PROJECT for College

7/28/2019 PROJECT for College

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ACKNOWLEDGEMENT

Before proceeding further I, Shreya Roy Chowdhury

(Student of Clinical nutrition and Dietetics, Bsc.V Part-

III) would like to extend my cordial gratitude to all the people

without whom and whose help and support my internship would

not have been possible.

I would like to express my cordial sense of gratitude andsincere indebtness to :-

Miss. Ujjyani Dasgupta , Head of the department ofClinical nutrition and Dietetics of GOKHALE MEMORIAL

GIRLS COLLEGE.

Mrs. Paramita Chatterjee , Lecturer of thedepartment of Clinical nutrition and Dietetics of

GOKHALE MEMORIAL GIRLS COLLEGE.

Mrs. Nirmala Kochar , Teacher-in-charge of GOKHALE

MEMORIAL GIRLS COLLEGE for sending me to train myselfin Child In Need Institute (CINI) & continuing my source

of encouragement and inspiration.

Last but not the least I would like to thank all the

staff members, Course co-ordinators, guest lecturers

of CINI who have helped me during my training.


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INTRODUCTIONGood health is a vital part of the great experience of living.

The World Health Organisation (WHO) defines Health as a

state of physical, mental and social well-being and not merely

the absence of disease or infirmity.

FOODS, SHELTER AND CLOTHING are the basic needs of thehuman being. Among them food is the most important for

survival.

Food may be defined as anything solid or liquid which when

swallowed, digested and assimilated in the body keeps it well.

NUTRITION is the science of foods, the nutrients and othersubstances therein ; their action, interaction and balance inrelationship to health and disease.

The word Nutrition is derived from Nutricus which means to

suckle at the best.

The term Nutrition can be defined as the process by which

the organism ingests, digests, absorbs, transports and utilises

nutrients and disposes of their end products.

Nutrients are the constituents in food that must be supplied

to the body in suitable amounts. These are proteins,

carbohydrate, fats, vitamins, minerals and roughage.

The study about the effect of different food on human

body,what they should eat and what not is the dietetics and

those dealing with these are the Dietitians and Nutritionist.

CLINICAL NUTRITION AND DIETETICS is the subject whichis offered by Calcutta University. The object of this course is to


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produce people with knowledge and skill for creative role in

society. Hence a practical work is necessary to become an

expert in this field and that is why this Internship has been

included in our subject.

WHAT IS

INTERNSHIP ?

Internship is a work including special learning objectives.Itis used to describe a variety of experience. My internship

programme was in highly structured corporate environment.

A good internship is an educational opportunity where one

can gain career related experience. Internship can be

found any time in the year and are available in every

field. Internship is usually performed under the guidance ofsupervisor.

The internship has helped me of a various aspects. The internship has given me the knowledge of the work

of a Dietitian.

I was intern to the NGOs working environment. I got the chance of interacting with the patients about their

likes.

I have learnt how to make diet charts for a patientaccording to situational needs.

I got good knowledge about the different disease conditionand their Dietary Modification.


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I , being the student of Food & Nutrition , Major in the

department of Clinical Nutrition & Dietetics. Calcutta

University has taken up my Internship in Child In Need

Institute (CINI).

I, the student of Gokhale Memorial Girls College, have spent 15

days (From 13th February to 29th February, 2012) for my

internship session at CINI.

My training

schedule is as

follows :-

Name of the NGO :- Child In Need Institute(CINI)


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Location :-CINI, Village : Daulatpur,

P.O.: Poilan, via Joka,

Pin 700104,

West Bengal, India

Duration :- 13th feb to 29th feb ,2012

Timing :- 10 A.M. to 4:30 P.M.

DATE :- 13.02.2012

In the first half (, the lecture was given about CINI

which are as follows :-


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CHILD IN NEED INSTITUTE

GENERAL INFORMATION ABOUT CINI

:-

Recognized as a national NGO, Child In Need Institute (CINI) is

guided by its mission of Sustainable Development in

Health, Nutrition and Education for the child, adolescent

and women in need. From a humble beginning in 1975, the

institute now reaches about 8,00,000 people in both rural andurbans in India. This includes 13,000 street children and 16,000

young people (10-24 years). Besides West Bengal, the institute

has spread its operations to operations to Jharkhand, Orissa,

Bihar, Madhya Pradesh and Chattisgarh. CINI is also the

Regional Resource Centre (under the RCH programme of the

Government Of India) for West Bengal, Orissa, Jharkhand and

Andaman and Nicobar Islands.

CINI has the unique honour of receiving the National Award for

Child Welfare twice. Presented by the Government of India, CINI

received this award for 2003-2004 and earlier in 1985.

CINI has received several other prestigious national and

International awards including :-

Parliament prize for infants given by Parliament Commissionfor Infants, Italy in November 2005.

The Allen Shawn Feinstone Hunger Award, Brown University,USA, 1993.

