A STUDY TO ASSESS THE EFFECTIVENESS OF PLANNED

TEACHING PROGRAMME ON KNOWLEDGE REGARDING

PROTEIN ENERGY MALNUTRITION AMONG MOTHERS OF
UNDER-FIVE CHILDREN IN A SELECTED RURAL
COMMUNITY IN MANGALORE

By

PONNU THOMAS

Dissertation submitted to
Rajiv Gandhi University of Health Sciences, Bangalore, Karnataka

In partial fulfilment
of the requirements for the degree of

Master of Science

In

Paediatric Nursing

Under the guidance of

Mrs. Jyothi Prameela Martis

Assistant Professor and HOD
Department of Paediatric Nursing
Athena College of nursing
Mangalore

2012
 Rajiv Gandhi University of Health Sciences, Bangalore, Karnataka

DECLARATION BY THE CANDIDATE

I hereby declare that this dissertation/ thesis entitled “A study to assess the

effectiveness of planned teaching programme on knowledge regarding protein

energy malnutrition among mothers of under-five children in a selected rural

community in Mangalore” is a bonafide and genuine research work carried out by

me under the guidance of Mrs. Jyothi Prameela Martis, Assistant Professor,

Department of Paediatric Nursing, Athena College of Nursing Mangalore.

Date:08.02.2012 Ponnu Thomas

Place: Mangalore

ii
 Rajiv Gandhi University of Health Sciences, Karnataka,

CERTIFICATE BY THE GUIDE

This is to certify that the dissertation/ entitled “A study to assess the

effectiveness of planned teaching programme on knowledge regarding protein

energy malnutrition among mothers of under-five children in a selected rural

community in Mangalore” is a bonafide research work done by Ponnu Thomas in

partial fulfilment of the requirements for the degree of Master of Science in Nursing

(Paediatric Nursing).

Date:08.02.2012 Mrs. Jyothi Prameela Martis

Place: Mangalore Assistant Professor
Department of Paediatric Nursing
Athena College of nursing
Mangalore

iii
 ENDORSEMENT BY THE HOD ,PRINCIPAL/HEAD OF THE
INSTITUTION

This is to certify that the dissertation entitled “A study to assess the

effectiveness of planned teaching programme on knowledge regarding protein
energy malnutrition among mothers of under-five children in a selected rural
community in Mangalore” is a bonafide research work done by Ponnu Thomas
under the guidance of Mrs. Jyothi Prameela Martis, Assistant Professor,
Department of Paediatric Nursing, Athena College of nursing, Mangalore.

Seal & Signature of the HOD Seal & Signature of the Principal
Mrs. Jyothi Prameela Martis Rev. Sr. Ann Rose D’ Almeida
Assistant Professor Principal
Dept. of Paediatric Nursing Athena College of Nursing

Date: 08.02.2012 Date: 08.02.2012

Place: Mangalore Place: Mangalore

iv
 COPYRIGHT

Declaration by the Candidate

I hereby declare that the Rajiv Gandhi University of Health Sciences,

Karnataka shall have the right to preserve, use and disseminate this dissertation/ thesis

in print or electronic format for academic / research purpose.

Date:08.02.2012

Place: Mangalore Ponnu Thomas

© Rajiv Gandhi University of Health Sciences, Karnataka

v
 DEDICATED

To My Loving LORD

&

My Family

&

Friends

vi
 ACKNOWLEDGEMENT

“My grace is sufficient for you,

for Power is made Perfect in Weakness” 2 Cor 12: 19.

I am grateful to God Almighty, for the guidance, strength and wisdom

showered on me throughout this research study.

With sincere feeling of gratitude, I acknowledge, all those who have

contributed to the successful completion of the study.

I would like to express my gratitude to my guide Mrs. Jyothi prameela

Martis, Asst. Professor and Head of the Department of paediatric Nursing, for

her efficient, expert and inspiring guidance, valuable suggestions, constant

encouragement and support which made me complete this task systematically.

I express my sincere thanks and appreciation to Mrs. Shalet D’Souza,

lecturer, department of paediatric nursing, Athena College of nursing for her

guidance, valuable direction and considerable interest shown towards the research

work.

My heart wells up with a deep sense of gratitude to Rev. Sr. Ann Rose

D’Almeida, Principal and HOD Medical Surgical Nursing, Athena College of

Nursing, Mangalore for her valid guidance, suggestions and constant support given, to

conduct this research.

vii
 I am extremely grateful to Dr. Sr. Alphonsa Ancheril, PG coordinator,

Athena College of Nursing for her inspiring and illuminating guidance, suggestions

and constant encouragement to make the work a successful learning experience.

I acknowledge with sense of gratitude to Mr. Suresh, Statistician for his

approachable nature, immense help, and direction in the statistical analysis needed for

the study.

It is my privilege and honour to thank Mrs. Asha K. Varghese, Sr. Dhanya

Devasia, Mr. Rajarathinam , Mrs. Deepa Anu Thomas, Mrs. Dharani Kumari,

Mrs. Sunitha Cloudia Lobo, Mrs. Suzy, Mrs. Salomi, Mrs. Sonia Lobo,

Mrs.Amudhavally, Mr.Harsha and all other faculty members of Athena College of

Nursing for their suggestions and timely help rendered for the completion of this

study.

I am indebted to Mr. R. S. Shettian, Chairman and Mrs. Asha Shettian,

Secretary Athena Institute of health Sciences, Mangalore for all the facilities made

available in this institution, to pursue this study.

I express my words of appreciation to the all the experts for their valuable

recommendations, corrections, constructive criticisms while validating the tool and

planned teaching programme.

It is my privilege to express my sincere gratitude to District Health and

Family Welfare Officer, Mangalore D. K District for granting me permission to

conduct the study.

viii
 My heartfelt gratitude to Dr. Jathanna, Medical Officer, Kudupu PHC,

Mangalore and Staff of PHC and sub-centre for permitting me to conduct pilot study

and main study.

My sincere thanks and gratitude to the librarians Ms. Suchithra and

Ms. Dhanavanthy who have rendered immense help in the successful completion of

this dissertation.

A word of appreciation to all the office staff of Athena College of Nursing,

Mangalore for their timely assistance and co-operation throughout the study.

My sincere thanks to Mr. Roshan Patrao for translating the tool to Kannada,

the effort to prepare the manuscript, and helping me take the print out of this study.

I wish to express sincere appreciation and heartfelt thanks to all the mothers

of under-five children who participated in the study for their support and patience in

answering the questions. It is their willingness and cooperation that has made this

study a truthful reality.

A million thanks to Ms. Alphonsa J, Ms. Bency Baby, Ms. Raji Babu,

Ms.Rosith K.P and friends from paediatric Department Sr. Janet, Ms. Joice Mary

Joseph, classmates for their enriching company, valuable friendship and encouraging

support and help.

I am proud to acknowledge my beloved parents and siblings. No individual

can learn and develop by herself, she need encouragement and assistance. This piece

of work is a fruit of prayer, concern, support and encouragement from my dad

Mr. Thomas John, my loving mother Mrs. Anancy Thomas and my siblings

Mr. Basil Thomas, Mr. Eldhose Thomas and my loving grandparents. I am indeed

ix
grateful to them for their constant encouragement & wholehearted support in all my

endeavours.

My sincere thanks and gratitude to all those who directly or indirectly helped

me in the successful completion of this thesis and to make this learning experience a

memorable one.

Date:08.02.2012

Place: Mangalore Ponnu Thomas

x
 ABSTRACT

“Children’s health is tomorrow’s wealth”

Background and objectives

Better nutrition is a prime entry point to ending the malnutrition maelstrom.

Better health means stronger immune systems which means less illnesses. Healthy

people feel stronger, can work better and may have more earning opportunities to

gradually lift them out of both poverty and malnutrition. Healthier, more productive

societies are a potential outcome. Protein energy malnutrition has been identified as

one of the major nutritional problem among children in India. Since mothers were the

primary care takers of children, if they possess adequate knowledge on food and

nutrition of children, they can be prevented from protein energy malnutrition.

The aim of the study is to assess the effectiveness of planned teaching

programme on knowledge regarding Protein energy malnutrition among mothers of

under-five children in a selected rural community in Mangalore.

Objectives of the study

1. To determine the pre-test level of knowledge of mothers of under-five children

regarding protein energy malnutrition as measured by structured interview

schedule.

2. To evaluate the effectiveness of planned teaching programme on knowledge

regarding protein energy malnutrition among mothers of under-five children in

terms of gain in mean post-test knowledge score.

xi
3. To find the association between mean pre-test knowledge score and selected

demographic variables (age of mother, education, family income, number of

children, type of family and religion).

