EFFECTIVENESS OF PLANNED TEACHING PROGRAMME

REGARDING MALNUTRITION IN TERMS OF KNOWLEDGE

AND PRACTICE AMONG MOTHERS WITH UNDER FIVE
CHILDREN IN AYYAMPATTY
AT TRICHY DISTRICT

Certified Bonafide Project Work

Done By

Ms. A.KANIMOZHI
M.Sc., Nursing II Year
Bishop’s College of Nursing
Dharapuram.

_________________________ _________________________
Internal Examiner External Examiner

COLLEGE SEAL

A DISSERTATION SUBMITTED TO
THE TAMILNADU DR. M.G.R. MEDICAL UNIVERSITY,CHENNAI
IN PARTIAL FULFILLMENT OF THE REQUIREMENT FOR THE
DEGREE OF MASTER OF SCIENCE IN NURSING
2008 – 2010

1
 CHAPTER – I

INTRODUCTION

“Children are our most valuable natural resource”

-By Herbert Hoover

BACK GROUND OF THE STUDY

Children are the wealth of Tomorrow. A nations wealth depends

on its healthy citizens. A healthy adult emerges from a healthy child. As

far as mankind is concerned, the earlier stages of growth and

development is the vital factor in determining the whole personality of

an individual.

Indian journal of pediatrics(2000)

Nutrition may be defined as the science of food and its

relationship to health. It is concerned primarily with the part played by

nutrients in the body growth, development and maintenance. A child

who is physically weak can not be expected to take full advantage of

schooling. The diet should contain all the nutrients in proper proportion,

adequate for maintenance of optimal health.

Ghai.O.P.,(2007)

2
 Nutritional disorders may result from either deficiency or excess of

any of the nutrients like protein, fat, vitamins, minerals and salt.

Malnutrition is a major pediatric problem and it is responsible for high

rates of morbidity and mortality.

Achar.,(2003)

Malnutrition is defined as the cellular imbalance between the

supply of nutrients and the body’s demand for them to ensure growth,

maintenance and specific functions.

WHO(2003)

Malnutrition continues to be a major health problem in the world

today, particularly in children under five years of age. The most extreme

form of malnutrition or protein energy malnutrition (PEM) are

kwashiorkor and marasmus.

Donna L. wong.,(2003)

Malnutrition is the most wide spread condition affecting the health

of children. Malnutrition makes more susceptible to infection, recovery is

slower and mortality is higher. Under nourished children do not grow to

their full potential of physical and mental abilities. Malnutrition in

Infancy and childhood leads to stunted growth.

Park.K., (2007)

3
 The effects of protein energy malnutrition on brain development

are restricts brain development, lowers concentration, limits child’s

cognitive development. The effects of protein energy malnutrition on

nervous system are tissue damage as well as tissue content in children,

growth arrest and reduction in the cell size, decrease in brain size,

functional impairment due to poor brain myelination.

Sreevani.R.,(2006)

India is home to 40 % of the world’s malnourished children and 35

percent of the developing world’s low birth weight infants. Every year

2.5 million children die in India, accounting for one in five deaths in the

world. More than half of these deaths could be prevented if children

were well nourished.

Ruel marie.Y., (2008)

Malnutrition continues to affect newborns and young children and

has been found to be the underlying cause of up to 50% of under five

deaths. About 55 million or one third of the world’s under weight

children under age five live in India with the worst affected states being

in Madhya Pradesh, Jharkand, Bihar, Gujarat, Orissa, Chattisgarh, Utter

Pradesh and Meghalaya.

Sinha kounteya K.S., (2008)

4
 Protein – energy malnutrition(PEM), refers to a class of clinical

conditions that may result from varying degree of protein lack and

energy inadequacy. Deficiency of proteins is usually not primary and

isolated. Almost always it appears to be due to poor intake of food as

such.

Malnutrition is a “Man – made disease” which often starts in the

‘womb’ and ends in the ‘tomb’. Broadly speaking, two major clinical

syndromes, kwashiorkor and nutritional marasmus, are widely

recognized. Kwashiorkor is said to result from gross deficiency of

proteins though energy deficiency is also present. Nutritional marasmus,

on the other hand, results from gross deficiency of energy though protein

deficiency also accompanies. Thus, it is clear that there is deficiency of

both protein and energy in both the states. The predominance of the

deficiency determines whether it is going to be kwashiorkor or

nutritional Marasmus. Many malnourished children show overlap in the

clinical picture, demonstrating features of both the deficiency states at a

time. It is often quite appropriate to label them a Marasmic-kwashiorkor.

Gupta suraj., (2006)

MALNUTRITION “ICE BERG”

That is what we see Just the tip of the vast problem in the hospital

5
 Severe

Moderate

Mild
Rest is hidden in the
Community – just like iceberg

All these form of PEM, in actually, constitute a continuous spectrum of

the manifestations of malnutrition. Growth failure and poor tissue repair

(due to protein lack) and energy shortage (due to calorie deficiency) are

common to all the forms.

Gupta suraj.,(2006)

In world-wide, 150 million children are malnourished , millions of

Indian children are equally deprived of their rights to survive, health,

nutrition, education and safe drinking water. It is reported that 63% of

them go to bed hungry and 53% suffer from chronic malnutrition.

UNICEF (2005)

In world-wide, 56.2 million children of aged 0-4 years are

malnourished with muscle wasting, 182.7 million children of aged 0-4

years are malnourished with stunted growth. The prevalence of

6
underweight children less than 5 years occupies 50% of the incidence in

India, the prevalence of stunned growth less than five years occupies

63% of incidence in India.

WHO (2006)

Infants and young children are more susceptible to PEMs

characteristic growth impairment because of their high energy and

protein needs and their vulnerability to infection. Globally, children who

are poorly nourished suffer up to 160 days of illness each year.

WHO (2007)

In the developing world, 146 million children under age five- 27

percent are under weight, the worst situation being in south Asia where

nearly half (46 percent) of children under age of five are under weight.

About 9.7 million children dying globally before they reach age of 5,

India accounts for 2.1 million. As many as 35% of world’s malnourished

children live in India.

UNICEF (2008)

At present 65% of children under 5 years of age are under weight.

This includes 47% moderate to severe cases, 18% severe malnutrition, of

these, 16% have moderate to severe wasting and 46% moderate to severe

stunting.

Park .K.,(2007)

7
 It was estimated that the under five population in India is 1,26,808

thousand in the year of 2007. Among that mortality rate was 72 per

thousand live births. Between the years 2000-2007 about 46% of under 5

children suffering from under weight (NCHS/WHO). In India for the

year 2003, 1-4 years age mortality was estimated to be 17.4 per 1000 live

births, in rural 19.2 per 1000 live birth and in urban 10.2 per 1000 live

births. The incidence of protein energy malnutrition (PEM) in India in

preschool age children is 1-2% because malnutrition can cause vicious

circle - infection contributing to malnutrition and malnutrition

contributing to infection, both acting synergistically. Impact of

malnutrition among children includes Weight loss, Growth faltering,

Immunity lowered, mucosal damage and frequent illness.

Park.K.,( 2000)

According to national monitoring bureau (2005) reported that

Protein energy malnutrition has been identified as a major health and

nutrition problem in India. It occurs particularly in children in first year

of life. It is characterized by low birth weight if the mother is

malnourished, poor growth in children and high level of mortality in

children between 12 and 24 months, and is estimated to be an underlying

cause in 30% of deaths among children under five years, as many as 3%

of children in developing world (230 million) have low height for their

8
age (stunting ) and 10%(50 million) children have low weight for height.

The rate of low height for age reflects the cumulative effects of under

nutrition and infections since birth or even before birth, high rates are

often suggestive of bad environmental conditions and/or early

malnutrition. On the other hand, a greater frequency of low weight for

height, often reflects current severe under nutrition or disease.

NEED FOR THE STUDY

Each year 27 million children are born in India. Around 10%

of them do not survive to 5 years of age. India contributes to 25% of over

10.6 million under five deaths occurring worldwide every year. In India

about 30% of the babies are born with risk of morbidity and mortality,

malnutrition is an important underlying cause of infant and child

mortality. About 50% of childhood deaths in India are attributable to

malnutrition. About 46% children aged under five years are stunted in

their growth. Contributing causes of malnutrition includes infections,

insufficient nutritional intake and inadequate home care practices.

Park.K., ( 2007)

Under nutrition contributes to 53% of the 9.7 million deaths of

children under five, each year in developing countries. This means that

one child dies in every six seconds from malnutrition and related causes.

9
 UNICEF(2009)

The database on Protein energy malnutrition in children under

five years in developing countries world wide has progressively fallen

from 42.6% in 1975 to 34.6% in 1995.However in south east Asian region

the fall in prevalence has not been rapid as the growth in population.

Currently, over three fourth (79%) of the worlds malnourished children

live in this region. 50% of child deaths in developing countries are related

to malnutrition potentiated effects and 83% of these deaths are

attributable to mild and moderate malnutrition.

WHO( 2005)

According to Government of Tamil nadu (2002) reported that in

India, the incidence of protein energy malnutrition among pre-school age

children is 1-2%, the greater majority of cases of protein energy

malnutrition, nearly 80% are the inter mediate ones, that is mild and

moderate cases which frequently go unrecognized. The problem exists in

all the states and that nutritional marasmus is more frequent than

kwashiorkor. Recent district level data on the prevalence of mild

malnutrition among 0 - 36 months old children in the year (2002) in

Coimbatore( 96.6), Cuddalore (90.5), Dharmapuri (90.5), Dindigul (94.1),

Erode (95.4), Kanniyakumari (97.8) Madurai (94.3) Nagapattinam (87.7),

10
Ramanathapuram (90.6), Salem (95.6), Sivagangai (93.1), Thanjavur

(91.1), Tiruchirapalli (93) Tirunelveli (91.1), Tiruvannamalai (89.6),

Toothukudi (94.5), Vellore (94), Villupuram (86) and Virudhunagar

(90.7).

IAP guidelines(2006) reported that in Tamil Nadu, the prevalence

of protein energy malnutrition is 12.6%. The four year multi centre

study, which began in 1999 involves 10,000 infants and children, includes

both longitudinal and cross sectional components and involves over a

quarter of a million individual Infant follow ups”. Protein energy

malnutrition affects every fourth child world – wide; 150 million (26.7%)

are underweight while 182 million (32.5%) are stunned. Geographically,

more that 70% of protein energy malnutrition children live in Asia, 26%

in Africa and 4% in Latin America and the Caribbean. Their plight may

well have begun even before birth with a malnourished mother.

About 60% of all deaths, occurring among children aged less than

five years(under five children) in developing countries could be

attributed to malnutrition. It has been estimated that nearly 50.6 million

under five children are malnourished and almost 90% of these children

are from developing countries.

11
 Ahmed Tahmeed Y.,(2008)

National institute of nutrition (2006) conducted a nutritional

survey carried out in 12 states of India reported that 60% of pre school

children were under weight, 62% were stunted and about 15% were

wasted.

Indian council for medical research (2004) had reported that only

5% of pre school children have normal body weight for age, 70% shows

severe degree of malnutrition, 41% suffer from mild malnutrition and 4%

from moderate malnutrition.

Nepal demographic and health survey (2001) had reported that

the percent prevalence for under weight and wasted children of under

five years of age are 48.3 and 10 percent. Around 50% of the under five

children are stunted. Children in rural areas are more likely to be stunted

(52%) than in urban area(37%)

The government of India introduces various nutritional programs

in its policy from time to time. Most of these are supplementary nutrition

programs are like mid-day meal program, Balwadi nutrition Program,

nutritional vitamin A prophylaxis program and nutritional anemia

control program. To be effective, the nutritional programs should be

comprehensive and emphasize upon improvement in general health and

12
quality of life of population, control of infections and effective

nutritional education besides provision of nutritional supplementation.

Ghai.O.P.,(2007)

Mukherjee Soma, et.al., (2008) conducted a study to assess the

prevalence of underweight, stunting, and thinness among rural school

children of Onda, Bankura Dt, India. A total of 454 (201 boys and 253

girls) Bengalee Hindu children aged 6-14 years were included in this

cross sectional study. The overall age and sex combined prevalence of

underweight, stunting, and thinness were 16.9%, 17.2% and 23.1%

respectively. Both sexes had similar rates of stunting (boys = 14.4%, girls

= 19.4%). The rates of underweight were high (20-29%) and medium (10-

19%), among boys (20.9%) and girls (13.8%).

V.G.Rao, et.al., (2005) conducted a study to asses the prevalence of

Protein energy malnutrition(PEM) in kundam block of Jabalpur district,

Madhya Pradesh revealed that the high prevalence of under nutrition in

terms of under weight(61.6%), stunting(51.6%) and wasting(32.9%) was

observed. Prevalence of clinical protein energy malnutrition (PEM) in the

form of marasmus was found in 6(0.6%) children, while Kwashiorkor

was not recorded.

Mother is an important primary care provider and therefore, her

education and access to information will help her, about care of her

infant. As children constitute the most important and vulnerable

segment of our population, mothers represent the most important health

13
worker as far as child health is concerned. Health education inputs for

mother should be strengthened. So that, she is capable of preventing and

identifying common childhood illness.

The mothers play a major role in promoting the health of below

6 years old children and child care activities. The child care includes

knowledge regarding prevention of child hood diseases, proper growth

and development and basic needs of the children. The mother is the key

person in the family to promote the child’s well being and to prevent the

diseases. The mother will get information regarding child care through

health care professional, family members, neighbours, and mass media.

Therefore the health care professionals must play a vital role to provide

education to the mothers regarding the services available in the society.

Gupta suraj

(2005)

During her clinical experience, the investigator found most of the

under-five children were under weight and found that their mothers are

unaware about the importance of nutrition in preventing infections. So,

this scenario insist the investigator to take up this study to create an

awareness regarding malnutrition and to alleviate malnutrition among

under five children.

STATEMENT OF THE PROBLEM

14
 A study to assess the effectiveness of planned teaching programme

regarding malnutrition in terms of knowledge and practice among

mothers with under five children in Ayyampatty at Trichy district.

OBJECTIVES

1. To assess the pretest knowledge and practice scores regarding

malnutrition among mothers with under five children.

2. To assess the posttest knowledge and practice scores regarding

malnutrition among mothers with under five children.

3. To compare pretest and post test knowledge scores regarding

malnutrition among mothers with under five children.

4. To compare pretest and post test practice scores regarding

malnutrition among mothers with under five children.

5. To correlate posttest knowledge and practice scores regarding

malnutrition among mothers with under five children.

6. To find association between post test knowledge scores with their

selected demographic variables among mothers with under five

children.

OPERATIONAL DEFINITIONS

EFFECTIVENESS:-

It means producing an intended result. In this study it

refers to determine the extend to which the Planned teaching

15
programme has achieved the desired effect in improving the knowledge

and practice regarding malnutrition among mothers with under five

children by using statistical measurement.

PLANNED TEACHING PROGRAMME:-

It is a systematically organized instruction developed to

help the people to learn. In this study it refers to a planned teaching

programme regarding definition, causes, risk factors, signs and

symptoms, management and prevention of malnutrition for 45 minutes

using posters to create an awareness on knowledge and practice

regarding Protein energy malnutrition (kwashiorkor and marasmus) to

mothers with under five children.

MALNUTRITION:-

Malnutrition is defined as any nutritional disorder caused by an

insufficient, unbalanced or excessive diet or impaired absorption or

assimilation of nutrients by the body. It is a state wherein adequate

nutrients are not delivered to the cells to provide the substrate for

optimal functioning.

Sreevani.R.,(2006)

In this study it refers to protein energy malnutrition(PEM) which

is a potentially fatal body depletion disorder. The term PEM, refers to a

class of clinical conditions that may result from varying degree of protein

16
lack and energy (calorie) inadequacy. The two main forms of Protein

energy malnutrition are kwashiorkor and marasmus.

Ghai.O.P.,(2007)

KNOWLEDGE:-

Information gained through education. In this study, it

refers to a verbal response of the mothers with under five children and

their level of understanding regarding malnutrition which is measured

by structured interview schedule and its scores.

PRACTICE:-

It means way of doing something. In this study it refers to

the knowledge on practice in terms of verbal response of the mothers

with under five children regarding malnutrition which is measured by

using structured interview schedule and its scores.

MOTHERS WITH UNDER FIVE CHILDREN:-

In this study, it refers to mothers who are having children with the

age group of 0-5 years.

HYPOTHESES

H1 - The mean post test knowledge score is significantly higher

than the mean pre test knowledge score.

H2 - The mean post test practice score is significantly higher than

the mean pre test practice score.

17
H3 - There will be significant correlation between post test

knowledge and practice scores regarding malnutrition.

H4 - There will be significant association between post test

knowledge scores of with their selected demographic

variables among mothers with under five children.

ASSUMPTION:-

• The mother may have less knowledge regarding malnutrition.

• Planned teaching programme may enhance the mothers

knowledge regarding Malnutrition.

• Adequate knowledge may help the mothers to protect their

children from malnutrition.

DELIMITATIONS:-

• The study is limited to 60 samples.

• The period of study is limited to 5 weeks only.

PROJECTED OUTCOME:-

The mothers will gain adequate knowledge through this planned

teaching programme which will improve their practice to prevent the

occurrence of malnutrition and its complications in children.

CONCEPTUAL FRAME WORK

18
 The conceptual frame work for this study was derived from

general system theory (Ludwig Von Bertlanffy, 1968). According to

general system theory, system is a set of interacting parts in a boundary

which makes the system work well to achieve its overall objectives.

General system theory is useful in breaking the whole process into

essential task to assure goal realization. The number of parts of the

systems totally dependent on what is needed to accomplish the goal or

purpose. The goal is necessary for any system to function. The aim of

the study is to improve the knowledge and practice regarding

malnutrition among mothers with under five children.

Bertlanffy explained that the system has four major concepts.

• Input

• Throughput

• Output

• Feedback

INPUT

According to theorist, input refers to the types of information that

enters into the system from the environment through its boundaries.

In this study, the input includes demographic variables such as

age, educational status, occupation, family size, type of family , number

19
of under five children, family monthly income, religion and assessing

the pretest knowledge and practice regarding malnutrition. Planned

teaching programme regarding malnutrition which includes definition,

contributing factors, definition of protein energy malnutrition, types,

meaning of kwashiorkor and marasmus, clinical features, dietary

management, complications and prevention of malnutrition by using

Posters.

THROUGHPUT

Throughput is the operational phase. It is the process that allows

the input to be transformed to mother on knowledge and practice

regarding malnutrition through Planned teaching programme .

OUTPUT

Out put is any information that leaves the system and enters to the

environment through system boundaries.

Assessing the post test knowledge and practice regarding

malnutrition. The Knowledge scores were interpreted as adequate,

moderately adequate and inadequate. The practice scores were

interpreted as inadequate, moderately adequate and adequate.

FEED BACK

Feedback is the result of knowledge of throughput. It allows the

system to monitor its internal function so that it can either increase or

restrict its inputs.

20
 In this study, it refers to reinforcement of the planned teaching

programme to mothers with under five children if their post test

knowledge score and practice score is inadequate.

21
 INPUT THROUGHPUT OUTPUT

Demographic PRE TEST POST TEST

Variables
Transformation Knowledge Adequate
• Age of Assess the knowledge and practice
regarding of knowledge
mother Malnutrition among mothers of under and knowledge Assess the
• Educational five children by using structured
on practice Moderately
status interview schedule and dichotomous
knowledge
structured interview schedule regarding Adequate
• Occupation
Malnutrition and
• Family size
through
• Type of practice
Planned teaching programme on Planned Inadequate
family Malnutrition among mothers of teaching regarding
• Number of under five children by using programme
under five Posters Malnutritio Adequate
¾ Definition
children ¾ Types n.
• Family ¾ Causes
Moderately
monthly ¾ Signs and symptoms
¾ Management Adequate
income ¾ Complications
Practice
• Religion ¾ Prevention
Inadequat
e

FEEDBACK

FIG : 1 MODIFIED LUDWIG VON BERTLANFFY SYSTEM THEORY (1968)

22
 CHAPTER - II

REVIEW OF LITERATURE

The review of literature for the present study has been organized

under the following headings.

PART - I

1. Overview of malnutrition.

PART - II

1. Studies related to Prevalence of malnutrition.

2. Studies related to risk factors of malnutrition.

3. Studies related to effects of malnutrition.

4. Interventional studies related to malnutrition.

PART-I

OVER VIEW OF MALNUTRITION

INTRODUCTION

Malnutrition is a major pediatric problem and it is responsible for

high rates of Mortality and Morbidity. In a vast majority of children,

mild to moderate malnutrition remains undetected due to lack of

awareness on the part of all concerned, medical and paramedical

23
personnel and parents. PEM is also referred to as protein energy

malnutrition. It develops in children and adults whose consumption of

protein and energy is insufficient to satisfy the body’s nutritional needs.

Protein energy malnutrition may also occur in persons who are unable

to absorb the vital nutrients or convert them to energy essential for

healthy tissue formation and organ function.

DEFINITIONS
MALNUTRITION

Malnutrition is defined as any nutritional disorder caused by an

insufficient, unbalanced or excessive diet or impaired absorption or

assimilation of nutrients by the body. It is a state wherein adequate

nutrients are not delivered to the cells to provide the substrate for

optimal functioning.

Sreevani.R.,(2006)

PROTEIN ENERGY MALNUTRITION

Protein energy malnutrition (PEM) is a potentially fatal body

depletion disorder. The term PEM, refers to a class of clinical conditions

that may result from varying degree of protein lack and energy (calorie)

inadequacy. The two main forms of Protein energy malnutrition are

kwashiorkor and marasmus.

