A STUDY REGARDING THE PROTEIN ENERGY

MALNUTRITION (PEM) OF SCHOOL AGE

CHILDREN UNDER THE AGE OF LESS THAN 12
YEARS LIVING IN SLUM AREA.
A DISSERTATION SUBMITTED IN PARTIAL FULFILLMENT OF THE
REQUIREMENT FOR THE DEGREE OF

MASTER OF SOCIAL WORK (MSW)

Submitted By

Rishabh Mishra
Roll No.2110011605095

Under the Supervision of

Prof. Gurnam Singh

DEPARTMENT OF SOCIAL WORK

UNIVERSITY OF LUCKNOW
LUCKNOW 2021-2023
 INTRODUCTION

“If you eat wrongly, no doctor can cure; and if you eat rightly no doctor is needed”
Victor G. Racine (1930)
Preamble

The child is the future citizen of the nation and one of the world‟s greatest resource for a

healthy future lies in the children of today. Today‟s children are tomorrow‟s citizens and

leaders. The majority of the children in India who live below the poverty line in an

environment of multideprivation and starvation have physical and developmental

retardation. It has been estimated that in India 65 percent, i.e.; nearly 80 million children

under five yearsof age suffer from varying degrees of malnutrition1.

Nutrition is a fundamental pillar of human life, health and development across the entire

life span. The food we eat is digested and assimilated in the body and used for its

maintenance and growth. Food also provides energy for doing work. Man has exhibited

much thought and foresight in cultivating a variety of grains, fruits, vegetables, nuts and

oil seeds and in rearing birds and animals for use as food. The selection of food best

suited for promoting good health has been found out by trial and error by continued use.

An adequate diet should contain liberal amount of protein rich and protective foods and

should supply all the dietary essentials in the required amounts.

Nutrition forms the most predominant influence on the development of the growing child.

Human survival has always depended upon food and hence nutrition has determined his

place of living and his way of living. According to WHO definition „malnutrition involves

a cellular imbalance between supply of nutrients and energy and the body‟s demand for

them to ensure normal growth, maintenance and specific tissue functions‟. Malnutrition

accounts for more than fifty percent of all infant mortality in developing countries,

especiallyin the below five years age group.

Need for the Study

Protein-energy malnutrition is the most common form of nutritional deficiency among

patients who are hospitalized in the developing countries. It is a state of poor nutrition due

to an insufficient or poorly balanced diet or faulty digestion or utilization of foods. Poor

nutrition leads to ill health and ill health contributes to further deterioration in nutritional

status. These effects are most dramatically observed in infants and young children, who

bear the brunt of the onset of malnutrition and suffer the highest risk of disability and death

associated with it.

Malnourished children who survive are more frequently sick and show poorer scholastic

performance, impaired intellectual and social development. Childhood stunting leads to a

significant reduction in adult size. One of the consequences of small adult size resulting

from childhood stunting has reduced work capacity, which in turn has an impact on

economic productivity of our Nation. Under nutrition among children varies greatly by

mother‟s education and household standards of living.

Protein energy malnutrition (PEM) is a global health problem, more prevalent in the

developing countries like India. It is a potentially fatal body depletion disorder and is the

cause of death in children in developing countries. It often starts in the womb and ends in

the tomb. PEM is a disease of multi deprivation and poverty, affecting nearly 150 million

children under the age of five years in the world. Out of 120 million children in India,

over 75 million are estimated to suffer from visible PEM. Almost half of children (47%)

under three years of age are underweight and among them 46% are stunted. Severely

underweight is observed in 18% of children and severe stunting for 23%. The sixteen

percentages of children are excessively thin. Rural children are much more likely than

urban children to be undernourished.

Statement of the Research Problem

A study regarding the Protein Energy Malnutrition (PEM) of school age children under
theage of less than 12 years living in Slum area.
Objectives

To determine the prevalence of protein energy malnutrition among children

To identify the current dietary practices of children

To determine the factors contributing to PEM in children

To identify the severity of PEM among children

To compare the problems of PEM among children with that of normal children

Operational Definitions

An operational definition is the description of how variables or concepts will be measured

or manipulated in the study. In this study, the investigator operationally defined the

following concepts.

