RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES

BANGALORE, KARNATAKA

SYNOPSIS PROFORMA FOR REGISTRATION OF SUBJECT

FOR
DISSERTATION

1. NAME OF THE CANDIDATE : MS. PARVINA BEGUM NAADAF

AND ADDRESS I YEAR M.Sc NURSING,
GOVERNMENT COLLEGE OF
NURSING, FORT,
BANGALORE-02.
2. NAME OF THE INSTITUTION : GOVERNMENT COLLEGE OF
NURSING,FORT,
BANGALORE-02
3. COURSE OF STUDY AND : M.Sc. NURSING
SUBJECT CHILD HEALTH NURSING
4. DATE OF ADMISSION : 27-07-2012

5. TITLE OF THE TOPIC : EVALUATE THE EFFECTIVENESS

OF “HYDERABAD MIX” ON
UNDERFIVE MALNOURISHED
CHILDREN OF SELECTED PHC
AREA, BANGALORE.

6. BRIEF RESUME OF THE INTENDED WORK

INTRODUCTION:

Children are the wealth of tomorrow; take care of them, if you wish to
have a strong India ever ready to meet various challenges.
PanditJawaharlal Nehru
Food means not only proteins, fats, minerals, vitamins and other nutrients-
but much more; it is part of security and civilization. Nations and civilization are
linked together not only by ideas, but also by bread. Hunger and malnutrition are
problems everywhere and have harassed mankind and threatened peace throughout
history. It is no wonder that the growing incidence of hunger and malnutrition should
have come to the forefront of international concern.1

The effects of malnutrition on the community are both direct and indirect.
The direct effects are the occurrence of frank and subclinical nutrition deficiency
diseases such as kwashiorkor and marasmus.2The indirect effects are high morbidity
and mortality among young children; nearly 50 percent of total deaths in the
developing countries occur among children under 5 year of age as compared to less
than 5 percent in developed countries.1

In India, gross malnutrition is said to kill around 5, 00,000 of our infants and
children every year. This quite understandable in view of the fact that around three-
fourth of our pediatric population is suffering from one or another nutritional
deficiency. Around 25% of the pediatric beds are occupied by patients whose major
problem is malnutrition.3

Children with mild to moderate malnutrition are best managed in their own
homes and kept under surveillance so as to find out improvement or deterioration in
their nutritional status. The parents of such children can enlighten about the
inadequacy in child’s intake and guided how to correct it. 3 Nutritional preparation by
National Institute of Hyderabad called “Hyderabad Mix” was found beneficial in
managing mild to moderate malnutrition at home level. The stress is given on the
locally available economic foods rather than on expensive tinned protein preparations
which should be reserve for special situations. The parents must be apprised of the
value of carbohydrates and the rationale of giving liberal amounts of semisolid and
solid food. Domiciliary treatment brings most of the times gratifying results and it
also reduces unnecessary hospitalization and in addition enlightens family members
regarding nutritional importance.3

6.1 NEED FOR THE STUDY:

Nutrition adequacy is one of the key determinants of the health and well-being
of the children.2Good nutrition is essential for proper growth during childhood. To
grow up healthy, with vitality and energy, children need adequate
nutrition.4Insufficient food will not only result in under-nutrition in terms of
inadequate weight gain but will also hinder growth. 5Under nourishment not only
retards physical development but also hampers the learning and cognitive process,
leading to sluggish educational social and economic development.4

When it comes to child malnutrition, children in low-income families are more

malnourished than those in high-income families. Children those belonging to
scheduled castes or tribes also face higher rates of malnourishment. This phenomenon
is most prevalent in the rural areas of India where more malnutrition exists on an
absolute level. Whether children are of the appropriate weight and height is highly
dependent on the socio-economic status of the population.6

Children of families with lower socio-economic standing are faced with sub-
optimal growth. While children in similar communities have shown to share similar
levels of nutrition, child nutrition is also differential from family to family depending
on the mother’s characteristic, household ethnicity and place of residence. It is
expected that with improvements in socio-economic welfare, child nutrition will also
improve.7

The World Bank estimates that India is ranked 2nd in the world of the number

of children suffering from malnutrition, after Bangladesh , where 47% of the children
exhibit a degree of malnutrition. The prevalence of underweight children in India is
among the highest in the world, and is nearly double that of Sub-Saharan Africa with
dire consequences for mobility, mortality, productivity and economic growth.8

The 2011 Global Hunger Index (GHI) Report ranked India 15th, amongst

leading countries with hunger situation. It also places India amongst the three
countries where the GHI between 1996 and 2011 went up from 22.9 to 23.7, while 78
out of the 81 developing countries studied, including Pakistan, Nepal, Bangladesh,
Vietnam, Kenya, Nigeria, Myanmar, Uganda, Zimbabwe and Malawi, succeeded in
improving hunger condition.9 

Under 5 mortality rate (per 1000 live births) in India is 74 per 1000 live
birth latest (2005-06) by NFHS – III. 10Malnutrition is one of the major causes of
infant and child mortality. According to UNICEF estimates globally, malnutrition is
an underlying factor in more than half the deaths of children underfive years of
age.11.As per UNICEF, India is among those countries with highest child mortality
rate. In India under 5 year mortality is 65.6/1000 (2011).12.