Ghai.O.P.,(2007)

KWASHIORKOR

24
 It is also called as wet protein energy malnutrition, is a form of

PEM characterized primarily by protein deficiency. This condition

usually appears at the age of about 12 months when breast feeding is

discontinued, but it can develop at any time during a child’s formative

years.

MARASMUS

Primarily caused by energy deficiency, marasmus is

characterized by stunted growth and wasting of muscle and tissue.

PREVALENCE

PEM is the most widely prevalent form of malnutrition among

children.

PEM affects every fourth child world wide. About 150 million

(26.7%) are under weight while 182 million (32.5%) are stunted.

As many as 31% of children in the developing world (230 million)

have low height for age is stunting, and 10% (50 million) children have

low weight for height.

The incidence of PEM India in preschool age children is 1 – 2%.

The great majority of cases of PEM, nearly 80% are the inter mediate

ones, that is the mild and moderate cases which frequently go

unrecognized. The problem exists in all the states and that nutritional

marasmus is more frequent than Kwashiorkor.

Ghai.O.P.,(2007)

25
TYPES OF MALNUTRITION

• Primary malnutrition results from a diet that lacks sufficient

sources of protein and or energy.

• Secondary malnutrition is more common in United states, where it

usually occurs as a complication of AIDS, cancer, chronic kidney

failure, inflammatory disease that impair the body’s ability to

absorb or use nutrients or to compensate for nutrient losses.

CLASSIFICATION OF PEM
PEM is generally classified according to weight for age. chronic

malnutrition is classified according to Height for age and acute

malnutrition according to weight for Height.

a. Classification according to weight for age.

Weight for age is the most commonly used parameter to classify

nutritional status.

i) Gomez’s classification:

Gomez and his associates are credited with the first classification

of PEM which came in 1956. It has three degrees.

Weight for age (Harvard % of

Nutritional status
expected.
Normal >90
First degree PEM 75 – 90
2nd degree PEM 60 – 75

26
3rd degree PEM <60
All cases with edema to be included in third degree PEM irrespective of
weight for age.

Suggested by Bengoa in 1977.

Achar.,(2003)

ii). Jelliffe’s classification:

It has 4 degrees of PEM and it was proposed in 1965.

Weight for age (Harvard) %

Nutritional status
of expected.
Normal >90
First degree PEM 80 – 90
2nd degree PEM 70 – 80
3rd degree PEM 60 – 70
4th degree PEM <60
Achar.,(2003)

iii. Welcome trust or International classification:

It is a clinical classification suggested by welcome trust in 1970. It

is based on weight for age and the presence or absence of edema.

Weight for age (Boston) %

Edema Clinical type of PEM
of expected
60 – 80 + Kwashiorkor

27
60 – 80 - Under weight
<60 - Marasmus
<60 + Marasmic kwashiorkor
Ghai.O.P.,(2007)

iv. IAP classification: It is the most popular classification in India

proposed by IAP in 1972.

It has 4 grades of PEM.

Nutritional status Weight for age (% of expected)

Normal > 80
Grade I PEM 71 – 80
Grade II PEM 61 – 70
Grade III PEM 51 -60
Grade IV PEM <50

If the patient has oedema of nutritional origin, the letter k is

placed along with the grade of PEM in order to demote Kwashiorkor.

Ghai.O.P.,(2007)

b) Classification according to Height for age:

The calculation based on weight for age does not help to exclude
other obvious syndromes of short stature. Moreover, it does not
simply whether the PEM is of recent or past onset. Almost
simultaneously two workers, waterlow from London & Mc Laren from
Beinet, independently came out with the height and weight for height
concept to indicate stunting and wasting respectively in 1972. Height
for age is used to grade stunting. It indicates past or chronic PEM.
Height for age:

28
 Visweshwara
Height for age Water lows MC Laren’s
Rao’s
(% of expected) classification classification
classification
Normal >95 >93 >90
1st degree
90 – 95 80 – 93 80 – 90
Stunting/short
second degree 85 – 90 - -
Third degree
<85 <80 <80
stunting /dwarf
Elizabeth.K.E.,(2005)
C). Classification according to weight for Height: It is used to grade
wasting, wasting indicates recent or acute PEM.
Weight for Height (%
Waterlow’s Mc Laren’s
of expected)
Normal >90 >90
1st degree wasting or
80 – 90 85 – 90
mild wasting
2nd degree wasting or
70 – 80 75 – 85
moderate wasting
3rd degree wasting-
<70 <75
severe wasting
Elizabeth.K.E.,(2005)

d) WHO cut off assessment of PEM:

WHO(world health organization) cut off to estimate PEM in

population analysis is the mean value minus two SD(standard

deviation). As adopted from wasterlow’s classification, the combined

position of two indicators, ie weight for height and height for age

29
distinguishes b/f wasting caused by acute PEM & stunting caused by

chronic PEM.

Cut off H/A(Height for W/H (weight H/A & W/H

age) for height)

> Mean – 250 Normal Normal Normal

<mean-250 Stunted Wasted Stunted &
wasted
Elizabeth.K.E.,(2005)

e). SD(standard deviation score) / Z score: The SD score is used in

population studies. Percentage of the median is calculated first to

interpret data at population level & Z score is than calculated.

Percentage of the median = Measured individual value x 100

Reference median
SD/Z score = Measured individual value – reference median
SD of the reference median.
Elizabeth.K.E.,(2005)
ETIOLOGY

• Poverty

• Low birth weight

• Infections

• Population growth

30
 • Feeding habits

• High pressure advertising of baby foods

• Social factors like wars, natural disasters such as floods,

earthquakes, droughts.

Ghai.O.P.,(2007)

CLINICAL MANIFESTATIONS
Mild to moderate malnutrition

• Growth lag is more pronounced in weight than height.

• Stunted height.

• Thin limbs

• Unduly large head

• Buttocks are flattened with wrinkling of skin over the front of

thighs.

• Scapula look winged.

• Thin abdominal wall and therefore distended abdomen.

Marasmus:

• Highest incidence seen in Infancy.

• Gross wasting of muscle and subcutaneous tissues resulting in

emaciation.

• Marked stunting and no edema.

• Body weight is less than 60% of the expected weight for age.

• Depletion of fat in the adipose tissue.

31
 • Muscles atrophied.

• Loose folds of skin are prominent over the glutei and inner side

of thigh.

• Buccal pad of fat is presented till the malnutrition become

extreme.

• Skin appears dry, scaly, and inelastic.

• Hair is hypo pigmented.

• Mid arm circumference is reduced.

• Shows voracious appetite.

Kwashiorkor

• Markedly retarded growth, psychomotor changes

• Edema of dependent parts.

• Muscles of the upper limb are wasted but the lower extremities

appear swollen.

• Muscle wasting is marked by well preserved subcutaneous tissue

and edema.

• Mental changes.

• Child becomes lethargic, listless and apathetic.

• Showed little interest in the environment and does not play with

toys.

Other manifestations:

32
 • Hepatomegaly.

• Hair changes – appears reddish brown.

• Skin changes – shows erythematic, followed by hyper

pigmentation, flaky paint dermatosis, Lesions are more marked

on extremities.

• Petechiae or ecchymosis appear in severe cases.

• Skin may become dry, inelastic, mosaic in appearance.

• Follicular keratosis, sores and scabies may also be observed.

• Infections.

Children often suffer from recurrent episodes of diarrhea,

respiratory and skin infections.
Ghai.O.P.,(2007)
MANAGEMENT
Severely malnourished children have to be shielded (treated or
presented) against.
S - Sugar deficiency (ie) hypoglycemia.
H - Hypothermia
I - Infection and septic shock
EL - Electrolyte imbalance.
DE - Dehydration
D - Deficiencies of Iron, Vitamins and other micronutrients.
8-36 Wks
Sequential approach to management of severe PEM.
6-8 Wks

2-6 Wks

Day 3-7
Follow up
Day1 - 2 33
Discharge
Catch up
Growth &
Prevent relapse
Dietary therapy:

Malnourished children need BEST dietary management.

B - Beginning of feeding.

E - Energy dense feeding.

S - Stimulation

T - Transfer to home diet.

Ghai.O.P.,(2007)

Nutritional therapy
Mild malnutrition

ƒ Dietary advice

ƒ Parents are advised to increase the food intake of child by all

available measures.

ƒ Adequate amount of calories and protein in the diet.

ƒ Child should be kept under surveillance of growth card.

Moderate malnutrition

ƒ Home treatment

Severe malnutrition

ƒ Treated in hospital

34
 Gupta Piyush(2003)

PREVENTION OF MALNUTRITION
Prevention at family level
• Exclusive breast feeding of Infants for 1st 6 months.

• Nutritional supplement should be introduced in diet of Infants

after 6 months of age.

• Vaccine preventable diseases should be prevented by appropriate

and adequate immunizations.

• Iatrogenic restriction of feeding in fevers and diarrhea should be

discouraged.

Prevention at community level

• Early detection of malnutrition and intervention.

• Integrated health package.

• Nutrition education.

• Vigorous promotion of family planning.

• Income generation activities.

• Promotion of education and literacy in the community.

• Technological measures.

Prevention at National level

• Nutrition supplementation

• Nutritional surveillance.

• Nutritional planning.

Ghai.O.P.,(2007)

35
COMPLICATIONS

ƒ Superadded infections- Septicemia, Pneumonia, Urinary tract

infection, Tuberculosis

ƒ Dehydration and dyselectrolytemia- Accompany diarrhea often

with lactose intolerance

ƒ Hydrothermia- <35’C may prove fatal (SIDS)

ƒ Congestive cardiac failure

ƒ Anemia

ƒ Bleeding

ƒ Disseminated intravascular coagulation

ƒ SIDS Gupta suraj (2004)

PART-II

1. STUDIES RELATED TO PREVALENCE OF MALNUTRITION

Kaushic Bose, et.al., (2008) conducted a study to assess the

prevalenc e of underweight, stunting and thinness by age and sex

among under five children in Midnapore, West Bengal. According to

WHO classification of severity of malnutrition among children, the

overall age and sex combined prevalence of underweight, stunting, and

thinness were 16.9%, 17.2% and 23.1% respectively. Among boys, the

underweight was high (20.9%) while thinness was very high (27.8%). In

36
case of girls, underweight was medium (13.8%) while thinness was very

high (19.4%). Both sexes had low (20%) rates of stunting.

Maria.M, et.al., (2008) conducted a study to determine the

prevalence of malnutrition and risk factors in children aged 0 – 10 years

attending outpatient clinics in Manaus, Brazil. Factors associated with

undernutrition were analyzed using a random effects logistic

regression. A cross sectional epidemiological study of a population of

347 children revealed that the overall prevalence of underweight,

stunting, and wasting were 18.1, 15.5 and 10.7% respectively, with

reference to CDC growth curves and 14.3, 17.3 and 4.4% respectively,

with reference to NCHS growth curves. The over all prevalence of

wasting was statistical higher according to CDC(centre for disease

control) reference than that estimated using the NCHS(National center

for health statistics) reference (P=0.02).

O. Abidoye, et.al.,(2007) conducted a study of prevalence of

Protein energy malnutrition among 0-5 years in rural Benue State,

Nigeria. Three hundred and seventy pre-school children (181 males and

189 females) were studied in order to document the prevalence of

protein energy malnutrition and factors that militate it. The prevalence

of protein energy malnutrition among children was revealed to be

41.6%(154). One hundred and fifty one (40.8%) of them were found to

have weight-for-height below -2SD indicating level of stunting among

37
children. Most malnourished children belonged to mothers who were

illiterate 97(54.8%) when viewed from the mothers educational

perspective. The study also showed the following factors that were

statistically significant with PEM : educational status of mothers

(p<0.05), marital status (p<0.05) of mothers, occupational status of

mothers (p=0.000), parental income per annum (p=0.000), length of

breast feeding (p=0.000), water supply and regularity, type of housing

and toilet facilities.

Biswas.S, et.al.,(2007) conducted a study investigated age and sex

variations in height and weight, levels of stunting, under weight and

wasting among 533 (254 boys and 279 girls) 3-5 year old children of

Bengalee ethnicity of Nadia district, West Bengal, India. Height for age,

weight for age and weight for height <-2 z-scores were used to evaluate

stunting, under weight and wasting respectively following NCHS

guidelines. Results revealed that boys were significantly heavier than

girls at age 3 years, The overall (age and sex combined) rates of

stunting, under weight and wasting were 23.9%, 31.0% and 9.4%

respectively. The rate of under weight and wasting was higher among

girls(under weight= 35.1%, wasting=12.2%) compared with boys (under

weight=26.5%, wasting=6.3%). Based on the WHO classification of

severity of malnutrition, the over all prevalence of under weight was

38
very high (>or=30%). The prevalence rates of stunting (20-29%) and

wasting (5-9%) were medium.

Phengxay .M, et.al., (2007) conducted a study to determine the

prevalence and risk factors associated with Protein energy malnutrition

(PEM) in children under 5 years of age in Luangprabang province,

Laos. Anthropometric measurements of 798 children were done.

Mothers were also interviewed with semi-structured questionnaire.

There was a high prevalence of stunting, underweight, and wasting,

that is ,54.6%, 35%, and 6% respectively. It was also noted that children

aged 12-23 months and khmu ethnic children had a high prevalence of

stunting(65% and 66%) and under weight (45% and 40%), respectively.

Socioeconomic-demographic factors, low maternal education, poor

nutrition knowledge for mother and feeding practices for sick children

are affecting children’s health regarding stunting and under weight.

Bose.K, et.al.,(2007) conducted a study on stunting, under

weight and wasting among ICDS scheme children aged 3-5 years of

Bengali ethnicity at 11 ICDS centers, West Bengal, India. Height for age

weight for age, weight for height, <-2 Z-scores were used to evaluate

stunting, under weight, and wasting. The results revealed that boys

were significantly heavier than girls at age of 3 years. The rate of under

weight and wasting was higher among girls(under weight=35.1%,

39
wasting=12.2%) compared with boys (under weight=26.5%,

wasting=6.3%). The study concluded that the nutritional status of the

subject is unsatisfactory.

Tripathi.M.S, et.al., (2006) conducted a study to assess the

nutritional status of pre schooler (2-6 years) in slum areas of Udaipur

city, Rajesthan. From the data collected and observations recorded was

observed that majority of the subjects were from nuclear family with

monthly income of less than Rs. 1500.Developmental pattern of these

subjects indicated that the height with age of both male and female

subjects increased, however, their body weight did not increase. More

than 50% of these preschoolers showed symptoms of Protein energy

malnutrition and anemia. Classification for degree of malnutrition as

per IAP showed that the majority of these subjects(66%) were under

weight (Grade I and II). Waterlow’s classification revealed that

majority of these pre schoolers were wasted (30%) or wasted and

stunted (42%).

Chakraborthy.S, et.al., (2006) conducted a study of Protein

energy malnutrition(PEM) in children (0 to 6 year) in a rural population

of Jhansi district (U.P). The multistage sampling procedure was

adopted to select approximately two hundred children (0-6 year) for the

study. The results showed that the overall occurrence of PEM in under 6

40
children was observed to be 67%, however it was found to be

significantly higher (80.9%) in the age group of 1-3 years as compared to

other groups. The overall PEM prevalence was seen to be higher among

the children of illiterate mothers whereas grade II,III,IV PEM was

higher amongst children of mothers having primary education. They

concluded that the extent of malnutrition can be encountered by

educating the parents with respect to basic nutritional requirements of

their children and encouraging them to consume locally available low

cost nutritious foods.

Swami.H.M, et.al., (2006) conducted a study to asses the

prevalence of Protein energy malnutrition (PEM) in urban, rural, and

slum areas of Chandigarh was found to be about 42% while 22.7%,

14.5%, and 0.7% children had grade I,II,III,IV PEM respectively. The

prevalence of PEM was significantly higher among females(47.6%), in 1-

3 years age group(53.80%), in slum area(67%) and children of labour

class(60.5%).

Bhutta Z.A, et.al., (2006) conducted a study to assess the micro

nutrient needs of malnourished children in Karachi estimated 32% (178

million) of children under 5 years of age were stunted. The

corresponding global estimate of wasting is 10% (55 million children) of

which 3.5% (19 million children) are severely wasted. It is also

41
estimated that nearly 11% of all children under 5 years of age die due to

four micronutrient deficiencies (Vit. A, zinc, Iron, Iodine)

Ishag Adam, et.al., (2005) conducted a study to assess the

prevalence, types and risk factors for malnutrition in displaced

Sudanese children. The nutritional status of 327 under five children

living in Mayoo displacement camp was assessed . Risk factors for

protein energy malnutrition(PEM) were also studied. According to

WHO criteria, a total of 186(56.1%) children had malnutrition, Of these

101(30.1%), 43(13.1%) and 42(12.8%) were mildly, moderately and

severely malnourished respectively. According to Welcome

classification, the commonest type of malnutrition was found to be

under weight (38.2%), marasmus, kwashiorkor were detected in (6.4%)

and (0.9%) respectively, there was no case of marasmic kwashiorkor in

the studied population.

Shaaban S.Y, et.al., (2005) conducted a cross sectional study to

assess the nutritional status of children aged 6to 36 months in Sharkia

Government aiming for early detection of malnourished cases in Cairo,

Egypt. Anthropometric measurements such as height, weight, mid-arm,

head circumference and skin fold thickness were assessed. The study

showed that all anthropometric measurements were lower than normal

in under weight and border line subjects. The prevalence rates of

wasting, stunting, and under weight were 15%, 24.4%, and 15.4% in

42
the studied infants in Sharkia Governorate, respectively. The study

concluded that there is a high prevalence of wasting, stunting and

under weight among infants and children of the studied sample in

Shakira Governerate explained by the low economic status, unbalanced

diet.

Miguel.A, et.al.,(2005) performed a cross sectional, community

based survey, supplemented by interviews with community leaders,

Mexico, to examine the prevalence and predictors of child malnutrition.

The prevalence rates of stunting, wasting, and underweight were

54.1%, 2.9% and 20.3% respectively in 2666 children aged younger than

5 years. Stunting was associated with increased ethnicity, poverty,

region of residence, Intra community division.

Berkley.J, et.al., (2005) conducted a Cohort study on assessment

of servere malnutrition among hospitalized in rural kenya with the

samples of 8190 revealed that, 16% (1282) of admitted children had

severe wasting (weight for height Z <or = -3) (n=756), Kwashiorkor (n-

778) or both. Clinical features of malnutrition were significantly more

common among children with Mid upper arm circumference (MUAC)

less than or equal to 11.5 cm than among those with weight for height Z

score ( WHZ) less then or equal to -3.

Hein N.N, et.al.,(2005) conducted a study to assess the nutritional

status and characteristics related to malnutrition in children less than 5

43
years of age Nghean, Vietnam with 650 samples revealed that 193 were

underweight 269 (44.3%) were stunting and 72 (11.9%) were wasting.

Region of residence, mothers level of education and occupation,

household size, number of children in the family, weight at birth and

duration of exclusive breast feeding were found to be significantly

related to malnutrition.

Harishankar, et.al., (2004) conducted study on nutritional status

of children under 6 years of age at Allahabad, India. The study aimed to

assess the magnitude of malnutrition among children less than 6 years

of age. The results revealed that amongst normal grade of nutrition,

majority 83 (78.30%) of children were in the age group 25-36 months (2-

3 years). The maximum overall prevalence of malnutrition was

recorded 33(32.02%) in age group 13-24 months. The maximum overall

prevalence of malnutrition was found to be in age 37-72 months.

Majority of children having grade II malnutrition were in age group 13-

24 months while maximum grade III malnutrition was recorded in age

groups 0-12 months. Maximum grade IV malnutrition children were

found to be 2 (1.88%) in age group 25-36 months followed by 1(0.65%)

in age group 37-72 months.

Mustafa Mabyou, et.al.,(2004) conducted a study on prevalence,

types, risk factors for malnutrition. According to WHO criteria, a total

of 186 (56.1%), Children had malnutrition, of these 101 (30.15), 43

44
(13.1%) and 42 (12.8%) were mildly, moderately and severely

malnourished respectively. According to welcome classification, the

commonest type of malnutrition was found to underweight (38.2%)

marasmus, kwashiorkor were detected in (6.4%) and 0.9%) respectively,

there was no case of marasmic Kwashiorkor in the studied population.

Khokhar Anita, et.al., (2000) conducted a study of malnutrition

among children aged 6 months to 2 years from a resettlement colony of

Delhi. Nutritional status of 1661 children aged 6 months to 2 years who

attended the well baby clinic of UHC (Urban Health centre) Gokulpuri,

Delhi was studied. 60.7% of them were malnourished. Undesirable

practices of discarding the colostrum, not exclusively breast feeding the

child till at least 4 months of age, delayed weaning, dilution of top milk,

use of bottle and nipple for feeding the children are still widely

prevalent.

2. STUDIES RELATED TO RISK FACTORS OF

MALNUTRITION

Colombatti Raffaella, et.al., (2008) conducted a study to

determine the extent of malnutrition and the risk factors for severe

malnutrition in Guinea Bissau. The results showed that 86.4% used

water from unprotected wells, 97.3% did not have a bath room at home,

78.2% lived in mud house. Weight-for-age was <-2SD in 23.0% of

45
children and <- 3SD in 10.3%; thirty-seven children(1.4%) were severely

malnourished and admitted for day care. All recovered with weight

gain of 4.45g/kg per d, none died or relapsed after 1 year. Severely

malnourished children were mainly infants, part of large families and

had illiterate mothers.

Mahgoub S.E, et.al., (2006) conducted a study to evaluate the

level of malnutrition and the impact of some socio-economic and

demographic factors of households on the nutritional status of children

under 3 years of age in Botswana. Factors included are number of

children under 3 years of age in the family, occupation of the parents,

marital status, family income, parental education, maternal nutritional

knowledge, residence location (urban or rural), gender, and breast

feeding practices. Four hundred households and mothers of children

under three, representing the 23 Health regions of Botswana,

participated in the study. The results show that the level of wasting,

stunting, and under weight in children under three years of age was

5.5%, 38.7%, and 15.6% respectively. Malnutrition was significantly

higher (p<0.01) among boys than among girls.

