· Web viewThe term weaning is derived from the Anglo-Saxon word wenian, which means "to become...
Transcript of · Web viewThe term weaning is derived from the Anglo-Saxon word wenian, which means "to become...
ETHICAL COMMITTEE CLEARANCE
1) TITLE OF THE DISSERTATION: “A STUDY TO ASSESS THE CORRELATION BETWEEN THE KNOWLEDGE OF MOTHERS REGARDING WEANING AND NUTRITIONAL STATUS OF THEIR UNDER-FIVE CHILDREN WITH A VIEW TO DEVELOP AN INFORMATION BOOKLET AT SELECTED PRIMARY HEALTH CENTERS OF DAVANGERE DISTRICT.”
2) NAME OF THE CANDIDATE : Mrs. AMBIKA M.S. 1st Year M.Sc., Nursing Kumuda Institute of Nursing Sciences, Kumuda College of Nursing, S. Nijalingappa Layout, Davangere- 577 004.
3) SUBJECT : PAEDIATRIC NURSING
4) NAME OF THE GUIDE : MR. LOKESH D.C. M.Sc., (Nursing)
Deparmtnet of Child Health Nursing Kumuda Institute of Nursing Sciences Davangere – 577 004.
5) APPROVED / NOT APPROVED:
(If not approved, suggestion)
Mr. Shymon K. Principal, Medical Surgical Nursing, Kumuda College of Nursing, S. Nijalingappa Layout, Davangere – 577 004.
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RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES
BANGALORE, KARNATAKA
PROFORMA FOR REGISTRATION OF SUBJECT FOR DISSERTATION
“A STUDY TO ASSESS THE CORRELATION BETWEEN THE
KNOWLEDGE OF MOTHERS REGARDING WEANING AND
NUTRITIONAL STATUS OF THEIR UNDER-FIVE CHILDREN
WITH A VIEW TO DEVELOP AN INFORMATION BOOKLET
AT SELECTED PRIMARY HEALTH CENTERS OF
DAVANGERE DISTRICT.”
Mrs. AMBIKA M.S.,
FIRST YEAR M.SC., NURSING,
PAEDIATRIC NURSING
KUMUDA INSTITUTE OF NURSING SCIENCES,
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DAVANGERE – 577 004.
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RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES,
BANGALORE, KARNATAKA, INDIA ANNEXURE – II
PROFORMA FOR REGISTRATION OF SUBJECTS FOR
DISSERTATION
1. NAME OF THE CANDIDATE AND
ADDRESS (IN BLOCK LETTERS)
Mrs. AMBIKA M.S.,
I YEAR M.Sc., NURSING,
KUMUDA INSTITUTE OF NURSING SCIENCES,
KUMUDA COLLEGE OF NURSING,
S. NIJALINGAPPA LAYOUT,
DAVANGERE-577 004.
2. NAME OF THE INSTITUTION KUMUDA INSTITUTE OF NURSING SCIENCES
3. COURSE OF THE STUDY AND
SUBJECT
FIRST YEAR M.SC., NURSING,
PAEDIATRIC NURSING
4. DATE OF ADMISSION 01-07-2011
5. TITLE OF THE TOPIC:
“A STUDY TO ASSESS THE CORRELATION
BETWEEN THE KNOWLEDGE OF MOTHERS REGARDING WEANING AND
NUTRITIONAL STATUS OF THEIR UNDER-FIVE CHILDREN WITH A VIEW TO
DEVELOP AN INFORMATION BOOKLET AT SELECTED PRIMARY HEALTH
CENTERS OF DAVANGERE DISTRICT.”
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6. BRIEF RESUME OF INTENDED WORK
6.0 INTRODUCTION:
“Let us sacrifice our today so that our children can have a better tomorrow”
Abdul Kalam.
