“PROJECT PROPOSAL”

“A STUDY OF NUTRITIONAL STATUS OF

PRE-SCHOOL CHILDREN AND KNOWLEDGE

OF MOTHERS ABOUT NUTRITION”

SUBMITTED BY

NAME: PUNEET KUMAR

ENROLMENT NO.: : 2200687080

(DNHE 4)

SUBMITTED TO:
INDIRA GANDHI NATIONAL OPEN UNIVERSITY
( IGNOU) ,NEW DELHI
INTRODUCTION
The importance of diet and nutrition for health and survival of the
living beings . The nutritional status of children is a comprehensive index that
best defines their general well being and reflects the quality of life of the
society which they are apart. Adequate nutrition enhances immunity and
lowers risk of infection, which in tur n, improves chances of survival and
optimal growth in the early years of a child's life (Yohannes Kinfu, 1999).

Well functioning metabolism based on a regular intake of the proper mix of

nutrients, safely ingested prepares our bodies for the main task at hand:
growth, development, and work, resistance to infection and the attainment
and enjoyment of physical and mental well-being. Nutrition is a key factor.

The effects of nutrition not only on growth and physical development, but also
on cognitive and social development are well documented (Gro Harlem Bruridt
land, 1999).

The nutritional status of a family is the resultant of an interaction of a

multitude of factors operating simultaneously and concurrently on the
members of a family. The food intake of different population groups largely
depends on food availability, economic systems, educational levels and food
behavior of the people. The food behavior of the family, in turn is influenced
by cultural, social, personal and environmental factors (Chandralekha, 2000).

Nutritional status is known to be closely related to health status, especially in

younger children. Disease can reduce the body's ability to digest food and
suppresses appetite, leading to possible weight loss and retarded growth in
children. In turn, poor nutritional status can reduce resistance to infection,
leading to a 'malnutrition-infection complex· (Jim Wright et.al, 2001).

In India, almost half of children under five years of age (48 percent) are stunted
and 43 percent are underweight (Ghaudhri, 2010). The proportion of children
who are severely undernourished (more than three standard deviations below
the median of the reference population) is also notable-24 percent according
to height-forage and 16 percent according to weight-for-age (Arun Aggarwal
(2006). Wasting is also quite a serious problem in India, affecting 20 percent of
children under five years of age. Very few children under five years of age are
overweight. Less than 2 percent have a weight-for-height estimate more than
two standard deviations above the median for the reference population and
less than 1 percent is more than two standard deviations above the median on
the weight-for-age indicator. The proportion of children under three years of
age who are underweight decreased from 43 percent in 1998-99 to 40 percent
in 2005-06, and the proportion severely underweight decreased from 18
percent to 16 percent. Stunting decreased by a larger margin, from 51 percent
to 45 percent. Severe stunting also decreased, from 28 percent to 22 percent.
However, the improvement in height-for-age combined with a somewhat
slower improvement in weight-for-age actually produced an increase in
wasting and severe wasting over time (NFHS 2014-15). Inadequate nutrition is
a problem throughout India, but the situation is considerably better in some
states than in others. Under nutrition is most pronounced in Madhya Pradesh,
Bihar, and Jharkhand. Nutritional problems are also substantially higher than
average in Meghalaya and (for stunting) in Uttar Pradesh. Nutritional problems
are least evident in Mizoram, Sikkim, Manipur, and Kerala, and low levels of
under nutrition are also notable in Goa and Punjab (Sabu George et.al., 2013).
Even in these states, however, levels of under nutrition are unacceptably high.
Under nutrition is substantially higher in rural areas than in urban areas. Even
in urban areas, however, 40 percent of children are stunted and 33 percent are
underweight. The decrease in stunting over time is greater in rural areas than
urban areas. The prevalence of of underweight in children who were
underweight decreased slightly more in urban areas than rural areas, but there
is very little improvement in the percentage of children
Who were severely underweight in urban areas (NFHS -4).) As per the national
family health survey (NFHS)-4 (2015-16)), 35.7 percent children below five
years are underweight, 38.4 percent are stunted and 21 percent wasted in the
country. The indicator children under 5 years who are underweight (weight for
age) is one of the composite indicator for child malnutrition. As per NFHS-4
data, the national average of children under 5 years who are underweight has
reduced from 42.5% as reported in NFHS-3(2005-06) to 35.7% in NFHS-4 (2015-
16).

