“A Study To Correlate Feeding Practices Of Mothers And Nutritional Status Of Their Children In A Selected Area, Bangalore”
By ROSAMMA K. J.
Dissertation submitted to the Rajiv Gandhi University of Health Sciences, Karnataka, Bangalore
In partial fulfillment of the requirements for the degree of
Master of Science
In
Paediatric Nursing
Under the guidance of PROF. J. LOVERA GRACE LILLY RANI Department of Paediatric Nursing Sarvodaya College of Nursing Agrahara Dasarahalli, Bangalore – 560 079
November 2007
RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCE, KARNATAKA
DECLARATION BY THE CANDIDATE
I, Rosamma K.J. hereby declare that this dissertation / thesis entitled “A Study To Correlate Feeding Practices Of Mothers And Nutritional Status Of Their Children In A Selected Area, Bangalore” is a bonafide and genuine research
work carried out by me under the guidance of Mrs. J. Lovera Grace Lilly Rani, Professor, Department of Pediatric Nursing, Sarvodaya College of Nursing.
Signature of the Candidate Date
:
Place : Bangalore
ROSAMMA K.J.
ii
RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCE, KARNATAKA
DECLARATION BY THE CANDIDATE
I, Rosamma K.J. hereby declare that this dissertation / thesis entitled “A Study To Correlate Feeding Practices Of Mothers And Nutritional Status Of Their Children In A Selected Area, Bangalore” is a bonafide and genuine research
work carried out by me under the guidance of Mrs. J. Lovera Grace Lilly Rani, Professor, Department of Pediatric Nursing, Sarvodaya College of Nursing.
Signature of the Candidate Date
:
Place : Bangalore
ROSAMMA K.J.
ii
CERTIFICATE BY THE GUIDE
This is to certify that this dissertation entitled “A Study To Correlate Feeding Practices Of Mothers And Nutritional Status Of Their Children In A Selected Area, Bangalore” is a bonafide research work done by Rosamma K.J in
partial fulfillment of the requirements for the award of degree of Master of Science in Pediatric Nursing.
Signature of the Guide
MRS. J. LOVERA GRACE LILLY RANI Professor Date:
Department of Paediatric Nursing
Place : Bangalore
Sarvodaya College of Nursing Bangalore
iii
ENDORSEMENT BY THE HOD, PRINCIPAL/HEAD OF THE INSTITUTION
This is to certify that this dissertation / thesis entitled “A Study To Correlate Feeding Practices Of Mothers And Nutritional Status Of Their Children In A Selected Area, Bangalore” is a bonafide research work done by Rosamma K. J in
partial fulfillment of the requirements for the award degree of Master of Science in Pediatric Nursing.
Seal & Signature of HOD
Seal & Signature of Principal
PROF. J. LOVERA GRACE LILLY RANI
PROF.T. BHEEMAPPA
Date:
Date:
Place: Bangalore
Place: Bangalore
iv
COPY RIGHT DECLARATION BY THE CANDIDATE
I hereby declare that the Rajiv Gandhi University of Health Sciences, Karnataka, Bangalore, shall have the rights to preserve, use and disseminate this dissertation in print or electronic format for academic / research purpose.
Signature of the Candidate Date: Place : Bangalore
ROSAMMA K.J
© Rajiv Gandhi University of Health Sciences, Karnataka, Bangalore
v
ACKNOWLEDGEMENT “Praise the Lord for He is good; Sing to our God for He is loving; To Him our praise is due.” (Ps.146:1)
“Gratitude is the attitude of mind and heart.” I raise my heart in gratitude to God Almighty, who has been my inspiration and guiding force behind all my efforts.
I wish to express my sincere thanks to all who have helped me in accomplishing this task successfully.
I express my thanks to Mr. V. Narayan Swamy, Chairman, Sarvodaya Group Of Institutions, Bangalore for his encouragement, support and deep
inspiration to conduct this PG programme in his esteemed institution.
The present study has been completed under the inspiring guidance and supervision of my guide Prof. J. Lovera Grace Lilly Rani, M.Sc. (N) , Head Of The Department, Paediatric Nursing, Sarvodaya College Of Nursing I express my
deep sense of gratitude for her valuable suggestions, encouragement and keen interest in the planning and execution of the study. I consider it a great honour and privilege to complete this study under her supervision.
I express my heartfelt gratitude to Prof. T. Bheemappa, Principal and HOD of Psychiatric Nursing, Sarvodaya College of Nursing for his valuable advice and
timely support during the study period.
I owe deep gratitude to my Prof. Victorial Selva Kumari M.Sc. (N), Vice Principal, Sarvodaya College of Nursing, for her encouragement, suggestions,
vi
timely assistance, guidance, genuine interest and moral support at every stage of this study.
It is my great pleasure and privilege to take up this study under the extensive support and meticulous corrections of Prof. Hemalatha Ravi MSc (N) Paediatric Nursing in the initial stages of this study.
I express my sincere gratitude to Mrs. Satya Lawrence M.Sc. (N) Asst. Professor, Dept of Child Health Nursing for her guidance, support and
encouragement during the course of this study.
I acknowledge my gratitude to Mrs. Maria Gladys M. Sc. (N), Lecturer, Dept of Child Health Nursing, Sarvodaya College of Nursing for her cooperation,
guidance and support during the study.
I wish to place my sincere thanks to all the members of Dissertation committee of Sarvodaya College of Nursing for their suitable suggestions, genuine
interest and timely encouragement which contributed towards the completion of the study.
I would like to extend my thanks to Dr. Gangaboraiah, Bio-Statistician, KIMS for his timely assistance and valuable suggestions and directions in the
statistical analysis and presentation of data.
I extend my thanks to Librarians of Sarvodaya College of Nursing for the computer assistance.
The investigators would like to extend her gratitude to all the experts who have contributed their times and effort towards validating the tool.
vii
I wish to acknowledge my gratitude to V.S Communications and Mr. Suraj Shetty, Netcom Technologies who helped me to bring this dissertation to
its final shape.
My thanks goes to Mrs. Nirmala Sridhar, M.A. Psychology, M.A. English Literature, M.A. M.Phil. P.G. Diploma in Guidance and counselling for editing
this manuscript. My gratitude goes to Mrs. A.B. Jayasree, M.A. Kannada for translating my tool in Kannada.
I extend my thanks to all my friends especially Mrs. Ceeba Francis, Mrs. Geeta Das, Miss. Lavanya, Miss. Rajini and Mrs. Rosmin for their
supportive and positive interaction during the study.
My special thanks to all the participants who helped me to complete my study.
I am immensely thankful to my Provincial Sr. Damian and all my community sisters for their constant prayers, encouragement and moral support
which sustained me throughout the study.
I am grateful to my beloved parents, brothers and sisters for their valuable support and encouragement.
My sincere gratitude to all those names have not mentioned but who have directly or indirectly helped me for the successful completion of the study.
Signature of the candidate
Date: Place : Bangalore
ROSAMMA K.J
viii
LIST OF ABBREVIATIONS USED
1. BF
:
Breast Feed
2. CF
:
Complimentary Feeding
χ
2
:
Chi – Square
4. DHS
:
Demographic and Health Survey
5. df
:
degree of freedom
6. HAZ
:
Height for age Z-scores
7. IAP
:
Indian Association of Paediatrics
8. NNMB
:
National Nutrition Monitoring Bureau
9. NCAER
:
National Council for Applied Economics Research
10. NM
:
Nutritional marasmus
11. PEM
:
Protein energy malnutrition
12 SD
:
Standard Deviation
13. Σ
:
Summation
14. TCFP
:
Traditional Complimentary Feeding Practice
3.
15. UNICEF :
United Nations International Children’s Emergency Fund
ix
TABLE OF CONTENTS
SL.NO.
CONTENTS
PAGE NO
1.
Introduction
1 - 15
2.
Objectives
3.
Review Of Literature
17 – 35
4.
Methodology
36 – 44
5.
Results
45 – 64
6.
Discussions
65 – 68
7.
Conclusion
69 – 72
8.
Summary
73 – 76
9.
Bibliography
77 – 82
10.
Annexure
83 – 110
16
x
LIST OF TABLES Sl. No.
1
Title of the Table
Area wise analysis of mean and standard deviation of feeding
Page No.
59
practices of mothers 2
Area wise classification of respondents on feeding practices
60
3
Correlation between feeding practice of mothers and selected
61
nutritional parameters of their children 4
Association between feeding practices and demographic
62
variables of mothers 5
Association between feeding practices and selected variables of children
xi
64
LIST OF FIGURES Sl.No.
Title of the Figure
Page No
1
Conceptual frame work
15
2
Schematic representation of research design
38
3
Frequency and percentage distribution of mothers by age
47
4
Frequency and percentage distribution of mothers by religion
48
5
Frequency and percentage distribution of respondents by type of family
6
Frequency and percentage distribution of mothers according to their educational status
7
Frequency and percentage distribution of mothers by occupation
8
Frequency and percentage distribution of mothers by family income
9
Frequency and percentage distribution of mothers by duration of married life
10
Frequency and percentage distribution of no of under five children
11
Frequency and percentage distribution of respondents by source of information
49
50 51 52
53
54
55
12
Frequency and percentage distribution of birth order of children
56
13
Frequency and percentage distribution of children by age
57
14
Frequency and percentage distribution of children by gender
58
xii
ABSTRACT Statement Of The Problem “A Study To Correlate Feeding Practices Of Mothers And Nutritional Status Of Their Children In A Selected Area, Bangalore.”
Background
Malnutrition is an important health problem in many developing countries including India. It is mainly due to faulty dietary habits. It is known that in addition to illness and infection in early childhood, inadequate food intake will contributes to stunting and underweight in most of the children in India.
The objectives of the study were
1. To assess the feeding practices of mothers. 2. To assess the nutritional status of children. 3. To find out the correlation between the feeding practices of mothers and the nutritional status of their children. 4. To find out the association between feeding practices of mothers and their children with selected variables.
Hypothesis
H1: There is a correlation between feeding practices of mothers and nutritional status of their children.
xiii
Method
The study was conducted in Chikkabasti and Doddabasti after obtaining permission from the Medical Officer, Primary Health Centre, K. Gollahalli. Survey approach and descriptive correlative design was adopted for the present study. The sample of the study consisted of 100 mothers and their children. The tool used for the study was structured questionnaire and the technique adopted for the study was structured interview schedule. The obtained data was analysed by using descriptive and inferential statistics and interpreted in terms of objectives of the study.
Results
The findings of the study revealed that most of the respondents were in the age group between 18 – 23 years. Education wise, majority of them were education upto high school. Occupation wise, 82 percent of them were housewives. Religion wise, majority of them (62 percent) of them were Muslims. Most of them belonged to nuclear families. 73 percent of them had income below Rs.5000. 60 percent of mothers had only one child and 50 percent of them had duration of 5 – 9 years of married life. Most of them had TV / radio as source of information.
With regard to children 48 percent were between 2 – 3 years of age among which females were 55 percent and male 45 percent. 48 percent of them belonged to second in birth order.
Among the total respondents, 5 percent of the respondents practiced not satisfactory feeding practices, 81 percent of them practiced moderately satisfactory feeding practices and only 14 percent of them practiced satisfactory feeding practiced.
xiv
Interpretation and conclusion
The study showed that there were significant association between feeding practices and mothers’ demographic variables such as education, occupation and religion of mothers. Whereas there was no-significant association between feeding practices and mothers’ demographic variables such as age, number of under five children, years of married life, income, type of family, birth order, age of the child, gender and sources of information.
However, there was positive correlation between feeding practices and selected nutritional parameters like present weight, height, mid arm circumference and chest circumference.
Key Words
Feeding practices, Nutritional status, mothers, children.
xv
1. INTRODUCTION “Look to your health and if you have it, praise God and value it next to conscience; for health is the second blessing that we mortals are capable of, a blessing money can’t buy”.
-
Izaak Walton
Children are the first call agenda of human resource development – not only because young children are the most vulnerable, but because the foundation for lifelong learning and human development is laid in these crucial early years. It is now globally acknowledged that investment in human resources development is a prerequisite for economic development of any nation. Early childhood constitutes the most crucial period in life, when the foundations are laid for cognitive, social, emotional, physical, motor development and cumulative life-long learning. 1
India is the home to the largest child population in the world. “The development of children is the first priority on the country’s development agenda, not because they are the most vulnerable, but because they are our supreme assets and also the future human resources of the country”. In these words, our Tenth Five Year Plan (2002-07) underlines the fact that the future of India lies in the future of Indian children. 1
There is a saying that, ‘if we have good health we would have achieved most of the things in life’. Every child has the right to possess good health. Life
would have been uncomplicated or simple, if we could attain all that we need automatically or without an effort. But then God has placed us in a world where we
1
have all that are needed for a healthy living and we on our part has to make use of these things in an effective manner.
It is recognized that the period from birth to two years of age is a “critical window” for the promotion of optimal growth, health and cognitive development. 2 Nutrition plays an important role in the physical, mental and emotional development of a child. Infants and pre-school children are the most vulnerable group. UNICEF has pointed out that malnutrition is the biggest and single cause of infant and child mortality. Malnutrition is largely by product of poverty, ignorance, insufficient education and large family size. These factors influence most directly the quality of life and are the true determinants of malnutrition in society.
A child’s early years have long been recognised as particularly critical time for developing good dietary habits. It also is an important time for taking in nutrients amounts required not only for optimal growth and development but for influencing mental development as well.3 It is very important that parents provide regular information about an infant’s or toddler’s nutritional needs, eating habits, cultural and religious preferences about food and health. It is well known that inadequate food intake in addition to illness and infection in the first two years of life contributes to stunting and underweight in millions of children in India and around the world. 4 Poor breast feeding patterns, low nutrient density and poor quality of complementary feed accounts for much of the nutrient deficiency.
Mother’s knowledge related to feeding of babies also reflects the nutritional status of the child. Children completely depend on mothers for their nutrition.
2
Breast-feeding, and other dietary practices adapted by her reflect the nutritional status of the child. Breast-fed infants and children grow normally during the first six months of their life, and show slow growth during the transitional period of weaning because they do not get enough nutritious foods.
Exclusive breast feeding for the first six months of life could save at least 1.3 million lives a year that’s about 3500 children each day according to UNICEF. The Indian Academy of Paediatrics supports exclusive breast feeding for six months and points out that breast feeding provides invaluable immunological protection from a whole host of diseases. 5
Gosh had argued that the high rates of malnutrition in India are not primarily caused by poverty; rather the behaviours of delayed initiation of breast feeding, early introduction of water and liquids and delay in complementary feeding result in a period of perpetual hunger for the child .6
Many researchers agree that socio-economic and environmental conditions, together with feeding practices, are important determinants of nutritional status in developing countries. Inadequate quantity and poor quality of food result in growth faltering, which is exacerbated by the high prevalence of fever and diarrhoeal diseases. Inappropriate feeding patterns may also contribute to child malnutrition. The World Health Organization recommends that children under the age of four months should be exclusively breastfed. 7 Appropriate complementary feeding promotes growth and prevents stunting among children between 6-24 months. The period of complementary feeding is when other foods or liquids are provided along with breast
3
milk. Rates of malnutrition usually peak at this time with consequences that persist throughout life. Stunting is seldom reversed in later childhood and adolescence.