1. Effectiveness: Refers to producing a desired or intended result. In this study it

refers to the extent to which the nutritional intervention has achieved the desired

goal as evidenced by changes in body weight after the intervention and was

measured using an observation record.

2. Protein energy malnutrition: In this study it refers to a nutritional deficiency

disorder which includes lack in varying proportions of proteins and calories occurring

in young children as measured by using observation record which was used to measure the

weight of the child and each child is grouped into 5 categories based on IAP (Indian

Academy of Paediatrics) classification of weight for age.

3. Nutritional intervention programme: It refers to the computer assisted teaching

session to mothers on culturally appropriate nutrition based on low cost diet,

feeding methods, reinforcement of the growth monitoring, hygiene and

immunization.
 4. Children: In this study it refers to children between 2-5 years and attending

inselected anganwadis.

5. Problems: It refers to the physical and psychological problems of children

withprotein energy malnutrition as measured by problem assessment

checklist.

Conceptual Framework

Conceptual framework includes the problem or phenomenon to be addressed, the current

state of knowledge about the phenomenon, the framework of the concepts and their

relationship that will be examined in a study. It helps to think, to observe, to interpret and

to adapt to research strategies. It also gives direction for the relevant questions

about the phenomenon under study and points out solutions to practical problems and

provides general criteria to know whether a problem has been solved63.

This study aimed to determine the prevalence and explore the problems of children with

protein energy malnutrition between 2-5 years and to assess the effectiveness of nutritional

intervention among them. The framework of this study is based on Betty Neuman‟s system

model (1989). The Neuman model focuses on the person as a complete system, the

subparts of which are interrelated physiologic, psychological, socio-cultural and

developmental factors.

Delimitations

The study was delimited to;

 The data collection was confirmed to only randomly chosen sample of slums areas

inLucknow District

 The children attending to selected less than 12 years old only

 The reported dietary practice by the mothers was assessed for identifying the

current dietary practice of children

 REVIEW OF LITERATURE
In this study the reviewed literature has been presented under the following heading;

1. Nutritional problems

2. Prevalence of PEM

3. Assessment of nutritional status

4. Factors influencing PEM

5. Nutritional supplementation in children with PEM

6. Prevention and rehabilitation of PEM

Nutritional problems
A correlation study to assess the knowledge on nutrition of under five children among
migrating mothers and prevalence of nutritional problems among their children. The sixty
migrating mothers and their 60 under five children were selected using non probability
convenience sampling technique. The study found that 98.33% of mothers had inadequate
knowledge on nutrition of under five children. The prevalence of clinical aspects of
nutritional problems was lack of lustre in 45 (70%), thin built 35 (58.3%) pale
conjunctiva 33 (55%), angular stomatitis 16 (26.6%), mottled enamel 32 (53.3%), dental
caries 18 (80%), parotid gland enlargement 1 (1.6%), dry and scaly skin 4 (96.6%),
koilonychia 5 (8.33%). With regard to degree of malnutrition 5 (8.33%) of them had third
degree malnutrition, 23 (38.33%) had second degree of malnutrition and 3 (5%) of them
had normal nutritional status.
Prevalence of PEM