6.9 million Children under the age 5 died in 2011 , According to WHO In
2010 about 20 million children worldwide were estimated to suffer from severe acute
malnutrition. Globally, in 2010 an estimated 171 million children below 5 years of
age, were stunted and 104 million were underweight. According to UNICEF 2010 in
India around 46%all children below the age of 3 are too small for their age, 47% are
underweight and at least 16% are wasted. the prevalence of malnutrition varies across
the states, with Madhya Pradesh recording the highest rate 55% and Kerala among the
lowest 27%13

Malnutrition is a widely prevalent problem in the India and one of

astonishing magnitude. Thirty five percent of the World’s undernourished children
live in India.7The third National Family and Health Survey has revealed that 46% of
the children are malnourished. Shockingly Karnataka known for its world class
information technology and high-tech industrial enterprises has 44% of its children
below 5 years underweight and 37% stunted growth.14

21% of all the deaths occurring among underfive is attributable to

malnutrition. Malnutrition takes a particularly severe toll among pre-school children 15.
Eighty percent of these preschool children stunted live in just 20 countries in Africa
and Asia Pacific region.16

Underfive mortality rate of Primary Health Centers (PHCs)at Karnataka is

26.8/1000 live birth.17 (MDG)1 pertains to eradicate prevalence of underweight
children less than 5 years of age. Thus these interventions like introduction of
appropriate and adequate complement and require special and sustained focus.18

Surveys carried out by a large number of workers in India and other

developing countries have shown that the diets consumed by a large majority of
preschool children are based mainly on cereals and contain only small amounts of
pulses, thus leading to incidence of protein-calorie malnutrition is particularly high
among preschool age.19

Since a large majority of preschool children in developing countries

consume inadequate diets and suffer from malnutrition, there is an urgent need to
institute supplementary feeding programs in the developing countries. The key
preventive measures suggested in the UNICEF report for these children are
appropriate complementary feeding. Low cost supplementary foods include cereals,
puffed Bengal gram dhal and roasted groundnut. Puffed Bengal gram dhal flour,
roasted groundnut powdered mixed with jaggery has been used for treatment of
protein calorie malnutrition in preschool children and hence can be fed as a
supplement to preschool children.20

A supplementary food based on a blend of roasted wheat flour (30 parts),

green gram flour (20 parts), groundnut (8 part) and sugar or jaggery (20 parts) has
been developed by National Institute of Nutrition, Hyderabad. The food contains
about 12.5 percent proteins. A daily supplement of 80g of the Hyderabad mix food
(providing 300kcal and 10g of proteins) has been found to bring about significant
improvement in the growth rate of pre-school children. 19 Studies have also shown that
the formula advised by the National Institute of Nutrition, Hyderabad specially
prepared protein mixtures provide an increase of weight after 22 days to 3 weeks or
little later.21

The 2011 Global Hunger Index (GHI) Report ranked India 15th,
amongst leading countries with hunger situation. It also places India amongst the
three countries where the GHI between 1996 and 2011 went up from 22.9 to 23.7,
while 78 out of the 81 developing countries studied, including Pakistan, Nepal,
Bangladesh, Vietnam, Kenya, Nigeria, Myanmar, Uganda, Zimbabwe and Malawi,
succeeded in improving hunger condition.22
 A Project has been conducting by Shree swami Samarth hospital of Ratnagiri
district in order to implement the project of “malnutrition among preschool children
and women in India” in nine villages. A total of 1267 were selected who attending
the 'anganwadis' as well as other children of these villages. Out of this the
undernourished children will form the target group of the project. This recipe is
devised by National Institute of Nutrition, Hyderabad and is modified by Walawalkar
Trust Hospital was given to the children in the form of ladu. Thus 5444 kcals are
provided by 30 'ladus'. One 'ladu' provides 181.46 kcals. Each undernourished child
of the project is supplemented daily with diet providing more than 300kcals along
with 10 to 12 grams of proteins. The project revealed that, all the 1267 children
surveyed and first degree malnourished will receive deworming, vitamin A
supplementation every six monthly. 352 with Grade II malnutrition will receive
supplementary nutrition with 2 'ladus' daily, 142 with Grade III and Grade IV
malnutrition will receive supplementary nutrition with 3 'ladus' each daily, and
multivitamin supplements. Totally parents of 1267 children will receive nutrition
education. The project suggests that, in the initial phase the project would work on
curative basis and treat under nutrition as a cause of childhood morbidity. It will be
supplemented by health education. Later the project will have promotive component
with monthly weight recording and continuing surveys in other villages. In the last
phase the project will be preventive when supplements will be slowly weaned off and
health education will form the major interventional measure so as to have a lasting
impact on the community and prevent malnutrition in the future generations.23

