RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES

BANGALORE, KARNATAKA

PERFORMA FOR REGISTRATION OF SUBJECTS FOR DISSERTATION

1 NAME OF THE CANDIDATE

AND ADDRESS

MRS. JASPREET KAUR,

H.NO.230-C, RATTAN NAGAR, TRIPRI,

PATIALA, PUNJAB.

2 NAME OF THE INSTITUTE NOOR COLLEGE OF NURSING,

NO.5, NOOR BUILDING, RMV 2nd STAGE,

BHOOPASANDRA MAIN ROAD,

BANGALORE-94.

3 COURSE OF STUDY &

SUBJECT

M.SC., NURSING 1ST YEAR, PAEDIATRIC

NURSING.

4 DATE OF ADMISSION 01st JUNE 2010.

5 TITLE OF THE TOPIC “A STUDY TO ASSESS THE KNOWLEDGE

REGARDING IMPORTANCE OF PROTEIN

INTAKE AMONG MOTHERS OF UNDER

FIVE CHILDREN ADMITTED IN

PAEDIATRIC WARD OF SELECTED

HOSPITAL AT BANGALORE WITH A VIEW

TO DEVELOP SELF INSTRUCTIONAL

MODULE.”

1

6. BRIEF RESUME OF THE INTENDED WORK

INTRODUCTION

Child health is the foundation of the family and wealth of a nation. Good nutrition is

the basic component of growth and development for maintenance of health throughout life.

“Nutrition is defined as combination of dynamic process by which the consumed food is

utilized for nourishment, structural and functional efficiency of every cell of the

body.” Under five children require balanced nutrition to become healthy for national growth

and economic development1.

Nutrition in early childhood can have lifelong implications. It is important to develop

healthy eating practices in childhood to prevent or delay the development of lifestyle related

diseases. Caregivers of this age must receive the best information and resources available.

The health and nutrition of the children need protection in order to ensure sound foundation

and secure the future of any society. In India, there are 53% of under five children in which

67% million – live without basic healthcare facilities. This means that India alone accounts

for about one-third of all children in the world aged below five who don’t have basic health

care2.

Protein comes from the Greek word meaning “ To take first place.” Proteins are the

chief substances in the cells of the body, they are composed of carbon, hydrogen, oxygen and

nitrogen. Some proteins also contain sulphur, phosphorus and other elements. Proteins are

made up to simpler substances called amino acids classified as essential and non-essential

amino acids Amino acids are essential for building of body tissues for growth, maintenance

and repair3.

Weaning is gradual process started at 4-5 months of age. If supplemented by suitable

foods rick in protein and other nutrient can improve the immunity, help in growth and

2

development. By the age of one year, the child should receive solid foods consisting of

cereals, pulses, vegetables and fruits.4

Growth faltering and malnutrition are highly prevalent in most south Asian countries.

Among the serious consequences, malnutrition is increased in risks of morbidity and

mortality in children as well as deficits in physical stature and lowered cognitive measures.

Protein malnutrition in poor households has been well documented in India, with the highest

rates observed in those aged 12-23 months. Countrywide national Family Health Survey II

data show mean underweight prevalence increases from 11.9% below 6 months infants to

58.4% at 12-23 months of age. The intervention group as a whole has improved feeding

practices.

Global hunger Index, South Asia, Shows that the highest child malnutrition rate is

about 5.6 million leading to child mortality. The 2006 report mentioned the low status of

women and lack of nutritional knowledge are important determinants of high prevalence of

under weight children in the specific region. U.S. Census Bureau and Agriculture department

2007 shows estimated 3.5 million children under the age of five are at risk of hunger and

protein malnutrition. The reason behind in under utilization of existing programmes as free

distribution of food stamps and school meals. 5

The most recent estimate in October 2010 by FAO says that 925 billion people are

undernourished. And the estimated proportions of deaths in which malnutrition is the

underlying cause are roughly similar for diarrhea 61% malaria 57% pneumonia 56% and

measles 45%.4 WHO estimates that more then 300 million children suffer from protein

deficiency only and mortality rate is an high as 40% in under five children. ‘The Lancet’

says protein malnutrition in first two years is irreversible. Protein deficient children grow up

to worse health and lower educational achievements.6

3

The Health status of under five children in 2001 census of Karnataka reported that

under five mortality rate is 69/1000 live births. The census also included that there are about

