KLE UNIVERSITY, BELGAUM.

ANNEXURE- II

PROFORMA FOR REGISTRATION OF SUBJECT FOR DISSERTATION

1.

NAME OF THE CANDIDATE AND ADDRESS

MR. SAWAN KUMAR YADAVPOST GRADUATE STUDENT,MASTER OF PUBLIC HEALTH,J. N . MEDICAL COLLEGEKLE UNIVERSITY,BELGAUM – 590010.Kumarsawan42@yahoo.com

2.

NAME OF THE INSTITUTE

DEPARTMENT OF PUBLIC HEALTH,J N MEDICAL COLLEGE, KLE UNIVERSITY , BELGAUM – 590010.

3.

COURSE OF STUDY AND SUBJECT MASTER OF PUBLIC HEALTH

4. DATE OF ADMISSION TO COURSE 28-07-2013

5. TITLE OF THE TOPIC

“PREVALENCE OF MALNUTRITION AMONG UNDER FIVE YEARS CHILDREN IN RUKAMININAGAR” - A CROSS SECTIONAL STUDY.

6. BRIEF RESUME OF THE INTENDED WORK:

6.1. NEED FOR THE STUDY: Adequate nutrition is essential in early childhood to ensure healthy growth, proper organ formation and function, a strong immune system and neurological and cognitive development. Economic growth and human development require well-nourished populations who can learn new skills, think critically and contribute to their communities. Child malnutrition impacts cognitive function and contributes to poverty through impeding individuals’ ability to lead productive lives. In addition, it is estimated that more than one-third of under-five deaths are attributable to under nutrition.1

Malnutrition is responsible, directly or indirectly, for 54% of the 10.8 million deaths per year in children under five and contributes to every second death (53%) associated with infectious diseases among children under five years of age in developing countries. Malnutrition is of particular concern in developing countries. A report by UNICEF published in 2006 states that around 146 million children in developing countries are underweight - that is one out of every fourth child. Out of these, over half of the world's underweight children live in just three countries: Bangladesh, India and Pakistan.2

Overall half of the young children in India are underweight 47%, stunted 46%, one in six children are wasted 16%, the levels of under nutrition are much higher in rural areas than urban areas, but even in urban areas more than one third of young children are stunted. Underweight under nutrition is most prominent in the states of Bihar, Madhya Pradesh and Rajasthan. About half of the children are underweight in Orissa, Maharashtra and west Bengal. In rural areas, 20.3% of the children were severely malnourished, 30.2% were moderately malnourished, 50.5% were malnourished (moderate and severe). In urban areas 12% of the children were severely malnourished, 27% of the moderately malnourished and 39% were malnourished (moderate and severe). Malnutrition levels were much higher among tribal children in rural areas in Maharashtra the incidence is as high as 73.6% .3

The present problem has high prevalence rate in India, so many under five children are suffering from malnutrition, and some factors influence and cause the prevalence of malnutrition in Karnataka hence the researcher found that it is necessary to find the prevalence and find its association with health influencing factors among under five children in selected areas of Belgaum.

6.2 OBJECTIVES:

1. To find the prevalence of malnutrition among under five children.2. To know the health influencing factors among under five year children.

6.3 REVIEW OF LITERATURE:A study was conducted on prevalence of malnutrition and socioeconomic

determinants among children in Sikasso (Mali) with a sample of 491 families. The determinants of wasting and stunting were analysed using logistic regression. The results revealed that the prevalence of stunting was about 25%. Prevalence of wasting was about 12%, which is very high, and had been increasing in the past years. No strong associations with socio-economic factors were observed for wasting. Stunting was strongly associated with the education level of both parents, and with the family assets.4

A multi centered case control study was conducted on evaluating risk factor for malnutrition in children under the age of six years in Iran. The sample was 76 children with malnutrition and 76 children without malnutrition were randomly recruited for case and control groups. The prevalence of risk factors in the two groups was compared. Data were gathered from a health center database and interviews with mothers and health workers. The Wilcox on signed-rank test and logistic regression were used for data analysis. The result revealed that the Female gender, poverty, short maternal height, and use of unhygienic latrines in the home were significantly associated with childhood malnutrition (P < 0.05). The conclusion was the results of this study indicate four main factors (poverty, small maternal height, female gender, and absence of hygienic latrines in the home) as underlying factors in malnutrition of children under the age of 6 years.5