Nutritional status of the child plays vital role in the physical and mental development of
the children. Timely balanced feeding makes babies healthy. Healthy babies are future wealth of
nation. Inadequate and imbalance diet leaded to malnutrition which may cause various types of
infections. Generally nutritional status depends on food habits, socio-economic conditions,
tradition, culture and knowledge of the family .The knowledge about nutrition of the family
directly effects nutritional condition of family. Malnutrition makes a child susceptible to
infections and delays recovery, thus increasing mortality and morbidity. Every time an innocent
child suffers the curse of malnutrition, the responsibility goes to the mother the family and to the
community due to their faulty or no knowledge regarding the harmful effects of prelacteal
feeding, benefits of exclusive breast feeding and initiation of proper weaning at the correct time.
6.1 NEED FOR THE STUDY:
Weaning is a process of gradual and progressive transfer of the baby from breast milk to
the what family diet. It does not mean discontinuing to breast feeding. Weaning begins from the
moment supplementary food is started and continues till the child is taken off the breast
completely. Infants in india thrive on breast milk alone up to six months of life and their growth
rate during this period is satisfactory. Breast milk alone is not able to provide sufficient amounts
of all the nutrients needed to maintain growth after the first six months. Increasing need of
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calories and protein of growing children cannot be met by the diminishing output of mother’s
milk. Milk is also a poor source of vitamin C and supplementation with fruit juice is essential.
Iron stores in liver of the infant would last only upto 4-6 months. Hence iron-rich foods should
be given atleast from six months onwards. Milk is also deficient in vitamin D. If the baby is to
maintain the expected rate of growth and remain healthy and well nourished, supplementary
feeding has to be resorted to round about the 6th month of life.1
The term weaning is derived from the Anglo-Saxon word wenian, which means "to
become accustomed to something different." The Concise Oxford Dictionary says to wean is "to
teach the sucking child to feed otherwise than from the breast." Weaning is often seen as the end
of something; however, it is more appropriately viewed as a beginning. We misuse the word
wean in the context of stopping other activities or habits; weaning is not the cessation of
breastfeeding but rather the addition of new foods.2
In the strictest sense of the word, weaning means getting a body used to drinking milk
from a cup instead of sucking milk from the breast or bottle; in the broader sense, it also means
getting the baby used to taking food by biting and Chewing instead of only by sucking; Weaning
is now discarded in favor of the phrase complementary feeding. To make weaning an easy
adjustment for a baby, it should be done gradually step by step.3
India is a third world war country, since independence, one of the gravest problems India
is confronting with is malnutrition among under – 5 children. About two-third of the under five
children of our country is malnourished. Among them, 5-8% are severally malnourished while
rest fall in the group of mild or moderate malnutrition. So it can be said that malnutrition is one
of the most widespread conditions affecting child health. The ‘germ’ of malnutrition ‘infects’ a
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foetus in the intra-uterine life due to lack of sufficient anternatal care on part of the mother. The
condition deteriorates further when after birth the infant is deprived of exclusive breast feeding
or initiation of wearing is delayed. Weaning should be started after the age of 6 months and
should contain energy rich semi sold food.4
Over 6 million deaths (55% of the 12 million children under 5 years of age) each year in
developing countries from infectious diseases, can be attributed to malnutrition. In the
developing world, one out of every 5 persons is chronically undernourished and about 200
million children under 5 years of age suffer from protein energy malnutrition1. Malnutrition
remains a global problem affect- ing development, particularly that of the under- privileged and
the poor. UNICEF has coined malnutrition a “silent emergency” that endangers children,
women, society and the future of mankind. Malnutrition is a major contributory factor to
mortality and morbidity. Its close association with diarrhoea, respiratory tract infection and
infectious diseases has been observed in many studies all over the world. There is a growing
realization that good and adequate nutrition is a necessary step in improving the quality of life.
The first few years of life are of paramount importance in laying the foundation of good health.
The effective measures for the prevention of malnutrition and protection against infection in
infancy is breast feeding and introduction of supplementary foods at proper age. Infant feeding
and weaning practices have cultural, social and economical roots making malnutrition more than
a medical problem. It has been indicated in many studies all over the world that these practices
are the subjects strongly influenced by customs, beliefs, superstitions, religion, cultural pattern,
mother’s education and socioeconomic status of the family. Malnutrition being the cause of
morbidity and mortality in under 5 years children has brought nutrition to the forefronts of
national and international concern. 5
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Over 10.5 million deaths occur each year among children of under five years of age and
22 percent of these deaths occur in India. This proportion is substantially higher than other
countries. Malnutrition in children is widely prevalent in India. It is estimated that 5.7 million
children are underweight (moderate and severe) and more than 50 percent of deaths in 0 – 4
years are associated with malnutrition. The most vulnerable period for malnutrition is first 3
years (usually 6 months – 2 years of life). 6
In the world, the average infant mortality rate is 51.5 per 1000 live births. Among that
our country has the highest infant mortality rate estimated to be about 61.4 per 1000 live births.
