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child health nursing - Rajiv Gandhi University of Health Sciences
RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES BENGALURU, KARNATAKA PROFORMA FOR REGISTRATION OF SUBJECT FOR DISSERTATION MR. MAHESH BAMANI 1ST YEAR MSc. NURSING CHILD HEALTH NURSING (2011-2013 BATCH) SRI SHANTHINI COLLEGE OF NURSING #188/B, PARVATHI NAGAR, OPP: SUB REGISTRAR OFFICE, LAGGERE MAIN ROAD, LAGGERE BANGALORE- 560058 RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES BANGALORE, KARNATAKA PROFORMA SYNOPSIS FOR REGISTRATION OF SUBJECT FOR DISSERTATION MR. MAHESH BAMANI 01 NAME OF THE CANDIDATE AND ADDRESS 1ST YEAR M.Sc. NURSING SRI SHANTHINI COLLEGE OF NURSING, #188/B, PARVATHI NAGAR, OPP SUB REGISTRAR OFFICE, LAGGERE MAIN ROAD, LAGGERE, BANGALORE-560058 SRI SHANTHINI COLLEGE OF 02 NAME OF THE NURSING, INSTITUTION #188/B, PARVATHI NAGAR, OPP SUB REGISTRAR OFFICE, LAGGERE MAIN ROAD, LAGGERE, BANGALORE-560058 03 04 05 COURSE OF THE STUDY AND SUBJECT DATE OF ADMISSION TO COURSE TITLE OF THE MASTER DEGREE IN NURSING CHILD HEALTH NURSING EFFECTIVNESS OF PLANNED HEALTH TOPIC TEACHING REGARDING KNOWLEDGE 30/06/2011 AND PRACTICE OF MOTHERS OF INFANTS ABOUT BOWL (KATORI) AND SPOON FEEDING 6. BRIEF RESUME OF THE INTENDED WORK INTRODUCTION “Growth is only evidence of life.” Childrens are major consumers of health care. Infants are considered as special risk groups, Majority of childhood sickness and death s are preventable by simple low cost measures. Providing balanced and sufficient nutritional is most important for infants to promote optimal growth and development to protect and mantain health of infants . In india there is increased mortality rate is due to improper knowledge of mothers about caring, feeding and hygienic practice , feeding techniques of infant1. Appropriate and healthy feeding of infants during the first year of life is extremely important. More growth occurs during the first year than at any other time in child's life. For the first few months, breast milk or formula is all that is needed. As infant grows, starting a variety of healthy foods at the proper time is important for proper growth and development. And, starting good eating habits at this early stage will help set healthy eating patterns for life. Nutrition and nurturing during the first years of life are both crucial for life-long health and well-being. In infancy, no gift is more precious than breastfeeding; yet barely one in three infants is exclusively breastfed during the first six months of life2. Infants are introduced to complementary foods at around 6 months of age. Intake of complementary foods should be gradual, should incorporate a range of tastes and should be based around family foods and customs. Feeding development in infants is important not only for of the purpose of acquiring nutrition but also for developing the ability to intake liquids. There are three acceptable choices human milk, commercially prepared whole cow’s milk and modified evaporated cow’s milk3. Selection of feeding method is one of the major decision faced by parents .Most of parents are not having sufficient knowledge regarding information about feeding of infants, i.e. feeding techniques, proper practice of hygiene during feeding. There are many methods of feeding infants like bottle feeding, feeding by bowl (katori) and spoon and exclusive breast feeding4. In india there is increased mortality rate due to lack knowledge of mothers about total care of infants. most of infants are die due to repeated attacks of diarrhoea and respiratory infections. These complication are due to lack of knowledge and practise of mothers regarding feeding of infants. Malnutrition is responsible, directly or indirectly for about one third of deaths among children under five. Well above two thirds of these deaths, often associated with inappropriate feeding practices, occur during the first year of life5. 6.1 NEED FOR STUDY Proper feeding is an important in infant’s life. Breast milk alone is adequate to mantain optimum growth and development of an infant up to 4 – 6 months. Than progressively transfer the child from breast feeding to usual diet is an important aspect. While feeding the infant by kotori and spoon there is chance to get food aspiration which is lead to pneumonia and middle ear infection because of lack of knowledge regarding feeding techniqes of infants, many of them will get diarrhoea due to unhygienic practices of feeding, many of them will not receive sufficient notional diet and this will affect retarded growth, may results in malnutrition. All these complications which directly or indirectly affect the childs optimum growth and development and may some times leads in death of infants. These all complications are results due to lack of knowledge and feeding practices of mothers of infants6. In India the infant mortality rate