A cross-sectional survey was conducted on the nutritional status of preschool-age children in a development area in the southern Indian state of Tamil Nadu. Sample size was 1223. The result revealed that 45% of the children were underweight (low weight-for-age), 51% were stunted (low height-for-age), and 21% were wasted (low weight-for-height). The rates of severe malnutrition using any of these criteria were low, and only 9.6% of the children were both wasted and stunted. The nature of the malnutrition strongly depended on age group. Rates of stunting increased with age, reaching 63% in the fifth year of life, whereas rates of wasting peaked at 36% in the second year of life and declined to 14% in the fifth year. Surveys that are designed to produce information on stunting and wasting are important in the planning and evaluation of nutrition intervention programmes.6

A cross sectional study was conducted on prevalence and determinants of chronic malnutrition in Dhaka city Bangladesh. The sample comprised 380 randomly selected children. Results of analysis of this study data revealed that the prevalence of stunting among preschool children in Dhaka city was 39.5%, with 25% severely stunted and 14% moderately stunted (p<0.001). Results of bivariate analysis revealed that socioeconomic and demographic factors were most significantly associated with the stunting of children. Children were found to

be well-nourished if their parents had a tertiary-level education or higher and if the mother held a job and had good knowledge of nutrition. Well-nourishment of the children were also associated with the height of mothers (above 148 cm), good family educational background, normal birth weight, greater frequency of food intake (more than six times/day), and fewer fever episodes in the last six months. Results of multivariate linear regression models showed that height of mothers, birth weight of children, education of fathers, knowledge of mothers on nutrition, and frequency of feeding were the most significant factors that had an independent and direct influence on the stunting of children. To achieve the Millennium Development Goal target of 34% malnutrition prevalence by 2015, it is important to have specific government intervention to focus on the causes that directly influence the stunting of children.8

A study was done in Nepal to assess the prevalence of energy malnutrition in children under five years and survives delivery responses in Nepal. NDHA 2006 reports that 49% of children in Nepal under five are stunted, 13 % are wasted, and 39% % are underweight. It also reports that the distribution of the problem is not uniform. Rural populations are the most affected with stunting, wasting, and underweight and that while stunting is a major problem in the mountainous areas, wasting is more significant in the terai. The study also shows that western areas are most affected by stunting.10

A cross sectional study was conducted to assess nutritional status of under five children in ubran slums of Bareilly during December 2010 to April 2011 at 3 purposively selected slums (Faltuganj, Kurramgotia and kalibadi) of Bareilley district, Uttar Pradesh. The cross sectional study was carried out in selected urban slums of Barilley district, Uttar Pradesh. Mothers of under five children were interviewed regarding socio demographic characteristics. Anthropometric measurements were done to assess the nutritional status of under five children by structured questionnaire. Out of the 166 under five children surveyed, 110(66.3%) were malnourished. Nearly 32.5%, 16.9%, 8.4% and 8.4% were suffering from grade I, II, III&IV malnutrition respectively. Malnutrition increased significantly with the increase in age and was slightly more prevalent among the boys. Malnutrition was slightly higher amongst those having mixed diet, belonging to nuclear families, living in semipucca houses, using water from well and hand pump, and using public latrines. 11

6.4 RESEARCH QUESTION:

What is the prevalence of malnutrition among under five years children of Rukmininagar?

7. MATERIALS AND METHODS:

7.1 SOURCE OF DATA:

The data will be collected from under five children and their mothers residing in selected areas of Rukmini Nagar.

7.2. METHOD OF COLLECTION OF DATA:

7.2.1 DATA COLLECTIONThe data will be collected by pre tested and pre designed questionnaire. The questionnaire will contain detailed information of age, sex, educational status, past history of illness, present history of illness, and followed by anthropometric measurement and systemic examination.

7.2.2 DATA COLLECTION INSTRUMENTS: The instrument require for find out the prevalence of malnutrition by using the parameters of malnutrition measured by using the standard tools like weighing machine and inch tape etc.

7.3. STUDY DESIGN:

A Cross Sectional Study.

7.4. STUDY PERIOD:February 2014 – October 2014

7.5 STUDY POPULATION:In this study, the population includes the children below the five years of age and residing in Rukmini Nagar.