In Karnataka, the IMR is about 58 per 1000 live births, in rural areas it is 70 per 1000 live births
and in urban areas it is 25 per 1000 live births.7
According to world face book 2010 estimation India is having highest IMR 50.78/1000
live births, among that Karnataka place top in south Indian states 43/1000 live births, compared
with 38/1000 live births in Maharashtra and 30/1000 live births in Tamil Nadu.8
A study was conducted on “Influence of infant feeding practices on nutritional
status of under five children” in urban anganwadi area, Allahabad. The information was
collected from 217 mothers of under five children by interview method and nutritional
assessment was done i.e., weight for age, height for age, weight for height. The results showed
that among 217 under five children, 36.4 percent had underweight, 51.6 percent had stunted
growth and 10.6 percent wasted. Proportions of underweight (45.5 percent) and stunting (81.8
percent) were found maximum among children aged 1 – 24 months, wasting was most prevalent
(18.2 percent) among children aged 37 – 48 months. They concluded that delayed initiation of
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breast feeding, deprivation from colostrum and improper weaning are significant risk factors for
under nutrition among under five children.9
A study was conducted by the department of pediatrics of Medical Science and Guru Teg
Bahadur Hospital, Delhi,, to assess the practice of complementary feeding (CF) in infants 6
month to 2 year, knowledge of mothers regarding CF, and reasons for inappropriate CF
practices. CF practices were assessed in children aged 6 months to 2 years using semi-structured
questionnaire. Demographic profile and mothers knowledge regarding CF was recorded. Cause
of inappropriate CF was ascertained by open-ended questions. Among the 200 children studied,
32(16%) were not started on CF at all, and only 35 (17.5%) received CF from 6 months. Of the
168 who were started CF, mean age of starting feeds was 13.37 months. Quantity was adequate
in 42(25%) and consistency of food was thick in 64(38%) cases. Only 7(3.5%) mothers started
CF at proper time, in adequate quantity and with proper consistency. Knowledge of proper
timing was present in 46% of children, adequate quantity in 46.5% and thick consistency in
25.5%. Only 16(8%) mothers had proper knowledge of all three aspects of CF. Knowledge
regarding appropriate timing and consistency varied significantly with maternal education and
paternal education (Chi-square P< 0.05). On multiple logistic regression only maternal education
of graduate level correlated with knowledge of timing of CF (P=0.089. OR-3.5, CI 0.826-15.2).
Most common reason for inappropriate practice in 154 mothers who delayed feeds was "tried but
did not eat, vomits everything" (52%). They conclude that CF practices were inappropriate and
knowledge inadequate in majority of the children studied.10
The investigator during her clinical postings identified that many of the under-five
children admitted in pediatric ward were underweight and most of them had some form of
malnutrition on interviewing, she observed that many of the mother lacking adequate knowledge
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about weaning, during literature review also the investigator found that very few studies are
conducted on correlation between the knowledge of mothers regarding weaning and nutritional
status of their under-five children. This motivated the investigator to choose this as her project
and to conduct a study to determine the knowledge of mother’s regarding weaning and
nutritional status of their under-five children with a view to develop an information booklet.