Kurup P.J, et.al., (2004) conducted a study to determine the risk

factors of protein energy malnutrition(PEM) among 0-5 year old

children in south batinah region, Oman. The median birth order among

PEM case was significantly higher compared to the children without

46
PEM (Mann whitney test ; p=0.029). Using multivariate logistic

regression technique, they found that low birth weight, higher birth

order and sibling with history of under weight were significant

predictors of PEM. They concluded that it is possible to identify

children with high-risk of PEM using information on birth weight, birth

order and history of PEM in sibling.

Rikimaru.T, et.al.,(2003) conducted study on risk factors for the

prevalence of malnutrition among urban African children in Ghana. A

case control study was completed at the princes Marie hours Hospital

among 170 children aged 8 – 36 months, normal nutritional status

babies under weight or severely malnourished babies were recruited at

the hospital. The severely malnourished children were more likely to

have young mothers (P<0.05) and low weight at birth (P<0.05). The

under weight children were also observed to have low birth weight

(P<0.05). The severely malnourished group showed reduced feeding

frequency (P<0.01) less access to breast feeding (P<0.01) and less

support by both parents (P<0.05). It is concluded that low birth weight

is one of the important risk factors for the prevalence of underweight

and severe malnutrition and that lack of mothers education is also a risk

factor for the prevalence of severe malnutrition in the urban children in

Ghana.

47
 Thankappan. K.R, et.al.,(2001) conducted a study for assessing

the risk factors factors for child malnutrition in rural Kerala, India.

Studies indicate that 42–57 per cent of all child deaths in developing

countries are due to the potentiating effects of malnutrition on

infectious disease, of which over three-quarters can be attributed to

mild-to-moderate malnutrition. Risk factors for underweight status in

children under 3 years of age were assessed in Kerala, India. Mothers of

34 children weighing below –1 SD for their age and 59 children

weighing more than 1 SD for their age, were interviewed for

information about maternal health, child feeding patterns, and sibling

gender and age data. Statistical analysis showed that current maternal

weight (odds ratio = 8.25, p = 0.0009), current maternal body mass index

(OR = 4.55, p = 0.03), infant birth weight (OR = 4.87, p = 0.01) and

excessive maternal vomiting in pregnancy (OR = 4.48, p = 0.04) were

significant risk factors for current child underweight status.

3. STUDIES RELATED TO THE EFFECTS OF MALNUTRITION

Psoter.w, et.al.,(2008) conducted a retrospective cohort study to

determine the effects of early childhood Protein energy

malnutrition(EC-PEM) and current nutritional status as defined by

anthropometric measures on n the exfoliation and eruption patterns of

teeth among adolescents in New York. Oral clinical examinations were

conducted using WHO diagnostic criteria. Anthropometric records

48
(weight-for-age) from Haitian Foundation computerized data base on

children from birth through 5- years old were utilized. Current heights

and weights were ascertained. The result showed that both a delayed

exfoliation of primary teeth and a delayed eruption of permanent teeth

were associated with EC-PEM and current stunting in adolescence. The

overall interpretation of the models is that malnutrition beginning in

the earliest years and extending throughout childhood influences the

exfoliation and eruption of teeth.

Nieto Jo- Cornelio, et.al.,(2007) conducted a study to assess the

effects of Protein energy malnutrition on the central nervous system in

children. Children suffer most from the shortage of nutrients because at

early ages, malnutrition has an important impact on the central nervous

system. The changes that malnutrition triggers in the brain of these

children will have severe consequences on their development and

learning abilities. The lack of environmental stimulation associated with

malnutrition worsens the damage to the central nervous system. They

used computerized tomography brain scans and magnetic resonance

imaging in children suffering from malnutrition show images that are

compatible with cerebral atrophy. The study concluded that Protein

energy malnutrition produces notable morphological changes in the

brains of children in developing world. These changes damage the

49
intellectual potential of those who survive and limit their capacity to

become part of the competitive world.

Kar Bhoomika R.B and Chandramouli B., (2008) conducted a

study on Cognitive development in children with chronic protein

energy malnutrition. The present study examined the effect of stunted

growth on the rate of development of cognitive processes using

neuropsychological measures. Twenty children identified as

malnourished and twenty as adequately nourished in the age groups of

5–7 years and 8–10 years were examined. NIMHANS

neuropsychological battery for children sensitive to the effects of brain

dysfunction and age related improvement was employed. The battery

consisted of tests of motor speed, attention, visuo-spatial ability,

executive functions, comprehension and learning and memory.

Malnourished children performed poor on tests of attention, working

memory, learning and memory and visuo- spatial ability except on the

test of motor speed and coordination. Chronic protein energy

malnutrition (stunting) affects the ongoing development of higher

cognitive processes during childhood years rather than merely showing

a generalized cognitive impairment.

Sesso.R., (2004) conducted a cross sectional study to assess the

association of malnutrition with increased blood pressure in childhood

in Brazil. Blood pressure of 72 children older than 2 years were

50
assessed. The results showed that a greater percentage of children in the

malnourished and recovered groups had increased systolic and

diastolic BP after adjusting for age, sex and height, compared to the

controls(29,20 and 2% respectively, p<0.001). Mean diastolic BP,

adjusted for age, sex, race, weight, height, and birth order was

significantly increased in malnourished and recovered children

compared to controls. BP is increased in malnourished children and in

those who recovered from malnutrition after an average period of 6

years. Malnutrition occurring during childhood may represent a risk

factor for increased BP later in life.

4. INTERVENTIONAL STUDIES RELATED TO MALNUTRITION

Sudha.R., (2008) conducted an experimental study to assess the

effectiveness of structured teaching programme on malnutrition to

mothers of malnourished under five children in a village at

Kancheepuram district, Tamilnadu. The simple random sampling

method (lottery method) was adopted in order to select the ICDS centre

for selection of samples for experimental and control group. Totally 60

malnourished under five children and their mothers were selected, 30

for each group. The results showed that the prevalence of first degree

malnutrition in experimental and control group was 20(66.7%) and

16(53.3%) respectively. Second degree malnutrition was present equally

51
in both groups [seven(23.3%)]. The prevalence of third degree

malnutrition in experimental and control group were three (10%) and

seven (23.3%) respectively. Regarding knowledge, in the experimental

group, in pre test, four (13.3%) mothers only had adequate knowledge.

In post test, 22(73.3%) mothers had adequate knowledge. In the control

group, 18(60%) mothers had inadequate knowledge in pre test and

15(50%) mothers had inadequate in post test. The paired T test value

was 16.51 and it was significant at P 0.001 level. This revealed that the

structured teaching programme had improved the knowledge.

Raffaella colombatti, et.al.,(2008) conducted a multidisciplinary

intervention to reduce protein energy malnutrition among children in

rural areas was piloted in 3 provinces of the Islamic Republic of Iran.

Based on an initial situation analysis, a range of interventions were

implemented through local non governmental organizations, including

nutrition, health and literacy education for mothers, improved growth

monitoring and fostering rural co-operativeness and income generation

schemes. Malnutrition before and after intervention were assessed

using anthropometric measurements of random samples of children

aged 6 – 35 mothers in control and intervention areas. Three years into

the intervention, all the indicators of malnutrition had consistently

decreased in all intervention areas and the prevalence of under weight

and stunting was significantly lower.

52
 Garcia garro A.J, et,al.,(2007) conducted a survey to assess the

impact in the management with soya of 1-4 years old suffering from

malnutrition in Mexico. A sample of 83 under nourished children from

1-4 years old was taken and 3 experimental and 3 control groups were

formed. They found that the experimental group from 1to 2 years old

increased in weight and size by over 80% whilst the weight and size

gain in other groups was significant, but not as much as expected.

Sheila Isanaka B.A, et.al., (2006) assessed the effect of a 3 month

distribution of Ready to use therapeutic foods (RUTF) to malnourished

children in a region with traditional high levels of child malnutrition

and evaluated the effectiveness of distribution of RUTF delivered at the

village rather than the Individual level. Children in six intervention

villages received a monthly distribution of 1 packet per day of Ready to

use therapeutic foods (500 calories/day) from August to Sep.2006, with

8 months of follow up. The researchers found a significant difference in

the rate of change in measurements of wasting over the 8 month

surveillance period, with the intervention resulting in a 36% reduction

in the incidence of wasting and a 58% reduction in the incidence of

severe wasting.

Bhargava, et.al., (2006) conducted a nutritional intervention in

the package form of medical care, supplementary feeding, and

education was offered to 82 severely malnourished children in two

53
villages of rural Health training centre, Naila Jaipur for 8 months.

Normal weight was restored in 6.09 percent of children respective to

their age, 18.3% improved to grade I and 40.2 percent to grade II, 25.3%

remained refractory. The maximum weight gain was 2.5Kg and 3.02 kg

in grade III and grade IV malnourished children respectively. On an

average it took 140.5 days for grade III and 180 days for grade IV

severly malnourished children to return to road to health with respect

to their weight for age.

Banerjee B and Mandal. O., (2005) conducted an intervention

study in malnutrition among infants in tribal community of West

Bengal. The objective is to study the magnitude of the problem and to

assess the impact of nutrition advice given to mothers of infants, on

their nutritional status of their children suffering from severe degree of

malnutrition. 300 infants selected from the infant register of 6 sub

centers by systemic random sampling, the sub centers in turn being

selected by simple random sampling using lottery method. For

statistical analysis z test of proportion and paired T test was used. The

prevalence of malnutrition was 50.67%. Malnutrition was more

common in females than males but this was not significant (p>0.05).

Grade I malnutrition was more common among males, while grade II

and grade III were more in females. None were suffering from grade IV

malnutrition. Prevalence also increased with increasing age and it was

significantly more (p<0.001) among infants > 6 months of age than

54
among those <6 months. Post intervention follow up after nutrition

education of mothers showed an average increase of 80.81 grams of the

weight of their severely malnourished infants, over the expected weight

gain. Nutrition education of mothers of infants has a positive effect on

the nutritional status of their children.

Rasania S. K, et. al., (2005) conducted a community based

intervention study in Jamboni block in Midnapore district of west

Bengal, the block mainly consisting of tribal population. 300 Infants

were taken as the sample. Out of the 20 subcentres situated in this

block, 6 were selected by simple random sampling using lottery

method. Prevalence of malnutrition was 50.67%. Malnutrition was

observed to be more common among females than male. The

prevalence rate of malnutrition among 3- 5 months old Infants was

lower than that among 0 – 2 months age group. Though pre and post

intervention dietary assessments were made by oral questionnaire

method, a definite improvement in the dietary intake of the 13 grade III

malnourished infants was observed during the follow up visit made

after nutritional advice given to the mothers.

Hiroshi Ushijima M.D, et.al., (2003) conducted a comprehensive

community based intervention carried out for 352 children born after

July 2001 and their mothers or care givers in half of the baseline survey

villages by the end of 2003. The intervention included participatory

55
intervention, community nutrition education, child growth monitoring

and distributing thiamine to new mothers just before or after delivery.

The change in prevalence of under weight children aged 6 – 17 months

prior to and after the intervention in Infants aged 6 – 11 months and

39.0% before and 26.4% after the intervention in young children aged 12

– 17 months. It is highlighted that population nutritional intervention

can produce better results with participation at a community level.

56
 CHAPTER - III

METHODOLOGY

This chapter deals with the methodology adopted for the study. It

includes research approach, research design, setting, population,

sample, criteria for sample selection, sample size and sampling

technique, scoring procedure, pilot study, method of data collection and

plan for data analysis.

RESEARCH APPROACH :-

The evaluative research approach was used to asses the

effectiveness of Planned teaching programme regarding malnutrition in

terms of knowledge and practice among mothers with under five

children.

RESEARCH DESIGN :-

The design for this study was pre experimental design i.e., one

group pre test and post test design.

Schematic Representation

Group I Pretest Intervention Posttest

I O1 X O2

57
 The symbol used
Group I- Mothers with under five children

O1 - Collection of demographic data, assess pretest level of knowledge

and Practice scores regarding malnutrition.

X - Implementing Planned teaching programme regarding

malnutrition.

O2 - Assess posttest level of knowledge and Practice scores regarding

malnutrition.

SETTING OF THE STUDY :-

The study was conducted in rural area in Ayyampatty which

comes under Thuvakudi Municipality at Trichy. The total population of
the area is 2550, out of that 102 mothers are having below 5 years old
children. The area consists of 7 streets. Most of the people are coolie
workers.

POPULATION :-

The Population of the study were mothers with under five children.

SAMPLE :-

The sample of the study was mothers who are residing in

Ayyampatty having children with age group of 0-5 years.

CRITERIA FOR SELECTION OF THE SAMPLE :-

Inclusion Criteria :-

58
 • Mothers who are available at the time of data collection.

• Mothers who can understand and speak Tamil.

Exclusion Criteria :-

• Mothers who are sick.

• Mothers who are not willing to participate in the study.

• Mothers who are having sick children.

SAMPLE SIZE :-

The samples selected for the study consists of 60 mothers with

under five children.

Sampling technique :-

Purposive sampling technique was used to select the samples for

this study.

INSTRUMENT :-

Instrument consists of two parts

PART I :-

59
 It deals with demographic variables such as age, educational status,

occupation, family size, type of family, number of under five children,

family monthly income, religion of mothers with under five children.

PART II :-

It Consists of structured interview schedule to assess the

knowledge regarding malnutrition among mothers with under five

children which consists of 25 multiple choice questions with four

options among which one(1) is the correct response.

PART III

Structured interview schedule to asses the practice regarding

malnutrition among mothers with under five children. It consists of 10

dichotomous questions with alternative response of ‘Yes’ or ‘No’.

SCORING PROCEDURE AND SCORE INTERPRETATION :-

Part - II

Structured interview schedule was used to assess the knowledge

regarding malnutrition among mothers with under five children. It

consists of 25 multiple choice questions, each correct answer was given

a score of ‘one’ and wrong answer was scored as ‘zero’. The total score

on knowledge was 25. The scores were interpreted as below:

60
 Level of knowledge Score Percentage (%)

Adequate 18-25 (69-100)

Moderately adequate 10-17 (37-68)

Inadequate 0-9 (0-36)

Structured interview schedule was used to assess the practice

regarding malnutrition. It consists of 15 dichotomous questions, each

correct answer was given a score of ’one’ and wrong answer was scored

as ‘zero’. The total score was 15. The scores were interpreted as below:

Level of Practice Score Percentage (%)

Adequate 10-15 (67-100)

Moderately adequate 5-10 (34-66)

Inadequate 0-5 (0-33)

VALIDITY AND RELIABILITY OF THE TOOL :-

Validity :-

The validity of the tool was established in consultation with guide

and four experts in the field of child health nursing and one in the field

of Pediatric medicine. The tool was modified according to the

suggestions and recommendations given by them.

Reliability :-

The reliability of the structured interview schedule on knowledge

and practice regarding malnutrition was assessed by testing the

61
stability and internal consistency. Stability was assessed by test re test

method, where Karl Pearson correlation of coefficient formula

was used. The value was found to be reliable (r=0.92). Internal

consistency was assessed by using split half technique where spearman

Brown prophecy formula was used. The value was found to be reliable

(R=0.89). Hence the structured interview schedule was found to be

reliable.

The reliability of the practice was computed by test-retest method

where Karl pearson correlation of co-efficient formula was used and the

value was found to be reliable(r=0.91). Internal consistency was

assessed by split half method using spearman’s Brown prophecy

formula. The value was found to be reliable (R=0.85). Hence the

structured dichotomous interview schedule for practice was found to be

reliable.

PILOT STUDY :-

The pilot study was conducted on 6 samples for a period of 7

days in Manakadavu, Dharapuram. The samples were selected by using

purposive sampling method. On the first day, demographic variables

were collected from 6 mothers with under five children and pretest was

conducted to assess the knowledge and practice using structured

62
interview schedule. On the same day after the pre test, group teaching

was given regarding malnutrition to the mothers of under five children

by using posters for 45 minutes. On the 7th day of teaching, post test

was conducted using same structured interview schedule. The data

were analyzed and findings of the pilot study showed that mean post

test knowledge (14) and practice(11.3) score was higher than the mean

pretest knowledge score (7.3) and practice score(7) and found that it is

feasible and practicable to conduct the main study.

PROCEDURE FOR DATA COLLECTION :-

The study was conducted at Ayyampatty which is rural area of

Thuvakudi. The written permission was obtained from president of

Thuvakudi Municipality. The data was collected for the period of 5

weeks. Oral consent was obtained from each participant. Per day 4-5

mothers with under five children were interviewed by the investigator.

The investigator maintained good rapport, collected demographic data

and conducted pretest by using structured interview schedule for 45

minutes for each sample to assess the knowledge and practice of

mothers with under five children. On the same day, the planned

teaching programme was given to 4-5 mothers for 45 minutes regarding

malnutrition by using posters in a common place. On the seventh day,

post test was done using the same structured interview schedule to

63
 assess the knowledge and practice of mothers with under five children

after planned teaching programme. The same procedure was continued

to obtain data from 60 samples.

PLAN FOR DATA ANALYSIS :-

The collected data were tabulated and analyzed by using

descriptive and inferential statistical methods.

S. Data Methods Remarks

No. Analysis
1 Descriptive Frequency To describe the demographic variables of mothers
statistics percentage of under five children.

Mean, To assess the pre and post test knowledge and

standard
practice scores regarding malnutrition.
deviation
2 Inferential Paired’t’ To compare the pretest and posttest level of
test
statistics knowledge and practice scores within the group.

Karl Pearson To correlate posttest knowledge and practice

correlation scores regarding malnutrition.

Chi – square To find out the association between post test

test knowledge scores regarding malnutrition among
mothers with under five children with their
selected demographic variables

PROTECTION OF HUMAN SUBJECT :-

The study was conducted after the approval of Dissertation

Committee. The written consent was obtained from the President of

Thuvakudi. Oral consent of each subject was obtained before starting

64
the data collection. Assurance was given to them that confidentiality

will be maintained.

65
 CHAPTER - IV

DATA ANALYSIS AND INTERPRETATION

This chapter deals with the description of sample characteristics,

analysis and interpretation of the data collected from mothers with

under five children in Ayyampatty village, Trichy.

The present study was designed to assess the effectiveness of

Planned teaching programme regarding malnutrition in terms of

knowledge and practice among mothers with under five children.

The collected data were calculated, analysed using descriptive

and inferential statistics and interpreted as per the objectives of the

study, under the following headings.

ORGANIZATION OF THE DATA:-

The data has been tabulated and organized as follows :

Section – A: Distribution of demographic variables.

Section – B : Comparison between pretest and post test

knowledge scores regarding malnutrition among

mothers with under five children.

66
Section – C : Comparison between pretest and post test practice

scores regarding malnutrition among mothers with

under five children.

Section - D: Correlation between posttest knowledge and Practice

scores regarding malnutrition among mothers

with under five children .

Section – E : Association between posttest knowledge score of

mothers with their selected demographic variables.

67
SECTION –A : Distribution of demographic variables.

Table: 1 - Frequency and percentage distribution of demographic

variables among mothers with under five children.

n=60

S. Percentage
Demographic Variables Frequency
NO (%)
1. AGE OF MOTHER
16 26.7
\\\

1.1 Below 25 years

36
60
1.2 26 – 30 years
8
13.3
1.3 31– 35 years
-
-
1.4 Above 36 years
2 EDUCATIONAL STATUS
2.1
No formal education 6 10

2.2
Primary Education 16 26.7

2.3
High school 15 25

2.4
Higher secondary 15 25

2.5
Graduate 8 13.3

68
 3 OCCUPATION
49 81.7
3.1 House wife
3 5
3.2 Coolie
2 3.3
3.3 Self employed
3 5
3.4 Private employee
3 5
3.5 Government Employee
4 FAMILY SIZE
(TOTAL FAMILY MEMBERS)

4.1 16 26.7
3 members

4.2 29 48.3
4 members

4.3 10 16.7
5 members

4.4 5 8.3
6 & above
5 TYPE OF FAMILY
48 80
5.1 Nuclear Family
12 20
5.2 Joint Family
6 NUMBER OF UNDER FIVE
CHILDREN
33 55
6.1 Children 1
23 38.3
6.2 Children 2
4 6.7
6.3 3 and above

69
 7 FAMILY MONTHLY
INCOME(in rupees)
7.1 8 13.4
1000-2000
7.2 24 40
2000-4000
7.3 11 18.3
4000-6000
7.4 17 28.3
Above 6000
8 RELIGION

8.1 Hindu 48 80
8 13.3
8.2 Christian 4 6.7
-
-
8.3 Muslim

8.4 Others

The table 1 shows that distribution demographic variables.