The International prize Linguria, Genoa, Italy, 1991

The mission and the process of continuous learning from field

realities has lead to the adoption of the Life Cycle Approach


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(LCA) as the key organizing principle in CINIs

interventions.The approach address issues like low birth

weight, malnutrition and various reproductive and sexual

health issues. The LCA intervention aims to break the

intergenerations cycle of poverty, malnutrition and ill health,

targeting critical stages of the lifecycle, i.e. pregnancy and

lactation period, 0-2 years, and adolescent. Implementing LCA

based interventions would result in lowered maternal and infant

deaths, reduced incidence of low birth babies and improved

awareness regarding nutrition and reproductive and sexual

health issues among adolescents.

The experiences and learnings of various thematic divisions(focussing on child health, adolescent health, womens health,

HIV/AIDS, urban health, education and child protection,

training, communication) and geographical units (state units

and also several district units in West Bengal) enrich the LCA

and thus the interventions involved. These divisions and units

focus on key areas (thematic/geographic) and are developing

as unique resources. Beside this, CINI is also involved in

running various institutional services that provide clinical andcounselling support to women, children and adolescents.

Partnership with the government, CBOs, other civil society

representatives, NGOs, International bodies and donor agencies

constitute a focus area for the institute. Recognizing that it is

this collective strength that makes change possible, CINI has

involved various stakeholders in all its endeavours.


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MILESTONES :-

1975-1985 Under 5 clinic started at Balananda hospital,and St. Vincent school, Thakurpukur, Kolkata

by Dr. S.N. Chaudhuri, sister Pauline Prince

and Rev.Fr.Hendricks SJ.

CINI registered as a society Nutrition Rehabilitation Center opened Relief operation in flood hit Moyna block of

Midnapore

Relief measures undertaken in cyclone hitareas of Andhra Pradesh

Projects of MCH initiated in Moyna (midnapur)and Baikunthapur (south 24 parganas), West

Bengal.

Relief operationin Kampuchea, Cambodia Sishu kalian sahayika and child sponsorship

program started.

Training of anganwadi workers initiated Research undertaken in collaboration with

Nutrition Foundation of India on women and

child health

Relief operation in cyclone affectedSunderban in South 24 Parganas district.

1985-1995 Health intervention initiated in Tollygungeslums

CINI received first National Award in 1985 for


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child welfare

Awareness programme on girl child initiated. CINI ASHA unit set up to look after urban

programs with key focus on street children

Adopt a Mother programme on girl childinitiated


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In the 2nd half, we were given a case study ( situational

analysis ). We had solved it by poster presentation.

The case study was based on NRHM and ASHA, which are

related to women and child care specially in rural areas.

CASE STUDY :-

CAUSES OF NEW-BORNS DEATH :-

1) Poverty


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2) Illiteracy ( family planning )

3) Malnutrition

4) Lack of hygiene

5) Lack of proper sanitation

6) Excessive physical work

7) Poor health of mother

8) Improper medical treatment

9) Inadequate dietary needs during pregnancy

10) Unscientific delivery technique

11) Superstition and prejudice

12) Delayed delivery

13) Poor gestational development

14) Low birth weight

15) Lack of awareness

16) Early pregnancy with low parity


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DATE :- 14.02.2012

1st half (10:00 a.m. to 11:00 a.m.) :-

NRHMThe National Rural Health Mission (2005-2012) seeks toprovide effective healthcare to rural population throughout the

country with general focus on 18 states, which have weak

public health indicators and/or weak infrastructure. They are

Arunachal Pradesh, Assam, Bihar, Chhattisgarh, Himachal

Pradesh, Jharkhand, Jammu and Kashmir, Manipur, Meghalaya,

Madhya Pradesh, Nagaland, Orissa, Rajasthan, Sikkim, Tripura,

Uttaranchal and Uttar Pradesh.

The goal of the Mission is to improve the availability of

and access to quality health care by people especially

for those residing in rural areas, the poor, women and

children.

NRHM - VISION :- It has its key components of decentralizing the health

facilities and prioritise the demands of the beneficiaries.

It also includes the major government departments besides

health like Panchayat, Department of Social Welfare, ULBs

It seeks to revitalize the local health traditions and

mainstream AYUSH into the public health system.


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It seeks to address the inter-state and inter-district

disparities, especially among the 18 high focus states, including

unmet needs for public health infrastructure.

It shall define time-bound goals and report publicly on theirprogress.

It seeks to improve access of rural people, especially poor

women and children, to equitable, affordable, accountable and

effective primary health care.

GOAL OF NRHM :-

Reduction in Infant Mortality Rate (IMR) and Maternal

Mortality Ratio (MMR).

Universal access to public health services such as womens

health, water, sanitation and hygiene, immunization and

nutrition.

Prevention and control of communicable and non-

communicable diseases, including locally endemic diseases.

Population stabilization, gender and demographic balance.

Revitalize local health traditions and mainstream AYUSH.

Promotion of healthy lifestyles.

STRATEGIES AND COMPONENTS :- Accredited Social Health Activists (ASHA)

Stengthening Primary health centres.

District health plan

Public-Private partnership for health goals, including

regulation of private sector.


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Reorienting health/medical education to support rural health

issues.