6.2 REVIEW OF LITERATURE:
Review of literature is a key in research process. According to Nancy burns, the review
of literature is a research report and it is a summary of current knowledge about a particular
problem and includes, what is known and not known about the problem. The literature is
received to summarize knowledge for use in practice or to provide basis for conducting a study.11
A study was conducted on Maternal child-feeding style during the weaning period:
association with infant weight and maternal eating style. A controlling maternal child-feeding
style has been show to have negative consequences for child weight and eating style for children
over the age of 12 months. Maternal restriction is associated with increased consumption of food
if given free access and child overweight. Pressure to eat conversely is associated with picky
eating and a lower child weight. In the current study, 642 mothers with a child aged 6-12
months completed a copy of the Child Feeding Questionnaire and reported infant and maternal
weight. Infant weight was positively correlated with maternal use of restriction, monitoring and
concern for infant weight. Moreover, mothers high in restraint, external and emotional eating
reported higher levels of concern for infant weight, restriction and monitoring and perceived
their infants to be larger. The findings suggest that the extent to which controlling feeding
practices are used is influenced by infant and maternal personal weight concerns even at this
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early stage. Potentially, these early behaviors could have long term consequences for child
weight and eating style.12
A study was conducted on Factors associated with weaning practices in term infants: a
prospective observational study in Ireland. The study is based on The WHO recommends
exclusive breast-feeding and delaying the introduction of solid foods to an infant's diet until 6
months postpartum. However, in many countries, this recommendation is followed by few
mothers, and earlier weaning onto solids is a commonly reported global practice. Therefore, this
prospective, observational study aimed to assess compliance with the WHO recommendation and
examine weaning practices, including the timing of weaning of infants, and to investigate the
factors that predict weaning at ≤ 12 weeks. 401 eligible mothers were followed up at 6 weeks
and 6 months postpartum. Quantitative data were obtained on mothers' weaning practices using
semi-structured questionnaires and a short dietary history of the infant's usual diet at 6 months.
Only one mother (0.2%) complied with the WHO recommendation to exclusively breastfeed up
to 6 months. Ninety-one (22.6%) infants were prematurely weaned onto solids at ≤ 12 weeks
with predictive factors after adjustment, including mothers' antenatal reporting that infants
should be weaned onto solids at ≤ 12 weeks, formula feeding at 12 weeks and mothers' reporting
of the maternal grandmother as the principal source of advice on infant feeding. Mothers who
weaned their infants at ≤ 12 weeks were more likely to engage in other sub-optimal weaning
practices, including the addition of non-recommended condiments to their infants' foods.
Provision of professional advice and exploring antenatal maternal misperceptions are potential
areas for targeted interventions to improve compliance with the recommended weaning
practices.13
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A descriptive study was conducted on weaning practices among the mothers of infants
in selected hospitals in Mangalore, on purposive sampling technique among 104 mothers of
infants in the age group of 6-12 months. The study revealed that (56.73%) majority of mothers
started weaning with liquid diet, which as fruit juice among 33.65% of mothers, where as
43.27% of mothers started with Ragi porridge. Among the total samples of mothers, 75 mothers
reported that they started weaning early to child whereas 6 month reported as late weaning, over
64% of mothers reported that due to inadequate breast milk started weaning early. The study
suggested to educate the mothers on weaning practices.14
A pre-experimental study was conducted on effectiveness of planned teaching
programme on knowledge and attitude on complementary feeding among mothers of infants in
Udupi. The study was done on 50 mothers with one group pre-test and post-test design , which
showed that the mean score of post-test attitude (68) was higher than the mean pre-test attitudes
and the mean post-test knowledge score(32) was higher than the pre test knowledge (14),
significantly (p<0.005) related with knowledge of mothers on complementary feeding between
pretest and post test scores. Finally the study suggested education on feeding among mothers of
infants.15
A cross sectional study was conducted to investigate the prevalence of under nutrition
among children 3.0- 5.9 years old in a rural area of West Bengal covered by the Integrated Child
Development Service scheme (ICDS) using composite Index of anthropometric failure (CIAF).
