Appendices

Appendices

Appendix No. Title Page No.

1 Definitions 245

2 Formative research to design a behavioral change

communication module for Infant and Young

children feeding practices in Udupi district

248

3 Important findings of In-depth interview and diet

survey

254

4 Report of the focus group discussion 255

5 Health Education Module – English 263

6 Health Education Module – Kannada 270

7 Flip chart - Kannada 271

8 Calendar 272

9 Important messages from formative research 273

10 List of experts involved in the study 274

11 Health education approach (model) followed in the

study

275

12 Letter of approval from Ethics committee, Kasturba

Hospital -Manipal

276

13 List of registered pregnant women with month of

registration

277

14 Distribution of study subjects anganawadi wise in

intervention group and control group

281

15 Patients information sheet, Informed consent form

(English and Kannada)

282

Appendix No. Title Page No.

16 Proforma on screening procedures followed to

assess the new born

291

17 Report of analysis, which compares anthropometric

measurements taken by investigator and

independent observer

292

18 Proforma to asses socio-demographic characteristics 293

19 Proforma to assess socio-economic status (as per

Udai-Pareek scale

295

20 Proforma to assess base-line knowledge of mothers 296

21 Proforma to assess neonatal history of the newborn 299

22 Proforma to assess feeding practices, hygienic

practices, anthropometric measurements and

immunization status

301

23 Proforma to assess dietary intake 325

24 Photographs showing procedures followed during

data collection

326

25 Infant and young child feeding (IYCF) training

certificate

327

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Appendix – 1

DEFINITIONS

Malnutrition: Malnutrition means, “badly nourished” but it is more than a measure of

what we eat, or fail to eat, clinically, malnutrition characterized by inadequate intake of

protein, energy and micronutrients and by frequent infections of disease1. In short, food,

health and caring the three ‘pillars of well being1.

Infant: Refers to all children less than 12 months of age1.

Young Children/Pre - schoolchildren: Children less than five years of age, including those

less than 12 months of age1.

Infant or child feeding: This refers to whole complex of dietary, behavioral, and

physiological processes involved in the child’s ingestion of food1.

Exclusive breast feeding: Exclusive breastfeeding means giving a baby no other foods or

drinks, including water, in addition to breastfeeding with the exception of syrup/drops or

vitamins, minerals and medicines (expressed breast milk is also permitted)176

.

Predominant breastfeeding: Predominant breastfeeding means breastfeeding a baby, but

also giving small amounts of water or water-based drinks – such as tea176

.

Full breastfeeding: Full breastfeeding means breastfeeding either exclusively or

predominantly176

.

Partial breastfeeding: Partial breastfeeding means giving a baby some breastfeeds, and some

artificial feeds, either milk, or cereals, or other food176

.

Bottle-feeding Bottle feeding means feeding a baby from a bottle, whatever is in the bottle,

including breast milk176

.

Cup feeding: Cup feeding means feeding a baby from cup (katori, pallad etc.) whatever is in

the cup including breast milk176

.

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Complementary feeding: Complementary feeding means giving other foods and liquids in

addition to breast milk or non-human milk176

.

Complementary food: Any nutrient containing foods or liquids other than breast milk given

to young children during the period of complementary foods1.

Artificial feeding: Artificial feeding means feeding a baby on any kind of artificial milk such

as animal milk, tinned milk etc. and no breastfeeding at all176

.

Timely complementary feeding: Timely complementary feeding means giving a baby

additional food and liquids in addition to breastfeeding when it is appropriate, from 6 months

of age176

.

Special transitional foods/ Weaning foods: Foods specifically designed to meet the

particular nutritional or physiological needs of the young child1.

Replacement feeding: Replacement feeding is a process of feeding a child who is receiving

no breast milk with a diet that provides all nutrients the infants need until the age at which

they can be fully fed on family foods176

.

Energy density: Energy density is the amount of energy or calories (kcal) per 100 grams of

food eaten in a day89

.

Feeding frequency: Feeding frequency indicates total number of meals and snacks consumed

throughout a 24-hour period89

.

Acute respiratory disease:

We consider a child has Acute Respiratory Infections (ARI), if the child suffers from any one

or more of the following symptoms/signs,

1. running nose 2. cough 3. sore throat

4. difficult breathing 5. ear problem58

.

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Acute diarrhoeal disease:

We consider a child as having Acute Diarrhoeal disease if the child passes more than three

loose, liquid or watery stools in a day58

.

Gestational age: Gestation is the period between conception and birth during which the fetus

grows and develops inside the mother’s womb. Gestation age is the time measured from the

first day of the women’s last menstrual cycle to the current date. It is measured in weeks. A

pregnancy of normal gestation is approximately 40 weeks, with a normal range of 38 to 42

weeks. Infants born before 37 weeks are considered premature. Infants born after 42 weeks

are considered post mature. Gestational age can be determined before or when the baby is

born183

.

Under weight: Proportion of under-fives falling below minus 2 standard deviations

(moderate underweight) and minus 3 standard deviations (severe under weight) from the

median weight-for-age of the reference population184

.

Stunting: Proportion of under-fives falling below minus 2 and minus 3 standard deviations

from the median height-for-age of the reference population184

.

Wasting: Proportion of under-fives falling below minus 2 and minus 3 standard deviations

from the median weight-for-height of the reference population184

.

Anganawadi: Anganawadi is one, which covers around 1000 population in a given

geographical area and is a unit, which provides nutritional services, to mothers and children

below 6 years of age under integrated child development project (ICDS).

Contamination: Contamination includes, transfer of information, which includes regarding

health education module and knowledge acquired by mothers through contact of anganawadi

worker, mothers and family members between the clusters in intervention and control groups.

(Working definition of contamination in our study) 171

.

Permanent resident: Permanent resident is that one who is living in the same place (house)

for the last one year and will be living in the same place for the next two years.

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Appendix 2 Formative research to design a behavioral change communication module

for Infant and Young children feeding practices

in Udupi district

1. Introduction:

For children to grow normally there are many parental care-giving behaviors related to food

that are essential to ensuring adequate nutritional intake. Obtaining and selecting foods that

meet nutritional requirements, preparing them safely and in a form that is appropriate for the

child’s age, feeding them in a manner that encourages adequate intake. To engage in these

critical care giving behaviors parents need access to the foods their children require. They also

need knowledge.

2. Objectives:

1. To find out the current Infant and Young child feeding practices in Udupi district.

2. To identify individual, household and community factors that may facilitate or

constrain adoption of recommended behaviors.

3. To use the information from the formative research to prioritize behaviors to be

targeted and design an effective behavior change communication strategy.

3. Methodology:

1. Existing data review

2. In-depth interview

3. Household observation

4. Trials of improved practices

5. 24- hour recall

6. Focus group discussion

3.1. Study area:

The study was conducted in the field practice area of Kasturba Medical College Manipal. A

convenience sample was selected from two Rural Maternity and Child Welfare Home

(RMCW Homes) area.

3.2. Sample selection: There are 6 RMCW Homes in field practice area. Out of this, two

RMCW homes were selected by a simple random sampling method. In the RMCW homes one

field ANM working in the field keeps a family record. Four groups were identified for the

study. Pregnant women, children aged birth to 6 months, seven to12 months, 13 to 24 months.

Four groups were listed separately from the available records and five families were selected

in each group in both centers for the study adopting a simple random sampling procedure.

Sl.No. Study group Age group Sample

1. Mothers 36 to 38 weeks

of gestation 5

2 Children 0 to 6 months 5

3. Children 7 to 12 months 5

4. Children 13 to 24 months 5

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3.3. Existing data review:

1. Lessons learned from other organizations

2. Use of existing reports and key informant interviews

3. Identify knowledge gaps

4. Reveal actual practices

5. Often conducted in depth interviews

6. Available resources to make realistic recommendations

The locally available health education materials were collected. Literature review was done to

collect the existing material and to know the work done in the field. WHO and UNICEF sites

were searched and material was collected. The recommended practices and appropriate

messages were documented. Visited to UNICEF Office at Hyderabad and collected health

education materials on child feeding practices. Discussed with the officials about the study,

required materials and collected them.

Visited National Institute of Nutrition Hyderabad Nutrition section and Field Division.

Discussed with the staff and collected information and materials. They suggested to conduct a

formative research to prepare a health education module. Accordingly, the formative research

was conducted to prepare a health education module.

3.4. In depth – interviews:

1. Use direct questioning - question as ‘why’

2. Reveal knowledge attitude and practices

3. Identify barriers in optimal practices

4. Formulate specific recommendation

Researcher visited the selected houses introduced himself, explained the purpose of the study.

Oral consent was obtained. A pre-tested questionnaire was used to collect the information. An

in-depth interview was conducted questioning the mother and other family members who ever

available at home. The knowledge was assessed, practices were identified and tried to

understand the attitude of the family members towards the child feeding practices. Finally,

few recommendations were made to improve the practices and discussed about the feasibility

of practicing. The gaps in practicing and the recommendations were noted.

3.5. Household observations: Guidelines for field observer –

1. Try not to have expectations for what you will observe

2. Try to recognize and dismiss your own assumptions and biases and remain open to

what you observe, try to see things through the participant’s perspectives.

3. Write field notes as soon as possible , do not discuss observation until the field notes

are written

3.6. Possible structured observation topics:

1. Mother’s infant and young child care and feeding practices

2. Children’s activities and behavior and the response of mother and other caregivers to

them

3. Breastfeeding, bottle feeding and other child feeding practices

4. Food preparation

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5. Family and child meal time, including who feeds the child, what kind of supervision

and feeding style is used, how actively the mother feeds, and whether the child has his

or her own plate

6. Special practices and behavior during illness and recovery

7. Conditions in the home, including hygiene

8. Food availability

During the home visit researcher observed the home the surroundings and cleanliness,

observed the feeding the child, food served, breastfeeding, child’s environment etc. relevant

things were noted down.

3.7. Trials of improved practices (Tips) (observations) – Best for learning about actual

practices and usually conducted during an in depth interview.

1. Involve a series of household visits to test recommendations for improving practices

2. Determines which recommendations are feasible and acceptable

3. Identifies motivators and barriers to practicing recommendations

4. Involves mother in process

5. Provides general information on practices

After the in-depth interview, the researcher visited to observe how much changes occurred in

the family. Observing the deserved changes in behavior of mother/care giver and the

discussed about the barriers in implementing the recommendations. The process was written

down. Guide was also attended in some observations. Later identified which practices are

feasible to be implemented and which will be difficult. Feeding water before 6 months was a

very strong practice, frequency of feeding 3 to 4 times a day. If the child cries’s more

frequently mother thinks that she does not have enough milk. Other observations that cold

food, hot food, and many times child were deprived of variety of foods.

3.8. Diet survey (24 – hour recall):

1. Ask respondents to recall and describe feeding and dietary practices from previous

day

2. Provides basis for discussion about practices and negotiate for feasible improvements.

A diet survey was conducted to find out the frequency and types of foods fed to child. The

NIN format was used for the survey. Researcher had diet training at NIN to conduct a diet

survey. Two days practical training was attended under the supervision of field staff and

assessed the training at the end found adequate and satisfactory.

3.9. Focus group discussion:

1. A small group (5-10) members with similar background to discuss specific topics

2. Use flexible topic guide with probing

3. Facilitator is then to collect information, not disseminate it

4. Focus on what people do, think and feel and why

Two focus group discussions were conducted in two RMCW Homes.

3.10. Non-verbal block for good communication

1. Nodding too often

2. Not looking at the person who is talking

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3. Acting disinterested

4. Allowing interruptions

5. Smiling or frowning in appropriately

3.11. Effective listening - ‘SOFTEN’

S – Smile O – Open posture

F - Forward lean T - Appropriate touch

E - Eye contact N - Nod the head

3.12. Channels of delivery: Looking into the different approaches adopted by different study

groups we considered contacting the mother directly at home and counseling would be more

effective. Therefore, we adopted a family level counseling to deliver the intervention. The

researcher was told to conduct the intervention himself. Few studies also suggested that

individual as well as group counseling would be an effective way improving feeding practices

among mothers. The pregnant women were contacted at home introduced by ICDS worker.

Pregnant women and the family members (others who ever available at home) were clearly

explained about the study and consent was taken. Baseline data and other information were

collected as per the schedule. Later the intervention counseling was started. Initially few

open-ended questions were asked and the mother and other family members were allowed to

respond on child feeding practices and childcare. Listening to them, reflecting back what they

think empathize them accept what do right, recognize and praise for good practices. At the

end, give very few specific suggestions and appropriate information to the mother and family

members. Try to find out the feasibility and acceptability of adopting the new suggestions.

During the next visit to follow up the previous problems and to give suggestions. If not

followed try to find out what was the problem etc.

Here negotiation is referred to while counseling involving the mother and other family

members at home (whoever is available) listen what they say, their experiences, feelings etc.

try to identify which are good practices encourage them and try to find out which are the

wrong ones. When they are practicing a wrong practice, discuss and try to make them

understand why it is not a healthy practice. Here we have to give an option for them to change

their practice and see the results so that they will change their behavior7, 19

.

3.13. Guidelines for formulating the questions

1. Open – ended question: Encourage answers that go beyond one word; disclose

feelings, actions reactions and knowledge. e.g. What do you think about?

How do you feel about?

Can you tell me more about?

2. Closed questions: encourage short answers – Yes/No

E.g., Do you, Did you, How many etc.

3. Two in one questions – Create confusion, they force the respondent to react to two

things at once. e.g. – How many times do you feed your child a day and what do you give?

