RAJIV GANDHI UNIVERSITY OF HEALTH SCEINCES
BANGALORE, KARNATAKA.
DISSERTATION PROPOSAL
“A DESCRIPTIVE STUDY TO ASSESS THE KNOWLEDGE ON IDENTIFICATION
AND MANAGEMENT OF SELECTED MICRONUTRIENTS DEFICIENCY IN CHILDREN
AMONG MOTHERS OF UNDER FIVE CHILDREN RESIDING AT RURAL AREAS OF
TUMKUR DISTRICT WITH A VIEW TO DEVELOP SELF INSTRUCTIONAL
MODULE”.
SUBMITED BY:
Mrs. YASHODA T L
Ist YEAR M.SC NURSING,
CHILD HEALTH NURSING,
SHRIDEVI COLLEGE OF NURSING,
TUMKUR,
2011-2013
RAJIV GANDHI UNIVERSITY OF HEALTH SCEINCES BANGALORE,
KARNATAKA.
SYNOPSIS PROFORMA FOR REGISTRATION OF SUBJECT
FOR DISSERTATION
1.
NAME OF THE CANDITATE AND ADDRESS
Mrs.YASHODA T L
1st YEAR M.SC. NURSING, SHRIDEVI COLLEGE OF NURSING TUMKUR
-572106
2.
NAME OF THE INSTITUTION
SHRIDEVI COLLEGE OF NURSING
3.
COURSE OF THE STUDY AND SUBJECT
1stYEAR M.SC. NURSING CHILD HEALTH NURSING
4.
DATE OF ADMISSION TO COURSE
01/07/2011
5.
TITLE OF THE TOPIC
“A DESCRIPTIVE STUDY TO ASSESS THE KNOWLEDGE ON IDENTIFICATION
AND MANAGEMENT OF SELECTED MICRONUTRIENTS DEFICIENCY IN CHILDREN
AMONG MOTHERS OF UNDER FIVE CHILDREN RESIDING AT RURAL AREAS OF
TUMKUR DISTRICT WITH A VIEW TO DEVELOP SELF INSTRUCTIONAL
MODULE”.
6. BRIEF RESUME OF INTENDED WORK
INTRODUCTION
“Never underestimate a child's ability to get into more
trouble”.
Martin Mull
Nutrition the word nutrition is derived from the word ’Nutricus’
which means to suckle at the breast. Nutrition is defined as
combination of Dynamic process by which the consumed food is
utilised for nourishment and structural and functional efficiency
of every cell of the Body. It is the science of food and its
relationship to health,Nutrition needs of a newborn, infant, child
and adolescent are different from that of adult, the different
stages of growth demands an understanding of the changing
nutritional requirement, in the paediatric population, the needs
for growth are superimposed on the high maintenance needs due to
higher metabolic and nutrient turnover role,There are essentially
seven classes of nutrients, Carbohydrate, protein, fat, minerals,
vitamins and water. Nutrients are classified in to macronutrients
and micronutrients. Macronutrients which constitute carbohydrate,
fat, and proteins are required in large quantities and are the
building block of the body. Micronutrients consist of vitamins and
minerals and though required in very small quantities play an
essential role in metabolic pathway and immunity, Micronutrient
deficiencies such as nutritional anaemia (especially iron
deficiency) which is very common in Indian children and vitamin
deficiencies like rickets, scurvy and vitamin a deficiencies are
some of the common conditions which require prompt attention.1
Micronutrient deficiency occurs all over the world but
particularly in developing countries, not all population are
equally at risk of each type of micronutrient deficiency, while
iron deficiency anaemia may affect all countries, the likelihood of
iodine and vitamin a deficiency varies from area, region to region
special attention should there for be given to population groups
who come from area of known specific deficiency. Micronutrients
deficiencies, also known as “HIDDEN HUNGER” are deter minded and
aggravating factors for health status and quality of life .three
nutritional problems that have serious consequences are
deficiencies of iron vitamin a and iodine. It is estimated that in
today’s world.2
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.3
Adequate nutrition can provide a rich environment for the
developing child conversely interfere with brain development and
other function, nutrition requirements change over the child “s
life and intellectual development, Nutrition provides the essential
requirements to maintain health and prevent illness.Some of the
factors contributing to poor nutrition include inadequate food
intake, lack of knowledge about nutritious diet in school and homes
, unsound social and cultural food practice, the ready availability
of process and nutritionally inadequate foods presence of illness
that interferes with ingestion, digestion and absorption of food in
growing child inadequate nutrition is associated with low cognitive