NRHMState

government

Panchay

at

NGOs ICDS

State action

plans

Prioritize

funding

Public health

budget

Manage

all public

health

institutions.

ASHAs

would be

selected

Prepare

the village

health plan

Jointoperation of

untied fund

PRI

involvement

in Rogi

Kalyan

Samitis

Provision

for training

of PRI

members

Making

available

healthrelated

Included in

institutional

arrangement

at National,

state and

district levels

including

standing

mentoring

group for

ASHA.

Member oftask groups

Provisions of

training, BCC

and technical

support for

ASHAs/DHM

Healthresource

organizations

Service

delivery for

identified

population

groups onselected

Hold

nutrition day

weekly

immunizatio

n day.

Provide

referral

services

Exclusive

breast

feeding

promotion

Awareness

to pregnant

lactating

mothers and

nursing

mothers

Taking

birth weight


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databases. themes

For

monitoring,

evaluationand social

credit

ICDS

ICDS ( Integrated Child Development Service ) was

started in 1975.

ICDS Beneficiaries :-

1) Children below 6 years

2) Expectant and nursing mother

3) Adolescent girls

4) Women in the age group 15-45 years

Services under ICDS :-

1) ICDS provides a package of integrated services in a

comprehensive and cost effective manner to meet the multi-

dimensional and inter-related needs of children.

2) ICDS beneficiaries receive health, nutrition and early

childhood care and education related services. In addition,

there is coverage of other important supportive services like

safe drinking water, environmental sanitation, womens

development and education programmes.


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3) All services in ICDS are expected to converge at the same

set of beneficiaries i.e. group of children and their family to

create an appreciable impact.

Integrated Package of services under ICDS :-

Nutrition :-

1) Supplementary Nutrition

2) Growth monitoring

3) Nutrition and health education

Health :-

1) Health check-up

2) Immunization

3) Identification and treatment of common childhood illness

and minor ailments

4) Referral services

THE ANGANWADICENTRE :-

1) An anganwadi centre a courtyard play centre located

within village or a slum, is the local point for delivery of all the

services under ICDS programme in an integrated manner tochildren and women.


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2) An anganwadi is a centre for convergence of services for

children and women.

3) An anganwadi is a meeting ground, where women/mothers

group can come together with other frontline workers to shareviews and promote action for development of children and

women.

4) An anganwadi is run by an anganwadi worker who is

supported by a helper in service delivery.

ICDS TEAM, THEIR ROLEAND JOB RESPONSIBILITIES

:-

1) A CDPO ( Child Development Project Officer ) is an overallincharge and is responsible for planning and implementation of

the project.

2) A CDPO is supported by a team of 4-5 supervisors who

guide and supervise Anganwadi Workers (AWWs).

3) In large ICDS project, where there are more than 150

Anganwadi centres in a project, an Assistant Child Development

Project O fficer is also a part of the team.

4) A supervisor has the responsibility of supervising 20,25 and

17 AWWs in rural, urban and tribal project respectively.

5) A supervisor guides an AWW in planning and organising

delivery of ICDS services at anganwadi centres and also gives

on the spot guidance and training as and when required.


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6) An anganwadi workeris a community based frontline

voluntary worker, selected from within the local community.

The selection is made by a committee at the project level.

7) An AWW is mainly responsible for effective delivery of ICDSservices to children and women in the community.

8) An AWW is an honorary worker who gets a monthly

honorarium.

9) At each anganwadi centre, a helper is appointed to assist an

AWW.

10) Helper is an honorary worker and is paid monthly

honorarium.

11) Health services in ICDS are given by a team of Health

Functionaries comprising Medical officer, Lady health officer,

ANM and Female health worker from primary health centre and

sub-centre in the project. At the community level ASHA will be

the first part of call for any health related demands and

deprived sections of the populations especially women and

children.

1st half (11:00 a.m. 1:00 p.m.) :-

Introduction to

Ante-natal care

Intra-natal care

Post-natal care

ANTE-NATAL CARE :-


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DATE 15.02.2012

The first half (10 a.m. to 4:30 p.m.) comprises the

discussion on child and neo-natal care, care for children upto 2

years of age, signs and symptoms of an ill or unhealthy baby

and jigsaw puzzle making.

CARE OF A NEWBORN :-Newborn babies need special care and attention.

Newborn care helps the baby to :-

Adjust to the new environment

Establish cardio-respiratory function

Maintain body temperature


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Avoid infections

Promote establishment of lactation

Helps in early detection and treatment of congenital

disorders.

CARE OF LOW BIRTH WEIGHT BABIES :-

If a is less than 2.5 kg, he/she is low birth weight baby and

needs special care.

Provide extra warmth by wrapping the baby well and

covering his head to prevent heat loss.

Keep the baby close to the mother and she should

breastfeed him/her frequenly.

Too many people should not be allowed to handle the baby.

People who have infection should be kept away from thebaby atleast during the first month.

DANGER SIGNS AMONG NEWBORNS :-

Baby doesnot suck or refuses to breastfeed.