Weaning is not a sudden withdrawal of child from the Breast. It is a gradual process starting around the age of 4-5 months.8 because breast milk alone is not sufficient to sustain growth and development for an infant of this age. 9 It is also said that introduction of food other than breast milk at an early period (before 4 months) decreases the frequency of breast feeding leading to malnutrition. 10 Weaning food should be rich in protein and other nutrients. Weaning can be traumatic experiences for the infant because it looses the oral gratification from sucking. 11
It is well established that nutritional status is major determinant of the health and well being among children and there is no doubt regarding the importance of the study of child’s nutritional status according to spatial and temporal dimension. Developing country like India, accounts for about 40 percent of under nourished children in the world and it is largely due to the result of dietary inadequacy in relation to their needs. In the light of the above, the assessment of nutritional status of an individual or population, anthropometry is widely recognized as one of the useful techniques, because it is highly sensitive to detect undernutrition. 12
Reliable community based data generated by the National Nutrition Monitoring Bureau (NNMB) from eight central and southern states. (Andhra Pradesh, Gujarat, Karnataka, Kerala, Madhya Pradesh, Maharashtra, Orissa and Tamil Nadu) also confirm a decline in clinical deficiency signs in pre-school children from 1975-79 to 1988-90 in rural areas. The overall prevalence of marasmus decreased from 1.3 to
4
0.6 per cent and kwashiorkor from 0.4 to 0.1 per cent. Among the 12,000 children evaluated in the ‘repeat surveys’. Gujarat showed the highest prevalence of both forms, while in the other states their prevalence was below 1 per cent. In the NNMB and the National Council for Applied Economics Research (NCAER) linked survey conducted in 1994 among 1828 pre-school children in the same eight states but in different sampled areas, the overall prevalence of kwashiorkor and marasmus as 0.2 and 0.4 per cent. Fortunately, a similar declining trend was documented in the under privileged urban slums of these six states. The overall prevalence of marasmus has diminished from 3.7 per cent in 1975-79 to 0.2 per cent in 1993-94. No cases of kwashiorkor were observed. 13
In India nearly 75 percent of the populations reside in the village, of the total rural population 50 percent is still under the poverty lines. Majority of children in India are not in a position to get adequate nourishment because of very low per capita income of their families. As per 2001 census, India has around 157.85 million children, constituting 15.42 percent of India’s population, who are below the age of 6 years. Of these 157.86 million children, 75.95 million children are girls and remaining 81.91 million children are boys. The sex ratio among children as per Census 2001 is 927 i.e. 927 females per 1000 males. A significant proportion of these children lives in economic and social environment which impedes the child’s physical and mental development. These conditions includes poverty, poor environmental sanitation, disease, infection, inadequate access to primary health care, inappropriate child caring and feeding practices.1 This present study is an effort to analyze the feeding practices of mothers and the nutritional status of their children in a selected community.
5
Need for the study
The child is the center of attraction in a family. The first important way the young children feel part of the family is through a schedule that is like that of the other family members. Being able to eat with the family goes a long way toward making children feel that they are now truly family members.
Children are the future of any nation. In India about three – fourth of the infant population lives in villages. It is imperative to preserve this wealth and to promote their well being through exercising utmost care in order to make them healthy and to protect them from deadly diseases. Care of children had always traditionally been the forte of mothers’ irrespective of education, income and social class differences. 14
Malnutrition is increasingly recognized as a prevalent and important health problem in many developing countries. This problem has serious long term consequences for the child and adversely influences their development. 15 Poor nutrition or malnutrition is caused by not getting the proper nutrients needed for normal growth and development. Undernourished children do grow to their full potential of physical and mental abilities. Malnutrition makes the child more susceptible to infection and recovery is slower and mortality is higher. 8
Over the past two decades, there has been a substantial and progressive decline in infant and child mortality rates in India. There has also been a significant reduction in the prevalence nutritional deficiency disorders. It is therefore important that increasing attention is now paid to the nutritional status of the survivors. The alarming reports of some international agencies which have placed India at about the
6
bottom-rung of an arbitrary world development scale, have raised apprehensions that the nutritional status of women and children in India shows no signs of improvement.13
“Children’s health is tomorrow’s wealth ”. The professional who work with
the children must have the knowledge of existing feeding practices among mothers and the nutritional status of their children. She must be able to identify the various feeding practices and taboos that exists and which in turn affect the nutritional status of children, should share her skill and knowledge to prevent malnutrition.
According to the National Family Health Survey, malnutrition affects children the most during 6–12 months of age and one of the major determinants is poor feeding practices during first year of life. Breast feeding is extremely important during illness, as children like to be with the mothers and continue to be breast fed. 4 Appropriate complementary feeding involves a combination of practices to maintain breast milk intake and, at the same time, improve the quantity and quality of foods children consume.
The 6-11 month period is an especially vulnerable time because infants are just learning to eat and must be fed soft foods frequently and patiently. Care must be taken to ensure that these foods complement rather than replace breast milk. Energy intake can be increased by increasing breastfeeding frequency, increasing food portion size, feeding children more frequently, and providing more energy-dense foods. Micronutrient intake can be increased by diversifying the diet to include fruits, vegetables, and animal products; using fortified foods; giving supplements. 10 During
7
the third trimester of pregnancy through the early childhood years malnutrition interferes with the development of the brain. This in turn affects the child’s ability to learn. As a result children will never be as bright as nature had meant them to be.
Knowledge of weaning foods and practice is an important aspect of preventive and social pediatrics. Programs to improve complementary feeding must conduct local assessments. Local studies should identify local diets and current good practices to be supported, test options for improving the traditional diet and related feeding practices, and identify target audiences and effective strategies for reaching them. 10
A study of Dietary Pattern, Household food Security and Nutritional Profile of Under-five Children of a Community of West Bengal conducted by Sandip Kumar Ray, Akshil Bandhu Biswas, Sathi Kumar , concluded that : the overall prevalence
of malnutrition based on IAP classification, among the under-five, was found to be 80.90 percentage and that of severe grades of malnutrition (grades III and IV) was 9.26 percentage Prevalence of both overall malnutrition as well as severe grades of malnutrition was highest in 12 to less than 24 months age group being 85.7 percentage and 18.2 percentage respectively while lowest prevalence was observed amongst the infants.
The prevalence of malnutrition including its severe grades was observed to be higher in females as compared to their male counterparts, amongst the families where number of children were 2 or more as well as amongst the families where mothers were working as compared to those who were not. 16
8
Breast milk is the ideal food for the infant. But after six months production of breast milk which is the source of nourishment is reduced. So complementary feeds should be in children’s diet.
Kumar D and Goel conducted a study on “Influence on infant feeding
practices and nutritional status of under-five children”. This study included 217 under-five children.
Initiation of Breast Feed: They found that 55.8 per cent were breast fed within six hours of birth of whom 30.6 per cent under weight, 49.6 per cent stunting and 12.4 per cent were wasting. Whereas 42.2 per cent were breast fed after 6 hours. Among them 43.7 per cent were under weight, 64.6 per cent stunting and 8.3 per cent wasting.
Colostrum Feeding: 42.2 per cent had colostrum feeding; among whom 27.5 per cent under weight, 42.1 per cent stunting, 10.5 per cent wasting. 54.8 per ce nt who didn’t have colostrum feeding of whom 43.7 per cent suffered under weight, 59.0 per cent stunting and 10.6 per cent wasting.
Exclusive Breast Feeding: 23.5 per cent had exclusive breast feeding among whom 27.4 percent under weight, 49.0 percent stunting and 5.6 percent wasting were found. And 76.5 percent who did not have exclusive breast feed also suffered from under weight, stunting and wasting i.e. 43.7 percent, 52.4 percent and 12.0 percent respectively.
9
Proper Complimentary Feeding: 38.7 percent had proper complimentary feeding of whom 28.6 percent under weight, 44.0 percent stunting and 8.3 percent wasting. Also 61.3 percent who did not have proper complimentary feeding suffered from underweight, stunting and wasting i.e. 41.3 percent, 56.4 percent and 12.0 percent respectively.17
The Institute for Research in Medical Statistics, New Delhi undertook a study to assess the nutritional status of the population residing in Bihar. Among children, nutritional deficiency was observed inspite of higher intake of energy. Therefore, to examine the role of dietary and other related factors on nutritional status of children, a detailed analysis was done for the data collected in the study.
The survey covered all the 50 districts including all 704 blocks, 1418 villages, 236 urban ward, 28360 households and about 11,000 children of Bihar. For selection of village and households, an appropriate sampling methodology was used. Information was collected on households characteristics, demographic profile, anthropometry etc. Children under five years of age were categorized using Gomez classification as severe, moderate, mild and normal.
This analysis indicates that the malnutrition among children depends on both better sanitary conditions and on dietary intake. The severe and moderate level of malnutrition among children was much higher among those with poor housing and sanitary conditions even with the same level of dietary intake whereas inspite of lower dietary intake, the level of malnutrition was much lower for those living in better sanitary conditions. Thus to reduce the problem of malnutrition among children, there
10
should be dual focus on dietary intake as well as providing safe drinking water, better sanitation and housing condition for improving their general standard of living. 18
Since mothers are solely responsible for the breast feed, weaning and preparing various type of diet for children, they should have sufficient knowledge regarding feeding to prevent malnutrition and promote optimum health for their children. Malnutrition in children is a complex problem and must be viewed within a broad frame work of child care including feeding practices. A good understanding of the nutritious situation of an area is necessary for improved planning of development of its people. So that nurses could assist mothers to improve or modify their feeding practices wherever necessary to improve their children’s health status. Therefore this study aimed at assessing the feeding practices of mothers and nutritional status of their children in a selected area, Bangalore.
Statement of the problem “A Study To Correlate Feeding Practices of Mothers And Nutritional Status Of Their Children In A Selected Area, Bangalore.”
Operational Definitions
1. Feeding practices: Refers to the pattern of feeding that are commonly practiced by mothers include breastfeed, type of food stuffs, quality and quantity, feeding techniques, number of feeds per day that mothers use for their children. 2. Nutritional status: It refers to assessment of selected nutritional parameters like present weight, height, and mid arm circumference and chest circumference.
11
3. Children: Refers to individuals between 6 months to 3 years of age. 4. Mothers: Refers to women between the age of 15 to 45 years and having children in the age group of 6 months to 3 years.
Hypothesis
H1: There is positive correlation between feeding practices of mothers and nutritional status of their children.
Inclusion criteria
1. Mothers of children who were willing to participate in the study. 2. Both male and female children.
Exclusion criteria
1. Mothers who have physically and mentally challenged children. 2. Mothers who did not have the children along with them at the time data collection.
Conceptual Framework
The Conceptual Framework for the study is based on health belief model. Health beliefs are person’s ideas convictions and attitudes about health and illness. They may be based on factual information or misinformation. The health behaviour usually results from health beliefs.
The Health Belief Model (HBM) was one of the first models that adapted theory from the behavioural sciences to health problems, and it remains one of the
12
most widely recognized conceptual frameworks of health behaviour. Rosenstoch (1974) and Becker’s and Maiman’s (1975) model , address the relationship between
the persons beliefs and behaviours. It is a way of understanding and predicting how clients will behave in relation to their health and how they will comply with health care therapies. Use of the model is based on a persons perceptions of susceptibility to an illness and the seriousness of the illness. 19
This model helps, nurse to understand various behaviours including mothers perception, beliefs and various behaviour in order to plan the most effective care.
The investigator felt that Becker’s model is suitable as conceptual framework for this study. Mothers feeding practices regarding breast feeding, weaning and family diet can be modified by health education and information by health personnel. Mothers can apply this knowledge in taking care of their children.
The model describes about 3 variables 1. Mothers Perception Mothers perceived knowledge regarding breast feeding, weaning and family diet. Foods according to the age, feeding technique and problems during each stage.
2. Modifying Factors Mother’s perception is influenced and modified by demographic variables like mothers age, religion, type of family, child’s age and sex, socio economic variables like education occupation and family income and structural variables
13
like feeding practices. The mother’s perception is also influenced by cues to action like mass media, information from elders and neighbours and information getting from health personnel.
3. Likelihood of Taking Action This part indicates that mothers may try to take action to assess nutritional need of their children and initiating proper feeding practices to prevent malnutrition, underweight and feeding problems. Thus to improve the nutritional status of their children. Perceived barriers like illiteracy, poor socio economic status and lack of knowledge of mothers may lead to unhealthy practices.
Projected Outcome
Study will provide an insight into satisfactory feeding practices of mothers and the nutritional status of their children, thereby help the nurses to sow the seeds towards correct feeding practices.
14
CONCEPTUAL FRAMEWORK Individual Perception
Modifying Factors Demographic variables:
Perceived susceptibility, perceived seriousness
Mothers Child Age Age Religion Sex Type of family Place of birth Socio economic variables: Education Occupation Family income Structural variables Practices of breast feeding weaning and family diet
Feeding practices and nutritional status of children
Likelihood of taking action
Perceived benefits - of proper breast feeding, - weaning, - prevention of malnutrition, perceived barrier - illiteracy - cost of food, cultural practices, level of education.
Mother’s prescribed threat of under weight, malnutrition, feeding problems of children Cues to Action • • •
Mass media Information from elders and neighbours Individual health education by health personnel Newspapers or magazine articles
Likelihood of taking action by nursing personnel to improve the feeding practices of mothers to improve the nutritional status of their children
Not included in the study Fig 1:Adapted from Rosenstochoch’s (1974) Becker’s (1975) Health Belief Model •
15
2. OBJECTIVES Statement of the problem “A Study To Correlate Feeding Practices of Mothers And Nutritional Status Of Their Children In A Selected Area Bangalore.”
Objectives of the study
1. To assess the feeding practices of mothers. 2. To assess the nutritional status of children. 3. To find out the correlation between the feeding practices of mothers and the nutritional status of their children. 4. To find out the association between feeding practices of mothers and their
2. OBJECTIVES Statement of the problem “A Study To Correlate Feeding Practices of Mothers And Nutritional Status Of Their Children In A Selected Area Bangalore.”
Objectives of the study
1. To assess the feeding practices of mothers. 2. To assess the nutritional status of children. 3. To find out the correlation between the feeding practices of mothers and the nutritional status of their children. 4. To find out the association between feeding practices of mothers and their children with selected variables.
16
3. REVIEW OF LITERATURE
Review of literature is a key step in research process. Review of literature refers to an extensive, exhaustive and systematic examination of publications relevant to the research project.9 The review of related literature is valuable guide to define the problem, recognising its significance, suggesting promoting data gathering devices, appropriate study design and source of data.
Review of literature for the present study has been organised under the following headings 1. Literature related to the prevalence of malnutrition and its relation with feeding practices. 2. Literature related to the feeding practices of mothers and nutritional status of their children. 3. Literature related to the influence of weaning practices on nutritional status of children 4. Literature related to the maternal nutritional knowledge and child nutritional status.