ability, poor emotional and mental health, increased susceptibility
to child illness, and stunted physical growth’ fast food’ or’ junk
food’ diet are one cause of child hood obesity and the increases in
the number of cases of childhood type 2 diabetes.New borns and
infants are experiencing tremendous growth and need diets that
support these rapid changes, iron deficiency anaemia in the first 2
years of life may be associated with development and psychomotor
delays even after correction of the anaemia, the effects may be
long lasting. 4
The most effective way to prevent micronutrients deficiency is
to provide a diet that is diversified and includes fresh food, for
practical and logistic reasons, however, emergency food supplies
usually consists of three or four basic items that are rarely
changed and do not normally includes fresh foods. A limited range
of food items for more than 2 months, run the risk of developing
nutritional deficiencies.1
6.1. NEED FOR STUDY:
“Children are natural mimics: they act like their parents in
spite of every attempt to teach them good manners”.
Ananymous
In india, there are about 60 million malnourished children and
every month about one lack children die due to effects of
malnutrition. About 2.5 million children of our country are
threatened by blindness in early childhood because of lack of
vitamin A and about 12000 to 14000 go blind every year because of
this deficiency which is eminently curable. About 75 to 80% of the
hospital. About 25% pediatric beds are occupied by patients whose
major problem is malnutrition is indirectly responsible for
hospitalization.5
According to child mortality data base 2007, 9.2 million
children born alive worldwide die before 5 years of age
malnutrition contributes to over a third of these deaths6 .
A study was conducted on clinical and subclinical vitamin A
deficiency among rural preschool of Maharasta, a cross sectional
study was carried out , a total 8646 preschool children were
examined, the study conclude that the prevalence of Bitot”s spot is
1.3% and subclinical VAD(55%) was significantly high among children
with night blindness (100%) and Bitot”s spot(89%)7.
A study was conducted on Prevalence of goiter among school
children in belgaum district, Karnataka a cross sectional study was
conducted in primary, middle and high school of villages selected,
all chidern were examined for the presence of goiter the study
states that over all prevalence of goiter was 16.7% prevalence of
palpable goiter was 16.4% and visible goiter was very
low(0.3%)8.
Iodine deficiency has tremendous developmental costs on country
, the problem of salt fortified with iodine a cross sectional study
was conducted in rural and urban area to determine the prevalence
of iodine deficiency in children (0-6) years and assess the use of
iodized salt at house hold level , results shows that 57% to19% and
30.2% to 11.2% respectively in rural and urban are among children
under 5 years of age the prevalence of iodine deficiency were 22%
:12.2% were severely 9.7% and moderately iodine deficit9.
Micronutrient deficiencies are common in infant between 6 and 24
months of age and are an important public health problem in Mexico,
a study was conducted to determine the prevalence of anemia and of
iron, folic acid and zinc, a national survey was conducted with a
sample of children younger than 2 years of age, a study results
that the prevalence of simulataneous iron folic acid and zinc was
10%, 9.2% and2.7% study concludes that the prevalence of
micronutrients deficiencies at this early age calls for effective
preventive public nutrition programs to address them10.
A study was conducted to determine the prevalence of anaemia and
associated factors among under fives and their mothers in rural
area of western Uganda a cross sectional investigation using both
qualitative and quantitative method,results shows that overall
prevalence of iron deficiency anaemia among children and their
mothers was 26.2% and 17.9% respectively there was significant co
relation between Hb levels of mothers and their children formal
education and nutrition knowledge of the mother were major factor
that were significantly associated low Hb level among children.
