RAJIVGANDHIUNIVERSITY OF HEALTH SCIENCES
BANGALORE, KARNATAKA
PROFROMA FOR REGISTRATION OF SUBJECT FOR
DISSERTATION
MR. AAMIR SUHAIL
1ST YEAR MSC.NURSING
COMMUNITY HEALTH NURSING
YEAR 2011- 2013
SRI VENKATESHWARA COLLEGE OF NURSING,
NO. 98, MARUTHI INDUSTRIAL ESTATE,
PEENYA 2ND STAGE,
BANGALORE- 560058.
RAJIVGANDHIUNIVERSITY OF HEALTH SCIENCES
BANGALORE, KARNATAKA
PROFORMAFOR REGISTRATION OFSUBJECT FOR DISSERTATION
1 / NAME OF THECANDIDATE AND
ADDRESS / MR. AAMIR SUHAIL
1ST YEAR MSc NURSING
SRI VENKATESHWARA COLLEGE OF NURSING, NO. 98, MARUTHI INDUSTRIAL ESTATE,
PEENYA 2ND STAGE,
BANGALORE- 560058.
2 / NAME OF INSTITUTE / Sri Venkateshwara college ofNursing,
No. 98, Maruthi industrial estate,
Peenya 2nd stage, Bangalore- 560058.
3 / COURSE OF STUDY AND
SUBJECT / 1ST YearM.Sc.Nursing
Community Health Nursing
4 / DATE OF ADMISSION TO COURSE / 19TH June 2011
5 / TITLE OF THE STUDY / “A comparative study to assess the health status of underfive children in selected ICDS and NON-ICDS area in, Selected Community at Bangalore.”
6. BRIEF RESUME OF THE INTENDED WORK.
6.0 INTRODUCTION:
Children see in their parents the past, their parents see in them the future; and if we find more love in the parents for their children than in children for their parents, this is sad
but natural. Who does not entertain his hopes more than his recollections.
-John Ruskin
The term childhood is non-specific and can imply a varying range of years in human development. Developmentally, it refers to the period between infancy and adulthood. Incommon terms, childhood is considered to start from birth. Some consider that childhood,
as a concept of play and innocence, ends at adolescence.
The concept of childhood appears to evolve and change shape as lifestyles change and adult expectations alter. Some believe that children should not have any worries and should not have to work; life should be happy and trouble-free. Childhood is usually a mixture of happiness, wonder, anger and resilience. It is generally a time of playing, learning, socializing, exploring, and worrying in a world without much adult interference, aside from parents. It is time of learning about responsibilities without having to deal with adult responsibilities
Childhood is often retrospectively viewed as a time of innocence, which is generally viewed as a positive term, an optimistic view of the world, in particular one where thelack of knowledge stems from a lack of wrongdoing, whereas greater knowledgecomes from doing wrong. A "loss of innocence" is a common concept, and is oftenseen as an integral part of coming of age. It is usually thought of as an experience orperiod in a child's life that widens their awareness of evil, pain or the world aroundthem.
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Children below 6 years constitute 17% of the total population of India that is, about 17 crores. As compared to other developed countries, infant mortality rate in our country is very high that is 58/1000 live births and under five mortality is 62/1000 live births.
Ignorance and illiteracy are still rampant around the rural people. Severe malnutrition even after 50yearsof independence, exist in more than 40% of the Indian due to actual poverty, which givesroom for low resistance and the consequential early childhood diseases.
The Government of Indiarecognized the fact that the foundation for physical, psychological and socialdevelopment are laid in early childhood. It agreed that the early childhood services, especially for the weaker will reduce the infant mortality, morbidity, malnutrition andstagnation is schools1.
6.1 NEED FOR THE STUDY
The child has always been considered the best resource for human development. But unfortunately it has never been accorded the priority it deserved be it the family or the national concern in health, nutrition or education. The approach has been to look at the health for a specific problem / disease and hardly ever as the child as a whole or in its totality.
According to USAID, Approximately 5 million children die each year ofdisease that are, preventable by existing vaccines. Our challenge is that to 16 millionmore children die each year because of our failure to develop effective vaccineagainst disease.
