RAJIVGANDHIUNIVERSITY OF HEALTH SCIENCES, BANGOLORE, KARNATAKA
PROFORMA FOR REGISTRATION OF SUBJECTS FOR DISSERTATION
1 / NAME OF THE CANDIDATE AND ADDRESS / MS.J. ARUNA 1 YEAR M.Sc. NURSINGHARSHA COLLEGE OF NURSING , No. 193/4,SONDEKUPPA CIRCLE, NH-4,NELAMANGALA, BANGLORE-562123
2 / NAME OF THE INSTITUTION / HARSA COLLEGE OF NURSING,
3 / COURSE OF STUDY AND SUBJECTS / DEGREE OF MASTER OF NURSING COMMUNITY HEALTH NURSING
4 / DATE OF ADMISSION TO COURSE
5 / TITLE OF THE TOPIC / A STUDY THE EVALUATE EFFCTIVENESS STRUCTURED TEACHING PROGRAM ON KNOWLEDGE REGARDING VITAMIN A AMONG MID DAY MEAL ORGANIZERS IN SELECTED SCHOOLS IN BANGALORE.
6. BRIEF RESUME OF THE INTENDED WORK
INTRODUCTION
BACKGROUND OF STUDY
Children health, nutrition and education are inseparable. WHO defines health as a state of complete physical, mental and social well being. The child can be physically health only if or she receives adequate nutrition.Mentl health, too, is possible only if the is strong.Historically speaking, the introduction of the medical inspection of school going children in the city of Baroda in 1909 was a landmark in the development of school health services in India in 1941, the joint committee of the central advisory Board of Health and Education emphasized the need for satisfactory medical inspection, treatment and school feeding in any system of public education.
In 1946, Bhore committee put stress on the provision of the physical and nutrition programme for school going children and started that the function of school health services should be under the health department.
Bhore committee recommendations for school health further envisaged that school teachers should receive adequate instructions in health education during the period of training, thorough medical examination should be conducted of midday meals at least for 1/3 of the daily calorie requirement and raising of kitchen gardens.
In 1962-63 ,as part of the minimum needs programme, mid day meals programme for the age group of 6-11 years was introduced to school children for 200 days in a year, Aims of midday meal programme was, to decrease the prevalence of malnutrition among children, to decrease the child mortality and morbidity rate, to improve enrolment in the school, to help in the reduction school dropout rates.
Bangalore is the successful state in respect of noon meal programme. The composition of school lunch in India are cereals and millets 75g, pulses 30g, oils and fats 8g, leafy vegetables 30g, non leafy vegetables 30g per day per child.
School health services were appointed in 1931 by the ministry of Health and family Welfare. Based on the recommendations of the task force, an intensive pilot project on school health services programme was launched in 1982 to cover 2.5 lakh primary school health children in rural areas. The project worked in 25 blocks and seventeen states and there union territories.
The important recommendation of the school health services programme was to give health education for prevention of preventable problems.
Through this education programme, changes were brought about in knowledge skills and behavior for a healthy living. So this school health service was a part of community health programme through which comprehensive care of the health and well being of children were maintained.
Other common problems occurring in school children are nutritional deficiency problems, fever, headache, cold, diarrhea, dysentery, upper respiratory infections, eye diseases, worm infestations, teeth and gum diseases.
Nutrition plays a very important role in the physical, mental and emotional development of the school children. Malnutrition is an important battle which is to be fought and won, so children should receive balanced diet which includes calories of 1800 Kcal, protein 33gm, calcium 0.4 to 0.5gm, iron 15 to 20mg, and vitamin A rational 400 mic.gm. Vitamin A carotene 1600 mic.gm.
As a consequence of this dietary deficiency several nutritional deficiencies with clinical manifestations and disabilities are encountered in our country namely, Protein energy malnutrition,
Vitamin A deficiency, Iron deficiency anemia, Iodine deficiency
B complex deficiency etc.( Herald of Health, May 1998).
These deficiency disorders are associated with poverty, low purchasing power, unavailability of food, population explosion, poor weaning practices, social injustice and customs, unhygienic environments, insanitary living conditions, infections and communicable diseases.
