A STUDY TO EVALUATE THE EFFECTIVENESS OF STRUCTURED

TEACHING PROGRAMME ON KNOWLEDGE OF MOTHERS

REGARDING PROTEIN ENERGY MALNUTRITION[PEM] AND IT’S

HOME BASED DIET MANAGEMENT AMONG THEIR PRE SCHOOL

CHILDREN IN SELECTED RURAL AREA’S AT GULBARGA

PERFORMA FOR REGISTRATION OF STUDENTS FOR DISSERTATION

DINESH KUMAR SHARMA

M.SC NURSING 1ST YEAR

PAEDIATRIC NURSING

YEAR 2010-2011(MID-STREAM)

AL-KAREEM COLLEGE OF NURSING BAREY HILLS NEAR ADARSH

NAGAR GULBARGA-585105

RAJIV GHANDI UNIVERSITY OF HEALTH SCIENCES BANGLORE, KARNATAKA

1

PERFORMA FOR REGISTRATION OF SUBJECTS FOR DISSERTION

01 NAME OF THE CANDIDATE &

ADDRESS

DINESH KUMAR SHARMA

1ST YEAR M.SC PAEDIATRIC NURSING AL-KAREEM COLLEGE GULBARGA

02 NAME OF THE INSTITUTION AL-KAREEM COLLEGE OF NURSING, GULBARGA

03 COURSE OF STUDY M.SC NURSING PAEDIATRIC

04 DATE OF ADMISSION TO THE COURSE

BATCH(2010-2011)

29.11.2010

2010-11(Mid-stream)

05 TITLE OF THE TOPIC:

A STUDY TO EVALUATE THE EFFECTIVENESS OF STRUCTURED TEACHING PROGRAMME ON KNOWLEDGE OF MOTHERS REGARDING PROTEIN ENERGY MALNUTRITION [PEM] AND IT’S HOME BASED DIET MANAGEMENT AMONG THEIR PRE SCHOOL CHILDREN IN SELECTED RURAL AREA’S AT GULBARGA

2

6.0 BRIEF RESUME OF THE INTENDED WORK:

6.1 INTRODUCTION:

The world health organization (WHO): defines malnutrition as the cellular imbalance

between the suppy of nutrients and energy and the body’s demand for them to ensure growth,

maintenance, and specific function “The term protein energy malnutrition(PEM) applies to a group

of related disorders that include marasmus, kwashiorkor and intermediate states of marasmus,-

kwashiorkor.

The term marasmus is derived from the greek word “Marasmos” which means

withering or wasting. Marasmus involves inadequate intake of protein and calories and is

characterized by emaciation. The term kwashiorkor is taken from the Ga language of Ghana and

means “The sickness of the weaning. Williams first used the term in 1933,and it refers to an

inadequate protein intake with reasonable calorie intake. Edema is characteristic of kwashiorkor but

is absent in marasmus.1

Nutritional deficiency disorders are major public health problem in India and other

developing countries they affect vast majority numbers if population abd responsible for

approximately 55% of childhood death, in India there are about 60 million malnourished children

and every month about 1 lakh children die due to effect of malnutrition.Malnutrition is a man made

disease of human society. The ecology of malniturition is complet with numbers of influencing

factors like desease condition, Infection, Socioeconomic status, Cultural practices and available

health and other services.2

Nutritional marasmus results from gross deficiency of energy through protein deficiency also accompanies. There is overlap in the clinical picture so it is apporiate to lable marasmic kwashiorkor. Growth failure and poor tissue repair(due to protein lack) and energy shortage(due to calories deficiency) is also common to all forms of PEM .3

Protein energy malnutrition (PEM) is a potentially fatal body in children in

developing countries.Primary PEM results from a diet that lacks sufficient sources of protein and/or

energy.Kwashiorkor also called wet protein-energy malnutrition, is a form of PEM characterized

primarily nby protein deficiency. This condition usually appears at the age of about 12 months when

breast feeding is discounted. But it can develop at any time during a child’s formative years. It

causes fluid retention(edema)dry, peeling skin, and hair discoloration.