The researcher’s clinical experience, it was that there was a high prevalence
of malnutrition among underfive children at Bangalore and so Hyderabad mix was
assumed to be the cheap and best supplementary food in treating the malnutrition
which is introduced by National Institute of nutrition at Hyderabad, hence to evaluate
the effectiveness of this recipe on malnourished children I have selected this problem
for my research study.

6.2 REVIEW OF LITERATURE:

 A descriptive study was conducted to analyses the degree of malnutrition in
children underfive years of age in Internally Displaced persons (IDPs) camp of
Jalozai. Samples of 100 children in the age group of 6-59 months were selected. The
study used Gomes and Havard classification, the study findings revealed that out of
100 malnourished children 40% were boys, and 60% were girls. 20% boys and 28.3%
girls had mild, while 80% boys and 71.7% girls had moderate malnutrition, 33% were
breast fed, 31.3% were bottle fed, and 4% were both bottle fed and breast fed, 3%
child gas not at all immunized. The study concludes that prevalence of malnutrition
increases for refugees and IDPs and is more common in females as compared to
males.19

A cross sectional study was conducted to assess the magnitude of the

problem of malnutrition in an municipal area of North Bengal and also assess dietary
pattern and average intake among 30 cluster sampling technique. Out of 316
participants, 30 clusters for assessment of nutritional status and 92 families for
assessment of dietary pattern were selected. The results of the study were prevalence
of malnutrition was observed to be 62.97% and prevalence of severe degree of
malnutrition was 6.65% more so amongst 12-23 months of age and amongst females
average calories intake was 2271.7 K calories and nearly half of the studied families
were getting less than 2400k cals.24

A study was conducted to assess the school breakfast environment in rural

Appalachian schools to inform school environment intervention and policy change,
among total of 4 rural schools with fourth- and fifth-grade students in East Tennessee.
A cross-sectional descriptive examination of the school food environment where food
service managers submitted school menus, production sheets, and vendor bid sheets
as part of the dietary data collection protocol for a school-based nutrition intervention
study. Results revealed that total fat provided slightly less than half the calories
(43%); 15% of calories were from saturated fat. The top-ranked foods for each meal
component were biscuits, sausage, 2% milk, orange juice, and gravy. 25

A cross sectional study was conducted on epidemiological correlates of

under nutrition in under 5 year among 200 randomly selected underfive children in an
urban slum of Ludhiana. The study findings revealed that 74% of the children were
foun to be stunted, 42% of them to be wasted and 29.5% of them were under weight.
The study concludes that the multiple risk factors for childhood malnutrition,
requiring a multi-sectoral approach in the fight against the silent killer of
malnutrition.26

A longitudinal study was conducted at Egypt on the effect of “An

Intervention Program for improving the nutritional status of children aged 2-5 years”.
The objectives of the study was to assess the feasibility of providing nutrition
intervention to 2-5 year old children in day care center setting; to help mothers
develop important concepts, attitudes and behaviour toward food; and to be able to
make wise choices about their children’s food and to evaluate the effect of a selected
intervention on the nutritional status of children. A pre test/post test intervention
design was used for the study population. The sample included in the study was 974
children aged 2-5 years from the areas of Alexandria 3 day care centers and their
mothers. Results of the study showed that mean score of mothers knowledge was
78.5% (SD 10.8%) before the intervention which increased significantly 1 year after
the intervention to 91.8% (SD 6.0%). Results also showed the percentage of
underweight boys before the intervention was 4.6% which decreased 1 year after the
program to 1.5%. The comparative percentages among girls were 4.6% and 0.3%. As
regards the percentage of stunted boys and girls they were 5% and 4.6% before the
intervention compared to 3.5% and 2.3% after the intervention respectively. Wasting
was present among 1.9% of boy and 2.3% of girls before the intervention compared
with 0.0% and 0.3% respectively after the intervention. The study concluded that
nutrition intervention can be provided to preschool children in day care centers. Short
interventions appear to be practical strategies for improving the nutritional status of
children.4