The mothers of under five children who belonged to the age group

of below 25 years were 16(26.7%), majority of the mothers with under

five children 36(60%) were in the age group of 26 – 30 years, 31 – 35

years of mothers with under five children were 8(13.3%). No mothers

were in the age group of above 36 year.( Fig-1)

70
 There were 6(10%) mothers with under five children were illiterate,

16(26.7%) of the mothers with under five children were studied

primary education, 15(25%) of the mothers with under five children

were studied high school and 15(25%) of mothers with under five

children studied higher secondary. Very few 8(13.3%) mothers with

under five children were graduate.(Fig-2)

According to their occupation, the data showed that the most 49(81.7%)

of the mothers with under five children were house wife, 3(5%) of the

mothers with under five children were coolies, 2(3.3%) of the mothers

with under five children were self employees , 3(5%) of the mothers

with under five children were private employees and 3(5%) of mothers

with under five children were government employees. (Fig-3)

With regard to family size, the data showed that 16(26.7%) of the

mothers with under five children had three members in the family,

29(48.3%) of the mothers with under five children had four members in

her family, 10(16.7%) of the mothers with under five children had five

members in her family, 5(8.3%) of mothers with under five children had

more than six members in her family. ( Fig-4)

71
 Regarding to the type of family, majority of 48(80%) the mothers with

under five children belonged to nuclear family where as 12(20%) of the

mothers with under five children belonged to joint family. (Fig-5)

According to number of under five children, there were 33(55%)

of mothers were having one under five children, 23(38.3%) of mothers

were having two under five children, only 4(6.7%) of mothers were

having three and more than three under five children. (Fig-6)

According to family monthly income, the data showed that

8(13.4%) of mothers with under five children were having the monthly

income of Rs.1000-2000, 24(40%) of mothers with under five children

were having the monthly income of Rs.2000-4000, 11(18.3%) of mothers

with under five children were having the monthly income of Rs.4000-

6000, 17(28.3%) of mothers with under five children were having the

monthly income of above Rs.6000. (Fig-7)

With regard to religion, the highest number 48(80%) of mothers

with under five children were Hindus, 8(13.3%) of mothers with under

five children were Christians, decrease in number of 4(6.7%) of the

mothers with under five children were Muslims and none of them

belonged to other religion. (Fig-8)

72
 100
90
80
PERCENTAGE

70 60%
60
Below 25 years
50
40
26.7% 26 – 30 years
30
13.3%
20
31– 35 years
10
0
Below 25 26 – 30 31– 35
years years years
AGE (In Years)
Fig 2 - Percentage distribution of mothers with under five children according to their age.

73
 100
No formal education
90
Primary Education
80 High school
70 Higher secondary
PERCENTAGE

60 Graduate

50
40
30 26.7% 25% 25%
20 13.3%
10%
10
0
No formal Primary High school Higher Graduate
education Education secondary
EDUCATIONAL STATUS
Fig 3 - Percentage distribution of mothers with under five children according to their education.

74
 100
House Wife
90 81.7%
Coolie
80 Self employed
70 Private employee

PERCENTAGE
60 Government employee

50
40
30
20
5% 3.3% 5% 5%
10
0
House Wife Coolie Self Private Government
employed employee employee
OCCUPATION

OCCUPATION

Fig 4 - Percentage distribution of mothers with under five children according to their occupation.

75
 100
90 Members 3
80 Members 4
Members 5
70
PERCENTAGE 60
6 & Above
48.3%
50
40
26.7%
30
16.7%
20 8.3%
10
0
Members 3 Members 4 Members 5 6 & Above
FAMILY SIZE
Fig 5 - Percentage distribution of mothers with under five children according to their family size.

76
 Nuclear Family
Joint Family

20%

80%

TYPE OF FAMILY

Fig 6 - Percentage distribution of mothers with under five children according to their type of family.

77
 1 Child
2 Children
3 & Above

6.7%

38.3% 55%

NUMBER OF CHILDERN

Fig 7 - Percentage distribution of mothers with under five children according to number of under five children.

78
 100 Rs 1000-2000
90 Rs 2000-4000
80 Rs 4000-6000
PERCENTAGE 70 Rs 6000 & Above
60
50 40%
40
28.3%
30
18.3%
20 13.4%
10
0
Rs 1000- Rs 2000- Rs 4000- Rs 6000
2000 4000 6000 & Above
FAMILY INCOME

FAMILY MONTHLY INCOME

Fig 8 - Percentage distribution of mothers with under five children according to family monthly income.

79
 RELIGION

Fig 9 - Percentage distribution of mothers with under five children according to their religion.

80
SECTION – B :Comparison between pre and post test knowledge

scores regarding malnutrition among mothers with under five

children.

Table : 2 Comparison between pre and post test knowledge scores

regarding malnutrition among mothers with under five children.

n=60

Pretest Post test

Level of knowledge F % F %
Adequate - - 38 63.4
Moderately adequate 12 20 22 36.6
Inadequate 48 80 - -
Total 60 100 60 100

The Table 2 showed that in pretest among 60 mothers 12

(20%) of the mothers had Moderately adequate knowledge, 48(80%) of

the mothers had inadequate knowledge regarding malnutrition .

In posttest among 60 mothers majority 38 (63.4%) of the

mothers had adequate knowledge and 22(36.6%) of the mothers had

moderately adequate knowledge regarding malnutrition.

81
 100
90 80% Pretest
Post test
80
63.4%
70

PERCENTAGE
60
50
36.6%
40
30 20%

20
10
0
Adequate Moderately Inadequate
adequate

LEVEL OF KNOWLEDGE

Fig 10 – Percentage wise comparison of pre and posttest knowledge scores among mothers with under five children.

82
Section – C : Comparison between pretest and post test practice

scores regarding malnutrition among mothers with under five

children.

Table : 3 Comparison between pre and post test practice scores of

mothers regarding malnutrition among mothers with under five

children.

n=60

Pretest Post test

Level of practice F % F %

Adequate 1 1.6 36 60

Moderately adequate 19 31.7 23 38.4

Inadequate 40 66.7 1 1.6

Total 60 100 60 100

The Table 3 showed that in pretest among 60 mothers

only one mother (1.6%) had adequate practice, 19 (31.7%) of the

mothers had Moderately adequate practice, 40(66.7%) of the mothers

had inadequate practice regarding malnutrition .

In posttest among 60 mothers majority 36 (60%) of the

mothers had adequate practice and 23(38.4%) of the mothers had

moderately adequate practice and 1(1.6%) of the mothers had

inadequate knowledge regarding malnutrition.

83
 LEVEL OF PRACTICE

Fig 11 – Percentage wise comparison of pre and posttest practice scores among mothers with under five children.

84
Table : 4 Comparison of mean, Standard deviation and paired ‘t’ value

of pre and posttest knowledge scores regarding malnutrition among

mothers wirh under five children.

n = 60

SI.No. Variable Mean SD ‘t’ value Table

value

1. Pre test 6.5 2.41

21.74 1.671

2. Post test 15.78 3.74

df=59 (P<0.05)

The table 4 showed that the mean pretest and posttest knowledge

scores regarding malnutrition were 6.5 (SD+2.41) and 15.78(SD+ 3.74)

respectively. The posttest mean knowledge scores were higher than the

pretest mean knowledge scores. The ‘t’ value is 21.74, which was

significant at 0.05 level.

85
Table-5 Comparison of mean, Standard deviation and paired ‘t’ test

value of pre and posttest practice scores regarding malnutrition among

mothers with under five children.

n=60

SI.No. Variable Mean SD ‘t’ value Table

value

5.5
1. Pre test 2.41
21.6 1.671
10.93
2. Post test 2.6

df=59 ( P<0.05)

The table 5 showed that mean pretest and posttest practice scores

regarding malnutrition were 5.5 (SD+2.41) and 10.93(SD +2.6)

respectively. The posttest mean practice scores were higher than the

pretest mean practice scores. The ‘t’ value is 21.6, which was significant

at 0.05 levels.

86
Section - D: Correlation between posttest knowledge and Practice

scores regarding malnutrition among mothers with under five

children .

Table : 6 Correlation between the mean posttest knowledge and

practice scores regarding malnutrition among mothers with under five

children.

n = 60

SI.NO Variable Mean scores Co-efficient Table value

co-relation(r
value)
1. Post test knowledge 15.78
0.93 0.25
2. Post test practice 10.93
df=58 P<0.05

Table 6 showed that there was positive correlation (r=0.93) between

mean posttest knowledge and practice scores of mothers with under

five children.

87
 Section – E : Association between posttest knowledge scores

with their selected demographic variables regarding malnutrition

among mothers with under five children.

Table : 7 Association between posttest knowledge scores with their

selected demographic variables regarding malnutrition among mothers

with under five children.

n=60

Level of knowledge Table

Adequate Moderately Inadequate x2 value

S.No Demographic

Inference
adequate
variables
F % F % F %

1. Age of mother

Below 25 years 12 20 4 6.7 - -

26 – 30 years 20 33.3 16 26.7 - - 1.62 3.841 NS

31– 35 years 5 8.3 3 5 - -

Above 36 years - - - - - -

88
2. EDUCATIONAL
STATUS

No formal
1 1.6 5 8.4 - -
education

4 6.7 12 20 - - 24.76 3.841 S

Primary education

10 16.6 5 8.4 - -
High school

15 25 - - - -
Higher secondary

8 13.3 - - - -
Graduate
3. OCCUPATION

Home maker 31 51.6 18 30 - -

Coolie 3 5 - - - -

Self employed 1 1.6 1 1.6 - - 33.6 3.841 S

Private employee 2 3.4 1 1.6 - -

Government
employee 1 1.6 2 3.4 - -
4 Family size(total
family members)
12 20 4 6.7 - -
3 members
20 33.4 - 1.22 3.841 NS
9 15 -
4 members
4 6.6 6 10 - -

89
 5 members 2 3.3 3 5 - -

Above 6
5 Type of family

Nuclear family 30 50 18 30 - - 0.071 3.841 NS

Joint family 8 13.4 30 6.6 - -

6 Number of under
five children

1 children 23 38.4 10 16.6 - -

2 children 13 21.8 10 16.6 - -
1.26 3.841 NS
3 and above 2 3.3 2 3.3 - -
7 Family monthly
income(in rupees)

1000-2000 4 6.7 -
4 6.7 -

2000-4000 17 28.3 -
7 11.6 -
14.91 3.841 S
4000-6000 6 10 -
5 8.4 -

Above 6000 11 18.3 -

6 10 -
8 Religion

Hindu 30 50 18 30 - -

Christian 5 8.3 3 5 - - 0.071 3.841 NS

Muslim 3 5 1 1.7 - -

90
 Others - - - - - -

df=1 NS – Not Significant S – Significant p<0.05

Chi-square values were calculated to find out the association (table

7) knowledge of mothers with their demographic variables such as age,

education, occupation, family size, type of family, number of under five

children, family monthly income and religion regarding malnutrition.

The demographic variables educational status, occupation, family

income was associated with knowledge of mothers with under five

children. Other demographic variables such as age, family size, type of

family, number of under five children , religion had no association with

knowledge regarding malnutrition.

91
 CHAPTER – V

DISCUSSION

The discussion chapter deals with sample characteristics and

objectives of the study. The aim of this present study was to evaluate

the effectiveness of planned teaching programme regarding

malnutrition among mothers with under five children in Ayyampatty at

Trichy district.

Description of sample characteristics

Distribution of mothers of under five children according to their

demographic variables showed that 16(26.7%) of mothers were below

25 years, 36(60%) of mothers were in the age group of 26-30 years,

8(13.3%) of mothers were in the age group of 31-35 years and no

mothers were in the age group of above 36 years. According to their

educational status, 6(10%) were illiterate, 16(26.7%) were studied

primary education, 15(25%) were studied high school, 15(25%) were

studied higher secondary education, 8(13.3%) were graduates. With

92
regard to their occupation, 49(81.7%) were house wives, 3(5%) were

coolies, 2(3.3%) were self employed, 3(5%) were private employees,

3(5%) were government employees. According to their family size,

16(26.7%) were having 3 members in the family , 29(48.3%) were having

4 members in the family, 10(16.7%) were having 5 members in the

family, 5(8.3%) were having above 6 members in the family. Regarding

their type of family 48(80%) were belonged to nuclear family, 12(20%)

were belonged to joint family type. According to the number of under

five children, 33(55%) were having 1 child, 23(38.3%) were having 2

children, 4(6.7%) were having 3 and above 3 children. According to

their family monthly income 8(13.4%) were having monthly income of

Rs.1000-2000, 24(40%) were having family income of Rs.2000-4000,

11(18.3%) were having monthly income of Rs.4000-6000, 17(28.3%) were

having the monthly income of above Rs.6000. With regard to their

religion 48(80%) were Hindus, 8(13.3%) were Christians, 4(6.7%) were

Muslims.

The findings of the study were discussed according to the objectives as

follows.

93
 1. To assess the pretest knowledge and practice scores regarding

malnutrition among mothers with under five children.

2. To assess the posttest knowledge and practice scores regarding

malnutrition among mothers with under five children.

3. To compare pretest and post test knowledge scores regarding

malnutrition among mothers with under five children.

4. To compare pretest and post test practice scores regarding

malnutrition among mothers with under five children.

5. To correlate posttest knowledge and practice scores regarding

malnutrition among mothers with under five children.

6. To find association between the post test knowledge scores with

their selected demographic variables.

First objective: To assess the pretest knowledge and practice scores

regarding malnutrition among mothers with under five children.

Pretest knowledge regarding malnutrition among mothers with

under five children were assessed, 48(80%) mothers had inadequate

knowledge,12(20%) had moderately adequate knowledge.

Pretest practice regarding malnutrition among mothers with

under five children were assessed, 40(66.6%) had inadequate

94
practice,19(31.7%) had moderately adequate practice and only one

(1.6%) had adequate practice.

The findings of the study was consistent with the study findings

of Mrs. R.Sudha (2008) to assess the effectiveness of Structured

teaching programme on malnutrition to mothers of malnourished under

five children in a village at Kancheepuram district, Tamilnadu stated

that regarding knowledge, among 30 mothers, 4(13.3%) mothers only

had adequate knowledge in pre test.

Second objective: To assess the posttest knowledge and practice scores

regarding malnutrition among mothers with under five children.

Post test knowledge regarding malnutrition among mothers with

under five children were assessed, 38(63.4%) had adequate

knowledge,22(36.6%) had moderately adequate knowledge.

Post test practice regarding malnutrition among mothers with

under five children were assessed, 36(60%) had adequate practice,

23(38.4%) had moderately adequate practice.

The findings of the study was consistent with the study findings

Mrs. R.Sudha (2008) to assess the effectiveness of Structured teaching

95
programme on malnutrition to mothers of malnourished under five

children in a village at Kancheepuram district, Tamilnadu stated that

regarding knowledge, among 30 mothers 22(73.3%) mothers had

adequate knowledge in the post test.

Third objective: To compare pretest and post test knowledge scores

regarding malnutrition among mothers with under five children.

Table 4 revealed that the mean pretest knowledge score of

mothers with under five children was 6.5(SD+ 2.41) and the mean post

test knowledge score of mothers with under five children was

15.78(SD+3.74). The mean post test knowledge score was higher than

the mean pre test knowledge score. It is highly significant at p<0.05

level. Hence H1 – The mean post test knowledge score is significantly

higher than the mean pre test knowledge score was accepted.

The study was consistent with the study findings by Mrs.

R.Sudha (2008) stated that regarding knowledge, in pre test, 4 (13.3%)

mothers only had adequate knowledge and in post test, 22(73.3%)

mothers had adequate knowledge. The paired T test value was 16.51

and it was significant at P 0.001 level. This revealed that the structured

teaching programme had improved the knowledge.

96
Fourth objective: To compare pretest and post test practice scores

regarding malnutrition among mothers with under five children.

Table 5 revealed that the mean pre test practice score of mothers

with under five children was 5.5(SD +2.41) and the mean post test

practice of mothers with under five children was 10.93(SD+2.6). The

mean post test practice score was higher than the mean pre test practice

score. It is highly significant at p<0.05 level. Hence the hypothesis H2-

The mean post test practice score is significantly higher than the mean

pre test practice score was accepted.

The findings of the study was consistent with the study

findings of Banerjee. B. et al., (2005) to assess the magnitude of the

problem and to assess the impact of nutrition advice given to mothers of

infants, on their nutritional status of their children suffering from severe

degree of malnutrition stated that, prevalence of malnutrition was 50 -

67% among the infants malnutrition was more common in females than

males but this was not significant (p>0.05).Post intervention follow up

after nutrition education of mothers showed an average increase of 80 -

81 grams of the weight of their severely malnourished infants, over the

expected weight gain. The study concluded that nutrition education of

97
mothers of infants has a positive effect on the nutritional status of their

education.

Fifth objective: To correlate posttest knowledge and practice scores

regarding malnutrition among mothers with under five children.

There was positive correlation (r=0.93) between mean posttest

knowledge and practice scores regarding malnutrition among mothers

with under five children (table 6). Further it could be informed that

knowledge and practice depends on each other. The reason might be

when the knowledge is improving, practice also will improve. Hence

H3 - there will be a significant correlation between the posttest

knowledge score and practice score was accepted.

Sixth objective: To find association between the post test knowledge

scores with their selected demographic variables.

Chi-square values were calculated to find out the association

(table 7) between the knowledge of mothers of under five children with

their age, education, occupation , family size , type of family , number of

under five children , Family monthly income and Religion.

98
 The demographic variables educational status, occupation, family

income showed statistically significant association with knowledge of

mothers (table 7) at p<0.05 level. The reason might be that education

helped them to gain more knowledge regarding malnutrition. Other

demographic variables (age, family size, type of family, number of under

five children, and Religion) had no association with knowledge regarding

malnutrition.

The findings of the study was consistent with the study findings of

Mrs. R.Sudha (2008) to assess the effectiveness of Structured teaching

programme on Malnutrition to mothers of malnourished under five

children in a village at Kancheepuram district, Tamilnadu revealed that

there was highly significant association between the educational status of

mother and knowledge at P 0.01 level. There was also a statistically

significant association between family income and knowledge at P0.05

level. There was no association found between knowledge and other

variables like age of the mother, family size and age of the child, sex of the

child, occupation and religion.

99
 CHAPTER – VI

SUMMARY, CONCLUSION, IMPLICATION, RECOMMENDATION AND

LIMITATION

SUMMARY OF THE STUDY:-

The study was done to assess the effectiveness of Planned teaching

programme regarding malnutrition in terms of knowledge and practice

among mothers with under five children. The research design used for the

study was pre experimental design. The research approach used for the

study was evaluative approach which was conducted in Ayyampatty at

Trichy. The conceptual frame work was based on the Ludwig

Vonbertlanffy system theory(1968) model. A sample of 60 mothers with

under five children who met the inclusion criteria were selected for the

study using purposive sampling technique. Pre test was conducted using

structured interview schedule to assess the knowledge and practice of mothers

with under five children. Immediately after the pretest, group teaching was given

to the mothers for 45 minutes using posters in a common place. On the 7th day,

post test was conducted using same structured interview schedule. The date were

analyzed using descriptive and inferential statistics.

100
MAJOR FINDINGS OF THE STUDY :-

• Most of the mothers with under five children(60%) were in the age

group of 26-30 years.

• Highest percentage of mothers with under five children (26.7%)

had studied primary education.

• Most of the mothers with under five children (81.7%) were home

wives.

• Highest percentage (48.3%) of the mothers with under five children

had 4 members in their family.

• Highest percentage( 80%) of the mothers with under five children

belong to Nuclear family.

• Highest percentage(55%) of mothers with under five children were

having one under five child.

• Highest percentage (40%) of mothers with under five children were

having their family income of Rs. 2000-4000.

• Most of the mothers with under five with children (80%) were

Hindus.

101
 During pretest most (80%) of the mothers with under five children

had inadequate knowledge and (20%) of the mothers with under five

children had moderately adequate knowledge where as in posttest (63.4%)

of the mothers had adequate knowledge and (36.6%) of the mothers had

moderately adequate knowledge regarding malnutrition.

During pretest (66.7%) of the mothers of under five children had

inadequate practice and (31.7%) of the mothers had moderately adequate

practice, Where as in posttest most (60%) of the mothers had adequate

practice and (38.4%) of the mothers had moderately adequate practice and

(1.6%) of the mothers had inadequate practice regarding

malnutrition. Highly significant relationship was found between pretest

and posttest knowledge and practice scores (p<0.05).

Significant association was found between posttest knowledge score

of mothers with under five children with education, occupation, family

income.

The study revealed that the knowledge and practice score using

Structured interview schedule regarding malnutrition was highly

102
significant after administration of Planned teaching programme. Findings

showed that the Planned teaching programme was effective in increasing

the knowledge and practice among mothers of under five children

regarding malnutrition. Thus planned teaching programme played an

important role in improving the knowledge and practice of mothers with

under five children.

CONCLUSION :-

Based on the findings of the study the following conclusions were

drawn. The study showed that the Planned teaching programme was

effective in increasing the knowledge and practice regarding malnutrition

among mothers with under five children. The ‘t’ value(21.74) for

knowledge and ‘t’ value(21.6) for practice was significant at ( p< 0.05)

level. Thus planned teaching programme played an important role in

improving the knowledge and practice of mothers with under five

children.

IMPLICATIONS FOR NURSING :-

Nursing Service :-

103
 1.Nurses working in the community and Hospitals play a vital role

in identifying malnutrition in children.

2.They can teach the mothers about the normal nutrition and

domicillary management of malnutrition.

3.They can conduct regular meeting for mothers to impart

knowledge about normal nutrition and its influence on Growth and

development of children.

4.In the Hospital, Nutrition Education centers can be established

which can teach , guide the people in selection and preparation of food

items, which are locally available and also demonstrate the preparation of

low cost high calorie food items.

Nursing Education :-

1.Malnutrition should be given focus in Nursing education. The

students are given opportunity to identify malnourished children and

conduct heath education programme using role play, puppet shows.

2.They are encouraged to do cooking demonstration of preparation

of low cost high calorie, high protein diet in the community set up.

104
 3.In Hospitals, certain out patient department like pediatric OPD,

Maternity OPD, the students can utilize to teach the mothers about

normal nutrition.

Nursing Administration :-

1.Nurse administrators has the responsibility to increase the Nurses

knowledge in early identification and management of malnutrition in

children. She can organize in - service education programs. She has the

responsibility to establish Nutrition education and demonstration centre in

Hospitals.

2.She also has the responsibility to utilize research findings related

to malnutrition. She would conduct regular meetings or workshops for

staff nurses to make them aware of latest research finding related to

malnutrition and encourage them to implement program based new data

in day to day practice.