6.2% of children with severe under nutrition, 45.4% with moderate under nutrition,

39.0%and only 9.4% are normal. Thus, from these data, it is evident that nutritional status of

the under five children in Karnataka is poor.7

A National family Health Survey report shows that 4 out of every 10 children in the

Karnataka stage are undernourished, born stunted or too short for their age. About 70% of the

children in the state in the age group of 6 to 59 months are anaemic. The national Nutrition

Monitoring Bureau report shows the consumption of green leafy vegetables, roots and tubers,

milk and milk related products, fats and oils is low in Karnataka. Considering that some

state-run programmes, like the integrated child Development Scheme ( ICDS), have been on

since 1975, it is surprising that the state is still unable to address the issue of malnutrition.

The ICDS programme is on in 54, 260 anganwadis in the state. Around 44 Lakhs

beneficiaries, including pregnant women, lactating mothers and anganwadi workers are

availing of the benefits. “With Rs.2 per beneficiary, it will take time to achieve complete

control on malnutrition and the government is planning to increase the amount to Rs.4 per

child beneficiary”.9

Protein deficiency constitutes a major health problem in India and other countries of

the developing world. In infants and children every year over 50% of children are

undernourished. The most vulnerable period of malnutrition is first five years. And it is

basically the result of poor knowledge on part of the mothers regarding nutritional

requirements.

6.1 NEED FOR THE STUDY4

“How wonderful it is that nobody need wait a single moment

before starting to improve the world.”

- Anne Frank.

Today’s healthy child is tomorrow’s better citizen. Development of healthy child is

influenced by many factors. Under five children are the most vulnerable groups who are

prone to many infective disease and nutritional deficiencies. Proteins are very important for

growth and development, wear and tear of tissue repair and maintenance, formation of

immune bodies, enzymes and harmones. Proteins also act as sources of energy when

consumed in excess of body need. Protein sources are basically classified as animal source

(eg : Cheese, Milk, liver, Fish, meat and eggs) Plant sources (eg: pulses, nuts, beans and soya

beans). Conventional sources (eg: oil seeds, cakes, sea weeds).10

The protein requirement depends upon the age, sex, physical, physiological and other

factors. ICMR 1981 recommended 1.83 gm per kg of body weight of protein up to 1-3 years

and 1.56 gm per kg of body weight of upto-4-5 years, i.e 22 gm and 29 gm of total

requirement respectively. For infants 2.3gm per kg up to 3 months, 1.8gm per kg up to 3-9

months, 1.5 gm upto 9-12 months is the daily recommended protein allowance. The mental

and social development of the child is dependent on the mother. The mother is the first

teacher of the child, and that is why the mother and child are treated as one unit.

A study conducted to find out the Effect of maternal factors on nutritional status of 1-

5 year old children in urban slum population among 482 children in Punjab reported that

education of mother significantly influenced the nutritional status of under fives as the

prevalence of under nutrition was 60.9% where mother was illiterate and it was only 21.2%

where education level was more than high school. Mother’s age showed highly significant

(p=0.001) effect on the prevalence of under nutrition. That is where mother’s age was less

5

than 20 years; the prevalence was 75.0% as compared to 32.2% where mother’s age was

more than 30 years.12

A vast majority of the children suffering from mild to moderate forms of malnutrition

remain hidden in the community. PEM results from the interaction of several factors among

which two are more as less directly responsible for the disease. First quantitatively

insufficient and qualitatively inadequate dietary intake, second infections processes such as

gastrointestinal and respiratory infections and other infections diseases of childhood.

Infections experienced by children during first year of life represent the major factor in

protein energy malnutrition. In child hood infections especially measles were traced in more

then half of the children. Similar observation concerning of precipitating effect of infections

processes such as measles, Germen measles, whooping cough, primary tuberculosis and

malaria have been seen.13

Insufficiency of food the so-called “food –gap” and lack of awareness are chief cause

of protein energy malnutrition, which is a major health problem particularly in first years of

life. The majority of cases of protein energy malnutrition were nearly 30% are mild and

moderate cases. The incidence of protein energy malnutrition is more in preschool children.