Randomly selected six ICDS centres of Chapra Block Nadia District, West Bengal, India were
Chosen. A total of 2016 children aged 3.0-5.9 years were studied. It was observed that boys were
heavier and taller than girls at all ages. Significant age differences existed in mean height and
weight in boys as well as in girls. Among the children 48.20%, 10.60% and 48.30% were
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stunted, wasted and underweight. The CIAF showed a higher prevalence of under-nutrition with
60-40% of the studied children suffering from anthropometric failure.16
A cross-sectional community based study was conducted on gender inequality in
nutritional status among under-five children in a village in Hooghly district, West Bengal, to
examine the differences in nutritional status of under-five male and females and to determine the
bio-social factors associated with such differences. It was found that 55.9% , 51.4% and 42.3%
of the girls were underweight, stunted and wasted respectively, compared to 46.6%, 40.5% and
35.3% of the boys and a significantly higher proportion of malnutrition was found to be present
among female children of higher birth order and those belonging to families with lower per
capita income compared to the males.17
A longitudinal study was conducted on “Introduction of complementary foods to
infants within the first six months postpartum in Xinjiang, China. Information was collected
from 1219 mothers. The results showed that after discharge, the overall introduction rates of
water, cow’s milk and solid food were 23%, 2% and 6% before discharge, and 76%, 39% and
78% at six months. The rates were different between ethnic groups. Mothers from Uygur and
other minorities introduced cow’s milk earlier than Han mothers. Uygur mothers also introduce
solid foods earlier (10% pre discharge and 91% by six months) when compared to Han (3% pre
discharge and 85% by six months) and other minorities (4% pre discharge and 48% by six
months). The pattern of introduction of complementary foods in this region does not follow
internationally recognized practices, suggesting the need for further education of parents.18
A study was conducted to examine the association between mother's education,
complementary feeding practices and malnutrition amongst mothers attending outpatient clinics
in Islamabad. Mothers of 500 Pakistani infants attending the Pediatric Outpatient department at
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the Federal Government Services Hospital, Islamabad completed pretested questionnaires on
mother's educational status and complementary feeding practices. A positive relationship was
found between the nutritional status of infants and educational status of mothers (P < 0.001). The
study revealed that the majority of infants with evidence of malnutrition belonged to the mothers
with virtually no school education. A similar relationship was observed between the educational
status of respondents and the introduction of complementary foods at an appropriate age (6
months) of infants (P < 0.001). The study conclude that Mother's education plays a vital role in
increased receptivity to knowledge and awareness related to nutritional requirements of their
infants.19
A cohort study was conducted on breast and complementary feeding practices in relation
to morbidity and growth in Malawian infants, UK. Babies’ weight, length, morbidity and feeding
patterns were recorded in 4 weekly intervals from birth to 52 weeks. the results revealed the
mean age at introduction of water was 2.5 month, complementary foods 3.4 months, solids 4.5
months, over 40% of infants received complementary foods by 2 month and 65% by 3 months,
infants with early complementary feeding had lower weight for age at 3-6 months (p<0.005) and
at 9 month (p=0.007). Early complementary feeding was significantly associated with increased
risk for respiratory infection (p<0.005), risk of eye infection. The study strongly recommended
health education on weaning among mothers.20
A randomized controlled study was conducted among 1500 children (640 rural, 840
urban) between 3 and 24 months of age, to examine feeding pattern of infants. As a result 48
per cent children are frequently breastfed up to 2 years of age. Semisolids are introduced in
about half the children (42 per cent) between 6 to 12 months. By 18 months most of them
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were getting semisolids. Rice is commonly introduced first. Proprietary preparations of milk
and weaning foods are not in general use. Dilution of natural milk and improper preparation
are common irrespective of domicile, education and financial status.21
A descriptive cross-sectional study on mothers knowledge and practices regarding
weaning in Butagira, south Ethiopia. A total of 1,543 mother-child pairs were included in the
study, of which 1,052(68%) children were on weaning diet and 491(32%) were exclusively
breast feeding. The finding of the study revealed that among children who were already weaned,
40 percentage were reported to have been started on weaning food at the age of 4-6 months and
amongst children who were reported to be exclusively breast feeding 34 percentage were beyond
the age of seven months. The most commonly used weaning foods were cow’s milk, adult food,
sorghum water and cereal gruel. The most important reasons for mothers to start weaning were
reduction in the amount of breast milk and mother’s belief that the child is at the right age to start
weaning food. Thus the study demonstrate the presence of inappropriate weaning practices in the
area which needs appropriate intervention.22
6.2.1 STATEMENT OF THE PROBLEM:
“A study to assess the correlation between the knowledge of mothers regarding weaning
and nutritional status of their under-five children with a view to develop an information
booklet at selected primary health centers of Davangere district.”