According to NFHS III report almost half of the children under five years of age (48%) are
stunted and 43% are underweight. Under nutrition is also the underlying cause of 53% of
the under five mortality. The UN estimated that 2.1 million Indian children die before
reaching the age of five years, every year, mostly from preventable illnesses such as
diarrhoea, typhoid, malaria, measles and pneumonia. Every day one thousand Indian
children die because of diarrhoea alone. Under nutrition was more prevalent in the age
group of 12-23 months, females where family size had more than three or more
children11.Mahatma Gandhi‟s statement “For the hungry, God is bread, is relevant for vast
sections of the Indian population even today. Preventing under nutrition has emerged as
one of the most critical challenges to Indian health planners”.
Anaemia prevalence in young children continues to remain over 70% in most part of India
and Asia. The most common group among the causes for anaemia is malnutrition and
among that group, iron deficiency makes up the bulk of it. Iron deficiency and the anaemia
that results from it, is a major health problem affecting more than 3.5 billion people in
developing countries, reducing vitality for the young and old alike, impairing the cognitive
development of children. National Family Health Survey (NFHS) III data showed the
prevalence of anaemia among children less than five years of age to be around 70%.
Assessment of nutritional status
A cross sectional study was conducted among 245 under-two-slum dwelling children in
Bankura town, West Bengal, to assess their feeding practices and its association with
nutritional status. Child‟s gender, number of family members, standard of living and
household food security were assessed through interview of mothers/caregivers. Child
feeding practices were measured by composite child feeding index comprising of age
appropriate, multiple infant and young child feeding (IYCF) indicators & expressed in the
standardized IYCF score. Weight and length of the children were measured and the
nutritional status was assessed using world health organization growth standard 2006. The
study showed that there was a linear relation between standardized IYCF scores and
grades of under nutrition, with severe grades having the lowest score. Underweight and
stunting were significantly associated with female gender, low /very low HFS (house hold
food security), low SLI, while wasting was associated significantly with low/very low
HFS.

Nutritional supplementation in children with PEM

An experimental only posttest with the control design study was conducted to assess the

effectiveness of home based diet therapy for malnourished children in Tamilnadu. The

sample selected was two hundred, first, second and third degree malnourished under fives

between 1.6-5.5 years of age, using multistage sampling technique. Study results show that

the highest number of the children, both in experimental (n=62) and control group

(n=48) had first degree malnutrition. It also observed that upper range values were more
scattered when compared to lower range values, which indicate that the diet therapy is

effective. The study concludes that there was high in weight gain for all the age groups in

the experimental group, revealing an increase in periodical weight gain at the time of diet

therapy extends.

Prevention and rehabilitation of PEM

A study conducted to evaluate the effect of nutritional Interventional measures undertaken

at NRCs in improving the nutritional status of admitted children through review of selected

anthropometric indicators at the time of admission and discharge and during their stay at

the centre. Mothers of the children were interviewed on health issues and therapeutic

feeding practice at the Nutrition Rehabilitation Cente rs (NRCS) using a predesigned and

pretested interview schedule. The study group consisted of 48 boys and 52 girls. 60% were

between 13 and 36 months of age. Ninety three children were analysed for anthropometric

indicators following a dropout rate of 7%. A statistically significant difference was

obtained between the weight of children at admission and discharge (t= 14.552, p > 0.001).

The average weight gain during the stay at the Center was 9.25 ± 5.89 g/kg/day. Results

showed that the mothers of children lacked adequate information on health issues and

composition and preparation of therapeutic diets at the centres. The study concluded that

the NRCs were effective in improving the condition of admitted children, but the effect

was not sustained following discharge due to high drop- out rate and lack of adequate

parental awareness.
 RESEARCH METHODOLOGY
Research Methodology is a primary need of any research and plays a pivotal role in it.
It is a blue print of a research. Hence planning of a research work in advance is
done to carry out this research work systematically. Research is an inseparable part of
human knowledge. Its role in human life is as precious as that of salt in a vegetable.
Life would lose its taste without research exactly in the same manner as a vegetable
without salt. Modern academics just cannot stand and meet the aspirations of a matured
society, if it does not provide for research and investigation.

Robert Burns (2003) describes it as, “a systematic investigation to find solution to a

problem.” Redman and Mory define research as, “a systematized effort to gain new
knowledge.”

According to Clifford Woody “Research comprises defining and redefining problems,

formulating hypothesis or suggested solutions; collecting, organizing and evaluating
data; making deductions and reaching conclusions; and at last carefully testing the
conclusions to determine whether they fit the formulating hypothesis.

Research is, thus, an original contribution to the exiting stock of knowledge making
for its advancement. It is the pursuit of truth with the help of study, observation,
comparison and experiment. In short, the search for knowledge through objective and
systematic method of finding solution to a problem is research.