This problem exists in all the states and the nutritional marasmus is more frequent than

kwashiorkor. 15

An cross sectional study was conducted to examine the nutritional status of children

(aged 1-5 years) who lived in the Klong Taey slum Bangkok. Anthropometric measurements

were made for 232 children; socio economic background information was obtained by

interviewing their mothers using a structured questionnaire. The results showed that family

income, maternal housewifely or unemployment food practice and a maternal education level

lower than primary school were associated with low nutritional status of under five children.

6

Findings implied that protein nutrition is remains as threat to the health of urban poor in

Bangkok. The finding should not be over looked countermeasures or indicated.

A study was conducted to determine the prevalence of PEM and its associated with

soil transmitted in Orang Aslu children Malaysia. The study result obtained from 368

children aged 2-15 years showed that the overall prevalence of mild and significant under

weight was 32.1 % and 56.5% respectively. The present study vividly showed that stunting

and under weight are highly prevalent among Orong Aslu children.17

Infants and children under five are the most vulnerable group. They are seriously

affected by deficiency of protein. Serious complications of advanced Protein energy

malnutrition(PEM) can happen leading to superadded overt and hidden infections like

septicemia, pneumonia, diarrhea, pyoderma, scabies, U.T.I, tuberculosis infection. Mothers

are the most wondrous care givers who nurture their kids. Thus they play a prime role in

providing nutrition. So they should have adequate knowledge of protein’s significance in

diet of under five children.

The nurse plays an important role in educating the mothers of under five children

about significance of protein in daily diet. Ongoing health education and reinforcement while

monitoring to reduce protein deficiency is an important challenge for nurses. Education of

mothers is the process of assistance to learn and incorporate healthy eating behaviors in

every day life. Providing sound and sincere advice regarding the measures to take adequate

protein will provide health promotion positively. Hence the investigator found need to assess

the knowledge of giving protein diet to the under five children among mothers.

6.2 REVIEW OF LITERATURE

7

The review of literature is defined as broad, comprehensive in depth, systematic and

critical view of scholarly publications, unpublished scholarly print material, audio-visual

materials and personal communications.

Review of literature provides the basis for future investigation, feasibility of study

and indicates constraints of data collection. Review of literature is extensive, exhaustive

examination of publication relevant to research project. It is under taken to establish the

need for the study methodology , development of a tool and structured teaching programme.

The review of literature in this chapter is presented under as follows.

Literature related to protein sources

Literature related to feeding practices among under Five children

Literature related to demographic variables of protein malnutrition

Literature related to knowledge of mothers of under five children regarding protein

energy malnutrition

Literature related to protein sources

An experimental study was conducted in among 3-5 years children living in rural area

who were below the 90th percentile of standard weight for age to compared the nutritional

status with serum protein and lipid to determine the effect of protein source egg on them.

The result shows that because of addition of three eggs per week, total cholesterol HDL level

has decreased and albumin prealbumin and HDL levels demonstrated significant increasing

levels so in conclusion three eggs for week can provide adequate protein for children of 3-5

years of age. 18

An Article stated for children 1-3 years the average daily intake of cereals and millets

among 1-2 years children was 136 g forming 78% of RDI. The intake of cereals of millets

was lower than the RDI in all the states except in Madhya Pradesh (106% of RDI). The

8

extent of deficit was the highest in Kerala and Gujarat (36%), followed by Tamil Nadu and

Maharashtra (33%), Karnataka, Orrisa West Bengal (20%)and Andra Pradesh(10%). The

mean intake of pulses of legumes(12g) was about a third of the RDI (35g). the consumption

of green leafy vegetables, a rich source of B carotene, was negligible(6g).19

A study was conducted to measures the levels of proteins in different vegetarian

sources by The Ralston Purina Company of St. Louis. The study revealed that soyabeans

contains 42% protein 33% carbohydrates, 20% oil, 5% hulls. It is clear from the study that

10-15% of babies in U.S. are raised on soy-based formula and almost 60% of their favourite

food supplements contain soy protein . Study concluded that soy a or bean protein is best out

of vegetarian sources of protein. 20

The study was conducted at Harvard University to assess the level of proteins in

vegetarian diets. Results showed that dairy and egg products are the complete sources for

lacto -ovo vegetarians only vegetable sources contain significant amounts of all eight types

of essential amino acids. It further concluded that essential amino acids can be obtained by

eating a variety of plant sources. 21

Literature related to feeding practices of under Five children

An article on “ Additional Reasons For a Vegetarian Diet” Stated that various

ethical reasons for choosing vegetarianism. Jainism teaches vegetarianism as a moral

conduct, so prohibit meat eating. Hinduism hold vegetarianism as an ideal and have

conviction that non-vegetarian food is detrimental for the mind and spiritual development.