3

Primarily caused by energy deficiency marasmus is characterized by stunted growth

and wasting of muscle and tissue.maramas usually develops between the ages of 6 months and one

year in children who have been weaned from breast milk or who suffer from weakening conditions

like chronic diarrhea.

Mild moderate and severe classifications have not been precisely defined, but patients

who lose 10-20% of their body weight without trying are usually said to have moderate PEM. This

condition is also characterized by a weakened grip and inability to perform high energy tasks. Losing

20% of body weight or more is generally classified as severe PEM.

Treatment is designed to provide adequate nutrition, restore normal body

composition, and cure the condition that caused the deficiency. In patients with severe PEM the first

stage of treatment consists of correcting fluid and electrolyte imbalances, treating infection with

antibiotic that don’t affect protein synthesis and addressing related medical problems. The second

phase involve replenishing essential nutrients slowly to prevent taxing the patients weakened system

with more food than it can handle. Physical therapy may be beneficial to patients whose muscles

have deteriorated significantly.

Breast feeding a baby for at least six months is considered the best way to prevent

early childhood malnutrition. Preventing malnutrition in developing countries is a complicated and

challenging problems4

6.1 NEED FOR THE STUDY:

The most recent estimates about the distribution of PEM at a worldwide level were

compiled by the world health organization (WHO) programme of nutrition, available in its global

database on child growth and malnutrition(de oxis and blossner 1997).This database covered 95

percent of the total population of children under syeals of age who lived in 103 developing nations in

1995, as was reported in nationally representative survey available at the time.

According to these data, an estimated 206.2 million children, who represent 38 percent

of all children under 5 years old, were stunted (low height forage); 167.3 million children (31

percent) were underweight (low weight for age), and 48.8 million children(9 percent) were

wasted(low weight for height).PEM is most often found in the poor regions known as the

4

“developing world”.the largest number of affected children were found in asia, where 41 percent of

all under 5 years old were stunted, 35 percent were under weight, and 8 percent wasted children of

all those under 5 years old; latin America and the Caribbean showed 17.9 percent stunted, 9.5

percent under weight and 3 percent wasted children of all those under 5 years old. The proportion of

children under 5 yearsa of age affected in oceania was 31.4 percent, 22.8 percent, and 5 percent

respectively but the total number of children living in this region is much lower, so in reality, these

percentages translate into many fewer children affected then in the other regions5

The world bank estimates that india is ranked 2nd in world of the number of children

suffering from malnutrition, after Bangladesh (in 1998), where 47% of the children exhibit a degree

of malnutrition. The prevalence of under weight children in india is among the highest. In the world,

and is nearly double that of sub-saharan Africa with dire consequences for mobility, mortality,

productivity and economic growth. The UN estimates 2.1 million Indian children die before reaching

the age of 5 every year –four every minute- mostly from preventable illness such as diarrhea,

typhoid, malaria, measles and pneumonia. Everyday,1000 Indian children die because of diarrhea

alone. According to the 1991 censes of India, it around 150 million children, constituting 17.5% of

Indian population, who are below the age of six years6

Though most of the population of india is still living below the national poverty line, its

economic growth indicates in the prevalence of chronic diseases which is observed in at high rates in

developed countries such as united states, Canada & Australia. The combination of people living in

poverty and the recent economic growth of India has led to the co-emergence of two types

malnutrition: under nutrition & over nutrition7

It has been recognized that malnutrition is the most common cause of immune

defecience world wide(Chandra 1991). Actually malnutrition and infection interact in a vicious

cycle: The presence of one more easily leads to the development of the other(scrimshaw, taylor, etal,

1968). There are several mechanisms involved in this relationship PEN impairs all-mediated

immunity, pdiagocitic immunoglobulin(IgA, IgM, and IgG) concentration, cytokine

production(Chandra 1991).

