RAJIV GANDHI UNIVERSITY OF HEALTH SCEINCES

BANGALORE, KARNATAKA.

“A STUDY TO ASSESS THE EFFECTIVENESS OF STRUCTURED

TEACHING PROGRAMME ON PREVENTION OF SELECTED

VITAMIN DEFICIENCY DISORDERS AMONG MOTHERS

OF UNDER FIVE CHILDREN IN SELECTED

RURAL AREAS AT

KOLAR”.

PROFORMA FOR REGISTRATION OF SUBJECT

FOR DISSERTATION

Mr. KULDEEP SINGH

A.E.&C.S. PAVAN COLLEGE OF NURSING

KOLAR, KARNATAKA.

RAJIV GANDHI UNIVERSITY OF HEALTH SCEINCES

BANGALORE, KARNATAKA.

PROFORMA FOR REGISTRATION OF SUBJECT

FOR DISSERTATION

1. NAME OF THE CANDITATE AND ADDRESS

MR. KULDEEP SINGH 1ST YEAR M.SC. NURSING, PAVAN COLLEGE OF NURSING KOLAR.

2. NAME OF THE INSTITUTION

A.E. & C.S, PAVAN COLLEGE OF NURSING, KOLAR.

3. COURSE OF THE STUDY AND SUBJECT

M.SC. NURSING CHILD HEALTH NURSING

4. DATE OF ADMISSION TO COURSE

03-06-08

5. TITLE OF THE TOPIC “A STUDY TO ASSESS THE EFFECTIVENESS OF STRUCTURED TEACHING PROGRAMME ON PREVENTION OF SELECTED VITAMIN DEFICIENCY DISORDERS AMONG MOTHERS OF UNDER FIVE CHILDREN IN SELECTED RURAL AREAS AT KOLAR”.

6. BRIEF RESUME OF INTENDED WORK

INTRODUCTION

‘’Children are the most valuable asset for any society they

Are the builders of the future of any nation,

Children health-Tomorrow’s wealth.’’

(Jawaharlal Nehru)

Health care of under five children has been markedly changed in developed countries.

There is a change in the view of children from, “Miniature adults” to “Unique individual”

with special need and qualities, the under five children has prime importance, as the

mortality and morbidity are higher in this group, due to vitamin deficiency disorders. In

1984 world health day rightly spotlighted the basic truth indicating that must all

safeguard the healthy minds and bodies of the family, external joy to the parents, thrill of

the society and hope the nation, their well being is the basic concern of the nation1.

Under five children focus on important segment of the Indian population. They contribute

to the vital human potential and impart strength to the national economy and

development.1

The word “vitamin” means life. Vitamin are substances essential for the maintenance of

normal metabolic functions they are required for the metabolism of carbohydrates, fats

and proteins. Vitamins are widely used as dietary supplements. Even through vitamin

supplements are of no demonstrated value for healthy infants, child adolescents or adult

who is consuming an adequate and varied diet.2

More than 254 million children suffer from vitamin deficiency world wide in each year,

20-40 million children suffer from mild vitamin-A deficiency and three million children

from severe deficiency. World health organization estimates that 100 to 140 million

children under the age of five may be living with dangerously low vitamin-stores. More

than four million children are world wide exhibit sign of severe deficiency. In Karnataka

0.3% of children are suffering from vitamin deficiency.3

1

Vitamin deficiency disease, which are mainly seen in under five children is due to

vitamin-A and D deficiency.

Vitamin-A deficiency is seen more commonly in under five children (1-5 yrs). Vitamin-A

deficiency affect the eyes. It causes “xeropthalmia” which is characterized by series of

clinical signs. These are include- Night blindness, Conjuctival xerosis, Bitot-spot,

Corneal ulceration, Karatomalacia and Corneal scar. Dietary deficiency of vitamin-A

most commonly and importantly affects the eyes, and it can lead to blindness.