In Buddhism there are several Sanskrit texts where Buddha instructs his followers to avoid

meat. The Sikhism prohibits Sikhs to eat meat and eggs. The article showed there is

definitely a concern of vegetarianism with protein deficiency. 22

9

A study was conducted to assess the nutritional status of 100 pre-schoolers from

anganwadi centers in slum areas of Udaipur city. Interview schedule containing questions on

background information about the family was used. Detailed information was also collected

from records of Anganwadi survey and beneficiary survey register. The assessment of

nutritional status of the subjects was based on weight for age. The study result reveals that

more than 50% of these pre-schoolers showed symptoms of protein energy malnutrition and

anemia, while 22% had pigeon chest deformity due to vitamin D and calcium deficiency.

Classifications for degree of malnutrition as per IAP showed that majority of these subjects

(66%) were under weight (Grade I and II). Water low’s classifications revealed that majority

of these preschoolers were wasted (30%) or wasted and stunted (42%).23

A study was conducted to examine the association between complementary feeding

practices and mother’s education status in Islamabad among mothers of 500 infants attending

the Pediatric Outpatient department. The study results showed a positive relationship

between the nutritional status of infants and educational status of mothers (P<0.001). A

similar relationship was observed between the educational status of respondents and the

introduction of complementary foods at an appropriate age (six months) on infants

(p<0.001).24

A study was conducted on physicochemical properties and nutritional traits of millet-

based weaning food suitable for infants in Kumaon hills, northern India. A weaning food

based on malted foxtail millet flour (30%), malted barnyard millet flour (30%), roasted

soybean flour (25%) and skin milk powder (15%) was prepared. The mix contained 18.37

grams proteins and 398 kcal energy per 100 grms, The nutrient composition of this fortified

weaning mix met the prevention of food adulteration standards. So, this met the

acceptability of criteria for weaning food.

10

A Study wad conducted on early in weaning increase infants’ acceptance of new

foods for up to two months at Nestle Research Center, Switzerland. Infants receiving their

first vegetable(carrot puree) and over the next 9 days either carrots every day, 3 vegetables

changed for every 3 days or 3 vegetables changed daily. On the 12 th and 23rd days receive

new vegetable purees, tomato then peas. Several weeks later, they received 2 more new

foods, meat and fish. Results showed that variety in weaning increased new food acceptance.

Frequency of change was more effective than number of vegetables fed. They concluded that

these interventions correspond to differences in milk and vegetable feeding have practical

consequences for acceptance of new foods.

The findings of the study on the influence of infant feeding practices on nutritional

status of under five children in selected four Anganwadi areas of urban Allahbad showed

that among all under five children surveyed, 36.4% underweight, 51.6% stunted and 10.6%

wasted. The result also revealed that initiation of breast feeding after six hours of birth,

deprivation from colostrums and improper complementary feeding were found significant

(P<0.05) risk factor for underweight.25

A study was conducted to assess the nutritional status and feeding practices of under-

five children in Tanzania. Face –to-face interviews with the sampled mothers were

conducted using a semi-structured questionnaire. Anthropometric measurements using

weight-for-age criterion were employed to assess the nutritional status. The study showed

that 31% of the children were undernourished, some (6%) of them severely. Breast feeding

duration of more than one year was common among the mothers. Fifty-four percent of the

weaned their children as early as two months after birth. The most common type of weaning

food was maize porridge mixed with cow’s milk (46%). An educated mother was less likely

11

to have an undernourished child, while a child from a teenage mother was more likely to be

undernourished.26

Literature related to demographic variables of protein malnutrition.