According to Black and Champion (1976), the research methodology could include:

 Selecting the population for the study

 Sampling plan to be followed for the selection of sample The size of sample to be studied

 Kind of tools and techniques for data collection (questionnaire, interview schedule,

observation, analysis of secondary sources, and so on) Statistical analys to be used (if any)

 The type of tabular presentation (e.g. graphs, tables, charts, figures etc

“All progress is born of inquiry. Doubt is often better than over confidence, for it leads to

inquiry, and inquiry leads to invention” is a famous Hudson Maxim in context of which the
significance of research can well be understood. Increased amounts of research make

progress possible. Research inculcates scientific and inductive thinking and it promotes the

development of logical habits of thinking and organization. Put quite simply, research is

important because it keeps us from making incorrect decisions or behaving in ways that are

nonproductive. The researcher avoids the waste of time, money and efforts. Research in

management is basically meant for a specific purpose; and that is why management

researches are by and large, result oriented .Research provides an analytical framework for

the subject matter of investigation. It establishes the relationship between the different

variables, especially the relationship of the dependent variables with the independent

variable. The cause effect relationship between different variables can also be identified,

leading to valuable observations, generalizations and conclusions

Research Design

A researcher design is a systematic approach that a researcher uses to conduct a scientific

study. It is the overall synchronization of identified components and idea resulting in

plausible outcomes. To conclusively come up with an authentic and accurate result.

In this research researcher is going use the descriptive cum Diagnosis Design to conduct

the scientific study and get a result outcome through the study.

Descriptive research is a study designed to depict the participants in an accurate way.

Simpler put, descriptive research is all describing people who take part in study. There are

three ways a researcher can go about doing a descriptive research projects, as follows:

Observational, defined as a method of viewing and recoding the participants. Case study,

defined as an in- depth study of an individual or group of individual or group of

individuals survey, defined as a brief interview or discussion with an individual. About a

Specific topic. 39
The use of Experimental Research Design will be done for conducting present research

work. This type of research design is a kind of a blueprint of the procedure that enables the

researcher to test his hypothesis by reaching valid conclusions about relationships between

independent and dependent variables. It refers to the conceptual framework within which

the experiment is conducted.

Objective of the study:

The present study aimed to evaluate the overall prevalence of PEM. The proposed

objectives are:

• To access the nutritional status of the children in slum area.

• To access the study regarding the Protein Energy Malnutrition (PEM).

Tools and Techniques:

 Questionnaire and interview.

 Various banner and charts, Flash cards, Posters and other media.

 Weighing machine, Standiometer, MUAC tape.

 Determination on behalf of Height for age (stunned), weight for height (wasted) and

weight for age (underweight).

Study area: The study will be conducted at Amarai, Poorva and Sugamau villages.

Study subjects: The study will be conducted among 10 school age children less than 12

years of age

Sample size: Total 10 school children will be interviewed.

A cross-sectional study In which we explore nutritional status in school age slum children

and analysis factors associated with malnutrition and suffering from PEM, will be selected

and examine with the help of pre-tested questionnaire, anthropometric measurements,

dietary pattern and clinical examination from 3 urban slum area.

Methodology:

This whole survey will take place in seven visits.

In the 1st visit, information of the child with the help of pre-tested questionnaire will be

collected. In the 2nd visit, body measuring data of the child will be taken, with the help of

anthropometric measurements. In the 3rd visit, suggestions like diet chart, sanitation

techniques, diet plans and other information will be given to the patient. Data will be

recollected in the 4th visit.

In the 5th visit, will find the patient who is not following the proper the instructions and

diet. The patient will be convince and follow-up In the 6th visit. In 7th visit, all data will be

compiled and will be analyzed and appropriate statistical test will be applied.

Evaluation:

Through ist, ivth and vith visits, various Growth assessment test and Anthropometric

examinations, the data will help to find the outcome that how many patients maybe or

maybe not have follow the suggestions and diet chart or diet plan. Types of Sampling:

Probability Sampling Methods

Probability Sampling is a sampling technique in which sample from a larger population are

chosen using a method based on the theory of probability. This sampling method considers

every member of the population and forms samples on the basis of a fixed process. There

are four types of probability sampling technique.

