RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES BANGALORE, KARNATAKA
PROFORMA FOR REGISTRATION OF SUBJECTS FOR DISSERTATION
1 / NAME OF THE CANDIDATE AND ADDRESS / Mrs. TINTU KURIACHANGAYATHRI COLLEGE OF NURSING.KOTTIGEPALYA BANGALORE
2 / NAME OF THE INSTITUTION / GAYATHRI COLLEGE OF NURSING.KOTTIGEPALYA BANGALORE
3 / COURSE OF THE STUDY AND SUBJECT / FIRST YEAR MSc NURSING
PAEDIATRIC NURSING 2010
4 / DATE OF ADMISSION TO COURSE / 28.05.2010
5. TITLE OF THE TOPIC
“A STUDY TO ASSESS THE EFFECTIVENESS OF STRUCTURED TEACHING PROGRAMME (STP) ON KNOWLEDGE AND PRACTICE REGARDING IMPORTANCE OF WELL BALANCED NUTRITION AMONG SCHOOL AGE CHILDREN IN A SELECTED SCHOOL, BANGALORE”
6. BRIEF RESUME OF AN INTENDED WORK
“The doctor of the future will no longer treat the human frame with drugs, but rather will cure and prevent disease with nutrition.” ~ Thomas Edison
INTRODUCTION
In India, 15% of the population contributes the school going children. There are now more school-age children in developing countries than ever before, due to population growth and the success of child survival programs. At the same time, there are more children in school as access to basic education has increased in most of the developing world.Children require an adequate supply of nutrients for growth, energy and for the maintenance. Nutrition is probably the single greatest factor that plays an important role in the maturation & development of central nervous system of children, both pre & post natal.1
Childhood has been called the latent time of growth as the rate of growth slows down & body changes occur gradually. A well-nourished child is one with access to adequate food supply, care and health. Such a child will have weight and height measurements that compare very well with the standard normal distribution of heights (H) and weights (W) of healthy children of the same age and sex. The best way to evaluate the nutritional status and overall health of a child is to compare the child’s growth indices with the set cut-off points in the standard normal distribution of well nourished children that are associated with adequate growth.2
A well-balanced diet means eating the right amount of nutrients to supply the body with the energy it needs to function properly. It also means getting the right amount of nutrition to support growth and development. The well-balanced diet contains vitamins, minerals, carbohydrates, proteins, fibers and the right kind of fats. A variety of foods from all of the food groups should be consumed on a regular basis. Food is supposed to nourish and keep the body working. Eating the right amount of the right types of food is the key to a healthier you.3
Nutrient deficiencies have negative effects upon mental functioning and can be a cause of learning difficulties. One of the most common nutrient deficiencies which have been found to have an impact upon children’s learning is iron. A deficiency in iron intake can lead to anaemia which can cause children to have smaller attention spans, irritability, fatigue and difficulty in concentrating. It has been found that children with anaemia do not perform as well in tests, vocabulary and also reading. In addition, fat is considered an important nutritional requirement in the body towards optimum mental functioning. Carbohydrates are another vital nutrient which is used to sustain glucose levels. When these levels are not maintained and fluctuation occurs, it can cause dizziness along with mental confusion.4
In developed countries there generally is a low prevalence of under nutrition, of specific nutritional deficiencies, and of disease conditions which place at risk the school progress of children and are major causes of public health concern. In developing countries - particularly among the low income segments of populations - infections and malnutrition are often endemic. Among them the prevalence of protein energy malnutrition (PEM), and micronutrient deficiencies including vitamins and mineral is generally extremely high.5
Malnutrition is a fairly wide-spread and complex problem that poses a serious threat to life in some parts of the world. Poor nutrition contributes to about 5.6 million child deaths per year and more than half of the total deaths take place in India. This is particularly true for India where the number of malnourished children has not changed significantly as seen from the National Health and Family Survey data in all the three surveys. The percentage of underweight children in the country was 53.4 in 1992; it decreased to 45.8 in 1998 and again rose to 47 in 2006.6
This study mainly focuses on the knowledge and practice regarding nutrition among school age children. Structured teaching program regarding importance of well balanced nutrition will be delivered to the children. The study hypothesized that the knowledge and practice of children regarding nutrition will be improved after the teaching program.
