instruction on feeding methods, deworming, environmental sanitation, the promotion of home-grown vegetables and reinforcement of the growth monitoring programme were chosen as the routes for intervention. All indices were reassessed in the region after 1 year. Results showed that nutritional awareness had grown among mothers, and that the incidence of malnutrition had dropped from 6.5% to 1.8%, as measured against the weight-for-height index.13

A study conducted on Child malnutrition and thiamine deficiency remain a matter of public concern in Dai children under 5 years old in Southwest areas of China. The aim of the present study was to understand the status and correlates of malnutrition and thiamine deficiency, and to explore an effective intervention for improving their nutritional status and decreasing the prevalence of malnutrition and thiamine deficiency in Dai children.Well-trained investigators completed a baseline evaluation survey, including questionnaire survey by maternal interviews, child physical measurements, lab examination of thiamine, and group discussions in a cross-sectional study. The baseline evaluation survey in 2000 indicated that the prevalence of moderate and severe protein-energy malnutrition was 19.5% for underweight, 16.4% for stunting, and 6.7% for wasting, respectively. With increasing age, the prevalence increased, peaking at 12-15 months. The prevalence of underweight in girls was higher than in boys. The prevalence of moderate and severe protein-energy malnutrition is high in Dai infants and young children. However, based on the local situation, participatory community-based comprehensive nutrition intervention effectively reduces the prevalence of child malnutrition and thiamine deficiency. It is highlighted that population nutritional intervention can produce better results with participation at a community level.14

A study conducted on We assessed the effect of a selected intervention on the nutritional status of 2-5-year-old children in day care centres. Using a longitudinal prospective pretest/post-test intervention design, 974 children from 3 day care centres in Alexandria were followed for 1 year. Anthropometric measurements and 3-day 24-hour recall data were gathered at base line and dietary intake was calculated and compared with recommended daily allowances. An intervention programme was implemented through the establishment of kitchens in the 3 centres, provision of 2 meals/day, nutrition education for parents and training of supervisors. Baseline data revealed deficient intake of most nutrients especially calcium, calories, vitamin C and iron. Post-intervention test revealed improvement in mothers' nutrition knowledge and the percentage of anaemic children decreased from 47.3% to 14.2%. A decrease in the percentage of underweight, stunted and wasted was also observed.15

A study conducted on Forty-two percent of Vietnamese children are stunted by two years of age. Since 1990, Save the Children Federation/US (SC) has implemented integrated nutrition programs targeting young children. Using a longitudinal, prospective, randomized design, we followed 238 children age 5 to 25 months old for six months with a re-survey at 12 months. Dietary energy intake was calculated using the 1972 Vietnamese food composition table. Key outcomes were daily frequency of consuming intervention-promoted food and non-breastmilk liquids and food, daily quantity of non-breastmilk liquids and food consumed, daily energy intake, and proportion of children meeting daily median energy requirements. Young rural children exposed to SC's program consumed intervention-promoted, and any, foods more frequently, ate a greater quantity of any food, consumed more energy, and were more likely to meet their daily energy requirements than comparison children. Some effects were only observed during the intensive intervention period; others persisted into or were evident only at the 12-month follow-up, approximately four months after program completion. Based on the mothers' reports, the intervention did not apparently compromise breastfeeding prevalence or frequency. The intervention improved children's food and energy intake and protected them from declining as rapidly as comparison children in meeting their energy requirements.16

A study conducted on Countries of the world have agreed on eradicating extreme poverty and hunger and reducing the mortality rate of children under five by two-thirds by 2015 as part of the Millennium Development Goals, and without mainstreaming maternal, infant, and young child nutrition in the development agenda, these goals cannot be achieved. Although the recent Lancet Series on Maternal and Child Undernutrition brought attention to the importance of early nutrition interventions to improve child health, nutrition, and future economic productivity, there needs to be a more concerted effort at clarifying the path forward, focusing on moving beyond projects and evidence from randomized, controlled trials towards developing large-scale programs with sound plausibility design to achieve results for children. In an effort to cast a fresh eye on nutrition programming in light of the new evidence, UNICEF Headquarters hosted an Expert Consultation on effective nutrition programming with participants from various academic organizations and United Nations agencies to discuss effective program strategies in nutrition. The consultation resulted in recommendations for UNICEF on eight focus areas for programming and recognition of six overarching themes. It is clear that more action is needed to accelerate progress: more effective global coalitions, better coordination, more coherence, and better targeting of efforts.17

A study conducted on With the rapid pace of the nutrition transition worldwide, understanding influences of child feeding practices within a context characterized by the co-existence of overweight and undernutrition in the same population has increasing importance. This qualitative study describes Brazilian mothers' child feeding practices and their perceptions of their association with child weight status and explores the role of socioeconomic, cultural and organizational factors on these relationships. Content analysis identified fourteen emergent themes showing mothers' child feeding practices in this setting were influenced by economic resources, mothers' immediate social support networks and participation in nutrition assistance programmes. Child malnutrition was the most common nutritional concern; nevertheless, mothers were aware of the negative health consequences of obesity but misunderstood its causes several reported their own struggles with overweight. Food assistance programmes emerged as an important influence on children's dietary adequacy, especially among mothers describing dire economic situations. The findings have implications for targeting food assistance as well as health and nutrition education strategies in low-income families undergoing the nutrition transition in north-east Brazil.18