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In Phase 2 the Methodology followed to record, evaluate, counsel and monitor the
Nutritional Intake was designed by implementing the following Schedules:
a. Food preferences Survey:
Research has shown that children‘s food preference predict their food
consumption patterns (Pilgrim 1961, Birch, 1979, Calfas et al., 1991, Domel. et
al., 1993, Domel et al., 1996, Resnicow et al., 1997, Ricketts1997, Drewnowski,
1997, Birch 1998,).A Child‘s preference for a food or flavor has been shown to
increase with repeated exposure. (Birch, 1979,; Birch and Marlin, 1982,; Pliner
and Pelchat, 1986,; Sullivan and Birch, 1990,; Domel, et.al., 1993,; Sullivan and
Birch, 1994,; Mennella, et al., 2001,; Gerrish and Mennella 2001,).
The parents of children from preschool and 1st to 4
th standard /children from 5
th to
9th
standard reported their food likes and dislikes. The evaluation of these
criterions in parents made it possible to understand and modify the diet during the
nutrition counseling and education sessions of the Nutrition Intervention. This
questionnaire (Table 2.4) was adapted from the data collection schedule
implemented by Skinner, et al., (2002).
In order to improve dietary intake, to prevent anemia in adolescent girls through
community kitchens in a urban population of Lima, Peru, Creed-Kanashiro et al.,
(2000) considered diet as a ―natural‖ treatment, which was perceived to be
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―better‖ than the clinical treatments such as use of vitamins or tonics. The foods
were selected for promotion on the basis of availability, accessibility,
acceptability, and cost-nutritional benefit. The ―best buys‖ for iron included
blood, spleen, beans and liver. For vitamin C, the ―best buys‖ included oranges,
papaya, cabbage, mandarin orange and lemon. As a result of a behavioral
analysis, in which each behavior was evaluated for potential nutritional effect and
feasibility of adoption, the primary dietary recommendations selected for the
intervention were intended to increase heme iron food sources in stews prepared
in the Community Kitchen and increase consumption of vitamin C–rich salads
and/or drinks with meals containing nonheme iron sources (mostly beans).
Table 2.4 The Food Preferences Survey Form:
The Food preferences Survey Form
Name of Child ____________Class ________Code No. ___________
Please select your most appropriate answer
(Select only one choice, A – E) for the following
A Likes and willingly eats
B Hates but eats when forced
C Hates and refuses to eat
D You have never heard off & never tasted
E You have Heard off but never tasted
Liver_____ A B C _D___E_
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Brain____ _A B C _D___E_
Kidney____ A B C _D___E_
Mutton_____A B C _D___E_
Beef___ __A B C _D___E_
Chicken __ _A B C _D___E_
Fish __ ___A B C _D___E_
Prawns _____A B C _D___E_
Egg _____A B C _D___E_
Milk A B C _D___E_
Curds _____A B C _D___E_
Panner _____A B C _D___E_
Lassi/Buttermilk____ _A B C _D___E_
Cheese_____A B C _D___E_
Chappati/ Roti ___ __A B C _D___E_
Ragi (Nachni) ____ _A B C _D___E_
Rice Flakes (Poha) _____A B C _D___E_
Rice Puffed (Kurmura) _A B C _D___E_
Bajra___ _ _A B C _D___E_
Jowar____ _A B C _D___E_
Cornflakes_____A B C _D___E_
Museli_____ A B C _D___E_
Glucose Biscuits___ _ _A B C _D___E_
Cream Biscuits___ __A B C _D___E_
Chocolate Biscuits____ _A B C _D___E_