Xerophthalmia, meaning drying of eyes (from the Greek word Xerox, meaning dry) is the

term now used to cover the eye manifestations resulting from vitamin-A deficiency.4

However, recently the world summit for children (1992) and the international conference

on nutrition (1992) called for the virtual elimination of vitamin-A deficiency and its

consequences including blindness, by the year 2000. Much more emphasis is now being

placed on the control of vitamin-A deficiency. World fit for children goal to achieve

sustainable elimination of vitamin-A deficiency by 2010 (WHO).5

Another vitamin is vitamin-D. The vitamin-D “Rickets” in under five children. It reduces

calcification of bones which affect growth of bones and causes deformity of bones, such

as- Curved legs, Pigeon chest, Rickets rosary, deformed pelvis. There is delayed teething,

Standing and Walking.4

The term “Rickets” is thought to be derived from either the English word ‘Wrick’

meaning to twist or from the Greek word Rachitis. The essential lesion is an excess of

osteoid tissue, which lacks mineralization in growing bones. The two main factors are

responsible for causing rickets- Vitamin-D and Non-vitamin deficiency rickets.6

As a result, vitamin deficiency disorders are quite prevalent in the developing World and

particularly in countries with the highest burden of under five deaths.

6.1. NEED FOR STUDY:

“We forget about what a child will become tomorrow,

Yet we forget that he is some today”.

2

(Stacia-Tauscher)

During the first year after birth, breast milk from a well nourished mother provide all

vitamins that an infants needs, since 12% of the children (1-5yrs) constitutes a valuable

and much neglected population of our country education and health status of children of a

nation is a highly reliable index of health of its population, under five children suffer

from major health problem of them is vitamin deficiency disorders and the reason are

overcrowding, unhygienic products, poor environmental health, poor education or lack of

knowledge in mothers and poor nutrition.7

Vitamin-A deficiency is a major public health problem; those most deficiency countries.

In children, Vitamin-A deficiency disorder is the leading cause of preventable visual

impairment and blindness. Vitamin-A was estimated to affect between 75 and 254 million

preschool children each year.In a recent meta-analysis conducted by West 127.2 million

preschool-aged children were vitamin A–deficient; this figure represents 25% of

preschool-aged children in developing countries and in one developed country

experiencing social conflict. Furthermore, 26% of vitamin-A deficient children lives in

Africa, with the largest number in Ethiopia (6.7 million). Estimated 250,000–500,000

vitamin- A deficient children become blind every year, and about half of them die within

a year of becoming blind vitamin-A deficiency significantly increases the risk of severe

illness and death from common childhood infections, particularly diarrhoeal diseases and

measles. It was estimated that worldwide, vitamin-A deficiency may be responsible for as

many as 1.3–2.5 million deaths annually. 5

A survey of blind school students in Nine Indian states revealed that 18.6% of the

blindness was due to vitamin-A deficiency and another 3.2% due to measles which

precipitates vitamin-A deficiency. On the other hand, vitamin-A deficiency contributed to

only 5.5% of the childhood blindness in a population-based survey in West Godavari

district of Andhra Pradesh. The magnitude of childhood blindness due to vitamin-A

deficiency probably varies considerably in different parts of India. This may be related to

variations in socioeconomic status. Vitamin-A deficiency also contributes to child

mortality, which can be reduced with vitamin-A supplementation.8

3

In Karnataka (2001) the stages of xerophthalmia in Rural areas are, Night-blindness

4.2%,Conjuctival-xerosis 18.6%,Bitot-spot 6.2% in Urban areas, Night-blindness

2.9%,Conjuctival-xerosis 15.7% and Bitot-spot 3.4%.9

Eyes are windows for the human being through which they are able to utilize the entire

glory of the nature. This vision can be affected by many factors such as-faulty practices

malnutrition, infection and refractive errors. The vitamin-A deficiency is the major cause

of disturbances in vision during preschool age. Vitamin-A is essential nutrient that play

an important role in vision.9

Inadequate dietary intake of vitamin-A is the primary cause of vitamin-A deficiency.

Low fat content of diet is also an important contributory factor. The consumption of

animal foods that contain performed vitamin-A is very low because of cost.10

The term “Rickets” is thought to be derived from either the English word ‘Wrick’

meaning to twist or from the Greek word Rachitis.6

It has been estimated that one million children world wide have vitamin-D deficiency.