4. Biased or leading questions – Lead respondents to say something they may not have

thought about and can limit the responses. e.g. - Is it good to breastfeed your baby?

Questions should stimulate rather than discourage discussion; they should be tested and

reviewed prior to being used in formative research.

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3.14. Probing

This can be achieved through

1. Silence that gives the respondent time to expand their thoughts

2. A question to follow up (why?)

3. A statement (I am a little unclear about that) or restatement (you said)

4. Repetition of key words in response (you said that is good – but what is good about it)

5. Reference to another person or group (what might other people think about that?)

6. It is important because it allows for a deeper understanding of the reasons behind a

response.

7. Deep probing of issues raised as respondents respond to the questions – is key to

successful qualitative research, try not to cover too many topics.

4. Focus group discussion

This study is conducted to understand the current practices, motivators and barriers related to

ideal behaviors. It also defines the acceptability and feasibility of adopting a new behavior

and convincing messages through an appropriate channel based on the tested

recommendations keeping the focus on issues important to the community.

4.1. Objectives:

1. To study the current Infant and Young child feeding practices in Udupi district.

2 To identify individual, house hold and community factors that may facilitate or

constrain adoption of recommended behaviors.

3. To use the information from the formative research to prioritize behaviors to be

targeted and to design an effective behavior change communication strategy.

4.2. Participants:

The study was conducted in the field practice area of Kasturba Medical College Manipal, in

two Rural Maternity and Child Welfare Home. The study population will be Mothers of

children less than 5 years of age. Two FGD’s were conducted in Katapady and Kaup RMCW

Home’s.

4.3. Topics for discussion;

1. What should be the first feed for a newborn baby?

(Probe - initiation of breast feeding, feeding colostrum and prelecteal feeds)

2. What do you think about giving only breast milk for the first six months of life?

(Probe – exclusive breastfeeding and early weaning)

3. How do you know a baby is ready for semi-solids and solid foods?

(Probe – starting complementary foods, frequency of feeding and consistency of

foods)

4. In your opinion when child is able to take family foods?

(Probe – Feeding with family pot, developmental milestones)

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5. When child is sick, do mothers feed the child adequately?

(Probe – breastfeeding, liquids regular feeding etc.)

6. In your opinion what are the precaution a mother has to take to prevent the

common sicknesses in the child?

(Probe – personal hygiene, keeping the child clean and immunization)

4.4 Focus group discussion Questionnaire:

1. Child malnutrition is one of the important problems we face today. Nearly about 35% of

our

children below the age of 3 are malnourished.

1. Do you think looking around in your neighborhood is it a problem?

2. What could be the reason for this malnutrition?

2. What do you feel about these practices in your neighborhood?

1. Breast feeding initiation

2. Feeding prelecteal feeds

3. Feeding colostrums

4. Exclusive breastfeeding

5. Night feeding

6. Introducing liquids and other semi-solids

7. Positioning

2.1. Complementary feeding

1. Early initiation of complementary foods

2. Ideal age to start semi-solids

3. Frequency of feeding

4. Types of foods and local verities of foods

5. Introducing family foods

6. Continuing breast feeding and duration of breast feeding

2.2 Common sickness and Hygiene

Home management of,

1. ARI

2. Diarrhoea

3. Measles

4. Immunization

5. Hygienic practices

2.3. Growth monitoring

Who is considered as a healthy child?

2.4. Feeding the following foods and its necessity

1. Multi vitamins

2. Gripe water

3. Herbal medicines

4. Anganawady food

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Appendix – 3

Important findings of In-depth interview and diet survey

Adequate Knowledge % In adequate knowledge %

Breast feeding initiation 76 Exclusive breast feeding 56

Feeding colostrums 88 Breast feeding in night time 64

Duration of breast feeding 56 Introducing liquids 84

Continuing breast feeding 100 Introducing semi solids 84

Home management of ARI 30 Positioning 92

Hygienic practices causes

sickness

100 Introducing complementary foods 84

Good Practices % Harmful practices %

Feeding pre-lacteal feeds 64 Feeding pre-lacteal feeds 36

Breast feeding problems 84 Breast feeding problems 16

Frequency of feeding 12 Frequency of feeding 88

Types of foods and density 48 Types of foods and density 52

Immunization 82 Immunization 18

Introducing family foods 48 Introducing family foods 52

Home management of diarrhea 35 Home management of diarrhea 65

Dilution of milk 18 Dilution of milk 82

Multi Vitamins 53 Growth monitoring 100

Herbal medicines 25 Feeding gripe water/ Bonison 70

Anganwadi food 12 Multi Vitamins 47

Herbal medicines 75

Anganwadi food 88

Mothers opinion

Motivators – doctor, elders, family members

Health educators visits - accepted

Messages - No response

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Appendix - 4

Report of the focus group discussion Date 8

th and 17

th August 2006

Place: Indiranagar Katapady and Polipu Kaup

Time: 3 pm to 4.15 pm

Focus group discussion was conducted at Indira Nagar anganawadi centre, Katapady and

Polipu anganawadi centre, kaup on 8th

and 17th

August 2006. Total 23 mothers from the

community participated in the program.

Mr. Divakar Nayak S was the facilitator and Mrs. Neelavathi was the Moderator.

The discussion was started with introduction on the purpose and objectives of FGD. The

participants were encouraged to talk about the topic without hesitation.

Focus group discussion started with introduction by Mrs. Neelavathi. Participants introduced

themselves before beginning the discussion.

Most of the participants are of the opinion that:

Q. 1. Child malnutrition is one of the important problems we face today. Nearly about 35%

of

our children below the age of two are malnourished. (statement)

Yes, we agree but could not see such children in our neighborhood.

Q. 2. Breast milk is the natural food available to a child from her mother, how this is fed to a

child in your area?

a) Breastfeeding initiation –

Soon after the birth breast milk should be given

Soon after the delivery it is possible

Immediately after the delivery within 10 minutes can be started

Initially 3 days milk is less

b) Feeding prelacteal feeds –

Some are giving dry grape water, lacotogen milk, glucose water, sugar water honey

These feeds should not be given

We don’t give anything

Some are giving hot water, so that child will cry

Some give honey/milk dipping the finger ring (golden) to the child (as a ritual)

c) Feeding colostrums –

Some are not giving this milk

Some squeeze and remove this milk

It should be given

When child starts crying it should be fed

Now everybody feeds, it is good, nutritious to child

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Child is protected by sickness

d) Exclusive breastfeeding –

Only breast milk, is enough only for 3 to 4 months

Some semi solids to be started at 4 months of age and fed 2 times a day

e) Breastfeeding in night

Night 2 times breast milk should be given

Child should be woken up and fed in the night

Night and day there is no difference in breast milk

If child is slept woke up the child and feed

f) Introducing liquids and other semi – solids –

Three to 4 months child should be given other foods

Breast milk alone is not enough after 4 months of age

g) Duration of breastfeeding –

Breast milk is to be given for 18 months (majority of them)

Breast milk is to be given 2 years (two mothers)

After one year the child starts to bite the breast, so it is stopped

To stop at 2 years we get pain, so we stop early, we don’t feed the child

Child should be fed till 3 years, it is good (two mothers)

h) Positioning –

Breast milk is to be given to child in sitting position, not to be given in sleeping

position

Breast has to cleaned before feeding

Mental state of mother, she should be calm

Child attachment and love to the child

Mother and child should be together

Mother should drink milk

Mother should drink some hot water before feeding the child

Mother should consume green leafy vegetables

Should not lie down to feed, even during night

Child vomits, if child is breastfed in lying position

Child will take 5 to 10 minutes breastfeed

Child should be fed from both breasts at one time other breast will become hard

and dry

If child is breastfed too many times and for longer time mother will become

week

About nipple feeding no answer

i) Breastfeeding problems -

Problems like swelling, hardness crack nipple

Once one side should be fed and second time the other side

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Q. 3. Breast milk alone is enough only to a certain age, what has to be fed afterwards? In

addition, how these foods are fed and in what frequency?

a) Introducing complementary foods

At 4 months semi solid foods should be started (biscuits, bakery butter, apple, fruits,

carrot boiled)

After 6 months – ragi, wheat, beaten rice, rava, biscuits, fruits, butter, cerleac,

After 8 months kanji and dal will be started, egg also can be added

Cow’s milk also can be given

Breast milk is not enough, after 4 months other milk can be given

When weaning starts child is getting problems – change in food, child does not have

energy to digest the new food.

b) Frequency of feeding:

At 4 months child can fed 2 times

4 times after some time - morning, noon, evening and night

3 times per day will be enough (one mother)

4 to 6 times will be good (one mother)

Twice in day time is more than enough (Two mothers)

At 6 months of age 3 times and slowly increased by 9 months

After 9 months biscuits and other food items can be given

c) Types of foods and its density:

Feed should be watery when it is introduced to child

Later it can be little thick but not very thick

Idly, banana, beaten rice with milk also can be given

4 months kanji, mashed potatoes to be given. Ragi, wheat powder mixed with milk

and boiled and given (porridge, manni)

Child should be given hard and thick food after 9 months of age

d) Introducing family food:

Give what all the food items that family eats give to the child in small quantity

Child is able to eat family food only child is 18 months and more (few mothers )

At one year normal family food can be given, we should feed the child

When we eat we should serve the child also in a separate plate

After 9 months family foods can be introduced, what the elders eat at home (moat of

the mothers)

e) Continuing breastfeeding:

Breast milk should be continued till 18 months of age

Some children ask only breast milk not eating other foods

Breastfeeding should be continued but after 18 months not required (majority)

It should be stopped when child is not eating well

We give till 2 years of age (three mothers)

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Q. 4. Is there any way that can we prevent few sicknesses? What are they and how?

1) Immunization schedule:

BCG has to be given at birth

Jaundice and MMR is given

Jaundice and malaria injection given

DPT starts at 45 days, BCG in 45 days and at 3 months

Q. 5. If a child is sick usually, what do you do? Is there any way to prevent or reduce the

severances of these sicknesses?

1) Home management of ARI:

We try home medicine for 2 days, if didn’t subside medical advice will be sought

For fever keeping ice water, keeping wet cloth on forehead and try

We go to Doctor

One day we try with home remedies like ginger, tulsi etc.

We scared to give anything to child, nothing else works, we consult Doctor

2) Home management of Diarrhoea:

Usually it is during teething time

We give ORS

Sugar and salt water also given

Some give araroote boiled in water

If did not improve for one day medical advice will be sought

We go to doctor for consultation

Child feeds should be clean

Always give hot foods to child

Once prepared food should not be kept for second time and fed

Wash hands with soap and water before feeding the child after using toilet

3) Hygienic practices:

Washing hands and plates before feeding the child

Keep cleanliness in and around the house

Boiled water to drink

Q. 6. Usually we learn many things from others; child-feeding practices are concerned who

Motivated you and which are the motivating factors?

Doctors tell us don’t give diluted cow’s milk

At home adults telling to give cow’s milk diluted otherwise child will get cold and

cough

Milk should not given before 5 years of age, it causes cough in children (3

participants opinion)

We take advice from sisters (ANM) also

Children don’t eat the way it is advised by Doctors or others

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We follow our own way which is we feel better

At home we listen to elders

Anganawadi workers also give us advice/information

Elders at home, child’s father, mother in law, advice but we cannot follow everything

what they say, sometimes we try to follow

Some have chubby children, we ask the mothers what they give to their children

Doctors tell to give banana, at home elders will object that, child get colds do not

give.

So we don’t know to follow whose advice

We give everything that child is eating (one mother)

Sometimes there may be financial constraints to give some kind of foods

We are not confident some time to give as advised

We try to do whatever told but it is not possible always. Sometimes child will not eat.

Q. 7. Many a time health professionals’ advice a lot of ideal feeding practices, but it may not

be

possible to practice them in a day today life? What are the barriers in practicing these?

1) Growth monitoring:

Doctor tells weight is correct or not when we go for any problem

In anganawadi we check the weight of the child

No response for growth monitoring every month

Child should be weighed once in a month in anganawadi

We will know the growth and activities

2) Feeding gripe water:

It is given to children (Benisons drops) (almost all responded

This is advised by Doctor

To give twice per day

This is good for digestion, sleep, stomachache etc.

Gripe water (Benison) should not be given, not good for health

They (doctors) say it is good for digestion

After delivery when we discharged they (doctors) advice to give

We give only once, good for digestion, stomach ache etc.

3) Giving multi vitamins:

When we discharged from hospital Doctor tells to give this to the child

Daily 8 drops for 6 months

Sometimes one year also

Doctors advice us to give

4) Herbal medicines:

We give that Baje, Ippli, grinded paste ones a week

It helps to improve to clear the speech, and to talk fast

Elders at home advice

For irritating children herbal medicines are good so we are giving

Oil if apply child sleeps well

Doctors advice not to give these

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5) Anganawadi food:

Child does not eat this food

No much response from the participants

Anganawadi food should be given, mixed in water and made as laddus is good, few

children eat it but some do not eat. They may not be tolerating the food

Q.8. If a health professional visits to your house to discuss about feeding practices, in such a

occasion do you like your mother-in-law or any family members present in the

discussion? In your opinion what is the suitable time for such visits?

No problem, it is better, mother-in-law is there, they also come to know about the

problems and it will be good for us

Afternoon is the best time, because we are relatively free

If all the family members are there it will be good

Not only mother-in-law husband and other family members also can be there

If mother–in–law is there is good, but for some it is not good (one mother).