1. Literature related to the Prevalence of malnutrition and its relation to feeding practices Chirumulay D, Nisal R has done a study on prevalence of malnutrition and
its relation with feeding practices in 605 tribal under five children. There was a significant relation of nutritional status of preschool children to feeding practices. Exclusive breast- feeding was beneficial only up to 6 months age. After this age, it lost its advantage. Children above one-year age exclusively fed on breast had a high
17
prevalence of malnutrition. No other factor, like sex of the child, parental literacy, past history of illnesses had any significant effect. Health education messages should stress on importance of timely weaning with introduction of solid foods by 6 to 9 months of age; to address the widespread problem of malnutrition in under five children.24
Abdul Sayed ZT has done the study on the determinants of nutritional
marasmus (NM) and kwashiorkor (K) using Sudanese children aged 6-36 months. Subjects consisted of 55 children with NM and 55 with K, admitted to the children’s Emergency Hospital in Khartoum. Mothers were interviewed in hospital, and information on duration of breastfeeding, age at introduction of supplementary foods, and weaning foods was obtained. Observations were made in 20 percent of homes of study children. The results suggest a positive association between prolonged breastfeeding without introduction of supplementary feeding between the ages of 6 and 24 months, and NM. Using multivariate analysis the data show that late introduction of supplementary foods produces an increase of 1.4 fold odds of developing nutritional marasmus, rather than kwashiorkor. In contrast the odds ratio is 1.9 for the two conditions in terms of age of cessation of breastfeeding, the kwashiorkor children breastfeeding for fewer months. Results suggest strategies to reduce the prevalence of NM and moderate PEM. 25
Srivastava N, Sandhu A did a study on Index for measuring child feeding
practices. The investigation was undertaken with the objective of creating an infant and child feeding index (ICFI) from a set of complementary feeding (CF) practices and to determine its association with growth of infants and young children (6-23
18
months). A semi-structured interview schedule was used to collect information for 204 children from one large slum and two private paediatric clinics of urban Vadodara. Results revealed that about half (5.05 percent) of the children were stunted Height for Age Z score,
nearly one-fourth (25.5 percent) were underweight, but
wasting was low (3 percent). It is concluded that the composite index in its present form can reflect the CF practices more holistically than just one or few behaviour studied separately. More research is needed in the direction of consulting of composite index which can then be used for research, monitoring, evaluation and much needed advocacy for complimentary feeding.2
Hossain I M, Yasmin R, Kabir I did a study on Nutritional and
immunisation status, weaning practices and socio-economic conditions of under five children in three villages of Bangladesh. A total of 479 children aged 6-60 months were studied during 1991 to 1992. According to Gomez classification, 96 percent of children had varying degrees of protein energy malnutrition. According to Waterlow classification 84 percent were stunted (36 percent mild, 33 percent moderate and 15 percent severe) and 67 percent were wasted (47 percent mild, 18 percent moderate and 2 percent severe). Of all children 368 received BCG and 439 received partial or full dose of DPT and Polio vaccines. Among children aged 13-60 months 75 percent received Measles vaccine. Weaning food was started at 8.4 months. Low household income, parental illiteracy, small family size, early or late weaning and absence of BCG vaccination were significantly associated with severe PEM. Timely weaning, education and promotion of essential vaccination may reduce childhood malnutrition especially severe PEM.26
19
Excler JL, Nicolas E, Mojon M conducted a study on Protein-energy
malnutrition in an urban African milieu, etiologic factors in kwashiorkor and marasmus-kwashiorkor. The etiologic factors of protein-energy malnutrition have been studied in 59 children with kwashiorkor (KWK) or marasmus-kwashiorkor (MKWK) and living in an African urban area. The decline of breast feeding leads to an earlier PEM, mainly MKWK. This decline is linked to urbanization, mother's activities, dislocation of traditional structures and use of artificial formulas. Essentially based on cereals, the diet is responsible of the post-weaning P.E.M. Poverty, ignorance and food taboos are related to a lack in weaning food varieties. A small number of infants with KWK had a rich protein diet putting back the cause of an hypoproteic diet on the KWK onset. Infections play a determinant role in the onset of KWK and of some MKWK, after 2 years of age. Diarrhoea, measles, bronchopulmonary and parasitic diseases are the most prevalent infections. Among socio-cultural factors, conjugal disorders are predominating with child-mother breakup and father's bonding failure. At the opposite of rural areas, the family size is reduced. The three first birth ranges are specially concerned with young inexperienced mothers.27
2. Literature related to Feeding practices of mothers and nutritional status of their children. Dinesh N.K, Goel, Poonam C, Mittal did a study to determine the nutritional
status of under-five children and to assess infant feeding practices and the association with the under nutrition in Anganwari area of urban Allahabad. Among all under five children surveyed, 36.4 percent were under weight, 51.6 percent had stunted growth and 10.6 percent had wasted proportions of underweight and stunting were found
20
maximum among children aged 13-24 months. Wasting was more prevalent among children aged 37-48 months. Initiation of breast feeding after six hours of birth, deprivation from colostrum and improper complementary feeding were found significant risk factors for underweight. Wasting was not significantly associated with any infant feeding practices studied. They conclude that delayed initiation of breast feeding, deprivation from colostrum and improper weaning are significant risk factors for under nutrition among under fives. There is a need for promotion and protection of optimal infant feeding practices for improving nutritional status of children.17
Hannan A, Hassan M, Fazlur Rahman AKM, Rahman A conducted a
study on Infant feeding practices from birth to two years of age and nutritional status of children and mothers in Bangladesh. Six nationwide cross-sectional surveys on infant feeding practices and child and maternal nutritional status were conducted every six months from July 1998 to February 2001. One district from each division of the country and two upazilas from each selected district were randomly selected. Anthropometric measurements of children included measurement of weight and height / length. The nutritional status of mothers were assessed by taking height and weight and expressing as body mass index. Information on breast feeding practices, complementary feeding and anthropometric measurements were collected using two sets of pre-tested questionnaire. The prevalence of continuation of breast feeding at one year in most surveys was more than 96 percent and at 2 years more than 85 percent. Despite national efforts to improve breast feeding and nutritional status of children and mothers in Bangladesh, the indicators have yet to reach an optional level.
21
These feelings can help policy – planners understand the need for intensifying future programmes.20
Nyaruhucha CNM, Msuya JM, Mamiro PS and Kerengi AJ conducted a
study on Nutritional status and feeding practices of under-five children in Simanjiro District, Tanzania. The study showed that 31 percent of the children were undernourished, some of them severely. Children 2 - 3 years old were the most affected. Breastfeeding duration of more than one year was common among the mothers. Fifty-four percent of the mothers weaned their children as early as two months after birth. The most common type of weaning food was maize porridge (gruel) mixed with cow's milk Generally, 87 percent of households were facing some degree of food insecurity where some of them either experienced food shortage for 3-4 months reported of eating less than three meals per day. An educated mother was less likely to have an undernourished child, while a child from a teenage mother was more likely to be undernourished. Small size of a household was in favour of nutrition status. There is a great need to undertake interventions through community education to rescue the situation in Simanjiro district. Efforts should also be undertaken to mobilize the community members to adopt practices that favour good nutrition of children.15
Kamau-Thuita F, Omwega AM, Muita JW conducted a study on Child care
practices and nutritional status of children aged 0 to 2 years in Thika, Kenya. Cross sectional descriptive survey using a structured questionnaire and taking of anthropometric measurements to determine the nutritional status of children aged 0 to 2 years. In addition, two day observations were conducted in a subsample of
22
households to assess time allocation for the main child care activities. The findings revealed that mother’s knowledge about child care influences the amount and type of care that is given to children. Time taken to perform various activities was also found to vary with the mother's education level, her occupation, number of children less than five years in the house and the child's age and birth order. Comparatively, children who were malnourished had less time devoted to them for breastfeeding, food preparation and feeding. Although mothers were the primary caregivers, the responsibility of care giving was shared with other household members as well as with neighbours. The amount and type of care that a child receives is determined to a large extent by the mother and caregivers knowledge. 21
Ruel MT, Menon P affirmed that Child feeding practices are associated with
child nutritional status in Latin America. Data from the Demographic and Health Surveys (DHS) for 5 Latin American countries, were used to explore the feasibility of creating a composite feeding index and to examine the association between feeding practices and child height-for-age Z-scores (HAZ). The variables used for the index were as follows: current breast-feeding, use of complementary foods and liquids in the past 24 hrs, frequency of use over the past week and feeding frequency. The index was made age specific for 6 to 9, 9 to 12 and 12 to 36 mo-old age groups, and agespecific feeding practices were created. Bivariate analyses showed that feeding practices were strongly and significantly associated with child HAZ in all 7 data sets, especially after 12 mo of age. Differences in HAZ between child feeding practices remained significant after controlling for potentially confounding influences, for all countries except Bolivia. Among children whose mothers had primary schooling compared with mothers with no schooling, or mothers with higher than primary
23
school level. The data available in DHS data sets can thus be used effectively to create a composite child feeding index and to identify vulnerable groups that could be targeted by nutrition education and behaviour change interventions. 22
Alvarado BE, Tabares RE, Delisle H, Zunzunegui MV conducted a study
on Maternal beliefs, feeding practices and nutritional status in Afro-Colombian infants. They combined ethnographic and epidemiological data. They collected information using a food frequency questionnaire. Nine focus groups and 5 deep interviews to mothers of children less than 2 years of age were performed. Their data showed a prevalence of wasting of 2.6 percent and prevalence of stunting of 9.8 percent. These practices are characterized by a universal onset of breast feeding, that lasted 10 months in average, and an early introduction of complementary food. Breastfeeding is a cultural norm. Weaning is related to new pregnancy, to low milk production and to negative effects of breast process on mothers’ health. Early complementary feeding and bottle-feeding are highly valued due to their positive effect on nutritional status and adaptation of children to adult-type diets. The introduction of complementary food after 4 months, the quality of the first food introduced and the diversity of complementary food predicted better nutritional status. They conclude that nutritional illiteracy and mothers' erroneous beliefs result in 50 percent of the mothers having inadequate feeding practices. 23
3.Literature related to the influence of weaning practices on nutritional status of children Hasan J, Ray J, Khan Z conducted a study on influences of weaning practices on
nutritional status in a cohort of 200 infants over a period of one year in the rural area of
24
Aligarh. Weaning was late in most of the infants under study. The nutritional status of infants up to 6 months was significantly better than that of infants more than 6 months of age. Most of them used the family- food as weaning food. 28
Osuhor PC had prepared a standardized questionnaire and administered to 65
mothers attending the Nutrition Clinic of the Ahmadu Bellow University Teaching Hospital, Kaduna, Northern Nigeria, over the October-December 1978 period to determine at what age the 1st supplementary diet was introduced, the age the child was weaned, and the weaning practices. The questionnaire dealt with various aspects of weaning knowledge, attitudes, and practices. The mothers were referred to the Nutrition Clinic because their babies already were suffering from protein energy malnutrition, had failed to thrive, or had severe infections, e.g., measles, gastroenteritis, or respiratory diseases. 58 of the families were of low socioeconomic status. 36 mothers introduced supplementary feeds when their ch8ildren were between 7-9 months. All the mothers used corn, or millet gruel. A decision to wean a child may be made if the child can crawl, walk, or has a good set of erupted milk teeth, even if the child has not reached the traditional weaning age of 20-24 months. The mean age of weaning was 17 months in this study. 78.5 percentage of the mothers responded to the question about weaning food taboos, prohibitions, and their reasons during the weaning period. Even when protein is available, a child may be denied the protein because of socioeconomic factors. The use of carbohydrate gruels among these low socioeconomic facilities coupled with sociocultural factors compounded the feeding problem, and, consequently, protein energy malnutrition was common during the weaning period.29
25
Puri RK, Sachdeva R had done a study on supplementary foods suited for
weaning and feeding of infants were developed, using locally available foods in Punjab.
Methods of cooking employed were those used commonly by low and
middle-income families, Cereal –pulse combinations along with some sesame seed and groundnuts were used to enhance the protein quality. The ratio used was such that the preparation did not deviate much from the accepted tastes of the population., Fresh green vegetables were also used. Fifteen recipes were standardized and acceptability trials carried out with mothers and infants or the different socioeconomic groups. The preparations were highly accepted by all. Analysis of these were done for protein, calories, vitamin C and iron to see their contribution to the diet. The cost per serving a very low cost a substantial amount of the above nutrients could be given to in making these recipes will go a long way towards popularizing such formulations.30
Jansen AA had done a study to assess Mild protein- calorie malnutrition in
Western Samoa. Severe protein-caloric malnutrition is also an important cause of death in infants and toddlers and anaemia in frequently found in small children. Data on infant and toddler feeding practices were collected from 90 mothers from the town of Apia and 38 mothers from island in Sava. Most belonged to the low income group. In Apia, weaning foods consisted of milk, meat, and other protein- rich foods; in Sava, taro, orange leaf tea and rice, were the main weaning foods. Generally, semisolids were nor introduced before the child was more than 6 months of age. Some mothers in Sava appeared to give their children monotonous diet. A number of cultural taboos appear to affect the children’s diet as well as that of pregnant and lactating mothers.31
26
Malla S and Shrestha SM conducted a study on Complementary Feeding
Practices and its Impact on nutritional status of under two old children in urban areas of the Kathmandu, Nepal. Magnitude of the malnutrition was very high in Nepal. Child nutrition problem due to faulty child feeding practice was widely observed in many parts of the country including Kathmandu valley. Complementary feeding practice among the young children has been found very critical in urban areas of Kathmandu valley. The study was based on primary data collected by applying the 30 cluster sampling method. Target population of the study were young children aged 024 months. A set of questionnaire was used to interview mothers of 150 households. Finding of the study indicated that about 92 percent households were found practicing Traditional Complementary Feeding Practices and 8 percent households were found
practicing
Commercial
Complementary
Feeding
Practices.
Traditional
complementary foods given to the children were found lacking in macronutrient carbohydrate and protein severely, therefore, not fulfilling the nutritional requirement of the children. Among traditional complementary food fed children, 63 percent of children were found suffering from mild to severe form of malnutrition where as among commercial food fed, only 41 percent of children were found suffering from such form of malnutrition. About 33 percent of the children suffering from severe malnutrition, parents were employed. Nutritional status of children from Kathmandu district found better compared to young children from other district. Children from Lalitpur district were found more severely malnourished. Surprisingly baby boys found more severely malnourished compared to baby girls. Traditional foods fed children were found more severely malnourished compared to commercial complementary food fed.32
27
Heath AL, Tuttle CR, Simons MS, Cleghorn CL, Parnell WR undertook a
study regarding breastfeeding and weaning practices during the first year of life in Dunedin, New Zealand. To investigate infant feeding practices during the first year of life in a group of white infants in Dunedin, New Zealand. Statistical analyses Regression analyses were performed to determine factors associated with successful breastfeeding initiation and duration. Among mothers, 88 percent initiated breast feeding, 42 percent were exclusively breastfed till 3 months, and 34 percent were partially breastfed till 12 months. Intention to breast feed increased the likelihood of successful breastfeeding initiation. Mothers who reported that they did not have enough breast milk tended to exclusively breastfeed for a shorter period of time. Tertiary education and exclusively breastfeeding at 1 month were associated with a longer duration of breastfeeding. Perception of breastfeeding in public as embarrassing was associated with a shorter duration of breastfeeding. Among infants, 45 percent were given non milk foods before 4 months of age, and 69 percent were given unmodified cow's milk as a beverage before 12 months. 33
Hussain AM, Rariquzzaman M had undertaken a study to determine the
weaning age in rural Bangladesh. Weaning beliefs and practices in two representative rural villages in Bangladesh by interviews with 180 mothers with infants between 1 and 12 months of age. Maternal parity and family size were not found to be related to weaning age. Family income and maternal education were consistently related to appropriate weaning. Bi-variate controlled analysis showed that a mismatch between mothers' responses and actual weaning behaviour toward infants 4-6 months old could be attributed to family poverty. 34
28
Moussa WA, Tadros MD, Mekhael KG, Darwish AE, Shakir AR
undertook a study on some simple methods of home processing and their implication with weaning foods. One of the most practical solutions to combat Protein Energy Malnutrition in low income groups is the intelligent mixing of cereals and legume make available low cost weaning food of high nutritional quality. One of the main obstacles to increase energy and-nutrient density of weaning foods of cereals and legumes is the bulk factor. In this study some simple methods of home processing to improve the nutritional quality of the home prepared weaning foods were tested and the processed weaning foods were chemically and biologically evaluated. Biochemical evaluation revealed that the germination of wheat raised its protein and fat and reduced carbohydrate, while there was almost no change on lentils. Comparing germination with a special chapati process, protein and fat content were higher in the formula processed by the former method, while minerals were higher in the same formula but processed by the latter method. Although further research is needed, germination of ingredients of weaning foods of vegetable origin seems to be a good option of the simple home processing technique.35
4. Literature related to maternal nutritional knowledge and child nutritional status Sharma S, Nagar S did a study to determine the impact of educational intervention
on knowledge of mothers regarding childcare and nutrition in Himachal Pradesh. The study aimed at providing educational interventions to mothers regarding knowledge on children and nutrition. A total sample of 150 mothers were selected from two villages, one of which served as experimental group and the other acted as control group. The tool consisted of a self structured questionnaire schedule covering aspects of childcare and nutrition. All mothers were first pre tested regarding their knowledge
29
on nursing, neonatal and infant care, health, child’s growth, behaviour and nutritional aspects. Intervention consisted of educating mothers in the experimental group for a period of one and a half years. All the mothers were then post-tested on the above aspects. Significant differences were seen in all the aspects of childcare and nutrition between experimental and control group mothers during post-testing. 14
Appoh LY, Krekling S undertook a study on Maternal nutritional knowledge
and child nutritional status in the Volta region of Ghana. The data was collected in Ghana on 55 well nourished and 55 malnourished mother-child pairs. Data on mother's demographic and socio-economic characteristics as well as child anthropometric data were also collected. Bi-variate analysis gave significant associations between child nutritional status and the following variables: time of initiating of breastfeeding, mother's knowledge of importance of colostrum and whether colostrum was given to child, age of introduction of supplementary food, and mother's knowledge about causes of kwashiorkor. Maternal formal education, and marital status were also found to be associated with child nutritional status in bivariate analyses. Further analysis with Logistic regression revealed that maternal nutrition knowledge was independently associated with nutritional status after the effects of other significant variables were controlled for. Maternal education on the other hand was not found to be independently associated with nutritional status. These results imply that mother's practical knowledge about nutrition may be more important than formal maternal education for child nutrition outcome. 36
Tada Y, Keiwkarnka B, Pancharuniti N, Chamroonsawasdi K had
conducted a study on Nutritional status of the preschool children of the Klong Toey
30
Slum, Thailand. Cross-sectional study to examine the nutritional status of children aged 1-5 years who live in the Klong Toey slum, Bangkok; the factors related to nutritional status were also determined. Anthropometric measurements were made for 232 children; socioeconomic background information was obtained by interviewing their mothers using a structured questionnaire. The prevalence of malnutrition among the study sample was 25.4 percent by weight for age, 18.1 percent by height for age, and 6.9percent by weight for height; the prevalence among pre-school children in Thailand and in the Bangkok metropolitan area by weight-for-age was reported to be 8.73 percent and 5.25 percent respectively. Multiple logistic regression analysis was used to identify the association with the nutritional status of children by height-forage. The results showed that family income, maternal housewifery or unemployment, food practice, and a maternal educational level lower than primary school were associated with the nutritional status of children. This finding implies that although malnutrition is no longer considered to be a major health problem in Thailand, it remains a threat to the health of the urban poor in Bangkok. This finding should not be overlooked and countermeasures are indicated. 37
Waihenya EW, Kogi-Makau W, Muita JW conducted a study on Maternal
nutritional knowledge and the nutritional status of preschool children in a Nairobi slum. Nutritional status of 363 children aged six to 24 months was measured and nutritional knowledge of their mothers assessed. Makina village was randomly selected as the study site and all consenting households were involved in the study. The study established that most mothers (97.5 percent) have access to nutrition education. Prevalence of stunting (86.2 percent) and underweight (58.4 percent) was high but that of wasting (1.9 percent) was low. There was no significant relationship between the nutritional status of children and overall nutritional knowledge.