Toast__ __ _A B C _D___E_
Khari__ ___A B C _D___E_
Bread___ __A B C _D___E_
Spinach (Palak) ___ __A B C _D___E_
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Corriander Leaves(Kotmir) ___ __A B C _D___E_
Colocasia Leaves(Alu Pata) ___ __A B C _D___E_
Shepu Leaves (Sova) ___ A B C _D___E_
Red Amaranth Leaves___ A B C _D___E_
Betal leaf (Pan) ___ __A B C _D___E_
Mustard Leaves( Sarson ka sag) ___ _A B C _D___E_
Radish Leaves (Mula ka pata) ___ __A B C _D___E_
Drumstick ___ _A B C _D___E_
Cabbage___ __A B C _D___E_
Carrots___ _A B C _D___E_
Ladies finger___ __A B C _D___E_
Chavli vegetable__ __A B C _D___E_
Cauliflower _ __A B C _D___E_
Chana Atta (Besan) _ __A B C _D___E_
Mutki ___ __A B C _D___E_
Chavli ___ __A B C _D___E_
Dried Peas (Green) __ __A B C _D___E_
Masoor (Whole) ___ A B C _D___E_
Toovar Dal___ _A B C _D___E_
Rajma___ __A B C _D___E_
Soya bean (whole) ___ __A B C _D___E_
Soyabean Atta___ __A B C _D___E_
Soya bean(Chunks/ Granules) __A B C _D___E_
Til___ __A B C _D___E_
Banana ___ A B C _D___E_
Chikkoo___ __A B C _D___E_
Apple___ A B C _D___E_
Orange___ __A B C _D___E_
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Guava___ A B C _D___E_
Pear ___ _A B C _D___E_
Papaya___ _A B C _D___E_
Pineapple___ A B C _D___E_
Bora___ A B C _D___E_
Amla___ A B C _D___E_
Mango Raw ___ _A B C _D___E_
Mango Ripe ___ _A B C _D___E_
Dates Dried (Kajhur) ___A B C _D___E_
Figs Dried ___ A B C _D___E_
Apricots(dry) ____A B C _D___E_
Sweet Lime ___ A B C _D___E_
Jackfruit (Phanas) A B C _D___E_
b. Attitude and Practices Questionnaire of the Children and Parents (AP):
Parents play an important role in the development of their child's eating
behaviors. Sherry, et al., (2004) conducted, 12 focus groups (three white, three
African-American, and three Hispanic-American low-income groups; three white
middle-income groups) of mothers (N=101) of 2- to less than 5-year-old children
to explore maternal attitudes, concerns, and practices related to child feeding and
perceptions about child‘s weight. The researchers identified, the following major
themes from responses to our standardized focus group guide: 12 groups wanted
to provide good nutrition, and most wanted children to avoid eating too many
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sweets and processed foods; 12 groups prepared foods their children liked,
accommodated specific requests, and used bribes and rewards to accomplish their
feeding goals (sweets were commonly used as bribes, rewards, or pacifiers); and
11 of 12 groups believed their children were prevaricating when they said they
were full and mothers encouraged them to eat more. Thus the researchers felt that
the common use of strategies that may not promote healthful weight suggests,
work is needed to develop culturally and socioeconomically effective overweight
prevention programs. Further study is needed to verify racial/ethnic or income
differences in attitudes, practices, and concerns about child feeding and
perceptions of child weight.
Questions with regard to good nutrition, eating and personal hygiene were also
included in the questionnaire. This information was collected before and after the
Nutrition Intervention Program. This schedule was labeled as a Nutrition and
Health Questionnaire in the Phase 1 and the same questions were included as a
final feedback form in Phase 3.The questions were as described in Table 2.5.