5

PEM can disrupt coginiton in several ways following the lessons learned from the effect

of PEM on the body during infections, the classic explanation was that malnutrition caused physical

damage to the brain, particularly during sensitive periods of development, namely, during the first

two years of life, when about 80% of the brains growth is achieved(Guilarte,1993,Levit sky and

Strupp,1995).

Which will be reflected in cognitiue disabilities, Motor impairment, or lower intelligent

quotient(IQ) by means of micronutrient deficiencies such as Vitamin B6 or iron, both of which are

vital for normal brain function(Guilarte,1993; Pollitt.1997)8

Severe deficiency of essential nutrients (ie Zinc, iron, and vitamin A required in the

synthesis of DNA maintenances factors; deterioration of repair mechanisms allowing the persistence

of an unusually high number of structural chromosomal aberrations ; and/or the absence of specific

factors needed to protect the cell against oxidative DNA damage9

6.2. REVIEW OF LITERATURE : This chapter presents review of literature related to the present study . the role of

literature review is to formulate and clarify the research problem, to ascertain what is already known

in relation to a problem of interest , for developing a broad conceptual Contest , facilitate cumulation

of scientific knowledge for interpreting the results of the study.

Review of literature involves systematic identification , location ,scrutiny and summary

of written materials that contain information on research problem , the literature review is based on

an extensive survey of books, journals and international nursing index.

The researcher presents their review under the following headings.

SECTION-I Studies related to prevalence of protein energy malnutrition among pre- school

children.

SECTION-II Studies related to protein energy mal nutrition in relation with socio-demographic

and socio economic factor.

6

SECTION-III Studies related to knowledge and practice on diet for protein energy mal

nutrition.

SECTION-IV Studies related to health education on protein energy malnutrition.

SECTION-I

Studies related to prevalence of protein energy malnutrition among pre-School children

A study was conducted to determine the prevalence of protein-energy malnutrition and its

association with soil-transmitted helminthiases in children The results obtained from 368 children

aged 2-15 years showed that the overall prevalence of mild and significant underweight was 32.1%

and 56.5% respectively. The prevalence of mild stunting was 25.6% while another 61.3% had

significant stunting. The overall prevalence of mild and significant wasting was 39.0% and 19.5%

respectively.The overall prevalence of ascariasis, trichuriasis and hookworm infection were 61.9%,

98.2% and 37.0% respectively and of these 18.9%, 23.5% and 2.5% of the children had severe

infection of the respective helminthes. The overall prevalence of giardiasis was 24.9%. The present

study vividly shows that stunting and underweight are highly prevalent among children and therefore

of concern in this community. identified as the main predictors of stunting and wasting respectively,

in addition to age between 2 to 6 years10

A study was conducted on WHO Global Database on Child Growth, which covers 87%

of the total population of under-5-year-olds in developing countries; we describe the worldwide

distribution of protein-energy malnutrition, based on nationally representative cross-sectional data

gathered between 1980 and 1992 in 79 developing countries in Africa, Asia, Latin America, and

Oceania. The findings confirm that more than a third of the world's children are affected. For all the

indicators (wasting, stunting, and underweight) the most favorable situation--low or moderate

prevalence’s--occurs in Latin America; in Asia most countries have high or very high prevalence’s;

and in Africa a combination of both these circumstances is found. A total 80% of the children

affected live in Asia--mainly in southern Asia--15% in Africa, and 5% in Latin America.

Approximately, 43% of children (230 million) in developing countries are stunted. Efforts to

7

accelerate significantly economic development will be unsuccessful until optimal child growth and

development are ensured for the majority. 11

A study was conducted on Malnutrition, with its 2 constituents of protein-energy

malnutrition and micronutrient deficiencies, continues to be a major health burden in developing

countries. It is globally the most important risk factor for illness and death, with hundreds of millions

of pregnant women and young children particularly affected. Apart from marasmus and kwashiorkor