6.3 OBJECTIVES OF THE STUDY:
1. To assess the knowledge of mothers regarding weaning.
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2. To assess the nutritional status of the under-five children.
3. To identify the correlation between the knowledge of mothers regarding weaning and
nutritional status of their under-five children.
4. To identify the association between selected socio demographic variables with the
knowledge of mothers regarding weaning.
5. To identify the association between selected socio demographic variables with the
nutritional status of under-five children.
6.3.1 OPERATIONAL DEFINITIONS:
1. Assess: Assess refers to recognition of nature and interrelationship between knowledge
of mothers regarding weaning and nutritional status of their under-five children.
2. Correlation: Correlation refers to statistically measured interrelationship between
knowledge of mothers regarding weaning and nutritional status of their under-five
children.
3. Knowledge: knowledge refers to the awareness of mothers regarding weaning diet as
measured by self reported questionnaire or interview schedule.
4. Mothers: Mothers refers to those who are having under-five children, fulfilling inclusive
and exclusive criteria.
5. Weaning: Weaning refers to systematic introduction of liquid, semi solid and solid foods
along with breast milk at appropriate time to provide adequate nutrient food to infants.
6. Nutritional status: nutritional status refers to recognition of the extent to which under-
five children are nourished based on recommendations of Gomez classification through
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the measurement of weight, expected weight and percentage of nutritional status as
following:
Between 90 and 110% - normal nutritional status.
Between 75 and 89% - 1st degree, mild malnutrition.
Between 60 and 74% - 2nddegree, moderate malnutrition.
Under 60% - 3rddegree, severe malnutrition.
7. Under-five children: Children aged between 0 to 5 years of age.
8. Information booklet: information booklet refers to health education literature prepared
for the mothers of under-five children regarding problem associated with weaning meant
for self directed learning with the credit of one hour.
6.3.2 ASSUMPTION:
1. Mothers are having knowledge regarding weaning.
2. Self administered questionnaire and interview schedule can measures the knowledge of
mothers regarding weaning.
6.3.3 HYPOTHESIS:
H1: There will be significant correlation between the knowledge score of mothers regarding
weaning and nutritional status of their under-five children at selected primary health centers of
Davangere district.
H2: There will be significant association between selected socio demographic variables with
knowledge of mothers regarding weaning.
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H3: There will be significant association between selected socio demographic variables with
nutritional status of their under-five children.
6.3.4 SAMPLING CRITERIA:
INCLUSION CRITERIA:
1) The mothers who are having under-five children.
2) The mothers who are willing to participate in this study.
3) The mothers who are able to speak Kannada, English.
4) The mothers who are available at the time of date collection.
EXCLUSION CRITERIA:
1) The mothers who are severely ill at the time of data collection.
2) The children who are severely ill at the time of data collection.
3) The mothers who are not available at the time of date collection.
6.3.1 DELIMITATION:
1) The study is limited only to knowledge instead of other determinants of behavior like
attitude and practice.
2) The study is limited only to 60 samples.
7. MATERIALS AND METHODS
7.1 SOURCE OF DATA:
Mothers of under-five children at selected primary health centers of Davangere district.
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7.2 METHOD OF DATA COLLECTION:
1) Research approach : Non- experimental approach.
2) Research Design : Co-relational survey design.
3) Setting : Selected primary health centers of Davanger
4) Population : Mothers of under-five children seeking health
care services from selected primary health centers
of Davangere.
5) Sample : Mothers of under-five children who are all
fulfilling the inclusive and exclusive criteria.
6) Sample Size : 60
7) Sampling Technique : convenient sampling.
8) Method of data collection : self reported method of data collection.
Tool for the data collection : Self administered questionnaire or structured interview
schedule.
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METHOD OF DATA ANALYSIS:
1. The descriptive statistics will be used for data analysis that is measures of central
tendency like mean, median, percentage and measures of dispersion like range,
standard deviation, graphical and diagrammatic.
2. The inferential statistic will be used like Karl pearson’s co efficient of correlation,
chi-square test and ANOVA.