Given the negative impact infections have on the nutritional status of children these failure represents only the apex of much more serious problems, that negatively affect the growth and development of children through out the would2
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In view of the above facts, the Government of India started the Integrated Child developmental Services (ICDS) In 1975 In 33 pilot projects. This scheme is the first and probably the only programme in the country, which is aimed at the holistic development of the child.
At the end of 1995 -96, the scheme has 5,614 projects. All the 5291 – community development blocks in the country and 310 major urban slums in the country were covered. The objectives of the ICDS scheme are to:
1. To lay firm foundation for proper psychological physical and social development of the child.
2. To reduce infant mortality and morbidity and also maternal mortality rate.
3. To improve the nutrition and health status of children below 6 yrs, pregnant women and nursing mothers.
4. To reduce the school dropout rate3.
To meet the above objectives, ICDS provides a wide range of services to the children below 6 years and pregnant and lactating women.
A study indicates that infant and young children mortality remains unacceptably high. About 12 million deaths occur annually in under 5 years old children. Seven out of every 10 of these are due to diarrhea, ARI, measles, or malnutrition and often a combination of these conditions.
More than 22% of children are born with LBW. Despite board and advanced sick care services; many ( that needy) are denied access to health and medical care. More often a particular disease conditions gets attended than the child as a whole. Mentally retarded children are still neglected as a whole. The child risk measures ( CRM) indicate the risk of child born in each country. India has a CRM of 45; a child in Europe has 6 and that in USA less than 5 when the world average is 304
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Since throughout the world the children are most vulnerable. They are abused, neglected during the sensitive period of growth and development. Because it results in complication in dimension of health which needs to increase mortality and morbidity rate.
To ensure that children get protection against abuse, neglect and exploitation, ICDS is one of the programme and scheme, initiated. Still there are many children who are not covered under this scheme. Hence the investigator felt that there is a need to study the difference in health status of under five children who are covered by ICDS and those who are not covered by ICDS, which will help the Community Health nurses to motivate and educate the mothers regarding the need for their participation in ensuring their children’s attendance at ICDS centers and utilize the services5.
6.3 STATEMENT OF PROBLEM:
“A comparative study to assess the health status of Under five children in selected ICDS and NON- ICDS area in, Makali, Bangalore
6.4 OBJECTIVES OF STUDY:
1. To assess the health status of under fives in ICDS area
2. To Assess the health status of under fives in Non – ICDS area
3. To compare the health status of under fives in ICDS and Non – ICDS area
4. To find out the association between health status of underfive children with selected demographic variables
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6.5 OPERATIONAL DEFINITIONS:
Assess:-In this study assess referes to examine or analyse the health status of the under five children in ICDS and Non ICDS area.
Knowledge: Knowledge refers to awarness about the nutritional programme and Nutritional facilities for the under five children. ICDS Programme.
Health status : Refers to physical status of under five Children with, Normal Anthropometric measurements as per their age; Free frominfectious diseases; and free from macro andmicro nutritional deficiencies.
Under Five Children: Children below five years of age.
ICDS Area : Area which has got a Integrated Child development Scheme center and services are utilized by under five children.
Non – ICDS Area: Area which do not have the integratedchild Development Scheme centers and Services are not utilized by fewer than five children.
6.6ASSUMPTIONS:
1. Children whose basic needs are satisfied grow healthier
2. Children who attend ICDS centers maintain better health status than other children.
6.7 HYPOTHESIS:
H1 : There will be significant different between health status of under five children attending ICDS centers and children who are not attending the ICDS centers.
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6.8 REVIEW OF LITERATURE:
Review of literature is an important step in the development of research project. It involves the systemic identification, factors and summary of written materials that contain information on research.
Astudy related to health status of Indian children observed that female child mortality between the age of 1– 4 years is one and a half times more than the male child mortality rate in urban i.e. 14.56and 19.7 respectively. The country requires major thrust in the areas of female literally, a female empowerment and female socio economic independence6.
In India 51% of children below 5 years are, under nourished. Amongst 106 children aged less than 2 years, 74% were normal nutritional status and 4% were in grade I, II, III & IV. However no active intervention has been initiated to tackle these possible etiological factors, which play an important role in combination of infaction and infestation, which are common in childrenbetween 16 – 18 months of age7.