31
Unexpectedly, a negative relationship was found between nutritional status and mothers' ability to recognize clinical signs of malnutrition, knowledge in the weaning process and dietary management during sickness. Knowledge on frequency of feeding was, however, positively related to nutritional states. In conclusion, nutritional knowledge alone is inadequate in ensuring young children's nutrition security and, hence, for nutritional education programmes to have a positive impact, facilitation strategies must be incorporated.38
Chit TM, Kyi H, Thwin A had done a study on Mothers' beliefs and attitudes
towards child weight, child feeding and related practices in Myanmar. They identified mother's attitude and concern regarding child weight and feeding practices and also to explore the importance of growth monitoring activity in preventing Protein Energy Malnutrition. Trained interviewers from the respective State/Division nutrition team interviewed ninety mothers from different areas and Divisions. Mothers were categorized into three groups of thirty; those with a well-nourished child, a malnourished child or a child who had died of infectious disease. 90 percent of well-nourished children were weighed at birth and 100 percent of them had received regular weighing. 89 percent of their mothers could identify their child birth weight as normal and all of them know the negative health consequences of Low Birth Weight. Regarding attitude towards feeding during illness, most mothers of a well-nourished child believe that feeding during illness is better for recovery. That proportion is high as twice as of the remaining groups. Data regarding child feeding practices show mothers of a well nourished child have timely and appropriate starting of these practices. It is inferred from the recent finding that mothers who had received growth monitoring program since delivery have better preventive behaviour for PEM and the role of basic health staff in these activity is also acknowledged.39
32
Das DK, Ahmed S had conducted a study on knowledge and attitude of the
Bangladeshi rural mothers regarding breast feeding and weaning. Two hundred and forty two mothers in 7 villages of Narayanganj district, Bangladesh were interviewed to assess their knowledge and attitude regarding breastfeeding and weaning using pretested questionnaires, though 83.5 percent mothers knew that colostrums is good for the child, less than 8 percent of them gave it as the first food to their babies. Most mothers did not have the correct knowledge about exclusive breastfeeding and the appropriate time for introduction of weaning foods; and only 3 percent of them knew how to prepare proper weaning foods.40
Pant I, Chothia K had undertaken a study to assess maternal knowledge
regarding breast feeding and weaning practices. The knowledge of mothers of the high income group of urban Baroda, related to breast feeding and weaning. Forty mothers with children aged 4 to 18 months were studied. Knowledge and practices regarding breast feeding and weaning were assessed using pre-tested questionnaires. Results indicated that only half the mothers breast fed their babies on the first day. Breast feeding was stopped when the child was 3-6 months; top feeding and solid supplements were initiated at 4-6 months. Mainly commercial baby foods were used for weaning. Most mothers avoided 'dals' for the child because these were believed to be difficult to digest and produced gas in the child's stomach. Fifty percent of mothers were not in favour of feeding the sick child with small frequent meals. 41
Bhat lA, Shah GN, Dhar GM, Mehnaz S conducted a study on the impact of
maternal knowledge and practice on the nutritional status of infants. They interviewed 123 mothers of infants attending the child health clinic of the S.K. Institute of Medical Sciences in Srinagar to determine whether maternal knowledge and practice were
33
associated with the nutritional status of the infants. 28 children were considered to be well nourished, while the remaining 95 children were determined to be in various degrees of malnutrition. Mothers whose infants were well nourished had a higher level of breast feeding knowledge than did those whose infants were moderate to severely malnourished. None of the mothers of malnourished infants had an excellent score on breast feeding practices. Little difference in infant nutritional status existed between mothers who scored fair and those who scored poor, but among mothers of well nourished infants, those who scored well were more likely to have infants of good nutritional status than those who did not score well. These findings show a decreasing trend between awareness and practice of breast feeding/infant weaning; suggesting that further improvement of health education is needed to reduce the lag between breast feeding awareness and practice.42
Bekle A, Berhane Y conducted a study on weaning in Butajira, South Ethopia
regarding mothers’ knowledge and practices. A descriptive cross sectional study on mothers' knowledge and practice related to weaning was conducted in Butajira in 1994. A total of 1,543 mother-child pair were included in the study, of which 1.052 children were on weaning diet and 491 were exclusively breast feeding. Among children who were already weaned, 40 percent were reported to have been started on weaning food at the age of 4-6 months. Of the children who were reported to be exclusively breast feeding, 34 percent were beyond the age of 7 months. The most commonly used weaning food were cow's milk, adult food, sorghum water and cereal gruel in descending order and the most important reasons for mothers to start weaning were reduction of the amount of breast milk and mothers' belief that the child is at the right age to start weaning food. The majority of the mothers used "swallow or
34
suffocate" method in feeding their children, though cups and bottles were also mentioned as important feeding methods. The study demonstrated the presence of inappropriate weaning practice in the area which needs appropriate intervention. 43
35
4. METHODOLOGY
Research methodology is a way to solve systematically the research problem. The methodology enables the researcher to project a blue print of the details, data, approach, analysis and findings of research undertaken. The methodology of research indicates the general pattern of an organized procedure for gathering valid and reliable data for the purpose of investigations.
This chapter includes the description of research approach, research design, variable setting, population, sample and sample size, sampling techniques, sampling criteria, development of tool, description of the tool, pilot study, data collection procedure, plan of data analysis.
This study was done to assess the correlation
between the feeding practices of mothers and nutritional status of their children in a selected area Bangalore.
Research approach
A research approach tells the researcher what data to collect and how to analyze it. It also suggests possible conclusions to be drawn from the data. In view of the nature of the problem selected for the study and objectives to be accomplished, a descriptive survey approach was considered as appropriate for the present study.
Research Design
A research design is a blueprint for conducting a study that maximizes control over factors that could interfere with the validity of the findings. It is the plan and structure and strategy of investigation of answering the research question. It helps the
36
researcher in defining the attribute, selection of population and type of statistical analysis to interpret the data.
The investigative design selected for this study is descriptive correlative design. The purpose of a descriptive co-relational design is to describe variables and examine relationships among these variables.
37
SELECTED AREA - RURAL
PURPOSE • •
To find out the correlation between the feeding practices of mother and nutritional status of their children. To find out the association between feeding practices of mothers and selected demo ra hic variables.
RESEARCH DESIGN Descriptive correlative design
SAMPLING TECHNIQUE :
SAMPLES Mothers between 15 – 45 years of age and children between 6 months to 3 years of age
Simple Random sampling
DATA COLLECTION INSTRUMENT Interview and anthropometric assessment after validation
• • •
DATA ANALYSIS Descriptive analysis Inferential analysis Inter retation of results
FINDINGS AND CONCLUSION Fig 2:SCHEMATIC REPRESENTATION OF THE RESEARCH DESIGN
38
Setting of the Study
Research setting is the specific place where data collection occurs. The selection of setting was done on the basis of feasibility of conducting the study, availability of the subject and co-operation from the authorities. The study was conducted at Doddabasthi and Chikkabasthi villages under K. Gollahalli PHC.
Variables
Burns and Grove explained that research variables or concepts are the qualities, properties or characteristics identified in the research purpose and objectives or questions that are observed or measured in a study. In the present study research variables are: • •
Feeding practices – breast feeding, weaning and family diet. Nutritional status – Anthropometry measurements
Demographic variables of mothers include • • •
Age Education No of under five children
•
Occupation,
•
Duration of married life
•
Family income and type of family.
Demographic variables of children •
Age
•
Gender
•
Birth weight
39
Population
The term population refers to the target population which represents the entire set of individuals who meet the sampling criteria.
The total number of the houses in Chikkabasti - 275 and female population 805 and in Doddabasti, total houses 96 and female population only 230. The sample is selected randomly. The target population for the present study comprises of all the mother of reproductive age group and having children between 6 months to 3 years of age and the same children residing at Chikkabasthi, Doddabasti Villages.
Sample
Sample refers to the subject of a population that is selected to participate in a particular study.44 It is the portion of the population which represents the entire population. In the present study samples consist of 100 mothers of reproductive age group and 100 children of same mothers at Chikkabasthi and Doddabasthi, Bangalore.
Sampling Technique
Sampling theory point of view each individual in the population should have an opportunity to be selected for the sample. One method of providing this opportunity is referred to as random sampling. Hence, simple random sampling technique was found to be apt for the study.
Sampling Criteria Inclusion criteria
1. Mothers of children who were willing to participate in the study. 2. Both male and female children.
40
Exclusion Criteria
1. Mothers who have physically and mentally challenged children. 2. Mothers who did not have the children along with them at the time of data collection.
Instrument
The information necessary for the study was obtained by the investigator. Treece and Treece explained that the instrument selected in the research should be as far as possible the vehicle that would provide data for drawing conclusions to the study and the same time add to the body of knowledge in the discipline. 45 The instrument used for the present study is structured interview schedule.
Development of the Instrument
Instrument was developed based on 1. Review of literature 2. Consultation with guides 3. Subject experts in paediatrics and investigators 4. Consultation with statistician for data analysis 5. Spearman Brown’s formula was used for reliability.
Preparation of the blue print
A blue print was prepared prior to the construction of the questionnaire based on which the items were developed. It depicted the distribution of items according to the content areas. (Annexure H)
41
Description of the Tool
The instrument used in this study was structured interview schedule which comprises of 3 sections.
Section I Demographic Data
The first part of the tool consists of 14 items of which first 9 are related to mothers background such as age, number of children, religion, education, occupation, duration of married life, family income, type of family, source of information regarding feeding practices and next five items are related to child’s age, gender, birth weight, birth order and presence of other problem.
Section II
Check list consist of 30 items to assess the feeding practices of mothers i.e. breast feeding, weaning and family diet. Total score is 30.
Section III
Anthropometry Maximum Score – 30 Minimum Score – 0 Each correct item was given 1 score and wrong item was given 0 score
Content Validity
Validity refer to the degree to which an instrument measures what it is supposed to measure. Content validity refers to the degree to which the items in an instrument adequately represent the universe of content.
42
The prepared instrument along with the objectives, operational definitions, blueprint, scoring key and criteria checklist for validation were submitted to 7 experts which included 5 nurse educators, 1 paediatrician and 1 statistician to establish content validity.
Reliability of the tool
Reliability of an instrument is the degree of consistency with which it measures the attributes that it is supposed to measure. It refers to the extent to which the same results are obtained on repeated administration of the instrument.
In order to establish the reliability of the tool, split half technique was used. The tool was administered to 10 subjects and the reliability was tested by using Spearman Brown’s prophecy formula.
Reliability of the tool was 0.9340 so the tool was found to be highly reliable for data collection.
Pilot Study
Pilot study is a trial run study conducted before the actual study in a different population with similar characteristics. Pilot study was conducted on 10 subjects in Maruthinagar under K. Gollahalli, PHC, Bangalore from 7 th August to 13 th August. The permission to conduct pilot study was obtained from the Medical Officer K. Gollahalli PHC. Subjects were chosen by random sampling technique. The purpose of the study was explained and informed consent was obtained from the samples. The analysis was done by using descriptive and inferential statistics.
43
Data Collection Process
The data collection was from 3 rd September to 3rd October 2007. Permission was obtained from the Medical Officer, Primary Health centre, K. Gollahalli. The investigator administered the tool to 100 mothers who were selected by using random sampling technique after introducing and explaining the purpose of the study. Then anthropometric measurements of their children were taken and recorded.
However, there few difficulties arose during the data collection period. Some houses mothers had gone for work leaving their children with relatives. In certain house mothers were there but children were with grand parents or gone to Anganawadi. So the investigator had to exclude those families and go to the next and get the 100 samples.
Plan for data analysis
Data was collected from 100 mothers and their children (100) from Chikkabasthi – Doddabasthi, K.Gollahalli. The collected data was conveniently summarized and tabulated by applying descriptive statistics such as mean, percentage, and standard deviation.
Diagrams were used for depicting the authentic nature of at the data collected on demographic variables and the practice aspects. Association between the selected demographic variables and feeding practices will be analyzed by using χ 2 and presented through diagrams and tables. Correlation for the present study was computed by using Spearman’s Rank Correlation.
44
5. RESULTS
This chapter deals with the analysis and interpretation of the data gathered to correlate the feeding practices of mothers and nutritional status of their children.
Ordinarily the amount of data collected in a study is too extensive to be reliably described by mere pursuit. In order to answer meaningfully the research questions, the data must be processed and analyzed systematically and testing of research hypothesis using those data. 46
Objectives
1. To assess the feeding practices of mothers. 2. To assess the nutritional status of children. 3. To find out the correlation between the feeding practices of mothers and the nutritional status of their children. 4. To find out the association between feeding practices and selected variables of mothers and their children.
Organization and presentation of data
The obtained data were organized and presented under the following sections. Section I
Describes the frequency distribution and percentage of demographic variables of mothers and their children.
Section II
In this section mean and standard deviation of feeding practices are described.