Table 2.5 Attitude and Practices Questions. (+ Positive /- Negative Statement)
2. Is your child willing to try new foods? (+)
3. Does your child eat foods he loves to eat? (-)
4. Do you try to give your child variety of foods? (+)
5. Do you force your child to eat certain foods because you think it is healthy? (-)
6. Does your child eat only when hungry? (+)
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7. Does your child eat sweets/chocolates? (-)
8. Does your child eat with rest of the family?(+)
9. Do you feel your child is too rushed in the morning so it is difficult to eat? (-)
10. Do you give the same food as a packed lunch that has been eaten for breakfast? (-)
11 Does your child love to eat green leafy vegetables (+)
12. Does your child loves eat one item like curd, paneer? (+)
13. Does your child love to eat fruits? (+)
14. Does your child drink buttermilk (chaas) (+)
15. Does your child eats from the road side hawkers? (-)
16. Does your child eat at least one of the following items- mutton, chicken, fish and
eggs? (+)
18 Do you insist your child should wash hands before/after using the toilet? (+)
19. Does your child wash hands before/after using toilet? (+)
20. Do you insist your child brush teeth twice a day? (+)
21. Does your child eat split food from the floor? (-)
22. Does your child eat food if flies are seen over that food? (-)
23. Does your child washes hands after eating sticky foods? (+)
24. Does your child wash mouth after eating sticky foods? (+)
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Computing the total score on attitudes and practice was as follows:
For Positive Practice/Attitude Statements e.g. Is your child willing to try new
foods?
Always=5 Sometimes=3 Rarely=1 Never=0
For Negative Practice/Attitude Statements e.g. Does your child love to eat outside
foods?
Always=0 Sometimes=2 Rarely=4 Never=5
For Positive Practice/Attitude Statements e.g. Does your child love to eat fruits?
Once a day=5 Twice a day=5 Once a week=4 Twice a week =2 Thrice a
week=3
Four times a week=3 Sometimes=2 Rarely=1 Never=0
For Negative Practice/Attitude Statements e.g. Does your child eats from the road
side hawkers?
Once a day=0 Twice a day=0 Once a week=1 Twice a week =3 Thrice a
week=2 Four times a week=2 Sometimes=3 Rarely=4 Never=5
For ‗Yes/No‘Questions it will be 5 & 0 for positive questions and 0 & 5 for
Negative questions e.g. does your child love to eat green leafy vegetables?
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c. Individual Counseling:
Three Personalized nutrition-counseling sessions based on the 24-hr. dietary recall
with regard to healthy eating habit and monthly follow-up was conducted as well
as dietary modifications of students were conducted over a period of four months.
Nutrition counseling is the sinequanon for bringing a permanent and favorable
solution to the problem of malnutrition. It is an effective tool of changing the food
habits of the people without affecting their sentiments. It is a process by which
knowledge, attitudes and beliefs about food and health are channelized into actual
practices which are sound and consistent with the individual needs, purchasing
power, food availability, health and socio-cultural background (Orstead, et al.,
1985).
Impact of Nutrition Counseling on Anthropometric and Biochemical Parameters
of School Girls (7-9 Years) has been reported by Sharma and Chawla, (2005). In a
study on sixty girls of 7-9 years belonging to lower socio economic group in
Ludhiana who were divided equally in control (C) and Experimental (E) groups.
The Experimental group comprising of 30 girls and their mothers was imparted
Nutrition Counseling (N.C.) twice a month for a period of four months.
Assessment of nutritional status was done before and after imparting nutrition
counseling. In case of anthropometric measurements: the mean height of subjects
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in C and E group was 116.1 and 117.1 cm at baseline and 116.2 and 117.9 cm
after experimentation. Also, a significant increase in weight and Mean Upper Arm
Circumference was observed in E group after N.C. However all the
anthropometric indices were lower than the standards. In case of biochemical
parameters: the hemoglobin level of school girls was 9.47 and 9.6 g/dl in C and E
group at baseline which significantly increased to 10.5g/dl in E group after N.C.
All the haemopoetic indices revealed the occurrence of iron deficiency anemia in
both the groups before and after N.C. But the status of respondents in E group
was comparatively better after N.C. when compared to before N.C. Thus it was
recommended by the researchers that nutrition counseling should be imparted for
a longer duration and should be included in school curriculum.
Dietary intake has been widely used as an indicator of nutritional Status before
and after the Nutritional Intervention Program where, a detailed food
consumption pattern was recorded in the form of a questionnaire format and the
dietary information thus collected was used to reflect on ―low‖ or ―excessive‖ or
―adequate‖ intake of nutrients as compared to the recommended dietary intake.