Baby doesnot cry/difficulty in breathing

Baby is cold or hot to touch

Baby develops yellowness in palm and soles

Baby has convulsions

Baby is drowsy or cries continuously

Baby does not pass stool within 24hours or urine within 48hours


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Baby has any birth defect

In the 2nd

half (10 a.m. to 4:30 p.m), the session startedwith the topic of immunization and its importance, CD

demonstration.

IMMUNIZATION CHART :-

AGE IMMUNIZATION

At birth BCG, Polio, Hepatitis-B

1 and half months

2 and half months

3 and half months

DPT, Hepatitis-B

8 months completes in 9

months

Measles, Vitamin-A oil

16-24 months DPT, Polio

5 years DT

CD DEMONSTRATION :-

NANHI SI JAANThis CD demonstation is about the care of pregnant women

and child.

The messages conveyed through this CD

demonstration were :-

The mother should not hide the news of pregnancy.


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The mother should take atleast 3 full meals a day as the poornutritional status of the mother may lead to weakness,

anaemia etc. leading to spontaneous abortion, still birth etc.

As the child totally depends on mother for nutrition, themother should take food from all food groups like rice, dal,

wheat, green leafy vegetables, curd, milk, chana, matar, fish,

ghee, meat, egg, germinated grams etc.

Regular health check up is necessary for the mother. Weightand haemoglobin level should be monitored. Folic acid and

iron tablets should be consumed.

BREAST CRAWL

After the delivery of the baby, the mother should start breast

feeding her baby as early as half an hour after normal

pregnancy. Breast crawl technique of breast feeding the infant.

In this technique, the baby crawl on the mothers body and

finds her breast and start suckling. It may take about 1 hour.

This is very useful technique because it increases the milk

secretion of the mother and also creates a strong bond

between the mother and baby.

DA

TE :- 16.02.2012

In the 1st half (10:00 a.m. to 1 p.m.) :-


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VISIT TO CINI 1

The Child in Need Institute phase I has three main

activity centres NRC (Nutrition Rehabilitation Centre),

Thursday clinic, Emergency ward. At first the mother gets the

babys name registered at the centre.

The weight of the baby is measured and if he/she is

malnourished, then he/she is referred to NRC for admission and

treatment.

The baby receives 7 meals a day and mother receives 5 meals

a day. The RCH clinic deals with Reproductive and Child Health

Services.

RCH deals with HIV AIDS and other sexually transmitted

diseases. The Thursday clinic of RCH is a special clinic for

screening AIDS, its treatment and rehabilitation.

At the NRC clinic, both mother and baby are admitted.

FOOD MENU provided at nrc :-

DAY AT 6

A.M.

AT 9

A.M.

AT

12:00

A.M.

AT

2:3

0

P.M

.

AT

4:30

P.M.

AT

7:3

0

P.M

.

AT

10

P.

M.


24/52

Monday Nutrimix

payesh/ha

lwa

Soojis

upma,

boiled egg

Rice, dal,

sabji,

Egg, lemon

Fruit Nutrim

ix

payes

h,puff

ed rice

with

badam

/chola,

cheera

Rice,

dal

sabji/

dal,ro

ti

Sooji

s

paye

sh/h

alwa

Tuesda

y

Nutrimix

payesh/ha

lwa

Nutrimix

laddoo,

boiled egg

Rice,dal,sabji

,nutrella,lem

on

Fruit Nutrim

ix

payes

h, gola

roti

prepared

with

ata+s

ooji+b

esan+

sabji+j

aggery

Rice,

dal

sabji/

dal,ro

ti

Sooji

s

paye

sh/h

alwa

Wednes

day

Nutrimix

payesh/ha

lwa

Puffed

rice,alook

abli andegg

Rice,dal,sabji

,chicken,lem

on

Fruit Nutrim

ix

payesh and

nutrim

ix barfi

Rice,

dal

sabji/dal,ro

ti

Sooji

s

payesh/h

alwa

Thursda

y

Nutrimix

payesh/ha

lwa

Cheeras

upma and

egg

Khichdi

pepared with

dal, green

leafy

vegetables

and othervegetables,

bhaji,

chutney,

salad

Fruit Nutrim

ix

payes

h,

puffed

ricewith

potato

,chola,

onion

Rice,

dal

sabji/

dal,ro

ti

Sooji

s

paye

sh/h

alwa

Friday Nutrimix

payesh/ha

lwa

Soft rice

boiled

with

gourd, dal

Rice, dal,

sabji,fish,

lemon

Fruit Soojis

barfi,

payes

h

Rice,

dal

sabji/

dal,ro

ti

Sooji

s

paye

sh/h

alwa

Saturda Nutrimix Soojis Rice,dal, fruit Nutrim Rice, Sooji


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y payesh/ha

lwa

upma and

egg

sabji,chutney ix

payes

h and

laddoo

dal

sabji/

dal,ro

ti

s

paye

sh/h

alwa

Sunday Nutrimixpayesh/ha

lwa

Payeshprepared

with

cheera,

dal,

jaggery

Khichdi withleafy

vegetables

and other

vegetables,

bhaji,

chutney/sala

d

fruit Payesh, gola

roti

with

besan,

jiggery

,ataa

Rice,dal

sabji/

dal,

roti

Soojis

paye

sh/h

alwa

In the 2nd half (1:30 p.m. to 4:30 p.m.) :-


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Firdausi bibi is a 23 years old housewife. She got married at the

age of 17 years and conceived her first baby within 3 months of

marriage. She lives in a joint family with more than 6 members.

