CHAPTER - 1shodhganga.inflibnet.ac.in/bitstream/10603/72525/9/09_chapter 1.pdf · Hence, more food is required by the mother during lactation to help meet the additional nutrient

CHAPTER - 1

INTRODUCTION

CHAPTER-1

INTRODUCTION

Every developed nation stands on toil and sweat of its people, likewise

families developed their pillars of health and nutrition through the nutritional

knowledge of the wives. Nutritional knowledge imparted through specific and

scientific nutrition education package; if imparted to pregnant and lactating

women, will maximally benefit them as well as their families because

pregnancy and lactation is a very crucial stage in the life of every woman and

her family. The issue of nutrition needs special attention as it affects the

vulnerable sections of the population, women and children. The nutritional

levels of the mother affect the child as well as her own chances of survival

(Human development - Vision 2010).

Improvement in maternal nutritional status can be a major contribution

of nutritionists in a multipronged approach for overcoming the scourge of low

birth weight babies. The percentage of underweight infants in India was about

32.00 percent in 1997 (Source, Human development report, 1999). It is a

direct indicator of malnourishment levels. It indicates that, India has a long

way to go with regard to improving the health status of the women in the

country (Vision, 2010, Social sector). Various schemes for supplying

nutritious food material to expectant mothers are in existence in India, but,

they serve a limited and a temporary purpose. If pregnant and lactating

mothers are educated about maternal nutrition, there can be much better and

long lasting improvement in their nutritional status, because such education

will bring about improvement in their behavior, about maternal nutrition, by

Impact of Standardized NEPack on Behavioral Change Among Pregnant and Lactating Women

1

changing their knowledge, attitude and practice. Nutrition educationist and

researchers need to take interest in this important field of study.

In recent years, there has been a remarkable upsurge in the interest in

health and nutrition problems of women in the country; thanks to the vigorous

'women's movements', which have served to highlight current disabilities of

our women. In order that this new awakening is channelised into truly

constructive directions, it is important that the scientific foundations of our

present concern with respect to women's health and nutrition are clearly

articulated and understood. (Gopalan, 1999).

To be sure, during the last 50 years, there have been some impressive

gains with respect to women's health, life expectancy at birth for females in

the country, which stood at 31.7 in 1950, rose to 59.7 in 1991. Female infant

mortality declined to 76 and female child mortality (0 to 4 years) to 132. But,

while more women are thus surviving, available evidence points only to a

marginal improvement in the health and nutritional status of the survivors.

The hallmark of poor maternal nutrition and poor antenatal care in a

community is the high proportion of babies born with low birth weight; less

than 2.5 kg (small for gestational age). This proportion was reported to be

nearly 38 per cent in poor rural communities in South India in 1955. Studies

carried out nearly 30 years later, indicated that the situation had not changed

much. Indeed, a study in Calcutta revealed a shocking proportion of, 56

percent of low birth weights among deliveries in urban slums. Even today,

nearly 33 per cent of the children born in our country are low birth weight

babies.

Impact of Standardized NEPack on Behavioral Change Among Pregnant and Ladating Women

2

Low birth weight of a newborn is not only an evidence of poor

maternal nutritional status; it is also an indicator of possible poor future

development of the baby. Maternal nutritional status, thus, not only

determines the state of the offspring at birth but also, the future course of its

development. We have, therefore, reason to feel concerned over the

persistent high proportion of deliveries of low birth weight newborns in the

country. The problem of LBW babies can be tackled economically and

successfully, if efforts are made to improve maternal nutritional status. The

present study was aimed at developing a standardized, scientific and universal

nutritional education package for pregnant and lactating women and

assessing its impact on their behavioral change about maternal nutrition. In

order to gain an insight of pregnancy and lactation it is natural to begin with

its meaning.

1.1 Meaning of Pregnancy and Lactation

Pregnancy is the period in the life of an adult woman when the fetus

i.e. the unborned baby, grows inside her body. To support the growth of the

fetus, certain physiological changes take place in the woman's body. These

changes, alongwith the growth of the fetus, necessitate an increase in the

nutrient requirements of the woman.

Lactation on the other hand, is the period of following the birth of the

child when the mother breast-feeds her baby. The baby, for the first few

months after birth, depends totally on breast milk for nourishment. Breast

milk contains several nutrients, which off course are supplied by the mother.


3

Hence, more food is required by the mother during lactation to help meet the

additional nutrient requirements.