(the 2 forms of protein- energy malnutrition), deficiencies in iron, iodine, vitamin A and zinc are the

main manifestations of malnutrition in developing countries. In these communities, a high

prevalence of poor diet and infectious disease regularly unites into a vicious circle. Interventions to

prevent protein- energy malnutrition range from

promoting breast-feeding to food supplementation schemes, whereas micronutrient deficiencies

would best be addressed through food-based strategies such as dietary diversification through home

gardens and small livestock. all such interventions require accompanying nutrition-education

campaigns and health interventions. To achieve the hunger- and malnutrition-related Millennium

Development Goals, we need to address poverty, which is clearly associated with the insecure

supply of food and nutrition. 12

A study was conducted study was undertaken from March to May 2004.

Anthropometric measurements of 798 children were done and data were transformed into height-for-

age, weight-for-age and weight-for-height ratios. Mothers were also interviewed with a semi-

structured questionnaire. There was a high prevalence of stunting, underweight and wasting, that is,

54.6%, 35%, and 6% respectively. It was also noted that children aged 12-23 months and Khmu

ethnic children had a higher prevalence of stunting (65% and 66%) and underweight (45% and

40%), respectively., vegetables during illness, and low maternal education it was also found that

boys were more prone to be stunted and underweight. Furthermore, restricted intake of meats.

Socioeconomic-demographic factors, low maternal education, poor nutrition knowledge for mother

and feeding practices for sick children are affecting children's health regarding stunting and

underweight. 13

8

A study was conducted on approximately 70.0% of the world's malnourished children

live in Asia, resulting in the region having the highest concentration of childhood malnutrition.

About half of the preschool children are malnourished ranging from 16.0% in the People's Republic

of China to 64.0% in Bangladesh. Prevalence of stunting and underweight are high especially in

South Asia where one in every two preschool children is stunted. Besides protein-energy

malnutrition, Asian children also suffer from micronutrient deficiency. The socio-economic cost of

the malnutrition burden to the individual, family and country is high resulting in lower cognitive

outcomes in children and lower adult productivity. Interventions that are cost-effective and culturally

appropriate for the elimination of childhood malnutrition deserve the support of all. 14

A study was conducted on Protein energy malnutrition (PEM) is a global problem.

Nearly 150 million children under 5 years in the world and 70-80 million in India suffer from PEM.

The studies in experimental animals in the west and children in developing countries have revealed

the adverse effects of PEM on the biochemistry of developing brain which leads to tissue damage

and tissue contents, growth arrest, developmental differentiation, myelination, reduction of synapses,

synaptic transmitters and overall development of dendritic activity. Many of these adverse effects

have been described in children in clinical data, biochemical studies, reduction in brain size,

histology of the spinal cord, Longer the PEM, younger the child, poorer the maternal health and

literacy, more adverse are the effects of PEM on the nervous system. Just like the importance of

nutrients on the developing brain, so are the adverse effects on the child development of lack of

environmental stimulation, emotional support and love and affection to the child.. Most important

being in family, school, community and various intervention programmes, local, regional and

national. Moreover medical students, health personnel, all medical disciplines concerned with total

health care and school teachers should learn and concentrate on the developmental stimulation and

enrichment of the child. 15

9

SECTION-II

Studies related to protein energy mal-nutrition in relation with

Socio-demographic and socio economic factor.

A study was conducted on protein energy malnutrition (PEM) is a common problem

worldwide and occurs in both developing and industrialized nations. In the developing world, it is

frequently a result of socioeconomic, political, or environmental factors. In contrast, protein energy

malnutrition in the developed world usually occurs in the context of chronic disease. recognition,

prompt management, and robust follow up are critical for best outcomes in preventing and treating.

Early recognition, prompt management and robust follow up are critical for best outcomes in

preventing and treating PEM. 16

A study was conducted on children from a low socioeconomical level where under

nutrition is prevalent are shorter than those from higher socioeconomic levels. We examined the

effects of severe and early protein energy malnutrition on growth and bone maturation. We studied

40 preschool children who had been admitted to hospital in infancy with protein energy malnutrition

and 38 children from the same socioeconomic level, paired for age and sex, who had never been

malnourished. Growth measurements were made over a period of 4-6 years, and bone age was

determined in a subgroup through wrist roentgenograms. Results showed a correlation between

protein energy malnutrition, birth weight of infants, and mother's height and head circumference.