Her husband is a daily wage earner, who earns Rs. 200/day.

During her pregnancy, she weighed 36 kg and suffered from

abdominal pain and anorexia. When She reported this to healthworker, she got an USG done which revealed that uterus was

small. Soon after she delivered her first baby boy who was

healthy.

She again conceived for the 2nd times, when her first baby was

2 year old. At the 8th month of her pregnancy due to water

breakage, she gave birth to premature baby boy weighing just

2 kg. Just after the birth, the baby started gasping for breath

and was turning blue. Then the baby was wrapped in the cloth

and held under the sun, so he recovered.

Both the time, her delivery was done at home by dai-ma.

Her 2nd baby named Farooqh Seikh is 2 years old and is

admitted to NRC unit of CINI 1 with a problem in walking. He

has completed all the immunization, he was exclusively breast

fed for 1 year. Their sanitation and personal hygiene is also

good.


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Communication is a two way process of sharing and

transmitting ideas, information and messages between

two or more individuals.

ELEMENTS OF COMMUNICATION :-

1) Communicator

2) Message

3) Medium

4) Receiver

5) Impact

COMMUNICATION IS AN INTERACTIVE

PROCESS OF 5 ELEMENTS WHICH

ENSURES :-

1) Who?

2) Says what?

3) In what channel?

4) To whom?

5) With what effect?


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FUNCTIONS OF COMMUNICATION :-

1) Sharing of information and ideas

2) Increasing knowledge

3) Influencing people for change in attitudes and beliefs

4) Bringing about behavioural change

5) Persuasion and negotiation

6) Motivation

7) Counseling

8) Giving instructions

9) Reaching a decision

10) Building human relationship

11) Entertainment

COMMUNICATION BARRIER :-

Communication becomes ineffective due to many hurdles

called Barriers of Communication. A good communicator

should be aware of the following communication barriers and

should try to overcome them to avoid problems :-

Poor planning Inadequate knowledge Too much or too less information Unaware of knowledge, attitude and practices of community Failure to understand cultural differences Poor communication skills of communicator


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Poor presentation Selection of inappropriate channels and medium,

Selection of messages contradicting existing beliefs andpractices

Inadequate communication material Inappropriate language Various forms of external noise Insufficient feedback Technical errors.

COMMUNICATION CHANNELS, MEDIA AND

TECHNIQUES :-

MASSCOMMUNICATION

GROUPCOMMUNICATI

ON

INTERPERSONAL

COMMUNICATIO

N

1) Electronic Media :-

Films; Film Quickies;

Radio programmes; Radio

spots; Audio tapes; TV

programmes; TV

quickies/Spot, slides.

2) Print Media :-

Books, booklets,

foldersand leaflets,

handbills, letters,

newspapers,

1) Lecture

2) Group

meetings

3)

Demonstration

4) Camps

5) Field visit

6) Role play

7) Flip book

1)Home visits

2)Counseling

3)Negotiation

4)Motivation and

persuation


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advertisements, press

release, posters,

photographs, hoardings,

magazines, newsletters,

journals.

3) Folk and Traditional

media :-

Song,dance,drama,kiortan

/bhajan,puppet show, wall

writing etc.

4) Alternate Media :-

Street play, nautanki etc.

5) Multi-media

campaigns :-

Publicity

campaigns/awareness

campaigns; exhibition

8) Flash cards

Etc............


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DATE :- 17.02.2012

In the first half (10 a.m. to 4 p.m.) :-

COUGH, COLD AND ACUTE

RESPIRATORY INFECTIONS (ARI)

ARI is the major cause of death among children. On anaverage children below 5 years of age suffer about 5

episodes of Acute Respiratory Infections (ARI) per year.

Cold, cough, sore throat and running nose are commonrespiratory infections and are of no cause of alarm. In some

cases, cough and cold are danger signs of more serious

respiratory as tuberculosis and pneumonia.

COUGH AND COLD :-

Cough and common cold is the most frequent problem inchildhood and is usually due to infection of the upper

respiratory tract.

Cough is a sign of some other sickness affecting the throat,lungs or air passage in the chest.

SYMPTOMS TREATMENT HOME TREATMENT


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AND CARE

Running nose,

sneezing,

sore throatand cough.

Children with

cough, cold,

running nose orsore throat who

are breathing

normally can be

treated at home

and will recover

without

medicine.

A child with

harsh cough

requires

immediate

referral.

Keep the child warm

and let him rest.