Therefore rural mothers should be sensitized on best practices for
prevention of anaemia among both women and children11.
Micronutrients deficiency occurs all over the world but
particularly in developing country not all population are equally
at risk of each type of micronutrients deficiency, while iron
deficiency anaemia may affect all countries,the likelihood of
iodine and vitamin A deficiency varies from area, region to region
special attention should there for be given to population groups
who come from area of known specific deficiency.1
All above studies suggests/reveals that there is prevalece of
micronutrients deficiencies amog children of under five years, thus
the investigator felt to assess the knowledge of mothers of under
five children regarding identification and management of selected
micronutrients dificiencies in children in order to develop and
provide health education to prevent those deficiency.
6.2. REVIEW OF LITERATURE
SECTION (A) Review of literature related to micronutrients
deficiency in children
Ramachandra Kamath, et al, (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 the overall prevalence of goitre was
16.7%. Prevalence of palpable goitre was 16.4 % and visible goitre
was very low (0.3%)8.
Hussain,et al,(2007). Conducted a study was to determine the
prevalence of iodine deficiency in children (0–5 years) Pakistan, A
cross sectional survey was conducted in urban and rural areas , The
results that the present study revealed that majority of the
respondents reported to be familiar with term of iodine and iodized
salt and the availability of salt in nearby market.Locations wise
the orientation level about iodine differed from 24% to 74.2% rural
to urban areas accordingly. Iodine test kits were used to check the
iodine content of household salt,which shows that the coverage of
iodized salt were low in both rural and urban sites, about 39%
respondents were reported to be using of iodized salt at household
level but iodized salt were seen (by labeling observation) at 21%
households at the time of household visit for interviews. The
results for both reported use and observed use were differed
location wise from 57% to 19% and 30.2% to 11.2% respectively in
urban and rural. Researcher Concludes that Iodine deficiency still
persists among children under 5 years of age and women of the
reproductive age9
Arlappa, et al,(2003) Conducted a study on the prevalance of
iron deficiency among preschool children of maharashtra , A
community based cross sectional study was conducted on total of
8646 preschool children, they 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.
Kikafunda J K, et al, Conducted a study to determine the
prevalence of anemia and associated factor among under five
children in Bushenyi distric,Westren uganda children aged 6-59
months and their mothers aged 15-49 years A cross sectional
investigation by using both qualitative and quantitative methods
stratified multi stage sampling methods were used to select the
study sample. The study results that overall prevalence of iron
defiency anemia among children and their mother was 26.2% and 17.9%
respectively. The study concludes iron deficiency anemia was found
to be major problem in this cohort of children and their mother’s,
it is therfore recommended that rural mothers should be sensitized
on best practies for prevalance of anemia among childrens12.
Njue MW,et al, Conducted a study on to determine Vitamin A
supplementation awareness, knowledge and believes among mother’s of
the children under five year old attending Mbagathi Distric
Hospital. Cross sectional study on mothers attending MDH MCH and
POPD. A systematic random sampling where every alternate client was
recurited and questionnaires administered to make 158 respondents.
The study results that almost half (49%) of respondents were aware
Vitamin A supplementation and majority(66%) had never discussed
about Vitamin A importance. The study concludes that mother’s were
positive and supportive of VAS, major source of information being
the health worker but they were lack of information and awarness
among both health workers and mothers13.
SECTION (B) Review of literature related to mother’s knowledge
on micronutrients deficiency
V. Anusuya devi(2011). Conducted a co rrelation study to assess
the knowledge on nutrition of under five children among the
migrating mother and prevalence of nutritional problems among their
children in selected rural community Thiruvallur district, this
study found that maximum 59(98.33%) of the mothers had inadequate
knowledge on nutrition of under five children1(1.67%) of the
mothers had adequate knowledge, when knowledge level decrease the
prevalence rate will increased this study conclude that 59(98.33%)
of the migrating mothers had inadequate knowledge on nutrition of
under five children14.