The group with protein energy malnutrition showed a significant delay in stature after four years,

especially the girls (p less than 0.001). Weight:height ratio was reduced in boys compared with

controls but not in girls. Both groups showed a delay in bone maturation, but there were no

significant differences between them. We found a positive correlation between bone age and arm fat

area in control boys and between bone age and height for age in boys with protein energy

malnutrition. The finding that rehabilitated children were shorter than the control group. 17

A study was conducted on demonstrates that the metabolic changes in PEM include

water and electrolytes imbalance, amino acids and proteins deficiencies, carbohydrates and energy

deficiencies, hypolipidaemias, hypolipoproteinaemias, hormonal imbalance, deficiency of anti-

10

oxidant vitamins and enzymes, depression of cell-mediated immune complexes and decrease in

amino acids and trace elements in skin and hair. The review therefore suggests that assessment of

these conditions in PEM patients could improve the management of this group of patients and hence

reduce the rate of morbidity and mortality from PEM. 18

SECTION-III

Studies related to knowledge and practice on diet for protein-energy mal nutrition.

A study was conducted on children indicate that the addition of lysine to either

supplemental breads provided at school, or to all wheat products consumed, resulted in no observed

beneficial effects. Other field studies report an increase in either weight or height with addition of

lysine to breads. A laboratory study with human adults suggests that wheat flour: soy flour mixture

has a higher biological value than wheat flour alone. The role, in human nutrition, of breads with

improved protein quality remains somewhat obscure. 19

A study was conducted on case-control method with a food frequency questionnaire

was used to assess the habitual diet. Children with severe childhood malnutrition presenting to the

central hospital in Blantyre, Malawi during a 3-month period in 2001 were eligible to participate.

The food frequency questionnaire collected data about foods consumed by siblings <60 months of

age in the home. It was assumed that the habitual diet of all siblings 1-5 years old in the same home

was similar. Dietary diversity was assessed using a validated method, with scores that ranged from 0

to 7. Regression modelling was used to control for demographic and disease covariates. A total of

145 children with kwashiorkor and 46 with marasmus were enrolled. Children with kwashiorkor

consumed less egg and tomato than those with marasmus: 17 (15) vs. 24 (31) servings per month for

egg, mean (SD), P < 0.01 and 27 (17) vs. 32 (19) servings per month for tomato, P < 0.05. Children

with kwashiorkor had a similar dietary diversity score as those with marasmus, 5.06 (0.99) vs. 5.02

(1.10), mean (SD). Further research is needed to determine what role consumption of egg and tomato

may play in the development of kwashiorkor. 20

11

A study was conducted on Quality protein maize (QPM), with twice the amount of

tryptophan and lysine than conventional maize, has improved the nutritional status of severely

malnourished children. This double-blind clinical study evaluated the impact of QPM on the growth

and morbidity of mild and moderately malnourished children. In a Nicaraguan day care center, 48

children 1 to 5 years old who were malnourished (> 2 indicators with < -1 Z for weight-age, height-

age or weight-height) were identified and randomly assigned to consume for 5 days/week for 3.5

months a snack prepared with QPM or conventional maize. QPM positively influenced children's

growth: weight (0.80 vs. 0.19 kg gained from baseline to endline between the QPM and conventional

maize groups, respectively), height (2.02 vs. 1.23 cm in QPM vs. conventional) and Z score for

weight-age (0.17 vs. -0.26 Z in QPM vs. conventional) and height-age (0.06 vs. -0.23 Z in QPM vs.

conventional). When other factors that could affect growth with respect to weight, height, weight-

age Z score and height-age Z score were controlled for, the intervention group (QPM >

conventional) was a statistically important factor (P < 0.01). The QPM snack, however, had no effect

on the incidence of diarrheal episodes or respiratory infections. In conclusion, QPM improves the

nutritional status of pre-school children who are mild or moderately malnourished. 21