A study was conducted on “Feeding from the family pot for prevention of
malnutrition” in four villages of Ropar district at Punjab, India. The objective of the
study was to test whether it was possible to utilize existing family resources for the
prevention and treatment of malnutrition. The study included 76 children less than six
years of age. The 76 children were visited at home three times a week for two weeks
and then once a fort night for four fortnight Fortnightly visits were continued and
weights were recorded every month. The results showed that 14.26 percent of children
were found to be suffering from grade 2 or grade 3malnutrition. Within six months
this figure had dropped to 5.63 percent and within the next 12 months only 2.06
percent of the children in the population had grade 2 or grade 3malnutrition. This
study concluded that the children continued to gain weight after the nutrition
demonstrations and that the malnutrition prevalence rate continued to decline for
several months shown that feeding from the “family pot” had been adopted as a
family habit.27

A study was conducted to evaluate the effectiveness of Maize and soy flour
mixes in treatment of moderate malnutrition in Malwai, South Africa, among Sixty-
one underweight, stunted children 42 to 60 months of age were recruited in rural
Malawi, in southeastern Africa. They received either RTUF (Recently developed
ready to use food) or maize or soy flour for 12 weeks. With outcome variables of
weight and height gain and dietary intake in either group, Periodic 24-hour dietary
recalls suggested that the children received 30% and 43%, respectively, of the
supplementary RTUF and maize and soy flour provided. This study concludes that
freshly prepared nutritive preparations have better outcomes in improving nutritional
status of malnourished children.28

A study was done on “locally available and natural therapeutic foods for
immune modulation in Protein energy malnutrition” because in children with PEM,
there is significant impairment of all specific and non-specific immune responses
which may lead to significant growth altering, developmental retardation and
micronutrient deficiencies. Hence cheap and easily available dietary supplements like
Hyderabad mix which enhance immune recovery are designed in the process of
nutritional rehabilitation by WHO as well. The study have shown beneficial effects on
supplementation of Hyderabad mix to children for 15 days and the study have
revealed that there is improvement in children by assessing the hematological and
immunological parameters of children with moderate to severe malnutrition.29

A prospective randomized trial study was carried out in Chandapur district

at Bangladesh. The objective of the study was to test the efficacy of an Intensive
Nutrition Education (INE) with or without supplementary feeding to improve the
nutritional status of moderately malnourished children and to change behaviors of
mothers relating to child feeding practice. The study included 282 moderate degree
malnourished children and their mothers and made two intervention groups and one
comparison group. The children were observed for six months. Results showed that
after three months of interventions a significantly higher proportion of children in the
INE (Intensive Nutrition Education) and INE+SF (Supplementary Feeding) groups
improved (37% and 47% respectively) from moderate to mild or normal nutrition
compared to the comparison group (18%) (p<0.001). At the end of six months of
observation, the nutritional status of children in the intervention groups improved
further from moderate to mild or normal nutrition compared to the comparison group
(59% and 86% vs 30%, p<0.00001). The frequency of child feeding and home-based
complementary feeding improved significantly (p<0.001) in both the interventions
groups after three months of interventions and six months of observation. Ability of
mothers to identify malnutrition improved from 15% to 99% in the INE group and
from 15% to 100% in the INE+ SF group, but reduced from 24% to 21% in the
comparison group. The study concluded from the findings that intensive nutrition
education significantly improves the status of moderately malnourished children with
or without supplementary feeding.30

A study was carried out in three backward states of Uttar Pradesh, Rajasthan
and Orissa in India on the nutritional status of the preschool children among. In each
of the states, three districts backward in terms of education, health care and economic
development were selected. In each of these districts, two blocks were selected on the
basis of maximum concentration of SCs (Schedule Castes) and STs (Schedule Tribes).
Two villages from each block, on the basis of random sampling, were taken up for the
study. A total of 80 samples were selected from each of the eighteen blocks, making a
sum of 1,440 samples for the entire study. The sample size for beneficiary / parents
schedule was 1080. In each village 30 children were selected from an anganwadi
center for growth measurement. The study revealed that overall about 36.8% of the
children whose height measurements were taken, were short for their age or stunted
32.9% in the age group below three years and 40.8% in the age group 3 to 6 years
measured below the standard height. This percentage indicates the prevalence of
chronic under-nutrition among these children. 58.4% mothers from all three states
said that lack of nutritive food was the prime cause of poor health in their children.
The study concluded that the higher percentage of severely malnourished children in
the upper age group of 3 to 5 years reflects the chronic nature of under nourishment.
This study reflects the need to provide a regular and adequate supplementary diet to
their children and need to educate mothers on proper feeding practices.2