45
Section III
Area wise classification of respondents on feeding practices is analyzed.
Section IV
Correlation between feeding practices of mothers and selected nutritional parameters of their children.
Section V
Association between feeding practices and demographic variables of mothers
Section VI
Association between feeding practices and selected variables of children.
46
SECTION- I
Frequency distribution and percentage of demographic variables of mothers and their children.
80 72% 70 60 s t n e 50 d n o p 40 s e r f o o 30 N
20
17% 11%
10 0 <20
21-30
31-40
Age in years
Fig.3 : Frequency and percentage distribution of the mothers by age
Among 100 mothers 17 percent were below 20 years of age, 72 percent were between 21 to 30 years, and 11 percent were between 31 to 40 years of age. (Fig.3)
47
62% 70 60
s t n e 50 d n o p 40 s e R f o 30 r e b m 20 u N
33%
5%
10 0 Hindu
Muslim
Christian
Religion
Fig.4 Frequency and percentage distribution of mothers by religion
Among 100 mothers 33 percent were Hindus, 62 percent were Muslims and 5 percent were Christians. (Fig.4)
48
Extended 7%
Joint 36%
Nuclear 57%
Type of Family
Fig.5: Frequency and percentage distribution of respondents according to type of family
Out of hundred mothers 57 percent had nuclear families, 36 percent had joint families and 7 percent had extended families (Fig.5.)
49
40% 40 35
s t n e 30 d n o 25 p s e R 20 f o r 15 e b m 10 u N
24%
13% 8%
10%
5%
5 0 Illiterate
Primary
Middle school
Sec ondar y
PUC
Gr aduate
Educational Level
Fig.6: Frequency and percentage distribution of mothers according to their educational status.
Among 100 mothers 5 percent were illiterate, 13 percent had primary education, 24 percent had middle school education, 40 percent had high school education, 8 percent had P.U.C and 10 percent were graduates (Fig.6.)
50
7% 11%
82%
Govt. employee Private employee House wife Fig.7: Frequency and percentage distribution of mothers by occupation.
Among 100 mothers 82 percent were housewives, 11 percent were private employees and 7 percent were government employees. (Fig.7.)
51
90 80
79%
s t 70 n e d n 60 o p s 50 e R f 40 o r e b 30 m u N 20
12%
9%
10 0 <5000
5001-10,000
>10,000
Family Income Fig.8: Frequency and percentage distribution of mothers by family income
Among 100 mothers 79 percent had family income below Rs.5,000, 12 percent had family income between 5,001 to 10,000 and 9 percent had above Rs.10,000.
52
50% 50 45
36%
s t n 40 e d 35 n o p 30 s e R 25 f o 20 r e b 15 m u 10 N
14%
5 0 1-4
5-9
10-13
Duration of Married life in Years
Fig 9 : Frequency and percentage distribution of mothers by duration of married life
After 100 mothers 36 percent had duration of married life between 1-4years, 50percent had married life between 5-9 years and 14 percent had married life between 10-13 years. (Fig.9)
53
60% 40% 60 s t 50 n e d n 40 o p s e 30 R f o r 20 e b m u 10 N
0 1
2
No. of under fiv e children
Fig 10 : Frequency and percentage distribution of no of under five children
Among 100 mothers 60 percent had only one childe below five years and 40 percent had 2 children below 5 years of age. (Fig 10)
54
43%
44%
45 40
s t n 35 e d n 30 o p s 25 e R f 20 o r e 15 b m 10 u N
13%
5 0
Family Radio/TV members/relatives/friends
Books/Journals
Sources of Information
Fig.11 : Frequency and percentage distribution of respondents by source of information
Among 100 mothers 43 percent had family members / relatives / friends as source of information, 44 percent had radio / T.V and 13 percent had books / journals as source of information (Fig.9)
55
48% 50 45
34%
n 40 e r 35 d l i h 30 c f o 25 r e 20 b m 15 u N 10
18%
5 0 1
2
>2
Birth order of children
Fig.12: Frequency and percentage distribution of birth order of children
Among 100 children 34 percent were first born, 48 percent were second in birth order and 18 percent were above two in birth order. (Fig.12)
56
46% 50 45
37%
s t n 40 e d 35 n o p 30 s e R 25 f o 20 r e b 15 m u 10 N
15%
2%
5 0 <1
1-2
2-3
>3
Age of Children
Fig.13: Frequency and percentage distribution of children by age.
Among 100 children 15 percent were below 1 year, 37 percent were between 1 to two years and 48 percent were between 2 to 3 years of age. (Fig.13)
57
Male 48% Female 52%
Gender of Children
Fig.14: Frequency and percentage distribution of children by gender.
Among 100 children 52 percent were females and 48 percent were males.
58
SECTION II
TABLE 1
Area wise analysis of mean and standard deviation of feeding practices of mothers
n =100 Sl. No 1
Area wise analysis
Max. score
Range
Mean
SD
Mean %
Breast feed
9
5-9
6.98
0.84
77.56
2
Weaning
10
4-10
7.11
1.08
71.10
3
Family diet
11
1-11
5.28
1.96
48.00
30
13-15
19.37
2.51
64.57
Total
The total score 30. The total mean feeding practices was 19.37 with a standard deviation of 2.51 while total mean percentage was 64.57. (Table 1).
59
SECTION III
TABLE 2
Area wise classification of respondents on feeding practices
n = 100
Sl. No
Area wise
Not satisfactory (<50%) No. of subjects
Percent
Moderately Satisfactory (51-75%) No. of Percent subjects
Satisfactory (>75%) No. of subjects
Percent
1
Breast feed
-
-
22
22
78
78
2
Weaning
5
5
59
59
36
36
3
Family diet
66
66
26
26
8
8
5
5
81
81
14
14
Total
As per breast feeding practices, none of them were under the classification of not satisfactory, 22 percent had moderately satisfactory feeding practices and 78 percent had satisfactory feeding practices with regard to weaning, 5 percent had not satisfactory feeding practices, 59 percent had moderately satisfactory feeding practices and 36 percent had satisfactory feeding practices. As per family diet; 66 percent had not satisfactory feeding practices, 26 percent had moderately satisfactory and 8 percent had satisfactory feeding practices. (Table 2)
60
SECTION IV
TABLE 3
Correlation between feeding practice of mothers and selected nutritional parameters of their children
n = 100 Spearman's correlation between the scores of feeding practices and selected nutritional parameters of children
Sl. No
Spearman's correlation value
1
Present weight (kgs)
0.161
2
Height
0.122
3
Mid arm circumference
0.074
4
Chest Circumference
0.086
Spearman’s correlation between scores of feeding practices and selected nutritional parameters of their children revealed that higher the knowledge level of respondents on feeding practices, better is the outcome of nutritional parameters. That is, there exist a positive relationship between feeding practices and present weight (r=0.161),
height
(r=0.122),
mid
arm
circumference
circumference (r=0.086) of the sample study group. (Table 3).
61
(r=0.074)
and
chest
SECTION V TABLE 4 Association between feeding practices and selected variables of children
n = 100
Variable Age (yrs) ▪ Religion▪ Type of Family▪ Education▪ Occupation▪ Income▪ Duration of Married life No. of Under Five Children
Category Mean >Mean Muslim Hindu and Christian Nuclear Joint/Extended Below middle school Secondary school Above PUC House wife Govt./Private employee ≤ Mean >Mode 1-4 5-9 10-13 1 ≤
2
Feeding practices Chiscore df square ≤Median >Median 40 20 0.463 1 24 16 46 16 7.358* 1 18 20 34 23 1.089 1 30 13 33 9 24 16 9.075* 2 7 11 58 24 8.96* 1 6 12 54 25 3.096 1 10 11 25 11 0.836 2 31 19 8 6 34 26 3.501 1 30 10
1 Birth Order 2 >2 Family Source of member/relatives/friends information▪ Radio/TV/Media
22 30 12
12 18 6
28
15
36
21
Table value 3.841 3.841 3.841 5.99 3.841 3.841 5.99
3.841
0.11
2
5.99
0.041
1
3.841
The expected frequencies in these variables were < 5, and hence, the some of the categories were merged and accordingly the degrees of freedom are adjusted. ▪
* Significance at p<0.05 level. Chi-square established at 0.05 level of significance denotes that the association between feeding practices and demographic variables such as religion,
62
education and occupation were statistically significant. However the Chi-square value established at 0.05 level of significance denotes that the association between feeding practices and demographic variables like age, type of family, income, duration of married life, number of under five children, birth order and source of information were not statistically significant. (Table 4).
63
TABLE 5 Association between feeding practices and selected variables of children
n = 100
Anthropometric variables Birth Weight (kgs) Present weight (kgs) Height (cms) Mid arm circumference (cms) Chest Circumference (cms) Age of Child (months) Gender
Total feeding practices score
ChiCategory square value ≤Median >Median Mean
28
20
>Mean
36
16
Mean
34
16
>Mean
30
20
Mean
52
26
>Mean
12
10
Mean
31
12
>Mean
33
24
Mean
40
18
>Mean
24
18
Mean
32
14
>Mean
32
22
Male
34
14
Female
30
22
≤
≤
≤
≤
≤
≤
df
Table value
1.287
1
3.841
0.694
1
3.841
1.094
1
3.841
2.145
1
3.841
1.487
1
3.841
1.145
1
3.841
1.871
1
3.841
No significant association was found between feeding practices and anthropometric variables of children like birth weight, present weight, height, mid arm circumference, chest circumference, age of the child and gender at P<0.05 level. (Table.5)
64
6. DISCUSSION The present study was aimed to correlate the feeding practices of mothers and nutritional status of their children. The correlation was done by making association between the demographic variables and feeding practices and correlation coefficient between feeding practices and parameters.
The study was conducted in Chikkabasthi and Doddhabasthi among reproductive age group of mothers who have children between the age of 6 months and 3 years.
A structured interview schedule was used to assess the feeding practices among mothers. The research design adopted for the study was descriptive correlative design. Random sampling technique was used to select 100 mothers and t heir children between the age group of 6 months to 3 years from rural communities.
Main findings of the study were discussed under the following sections. Section – 1 Findings related to the demographic characteristics of respondents
Among 100 mothers, 17 percent of them were below 20 years of age, 72 percent of them were between 21 – 30 years and 11 percent were between 31 – 40 years of age. 3 percent among the total respondents were Hindus, 62 percent of them were Muslims and 5 percent of them were Christians. 57 percent of them belonged to nuclear families, 36 percent of them lived in joint families and 7 percent of them lived in extended families. Education wise, only 5 of them were illiterate, 13 percent had primary education, 24 had middle school education, 40 percent had high school
65
education, 8 percent were educated upto PUC and 10 percent of them were graduates. Occupation wise, 82 percent of them were housewives, 11 percent of them were private employees and 7 percent were government employees. Family income wise, 79 percent of them had an income of below Rs. 5000, 12 percent of them had an income between Rs.5001 and Rs.10000 and 9 percent of them had a family income of above Rs. 10000. Among the total mother respondents 36 percent had a duration of 1 – 4 years of married life, 50 percent had a duration of 5 – 9 years of married life and 14 percent had a duration of 10 – 13 years of married life.
Among the 100 subjects, 60 percent had only 1 child below 5 years and 40 percent of them had 2 children below 5 years of age.43 percent of the respondents attributed family members/ relatives/ friends as the source of information on feeding practices, 4 percent attributed the same to radios/ television and 13 percent of them attributed it to books and journals. Among 100 children 34 percent were first born, 48 percent were 2 nd in birth order and 18 percent of them held an ordinal position of >2. 15 percent of the children were below 1 year, 37 percent were between 1 – 2 years of age and 48 percent were 2 to 3 years of age. Among the total children subjects 52 percent of them were females and 48 percent of them were males.
The first objective was to assess the feeding practices of mothers
Breast feeding aspect maximum score was 9 and response on feeding practice mean 6.98, mean percentage 77.56 and SD 0.84. Weaning aspect maximum score 10 and response on feeding practice mean 7.11, mean percentage 71.10 and SD 1.08. Family diet – maximum score 11, mean 5.28, mean percentage 48.00 and SD 1.96.
66
The second objective was to assess the nutritional status of children
As per breast feeding practices, none of them were under the classification of not satisfactory, 22 percent had moderately satisfactory feeding practices and 78 percent had satisfactory feeding practices with regard to weaning, 5 percent had not satisfactory feeding practices, 59 percent had moderately satisfactory feeding practices and 36 percent had satisfactory feeding practices. As per family diet; 66 percent had not satisfactory feeding practices, 26 percent had moderately satisfactory and 8 percent had satisfactory feeding practices.
The third objective was to find out correlation between the feeding practices of
mothers and the nutritional status of their children. Spearman’s correlation between scores of feeding practices and selected nutritional parameters of their children revealed that higher the knowledge level of respondents on feeding practices, better is the outcome of nutritional parameters. That is, there exist a positive relationship between feeding practices and present weight (r=0.161), height (r=0.122), mid arm circumference (r=0.074) and chest circumference (r=0.086) of the sample study group.
The fourth objective was to find out the association between feeding practices of mothers and their children with selected variables.
Chi-square established at 0.05 level of significance denotes that there is statistically significant association between feeding practices and demographic variables of mothers such as religion, education and occupation. The remaining variables are found non-significant.
67
No significant association was found between feeding practices and anthropometric variables of children like age, gender, birth weight, present weight, height, mid arm circumference and chest circumference at p<0.05 level.
Testing of hypothesis
H1: There is correlation between feeding practices of mothers and nutritional status of their children.
Since there exist a positive relationship between feeding practices and present weight (r=0.161), height (r=0.122), mid arm circumference (r=0.074) and chest circumference (r=0.086), the researcher concluded that there is positive correlation between feeding practices of mothers and nutritional parameters of their children. Hence the score is positive the hypothesis is accepted.
68
7. CONCULSION The present study was aimed to correlate the feeding practices of mothers and nutritional status of their children. The correlation was done by making association between the demographic variables and feeding practices and correlation coefficient between feeding practices and parameters.
The study was conducted in Chikkabasthi and Doddhabasthi among reproductive age group of mothers who have children between the age of 6 months and 3 years.
A structured interview schedule was used to assess the feeding practices among mothers. The research design adopted for the study was descriptive correlative design. Random sampling technique was used to select 100 mothers and t heir children between the age group of 6 months to 3 years from rural communities.
The following conclusions are made from the study •
The participants included in the study were between the age group of 18 – 40 years.
•
There is non significant association between age of the mothers and feeding practices.
•
As per educators 5 percent illiterate, 8 percent PUC, 10 percent graduates and 13 percent primary school, 24 percent middleclass school and 40 percent high school.
•
There was significant association between education and feeding practice.
•
With regard to under five children most of them had only one child and others 2.
•
But there was not significant association between no of under five children and feeding practices.
69
•
Occupation wise most of them were housewives 82 percent, 7 percent government employees and 11 percent private employees respectively.
•
There was significant association between occupation and feeding practices.
•
As per family income, most of them had below Rs.5000, 12 percent had between 5,001 to 10,000 and 9 percent had above Rs.10,000 as family income.
•
With regard to duration of married life – up to 1 to 4 years 36 percent, 5-9 years 50 percent above 10 years 13 years 14 percent were there. But there was no association between duration of married life and feeding practice of mothers.
•
As per source of information TV / radio was used by 44 percent, family members / relatives 43 percent and book/journal was used by 13 percent.
•
Correlation between feeding practices and nutrition parameter; present weight r = 0.161, height r = 0.122, mid arm circumference r = 0.074 and chest circumference r = 0.086 were positively correlated. So findings of the study reveal that there is a positive correlation between
feeding practices of mothers and nutritional status of their children’s parameters.
Implications of the study
The findings of the study have implications in various fields of nursing. They are: •
Nursing education
•
Nursing practices
•
Nursing administration
•
Nursing research
70
Nursing Education
Nursing education emphasizes on preparing dedicated nurse to impart health education both in community settings and clinical areas by using various methods of educational technology to improve the feeding practices.