Because of vitamin A deficiency, the school children are suffering from conjunctiva xerosis, Biotot’s spot scar, xerophthalmic fundi, dry skin and growth failure, Deficiency of vitamin A is a leading causes of blindness among school children.
It is believed that feeding of locally available carotene rich foods such as green leafy vegetables, yellow and orange vegetables and fruits like pumpkin, carrot, papaya, mango, oranges, etc to the school children helps to prevent vitamin A deficiency. The recommended allowance of vitamin A is 5000 IU per day
National prophylaxis programme for prevention of Blindess due to vitamin A deficiency aims at protecting children from Vitamin A deficiency and is in operation in the country since 1970. It is carried by paramedical personnel in public health department.
It is pity that, though WHO has recognized vitamin A deficiency as “one of the major preventable causes of blindness” for over a decade, it is far from having been controlled. This paradoxical situation appears to be the result of such factors as public ignorance, lack of nutrition, education, failure to suspect the disease at an early stage.
NEED FOR STUDY
The vast bulk of India’s children continue to be in a sub- standard state of health and nutrition. These children grow into adults of tomorrow with varying degrees of physical stamina and productivity.At home young children demand food and eat whenever they feel hungry. This routine gets upset when they start going to school, because a specific time is set apart for meals, Children may not give much importance to food at school because they are far too busy in playing with their newly found friends. They either skip a meal or gulp it down within a few minutes
without properly chewing it . For these reasons, it is duty both the mid day meal organizers and parents to see that children adjust their food habits to suit the new situations and consume adequate amounts of food. If the mid day meal organizers are educated especially about Vitamin A, it helps them to identify the sings and symptoms of vitamin A deficiency, and provide food items enriched with vitamin A as well.
The world population of school age children is 724 million. India is a large country having the population of more then one billion. Nearly 400 million children constitute pediatric population under the age of 15. there are more than 82, 00,000 schools in India.Ray (2001) stated that malnutrition contributes to about 40-50 percent of the child mortality in India. Micronutrient malnutrition poses a serious that to the health of the vulnerable groups of population. These micro nutrients govern many vital functions connected with metabolism, reproduction, immune mechanism and intelligence, The three important micronutrient deficiency of public health significant in India are vitamin A deficiency, Iron deficiency anemia, Iodine deficiency disorders
Vitamin A deficiency is the, most common cause of blindness in young children and can raise young mortality rates by 20-30%. 76 countries have vitamin A deficiency. The prevalence of vitamin A deficiency is 2850 in 2001. In general 3 to 10% of children suffer from vitamin A deficiency in north India . Survey conducted by child health study group reveal incidence of 6 to 7% in pre schoolers and 8.7 in school going children. The prevalence in south India is even higher.
Dr. Bruno de Benosi (1999) described that three million young children have clinical vitamin A deficiency and atleast 75 million have sub clinical vitamin A deficiency. (Health Dialogue. September 1999)
Milwanker (2002) , stated that the most vitamin A deficiency are often associated with protein calorie malnutrition and affect over 120 million children worldwide. It is also a leading cause of childhood blindness.
Herald of health (1998)n states vitamin A deficiency is a major nutrition problem affecting young children leading to blindness. It is estimated that nearly 20, 000 children go blind every year due to severe vitamin A deficiency in India.
According to the who there are approximately 1.3 million children in the region who have signs of xeropthalmia. A base line survey (1998) for a vitamin A supplementation trial in Bangalore noted high xeropthalmia rates including XN (night blindness)=3.7% X1B (Bitot’s spot)=7.2% and total xeropthalmia rate was 10.95% studies also indicated that, there were no manifestations of vitamin A deficiency in infants, its prevalence increased with age, further a higher prevalence was seen in school children in all groups. and symptoms, methods of identification, treatment, prevention, complications of vitamin A.
6.2 REVIEW OF LITERATURE:
A literature review involves the systematic identification location, scrutiny and summary of written materials that contain information on a research problem (polit hungler,1982)
A search was made to explore the studies, reportsand publications, published in medical and nursing field. In India and abroad. Investigator utilized both manual computer search.