Methods

A pre-experimental one group pre-test – post-test design was used for the

study. The sample consisted of 30 subjects. Mothers of under-five children were

selected by purposive sampling technique. The study was conducted in Vamanjoor a

rural area at Mangalore from 1-08-2011 to 30-08-2011. The investigator obtained

written permission from concerned authority prior to the study and written consent

was obtained from mothers and assured confidentiality of information. Data was

collected by structured interview schedule. After the pre-test a PTP was administered

to the subjects and on the seventh day post-test was conducted with the same

questionnaire. The collected data was analyzed by using descriptive and inferential

statistics.

Result

In the pre-test none of the mothers had good knowledge 60% had poor

knowledge and 40% had average knowledge whereas in the post-test 33.3% had good

knowledge and 66.7% had average knowledge. The mean post test knowledge scores

obtained by subjects (13.86) was higher than the mean pre-test knowledge score (9.1).

Paired ‘t’ test was done to find out the difference between the mean pre-test and post

test knowledge score and statistically it was highly significant (t=9.69, p<0.05). There

was no significant association between the mean pre-test knowledge score and the

selected variables like age of mother in years (χ2=0.008) educational status of mother

xii
(χ2=0.027) family income/month (χ2=0.165) number of children (χ2=0.128) religion

(χ2=0.212) type of family (χ2 = 0.0382).

Interpretation and conclusion

Finding of the study showed that the knowledge scores of mothers were very

low before the introduction of PTP. The PTP facilitated them to improve their

knowledge about protein energy malnutrition which was evident from the post-test

knowledge scores. Hence PTP was an effective strategy for providing information and

to improve knowledge of mothers which was well appreciated and accepted by

mothers.

Keywords

Effectiveness; knowledge; protein energy malnutrition; mothers of under-five

children; planned teaching programme; structured interview.

xiii
 TABLE OF CONTENTS

Chapter
No. Title Page No.

1. Introduction 1-4

2. Objectives 5-12

3. Review of literature 13-27

4. Methodology 28-39

5. Results 40-50

6. Discussion 51-54

7. Conclusion 55-60

8. Summary 61-64

9. Bibliography 65-70

10. Annexure 71-131

xiv
 LIST OF TABLES

Table
No. Title Page No.

1. Frequency and percentage of distribution of sample 42

characteristics

2. Frequency and percentage distribution of pre-test and post-test 46

knowledge scores

3. Range, mean, mean percentage scores of pre-test and post-test 47

knowledge scores

4. Significant difference between the mean pre-test and post test 48

knowledge score

5. Chi-square showing the association between mean pre-test 49

knowledge scores and selected demographic variables

xv
 LIST OF FIGURES

Figure
No. Title Page No.

1. Conceptual framework for evaluating the effectiveness of PTP 11

regarding protein energy malnutrition based on system
theory(by Ludwig Von Bertalanffy 1968)

2. Schematic representation the study design 30

3. Bar diagram showing the distribution of sample according to 43

the age

4. Bar diagram showing the distribution of sample according to 43

educational status

5. Cylindrical diagram showing distribution of sample according 44

to their family income

6. Dounght diagram showing distribution of sample according to 44

number of children

7. Cylindrical diagram showing distribution of sample according 45

to religion

8. Bar diagram showing distribution of subjects according to 45

type of family

9. Cylindrical diagram showing the pre and post-test knowledge 46

of subjects

xvi
 LIST OF ANNEXURES

Figure
No. Title Page No.

1. Letter requesting and granting permission to conduct pilot 71

study

2. Letter requesting and granting permission to conduct research 72

study

3. Letter requesting consent to participate in the study 73

4. Letter requesting opinion and suggestions of experts to 75

validate the tool

5. Acceptance for tool validation 76

6. Content validation certificate (PTP) 77

7. Blue print for structured knowledge questionnaire 78

8. Tool-English 79-83

9. Tool-Kannada 84-89

10. Criteria checklist for validation of tool 90-91

11. Criteria check list for evaluation of PTP on protein energy 92

malnutrition

12. Planned teaching programme – English 93-107

13. Planned teaching programme – Kannada 108-122

14. AV Aids (Charts and Flash cards) 123-127

15. List of validators 128

16. Master data sheet 129-130

17. Statistical formulas 131

xvii
 1. INTRODUCTION

“......The first wealth is health.......”

(Ralph Waldo Emerson)

Background of the study

Nutrition is an input to and foundation for health and development. Better

nutrition means stronger immune system, less illness and better health. Healthy

children learn better. Healthy people are stronger, are more productive and are more

able to create opportunities to gradually break the cycles of poverty and hunger in a

sustainable way. Better nutrition is a prime entry point to ending poverty and a

milestone for achieving better quality of life.1

Malnutrition means “badly nourished” but it is more than a measure of what

we eat or fail to eat. Nutritional status is the result of the complex interaction between

the food we eat, our overall state of health, and the environment in which we live- in

short, food, health and caring, the three “pillars of well-being”. Child malnutrition is

the biggest challenge our country is facing today, even when the economy is said to

be surging ahead. Every second child under three in the country is malnourished.2

The concept of a close association between diet and disease has been existing

since ancient times in Indian history. Today nutritional deficiencies constitute a major

public health problem in India and other countries of third world. Nutrition of under-

five children is of paramount importance because the foundations of our life time,

health, strength and intelligence vitality is laid during this period. As we have entered

the new millennium, India faces the burden of diseases in which nutritional

deficiencies are more common. Among the nutritional problems PEM (protein energy

1
malnutrition) has been identified as a major health and nutritional problem in India.

Protein energy malnutrition is by far the most lethal form of malnutrition. Children

are its most visible victims. It is not only an important cause of childhood morbidity

and mortality but also leads to permanent impairment of physical and mental growth

of those who survive. The current concept of PEM is that its clinical forms-

kwashiorkor and marasmus are two different clinical pictures at opposite poles of a

single continuum.3

According to WHO, protein energy malnutrition affects every fourth child

world wide. One hundred and fifty million (26.7%) are underweight while 182 million

(32.5%) are stunted. Geographically more than 70% of PEM children live in Asia,

26% in Africa and 4% Latin America and the Caribbean. Their plight may well have

begun even before birth with a malnourished mother.4

Need for the Study

“Disease-free young children are the pillars of our nation”

A nation’s health depends on healthy citizens. A healthy adult emerges from a

healthy child. Children are priceless resources and if the nation neglects their health, it

would become a nation of unhealthy citizens.5

Malnutrition is a “man-made disease” which often starts in the womb and ends

in the tomb. Malnutrition is defined as any nutritional disorder caused by an

insufficient, unbalanced, or excessive diet or impaired absorption or assimilation of

nutrients by the body. It is a state wherein adequate nutrients are not delivered to the

cells to provide the substrate for optimal functioning. The term malnutrition includes

both under-nutrition as well as over-nutrition.6

2
 The UNICEF 2005 report says that 150 million children are malnourished

worldwide; millions of Indian children are equally deprived of their rights to survival,

health and safe drinking water. It is reported that 63% of them go to bed hungry, 53%

suffer from chronic malnutrition.6

A study was conducted among mothers of under-five children admitted to the

paediatric wards of Rajah Muthiah Medical College and Hospital at Chidambaram to

assess the knowledge regarding protein energy malnutrition. The data were collected

from thirty mothers of under-five using descriptive design. The result showed that

26.67% of mothers had inadequate knowledge, 53.33% of mothers had moderately

adequate knowledge, and 20% of mothers had adequate knowledge regarding protein

energy malnutrition.3

A cross-sectional community based study was conducted on gender inequality

in nutritional status among under-five children in a village in Hooghly district, West

Bengal, to examine the differences in nutritional status of under-five male and

females and to determine the bio-social factors associated with such differences. It

was found that 55.9% , 51.4% and 42.3% of the girls were underweight, stunted and

wasted respectively, compared to 46.6%, 40.5% and 35.3% of the boys and a

significantly higher proportion of malnutrition was found to be present among female

children of higher birth order and those belonging to families with lower per capita

income compared to the males.7

Protein energy malnutrition is manifested commonly among under-five

children (0-5 years). The investigator, during her community experience, found that

mothers of under-five children have inadequate knowledge regarding protein energy

malnutrition. The investigator’s own experience, discussion with the colleagues and

3
experts helped her realise that protein energy malnutrition among under-five children

is a major problem in communities. If mothers are educated, protein energy

malnutrition can be controlled to some extent. Health education has become the most

important tool in community health which informs, motivates and helps people to

adopt and maintain the healthy practices and life style. Therefore, the investigator

decided to undertake the study to assess the effectiveness of planned teaching

programme for mothers in a selected community at Mangalore.