is 70 per thousands of live births. Thousands die due to diarrhoea and respiratory tract infection. As many as 10 percent infants in India die from diarrhoea. The main cause is contaminated water supply, unhygienic habits of feeding practice and lack of knowledge about feeding of the infants. Appropriate and healthy feeding of infants during the first year of life is extremely important. More growth occurs during the first year than at any other time in child's life. There is increased demand of nutritional value after 6 months of age. There is necessary for infants to provide around 5 month old is between 24-32 ounces of formula each day. It is usually recommended that start a baby on solid foods between 4-6 months, beginning with an iron fortified rice cereal. next offer a vegetable or fruit, although the timing of that depends on when started cereal7. Peadiatrics kerala.com was conducted a study regarding complications of feeding in Cuba more than 50 percent of accidental death among infants were caused by aspiration of food during or after feeding due to lack of knowledge regarding proper technique or method of feeding8. Nirmala Kesari was conducted a study regarding feeding pattern in davangere, Karnataka region related to feeding patterns of 1500 childrens (60 rural and 840 urban) between 3 and 24 months of age in around davengere. Were studied there was no significant decreasing trends in breast feeding irrespective of urban and rural settings, childrens (48 percent)were frequently breast fed up 2 years of age, simisolids were introduced in about half of the children (42 percent) between 6 to 12 months. By 18 months most of them getting semisolids. Rice was commercially introduced first. Proprietary preparation of milk ad weaning foods were not in general use. Dilution of natural milk and improper preparation were common irrespective of domicile, educational and financial status. Parents frequently sought advice regarding nutrition from doctor and the physician also frequently nutrition health education9. All above articles or studies or reports show that there is increased mortality rate due to Acute Respiratory Tract Infection and Diarrhoea related to improper feeding techniques hence it is necessary to improvement the knowledge and practice of mothers regarding bowl (katori) and spoon feeding. 6.2 REVIEW OF LITERATURE Health Care and Research Association for Adolescents, and Indian National Science Academy, New Delhi, India conducted a study on weaning practice in other parts of world sated that Infant feeding and weaning practices in India continue to demonstrate that a significant number of infants do not receive colostrum (62.8% according to the National Family Health Survey, NFHS-2), though breastfeeding is universal and continued for a longer period. In NFHS-3 (20052006), there is improving trend for breastfeeding within the first hour of birth (23.4%) and exclusive breastfeeding up to 5 months (46.3%); however, weaning for semisolids is delayed (55.8% only at 6-9 months of age). The infant weaning foods are inadequate in energy-protein and micronutrients. Further, weaning foods and feeding/cooking utensils are contaminated with bacteria, resulting in frequent episodes of diarrhea. Indeed, these are the factors responsible for initiation and continuation of early malnutrition which the country has failed to control as observed in the three NFHS. Over a span of 7 years, i.e. from NFHS-2 (1998-1999) to NFHS3, there was only marginal reduction in under nutrition. Thus, uncontrolled fetal malnutrition, poor initiation of breastfeeding, inadequate and delayed weaning, and contaminated food and water demand urgency to develop affordable hygienic weaning foods, education to clean utensils, timely weaning and available potable chlorinated water to prevent and control malnutrition10. Ishada was conducted a study related to feeding development in infant the aim of this study was to determine the appropriate form of spoon for infant feeding development. Eleven healthy infants (3 girls and 8 boys, 10-18 months old, mean age: 13.3 months) were recruited with their guardians' consent. We made 3 types of prototype spoon: A, oval (a standard renge soup spoon); B, flared-out (with the margin of the bowl flared out); and C, hemispherical (with a hemispherical bottom, and smaller than type A or B). We observed infants taking liquid supported by their mothers and evaluated the following responses: 1) confusion with regard to lip position, 2) spillage and 3) choking. Type C showed statistically less confusion with regard to lip position than type A or B (p<0.01), and B showed less than type A (p<0.05). No statistically significant differences were observed in spillage or choking among the three types of spoon. The renge soup spoon is often used to smooth the transition from breast/bottle to cup feeding. In this study, we demonstrated