SYNOPSIS FOR REGISTRATION OF SUBJECT FOR DISSERTATION
SUBMITTED TO:
RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES
IN PARTIAL FULFILLMENT
OF
M.Sc (N) IN CHILD HEALTH NURSING
SUBMITTED BY:
Ms. TEENA GEORGE
I YR M.Sc(N)
UNDER THE GUIDANCE OF:
Mrs.SHEELA BERNET
VICE-PRINCIPAL
H.O.D
CHILD HEALTH NURSING
NARAYANA HRUDAYALAYA COLLEGE OF NURSING
NO: 258/A, BOMMASANDRA INDUSTRIAL AREA
ANEKAL TALUK, BANGALORE-99
1 / Name of the candidate and Address / Ms. TEENA GEORGEI YEAR MSc NURSING,
NARAYANA HRUDAYALAYA COLLEGE OF NURSING,
BOMMASANDRA INDUSTRIAL AREA, BANGALORE – 99.
2 / Name of the Institution / NARAYANA HRUDAYALAYA COLLEGE OF NURSING.
3 / Course of study and subject / 1ST YEAR M.Sc NURSING (CHILD HEALTH NURSING)
4 / Date of admission to Course /
08-06-2009
5 / TITLE OF THE TOPIC / THE EFFECTIVENESS OF A STRUCTURED TEACHING PROGRAMME ON THE KNOWLEDGE OF TEACHERS REGARDING IDENTIFICATION OF NUTRITIONAL DEFICIENCIES IN SELECTIVE ASPECTS OF IRON, VITAMIN ‘A’ AND IODINE DEFICIENCIES AMONG PRIMARY SCHOOL CHILDREN
6. BRIEF RESUME OF THE INTENDED WORK
INTRODUCTION
“CHILD’S HEALTH IS NATIONS WEALTH”
Childhood holds a very important place in the life of every human being. Children are nations hope and pride. Since they are the future of a country, an unhealthy malnourished child today will contribute to unhealthy future of country.
The school as a portal of personalized health care is an important concept. Significant number of school age children is in need of adequate source of health care and early one fifth of the population of every country comprised these children. Most of the primary school children are suffering with nutritional deficiency disorders. Micronutrients deficiencies have emerged as the most widespread devasting nutritional deficiencies of the global scenario. Large number within the South-Asian population, and particularly Indians, suffer from iron, vitamin ‘A’ and iodine deficiencies.
Teachers play a major role in identification of nutritional deficiency disorders among primary school children.
6.1: NEED FOR THE STUDY
Our country is committed to achieve an appropriate level of Health For All by 2020 AD. The need of the children and our duties towards them became a part of our constitution.
-Kidwai Moshina, 1986-
The quality of one’s life is greatly influenced by the school environment, which in turn is influenced by school teachers. She/he is a person who identifies the deviation of health from the normal.
Studies show that anaemia and vitamin A deficiency diseases are the commonest nutritional disease in school children. An estimated 53% of school children suffer from iron deficiency anaemia globally. A study conducted in India in January 2009 shows that the prevalence of iron deficiency anaemia in children is about 14-88%.It is seen even in urban middle class family also. Asia has the highest prevalence of anaemia. Vitamin A deficiency affects 7% of the school children worldwide. About 2.5 million of our Country are threatened by blindness in early childhood because of lack of vitamin A. About 12000-14000 go blind every year because of this deficiency which is eminently curable. Vitamin A deficiency affects 7% of the school children worldwide. Iodine deficiency affects an estimated 5% of children.1
Iron deficiency anaemia is the most common micronutrient deficiency and can be caused by insufficient dietary intake of iron, parasitic diseases, in particular worm infections and malaria, and deficiencies in other micronutrients, for instance, Vitamin B12 and folate. It is an important mineral in the formation of hemoglobin and myoglobin.