Encourage the child to

eat normally

Increase the amount of

fluids including

breastfeeding

Soothe the throat and

relieve the cough

remedy i.e. Ginger tea

with honey; lemon

drink; drink with tulsi

leaves, saunf and

elaichi; hot soups etc.

Sponge/bathe with cool

but not cold water if

child has fever

Clean the nose by

putting in nose drops

(boiled and cooled

water mixed with salt)

or by cleaning the nose

with a soft cotton wick.

A moist atmosphere canmake breathing easier.

Medication should be

used only if prescribed

by a doctor.

PNEUMONIA :-

SYMPTOMS ASSESSMENT TREATMENT


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A child with cough

and cold and fast

breathing haspneumonia

To assess

whether the child

has fastbreathing or not

count the

breathing rate for

one minute.

Breathing rate of

a child is as per

his age. As the

child grows older,

breathing rate

slows down

A child have

pneumonia is

treated withcontrimoxazole.

Contrimoxazole is

not provided in

the medicine of

AWW. She may

contact ANM

immediately, who

can prescribe the

medicine and has

it in her stock.

PREVENTION :-

Million of child deaths from pneumonia can be prevented if :-

Parents and caregivers know that rapid and difficultbreathing are danger signs requiring urgent medical help.

Parents and caregivers know where to get medical help. Medical help and low cost antibiotics are readily available. Babies are exclusively breastfed for 6 months and are fully

immunized.

Children and pregnant women are particularly at risk ifexposed to smoke from tobacco or cooking fires.

SEVERE PNEUMONIA :-

SYMPTOMS ASSESSMENT TREATMENT

If a child with

cold and cough

has chest

chewing, he has

To assess severe

pneumonia, look

for chest

indrawing at the

Refer the child

with chest

indrawing to

PHC/hospital


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severe

pneumonia.

Normally, the

lower chest wallcomes out when

the child

breathes in. In

case of severe

pneumonia, the

whole of lower

chest wall goes

in as the childbreathes in. This

is called chest

indrawing.

lower chest wall

when the child

breathes in.

Make sure thatthe childs lower

chest is fully

exposed, child is

not crying and

childs nose is

not blocked.

immediately, as

this is a specific

danger sign.

DIARRHOEA :-

A child has diarrhoea if he/she passes three or more watery

stools per day.

Diarrhoea is more common among under-nourished children

than in normal children.

Diarrhoea kills children by draining liquid from the body thus

dehydrating the child.

If diarrhoea continues for more than two weeks, it is

persistent diarrhoea. In this case, the child needs

immediate attention and should be referred to PHC/hospital.

If a child has blood in stools, he/she has dysentery and

should be referred to PHC/Hospital.


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Mild Diarrhoea/No dehydration Child drinks normally.

Moderate Diarrhoea/Some Dehydration Child is thirsty

and drinks eagerly

Severe Diarrhoea/Severe Dehydration Child drinks

poorly or is not able to

TREATMENT :-

Diarrhoea usually cures itself in a few days.

Do not give a child with diarrhoea any tablets, antibiotics or

other medicines unless prescribed by a doctor.

A child with persistence diarrhoea or dysentery or severe

diarrhoea should be referred to PHC/hospital.

Home treatment of diarrhoea includes :-

a) Intake of Home available fluids :-

A child with diarrhoea should be given extra fluids availableat home like soups, rice water, coconut water, weak teawith a little sugar, clean water from safe sources, diluted dal,

butter milk and breastmilk (if child is breastfed).

Fluids should not be diluted. If the fluid is heavy for the child,plain clean water can be given to the child after giving fluid.

If the child vomits, wait for 10 minutes, then continue givingfluids, but more slowly.

b)Continued feeding :-

A child with diarrhoea needs to be fed continuously While recovering from diarrhoea, the child needs atleast one

extra meal every day for atleast 2 weeks.

Mother should not stop feeding the child.c) Continued Breastfeeding :-


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Breast milk is the best source of liquid and food for a younginfant with diarrhoea. It can reduce the severity and

frequency of diarrhoea.

Breast feed the baby frequently and for longer time thanusual.

In the 2nd half (1:30 p.m. to 4:30 p.m.) :-

HANDS ON PRACTISE :-We did the hands on practise. We were divided into three

groups. One was given poster presentation on New born care,

the second one was given puppet show on PNC and the third

one was given street drama on ANC.

Our group was allotted for puppet show and so we did the

hands on practise in the second half.

DATE :- 20.02.2012

In the 1st half, we were taught about the growth chart .

This chart is used to monitor the growth of the children

according to their age and weight.


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GROWTH

MONITORINGWhat is Growth Monitoring ? Growth Monitoring means keeping a regular track of the

growth of the child through key indicators like weight,

height according to age etc. at regular intervals.

Growth Monitoring is a way to detect growth failure inchildren at an early stage and take immediate and effective

action.

Growth Monitoring must start right from the birth of the

child.

In ICDS, Growth Monitoring is done with the help of growth

chart.

Growth Chart :- Growth chart is a tool for assessing the growth of the child

using weight-for-age as indicator. It is a visual record of the

growth pattern of a child.