the appropriate spoon form for infant feeding development11. Nirmala Keari was conducted a study in davangere, Karnataka region related to feeding patterns of 1500 childrens (60 rural and 840 urban) between 3 and 24 months of age in around davengere. Were studied there was no significant decreasing trends in breast feeding irrespective of urban and rural settings, childrens (48 percent)were frequently breast fed up 2 years of age, simisolids were introduced in about half of the children (42 percent) between 6 to 12 months. By 18 months most of them getting semisolids. Rice was commercially introduced first. Proprietary preparation of milk ad weaning foods were not in general use. Dilution of natural milk and improper preparation were common irrespective of domicile, educational and financial status. Parents frequently sought advice regarding nutrition from doctor and the physician also frequently nutrition health education12. Patel was conducted a study regarding care of low birth baby. A 1 year follow-up study of 289 low birth weight infants (LBW) was carried out during 198485 in slums of Bombay: 151 were males and 138 were females. 52.9% of babies had birth weight less than 2.5 kg. Male children suffered 9.7 and females 8.6 episodes of sickness per year. Annual mean episodes of illness were: diarrhea 3.2, cough 5.3, and fever 4.8. Upper respiratory tract infection was considered fever. 98.6% breast fed successfully in the 1st week keeping it up for 2 months. Of 209 mothers, 88.5% had weaned their babies before 6 months. Commercial formula was used by only 1 mother whose baby had gastroenteritis and dies. Of 289 infants, bottle feeding was done in only 3 cases. Feeding with bowl and spoon was done in 71.3% of infants, 27.7% were not weaned at all with breastfeeding lasting 1 year. Most babies lost weight around the 7th and 8th months of life along with maximum episodes of sickness. Babies below 2 kg showed accelerated growth after weaning, and achieved grade I nutritional status. 2.7 to 3 kg weight babies failed to show any gain from the 5th month, thus advanced to 3rd grade malnutrition. 6 deaths occurred, 4 of which had birth weights less than 2 kg. 2 babies died of gastroenteritis and septicemia during the 4th and 5th month. Mortality in babies born less than 2 kg was 44.4% and above 2 kg birth weight was less that 1%. The infant mortality rate (IMR) was 38/1000 live births vs. the national range of 39-177. Prematurity caused 1.2% of deaths. Antenatal care, detection of at risk pregnancies, proper feeding and weaning practices, and complete immunization coverage can help reduce IMR in slums, and the goal of a rate below 60 by the year 2000 is feasible13. Karas was conducted a study about Home Care Practices for Newborns in Rural Southern Nepal. According to this study . Data were analyzed for 23 of 356 and 22 of 766 newborns on Days 1 and 14, respectively. About 56.6% of the babies were breastfed within 24 h and 80.4% received pre-lacteal feeds within the first 2 weeks of life. Only 13.3% of the caretakers always washed their hands before caring for their infant. Massage with mustard oil was near universal, 82.2% of the babies slept in a warmed room and skin-to-skin contact was rare (4.5%). Many of these commonly practiced behaviors are detrimental to the health and survival of newborns. Key areas to be addressed when designing a community-endorsed care package were identified14. Whelser was conducted a study on nutrition and health status of young children in the Sahel region of sub Suharan Africa to improvement in feeding practice in infants. . In view of this uneven progress, a working group of international agencies was convened to 'Reposition children's right to adequate nutrition in the Sahel.' The first step towards this goal was to organize a situational analysis of the legislative, research, and programmatic activities related to infant and young child nutrition (IYCN) in six countries of the sub-region: Burkina Faso, Chad, Mali, Mauritania, Niger, and Senegal. The purposes of this introductory paper are to review current information concerning the nutritional and health status of infants and young children in the Sahel and to summarize international guidelines on optimal IYCN practices. These guidelines were used in completing the above-mentioned situational analyses and encompass specific recommendations on: (i) breastfeeding (introduction within the first hour after birth, exclusivity to 6 months, continuation to at least 24 months); (ii) complementary feeding (introduction at 6 months, use of nutrient dense foods, adequate frequency and consistency, and responsive feeding); (iii) prevention and/or treatment of micronutrient deficiencies (vitamin A, zinc, iron and anaemia, and iodine); (iv) prevention and/or treatment of acute malnutrition; (v) feeding practices adapted to the maternal situation to reduce mother-to-child transmission of HIV; (vi) activities to ensure food security; and (vii) the promotion of hygienic practices concerning food preparation and storage and environmental sanitation. The following papers in this issue will present results of the situational analyses for the individual countries15. Marsha Walker was conducted a study about infant feeding A risk/benefit analysis by the United States National Institute of Environmental Health Sciences estimated that for every 1000 infants born in the US each year, four will die because they are not breastfed. 