Every woman has right to become mother and at the same time, every

baby has the right to begin life with a healthy 'well formed' body, free from

deficiency and to receive the advantages of mother's milk. Every mother

should remain in good health throughout pregnancy, for optimum growth and

development of fetus.

Pregnancy is a sacred responsibility. When a woman is pregnant, she

is forging a link in the chain of life- a link between past and future generations.

The goal of pregnancy is not merely to thus carry on the species, but also to

give birth to a baby who will be able to thrive and reach its full potential as a

healthy, happy human being.

Studies made at Harvard University concluded that, a mother's

nutritional status at the onset of pregnancy is an important factor in

determining the condition of the infant at birth. This fact highlights the great

need of nutritional education, so that women will understand the importance

of good nutrition for a successful pregnancy. Pregnancy is a period of

considerable stress, which calls for additional requirement of nutrients. It

becomes essential that, this group of population be ensured with sound

nutritional care and be able to perceive the importance of maternal nutrition.

1.2 Importance of Nutrition in Pregnancy and Lactation

A woman who has been well nourished before conception begins her

pregnancy with reserves of several nutrients so that the need of the growing


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fetus can be met without affecting her health. Infants, who are well

nourished in the womb, have an enhanced chance of entering life in good

physical and mental health. The effect of under-nutrition during

reproduction will vary depending upon the nutrient involved, the length of

time it is lacking and the stage of gestation at which it occurs.

A woman, whose diet is adequate before pregnancy, is usually able to

bear a full term viable baby without extensive modification of her diet.

Mother's diet should produce adequate nutrients so that maternal stores do

not get depleted and yet produce sufficient milk to nourish her child after

birth. According to UGC-DSA Report (1996), the results of studies on dietary

intake of ladating mothers and the breast milk composition indicate that

maternal intakes do influence breast milk composition. Maternal nutrition is at

most important not only for good fetal outcome but also for proper child

nutrition. (G. Subbulakashmi et ah, 1996). Intrauterine nutrition is highly

important for the growth of the central nervous system and kidneys of the

fetus, which mature during the latter part of pregnancy. Therefore, nutrition

deficits before birth can never be wholly reversed after birth. "Maternal

malnutrition is, thus, root cause of adulthood disorders of her babies."

Intrauterine growth and development of fetus depends on the nutriente it

receives from its mother through the lifeline of placenta and umbilical cord.

1.3 The Nutritional Lifeline during Pregnancy

An amazing thing happens when an embryo attaches itself to a

woman's uterus. Nature 'hides' the embryo, first by suppressing the cells that


5

reject foreign bodies (such as skin grafts). Then, the embryo is surrounded by

tightly packed cells that form a protective barrier.

Maternal and fetal blood never mix. The fetus is dependent upon the

mother but maintains its own systems. An 'exchange' takes place in the

placenta. The fetus is connected to the placenta by the umbilical cord. The

cord contains one vein that carries oxygen and nutrient containing blood to

the fetus, and two arteries that return waste products and carbon dioxide to

the placenta. There are no nerves in the umbilical cord, which is why the

baby feels no pain when the cord is cut at birth. The umbilical vein and

arteries project into placenta in little root like structure called villi.

Maternal blood flows into the placenta through arteries in the placental

valves. The blood pools around the fetal villi. Here the critical transfers take

place. While the placenta was once thought to act as a barrier to substances

in the mother's blood that could be harmful, now we know that size and

chemical structure, not potential toxicity, dictate what goes through the

placenta. It is more accurate to describe the placenta as a filtering system or

sieve than a protective barrier.

Some substances pass readily from the mother to the fetus by the

process called diffusion. If, for instance, the mother takes mega doses of fat-

soluble vitamin A or D, the vitamin will diffuse from the mother's blood into

the fetal blood stream until the vitamin concentrations are equal. Levels that

may not be harmful to an adult woman can endanger a developing baby.

Most proteins do not cross the placenta, since they are too large to be

absorbed by the villi. Instead, there is an exchange of amino acids, the

Impact of Standardized PJEPack on Behavioral Change Among Pregnant and Lactating Women

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building blocks of proteins. From amino acids, the fetus can make the

various proteins it needs for growth and development.

However, immunoglobulin IgG, does cross the placenta intact. IgG

gives the baby the mother's antibodies that resist infectious disease, kind of

parental vaccination. IgG continues to protect the baby for the first six to

nine months after birth.