Q. 9. Whom do you call as healthy child?

Child will be active

It will play

Not irritating

Child will having good sleep

Passing motion regularly

Child’s activities –turning over etc. are normal

Weight will be increasing regularly

Some children may late may not talk till 2 years

Eating properly

Activities are good/ correct

According to age the weight gain should be there

Activities should be accordingly to the age

Q. 10. In your opinion what could be an ideal feeding message for a behavior

change in mothers feeding practices?

“Sanna maguvige hale amrita” (Small child milk only good food)

Child needs nutritional food and psychologically healthy environment

Take care with love and affection don’t scold to the child

Response from the group:

1. All most all the mothers responded and participated in the discussion

Responding to others opinion, discussion about a particular statement etc. was not

much

Facilitator has to intervene and ask for the response

The mothers responded very well

Group discussion was encouraging

They were freely and openly expressing views

Appendices

P a g e | 261

Not hesitant to express their practices and opinion

Other observation:

One lady did not respond at all, others minimum

3 women have responded very well

In the group 4 members were active

Discussion among the members was limited

Facilitator had to intervene in between

One member did not speak at all when asked the question directly only smile no

answer

On member was nodding her head to show that she agreed with what others told

Facilitator extended the vote of thanks to all the participants, the anganawadi worker staff and

others who helped to conduct the FGD successfully.

The complete process was tape-recorded and two people wrote down

Particulars of the participants attended at Indira Nagar, Katapadi

Sl.

No. Name

Age

in

Years

Sex Education Occupation

No of <5

Children

1

Vijaya N Shenoy 39 F B.A. House Wife 1

2

Harinakshi 26 F 10th

House Wife 2

3

Yashoda 25 F 7th

House Wife 1

4

Usha 27 F 3rd

Beedi rolling 2

5

Shaila 33 F 10th

House Wife 1

6

Shobha 25 F PUC House Wife 1

7

Rahamath 23 F 7th

Beedi rolling 1

8

Shameena 25 F 10th

House Wife 3

9

Chandika 35 F PUC Beedi rolling 1

10

Shameera 26 F 10th

House Wife 1

Appendices

P a g e | 262

Particulars of the participants attended at Polipu anganwadi centre, Kaup

Sl.

No. Name

Age in

Years Sex Education Occupation

No of <5

Children

10 Usha 32 F 7th

House Wife 1

2.

Sheela 31 F B.A. House Wife 1

3

Mohini 31 F 8th

House Wife 1

4

Hemavathi 28 F 2nd

House Wife 2

5

Sunitha 27 F 10th

Beedi rolling 1

6.

Vimala 31 F 8th

House Wife 2

7

Nalini 32 F 10th

Clarical 2

8

Shailaja 28 F 10th

House Wife 1

9

Thejavathi 35 F 10th

House Wife 1

10

Radhika 32 F 10th

House Wife 1

11

Sunitha Babu 23 F 10th

House Wife 1

12

Savitha 32 F PUC House wife -

13

Nethravathi 29 F 7th

House wife 2

Appendices

P a g e | 263

Appendix – 5

Health Education Module

(46 pages –English, attached to thesis)

Appendices

P a g e | 264

Appendices

P a g e | 265

Appendices

P a g e | 266

Appendices

P a g e | 267

Appendices

P a g e | 268

Appendices

P a g e | 269

Appendices

P a g e | 270

Appendix – 6

Appendices

P a g e | 271

Appendix – 7

Flip chart - Kannada

Appendices

P a g e | 272

Appendix – 8

Calendar

Appendices

P a g e | 273

Appendix -9

Important messages from formative research

1. Breastfeeding – Breast-feed the newborn immediately after the birth. Do not give any

kind of fluids to newborn baby before initiating breast milk like glucose water, warm

water, sugar water, honey, lactogen milk or cow’s milk etc.

2. Signs of proper positioning and attachment – To give maximum benefit of the

breastfeeding hold the baby in the correct position close to your breast.

3. Optimal breastfeeding – Initiation of breastfeeding immediately after birth, allow the

baby to remain with mother, breastfeed frequently (demand feeding), exclusive

breastfeeding till 6 months of age, continue breastfeeding even if mother or child

becomes sick, avoid bottle feeding and mothers should eat and drink sufficiently to

satisfy their hunger and thirst.

4. Growth monitoring – Weigh the child frequently at the nearby anganawadi and see

that your child is moving in the right direction (road to health) using the growth chart.

5. Home management of ADD and ARI – Breast-feed frequently, give oral rehydration

solution (ORS), continue normal food and if any danger signs, shift the child

immediately to hospital. Keep the child warm, if within one-day fever doesn’t subside,

shift the child to hospital, breast feed frequently, put wet cloth on forehead, hand and

legs, seek medical help.

6. Optimal feeding practices – Start complementary foods at 6 months of age, slowly

increase the quantity, frequency, and thickness of the food, and give iron and vitamin

A. rich foods. Do not give tea/coffee to your child; sit with the child and feed.

Appendices

P a g e | 274

Appendix - 10

List of experts involved in the study

1. Dr. Asha Hegde

Associate Professor,

Department of Pediatrics,

Dr. T. M. A. Pai Rotary Hospital,

Karkala – Udupi district.

2. Dr. Suma Nair

Associate Professor,

Department of Community Medicine,

Kasturba Medical College –Manipal.

3. Dr. Rathna Prakash

Professor,

Manipal College Of Nursing – Manipal.

4. Dr. George P. Jacob

Assistant Professor,

Department of Community Medicine,

Kasturba Medical College – Manipal.

5. Dr. Maya Ranganathan

Professor,

Manipal Collge of Communications Manipal.

Appendices

P a g e | 275

Appendix -11

Health education approach (model) followed in the study

The health education approach adopted to impart the intervention was through counseling the

mother and other family members at their residence. Other family members like husband,

mother, mother-in-law and any other family members available at home during the

intervention were involved in the discussion. Follow the sequence and talk to mother and give

few suggestions at the end.

1. Introduce yourself to the family member

2. Explain the purpose of the visit

3. Ask about the pregnant mother /child, the health condition, how are you etc. with

casual talk.

4. Start the discussion talking about one problem brought by them. Slowly build it

with the main topic of discussion.

Model question - Topic breastfeeding, how is the breastfeeding going on? In addition,

what else do you feed to your child? If mother fed little water to the child, ask her

whether breast milk and water which of this is better for the child. Then continue

question and answer session like if breast milk is good why you are feeding water.

Child will take whatever you feed, the quantity and type of food. So when you have

enough milk why you have to feed water. Explain the content of the breast milk that it

contains 88% of water so that at any season you need not feed extra water to the child

until the age of six months. So let the mother decide and give which feed is better for

her child. Let her bring the problem and discuss the advantages and disadvantages so

finally let her decide which one to follow.

5. Show the concerned pictures to confirm the statement that already made, and any

evidence or examples that are relevant to the topic of discussion. Ask do you have any

doubts or quarries and conclude the discussion telling the mother that these are the

recommended practices, which will help your child.

6. Say thanks for spending the valuable time and making the discussion live. Tell her that

you will be re-visiting and confirm whether she will be following all the practices that

she agreed to follow here onwards.

Appendices

P a g e | 276

Appendix - 12

Letter of approval from Ethics committee, Masturbate Hospital –Manipal

Ap

pen

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07

Infa

nt

dea

th

34

. S

ug

and

hi

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aik

2

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6/2

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35.

Judit

h L

ewis

R

onal

d L

ewis

3

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5/2

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Mig

rate

d

36.

Nam

itha

shre

e P

rom

odh

3

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37

. S

hre

emat

hi

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anan

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7

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38.

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tha

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has

kar

6

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39

. K

usu

ma

S

hek

ar

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1

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07

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t d

eath

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007

Appendices

P a g e | 281

Appendix - 14

Distribution of study subjects anganawadi wise in intervention group and control group

1. Intervention area

Sl.

No.

Name of

anganawadi

Nov.

2006

Dec.

2006

Jan.

007

Feb.

2007

March

2007

April

2007

May

2007

June

2007

July

2007

Total

1. Golikatte 1 1 - - - - - - - 2

2. Kelinje 1 - - 1 1 - 1 - 4

3. Herebettu 1 - 2 2 - 1 3 1 - 10

4. Padunittur 1 - 1 - 1 1 - 1 - 5

5. D.kumeri - - - - 1 1 - - - 2

6. L.V.P.1 2 1 1 - 1 2 - - 2 9

7. Muggeri 1 - - - 1 - - - 1 3

Total 7 2 4 3 5 5 3 3 3 35

2. Control group

Sl.

No.

Name of

anganawadi

Nov.

2006

Dec.

2006

Jan.

007

Feb.

2007

March

2007

April

2007

May

2007

June

2007

July

2007

Total

1. Nellikatte - - - - 1 2 - - - 3

2. K.karia - - - 1 1 - - - - 2

3. Moodubelle - - - 1 2 - 1 1 - 5

4. Kudi. 82 1 - - -- - - -1 - - 2

5. Bhairanje 2 - 2 3 3 2 - - - 12

6. Devaragudda 1 1 - 1 - 1 1 - - 5

7. Kattingeri 1 1 - 1 - 2 - - - 5

Total 5 2 2 7 7 7 3 1 34

3. Details of subjects recruited for the study

Sl.No. Details Intervention

group

Control

group

Total

1. Total number of pregnant mothers

registered for the study

40 37 77

2. Total number of children for the

study

40 37 77

3. Lot for follow up

1. Infant death

2. Home delivery

3. Migration

2

-

3

-

1

2

2

1

5

4. Total number of children lost for

follow up

5 3 8

5. Total number of children followed

up for 24 months

35 34 69

Appendices

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Appendix – 15

Patient’s information sheet, Informed consent form (English and Kannada)

Title of the study: Effect of educational intervention on growth pattern and feeding practices

in children (less than 24 months of age) in Udupi district – A community-based cluster

randomized controlled trial.

Investigator: Guide:

Mr. Divakar Nayak S. Dr. Nagaraj Kondagunta

Department of Community medicine Additional Professor,

Kasturba Medical College, Manipal, Dept. of Community Medicine

Udupi district – 576104, Karnataka, India, Kasturba Medical College, Manipal

Tel. No. 0820 – 2571201 ext. 22234, 22275. Udupi district-576104, Karnataka.

e-mail – shenidivakar@yahoo.com Tel. No.0820-2575771,

email-sanjurajrekha@yahoo.com

I am Mr. Divakar Nayak S, working in the department of Community Medicine, Kasturba

Medical College, Manipal. I am doing a study on effect of an educational intervention on

growth pattern and feeding practices of children below 24 months of age in Udupi taluk

Purpose

Malnutrition is a very common problem in children below 2 years of age. I would like to find

out whether an educational intervention to mothers will improve the growth pattern and

feeding practices, so that malnutrition can be reduced.

Research Intervention

The study will involve mothers and the newborn children. The study will be conducted in two

randomly selected areas, one will be the intervention group and the other one will be the

control group. In intervention group the mothers will receive specially designed health

education. If you decide to be in the study and are selected for educational intervention your

participation will be required once during 36 to 38 weeks of gestational age and there after at

repeated intervals (at the age of 2, 5, 8, 11, 14, 16 and 20 months of your child)

You may have to answer some of my questions to assess your baseline knowledge about

feeding practices using a questionnaire. The intervention messages cover the appropriate

feeding practices, which will be based on “Integrated Management of Childhood Illness

Training Manual on Nutrition Counseling” by WHO.

Participant’s selection

All the pregnant mothers who are residents in the selected anganawady area will be included

during study period.

Appendices

P a g e | 283

Voluntary Participation

Your participation in this research study is voluntary. It is your choice to participate or not.

You may change your mind and withdraw from the study even if you have agreed earlier

Description of the Process

- During the research study, I will be visiting seven times to your house and each visit will

not be more than 15 to 20 minutes.

- A survey questionnaire will be used to assess the socio-demographic details and feeding

practices.

- When your child is 4, 6, 9, 12, 15 18 and 24 months of age the anthropometric

measurements like height, weight, mid-arm circumference, chest circumference and a

diet assessment will be done. The study will take place over 24 months in total.

Discomforts

I under stand that by participating in this research study you may experience some

discomforts such as answering the questions and your child may experience minimum

discomfort during the time of taking the measurements.

Benefits

If you participate in this study, you may have the benefit of knowing about the growth of the

child. There may not be any benefit for you but your participation is likely to help us to find

the answer to our research question. There may not be any benefit to the society at this stage

of research, but future generations may likely to benefit.

Confidentiality

Information that is collected from you will be kept confidential and no one but the researcher

will be able to see it. It will not be shared with or given to anyone except MAHE University

(Manipal Academy of Higher Education, Manipal).

Sharing the results

The Knowledge that we get from doing this research will be shared with you before it is

widely available to the public. Confidential information will not be shared. There will be a

small meeting in the community and these findings will be informed. After these meetings,

we will publish the results in order that other interested people may learn from our research.

Right to refuse or withdraw

You do not have to take part in this research if you do not wish to do so. You may withdraw

from the study at any time you choose. It is your choice and all of your right that will be

respected.

Whom to Contact

If you have, any questions you may ask them now or later, even after the study has started you

can contact any time Dr. Suma Nair. Assistant Professor, Dept. of Community Medicine,

Kasturba Medical College, Manipal, Tele. No. 0820 – 2571201, ext. 22234, 22275. e –mail –

suvi555@yahoo.co.uk

Appendices

P a g e | 284

Informed consent form

Title of the study: Effect of educational intervention on growth pattern and feeding practices

in children (less than 24 months of age) in Udupi district – A community-based cluster

randomized controlled trial.