The counseling initiated ―Be wise about your diet, cost & life‖ campaign, which
was be aimed to assist children & parents in make healthier food choices that
promote healthy body weights and reduce health risks. As is well established
healthier lifestyle decreases the risk for many of the diseases associated with poor
nutrition and physical inactivity. Such counseling is expected to help
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parents/students to take the first steps toward healthy eating, including learning to
select portions that meet their nutritional needs without providing excess calories.
This counseling was aimed at the parents of children studying in nursery to fourth
standard, where as for those children studying in 5th
– 9th
standard there was one
counseling session with the parent and the remaining two sessions were
conducted with the child.
24 hour Dietary Recall –The parent /child is asked to report the food consumed
the previous day which is recorded in standard volumetric measures and is later
converted to raw weight of cooked foods in grams and the nutritive value is
calculated using food values as published by Gopalan, et al., (1989).
Methodology for 24 hrs Dietary Recall
(Reference source: www.ibms.sinica.edu.tw/~pan/class2004/epi0929a.ppt;
riskfactor.cancer.gov/diet/.../thompson_subar_dietary_assessment_methodology.p
df)
24-Hour dietary recall and food record was taken based on foods and amounts
actually consumed by the student on one specific day. Diet histories were taken
based on students perceptions of usual intake over a less precisely defined period
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of time. An in-depth interview conducted by a trained nutritionist Interviewees—
students, parent, caretaker.
A dietary recall is a retrospective method of dietary assessment where an
individual is interviewed about their food and beverage consumption during a
defined period of time, typically the previous day or the preceding 24 hours.
Recall of intake over a longer time period is problematic due to the limitations of
memory. Several national surveys use the 24-hour recall method because of its
high response rate and its ability to obtain detailed information. The interview
can be carried out in person, by telephone or increasingly via the Internet. In the
Norwegian arm of the EPIC study no significant differences in the dietary data
obtained were found when face-to-face 24-hour recalls were compared to
telephone 24-hour recalls (Brustad, et al., 2003).
A single 24-hour recall is not considered to be representative of habitual diet at an
individual level but is adequate for surveying intake in a large group and
estimating group mean intakes. In a preliminary study to decide the method for
the UK Low Income Diet and Nutrition Survey (LIDNS), four repeat 24-hour
recalls were recommended as the most appropriate method of dietary assessment
in this group (Holmes et al., 2008). Repeat 24-hour recalls can be employed to
assess a typical diet at an individual level; these are also known as multiple
recalls. In a recent Australian study in adults, eight repeat 24-hour recalls were
recommended to capture the variation in macronutrient intake (Jackson et al.,
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2008); The nutritionist gather detailed information about everything the subject
ate and drank from morning to night of the previous day or over the 24-hour
period, either backward or forward depending on short term memory and
cooperation from the interviewer
Food preparation methods, recipe ingredients, brand name of commercial
products, use of dietary supplements were asked by using open-ended questions in
nonjudgmental manner in a neutral attitude & by avoiding, asking questions in a
manner that might influence the subject‘s responses
To get an accurate quantification of amounts of foods amount estimation tool,
food containers, geometric shapes & number were used.
Strengths and limitations of the 24-hour dietary recall.
The strengths are based on actual intake to estimate absolute amount rather than
relative amount of nutrients Open ended—high level of specificity Interviews
could be sensitive to the cultural difference
The Limitations include day to day variation in dietary intake. Therefore to reduce
the error from dietary recall interviewers were given considerable training and
practice.The interviews were conducted by nutritionist and dietitians. During the
interviews there was a relaxed and unhurried atmosphere.
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A 24-hour Dietary recall was elicited in the beginning and consequently followed
for 2 sessions, (1 + 2 = 3) over a period of four months. Dietary intake was
recorded during the individual session, followed by a counseling of Parents of
children Nursery to 4th
standard and children themselves from 5th
to 9th
standard
and modifications in their diet were suggested using the formats ( Table 2.6) have
been given below.