A study was conducted on Few Senegalese mothers are skilled in handling the dietary

transition from nursing to adult food for their children. At least 20% of the children aged 1 to 4 are

affected by 2 broad types of protein-calorie malnutrition, marasmus and kwashiorkor. To correct

these diets, nutritional rehabilitation centers (NRCs) have been established in 2 villages. Children

and mothers come to these centers for periods of up to 3 weeks. Mothers learn to use locally

available, inexpensive food products to prepare well-balanced meals high in calories and protein.

Traditional cooking techniques of the typical rural home are used (examples of recipes used in NRCs

are given), and mothers are also taught better methods of selecting, cultivating, and preserving foods .

22

12

SECTION-IV

Studies related to health education on protein energy

Malnutrition

A study was conducted on Current guidelines for the management of severe malnutrition

are mainly based on new concepts regarding the causes of malnutrition and on advances in our

knowledge of the physiological roles of micronutrients. severely malnourished children require

special micronutrients, a mineral-vitamin mix is added to the milk-based formula diets, which are

specially designed for the initial treatment and the rehabilitation phase. To further improve

nutritional rehabilitation and reduce cases of relapse, 'ready-to-use therapeutic food' and 'ready-to-eat

nutritious supplements' with relatively low protein (10% protein calories) and high fat content (54-

59% lipidic calories) have been developed. Although current dietary recommendations do not

differentiate between oedematous and nonoedematous forms of malnutrition or between adults and

children, there are indications that further clarification is still needed for applying dietary measures

for specific target groups. 23

A study was conducted on Protein-calorie malnutrition is found in environments

characterized by ignorance, illiteracy, poverty, poor hygiene, and absence of food processing

industries. At the Mondongo rural health center in Zaire, malnourished children are not rare,

although they live in an environment rich in the foods necessary for growth and development.

Parents are poorly informed about the desirable age at weaning, the nutritional requirements of

weaned infants, and appropriate diet and food preparation for weaned children. The income of local

residents does not permit purchase of imported foods. Children must thus be nourished with local

foods. Manifestations of protein-calorie malnutrition range from slight retardation of growth to

serious disease, including marasmus and kwashiorkor. Among 337 children studied in Mondongo,

66 (19.5%) were seriously malnourished, with upper arm circumferences of less than 13 cm, or

weight being 60% of normal weight for their age. 81 children (21%) had moderate malnutrition, with

are circumferences of barely 15 cm, or weight for age 60-80% of normal. 190 children were

adequately nourished, with arm circumferences of at least 16 cm and weight over 80% of normal for

their age. A formula for a weaning food called Mariso proposed by a group of researchers in 1984

was found to be poorly accepted because it included soybeans, which are not widely available or

well accepted. Two mixtures more appropriate to local realities were developed. Mariche combines 13

maize, rice, and locally harvested and smoked caterpillars, while mariop combines maize, rice, and

eggs. The mixtures can be stored for short periods in ordinary containers in a dry place. Sugar or salt

may be added during cooking. Two mixtures are sufficiently inexpensive to be available to all

population sectors. Mariop was found to be slightly more effective than Mariche in treatment of

malnourished children. But protein-calorie malnutrition is a curable deficiency avoidable at low cost

using locally available resources. Parents must be trained to provide adequate nutrition for their

young children. 24

6.3 STATEMENT OF PROBLEM :

“A STUDY TO EVALUATE THE EFFECTIVENESS OF STRUCTURED

TEACHING PROGRAMME ON KNOWLEDGE OF MOTHERS REGARDING PROTEIN

ENERGY MALNUTRITION [PEM] AND IT’S HOME BASED DIET MANAGEMENT

AMONG THEIR PRE SCHOOLER CHILDREN IN SELECTED RURAL AREA’S AT

GULBARGA”

6.4 OBJECTIVES OF THE STUDY:

1. To assess the knowledge of mothers regarding Protein Energy Malnutrition[PEM] and its

home based diet management.