Nursing Research :-

1.The essence of research is to build up a body of knowledge in

Nursing as an evolving profession. This study can be effectively utilized

by the emerging researchers.

2.This study can be baseline for further studies to build upon.

105
RECOMMENDATIONS :-

1. Comparative study can be conducted in rural and urban areas. 2

.Similar study can be conducted in different social settings.

3. This similar study can be replicated on large sample there by

findings can be generalized for a large population.

LIMITATIONS :-

It was more time consuming to explain the mothers because of

difference in their understanding.

106
 REFERENCES

Book references
1. Ann burgers., (1998). ‘’Nutrition for developing countries’’, (3rd

ed.). New Delhi: Jaypee publishers, 209-211.

2. Basavanthappa B.T., (2006). ‘‘Pediatric/child health Nursing’’, (2nd

ed.).

Bangalore: Ahuja Publishing house, 546-548.

3. Donna L.Wong ., (2003). ‘‘Nursing care of Infants and children’’,

(6th ed.). New Delhi: Mosby publications, 678-679.

4. Elizabeth.K.E., (2005). ‘’Nutrition and child development’’, (3rd ed.).

Hyderabad: Paras Medical Publisher, 203-209.

5. Gupta suraj., (2006). ‘’ The short text book of pediatrics’’, (10th ed.).

Noida: Gopsons papers ltd, 376-379.

6. Kumar santhosh., (2000). ‘’Hand book of pediatrics’’, (2nd ed.). New

delhi: All India publishers, 21-21.

7. Marilyn J. Hocken bery wongs., (2005). “Essentials of Pediatric

Nursing,”(7th ed.). New Delhi: Mosby publication, 460 – 470.

107
 8. Nick L. Potts et.al., (2007). “Pediatric Nursing”, (2nd ed.). Australia:

Thomson Delmar learning publishers, 1207 – 1231

9. Prabakara.G.N., (2002). ‘‘Short text book of preventive and social

Medicine.’’(1st ed.). New Delhi: Mosby publishers, 289-234.

10. Park. K., (2007). ‘’Text Book Of Preventive And Social Medicine’’,

(19th ed.). Jabalpur: Bansaridas Bhanot Publishers, 164-168, 115-117.

11. Polit. F., (2008). ‘’Nursing Research’’, (8th ed.). New Delhi: Wolters

Kilewer India private Ltd, 678-780.

12. Richard E. Behrman et.al., (2007), “Nelson Text Book of Pediatrics”,

(25th ed.). Philadelphia: W.B. Saunders company, 156-161.

13. Santhosh kumar.,(2000). ‘‘Hand book of pediatrics’’, (2nd ed.).New

Delhi: All India Publishers, 268-273.

14. Sundar Rao P.S., (1999). ‘’An introduction to Bio statistics’’, (3rd

ed.). New Delhi : Prentice hall of India Private Ltd, 121-123.

15. Swaminathan.M., (2005). ‘’Hand book of food and nutrition’’,(5th

ed.). Bangalore: Bangalore printing and publishing company, 170-

174.

Journal references
16. Sreevani. R., (March 2006).’’Malnutrition and mental

development.’’ The Nightingale Nursing Times’ 21-22.

108
17. World food day (Oct 2007),’Preventing micro nutrient malnutrition,’

The Nightingale Nursing Times,’ , 7-8.

18. S.Chakraborthy, et. al., (2006),’ A study of Protein energy

malnutrition (0-6 yr) in a rural population of Jhansi District (UP),’

Indian Journal of community medicine,’ volume-31, Number-24,

291-292.

19. Phengxay M et al, (2007),’ Risk factors for Protein energy

malnutrition in children under 5 years,’ Laos Japan.

20. Bridge A, et al, (2006),’Nutritional status and food consumption

patterns of young children,’ Canada.

21. Cornelio-Nieto Jo, (2007),’The effects of Protein energy

malnutrition on the central nervous system in children,’ Mexico.

22. Ayaya SO et al, (2004),’ Socio economic factors predisposing under

five year old children to serve Protein energy malnutrition,’

Kenya.

23. Kurup PJ, et al, (2004),’Low birth weight as a determinant of

Protein energy malnutrition in 0-5 years,’ Oman.

24. El-Khayat H, et al, (2007), ‘Cognitive functions in Protein Energy

Malnutrition ,’ National Research center, Cario, Egypt.

109
25. Sudha .R., (June 2008). ‘’ An experimental study to the effectiveness

of Strutured teaching programme on malnutrition to mothers of

malnourished under five children in a village at Kancheepuram

district, Tamilnadu.’’ ‘Indian Journal of Holistic Nursing’ Volume

4. Number 1. 17-19.

26. Banerjee.B and Mandal.O.N., (2005). ‘’An intervention study in

malnutrition among Infants in a tribal community of West Bengal.’’

Indian Journal of community medicine. Volume 30. Number 1.21-

24.

27. Bose Kaushik., (2008). ‘’Anthropometric characteristics and

nutritional status of rural school children.’’ The Internet Journal of

biological Anthropology. Volume 2. Number1. 5-8.

28. Pradhan. A., (2005). ‘’Child nutrition in Nepal.’’ ‘Kathmandu

University Medical Journal’ Volume 3. Number 1. Issue 9. 2-3.

29. Phengxay Manilay.,(2007). ‘’Risk factors for Protein-energy

malnutrition in children under five years’’ Study from

Luangprabang province, Laos.’’ Pediatrics International. Volume

49. Issue 2.

110
30. Rao.V.G., et.al., (July2005). ‘’Undernutrition and childhood

morbidities among tribal pre school children’’ Indian Journal of

Medical research Volume 23. Number 4. 7-10

31. Abidoye. O. and Sikabofori., (2000). ‘’A Study of Prevalence of

protein energy malnutrition among 0-5 years in rural Benue state,

Nigeria’’ Nutrition and Health. Volume 13. Number 4. 235-247.

32. V. Bhatia., et.al., (Dec 2007). ‘’ Malnutrition among under six

children in Chandigarh’’ Volume 1. Issue 6. 483-487.

33. Koletzko.B., (2008). ‘’The prevalence of malnutrition and its risk

factors in children attending out patient clinics in the city of Manaus,

Amazons, Brazil.’’ Child Nutrition. Volume 27. Issue 1. 72-76.

34. Ahmed shamsir AM., (2008) ‘’Nutrition: Basis for healthy children

and mothers in Bangladesh.’’ Journal of health, Population and

Nutrition. Volume 26. Number 3. 325-339

35. Mittal A., et.al., (oct 2007). ‘’Effect of maternal factors on nutritional

status of 1-5 year old children in urban slum population.’’ Indian

Journal of community medicine. Volume 32. Number 4. 264-287.

36. Khattak Marjan aziz., et.al., (June 2007). ‘’ Evaluation of nutritional

knowledge of mothers about their children.’’ Government Journal

of Medical sciences. Pakistan: Volume 5 Number 117-21

111
37. Lakshminarayana J., et.al., (2003)‘’ childhood illnesses and

malnutrition in under five children in drought affected desert area

of western Rajesthan, India.’’ Desert medicine Research Centre.

Volume 57. Issue 7. 286-289.

38. Al-Mekhlafi., et.al., (sep 2008).’’Current prevalence and predictors of

protein energy malnutrition among school children in rural

peninsular Malaysia.’’ The southeast Asian Journal of tropical

medicine and public health. Volume 39. Issue 5.

39. Psoter.W., (April 2008)., ‘’Effect of early childhood malnutrition on

tooth eruption in Haitian adolescents.’’ Community Dental Oral

Epidemiology. Volume 36. Number2. 179-189.

40. Hien NN.,(2008)., ‘’Nutritional status and the charecteristics related

to malnutrition in children under five years of age in Nghean,

Vietnam.’’ Journal of preventive medical public health. Volume 40.

Number 4.

41. Bose K. Biswas S., (2007)., ‘’Stunting, under weight and wasting

among integrated child developmental services scheme children

aged 3-5 years of chapra, Nadia district, West Bengal.’’ Volume 3.

Number 3. 216-221.

112
42. Berkley J ., et.al., (2005). ‘’ Assessment of severe malnutrition

among hospitalized children in rural Kenya,’’ Volume 294.

Number 20. 591-597.

43. Cornelio-Nieto Jo., et.al., (2007). ‘’ The effects of protein energy

malnutrition on the central nervous system in children’’ volume 2.

Number 44.

44. Garro AJ., et.al., (2007). ‘’Management with soya of 1-4 years old

suffering malnutrition.’’ Volume 39. Number 2.

45. Shaaban SY., (2005). ‘’Early detection of protein energy

malnutrition in Sharkia Governorate.’’ Volume 80. 5-6.

46. Puoane T., et.al.,(2006). ‘’Training nurses to save lives of

malnourished children’’, 29(1) 73-78.

47. Chit TM., et.al.,(2003). ‘’Mother’s beliefs and attitudes towards

child weight, child feeding and related practices in Myanmar’’,

17(3) 231-254.

48. Saito K, et.al., (2000). ‘’ A case control study of maternal

knowledge of malnutrition and health care seeking attitudes in

rural South India’’, 70(2) 149-160.

113
 49. Nagavi M, et.al., (2000). ‘’ Community based nutritional

intervention for reducing malnutrition among children under 5

years of age in Islamic republics of Iran’’, Faculty of public health,

6(2-3) 238-245.

50. Lindsay A.C, et.al., (2009). ‘’Brazilian mothers beliefs, attitudes

and practices related to child weight status and early feeding

within the context of nutrition transition’’, 41(1) 21-37.

51. Alvarado B.E, et.al., (2005). ‘’Maternal beliefs, feeding practices

and nutritional status in Afro-colombian Infants’’, 55(1) 55-63.

52. Schroeder D.G, et.al., (2002). ‘’An integrated child nutrition

intervention improved growth of younger, more malnourished

children in northern Vietnam’’, 23(4) 53-61.

Net References

53. www.ifpri.org

54. [email protected]

55. http://emedicine.medcape.com/article/-overview

56. http://en.wikipedia.org/wiki/Marasmus

57. http://en.wikipedia.org/wiki/kwashiorkor

58. http://www.childinfo.org/undernutrition.html

59. http://www.ncbi.nlm.gov/pubmed

114
60. http://www.thp.org/sac/unit2/index.html

61. http://www.solutionexchange-un.net.in/health/comm

62. [email protected]

63. http://www.indianjmedsci.org/text

115
116
 PLANNED TEACHING PROGRAMME

Topic : Malnutrition
Group : Mothers with under five children
Place : Ayyampatty
Duration : 45 Minuets
Mother of teaching : Lecture cum discussion
Teacher aid : Posters
Medium of Instruction : Tamil

Central objective:

At the end of the teaching, mothers with under five children will gain knowledge and understanding on
malnutrition and develop desirable attitude and skill to apply this knowledge in their day to day life.

cxvii
Specific objective
Mother will be able to
• define malnutrition
• list out the contributing factors of malnutrition
• define protein energy malnutrition
• enlist the types of PEM
• list down the etiology of PEM
• define kwashiorkor
• describe the causes of kwashiorkor
• enumerate the clinical features of kwashiorkor
• enunciate the management of kwashiorkor
• list down the protein rich foods
• define marasmus
• elaborate the causes of marasmus
• describe the management of marasmus
• list the calorie rich foods
• explain the preventive measures of malnutrition

cxviii
 Teacher-
Specific
Content AV Aids Learners
Objectives
activity
Introduction:
Malnutrition is a major pediatric problem and it is responsible posters

for high rates of Mortality and Morbidity. In a vast majority of

children, mild to moderate malnutrition remains undetected due to
lack of awareness on the part of all concerned, medical and
paramedical personnel and parents.
define Definition: Lecture cum
malnutrition Malnutrition is defined as the physical state resulting from discussion
inadequate food intake for longer periods of time. Malnutrition in
early childhood has serious, long term consequences because it
impedes motor, sensory, cognitive, social and emotional development.
list out the Contributing factors for Malnutrition:
contributing • Household food insecurity
factors for • Intra household food distribution
malnutrition • Imbalanced Diet

cxix
 Teacher-
Specific
Content AV Aids Learners
Objectives
activity
ƒ Gender inequalities
ƒ Inadequate health services
ƒ Lack of access to education for Women
ƒ Insufficient knowledge of good nutrition, proper care and
Infant feeding practices
ƒ Inadequate care of women and girls especially during
pregnancy, result in low birth weight babies.
define Protein Energy Malnutrition: Lecture cum
Protein Protein energy malnutrition develops in children whose discussion
energy consumption of protein and energy is insufficient to satisfy body’s
malnutrition nutritional needs.
Prevalence of PEM:
PEM is the most widely prevalent form of malnutrition among
children Under 5 years of age. PEM affects every fourth child world
wide.

cxx
 Teacher-
Specific
Content AV Aids Learners
Objectives
activity
Main types of PEM:
enlist the ƒ Kwashiorkor
types of PEM ƒ Marasmus
ƒ Marasmic kwashiorkor
Etiology of Protein Energy Malnutrition:
list down the Primary PEM:
etiology of ƒ Maternal malnutrition during pregnancy and lactation Lecture cum
PEM ƒ Social conditions such as poverty to a limited or selective discussion
unavailability of food
Secondary causes:
ƒ Impair food intake, absorption or utilization
ƒ Increase energy or protein requirements or losses
ƒ Biological conditions interfere with food intake such as
¾ Congenital anomalies

cxxi
 Teacher-
Specific
Content AV Aids Learners
Objectives
activity
¾ Mal absorption Syndrome
¾ Inherited Metabolic diseases
¾ Infectious diseases accompanied by fever and other
diseases like Tuberculosis
¾ Immature immune system causing greater
susceptibility to infection
¾ Intestinal parasitism Lecture cum
ƒ Social causes that affect food intake include discussion
¾ Poverty
¾ Ignorance
¾ Inadequate weaning practices
¾ Child abuse
¾ Poor hygiene

cxxii
 Teacher-
Specific
Content AV Aids Learners
Objectives
activity
Kwashiorkor
define Definition:
kwashiorkor Kwashiorkor is a form characterized primarily by protein
deficiency with adequate carbohydrate consumption.
In India, it develops mainly to the children between three and
five years of age.
Causes: Lecture cum
ƒ Non availability of suitable protein rich foods discussion
describe the ƒ Poor socio economic status

causes of ƒ Faulty feeding habits arise from ignorance Prejudices and

kwashiorkor superstitions
ƒ Prolonged breast feeding only
ƒ Infections and infestations

cxxiii
 Teacher-
Specific
Content AV Aids Learners
Objectives
activity
Diarrhea and decreased intake and poor digestion of food
ƒ Vomitting
ƒ Size of the family (more than 4 or 5 children)
Clinical features:
ƒ Edema of dependent parts. It starts in the lower extremities and
enumerate later involves upper limbs and face
the clinical ƒ Failure to thrive Lecture cum
features of ƒ Moon facies discussion
kwashiorkor ƒ A swollen abdomen (pot belly)
ƒ Fatty liver
ƒ Mental changes like lethargy, irritable, apathetic to external
stimuli
ƒ Marked retarded growth
ƒ Growth failure and hair changes

cxxiv
 Teacher-
Specific
Content AV Aids Learners
Objectives
activity
De pigmentation of hair causes it to be reddish yellow to white.
Curly hair becomes straightened, alternating bands of pale and
dark hair called ‘flag sign’. Hairs become dry, lusterless, sparse,
brittle easily pluckable.
ƒ Skin lesions like erythema, dryness, deep ulcerations,
petechiae, eccymoses like enamel pain skin.
ƒ Skin becomes inelastic mosaic in appearance. Lecture cum
ƒ Recurrent episodes of Diarrhea, respiratory and skin discussion
infection
ƒ Poor appetite
ƒ Nail plates are thin and soft, may be fissured or ridged.
ƒ Atrophy of the papillae on the tongue angular stomatitis,
Xeropthalmia, cheilosis can occur

cxxv
 Teacher-
Content AV Aids Learners
activity
Grading of Kwashiorkor:
Grade – I: Pedal edema
Grade – II: Pedal edema and puffy face
Grade – III: Grade II + edema of the chest and Para nasal
areas
Grade IV: Grade III + ascites Lecture cum
Management: discussion
ƒ Liberal amounts of protein must be offered to these protein
enunciate the depleted children
management ƒ Enough CHO and fat must also be supplied to take care of their
of calorie needs. Otherwise protein is liable to be used up for
kwashiorkor energy production instead of being available for tissue repair
ƒ Protein intake of 4.0g/ Kg body weight is optimal. Higher
protein intake of 5 – 6 gm/ Kg is needed in presence of infection.

cxxvi
 Teacher-
Specific
Content AV Aids Learners
Objectives
activity
ƒ Calories 120 – 150 cal/Kg/day is optimal
ƒ Control of infections is necessary
Diarrhea is controlled by fluid therapy and dietary management.
Appropriate drugs must be given to treat infection.
Dietary Management:
Protein rich foods:
list down the ƒ Cereals, Rice, Ragi
protein rich ƒ Pulses and legumes such as Bengal gram, Red gram, green
Lecture cum
foods gram, horse gram.
discussion
ƒ Milk and Milk products especially cheese
ƒ Germinated pulses
ƒ Egg
ƒ Nuts and oil seeds such as cashew nut, gingelly seeds, coconut,
ground nuts
fish and meat especially liver

cxxvii
 Teacher-
Specific
Content AV Aids Learners
Objectives
activity
Marasmus
Definition:
define Marasmus is an insufficient energy intake to match the
marasmus body’s requirements. Mostly it occurs in younger age of 0 – 2 years.
Causes:
Primary causes:
ƒ Inadequate diet Lecture cum
elaborate the ƒ Infections such as gastro – enteritis discussion
causes of ƒ Poor socio economic status

marasmus ƒ Parents lack of education

Secondary Causes:
Age
ƒ More common in infants than older children. Premature
infant and low birth weight babies are more prone.

128
 Teacher-
Specific
Content AV Aids Learners
Objectives
activity
Chronic Vomitting:
It leads to muscle wasting
Repeated episodes of Chronic Diarrhea:
It leads to loss of weight
Chronic Infections:
Congenital syphilis, Tuberculosis, Upper respiratory
infections Lecture cum
Congenital diseases: discussion
Like Cleft palate, Hydrocephalus
Clinical features:

enlist the ƒ Complete loss of subcutaneous fat especially from the

clinical buttocks, abdomen, medical aspect of things and arms and

features of even the face.

marasmus ƒ Face has prematurely aged look

ƒ Cheeks and temples are hollow due to complete loss of fat

129
 Teacher-
Specific
Content AV Aids Learners
Objectives
activity
ƒ Muscle mass is wasted
ƒ Skin is loose and wrinkled with loss of elasticity
ƒ Purpura, Scaphoid abdomen with visible intestinal peristalsis
ƒ Irritable, loud cry
ƒ Monkey facies
ƒ Mental changes
ƒ Fine, brittle hair, alopecia, Impaired growth Lecture cum
Grading: discussion
Grade I – Axilla and groin (loose skin folds in these areas)
Grade II – Abdomen and Gluteal region
Grade III – Chest and back
Grade IV – Buccal pad of fat
Management:
ƒ Most important aspect of management is to provide calories

130
 Teacher-
Specific
Content AV Aids Learners
Objectives
activity
describe the ƒ Provide 100 calories/Kg of actual body weight. If well
management tolerated, the amount is gradually increased.
of marasmus ƒ Infections must be treated with appropriate drugs
Emotional needs of the child should also be satisfied by
giving love and tender care at house.
Dietary Management:
Calorie and rich foods: Lecture cum
ƒ Cereals like Rice, wheat, Ragi, Millet Jowar. discussion
list down the ƒ Pulses and legumes like Bengal gram, red gram, soya bean,
calorie rich green gram, horse gram.
foods ƒ Roots and tubers like sweet potato, Tapiaco
ƒ Nuts and oil seeds like ground nut, gingelly seeds, coconut.
ƒ Milk and Milk products
ƒ Fish, meat, and chicken

131
 Teacher-
Specific
Content AV Aids Learners
Objectives
activity
explain the Prevention of Malnutrition:
preventive At family level:
measures of ƒ Exclusive breast feeding of Infants for 1st six months
malnutrition ƒ Start weaning by 6th month of Child’s age
ƒ Breast feeding up to 1 Year of Child’s age
ƒ Proper immunization
ƒ Checking Weight regularly Lecture cum
ƒ Maintaining growth chart discussion
ƒ Environmental Sanitation
ƒ Using chappels to prevent worm infestation
ƒ Avoid walking with bare foot anywhere
ƒ Eating high calorie and high protein diet
ƒ Avoid open field defecation and using sanitary latrines
ƒ Keeping food items covered to prevent contamination by fly

132
 Teacher-
Specific
Content AV Aids Learners
Objectives
activity
ƒ Include fruits and vegetables in Diet
ƒ Drinking boiled and cooled water.
At Community level:
ƒ Early detection of malnutrition and intervention
ƒ Integrated Health Package
ƒ Nutrition Education
ƒ Vigorous promotion of family planning Lecture cum
ƒ Income generation activities discussion
ƒ Promotion of education and literacy in the Community
ƒ Technological measures
At National level:
ƒ Nutrition Supplementation
ƒ Nutritional surveillance
ƒ Nutritional Planning

133
 Teacher-
Specific
Content AV Aids Learners
Objectives
activity
Complications:
ƒ Anemia, lower resistance
ƒ Growth failure
More prone to infections

Lecture cum
discussion

134
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135
 7. Gujf; Fiwghl;bd; mwpFwpfis tpsf;Fjy;

8. Gujr;rj;J kpFe;j czTfis gl;baypLjy;

9. cly; fiuT vd;gij tiuaiwjy;

10. cly; fiutpd; fhuzq;fis tpsf;Fjy;

11. cly; fiuT Nehia fl;LgLj;Jjy; gw;wp tpsf;Fjy;

12. rf;jp kpFe;j czTg;nghUl;fis gl;baypLjy;

13. Nghjh Cl;lj;ij jLg;gjw;fhd topKiwfis gl;baypLjy;

Kd;Diu:

ehk; eyKld; ,Ug;gjw;F ekJ clYf;F Cl;lk; Njitg;gLfpwJ.

xU nrb> mjw;Fr; #hpa nrspr;rk;> ePh; kw;Wk; jFe;j vU ,y;iynad;why
ed;Ftsuhjijg; Nghy kdpjh;fSf;Fk; jq;fs; clYf;F Cl;lk; mspf;Fk;
gytifg;gl;l czTg; nghUl;fs; Njit. Nghjh Cl;lk; vd;gJ
Foe;ijfs; ,wg;G kw;Wk; NehAWjypy; mjpfg;gq;F tfpf;fpwJ.
tiuaiw:

rhpahd czTfis cz;zhj my;yJ Nghjpa msT

Cl;lkspf;Fk; czTfis cz;zhj xUth; Nghjh Cl;lk; cilath;

Mthh;. Mij ehk; Nghjh Cl;lk; vd;fpNwhk;.,e;jpahtpy; cs;s

Foe;ijfspy; Nghjh Cl;lk; kpfr; rhjhuzkhf cs;sJ. ,e;j epiyiag;

ngUk;ghYk; czh;e;J nfhs;s Kbtjpy;iy. Vnddpy; Nghjh Cl;lk;

cila xU Foe;ij ed;whf ,Ug;gJ NghyNt jhd; Njhd;Wk; Mdhy;

mNj taJila eykhh;e;j Foe;ij xd;wpd; gf;fj;jpy; epw;f itj;Jg;

ghh;j;jhy; mtd; kpfTk;; rpwpatdhf njhpthd;. mtd; Fiw vil

cs;stdhf ,Ug;ghd;. Vnddpy; tsh;r;rpf;Fj; Njitg;gLk; tifahd

136
czT Nghjpa msT fpilf;fhjNj fhuzkhFk;. ,e;jpahtpd; gy

gFjpfspy; Foe;ijfs; mth;fsJ taJf;Ff; Fiw -vil

cs;sth;fshfNt ,Uf;fpd;wdh;.