One study fond the prevalence of rickets in under five children to be 1.6% and the UK,

The prevalence of vitamin-D insufficiency in under five children is 14.5%.76% pregnant

mother are severely vitamin-D deficient, causing widespread vitamin-D deficiencies in

their unborn children which predisposes them to type one-Diabetes, Arthritis, Multiple-

sclerosis and Schizophrenia later in life 81% of children born to these mothers were

deficient.11

Rickets is a public health problem in Bangladesh during past two decades. Up to eight

percent of children clinically affected in some areas, Insufficiency of dietary calcium is

thought to be the underlying cause and treatment is calcium is curative. Effective

preventive measures that can feasibly reach entire communities are needed and these may

differ between various affected regions.12

In India, rickets still exists. The age incidence of vitamin-D deficiency rickets is higher

and the most response to vitamin-D is satisfactory. Most hospitalized children with frank

4

vitamin-D deficiency rickets in the tropical countries are between the age of two and four

years and constitutes nearly two-third of the total cases. A nutritional survey conducted

by the national Institute of nutrition Hyderabad has placed the incidence of rickets at the

five percent among the deficiency disease while a higher rate of prevalence of diseases

has been observed in Maharashtra.14

Vitamin-D deficiency rickets and osteomalacia caused by inadequate exposure of

sunlight, dietary calcium deficiency and fluoride interaction syndromes, were commonest

disorders responsible for bone disease and deformities, besides caused by endemic

skeletal flurosis as a single entity in endemic flurosis villages. Vitamin-D deficiency

rickets in children and osteomalacia in the mothers are commonest disorders prevalent in

the rural population of India.13

Karnataka has a population of 45 million,The state has a literacy rate of 56%. The food

consumption patterns reveal that cereals and millets are the main food items. However,

protective foods (i.e. foods that are rich in proteins, vitamins and minerals) are consumed

in lesser amounts. When compared with the average Indian recommended dietary intake

(RDI), the intake of energy in adults was found to be higher, as was protein. The average

intake of vitamins, however, was 50% less than the recommended dietary intake. An

improvement in the nutritional status of rural adults has been observed in recent years.

Protein energy malnutrition, vitamin (A and D) deficiency disorders are the major

nutritional deficiencies among preschool children, in Karnataka.14

The Researcher during his experience has also found that mothers had lack of knowledge

regarding prevention of selected vitamin deficiency disorders. So investigator felt the

need to assess the mother’s knowledge regarding prevention of selected vitamin

deficiency disorders in under five children and to impart structured teaching programme

to improve the mothers knowledge.

6.2. REVIEW OF LITURATURE:

A literature review is a written summary of the state existing knowledge on a

research problem, the lack of reviewing research literature involves the

identification, selection critical analysis & written description of existing

information on a topic.

5

(Polit & Hungler 2003)

This chapter deals with a review of published and unpublished research studies and from

related material for the present study. The review helped the investigator to develop an

insight into the problem area. This helped the investigator in building the foundation of

the study.

The reviews of related literatures are presented under following situations.

1. Studies related to etiology & risk factors on vitamin-A and vitamin-D deficiencies.

2. Studies related to manifestation, treatment and prevention of vitamin-A and vitamin-D

deficiencies.

3. Studies related to Lack of knowledge and the effectiveness of Structured Teaching

Programme on prevention of selected vitamin deficiency disorders.

1. Studies related to etiology & risk factors on vitamin-A deficiencies.

A study was conducted to determine the risk factors of xeropthalmia among preschool

children in rural India. The cross sectional method was used. The area of bihta, primary

center in Bihar, India and included 4,205 preschool children from 14 villeges.The

outcomes was risk factors of xerophthalmia, nearly socioeconomic status and a history of

repeated diarrhoea, measles, passing worm in stool and respiratory tract infection. The

result indicate that the socio economic status of families, a history of passing round worm

in stool and diarrhorea were important antecedent risk factors in vitamin-A deficient in

pre school children.15

A study conducted on Drumstical leaves as a source of vitamin-A in ICDS-SEP, An

integrated approach was adopted in this study. This included comprehensive training

sessions for the staff of the ICDS and non government organization (NGO) involved in