Search. Through it has been realized that teaching is an integral part of rehabilitation of a person. Such studies were found to be limited in medical literature. The investigator reviewed the related literature to broaden the understanding and gain insight into the selected problem under study. This present study is aimed at developing an information booklet on knowledge of vitamin a in mid day meal organizers for a better understanding of present study, the related literature review has been made and described under the following areas. Studies related to effecict
- Studies related to effectiveness of information booklet.
- Review of literature related to effectiveness of knowledge assessment of prevention vitamin A deficiency.
1. Usha Rama Krsihna (2002) conducted experimented study on assessment and control of vitamin A deficiency disorders
The XX International Vitamin A Consultative Group (IVACG) meetingin Hanoi, Vietnam, in February 2001 celebrated 25 y of progressin prevention and control of vitamin A deficiency disorders(VADD). Programmatic themes included the following: 1) interventioninnovations, 2) integration of vitamin A interventions, 3) theincreased risk to health of women who are deficient, 4) measurementof progress and impact andProgrammatic sustainability. Thehistory of IVACG was remembered and the growth of the groupfrom a meeting of 30 to 40 persons in 1975 to nearly 600 delegatesfrom 63 countries was described. Successful adaptation to newchallenges and scientific advances, in moving science to practice,was noted.
2. D.D Murray Mc Gavin(2000) conducted experimented study on vitamin A on vitamin A deficiency disorders (VADD) has been compiled by two internationally recognized authorities in the field.
This is much more than an introduction to the subject of VADD although it is also described by the authors as a ‘companion to study’. The Manual is designed for those health and nutrition workers involved with real needs, particularly the protection and preservation of eyesight and child survival.
3. En Francais (1992) conducted experimented study on vitamin A programme.
HKI saves the sight and lives of thousands of people every year through vitamin A supplementation programs.
Vitamin A deficiency, VAD, has been recognized as the leading cause of preventable pediatric blindness in developing countries. Over the last 25 years
Today, 127 million pre-school children and 7 million pregnant women are vitamin A deficient. Every year, between 250,000 and 500,000 children around the world go blind from a lack of vitamin A in their diet. Seventy percent of these children die within one year of becoming blind. It is estimated that provision of adequate amounts of vitamin A reduces overall child mortality by 23 - 34%.
VAD leads to decreased production of a photosensitive pigment in the rods of the eye, so the level of light needed for vision increases and night blindness results. Small, concentrated capsules of Vitamin A supplements combat both night blindness and xerophthalmia, where the membranes of the eye lose their mucous secreting cells and take on a rough appearance followed by damage to the cornea. Prompt doses of vitamin A can stop this deterioration although scarring may remain. Left untreated, the cornea can melt, leaving the patient irreversibly blind.
Blindness from vitamin A deficiency can also strike when infections reduce appetite, stores or the body's ability to absorb this vital micronutrient. Children who receive vitamin A supplements to protect their eyes are also less susceptible to diarrhea and measles, which often prove fatal in developing countries. Data shows that in settings where VAD is prevalent, improving the vitamin A status of children reduces their risk of mortality from measles by an average 50%, from diarrhea by an average 40%.
All of HKI's Africa programs and five of seven Asian Pacific country offices support mass vitamin A supplementation, VAS, programs for children between the ages of six months and five years. The goal of our programs is to strengthen country-driven plans to achieve and sustain high VAS coverage of greater than 80 percent of targeted children. More than 33 million African children and 20 million Asian children have benefited from our programs, with most of these countries in Africa surpassing the 80% goal.
HKI also combats VAD by promoting the production and consumption of vitamin A-rich foods through homestead food production, orange-fleshed sweet potatoes, community and school gardens, and by working with the private sector to fortify commercially-produced foods such as cooking oils with Vitamin A
School health or food fortification links on the left-hand side of this page.