Growth chart also determines the grades of malnutrition of a

child, identifies beneficiaries for supplementary feeding, and

is used for imparting nutrition and health education to

mothers.

Four growth curves on the growth chart depict the growth of

the child and help in assessing his/her nutritional status.

Growth chart has two axis :-


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a) The horizontal axis is for recording the age of the child

and is being referred as month axis.

b) The vertical axis is for recording the weight of the child

and is being referred as weight axis.

Weight of the child as per the the age is plotted on the

growth chart.

When should an Anganwadi workers weigh thechild ?

Weigh all children upto 3 years of age per month.

Weigh children 3-6 years old every three months.

Severely malnourished children and child who have not

gained weight consecutively for three months should be

weighed every month (irrespective of the age)

How to monitor growth of children ?Steps in Growth Monitoring :-

1. Determine correct age of child.

2. Determine correct weight of child.

3. Plot weight accurately on the growth chart.

4. Interpret the direction of the growth curve and recognize

growth failure, if any.

5. Discuss childs growth with mother and the follow-up

STEP 1 : Determine the correct age of

the child :-


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Knowing the correct age of the child is necessary for

accurate growth monitoring.

Assess the childs age by :

a)Asking mother/older members of the family.

b)Checking birth register/home visit, resister/hospital records

for the age of the child.

c) Using local events calendar while talking to the mother about

childs age. A local events calendar indicates all the dates on

which important events took place during the past five years

like name of months, important events in the agriculturalseason of the area, local festivals, national festivals, phases

of moon etc.

STEP 2 : Determine the correct weight of

the child :-

Anganwadi workers are provided salter/bar weighing scalefor taking the weight of a child.

Steps involved in weighing the child are :-

a)Setting the scale -

o Hang the scale securely from a beam or branch of a tree.

o Keep the dial at eye level so that the weight can be easily

read.

o Place the cradle or infant sling on the cradle hook.

o Adjust the pointer to zero by turning the screw on the top of

the scale.

b)Weighing the infant or child -

o

Ask the mother to remove childs heavy clothing.


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o Place the child in the cradle.

o Childs feet should not touch the ground.

c) Reading the scale -

o Scale is graduated from 0 to 25 kg. Each kilogram is divided

by a 500 gm or a 100 gm marking. Read the pointer on the

scale to nearest 100 gms.

o Ask the mother to stand near the child and talk to him/her so

that he/she does not cry.

o Read the weight while standing exactly opposite the scale.

Do not read the scale from the side.

STEP 3 : Plot weight accurately on

growth chart :-

Plotting the weight on the growth chart reveals whether the

child is growing normally or not.

Growth chart should be filled-up systematically as givenbelow :-

a)Fill-up all the necessary information about the child in the

index box on the growth chart register.

b)Fill-up the information box on the growth chart which gives

the childs name, fathers name, mothers name and family

registration number.

c) On the month axis, in the first box write the name of month

and year during which the child was born and then fill-up the

remaining months and year columns for all the five months.

d)On the month axis identify the month box which indicate

the present age of the child.

e)Write the weight taken below the month box.


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f) On the weight axis, identify the line which indicates the

present weight of the child.

g)Plot the weight in the appropriate square above the

identified month box.

h)Draw a circle around the dot so as to know its position.

i) Now connect this dot with the dot made on the previous

month with a line. This forms the growth curve.

STEP 4 : Interpret the direction of growth

curve :-

Direction of growth curve of the child can be upward, flat or

downward.

Direction of growth curve is more important than the actual

weight of the child at any point. It can be interpreted as :-

a)Upward growth curve indicates that the child is gaining

weight and is growing.

b)Flat growth curve indicates that the child is not growing

adequately.

c) Downward growth curve indicates that the child is in danger

and needs immediate health care.

Weight of all normal healthy children fall above the top

curve.

Corrective action on the first sign of growth faltering can

help in restoring health.

STEP 5 : Discuss childs growth with

mother and follow up :-

Priortise children who are malnourished and whose mother

need counselling.


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Show the growth chart to the mother and explain the

direction of the growth curve.

Discuss and ask the parents the reasons for no or poor

weight gain

Advise parents about nutrition care, frequency of feeding

and blending with family food patterns.

Monitor the growth of malnourished child regularly

Convince mothers to bring the children regularly to

anganwadi workers for weighing.

Refer the children whose growth is faltering consecutively for

2-3 months or who are severely malnourished to PHC

hospital.

In the 2nd half, we were told about BMI (Body Mass Index

) and its calculation. Again we were divided into groups

and told to determine our own groups.

BODY MASS INDEX

Body Mass Index (BMI) is a simple index of weight-for-heightthat is commonly used to classify underweight, overweight and

obesity in adults.

BMI is defined as the weight in kilogram divided by the square

of the weight in metres (kg/m2).