Fig.l- A fetus in a womb.

Most substances in the fetal blood stream that are not used are carried

back through the umbilical arteries, pass through the placenta, and return to

the maternal blood stream to be processed or excreted. Other substances,

such as vitamin C, are converted in the fetus into complex forms or become

trapped in the fetus and cannot pass back through the cell walls of the villi.

Thus, potentially harmful concentrations can build up in the fetus.


7

The average full term pregnancy lasts 280 days or approximately 9

months. The baby grows and develops during all phases of pregnancy,

different parts at different times. Excess or deficiency of some nutrients during

embryogenesis, when organs are getting formed or bones and blood are being

built, can result in fewer cells or imperfectly formed cells. In addition, what a

pregnant woman eats will influence the size of the placenta and maternal

blood supply, essential elements of the nutrient delivery system. Baby's

growth usually follows a natural pattern.

Baby's Growth in Womb

Time

First trimester

Development

Vital need for good nutrition to support growth of maternal tissues and development of fetal internal organs, limbs, and sense organs.

Fertilization 7 days Implantation in uterus Primitive circulation between Placenta and embryo is established.

4 weeks (1 month) Beginning of sense organs.

Second trimester Crucial time for refinement of physical structures. Mother's mineral intake important for developing strong bones and blood in fetus.

16 weeks (4 months)

Third trimester

Motor activity begins. Digestive system develops.

Fetus doubles in size in this trimester Nutrients and calories are vital to development


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28 weeks (7months)

32 week (8 months)

36 weeks (9 months)

40 weeks (birth)

of the baby and preservation of maternal stores. Transfer of minerals to baby's body to calcify bones and to build iron reserves in liver for the first few months of life. Body developing fat; nails appear; lungs and eyes develop.

Fetal weight is increasing rapidly. Calcification of bones in fingers and toes. Teeth are developing. Transfer of iron to baby's liver to protect against anemia in early infancy.

Skin smooth as fat forms under it Lungs are fully developed; metabolic system is developing to support life after birth. Fetus is able to sustain life outside womb.

Skin smooth. Insulation of brain begins, brain cells continue to develop.

Adequate birth weight is critical, to getting a child off to a good start in

life. Full term babies-

• have fewer physical handicaps

• are less likely to have birth defects

• have a lower rate of infant mortality

• are less likely to be mentally retarded

• are more likely to have higher lQs

• suffer fewer serious illness during childhood1

• have fewer hearing and visual disorders


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• are less likely to have respiratory and other infectious diseases

• have fewer behavioral problems

• are more mature and better able to handle environmental stress

• have a head start, both physically and mentally, over their smaller

peers who may never catch up.

The growth pattern of the fetus will be proper provided it receives

adequate nutritional support, which will occur naturally if the mother has

good nutritional status and nutritional knowledge. For such a situation it is

essential that the mother be benefited by maternal nutrition education.

1.4 Need of Nutrition Education

India's food and nutrition problems continue to be formidable and

malnutrition is still one of the crucial problems in the process of development.

Nearly two-thirds of India's population is on a nutritionally unbalanced diet.

Nutritional surveys conducted and repeated over a number of years have

indicated that a majority of population of every age group, including both the

sexes, suffer from malnutrition, bordering on both calories and protein

starvation and a complete lack of protective foods rich in minerals and

vitamins. (Gopalan, 1966; Ranganathan, 1968; Devdas, 1972, NIN Annual

Reports, 1981-1982).

Malnutrition affects people in general, but its adverse effects are more

pronounced among the vulnerable groups of women and children in rural and

urban areas. Several studies support this statement (NNMB Surveys, 1977,

ICMR, 1977, Gopalan, 1973, NIN Annual Reports, 1978, 1980-1981- 1982,


10

ICMR, 1985). Malnutrition is not exclusively due to non-availability of

nutritious food. Failure to use the available resources in a meaningful manner

can be another cause. This is mainly due to lack of knowledge of the value of

foods in relation to the needs of the individual. Ignorance and superstition

play a great role in the rejection of locally available cheap nutritious foods.

(Shanti Chakravarthy, 1977; Raju et al, 1977).

Financial constraints alone cannot be taken as the basis for prevailing

malnutritional status. A majority of the people, no matter of what class, have

status symbols, which force them to spend their income for purposes other

than that of securing food. Even when more money is spent on food, it is

spent on the wrong types of foods (Davidson et al, 1973; Raju et al, 1977).