Investigator: Guide:

Mr. Divakar Nayak S. Dr. Nagaraj Kondagunta

Department of Community medicine Additional Professor,

Kasturba Medical College, Manipal, Dept. of Community Medicine

Udupi district – 576104, Karnataka, India, Kasturba Medical College, Manipal

Tel. No. 0820 – 2571201 ext. 22234, 22275. Udupi district-576104, Karnataka.

e-mail – shenidivakar@yahoo.com Tel. No.0820-2575771,

email-sanjurajrekha@yahoo.com

Namaskara,

I Mrs…………………………………………………(Name) aged……Years, have understood

to my satisfaction the objectives and implications of the above mentioned research study, as

explained to me by Mr. Divakar Nayak S.

This study is being conducted to study the effect of an educational intervention on growth

pattern and feeding practices in children less than 24 months of age in Udupi district,

Karnataka.

If you decide to be in the study and are selected for educational intervention your participation

will be required once during 36 to 38 months of gestational age and thereafter at repeated

intervals (at the age of 2, 5, 8, 11, 14, 16, and 20 months of your child). I understand that it

will involve collecting information on feeding practices and dietary assessment through an

interview and taking the anthropometric measurements of my new born child at different age

intervals (4, 6, 9, 12, 15 18 and 24 months of age)

I am aware that there may be no benefit to me or to my child personally by participating in

this study. I understand that participating in this research study, I may experience some

discomfort such as answering the questions and my child may experience some minimum

discomfort during the time of taking the measurements.

I am aware that my identity will not be disclosed and results obtained from this study will be

used exclusively for research purpose.

Appendices

P a g e | 285

There is no direct or indirect commercial interest behind this work. I am convinced that the

information collected during the study will be kept confidential and will not be shared with or

given to anyone except MAHE University.

I had the opportunity to ask questions about this study and my questions have been answered

to my satisfaction. I have voluntarily consented to participate in this research and understand

that I have the right to withdraw from the research study at any time without in any way

affecting my medical care.

I am aware that if I have any doubt or clarifications regarding the study, I am at my liberty to

contact Dr. Suma Nair. Assistant Professor, Dept. o f Community Medicine, Kasturba

Medical College, Manipal, Tele. No. 0820 – 2571201, ext. 22234, 22275.

e –mail – suvi555@yahoo.co.uk

Name of Participant …………………………….. Signature of the Participant

Place: …………………. Date: ……………………..

I have witnessed the accurate reading of the consent form by the potential participant, and the

individual has had the opportunity to ask questions. I confirm that the individual has given

consent voluntarily.

Name of Witness …………………….. Thumb print of Participant

Signature of witness …………………. Date: …………………….

I have accurately read or witnessed the accurate reading of the consent form by the potential

participant, and the individual has had the opportunity to ask questions. I confirm that the

individual has given consent voluntarily.

Name of Researcher …………………………….. Signature of Researcher

Place: ………………….. Date: ………………….

A copy of this informed consent form has been provided to participant ………….

(Initiated by the researcher/ assistant)

Appendices

P a g e | 286

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²PÀëtzÀ ¸ÀAzÀ¨sÀðzÀ°è ¤ÃªÀÅ ªÀÄUÀÄ«£À ¥ÉÇõÀuÉ0iÀÄ°è JzÀÄj¸ÀĪÀ ¸ÀªÀĸÉåUÀ¼À §UÉÎ ZÀað¸À¯ÁUÀĪÀÅzÀÄ. F DgÉÆÃUÀå ²PÀët «µÀ0iÀÄUÀ¼À£ÀÄß eÁUÀwPÀ DgÉÆÃUÀå ¸ÀA¸ÉÜ0iÀÄ ªÀiÁ»w0iÀÄ£ÀÄß DzsÀj¹ vÀ0iÀiÁj¸À¯ÁVzÉ. ¨sÁUÀªÀ»¸ÀĪÀ ¸ÁévÀAvÀæ÷å: F CzsÀå0iÀÄ£ÀzÀ°è ¨sÁUÀªÀ»¸ÀĪÀÅzÀÄ ¤ªÀÄä ¸ÀévÀAvÀæ ¤zsÁðgÀªÁVgÀÄvÀÛzÉ. EzÀgÀ°è ¨sÁUÀªÀ»¸À¨ÉÃPÉà ¨ÉÃqÀªÉà JAzÀÄ ¤zsÀðj¸À®Ä ¤ÃªÀÅ ¸ÀévÀAvÀæjgÀÄwÛÃj. ¤ÃªÀÅ 0iÀiÁªÀÅzÉà ¸ÀAzÀ¨sÀðzÀ°è F CzsÀå0iÀÄ£À¢AzÀ »AvÉUÉzÀÄPÉƼÀî®Ä ¤ªÀÄä EZÉÒ0iÀÄAvÉ £ÀqÉzÀÄPÉƼÀî®Ä CºÀðjgÀÄwÛÃj. ¨sÁUÀªÀ»¸ÀĪÀªÀgÀ£ÀÄß Dj¸ÀĪÀ «zsÁ£À: CzsÀå0iÀÄ£ÀPÉÌ Dj¸À®àlÖ CAUÀ£ÀªÁrà PÉÃAzÀæzÀ°è SÁ0iÀÄA DV ªÁ¹¸ÀĪÀ J¯Áè UÀ©üðt ¹ÛçÃ0iÀÄgÀ£ÀÄß F ¸ÀAzÀ¨sÀðzÀ°è zÁR°¹PÉƼÀî¯ÁUÀĪÀÅzÀÄ. CzsÀå0iÀÄ£ÀzÀ ¸ÀÆÜ® ¥ÀjZÀ0iÀÄ: F CzsÀå0iÀÄ£ÀzÀ ¸ÀAzÀ¨sÀðzÀ°è £Á£ÀÄ ¤ªÀÄä ªÀÄ£ÉUÉ 7 ¸À® ¨sÉÃnPÉÆqÀ°zÀÄÝ ¥Àæw¸À®zÀ ¨sÉÃn0iÀÄÄ 15jAzÀ 20 ¤«ÄµÀ «ÄÃj EgÀĪÀÅ¢®è. MAzÀÄ ¥Àæ±ÁߪÀ½0iÀÄ£ÀÄß §¼À¹PÉÆAqÀÄ ¤ªÀÄä ªÀÄ£É0iÀÄ DyðPÀ ºÁUÀÆ ¸ÁªÀiÁfPÀ ¹ÜwUÀw, ¸ÁA¸ÁjPÀ ªÀiÁ»w EvÁå¢UÀ¼À£ÀÄß ¸ÀAUÀ滸À¯ÁUÀĪÀÅzÀÄ. ¤ªÀÄä ªÀÄUÀÄ«UÉ 4, 6, 9, 12, 15, 18 ªÀÄvÀÄÛ 24£Éà wAUÀ¼À ªÀ0iÀĹì£À°è ªÀÄUÀÄ«£À vÀÆPÀ, JvÀÛgÀ, JzÉ0iÀÄ ¸ÀÄvÀÛ¼ÀvÉ ªÀÄvÀÄÛ vÀ¯É0iÀÄ ¸ÀÄvÀÛ¼ÀUÀ¼À£ÀÄß ¥ÀqÉzÀÄPÉƼÀî¯ÁUÀĪÀÅzÀÄ ºÁUÀÆ £Á®ÄÌ ¸À® ªÀÄUÀÄ«£À DºÁgÀ ¸ÉêÀ£É0iÀÄ ªÀiÁ»w0iÀÄ£ÀÄß ¥ÀqÉ0iÀįÁUÀĪÀÅzÀÄ. F CzsÀå0iÀÄ£ÀªÀÅ ¤ªÀÄä ªÀÄUÀÄ«UÉ 24 wAUÀ¼ÀÄ vÀÄA§ÄªÀ vÀ£ÀPÀ ªÀÄÄAzÀĪÀj0iÀÄĪÀÅzÀÄ. C£Á£ÀÄPÀÆ®vÉUÀ¼ÀÄ: F CzsÀå0iÀÄ£ÀzÀ°è ¥Á¯ÉÆμÀÄîªÀÅzÀjAzÀ ¤ÃªÀÅ £À£Àß PÉ®ªÀÅ ¥Àæ±ÉßUÀ½UÉ GvÀÛj¸ÀĪÀ ºÁUÀÆ ¤ªÀÄä ªÀÄUÀÄ«UÉ vÀÆPÀ, JvÀÛgÀ EvÁå¢ C¼ÀvÉUÀ¼À£ÀÄß vÉUÉ0iÀÄĪÁUÀ GAmÁUÀĪÀ vÉÆAzÀgÉUÀ¼ÀÄ CvÀå®àªÁVgÀÄvÀÛªÉ. C£Á£ÀÄPÀÆ®vÉUÀ¼ÀÄ: F CzsÀå0iÀÄ£ÀzÀ°è ¨sÁUÀªÀ»¸ÀĪÀÅzÀjAzÀ ¤ÃªÀÅ ¤ªÀÄä ªÀÄUÀÄ«£À ¨É¼ÀªÀtÂUÉ0iÀÄ §UÉÎ w½zÀÄPÉƼÀÀÄzÀÄ. EzÀgÀ ºÉÆgÀvÀÄ ¤ªÀÄUÉ 0iÀiÁªÀÅzÉà ¥Àæ0iÉÆÃd£À«gÀĪÀÅ¢®è. DzÀgÉ ¤ÃªÀÅ EzÀgÀ°è ¨sÁUÀªÀ»¸ÀĪÀÅzÀjAzÀ £ÀªÀÄUÉ £ÀªÀÄä ¸ÀA±ÉÆÃzsÀ£É0iÀÄ ¥Àæ±ÉßUÉ GvÀÛgÀ PÀAqÀÄPÉƼÀî®Ä ¸ÁzsÀåªÁUÀÄvÀÛzÉ. F ºÀAvÀzÀ°è ¸ÀªÀiÁdPÉÌ EzÀjAzÀ 0iÀiÁªÀÅzÉà ¥Àæ0iÉÆÃd£À«®è¢gÀ§ºÀÄzÀÄ. DzÀgÉ ªÀÄÄA¢£À d£ÁAUÀ EzÀgÀ ¥Àæ0iÉÆÃd£À ¥ÀqÉ0iÀÄĪÀ ¸ÁzsÀåvÉUÀ½ªÉ. UË¥ÀåvÉ: F CzsÀå0iÀÄ£ÀzÀ CªÀ¢ü0iÀÄ°è ¤«ÄäAzÀ ¸ÀAUÀ滹zÀ ªÀiÁ»w0iÀÄ£ÀÄß UË¥ÀåªÁV Ej¸À¯ÁUÀĪÀÅzÀÄ. F CzsÀå0iÀÄ£ÀzÀ ¸ÀA±ÉÆÃzsÀPÀjUÉ ºÉÆgÀvÀÄ ¨ÉÃgÉ 0iÀiÁjUÀÆ EzÀgÀ ®¨sÀåvÉ EgÀĪÀÅ¢®è. F ªÀiÁ»w0iÀÄ£ÀÄß ¸ÀA±ÉÆÃzsÀPÀgÀÄ ºÁUÀÆ ªÀiÁºÉ «±Àé«zÁ央0iÀÄ ªÀiÁvÀæ ºÀAaPÉƼÀÄîvÀÛªÉ ªÀÄvÀÄÛ ªÀÄÄAzÉ ¥sÀ°vÁA±ÀUÀ¼ÀÄ ¥ÀæPÀlUÉÆAqÀgÀÆ ¤ªÀÄä UÀÄgÀÄvÀ£ÀÄß §»gÀAUÀ¥Àr¸ÀĪÀÅ¢®è. ¥sÀ°vÁA±ÀUÀ¼À£ÀÄß ºÀAaPÉƼÀÄîªÀÅzÀÄ: F ¸ÀA±ÉÆÃzsÀ£É¬ÄAzÀ ºÉÆgÀ ºÉÆ«ÄäzÀ ¥sÀ°vÁA±ÀªÀ£ÀÄß ¸ÁªÀðd¤PÀjUÉ ©qÀÄUÀqÉ ªÀiÁqÀĪÀ ªÉÆzÀ®Ä ¤ªÉÆäA¢UÉ ºÀAaPÉƼÀî¯ÁUÀĪÀÅzÀÄ. UË¥ÀåvÉ0iÀÄ «ZÁgÀUÀ¼À£ÀÄß ºÀAaPÉƼÀî¯ÁUÀĪÀÅ¢®è. ¸ÀªÀÄÄzÁ0iÀÄzÀ°è MAzÀÄ aPÀÌ ¸À¨sÉ £Àqɹ CzsÀå0iÀÄ£ÀzÀ ¥sÀ°vÁA±ÀUÀ¼À£ÀÄß w½¸À¯ÁUÀĪÀÅzÀÄ. C£ÀAvÀgÀ EzÀ£ÀÄß ¨ÉÃgÉ0iÀĪÀgÀ ¸À¢é¤0iÉÆÃUÀPÁÌV ¥ÀæPÀn¸À¯ÁUÀĪÀÅzÀÄ.