2. To prepare and administer the structure teaching programme on PEM and its home based diet

management.

3. To evaluate the effectiveness of structure teaching programme on PEM and its home based

diet management.

4. To determine the association between pre test knowledge score with selected demographic

variables.

14

6.5 OPERATIONAL DEFINATIONS:

Evaluation:

It refers to the findings of the value of structure teaching programme on the knowledge of mothers regarding home based diet management for protein energy malnutrition [PEM].

Effectiveness:

It refers to the desirable changes brought by the structure teaching programme as measured in terms of significant knowledge gain in post test and graded as adequate knowledge, moderately adequate knowledge, and inadequate knowledge.

Structure teaching Programme :

It refers to the systematically developed time bond teaching programme in kannada by the investigator containing information regarding protein energy malnutrition and its home based diet management.

Knowledge:

It refers to the level of understanding or awareness of mother of preschooler regarding home based diet management for protein energy malnutrition.

Mother:

In this study it refers to the mothers who are having the preschool children [3 to 5 years]

Protein Energy Malnutrition [PEM]:

The diet which lacks of protein and calorie which lead to deficiency disorder.

Preschool children:

In this study it refers to the children’s with the age of 3 to 5 years.

15

6.6 Assumption:

This study assumes that

Mothers may have the knowledge regarding home base diet management for protein energy malnutrition to the some extent.

Structure teaching programme is considered as a accepted strategy for enhancing the level of knowledge.

Mothers may have the desire to learn about home based diet management for protein energy malnutrition.

6.7 Delimitations:

The study will be delimited to

Mothers of preschool children(3 to 5 years) Study will be conducted in selected rural areas.

6.8 Hypothesis:

H1: The mean post test knowledge score is significantly higher than the pre test knowledge

Score of mothers regarding protein energy malnutrition and its home based diet

management.

H2: There will be significant association between the pre test knowledge score with selected

Demographic variables of mothers regarding protein energy malnutrition and its home

based diet management.

7. MATERIAL AND METHODS :

7.1 Source of data:

Data will be collected from the mothers of preschool children.

7.1.1 Research design:

The research design selected for this study is one group pre-test post-test design.

16

7.1.2 Research approach:

Pre experimental approach

7.1.3 Setting:

The study will be conducted in selected rural areas at Gulbarga.

7.1.4 Population:

This study population refers to mothers of preschool children(3-5 years)

7.2.3 Inclusion Criteria:

The study samples includes

The mothers of preschool children [3-5 years]. Residing in selected rural areas. Willing to participate in the study.

7.2.4 Exclusion Criteria:

The study sample exclude

Who have attended the health talk on protein energy malnutrition and its home based diet management.

who are not available at the time of study.

7.2.5 Intruments Intended to be used:

Socio demographic performa structure knowledge questionnaire on PEM and its home based diet management

7.2.6 Data collection method:

Formal permission will be obtained from the concerned authorities and participant after explaining the purpose of the study by the investigator. Prior to the data collection, the pretest will be conducted by administering socio demographic performa and the structure knowledge questionnaire on PEM and its home based diet management following which on the same day STP will be implemented to the participant after 7 days, the post test will be conducted by administering the same tool that was used for the pretest.

17

7.2.7 Data analysis plan:

Data analysis is the systematic organization and synthesis of research date and testing of research hypothesis.

The data will be analyzed using descriptive and inferential statistic. Demographic data will be analyzed by frequency and percentage. The knowledge score before and after administration of STP will be analyzed by mean,

standard deviation and “t” test. The relationship between knowledge score and demographic variable will be assessed by

“chy-sauare test”

7.3. Does the study require any investigation to be conducted on patients or other humans

or animals? if so please describe briefly:

Yes, the investigator is giving structure teaching programme on PEM and its home

based diet management among mothers of pre schoolers.