the SF preparations. Prior to the acceptability trails, data were elicited on the

socioeconomic profile and knowledge about vitamin-A, of 60 children of 1-5 years of age

attending two aganwadi centers of the ICDS.The result indicated that integration of

nutrition communication along with the introduction of unconventional Dehydrated

Drumstick leaves (DDL), into the ICDS-SF, was feasible and can be endeavored for a

longer duration in the existing national programme.16

6

A practices and study conducted on dietary xerophthalmia in under five in Jimma town,

south west Ethiopia to assess patients knowledge about children need for plants sources

of vitamin-A intake, to estimate the prevalence of xerophthalmia and to forward

appropriate recommendations. Eight hundred and thirty one randomly selected children

between the ages of six to 59 months formed the study population. The result of study

showed that only eighty percent of the children were getting green vegetables, fruits and

carrots once a weekly or more. The major reasons given for not including green

vegetables, fruits and carrots in the diet were “can not afford” (39%) ”not available”

(33%) and child too young (16).This it was recommended that periodic vitamin-A

supplementation, preferably combined with immunization, should be a priority action and

parents need to be educated about vitamin-A deficiency and its prevention.17

A study was conducted to investigate risk for sub clinical vitamin-A deficiency in under

six years of age in urban slums of Nagpur, India. The study included 308 non-

xeropthalmic children selected randomly from the study population, The current study

recognized a significant association between female gender, ill-literate mother, lower

socio economic status, more than two children of under five years of age at home, under

nutrition, history of Diarrhoea, Measles, Acute respiratory tract infection and sub clinical

vitamin-A deficiency on univariate analysis.18

Studies related to etiology & risk factors on vitamin-D deficiencies.

A study was performed to determine the prevalence of vitamin-D deficiency and

insufficiency in children with osteopenia or osteoporosis held in Columbus children

hospital USA. Were obtained for 85 pediatric children with primary osteoporosis and

secondary osteopenia or osteoporosis caused by various under line chronic illness.

Person’s correlation was used to assess the relationship between vitamin-D level and

different bone parameters. Their result revealed that vitamin-D insufficiency was

observed in sufficiency was remarkably common in pediatric children with primary and

secondary osteopenia or osteoporosis.19

A study was conducted on vitamin-D deficiency present in under five children in selected

districts in London. The retrospective (method) review of children presenting in college

7

hospitals in London between 1996 to 2001with rickets caused by vitamin-D deficiency

they found that sixty five children, mostly from black or Asian ethnic minority groups,

were identified, 29 of radiological evidence of rickets. They concluded that rickets

remain a problem in the UK especially in “at risk” ethnic minority group.20

A study was conducted on vitamin-D deficiency rickets among under five in Canada, In

children hospital of eastern Ontario. A total of 2325 Canadian pediatricians were

surveyed monthly from July 1, 2002 to June 30, 2004, through the Canadian pediatrics

surveillance programme. Their result was indicated that 104 confirmed cases of vitamin-

D deficiency rickets during the study period the over all annual incidence rate was two to

nine cases per 100,000. They concluded that vitamin-D deficiency is persistent in

Canada, particularly among under five who reside in the north and among infants with

darker skin who are breast-fed without appropriate vitamin-D supplementation. 21

A study was performed on vitamin-D deficiency rickets caused by improper lifestyle in

Japanese children, in children hospital Fukuoka, Japan. Clinical records were received

and obtained information and data were summarized. Their result revealed that eight

children with vitamin-D deficiency rickets remains a common condition that is best

managed by education and disease prevention. 22

2. Study related to manifestation, Treatment and Prevention of vitamin-A

deficiencies.