Duration of study: 16 moths.
Duration of intervention to: 4 weeks
Duration of data collection: 8 weeks
VARIABLES:
1. Dependent variable: knowledge of mothers regarding weaning and nutritional status of
their under-five children.
2. Independent variable: socio demographic variables like parity, birth order, age,
educational status, economic status, type of diet, type of family and religion.
7.3 Does the study require any investigations or interventions to be conducted on
patients or other humans or animals?
Yes: Investigation is in the form of assessment of knowledge regarding weaning and
nutritional status of their under-five children.
7.4 Has ethical clearance been obtained from your institution?
Yes: Permission obtained from institutional review committee.
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8. BIBLIOGRAPHY:
1. B.T.Basavanthappa .Community Health Nursing. Jaypee publication. New Delhi. Second
edition. 2008:P: 505.
2. Brylin Highton: Weaning as a natural process. LEAVEN, Vol. 36. No. 6, December
2000-January 2001, PP: 112-114. Available on: http://www.llli.org/llleaderweb/
lv/lvdec00jan01p112.html
3. Helizabeth B Hurlock. Child growth and development. Tata Mc Graw publications. New
Delhi. 5th ed. 2007: P: 697.
4. S. Chatterjee and S. Saha : A Study On Knowledge And Practice Of Mothers Regarding
Infant Feeding And Nutritional Status Of Under-Five Children Attending Immunization
Clinic Of A Medical College. The Internet Journal Of Nutrition and Wellness. 2008
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nutrition-and-wellness/volume-5-number-1/
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Mothers Regarding Child Feeding. Biomedical volume 21:2005.PP: 71-75.Available on:
http://www.thebiomedicapk.com/articles/40.pdf
6. Ann Ashworth, Alan Jackson, ‘Focusing on Malnutrition management to improve child
survival in India’ Journal of the Indian Academy of pediatrics. June 2007; 44 (6) : p.413.
Available on: http://medind.nic.in/ibv/t07/i6/ibvt07:6p413.pdf
7. Park K, Textbook of Preventive Social Medicine, 2000, 16 th edition, Banarsidas, Bhanot
Publishers; Jabalpur; pp.367, 386-387.
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8. The Hindu, “Infant mortality rate on infants”, Thursday , Jan 07, 2010
9. Dinesh Kumar, Goel N.K, Poonam C, Mittal, Purnima, Misra, “Influence of infant
feeding practices on nutritional status of under five children”. Indian journal of pediatrics
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reasons for inappropriateness in timing, quantity andconsistency department of pediatrics,
university college of medical science and Guru Teg Bahadur .By Hospital, Delhi, India:
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/pubmed/18245935
11. Burns nancy, Grover K susan, “Text Book of Undestanding Nursing Research,” 2nd ed.
WB Saunders Company, Philadelphis. p:34-35
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Available on : http://www.ncbi.nlm.nih.gov/pubmed/21385639.
13. Terrant RC, Younger KM, Sheridan – Periram, White MJ, Kerney JM: Factors associated
with weaning practice in term infants: a prospective observational study in Ireland Br J
Nutr. 2010 Nov: 104 (10): 1544-54 Available on: http://www.ncbi.nlm.nih.gov/
pubmed/20598218.
14. Arun kumar Jindal: Weaning Practices among mothers in selected hospitals in
Mangalore. The nursing journal of India. Volume C. No. 8 august 2009. Available on:
http://www.tnaionline.org/august-09/10.htm.
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15. Anjalin Dsouza, et al. Manipal College of Nursing: effectiveness of planned teaching
programme on knowledge and attitude on complementary feeding among mothers of
infants in Udupi. 2009. The Nursing Journal of India, vol. C. No 11. Available on:
http://www.tnaionline.org/nov-09/4.htm.
16. Biswas S, Bose K, Mukhopadhyay A, Bhadra M. Prevalence of under-nutrition among
pre-school children of Chapra, Nadia district, West Bengal, India, measured by
composite index of anthropometric failure (CIAF). Anthropol Anz 2009 Sep;67(3):269-
79. Available on: http://www.ncbi.nlm.nih.gov/pubmed/20405700.
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