Table 2.6 A 24 – Hour. Dietary Recall and a Diet Suggestions and Counseling
Format
24 – HR. DIETARY RECALL
Name of the Child_____________Class___________ Code No________
TIME MEAL QTY ITEMS
BREAKFAST
MIDDAY
LUNCH
EVENING
DINNER
LATENIGHT
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DIET SUGGESTIONS & COUNSELING FORMAT
Name of the child_____________ Class________________ Code No___________
TIME MEAL QTY MENU
BREAKFAST Almonds/ Walnuts/ Khajur /Figs
Raisins/ Kharik
Herbal Tea
Milk
Oats/ Museli /Cornflakes/ Wheatflakes
/ Rice flakes
Chappati / Roti / Fulka / Parathas
Bhakris / Multi grain Bread /Thepla
Idlis / Dosa/ Uttapam/ Dhoklas/
Muthias / Thalipeeth
Besanomlet/Pudlas/Chilas/rava
pancakes
Egg any Variety, Veg/ non veg cutlets
& kababs (shallow fried),
Poha / Upma / Dalia/ Vermicelli
Fruits
MIDAY SNACK Herbal Tea
Boiled masala whole pulses/ sprouts
(usal) /dal
Chappati / Roti / Fulka / Parathas
/Bhakris /Multi grain Bread /Thepla
with green leafy vegetables eaten with
various types of chutneys, all types of
khakras
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Khichadis, Veg / Nonveg pulav,
Biryani/ Fried Rice
Idlis ,Dosa, medu vadas, besan tomato
omlets, Dhokla, upma or poha with
roasted channa dal
All types of Sabjis with rotis,
Any non veg, egg, paneer, cheese
sandwiches (multi grain bread) No
mayonnaise
Lassi, buttermilk, limbu pani
Chikki of all types,
Ladoos of Besan, Rawa, Rajgira,
Garden cress seeds (Halim)
Mixed Roasted Chivda all varieties
LUNCH Veg / Non Veg Soup Home made
All Varieties of cooked Vegetables
Chappatis, Rotlas, Bhakri, Phulka,
Thalipeeth
Rice, Khichidi ,Pulav , Biryanis, ,
Dals , Whole Pulses , Sprouts
Homemade Paneer,
Buttermilk, Lassi, Curd,
Variety of Raw Salads with lemon
juice
Non Veg Items
Fruits
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EVENING
SNACK
Herbal Tea
All types of khakras,
Idlis , medu vadas, besan tomato
omlets
upma or poha with roasted channa
dal,
Any non veg, egg, paneer, cheese
sandwiches (multi grain bread, no
mayonnaise)
Milk, Lassi, buttermilk, Fruit Juice,
limbu pani, Fruitbased Milkshake
Chicki of all types, Ladoos of besan,
Rawa, Rajgira, Garden cress seeds
(Halim)
Roasted poha, kurmura, channa dal ,
moong dal
Mixed Roasted Chivda all varieties
Veg/ Non Veg Soup(Homemade)
Fruits
DINNER Veg / Non Veg Soup Home made
All Varieties of cooked Vegetables
Chappatis, Rotlas, Bhakri, Phulka,
Thalipeeth
Rice, Khichidi ,Pulav , Biryanis,
Dals , Whole Pulses , Sprouts
Paneer,
Buttermilk, Lassi, Curd,
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Variety of Raw Salads with lemon
juice
Non Veg Items
Fruits
A HEALTHY START TO A WEALTHY LIFE Food Groups
Cereals –Wheat flour, Broken wheat (Dalia), Rava, Bajra flour, Jowar flour , Rice flour, Corn
flour, Ragi flour. Rice products like Poha, Kurmura, Also included are ready made products made
from Maida – Breads, Naans, Biscuits, Khari, Toast, Butters, Noodles ,Pastas, Macroni, Spagetti,
Lasagne, Sponge Cakes etc.