CLASSIFICATION :-

Classification Principle cut off

points

Additional cut

off


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Underweight < 18.5 < 18.50

Severe thinness < 16.00 < 16.00

Moderate

thinness

16.00 16.99

Mild thinness 17.00 18.49

Classification Principle cut off

points

Additional cut

off

Normal range18.50 24.99 23.00 24.99

Overweight 25.00 25.00

Pre-obese 30.00 30.00

Obese class I 30.00 34.99 30.00 32.49

32.50 34.99

Obese class II 35.00 39.99 37.50 39.99

Obese class III 40.00 40.00

Calculation of my own BMI are

given below :-

[My weight = 56 kg

My height = 5 ft 2 inches

= 152 + (2.54 x 2)

= 152 + 5.08

= 157.08 cm


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= (157.08)2

= 24674.1264 cm2]

Height in m2 = 2.46 m2

BMI is equals to weight in Kg divided by Height in m2

i.e 56 Kg / 2.46 m2

= 23.15 ( Normal range)

Therefore my BMI is 23.15, which is of normal value.

After this we were given the layout the layout of the diet survey

and it was explained to us. The day ended with hands on

practise.

HANDS ON

PRACTISE :-We did the hands on practise. We were divided into three

groups. One was given poster presentation on New born care,

the second one was given puppet show on PNC and the third

one was given street drama on ANC.

Our group was allotted for puppet show and so we did thehands on practise in the second half.


46/52

It was an informative day which we thoroughly enjoyed.

DEMOGRAPHIC DATA OF DIET SURVEY :-

NAME OF RESPONDENT :- Mrs. Channda Chatterjee

FAMILY SIZE :- Nuclear

TOTAL FAMILY MEMBERS :- 3


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MALE FEMALE

ADULT 1 2

CHILDREN - -

FAMILY HISTORY :-

SL

N

O.

NA

ME

AGE SE

X

EDUCAT

ION

OCCUPA

TI-ON

INCO

ME

PHYSIO-

LOGICA

L

STATUS

PHYSI

CAL

STATU

S

A.C.

U.

1 Ch

ann

da

DATE :- 21.02.2012

MENU :-

EARLY MORNING (6A.M.)

Tea, 2 biscuits

BREAKFAST (8:30 A.M.) 2 Roti (2 pcs. for each

member), sabji

LUNCH (12 P.M.) Rice , dal, sabji, fish curry

(charapona)


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EVENING SNACKS (4

P.M.)

Puffed rice, tea, biscuits

DINNER (9-9:30 P.M.) 3 roti (for each member), dal,

sabji

DATE :- 23.02.2012

MENU :-

EARLY MORNING (6

A.M.)

Tea, biscuits (2 pcs.)

BREAKFAST (8:30

P.M.)

Roti (2 pcs. for each member),

sabji

LUNCH (12:00 P.M.) Rice, mixed veg curry (ladys

finger, broad beans, brinjal,

cabbage, tomato), brinjal fry,

ladys finger,poppy seeds, egg

curry

EVENING SNACKS (4

P.M.)

Puffed rice, tea

Dinner (9-9:30 P.M.) Roti (3 pcs. for each member),

Mixed veg curry


49/52

DATE :- 23.02.2012

MENU :-

EARLY MORNING (6

A.M.)

Tea, biscuits (2 pcs.)

BREAKFAST (8:30 A.M.) Roti (2 pcs. for each member),

sabji

LUNCH (12:00 P.M.) Rice, masoor dal, mixed veg

(broad beans, brinjal, tomato,

onion), cabbage with macher

muro.

EVENING SNACKS Puffed rice, tea

DINNER (9-9:30 P.M.) Roti (3 pcs. for each member),

mixed veg.

CALCULATION :-

SERIA

L

NUMB

FOOD

STUFF

DA

Y 1

DA

Y

2

DA

Y 3

AVERAGE

CONSUMPT

ION

PERHEAD

CONSUMPT

ION


50/52

ER

1 Rice 25

0

gm

2 Atta 27

0

gm

3 Dal

(masoor)

70

gm

4 Fish 25

0gm

5 Egg -

6 Mix veg

(a)ladys

finger

(b)broadbeans,

(c)brinjal

, (d)

cabbage,

(e)

tomato

-

7 Milk

8 Poppy

seeds

9 Biscuits

10 Oil


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11 Puffed

rice

12 Onion

Serial

numb

er

Food

stuffs

Stand

ard

intake

Field

values

Exces

s

value

Defici

ency

value

1 Cereals 460 gm. 227.35

gm

- 232.65

gm

2 Pulse 40 gm. 14.28

gm.

- 25.72

gm.

3 Green

leafy

vegetabl

es

60 gm. 95.23

gm.

35.23

gm.

-


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4 Other

vegetabl

es

50 gm. 164.27

gm.

114.27

gm.

-

5 Rootsand

tubers

50 gm. 45.23gm.

- 4.77 gm.

6 Milk 150 ml. 89.28

ml.

- 60.72 gm

7 Flesh

food

40 gm. 84.51

gm.

44.51

gm.

-

8 Fats andoils

40 gm. 25.59gm.

- 14.41gm

9 Sugar

and

jaggery

30 gm. - - 30 gm.

10 Fruits 30 gm. - - 30 gm.

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