It helps in the development and function of brain, regulation of temperature, muscular activity add catecholamine metabolism. The most important function of iron is oxygen transport and cell respiration Iron supplementation is an important component of school-based health and nutrition programmes.2
Vitamin A is indispensable for normal vision. It helps to form retinal pigments, rhodopsin and iodopsin, for vision in dim light. It is essential for normal function of glandular and epithelial tissues of skin, eye, digestive, respiratory, urinary and reproductive systems. It promotes bone and teeth development. It acts as antioxidant and anti infective.2
Iodine is a significant micronutrient essential for the synthesis of thyroid hormones. It is also required in small amount for growth and development.2
Nutritional deficiency disorders are major public health problems in India and other developing countries. They affect vast majority numbers of population and responsible for approximately 55% of childhood deaths. In school most of the children will be affected with certain deficiency disorders like vitamin and mineral deficiency diseases. If these deficiency disorders are treating at early stage then it is curable. A teacher plays a pivotal role in this. She/he should have enough knowledge about the deficiency disorders and should able to find out these deficiency disorders at the earlier stage. If these deficiency disorders are treating in the earlier stages, we can reduce the childhood morbidly and mortality rates in our country.3
In India most of the studies were done on malnutrition and its effects and much emphasis is not given to improve the knowledge of teachers especially in Karnataka. Hence investigator felt the need to assess the knowledge of teachers regarding identification of nutritional deficiencies in selective aspects of iron, vitamin a and iodine deficiencies among primary school children. The investigator is interested to develop a structured teaching programme for teachers on identification of nutritional deficiency among primary school children.
6.2: REVIEW OF LITERATURE
The literature from various sources had been reviewed & arranged under following categories.
SECTION A: Literature review on nutritional deficiencies
SECTION B: Literature review iron, vitamin A and iodine deficiencies
SECTION C: Literature review on knowledge of teachers
SECTION A
Literature review on nutritional deficiencies
Parul Dutta (2009) states that nutritional deficiency disorders are the major public health problem in India and other developing countries. They affect vast majority numbers of population and responsible for 55% of child death. In India, there are about 60 million malnourished children and every month about 1 lakh children die due to effects of malnutrition. On a global scale five principal nutritional deficiency diseases that are accorded the highest priority action are kwashiorkor, marasmus, xerophthalmia, nutritional anaemias and endemic goiter. These diseases represent the tip of the iceberg of malnutrition, a much larger population are affected by hidden malnutrition which is not easy to diagnose. The effects are high morbidity and mortality among young children, retardation of physical and mental growth and development, lowered vitality of the people leading to lowered productivity, permanent disability and reduced life expectancy.1
O P Ghai (2003) states that under nutrition is widely recognized as a major health
problem in developing countries of the world. Nutritional status of the children is an indicator
of nutritional profile of the entire community. Under nutrition, stunting and thinness
are often diagnosed by comparing weight, height and midarm circumference of the children.
The prevalence of under nutrition cannot be judged solely from an estimate of the quantity
of food consumption. Human body has a remarkable capacity to adjust its metabolism to
meet some variations in the daily intake of food. Unless the nutritional deprivation
is severe and prolonged, short term deficit may not produce any significant physiological
disturbance.2
Dutta A, Pant K, Puthia R, Sah A (2007) did a study on prevalence of under nutrition among children in the Garhwal Himalayas. They selected 240 families by random sampling. The nutritional status of 353 children are assessed by nutritional anthropometry and compared with tables of weight for age and height for age z scores, identifying stunting and wasting. The study reveals that only 11.3% of children had normal HAZ and 10.3% had normal WAZ. The rate of malnutrition among children in Garhwal is very high. The majority are severely stunted and wasted, indicating a high prevalence of both chronic and acute malnutrition.4
Dang S, Yan H, Yamamoto S, Wang X, Zeng L(2004) conducted a study on poor nutritional status of younger children living at high altitudes of Tibet. The cross sectional survey was conducted and a sample of 1655 children below 36 months old was obtained using a stratified multistage cluster random sampling method from a total of 7 districts of Tibet. Height, weight and hemoglobin concentration were measured. The study shows that prevalence of malnutrition of children was 39% for stunting, 23.7% for underweight and 5.6% for wasting. For Tibetian young children, the nutritional status of entire population is poor and prevalence of malnutrition is higher.5
SECTION B
Literature review iron, iodine and vitamin A deficiencies
Parul Dutta (2009) states that iron has great significance as nutritional element. The most important function of iron is oxygen transport and cell respiration. Deficiency of iron leads to nutritional anaemia of microcytic hypo chromic nature. Prevention of iron deficiency requires for iron rich dietary intake by mother and child, treatment of chronic blood loss and worm infestation along with promotion of iron absorption by changing diet habits. Iodine is a significant micronutrient essential for synthesis of thyroid hormones. It is also required in small amount for growth and development. Iodine deficiency disorders include goiter, hypothyroidism, cretinism, dwarfism, subnormal intelligence, impaired physical and mental growth and delayed motor mile stones. Vitamin A deficiency is a systemic disease with major effect on eye. About 2.5 million children of our country are threatened by blindness because of lack of vitamin A.