A cross sectional study was conducted on “Under nutrition and childhood

morbidities among tribal preschool children in Jabalpur district at Madhya Pradesh.
The objective was to assess the nutritional status, nutritional deficiency signs and
other morbidities among pre-school children of fond tribal community of Madhya
Pradesh, India. In order to assess nutritional status of preschool children, 27 of the
197 tribal villages were selected. The sample size was thus estimated a total of 1022
children were examined (Male 527, Female 495). Results showed high prevalence of
under nutrition in terms of underweight (61.6%), stunting (51.6%) and wasting
(32.9%) was observed among them. The study revealed severe degree of underweight,
stunting and wasting in 27.8, 30.3 and 6.5 percent children, respectively. More than
60 percent children were underweight and more than 25 percent had severed under
nutrition. The study concluded that the problem of under nutrition amongst pre-school
tribal children needs to be addressed through comprehensive preventive promotive
and curative measures. Appropriate nutritional programs should be designed to meet
the requirements. A comprehensive child survival program with supplementary
feeding, growth and development monitoring and early, prompt treatment during
illness needs to be devised and implemented ensuring community participation.15

A study was conducted on a supplementary food based on Hyderabad mix in

National Institute of Nutrition, Hyderabad on acceptability trials with three types of
recipes was carried out on 184 young preschoolers (6 months to 35 months) residing
in four nearby villages around Hyderabad. Results of this study indicated that among
the 3 types of supplementary foods (Sweet Ready Mix, Sweet Ready Mix with
Amylase and Therapeutic food tested here, the Therapeutic food was more acceptable
(taste, smell and bulk) to the children. The criteria for acceptability of the food was
defined as the ability of 75% of the children to consume 75% or more of the food
supplement at one sitting for 70% of the days of the trial. The Therapeutic food, a
calorie dense supplement, met the above criteria. The acceptability was poor for the
Sweet Ready Mix and Sweet Ready Mix with Amylase (< 4%) mainly due to
quantitys rather than taste and smell as revealed by the mothers. The mothers of the
children also liked the taste and smell of the therapeutic food better. Consumption of
the therapeutic food caused minimal side effects like diarrhea and vomiting when
compared to side effects after eating Sweet Ready Mix and Sweet Ready Mix with
Amylase in children.20

A detailed study was carried out on the Hyderabad mix recipe in a village
around Hyderabad by the National Institute of Nutrition with an objective to show
that it is possible to develop action programs with the active participation of the
community to utilize the Hyderabad mix recipe as local food resources for the best
advantage of the preschool children in the community. In this program, all the
operations including preparation of the food and its distribution to children were
carried out by the women of the village and by the members of the local youth club.
This work clearly showed that such a program would be received well by the village
community and an evaluation of the feeding program revealed that the incidence of
malnutrition among preschool children can be considerably reduced with such
preparation which is much cheaper than proprietary and processed foods.31

STATEMENT OF THE PROBLEM

EVALUATE THE EFFECTIVENESS OF “HYDERABAD MIX”ON

UNDERFIVE MALNOURISHED CHILDREN OF SELECTED
PHC AREA, BANGALORE.

6.3 OBJECTIVES OF THE STUDY.

1. To assess the nutritional level of underfive malnourished children of control

and experimental group.

2. To prepare and provide Hyderabad Mix to underfive malnourished children of

selected PHC area, Bangalore.

3. To evaluate the effectiveness of Hyderabad Mix on underfive malnourished

children of selected PHC area, Bangalore. 

4. To find an association between the pre test scores with selected demographic
variables.

6.3.1. RESEARCH HYPOTHESES.

H-1: there will be a significant effect of Hyderabad mix on underfive malnourished
children of selected PHC area, Bangalore.
H-2: There will be a significant association between the underfive malnourished
children of selected PHC area and demographic variables.

6.3.2. RESEARCH VARIABLES.

1 Independent variable : Hyderabad mix.

2 Dependent variable : Nutritional level of underfive malnourished

. children of selected PHC area.

3 Attribute variables : Age, Gender, Type of family, Religion, Family

income.

4 Extraneous variables : Food habits, education of the parents, sources of

information, quality of food and illness.