Yadav, R. J. et al,(2004). Conducted a study was to asses the
Knowledge, attitude and practices of mothers about nutrition,
breast feeding in Bihar. Two villages were selected fromeach block
using Probability Proportion to Size (PPS) sampling. In each
village, 20households were selected. The survey covered about
28,000 households from all 591blocks of the districts. About 8000
mothers were interviewed. Information was collected on household
characteristics,demographic profile, anthropometry, breastfeeding
practices, special food intake during pregnancy, lactation,
awarenessand cause of night blindness. A study result that mother’s
knowledge and practices about nutrition and breast feeding was in
adequate. A researcher conclude that majority of the mothers were
not aware of night blindness and anaemia15.
Bilenko N et al,(2001). Conducted a study to examine mother’s
knowledge regarding iron supplementation and assess the prevalance
of anemia in southern isrel , researcher took 101 mother’s and
infants they assessed the knowledge by using a strucured
questionnaire and medical chart, The results shows that the
mother’s had low level of knowledge regarding anemia. The study
concludes that presence of iron deficiency anemia in infants in
southern Israel is inversely affected by the level of maternal
knowledge of anemia and adherence to iron supplementation. Low
level of knowledge is also directly related to low adherence
16.
Gujral S et al,(1995). Conducted a study was on assess the
knowledge of mother regarding iron deficiency anemia, risk factors
of nutritional blindness and determinants of a successful vitamin A
prophylaxis programme, a evaluation suevey were analysed, a data
collected from 7668 children and their 4621 mother’s. The result
indicates that mother’s health and nutrition, knowledge and
maternal literacy status were less. The study concludes the
supervision of mother were improves the health knowledge of mother
17.
Bendech MA. et al, (1995) Conducted a study was to asses the
knowledge and attitude on Vitamin A deficiency and symptoms in
under five children in rural distric of Mali. A cluster sample of
2631 children and 262 sub sample were selected for interviews
consering their knowledge and attitude. The result shows the
prevalence of clinical symptoms was 2% night blindness,0.3% for
Bitot’s spots and 0.2% for carneal scars were identified. The study
concludes the knowledge of mother’s regarding Vitamin A deficiency
and symptom was very poor18.
PROBLEM STATEMENT
“A DESCRIPTIVE STUDY TO ASSESS THE KNOWLEDGE ON IDENTIFICATION
AND MANAGEMENT OF SELECTED MICRONUTRIENTS DEFICIEMCY IN CHILDREN
AMONG MOTHERS OF UNDER FIVE CHILDREN RESIDING AT RURAL AREAS OF
TUMKUR DISTRICT WITH A VIEW TO DEVELOP SELF INSTRUCTIONAL
MODULE”.
6.3. OBJECTIVES OF THE STUDY
1. To assess the level of knowledge regarding identification of
selected micronutrients deficiency in a children among mothers of
under five children.
2. To assess the level of knowledge regarding managenment of
selected micronutrients deficiencyin children among mother’s of
under five children.
3. To findout the association between the level of knowledge
with selected socio demographic variables.
4. To develop and distribute self instructional module on
identification and management of selected micronutrients deficiency
in children.
6.4 OPERATIONAL DEFINITIONS:
Assess – Evaluation of the knowledge mothers of under five
children regarding selected micronutrients deficiency by
administering questionnaire.
Knowledge -.It refers to the mothers of under five children
intellectual ability to answer the question regarding selected
micronutrients deficiency in children as assessed by knowledge
questionnaire.
Micronutrient deficiency – it refers to micronutrients are the
food substances which are usually required to body in small
quantities like Iron, Iodine and vitamin A and are essential for
physiological regulation, absence of which leads to disorder like
anemia,goiter and night blindness.
Self instructional module –In this study it refers to the
written and valid information to equip the mothers of under five
children on selected micronutrients deficiency in children which
includes introduction,definition, causes, signs and symptoms,
diagnosis,treatment , prevention and complications.
Mother’s – In this study it refers to mothers of under five
children residing at rural areas at Tumkur district.
Rural areas- A permanent small settlement area having pucca,
semi pucca and katcha housing consist of different castes and
agricultural communities relevant for conducive living in order to
meet the basic needs of the community.