Nursing Practice “When love and skill work together expect a master piece”. – John Ruskin
Nurse plays an important role in the feeding of children. It starts even before a mother is pregnant. Through health education demonstration of preparation of feed and feeding, nurse can help to improve the feeding practices of mothers wherever it is needed. Not only during infancy, but also till adolescence this teaching has to be continued. Planned health teaching programme can be made ongoing process both in clinical setting as well as in community setting is mandatory.
Nursing Administration
Nursing administration should have proper vision vision and mission mission while making and implementing the policy with regard to health care of the children. Since children are the dependable and vulnerable population, mothers should be taken into consideration for the improvement of children’s nutritional status.
Nursing Research
We can bring about a tremendous improvement in the health status of children through research. Though the present correlative study is like a drop in an ocean, can prepare the path for future quantitative and qualitative research to improve the feeding practices of mothers to establish establish a better nutritional status for their children.
71
Limitations •
Only certain parameters were used to assess the nutritional status of children.
•
Interview technique does not collect the accurate data regard to feeding practices.
•
The tool used by the investigator needs a broad and comprehensive validation.
Recommendations •
Study can be replicated in different community setting
•
Structured teaching program can be arranged for mother as part of experimental study to improve their feeding techniques.
•
A comparative study can be conducted between rural and urban settings.
72
8. SUMMARY The main purpose of the study was to correlate the feeding practice of mothers and nutritional status of their children.
Objectives of the study were
1.
To assess the feeding practices of mothers
2. To assess the nutritional status of children 3. To find out the correlation between the feeding practices of mother and the nutritional status of their children. 4. To find out the association between feeding practices of mothers and their children with selected variables.
The conceptual frame work adopted for this study was based on Rosenstoch’s and Becker’s health belief model.
The review of related literature and non research literature helped the investigator to develop the conceptual frame work, structured interview schedule and plan for data analysis.
The study was conducted in Doddabasthi and Chikkabasthi from 3 rd September to 3rd October 2007. The study adopted descriptive survey approach with random sampling technique.
Sample of the study consisted of 100 rural mothers and their children. The tool used for data collection was structured interview schedule.
73
It consists of the following sections
Section I
Deals with demographic variables which include age of the mothers. Number of under five children, religion, education, occupation duration of married life, family income, type of family, source of information regarding feeding practices.
Also children’s demographic variables such as age, gender, birth weight, birth order and presence of other problems.
Section II
It consists of 30 items with regard to practices of mothers concerning breast feeding, weaning and family diet. Total score was 30.
The steps involved in the development of instruments were preparation of blue print, construction of items, content validity and preparation of the final copy of the tool.
After obtaining formal permission from Medical officer of K. Gollahalli, PHC, the tool was used for data collection. Then the collected data were analyzed using using descriptive and inferential statistics and interpreted in terms of objectives.
Section III
Deals with the anthropometry of the children
74
Major findings of the study 1. Findings regarding the demographic characteristics of the respondents
Participants included in the study were mothers between 18 to 40 years of age. Majority of them (72 percent) were between 21 to 30 years. Most of them (62 percent) were Muslims. There were 33 percent Hindus and only 5 percent Christians. Majority (57 percent) had nuclear families, 36 percent had joint families and only 7 percent had extended families.
With regard to education ; majority (40 percent) had high school education, only 5 percent illiterates and 10 percent graduates were there as per occupation 82 percent were housewives. 11 percent private employees and only 7 percent Government employees. As per family income 79 percent had below Rs.5,000, 12 percent had between 5,001 to 10,000 and only 9 percent had above Rs.10,000 as their income. Half (50 percent) of them had married life between 5 to 9 years, 36 percent between 1 to 4 years and only 14 percent between 10 to 13 years. Among them 60 percent had only 1 child below five years and 40 percent had 2 children below five years.
As source of information 44 percent had TV/Radio, 43 percent had family members/relatives/friends and only 30 percent used mass media.
With regard to children 48 percent were between 2 to 3 years of age, 37 percent between 1 to 2 years and only 15 percent below 1 year. Among them 52 percent females and 48 percent males were there.
75
2. Findings pertaining to area wise classification of feeding practices Breast feeding: 78 percent adequate, 22 percent satisfactory and none of them had
not satisfactory feeding practices.
Weaning : 5 percent not satisfactory, 59 percent satisfactory and 36 percent had
adequate feeding practices.
Family diet: 66 percent not satisfactory, 26 percent satisfactory and 8 percent had
adequate feeding practices. Overall 5 percent not satisfactory, 81 percent satisfactory and 14 percent had adequate feeding practices.
3. Correlation between feeding practices and selected nutritional parameters.
Finally, it is found that there is a positive correlation between mothers feeding practices and nutritional status of their children. Spearman’s Rank Correlation value to correlate the feeding practices of mothers and selected nutritional parameters of children is found to be r = +0.161 for the present weight (kgs), r = +0.122 for height, r = +0.074 for mid arm circumference and r =+ 0.086.
4. Association between demographic variables and feeding practices.
There were significant association between demographic variables like religion, education and occupation of mothers and feeding practices. However there was no significant association between demographic variables such as age, type of family, income, duration of married life, number of under 5 children, birth order, age of the child, gender and source of information.
76
9. BIBLIOGRAPHY 1. Child
development
–
An
Introduction
available
from:
http://wcd.nic.in/cdintro.html [cited 2007 Sep 22].
2. Srivatsava N, Sandhu A. Index for Measuring Child Feeding Practices. Indian J. Pediatr. 2007 April; vol. 74(4): 363-8.
3. David P. Nutrition Assessment of Infant and Toddlers. Healthy Child Care 2003
[online].
[cited
2007
May
6];
Available
from:
http://www.frontiernet/~manage/ccni
4. Engle PL, Pelto G, Bentley. Care for Nutrition and Development. JIMA. 2000 Sep. vol. 98, No.9.
5. Breastfeeding and Family Foods Loving and Healthy [editorial] Pediatric Companion April – June 2005.
6. Gosh S. Integrated Child Development Services Programme – Need for Reappraisal. Indian Pediatr. 1997; 34: 911-8.
7. Child
Malnutrition
and
feeding
practices
in
Malawi.
www.unu.edu/unupress/foodN182e/ch13.htm
8. Park k. Parks text book of preventive and social medicine. 18 th ed. Jabalpur: Banarsidas Bhanot; 2005. P 399
9. Dr. BT Basavanthappa. Nursing research. New Delhi : Jaypee Brothers; 2005. P 113-23
77
10. Linkages. Facts for feeding. Academy for Educational development.1825 Connecticut, Ave, NW, Washington UK. www.linkagesproject.org
11. Redding A.B, Marlow RD. Text book of pediatric Nursing. 6 th ed. New Delhi: Elsevier; 2005. P 584-8
12. Mitra M, Kumar PV, Chakrabarty S, Bharath P. Nutritional Status of Kamar Tribal children in Chhittisgarh. Indian J Peadtr. 2007 Apr; vol.74(4): 381-4
13. Sachdev HPS. Nutrition status of Children and Women in India, Recent Trends. Nutrition foundation of India Events at NFI, 1997 Jul.
14. Sharma S, Nagar S. Impact of Educational Intervention on knowledge of mothers regarding child care and nutrition in Himachal Pradesh. J. Soc. Sci; 12(2); 2006. 139-42.
15. Nyarucucha CN, Msuya JM, Mamira PS, Kerengi AJ. Nutritional status and Feeding Practives of under five children in Simanjiro Dt. Tanzania. Tanzania Health Research Bulletin, 2006. Vol.8. No.3 P162-7.
16. Ray SK, Biswas AB, Kumar S. A study of Dietary Pattern, Household Food Security and Nutritional Profile of Under-five Children of a Community of West Bengal. Vol. 98, No. 9, Culcatta : JIMA advertiser ; 2002 P 519.
17. Kumar D, Goel NK, Poonam Sing, Mittal. Influence of infant feeding practices on nutritional status of under five children. Indian J. Pediatr. 2006 May; Vol.73(5): 417-21.
78
18. Yadav RJ, Singh P. Factors influencing Nutritional Status of Children in Bihar, Available from : http//www.indianpediatrics.net/ictt2.html [cited 2007 Sep 23].
19. Potter PA, Perry AG. Fundamentals of Nursing. 6 th Ed. New Delhi: Mosby; 2005. P 91-2.
20. Hannan A, Hassan MQ, Fazlur AK, Rahman A. Infant feeding practices from birth to 2 years of age and nutritional status of children and mothers in Bangladesh. 10th ASCON Abstract No: 133, Dhaka 1362, Bangladesh.
21. Kamau TF, O Mwega GM, Muita JW. Child care practices and nutritional status of children aged 0-2 years in Thika, Kenya. East Afr Med J. 2002 Oct; 79(10): 524-9. Available PMID: 12635757.
22. Ruel MT, Menon P. Child feeding practices are associated with child nutritional status in Latin America: innovative used of the demographic and health surveys. J Nutr. 2002 Jun; 132(6): 1180-7. Available PMID: 1204231.
23. Alvarado BE, Tabarer RE, Delisle H, Zunzunegni MV. Maternal beliefs, feeding practices and nutritional status in Afro – Colombian infants. Arch Latinoam Nutr. 2005 Mar; 55(1): 55-63. Available PMID 16187679.
24. Chirmulay D, Nisal R. Nutritional status of tribal under five children in Ahemadnagar District, Maharastra in relation to weaning/feeding practices. Indian Pediatr. 1993 Feb; 30(2):215-22. Available fr om PMID: 8375884
79
25. Abdul Sayed ZT, Latham MC, Roe DA. Prolonged breast feeding without the introduction of supplementary feeding. J Trap Pediatr. 1995 Feb;41(1):29-33. Available PMID: 7723126.
26. Hossain IM, Yasmin R, Kabir I. Nutritional and immunization status, weaning practices and socio economic conditions of under five children in three villages of Bangladesh. Indian J Public Health. 1999 Jan – Mar; 43(1): 31-41. Available PMID 11243087.
27. Excler JL, Nicolas E, Mojon M. Protein – energy malnutrition in an urban African milieu Med Trop (Mars). 1985 Apr – Jun; 45(2): 155 – 61. Available PMID: 3978552.
28. Hasan J, Ray J, Khan Z. Role of meaning in the nutritional status of infant-a longitudinal study in the rural area of Aligarh. J. Indian med Assoc. 1996 May; 94(5):169,215. PMID:8855567
29. Osuhar PC. Weaning practices in Kaduna. Northern Nigeria. Indian J public Health. 1986 Jul-Sep Indexed for MEDLINE(3):138-44 Available PMID: 3610298.
30. Puri RK, Suchdeva R. Development low cost supplementary foods for infants and children from locally available food in Punjab Child care Health Dev. 1984 Jul-Aug;19 (4);227-36. Available PMID: 6434193.
31. Jansena A. Malnutrition and child feeding practices in western Samoa. J Trop Pediatr Eniron child Health. 1977 Dec; 23(6): 293-306. Available PMID: 415150.
80
32. Malla S, Sherestha. Complementary feeding practices and its impact on nutritional status of under two year old children in urban area of the Kathmandu, Nepal. Journal of Nepal Health Research Council. 2004 Apr ; Vol.2. No.1.
33. Heath AL, Tuttle CR, Simons MS, Cleghorn CL. A longitudinal study of breast feeding and weaning practices during the first year of life in Dunedin, New Zealand. J Am Diet Assoc. 2002 Jul; 102(7): 937-43. Available PMID: 12146555.
34. Hussain AM. Rafiquzzaman M. Determinants of weaning age in rural Bangladesh. Soc Biol, 1994 Spring – Summer; 41(1-2): 78-82. Available PMID 7973842.
35. Moussa WA, Tadros MD, Mekhael KA. Some simple methods of home processing and their implications with weaning foods. Nahrung. 1992; 36(1): 26-33. Available PMID: 1579153.
36. Appah LY, Krehling S. Meternal Nutritional Knowledge and Child Nutritional Status in Volta region of Ghana. Matern Child Nutr. 2005 April. [cited on 2007 June 1]; 1(2): 100-10. Available PMID: 16881885 [pubmed-indexed for medline]
37. Tada Y, Keiwkarnka B, Pancharuriti N, Chamaroonsawasdi K. Nutritional Status of preschool children of the Klong Toey slum Bangkok. Southern Asian J Trop Med Public Health. 2002 Sept, 628-37. Available PMID: 12693602
38. Washenya EW, Kogi-Makan W, Muita JW. Maternal nutritional knowledge and the nutritional status of preschool children in a Nairobi Slum. East Afr Med J. 1996 Jul; 73(7): 417-8. Available PMID: 8918000.
81
39. Chit TM, Kyi H, Thuwin A. Mother’s beliefs and attitudes towards child weight, child feeding and related practices in Myanmar. Nutr Health. 2003; 17(3) 231-54. Available PMID 14703156.
40. Das DK, Ahmed S. Knowledge of the Bangladeshi rural mothers regarding breast feeding and weaning. Indian J Pediatr. 1995 Mar – Apr; 62(2) 213-7. Available PMID 10829870
41. Pant I, Cholthia K. Maternal knowledge regarding breast feeding and weaning practices. Indian J Pediatr. 1990 May – Jun; 57(3): 395-400. Available PMID 2228093.
42. Bhat IA, Shah GN, Dhar GM, Mehnaz S. A study on the impact of maternal knowledge and practices on the nutritional status of infants. Indian J Matern Child Health. 1992 Jan-Mar; 3(11): 12-5. Available PMID: 12318654.
43. Bekele A, Berthane Y. Weaning in Butajira, South Etiopia: A study on mother’s knowledge and practices. Ethiop Med J. 1998 Jan; 36(1): 37-45. Available PMID 10214446.
44. Burns N, Grove S.K. Understanding Nursing Research. 2 nd ed. New Delhi: Saunders; 2002 p185.
45. Treece EW, Treece JW. Element of Research in Nursing. St. Louis: Mosby; 1977 p349.
46. Polit FT, Beck JC. Nursing Research. Principles and Methods. 2 nd ed. Philadelphia: Lippincott Williams and Williams; 2004 p716.
82
10. LIST OF ANNEXURE Sl.No.
Annexure
Page No
A
Letter seeking permission to conduct pilot study
84
B
Letter granting permission to conduct pilot study
85
C
Letter seeking permission to conduct main study
86
D
Letter granting permission to conduct main study
87
E
Letter seeking expert opinion on content validity of the tool
88 – 89
F
Criteria checklist for validating the tool
90 – 91
G
Certificate of content validity
92
H
Blue Print
93
I
Tool used for the study (English)
94 – 98
J
Tool used for the study (Kannada)
99 – 103
K
Scoring Key
104
L
Letter seeking consent of the participant (English)
105
M
Letter seeking consent of the participant (Kannada)
106
N
Certificate of analysis of data
O
Certificate of Editing
P
List of experts
107 108 109 - 110
83
ANNEXURE – A LETTER SEEKING PERMISSION TO CONDUCT THE PILOT STUDY
From, Rosamma K.J, II Year M.Sc. Nursing, Sarvodaya College of Nursing Bangalore
To, The Medical Officer Primary Health Centre K. Gollahalli Bangalore South
Through, The Principal Sarvodaya College of Nursing Bangalore
Respected sir, Sub.: Seeking permission to conduct pilot study
I, Rosamma K.J am a bonafide PG Student of Sarvodaya College of Nursing affiliated to Rajiv Gandhi University of Health Sciences, Bangalore with a specialization in Pediatric Nursing. I have to conduct a pilot study as a part of my main research for the purpose of partial fulfillment of my course. My problem statement is “A Study To Correlate Feeding Practices Of Mothers And Nutritional Status Of Their Children In A Selected Area Bangalore”.