7.6 SAMPLING TECHNIQUE:Simple Random sampling.

7.7. SAMPLE SIZE: The prevalence of malnutrition under five has been estimated 46% as a whole in the country. 20

So, Prevalence (p) = 46% Q(100-p) =54% Error taken (d) =5%Confidence level =95%Now, n = (zα

2 pq)/d2

= (1.962 ×46×54)/52

= 381.2 =381.2 385A total 385 under five children will be selected for the present

study.

7.8 INCLUSION CRITERIA:Those children who have not turned 5 years of age as on 1st January 2014.

7.9 EXCLUSION CRITERIA: 1. Those parents who will not give consent.2. Those who are sick at the time of data collection.

7.10 DATA ANALYSIS: 1. Data will be compiled and coded in MS-EXCEL 2. Data analysis will be done using statistical software i.e. SPSS, 3. Percentage and Chi-square test will be used as a statistical test.

7.11 Has Ethical clearance been obtained from your institution?Awaited.

8. LIST OF REFERENCE

1. Onis M, Brown D, Blössner M and E. orghi B;.Levels and trends in child malnutrition, World Health Organization and UNICEF. Accessed on 13thSeptember,2013 2. Joseph B., Rebello A, Kullu P, and V.D. Raj;Prevalence of Malnutrition in Rural Karnataka, South India, A Comparison of Anthropometric Indicators, Journal of health population nutrition 2002 Sep;20(3):239-244.3. Malnutrition in India, http/www.nutrition.org/misc/terms.shtml..Accessed on 13thSeptember,20134. SS Yamamoto, Malik AA, Haque MA , Prevalence and determinants of chronic malnutrition among preschool children, Journal of Health Population and Nutrition. 2011 Oct;29(5):494-9.5. Girish B, A study of nutritional status of anganwadi children of nagamangala taluk, mandya district, Karnataka state http://hdl.handle.net/123456789/5404.6. Gugsa Yimer, original article Malnutrition among children in Southern Ethiopia: Levels and risk factors, the Ethiopian Journal of Health Development, 2000;14(3):283-292.7. Steinhoff MC, Hilder AS, Srilatha VL, Mukarji D,Prevalence of malnutrition in Indian preschool-age children: a survey of wasting and stunting in rural Tamil Nadu, 1983, Bull World Health Organ. 1986;64(3):457-63. 8.Sharghi A, Kamran A, Faridan M,”Evaluating risk factors for protein energy malnutrition in children under the age of six years in Iran”, Int Journal Gen Med. 2011;4:607-11. E pub 2011 Aug 17.9. Bouvier P, Papart JP, Wanner P, Picquet M, Rougemont, A Malnutrition of children in Sikasso (Mali): prevalence and socio-economic determinants Soz Praventivmed. 1995;40(1):27-34.10. A.bastola; Prevalence of energy malnutrition in children under five years and service delivery responses in Nepal; International journal of health sciences and research ISSN;2249-9571,vol.2; issue:7;October 201211. Srivastava A, Bhushan Kr, Mahmood S E, Shrotriya v, Mishra S, Payal and Shaifali I.Nutritional status of under five children slums of Bareilly. Indian Journal of Maternal and child health.vol.14 (1), 2012.

BUDGET PLAN: (Approximate)

1.Expenditure in printing materials:

A) Consent forms 2000/-

B) Questionnaire forms 3000/-

2. Instrumental charge:(Weighing machine and measuring tape)

4000/-

3. Preparation of dissertation9,000/-

4. Expenditure in travel 3,000/-

5. Miscellaneous: 4,000/-

TOTAL ESTIMATED BUDJET 25,000/-

TIME PLAN

Phases Time period Outline of plan

Phase IAugust-December 2013 i. Selection of Topic

ii. Preparation of questionnaire

iii. Informed Consent

iv. Submission of Synopsis

Phase II

Phase III

Phase IV

DEC-2013

FEB 2014-OCT 2014

NOV 2014-MAR 2015

i. synopsis registration

ii. Ethical clearance

i. Enrollment of study subject

ii. Data Collection

i. Analysis of collected data

ii. Discussion & writing up work

iii. Submission of dissertation to KLE university

9. SIGNATURE OF THE

CANDIDATE

10. REMARKS OF THE GUIDE

11. NAME AND DESIGNATION

11.1 GUIDE DR.(MRS.) MUBASHIR ANGOLKAR,

CO-ORDINATOR OF PUBLIC HEALTH,

DEPARTMENT OF PUBLIC HEALTH

J.N.MEDICAL COLLEGE,

(KLE UNIVERSITY)BELGAUM-590010.