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M¦àUÉ ¥ÀvÀæ

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F CzsÀå0iÀÄ£ÀzÀ §UÉÎ J¯Áè ªÀiÁ»w0iÀÄ£ÀÄß £À£ÀUÉ w½¸À¯ÁVzÀÄÝ, £À£Àß ¸ÀA±À0iÀÄUÀ¼À£ÀÄß £À£ÀUÉ

vÀȦÛ0iÀiÁUÀĪÀAvÉ «ªÀj¸À®Ä CªÀPÁ±À PÀ°à¸À¯ÁVzÉ. £Á£ÀÄ ¸Àé0iÀÄA ¥ÉæÃgÀuɬÄAzÀ F CzsÀå0iÀÄ£ÀzÀ°è ¥Á¯ÉÆμÀÄîwÛzÀÄÝ. £Á£ÀÄ 0iÀiÁªÀÅzÉà ºÀAvÀzÀ°è £À£Àß ¸Àé EZÉÒ¬ÄAzÀ 0iÀiÁªÀÅzÉà PÁgÀt CxÀªÁ ¥ÀǪÀð ¸ÀÆZÀ£É0iÀÄ£ÀÄß PÉÆqÀzÉ F ¸ÀA±ÉÆÃzsÀ£É¬ÄAzÀ »AvÉUÉzÀÄPÉÆAqÀ°è £À£ÀUÉ 0iÀiÁªÀÅzÉà vÉÆAzÀgÉ DUÀĪÀÅ¢®èªÉAzÀÄ w½¢gÀĪɣÀÄ.

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C£ÉéõÀPÀjUÉ CªÀ±ÀåPÀ ªÀiÁ»w0iÀÄ£ÀÄß PÉÆlÄÖ F ¸ÀA±ÉÆÃzsÀ£É0iÀÄ°è ¸ÀºÀPÀj¸À®Ä ¥ÀÇwð M¦àUÉ PÉÆnÖgÀĪɣÀÄ. ¨sÁUÀªÀ»¸ÀĪÀªÀgÀ ºÉ¸ÀgÀÄ: ¸À»: ¸ÀܼÀ: ¢£ÁAPÀ :

£À£Àß ¸ÀªÀÄPÀëªÀÄzÀ°è C£ÉéõÀPÀgÀÄ ¸ÀA±ÉÆÃzsÀ£Á CzsÀå0iÀÄ£ÀzÀ §UÉÎ «ªÀgÀªÁV w½¹gÀÄvÁÛgÉ. ¨sÁUÀªÀ»¸ÀĪÀªÀgÀÄ J¯Áè «µÀ0iÀÄUÀ¼À §UÉÎ «ªÀgÀªÁV w½zÀÄPÉÆAqÀÄ M¦àUÉ0iÀÄ£ÀÄß ¤ÃrgÀÄvÁÛgÉ. ¸ÁQëzÁgÀgÀ ºÉ¸ÀgÀÄ : ¸À»: ¸ÀܼÀ : ¢£ÁAPÀ: C£ÉéõÀPÀgÀ ºÉ¸ÀgÀÄ: ¸À» : ¸ÀܼÀ : ¢£ÁAPÀ: F M¦àUÉ ¥ÀvÀæzÀ MAzÀÄ ¥Àæw0iÀÄ£ÀÄß C£ÉéõÀPÀgÀ ¸À»0iÉÆA¢UÉ ¨sÁUÀªÀ»¸ÀĪÀªÀjUÉ MzÀV¸À¯ÁVzÉ.

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Appendix – 16

Proforma on screening procedures followed to assess the new born

Serial No: _____ Date of Visit ___/____/______

Intervention (1) Control (2) Anganwadi: (1), (2), (3), (4), (5), (6), (7).

Name of the mother: ________________ Date of birth: ______________________

The newborn will be screened for the presence of any anomalies or other diseases. If the

newborns are found to have any anomaly or major disorder, they will be excluded from the

study.

Screening procedures:

The newborn will be assessed for the presence of any morbidity based on the delivery records.

A symptom questionnaire will be used to screen the new born for any morbidity pertaining to

different systems of the body. Those new born who are suspected to have morbidity would be

referred and evaluated by a Pediatrician. If the newborns are found to have diseases like

congenital heart diseases, or other congenital anomalies, such children will be excluded from

the study.

Screening Method:

If the answer to the following questions is ‘NO’ such child a will not be included in the

study:

1. Is the mother permanently residing in the Anganawadi area? Yes / No

2. Is the birth weight of the child available? Yes /No

The following details will be collected from the hospital records.

If any of the following answers are found to be ‘Yes’ then such a child will not be

included in the study:

1. Is the delivery preterm? Yes / No

(Less than 36 weeks of gestation)

2. Did the child have any structural anomalies like Cleft lip/palate? Yes /No

3. Does the Child have any h/o birth asphyxia? Yes /No

4. Does the child have any chromosomal anomaly like Down’s syndrome? Yes /No

5. Does the child have any congenital heart disease? Yes /No

6. Does the child have any congenital renal disease? Yes /No

Appendices

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Appendix -17

Report of analysis, which compares anthropometric measurements taken

by investigator and independent observer

ICC measure of agreement for the parameters

Sl.No. Characteristics ICC

Values

1. Weight 0.99

2. Height 0.944

3. Chest circumference 0.91

4. Head circumference 0.765

5. Mid arm circumference

0.805

There may be a scope for selection bias during the process of assessment of

anthropometric outcomes as the investigator himself did the intervention and ascertained the

outcomes. Therefore, to address this issue an independent observer (not connected with the

study) has ascertained the outcomes measurements (anthropometry) independently. Research

guide randomly selected the subjects and assigned the job to collect the measurements on the

following day after the researcher collect the data. The anthropometric measurements

ascertained by the investigator and those ascertained by independent observer were compared.

It was found that there was strong agreement, which was statistically significant between the

anthropometric measurements. ICC of more than 0.7 consider to be good

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Appendix -18

Proforma to assess socio-demographic characteristics

Serial No. ____________ Date of interview:

____/____/____

Name of Head of the family: ____________ Village:

_____________________

Intervention group (1) Control group (2) Anganawady: (1), (2), (3), (4), (5), (6), (7).

1. FAMILY – GENERAL INFORMATION:

1) Religion: (1) Hindu (2) Muslim (3) Christian (4) Others (Specify)

2) If Hindu which Caste do you belong: (1) SC (2), ST (3), OBC (4), FC (0), not

applicable

2. Particulars of family members:Sl.

N.

Name Age Sex Relation

to Head

Marital

status

Edu. Occu. Income

Monthly

Habits/

Remarks

1.

2.

3.

4.

5.

6.

7.

8.

Literacy: (1) Illiterate (2) Primary (1-5) (3) Secondary (6-8) (4) High school (9-12)

(5) University (6) Others (Specify) _______________________________

Occupation: (1) Professional (2) Skilled (3) Semi Skilled (4) Unemployed (5) Housewife

(6) Others (Specify) ____________________________

1. Family type: (1) Nuclear (2) Joint (3) Extended family.

2. Percapita Income: Rs ____________

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3. How much do you spend for food per month? Rs ____________

3. ENVIRONMENT:

1. House: (1) Kutcha (2) Pucca (3) Mixed 2. Ventilation: (1) Adequate (2)

Inadequate

3. Light: (1) Adequate (2) Inadequate 4. Overcrowding: (1) Yes (2) No

5. Separate kitchen: (1) Yes (2) No 6. Smoke outlet: (1) Yes (2) No

7. Animal and pets: (1) Yes (2) No 8. Electricity: (1) Yes (2) No

9. Source of Drinking water supply: (1) Open well (2) Open well with Pump (3) Deep well

(4) Household Tap (5) Public Tap (6) Pond (7) Others (Specify) _____________

10. Time to get drinking water: (1) less than 15 minutes (2) more than 15 minutes

(3) Actual time (Specify) ____________

11. Method of drinking water purification: (1) Strains water by cloth (2) Uses alum

(3) Water filter (4) Boils water (5) Electric purifier (6) does not purify

(7) any others specify _______________________________________

12. Distance to Primary Health Centre/ Hospital:

(1) Actual (2) less than 5 KM (3) 5-9 KM (4) >9 KM

4. Mode of disposal of domestic waste:

1. Refuse: (1) Dumping indiscriminately (2) Dumping in pit (3) Community dumping

(4) Manure pit (5) Burning (6) others

2. Sullage: (1) Soakage pit (2) Open drain (3) Public drain (4) Kitchen garden (5) others

3. Human excreta disposal: (1) Open air (2) Public latrine (3) Household latrine

(4) Flush toilet (5) Any other ____________________

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Appendix – 19

Proforma to assess socio-economic status (as per Udai Pareek scale)

B1. Type of Houses: Code

Kutcha 02

Mixed 03

Pacca 05

B7. Socio-Participation Code

No Participation 00

Member of one Organization 05

More than one Organization 10

Office holder 15

Wide public leader 20

B2. Ownership Code

Own 05

Rental 03

Free 00

B8. Occupation of eldest earning

member of the household

Code

Professional/ White collar 15

Business 10

Skilled 08

Semiskilled 06

Coolie/ unskilled 05

Unemployed 00

B3. Land holding Code

<100 cents (1 acre) 02

(1- 4) acres 05

(5- 9) acres 10

>10 acres 15

B9. Highest literacy status of eldest

earning member of the household

Code

Post graduation and above 20

Graduation 15

PUC 12

Middle & High school (5- 10) 10

Primary (1- 4) 05

Illiterate 00

B4. Vehicles Code

Bicycle 02

Two- wheeler 04

Auto/ Boat 08

Four wheeler 10

B10. Family members working abroad

Code

Yes 05

No 00

B5. Household Belongings

Code

Radio 02

Television 05

Telephone 08

Total score: ______________

SE Status: ______________

B6. Livestock Code

Goat 02

Cow 02

Buffalo 04

Score Grade Code

0- 39 Low 01

40- 69 Middle 02

>70 High 03

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Appendix – 20

Proforma to assess base-line knowledge of mothers

Pregnant mother-

Serial No: ____________ Date of interview: ____________

Intervention (1) Control (2) Anganawady: (1), (2), (3), (4), (5), (6),

(7).

Name of the mother: ___________ Age: _______years

Occupation: ___________ Education: _____________

1. When should breast- feeding be started for the newborn after the delivery?

(1) < 30 minutes (2) 30 to 60 minutes (3) 1 hour to 4 hour (4)1 to 2 days

(5) 3rd

day on wards (9) don’t know

2. Do you think the yellow thick milk (colostrums) which comes during first few days

after delivery should be fed to the baby?

(1) Yes (2) No (9) don’t know

3. According to you, is it required to give prelecteal feeds to the baby?

(1) Yes (2) No (9) don’t know

4. According to you, what is the correct positioning to breast- feed the child?

(9) Don’t know

(1) Baby’s head back and buttocks are in a straight line (1) Yes (2) No (9) DK

(2) Baby’s chin is touching the breast (1) Yes (2) No (9) DK

(3) Baby’s mouth is wide open (1) Yes (2) No (9) DK

(4) Baby’s face is close to the breast (1) Yes (2) No (9) DK

(5) More areola is showing above the baby’s upper lip than lower lip

(1) Yes (2) No (9) DK

(6) Baby is brought to the breast buttocks supported (1) Yes (2) No (9) DK

(7) Baby is taking slow and deep sucks (1) Yes (2) No (9) DK

(8) Mother does not feel nipple pain and breast feels softer after feeding

(1) Yes (2) No (9) DK

(10) Baby is relaxed and satisfied at the end of the feed (1) Yes (2) No (9) DK

(11) Baby’s whole body is facing the breast and stomach is touching mother’s

stomach

(1) Yes (2) No (9) DK

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5. What is exclusive breast- feeding?

(1) Child is fed only breast milk nothing else

(2) Child is fed with breast milk and water in between the feeds

(3) Child is fed breast milk and extra milk

(9) Don’t know

(4) Any other (Specify)

6. What are the benefits of exclusive breast- feeding?

(1) Breast milk is better for the baby

(2) Breast feeding helps prevent allergies

(3) Breast feeding is more convenient and cheaper (9) don’t know

(4) Any other (Specify) ____________

7. What is the duration of exclusive breast- feeding?

(1) 0-3 months (2) 3-4 months (3) 4-6 months

(4) 6 months (5) 7-9 months (9) Don’t know

8. Do you think that before 6 months of age, any extra milk is required?

(1) Yes (2) No (9) don’t know

9. If top milk is to be given to the child during this time, it is to be diluted?

(1) Yes (2) No (9) don’t know

10. Do you think water has to be given to the child during the first 6 months of age?

(Period of exclusive breast- feeding)

(1) Yes (2) No (9) don’t know

11. Do you think drinking lactation; mother has to take any extra food?

(1) Yes (2) No (9) don’t know

12. According to you if mother is anemic, (anemic has to be explained) can she breast-

feed adequately?

(1) Yes (2) No (9) don’t know

13. In your opinion what should be the duration of breast- feeding?

(1) 6 months (2) 6months to 12 months (3) 12months to 18 months

(4) 24 months (5) More than 24 months (9) don’t know

14. Can you name the vaccines a child has to receive before the child completes the first

birthday? (BCG, ‘0’ OPV, DPT I, II, III, OPV I, II, III, Measles, DPT +OPV 1st

booster)

(1) All correct (2) Partially correct (9) don’t know

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15. What are the breast feeding problems a mother can come across during breast- feeding

her child?

(1) Inverted nipples (2) Cracked or sore nipples

(3) Baby gets too much milk (4) Baby gets milk too fast

(5) Baby too tired to feed (6) Difficulty in expressing milk

(7) Baby not gaining enough weight (8) Baby has difficulty in sucking

(9) Breast engorged (too full) (10) Baby doesn’t wake up for feeds

(11) Not enough milk

(12) Feeling that I’m not doing well at Breast feeding

(13) Any other reason (Specify) ____________

(9) Don’t know

16 What is the ideal age of the following foods to the child with breast milk?

Sl. No. Age of the child Liquid type of

food

Semisolid type

of food

Solid type

of food

1.