In this regard, I kindly request you to grant me permission for conducting pilot study. Thanking you,
Date:
Yours faithfully,
Place:
ROSAMMA K.J
84
ANNEXURE – B LETTER GRANTING PERMISSION TO CONDUCT THE PILOT STUDY
From, The Medical Officer,
Primary Health Centre, K. Gollahalli, Bangalore South.
To, Rosamma K.J,
2nd Year M.Sc. Nursing, Sarvodaya College of Nursing, Bangalore.
Dear Student,
As per your request forward through the Principal, Sarvodaya College of Nursing you are permitted to do the pilot study in K. Gollahalli, Bangalore as mentioned in your letter.
Date: Place :
85
ANNEXURE – C LETTER SEEKING PERMISSION FOR CONDUCTING THE MAIN STUDY
From, Rosamma K.J. 2nd Year M.Sc. Nursing, Sarvodaya College of Nursing Bangalore
To, The Medical Officer of Health, PHC K. Gollahalli, Bangalore South, Bangalore
Through, The Principal Sarvodaya College of Nursing Bangalore Sub: Seeking permission to conduct main study Respected sir, I, Rosamma K.J is a bonafide PG Student of Sarvodaya College of Nursing affiliated to Rajiv Gandhi University of Health Sciences, Bangalore with a specialization in Pediatric Nursing. I have to conduct a main study as a part of my main research for the purpose of partial fulfillment of my course. My problem statement is “A Study To Correlate Feeding Practices Of Mothers And Nutritional Status Of Their Children In A Selected Area, Bangalore”.
In this regard, I kindly request you to grant me permission for conducting main study. Thanking you,
Date:
Yours faithfully,
Place:
ROSAMMA K.J
86
ANNEXURE – D
LETTER GRANTING PERMISSION TO CONDUCT THE MAIN STUDY
From, The Medical Officer of Health,
PHC K. Gollahalli, Bangalore South, Bangalore.
To, Rosamma K.J,
2nd Year M.Sc. Nursing, Sarvodaya College of Nursing Bangalore
Dear Student,
As per your request forward through the principal Sarvodaya College of Nursing you are permitted to do the main study in K. Gollahalli PHC in Bangalore as mentioned in your letter.
Date:
Place:
87
ANNEXURE – E
LETTER SEEKING EXPERTS OPINION AND SUGGESTIONS FOR THE CONTENT VALIDITY OF THE TOOL.
From, Rosamma K.J,
II Year M.Sc. Nursing, Sarvodaya College of Nursing, Bangalore.
To,
Through, The Principal,
Sarvodaya College of Nursing, Bangalore.
Dear Madam / Sir, Sub.: Request for opinion and suggestions of experts for establishing content validity of research tool.
I, Rosamma K.J II Year Student
of Master of Science in Nursing
(Pediatric Nursing), student of Sarvodaya College of Nursing, Bangalore, have
selected the following topic for my research project, to be submitted to Rajiv Gandhi University of Health Sciences, Karnataka, Bangalore, in partial fulfillment university requirement for the award of Master of Nursing degree.
TITLE OF THE TOPIC “A Study To Correlate Feeding Practices Of Mothers And Nutritional Status Of Their Children In A Selected Area Bangalore”.
88
The objectives of the study are
1. To assess feeding practices of mothers. 2. To assess the nutritional status of children. 3. To find out the correlation between the feeding practices of mothers and the nutritional status of their children. 4. To find out the association between feeding practices of mothers and the selected demographic variables.
With regard to this may I request you to validate my tool (Structured Interview Schedule) for its appropriateness and relevancy. I would be highly obliged and remain thankful for your great help if you could validate the tool and give your valuable opinion and suggestions wherever required.
Herewith I am enclosing a copy of a) Questionnaire b) Correct response and scoring key c) Evaluation criteria d) Content validity certificate
Thanking you, Date:
Yours faithfully,
Place: Bangalore
ROSAMMA K.J.
89
ANNEXURE – F Evaluation Criteria for validation of tool Instruction
A tool has been constructed for data collection. It consist of four parts. Section : I
Deals with demographic data.
Section : II
Deals with practices of mothers regarding breast feeding, weaning and family diet.
Section : III
Deals with Anthropometry
Areas
Item No.
Section I Demographic data
1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. 13. 14. 1. 2. 3. 4.
Section II Checklist
Relevant
Relevant to Certain Extent
5. 6. 7. 8. 9. 10. 11. 12. 13.
90
Not Relevant
Suggestions
Areas
Item No.
Relevant
Relevant to Certain Extent
14. 15. 16. 17. 18. 19. 20. 21. 22. 23. 24. 25. 26. 27. 28. 29. 30.
91
Not Relevant
Suggestions
ANNEXURE – G
CERTIFICATE OF CONTENT VALIDITY
This is to certify that the tool developed by Rosamma K.J., M.Sc. Nursing Student of Sarvodaya College of Nursing, Bangalore (Affiliated to Rajiv Gandhi University of Health Sciences), has been validated by the undersigned and can proceed with this tool and conduct the main study for dissertation entitled “A Study To Correlate Feeding Practices Of Mothers And Nutritional Status Of Their Children In A Selected Area, Bangalore” .
Signature
:
Name
:
Designation
:
Date
:
Seal
:
92
ANNEXURE - H BLUE PRINT OF STRUCTURED INTERVIEW SCHEDULE
Sl No.
Components
Comprehension Application
Total No. of Questions
Percentage
9
30%
10
33.3%
11
36.7%
30
100%
Knowledge regarding
1.
Breast feed.
3, 4 , 9
1, 2, 5, 6, 7, 8
2.
Weaning.
10, 11, 14, 15
12, 13, 16, 17, 18, 19
3.
Family Diet
20, 22, 24, 28
21, 23, 25, 26, 27, 29, 30
TOTAL
36.7%
63.3%
93
ANNEXURE – I STRUCTURED INTERVIEW SCHEDULE SECTION – I DEMOGRAPHIC DATA Code No. Mother
1. Age (years) _________ 2. Number of under five children ________ 3. Religion ________ Hindu Muslim Christian 4. Education of the mother ________ Illiterate Primary School Middle School High School PUC Graduate 5. Occupation of the mother ________ Housewife Government Private Business Agriculture 6. Duration of married life (years) ________ 7. Family income (per month) Rs.________ 8. Type of family 9.1. Nuclear 9.2. Joint 9.3 Extended 9. Source of information regarding feeding practices.
94
10.1. Health Personnel 10.2. TV / Radio 10.3. Magazines / Journals / Books. 10.4. Family members / relatives 10.5. Friends / Neighbours Child Details
10. Age of the child (months / year) ___________ 11. Gender of the child ___________ 12. Birth weight of the child (kg.)___________ 13. Birth order First / Second / Third ___________ 14. Presence of other problem 14.1.Handicap 14.2.Mentally challenged 14.3.Others 14.4.None
95
SECTION - II Sl.No.
Feeding practices
1.
Did you initiate breast feeding within one hour of child birth?
2.
Have you breast fed the baby exclusively for 6 months?
3.
Did you prepare yourself during antenatal period for breast feeding?
4.
Did your baby sleep well after breast feed?
5.
Did you practice demand feeding?
6.
Did you feed your baby with expressed breast milk?
7.
If yes, did you warm the milk by placing it in a bowl of hot water?
8.
Did you burp your child after every feed?
9.
Do you consider regurgitation of small amount of feed as normal?
10.
Did you use liquid diet as first weaning food?
11.
Did you observe any psychological problem for your baby while weaning?
12.
Did you give weaning food immediately after bath?
13.
Did you keep 5 – 7 days interval between two different types of weaning food?
14.
Did you include fruits and boiled mashed vegetables in your
96
Yes
No
Sl.No.
Feeding practices
babies diet between 8 – 12 months 15.
Have you observed any food allergies while weaning your baby?
16.
If you have observed allergies have you stopped that particular food item for a week and restarted in small quantities?
17.
Have you given weaning food before the breast feed?
18.
Do you wash your hands with soap and water before cooking, serving and feeding your child?
19.
Is there any cultural taboos or family tradition to be followed before starting the weaning food?
20.
Does your child get nutritional food from Anganawadi?
21.
When your child was one year old, did you give family diet for him/her?
22.
Was your child been given vitamin A solution?
23.
Do you check the weight of your child as per age?
24.
Did you get any health education regarding feeding practices from health personnel?
25.
Did you give soft mixture of rice and dhal as complementary food?
26.
Did you give breast feed along with ORS when the child had diarrhoea?
97
Yes
No
Sl.No.
Feeding practices
27.
Did you regularly check the weight of your child during second year and maintain a record?
28.
Do you consider half amount of mothers diet as daily requirement of 12 to 18 months old child?
29.
Did you use spoon or pallada while giving complementary feed?
30.
Did you take your child to pediatrician in regular intervals?
SECTION – III
Anthropometry
1. Present weight (kg) of the child ___________ 2. Height (cm) of the child ___________ 3. Mid arm circumference (cm) ___________ 4. Chest circumference (cm) ___________
98
Yes
No
ANNEXURE - J
DPÁgÀ ¸ÀAzÀ±Àð£À C£ÀħAzsÀ ¨sÁUÀ – 1 PɼÀPÀAqÀ ¥Àæ±ÁߪÀ½UÀ½UÉ ¤ªÀÄUÉ w½¢gÀĪÀ ªÀiÁ»wUÀ¼À£ÀÄß zÀAiÀÄ«lÄÖ ¤ÃqÀ¨ÉÃPÀÄ. vÁªÀÅw½¸ÀĪÀ ªÀiÁ»wUÀ¼À£ÀÄß UË¥ÀåªÁVqÀ¯ÁUÀĪÀÅzÀÄ ªÀÄvÀÄÛ ¸ÀA±ÉÆÃzsÀ£É GzÉÝñÀPÉÌ ªÀiÁvÀæ §¼À¸À¯ÁUÀÄvÀÛzÉ. d£À¸ÀASÁå zÀvÁÛA±À : ¸ÀAPÉÃvÀ ¸ÀASÉå : vÁ¬ÄAiÀÄ «ªÀgÀUÀ¼ÀÄ : 1. ªÀAiÀĸÀÄì (ªÀµÀðUÀ¼À°è)
:
2. LzÀÄ ªÀµÀðzÉƼÀV£À ªÀÄPÀ̼À ¸ÀASÉå 3. zsÀªÀÄð
:
C) »AzÀÄ §) ªÀÄĹèÃA PÀ) Qæ²ÑAiÀÄ£ï 4. vÁ¬ÄAiÀÄ «zÁåºÀðvÉ
:
C) C£ÀPÀëgÀ¸ÉÜ §) ¥ÁæxÀ«ÄPÀ ±Á¯É PÀ) ªÀiÁzsÀå«ÄPÀ ±Á¯É qÀ) ¥sËæqsÀ ±Á¯É E) ¥ÀzÀ« ¥ÀǪÀð ¥sÀ) ¥ÀzÀ« 5. vÁ¬ÄAiÀÄ HzÉÆåÃUÀ
:
C) UÀȺÀt §) ¸ÀPÁðj £ËPÀj PÀ) SÁ¸ÀV PÉ®¸À 99
:
qÀ) ªÁå¥ÀgÀ E) ªÀåªÀ¸ÁAiÀÄ 6. ªÉʪÁ»PÀ fêÀ£À (ªÀµÀðUÀ¼À°è)
:
7. PÀÄlÄA§zÀ ªÀgÀªÀÄ£À (wAUÀ½UÉ gÀÆ.UÀ¼À°è) 8. PÀÄlÄA§zÀ «zsÀ
:
:
C) «¨sÀPÀÛ PÀÄvÀÄA§ §) C«¨sÀPÀÛ PÀÄlÄA§ PÀ) «¸ÀÛgÀuÁ PÀÄlÄA§ 9. ºÁ®Æt¸ÀĪÀ C¨sÁå¸ÀzÀ §UÉÎ ¥ÀqÉ¢gÀĪÀ ªÀiÁ»wUÀ¼À ªÀÄÆ® : C) DgÉÆÃUÀå ¹§âA¢ §) zÀÆgÀzÀ±Àð£À / DPÁ±ÀªÁt PÀ)
¥ÀĸÀÛPÀ / ¤AiÀÄvÀPÁ°PÉUÀ¼ÀÄ / ¸ÀªÀiÁZÁgÀ
¥ÀwæPÉUÀ¼ÀÄ qÀ) PÀÄlÄA§zÀªÀgÀÄ / §AzsÀÄUÀ¼ÀÄ E) UɼÉAiÀÄgÀÄ / CPÀÌ¥ÀPÀÌzÀªÀgÀÄ
ªÀÄUÀÄ«£À «ªÀgÀUÀ¼ÀÄ : 10. ªÀÄUÀÄ«£À ªÀAiÀĸÀÄì : 11.
ªÀÄUÀÄ«£À °AUÀ
:
12.
ºÀÄnÖzÁUÀ ªÀÄUÀÄ«£À vÀÆPÀ (Q.UÁæA) :
13. ºÀÄnÖ£À PÀæªÀÄUÀ¼ÀÄ ªÉÆzÀ®£É / JgÀqÀ£Éà / ªÀÄÆgÀ£Éà : 14.
EvÀgÉ vÉÆAzÀgÉUÀ¼ÀÄ :
C) CAUÀ«PÀ® §) ªÀiÁ£À¹PÀ C¸Àé¸ÀÜvÉ
100
PÀ) EvÀgÉ R) AiÀiÁªÀÅzÀÆ E®è
¨sÁUÀ – 2 PÀæ. ¸ÀA. 1.
ºËzÀÄ E®è ªÀÄUÀÄ
ºÀÄnÖzÀ
UÀAmÉAiÉƼÀUÉ
MAzÀÄ
¤ÃªÀÅ
JzÉ
ºÁ®£ÀÄß PÀÄr¹gÀÄ«gÁ? 2.
DgÀÄ wAUÀ¼ÀªÀgÉUÉ ªÀÄUÀÄ«UÉ §jà JzÉ ºÁ®£ÀÄß ªÀiÁvÀæ PÀÄr¹gÀÄ«gÁ?
3.
¥Àæ¸ÀªÀ ¥ÀǪÀðzÀ°èAiÉÄ ¤ÃªÀÅ JzÉ ºÁ®£ÀÄß
ªÀÄUÀÄ«UÉ
PÀÄr¸À®Ä
vÀAiÀiÁj £Àqɹ¢ÝÃgÀ? 4.
JzÉ ºÁ®Ä PÀÄr¹zÀ £ÀAvÀgÀ ªÀÄUÀÄ ZÉ£ÁßV ¤zÉæ ªÀiÁqÀÄvÀÛzÉAiÉÄÃ?
5.
DºÁgÀ ¸ÉêÀ£É ªÀÄUÀÄ«£À ºÀPÀÄÌ JA§AvÉ C¨sÁå¸À ªÀiÁr¢ÝÃgÁ?
6.
JzɬÄAzÀ
»ArvÉUÉzÀ
ºÁ®£ÀÄß
ªÀÄUÀÄ«UÉ PÀÄr¹¢ÝÃgÁ? 7.
ºËzÁzÀgÉ,
ºÁ®£ÀÄß
©¹¤Ãj£À°èlÄÖ
¨ÉZÀÑUÉ ªÀiÁr ¤Ãr¢ÝÃgÁ? 8.
ºÁ®Ä
PÀÄr¹zÀ
ªÀÄUÀĪÀ£ÀÄß
£ÀAvÀgÀ vÉÃUÀĪÀAvÉ
ªÀiÁr¢ÝÃgÁ? 9.
QrzÀ
ºÁ®Ä
¸Àé®à
¥ÀæªÀiÁtzÀ°è
ºÉÆgÀ§gÀÄvÀÛzÉ.