Problem Statement

A study to assess the effectiveness of planned teaching programme on

knowledge regarding Protein energy malnutrition among mothers of under-five

children in a selected rural community in Mangalore.

Summary

This chapter has presented the background of the problem, need for the study

and statement of the problem.

4
 2. OBJECTIVES

Objectives are the specific accomplishments the researcher hopes to achieve

by conducting the study. Specific achievable objectives provide clear criteria against

which proposed research methods can be used. This chapter contains main objectives,

concepts involved and conceptual framework of the study.

Problem Statement

A study to assess the effectiveness of planned teaching programme on

knowledge regarding protein energy malnutrition (PEM) among mothers of under-

five children in a selected rural community in Mangalore.

Objectives of the Study

1. To determine the pre-test level of knowledge of mothers of under-five children

regarding protein energy malnutrition as measured by structured interview

schedule.

2. To evaluate the effectiveness of planned teaching programme on knowledge

regarding protein energy malnutrition among mothers of under-five children in

terms of gain in mean post-test knowledge score.

3. To find the association between mean pre-test knowledge score and selected

demographic variables (age of mother, education, family income, number of

children, type of family and religion).

5
Operational Definitions

1. Knowledge: In this study, knowledge refers to the correct responses obtained

from mothers to the questions in the knowledge questionnaire on protein

energy malnutrition.

2. Effectiveness: In this study, effectiveness refers to the extent to which

planned teaching programme on protein energy malnutrition has achieved the

desired effect in terms of gain in mean post-test knowledge score

3. Planned teaching programme: In this study, planned teaching programme

refers to the information provided to mothers of under-five children regarding

protein energy malnutrition which include definition, sources and function of

protein, incidence, etiology, types, clinical manifestation, diagnosis,

prevention, management and complications using lecture cum discussion and

AV aids.

4. Protein energy malnutrition: In this study, protein energy malnutrition refers

to a group of clinical conditions such as marasmus and kwashiorkor that may

develop in varying degree due to inadequate intake of food containing protein

and carbohydrate.

5. Mothers: In this study, mothers refer to women who have under-five children.

Variables under study

Independent variable: planned teaching programme on protein energy malnutrition.

Dependent variable: Knowledge of mothers of under-five children.

6
Extraneous variables: Age of child, age of mother, education, family income,

religion, type of family, number of children, duration of breastfeeding.

Assumptions

1. Mothers of under-five children may have some knowledge regarding protein

energy malnutrition.

2. Planned teaching programme will be effective in improving the knowledge

regarding protein energy malnutrition.

3. Knowledge of mothers of under-five children may vary according to

demographic variables.

Projected outcome (Hypotheses)

All hypotheses will be tested at 0.05 level of significance.

H1 : The mean post-test knowledge score of mothers regarding protein energy

malnutrition will be significantly higher than their mean pre-test knowledge

score.

H2 : There will be significant association between the mean pre-test knowledge

score of mothers and selected demographic variables.

Conceptual framework

A conceptual framework is a theoretical basis to the study of problems that are

scientifically based and emphasizes the selection, arrangement and clarification of its

concepts. A conceptual framework states functional relationships between events and

is not limited to statistical relationships.8

7
 The conceptual framework of the present study was developed by the

investigator based on Ludwig von Bertalanffy’s general system theory (1968).

According to the system theory, a system is a group of elements that interact with one

another in order to achieve the goal. An individual is a system, because he/ she

receive input from the environment. This input processed provides an output. This

system is cyclical in nature and continues to be so, as long as the input, process,

output and feedback keep interacting. If there are any changes in any of the parts,

there will be changes in all the parts. Feedback from within the system or from the

environment provides information, which helps the system to determine whether it

meet its goal.9

The four major aspects of this system are

4. Input

5. Throughput

6. Output

7. Feedback

This theory is useful in breaking the whole process into sequential tasks to

ensure goal realization.

Input

Input is any type of information, energy, or material that enters the system

from the environment through its boundaries.9

8
 In this study, the input refers to the learners or target group, the mothers of

under-five children and influencing demographic variables as age of child, age of

mother, education, family income, religion, type of family, number of children and

duration of breast feeding.

Process

It refers to the action needed to accomplish the desired task, i.e, energy and

information for the maintenance of homeostasis of the system. Through dynamic

interaction with the environment, the system changes information in different forms

such as verbal and behavioural communication.9

In this study, process refers to the series of events that take place in the

mothers of under-five children. These include increase in the knowledge of mothers

after being exposed to the planned teaching programme development of interest to

learn more about protein energy malnutrition seeking more information regarding

protein energy malnutrition from other sources like media, family members, friends

and acquaintances.

Output

Output is any information, energy and material that leaves the system and

enters into the environment through the system boundaries.9

In the present study, Output refers to the effectiveness of planned teaching

programme regarding protein energy malnutrition that may also be regarded as the

product of the process.

9
Feedback

Refers to the process by which information is received at each stage of the

system and is fed back as input to guide or direct in its evaluation.9

Accordingly, the higher knowledge score obtained by the mothers of under-

five children in the post-test indicates that the planned teaching programme was

effective in increasing the knowledge of mothers; low score indicate that the planned

teaching programme was not effective in increasing the knowledge score; hence

alternative measures should be taken to improve the knowledge.

Environment

The individual environment is the fixed constraint that may influence the

effectiveness of planned teaching programme. It includes inter-personal relationship

with family members, neighbours, health team members and others.

Diagrammatic representation of the conceptual frame work for the present

study is depicted in Figure-1

10
 Environment-community

INPUT PROCESS OUTPUT 

y Assessment of knowledge
using knowledge
Demographic variables of questionnaire
mothers of under-five y Administration of PTP Adequate
children Ï definition Knowledge
Ï incidence
Ï causes
Ï classification
y Age of child Ï types
y Age of mother Ï signs and symptoms
y Education Ï prevention
y Family income Ï management
y Number of children Ï complications Inadequate
y Type of family y Evaluation of effectiveness knowledge
y Religion of PTP
fb

Not under study

FEEDBACK 

Figure 1: Conceptual framework for evaluating the effectiveness of PTP on protein energy malnutrition based on System Theory (by
Ludwig Von Bertalanffy 1968)

11
Delimitations

Study will be delimited to mothers of under-five children in a selected rural

community at Mangalore who are available at the time of data collection.

Scope of the study

• The findings of the present study would help the nursing personnel to develop

an insight into the importance of health education regarding protein energy

malnutrition.

• The present study would help the nursing personnel to understand the level of

knowledge of mothers of under-five children regarding protein energy

malnutrition.

• Based on the findings various awareness programme can be conducted for the

mothers of under-five children.

Summary

This chapter dealt with objectives, operational definitions, assumptions,

hypothesis and conceptual framework, variables, which is a predictive statement of

the relationship between the independent and dependent variables, and delimitations

of the study. The conceptual framework of the present study is based on general

systems theory.

12
 3. REVIEW OF LITERATURE

The term literature review refers to the activity involved in identifying and

searching for information on a topic and developing understanding of the state of the

knowledge of topic. The term is also used to designate a written summary of the state

of the art on a research problem.10

Review of literature is the writings of recognized authorities and of previous

research, which provides the evidence that the researcher is familiar with what is

already known and what is still unknown.

Citing studies that show substantial agreement and those that seem to present

conflicting conclusions helps to sharpen and define understanding of the existing

knowledge in the problem area, provides background for the research project, and

makes the reader aware of the status of the issue.10

The investigator carried out an extensive review of literature on the research

topic in order to gain deeper insight into the problem as well as to collect maximum

relevant information for building up of the study.

In order to gain more knowledge the investigator used Internet and surveyed

the books and journals. Review was done on research and non-research literature.