A descriptive study was conducted to find underlying causes of protein malnutrition

in under five children on Nigeria. It was found using modified Wellcome classification that

prevalence of PEM was 27% in rural Nigerian community. It also concluded poverty,

inadequate food production, ignorance and uneven distribution of food are also the

underlying causes of malnutrition in under five children. 27

A case controlled study was conducted to determine the socio-economic factors

predisposing under five children to severe protein malnutrition in 66 children age 3-36

months attending out patient department Moi Teaching and Referral Hospital in Eldoret,

Kenya. The result showed social rick factors were single mothers (OR 14.93), young

mothers (OR 3.95), living in temporary house (OR 3.627), caretaker who was not married to

child’s parent (OR 0.10). It conclude that socio –economic for protein malnutrition are single

mothers, poverty, social conditions, sex of the child and incomplete immunization. 28

A study was undertaken to assess the impact of drought on childhood illnesses and

nutrition among 914 under five children of rural population using three stage sampling

design in Rajasthan. The findings of the study revealed that children suffered from recent

and long term malnutrition were 39% and 26% respectively as per National Centre for Health

Statistics (NCHS) standards. The extent of malnutrition was significantly higher in females

than in males (P<0.01). Vitamin A & B complex deficiencies were 0.7% and 3%

respectively. The protein energy malnutrition (PEM) was observed in 44.4%. Overall mean

calorie and protein intake deficit was observed to be very high (76.0 & 54.0%). The

12

comparison of present drought results with earlier studies in normal and drought conditions

showed higher prevalence of PEM and deficiencies of calories & proteins in their diet.29

A survey was conducted to examine how economic inequality was associated with

chronic childhood PEM, Information was collected on 32-35 children aged 0-59 month.

Household wealth status was measured by an index based on household ownership of durable

assets. The results of this study indicated that children in poorest 20% household were more

than twice as likely to suffer from stunting as children in richest 20% households. The study

concluded the wealth inequality is associated with chronic childhood under nutrition and

emphasizes that reducing poverty and making

services accessible to poor will be key to improve nutritional status of under five children in

Combodia. 30

A repeated cross sectional study was conducted to measure rates of hunger and food

insecurity among young U.S born Latino children with Mexican immigrant parents

compared with a non-immigrant non-latino in a low income clinic population. A survey was

done on 4278 caregivers of children <3 years of age in a pediatric clinic for 5 years period.

The results showed young Latino children has higher rates of child hunger than non-Latinos

6.8 vessus 0. 5% It concluded that young children in Mexican immigrant families are

especially high rick for hunger, household in security and in turn malnutrition. 31

A study was conducted among 90 mothers of weaning age children on infant feeding

practices of Pakistani mothers in England and Pakistan. 45 were in England and 45 in

Pakistan. A questionnaire available in English and Urdu was used to find out about general

beliefs about weaning. Result showed that mothers in both groups commence weaning

between 3-4 months, common weaning foods included rice, cereals and eggs with

progression to fruit and vegetables and family food in Pakistan, and fruit, Vegetables, meat

13

and convenience foods( especially sweet options) in England. Both groups of mothers

wanted more information about infant feeding practices. It was concluded that mothers in

Pakistan demonstrated more confidence in weaning practices than in England because of

experiences with other siblings and advice from relatives. More advice from health

professionals was requested and is needed by all mothers in order to improve weaning

practices of the infants. 32

A cross- sectioned study was conducted to determine the prevalence and to identify

risk factors associated with protein-energy malnutrition (PEM) in 798 children under five

years of age in Luangprabang province, Laos. Anthropometric measurements of 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. The

findings reveled that there was a high prevalence of stunting, underweight and wasting,

which 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. However, it was also found that boys were more

prone to be stunted and underweight. Furthermore, restricted intake of meats, vegetables

during illness, and low maternal education were main risk factors for child malnutrition in

the study area.33

A study was conducted to examine the factors causing Malnutrition in Bangladesh

among 560 under Five Children. The analyses revealed that 45 percent of the children under

age five were suffering from chronic malnutrition, 10.5 percent were acutely malnourished

and 48 percent had under-weight problem. The main contributing factors for under five

malnutrition were found to be previous birth interval, size at birth, mother’s body mass index

at birth and parent’s education.34

14

Literature related to knowledge of mothers of under five children

regarding protein energy malnutrition

A study was conducted on intensive nutritional education with or without

supplementary feeding improves the nutritional status of moderately malnourished children

in rural Bangladesh. About 282 moderately malnourished children aged 6-24 months were

considered. Mother of them were divided in two groups; one with intensive nutrition

education group and other with both intensive nutrition education, and their children received

additional supplementary feeding. Ability of mothers to identify malnutrition improved from