2.

3.

17. At what age child is able to eat family foods?

(1) 9 months of age (2) 12 months of age (3) 18 months of age

(4) 24- months of age (9) don’t know

18. Where do you plan your delivery?

(1) Hospital (2) Home (9) don’t know

19. If hospital specify the name ______________

20. LMP: date _____day___month ______year. EDD: ______day ______month _____year

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Appendix – 21

Proforma to assess neonatal history of the newborn

1. Family particulars: Schedule No. V Serial No.

______

1) Name of mother: ___________ 2) Name of Father:

____________

3) History of consanguinity: (1) Yes (2) No

4) Age of marriage (mother): ________years

2. NEONATAL DETAILS:

1) Date of birth ____/ ____/ ______

2) Sex (1) M (2) F 3) No. of antenatal visits: __________

4) Birth order: 1 / 2 / 3 / 4 5) Birth interval: (1) <24 m (2) >24 m (0)

NA

6) Age of previous child: …..yrs (0) NA 7) Gestational period: ……. weeks

8) Did the baby cried immediately after the birth: (1) Yes (2) No (3) Don’t know

9) Place of delivery: (1) Hospital (2) Home

10) If hospital, specify the name ________________

11) Mode of delivery: (1) Vaginal (2) Caesarian section (3) Instrumental

12) Birth attendant: (1) Doctor (2) ANM (3) TBA (4) UTBA (5) Family member

13) Was the baby kept by the side of the mother (rooming): (1) Yes (2) No

14) How many days baby was stayed in hospital? _____days.

15) Whether baby friendly hospital: (1) Yes (2) No

16) Did anybody taught you about breast feeding method in the hospital: (1) Yes (2)

No

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3. Anthropometric measurements:Date of Birth: …. day … month … year

Sl.

NO.

Age in

months

Date

of

visit

Weight/

(kg)

Height/

Length/

(cm)

Chest

Circumfe

rence

(cm)

Head

Circumfe

rence

(cm)

Mid arm

circumfer

ence (cm)

Remarks

1. At birth

4. Any foods initiated:

Sl. No. Age of the child Liquid type of food Semisolid type of

food

Solid type of food

1.

5. Childhood morbidity: (for the last two weeks)

Sl. No. Age in

months

ADD ARI Measles Polio Worms

1.

2.

6. Immunization status:

Vaccine Due date Date given (1) In time

(2) Late

Remarks

‘O’ dose OPV

BCG

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Appendix – 22

Proforma to assess feeding practices, hygienic practices, anthropometric

measurements and immunization status

0 to 15 days child

Serial No. _________________ Date of interview:

_________________

Intervention (1) / Control (2) Anganawady: (1), (2), (3), (4), (5), (6),

(7).

Name of the mother: ______________________________

Breastfeeding:

1. Do you Breast-feed your child currently? (If no, go to Q. No. 13)

(1) Yes (2) No

2. If yes when did you start breast- feeding the child after delivery?

(0) Not Applicable (1) Within ½ hour (2) ½ hour to 2 hours (3) 2 to 4 hours

(4) More than 4 hours less than 24 hours (5) after 24 hours (6) after 3 days

3. Did you give any other feeds (prelecteal feeds) before starting breast- feeding?

(1) Yes (2) No (9) don’t know

4. Did you give the first yellow thick milk (Colostrum) to the child first three days?

(0) NA (1) Yes (2) No (9) don’t know

5. Was the baby kept the side of the mother to start breast- feeding immediately after

birth? (1) Yes (2) No (9) don’t know

6. How do you breast- feed your child?

(0) NA (1) On demand (2) Once in 2 hours (3) Once in 4hours

(4) Others (specify) __________________

7. Do you follow the following positioning of breast- feeding to breast- feed your child?

(0) Not Applicable

(1) Baby’s head back and buttocks are in a straight line (1) Yes (2) No (9) DK

(2) Baby’s chin is touching the breast (1) Yes (2) No (9) DK

(3) Baby’s mouth is wide open (1) Yes (2) No (9) DK

(4) Baby’s face is close to the breast (1) Yes (2) No (9) DK

(5) More areola is showing above the baby’s upper lip than lower lip

(1) Yes (2) No (9) DK

(6) Baby is brought to the breast buttocks supported (1) Yes (2) No (9) DK

(7) Baby is taking slow and deep sucks (1) Yes (2) No (9) DK

(8) Mother does not feel nipple pain and breast feels softer after feeding

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(1) Yes (2) No (9) DK

(9) Baby is relaxed and satisfied at the end of the feed (1) Yes (2) No (9) DK

(10) Baby’s whole body is facing the breast and stomach is touching mother’s

stomach (1) Yes (2) No (9) DK

8. How many times you breast- feed your child in a day (24 hours)?

(0) NA, Daytime ____________ Nighttime ____________

9. Do you feel you have sufficient breast milk to feed your child? (If yes, go to Q. No.

11)

(0) NA (1) Yes (2) No (9) don’t know

10. If no, how do you confirm this?

(0) NA (1) Child is crying even after feeding

(2) Urine output is less (less than six times)

(3) Not gaining weight (4) Not active (5) Very thin (6) any other (specify)

__________

11. Are you currently exclusively breast- feeding the child?

(Exclusive breast- feeding means only breast milk, nothing else even a drop of water)

(0) NA (1) Yes (2) No (9) don’t know

12. How long does your baby spend at the breast for a feed?

(0) NA (1) Less than 15 minutes (2) 15 minutes to half an hour

(3) Half an hour to 1 hour (4) Child is bottle fed (5) don’t know

Introducing other foods:

13. If not breast- feeding, when did you stop breast- feeding?

(0) Not applicable (1) Actual day’s _______________

14. When did you introduce other foods?

(0) Not applicable (1) Actual time / day’s _______________

15. Did you introduce milk to your child?

(0) NA (1) Yes (2) No

16. If yes, what type of milk do you give your child?

(0) NA (1) Cow’s milk (2) Buffalo milk (3) Tin milk (4) Dairy milk

(5) Any other (specify) ________________

17. Did you give water to your child in between the feeds?

(0) NA (1) Yes (2) No

18. If yes, what type of water do you give to your child?

(0) NA (1) Boiled (2) Not boiled (3) Mineral water

(4) any other (specify) ___________

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19. How do you administer these feeds?

(0) NA (1) Feeding bottle (2) Cup and spoon

(3) Tumbler (4) any other (specify) ______________

20. If feeding bottle is used, how do you clean the bottle?

(0) NA (1) Boil in water after every feed (2) Boil in water once a day

(3) Cleaning in normal water (4) others (specify) ________________

21. Did you give any multi vitamin syrup to the child?

(1) Yes (2) No (9) don’t know

22. Did you give gripe water/ Benison to the child?

(1) Yes (2) No (9) don’t know

23. Do you give any other herbal/ Ayurvedic medicines?

(1) Yes (2) No (9) don’t know

24. Are you sick for the last 15 days? (If no, go to Q. No. 26)

(1) Yes (2) No (9) don’t know

25. If yes, did you continue breast- feeding your child?

(0) NA (1) Yes (2) No

26. Did your child have any illness for the last 15 days? (If no, go to Q. No. 32)

(1) Yes (2) No (9) don’t know

27. If yes, what was the problem?

(0) NA (1) ARI, fever (2) Diarrhoea, vomiting (3)

Eye

(4) Skin Eczema (5) Gastrointestinal (6) Colic (7) Nappy rash

(8) Ear (9) Mouth

28. How do you feed your baby when child is sick?

(0) NA

(1) Breast feeding in small quantity in more frequently

(2) Continue the normal foods

(3) Feed more liquids

(4) Give ORS if child has diarrhoea (above 6 months)

(5) Stop giving liquids

(6) Stop giving other foods

(7) Any other (specify) ____________________

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29. What measures have you taken at home, when your child was sick?

(0) NA

(1) Continue breast feeding (1) Yes (2) No

(2) Homemade fluids (1) Yes (2) No

(3) ORS (1) Yes (2) No

(4) Continue normal foods (1) Yes (2) No

(5) Small feeds more frequently (1) Yes (2) No

(6) Putting wet cloth on the head (1) Yes (2) No

(7) Consulted health worker (1) Yes (2) No

(8) Consulted Doctor (1) Yes (2) No

(9) Don’t know

(10) Any other specify _____________________________________

30. When the child was sick, did you try any home remedies?

(0) NA (1) Yes (2) No (9) don’t know

31. Feeding practices during illness: Breast- milk other foods

(0) NA

(1) During fever (1) Yes (2) No

(2) During cough and cold (1) Yes (2) No

(3) During diarrhea (1) Yes (2) No

32. When did you start giving bath to your child?

Actual days - (1), (2), (3), (4), (5), (6), (7), after 7 days (8).

33. Did you find any danger sign in your child?

(If the respiratory rate is high, (>60/min. in 0-2months, 50/min. in 2- 12 months,

>40/min. in 1- 5 years) difficulty in breathing, difficulty in sucking the breast milk,

child is very sick, if high fever is present)

(1) Yes (2) No (9) don’t know

34. If yes, what did you do?

(0) NA (1) Consulted a health worker (2) Consulted a Doctor (3) Did not do anything

(4) Any other (specify) __________________________

35. Is your child immunized to the age, as per the national immunization schedule?

(1) Yes (2) No (9) don’t know

36. Do you consume extra food during lactation period especially first 6 months?

(1) Yes (2) No (9) don’t know

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Feeding- Practices

4 and 6 months child

Serial No. ____________ Date of interview: _____________

Intervention (1) Control (2) Anganawady: (1), (2), (3), (4), (5), (6), (7).

Name of the mother: ______________________________

Breast- feeding

1. Do you Breast-feed your child currently? (If no, go to Q. No. 9)

(1) Yes (2) No

2. If yes, how do you breast- feed your child?

(0) NA (1) On demand (2) Once in 2 hours (3) Once in 4hours

(4) Others (specify) __________________

3. Do you follow the following positioning of breast- feeding to breast- feed your child?

(0) Not Applicable

(1) Baby’s head back and buttocks are in a straight line (1) Yes (2) No (9) DK

(2) Baby’s chin is touching the breast (1) Yes (2) No (9) DK

(3) Baby’s mouth is wide open (1) Yes (2) No (9) DK

(4) Baby’s face is close to the breast (1) Yes (2) No (9) DK

(5) More areola is showing above the baby’s upper lip than lower lip

(1) Yes (2) No (9) DK

(6) Baby is brought to the breast buttocks supported (1) Yes (2) No (9) DK

(7) Baby is taking slow and deep sucks (1) Yes (2) No (9) DK

(8) Mother does not feel nipple pain and breast feels softer after feeding

(1) Yes (2) No (9) DK

(9) Baby is relaxed and satisfied at the end of the feed (1) Yes (2) No (9) DK

(10) Baby’s whole body is facing the breast and stomach is touching mother’s

stomach

(1) Yes (2) No (9) DK

4. How many times you breast- feed your child in a day (24 hours)?

(0) NA, Daytime ____________ Nighttime ____________

5. Do you feel you have sufficient breast milk to feed your child? (If yes, go to Q. No. 7)

(0) NA (1) Yes (2) No (9) don’t know

6. If no, how do you confirm this?

(0) NA (1) Child is crying even after feeding (2) Urine output is less (less than six

times) (3) Not gaining weight (4) Not active (5) Very thin

(6) Any other (specify) _____________________

7. Are you currently exclusively breast- feeding the child? (If no, go to Q. No. 9)

(Exclusive breast- feeding means only breast milk, nothing else even a drop of water)

(0) NA (1) Yes (2) No (9) don’t know

8. How long does your baby spend at the breast for a feed?

(0) NA (1) Less than 15 minutes (2) 15 minutes to half an hour

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(3) Half an hour to 1 hour (4) Child is bottle fed (5) don’t know

Introducing other foods:

9. If not breast- feeding, when did you stop breast- feeding?

(0) Not applicable (1) Actual month’s _______________

10. When did you introduce other foods?

(0) Not applicable (1) Actual Day’s / Month’s _______________

11. Did you introduce milk to your child?

(0) NA (1) Yes (2) No

12. If yes, what type of milk do you give your child?

(0) NA (1) Cow’s milk (2) Buffalo milk (3) Tin milk (4) Dairy milk

(5) Any other (specify) ________________

13. Do you give water to your child in between the feeds?

(0) NA (1) Yes (2) No

14. If yes, what type of water do you give to your child?

(0) NA (1) Boiled (2) Not boiled (3) Mineral water (4) any other (specify)

___________

15. How do you administer these feeds?

(0) NA (1) Feeding bottle (2) Cup and spoon

(3) Tumbler (4) any other (specify) ______________

16. If feeding bottle is used, how do you clean the bottle?

(0) NA (1) Boil in water after every feed (2) Boil in water once a day

(3) Cleaning in normal water (4) others (specify) ________________

17. Did you start any complementary foods to your child?

(0) NA (1) Yes (2) No

18. How much food is given to baby in one sitting?

(0) NA (Quantity with the standardized cups) Cup No. ___________

19. How do you decide the amount of food to be given at a time?

(0) NA (1) Child starts refusing the food (2) Finish the quantity prepared

(3) Any other (specify) _________

20. What do you do if your child does not want to eat?

(0) NA (1) Sit with the child and make child to eat

(2) Give small quantity more frequently (3) Change the food and feed

(4) Any other (specify) ____________________

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21. Did you give any multi vitamin syrup to the child?