The literature was reviewed and grouped under the following headings:

1. Meaning of protein energy malnutrition

2. Causes of malnutrition

3. Signs and symptoms and diagnosis of protein energy malnutrition

13
4. Management and prevention of protein energy malnutrition

5. Effectiveness of planned teaching programme

Studies related to meaning on protein energy malnutrition

A correlational study was conducted to assess the knowledge on nutrition of

under- five children among the migrating mothers and prevalence of nutritional

problems among their children in selected rural community, thiruvallur district, Tamil

Nadu. The study found that, maximum 59(98.33%) mothers had inadequate

knowledge on nutrition of under-five children, 1(1.67%) mother had adequate

knowledge. The mean score of overall knowledge on nutrition of under-five as 8.57

with S.D 2.63, the mean score of degree of malnutrition was 74.37 with S.D 10.5 with

an “r” value of -0.225 which indicate that when knowledge level decrease the

prevalence rate will be increased.11

A study was conducted on malnutrition in urban slums in Hyderabad. The

sample consisted of 100 children aged 1-5 years. A pre-tested structured interview

schedule was used for collecting socio-demographic data and anthropometric

measurements of height and weight were measured as per the WHO guidelines, to the

nearest 0.5 cm and 0.1 kg. The overall under-nutrition prevalence was 69% and

prevalence of severe under nutrition was 33%. Prevalence of stunting among children

was 61%; out of which 25% were severely stunted, 47% children were underweight

with 24% severe underweight and stunting.12

A study was undertaken to assess the impact of drought on childhood illnesses

and nutrition in under-five children of rural population using three stage sampling

design in Jodhpur district. Samples consisted of 914 under- five children. Result of

14
the study reveal that the extent of malnutrition was significantly higher in females

than in males (p<0.01). Vitamin A & B complex deficiencies were 0.7% and 3%

respectively. The protein energy malnutrition (PEM) was observed in 44.4%. Overall

mean calorie and protein intake deficit was observed to be very high (76.0 & 54.0

%).13

A case-controlled study was conducted in a rural area in Tamil Nadu. The

Sample consisted of thirty-four cases and 34 controls. Result showed that Poor

nutritional status was associated with socioeconomic variables such as sex of the child

and father's occupation. Female gender (OR = 3.44, p = .02) and father's occupation

as a laborer (OR = 2.98, p = .05) were significant risk factors for severe malnutrition.

The two groups showed a significant difference in nutrition-related knowledge of

mild mixed malnutrition (OR = 2.62, p = .05).14

Causes of protein energy malnutrition

A cross-sectional descriptive study was conducted on biochemical nutritional

indicators in children with protein energy malnutrition attending Kanti Children

Hospital, Kanthmandu, Nepal. The sample size was a total 120 cases, which included

60 with PEM cases and 60 controls were selected. The result obtained showed that the

educational status of parents of children with PEM was found to be significantly less

(P<0.05) as compared to their non-PEM counter parts. The mean serum glucose,

sodium, potassium, cholesterol haemoglobin was not significantly different in both

groups while mean total protein, albumin and calcium were significantly (p<0.05)

higher incidence of hypoproteinemia, hypoalbuminaemia and hypocalcaemia in PEM

group compared to control group.15

15
 A study was conducted among urban Nigerian children. The samples were 458

under- five years of who were clinically diagnosed with protein energy malnutrition.

The majority of these children were of higher birth order (3rd child and higher):

63.2% based on the mother's parity and 56.4% based on the father's parity. More than

half (54.8%) of the malnourished children's mothers were the first wives of their

respective husbands. The result shows 43.9% of the children's fathers were urban

(public minibus transport) drivers. Half (51.5%) of the mothers who claimed to be

single opted into single status and were mostly from polygamous households, but

87.6% of the children were from polygamous families, of which 18.6% of the mothers

had divorced. Only 27.7% of the children lived with both parents; 40.4% lived with

their grandparents, and 37.8% were the financial responsibility of their grandparents.

There is an association between children treated for malnutrition and father's

occupation, parents' marital status, mothers' seniority among other wives, and source

of financial responsibility for the children.16

A study was conducted on the risk factors of protein energy malnourishment

(PEM) among 0-5 year old children in South Batinah region, Oman. the risk factors of

protein energy malnourishment (PEM).The result of the study were the median birth

order among PEM cases was significantly higher compared to the children without

PEM (Mann Whitney test; p=0.029). Using multivariate logistic regression technique,

we found that low birth weight (odds ratio [OR] 2.32; confidence intervals [CI] 95%

1.61-3.33), higher birth order (OR 1.04; CI 95% 1.01-1.08) and sibling with history of

under weight [OR 1.79 (CI 95% 0.97-3.28)] were significant predictors of PEM.17

A cross-sectional study was conducted on factors influencing nutritional status

and to explore the pattern of snack consumption in a rural area of the Northeastern

16
region in Thailand. Samples were 85 normal and 85 undernourished pre-school

children with ages ranging from 2-6 years old. The results indicated that children in

both groups preferred crispy snacks between breakfast and lunch. Energy, protein, fat,

carbohydrate, calcium and sodium intake derived from snacks and overall intake were

significantly lower in undernourished children than those in normal children (p-value

< 0.01) and energy intake in pre-school malnourished children (2-3years) as

percentage of recommended daily allowance was lower than the recommended level.

The results supported the observation that snack foods contribute to excessive sodium

intake.18

Prevalence of protein energy malnutrition

A national survey among preschool children in Oman on protein energy

malnutrition. The total sample comprised 19,440 children; 9911 males and 9529

females. The prevalence of underweight, wasting and stunting among preschool

Children were assessed. Within each region, samples of males and females in the age

groups 0-5, 6-11, 12-23, 24-35, 36-47 and 48-60 months were drawn from the

registers of health institutions and the weight and height/length of the children were

measured. Data were analysed according to the World Health Organization protocols.

The prevalence rates of wasting, stunting and underweight were 7.0%, 10.6% and

17.9% respectively at the national level. 19

A study was conducted among rural Nigerian community to determine the

prevalence of malnutrition. Using the modified Wellcome Classification, the

prevalence of protein energy malnutrition (PEM) was 20.5%. The prevalence of

underweight, wasting and stunting were 23.1%, 9% and 26.7%, respectively. The low

prevalence of PEM in the rural Nigerian community may be due to the services and

17
intervention provided by a non-governmental organization in the community. This

method of intervention is similarly achievable in other communities.20

A cross sectional study was conducted to investigate the prevalence of under

nutrition among children 3.0- 5.9 years old in a rural area of West Bengal covered by

the Integrated Child Development Service scheme (ICDS) using composite Index of

anthropometric failure (CIAF). Randomly selected six ICDS centres of Chapra Block

Nadia District, West Bengal, India were Chosen. A total of 2016 children aged 3.0-5.9

years were studied. It was observed that boys were heavier and taller than girls at all

ages. Significant age differences existed in mean height and weight in boys as well as

in girls. Among the children 48.20%, 10.60% and 48.30% were stunted, wasted and

underweight. The CIAF showed a higher prevalence of under-nutrition with 60-40%

of the studied children suffering from anthropometric failure.21

A study was conducted on prevalence of protein energy malnutrition and

factors that militate it. The samples were three hundred and seventy pre-school

children 181 males and 189 females. The prevalence of protein energy malnutrition

among the children was revealed to be 41.6% (154). One hundred and fifty one

(40.8%) of them were found to have weight-for-height below -2SD indicating level of

stunting among the children. Most of the malnourished children belonged to mothers

who were illiterate 97 (54.8%) when viewed from the mothers' educational

perspective and also the following factors were statistically significant with PEM:

educational status of mothers (p<0.05), marital status (p<0.05) of mothers,

occupational status of mothers (p=0.000), parental income per annum (p=0.000),

length of breastfeeding (p=0.000), water supply and regularity, type of housing and

toilet facilities.22

18
 A cross sectional survey was conducted to assess the dietary intake and

nutritional status in children of the tribal areas of Bihar. The samples consisted of

1847 preschool children (0-6 Years). The overall prevalence of stunting was about

60% and underweight about 55% and was comparable in boys and girls. The wasting

was more frequent in girls (urban - 34.5% vs. 16.3% and rural - 34.9% vs 18%).23

A study was conducted in eastern province of Turkey. The samples were

consisted of 1000 children. The result reveals that general malnutrition rate was

30.5% according to weight for age, 27.7% for weight for height and 33.7% for mid

upper arm circumference (MUAC) to head circumference (HC) ratio. The rates of

severe malnutrition were noted to be low (1.8-2.2%) when using this criteria.24

Signs and Symptoms and diagnosis of protein energy malnutrition

A community based cross-sectional survey was conducted among children in a

poor area of China regarding malnutrition. The WHO standards were used to calculate

Z-scores of height-for-age (HAZ), weight-for-age (WAZ),weight-for-height (WHZ)

and BMI-for-age (BMIZ).The samples were 8041 children aged <5 years were

measured during a 2-month period from August to October 2006. The result shows

the prevalence of stunting, underweight and wasting were 30.2 %, 10.2 % and 2.9 %,

respectively. The prevalence of overweight and the possible risk of overweight were

as high as 4.1 % and 16.8 %. Further analysis among the children with possible risk of

overweight found that the percentage of stunting (HAZ <or-2) was 57.6 %, the

percentage with -2 <or= HAZ <or= 2 was 41.0 % and the percentage with HAZ > 2

was only 1.4 %. The prevalence of stunting was 21.9 % and of underweight was 12.7

% by the NCHS reference. Stunting was the most serious problem that was impeding

child growth and development.25

19
 A case control study was carried out among Bangladeshi children with protein

energy malnutrition to explore the status of serum zinc and copper level in the

department of Biochemistry, Mymensingh Medical College, Dhaka. Samples were 68

children aging from five months to five years. The subjects were divided into two

groups and result shows mean+/-SD (Standard Deviation) of serum zinc in PEM

(59.85+/-11.18 microg/dl), Marasmus (66.73+/-8.23 microg/dl), Kwashiorkor

(49.69+/10.35 microg/dl) and Marasmic Kwashiorkor (60.63+/-8.04 microg/dl) were

all significantly lower (p<0.001) than in control group (106.16+/-13.36 microg/dl).