4. Barbara A. Underwood conducted experimented study on Strategies for the prevention of vitamin-a deficiencyThe long-term goal of a strategy to prevent vitamin-A deficiency is, broadly defined, to provide all people with a diet adequate in the vitamin and other nutrients that interact in vitamin-A metabolism. WHO has compiled a list of 73 countries whose populations are likely to have an inadequate level of vitamin A to a degree worthy of immediate public health attention. Obviously, a general upgrading of the level of development in these countries and a more equitable distribution of the benefits ofdevelopment, including income, would substantially reduce the magnitude of the problem. We cannot wait for this to occur while the irreversible consequences of acute deficiency of vitamin A accrue. Hypovitaminosis A is amenable to solution through public health programmes that need not await overall development. Where the serious, irreversible forms of visual impairment are prevalent, appropriate intervention programmes should be instituted immediately. Where milder forms exist, and where resources are available, earnest consideration should be given to improving vitamin-A nutrition for the general population as well. A global political commitment is needed for the eradication of hypovitaminosis A as a public health nutrition problem.
5. Agarwal GG, Aswasthi S, Walter SD:
Department of statistics, Lucknow University, India, girdhar51
In many community-based surveys, multi-level sampling is inherent in the design. In the design of these studies, especially to calculate the appropriate sample size, investigators need good estimates of intra-class correlation coefficient (ICC), along with the cluster size, to adjust for variation inflation due to clustering at each level. The present study used data on the assessment of clinical vitamin A deficiencyand intake of vitamin A-rich food in children in a district in India. For the survey, 16 households were sampled from 200 villages nested within eight randomly-selected blocks of the district. ICCs and components of variances were estimated from a three-level hierarchical random effects analysis of variance model. Estimates of ICCs and variance components were obtained at village and block levels. Between-cluster variation was evident at each level of clustering. In these estimates, ICCs were inversely related to cluster size, but the design effect could be substantial for large clusters. At the block level, most ICC estimates were below 0.07. At the village level, many ICC estimates ranged from 0.014 to 0.45. These estimates may provide useful information for the design of epidemiological studies in which the sampled (or allocated) units range in size from households to large administrative zones.
6. Pal R Sagar V: conducted experimented study on Correlates of vitamin A deficiency among Indian rural preschool-age children Department of Community Medicine, Sikkim-Manipal Institute of Medical Sciences (SMIMS), Gangtok, Sikkim, In India, 52,000 children go blind every year on account of vitamin A deficiency. The purpose of the study was to determine the correlates of vitamin A deficiency among 4,205 preschool-age children. METHODS: Case-control study in BihtaPrimaryHealthCenter area, Bihar, India. Main outcome measures were dietary habits, maternal literacy, and birth order. RESULTS: Vitamin A deficiency was found to be significantly higher (p<0.01) in children on a vegetarian diet (7.14%) (OR 5.32). Children born to a literate mother had a prevalence of only 1.35% in relation to a corresponding value of 4.11% in children born to illiterate mothers (p<0.01) (OR 3.15). Birth order of preschool-age children was significantly related to vitamin A deficiency. In birth order less than or equal to three, the prevalence was 2.81%, in comparison to those with birth order four or more, in whom the magnitude was significantly higher (p<0.01) at 5.61% (OR 2.08).
STATEMENT OF PROBLEM
A study the evaluate effective on structure teaching program knowledge regarding vitamin A among under five mothers in
6.3 OBJECTIVE OF STUDY
6.3.1 To assess the knowledge regarding vitamin A among under five mothers.
6.3.2 To test the effectiveness of structured teaching program regarding knowledge on vitamin A among under five mothers.
6.3.3 To find association between knowledge regarding vitamin A and selected demographic variables among under five mothers
6.3.4 To correlate the pre test and post test results by using chi square test.
6.4 OPERATIONAL DEFINITIONS:
Knowledge:
Refers to responses of under five mothers to the items in the self administer questionnairey regarding vitamin A there are measured in terms of knowledge score.
Effectiveness:
The out com of information booklet identified with the help of structured questionnaire given to under five mothers before and after providing the information booklet.
Structured Teaching Programe:
It is systematically developed content and teaching aid about vitamin A for under five mothers. That content include meaning elements, sources, metabolisations, functions, effect of deficiency, causes, signs and symptoms, methods of identification, treatment, prevention, complications of vitamin A.