Nghjh Cl;lk; njhlh;ghd fhuzq;fs;;:

™ tWik kw;Wk; Nkhrkhd Rw;Wg;Gwr; #oy;

™ mwpahik> fy;tpapd;ik> czT Mh;tf; nfhs;isfs; kw;Wk;

gof;fq;fs;

™ jpUk;gj; jpUk;g tUk; njhw;W Neha;fs; tapw;Wg; Nghf;F kw;Wk; %r;R

njhlh;ghd njhw;Wfs; Nghd;wit.

™ nghpa FLk;gk;

™ gpwg;gpy; vilf;FiwT kw;Wk; ,uj;jr; NrhifAs;s jha;

™ rkr;rPuw;w czT Kiw

™ Mz; ngz; NtWghLfs;

Nghjh Cl;lj;jpd; mwpFwpfs;

™ 1. vil: eykhh;e;j Foe;ij tsh;fpwJ. ‘eytho;Tg;ghij”

tiug;glj;jpy; (Road to health chart) tisTf;NfhL njhlh;e;J

cah;e;J nfhz;Nl NghfpwJ. 5 taJf;Ff; Fiwe;j Foe;ijfs;

fhyKiwg;gb vil ghh;f;fg;gl;L mtdJ tptug;glj;jpy; Fwpf;fg;gl

Ntz;Lk;.

137
 ™ Nky;ifr; Rw;wsT: xU Foe;ij Nghjh Cl;lk; nfhz;ljhf

,Ue;jhy; mtd; nfhO nfhO vdj; Njhd;wpdhYk; mtdJ

jirfs; tPzbf;fg;gLfpd;wd. mtdJ Nky; if nky;ypajhf Mfp

tpLfpwJ. 1 Kjy; 5 taJ tiu cs;s eykhh;e;j Foe;ijfSf;F

Nky; ifapd; Rw;wsT Rkhh; 16 nr.kP ,Uf;Fk; xU Foe;ij Nghjh

Cl;lk; nfhz;ljhf ,Ue;jhy; mJ 13 nr.kPf;Fk; Fiwthf

,Uf;Fk;. 12 nr.kPf;Fk; Fiwthf ,Ue;jhy; kp;ff; fLikahf Nghjh

Cl;lk; nfhz;bUf;fpwJ.

Gujk; rf;jpg; gw;whf;Fiwahfpa Nghjh Cl;lk;

™ Foe;ijfspd; cly; tsh;r;rpf;Fj; Njitahd czTfisj;

juhjjhy; Foe;ijf;F Gujj; rf;jpg; gw;whf;Fiw vw;gLfpwJ.

mjpfkhf Gujk; - rf;jpg; gw;whf;Fiw fhzg;gLjy;

Ie;J tajpd; fPo; cs;s Foe;ijfSf;F Gujk; rf;jpg; FiwghL

mjpfkhf fhzg;gLfpwJ. Cyfpy;Ie;jpy;ehd;F Foe;ijfSf;F

,f;FiwghL Vw;gLfpwJ.

Gujk; rf;jpg; gw;whf;Fiwapd; tiffs;

- Gujg; gw;whf;Fiw

- cly; fiuT

- Gujg; gw;whf;Fiw kw;Wk; cly; fiuT ,uz;Lk;

138
Gujk; rf;jpg; gw;whf;Fiwapd; fhuzq;fs;

Kf;fpa fhuzq;fs;

- fh;g fhyj;jpYk;> ghY}l;Lk; fhyj;jpYk;czT gw;whf;Fiw

- r%f tho;f;if Kiw

- tWik msthd czT fpilj;jy; my;yJ Fwpg;gpl;l rj;Js;s

czT fpilf;fhky; ,Ug;gJ

mLj;j fhuzq;fs;

- NghJkhd czT cz;zhik nrhpahik> Cl;lr;rj;J

gad;gLj;jhik

- mjpf rf;jp kw;Wk; Gujr; rj;J Njitg;gLjy;

czT cl;nfhs;Sjy; rk;ke;jkhd caphpay; fhuzq;fs;

- gpwtpf; NfhshWfs;

- czT nrhpj;jy; NfhshWfs;

- guk;giu rk;ke;jgl;l Neha;fs;

- njhw;W Neha; vjph;g;Gj; jpwd; fhuzkhf Nehaj; njhw;W

- tapw;Wg; GOf;fs;

czT cl;nfhs;Sjy; rk;ke;jkhd rKjhaf; fhuzq;fs;

- tWik

- mwpahik

- ,iz czT nfhLj;jypy; jtwhd gof;ftof;fq;fs;

- Foe;ij J\;g;uNahfk;

- Rfhjhukw;w #o;epiy

139
Gujg; gw;whf;Fiw

tiuaiw

NghJkhd msT Gujr;rj;Js;s czTg; nghUl;fis cl;nfhs;shjjhy;

Gujg; gw;whf;Fiw Vw;gLfpwJ. ,jid ePh;k Cl;lf;Fiw (f;th\pNahh;f;fh;)

my;yJ Nghjh <u Cl;lk; (wet malnutrition) vd;Wk; $wg;gLk;.

,e;Neha; ,e;jpahtpy; 3 Kjy; 5 taJ Foe;ijfSf;F

fhzg;gLfpwJ.

fhuzq;fs;:

- Gujr; rj;J mlq;fpa czT gw;whf;Fiw

- Vo;ikahd r%f nghUshjhu epiyik
- mwpahik kw;Wk; %l ek;gpf;iffs; nfhz;l jtwhd czT Kiw
gof;f tof;fq;fs;
- ePz;l fhyj;jpw;F jha;g;ghy; kl;LNk jUjy;
- Neha; njhw;Wfs;
- Fly; GOf;fs;
- tapw;Wg; Nghf;F> the;jp> nghpa FLk;gk; (4 my;yJ 5 Foe;ijfs;
,Ug;gJ)
-
mwpFwpfs;:

- ePh;Nfhh;it Kjypy; fhy;fs; gpd;dh; iffs; kw;Wk; Kfj;jpy;

ePh;f;Nfhit.
- ,aw;ifahd tsh;r;rpapd;ik
- epyT Nghy Kfj;Njhw;wk;
- tapW tPf;fk;
- fy;yPuy; tPf;fk;

140
 - Nrhk;gy;> vhpr;ry;> tpisahl;by; Nrhh;T Nghd;w kdg;ghd;ik
- tsh;r;rpf;FiwT
- tsh;r;rpapd;ik
- Kbapy; Vw;gLk; khw;wq;fs;

Kbapy; epw khw;wq;fs; Kjypy; nrk;gl;il fyhpy; ,Ue;J nts;is epwkhf

khWjy; RUs; Kbfs; ePl;lkhf fhzg;gLjy; mlh;j;jpapd;w gutyhf

tsUjy; nehUq;fp tpLjy; kw;Wk; vspjhf gpLq;Fjy;

- Njhy; khw;wq;fs;

Njhy; jbj;jy;> cyh;jy;> Gz;fs;>rpfg;G nfhg;gsq;fs;> nrjpy;yhf Njhy;

chpjy;
- mbf;fb tapw;Wg;Nghf;F> rthrj; njhw;W kw;Wk; mbf;fb
fhzg;gLjy;

- grpapd;ik

- efq;fs; nky;ypajhf ,Uj;jy; kw;Wk; tphpry; ciljy;

- tha;g;Gz;> fz;fs; eyf;Fiw

mwpFwpfis itj;J tifg;gLj;Jjy;

tif 1- fhy;fspy; ePh;Nfhh;it (tPf;fk;)

tif 2- fhy; tPf;fk; kw;Wk; Kf tPf;fk;

tif 3- fhy;tPf;fk; Kf tPf;fk; kw;Wk; neQ;R %f;F gFjpfspy; ePh;Nfhh;it

tif 4- fhy; ePh;Nfhh;it Kf ePh;Nfhh;it+neQ;R %f;F gFjpfspy;

ePh;Nfhh;it kw;Wk; tapw;W tPf;fk; (kNfhjuk;)

141
rpfpr;ir Kiwfs;:

- Foe;ijfspd; tsh;r;rpf;Fj; Njitahd Gujr;rj;J kpFe;j

czTg;nghUl;fis toq;Fjy;

- Neha;j; njhw;Wfis fl;Lg;gLj;Jjy;

™ tapw;Wg;Nghf;F- jput kw;Wk; czT Kiwfspy; fl;Lg;gLj;jy;

Ntz;Lk;

™ Neha; njhw;Wf;fhd rhpahd khj;jpiufis nfhLj;jy;

Ntz;Lk;

Gujk; kpFe;j czTg; nghUl;fs;

- tpyq;Fg; Gujq;fs; - ghy;> japh;> ghyhilf;fl;b> Kl;il> kPd; kw;Wk;

,iwr;rp

- fha;fwpg;Gujk; - epyf;fliy kw;Wk; Nrhah gPd;];

- rpW jhdpaq;fs;> gapW tiffs;> gUg;G kw;Wk; gaWfs;> gaw;W new;W

gl;lhzp> kw;Wk; gPd;];> vz;nza; tpj;Jf;fs;

- Kis fl;ba gaW tiffs;

- Ke;jphp gUg;G>fliy gUg;G

gr;irg;gapW> nfhs;S> jl;ilg;gaW

142
cly; fiuT Neha;

tiuaiw

NghJkhd msT rf;jp kpFe;j czTg; nghUl;fis cl;nfhs;shky;

,Ug;gjhy; cly; fiuT Neha; Vw;gLfpwJ.

,e;Neha; 0-2 taJ Foe;ijfSf;F mjpfkhf fhzg;gLfpwJ.

fhuzq;fs;:

Kf;fpa fhuzq;fs;

- czT gw;whf;Fiw

- Neha; njhw;W

- Vo;ikahd r%f nghUshjhu epiy

mLj;j fhuzq;fs;

taJ

tsh;e;j Foe;ijfis tpl 6 khjk; Kjy; 1 taJ Foe;ijfs; mjpfkhf

ghjpf;fg;gLth;

- Fiw gpurtk; kw;Wk; Fiwe;j vil cs;s Foe;ijfs; mjpfkhf

ghjpf;fg;gLth;

njhlh; the;jp

,jdhy; jir Nrjkiljy; fhzg;gLk;

njhlh; tapw;Wg;Nghf;F (Ngjp)

,jdhy; vil Fiwjy; fhzg;gLk;

143
ehl;gl;l Neha; njhw;Wfs;

fhrNeha;> %r;R njhlh;ghd Neha;j;njhw;W> gpwtp Nkf fpue;jp Neha;

gpwtp Neha;fs;:

md;d gpsT> jiy tPf;fk;

mwpFwpfs;:

- Foe;ij rpwpajhfTk;> kpf nkype;Jk;>Njhypd; fPo; nfhOg;Ng

,y;yhky;> vYk;G cs;sjhfTk; ,Uf;Fk;.

- Kfk; nkyph;jy;> taJ Kjph;e;j Njhw;wk;.

- taJf;F ,Uf;f Ntz;ba vilapy; ghjpahf Fiwjy;

- Nky; ifr;Rw;wsT 14 nr.kPf;Fk; kpf Fiwe;J ,Uf;Fk;

- neLehs; Ngjp ,Uf;Fk;

- ePh; ,og;G mwpFwpfs;

- Njhy; RUf;fk;

- tapW> njhil> if Kfg;gFjpfspy; Njhypd; fPo; nfhOg;G ,y;yhky;

fhzg;gLjy;

- Fuq;F Kfj;Njhw;wk;

- tsh;r;rp Fiwjy;

- Kb cjph;jy;

144
mwpFwpfis itj;J tifg;gLj;Jjy;

tif1- ifapLf;fpy;> kw;Wk; fhypLf;fpy; Njhy; RUf;fk;

tif 2- tapW kw;Wk; ,Lg;gpy; Njhy; RUf;fk;

tif 3 - neQ;R kw;Wk; KJfpy; Njhy; RUf;fk;

tif 4- fd;dk; Fiwe;J fhzg;gLjy;

rpfpr;ir Kiwfs;

- fNyhhp kpFe;j czTg;nghUl;fis toq;Fjy;

- jFe;j kUe;jpidj; nfhz;L Neha;j; njhw;Wfis Fzg;gLj;Jjy;

Ntz;Lk;

- Foe;ijf;F Njitahd md;igAk;> mutizg;igAk; ju Ntz;Lk;

fNyhhp kpFe;j czTg;nghUl;fs;

- rpW jhdpaq;fs; kw;Wk; jhdpaq;fs;- NfhJik- nuhl;b> rg;ghj;jp>

mhprp> fk;G> Nrhsk; kw;Wk; Nfo;tuF (jpiz)

- khTr;rj;Js;s fha;fs;- cUisf;fpoq;F rh;f;fiu ts;spf;fpoq;F

kw;Wk; kuts;spf;fpoq;F

- khTr;rj;Js;s goq;fs;> thiog;gok;> <ug;gyh

- rh;f;fiu Njd; kw;Wk; nty;yk;

- nfhOg;Gfs; kw;Wk; vz;nza;fs; - ntz;nza;> nea;

145
jLg;G Kiwfs;

FLk;g mstpy;

- Kjy; 6 khjj;jpw;F Foe;ijf;F jha;g;ghy; kl;LNk nfhLj;jy;

Ntz;Lk;

- Foe;ijapd; 6 tJ khjj;jpy; ,iz czT Muk;gpj;jy; Ntz;Lk;

- jha;g;ghy; 1 tUlk; tiu nfhLj;jy; Ntz;Lk;

- %d;W khjj;jpw;F xU KiwahtJ Foe;ijf;F vil ghpNrhjpj;jy;

Ntz;Lk;

- Foe;ij tsh;r;rp tiuglk; rhpghh;j;jy;

- Rw;Wr;#oy; Rfhjhuk;

GOj;njhw;iw jLf;f Foe;ijfSf;F fhyzpfis mzptpf;f Ntz;Lk;

- ntWk; fhy;fspy; elg;gij jtph;f;f Ntz;Lk;

- fNyhhp kw;Wk; Gujk; kpFe;j czT nghUl;fis nfhLj;jy;

Ntz;Lk;

- jpwe;j ntspapy; kyk; fopf;ff;$lhJ

- Rfhjhukhd fopg;gplj;ij gad;gLj;Jjy; Ntz;Lk;

- czTg; nghUl;fis <> nfhR> Nghd;witfs; nkha;f;fhjthW %b

itf;f Ntz;Lk;

- fha;fwpfs;> kw;Wk; goq;fis cztpy; Nrh;j;Jf; nfhs;s Ntz;Lk;

- nfhjpj;J Mw itj;j ePh; kl;LNk Foe;ijfSf;F nfhLf;f

Ntz;Lk;

146
rKjha mstpy;

- Muk;gj;jpNyNa czT gw;whf;Fiwia fz;lwpe;J fisjy;

- tWikapypUe;J tpLgl nghUshjhu tsh;r;rp

- Foe;ijfs; eytho;Tg; guhkhpg;Gj; jpl;lj;ijg; gads;s tifapy;

elj;Jjy;

- Rw;Wg;Gwr;#oy; Jg;Guitj; Kd;Ndw;Wjy;

- Cl;l czT kw;Wk; eytho;Tf; fy;tp

- FLk;g eyj;jpl;lk;

Njrpa mstpy;

- rj;JzT mwpit gj;jphpf;if> Gj;jfk; thapyhf gug;Gjy;

- rj;JzT ,d;ik epiyikfis fz;fhzpj;jy;

- rj;JzT jpl;lq;fisj; jahhpj;jy;

ghjpg;Gfs;

- ,uj;jNrhif> tsh;r;rpapd;ik

- Neha;njhw;W mjpfkhf fhzg;gly;

147
 APPENDIX - G

STRUCTURED INTERVIEW SCHEDULE

PART-I
DEMOGRAPHIC DATA OF THE MOTHER

1. Age of the mother in years

a) Below 25

b) 26-30

c) 31-35

d) Above 36

2. Educational status of the mother

a) No formal education

b) Primary education

c) Middle education

d) High school

e) Higher secondary

f) Graduate

3. Occupation of the mother

a) House wife

b) Coolie

c) Self employed

d) Private employee

e) Government employee

148
4. Family size(Total number of family members)

a) 3 members

b) 4 members

c) 5 members

d) 6 and above

5. Type of family

a) Nuclear

b) Joint

6. Total number of under five children

a) 1 child

b) 2 children

7. Total family income per month

a) 1000-2000

b) 2000-3000

c) 4000-6000

d) 6000 and above

8. Religion

a) Hindu

b) Muslim

c) Christian

d) Others

149
 PART-II
STRUCTURED INTERVIEW SCHEDULE/ KNOWLEDGE
QUESTIONNAIRE
1. What is malnutrition?

a) Adequate food and calorie intake

b) Inadequate food intake for longer period

c) Excess food intake

d) Excess intake of fatty foods

2. Which of the following age group has greatest prevalence of malnutrition?

a) 9-12 months of age

b) 6 month-3 years of age

c) 1-2 years of age

d) 3-5 years of age

3. What are the signs and symptoms of malnutrition?

a) Fever and cold

b) Cough and vomiting

c) Loss of weight and growth failure

d) Weight gain and irritability

4. Which is not a primary cause of Protein energy malnutrition?

a) Poverty

b) Maternal malnutrition

c) Unavailability of food

d) Environmental sanitation

150
5. What are the common forms of Protein energy malnutrition?

a) Goitre and myxedema

b) Rickets and scurvy

c) Beri beri and keratomalacia

d) Kwashiorkor and marasmus

6. What is kwashiorkor?

a) Protein deficiency disorder with adequate carbohydrate consumption

b) Vitamin deficiency disorder with adequate protein consumption

c) Calorie deficiency disorder with adequate vitamin consumption

d) Vitamin A deficiency disorder with adequate protein consumption

7. Which age group is mostly affected by kwashiorkor?

a) 0-2 years

b) 4-5 years

c) 3-5 years

d) 0-1 year

8. What are the signs and symptoms of kwashiorkor?

a) Redness of eyes and irritability

b) Edema and mental changes

c) Leg pain and giddiness

d) Throat pain and cough

151
9. How the kwashiorkor child looks?

a) Short and stout

b) Thin and tall

c) Obese and vision changes

d) Edematous and hair changes

10. What is the dietary management for kwashiorkor?

a) Providing vitamin rich diet

b) Providing calorie rich diet

c) Providing protein rich diet

d) Providing calcium rich diet

11. What are the protein rich foods given below?

a) Milk, pulses, meat

b) Jaggery, honey, dates

c) Sugar, potato, cucumber

d) Rice, ragi, bajra

12. What is Marasmus?

a) Fat deficiency disorder

b) Vitamin deficiency disorder

c) Protein deficiency disorder

d) Calorie deficiency disorder

152
13. Which age group is mostly affected by Marasmus?

a) 2-3 years

b) 0-2 years

c) 3-4 years

d) 4-5 years

14. What are the signs and symptoms of Marasmus?

a) Head ache and abdominal pain

b) Fever and vomiting

c) Loss of subcutaneous fat and muscle wasting

d) Itching and skin lesions

15. How the Marasmic child looks?

a) Active and weight gain

b) Very tall

c) Obesed

d) Very thin and little old man facies

16. What is the dietary management for Marasmus?

a) Providing calorie rich diet

b) Providing vitamin rich diet

c) Providing Calcium rich diet

d) Proving protein rich diet

153
17. What are the calorie rich foods given below?

a) Rice, maize, ragi

b) Egg, milk, ghee

c) Fish, meat, crab

d) Green leafy vegetables, cucumber, ladies finger

18. What are the common infections frequently encountered by malnourished

child?

a) Skin infections and urinary tract infections

b) Diarrhea and respiratory infections

c) Ear infections, skin infections

d) Urinary tract infections and eye infections

e)

19. What are the risk factors of Malnutrition?

a) Obesity

b) Psychological disturbances

c) Heriditary

d) Poverty

20. Which is the appropriate age for weaning to prevent malnutrition?

a) By 6th month

b) By 8th month

c) By 7th month

d) By 9th month

154
21. How often weight should be checked for 0-3 years of children?

a) Once in a month

b) Once in 2 months

c) Once in 3 months

d) Once in 4 months

22. How often weight should be checked for 3-6 years of children?

a) Once in 6 months

c) Once in 4 months

d) Once in 3 months

e) Once in 9 months

23. What is the normal mid arm circumference for 1-5 years of children?
a) 14 cms

b) 13 cms

c) 15 cms

d) 12 cms

24.Which is not a preventive measure of malnutrition at family level?

a) Providing high protein diet

b) Providing high calorie diet

c) Checking weight regularly

d) Meeting play needs

25.What are the complications of Malnutrition?

a) Hepatic failure

b) Growth failure

c) Respiratory failure

d) Renal failure

155
 PART-III
STRUCTURED INTERVIEW SCHEDULE/PRACTICE
QUESTIONNAIRE
SI.NO ITEMS YES NO
1 Do you give calorie rich diet to your child?