Solving the problem of malnutrition therefore involves not only having the

food to eat but also the proper selection, preparation and consumption of

foods (Chakravarthy, 1977).

The magnitude of malnutrition and the ignorance about the

relationship of food to health among a majority of the population project the

need of nutrition education at all levels. This approach in the long run may

promote self-reliance and self-support in the communities.

Deliberate and sustained nutrition education has been recognized as a

potent weapon for prevention and control of malnutrition. Obviously, the

goal of these educational efforts ought to be beyond mere transfer of

information. What is envisaged is to motivate and bring about behavioral

changes among the community members in the choice of foods

(Ramdasmurthy, 1982).


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1.5 Meaning of Nutrition Education

Nutrition education is the foundation for any program intended for

nutritional improvement (Devdas et ai, 1970).

Albanese (1971) defines nutrition education as a means of translating

nutritional requirements into food and adjusting the food choices to satisfy

nutritional, cultural, psychological and economic needs.

The American Dietetic Association (1973) define nutritional education

as the process by which beliefs, attitudes, environmental influences and

understanding about food leads to practices that are scientifically sound,

practical and consistent with individual needs and available food resources.

Leverton in 1974 stated that it is a multidisciplinary process that involves the

transfer of information, development of motivation and modification of food

habits where needed.

According to Obert (1978), it is the process of applying knowledge of

nutrition related scientific information of social and behavioral sciences in

ways designed to influence individuals and groups to eat the kinds and

amount of foods that will mate a maximum contribution to health and social

satisfaction. The importance of nutrition education was stressed by White

(1976) who stated that for making judicious food choices and for the

achievement of one's genetic potential, the knowledge of nutrition is

imperative.

All the above suggests that, nutrition education aims at bringing in

improvement in nutrition behaviors, which promote health of an individual.


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1.6 Behavioral Change

The Oxford Dictionary meaning of Behavior is, "the way in which

someone act or conduct oneself in a specified way or conduct oneself in

accordance with accepted norms". In practical terms, it can be said that,

"behaviour is a series of processes beginning with thoughts in mind and

culminating in actual practice".

For the purpose of present study, researcher is of the view that, an

individual gets to know something. Based on the 'knowledge' so acquired,

that person develops his 'attitude, towards it. This attitude influences the

extent and nature of 'practice' that he adopts in his life. These serial processes

constitute his 'behaviour'.

Hence, behavior was considered by the researcher in the sequence of

Knowledge-Attitude-Practice (K-A-P). The change in K-A-P was considered as

behavioral change. Behavioral change in general is brought about by

educational pursuits undertaken by a person. The researcher wanted to

ascertain, if imparting nutrition education brought about behavioral change in

pregnant and lactating women, a well planned and properly executed study

was needed for this purpose.

1.7 Need of the Study

Healthy citizens constitute a healthy nation. If, newborns and

infants are healthy, they are more likely to build a healthy adult population.

Many international agencies like, World Health Organisation (WHO), Food


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and Agriculture Organisation (FAO), United Nation's International Children's

Education Fund (UNICEF), Cooperative for Assisatance and Relief Everywhere

(CARE) and national agencies like, National Institute of Nutrition (NIN),

Nutrition Foundation of India, (NFI), Food and Nutrition Board (FNB),

Central Food Technology Research Institute (CFTRI), National Nutrition

Monitoring Bureau (NNMB), Child Survival and Safe Motherhood (CSSM)

Programme, Central Social Welfare Board (CSWB), Nutrition Society of India

(NSI), Information Centre Committee on Science and Technology in

Developing Countries (COSTED- IDA), Applied Nutrition Programme), SNP

(Supplementary Nutrition Programme (ANP), have been playing an important

role in combating malnutrition.

Inspite of such efforts, many studies have confirmed that malnutrition is

rampant in India. Malnutrition is not exclusively due to non-availability of

nutritious foods. Failure to use the available resources in a meaningful

manner can be another cause. This is mainly due to lack of knowledge or the

value of foods in relation to the needs of the individual. Ignorance and

superstition play a great role in the rejection of locally available cheap

nutritious foods. (Chakravarthy, 1977, Raju et ah, 1977). In order to

overcome such obstacle of lack of nutritional knowledge, this researcher felt

the crying need to develop a nutritional educational package, with emphasis

on maternal nutrition, for pregnant and lactating mothers.