RATIONALE OF THE STUDY

Nutrition plays a vital role as inadequate nutrition may lead to malnutrition,
growth retardation, reduced work capacity and poor mental and social
development. Lack of access to highly nutritious foods, especially in the
present context of rising food prices, is a common cause of malnutrition. Poor
feeding practices, such as inadequate breastfeeding, offering the wrong foods,
and not ensuring that the child gets enough nutritious food, contribute to
malnutrition. Infection - particularly frequent or persistent diarrhea,
pneumonia, measles and malaria - also undermines a child's nutritional status.

Age of the child increases the nutritional requirement of the child and
inadequate supplementary food may lead to under nutrition. In some part of
Delhi sex preference is still prevailing which also contributed to child under
nutrition. Age of mother and father are not the least to cause indirectly to the
nutritional status but with increased birth order. Regarding the socioeconomic
characteristics of father and mother, literacy, family income and caste
contributed to some extent of under nutrition while the living environment of
the child and use of sanitary toilet by the family members are high.
OBJECTIVE OF THE STUDY
The objectives of this study include:

● To study the nutritional status of pre-school children.

● To assess the dietary intake of pre-school children.

● To study the assessment of knowledge, attitudes and practices of mothers

regarding nutrition

METHODOLOGY
Locale of the study
In Punjab 2 pre-school will be selected as a locale of the study. It was selected
purposively for the present study as it will be convenient, so regular visit could
be made authentic for data collection.

Sample unit
Children aged 1-5 years

Sample size
100 pre-school children

Sampling Method
Random sampling method will be employed to carry out this piece of research
work.

Inclusions

● Only pre-school children of Punjab will be included.

● Pre-school children of 1-5 years old.

Exclusions

● Telephonic/ web survey method interviewing

● not willing mothers will be not included.

TOOLS AND TECHNIQUES/ DATA COLLECTION A) DEMOGRAPHIC

PROFILE
The data regarding the demographic profile of respondents a specialized
questionnaire was prepared according to Kuppuswamy Scale 2017. It was
include questions related to respondent’s name, age, religion, marital status,
educational status, employment status, overall income of household and socio-
economic status, etc. B)

ASSESSMENT OF NUTRITIONAL STATUS OF CHILDREN

To measure nutritional status of the pre-school children, anthropometric
measurements were taken and Simple clinical observation was considered.

In 2006, the World Health Organization (WHO) published the first growth
standards as prescriptive charts for children under the age of 5 years to be
used as a single uniform global standard; IAP and Government of India have
adopted these standards for use in Indian children under 5 years of age.

The degree of under nutrition expressed in mean/median and standard

deviation based on both height and weight is used. Children are considered
underweight (weight is too low for their age) or stunted (too. short for their
age) if the weight-forage and height-for-age and weight-for-height z-scores
below −2 are classified as wasted children; z-scores fall below −2 standard
deviations of the mean of the WHO references (weight is too low for their
height). It is denoted as class1. Similarly, children are considered overweight
(weight is too high for their age), if the weight-forage,

Height-for-age and weight-for-height z-scores above 2. It is denoted as class3.

Children are considered normal weight (weight is normal for their age) if the
weight-for-age, height-for-age and weight-for-height z-scores between −2 and
+2; z-scores fall between −2 and +2 standard deviations of the mean of the
WHO references.

Weight
The weight of child was recorded with the help of the weighing machine with
precision up to 100g .The weight of the study subjects will be recorded with
minimum clothing and bare foot.

Height
The height was measured while the child was standing by the side of wall
upright with heels close to each other and arm hanging by the side of body.
The height was measured from head to heels by an ordinary measuring tape.

MUAC
MUAC was measured with non-stretchable fiberglass tape/ shakir’s tape
(colored tapes). WHO child growth standards (11cm≤x≥ 13.5cm )

Cut-off points for screening in the community for SAM and MAM using MUAC

Target Groups MUAC (in cm) Malnutrition

Children under five 11-11.9 Moderate acute malnutrition (MAM)

< 11 cm severe acute malnutrition (SAM)

C) DIETARY ASSESSMENT

24 hour recall method was used for the dietary assessment of pre-school
children. Three days recall was done on each individual 2 working days and a
holiday.
The method consists of precisely recalling, describing and quantifying the
intake of foods and beverages consumed in the 24-hour period prior to, or
during the day before the interview, from the first intake in the morning until
the last foods or beverages consumed at night (before going to bed or later, in
the case of those who get up at midnight and eat and/or drink something). The
estimated average interview time can vary between 20 to 30 minutes