2 Do you provide adequate cereals, green leafy vegetables

to your child?

3 Do you provide small and frequent diet to your child?

4 Do you provide mid day snacks to your child?

5 Do you provide protein rich diet to your child?

6 Do you provide germinated pulses to your child?

7 Do you provide fruits to your child?

8 Do you provide egg to your child?

9 Do you provide milk to your child before bed time?

10 Have you given breast feeding up to one year to your

child?
11 Have you started weaning at 6th month of child’s age?

12 Do you check your child’s height and weight regularly?

13 Do you make sure that your child is not suffered from

frequent respiratory infections and diarrhea?

14 Have you given immunization up to your child’s age?

15 Have you given vitamin ‘A’ drops to your child?

156
 APPENDIX – H
SCORES RELATED TO KNOWLEDGE REGARDING MALNUTRITION
AMONG MOTHERS WITH UNDER FIVE CHILDREN

S.NO A B C D
1 0 1 0 0
2 0 1 0 0
3 0 0 1 0
4 0 0 0 1
5 0 0 0 1
6 1 0 0 0
7 0 0 1 0
8 0 1 0 0
9 0 0 0 1
10 0 0 1 0
11 1 0 0 0
12 0 0 0 1
13 0 1 0 0
14 0 0 1 0
15 0 0 0 1
16 1 0 0 0
17 1 0 0 0
18 0 1 0 0
19 0 0 0 0
20 1 0 0 0
21 1 0 0 0
22 0 0 1 0
23 0 1 0 0
24 0 0 0 1
25 0 1 0 0
Correct answer-1 Wrong answer-1

157
SCORES RELATED TO PRACTICE OF MOTHERS OF UNDER FIVE
CHILDREN REGARDING MALNUTRITION

S.NO YES NO

1 1 0

2 1 0

3 1 0

4 1 0

5 1 0

6 1 0

7 1 0

8 1 0

9 1 0

10 1 0

11 1 0

12 1 0

13 1 0

14 1 0

15 1 0

Correct answer-1 Wrong answer-1

158
 xUq;fpize;J fw;gpf;Fk; jpl;lk;

jiyg;G - Nghjh Cl;lk;

FO - 0-5 tUl Foe;ijfspd; jha;khh;fs;

,lk; - ma;ak;gl;b

Neuk; - 45 epkplq;fs;

fw;gpf;Fk; Kiw - fye;Jiuahly; kw;Wk; tpsf;fkspj;jy;

fw;gpf;f gad;gLj;Jk; cgfuzk ;- Rtnuhl;b tpsk;guj; jhs;fs;

nkhop - jkpo;

nghJ Nehf;fk;

0 - 5 tUl Foe;ij tsh;g;gpy; Nghjh Cl;lj;jpd; Kf;fpaj;Jtj;ij

jha;khh;fs; czh;e;J nfhs;sTk; ,f;Fiwghbd;wp Foe;ij tsh;f;f

jq;fsJ jpdrhp tho;f;ifapy; Kay Cf;Ftpg;gJk; ,jd; Nehf;fk; MFk;.

Fwpg;gpl;l Nehf;fq;fs;:

fPo; fz;litfis jha;khh;fSf;Fk; tpsf;f Ntz;Lk;

14. Nghjh Cl;lj;jpd; tiuaiwjy;

15. Nghjh Cl;;lk; njhlh;ghd fhuzq;fis gl;baypLjy;

16. Gujk; rf;jp Nghjh Cl;lj;ij tiuaiwjy;

17. Gujk; rf;jp Nghjh Cl;lj;jpd; tiffis gl;baypLjy;

18. Gujk; rf;jp Nghjh Cl;lj;jpd; tiuaiwjy;

159
 19. Gujf; Fiwghl;bd; fhuzq;fis gl;baypLjy;

20. Gujf; Fiwghl;bd; mwpFwpfis tpsf;Fjy;

21. Gujr;rj;J kpFe;j czTfis gl;baypLjy;

22. cly; fiuT vd;gij tiuaiwjy;

23. cly; fiutpd; fhuzq;fis tpsf;Fjy;

24. cly; fiuT Nehia fl;LgLj;Jjy; gw;wp tpsf;Fjy;

25. rf;jp kpFe;j czTg;nghUl;fis gl;baypLjy;

26. Nghjh Cl;lj;ij jLg;gjw;fhd topKiwfis gl;baypLjy;

Kd;Diu:

ehk; eyKld; ,Ug;gjw;F ekJ clYf;F Cl;lk; Njitg;gLfpwJ.

xU nrb> mjw;Fr; #hpa nrspr;rk;> ePh; kw;Wk; jFe;j vU ,y;iynad;why

ed;Ftsuhjijg; Nghy kdpjh;fSf;Fk; jq;fs; clYf;F Cl;lk; mspf;Fk;

gytifg;gl;l czTg; nghUl;fs; Njit. Nghjh Cl;lk; vd;gJ

Foe;ijfs; ,wg;G kw;Wk; NehAWjypy; mjpfg;gq;F tfpf;fpwJ.

tiuaiw:

rhpahd czTfis cz;zhj my;yJ Nghjpa msT

Cl;lkspf;Fk; czTfis cz;zhj xUth; Nghjh Cl;lk; cilath;

Mthh;. Mij ehk; Nghjh Cl;lk; vd;fpNwhk;.,e;jpahtpy; cs;s

Foe;ijfspy; Nghjh Cl;lk; kpfr; rhjhuzkhf cs;sJ. ,e;j epiyiag;-

ngUk;ghYk; czh;e;J nfhs;s Kbtjpy;iy. Vnddpy; Nghjh Cl;lk;

cila xU Foe;ij ed;whf ,Ug;gJ NghyNt jhd; Njhd;Wk; Mdhy;

mNj taJila eykhh;e;j Foe;ij xd;wpd; gf;fj;jpy; epw;f itj;Jg;-

160
ghh;j;jhy; mtd; kpfTk;; rpwpatdhf njhpthd;. mtd; Fiw vil

cs;stdhf ,Ug;ghd;. Vnddpy; tsh;rr

; pf;Fj; Njitg;gLk;

tifahd czT Nghjpa msT fpilf;fhjNj fhuzkhFk;.

,e;jpahtpd; gy gFjpfspy; Foe;ijfs; mth;fsJ taJf;Ff; Fiw - vil

cs;sth;fshfNt ,Uf;fpd;wdh;.

Nghjh Cl;lk; njhlh;ghd fhuzq;fs;;:

™ tWik kw;Wk; Nkhrkhd Rw;Wg;Gwr; #oy;

™ mwpahik> fy;tpapd;ik> czT Mh;tf; nfhs;isfs; kw;Wk;

gof;fq;fs;

™ jpUk;gj; jpUk;g tUk; njhw;W Neha;fs; tapw;Wg; Nghf;F kw;Wk; %r;R

njhlh;ghd njhw;Wfs; Nghd;wit.

™ nghpa FLk;gk;

™ gpwg;gpy; vilf;FiwT kw;Wk; ,uj;jr; NrhifAs;s jha;

™ rkr;rPuw;w czT Kiw

™ Mz; ngz; NtWghLfs;

Nghjh Cl;lj;jpd; mwpFwpfs;

™ 1. vil: eykhh;e;j Foe;ij tsh;fpwJ. ‘eytho;Tg;ghij”

tiug;glj;jpy; (Road to health chart) tisTf;NfhL njhlh;e;J

cah;e;J nfhz;Nl NghfpwJ. 5 taJf;Ff; Fiwe;j Foe;ijfs;

fhyKiwg;gb vil ghh;f;fg;gl;L mtdJ tptug;glj;jpy; Fwpf;fg;gl

Ntz;Lk;.

161
 ™ Nky;ifr; Rw;wsT: xU Foe;ij Nghjh Cl;lk; nfhz;ljhf

,Ue;jhy; mtd; nfhO nfhO vdj; Njhd;wpdhYk; mtdJ

jirfs; tPzbf;fg;gLfpd;wd. mtdJ Nky; if nky;ypajhf Mfp

tpLfpwJ. 1 Kjy; 5 taJ tiu cs;s eykhh;e;j Foe;ijfSf;F

Nky; ifapd; Rw;wsT Rkhh; 16 nr.kP ,Uf;Fk; xU Foe;ij Nghjh

Cl;lk; nfhz;ljhf ,Ue;jhy; mJ 13 nr.kPf;Fk; Fiwthf

,Uf;Fk;. 12 nr.kPf;Fk; Fiwthf ,Ue;jhy; kp;ff; fLikahf Nghjh

Cl;lk; nfhz;bUf;fpwJ.

Gujk; rf;jpg; gw;whf;Fiwahfpa Nghjh Cl;lk;

™ Foe;ijfspd; cly; tsh;r;rpf;Fj; Njitahd czTfisj;

juhjjhy; Foe;ijf;F Gujj; rf;jpg; gw;whf;Fiw vw;gLfpwJ.

mjpfkhf Gujk; - rf;jpg; gw;whf;Fiw fhzg;gLjy;

Ie;J tajpd; fPo; cs;s Foe;ijfSf;F Gujk; rf;jpg; FiwghL

mjpfkhf fhzg;gLfpwJ. Cyfpy;Ie;jpy;ehd;F Foe;ijfSf;F

,f;FiwghL Vw;gLfpwJ.

Gujk; rf;jpg; gw;whf;Fiwapd; tiffs;

- Gujg; gw;whf;Fiw

- cly; fiuT

- Gujg; gw;whf;Fiw kw;Wk; cly; fiuT ,uz;Lk;

162
Gujk; rf;jpg; gw;whf;Fiwapd; fhuzq;fs;

Kf;fpa fhuzq;fs;

- fh;g fhyj;jpYk;> ghY}l;Lk; fhyj;jpYk;czT gw;whf;Fiw

- r%f tho;f;if Kiw

- tWik msthd czT fpilj;jy; my;yJ Fwpg;gpl;l rj;Js;s

czT fpilf;fhky; ,Ug;gJ

mLj;j fhuzq;fs;

- NghJkhd czT cz;zhik nrhpahik> Cl;lr;rj;J

gad;gLj;jhik

- mjpf rf;jp kw;Wk; Gujr; rj;J Njitg;gLjy;

czT cl;nfhs;Sjy; rk;ke;jkhd caphpay; fhuzq;fs;

- gpwtpf; NfhshWfs;

- czT nrhpj;jy; NfhshWfs;

- guk;giu rk;ke;jgl;l Neha;fs;

- njhw;W Neha; vjph;g;Gj; jpwd; fhuzkhf Nehaj; njhw;W

- tapw;Wg; GOf;fs;

czT cl;nfhs;Sjy; rk;ke;jkhd rKjhaf; fhuzq;fs;

- tWik

- mwpahik

- ,iz czT nfhLj;jypy; jtwhd gof;ftof;fq;fs;

- Foe;ij J\;g;uNahfk;

- Rfhjhukw;w #o;epiy

163
Gujg; gw;whf;Fiw

tiuaiw

NghJkhd msT Gujr;rj;Js;s czTg; nghUl;fis cl;nfhs;shjjhy;

Gujg; gw;whf;Fiw Vw;gLfpwJ. ,jid ePh;k Cl;lf;Fiw (f;th\pNahh;f;fh;)

my;yJ Nghjh <u Cl;lk; (wet malnutrition) vd;Wk; $wg;gLk;.

,e;Neha; ,e;jpahtpy; 3 Kjy; 5 taJ Foe;ijfSf;F

fhzg;gLfpwJ.

fhuzq;fs;:

- Gujr; rj;J mlq;fpa czT gw;whf;Fiw

- Vo;ikahd r%f nghUshjhu epiyik

- mwpahik kw;Wk; %l ek;gpf;iffs; nfhz;l jtwhd czT Kiw

gof;f tof;fq;fs;

- ePz;l fhyj;jpw;F jha;g;ghy; kl;LNk jUjy;

- Neha; njhw;Wfs;

- Fly; GOf;fs;

- tapw;Wg; Nghf;F> the;jp> nghpa FLk;gk; (4 my;yJ 5 Foe;ijfs;

,Ug;gJ)

mwpFwpfs;:

- ePh;Nfhh;it Kjypy; fhy;fs; gpd;dh; iffs; kw;Wk; Kfj;jpy;

ePh;f;Nfhit.

- ,aw;ifahd tsh;r;rpapd;ik

- epyT Nghy Kfj;Njhw;wk;

164
 - tapW tPf;fk;

- fy;yPuy; tPf;fk;

- Nrhk;gy;> vhpr;ry;> tpisahl;by; Nrhh;T Nghd;w kdg;ghd;ik

- tsh;r;rpf;FiwT

- tsh;r;rpapd;ik

Kbapy; Vw;gLk; khw;wq;fs;

Kbapy; epw khw;wq;fs; Kjypy; nrk;gl;il fyhpy; ,Ue;J nts;is epwkhf

khWjy; RUs; Kbfs; ePl;lkhf fhzg;gLjy; mlh;j;jpapd;w gutyhf

tsUjy; nehUq;fp tpLjy; kw;Wk; vspjhf gpLq;Fjy;

- Njhy; khw;wq;fs;

Njhy; jbj;jy;> cyh;jy;> Gz;fs;>rpfg;G nfhg;gsq;fs;> nrjpy;yhf Njhy;

chpjy;

- mbf;fb tapw;Wg;Nghf;F> rthrj; njhw;W kw;Wk; mbf;fb

fhzg;gLjy;

- grpapd;ik

- efq;fs; nky;ypajhf ,Uj;jy; kw;Wk; tphpry; ciljy;

- tha;g;Gz;> fz;fs; eyf;Fiw

165
mwpFwpfis itj;J tifg;gLj;Jjy;

tif 1- fhy;fspy; ePh;Nfhh;it (tPf;fk;)

tif 2- fhy; tPf;fk; kw;Wk; Kf tPf;fk;

tif 3- fhy;tPf;fk; Kf tPf;fk; kw;Wk; neQ;R %f;F gFjpfspy; ePh;Nfhh;it

tif 4- fhy; ePh;Nfhh;it Kf ePh;Nfhh;it+neQ;R %f;F gFjpfspy;

ePh;Nfhh;it kw;Wk; tapw;W tPf;fk; (kNfhjuk;)

rpfpr;ir Kiwfs;:

- Foe;ijfspd; tsh;r;rpf;Fj; Njitahd Gujr;rj;J kpFe;j

czTg;nghUl;fis toq;Fjy;

- Neha;j; njhw;Wfis fl;Lg;gLj;Jjy;

™ tapw;Wg;Nghf;F- jput kw;Wk; czT Kiwfspy; fl;Lg;gLj;jy;

Ntz;Lk;

™ Neha; njhw;Wf;fhd rhpahd khj;jpiufis nfhLj;jy;

Ntz;Lk;

Gujk; kpFe;j czTg; nghUl;fs;

- tpyq;Fg; Gujq;fs; - ghy;> japh;> ghyhilf;fl;b> Kl;il> kPd; kw;Wk;

,iwr;rp

- fha;fwpg;Gujk; - epyf;fliy kw;Wk; Nrhah gPd;];

- rpW jhdpaq;fs;> gapW tiffs;> gUg;G kw;Wk; gaWfs;> gaw;W new;W

gl;lhzp> kw;Wk; gPd;];> vz;nza; tpj;Jf;fs;

- Kis fl;ba gaW tiffs;

- Ke;jphp gUg;G> fliy gUg;G> gr;irg;gapW> nfhs;S> jl;ilg;gaW

166
cly; fiuT Neha;

tiuaiw

NghJkhd msT rf;jp kpFe;j czTg; nghUl;fis cl;nfhs;shky;

,Ug;gjhy; cly; fiuT Neha; Vw;gLfpwJ.

,e;Neha; 0-2 taJ Foe;ijfSf;F mjpfkhf fhzg;gLfpwJ.

fhuzq;fs;:

Kf;fpa fhuzq;fs;

- czT gw;whf;Fiw

- Neha; njhw;W

- Vo;ikahd r%f nghUshjhu epiy

mLj;j fhuzq;fs;

taJ

tsh;e;j Foe;ijfis tpl 6 khjk; Kjy; 1 taJ Foe;ijfs; mjpfkhf

ghjpf;fg;gLth;

- Fiw gpurtk; kw;Wk; Fiwe;j vil cs;s Foe;ijfs; mjpfkhf

ghjpf;fg;gLth;

njhlh; the;jp

,jdhy; jir Nrjkiljy; fhzg;gLk;

njhlh; tapw;Wg;Nghf;F (Ngjp)

,jdhy; vil Fiwjy; fhzg;gLk;

ehl;gl;l Neha; njhw;Wfs;

fhrNeha;> %r;R njhlh;ghd Neha;j;njhw;W> gpwtp Nkf fpue;jp Neha;

167
gpwtp Neha;fs;:

md;d gpsT> jiy tPf;fk;

mwpFwpfs;:

- Foe;ij rpwpajhfTk;> kpf nkype;Jk;>Njhypd; fPo; nfhOg;Ng

,y;yhky;> vYk;G cs;sjhfTk; ,Uf;Fk;.

- Kfk; nkyph;jy;> taJ Kjph;e;j Njhw;wk;.