In India, many babies are born under-nourished. This is a major

contributory cause of high Perinatal Mortality Rate (PMR) and Infant Mortality

Rate (IMR), as is evident from IMR, NMR (Neonatal Mortality Rate) and MMR

rates 1976-1989, as reported by Vinodini Reddy (1993). Intrauterine


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Growth Retardation (IUGR), in otherwise normal pregnancies is caused, to a

great extent, by maternal under nutrition, which has high prevalence in India.

Maternal nutritional deficiencies are responsible for high maternal mortality

rate, too. The disturbing part of this scenario is that, in many cases maternal

and infant mortality can be prevented, by as simple a means as proper

nutritional care. There is a need to educate eligible couples and concern

family members about the great importance of maternal nutrition.

India needs to make its 'National Family Welfare Program' successful to

control population explosion. Small Family Norm' will be adopted by eligible

couples only if they are reasonably sure about their child's long-term health.

This can be achieved with reasonable success and minimum cost through

good maternal health and nutrition. In this context, the researcher is mindful

of the slogan used by the International Food Agencies which illustrates the

philosophy of the Chinese proverb," Give a man a fish and feed him for a

day-, teach a man to fish and you feed him for life time" (Winter, 1970) This

may be paraphrased as "Give a mother a meal and you relieve her immediate

needs. Teach the mother about maternal nutrition and it will benefit her and

her fetus", It will also help her family, the wider community and nation. It is

rightly said, "what benefits woman - benefits nation and humanity"- Mothers

can be exposed to maternal nutritional education during their antenatal care.

Today our antenatal services have not made the desired impact for the

reason that, our system of antenatal care is patterned on lines, which may be

appropriate and adequate for the affluent and not for the poor. At present a

pregnant woman is contacted by the health services for antenatal care (if at

all) only halfway through her pregnancy. Even this 'contact' takes place in less

Impact of Standardized NEPack on Behavioral Change Among Pregnant and Lactatxng Women

15

than 15 per cent of cases; and the 'contact' may be no more than one or two

visits to the Health Centre throughout pregnancy. It must be remembered

that the woman is already anemic (in a good proportion of cases) and stunted

and of low body weight even at the start of her pregnancy. In the interval of

barely 12 weeks between the time of contact by the health system and the

delivery of her baby, even with an efficient antenatal service, it will be

extremely difficult to correct, to any significant degree, the fairly large pre-

pregnancy nutritional deficit that she is already suffering from and, in

addition, provide for her added demands of pregnancy. Thus, a stunted

woman who starts on her pregnancy with a body weight of 38 kg or less and a

hemoglobin level below 8 gm per cent is unlikely to achieve a body weight

increase of more than 5 to 6 kg, and a hemoglobin level of 11 gm per cent, by

the end of her pregnancy with the type of inputs which our health system is

now able to provide. Clearly, therefore, the answer lies in ensuring that the

opportunities provided by the precious years of adolescence are not wasted

by our health system. Programmes aimed at improving the health and

nutritional status of girls during adolescence and programmes such as supply

of iron and foliate tablets to anemic adolescents are necessary so that the girls

can enter their pregnancy with no serious handicaps. (Gopalan, 1999).

These factors have to be borne in mind by ICDS workers also.

In our ICDS programmes, the focus on pregnant women and nursing

mothers is extremely weak. The ICDS programme needs to be restructured in

order to correct this major deficiency. Monitoring weight gains of women

during pregnancy, improvement of their diets, and correction of their anemia

must figure as central items in the agenda of the programme. The primary


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focus of any nutrition programme initiated today must be to prevent

malnutrition and promote better health and nutrition in mothers and children

rather than only identifying malnourished children and providing them

supplements. Thus, it is essential that the narrow objective of 'child survival'

be replaced by a more positive strategy directed to the broader objective of

'health promotion and nutritional upliftment of mothers and children' - a

strategy that will ensure not just escape from death but better health and

nutrition for our future generations.

Many researchers in various parts of India have assessed the existence of

poor nutritional status of expectant and lactating mothers. UGC-DSA Report

(1996), unambiguously confirms the need for maternal nutrition education.

Thus, the problem has been identified. Next step was formulating a proper

solution for the same. An essential step in solving nutritional problem related

to expectant and lactating mother was to modulate a package for imparting

nutritional education to these women and assessing its impact on their

behavior. The study was needed in order to fulfill this requirement. Having

realize the need of the study, importance of the study also needs to be

highlighted.