Similarly mean+/-SD of serum copper in PEM (82.73+/-16.35 microg/dl),Marasmus

(93.72+/-9.77 microg/dl), Kwashiorkor (63.75+/-13.12 microg/dl) and Marasmic

Kwashiorkor (86.52+/-8.68 microg/dl) were all also significantly lower(p<0.001) than

in control group (135.88+/-11.88 microg/dl). It is evident from the study that serum

zinc and copper level significantly decrease in children with PEM.26

Diagnosis

A study was conducted in pre-schoolers (2-6 years) from ten different slums of

Udaipur City in Rajasthan with the aim to assess their nutritional status.

Developmental pattern of these subjects indicated that the height with age of both

male and female subjects increased, however, their body weight did not increase.

More than 50% of these pre-schoolers showed symptoms of protein energy

malnutrition and anaemia, while 22% had pigeon chest deformity due to vitamin D

and calcium deficiency. Classification for degree of malnutrition as per IAP showed

that majority of these subjects (66%) were under weight (Grade I and II). Waterlow's

classification revealed that majority of these pre-schoolers were wasted (30%) or

20
wasted and Stunted (42%). This malnutrition was either of PCM (past chronic) or

CLM (current long duration) type as per Seoane and Latham's classification.27

A study was conducted on efficiency of several biochemical parameters as

indicators of moderate protein-energy malnutrition was investigated in the forest

region of southern Cameroon. The sample consisted of 810 children aged under 5

years were studied. The means values of most of the biochemical parameters were

decreased in the malnourished group. Prealbumin, Transferrin, Hydroxyproline index

and Albumin/Globulins ratio showed the most significant decreases. There were

highly significant (P less than 0.001) correlations between the parameters and all the

anthropometric tests.28

Studies related to Management and prevention of Protein energy malnutrition.

A study on Home-based rehabilitation of severely malnourished children in

resource poor Setting in Delhi. The sample were Thirty-four severely malnourished

(weight for length <70% of WHO reference) children between the ages of 6 months to

5 years. The result shows that the home based management phase, the reported mean

(±SD) calorie intake increased from 100 (± 5) kcal/kg/d at entry point to 243 (± 13)

kcal/kg/d at 16 weeks (P=0.000). Similarly, reported protein intake increased from 1.1

(± 0.3) g/kg/d to 4.8 (± 0.3) g/kg/d (P=0.000). During hospital stay (n=19), children

had weight gain of 9.0 (±5.3) g/kg/d, while during home based follow up (n=29),

weight gain was 3.2 (± 1.5) g/kg/d only. During home based rehabilitation, only 3

(11.5%) children had weight gain of more than 5 g/kg/d by the end of 16 weeks.

Weight for height percent increased from an average (±SD) of 62.9% (± 6.0%) to

80.3% (± 5.7%) after the completion of 16 weeks (P=0.000).Thirteen (45%) children

recovered completely from malnutrition achieving a weight. For length of >80 %

21
whereas 15 (51.7%) recovered partly achieving weight for length >70%. There was no

death during the home stabilization.29

A systematic review of pharmacokinetics studies in children with protein-

energy Malnutrition in Royal Derby Hospital, UK. Malnutrition, undernutrition,

underweight, protein-energy malnutrition, protein-calorie malnutrition, marasmus,

marasmic-kwashiorkor or kwashiorkor was the medical subject heading (MeSH)

descriptor used. A total of 34 drugs were studied. The absorption of 18 drugs was

studied; the extent of absorption (AUC) was unaffected for 10 drugs. The plasma

protein binding of 20 drugs was evaluated; it was significantly reduced for 12 drugs.

The volume of distribution (Vd) of 13 drugs was evaluated; it was, however,

unaffected for most of the drugs. The effect of PEM on total clearance and the half-

life of drugs primarily metabolized by the liver was studied for 8d rugs. There was

decreased total clearance and an associated increased half-life of 5 drugs. For 2 drugs

(chloramphenicol and quinine), different degrees of PEM affected total clearance

differently. The total clearance of six drugs primarily eliminated by the kidneys was

studied; it was unaffected for four drugs, but significantly decreased for two drugs

(cefoxitin and penicillin).30

A hospital based study of severely malnourished children regarding

Composition of weight gain during nutrition rehabilitation in hyderabad. This study

examined the composition of weight gain in severely undernourished children who

underwent nutrition rehabilitation in a hospital from India. The result shows mean

weight for age z score, height for age z score and weight for height z score (WHZ)

were -5.0, -4.2 and -4.1 respectively. Children consumed a mixed diet and mean

energy intake was 177 kcal/kg/day with a protein energy ratio of 13. Overall, the

22
mean weight gain was 6.1 g/kg/day and fat mass contributed to about 40% of the

weight gain. When the composition of weight gain was analysed in tertiles of

baselineWHZ score, children in the lowest tertile of WHZ score had significantly

higher weight gain and fat free mass (FFM) gain. The study demonstrates that it is

possible to achieve rapid weight gain with recovery of lost tissue in severely

malnourished children with mixed diets. Children with lowest WHZ scores at baseline

gained higher FFM during nutrition rehabilitation when compared to the children with

relatively higher WHZ score probably in an attempt to recover the lost tissue.31

A pair-matched controlled study was conducted on Zinc supplementation in

protein energy malnutrition in India. The sample consisted of 30 children (15 males,

15 females) of mild to moderate PEM in test and equal number in control groups,

aged 8-24 months old. The result at the end of 3 months showed that children in test

group had a weight gain of 3.742 +/- 0.488 kg against 2.035 +/- 0.383 kg of the

control group. Similarly, weight velocity was 5.752 +/- 0.818 g/kg/day in test group

against 3.153 +/- 0.617 g/kg/day of the control group. These differences in weight

gain and weight velocity were highly significant (p < 0.001). Serum zinc levels,

initially and at the end of study were 87.5 +/- 9.6 micrograms/dl and 121.0 +/- 10.1

micrograms/dl, respectively in test group in comparison to 91.2 +/- 9.8 micrograms/dl

and 91.0 +/- 10.1 micrograms/dl in controls. This difference was also highly

significant (p <0.001). 32

A study was conducted among malnourished children in Central African

Republic. The samples were 860 cases, have been treated by supplementing their diet

with traditional food available within the study area. The result showed that 40% had

a significant gain of weight within 10 days and a weight curve back to normal with 6

23
months for 61.7% of the study cases. After 6 years, 68% of the ones still under study

are cured and in good health.33

A project was conducted in a rural area with the aim of decreasing the

incidence of protein-energy malnutrition among children under 5 years, by nutritional

intervention through the primary health care system. Practical instruction on feeding

methods, deworming, environmental sanitation, the promotion of home-grown

vegetables and reinforcement of the growth monitoring programme were chosen as

the routes for intervention. All indices were reassessed in the region after 1 year.

Results showed that nutritional awareness had grown among mothers, and that the

incidence of malnutrition had dropped from 6.5% to 1.8%, as measured against the

weight-for-height index.34

Studies related to effectiveness of planned teaching programme

Investigator could not locate any studies regarding effectiveness of PTP on

protein energy malnutrition. The related studies were included where methodology

and procedures are similar.

A study was conducted on the effectiveness of planned teaching programme

regarding toilet training to mothers of children below 1-3 years in selected day care

centres at Mangalore. The sample consisted of 60 mothers having children between

1-3 years. Convenient sampling technique was used for selecting the sample. The

findings revealed the higher mean post-test knowledge scores (28.05) with that of

mean pre-test knowledge score (17.82). The ‘t’ value showed significant difference

between pre and post-test knowledge score (t(59) = 32.05, P < 0.05). Therefore it is

confirmed that PTP is an effective teaching strategy to improve the knowledge level

of mothers.35

24
 A study was conducted to evaluate the effectiveness of a structured teaching

programme among mothers of asthmatic children on home management of children

with asthma in a selected hospital in Udupi district. Pre-experimental one group pre-

test – post-test design was used. Structured knowledge questionnaire was used to

assess the knowledge of 30 mothers on management of asthma in children and belief

was assessed by means of a 3-point rating scale on Day 1, following which a

structured teaching programme was given. The post-test was given on the 15th day.