17 Most of the infant deaths worldwide (1.5 million/year) related to artificial feeding are due to diarrheal illness. In the United States, five hundred children aged one month to four years die each year from diarrhoea. 18 At least 70 percent of these deaths are caused by rotavirus infection in children four to 36 months of age, against which breast milk has a known protective effect. One sudden infant death per 1000 live births occurs as a result of failure to breastfeed in western industrialized nations.19.11 Formula feeding has been identified as a risk factor for sudden infant death syndrome (SIDS, cot death) in the results of the SIDS study conducted by the National Institute of Child Health and Human Development. 21 Seventy-nine percent of deaths from SIDS in New Zealand are attributable to three factors-maternal smoking, prone infant sleeping position, and not being breastfed16. STATEMENT OF THE PROBLEM A Study to Assess the Effectiveness of Planned Health Teaching Regarding Knowledge and Practice of mothers of infants about Bowl (Katori) and Spoon feeding in selected rural areas of Bengaluru. 6.3 OBJECTIVES OF THE STUDY 1. To assess the existing knowledge and practise of mothers about bowl and spoon feeding 2. To assess the post test knowledge and practice of mothers about bowl and spoon feeding 3. To find out the association between knowledge and practice of mothers about bowl and spoon feeding practice of mothers. 4. To assess effectiveness of planned teaching regarding knowledge and practice of mothers about bowl and spoon feeding. 5. To compare the knowledge and practice of mothers with selected demographic variables. 6.4 HYPOTHESIS OF THE STUDY H1: There will be significant difference between pre test and post test level of knowledge and practice of mothers infants regarding feeding with bowl and spoon by planned health teaching. H2: There will be significant association between knowledge and practice of mothers with selected demographical variables such as educational status, occupational status, monthly income, age of mothers, parity of mothers, age of infants and sex of infants. 6.5 VARIABLES A concept which can take on different quantitative values is called a variable. DEPENDENT VARIABLES In this study the dependent variables will be knowledge and practice of mothers of the infants. INDEPENDENT VARIABLES In this study independent variables will be planned health teaching. 6.6 OPERATIONAL DEFINITIONS ASSESS Assess refers to the process critical analysis and valuation or judgement of the knowledge of mothers about bowl and spoon feeding. EFFECTIVENESS Effectiveness is a measure of the ability of education programme to produce a specific desired effect or result that can be qualitatively measured. PLANNED HEALTH TEACHING Administered to improve the knowledge on feeding of infant with bowl and spoon, that includes physical functioning, techniques of feeding, position of infant. KNOWLEDGE It is a familiarity with someone or something unknown, which can include information, facts descriptions acquired through experience or education. PRACTICE Habitual or customary way of repeated performance to acquire skill. MOTHERS Primary care giver to babies. INFANTS Newly born babies first 28 days of life. BOWL FEEDING Feeding someone (as baby) by bowl. SPOON FEEDING Feeding someone (as baby) from a spoon. RURAL AREA Areas that are not urbanized, through when large areas are described. They have low population density and typically much of land is devoted to agriculture. 6.7 ASSUMPTIONS 1. Mothers of infants may have inadequate information and knowledge regarding feeding of infants with bowl (katori) and spoon feeding. 2. Structured teaching programme may improve the knowledge and practice of mothers regarding proper feeding of infants by bowl (katori) and spoon feeding. 6.8 DELIMITATIONS OF THE STUDY The Study is delimited to mothers of infants between 5-12 months of age. 7. MATERIALS AND METHODS 7.1 SOURCE OF DATA The data will be collected from mothers who are feeding Their infants 7.2 METHODS OF COLLECTION OF DATA 7.2.1 RESEARCH DESIGN Quasi-experimental design The research design adopted for this study is quasi experimental in nature. One group pre test- post test design. 7.2.2 REASEARCH APPROACH Quantitative Approach. 