7.4. Has ethical clearance been obtained from your institution in case of 7.3?

Yes, ethical clearance will be obtained from the concerned authority.

18

8.0.BIBLIOGRAPHY.

1.Available from http:/www.pubmad.com;introduction to malnutrition.

2. Parul Datta “pediatric Nursing” department of neonatology IPGGMER and SSKM Hospital

Kolkatta WB India 2nd edition 2009.

3.Balram Chowdhry “Pediatric Lecture notes” 7/31 Amari road daryagunj New Delhi 1st

edition 2007.

4.American College of nutrition, 722 Robert ELee drive,Wilmington(2008) NC 20412-

0927,(919)152-1222.

5.ACC/SCN.third report on the world nutrition situation,Geneva,Switzerland 1997.

6.”World Bank report” world bank report on malnutrition in India;2009-03-13.

7.journal of the American medical association “ the global burden of chronic diseases” JAMA

2004,2009-11-23

8.Allen ,Lindsay H.” The nutrition CRSP:what is marginal malnutrition and does it affect human

function” nutrition review 51(1993):255-267.

9.Susana A.salcedac.etal” protein-energy malnutrion contributes to increased structural

chromosomal alteration frequencies” 2008 may.

10.Al-Mekhlafi HM,et.al “ protein-energy malnutrition and, soil-transmitted helminthiases?

Kualalumpur Malaysia 2005:14(2):188-94

19

11. de Onis M,et.al “ The world wide magnitude of protein-energy malnutrition: an overview

from the WHO Global data base on child growth” 1993;71(6):703-12. data base on child

growt 1993;71(6):703-12.

12. Muller O,krawinkelm. “malnutrition and health in developing countries”.Heide;berg,Germany,

2005 aug;2:173(3):279-86.

13.Phengxay m,et.al “risk factor protein-energy malnutrition in children under 5 years” Tokyo japan

2007 apr 49(2):260-5.

14.Khor GL. “Update on the prevalence of malnutrition” serdang Malaysia 2003 dec:5(2):113-22.

15.Udani PM “ protein energy malnutrition (PEM), brain and various facet’s of child development”

Mumbai hospital, 1992 mar-apr;59(2)165-86.

16.Grover Z, Ee LC “ protein energy malnutrition” queensland 4029, Australia 2009 oct.56(5):1055-

68.

17.JAlvear,et.al, “ physical growth and bone age of survivors of protein energy malnutrition” 1986

mar,61(3):257-62.

18.S A Akuyam “ a review of some metabolic changes in protein-energy malnutrition” Zaia Nigeria

2007 jun.14(2):155-62.

19 Brschart AA “ improving protein quality of bread-nutritional benefits and realities”

1978,105:703-34.

20. Sullivan J,et.al “ the quality of th diet in children with kwashiorkor and Marasmus” st.louis

Missouri, USA 2006 apr,2(2),114-22

21. Ortega Aleman edel C “ The effect of consuming quality protein maize or conventional maize on

the growth and morbidity of malnourished children” Managua, Nicaragua 2008 dec:58(4):377-85.

20

22. DE Lauture H,et.al “a model for combating malnutrition in children : nutritional rehabilitation

centres” 1982;1(2)18-21.

23.Scherbaum “New concepts on nutritional management “ 2000 jan;3(1)31-8

24. kalissa V,Monziba B “ local food mixturefor treatment of protein. Calorie malnutrition” 1993;

(103):24-9.

21

9. SIGNATURE OF THE CANDIDATE

10. REMARKS OF THE GUIDE THE SELECTED PROBLEM IS APPROPRIATE

11.

NAME AND DESIGNATION OF

11.1 GUIDE

11.2 SIGNATURE

11.3 CO-GUIDE

11.4 SIGNATURE

12. 12.1 HEAD OF THE DEPARTMENT

12.2 SIGNATURE

13. 13.1REMARKS OF THE CHAIRMAN & PRINCIPAL

THE SELECTED PROBLEM IS APPROPRIATE

13.2 SIGNATURE

22