6.1 NEED FOR THE STUDY
Research into the health and wellbeing of schoolchildren has shown that there are significant concerns about their current and future health, in particular the increase in obesity and related conditions. There is evidence that the impaired childhood growth and development that result from poor nutrition are linked to chronic disease in adulthood. In addition, poorly nourished children, particularly those who are overweight or obese, often experience significant social and psychological problems. Eating habits are developed from a young age and messages about healthy lifestyles need to be delivered in a clear and consistent manner if children are to develop the knowledge, understanding and skills they need to make appropriate food choices and develop positive attitudes to diet and health.3 Today’s fast paced world both the parents are in work force or with a single parent in the work force, the children may leave the home without having adequate diet. Based on the findings of the other studies, it is feasible to suggest that poor nutritional status impacts the behavior of children, school performance and overall development. Further studies are needed to look at the value of child nutrition. Thus there is a need to assess the knowledge of the children regarding good nutrition and to educate the children regarding importance of well balanced nutrition.
6.2 REVIEW OF LITERATURE
Review of literature is a key step in research process; it refers to an extension, exhaustive and systemic examination of publications relevant to research projects.
1. STUDIES RELATED TO INCIDENCE AND PREVALANCE OF NUTRITIONAL DISORDERS AMONG CHILDREN
Mohammad I El Mouzan ,Peter J Foster, Abdullah S Al Herbish, Abdullah A Al Salloum, Ahmad A Al Omar and Mansour M Qurachi (2010) conducted a study on Prevalence of malnutrition in Saudi children The number of children younger than 5 years of age was 15 516 and 50.5% were boys. The prevalence of moderate and severe underweight was 6.9% and 1.3%, respectively. The prevalence of moderate and severe wasting was 9.8% and 2.9%, respectively. Finally, the prevalence of moderate and severe stunting was 10.9% and 2.8%, respectively. The prevalence was lower in girls for all indicators. Comparison of the prevalence of nutritional indicators in selected countries demonstrates large disparity with an intermediate position for Saudi Arabia.7
B. K. Das and S. Bisai (2009) conducted a study on Prevalence of under nutrition among Telaga adolescents in India. Under nutrition among adolescents is of public health importance in developing countries including India. However, there is little information on nutritional status of adolescents in urban West Bengal. In view of this present study was conducted to ascertain the level of under nutrition among Telaga adolescents in Kharagpur town. A total of 930 (472 boys and 458 girls) children were measured. The mean BMI of children had shown a consistently increasing trend in both sexes from age of 13 years onwards. Moreover, there is a gender bias in favor of girls in higher mean BMI at all ages except 10 and 13 years. The overall prevalence of under nutrition was 28.60%. The rates were significantly higher among boys (37.59 %) compared with girls (19.43%). 8
Marcelle M .M, Mariya A and Erica C M (2008) conducted a study on the prevalence of malnutrition and its risk factors in children, Brazil states that the overall prevalence of underweight, stunting and wasting were 18.1, 15.5 and 10.7%, respectively, with reference to Centers for Disease Control (CDC) growth curves, and 14.3, 17.3 and 4.4%, respectively, with reference to National Center for Health Statistics (NCHS) growth curves. The overall prevalence of wasting was statistical higher according to the CDC reference than that estimated using the NCHS reference (P=0.02). The prevalence rate of intestinal parasites was 58.8%. Risk factors associated with malnutrition were: low educational level of guardian respondent (OR=4.55), energy intake <54.5kcal/kg (OR=4.55), children in age group 6-10 years (OR=3.54), and attendance at outpatient clinic for pediatric visit (OR=2.71). 9
Salah E.O. Mahgoub, Maria Nnyepi and Theodore Bandeke (2006) conducted a study on factors affecting prevalence of malnutrition among children at Botswana. The results show that the level of wasting, stunting, and underweight in children under three years of age was 5.5 %, 38.7 %, and 15.6 % respectively. Malnutrition was significantly (p < 0.01) higher among boys than among girls. Underweight was less prevalent among children whose parents worked in the agricultural sector than among children whose parents were involved in informal business. Children brought up by single parents suffered from underweight to a significantly (p < 0.01) higher level than children living with both parents. The prevalence of underweight decreased significantly (p < 0.01) as family income increased. The higher the level of the mother’s education, the lower the level of child underweight observed. Breast feeding was found to reduce the occurrence of underweight among children. 10