One of the best probability sampling techniques that helps in saving time and resources,
is the Simple Random Sampling method. It is a trustworthy method of obtaining
information where every single member of a population is chosen randomly, merely by
chance and each individual has the exact same probability of being chosen to be a part
ofa sample.
Cluster Sampling

Cluster Sampling is a method where the researchers divide the entire population into
sections or clusters that represent a population. Clusters are identified and included in a
sample on the basis of defining demographic parameters such as age, location, sex etc.
which makes it extremely easy for a survey creator to derive effective inference from
the feedback.
Systematic Sampling

Using systematic sampling method, members of a sample are chosen at regular

intervals of a population. It requires selection of a starting point for the sample and
sample size that can be repeated at regular intervals. This type of sampling method has a
predefined interval and hence this sampling technique is the least time-consuming.

Stratified Random Sampling

Stratified Random Sampling is a method where the population can be divided into
smaller groups, that don‟t overlap but represent the entire population together. While
sampling, these groups can be organized and then draw a sample from each group
separately.

Types of Sampling: Non-probability Sampling Methods

The non-probability method is a sampling method that involves a collection of

feedback on the basis of a researcher or statistician‟s sample selection capabilities and
not on a fixed selection process. In most situations, output of a survey conducted with a
nonprobable sample leads to skewed results, which may not totally represent the
desired target population. But, there are situations such as the preliminary stages of
research or where there are cost constraints for conducting research, where non-
probability sampling will be much more effective than the other type. There are four
types of non-probability sampling which will explain the purpose of this sampling
method in a better manner

Convenience sampling

This method is dependent on the ease of access to subjects such as surveying customers
at a mall or passers-by on a busy street. It is usually termed as convenience sampling, as
it‟s carried out on the basis of how easy is it for a researcher to get in touch with the
subjects. Researchers have nearly no authority over selecting elements of the sample
and it‟s purely done on the basis of proximity and not representativeness. This non-
probability sampling method is used when there are time and cost limitations in
collecting feedback. In situations where there are resource limitations such as the initial
stages of research, convenience sampling is used.

Judgmental or Purposive Sampling:

In judgmental or purposive sampling, the sample is formed by the discretion of the

judge purely considering the purpose of study along with the understanding of target
audience.
Also known as deliberate sampling, the participants are selected solely on the basis of
research requirements and elements that d4o 2not suffice the purpose are kept out of
the
sample. For instance, when researchers want to understand the thought process of
people who are interested in studying for their master‟s degree. The selection criteria
will be: “Are you interested in studying for Masters in …?” and those who respond
with a “No” will be excluded from the sample

Snowball sampling

Snowball sampling is a sampling method that is used in studies

which need to be carried out to understand subjects which are difficult to trace. For
example, it will be extremely challenging to survey shelter less people or illegal
immigrants. In such cases, using the snowball theory, researchers can track a few of
that particular category to interview and results will be derived on that basis.

Quota sampling

In Quota sampling, selection of members in this sampling technique happens on basis

of a pre-set standard. In this case, as a sample is formed on basis of specific attributes,
the created sample will have the same attributes that are found in the total population. It
is an extremely quick method of collecting samples.

Sampling is the statistical process of selecting a subset (called a "sample") of a

population of interest for purposes of making observations and statistical inferences
about that population. Social sciences research is generally about inferring patterns of
behaviors within specific populations. The inmates of the halls of the University of
Lucknow selected as respondents will be the sample for the purpose of study.

Sample size:

10 children from selected area.

Sampling Type

A specific population is considered for the purpose of the study from where the data for
the stud can be collected and is known as universe and out of which certain respondents
are taken as a sample that represents the universe. For the purpose of this research
Simple Random Sampling will be used, by following due process.
 CONCLUSION AND SCOPE FOR FURTHER WORK

Food is required for every essential function of the body; for energy, growth,
protection against infection and for our ability to fight against illnesses. Malnutrition
in a person reduces his/her immunity to infection thus making them more susceptible
to falling ill. More particularly in children, poor appetite during an illness episode
reduces their body weight that further affects the immune system, thus making them
more prone to continuing or newer infections. Protein energy malnutrition is the
most widely prevalent form of malnutrition among children. Early malnutrition can
have lasting effects on growth and functional status. Proper feeding practices
starting from the time of birth are important for the physical and mental
development of the child. The timing and type of foods introduced in a child‟s diet
also have significant effects on the child’s nutritional status. In India children with
mild to moderate malnutrition are best managed in their own homes and kept under
surveillance. So as to find out the improvement in their nutritional status. There is
evidence that domiciliary treatment brings about gratifying results37. The purpose of
this quasi experimental research study was to assess the effectiveness of the
nutritional intervention programmer to prevent protein energy malnutrition among
children attending anganwadis.
Major conclusions of the study

The following conclusions were drawn on the basis of the findings of the
present study.