1.8 Importance of the Study

India desires to achieve the status of a ' Developed Nation'. To reach

this goal, its citizen should be 'Healthy and Vibrant'. This in turn can be

possible if the newborn babies are healthy-, because, firstly, today's babies are

tomorrow's citizens and secondly, many adulthood disorders are known to


17

have fetal origin. (Fallkerochieve, 2001). Proper maternal nutritional

education as envisaged in the study will improve the nutrition and health of

mother and fetus. Health disorders are a financial burden on society.

Money spent on looking after sick population can be saved if 'Health for

all' is achieved. The money so saved can be utilized for the constructive

national programs. Recently, 'empowerment of women' has become one of

the most important national program. With lesser number of healthy

children, each woman will get more time and energy to uplift her own life, as

a woman and indirectly uplift the family and society.

Upliftment of women can be achieved, provided they are healthy.

Health of a woman, especially a mother, is to a large extent dependent on

her nutrition. Unfortunately, nutritional supplementation has become

synonymous with various 'tonics' or 'ready to use food supplements', like

milk powder, for pregnant woman. These marketed products are slowly

displacing the natural, traditional and readily available as well as cheap

nutrients, just as, "Top feeding is displacing Breast feeding". Action against

malnutrition is bom imperative and possible. Policies for combating

micronutrient malnutrition must be firmly rooted in food-based rather than

drug-based approaches'. (B. Srilakshmi, 2002). Poverty and ignorance

deprived women of ready to use as well as traditional food supplements.

It is well known that 'poverty' and 'ignorance' are two most important

causative factors of maternal under-nutrition'. Proper maternal nutritional

education can completely, successfully wipe out the 'ignorance' factor. At

the same time such nutritional education, will, to a large extent take care of

the 'poverty' factor, by teaching poor mothers to get the maximum


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nutritional benefits out of the available resources. In this way poor women

will help themselves as well as their families, because having realized the

importance of fetal nutrition, they will be better motivated to 'space' their

children and adopt 'small family norm'. Such families will, in the course of

time, lift themselves above the poverty line. This will lead to empowerment

of women belonging to all the sections of society. Nutritional education can

prevent nutritional deficiencies, thus making various nutritional

supplementation programs gradually unnecessary and ultimately obsolete.

Nutritional education does not merely teach about nutrients, it imparts

behavioral change (knowledge, attitude and practice) among the

beneficiaries.

Nutritional education among pregnant and lactating women being so

important, it was considered necessary to prepare a standardized nutritional

education package for them. This study aims to fulfill this requirement and

also assess the impact of such a standardized nutritional education package

on the behavioral change (knowledge, attitude and practice), with certain

objectives.

1.9 Objectives of the Study

After careful consideration and in the light of prevailing knowledge

pertaining to nutritional package among pregnant woman, present study was

planned and directed to understand and assess the impact of nutritional

package on the behavioral changes among pregnant and lactation woman.


19

However, the specific objectives of the study were as under:

1. To know the personal, social, economical, psychological, and

situational characteristics of the pregnant and lactating women.

2. To assess nutritional status and nutritional education status of the

pregnant and lactating women.

3. Development and standardization of Nutritional Education Package.

4. To assess the impact of standardized nutritional education package on

behavioral changes on the part of pregnant and lactating women.

5. To estabMsh relationship between the characteristics of pregnant and

lactating women behavior change of the pregnant and lactating

women.

6. To understand problems encountered in the adoption of standardized

nutritional package by the pregnant and lactating women.

7. To invite suggestions from the pregnant and lactating women for

adoption of package.

On the basis of aforesaid objectives, hypotheses of the study were

framed.

1.10 Hypotheses of the study

1 There is influence of nutrition education through NEPack on

Knowledge level of respondents.

2 There exists influence of nutrition education through NEPack on

Attitude level of respondents


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3 Practice level of respondents is influenced by nutrition education

through NEPack.

4 There is impact of the NEPack on percent change in Knowledge-

Attitude-Practice (Behaviour) of respondents.

5 There is agreement between mean values of dependent and

independent variables of pregnant and lactating rural respondents,

pregnant and lactating urban respondents and both taken together.