The post-test knowledge score (t(29) = 6.67, P < 0.05) obtained was significantly

higher than pre-test score. The post-test belief score (t(29) = 5.32, P < 0.05) was

significantly higher than pre-test score, thereby stressing the effectiveness of

structured teaching programme.36

A study was conducted to evaluate the effectiveness of planned teaching

programme on knowledge of school teachers regarding risk factors of coronary heart

diseases. The study was conducted in three selected private schools of Kerala. The

sample consisted of a cohort group of 50 teachers, teaching from one to ten standards.

Tool used was a structured questionnaire with 50 items to assess the knowledge of

school teachers regarding risk factors of coronary heart disease. A quasi experimental

approach was used with one group pre-test, post-test design. Results showed higher

post-test knowledge scores (43.54) compared to pre-test knowledge score (21.46) at

0.001 level of significance. This shows the effectiveness of PTP in increasing the

knowledge of school teachers regarding the risk factors of coronary heart disease.37

An evaluative study was conducted to determine the effectiveness of planned

teaching programme on the care of adolescent girls with regard to menstruation for

mothers in selected communities in Kerala. The sample of study consisted of 30

25
mothers. Convenience sampling was used for selecting the sample. A structured

knowledge questionnaire was used for data collection. The findings revealed that the

mean pre-test and post-test scores as 22.63 and 36.4. The ‘t’ value showed a

significant difference between pre-test and post-test (t(29) = 17.1268, P < 0.05). This

indicates that PTP was effective in gaining knowledge.38

A study was undertaken to determine the effectiveness of a planned teaching

programme on pain management in children for staff nurses working in a selected

hospital of Karnataka. The sample comprised of a batch of 45 B. Sc. Nursing

graduates who had 10 months of experience in various wards of the hospital chosen

through purposive sampling. The data was collected through a structured knowledge

questionnaire. Descriptive and inferential statistics were used to analyse the data. The

findings revealed higher post-test knowledge score (x = 51.33) as against pre-test

knowledge score (x = 31.44). The‘t’ value showed significant difference between pre

and post-test knowledge scores (t(44) = 43.08, P < 0.05). This shows the effectiveness

of PTP in increasing the knowledge of staff nurses regarding pain management in

children.39

Summary

The above cited studies revealed various aspects of research problem. It

improves methodology and broadens knowledge base. This chapter has dealt with

review of literature related to research materials. The review of literature has enabled

the investigator in establishing the need for the study, developing the conceptual

frame work, constructing the tool and selecting the research design. The review

literature for the present study emphasized in the areas such as meaning of protein

energy malnutrition, causes of protein energy malnutrition, prevalence of protein

26
energy malnutrition, signs and symptoms and diagnosis of protein energy

malnutrition, prevention and management of protein energy malnutrition. The review

has helped the researcher to gain an insight into the problem and to develop the tool

and planned teaching programme.

27
 4. RESEARCH METHODOLOGY

Methodology of research organises all the components of the study in a way

that is most likely to lead to valid answers to the sub-problems that have been posed.41

This chapter discusses the methodology adopted for the study. The

methodology of the study includes research approach, research design, setting of the

study, population, sample and sampling technique, inclusion and exclusion criteria for

sampling, data collection tool, development of the tool, preparation of blue print,

content validity and reliability of the tool, description of the tool, preparation of

intervention, content validity of intervention, pilot study, data collection method,

problems faced during data collection and plan for data analysis. On the whole it

gives a general pattern for gathering and processing research data. This study is aimed

at finding out the effectiveness of the planned teaching programme on protein energy

malnutrition among mothers of under- five children in a selected community in

Mangalore.

Research approach

Evaluative research is an applied form of research that involves finding out

how well a programme, practice, procedure or a policy is working. Its goal is to assess

or evaluate the success of a programme.40

As the study is to find out the effectiveness of planned teaching programme on

protein energy malnutrition among mothers of under-five children in a selected

community, an evaluative research approach was used in this study.

28
Research design

Research design is a researcher’s plan for obtaining answers to the research

question or for testing research hypothesis. A research design is collecting and

analysing data, including specifications for enhancing the internal and external

validity of the study. The research design spells out the basic strategies that the

research adopts to develop information, which is accurate and interpretable. 41

Pre-experimental one group pre-test-post-test design is adopted for the study.

In one group pre-test and post-test design (O1 X O2) the investigator introduced a base

measure before and after a planned teaching programme which is depicted as O1 and

O2 respectively. In this study the base measure is the knowledge and the independent

variable is planned teaching programme depicted as X.

O1 X O2

O1 : Pre-test

X: planned teaching programme

O2 : Post-test

The schematic representation of the study design is given in Figure 2.

29
Population Samples & sampling Variables Data collection
Data collection tool
tool Plan for data analysis
technique

Mothers of Sample
under- five Extraneous Demographic Descriptive statistics
children who 30 mothers of under- variables: Proforma for baseline
meets the five children. characteristics
Age of the child
inclusion Age of mother
criteria. Educational status Chi-square to find the
of mother
Structured
interview association between
Family income
schedule on mother’s knowledge
Number of
children Knowledge on with selected
religion PEM demographic
type of family variables.
Sampling technique duration of breast Administration
feeding of PTP paired‘t’ test for
Purposive sampling effectiveness of PTP

Dependent
variables: Knowledge
regarding PEM

Independent
variable
PTP

Figure 2: The schematic representation of study design

30
Setting of the study

The study was conducted in a selected rural community at Mangalore.

Vamanjoor is the selected rural area which comes under Kudupu PHC which is 12 km

away from the Mangalore city and under the governance of Mangalore City

corporation. Kudupu PHC has 6 sub-centres and the population is around 26817.

Variables under study

A concept which can take on different quantitative values is called a

variable.41 Three types of variables were identified in the study.

Dependent variable

If one variable depends upon or is a consequence of other variable, it is termed

as dependent variable.41

In the present study, Knowledge of mothers of under-five children regarding

protein energy malnutrition is dependent variable.

Independent variable

A variable that is antecedent to the dependent variable is termed as

independent variable.41

In this study it refers to the planned teaching programme on protein energy

malnutrition.

Extraneous variable

Independent variable that are not related to the purpose of the study, may

affect the dependent are termed as extraneous variable.41

31
 In this study Age of child, age of mother, education, family income, religion,

type of family, number of children, duration of breastfeeding.

Population

In this study population consisted of mothers of under-five children residing in

selected area. Approximately 5000 people are residing in the area and around 100

mothers have under-five children.

Sample

The sample for the present study consists of 30 mothers of under-five children

in a selected rural community of Mangalore.

Sampling technique

The sample for the study consists of mothers of under-five children. Purposive

sampling technique was used in selecting the sample. Sample consists of 30 mothers

of under-five children.

Inclusion criteria for sampling

1. Mothers who have under-five children.

2. Mothers of under-five children who are willing to participate in the study.

3. Mothers who can speak and understand Kannada/English.

4. Mothers who are available at the time of data collection.

Exclusion Criteria for sampling

• Mothers who are not willing to participate in the study.

32
Data collection tool

A tool is a written device that a researcher uses to collect data.41 The tool was

prepared on the basis of the objectives of the study. The tool used in this study is

demographic proforma and interview schedule using structured knowledge

questionnaire on protein energy malnutrition.

Development of the tool

The following steps were adopted in the development of the tool

• Review of literature

• Discussion with experts

• Development of a blueprint

• Construction of structured interview schedule items

• Content validity

• Reliability

Preparation of the blue print

A blueprint was prepared prior to the construction of structured knowledge

questionnaire. It depicted the distribution of items according to the content areas. It

included three domains knowledge, comprehension, and application. It had 9

knowledge items (30%), 15 comprehension items (50%) and 6 application item

(20%). The structured knowledge questionnaire consists of 30 items and demographic

proforma had 8 items. (Annexure-7)

33
Content validity

Content validity refers to the degree to which an instrument measures, what it

is supposed to measure.41

The tool was validated by eleven experts, of whom nine were from nursing

field, two physicians from paediatrics (Annexure-15). The experts were requested to

give their opinion regarding accuracy, relevancy and appropriateness of the content

against the criterion rating scale, which had columns for “agree”, “disagree”,

“remarks” and “suggestion”.(Annexure-10)

Part I: Demographic proforma

Initial tool had 7 items and all the items retained after validation with

modifications of some items and one more item also added. All the items had 100%

agreement.