6.3.3. OPERATIONAL DEFINITION.

a. Effectiveness : It refers to the extent to which Hyderabad mix had an effect

on improvement in the nutritional level of malnourished
underfives of selected PHC area.
b Hyderabad : It refers to a supplementary feed made of a mixture of
. mix wheat (40 gm) ,Bengal grams 16 gm, groundnut (10 gm)
and jaggery (20 gms).A ball of Hyderabad mix weighing 86
gms will be providing 330kcal energy and 11.3gms
protein, which will be given for a period of 30 days.

c. Underfive : Refers to the children in the age group of 1-5 of selected

PHC area.
d Malnourished : According to WHO reference standards if the weight of the
. children children is between 80% and 70% lines it indicates mild
malnutrition, if the weight is between 70% and 60% lines it
indicates moderate malnutrition.
E Primary health It refers to the basic heath unit, to provide integrated
centre curative and preventive health care to the rural population
with emphasis on preventive and promotive aspects of
health care.

7. MATERIALS AND METHODS.

7. Source of data : Data will be collected from underfive

1 malnourished children of selected PHC area,
 Bangalore.
7. Method of collection of data
2

7.2. Definition of the study subjects : Underfive malnourished children of selected

1 PHC area, Bangalore.

7.2.2 Inclusion and Exclusion criteria

a) Inclusion criteria : 1. Undrefive children of selected PHC area,
Bangalore.
2. Underfive children who are mild and
moderately malnourished.
3. Mother willing to allow the child to
participate in the experimental study.
4. Underfive malnourished children present
at the time of data collection.
b) Exclusion criteria : 1. Underfives who are sick or ill.
2. Severely malnourished underfive children

7.2.4 Research design : True experimental design.

Pretest-post test control group design.

7.2.5 Research Setting : The study will be conducted in the urban

selected PHC area, Bangalore.
7.2.6 Sampling technique : Simple random technique by using lottery
method.

7.2.7 a) Sample size : Total 40underfive malnourished children.

20 control group and 20 experimental group.
b) Duration of the study : 30 days.

7.2.8 Tool of research : The following tools will be used

1. Structured interview schedule.
 The investigator will use the
demographic variables such as Age,
Gender, Educational status, Type of
 family, Religion, Family income,
Source of information.
2. Assessment of nutritional level: on
the bases of their heights and weights
for their respective ages, by using
WHO growth chart.
 Percentage of mal nutrition will be
calculated by using formula:
% of malnourished = actual
weight/expected weight *100
 And degree of malnutrition is
compared with the Percentage
reference line of WHO growth chart
used by ICDS in India.

7.2.9 Collection of data : After obtaining consent from the

concerned authority and mothers of study
subjects, investigator herself collects the
data by,
Group Pre Interventi Post
- on -test
test
1)control O1 _ O2
2)experimen O1 X O2
tal

O1)pre-test data will be collected by

 Structured interview schedule.
 Assessment of nutritional level by
using WHO growth chart.

X) Preparation and administration of

Hyderabad mix.
 O2) Post test data will be recorded by
assessing nutritional status, after 30 days of
administering Hyderabad mix tounderfive
malnourished children of selected PHC area.

7.2.10 Method of data analysis : (i) Descriptive and inferential statistics will be
and presentation
used to analyze the data
1). Frequency, mean, median, mode, standard
deviation to analyze the test scores.
2).Paired ‘t’ test to find the improvement in
the nutritional status of underfive
malnourished children of selected PHC area.
3). Chi square to find the significant
association between pre test and post test
scores and their selected personal variables,
(ii) The analyzed data will be presented in the
form of tables, diagrams and graphs.

7.3 Does the study require investigation to be conducted in patients?

Or other human or animals? If so please describe briefly.
Yes, the study will be conducted onunder five malnourished children of selected PHC
area. Regarding assessing nutritional level and evaluating the effectiveness of
Hyderabad mix on malnourished underfives.

7.4 Has ethical clearance been obtained from your institution in case of 7.3?

 Yes.
8. LIST OF REFERENCES

1. Park K. Text of preventive and social medicine. 19th ed. BanasidarsBhanot

Publishers, Jaipur. India: 2000; P.No 408,428,548.

2. Kumar S. Malnutrition in children of the Backward states of India and the

ICDS programme. Journal of Health and Development. [Online] 2005 Dec
[Cited 2008 Nov 12]; 1(3-4):1483-1490

3. Gupte S. The short text book of Pediatrics. 10thed. New Delhi: Jaypee Brothers
Medical Publishers (P) Ltd; 2004. p. 125-147.

4. Ghoneim EH, Hassan MHA, Amine EK. An intervention programme for

improving the nutritional status of children aged 2-5 years in Alexandria.
Eastern Mediaterranean Health Journal. [Online] 2004 Nov [Cited 2008 Nov
10]; 10(6): 828-
 843.Availablefrom:URL:http://www.emro.who.int/publications/EMHJ/1006/A
n_intervention.htm.

