RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCE BANGALORE, KARNATAKA
A study to assess the effectiveness of planNed teaching programme on knowledge regarding icds programme among the mothers of under five children at selected rural area IN murUgamalLa phc AT chintamani .
PROFORMA FOR REGISTRATION OF SUBJECT FOR
DISSERTATION.
Ms. VEENA.M
S L E S COLLEGE OF NURSING, CHINTAMANI – 563 125
RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCE
BANGALORE, KARNATAKA PROFORMA FOR REGISTRATION OF SUBJECT FOR DISSERTATION
1 / NAME OF THE STUDENT / Ms. VEENA. M Ist M.Sc NURSING STUDENTS L E S COLLEGE OF NURSING, CHINTAMANI -563 125.
2 / NAME OF INSTITUTION / S L E S COLLEGE OF NURSING, CHINTAMANI -563 125.
3 / COURSE OF STUDY / M.Sc NURSING IN
COMMUNITY HEALTH NURSING.
4 / DATE OF ADMISSION TO COURSE / 30/06/2012
5 / TITLE OF TOPIC / A study to assess the effectiveness of planNed teaching programme on knowledge regarding icds programme among the mothers of under five children at selected rural area IN murUgamalLa phc AT chintamani .
6.
7. / BRIEF RESUME OF THE INTENDED:
INTRODUCTION:
Children’s are the call on agenda of human resource development not only because young children’s are the most vulnerable, but the foundation for lifelong learning and human development is laid in these crucial early years. It is now globally acknowledged that investment in human resource development is a prerequisite for economic development of any nation.1
The country is the most precious of mankind most loved and perfect in its innocence. India about 43%of population were children. They have to be loved as they have a special place in the lives of the people , but large number of children become a cause of sorrow because o f illness and ultimate death.2
As per Census of India 2011, there are 15,87,89,287 children below 5 years of age, and many of them have inadequate access to health care, nutrition, sanitation, child care, early stimulation, etc. To ensure that all young children, even those from vulnerable sections of society have access to their basic rights, ICDS was launched in 1975 to provide a package of services to ensure their holistic development.3
Integrated child development services program launched on October 1975. today ,ICDS programme represents one of the word largest and most unique programme for early child hood development . India has got the response to provide preschool education to reduce malnutrition, morbidity and mortality of children. 4
ICDS programme is largest national programme for promotion of mother and child health development in the world. The beneficiaries include children below 5 year, pregnant and lactating mothers an d adolescent girls. 4
ICDS programme provides an integrated approach for converging all basic Services for improved child care, early stimulation and learning, health and nutrition. Water and environmental sanitation aimed at the young children, expectant and lactating mothers, other women and adolescent girls in community. The objectives of ICDS programme are, to improve nutritional status of children of 0-5 years, to reduce the incidents of morbidity, mortality, malnutrition and school dropout, achieve effective co-ordination amongst various departments to promote child development, to lay foundation of proper psychological, physical and social development of child, to enhance mothers capability to look after normal health and nutritional needs of the child.5
The package of services provided by ICDS programme includes supplementary nutrition, immunization, health checkups, referral services, nutrition health education and pre-school education. The distribution of iron and folic acid tablets and mega dose of vitamin A is also undertaken, to prevent iron deficiency anemia and exophthalmia respectively. Though there are some short comings in ICDS. Still future thrust of the programme is necessary for aiming of the up liftment of underprivileged sections of the population. Operative research in various areas is suggested which can help in improving the efficiency of ICDS.4
The aim of this programme is the welfare of children which includes supplementary feeding for children in the age group of 0-5 years and for expectant women and nursing mothers. Supplementary nutrition includes supplementary feeding and growth monitoring, and prophylaxis against vitamin A deficiency and control of nutritional anemia. All families in the families in community are surveyed, to identify children below 5 years of age, pregnant, nursing mothers. The avail of supplementary feeding support for 300 days in a year. Supplementary Nutrition Programme in the Nutrition Sector is given through 50 ICDS blocks. Supplementary Nutrition programme has been included as one of the most important components of ICDS progamme.6
A Knowledge of ICDS programme is an important aspect of preventive and social pediatrics. Hence knowledge and practice of mothers of under five children regarding ICDS programme is very essential to overcome malnutrition and other deficiency disorders for healthy growth of child.7
6.1 NEED FOR THE STUDY:
Children are the future of society and their mothers are guardians for that future. The average Indian child has a poor start to life. Both infant and under-five mortality rates for Indian children – at 67 and 93 respectively are higher than the developing country average. One in four newborns is underweight. Only about one in three is exclusively breastfeed for the first six months. Nearly one in two children less than five years of age suffers from moderate or severe malnutrition. One in three children does not get a full course of DPT and only one in three has the opportunity to be in an early learning Programme. Just about one in five is protected against vitamin A deficiency.8
Approximately 60 million children are underweight in India. Given its impact on health, education and productivity, persistent under nutrition is a major obstacle to human development and economic growth in the country, especially among the poor and the vulnerable, where the prevalence of malnutrition is highest. Majority of children in India have underprivileged childhoods starting from birth. The infant mortality rate of Indian children is 50[1] and the under-five mortality rate is 93 and 25% of newborn children are underweight among other nutritional, immunization and educational deficiencies of children in India. Figures for India are substantially worse than the developing country average. 9
Under nutrition, both protein-energy malnutrition and micronutrient deficiencies, directly affects many aspects of children’s development As a result, malnutrition has been estimated to be associated with about half of all child deaths and more than half of child deaths from major diseases, such as malaria (57 percent), diarrhea (61 percent) and pneumonia (52percent), as well as 45 percent of deaths from measles (45 percent). In India, child malnutrition is responsible for 22 percent of the country’s burden of disease. 46% of India’s children are malnourished. The rate of malnutrition is reported in (2010) in Andhra Pradesh (50%), Gujarat(57%), Gujarat(53%), Karnataka(52%), Kerala(37%), Madhya Pradesh(44%), Orissa(53%), Rajasthan(47%), Tamilnadu36%), Uttar Pradesh(53%) and West Bengal(49%) .10
A national study conducted in 1992 by the National Institute of Public Cooperation and Child Development confirmed the positive impact of ICDS. Where the programme was operating, there were lower percentages of low-birth-weight babies, lower infant mortality rates, higher immunization coverage, higher utilization rates for health services, and better child nutrition. The percentage of severely malnourished children declined.11
The Ministry of human and child development (2004) conducted a study at the national level. This will have greater impact on health and nutritional status of children. As a means of ensuring good health and nutrition of children, reaching their mothers with health education and counseling should be given utmost priority. It should be followed up vigorously to ensure proper utilization of this facility.11
A study was conducted on utilization of ICDS scheme in children one to 5 years of age in a rural block of central India in Madhya Pradesh. The findings of the study showed that ICDS scheme is underutilized because of lack of awareness among the mothers with below 6 years old children.12
Mother is an important primary care provider and therefore, her education and access to information will help her, about care of her infant. As children constitute the most important and vulnerable segment of our population, mothers represent the most important health worker as far as child health is concerned. Health education inputs for mother should be strengthened. So that, she is capable of preventing and identifying common childhood illness.12
The mothers play a major role in promoting the health of below 5 years old children and child care activities. The child care includes knowledge regarding prevention of child hood diseases, proper growth and development and basic needs of the children. The mother is the key person in the family to promote the child’s well being and to prevent the diseases. The mother will get information regarding child care through health care professional, family members, neighbors, and mass media. Therefore the health care professionals must play a vital role to provide education to the mothers regarding the services available in the society
During the posting in ICDS Center the investigator noted that only a few number of children are coming to the centre regularly and utilizing the services. It was noted that ICDS services were not fully utilized by the mothers with below 5 years old children because of lack of knowledge on ICDS services. The nurse plays an important role in educating the mothers regarding the services available to promote health among children. So the investigator felt the need to educate the mothers regarding ICDS services and its utilization. The improvement of knowledge related to ICDS services will help the mothers to involve positively and utilize the ICDS services adequately. The mother’s positive approach will bring healthier children to nation. The strength of the nation depends on healthy families and children who are destined to be successful citizens of tomorrow.12
6.2 REVIEW OF LITERATURE:
Review of literature is defined as the broad comprehensive, in-depth, systemic and critical review of the scholarly publications, unpublished scholarly print materials, audio visual materials and personal communications.