Under five children- Children in the age group of 0-5 years.
6.5. HYPOTHESIS:
H1-There is a significant association between the knowledge of
mothers of under five children regarding selected micronutrients
deficiency in children with selected socio demographic
variables.
6.6.Assumptiorns
· Mothers of under five children will have some knowledge
regarding selected micronutrients deficiency
· Mothers of under five children will have less knowledge
regarding the identification and management of selected
micronutrients deficiency in children
· The self instructional module will be a usefull source to
improve the knowledge related to micronutrients deficiency in
children
6.7. Delimitation of the study
· A Study is limited to a sample of 80 mothers of under five
children residing in rural areas at Tumkur district
· A study is limited to rural areas at Tumkur district.
6.8.PILOT STUDY
The pilot study will be conducted on 8 samples the purpose of
pilot study is to find out the feasibility of conducting study and
design on plan of stastical analysis the findings of the pilot
study sample will not be included in main study
6.9 VARIABLES
Research variables are the concepts of various levels of
abstractions that are entered manipulated and collected in a
study.
· Dependent variable: Knowledge of mothers of under five
children regarding identification and managent of selected
micronutrient deficiency in chidren.
· Demographic Variables: Age, Religion,occupation,family income,
type of family, source of health information, number of children in
family etc.
7.0 MATERIALS AND METHOD
This study is designed to assess the knowledge of mother of
under five children on selected micronutrients deficiency.
.7.1.1 SOURCES OF DATA
The data will be collected from mother s of under five children
who are residing in rural areas at Tumkur.
7.1.2 RESEARCH DESIGN
The design for this study is non experimental descriptive
design.
7.1.3 RESEARCH APPROACH
The research approach for this study is descriptive survey
approach .
7.1.4 RESEARCH SETTINGS
The study will be conducted in selected rural areas at Tumkur
district.
7.1.5 POPULATION
The populations for the study are the mothers of under five
children are residing in rural areas at Tumkur district.
7.1.6 SAMPLE SIZE
The total study sample consists of 80 mothers of under five
children residing in rural areas at Tumkur district
7.1.7 SAMPLING PROCEDURE
Non probability convenient sampling will be used to select the
sample.
CRITERIA FOR SAMPLE COLLECTION
7.1.8 INCLUSION CRITERIA
1. mothers of underfive children who are willing to participate
in the study.
2. are able to understand kannada or English.
3. are present during the time of data collection.
7.1.9 EXCLUSION CRITERIA
1.The mothers of under five children who have undergone any
medical or paramedical cours.
7.2 METHODS OF DATA COLLECTION
The data collection procedure will be carried for a period of 6
weeks. The study will be conducted after obtaining permission from
the concerned authorities and informed consent from the
samples.
The data will be collected from mothers of under five children
by using structured questionnaire to asses the knowledge regarding
selected micronutrients deficiency in children.
.
7.2.1 TOOLS FOR DATA COLLECTION
The structured questionnaire consists of following section.
· SECTION A: - A questions related to demographic profile.
· SECTION B:- A questions developed to assess the knowledge
regarding selected micronutrients deficiency in children among
mothers of under five children.
7.2.2 DATA ANALYSIS METHOD
The data collected will be analyzed by using,
(A). DESCRIPTIVE STATISTICS: -
· Frequency and percentage and standard deviation,will be used
for assessing level of knowledge. ..
(B). INFERENTIAL STATISTICS; -
· Chi-square test will be used to find out the association
between knowledge score and selected demographic variables.
7.2.3TIME AND DURATION OF THE STUDY
The time and duration of the study will be limited to 6 weeks or
as per guidelines of university.
7.3 DOES THE STUDY REQUIRE ANY INVESTIGATION OR INTERVENTION TO
BE CONDUCTED ON PATIENT OR OTHER HUMAN OR ANIMAL? IF SO, PLEASE
DESCRIBE BRIEFLY.
No, since the study is descriptive analysis is natural, no
interventions are required.