The cereal - pulse combination gives a superior quality protein.
Pulses – Whole Legumes, Dals & Flours of Toovar ,Moong, Massoor, Matki, All types of
Channa, Chick peas,Urad, Kulith, All types of Vatana, Soya bean & its products like Soya chunks,
Granules, Tofu, & Milk, All types of Rajma, etc.
Green leafy and Stem Vegetable –Palak, Methi Cabbage, Colacasia leaves, Spring onions,
Corriander leaves. Mint Leaves, Suva Bhaji, Mayalu, Amaranth Leaves, Radish leaves, Curry
Leaves, Drumstick Leaves Cauliflower Greens, Lettuce, Celery, Parsley, Garlic greens Asparagus,
Lotus stem Leek etc.
Cook leafy vegetables in their own moisture is advised. Take green leafy vegetables daily.
Roots & Tubers - Potato, Sweet potato, Turnip, Cassava, Yam, Ginger, Carrot, Raddish
Beetroot, Arbi, Onions, Garlic. Bamboo Shoots,Artichoke, Water Chestnuts.Parsnip etc.
Cook vegetables without peeling.
Other Vegetables –. Tendli, brinjal, Carrots, Chavli, Capsicum, Bhendi ,Tindola, Yellow Pumkin,
French Beans, Karela, Lauki, Cauliflower, Ash Gourd, Snake Gourd, Cucumber, Green Tomatoes,
Brocoli, Green peas, Walor, Mushrooms Sweet Corn ,All varieties of green chillies , Zuckini, etc.
Eat raw vegetables as salads daily.
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Milk / milk products - Cow‘s, Buffalow, paneer, cheese, Buttermilk, Lassi, Curd, Skimmed
Milk, Chenna, Khoa, Butter , Ghee.
Non veg - Chicken, Mutton, Egg, Fish,
Fats & Oils - Butter, Ghee, Hydrogerated fat, cooking oils like Groundnut, Mustard, Safflower,
Sun flower, Rice Bran Canola, Coconut.
Nuts & Oily Seed – Almonds, cashew nuts, walnuts, Pista, Flax seeds, Garden cress seeds etc.
Sugar: Jaggery, Table Sugar, Brown Sugar, Honey.
Fruits –Banana, Apple, Chickoo, Mango, Guava, Tomato, Papaya, Orange, Sweet lime
Watermelon. Grapes, Pear, Pineapple, Pomegranate, dates fresh & dry etc.
Always try to eat fruits in season.
Water – 10 – 12 glasses /day.
The dietary intake was calculated using food values as published by Gopalan, et
al., 1989 for the following nutrients:-Total Calories, Protein, Carbohydrate, Fat,
Calcium, Total Iron, Heme and Non Heme
d. Small Group Sessions:
Among the rapid assessment procedures (RAP), the focus group discussions
(FGD) are the most appropriate when quick assessment of the community beliefs,
their points of resistance and insights into facilitating points are needed Since
growth (nutrition) and development are interlinked, caring practices for one may
also be relevant to the other. Therefore, positive deviance in the growth and
development of children depends on caregiver‘s behavior and the positive
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interaction even in the face of multiple socio-economic deprivations. Such
mothers are, therefore, different from mothers who fail to cope positively with
child rearing under similar conditions. (ICMR Bulletin, 2003).
The methodology adopted for the small group discussions was an interactive form
of education, where the parents (learners) addressed a specific topic, shared their
knowledge and experience with other group members. The nutritionist facilitated
and encouraged this discussion by also sharing meaningful nutrition information,
encouraged and motivated those parents who gave positive approaches and
solutions to problems which arose in the course of discussion, any misinformation
was also clarified. The parents were encouraged to take down notes. At the end of
each discussion written information was distributed, which was again summarized
and reinforced and by the nutritionist before the session ended. For each session
which lasted for 1 hour, a group of 15-20 parents were invited to participate
according to the standard their children were in. These sessions were organized in
a relaxed and comfortable atmosphere, where the parents freely communicated
with one another.
