5. TITLE OF THE TOPIC :
“A STUDY TO EVALUATE THE EFFECTIVENESS OF STRUCTURED TEACHING PROGRAME ON KNOWLEDGE AND PRACTICE OF GROWTH MONITORING AMONG UNDER FIVE MOTHERS IN A SELECTED RURAL AREA OF BANGALORE.”
6.0. BRIEF RESUME OF INTENDED OF WORK:
INTRODUCTION
Children of today are the citizens of tomorrow, who can build a healthy nation and are resources for the future child health is the corner stone of national Progress and the country which neglects, it, neglects, its future progress1. The age group up to five years is an important period of life. At each stage of a child’s growth and development, appropriate care is very essential. 2
Nutrition is one of the basic human need for growth, maintenance and survival, growth and development of infant is highest among all the age groups. Anthropometry is considered to be the most sensitive parameter for assessing the nutritional states of communities, and especially that at growing children. Weight is the basic index of the health and nutritional status of an individual. 3
Nutritional anthropometry is most important in nutritional assessment because the physical dimensions of the body are mostly affected by nutrition, specially in rapidly growing children. 3
Faltering of child growth is the best single indicator of incipient problems in child health and development. 3 Growth monitoring is oriented to the individual child, and is a dynamic measure of its health from month to month. It focuses on normal nutrition and the means to promote continued growth and good health. 4
Accurate measurement of height and weight is essential during growth assessment, as weight shows acute variation in nutritional pattern and height shows chronic malnutrition4.
6.1 Need for the Study
The Late Prime Minister, Jawaharlal Nehru once said “Children are the Wealth of tomorrow take care of them if you wish to have strong India, Eveready to meet various challenges”. 1
Children under five year of age constitute 15 to 20% of population in developing countries and 35 to 60% of all death occur in this age group, childhood is a period of rapid growth and development, children under five years of age require special health care. 4
In the world one of the major condition heading to under five mortality is malnutrition 5 Around 50% of total deaths in India occur among under five children indicating the need for special attention towards this age group. 6
Growth is an essential Feature in the life of a child; Childhood is a period of rapid growth and development. Hence, growth and development of children till the age of five to six years is very important to have an adult life, Childhood malnutrition may result in severe limitation in their development. 6
In India 53% of under fives are moderately or severally underweight, out of which 21% are severally underweight. An estimated 108 children per every 1000 live births in India die before completing 5 years of age and mortality rates are higher amongst backward sections of or society. 6
One of the major conditions which is to be considered to prevent the under five morality is by improving nutrition and interventions that effect nutritional status of the children. 5
According to WHO report (1986) growth is the most sensitive index of health in child hood. Growth monitoring is a simple low cost technology which can significantly contribute to the promotion of child health and nutrition. The process by which the growth and development of a child starts faltering is silent, invisible, prolonged and spread throughout thousands of poor communities in India. 6
One of the basic activities of under five clinic is growth monitoring, ie., to weigh the child periodically at monthly intervals during the first year, every two months during the second year and every three months thereafter up to the age of 5 to 6 years to detect early onset of growth failure. 4
Growth monitoring enables the mother to detect early signs of malnutrition’s. The growth chart is primarily meant for the mothers to visualize and motivate concern for healthy growth in her child. 1
Growth monitoring and promotion is an operation strategy of enabling mothers to visualize growth or lack of growth and to receive specific, relevant and practical guidance in ways in which she, her family and community can act to assure health and continued regular growth in her child. 7
Further community participation is one of the principles of primary health care. Hence, it is felt that mothers participation in the growth monitoring will help to eradicate malnutrition by early detection and improving nutritional status based on the growth pattern of the child.
Growth monitoring is one of the promotive health services provided by the PHC to assess nutritional status. The study conducted by8 in the PHC Surathkal reveals that none of the families were utilizing growth monitoring services at health centre due to non availability or ignorance. 8
Hence, it is felt that a study on knowledge and practices of mother related to growth monitoring of the under fives is essential to identify the deficiencies which may fill the gap between the differences in the availability and use of the growth monitoring services of the mother.
One of the objectives of the RCH programme also focuses on the child health and nutrition. The community health nurse plays significant role at peripheral level to implement nutritional programme in the rural area where the underline malnutrition is higher. 8
Moreover, the nutritional status of the rural children is poor due to poverty and illiteracy when compared to urban area . 8
Hence, the investigator is interested to carry out this study is rural area where health awareness is poor and mothers have poor exposure to the medias of information.
Further, it is observed that many studies were conducted on the nutritional status of the under fives by weight and height assessment, but a few studies are available on the knowledge and practices of the mothers on growth monitoring of under fives, especially in India.
Surathkal PHC is being utilized by the institution where the investigator is a student and the investigator observed that mothers are not coming regularly for weight monitoring to the PHC regularly as desired.
Lastly study on knowledge and practices was felt to be carried out together as the investigator felt that ignorance may lead to poor attitude and hence less practices due to lack of motivation. It is felt that this study will enable the investigator to identify the factors to be considered while implementing growth monitoring program and over come the obstacles in improving nutritional status and reach the objective of the under five clinic.