A study was conducted to compare vitamin-A supplementation status of children age 6-

60 months to the prevalence of vitamin deficiency disease, mal-nutrition, diarrhea and

acute respiratory tract infections with the help of trained female community health

worker. They interviewed mothers about child health status using a standardized

questionnaire. The nutritional status of children were estimated using mid upper arm

circumference measurements. The result indicated that compared to children who did not

receive supplements, children who received vitamin-A supplements regularly had less

malnutrition, diarrhea and acute respiratory tract infections regardless of the number of

children per house hold, age, sex or fathers occupation.23

8

A study was performed in a research project to evaluate the effectiveness of a wide

spread vitamin-A supplementation programme and to describe indicators of compliance

with the programme in Indonesia. The design used was prospective cohort study and the

subjects were children aged 1-5yrs. The study concluded that vitamin-A supplementation

programme marginally decreased the portion of vitamin-A deficiency and had a marginal

effect on the nutritional status of the recipients. Thus it was recommended that more than

one micronutrient intervention is needed to increase the effectiveness of the

supplementation programme. To increase compliance and coverage in the

supplementation programme, nutrition communication and private health care practices

need to be included in the programme. 24

A study was conducted to determine the impact of vitamin-A supplementation on child

morbidity and nutritional status. The design was communities based follow up

(interventional) in nature. Two randomly selected weredas (district) of tigrary, north

ethopia were studied between 1996 and 1997. The pre and post intervention data on

xerophthalmia, morbidity, nutritional status and serum retinol levels were compared. The

results indicated that vitamin-A capsule coverage of 87 percent in all village of weredas

and a statistically significant (p<0.05) reduction in the prevalence of Bitots-spot, Measles,

conjunctivis and Diarrhoea. It was concluded that the significant improvement in

morbidity and nutritional status that followed the intervention programme although

encouraging, it still indicates the importance of concluding periodic provision of vitamin-

A capsules with nutrition education.25

A study carried out on effect of vitamin-A supplementation on childhood morbidity and

mortality. In a double blind design, 1520 children aged <10 years were individually

randomized in vitamin-A and placebo group in slums of Chandigarh. The result revealed

that prevalence of vitamin-a deficiency was significantly reduce in vitamin-A compared

to placebo group during the follow up period. Thus it was recommended that promotion

of vitamin-A rich diet or supplementation with synthetic vitamin-A at 4-6 month interval

should be a priority in populations where risk of vitamin-A deficiency is high. 26

9

A study was performed on assessment of progress in prevention and control of vitamin

deficiency disorders in department of international health, Emory University, Atlanta,

USA. They found that key recommendations for specific interventions were to double the

existing dose of prophylactic Vitamin-A supplementation to 50,000 IU at three expanded

programme on Immunization contact for young infants and two doses of 2,00,000 IU

each for women with in six-week after delivery and to include promoting breast feeding

and consuming animal product they concluded that the 21st century and called for

successful implementation of integrated approaches that will eliminate vitamin-A

deficiency disorders.27

A study was conducted on the coverage of vitamin-A supplements in children under five

years of age and to assess the incidence of symptoms related to Hypervitaminosis, The

study held in block I.A. of Gulshan-e-Sikanderabad, Karachi. A survey was conducted.

Their results revealed that data was obtained in 489 children. The coverage of polio and

vitamin-A supplementation was 88% and 74.8%. They found that vitamin-A

supplementation can save lives. It is only a short term measures, what is needed is a

multistrategy approach including short and long term strategies.28

A study carried out on administration of 25,000 IU vitamin-A doses at routine

immunization in under five children. The study was held on clinic of a large diarrhea

treatment centre, Dhaka, Bangladesh. Infant were randomly assigned to receive either

25,000 IU vitamin-A or placebo. Their result revealed that 101 infants received vitamin-

A and 98 received placebos. Decreased feeding, Irritability. Diarrhoea and Vomiting

were comparable between two groups they concluded that the results suggested that

administration of 25,000 IU of Vitamin-A in under five children along with routine

immunizations through associated with increased incidence of transient bulging

fontanalle without any associated adverse sign and symptoms, may still be inadequate to

prevent deficiency population.29

Study related to manifestation, Treatment and Prevention of vitamin-D deficiencies.

10

A Study was concluded that the treatment for x-linked hypophosphatemia with phosphate

calciferol can be complicated by secondary hyperparathyroidism and nephrocalcinosis.