7.4 HAS ETHICAL CLEARANCE BEEN OBTAINED FROM YOUR
INSTITITION?
The pilot study and the main study will be conducted after
getting the approval from the research committee. Permission will
be obtained from the concerned head of the institution. The purpose
and details of the study will be explained to the study subjects
and assurence will be given regarding the confidentiality of the
data collected.
8. REFERENCE
1. RGUHS Journals of medical sciences, www.rguhs.ac.in. p
42-49.
2.Authorised reprint World Health Oraganization Geneva. The
Management of nutrition in major emergencies. AITBS publishers, p :
15-16, 149-150.
3. Dutta A. Pant K. Puthia R. Sah A. prevalaence of under
nutrition among children in the Garhwal Himalayas. Food Nutr Bull.
2009 Mar; 30(1):77-81.
4. Terri Kyle. Essential of pediatric nursing. South asian
edition. First Indian re prient. Wolters kluwer(India)2009.p
41-42,94,123-124,153.
5. Parul dutta. pediatric nursing,published by Jaypee. brothers
medicalpublishers(p)ltd.p199
6. Statistics by area/ child survival and health. mortality data
base:2008 sep. http://www.child info.org/mortality.html.
7. Arlappa N. Laxmaiah A. Balakrishna N. Harikumar R. Brahmam
GN. Clinical and sub-clinical vitamin A deficiency among rural
pre-school children of Maharashtra. India. Ann Hum Biol. 2008
Nov-Dec; 35(6):606-14.
8. Ramachandra
Kamath.V.Bhat,R.S.P.Roa.D.Acharya.U.Kapil.M.S.Kotian and D.S.
Nayak.Prevalence of goiter among school children in Belgaum
district. Indian J Ped.2009 Aug:76:8
9.Hussain. G Nawaz.S Soofi. A Karmani. A Rizvi. Z Bhutta. Aga
Khan University.Karachi.Pakistan. Assessment of use of iodized salt
at house hold level and iodine deficiency status among children
under five years.2007 Jan.
10. Social Security Institute Ximena Duque.Sergio
Flores-Hernandez. Prevalance of anemia and deficiency of iron.
folic acid. and zinc in children younger than 2 years of age who
use the health services provided by the Mexican.Public healh
nutr2007,10(5);34. 11.The association between anemia in infants and
maternal knowledge and adherence to iron supplementation in
southern Israel. 2000-2001. PMID: 17710783 [pubmed-midline]
12.Anemia and associated factors among under-fives and their
mothers in bushenyi district. Western Uganda. Department of food
and science and technology. PMID:19344541. [ pubmed- index for
MIDLINE].
13.Viamin A supplementation awareness among mothers of children
under-five years old at mbagathi district hospital. Nairobi.
[email protected]. PMID:21516961. [pubmed-index for
MIDLINE].
14. V. Anusuyadevi http://www.anvpublication.org/ajner.htm
15. Yadav. R. J. and Singh. P. (2004).
Knowledge.attitude and practices of mothers about nutrition.
breastfeeding in Bihar.
Indian Journal of Community Medicine, 29(3) : 130-31.
16. Bendech MA. Chauliac M. Carles C.Diarra M.
Vitamin A deficiency and food consumption of children aged 6 to
84 months in a Direction nationale de la Santé publique. Bamako.
Mali. Sante. 1995 Mar-Apr;5(2):77-83
17.Risk factors of nutritional blindness and determinants of a
successful vitamin A prophylaxis programme.
PMID:8635782[pubmed-indexed for midline]
18.Vitamin A deficiency and food consumption of children ared 6
to 84 months 1995. PMID:7780670[pubmed- index for midline].
9.
SIGNATURE OF THE CANDIDATE:
10.
REMARKS OF THE GUIDE:
11.
NAME AND DESIGNATION OF:
11.1 GUIDE:
11.2 SIGNATURE
11.3 Co-Guide
11.4 Signature
11.5 HEAD OF DEPARTMENT:
11.6 SIGNATURE
12.
12.1 REMARK OF THE PRINCIPAL:
12.2 SIGNATURE