6.2 REVIEW OF LITERATUE
Review of literature is a systematic identification, location, scrutiny and summary of written materials that contain information on research problems. 8
A literature review is a compilation of further study, it is frequently found as a sub section of a published research study. Review of literature are also published as free standing explorations of a body of knowledge. 8
The researcher presenting the review of related literature which helps to study the problem in depth. It also serves as a valuable guide to understand what has been done and what is still unknown and untested.
The related literatures are presented in the following subheadings.
- Importance of child health.
- Importance of growth monitoring.
- Knowledge of mothers on growth monitoring.
Importance of Child Health.
Children of today are the citizens of tomorrow, who can build a healthy nation and resources for the future. The late Prime Minister, Jawaharlal Nehru once said “Children are the health of tomorrow take care of then if you wish to have strong India, ever, ready to meet various challenges”. 1
Child health is the corner stone of national progress and the country which neglects it, neglects its future progress. The age group of one to five years is an important period of life. At each stage of a child’s growth and development appropriate care is very essential. A Childs growth and development, is the result of satisfaction of all his needs. Community health nurse has an important role in educating the families regarding the normal growth problem of children. Importance of care of the child after birth in every aspect. 2
Children constitute the most important and vulnerable segment of or population. They are truly the foundation of a nation. The focus of every citizens should be to promote their health and safe guard their interest. A healthy child is a sure future is one of the themes of WHO. Healthy children grow to become healthy adults, who are strong both in body and mind. Every child should be allowed to achieve his optional growth and development potential, so that he can effectively contribute towards nationals productivity. The feature of our nation depend on the way in which we nature our children today. We have to provide every child with a happy childhood. We should make growth and development of children, our main priority. 9
Children have the highest health risk in terms of number of illness and deaths. The early identification of health problems and prompt treatment of diseases among children can yield life long benefits for the individuals, their families and the committees in which they live. 10
Once of the global strategy for health for all by the year (2000 is under five morality rate below seventy per thousand live births and infant mortality rate below fifty per one thousand live birth. 5
A nations progress is indicated by the quality of life its children lead. Their well being can be assessed on the basis of their nutritional status education and rights children are more numerous and more vulnerable than women or men. As per 1997 statistics (State of World’s children, 199) 25 Million children are born every year in India. Only a fraction of these children live to attain any where near their natural potential of physical and mental growth. 5
One of the focus in ninth five year plan will be on at risk groups – children in the age group of six to twenty three months. 11
“The children or today are the citizen of tomorrow”. The nation will be shaped and malted into a healthier and stranger one, if its children are strong and healthy. Children between the age group of 0-5 years constitute 15-16 years of India’s total population also 44% of nations deaths are contributed by this age group 22% of the mortality of children occurs in the age group below one year. 12
Children are the future pillars of a nation. Child health is the mot crucial factor to determine growth of child especially first two years of life. The child population of the world is growing at the rate of two million a month. Shaping of tomorrow India, by investing in children today is the best possible development strategy for the country. The Government of India is committed to child development as a policy priority. 4
Children’s constitute a critical group in every society and care of children is given a priority in all countries of the world. The future of a society depends upon the quality of life of its children. All children need care and attention. 13
Without optional child growth and development being issued, even efforts to accelerate economic development significantly will be unsuccessful. 5
The world submit for children in 1990 in which 159 countries participated agreed to end malnutrition and other health problems of children before the end of the decade. 5
Provision of nutritional service is a component of India’s national policy for children and all individuals. Governmental and non-Governmental organizations are charged with responsibility for child health and care. 5
Better nourished children tend to be more active and able to explore the environment. 5
Government of India has promised to its citizens that all children below five years will be weighed every month and a growth chart maintained. 14
Thomas stated that the critical period of under five when affected by under nutrition results in development which cannot be reversed back even with subsequent adequate nutrition.
A child’s entire lift is determined in large measure by the Food be consumes during his first five years of life. A series of dietary deficiencies will damage his health and inhibit growth and development. He may not live to see his sixth birthday and if he will survive he may very well carry the scares throughout his life. 15
Importance of Growth Monitoring:
Growth monitoring has been described as operational strategy of enabling mothers to visualize growth, or lack of growth, and to receive specific, relevant and practical guidance in ways in which she, her family and community can act to assure health and continued regular growth in her child. In short it is a communication strategy for making and nutrition education more individualized. More convincing and more effective”. 7
Growth mentioning has been considered vital for promoting child health and growth chart are essential for the longitudinal care of the child. Recording weights as a growth chart is the only way of assuring early detection of growth faltering something that cannot be seen with the eye.
UNICEF shows growth monitoring as one of far essential components in its strategy for child survival. The growth chart has been described as a basket for primary health care activities because it is the single comprehensive record of the child’s health. 11
The weight of a growing child increases a little every month when the child is not growing properly or is sick his / her weight will not increased. It may even decrease. Therefore, regarding the weight of a child every month fells he or she is growing properly or not. 5