Part II: Structured knowledge questionnaire

Initial tool had 30 items. Among those, 17 items had 100% agreement, 8 items

had 80% agreement and 5 had 70% agreement. Since there were suggestions to reduce

the number of items, all the items of 70% agreement was discarded. The remaining 25

items after making necessary modifications were retained as such.

The knowledge scores obtained are arbitrarily graded as follows:

Range Scoring Percentage

0-8 Poor 0-32

9-16 Average 33-67

17-25 Good 68-100

34
Reliability of the tool

The reliability of the measuring instrument is a major criterion for assessing

the quality and adequacy. The reliability of an instrument is the degree of consistency

with which it measures, the attribute it is supposed to be measuring.40 The purpose

was to find out the accuracy of measuring instrument. The reliability of the instrument

was established using split half technique, which measures the coefficient of internal

consistency. The reliability was tested using Karl Pearson’s product moment

correlation formula. Spearman Brown Prophecy formula was used to find the

reliability of the full test. The reliability of the tool was found to be 0.89. The tool was

found to be valid, reliable and feasible. No further modifications were made to the

tool.

Description of the final tool

The tool consisted of Part I and Part II.

Part I – Demographic proforma

The tool consisted of 8 items which dealt with socio demographic variables

such as age of the child, age of mother, educational status of mother, family income

per month, number of children, religion, type of family and duration of breast feeding.

(Annexure-8)

Part II – Structured knowledge questionnaire on protein energy malnutrition

There were totally 25 items that include definition, sources, incidence, causes,

signs and symptoms, diagnosis, prevention, management and complication. Each item

35
had three choices. There was one correct response that carried ‘1’ mark. The total

score was 25. (Annexure-8)

Preparation of planned teaching programme

The PTP for mothers was developed after reviewing the literature, seeking

opinion of the experts and from personal experience. (Annexure-12)

The steps involved in the development of PTP were:

1. Preparation of first draft of PTP,

2. Development of criteria checklist,

3. Content validation,

4. Preparation of the final draft of PTP.

Content validity of planned teaching programme

The first draft of the PTP was developed after reviewing the available

literature and consulting with the experts. A criteria checklist was prepared to assess

the validity of the PTP. The PTP was sent to ten experts. There was 100% agreement

among experts. The content of PTP included definition, sources, causes, signs and

symptoms, diagnosis, management, prevention and complications of protein energy

malnutrition. (Annexure-6)

The teaching material was translated into Kannada by a language expert.

36
Pilot study

A pilot study is a small preliminary investigation of the same general character

as a major study.40

Pilot study was conducted from 09th June to 16th June 2011 in order to check

the feasibility and practicability. Formal permission was obtained from the authority

before conducting the study. It was conducted in Mallur community, Mangalore. The

investigator assessed the knowledge by using structured interview schedule.

(Annexure-1)

The tool was administered to 10 mothers of under-five children who fulfilled

the sampling criteria. The purpose of the study was explained to the subjects prior to

the study to get their cooperation. After obtaining their consent, interview was

conducted by using demographic proforma and structured knowledge questionnaire.

Immediately after pre-test, planned teaching programme was administered. The post-

test was conducted on the seventh day using the same tool. The time taken for

interview was 20-25 minutes. Planned teaching programme took 45 minutes. At the

end of data collection the investigator thanked the mothers for their co-operation. The

investigator faced no problems during the data collection procedure. The study was

found feasible and practicable.

Method of data collection

The data collection period extended from 1st August 2011 to 30th August 2011.

Permission was obtained from concerned authority prior to the data collection

process. (Annexure-2) Prior to data collection, the investigator familiarised herself

with the subjects and explained the purpose of the study to them. Confidentiality was

37
assured to all subjects. An informed consent was taken from the subjects

(Annexure-3)

Using purposive sampling 10 samples were selected daily till the desired

sample size was obtained. Data was collected using interview schedule method from

the sample selected for the day. Immediately after collecting data a planned teaching

programme was given to the group. On seventh day after planned teaching

programme post-test was conducted using the same method of pre-test. Data

collection lasted for one month. The samples were thanked for their co-operation.

Problem faced during data collection

The investigator did not face any problem during data collection.

Plan for data analysis

Data analysis is the systematic organisation and synthesis of research data and

the testing of research hypothesis using those data.

Master sheets will be prepared to analyse the data. The data will be analysed

in terms of descriptive and inferential statistics.

1. Demographic data will be analysed in terms of frequency and percentage.

2. The knowledge scores before and after the planned teaching programme will

be analysed in terms of frequency, percentage, mean, and standard deviation.

3. The significant difference between the mean pre-test and post-test knowledge

score will be determined by‘t’ test.

38
4. The association between selected demographic variables and pre-test

knowledge score regarding protein energy malnutrition will be determined by

Chi-square test.

Conclusion

Research methodology gives a bird’s eye view of the entire process of tackling

a research problem in a scientific and systematic way. This chapter dealt with

description about research approach, research design sample and sampling technique,

research setting, study instruments validity and reliability of the tools, pilot study,

data collection techniques and plan for data analysis. The data is planned to be

analysed in terms of both descriptive and inferential statistics.

39
 5. RESULTS

Analysis is the process of organising and synthesising the data in such a way

that research questions can be answered and hypotheses is tested. 9

The purpose of the analysis is to reduce the data into an intelligible and

interpretable form, so that the relation of research problem can be studied and tested.

Analysis and interpretation of data were done based on the objectives and hypotheses

of the study using descriptive and inferential statistics.

This chapter deals with the analysis and interpretation of data collected from

30 mothers of under-five children regarding the knowledge about protein energy

malnutrition.

In this study the data was arranged based on the objective of the study using

descriptive and inferential statistics.

Objectives of the Study

1. To determine the pre-test level of knowledge of mothers of under-five children

regarding protein energy malnutrition as measured by a structured interview

schedule.

2. To evaluate the effectiveness of planned teaching programme on knowledge

regarding protein energy malnutrition among mothers of under-five children in

terms of gain in mean post-test knowledge score.

3. To find the association between mean pre-test knowledge score and selected

demographic variables (age of mother, education, family income, number of

children, type of family and religion).

40
Hypotheses

All hypotheses will be tested at 0.05 level of significance.

H1 : The mean post-test knowledge score of mothers regarding protein energy

malnutrition will be significantly higher than their mean pre-test knowledge

score.

H2 : There will be significant association between the mean pre-test knowledge

score of mothers and selected demographic variables.

Organization of findings

The data collected were analyzed and presented under the following headings:

Section I: Description of demographic variables

Section II: Knowledge of mothers of under-five children regarding protein energy

malnutrition.

Section III: Effectiveness of planned teaching programme on protein energy

malnutrition in terms of gain in knowledge score.

Section IV: Association between mean pre-test knowledge score and demographic
variables.

41
Section I: Description of demographic variables

Table 1: Frequency and percentage distribution of the sample characteristics

N= 30

Variable Frequency Percentage

1. Age of the mother

a. Below 20 yrs 2 6.7
b. 20-30 yrs 21 70.0
c. ≥30 yrs 7 23.3

2. Educational status of mother

a. No formal education 5 16.7
b. Primary education 14 46.6
c. Secondary education 7 23.3
d. Higher secondary 2 6.7
e. graduate and above 2 6.7
3. Family income per month(Rs)
a. <2000 3 10.0
b. 2001-5000 14 46.7
c. 5001-10000 10 33.3
d. >10001 3 10.0
4. Number of children
a. One 12 40.0
b. two 10 33.3
c. three 7 23.3
d. more than three 1 3.4
5. Religion
a. Hindu 12 40.0
b. Muslim 8 26.7
c. Christian 10 33.3
6. Type of family
a. Joint 14 46.6
b. Nuclear 14 46.6
c. Extended 2 6.7

42
Figure 3: Bar diagram showing the distribution of sample according to their age
in years

Data presented in Table 1 and Figure 3 shows that majority of the mothers

(70%) were in the age group of 20-30 yrs and 23.30% mothers were in the age group

of 30-40 years, and only 6.70% mothers were less than 20 years.

Figure 4: Bar diagram showing the distribution of sample according to

educational status

Data in Table 1 and Figure 4 shows that nearly half of mothers (46.60%) had

primary education, 23.30% had secondary education and 16.70% had no formal

education, and mothers who had higher secondary, graduate and above were only

6.70% each.