11.2 SIGNATURE

11.3 CO-GUIDE DR (MRS.) ASHWINI NARASANNAVAR

DEPARTMENT OF PUBLIC HEALTH,

J.N.MEDICAL COLLEGE, KLEU.

BELGAUM-590010

11.4 SIGNATURE

11.5 HEAD OF THE DEPT.DR (Mrs.) VIJAYA A NAIK

PROF.AND HEAD,

DEPT.OF PUBLIC HEALTH,

J.N. MEDICAL COLLEGE,

KLE, UNIVERSITY, BELGAUM. KARNATAKA

11.6 SIGNATURE

12. PRINCIPAL DR. A.S. GODHI

PRINCIPAL, J.N . MEDICAL COLLEGE,

BELGAUM.

13. REMARKS/SIGNATURE

APPENDEX- I

INFORMED CONSENT FORM

“Prevalence of malnutrition among under five years children of RukminiNagar,

Belgaum” – A Cross sectional study

INVESTIGATOR – SAWAN KUMAR YADAV P.G STUDENT, JNMC, KLE

BELGAUM-590010GUDIDE – DR. MUBASHIR ANGOLKAR

CO-ORDINTAOR OF PUBLIC HEALTH,

DEPARTMENT OF PUBLIC HEALTH

Introduction:This study is going to be carried out to assess the prevalence of malnutrition so, You are invited to participate in this study which intends to obtain information on nutritional status of your children and your socio-economic factors that directly influence it.Objective:

To find the prevalence of malnutrition among under five children and to know the health influencing factors among under five year children residing in the selected area of Rukmini Nagar.

Explanation of procedures:In this study, you will have to answer a few questions about your socio demographic details and anthropometric details of children like Height, weight and mid-arm circumference will be taken. The entire procedure may take about 15-20 minutes.

Possible Benefits:This study will help to understand the pattern of physical growth of children. It will help to know the underlying causes of malnutrition.

Risks:There is no risk Involved in participating in this study.

Confidentiality:Your identity will not be revealed. All information collected will be coded and kept confidential.

Withdrawal:Participation in this study is voluntary. If you do not wish to participate in this study, you will not lose benefits to which you are entitled.Costs of participation:

The cost of the study will be borne by the researcher. There will be no additional cost to you for participating in this study.

Payment for participation:

No incentives will be provided to you for participating in this study.

Authorization to Publish Results:

The results of the study will be used for publication, However the Participant’s Identity will be kept Confidential.

Questions:

You have the right to ask & have answered, to any questions or doubt you have about this study. If you have queries or concerns, you can contact MR. SAWAN KUMAR YADAV , POST GRADUATE STUDENT, MASTER OF PUBLIC HEALTH, DEPT. OF PUBLIC HEALTH, KLE UNIVERSITY, BELGAUM – 590010, Mobile No. 8867712573 or GUIDE, Dr. MUBASHIR ANGOLKAR, Co-RDINATOR OF DEPARTMENT OF PUBLIC HEALTH, J.N.M.C, KLEU, mobile no.9886983624.If you have any questions about rights as a study participant. You may contact Dr.GANGA.S.PILLI, Chairperson of Institutional Ethics Committee, JNMC, KLE University, and Belgaum. Phone no. - 0831- 2473777(Extn-4052).Legal rights By signing this consent form, we are not waiving any of your legal rights.

CONSENT STATEMENTI have permitted the investigator to conduct the study. My signature below indicates my permission and I have read the information provided above (or the information provided above has been read to me) and I was given the opportunity to ask questions and that they have been answered to my satisfaction.

_______________________________ Name of Participant Signature or Left hand thumb impression.

_______________________________ Name of Witness Signature of Witness

_______________________________ Name of Researcher Signature of ResearcherDATE………………………….PLACE………………………...

ASSENT STATEMENT

I volunteer and give assent to participate in this study. I have read (or have been read to me) the information sheet. Full opportunity was given to me to ask for clarification of doubts. I am fully satisfied with the answers to the questions/queries/doubts I wished to clarify. I hereby voluntarily agree to participate in this study. Furthermore , I recognize that I have the complete right to withdraw this consent at any point during the study. I understand that the information given by me will be confidential and is being used for research purpose only.Futher, I am aware that the results of this research will be published without disclosing any identification of the participants.