15% to 99% in the intensive nutrition education group and from15% 0 100% in the intensive

nutrition education and supplementary feeding. It was concluded the study that intensive

nutrition education improves the status of children with or without supplementary feeding. 35

A study was conducted to find the relationship between the maternal nutritional

knowledge and nutritional status in Ghana. The data were collected from 55 well

nourished and 55 malnourished mothers – child pairs. A questionnaire designed to collect

data on mother’s knowledge and practices related to child care and nutrition was

administered to the mothers. The data on mother’ demographic and socioeconomic

characteristics as well as child anthropometric data were also collected. Maternal

education on the other hand was not found to be independently associated with nutritional

status. These results imply that mother’s practical knowledge about nutrition may be more

important than formal maternal education for child nutrition outcome.36

A cross-sectional study conducted on Evaluation of nutritional knowledge of thirty

mothers (house wives) about their children in Pakistan revealed that early weaning was noted

in 12 (11.4%) infants, 41 (39%) infants were weaned in 4-6 months and delayed weaning

was noted in 52 (49.5%) infants. Boiled water was used by 14(46.6%) mothers and filtered

15

water by 4(13.3%) while 12 (40%) mothers used tap water. 80(76.19%) infants received

Gutti as first feed while colostrums was given to 25(23.80%) . 28(93.3%) mothers did breast

feeding, 10(33.3%) gave cow’s milk along with breast milk and 11(36.6%) formula milk

along with breast milk.37

A case control study was conducted to find out maternal knowledge of malnutrition

and health care seeking attitudes of 68 mothers in rural Tamil Nadu. The study reported

that 34 mothers of well nourished children have more knowledge (59%) regarding role of

lack of food or nutrition in mild marasmus – kwashiorkor mixed malnutrition compared to

the 34 mother of severely malnourished children (35%). There were 67.6% of poor and

illiterate mothers out of 68 mothers. The study also reported that only 28% of mothers

would seek medical care for malnutrition.40

6.3 STATEMENT OF THE PROBLEM

“A Study To Assess the knowledge regarding importance of protein intake

among mothers of under five children admitted in peadiatric ward of selected hospital

at Bangalore with a view to develop self instructional module”.

6.4 OBJECTIVES OF THE STUDY

To assess the level of knowledge regarding importance of protein intake among

mothers of under five children.

To find out association between level of knowledge among mothers of under five

children with their selected demographic variable.

To prepare Self instructional module (SIM) regarding importance of protein intake.

6.5 OPERATIONAL DEFINITIONS

Assess: It is the statistical measurement of level of knowledge regarding

importance of protein intake among mothers of under five children observed by 16

structured knowledge questionnaire.

Knowledge : It refers to the verbal responses given by mothers of under five

children regarding importance of protein intake.

Mothers : In this study it refers to the mothers who have children below

five years of age and taking care of them.

Under five Children : In this study it refers to the children who were below the

age group of five years.

Protein intake: Protein is the chemical compound composed of carbon, oxygen

and nitrogen. It is needed for growth and development of children.

Self instructional module : It refers to the informational booklet which include the

definition, meaning of protein, sources of protein, functions, importance/ need of

protein intake and deficiency problems with management and preventive measures

of protein.

6.6 ASSUMPTIONS

Mothers of under five children possess some knowledge regarding importance of

protein intake.

Self instructional module regarding importance of protein intake will help them to

enhance their knowledge to follow during practice.

6.7 DELIMITATIONS

The Study is Limited to

Mothers of under five children

Pediatric wards of selected hospitals at Bangalore.

The study is limited to 6 weeks.

17

7 MATERIAL AND METHOD

7.1 Primary source : Mothers who are having under five children admitted in Peadiatric

ward of selected hospital at Bangalore.

7.2 Research Approach : Descriptive approach

7.3 Research Design : Descriptive design.

7.4 Settings of the Study: The study will be conducted in Mediscope, Republic, Green

View Hospital of Peadiatric ward at Bangalore. These hospitals approximately 5 to 10

Kms away from Noor College of Nursing.

7.6 Population : Mothers of under five children who are admitted in peadiatric ward of

selected hospital at Bangalore.