5. Basavanthappa BT. Community Health Nursing. 1st edn. New Delhi: Jaypee
Publication; 2005. 526.

6. HUNGaMA Survey Report. Naandifoundation.Retrieved 1 February 2012.

Available from:http://www.hungamaforchange.org/HungamaBKDec11LR.pdf

7. Kanjilal, Barun, Mazumdar, Mukherjee, Rahman (January 2010). "Nutritional

status of children in India: household socio-economic condition as the
contextual determinant". International Journal for Equity in Health 9: 19–31
Available from: http://www.digplanet.com/wiki/Malnutrition_in_India

8.  World Bank Report.Source: The World Bank (2009). Retrieved 2009-03-13.

"World Bank Report on Malnutrition in India. Available from:
http://en.goldenmap.com/Malnutrition_in_India

9. 2011 Global Hunger Index Report. International Food Policy Research Institute
(IFPRI).Available from:www.ifpri.org/sites/default/files/publications/ghi11.pd

10. Primary Health Care. Indian Scenario Natioinal Family Health Survey-III.
[Online] 2005-06:118 Available from: www.un.org/millenniumgoals/
URL:http://www.hindu.com/2008/01/23stories/2008012355961300.htm.

11. The Media and children’s Rights. Millennium Development Goals. Connect
World-Global Themes-Children [Online] 2008 [Cited 2008 Nov 10]. Available
from: URL:http://www.connect-
world.net/global_themes/children/overview.html.

12. UNICEF India- the children- nutrition.URL: www.unicef.ora/india/children

2356.htm

13. WHO Media centre. Children: reducing mortality. Available from URL:
www.who.int/mediacentre/factsheets/fs178/en/index.htmlTelephone:
+41227912222

14. Sarkaritel UNICEF report, New Delhi. [Online] 2008 Jan [Cited 2008 Nov
10].Available
from
:URL:http://www.sarkaritel.com/news_and_features/infa/january08/27child
15. Rao VG, Yadav R, Dolla CK, Kumar S, Bhondeley MK. Under nutrition and
childhood morbidities among tribal preschool children. Indian Journal Med
Res. 2005 July; 122:43-7 Available from URL: www.jdrntruhs.org/text.asp?
2012/1/4/233/105109

16. The Deadly Scourge of Child Malnutrition. PDF World Insecurity and
Malnutrition, Scope, Trend, Cause [Online] 2008 [Cited 2008 Nov
10].Available from :URL:ftp://ftp.fao.org/doccrep/fao/010/a:799e/ai799e02
www.rguhs.ac.in/cdc/onlinecdc/uploads/05_N016_6817.doc

17. Primary Health Care - Indian Scenario. Tenth Five Year Plan, RCHII,
NPP2000, Millennium Development Goal. [Online] 2005 [Cited 2008 Nov
10].Available
from:URL:http://www.mohfw.nic.in/nrhm/presentations/multidimensionalwork
shop/ppp- karnatakast.zip.

18. Agarwal RK. Importance of optimal Infant and Young Child Feeding in
Achieving Millennium Development Goals.Indian Paediatrics. 2008 Sep;
45(9):719-21.

19. RiyazGul, M. AamirKiramat. A Profile of Nutritional Status of Underfive Year

Old Children in Internally Displaced Persons (IDPS) CAMP, Jalozai district
Nowshera. JPMI 2012 VOL 26 NO. 01:43-47

20. Rao DH, Sharma KV, Kumar S, Reddy CG, Roan NP. Acceptability trails with
ready to use food in rural area. National Institute of Nutrition, Indian Council
of Medical Research Hyderabad. PMID- 1291497 . 1992 Dec 29(12) 1513-18.

21. Chellappa JM. Paediatric Nursing. 1st Edn. Bangalore: Gajanana Book
Publishers and Distributors; 2005.273.

22. 2011 Global Hunger Index Report, International food Policy Research
Institute.Child health. Available at URL:(http://updateox.com/tag/child-health)
(http://updateox.com/wp-content/uploads/2011/07/child-morality-rate-in-
India.jpg.