6 There is no significant correlational influence of socio, economic,

demographic and psychological factors (Independent variables) on

the percent change in Knowledge of maternal nutrition of pregnant

and lactating women due to NEPack.



the percent change in Attitude of maternal nutrition of pregnant and

lactating women due to NEPack.



the percent change in Practice of maternal nutrition of pregnant and


9 There is no significant relational influence of socio, economic,


the percent change in Knowledge of maternal nutrition of pregnant

and lactating women due to NEPack.


21



the percent change in Attitude of maternal nutrition of pregnant and




the percent change in Practice of maternal nutrition of pregnant and


12 There is variation in the contribution of socio, economic,

demographic and psychological factors (Independent variables) in

predicting percent change in Knowledge of maternal nutrition

among pregnant and lactating women due to NEPack.



predicting percent change in Attitude of maternal nutrition among

pregnant and lactating women due to NEPack.



predicting percent change in Practice of maternal nutrition among

pregnant and lactating women due to NEPack.

15 There is interrelationship between percent change in Knowledge-

Attitude-Practice of Maternal nutrition because of NEPack.

16 There is no difference in the influence on percent change in

Knowledge of maternal nutrition in case of respondents of rural


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groups & and urban group. (Rural-Pregnant & Lactating; Urban-

Pregnant& Lactating).

17 There is no difference in the influence on percent change in Attitude

of maternal nutrition in case of respondents of rural and urgan

group. (Rural-Pregnant & Lactating; Urban-Pregnant & Lactating).

18 There is no difference in the influence on percent change in Practice

of maternal nutrition in case of respondents of rural and urban

group. (Rural-Pregnant & Lactating; Urban-Pregnant& Lactating).

19 Respondents will have problems in adopting standardized nutritional

educational package.

20 Respondents have number of suggestions to adopt standardized

nutritional educational package.

21 There is no improvement in the nutritional status of rural and urban

respondents, in the first trimester of pregnancy, because of NEPack

education.

After formulating the hypotheses, the length and breadth of the study

was planned to determined scope of the study.

1.11 Scope of the Study

The total duration of the study was of two years. At the outset, need of

the study was assessed and confirmed. This was followed by development of

standardized NEPack.


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Respondents of the study were 360 pregnant and 360 lactating (upto 3

months) women from urban and rural area, in and around Akola city, selected

by 'stratified purposive proportionate random sampling' method. The

independent variables were Age, Family members, Education, Annual Family

income, Social status, Maternal Attitude and Nutritional status. Dependent

variables in the study were Knowledge, Attitude and Practice about maternal

nutrition.

'Before-and-after without control' type of informal experimental design

was utilized as the research design of the study.

The study has a wide scope in the community as it deals with the

impact of maternal nutrition education on behaviour of pregnant and lactating

women, directly benefiting the families and indirectly benefiting the

community. The study, by its very nature, could be very vast and exhaustive.

The scope of the study and resources available to the researcher thrust certain

limitation on the study.

1.12 Limitations of the Study

Present study is likely to suffer from the limitations listed below-

1. In view of large size of sample, development of systematic and

comprehensive standardized nutritional education package, precisely

ascertaining the behavioral changes among the respondents is likely to

take much time. Obviously, author may find short of time and hence time

was limitation.


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2. In view of nature of the study at hand and resources placed at the disposal

of the researcher, available resources was limitation.

3. In the present study impact of standardized nutritional educational

package on behavioral changes of the respondents has precisely been

assessed, it would have been appropriate if the impact of standardized

health education package would have been assessed. This, however, was

not possible. This therefore, was considered as limitation.

4 Clinical information data collection was limitation. (Details under Chapter

of Methodology).

5. The researcher for the purpose of this study considered respondents

belonging mainly to middle and high income groups and the few

respondents belonging to low income group were also included, but

women belonging to Economically Weaker Section (EWS) were not

considered and hence a limitation.

The researcher is of the opinion that it is difficult to bring about any

radical change through education alone in the case of EWS. Any Govt.,

with all the facilities at its disposal cannot improve the condition of EWS in

a short period. Instead of making an attempt, which was most likely to be

a futile one, to target the EWS, the researcher thought that, it was

worthwhile to concentrate on, for the purpose of this study, the income

groups higher than EWS. Hence, a limitation.

6. The findings in the study are based on individual respondent's personal

perception.


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CHAPTER - 1shodhganga.inflibnet.ac.in/bitstream/10603/72525/9/09_chapter 1.pdf · Hence, more food is required by the mother during lactation to help meet the additional nutrient