7.7 Sample : In this study mothers those who all are having under five children admitted

in peadiatric ward of selected hospital at Bangalore.

7.8 Sample Size : The sample size of this study is 60.

7.9 The Sampling Technique : Non Probability Convenience sampling.

7.10 SAMPLING CRITERIA

(i) INCLUSION CRITERIA : The mothers

Who have under five children.

Who all are having either male or female babies.

Who are willing to participate in the study

Who can read and write English or Kannada.

(ii) EXCLUSION CRITERIA : The mothers

Who have children more than the age of five years.

Who are not willing to participate in study

Who don’t know Kannada or English.18

8 DESCRIPTION OF VARIABLES

The study variable is knowledge of mothers of under five children regarding protein

in take.

9 METHOD OF DATA COLLECTION

Prior to data collection, permission will be obtained from the concerned authority for

conduction of study. After obtaining consent from the subject, the investigator will

explain the purpose of the study and the structured knowledge questionnaire will be

administered to collect the data, followed by self instructional module regarding importance

of Protein in take will be provided. The study period is 4-6 weeks.

10 DESCRIPTION OF TOOL

As per expert opinion structured knowledge and occupation of mother questionnaire

will be prepared. It will consist of :

Demographic variables like age and sex of child, education of mother, occupation,

religion and residential area etc.

Structured knowledge questionnaire regarding importance of protein intake among

under five children’s mothers.

11 STATISTICAL ANALYSIS

Data obtained will be assessed in terms of objectives of the study by using descriptive

and inferential statistics.

Descriptive statistics

Frequency and percentage distribution will be used to analyse the demographic data

of mothers of under five children.

Mean and standard deviation will be used to assess the level of knowledge regarding

importance of protein intake among mothers of under five children.19

Inferential Statistics

Chi square (x2) will be used to find out the association between the knowledge score

of mothers of under five children with their selected demographic variable.

12. DOES THE STUDY REQUIRE ANY INVESTIGATION OR INTERVENTION

ON PATIENT OR OTHER HUMAN BEINGS ANIMALS. IF SO PLEASE

DESCRIBE:

Yes, SIM will be administered and level of knowledge will be assessed.

13. ETHICAL CONSIDERATIONS TOWARDS SAMPLE RELATED TO STUDY

YES

Permission will be obtained from concerned authority in the selected pediatric

hospital to conduct the study. A written consent will be obtained from the participants of this

study

20

14. LIST OF REFERENCES

1) Mrs.Vasundra, Community health nursing 1994, 2nd edition, JP Brothers P135.

2) Park. K, Text Book of Preventive and Social Medicine 200, 18 th edition,

Banarasidas Bhanot Publishers. P 432, 435, 654.

3) http://e b health care . com / http://: goggle.com

4) http://iresearch . World bank .org/Povcal Net. Life Style lounge. http//i love india

com.

5) Tada Y, Keiwkarnaka B, Pancharuniti N, Chamroonsawasdi K. Nurtritional status

of the preschool children of the klong Toey slum Bangkok. Southeast Asian J Trop

Med Public Health.2002 Sep;33:628-37.

6) Nirmala M Nagaraj. Nutrition still a distant dream. 4 out of 10 kids in Karnataka are

under nourished. The Times of India, Bangalore 2008 Dec 2; Times city(col.7).

7) Karnataka’s Health Action 2001 Aug: 36-39.

8) Suraj Gupta, the short Text Book of Pediatrics, 2009, 11th edition Jaypee Brothers

Medical Publishers P. Ltd P146.

9) Ghai OP Essential pediatrics, 1996, 4th edition, Inter print Publishers New Delhi

P47-48.

10) Iqbal Hossain M, Yasmin R, Kabir I, Nutritional and immunization status, weaning

practices and socio-economic conditions of under five children in three villages of

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15. SIGNTURE OF THE CANDIDATE

16 REMARKS OF THE GUIDE

17 17.1 NAME AND DESIGNATION

OF THE GUIDE

17.2 SIGNATURE

17.3 CO-GUIDE

17.4 SIGNATURE:

17.5 HEAD OF THE

DEPARTMENT

17.6 SIGNATURE

18 18.1 REMARKS OF THE

CHAIRMAN AND

PRINCIPAL

18.2 SIGNATURE

25