23. Project on Malnutrition among Pre-School Children & Women in

India.Available at:
URL:http://www.swamisamarth.com/projects/project_1_3.html
24. Sandip Kumar Ray, AkhilBinduBiswas, Samir Das Gupta, et all. Rapid
assessment of nutritional status and dietary pattern in municipal area. Indian
journal of community medicine vol XXV, No.1, Jan march 2000. Department
of community medicine medical college Calcutta.
Availablefrom:URL:medind.nic.in/iaj/t00/i1/iajt00i1p14.pdf

25. Graves A, Haughton B, Jahns L, Fitzhugh E, Jones SJ.Biscuits, milk and

orange juice; school breast fast environment in rural Appalchain schools. J. Sch
health [serial online] 2008 Apr[cited on 2010 Mar 11]; 78(4): 197-
202.Available from:URL: 21 www.ncbi.nlm.nih.gov/pubmed/18336678

26. Paramita, Sengupta, Nina Philip and A. I. Benjamin. Epidemiological

correlates of under-nutrition in under-5 years children in an urban slum of
Ludhiana. HPPI Vol. 33(1), 2010. Available from: URL:
http://medind.nic.in/hab/t10/i1/habt10i1p1.pdf

27. Walia BNS, Gambhir SK, Kumar D, Bhatia SPS.Feeding from the family pot
for prevention of Malnutrition Chandigarh: Department of Paediatrics. Institute
of Medical Education and Research; [Online] 1981 [Cited 2008 Nov
10].Available from :URL:http://www.unu.edu/unupress/food/8F-
074e/8F074E07.htm

28. Maleta K, Kuittinen J, Duggan MB, Briend A, Manary M, Wales J et al.

Supplementary feeding in underweight, stunted Malawian children with a
ready to use food. J. Pedia Gastro Nutr [serial online] 2004 Feb [cited on 2010
Mar 11]; 38(2): 152-5.Available
from:URL:www.ncbi.nlm.nih.gov/pubmed/14734876

29. Elizabeth KE. Locally available and natural therapeutic food for immuno-
modulation in protein energy malnutrition. Indian Journal of Medical
Research; 2007 Sep. Available from :URL:http://findartciles.com/p/articles/mi-
qa3867/is-200709/ai-n21278799/pg-2

30. Roy SK, Funchs GJ, Mahmud Z, Ara G, Islam S. et al Intensive Nutrition
Education with or without supplementary feeding improves the Nutritional
Status of Moderately Malnourished children in Bangladesh. The Journal of
Health, population and nutrition. [Online] 2005 Dec [Cited 2008 Nov 10];
23(4):320-30.Available from :URL:http://www.bioline.org.br/request?hn05043
 31. Gopalan C, Ramashastri BV, Balasubramanian SC. National Institute of
Nutrition Hyderabad. 1st edn. New Delhi: Indian Council of Medical
Research; 1985-54.

9 SIGNATURE OF THE :
CANDIDATE

10 REMARKS OF THE GUIDE : Recommended and forwarded

11 NAME AND DESIGNATION OF : MRS. RENUKA.M.SC (N)

GUIDE LECTURER AND HOD
CHILD HEALTH NURSING,
GOVERNMENT COLLEGE OF
NURSING,
FORT, BANGALORE -02.
 11.1 SIGNATURE :

11.2 HEAD OF THE DEPARTMENT : MRS. RENUKA.M.SC (N)

LECTURER AND HOD
CHILD HEALTH NURSING,
GOVERNMENT COLLEGE OF
NURSING,
FORT, BANGALORE -02.

11.3 SIGNATURE :

12 REMARKS OF THE PRINCIPAL : Recommended and forwarded

12. SIGNATURE :
1

ETHICAL COMMITTEE CLEARANCE

The study titled “evaluate the effectiveness of “hyderabad mix”on underfive malnourished
children of selected PHC area, Bangalore” proposed to be conducted by Ms. Parvina Begum
Nadaf as a part of partial fulfilment of requirement for the degree of Master of Science in
Paediatric Nursing.
Ethical committee members have gone through the study methodology and have opined
that the study been no ethical encumbrance, hence ethical clearance is given to the above
prepared study.
MEMBERS OF ETHICAL COMMITTEE.
1. Dr. BHARTI. M Signature
Principal Chairperso
Government College of Nursing,
n
 Fort, Bangalore -02
2. Dr. SUVARNA. B. TALAWAR
Head of the Department Member
Obstetrics and Gynecological Nursing,
Government College of Nursing, Fort,
Bangalore -02
3. Smt. RENUKA.N
Head of the Department Member
Paediatric Nursing,
Government College of Nursing, Fort,
Bangalore -02
4. Mr. H .B. PRAKASH
Head of the Department Member
Community Health Nursing,
Government College of Nursing, Fort,
Bangalore -02
5. Mr. BASAVARAJU. G
Head of the Department Member
Medical surgical Nursing,
Government College of Nursing, Fort,
Bangalore -02
6. Mr. GANGADHAR.K.R
Head of the Department Member
Psychiatric Nursing,
Government College of Nursing, Fort,
Bangalore -02