Balance Diet for infants and Children (ICMR 2010)

(Number of portions)
g/portion Infants -12 1-3 years 1-6 years
months
Cereals and 30 0.5 2 4
millets
Pulses 30 0.25 1 1.0
Milk and 100ml 4* 5 5
milk
products
Roots and 100 0.5 0.5 1
Tubers
Green leafy 100 0.25 0.5 1
vegetables
Other 100 0.25 0.5 1
vegetables
Fruits 100 1 1 1
Sugar 5 2 3 4
Fats 5 4 5 5

Quantity indicates top milk. For breastfed infants, 200 ml top milk is required.
One portion of pulse may be exchanged with one portion (50 g) of
egg/meat/chicken/fish. For infants introduce egg/meat/chicken/fish around 9
months.

D) ASSESSMENT OF KNOWLEDGE, ATTITUDES AND PRACTICES OF

MOTHERS REGARDING NUTRITION STATUS OF CHILDREN
The knowledge of the mother regarding nutritional status of pre-school
children was assessed by a questionnaire. The questionnaire was test the
knowledge of mother regarding the nutrition and diet intake of pre- school
children. The questionnaire was designed in multiple choice formats. Each
question was assessed with 2-point scale (0 is for wrong or don’t know
response and 1 for correct response). The attitude was assessed by
questionnaire regarding nutritional status and diet intake of pre- school
children. Attitude towards the questions was assessed using Likert response
scales and hence responses can be rated as +2 to -2. +2= strongly agree, +1=
agree, 0= neutral, -1= disagree, -2= strongly disagree.
REFERENCES

• Agarhar Murugkar G. (2005) - Nutritional status of Khasi school girls in

Meghalaya, Nutrition; 21(4): 425-3 1.
• Aggarwal, A. and Singh P. (2002). Nutritional status and dietary intake of
preschool children in Delhi. Indian Journal of Nutrition and Dietetics; 39:
668-670.
• Awasthi, N. and Kumar, A. R. (1999). Nutritional Status of hill primary
school children. Indian Journal of Nutrition and Dietetics; 36 : 453-59
• Becky, Hand. (2005). A parent's guide to Nutrition for Kids

. http://sparkepeople.com/resource/nutrition_articles.asp

• Chandna, S. and Sehgal, S. (1995). Comparative nutritional status of boys

and girls (9-12 years) of Panipat city. Journal Dairying, Foods and Home
Science; 14: 221-28.
• Chhabra , P., Garg, S., Sharma, N. and Bansal, R. D. (1996).
• Health and nutritional status of boys 6 to 12 years in a children observation
home. Indian Journal of Public Health; 40(4): 126-129.
• Devi, Y. P. and Geervani, P. (2000). Determinants of nutritional status of
pre-school of various socio-economic groups. Indian Pediatrics; 14(2): 103-
1 06.
• Devi, P.V. and Geervani, P. (1997). Determinants of nutrition status of rural
children in Andhra Pradesh, India. Food and Nutrition Bulletin.
• Dutta, A. and Kumar, J. (1997). Impact of sex and family size on the
nutritional status of hill children of Utter Pradesh. Indian Journal of
Nutrition and Dietetics; 34: 121-26.
• Hardenberqh, S. H. B. (1997).Why is small? Child growth, diet and gender
near
• Ranomafana. Social Science and Medicine;44(11): 1725-1738.
• Joshi, S. A. (2000). Nutrition and dietetics. New Delhi Tata Me Graw Hill
Publishing Company Limited. p 374.
• Kauser, F. and Praveen, S. (2001 ).Effect of spirullina as nutritional
supplement on malnourished children. Indian Journal of Nutrition and
Dietetics; 38(8):269-273.
• Kenjle, K., Limaye, S., Ghugre P. S. and Udipi, S. A (2005). Grip strength as
an index for assessment of nutritional status of children age 6-10 years.
Journal of Nutrition; 51 (2): 87-92
• Laxmaiah, A., Rao, K. M., Brahmam, G.V. N., Kumar, S., Ravindranath, M.,

Kashinath, K., Radhaiah, G., Rao, D. H.