Three Interactive small group sessions were organized with power point
presentations. Various topics were discussed such as:Basic functions of food, food
hygiene, how to preserve nutrients while cooking, anemia and other nutrient
deficiencies, worm infestations, and dental hygiene. It was an interactive session
with feedback from the audience.(Several Topics dealt with in large group
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sessions were repeated in small group sessions this enabled the participants to
express their views and further clarify their doubts)
Cooking Demonstration with nutrition education was conducted for 50 parents at
one time for all parents; Care was taken to elaborate on the nutritive value of
every ingredient used and variations of recipes. A variety of recipes were
demonstrated and samples were given for tasting. Some of the recipes includedin
this programme were: – green rice, vegetable potli, handwa, palak whistle,
thalipeeth, vegetable kachori, recotta cheese sandwich, til ladoo, harabhara
kababs, morning delight ,curry leaves chutney, kurmura chivda, dates and banana
pressure cooker cake ,tomato dip two different salad dressing, stuffed puris to
name a few.
Mid day meal planning for preschool children: – Parents of each child had to take
turns in providing the class of their child a mid day snack. This was planned and
implemented under the guidance of the nutritionist on a monthly basis.
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e. Three Large Group Sessions:
Talks(lecture method) with power point presentations was organized for parents
as well as children during the intervention months followed by Question Answer
session It was an interactive session with feedback from the audience. These
sessions were conducted by doctors, child psychologist and nutritionist. Parents,
grandparents, teachers were invited. Approximately 300 participants attended
each session, which lasted atleast 3 hours.
Topics for Large Group Sessions were:
Diabetes and nutrition, Bone Health, Vitamin and Mineral deficiencies, Worm
infestations, Dental hygiene, Out of box approach to dealing with a fussy eater.
f. Learning through fun activities:
One fun activity like Nutrition game or Nutri - Quiz, was conducted for children
every month for three months.
A Nutri Taste Game for children, which was a modified version of memory
games, was conducted, where the benefits and ill effects of good and bad nutrition
were reinforced. This Game of Sensory Evaluation was organized 1st to 9
th
standard. It was an Interactive session with the students, in this activity students
were paired in two, one child was blind folded, and then he was made to taste and
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guess the food item. The other partner was handed placard that read points about
that food item, memorize them and present them in front of the class. Students
who won the game were given prizes. Example: If the blind-folded partner is
made to taste orange then the other partner will read and memorize the points that
describe the nutritive qualities of the same. ―The focus of the game conducted was
to create awareness for vitamin A, vitamin C, calcium, fiber and protein rich
foods and also to reinforce the overall theme of ―Excellence Begins with
Breakfast‖. By consuming a good breakfast each morning students can become
their own super hero. The message sent across was very apt and straight forward
―Eat right and be bright‖.
‗
A Nutri Memory Game was conducted for the students of 1st- 9
th standard
.
Students were shown 25 food products and then they were asked to record the
names, which would test their memory. Ill effects of junk foods were also
explained.
A Nutrition Exhibition was organized by the teachers and Parents of the Preschool
section Nursery, Lower KG & Higher KG were the children were taught a small
song and action dance of good food habits and Parents and teachers prepared
charts and posters on good food habits exhibition was open to all the Parents and
students of the school as well as all the members of Bohra Community
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Fun activity for parents - A nutritious recipe competition was organized as well as
a Slogan competition was conducted as a part of large group sessions
A Nutri Quiz, the ―nutri - edu‖ fun activity was also conducted for all children as
well as for parents
g. Tiffin Box Checking:
Random Tiffin box checking, once every 15 days was done by the nutritionist
during the short break time, to ensure the children did not bring any products like
biscuits, khari (puff pastry), toast, wafers, chocolates, cakes etc. If any child was
found carrying it, the parents were immediately called telephonically and
persuaded to give a more nutritious snack or lunch for the child. The child was
also motivated and encouraged to carry a healthier option.