Jean-François Schémann, Albert A. Bane,, Ando Guindo, Vincent Joret, Laminas Traore and Denis Malvy (2002) conducted a study on Prevalence of Under nutrition and Vitamin A Deficiency in the Dagon Region, Mali Of the studied children, 4.3% (95% Confidence interval [CI]: 3.2–5.3) reported night blindness and 2% (95% CI: 1.3–2.7) had Bitot spots. Prevalence of exophthalmia attested by at least one of these signs was 5.4% (95% CI: 4.2–6.5). The prevalence reached 10.5% at three years of age. The MRDR test proved abnormal in 77.1% of the subjects (95% CI: 70.3–82.7). Serum retinol was lower than 0.35 µmol/L in 43.8% (95.6% CI: 36.9–51.3) and less than 0.70 µmol/L in 92.7% of the children (95% CI: 87.8–95.8). Weekly consumption of vitamin A rich food was rare: 75.8% had not eaten any animal vitamin A rich food, and 22.1% had consumed less than seven times a vitamin A rich food of either vegetable or animal origin. 11
Joyce K. Kikafunda, Ann F. Walker, David Collett, and James K. Tumwine (1998) conducted a study on Risk Factors for Early Childhood Malnutrition in Uganda. A large minority (21.5%) of the children surveyed were found in poor health after clinical examination: 3.8% being classified as suffering from kwashiorkor and 5.7% with marasmus. A high proportion of children were stunted (23.8%), underweight (24.1%), or had low MUAC (21.6%). Although rural living, poor health, the use of unprotected water supplies, lack of charcoal as fuel, lack of milk consumption, and lack of personal hygiene were shown as risk factors for marasmus and underweight. 12
2. STUDIES RELATED TO ROLE OF NUTRITION AND ACTIVITIES OF CHILDREN
J. McCary (2006) conducted a study on Improving Access to School-Based Nutrition Services for Children with Special Health Care Needs states that lack of proper nutrition can be considered a barrier to optimal learning, justifying nutrition services for school-aged children in the school setting. Nutrition may be especially important for children with disabilities and special health care needs. Children with disabilities and special health care needs often have more physical health-related problems that impact their education and nutrition status. It is estimated that at least 40% of children with special health care needs are at risk for nutrition-related challenges. Common issues include growth alterations, oral-motor problems that adversely affect feeding, medication–nutrient interactions, altered energy and nutrient needs, and partial or total dependence on enteral or parenteral nutrition. 13
Howard Taras (2005) conducted a study on Nutrition and student performance at school and found that children with iron deficiencies sufficient to cause anemia are at a disadvantage academically. Their cognitive performance seems to improve with iron therapy. A similar association and improvement with therapy is not found with either zinc or iodine deficiency, according to the reviewed articles. There is no evidence that population-wide vitamin and mineral supplementation will lead to improved academic performance. Research indicates that school breakfast programs seem to improve attendance rates and decrease tardiness. Among severely undernourished populations, school breakfast programs seem to improve academic performance and cognitive functioning.13
J. Bryan (2004) conducted a study on Nutrients of Cognitive Development in School-aged Children., states that Under nutrition and deficiencies of iodine, iron, and folate are all important for the development of the brain and the emergent cognitive functions, and there is some evidence to suggest that zinc, vitamin B12, and omega-3 polyunsaturated fatty acids may also be important. Considerations for future research include a focus on the interactions between micronutrients and macronutrients that might be influential in the optimization of cognitive development.13
Mukudi E (2003) conducted a study on nutrition status, education participation, and school achievement among Kenyan middle-school children. Data collected from 851 students from 5 elementary schools included height, weight, attendance records, and raw scores from standardized tests.29% of students fell below 90% cutoff of acceptable weight for height (described as a measure of nutrition). The measure of "weight for height" was the second strongest predictor of achievement on standardized tests.13
R.O. Abidoye, D.I. Ewe( 2000)conducted a study on Comparative school performance through better health and nutrition in Nsukka, Enugu, Nigeria, Two hundred and eighty five (73.1%) of the pupils selected, participated in the final studies. There was predominance of malnutrition among the pupils. Only 28.9% of the pupils were of normal weight for height (using Z-scores on Nutritional Center for Health Statistics Values). 47.1% were mildly underweight, 20.1% were moderately underweight while 4.0% were severely underweight. Overall nutritional status (using weight-for-age Z-scores) significantly affects school performance (p<0.05). Only 26.0% of the pupils were of normal height-for-age, the rest were stunted. 13