(1) Yes (2) No (9) don’t know

22. Did you give gripe water/ Benison to the child?

(1) Yes (2) No (9) don’t know

23. Do you give any other herbal/ Ayurvedic medicines?

(1) Yes (2) No (9) don’t know

24. Are you sick for the last 3 months? (If no, go to Q. No. 26)

(1) Yes (2) No (9) don’t know

25. If yes, did you continue breast- feeding your child?

(0) NA (1) Yes (2) No

26. Did your child have any illness for the last 3 months? (If no, go to Q. No. 32)

(1) Yes (2) No (9) don’t know

27. If yes, what was the problem?

(0) NA

(1) ARI, fever (2) Diarrhoea, vomiting (3) Eye

(4) Skin 5) Gastrointestinal (6) Colic

(7) Nappy rash (8) Ear (9) Mouth

28. How do you feed your baby when child is sick?

(0) NA

(1) Breast feeding in small quantity in more frequently

(2) Continue the normal foods

(3) Feed more liquids

(4) Give ORS if child has diarrhoea (above 6 months)

(5) Stop giving liquids

(6) Stop giving other foods

(7) Any other (specify) ____________________

29. What measures have you taken at home, when your child was sick?

(0) NA

(1) Continue breast feeding (1) Yes (2) No

(2) Homemade fluids (1) Yes (2) No

(3) ORS (1) Yes (2) No

(4) Continue normal foods (1) Yes (2) No

(5) Small feeds more frequently (1) Yes (2) No

(6) Putting wet cloth on the head (1) Yes (2) No

(7) Consulted health worker (1) Yes (2) No

(8) Consulted Doctor (1) Yes (2) No

(9) don’t know

(10) Any other specify _____________________________________

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30. When the child was sick, did you try any home remedies?

(1) Yes (2) No (9) don’t know

31. Feeding practices during illness: Breast- milk other foods

(0) NA

(1) During fever (1) Yes (2) No (1) Yes (2) No

(2) During cough and cold (1) Yes (2) No (1) Yes (2) No

(3) During diarrhea (1) Yes (2) No (1) Yes (2) No

32. Did you find any danger sign in your child? (If no, go to Q. No. 48)

(If the respiratory rate is high, (>60/min. in 0-2months, 50/min. in 2- 12 months,

>40/min. in 1- 5 years) difficulty in breathing, difficulty in sucking the breast milk,

child is very sick, if high fever is present)

(1) Yes (2) No (9) don’t know

33. If yes, what did you do?

(0) NA (1) Consulted a health worker

(2) Consulted a Doctor (3) did not do anything

(4) Any other (specify) __________________________

34. Is your child immunized to the age, as per the national immunization schedule?

(1) Yes (2) No (9) don’t know

35. According to you, is your child growing normally? (If no, go to Q. No. 41)

(1) Yes (2) No (9) don’t know

36. If yes, how do you confirm this?

(0) NA (1) Weighing the child (2) Cloth gets tight

3) Age specific activities (4) any other (specify) _____________________

37. If not, what did you do?

(0) NA (1) Consulted the health worker (2) Consulted the doctor

(3) Took advice from family members (4) did not do anything

(5) First child also like this only (6) Any other reason (specify)

_________

38. Do you spend enough time playing with your child?

(1) Yes (2) No (3) No time (9) don’t know

39. If yes, how much time do you spend playing with your child per day?

(0) NA (1) ½ an hour (2) 1 hour

(3) More than 2 hours- less than 4 hours (4) More than 5 hours

40. Are you a working mother?

(1) Yes (2) No (9) don’t know

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41. If yes, how do you breast- feed your child?

(0) NA (1) Express the milk and keep to feed in my absence

(2) No breast milk in my absence (3) only cow’s milk in feeding bottle

(4) only cow’s milk in cup and spoon (5) any other (specify)

________________

42. How old were you when you started working?

(0) NA, Actual month’s _________________

43. What are the other foods do you feed you are not there?

(0) NA, specify the foods ____________________

44. Can you tell which foods you avoid giving to your child?

(0) NA (1) Banana (2) Papaya (3) Any fruits (4) Spicy foods

(5) Meat (6) Egg (7) Fish (8) Vegetables (9) Cucumber

(10) Potato (11) Carrot (12) any other (specify) ___________

45. What are the hygienic practices do you follow before feeding the child?

(0) NA (9) don’t know

(1) Hands washed before preparing food (1) Yes (2) No

(2) Fruits washed before eating (1) Yes (2) No

(3) Hands of the child washed before eating a meal (1) Yes (2) No

(4) Bottle used is clean and covered (1) Yes (2) No

(5) Clean appropriate places for child to stay (1) Yes (2) No

(6) Kitchen floor clean (1) Yes (2) No

(7) Living room floor clean (1) Yes (2) No

(8) Barriers against animals in the house (1) Yes (2) No

(9) All water vessels for drinking water covered (1) Yes 2) No

(10) No human faces around the house (1) Yes (2) No

(11) No animal faces around the house (1) Yes (2) No

(12) Mother washes hands after visiting latrine (1) Yes (2) No

(13) Washing hands with soap and water both mother and child before each feed

(1) Yes (2) No

(14) Washing hands with only normal water both mother and child before each feed

(1) Yes (2) No

46. Do you consume extra food during lactation period especially first 6 months?

(1) Yes (2) No (9) don’t know

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3. Anthropometric measurements

Date of birth: day …. Month … Year ……..

Sl.

NO.

Age in

months

Date

of

visit

Weight/

(kg)

Height/

Length

/ (cm)

Chest

Circumf

erence

(cm)

Head

Circumf

erence

(cm)

Mid arm

circumfe

rence

(cm)

Remarks

1.

4. Complementary foods initiated: Sl. No. Age of the child Liquid type of

food

Semisolid type

of food

Solid type of

food

1.

2.

3.

5. Developmental history Development mile stones Expected Age Actual age Normal Yes (1)

No (2) Remarks

1. Social smile 6-8 weeks

2. Holds head erect 3 months

3. Turning over 3 months

4. Sits without support 6-8 months

6. Childhood morbidity: (for the last two weeks) Sl. No. Age in

months

ADD ARI Measles Polio Worms

1.

2.

3.

4.

7. Immunization status: Vaccine Due date Date given (1) In time(2) Late Remarks

‘O’ OPV

BCG

DPT + OPV 1st

DPT + OPV 2nd

DPT + OPV 3rd

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Feeding- Practices

9 and 12 months child Schedule No. X

Serial No. ____________ Date of interview: _____________

Intervention (1) Control (2) Anganawady: (1), (2), (3), (4), (5), (6),

(7).

Name of the mother: ______________________________

Breast- feeding

1. Do you Breast-feed your child currently? (If no, go to Q. No. 7)

(1) Yes (2) No

2. If yes, how do you breast- feed your child?

(0) NA (1) On demand (2) Once in 2 hours (3) Once in 4hours

(4) Others (specify) __________________

3. How many times you breast- feed your child in a day (24 hours)?

(0) NA, Daytime ____________ Nighttime ____________

4. Do you feel you have sufficient breast milk to feed your child?

(0) NA (1) Yes (2) No (9) don’t know

5. Are you currently exclusively breast- feeding the child?

(Exclusive breast- feeding means only breast milk, nothing else even a drop of water)

(0) NA (1) Yes (2) No (9) don’t know

6. How long does your baby spend at the breast for a feed?

(0) NA (1) Less than 15 minutes (2) 15 minutes to half an hour

(3) Half an hour to 1 hour (4) Child is bottle fed (5) don’t know

Introducing other foods:

7. If not breast- feeding, when did you stop breast- feeding?

(0) Not applicable (1) Actual month’s _______________

8. When did you introduce other foods?

(0) Not applicable (1) Actual Day’s / Month’s _______________

9. Did you introduce milk to your child?

(0) NA (1) Yes (2) No

10. If yes, what type of milk do you give your child?

(0) NA (1) Cow’s milk (2) Buffalo milk (3) Tin milk (4) Dairy milk

(5) Any other (specify) ________________

11. Do you give water to your child in between the feeds?

(0) NA (1) Yes (2) No

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12. If yes, what type of water do you give to your child?

(0) NA (1) Boiled (2) Not boiled (3) Mineral water

(4) any other (specify) ___________

13. How do you administer these feeds?

(0) NA (1) Feeding bottle (2) Cup and spoon

(3) Tumbler (4) any other (specify) ______________

14. If feeding bottle is used, how do you clean the bottle?

(0) NA (1) Boil in water after every feed (2) Boil in water once a day

(3) Cleaning in normal water

(4) others (specify) ________________

15. Did you start any complementary foods to your child?

(0) NA (1) Yes (2) No

16. Did you start feeding your child from the family pot?

(Ask if child is more than 9 months of age and (if yes, go to Q. No. 18)

(1) Yes (2) No (9) don’t know

17. If not, do you prepare special food for the child?

(1) Yes (2) No (9) don’t know

18. If yes, what do you prepare for the child?

(Information is derived from the diet survey schedule)

19. Do you provide separate plate for the child and make the child to sit with the family

members to eat?

(1) Yes (2) No (9) don’t know

20. What do you do if your child does not want to eat?

(0) NA (1) Sit with the child and make child to eat

(2) Give small quantity more frequently (3) Change the food and feed

(4) Any other (specify) ____________________

21. How much food is given to baby in one sitting?

(0) NA (Quantity with the standardized cups) Cup No. ___________

22. How do you decide the amount of food to be given at a time?

(0) NA (1) Child starts refusing the food (2) Finish the quantity prepared

(3) Any other (specify) _________

23. Did you give any multi vitamin syrup to the child?

(1) Yes (2) No (9) don’t know

24. Did you give gripe water/ Benison to the child?

(1) Yes (2) No (9) don’t know

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25. Do you give any other herbal/ Ayurvedic medicines?

(1) Yes (2) No (9) don’t know

26. Are you sick for the last 3 months? (If no, go to Q. No. 28)

(1) Yes (2) No (9) don’t know

27. If yes, did you continue breast- feeding your child?

(0) NA (1) Yes (2) No

28. Did your child have any illness for the last 3 months? (If no, go to Q. No. 34)

(1) Yes (2) No (9) don’t know

29. If yes, what was the problem?

(0) NA

(1) ARI, fever (2) Diarrhoea, vomiting (3) Eye

(4) Skin Eczema (5) Gastrointestinal (6) Colic

(7) Nappy rash (8) (9) Mouth

30. How do you feed your baby when child is sick?

(0) NA

(1) Breast feeding in small quantity in more frequently

(2) Continue the normal foods

(3) Feed more liquids

(4) Give ORS if child has diarrhoea (above 6 months)

(5) Stop giving liquids

(6) Stop giving other foods

(7) Any other (specify) ____________________

31. What measures have you taken at home, when your child was sick?

(0) NA

(1) Continue breast feeding (1) Yes (2) No

(2) Homemade fluids (1) Yes (2) No

(3) ORS (1) Yes (2) No

(4) Continue normal foods (1) Yes (2) No

(5) Small feeds more frequently (1) Yes (2) No

(6) Putting wet cloth on the head (1) Yes (2) No

(7) Consulted health worker (1) Yes (2) No

(8) Consulted Doctor (1) Yes (2) No

(9) don’t know

(10) Any other specify _____________________________________

32. When the child was sick, did you try any home remedies?

(1) Yes (2) No (9) don’t know

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33. Feeding practices during illness: Breast- milk other foods

(0) NA

(1) During fever (1) Yes (2) No (1) Yes (2) No

(2) During cough and cold (1) Yes (2) No (1) Yes (2) No

(3) During diarrhea (1) Yes (2) No (1) Yes (2) No

34. Did you find any danger sign in your child? (If no, go to Q. No. 45)

(If the respiratory rate is high, (>60/min. in 0-2months, 50/min. in 2- 12 months,

>40/min. in 1- 5 years) difficulty in breathing, difficulty in sucking the breast milk,

child is very sick, if high fever is present)

(1) Yes (2) No (9) don’t know

35. If yes, what did you do?

(0) NA (1) Consulted a health worker (2) Consulted a Doctor

(3) Did not do anything (4) any other (specify) __________________________

36. Is your child immunized to the age, as per the national immunization schedule?

(1) Yes (2) No (9) don’t know

37. According to you, is your child growing normally? (If no, go to Q. No. 48)

(1) Yes (2) No (9) don’t know

38. If yes, how do you confirm this?

(0) NA (1) Weighing the child (2) Cloth gets tight

(3) Age specific activities (4) any other (specify) _____________________

39. If not, what did you do?

(0) NA (1) Consulted the health worker (2) Consulted the doctor

(3) Took advice from family members (4) did not do anything

(5) First child also like this only

(6) Any other reason (specify) ___________________

40. Do you spend enough time playing with your child? (If no, go to Q. No. 42)

(1) Yes (2) No (3) No time (9) don’t know

41. If yes, how much time do you spend playing with your child per day?

(0) NA (1) ½ an hour (2) 1 hour (3) More than 2 hours- less than 4 hours

(4) More than 5 hours

42. Are you a working mother?

(1) Yes (2) No (9) don’t know

43. If yes, how do you breast- feed your child?

(0) NA (1) Express the milk and keep to feed in my absence

(2) No breast milk in my absence (3) only cow’s milk in feeding bottle

(4) only cow’s milk in cup and spoon (5) any other (specify) ______________

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44. How old were you when you started working?