Analysis of demographic characteristics revealed that regarding the age, the

majority of the children belonged to the age of 3-<4 years. It was found that most of
them were males. The study reported that the majority of their parents has a
secondary level of education. It was found that the majority of fathers of children
had occupiedas physical worker and mothers as private job. The majority of
family‟s had an average monthly income of Rs- 1000-2499 /- only. The majority of
parents has three children. It was found that the majority of children born as the
second child of the family. Most of the children belonged to nuclear family. The
study showed that the majority of children were breastfed for a period of less than
six months. Most of the children had completed the primary immunization. It was
found that the majority of children had no
history of communicable disease. Most of the children took an on-vegetarian diet.
The study reported that the majority of children had no food allergies.

Numerous determinants play a role in under nutrition of young children. Age,

sociocultural factors, feeding practices, birth weight, occupation of parents, and
education of parents, immunization and communicable diseases were found to be
independent determinants of malnutrition in this population, indicating the need
towards a targeted approach for modifying these factors. Family education regarding
the importance of nutrition is to be given in order to reduce the risk of malnutrition
among under-fives.

The prevalence of grade III PEM is comparatively low. There was a higher
prevalence of grade I and grade II Protein energy malnutrition. The major
intervention that can be done to reduce the prevalence of under nutrition among
under-fives is to strengthen the ICDS programme so that it will cover the full target
age group of under six years of children. Health education programme in order to
create an awareness and supplementation programmes based on the research
findings, specially meant for under-fives need to be introduced to the community to
ensure that no under-five is malnourished.

High prevalence of protein energy malnutrition also indicates that it is not limited to
below poverty line population only. Its causes are both for the poor as well as those
with purchasing power. The majority of children is fed in inadequate amounts and in
unhygienic ways. So the children are at substantial risk of malnutrition because of
poor dietary practices. Faulty feeding practices were reported by the mothers and
most of the children‟s diet was not adequate in calories and proteins as per ICMR
guidelines.

With regard to cultural factors parents showed gender differences among their
children. In which majority showed a male preference. The majority of parents did
not restrict food items to their children. It was found that most of the children had
the habit of eating junk foods. With respect to the child factors majority of children
had frequent attack of infections. Most of the children had not undergone health
checkups.
Nursing Implications

The findings of this study have implications for nursing practice, nursing
education, nursing administration and nursing research.
Nursing implication to nursing practice

Nurses, being the largest category of professionals in the present day health
care delivery system can do much towards curtailing the menace of malnutrition
and its after effects. The scope of nursing in today‟s world is wide; nurses work in
various settings in hospitals, nursing homes, industries, schools and at village level
in primary health centres and sub centres. The expected level of nursing care from
every nurse is to provide comprehensive nursing; i.e. preventive, promotive, curative
and rehabilitative care within their authorized limit. Therefore, nurses should utilize
their work arenas to inform and educate mothers and family on healthy eating
patterns, which is an important factor to tackle malnutrition.
The nurses working in the Kerala state public health care system conduct
regular home visits in both rural and urban areas. Health education is considered to
be the backbone of public health services which will help to bring about a
change in knowledge and attitude of the general public. While bringing about a
change in knowledge is relatively easy, bringing about a change in attitude is a
Herculean task. Repeated health educations with illustrations and demonstrations on
cooking cost effective nutritious foods, are necessary to achieve this. Health
education programmes can be organized in the public place such as community halls
or Panchayat halls, immunization clinics, anganwadis and schools to impart
awareness on healthy feeding practices, environmental sanitation, immunization and
consumption of cost effective nutritious diet. If education programmes were
organized in schools during the regular school health programme the school children
carry the message home and neighbours.