A study was carried out to provide baseline data for the implementation and evaluation of the Nutrition Friendly School Initiative of WHO. Six intervention schools and six matched control schools were selected and a sample of 649 schoolchildren (48% boys) aged 7-14 years old from 8 public and 4 private schools were studied. Anthropometric and hemoglobinmeasurements, along with thyroid tests were performed.. WHO criteria were used to assess nutritional status.
Micronutrient malnutrition was highly prevalent, with 38.7% low serum retinol and 40.4% anemia. The prevalence of stunting was 8.8% and that of thinness, 13.7%.The prevalence of anemia and vitamin A deficiency was significantly higher in public than private schools. Goitre was not detected.
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Overweight/obesity was low (2.3%) and affected significantly more children in private schools and younger children thinness and stunting were significantly higher in peri-urban compared to urban schools and almost 15% of the children presented at leasttwo nutritional deficiencies12.
A study related to immunization status of all children in India Found that ,796 children in the age group 12 -23 months with proportion of their distribution in urban rural and slum areas. Evaluation recorded not immunized as 4.64%. Efforts must be made to strengthen routine
Immunization programme especially in the under privileged area and group such as urban slums so that target of universal coverage can be achieved as envisaged at national levell8.Found the reasons for non- immunization of children on 500 children under the age of 5 years belonging to a low – income group, in teaching hospital in NewDelhi, India, that only 25% were found to have received complete primary immunization as per the NIS.
The lack of awareness and fear of side effects constituted a small minority of reasons or non – immunization9.
A study regarding the immunization status of children found the immunization status of children in the state of Bihar, Madhya Pradesh, Rajasthan, and UP covered 6300 children of under fives. About 48% of children has received all the vaccines, the rest were not immunized. Information, education and communication activities should specially be targeted to educate the mothers in rural areas10.
It also assessed the immunization status among 19,000 children. About 63% of children received all the vaccines. Further improvement may be achieved by targeting illiterate mothers, inaccessible and tribal areas and low performing states11.
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Studies related to health status of children in icds and non – icds:assessed the magnitude severity and possible etiology of anemia and iron deficiency among total of 545 children aged 9 – 39 months. Prevalence of anemia was found in 64%, on sub sample study iron deficiencywas found in 88% in an ICDS urban slum in New Delhi11.
It also assessed the Nutritional status of 1243 children in relation to utilization of ICDS. Most of the children were non – beneficiaries (59.1%) statistically significant association (P<0.005) with malnutrition11.
A study related to integrated child development scheme: (icds) assessed the utmost urgency and importance of giving highest priority to develop human resources.
The government of India found it most essential to evolve a national programme for the over all development of our children the most precious asset and symbol of the country’s future.
The result of this concern is the emergence of national programme called integrated child development services scheme in the year 1975 with the modest coverage of 33 projects in the country11.
The ICDS programme was started in Karnataka on 2nd October 1975 with a pilot project at T. Narasipura of Mysore District with just 10 Anganawadi centers.
The national consultation by human Nutrition unit, AIIMS 2001, observed the following:
Strength & weakness of ICDS scheme:
i)Strengths – ICDS is a long - term development programme and is not an emerging relief operation.
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ii)All efforts should be continued to strengthen the ICDS scheme to make it more successful. These following aspects were suggested to strengthen ICDS programme.
Utility of growth monitoring in prevention of PEM and promotion of child health in ICDS programme. Impact of supplementary food provided in ICDS scheme; current status and future recommendations. Fortification of ICDS food with micronutrients.
Precautions for distributions of genetically modified micro foods as supplementary nutrition in ICDS programme. Nutrition counseling of mothers through ICDS scheme for promotion of nutrition and health of children. Community based rehabilitation of severely malnourished children through integrated health and nutrition interventions.
Realistic expectations that can be achieved in the field of nutrition and maternal and child health by implementation of ICDS scheme.
Home based care of newborns by Anganawadi workers. Multiple job responsibilities assigned Awws. Early childhood care for survival, growth and development of children in ICDS scheme15.