7.2.3 SETTING OF THE STUDY The Study will be conducted in some selected rural areas of Bengaluru. 7.2.4 POPULATION The mothers of infants between 5-12 months of age. 7.2.5 SAMPLE SIZE The sample consists of 60. The mothers of infants who fulfil the inclusion criteria will be the sample. 7.2.6 SAMPLING TECHNIQUE Purposive sampling method. 7.2.7 SAMPLING CRITERIA INCLUSION CRITERIA 1. The mothers of 5-12 months of infants in some selected areas of Bengaluru. 2. Mothers who can read, write and understand the Kannada. 3. Mothers who are willing to participate in the study. EXCLUSION CRITERIA 1. Infants below 5 months who are on breast feeding alone 2. Mothers who are not willing to participate in the study. 7.2.8 TOOL FOR DATA COLLECTION The researcher develops structured knowledge questionnaires. It consists of Section A, Section B and Section C Section A: Interview schedule on Demographic variables of mothers such as age, educational status, occupation, monthly income, parity, age and sex of child. Section B: Interview schedule consisting of structured questionnaire to assess the pretest and post test knowledge of mothers of infants regarding feeding with bowl (katori) and spoon. Section C: Education module on improving the knowledge and practice of mothers of infants. 7.2.9 DATA ANALYSIS METHOD The data will be analyzed by using descriptive and inferential statistics. DESCRIPTIVE STATISTICS Frequency, Percentage Distribution, Mean and Standard Deviation will be used. INFERENTIAL STATISTICS Paired “t” test will be used to analyze the significant difference between the mean pre test and post test knowledge score. Chi Squire Test will be used to analyze the association between the post test knowledge and selected demographic variables. 7.3 DOES THE STUDY REQUIRE ANY INVESTIGATION OR INTERVENTIONS TO BE CONDUCTED ON PATIENTS OR OTHER HUMANS OR ANIMALS? -No- 7.4 HAS ETHICAL CLEARENCE BEEN OBTAINED FROM YOUR INSTIITUTION Permission will be obtained from the Research Committee of Sri Shanthini College of Nursing. 8. LIST OF REFERENCE 1. KN Agarwal. Infant feeding in india. Health Care and Research Association for Adolescents and Indian National Science Academy. New Delhi India 2011. http://www.springerlink.com/content/nt 2. Patel RB.Care of low birth weight babies.http://www.ncbi.nlm.nih.gov/pubmed/ 3. K.N Agarwal. Hygienic practices of feeding.Indian Journal of Pediatrics 49:285288. 1981 http://www.ncbi.nlm.nih./pubmed/22044894 4. Dr,Sanjeev. Artificial feeding of infants. http://www.indiastudychannel.com/resources/artificial-feeding-infant.aspx 5. Ishda R. Appropriate spoon form for feeding of liquids in infant.PMID-21986396 http://www.ncbi.gov/pubmed/ 6. Karas DJ. Accelerating improvements in nutrition and health status of young childrens. Department of International Health Johns Hopkins Bloomberg School of Public Health Baltimore. MD. USA. http://www.ncbi.nlm.gov/pubmed/ 7. Nirmala K. Feedind patterns in davengere Indian journal of paediatrics vol 48:281-284 1981.Department of paediatrics J.J.M.Medical College davangere Karnataka.http://www.springerlink.com/content/ 8. Cristian kind. Provision of supplementary fluids. http://www.springerlink.com/conten/ 9. Naswati. Feeding and rearing practices in rural area. http://www. .springerlink.com/content/nt 10. Vincent. Infant feeding guidlines.http://paediatrics.about.com/weekly question/a/04_fdng-gidlns.htm. 11. Widdson. Preperations used for artificial feeding of infant.Departmant of medicine Addenbrookes Hospital(March 1978)54,176179.http://www.ncbi.nlm.gov/pmc/articles/pmc 12. Marsha Walfer. Risk of artificial feeding of infant. lactation consultant and the President of Lactation Associates and the Director of the Breastfeeding Support Program at Harvard Community Health Plan Wellesley. Massachusetts Address correspondence to : MW 254 Conant Road Weston MA 02193 USA,.August 11 1992.Manuscript Publication,http://www.infant feeding.info/risk of AF.html 13. I.C.Varma. Atypical pneumonia in spain.From morb&mort wkly Rep30:237.1981.Indian Journal of paediatrics vol49.no.392.http://www. .springerlink.com/content/ 14. Gupta BD. Suthi feeding.http://www.ncbi.nlm.gov/pubmed/ 15. Sister Amy. Artificial feeding of infants American journals of nursing vol 7 (7 april-1907) hhttp://www.globalhealth.org/childhealth/?gclid 16. Warren. Feeding of infants (3/19/1997). http://www.mindspring.com/~drwarren/feedbaby.html. 9. SIGNATURE OF THE STUDENT 10. REMARKS OF THE GUIDE : : The study will help the mothers of infants to improve the knowledge and practice regarding bowl and spoon feeding. 11. NAME AND DESIGNATION OF 11.1 GUIDE : Mrs.Vasantakumari Associate professor, 11.2 SIGNATURE : 11.3 HEAD OF THE DEPARTMENT : Mrs.Vasantakumari Associate professor, 11.4 SIGNATURE : 12. REMARKS OF PRINCIPAL : The researcher selected the appropriate topic to help the mothers to know about the bowl and spoon feeding of infants 12.1 SIGNATURE :