Implication to nursing administration

Nurse administrators can conduct campaigns to improve public awareness in
service education and continuing nursing education programmes for nurses to
update the knowledge on nutritional disorders.
Estimating under-nutrition burden is not sufficient to combat the curse of
under nutrition in India. There are many other factors playing an important role to
 determine nutritional status of a child. Nurse administrators should focus on the
associated risk factor prevalent in the area and reemphasize their importance under
the national and state nutrition programmes.

Nurses should be trained through in service education to monitor growth and

to assess the nutritional status of children. Nurse administrators can develop effective
community based early child care interventions by preparing audiovisual aids such
as charts and exhibits for propaganda.
Implications in nursing education

Nurses are like everyone else ordinary citizens of the state, who have the
rights and responsibilities towards his/her fellowmen. Nurses get an opportunity to
assess the nutritional status of the child in hospital and home during home visits.
Nursing curriculum already includes a course on nutrition in the first year of
training and careof children with malnutrition in the third year of their course.
Students can utilize the nutritional intervention programme and module for
imparting health education to the mothers of all children admitted in hospital and
in the community settings. Nurse educators can utilize the material as a model to
teach students in clinics, classroom settings and in the community.
Implications in nursing research

Under nutrition is a very complex entity. Socioeconomic factors, cultural

factors, urban, rural setting and many similar factors play a role in the occurrence of
under nutrition. So various innovations in nursing can be applied for the
prevention and control of PEM. Every innovative idea originates after a lot of
working experience in that practice area. The innovative ideas on various aspects of
malnutrition can be tested through nursing research. Nursing research can be
conducted on aspects of appropriate feeding practices, determinants of child
malnutrition, therapeutic diet from locally available food materials etc.

Carefully tested findings of the research studies would guide the nurses in
evidence based, need based care of malnourished children, which is essential for
attaining and maintaining proper nutrition and health.
Limitation
The present study has made an attempt to assess the effectiveness of the nutritional
 intervention programme to prevent PEM among children. Under nutrition is a very
complex entity. Socio economic factors, cultural factors, urban and rural setting and
many similar factors play a role in the occurrence of PEM. Though an attempt was made to
select from different anganwadis the nature of representation is limited. Hence, care should
be taken while generalizing the study findings.
 The reported dietary practice by the mothers alone was assessed for identifying
the current dietary practice of children.
 The effect of intervention was measured only for 6 months, so the pattern of
weight gain in subjects could not be elicited.
 The study did not have a control group.

 The Present study has relied largely on quantitative methodology of data

collection and therefore restrictive in collection of information.
Recommendations Recommendationsfor
future research
 A similar study can be carried out among under five children admitted ina
hospital setting.
 An observational study about dietary practices and feeding habits of children in
the community.
 A retrospective study of causes and effects of protein
energymalnutrition can be done by perusing hospital records.
 Other treatment modalities can be planned to see the effect on the PEM.
 Study may be replicated using a large population of children.

Suggestions

 In the light of above study the following suggestions are put forth:

 All the children under 5 years of age should undergo a nutritional assessment every
6 months, which can be implemented with the help of anganwadi workers.
 All parents should be motivated to have a periodic assessment of the growth and
development of their child during their visit to immunization clinic.
 An awareness programme can be conducted through mass media about the
importance of nutrition.
 Posters can be made and displayed through anganwadis, sub centres, PHCs,
outpatient departments and schools.
 Summary

This chapter dealt with the conclusions of the study, its implications in nursing
field, limitations of the study, recommendations and suggestions and summary of
thestudy. The participants were co-operative and willingly participated in the study. The
experience gained during the study has influenced and motivated the investigator to
take up other research studies. The results obtained will motivate other researchers for
further studies. It also helped the researchers to assess the effectiveness of the
nutritional intervention programme to prevent protein energy malnutrition among
children. These study findings, tools and intervention really going to help as a
foundation for many more future researchers.
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 Prof. O.A.T. EBUEHI,Department of Biochemistry College of Medicine,
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