______________________________________ _______________Name &signature / left hand thumb impression Date & Place

______________________________________ _______________Name & signature of person obtaining consent Date & Place

QUESTIONNAIRE

“PREVALENCE OF MALNUTRITION AMONG UNDER FIVE YEARS CHILDREN IN RUKAMININAGAR” -A CROSS SECTIONAL STUDY .

The information will be obtained by the investigator.

PART-I (GENERAL INFORMATION)

01. Name of the interviewee ……………………………………………………………………02.Address ………………………………………………………………………………….........03. Age: ………………………….. sex: ………………………………………04. Name of the head of the family………………………………………………………….05. Type of the family: - 1.Nuclear 2. Joint 3. Others 06. Religion: Hindu / Muslim / Christian / others ( specify………………… ) Cast: sc / ST / OBC / general07. Relation of the respondents to the children…………………………………………......08. Family description.

SN. NAME OF THE FAMILY MEMBERS AGE SEX EDUCATION01.02.03.04.05.06.07.08.09.

09. Number of children in the family………………..10. Number of children under one year……………..11. Number of children under five year……………..12. Housing condition.

Roof Wall FloorType of material use for construction of the roof

Type of material use for construction of the wall

Type of material use for construction of the floor

a. Iron sheetsb. Tilesc. Asbestosd. Concretee. Tinsf. Grass/rapyrusg. Others(specify)

a. Burnt/stabilized bricks with cement

b. Burnt/ stabilized bricks with mud

c. Cement blocksd. concretee. Stone with cement f. Unburnt bricks with

cementg. Unburnt bricks with

mudh. Mud and polesi. Other(specify)

a. Concrete/stoneb. Bricksc. Cement screedd. Rammed earth e. Woodf. Others(specify)

13. If yes, how much is the distance of shed to the residency? a). 10m. b. less than 20m. c. more than 20m

14. Toilet room status. a).yes b) no

PART – IISOCIO- ECONOMIC STATUS

15. Occupation of the head of the family……………………………………...................16. Monthly income ……………………………………………………………………..17. No. of dependent person in the family……………………………………………….18. Expenditure detail in monthly:

S.N. Expenditure in Amount in Rs.01. health02. Education03. Food04. Saving05. others

19.What is the source of drinking water for members of your household?a) piped-in dwellingb) Public tapc) Tube well or boreholed) Protected dug well or protectede) springf) Unprotected dug well or spring,g) rainwaterh) Pond, river or streami) Tanker-truck, vendoWj) Other20.How far is this source from your dwelling?

a. one premisesb. Less than 100 mc. 100m to less than 500md. 500m-1KMe. Don’t know

PART- III

ANTHROPOMETRIC MEASUREMENT21.Name of the child……………………………………………………………………22.Date of birth ………………………………………………………………………..23.Age……………………24.Sex a). Male b). female

25.PHYSICAL EXAMINATION

Body Mass Index ( BMI ): wt (kg)/ ht(m 2 )

a. height (cm): ………………………weight (kg): ………………………….…...……………….….cm

b. mid- arm circumference: ……………….…….cmc. head circumference: ……….….…...…….......cmd. chest circumference:………….………...........cme. waist ..circumference:………. ………..….......cmf. hip circumference: ……………......................cmg. body mass index: …………………….….........cm

26. Illness history of the children;

a. past history of illness:…………………………………………………………………………………………

…………………………………………………………………………………………

………………………………………………………………………………………

b. present history of illness:

………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………27. Immunization status

BENEFICIARY AGE VACCINE

STATUS

A= continue, B= finished, C= drop, D= haphazardly

Infants Birth BCG* and OPV**

6 weeks DPT&OPV

10weeks DPT&OPV

14 weeks DPT&OPV

9 months Measles vaccine

18 months DPT&OPV(Booster dose)

Children 5 years DT vaccine

28.Mother and Child Listing Form Line 1. Name: 2. Is 3. Date of birth? 4. 5. Age 5

no.: male orfemale?1=male2=female

(dd/mm/yy) Ageinyears

orover?

1 21 21 21 21 21 2

29.Age of weaning to the baby? ………………………….30.Are you sending your baby to the care of Anganwadi?

a. Yes b. no31. If yes then does the anganwadi worker informed about any health complication of

the baby?a. Yes b. no

32.Does the anganwadi worker help you to solve the health problem of your baby?A. Yes b. no

33. If yes, how does they help you?a. By supplying nutrition foodb. Health counselingc. Rupees

d. Others.(specify)…………………………………………………………………………***THE

END***