(0) NA, Actual month’s _________________

45. What are the other foods do you feed you are not there?

(0) NA, specify the foods ____________________

46. Can you tell which foods you avoid giving to your child?

(0) NA (1) Banana (2) Papaya (3) Any fruits

(4) Spicy foods (5) Meat (6) Egg (7) Fish

(8) Vegetables (9) Cucumber (10) Potato (11) Carrot

(12) any other (specify) ___________

47. What are the hygienic practices do you follow before feeding the child?

(0) NA (9) don’t know

(1) Hands washed before preparing food (1) Yes (2) No

(2) Fruits washed before eating (1) Yes (2) No

(3) Hands of the child washed before eating a meal (1) Yes (2) No

(4) Bottle used is clean and covered (1) Yes (2) No

(5) Clean appropriate places for child to stay (1) Yes (2) No

(6) Kitchen floor clean (1) Yes (2) No

(7) Living room floor clean (1) Yes (2) No

(8) Barriers against animals in the house (1) Yes (2) No

(10) All water vessels for drinking water covered (1) Yes (2) No

(11) No human faces around the house (1) Yes (2) No

(12) No animal faces around the house (1) Yes (2) No

(13) Mother washes hands after visiting latrine (1) Yes (2) No

(14) Washing hands with soap and water both mother and child before each feed

(1) Yes (2) No

(15) Washing hands with only normal water both mother and child before each feed

(1) Yes (2) No

48. Do you consume extra food during lactation period especially first 6 months?

(1) Yes (1) No (9) don’t know

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3. Anthropometric measurements Date of birth: day …month … year

…….

Sl.

NO.

Age in

months

Date

of

visit

Weight/

(kg)

Height/

Length

/ (cm)

Chest

Circumf

erence

(cm)

Head

Circum

ference

(cm)

Mid arm

circumfe

rence

(cm)

Remarks

1.

4. Complementary foods initiated:

Sl. No. Age of the child Liquid type of

food

Semisolid type

of food

Solid type

of food

1.

2.

3.

5. Developmental history

Development mile

stones

Expected Age Actual age Normal Yes (1)

No (2) Remarks

1. Social smile 6-8 weeks

2. Holds head erect 3 months

3. Turning over 3 months

4. Sits without

support

6-8 months

5. Crawling 9-10 months

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6. Childhood morbidity: (for the last two weeks)

Sl. No. Age in

months

ADD ARI Measles Polio Worms

1.

2.

3.

4.

7. Immunization status:

Vaccine Due date Date given (1) In time

(2) Late

Remarks

‘O’ OPV

BCG

DPT + OPV 1st

DPT + OPV 2nd

DPT + OPV 3rd

Measles

Vit. A

Hep ‘O’ dose

Hep 1st dose

Hep 2nd

dose

Appendices

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Feeding- Practices

15, 18 and 24 month’s child

Serial No. ____________ Date of interview: _____________

Intervention (1) Control (2) Anganawady: (1), (2), (3), (4), (5), (6), (7).

Name of the mother: ______________________________

1. Breast- feeding

1. Do you Breast-feed your child currently? (If no, go to Q. No. 4)

(1) Yes (2) No

2. How many times you breast- feed your child in a day (24 hours)?

(0) NA, Daytime ____________ Nighttime ____________

3. Do you feel you have sufficient breast milk to feed your child?

(0) NA (1) Yes (2) No (9) don’t know

2. Introducing other foods:

4. If not breast- feeding, when did you stop breast- feeding?

(0) Not applicable (1) Actual month’s _______________

5. When did you introduce other foods?

(0) Not applicable (1) Actual Day’s / Month’s _______________

6. Did you introduce milk to your child?

(0) NA (1) Yes (2) No

7. If yes, what type of milk do you give your child?

(0) NA (1) Cow’s milk (2) Buffalo milk (3) Tin milk

(4) Dairy milk (5) any other (specify) ________________

8. Do you give water to your child in between the feeds?

(0) NA (1) Yes (2) No

9. If yes, what type of water do you give to your child?

(0) NA (1) Boiled (2) Not boiled (3) Mineral water

(4) any other (specify) ___________

10. How do you administer these feeds?

(0) NA (1) Feeding bottle (2) Cup and spoon

(3) Tumbler (4) any other (specify) ______________

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11. If feeding bottle is used, how do you clean the bottle?

(0) NA (1) Boil in water after every feed (2) Boil in water once a day

(3) Cleaning in normal water (4) others (specify) ________________

12. Did you start any complementary foods to your child?

(0) NA (1) Yes (2) No

13. Did you start feeding your child from the family pot?

(Ask if child is more than 9 months of age and if yes, go to Q. No. 15)

(1) Yes (2) No (9) don’t know

14. If not, do you prepare special food for the child?

(1) Yes (2) No (9) don’t know

15. If yes, what do you prepare for the child?

(Information is derived from the diet survey schedule)

16. Do you provide separate plate for the child and make the child to sit with the family

members to eat?

(1) Yes (2) No (9) don’t know

17. What do you do if your child does not want to eat?

(0) NA (1) Sit with the child and make child to eat

(2) Give small quantity more frequently (3) Change the food and feed

(4) Any other (specify) ____________________

18. How much food is given to baby in one sitting?

(0) NA (Quantity with the standardized cups) Cup No. ___________

19. How do you decide the amount of food to be given at a time?

(0) NA (1) Child starts refusing the food (2) Finish the quantity prepared

(3) Any other (specify) _________

20. Did you give any multi vitamin syrup to the child?

(1) Yes (2) No (9) don’t know

21. Did you give gripe water/ Benison to the child?

(1) Yes (2) No (9) don’t know

22. Do you give any other herbal/ Ayurvedic medicines?

(1) Yes (2) No (9) don’t know

23. Are you sick for the last 3 months? (If no, go to Q. No. 25)

(1) Yes (2) No (9) don’t know

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24. If yes, did you continue breast- feeding your child?

(0) NA (1) Yes (2) No

25. Did your child have any illness for the last 3 months? (If no, go to Q. No. 32)

(1) Yes (2) No (9) don’t know

26. If yes, what was the problem?

(0) NA

(1) ARI, fever (2) Diarrhoea, vomiting (3) Eye

(4) Skin Eczema (5) Gastrointestinal (6) Colic

(7) Nappy rash (8) Ear (9) Mouth

27. How do you feed your baby when child is sick?

(0) NA

(1) Breast feeding in small quantity in more frequently

(2) Continue the normal foods

(3) Feed more liquids

(4) Give ORS if child has diarrhoea (above 6 months)

(5) Stop giving liquids

(6) Stop giving other foods

(7) Any other (specify) ____________________

28. What measures have you taken at home, when your child was sick?

(0) NA

(1) Continue breast feeding (1) Yes (2) No

(2) Homemade fluids (1) Yes (2) No

(3) ORS (1) Yes (2) No

(4) Continue normal foods (1) Yes (2) No

(5) Small feeds more frequently (1) Yes (2) No

(6) Putting wet cloth on the head (1) Yes (2) No

(7) Consulted health worker (1) Yes (2) No

(8) Consulted Doctor (1) Yes (2) No

(9) Don’t know

(10) Any other specify _____________________________________

29. When the child was sick, did you try any home remedies?

(1) Yes (2) No (9) don’t know

30. Feeding practices during illness: Breast- milk other foods

(0) NA

(1) During fever (1) Yes (2) No (1) Yes (2) No

(2) During cough and cold (1) Yes (2) No (1) Yes (2) No

(3) During diarrhea (1) Yes (2) No (1) Yes (2) No

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31. Did you find any danger sign in your child? (If no, go to Q. No. 45) (If the respiratory

rate is high, (>60/min. in 0-2months, 50/min. in 2- 12 months, >40/min. in 1- 5 years)

difficulty in breathing, difficulty in sucking the breast milk, child is very sick, if high

fever is present)

(1) Yes (2) No (9) don’t know

32. If yes, what did you do?

(0) NA (1) Consulted a health worker (2) Consulted a Doctor

(3) Did not do anything (4) any other (specify) _______________

33. Is your child immunized to the age, as per the national immunization schedule?

(1) Yes (2) No (9) don’t know

34. According to you, is your child growing normally? (If no, go to Q. No. 36)

(1) Yes (2) No (9) don’t know

35. If yes, how do you confirm this?

(0) NA (1) Weighing the child (2) Cloth get tight (3) Age specific activities

(4) Any other (specify) _____________________

36. If not, what did you do?

(0) NA (1) Consulted the health worker (2) Consulted the doctor

(3) Took advice from family members (4) did not do anything

(5) First child also like this only (6) any other reason (specify)

____________

37. Do you spend enough time playing with your child? (If no, go to Q. No. 39)

(1) Yes (2) No (3) No time (9) don’t know

38. If yes, how much time do you spend playing with your child per day?

(0) NA (1) ½ an hour (2) 1 hour (3) More than 2 hours- less than 4 hours

(4) More than 5 hours

39. Are you a working mother?

(1) Yes (2) No (9) don’t know

40. If yes, how do you breast- feed your child?

(0) NA (1) Express the milk and keep to feed in my absence

(2) No breast milk in my absence (3) Only cow’s milk in feeding bottle

(4) only cow’s milk in cup and spoon (5) any other (specify)

________________

41. How old were you when you started working?

(0) NA, Actual month’s _________________

42. What are the other foods do you feed you are not there?

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(0) NA, specify the foods ____________________

43. Can you tell which foods you avoid giving to your child?

(0) NA (1) Banana (2) Papaya (3) Any fruits

(4) Spicy foods (5) Meat (6) Egg (7) Fish

(8) Vegetables (9) Cucumber (10) Potato (11) Carrot

(12) any other (specify) ___________

44. What are the hygienic practices do you follow before feeding the child?

(0) NA (9) don’t know

(1) Hands washed before preparing food (1) Yes (2) No

(2) Fruits washed before eating (1) Yes (2) No

(3) Hands of the child washed before eating a meal (1) Yes (2) No

(4) Bottle used is clean and covered (1) Yes (2) No

(5) Clean appropriate places for child to stay (1) Yes (2) No

(6) Kitchen floor clean (1) Yes (2) No

(7) Living room floor clean (1) Yes (2) No

(8) Barriers against animals in the house (1) Yes (2) No

(10) All water vessels for drinking water covered (1) Yes (2) No

(11) No human faces around the house (1) Yes (2) No

(12) No animal faces around the house (1) Yes (2) No

(13) Mother washes hands after visiting latrine (1) Yes (2) No

(14) Washing hands with soap and water both mother and child before each feed

(1) Yes (2) No

(15) Washing hands with only normal water both mother and child before each feed

(1) Yes (2) No

45. Do you consume extra food during lactation period especially first 6 months?

(1) Yes (1) No (9) don’t know

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3. Anthropometric measurements Date of birth: day … Month ….

Year…

Sl.

NO.

Age in

months

Date

of

visit

Weight/

(kg)

Height/

Length

/ (cm)

Chest

Circumf

erence

(cm)

Head

Circum

ference

(cm)

Mid arm

circumfe

rence

(cm)

Remarks

1.

4. Complementary foods initiated:

Sl. No. Age of the child Liquid type of

food

Semisolid type

of food

Solid type

of food

1.

2.

3.

5. Developmental history

Development mile

stones

Expected Age Actual age Normal Yes (1)

No (2) Remarks

1. Social smile 6-8 weeks

2. Holds head erect 3 months

3. Turning over 3 months

4. Sits without

support

6-8 months

5. Crawling 9-10 months

6. Stands with support 10-11 months

7. Speaking few

words

10-11 months

8. Short sentences and

running

24 months

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6. Childhood morbidity: (for the last two weeks)

Sl. No. Age in

months

ADD ARI Measles Polio Worms

1.

2.

3.

4.

7. Immunization status:

Vaccine Due date Date given (1) In time

(2) Late

Remarks

‘O’ OPV

BCG

DPT + OPV 1st

DPT + OPV 2nd

DPT + OPV 3rd

Measles

DPT+ OPV – 1st

BOOSTER

Hep ‘O’ dose

Hep 1st dose

Hep 2nd

dose

Vit. A

Vit. A

Vit. A

Vit. A

Ap

pen

dic

es

Pa

ge

|325

Ap

pen

dix

- 2

3

Pro

form

a t

o a

sses

s d

ieta

ry i

nta

ke

Dat

e o

f in

terv

iew

;_

__

___

__

__

__

__

_ S

ched

ule

no

.__

__

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__

__

_ V

illa

ge

__

__

__

__

__

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__

Nam

e o

f A

ng

anaw

ady

__

__

__

__

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__

_

Nam

e _

__

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_A

ge_

__

__

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Inte

rven

tio

n /

Co

ntr

ol

gro

up

__

__

__

__

__

__

__

__

__

__

__

__

__

__

_

Mea

l

pa

tter

n

Na

me

of

the

pre

pa

rati

on

Na

me

of

food

stu

ff

Fo

od

co

de

To

tal

raw

qty

. co

de

Ra

w

qty

.(g)

To

tal

coo

ked

–

cod

e

To

tal

coo

ked

(g

)

Inta

ke

cod

e

Inta

ke

Bre

ak

fast

Lu

nch

Even

ing

Din

ner

Appendices

P a g e | 326

Appendix – 24

Photographs showing procedures followed during data collection

Appendices

P a g e | 327

Appendix – 25

Infant and young child feeding (IYCF) training certificate