S.C. Jai Prabhakar and M.R. Gangadhar (2009) conducted a study on Prevalence of Anaemia in Jenukuruba Primitive Tribal Children of Mysore District, Karnataka. For the study 175 children ranging in age group 6-10 years were selected and estimated the haemoglobin level by cyanmethaemoglobin method. The study revealed that, 36.57% of children were moderately anaemic, 26.29 per cent were mildly anaemic and 14.86 percent severely anaemic. On the whole 77.71% were suffering from different forms of anaemia. Prevalence of anaemia was more among the girls than boys.6
Arlappa N, Laxaiah A, Balakrishna N, Harikumar R, Brahman G N (2003) did a study on clinical and subclinical vitamin A deficiency among rural preschool of Maharashtra. A community based cross sectional study was carried out in rural areas of Maharastra.A total of 8646 preschool children were examined for the presence of signs and symptoms of VAD.The study shows that the prevalence of Bitot’s spot is 1.3% and night blindness is 1.1% and subclinical VAD (55%)was significantly high among children with night blindness(100%) and Bitot’s spot (89%).7
RamachandraKamath, V.Bhat, R.S.P.Rao, D.Acharya, UKapil, M.S.Kotian and D.S.Nayak (2009) conducted a study on prevalence of goitre among school children in Belgaum district,Karnataka . A school survey was conducted to estimate the prevalence of goitre among schoolchildren in Belgaum district. A cross-sectional study was conducted in primary, middle and high schools of villages selected. All the children of the selected schools were examined for the presence of goitre and the salt samples obtained from their homes were tested for iodine content. The study states that theoverall prevalence of goitre was 16.7%. Prevalence of palpable goitre was 16.4 % and visible goitre was very low (0.3%).8
SECTION C
Literature review on knowledge of teachers
Alice C O (2006) conducted a study on effectiveness of planned teaching programme on knowledge of primary school teachers on health appraisal of school children in Udupi. A sample of 60 school teachers of primary English medium schools in Udupi district were selected by non probability convenience sampling techniques. The study indicates that majority of teachers have poor knowledge on health appraisal of children. So it is very important to give information to teachers about health appraisal. The planned teaching programme was an effective strategy for gaining knowledge.9
Galal OM, Ismail I, Gohar AS, Foster Z (2005) did a study on schoolteachers' awareness about scholastic performance and nutritional status of schoolchildren in Egypt. This study assesses the awareness of schoolteachers about the impact of malnutrition on the scholastic performance of primary schoolchildren living in Egypt. Two focus group discussions were conducted with Egyptian schoolteachers from the Quena and Kharbia Governorates. The study indicates that schoolteachers consider low body weight and thinness as the primary signs of malnutrition. They do not prioritize malnutrition as a factor for poor scholastic performance. They also suggest that unhealthful eating habits, especially a lack of breakfast, negatively affect children's interaction with schoolteachers and their ability to excel in their studies. Schoolteachers endorse a more reliable and nutritionally valuable school-feeding program as a way to increase the scholastic performance of their students.10
Chen Y H,Yeh C Y conducted a study on effect of implementation of health promoting schools on school teachers nutriton knowledge &dietary intake in Taiwan.The result shows that better knowledge& dietary behaviour were observed in teachers after health promoting school programme on nutrition.11
PROBLEM STATEMENT
A study to assess the effectiveness of a structured teaching programme on the knowledge of teachers regarding identification of nutritional deficiencies in selective aspects of iron, vitamin A and iodine deficiencies among primary school children in selected primary schools of Anekal Taluk, Bangalore.
6.3: OBJECTIVES OF THE STUDY
1) To assess the knowledge of teachers regarding identification of nutritional deficiencies among primary school children.
2) To determine the association between the knowledge of teachers and selected demographic variables.
3) To assess the effectiveness of structured teaching programme on knowledge of teachers regarding identification of nutritional deficiencies among primary school children.
6.4: OPERATIONAL DEFINITIONS
Ø Assess - It refers to the appraisal of knowledge score of teachers attending structured teaching programme regarding identification of nutritional deficiencies in selective aspects of iron, vitamin A and iodine deficiencies among primary school children.
Ø Effectiveness - It refers to the improvement in the knowledge score after the structured teaching programme.
Ø Structured teaching programme - It refers to systematically organized teaching strategy on causes, clinical features, nutritional and medical management and prevention of nutritional deficiencies among primary school children
Ø Knowledge - It refers to the information and understanding of school teachers regarding identification of nutritional deficiencies in selective aspects of iron, vitamin A and iodine deficiencies among primary school children, as measured by a structured questionnaire