Researchers almost never conduct a study in an intellectual vacuum; their studies are usually undertaken within the context of existing knowledge base. A literature review helps to lay foundation for the study, and can also inspire new researcher ideas.
The review of literature is categorised under the following sections:
Section A: Studies related to the ICDS programme.
Section B: studies related to effectiveness of structured teaching programme
regarding ICDS programme to mothers.
Section A: Studies related to the ICDS programme
A cross sectional study was conducted to evaluate the delivery of services through the ICDS in Kashipure. Uttar Pradesh. A stratified sample of 17,904 children was registered for the study, and 92% of them were available for baseline and follow up study. The study results showed that improvement in nutritional status. The study concluded that the prevalence of severe malnutrition in children younger than the age 3 decreased from 25.5% to 9.7%. 13
A descriptive study was conducted to determine the impact of programme on nutritional status of children aged 0-5 years in Sikar, Gujart. The study results showed that the children with normal nutrition in ICDS blocks constituted 50% of the surveyed population in 1976 in comparison to 75% observed in baseline data of 1990 survey. The study concluded that there was a highly significant decreased in severely malnourished children from 21% in 1976 to 7% in 1990. 14
A Comparative study was conducted to evaluate the nutritional and immunization services was undertaken in the rural ICDS blocks Sanwe r(Madhya Pradesh) . A door to door survey was conducted in six anganwadi areas in ICDS blocks and five randomly selected matched non ICDS rural area served as controls. There were a total of 709 children in ICDS and 500 in non ICDS block in 1-5 years age group. The result showed that the difference was not statistically significant for nutritional status in the two blocks, but a remarkably better immunization status (p<0.005) was observed in non ICDS blocks.15
A study conducted on “Mother’s attitude towards child’s health, education and play in ICDS and non – ICDS areas. Researchers distributed a questionnaire to 419 mothers of 3-5 years old children in Dalman and Talganj blocks in India. The results concluded that the ICDS programme has indeed had an impact on changing the attitude of mothers so as to bring about a positive attitude.16
A longitudinal study was conducted by the pediatrics department at RNT Medical college in Udaipur analyzed 1981 and 1991 survey data on 478and 823 children under 5 years old, respectively , living in the same 6 villages of Garhi tribal block of South Rajasthan to evaluate the ICDS. The study concluded that ICDS programme improved the nutritional and immunization status of children. 17
A cross sectional study was conducted to find out the complications of malnutrition among children. By the pattern of food practice associated among children in Varanasi. The sample of 216 children age 2-5 years were observed for the practice in rural area of Varanasi District. The study result found that 82.4% of children have imbalanced diet and 22% of children have poor personal hygiene. Hence the study conclusion indicates that a need for health education programme to promote healthy feeding and to prevent malnutrition episodes.18
A study conducted on stunting, underweight, and wasting among ICDS scheme children aged 3 – 5 years of Bengali ethnicity at 11 ICDS Centers, West Bengal, India. The rate of underweight and wasting was higher among girls compared with boys The study concluded that the nutritional status of the subject is unsatisfactory. There is scope for improvement in the form of enhanced supplementary nutrition19.
A study conducted to assess the community contribution to the ICDS programme in Agra district. Three rural ICDS projects in the district were selected. Out of which a total of 74 Anganwadi centers were selected for the study. The study concluded that community assistance in bringing children to the AWC were the most common forms of community contribution to the ICDS programme20
A study conducted to estimate prevalence of sub clinical Vitamin ‘A’ deficiency among under 5 children by using conjunctival impression cytology in urban slums of Nagpur city in central India. The study population included 308 non xeropthalmic under 5 children selected randomly. The study concluded that vitamin A deficiency is more prevalent in urban slums.21