The study was conducted in childrens Mercy Hospital USA. Their result revealed that

oral phosphate load increased serum phosphate decreased ionized calcium and

parathyroid hormone.24 hours later, FGF23 and 1,25(OH)(2) D-decreased. They

concluded that traditional therapy of short-term treatment with calciferol elevates FGF23

and has the potential to stimulate parathyroid hormone. Short-term treatment with

cinacalcet suppresses Para thyroid hormone, leading to increase in Tubular threshold for

phosphate/glomerular filtration rate and serum phosphate.30

A study was performed on Rickets, osteomalacia and renal osteodystrophy are disorder of

mineralization of bone that results from a lack of available calcium, phosphorus or both.

The disorder in children known as Rickets, produce bowing and related to the profound

effect of deficiency states on epiphyseal plate.31

A study carried out to improve vitamin-D status of under five children from Ushuaia, at

the south of Argentina, double supplementation with 1,00,000 IU of vitamin-D was

administered at beginning of winter and three month after receiving the second

supplementation. They concluded that to prevent vitamin-D deficiency for under five

children at zones of risk at the south of our country. Double supplementation of 1,00,000

IU of vitamin-D during autumn and winter, would be adequate and safe.32

A study was examined that the prevalence of vitamin-D supplementation in infants in

Switzerland and present risk factors for non-supplements. Mothers of 2861 randomly

selected infants aged 0-9 months received a questionnaire on infant feeding, including a

question on vitamin-D supplementation. Their result revealed that 64% of the infants had

received vitamin-D, They concluded that supplementation of vitamin-D is recommended

for all infants the supplementation prevalence in Swiss infants unsatisfactory low.33

A study was performed that to prevent vitamin-D deficiency in infants and childhood

period, those who are dark skinned or veiled, should be screened and treated for vitamin-

11

d deficiency. Regular sunlight exposure can prevent vitamin-d deficiency, at risk children

should receive 400 IU vitamin-D daily, if compliance is poor an annual dose of 1,50,000

IU may be considered. Treatment of vitamin-D deficiency involves giving ergocalciferol

or cholecalciferol for three months. High dose bolus therapy should be considered for

children over 12 months of age of compliance or absorption tissue are suspected.34

A study was conducted on to determine primary care pediatricians’ level of awareness in

diagnosis and management of Rickets. A sample of 510 pediatricians in states

surrounding the great lakes. Their results revealed that of the 248 respondents. They

concluded that educational interventions are still necessary for both physician and parents

to promote widespread use of Vitamin-D supplementation in all breastfed infants or

under five children.35

A study was examined that vitamin-D deficiency due to inadequate sun exposure and

resulted in growth retardation, muscle weakness, skeletal deformities, hypocalcaemia,

tetany and seizures. The encouragement of sensible sun exposure and the fortification of

milk with vitamin-D resulted in almost complete eradication of the disease. He concluded

that vitamin-D in the presentation of rickets and its importance in overall health and

welfare of infants and children.36

3. Studies related to Lack of knowledge and the effectiveness of structured teaching

programme on selected vitamin-A deficiencies.

A study was conducted on nutrition education efforts for mothers of under five children

to prevent vitamin-A deficiency. A cross-sectional survey was administered to mothers

(N-15) from rural/ peri-urban villages’ provinces to assess vitamin-A knowledge

regarding vitamin-A was low in all villages regardless of difference in socioeconomic

status and level of education, they concluded that educational interventions should focus

on basic vitamin-A Knowledge regarding sources as well as symptom of deficiency.

Education should also emphasize increasing the variety of food rich in pro-vitamin-A

carotetnoids grown in home garden.37

12

A study carried out to evaluate the long term effect of a horticultural and nutrition

education intervention. A quasi-experimental post term design was used. The research

was carried out in 10 villages in Singida region, Tanzania. Mothers and their children

aged 6-71 months (n-236) from experimental (Ilongero) and control (Ihanja) were

interviewed regarding knowledge and practices were more favorable to vitamin-A intake

in of green leaves was associated with higher serum retinol values. Thus it was concluded

that food based vitamin-A programmes can make sustainable improvements in

knowledge and dietary practices. 38

A study was performed that on the effectiveness of training on the knowledge of vitamin-

A deficiency among Anganwadi workers in a rural area of North India. Training of 95

Anganwadi workers was done in two groups’ i.e.expremental and control groups in a

rural block of Hyrayana state, India to impart knowledge on vitamin-A deficiency

through lecture, demonstration and discussion methods. This study revealed the need for

in-services training of Anganwadi workers using appropriate teaching methods

incorporating audio-visual aids like film slide shown for control of vitamin-A

deficiency.39

Studies related to Lack of knowledge and the effectiveness of structured Teaching

programme on selected vitamin-A deficiencies.