EzÀ£ÀÄß
¸ÁªÀiÁ£ÀåªÉAzÀÄ ¥ÀjUÀt¹¢ÝÃgÁ? 10.
zÀæªÀ
¥ÀzÁxÀðªÀ£ÀÄß 101
ªÉÆzÀ®
¥ÀÆgÀPÀ
DºÁgÀªÉAzÀÄ
¥ÀjUÀt¹¢ÝÃgÁ? 11.
¥ÀÇgÀPÀ
DºÁgÀªÀ£ÀÄß
¥ÁægÀA©ü¹zÁUÀ
ªÀÄUÀÄ«£À
ªÀiÁ£À¹PÀ
¹ÜwUÀwAiÀÄ£ÀÄß
UÀªÀĤ¹¢ÝÃgÁ? 12.
¸ÁߣÀ
ªÀiÁrzÀ
vÀPÀët
¥ÀÇgÀPÀ
DºÁgÀªÀ£ÀÄß ¤ÃqÀÄwÛÃgÁ? 13.
JgÀqÀÄ
«zsÀzÀ
¥ÀÇgÀPÀ
DºÁgÀªÀ£ÀÄß ¤ÃqÀĪÁUÀ £ÀqÀÄªÉ 5 – 7
¢£ÀUÀ¼À
CAvÀgÀzÀ°è
ªÀiÁqÀÄwÛÃgÁ? 14.
15.
8 – 12 wAUÀ¼À°è ªÀÄUÀÄ«UÉ ¤ÃqÀĪÀ DºÁgÀzÀ°è ºÀtÄÚUÀ¼ÀÄ, §qsÀ¬Ä¹zÀ ªÀÄvÀÄÛ ZÉ£ÁßV QªÀÅazÀ vÀgÀPÁjUÀ¼À£ÀÄß ¤ÃqÀÄ«gÁ? ¥ÀÇgÀPÀ DºÁgÀ ¤ÃqÀĪÀ ¸ÀªÀÄAiÀÄzÀ°è
DºÀgÀ¢AzÀ
§j¸À§ºÀÄzÁzÀ
SÁ¬Ä¯É
AiÀiÁªÀÅzÀPÀÆÌ
¸ÀÆPÀëöä
¸ÀAªÉâAiÀiÁVgÀĪÀ
¥ÀgÀ¸ÀÜwAiÀÄ£ÀÄß JzÀÄj¹¢ÃgÀ? 16.
ºÁUÁVzÀÝ°è MAzÀÄ
CAvÀºÀ
ªÁgÀ
¤°è¹
DºÁgÀªÀ£ÀÄß £ÀAvÀgÀ
C®à
¥ÀæªÀiÁtzÀ°è ¥ÀÅ£ÀB ¤ÃqÀÄ«gÁ? 17.
JzÉ
ºÁ®£ÀÄß
¤ÃqÀĪÀ
ªÀÄÄ£Àß
¥ÀÇgÀPÀ DºÁgÀªÀ£ÀÄß ¤ÃqÀÄ«gÁ? 18.
CqÀÄUÉ ªÀiÁqÀĪÀ ªÀÄÄ£Àß §r¸ÀĪÀ ªÀÄvÀÄÛ G¤¸ÀĪÀ ªÀÄÄ£Àß ¤ªÀÄä PÉÊUÀ¼À£ÀÄß
¸Á§Æ£ÀÄ 102
ªÀÄvÀÄÛ
¤Ãj¤AzÀ vÉƼÉzÀÄPÉƼÀÄî«gÁ? 19
¥ÀÇgÀPÀ
DºÁgÀªÀ£ÀÄß
¥ÁægÀA©ü¸ÀĪÀ
ªÀÄÄ£Àß
¸ÁA¥ÀæzÁAiÀÄPÀ
¤µÉÃzÀ
CxÀªÁ
PÀÄlÄA§zÀ°è DZÀgÀuÉ EzÉAiÉÄÃ? 20.
CAUÀ£ÀªÁr PÁAiÀÄðPÀvÀðjAzÀ ¤ªÀÄä ªÀÄUÀÄ«UÉ
¥ËµÀ×PÀ
DºÁgÀ
¹UÀÄwÛzÉAiÉÄÃ? 21.
¤ªÀÄä
ªÀÄUÀÄ«UÉ
ªÀµÀðªÁzÁUÀ
MAzÀÄ
PÀÄlÄA§zÀªÀgÀÄ
¸Éë¸ÀĪÀ DºÁgÀªÀ£ÀÄß ¤ÃrgÀÄ«gÁ ? 22.
¤ªÀÄä
ªÀÄUÀÄ«UÉ
fêÀ¸ÀvÀé
“J”
¤ÃqÀÄ«gÁ ? 23.
ªÀAiÀĹìUÀ£ÀÄUÀtªÁV
ªÀÄUÀÄ«UÉ
vÀÆPÀªÀ£ÀÄß £ÉÆÃqÀÄ«gÁ? 24.
DgÉÆÃUÀå
¹§ãA¢UÀ½AzÀ
¸ÉêÀ£ÉAiÀÄ DgÉÆÃUÀå
DºÁgÀ
C¨sÁå¸ÀUÀ¼À£ÀÄß ²PÀëtzÀ
ªÀÄÆ®PÀ
¥ÀqÉ¢¢ÝÃgÁ? 25.
ªÉÄvÀÛUÉ ¨ÉìĹzÁ C£Àß ªÀÄvÀÄÛ ¨ÉüÉAiÀÄ£ÀÄß
¥ÀÇwðPÀgÀ
DºÁgÀªÁV ªÀÄUÀÄ«UÉ ¤ÃqÀÄwÛÃgÁ? 26
ªÀÄUÀÄ«UÉ Cw¸ÁgÀ ¨ÉâAiÀiÁzÁUÀ JzÉAiÀÄ
ºÁ®£À
eÉÆvÉ
N.Dgï.J¸ï.
PÀÆqÀ ¤ÃqÀÄwÛ¢ÝÃgÁ? 27.
ªÀÄUÀÄ«£À
JgÀqÀ£ÉÃ
C£ÀÄPÀæªÀĪÁV
ªÀµÀzÀ°è ªÀÄUÀÄ«£À
vÀÆPÀªÀ£ÀÄß
£ÉÆÃr
103
zÁR°¸ÀÄwÛ¢ÝÃgÁ? 28.
vÁ¬ÄAiÀÄÄ ¢£Á®Ä ¸Éë¸ÀĪÀ DºÁgÀ ¥ÀæªÀiÁtzÀ CzsÀðzÀµÀÄÖ 12 – 18 wAUÀ¼À
ªÀÄUÀÄ«£À
DºÁgÀªÁVgÀÄvÀÛzÉ
JAzÀÄ
£ÀA§ÄwÛÃgÁ? 29.
M¼À®qÀ
CxÀªÁ
¥ÀÇwðPÀgÀ
ZÀªÀÄZÉAiÀÄ£ÀÄß
DºÁgÀ
¤ÃqÀĪÁUÀ
G¥ÀAiÉÆÃV¹¢ÝÃgÁ? 30.
PÀæªÀħzÀÞªÁV
²±ÀÄvÀdÕjAzÀ
ªÀÄUÀĪÀ£ÀÄß
vÀ¥Á¸ÀuÉUÉ
M¼À¥Àr¸ÀÄwÛ¢ÝÃgÁ?
¨sÁUÀ – 3 ªÀÄ£ÀĵÀå£À zÉúÀ ªÀiÁ¥sÀ£ÀPÉÌ ¸ÀA§A¢ü¹zÀ «ªÀgÀUÀ¼ÀÄ : 1. ªÀÄUÀÄ«£À FV£À
: ………………………………………………
vÀÆPÀ
(Q.UÁæA. UÀ¼À°è) 2. ªÀÄUÀÄ«£À JvÀÛgÀ
: ……………………………………………… (¸ÉA.
«ÄÃlgï UÀ¼À°è) 3. ªÉÄïÁãUÀzÀ
: ………………………………………………
PÉÊAiÀÄ ªÀÄzsÀåzÀ°è£À ¸ÀÄvÀÛ¼ÀvÉÀ ¥Àj¢ü (¸ÉA.
«ÄÃlgï
104
UÀ¼À°è) 4. JzÉAiÀÄ
: ………………………………………………
¸ÀÄvÀÛ¼ÀvÉ (¸ÉA.
«ÄÃlgï
UÀ¼À°è)
105
ANNEXURE – K
SCORING KEY Q. No.
Correct Option
Score
1.
Yes
1
2.
Yes
1
3.
Yes
1
4.
Yes
1
5.
Yes
1
6.
Yes
1
7.
Yes
1
8.
Yes
1
9.
Yes
1
10.
Yes
1
11.
Yes
1
12.
Yes
1
13.
Yes
1
14.
Yes
1
15.
Yes
1
16.
Yes
1
17.
Yes
1
18.
Yes
1
19.
Yes
1
20.
Yes
1
21.
Yes
1
22.
Yes
1
23.
Yes
1
24.
Yes
1
25.
Yes
1
26.
Yes
1
27.
Yes
1
28.
Yes
1
29.
Yes
1
30.
Yes
1
106
ANNEXURE – L
CONSENT FORM FOR THE RESPONDENTS
Dear Participant,
I, Rosamma K.J ., 2 nd year Nursing student of Sarvodaya College of Nursing as part of the partial fulfilment of the course, have to conduct a study and the problem selected is “A Study To Correlate Feeding Practices Of Mothers And Nutritional Status Of Their Children In A Selected Area, Bangalore ”.
I request you to participate in the study and respond to the questions asked.
The information provided by you will be strictly confidential and will be used only for the study purpose. This is for your information and kind participation.
Thanking you,
Yours sincerely
Signature of the investigator
(Rosamma K.J)
I am willing to participate in the study and aware that the information provided by me will be kept confidential and used for the study purpose.
Place: Bangalore
Date:
Signature of the Participant
107
ANNEXURE – M
GvÀÛgÀ PÉüÀĪÀªÀgÀ ¸ÀªÀÄäw £ÀªÀÄÆ£É F PÁAiÀÄðPÀæªÀÄzÀ°è ¨sÁUÀªÀ»¸ÀĪÀªÀgÉÃ, ¸ÀªÉÇÃðzÀAiÀÄ PÁ¯ÉÃeï D¥sï £À¹ðAUï£À JA. J¸ï. ¹. ¢éwÃAiÀÄ ªÀµÀðzÀ «zÁåy𤠹¸ÀÖgï. gÉÆøÀªÀÄä eÉÆøÀ¥sï DzÀ £Á£ÀÄ vÀªÀÄä°è «£ÀAw¹PÉƼÀÄîªÀÅzÉãÉAzÀgÉ £À£Àß CzsÀåAiÀÄ£ÀzÀ CAUÀªÁV ¤ªÀÄä°è PÉ®ªÀÅ ªÀiÁ»wUÀ¼À£ÀÄß ¸ÀAUÀ滸À®Ä
EaÒ¸ÀÄvÉÛãÉ.
£À£Àß
CzsÀåAiÀÄ£ÀzÀ
«µÀAiÀĪÉãÉAzÀgÉ ‘¨ÉAUÀ¼ÀÆj£À ¤UÀ¢vÀ ¥ÀæzÉñÀzÀ°è vÁAiÀÄA¢gÀÄ vÀªÀÄä ªÀÄPÀ̽UÉ ºÁ®Ær¸ÀĪÀ PÀæªÀÄ ªÀÄvÀÄÛ ªÀÄPÀ̼À ¥ËµÀ×PÁA±ÀzÀ ¨É¼ÀªÀtÂUÉUÉ EgÀĪÀ ¸ÀA¨sÀAzsÀ’ ªÀ£ÀÄß PÀÄjvÀÄ. DzÀÝjAzÀ ¥Àæ±ÉßUÀ½UÉ
vÁªÀÅ
zÀAiÀÄ«lÄÖ
£Á£ÀÄ
GvÀÛj¸À¨ÉÃPÉAzÀÄ
PÀ¼ÀĪÀ ºÁH
F
PÁAiÀÄðPÀæªÀÄzÀ°è ¸ÀQæAiÀĪÁV ¥Á¯ÉÆμÀî¨ÉÃPÉAzÀÄ «£ÀAw¸ÀÄvÉÛãÉ. ¤ÃªÀÅ MzÀV¸ÀĪÀ ªÀiÁ»wAiÀÄÄ PÉêÀ® «zÁå¨sÁå¸ÀzÀ zÀȵÀ׬ÄAzÀ ªÀiÁvÀæ §¼À¸À®UÀĪÀÅzÀÄ ºÁUÀÆ CzÀ£ÀÄß UÉÆÃ¥ÀåªÁV EqÀ¯ÁUÀĪÀÅzÀÄ. ªÀAzÀ£ÉUÀ¼ÉÆA¢UÉ, vÀªÀÄä «±Áé¹,
«ZÁj¸ÀĪÀªÀgÀ ¸À»
108
£Á£ÀÄ MzÀV¸ÀĪÀ F ªÀiÁ»wAiÀÄÄ CzsÀåAiÀÄ£ÀPÁÌV §¼À¸À¯ÁUÀÄvÀÛzÉ EqÀ¯ÁUÀÄvÀÛzÉ PÁAiÀÄðPÀæªÀÄzÀ°è
ºÀUÀÆ JA§ÄzÀ£ÀÄß
CzÀ£ÀÄß w½zÀÄ
¸ÀQæAiÀĪÁV
EaÒ¸ÀÄvÉÛãÉ.
¸ÀܼÀ : ¨ÉAUÀ¼ÀÆgÀÄ ¢£ÁAPÀ : ¨sÁUÀªÀ»¸ÀĪÀªÀgÀ ¸À»
109
UÉÆÃ¥ÀåªÁV £Á£ÀÄ
F
¨sÁUÀªÀ»¸À®Ä
ANNEXURE – N CERTIFICATE OF ANALYSIS OF DATA
This is to certify that data analysis done by Rosamma K.J. , Second Year M.Sc. Nursing, Sarvodaya College of Nursing, Bangalore, in her study titled “ A Study To Correlate Feeding Practices Of Mothers And Nutritional Status Of Their Children In A Selected Area, Bangalore ” has been verified by me.
Date
:
Signature
Place : Bangalore
Seal
110
ANNEXURE – O
CERTIFICATE OF EDITING
This is to certify that data analysis done by Rosamma K.J. , Second Year M.Sc. Nursing, Sarvodaya College of Nursing, Bangalore, in her study titled “ A Study To Correlate Feeding Practices Of Mothers And Nutritional Status Of Their Children In A Selected Area, Bangalore ” has been edited by me.
Date
:
Signature of the Editor
Place : Bangalore
Mrs. Nirmala Sridhar, M.A English, M.A Psychology, PG Diploma in Guidance & Counselling
111
ANNEXURE - P
LIST OF EXPERTS 1.
Dr. G. Kasthuri, Ph.D Prof. and HOD, Dept. of Pediatric Nursing Oxford College of Nursing Bangalore
2.
Mrs. Hemalatha Ravi, M.Sc. (N) Prof. and HOD, Dept. of Pediatric Nursing Maruthi College of Nursing Bangalore
3.
Mrs. J. Lovera Grace Lilly Rani, M.Sc. (N) Prof. and HOD, Dept. of Pediatric Nursing Sarvodaya College of Nursing Bangalore
4.
Mrs. Satya Lawrence, M.Sc. (N) Asso. Professor, Dept. of Pediatric Nursing Sarvodaya College of Nursing Bangalore
5.
Mrs. Renuka N, M.Sc. (N) Lecturer Dept. of Pediatric Nursing, Govt. of College of Nursing Fort, Bangalore
6.
Mr. G.R. Chamnalkar, M.Sc. (N) Prof. Pediatric Nursing, Dept. of Pediatric Nursing Oriental College of Nursing Bangalore
7.
Dr. Jayaprakash Rai, MD Pediatrician, Sarvodaya Hospital Bangalore
112