h. Interactive Sessions with Management:
Interactive sessions were held with the canteen man intentionally to enhance the
type of products he sold in the school. Recommendations given were with regard
to modifications in the existing menu which was batata wada pau, samosa, or
bread bhajia. Emphasis was placed on reducing the bread / pav to twice a week
and inclusion of kheema pau ,idlis, meduvadas, veg.cutlets chanabatata chat,
mince kebabs, addition of vegetables to noodles in their menu.
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An Oral Feed Back was taken after each session - Large or small group. During
this session parent‘s point of views regarding the session and ongoing nutrition
program were discussed also, barriers in attitudinal and environmental factors,
such as conflicts with of mother- in law in child‘s dietary habit, role of
grandparents, junk foods in school canteen, school water facility hygiene,
handling a fussy eater, were all dealt with in subsequent sessions and making
necessary revisions in program strategies to address the parents and children in a
more effective manner.
As the program matured the behavioral changes did begin as it was reflected in
the hematological, biochemical and dietary parameters.
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8. Academic Performance (Marks) Assessment.
Hallberg, (1989) reported, a one of the confounding factors that may influence
brain function in poor diet is iron deficiency, which might be part of the general
protein-energy-malnutrition syndrome or be combined with other nutritional
deficiencies.
Academic performance during the present research was obtained by recording the
data from school records and registers. Marks given by teachers for tests and
terminal examinations were recorded.
Phase 1 was all tests from JULY‘08-OCTOBER‘08 and
Phase 3 was considered from NOVEMBER‘08-FEBUARY‘09.
Subjects for whom the marks were recorded are listed below; these marks were
converted into percentages and taken for analysis.
Subjects were as follows: -Art / Environmental Studies / Mathematics/ English /
Hindi for 1st Standard.
-Art / Mathematics / English / Hindi /History-Geography /Science / Marathi for
2nd
to 9th
Standard.
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9. Attendance Assessment.
According to Gopaldas and Seshadri, (1987), a higher attendance, as a percentage
of enrollments, would no doubt, reflect high priority given by parents to education
of their children, but it would also indirectly reflect the nutritional health status of
the school going child. This is so because a common reason for not attending
school is illness of the child. (Kanani, 1984)
Attendance was recorded and percentages were derived. For Nursery to 9th
Standard. Phase 1 was considered from 1 JULY‘08-OCTOBER‘08 & Phase 3
from NOVEMBER‘08-FEBUARY‘09,
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10. Stool Examination.
The parents were encouraged to get the stool of child tested. These were arranged
at the end of Intervention Phase 2 for all pre-primary students at Saifee
Ambulance, Medical and Diagnostic Center. Reports were collected & explained
to the respective parents with a power point presentation on types of worms and
infections in man.
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11. Good Will Sessions.
As the program drew to an end the parents were very motivated and suggested
that they wanted to learn more on health and fitness. Therefore on parent‘s
demand two sessions of Yoga were organized, where breathing techniques and
stretches were demonstrated. One session on Acupressure was also organized.
Such a gesture created immense good will and a desire to improve their own
health, and this was an excellent way to end the nutrition intervention program.
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12. Statistical Methods.
Statistical analysis carried out using SPSS 12.0 FOR Windows.msi and
submission of the report to the School authorities with regard to the improvement
in the nutritional and Health Profile of each child was accomplished.
It was both descriptive and inferential statistics.
Descriptive statistics for each parameter was represented as a Mean Value ±
Standard Deviation.
Inferential statistics involved correlations; paired T test and ANOVA (Analysis of
Variance) were also used. A p value was used to stat the significance
Positive/Negative Correlations between parameters were statistically reported.
The interpretation of results and discussion as well as suggestions for further
research are detailed in the next chapter.