A study regarding the nutrition among children observed the effect of supplementary nutrition in ICDS projects which revealed that there was a gradual increase in the normal (normal + grade I malnutrition) children from 50>6% (1976) to 80.9% (1994). The utritional status of children residing in ICDS projects significantly improved.
The prevalence of severe malnutrition decreased from 20.5% in 1976 to 4.3%. The vitamin A distribution increased from 12% in 1976 to 33% in 1994 and iron and folic acid distribution has increased from 17.3% to 31%16.
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6.9 DEMILITATIONS:
1. Study is limited to those children who are beneficiaries of ICDS services and who are not benefited by ICDS services.
2. The study is limited to phusical health status of under five children only
7. MATERIALS & METHODS:
7.1. SOURCE OF DATA:
The mother’s of fewer than five children and under five children who are attending the ICDS centre and who are not convered by ICDS services.
7.2 METHODS OF DATA COLLECTION:
1) RESEARCH DESIGN:
Descriptive Survey Method
II)SETTING:
Selected Integrated Child Development Scheme are and Non – ICDS area in Makali Bangalore
III) POPULATION:
Under five years of age children in Integrated Child Development Scheme and Non-
Integrated Child Development Scheme area.
IV) SAMPLE TECHNIQUE:
Stage I;- Simple random sample of the children attending Integrated Child Development Scheme and Non - Integrated Child Development Scheme areas.
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V) SAMPLE SIZE:
In the present study 50 under five children in ICDS area and 50 children in Non- ICDS area ill randomly selected.
VI) CRITERIA FOR SELECTION OF THE SAMPLE:s
Inclusive Criteria: The study includes
- Under fives available during the period of date collection in ICDS and Non – ICDS area
2. Under five children who will be allowed by the parents to participate
Exclusive Criteria:The study excludes:
- Children above five years
- Children who are sick during data collection
VII) DATA COLLECTION TECHNIQUE:
The researcher will collect the data by using observational checklist, record of anthropometric measurements and structured interview schedule.
a)Observational check list - to assess the physical health status
b)Record of anthropometric measurement. Height, weight, mid - armcircumference, chest circumference and head circumference
c)Structured interview schedule to assess the knowledge and practices of mothers as stated by them.
VIII) COLLECTION OF DATE:
Data will be collected by using the tool after obtaining prior permission from the concerned authority
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IX) METHOD OF DATA ANALYSIS AND PRESENTATION:
Descriptive Statistics: frequency, mean, mean percentage and standard deviation of described demographic variables.
Inferential Statistics : Chi- square test will be used to find out association with selected demographic variables
7.3 DOES THE STUDY REQUIRE ANY INTERVENTIONS TO BE CONDUCTED ON PATIENTS OR OTHER HUMANS OR ANIMALS?
-- No --
7.4 HAS ETHICAL CLEARANCE BEEN OBTAINED FROM YOUR INSTITUTION?
1. Permission will be obtained from the research committee of the Sri Venkateshwara College of Nursing.
2. Authorities of selected ICDS area in Bangalore
3. Informed consent will be obtained from the children and their parents who are willing to participate in the study
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8. LIST OF REFERENCES:
1. Kapil U, and Pradhan R. Integrated child development services scheme (ICDS) and its impact on nutritional status of children in India and recent initiatives. Indian Journal of Public health, 1999 Jan – Mar. 43(1) PP: 21 – 25.
2. Sanjiv K.B. and Bhatia V. et al., Long -- term nutritional effects of ICDS. Indian Journal of paediatric. 2000 Mar 68 (3) 211 – 16.
3. Ansari Nagar. Immunization status of children of India. Indian Paediatric Journal. 2000 Nov. 37 (17)
4. Aneja B. and Singh P. et al., etiology factors of malnutrition amoung infants in two urban slums of Delhi. Indian Paediatric : 2001 Feb. 38(4): 160 – 64.
5. Siddartha R. The National Family Health survey childhood mortality rate. Ind J Paed: 2001 Mar 38(3): 263 – 68.
6. Padam Singh. Immunization status of children in Bimaraja states. Ind J. Paed; 2001 Jan 68 495 – 99.
7. Anon. National consultation to review the existing guidelines in ICDS scheme in the field of health and nutrition. Ind paed J: 2001 Jul 38 (7) 721 – 27.