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ICDS package of services includes : supplementary nutrition, immunization, health check
up, referral services, nutrition and health education and non formal preschool education.2
Despite vast infrastructure in ICDS programme, the nutritional status of women and
children remain almost the same as that of previous years.
Reasons for lack of improvement include,
Poor education on nutrition to improve feeding practices at home.
Inadequate training of Anganwadi workers.
Poor supervision.3
In view of the above, the present intervention is undertaken to evaluate the effect of nutrition
education and supplementary nutrition on the nutritional status of preschool children in ICDS
centres.
6.2 REVIEW OF LITERATURE:
6.2.1 Gopal Chandra Mandal, Kaushik Bose, Samiran Bisai, Sanjib Ganguli in their study on
undernutrition among ICDS scheme children aged 2-6 years of Arambag,
Hoogly District, West Bengal, India: from November 2005-2006 showed that the rate
of underweight was 63.3%.4
6.2.2 B.N Tandon, U. Kapil in their study- ICDS scheme: A program for development of
mother and child showed that severe undernutrition among preschool children in ICDS
area has declined from 19.1% - 6.3% in 8 years and moderate undernutrition
from 27.0% - 19.7%.2
6.2.3 B. Banerjee, O.N Mandal in their study: An intervention study in malnutrition amonginfants in tribal community of West Bengal, showed that post intervention follow up
after nutritional education of mothers showed an average increase in 80.81 grams of
weight of their severely malnourished infants, over the expected weight gain.5
6.2.4 Bobby Joseph, Aaron Rebello, Poonam Kullu, Vimal D. Raj in their study: Prevalence
of malnutrition in rural Karnataka, South India showed the prevalence of wasting,
stunting, stunting and wasting was 31.2%, 9.4% and 29.2% respectively. 6
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6.3 OBJECTIVES OF THE STUDY:
1) To assess the nutritional status of preschool children among ICDS scheme.
2) To evaluate the effect of nutrition education on mothers of children with PEM and the
effect of supplementary nutrition on nutritional status of children under ICDS.
7 MATERIALS AND METHODS:
7.1 Source of data:
7.1.1 Type of study: Interventional study.
7.1.2 Study period: one year (January December 2010).
7.1.3 Study area: Selected anganwadis in field practice area of VIMS and RC.
7.1.4 Study population: Children aged between 2-6 years from selected anganwadis attached
to field practice area of VIMS and RC.
7.2 METHOD OF COLLECTION OF DATA: (including sampling
procedure if any).
SAMPLE SIZE:
It was observed from earlier study by Gopal Chandra Mandal, Kaushik Bose, Samiran
Bisai, Sanjib Ganguli the prevalence of underweight for preschool children was 63.3%.4
Assuming for present study the prevalence rate 63% at 95% confidence level and 10%
of allowable error, the sample size required will be 226.
N = Z2 Pq/d2 Z = 1.96
P = 63%q = 100-63 = 37
d = 10% of 63 = 6.3
N = (1.96)2 x63x37/(6.3)2
= 226
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STATISTICAL ANALYSIS:
The values will be statistically analysed by the following tests-
1) Mean.
2) Standard deviation.
3) Paired t test.
4) Multivariate analysis.
INCLUSION CRITERIA:
Children aged between 2 6 years in selected Anganwadis in field practice area of
VIMS and RC.
EXCLUSION CRITERIA:
Children who are not attending Anganwadis regularly.
Data collection methodology:
The study will be carried out in Sarjapura Primary Health Centre area which is the field
practice area of VIMS and RC.
The anganwadis in these villages will be selected by stratified random sampling and
from each anganwadi all children aged between 2 6 years will be selected.
Nutritional status of the children will be assessed by anthropometric measurements using
standard methodology as recommended by WHO.
The prevalence of malnutrition among these children will be determined by comparing
the anthropometric measurements with NCHS standards.
The expected weight of the child will be calculated using Fields formula,
2x+8 = Expected weight in kg (reference weight)
x = Age in years.
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The grades of malnutrition will be determined using IAP classification.
The malnourished children from the study group will be selected and mothers of these children
will be interviewed by house to house visit. In absence of the mother, any other responsible
adult member of the family who is involved in taking care of the children will be interviewed
and proper advice on the diet will be given according to the requirement of these children and
also based on the use of low cost, easily available food items.
The anganwadi workers will also be interviewed and trained regarding proper
nutritional supplementation and to give nutrition education to the mothers of anganwadi
children.
Supervision of all selected anganwadis for regular food deliveries and supplementary
feeding practices by anganwadi workers will also be done.
Nutritional status of malnourished children will be reassessed every 3 months for
a period of one year after the intervention to evaluate the effect of nutrition education and
supplementary nutrition on the nutritional status of these children.
7.3 Does the Study require any investigation or intervention to be
conductedon patients or other human subject or animals? If so,
please describe briefly.
Yes.
Non invasive intervention.
Nutrition education to mothers of malnourished children aged between 2 - 6 years
under ICDS scheme.
Training to anganwadi workers regarding proper nutritional supplementation.
Supervision on all selected anganwadis for regular food deliveries and supplementary
feeding practices by anganwadi workers.
Non invasive investigation.
Measurement of weight.
7.4 Has Ethical Clearance been obtained from your Institution?
Yes.
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8. LIST OF REFERENCES:
1) Parthasarathy A, Nair MKC, Menon PSN. IAP text book of paediatrics. 3rd ed. New
Delhi: Jaypee brothers Medical publishers Ltd; 2006. P.120-1.
2) Tandon BN, Kapil U. ICDS scheme: a program for development of mother and
child health. Indian Pediatr 1991 Dec; 28:1425-8.
3) Kishore J. National Health Programmes of India. 7 th ed. New Delhi: Century
publications; 2007. p.351.
4) Mandal GC, Bose K, Bisai S, Ganguli S. Undernutrition among ICDS scheme
children aged 2 6 years of Arambag, Hoogly District, West Bengal, India. IJPH
2008; 5(1):28-33.
5) Banerjee B, Mandal ON. An intervention study in malnutrition among infants in
tribal community of west Bengal. Indian J Com Med 2005 Jan-Mar; 30(1):27-9.
6) Joseph B, Rebello A, Kullu P, Raj VD. Prevalence of malnutrition in rural
Karnataka, south India. J Health Popu Nutr 2002 Sep; 20(3):239-44.
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9 Signature of the Candidate
10 Remarks of the Guide I am willing to guide Dr. Mohammed Imran in his
dissertation entitled Impact of nutrition educationand supplementary nutrition under ICDS scheme
on nutritional status of preschool children in
Rural field practice area.
11 Name and Designation of
(in block letters)
11.1 Guide
11.2 Signature
11.3 Co-Guide (if any)
11.4 Signature
11.5 Head of Department
11.6 Signature
Dr. MANGALA SUBRAMANIAN MDPROFESSOR,
DEPARTMENT OF COMMUNITY MEDICINE
VYDEHI INSTITUTE OF MEDICAL SCIENCESAND RESEARCH CENTRE.
BANGALORE-560066.
Dr. G SUBRAHMANYAM MD DPHPROFESSOR AND HEAD,
DEPARTMENT OF COMMUNITY MEDICINE
VYDEHI INSTITUTE OF MEDICAL SCIENCESAND RESEARCH CENTRE.
BANGALORE-560066.
12 12.1 Remarks of the Chairman
And Principal.
12.2 Signature