A study was conducted on intake of vitamin-D from food and supplements among

Finnish children age three month to three years. A structured questionnaire method was

used to study in University of temper Finland. Their result revealed that the mean dietary

vitamin-D intake exceeded the recommendation (10 micro g. /day) at the age of three

(11-0micro g.) and six months (12.0 micro g.). Vitamin-D intake from did not differ in

children who used and did not use vitamin-D were margarine, fish, body foods, low-fat

milk and eggs. They concluded that vitamin-D supplements are not used according to the

dietary recommendation.40

A study was performed that to assess health visitors knowledge of government guide

lines for vitamin supplementation for infants and children and advice given to mothers.

13

The study was conducted in central middle sex, Hospital London UK. The questionnaires

method was used. Their result revealed that a total of 98% (69%) questionnaires were

returned from health visitors. They concluded that rickets has become a national public

health issue. The majority of health visitors are advising vitamin supplements according

to government guide lines for breast feeding infants and the age to which children should

continue vitamin supplements. Awareness need to be raised about the government

guideline for vitamin-D supplementation for ethnic minorities to ensure all health visitors

are imparting consistent, correct advise to these families.41

A study carried out on the prevalence of maternal belief about the therapeutic uses of

sunlight in infancy in tropical Australia. Data were collected by interviewing, 114 post-

partum patients. Their result indicated that half of the women had at least one risky belief

about the perceived benefit of the sunning their baby. 36% were in favour of using

sunlight to treat neonatal jaundice, 20.2% believed it was necessary to Sun their baby to

prevent vitamin-D deficiency and 10.5% thought sun light was a good remedy for nappy

rash. They found that post-parturient women had a high prevalence of beliefs that may

result in their infant being intentionally exposed to sunlight and which could increase

their Childs future risk of skin Neoplasia. Professional education is needed to change the

beliefs of health professional who recommended therapies involving sunlight. 42

PROBLEM STATEMENT

“A STUDY TO ASSESS THE EFFECTIVENESS OF STRUCTURED TEACHING

PROGRAMME ON PREVENTION OF SELECTED VITAMIN DEFICIENCY

DISORDERS AMONG MOTHERS OF UNDER FIVE CHILDREN IN ASELECTED

RURAL AREAS AT KOLAR”.

14

6.3. OBJECTIVES OF THE STUDY

1. To assess the existing knowledge level of mothers regarding prevention of

selected vitamin deficiency disorders among mothers of under five children.

2. To determine the effectiveness of structured teaching programme regarding

prevention of selected vitamin deficiency disorders among mother of under five

children.

3. To find the association between post test knowledge level with their selected

demographic variables.

6.4 OPERATIONAL DEFINITIONS:

Assess – Statistical measurements of knowledge of mothers regarding Prevention of

selected vitamin deficiency disorders using structured interview schedule.

Effectiveness-.It is the statistical difference of pre & post test scores regarding

prevention of vitamin deficiency disorders.

Structured teaching programme- It refers to the information provided to the mothers

regarding prevention of selected vitamin deficiency disorders.

Prevention-Steps taken by the mother to avoid the selected vitamin deficiency disorder

in under five children.

Vitamin Deficiency Disorder-In this study, it refers to problems related to the deficiency

of vitamin A & D.

15

Mothers- Women who are having children age group between 1-5 years.

Under five children- Children in the age group of 1-5 years.

6.5. HYPOTHESIS:

H0-There is no significant relationship between pre & post test knowledge scores of

mothers of under five children regarding prevention of selected vitamin deficiency

disorders.

6.6. REASEARCH VARIABLES:

Independent variable: structured teaching programme on prevention of selected vitamin

deficiency disorders.

Dependent variable: knowledge of mothers regarding prevention of selected vitamin

deficiency disorders.