- taJf;F ,Uf;f Ntz;ba vilapy; ghjpahf Fiwjy;

- Nky; ifr;Rw;wsT 14 nr.kPf;Fk; kpf Fiwe;J ,Uf;Fk;

- neLehs; Ngjp ,Uf;Fk;

- ePh; ,og;G mwpFwpfs;

- Njhy; RUf;fk;

- tapW> njhil> if Kfg;gFjpfspy; Njhypd; fPo; nfhOg;G ,y;yhky;

fhzg;gLjy;

- Fuq;F Kfj;Njhw;wk;

- tsh;r;rp Fiwjy;

- Kb cjph;jy;

mwpFwpfis itj;J tifg;gLj;Jjy;

tif1- ifapLf;fpy;> kw;Wk; fhypLf;fpy; Njhy; RUf;fk;

tif 2- tapW kw;Wk; ,Lg;gpy; Njhy; RUf;fk;

tif 3 - neQ;R kw;Wk; KJfpy; Njhy; RUf;fk;

tif 4- fd;dk; Fiwe;J fhzg;gLjy;

168
rpfpr;ir Kiwfs;

- fNyhhp kpFe;j czTg;nghUl;fis toq;Fjy;

- jFe;j kUe;jpidj; nfhz;L Neha;j; njhw;Wfis Fzg;gLj;Jjy;

Ntz;Lk;

- Foe;ijf;F Njitahd md;igAk;> mutizg;igAk; ju Ntz;Lk;

fNyhhp kpFe;j czTg;nghUl;fs;

- rpW jhdpaq;fs; kw;Wk; jhdpaq;fs;- NfhJik- nuhl;b> rg;ghj;jp>

mhprp> fk;G> Nrhsk; kw;Wk; Nfo;tuF (jpiz)

- khTr;rj;Js;s fha;fs;- cUisf;fpoq;F rh;f;fiu ts;spf;fpoq;F

kw;Wk; kuts;spf;fpoq;F

- khTr;rj;Js;s goq;fs;> thiog;gok;> <ug;gyh

- rh;f;fiu Njd; kw;Wk; nty;yk;

- nfhOg;Gfs; kw;Wk; vz;nza;fs; - ntz;nza;> nea;

jLg;G Kiwfs;

FLk;g mstpy;

- Kjy; 6 khjj;jpw;F Foe;ijf;F jha;g;ghy; kl;LNk nfhLj;jy;

Ntz;Lk;

- Foe;ijapd; 6 tJ khjj;jpy; ,iz czT Muk;gpj;jy; Ntz;Lk;

- jha;g;ghy; 1 tUlk; tiu nfhLj;jy; Ntz;Lk;

- %d;W khjj;jpw;F xU KiwahtJ Foe;ijf;F vil ghpNrhjpj;jy;

Ntz;Lk;

169
 - Foe;ij tsh;r;rp tiuglk; rhpghh;j;jy;

- Rw;Wr;#oy; Rfhjhuk;

GOj;njhw;iw jLf;f Foe;ijfSf;F fhyzpfis mzptpf;f Ntz;Lk;

- ntWk; fhy;fspy; elg;gij jtph;f;f Ntz;Lk;

- fNyhhp kw;Wk; Gujk; kpFe;j czT nghUl;fis nfhLj;jy;

Ntz;Lk;

- jpwe;j ntspapy; kyk; fopf;ff;$lhJ

- Rfhjhukhd fopg;gplj;ij gad;gLj;Jjy; Ntz;Lk;

- czTg; nghUl;fis <> nfhR> Nghd;witfs; nkha;f;fhjthW %b

itf;f Ntz;Lk;

- fha;fwpfs;> kw;Wk; goq;fis cztpy; Nrh;j;Jf; nfhs;s Ntz;Lk;

- nfhjpj;J Mw itj;j ePh; kl;LNk Foe;ijfSf;F nfhLf;f

Ntz;Lk;

rKjha mstpy;

- Muk;gj;jpNyNa czT gw;whf;Fiwia fz;lwpe;J fisjy;

- tWikapypUe;J tpLgl nghUshjhu tsh;r;rp

- Foe;ijfs; eytho;Tg; guhkhpg;Gj; jpl;lj;ijg; gads;s tifapy;

elj;Jjy;

- Rw;Wg;Gwr;#oy; Jg;Guitj; Kd;Ndw;Wjy;

- Cl;l czT kw;Wk; eytho;Tf; fy;tp

- FLk;g eyj;jpl;lk;

170
Njrpa mstpy;

- rj;JzT mwpit gj;jphpf;if> Gj;jfk; thapyhf gug;Gjy;

- rj;JzT ,d;ik epiyikfis fz;fhzpj;jy;

- rj;JzT jpl;lq;fisj; jahhpj;jy;

ghjpg;Gfs;

- ,uj;jNrhif> tsh;r;rpapd;ik

- Neha;njhw;W mjpfkhf fhzg;gly;

171
 APPENDIX - G

STRUCTURED INTERVIEW SCHEDULE

PART-I
DEMOGRAPHIC DATA OF THE MOTHER

1. Age of the mother in years

a) Below 25

b) 26-30

c) 31-35

d) Above 36

2. Educational status of the mother

a) No formal education

b) Primary education

c) Middle education

d) High school

e) Higher secondary

f) Graduate

3. Occupation of the mother

a) House wife
b) Coolie
c) Self employed
d) Private employee
e) Government employee

172
4. Family size(Total number of family members)

a) 3 members

b) 4 members

c) 5 members

d) 6 and above

5. Type of family

a) Nuclear

b) Joint

6. Total number of under five children

a) 1 child

b) 2 children

7. Total family income per month

a) 1000-2000

b) 2000-3000

c) 4000-6000

d) 6000 and above

8. Religion

a) Hindu

b) Muslim

c) Christian

d) Others

173
 PART-II
STRUCTURED INTERVIEW SCHEDULE/ KNOWLEDGE
QUESTIONNAIRE
1. What is malnutrition?

a) Adequate food and calorie intake

b) Inadequate food intake for longer period
c) Excess food intake
d) Excess intake of fatty foods
2. Which of the following age group has greatest prevalence of malnutrition?
a) 9-12 months of age
b) 6 month-3 years of age
c) 1-2 years of age
d) 3-5 years of age

3. What are the signs and symptoms of malnutrition?

a) Fever and cold
b) Cough and vomiting
c) Loss of weight and growth failure
d) Weight gain and irritability

4. Which is not a primary cause of Protein energy malnutrition?

a) Poverty
b) Maternal malnutrition
c) Unavailability of food
d) Environmental sanitation

5. What are the common forms of Protein energy malnutrition?

a) Goitre and myxedema
b) Rickets and scurvy
c) Beri beri and keratomalacia
d) Kwashiorkor and marasmus

174
6. What is kwashiorkor?
a) Protein deficiency disorder with adequate carbohydrate consumption
b) Vitamin deficiency disorder with adequate protein consumption
c) Calorie deficiency disorder with adequate vitamin consumption
d) Vitamin A deficiency disorder with adequate protein consumption

7. Which age group is mostly affected by kwashiorkor?

a) 0-2 years
b) 4-5 years
c) 3-5 years
d) 0-1 years

8. What are the signs and symptoms of kwashiorkor?

a) Redness of eyes and irritability
b) Edema and mental changes
c) Leg pain and giddiness
d) Throat pain and cough

9. How the kwashiorkor child looks?

a) Short and stout
b) Thin and tall
c) Obese and vision changes
d) Edematous and hair changes

10. What is the dietary management for kwashiorkor?

a) Providing vitamin rich diet
b) Providing calorie rich diet
c) Providing protein rich diet
d) Providing calcium rich diet

175
11. What are the protein rich foods given below?
a) Milk, pulses, meat
b) Jaggery, honey, dates
c) Sugar, potato, cucumber
d) Rice, ragi, bajra

12. What is Marasmus?

a) Fat deficiency disorder
b) Vitamin deficiency disorder
c) Protein deficiency disorder
d) Calorie deficiency disorder

13. Which age group is mostly affected by Marasmus?

a) 2-3 years
b) 0-2 years
c) 3-4 years
d) 4-5 years

14. What are the signs and symptoms of Marasmus?

a) Head ache and abdominal pain
b) Fever and vomiting
c) Loss of subcutaneous fat and muscle wasting
d) Itching and skin lesions

15. How the Marasmic child looks?

a) Active and weight gain
b) Very tall
c) Obesed
d) Very thin and little old man facies

176
16. What is the dietary management for Marasmus?
a) Providing calorie rich diet
b) Providing vitamin rich diet
c) Providing Calcium rich diet
d) Proving protein rich diet
17. What are the calorie rich foods given below?
a) Rice, maize, ragi
b) Egg, milk, ghee
c) Fish, meat, crab
d) Green leafy vegetables, cucumber, ladies finger

18. What are the common infections frequently encountered by malnourished

child?
a) Skin infections and urinary tract infections
b) Diarrhea and respiratory infections
c) Ear infections, skin infections
d) Urinary tract infections and eye infections

19. What are the risk factors of Malnutrition?

a) Obesity
b) Psychological disturbances
c) Heriditary
d) Poverty

20. Which is the appropriate age for weaning to prevent malnutrition?

a) By 6th month
b) By 8th month
c) By 7th month
d) By 9th month

177
21. How often weight should be checked for 0-3 years of children?
a) Once in a month
b) Once in 2 months
c) Once in 3 months
d) Once in 4 months

22. How often weight should be checked for 3-6 years of children?
a) Once in 6 months
b) Once in 4 months
c) Once in 3 months
d) Once in 9 months

23. What is the normal mid arm circumference for 1-5 years of children?
a) 14 cms
b) 13 cms
c) 15 cms
d) 12 cms

24. Which is not a preventive measure of malnutrition at family level?

a) Providing high protein diet
b) Providing high calorie diet
c) Checking weight regularly
d) Meeting play needs

25. What are the complications of Malnutrition?

a) Hepatic failure
b) Growth failure
c) Respiratory failure
d) Renal failure

178
 PART-III
STRUCTURED INTERVIEW SCHEDULE/PRACTICE
QUESTIONNAIRE
SI.NO ITEMS YES NO
1 Do you give calorie rich diet to your child?
2 Do you provide adequate cereals, green leafy
vegetables to your child?

3 Do you provide small and frequent diet to your child?

4 Do you provide mid day snacks to your child?

5 Do you provide protein rich diet to your child?

6 Do you provide germinated pulses to your child?

7 Do you provide fruits to your child?

8 Do you provide egg to your child?

9 Do you provide milk to your child before bed time?

10 Have you given breast feeding up to one year to your

child?

11 Have you started weaning at 6th month of child’s age?

12 Do you check your child’s height and weight
regularly?

13 Do you make sure that your child is not suffered from

frequent respiratory infections and diarrhea?

14 Have you given immunization up to your child’s age?

15 Have you given vitamin ‘A’ drops to your child?

179
 APPENDIX – H
SCORES RELATED TO KNOWLEDGE REGARDING MALNUTRITION
AMONG MOTHERS WITH UNDER FIVE CHILDREN

S.NO A B C D
1 0 1 0 0
2 0 1 0 0
3 0 0 1 0
4 0 0 0 1
5 0 0 0 1
6 1 0 0 0
7 0 0 1 0
8 0 1 0 0
9 0 0 0 1
10 0 0 1 0
11 1 0 0 0
12 0 0 0 1
13 0 1 0 0
14 0 0 1 0
15 0 0 0 1
16 1 0 0 0
17 1 0 0 0
18 0 1 0 0
19 0 0 0 0
20 1 0 0 0
21 1 0 0 0
22 0 0 1 0
23 0 1 0 0
24 0 0 0 1
25 0 1 0 0
Correct answer-1 Wrong answer-1

180
SCORES RELATED TO PRACTICE OF MOTHERS OF UNDER FIVE
CHILDREN REGARDING MALNUTRITION

S.NO YES NO

1 1 0

2 1 0

3 1 0

4 1 0

5 1 0

6 1 0

7 1 0

8 1 0

9 1 0

10 1 0

11 1 0

12 1 0

13 1 0

14 1 0

15 1 0

Correct answer-1 Wrong answer-1

181
 gFjp - I
Ra Fwpg;G tpguq;fs;

jhapd; Ratpguk;

1. taJ (tUlj;jpy;)

m) 25 tajpw;Fk; Fiwthf

M) 26 - 30

,) 31 - 35

<) 36 tajpw;Fk; Nky;

2. fy;tpj;jFjp

m) gbf;fhjth;

M) Muk;g fy;tp

,) cah;epiyf; fy;tp

<) Nky;epiyf;fy;tp

c) gl;lg;gbg;G gbj;jth;

3. njhopy;

m) FLk;g jiytp

M) $yp Ntiy nra;gth;

,) Ra njhopy; nra;gth;

<) jdpahh; epWtdj;jpy; Ntiy nra;gth;

c) murhq;f epWtdj;jpy; Ntiy nra;gth;

182
4. FLk;gj;jpd; nkhj;j egh;fs;?

m) 3

M) 4

,) 5

<) 6-f;F Nky;

5. FLk;g tif

m) jdpf;FLk;gk;

M) $l;Lf;FLk;gk;

6. Ie;J tajpd; fPo; cs;s Foe;ijfspd; nkhj;j vz;zpf;if?

m) 1

M) 2

,) 3-f;Fk; Nky;

7. FLk;gj;jpd; khj tUkhdk; (&ghapy;)

m) 1000 - 2000

M) 2000 - 4000

,) 4000 - 6000

<) 6000 - f;Fk; Nky;

8. kjk;

m) ,e;J

M) fpwp];jtk;

,) ,];yhkpak;

<) gpw

183
 gFjp - II

mwpTj; jpwd; Nfs;tpfs;

Fwpg;G:- rupahd tpilf;fhd vOj;ij fl;lj;jpy; Fwpg;gpLf.
1. Nghjh Cl;lk; vd;why; vd;d?
m) Nghjpa msT czT cl;nfhs;Sjy;
M) clypy; Cl;l czT gw;whf;Fiw Vw;gLjy;
,) mjpf msT czT cz;gJ
<) nfhOg;Gr; rj;J mjpfKs;s czT cl;nfhs;Sjy;

2. ve;j taJ Foe;ijfSf;F Nghjh Cl;lk; mjpfkhf fhzg;gLfpwJ?

m) 9-12 khjk;
M) 6 khjk; Kjy; 3 taJ tiu
,) 1 taJ Kjy; 2 taJ tiu
<) 3 taJ Kjy; 5 taJ tiu

3. Nghjh Cl;lj;jpd; mwpFwpfs; ahit?

m) ryp kw;Wk; fha;r;ry;
M) ,Uky;> the;jp
,) vil Fiwjy;> tsh;r;rpapd;ik
<) vil $Ljy;> Nfhgg;gLjy;

4. fPo; fz;ldtw;Ws; vit Kjd;ik Gujk; - rf;jp (fNyhhp) Nghjh

Cl;lj;jpd; fhuzpahfhJ ?
m) tWik
M) fh;g;gpzp ngz;fSf;F tUk; Nghjh Cl;lk;
,) czT gw;whf;Fiw
<) Rw;Wg;Gwj; J}a;ik

184
5. Gujk; rf;jp Nghjh Cl;lj;jpd; tiffs; ahit?
m) Fuy; tiy Rug;gp tPf;fk;> Fuy; tiy Rug;gp FiwghL
M) tYtw;w vYk;G Neha;>gw;fspy; ,uj;j frpT Neha;
,) khiyf;fz; Neha;> fz; Giw Neha;
<) ePh;k Cl;lf;FiwT> gl;bdpahy; cly; fiuT.

6. ePh;k Cl;lf;FiwT vd;why; vd;d?

m) Njitahd msT fNyhhpAld; $ba Guj gw;whf;Fiw
M) Njitahd msT Gujj;Jld; $ba itl;lkpd;fs; gw;whf;Fiw
,) Njitahd msT itl;lkpd;fSld; $ba fNyhhp gw;whf;Fiw
<) Njitahd msT Gujj;Jld; $ba itl;lkpd; V gw;whf;Fiw

7. ve;j taJ Foe;ijfSf;F ePh;k Cl;lf; FiwT Neha; fhzg;gLfpwJ?

m) 2 - 3 taJ
M) 0 - 2 taJ
,) 3 - 5 taJ
<) 4- 5 taJ

8. ePh;k Cl;lr;rj;J Fiwghl;bd; mwpFwpfs; ahit?

m) fz;NfhshW> Nfhgg;gLjy;
M) tPf;fk; kw;Wk; kdepiy khw;wk;
,) Koq;fhy; typ> kaf;fk;.
<) njhz;il typ> ,Uky;

9. ePh;k Cl;lf;FiwT Vw;gl;l Foe;ij vt;thW fhzg;gLk;?

m) Fs;sk; kw;Wk; Fz;lhf
M) xy;yp kw;Wk; caukhf
,) cly; gUkd; kw;Wk; ghh;it NfhshWfs;
<) cly; tPf;fk; kw;Wk; Kbfspy; epwkhw;wk;

185
10. ePh;k Cl;lf;FiwT Nehapid fl;Lg;gLj;jf; $ba czT Kiw
vd;d?
m) itl;lkpd; kpFe;j czTfis nfhLj;jy;
M) rf;jp (fNyhhp) kpFe;j czTfis nfhLj;jy
,) Gujk; kpFe;j czTfis nfhLj;jy;
<) fhy;rpak; kpFe;j czTfis nfhLj;jy;

11. fPo; fz;ldtw;Ws; Guj kpFe;j czTg;nghUl;fs; ahit?

m) ghy;> Kis fl;ba gaW tiffs,,iwr;rp.
M) nty;yk;,Njd;,Ngupr;rk;gok;.;
,) ru;f;fiu,cUisfpoq;F,nts;sup.
<) muprp,Nfs;tuF,fk;G

12. gl;bdpahy; cly; fiuT Neha; vd;why; vd;d?

m) nfhOg;Gr; rj;J gw;whf;Fiw
M) itl;lkpd; gw;whf;Fiw
,) Gujk; gw;whf;Fiw
<) fNyhhp (rf;jp) gw;whf;Fiw

13. ve;j taJ Foe;ijfSf;F gl;bdpahy; cly; fiuT Neha;

fhzg;gLfpwJ?
m) 2 - 3 taJ
M) 0 - 2taJ
,) 3 - 4 taJ
<) 4 - 5 taJ

186
14. gl;ldpahy; cly; fiuT Nehapd; mwpFwpfs; ahit?

m) jiytyp kw;Wk; tapw;W cghij

M) fha;r;ry;> the;jp
,) cly; nkypjy;> Njhypd; fPo; nfhOg;G fiujy;
<) mhpg;G> Njhy; Gz;fs;

15. gl;bdpahy; cly; fiuT Neha; Vw;gl;l Foe;ij vt;thW fhzg;gLk;?

m) RWRWg;ghf ,Ue;jhy; kw;Wk; vil $Ljy
M) kpf caukhd Njhw;wk;.
,) cly; gUkd;;
<) kpf nkype;j Njfk;> taJ Kjph;e;j Njhw;wk;;

16. gl;bdpahy; cly;FiwT Nehapid fl;Lg;gLj;jf; $ba czT

Kiw vd;d?
m) rf;jp epiwe;j czT tiffis nfhLj;jy;;
M) itl;lkpd; mjpfKs;s czT tiffis nfhLj;jy;
,) fhy;rpak; mjpfKs;s czT tiffis nfhLj;jy;
<) Gujk; mjpfKs;s czT tiffis nfhLj;jy;

17. fNyhhp kpFe;j czTg; nghUl;fs; ahit?

m) mhprp> Nrhsk;> Nfo;tuF
M) Kl;il> ghy;> nea;
,) kPd;> ,iwr;rp> ez;L
<) fPiutiffs;> nts;shp> ntz;ilf;fha;

187
18. Nghjh Cl;lk; Vw;gl;l Foe;ijf;F fhzg;gLk; nghJthd Neha;j;
njhw;Wfs; ahit?
m) Njhy; Neha; njhw;W> rpWePuf ghij Neha; njhw;W
M) tapw;Wg;Nghf;F> %r;Rf;Foha; njhw;W
,) fhJ Neha; njhw;W> Njhy; Neha; njhw;W
<) rpW ePufg; ghij Neha; njhw;W> fz; Neha; njhw;W

19. Nghjh Cl;lk; Vw;gl njhlh;Gs;s fhuzq;fs; ahit?

m) cly; gUkd;
M) kdhPjpahd NfhshWfs;
,) guk;giu fhuzk;
<) tWik> njhw;Wfs;

20. ,iz czT Muk;gpf;f jFe;j khjk; vJ?

m) 6 khjj;jpy;
M) 8 khjj;jpy;
,) 7 khjj;jpy;
<) 9 khjj;jpy;

21. 0 Kjy; 3 taJ Foe;ijfSf;F vj;jid Kiw vil ghpNrhjpf;f

Ntz;Lk;?
m) xU khj;jpw;F xUKiw
M) ,uz;L khj;jpw;F xUKiw
,) %d;W khj;jpw;F xUKiw
<) ehd;F khj;jpw;F xUKiw

188
22. 3Kjy; 6taJ Foe;ijfSf;F vj;jid Kiw vil ghpNrhjpf;f
Ntz;Lk;?
m) 6 khjj;jpw;F xUKiw
M) 4 khjj;jpw;F xUKiw
,) 9 khjj;jpw;F xUKiw
<) 9 khjj;jpw;F xUKiw

23. 1 Kjy; 5 taJ Foe;ijfspd; ruhrhp Nky;ifr;Rw;wsT vd;d?

m) 14 nr.kP
M) 13 nr.kP
,) 15 nr.kP
<) 12 nr.kP

24. FLk;g mstpy; Nghjh Cl;lj;ij jLf;f jtph;g;G Kiwfs; ,ij jtpu
m) jLg;G+rpfis jtwhky; nfhLj;jy;
M) fNyhhp> Guj rj;Js;s czT nghUl;fis nfhLj;jy;
,) %d;W khjj;jpw;F xUKiw vil ghpNrhjpj;jy;
<) tpisahl;Lg; nghUl;fis nfhLj;jy;

25. Nghjh Cl;lj;jhy; Vw;gLk; ghjpg;Gfs; ahit?

m) fy;yPuy; ghjpg;G
M) tsh;r;rpapd;ik
,) EiuaPuy; ghjpg;G
<) rpWePuf ghjpg;G

189
 gFjp - III

Nghj Cl;lj;jpd; gof;f tof;fj;ij fz;lwpAk; tpdhf;fs;

Fwpg;G:- rupahd tpil (Mk;/,y;iy) vJ vd;gij( ) ,jd; %yk;

fl;lj;jpy; Fwpg;gpLf.

t.
Nghjh Cl;lk; gw;wpa gof;fj;ij fz;lwpAk; tpdhf;fs; Mk; ,y;iy
vz;

1. cq;fs; Foe;ijf;F fNyhhp kpFe;j czTfis

nfhLf;fpwPh;fsh?

2. cq;fs; Foe;ijf;F Njitahd jhdpaq;fs;>

gr;irf;fha;fwpfs; nfhLf;fpwPh;fsh?

3. cq;fs; Foe;ijf;F mbf;fb Fiwe;j msT czTfis

nfhLf;fpwPh;fsh?

4. cq;fs; Foe;ijf;F ew;gfypy; rpw;Wz;b nfhLf;fpwPh;fsh?

5. cq;fs; Foe;ijf;F Gujr;rj;J kpFe;j czTfis

nfhLf;fpwPh;fsh?

6. Kis fl;ba gUg;G tiffis cq;fs; Foe;ijf;F

nfhLf;fpwPh;fsh?

7. cq;fs; Foe;ijf;F goq;fs; nfhLf;fpwPh;fsh?

8. cq;fs; Foe;ijf;F Kl;il kw;Wk; kPd; nfhLf;fpwPh;fsh?

9. cq;fs; Foe;ijf;F ,uT cwq;f NghFk; Kd; ghy;

nfhLf;fpwPh;fsh?

190
10. cq;fs; Foe;ijf;F xU taJ tiu jha;g; ghy;

nfhLf;fpwPh;fsh?

11. Foe;ijapd; MW khjj;jpy;,iz czT

Muk;gpj;jPh;fsh?

12. cq;fs; Foe;ijapd; cauk;> vil Mfpatw;iw Kiwahf

rhpghh;g;gPh;fsh?

13. %r;Rf; NfhshW> Ngjp Nghd;w gpur;ridfs; cq;fs;

Foe;ijfSf;F mbf;fb tuhky; ,Uf;fpwJ vd;W

mwptPh;fsh?

14. cq;fs; Foe;ijf;F chpa Neuj;jpy; jLg;G+rpfisf;

nfhLj;jPh;fsh?

15. cq;fs; Foe;ijf;F itl;lkpd; V kUe;J nfhLj;jPh;fsh?

191