Attributed variables: Age, Parity, Education, Economic status, Occupation, Religion

and Type of family, Age of children, and Sources of information.

7.0 MATERIAL AND METHODS:

7.1. SOURCE OF DATA.

Mothers of under five children (1-5years) from selected rural areas of kolar.

7.2. METHOD OF DATA COLLECTION:

7.2.1. Research design - Quasi-Experimental design (One group Pre and post test).

7.2.2. Research approach- Evaluative approach.

16

7.2.3. Research setting – Study will be conducted in selected rural areas of Kolar

(Vokalleria, Arabikothanur) which are 10kms away from Pavan College of nursing.

7.2.4. Population - The population of study comprises all mothers of under five children

in selected areas.

Sample- Mothers of under five children residing at (Vokalleria, Arabikothanur) Kolar.

7.2.5. Sample size- The sample size will be 60 mothers of under five children.

7.2.6. Sampling Technique -Systematic random sampling technique.

7.2.7. Sampling criteria –

Inclusion criteria –

1. Mothers of under five children.

2. Mothers who are willing to participate in the study.

3. Mothers who are able to understand in Kannada.

Exclusion criteria-

1. Mothers who are not willing to participate in the study.

2. Mothers who do not have under five children.

3. Mothers who are not able to understand in Kannada.

7.2.8. Tool

A structured Interview schedule will be used to assess the knowledge among mothers of

under five children regarding prevention of selected vitamin deficiency disorders.

Description of tool: The questionnaire consists of two sections.

17

Section – A:

It consists of demographic variables like age, parity, education, economic status &

occupation, Religion, type of family, age of children, and sources of Information.

Section –B:

It consists of questions regarding knowledge on prevention of selected vitamin

deficiency disorders.

7.2.9 METHODS OF DATA COLLECTION:

Structured interview method will be used to assess the knowledge regarding prevention

of selected vitamin deficiency disorders among mothers of under five children.

DATA ANALYSIS AND INTERPRETATION

The data collected from mothers of under five children will be grouped and analyzed by

descriptive and inferential statistics, like- Frequency, percentage, standard deviation,

Paired t-test, Chi-square test and then analyzed data will be presented in the form of

tables, graphs, diagrams, etc.

7.3 DOES THE STUDY REQUIRE ANY INVESTIGATION OR INTERVENTION

TO BE CONDUCTED FOR PATIENTS OR OTHER HUMANS OR ANIMALS?

IF SO, DESCRIBE BRIEFLY.

Yes

The study will be conducted for the mothers of under five children by providing

structured teaching programme.

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7.4 HAS ETHICAL CLEARENCE BEEN OBTAINED FROM CONCERED

AUTHORITIES?

Yes

Prior to study, the permission will be obtained from the concerned authorities to conduct

the study in Kolar rural areas and also from research committee of Pavan College of

Nursing Kolar.

The purpose of the study will be explained to the samples of under five children in

residing areas at Kolar.

8. REFERENCE

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publication, 2005; 412-4.

5) www.who.com. (World health organizations micronutrient information, 2008).

6) Viswanthan J, Desai A.B, Achars. Textbook of pediatric. . 3rd ed., New-Delhi: Orient

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Logman private limited, 1989: 82-113.

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Nigeria :International institute of tropical Agricultural.

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role of conjunctival impression cytology in detecting vitamin-A deficiency.

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Indonesia.Public health Nutrition 2003; 6 (2): 209-16.

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status. American Journal of Nutrition 2003; 16: 1295-303.

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mortality, Indian Jouranal of Medical Science 2002; 56 (6): 259-64.

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25,000 IU vitamin-A doses at routine immunization in young infants. 1995.Jan;

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9. SIGNATURE OF THE CANDIDATE:

10. REMARKS OF THE GUIDE:

11. NAME AND DESIGNATION OF:

11.1 GUIDE:  

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11.2 SIGNATURE

11.3 CO-GUIDE

11.4 SIGNATURE

11.5 HEAD OF DEPARTMENT:      

11.6 SIGNATURE

12. 12.1 REMARK OF THE PRINCIPAL:

12.2 SIGNATURE

23