43
Figure 5: Cylindrical diagram showing the distribution of the sample according
to their family income

Data presented in Table 1 and Figure 5 shows that nearly half of the families

(46.70%) had a monthly income of Rs 2001-5000, whereas monthly income < Rs2000

and >Rs10001 were only 10% each.

Figure 6: Doughnut diagram showing the distribution of sample according to

number of children

Table 1 and Figure 6 shows that 40% of mothers had one child and 33.30% of

mothers had 2 children, 23.30% of mothers had three children and 3.40% had more

than three children.

44
Figure 7: Cylindrical diagram showing the distribution of sample according to
their religion

Data presented in Table 1 and Figure 7 shows that 40% of subjects belonged

to Hindu religion, 33.3% were Christians, and 26.7% were Muslims.

Figure 8: Bar diagram showing the distribution of the sample according to type
of family

Data presented in Table 1 and Figure 6 shows that nearly half of the sample

(46.60%) were from both nuclear families and from joint families and 6.70% were

from extended family.

45
Section II: Knowledge of mothers regarding protein energy malnutrition

Table 2: Frequency and percentage distribution of pre-test and post-test

knowledge scores

N = 30

Pre-test Post-test
Knowledge score F % F %

Good(17-25) 0 0 10 33.33

Average(9-16) 12 40.00 20 66.67

Poor(0-8) 18 60.00 0 0.00

Maximum score – 25

Figure 9: Cylindrical diagram showing the pre and post-test knowledge of

subjects
Data presented in the Table 2 and Figure 9 indicates the pre-test and post-test

knowledge scores of mothers. In the pre-test majority (60%) had poor scores and 40%

had average scores, whereas in the post-test majority (66.67%) had average scores and

33.33% had good scores.

46
Table 3: Range, Mean, Mean percentage scores of pre-test and post-test
knowledge scores
N = 30

Area Range Mean SD Mean %

Pre-test 4-12 9.10 2.160 30.21

Post-test 9-19 13.86 1.007 46.20

Maximum score 25

Data presented in the Table-3 shows that post-test knowledge scores ranged

between 9-19, which is higher than their pre-test knowledge scores 4-12. The mean

post-test knowledge scores (13.86 ± 1.007) was apparently higher than the mean pre-

test knowledge scores (9.1±2.16).

Section III: Effectiveness of planned teaching programme on protein energy

malnutrition

In order to find out the significant difference between mean pre-test and post-

test knowledge scores, paired “t” test was computed. To test the statistical difference

following null hypothesis was formulated.

H01: There will be no significant difference between the mean pre-test and post-test

knowledge scores of the subjects regarding protein energy malnutrition at 0.05

level of significance.

47
Table 4: Significant difference between the mean pre-test and post test
knowledge score

N=30

Mean SD of
Mean Score Difference difference t value

Pre test 9.10

4.76 3.115 9.69*
Post test 13.86
Maximum score=25, t29=2.045, p< 0.05* Significant

Data presented in Table 4 shows that the mean post-test knowledge score

(13.86)was higher than the mean pre-test knowledge score (9.1). The computed ‘t’

value (t=9.69), was higher than the table value (t29 =2.045) at 0.05 level of

significance. Hence the null hypothesis is rejected and research hypothesis is

accepted. It can be inferred that the planned teaching programme was highly effective

in improving the knowledge score of mothers of under-five children on protein energy

malnutrition.

Section IV: Association between Pre-test Knowledge Scores and demographic

variables

H02: There will be no significant association between mean pre-test knowledge

score and selected demographic variables at 0.05 level of significance.

Chi-square using Yates correction formula was computed to test the

hypothesis.

48
Table 6: Chi-square showing the association between mean pre-test knowledge
score and selected demographic variables

N=30

Sl. Knowledge score

No. Variable ≤ mean ≥ mean χ2 Significance
1. Age of the mother in years
a. ≤30 years 16 5 not significant
0.008
b. > 30 years 6 3
2. Educational status of mother
a. ≤primary education 14 5
0.027 not significant
b. ≥secondary education 7 4
3. Family income/month (Rs)
a. ≤5000 13 4
0.165 Not significant
b. >5000 10 3
4. Number of children
a. ≤2 16 6
0.128 Not significant
b. ≥3 7 1
5. Religion
a. Hindu and Muslim 17 3
0.212 Not significant
b. Christian 7 3
6. Type of family
a. Joint 12 2
0.0382 Not significant
b. Nuclear and extended 11 5
χ2 = 3.84, P ≤ 0.05

The data in table 6 shows that there was no association between pre-test

knowledge score and demographic variables. Hence the null hypothesis (H02) was

accepted.

49
Summary

Findings of the study revealed that PTP is effective in improving the

knowledge of mothers. It is evident from gain in mean post test knowledge score. The

obtained value is higher than the tabled value and the significance .05 level. Therefore

it can be concluded that PTP is effective. There was no association between

demographic data and mean pre-test knowledge score.

50
 6. DISCUSSION

This chapter presents the major findings of the study and reviews them in

relation to the findings from other studies.

The aim of the study was to assess the effectiveness of planned teaching

programme on knowledge regarding protein energy malnutrition among mothers of

under-five children in selected rural community in Mangalore using knowledge

questionnaires. Data collection and analysis were carried out based on the objectives

of the study.

Major findings of the study

Sample characteristics

y The study revealed majority of the mothers (70%) were in the age group of 20-

30 yrs and 23.30% mothers were in the age group of 30-40 years 6.70% of

mothers belongs to below 20 years.

y Nearly half of mothers (46.60%) had primary education, 23.30% had

secondary education, 16.70% had no formal education and 6.70% were

graduate.

y Nearly half of the families (46.70%) had a monthly incomes of Rs. 2001-5000,

33.30% had a monthly income of Rs. 5001-10000, 10% of the families had an

income of less than Rs. 2000 and 10% had monthly income of more than Rs.

10001 per month.

• Nearly half of the mothers (40%) had 1 child while 33.30% had 2 children and

23.30% had three children and very few 3.40% had more than three children.

51
• With regard to religion 40% were Hindu and 33.3% were Christian and 26.7%

were muslim.

• Equal number of the sample (46.60%) were from nuclear and joint families

and 6.70% were from extended family.

Section I: Knowledge of mothers regarding protein energy malnutrition

The mothers of under-five children have poor knowledge on protein energy

malnutrition. This is reflected by the mean percentage of pre-test knowledge score

(30.21%). Highest percentage of the mothers (60%) had poor knowledge (score range:

0-8).

The findings of the present study are consistent with findings from other

studies where in it was found that 98.33% of mothers had inadequate knowledge,

whereas 1.67% of mothers had adequate knowledge regarding protein energy

malnutrition.11

Effectiveness of PTP in terms of gain in knowledge scores

1. Pre and post-test knowledge scores of the subjects ranged from 4-12 and 9-19,

respectively.

2. In the post-test 33.33% had good knowledge score and 66.67% had average

knowledge score. In the pre-test 60% had poor knowledge and 40% had

average knowledge. None of the sample had good knowledge

3. The mean post-test knowledge scores (13.86) was higher than mean pre-test

knowledge score (9.1) suggesting that the PTP helped in improving the

knowledge of mothers regarding protein energy malnutrition.

52
4. The mean percentage of post-test knowledge score was (46.20%) higher than

the mean percentage of pre-test knowledge score (30.21%).

The findings are statistically significant at 0.05 level (t=9.69 p<0.05). These

findings of the present study are consistent with the findings from other studies.

Planned teaching programme is effective in improving the knowledge of

mothers. A study conducted to find out the effectiveness of planned teaching

programme for mothers regarding toilet training of children showed that the planned

teaching programme was effective in improving the knowledge of mothers(t59=32.05

p<0.05)35

Another study showed the planned teaching programme was helpful in

improving the knowledge of mothers regarding management of asthmatic children.

(t29=5.32 p<0.05)36

Association between the pre-test knowledge scores of mothers of under-five

children and selected variables

There was no association between the mean pre-test knowledge score of

mothers of under-five children on protein energy malnutrition and selected

demographic variables.

This study contradicts the findings of the previous studies where in it was

found that there is significant association between the knowledge and educational

status of mother (χ2=3.92).3

53
Summary

This chapter discussed the findings of the study in relation to other studies.

Earlier studies conducted by other researchers also showed that educational

programmes are helpful in increasing the knowledge and attitude of mothers of under-

five children. The next chapter deals with the conclusions drawn based on the findings

of this study.

54
 7. CONCLUSION

This chapter deals with the conclusion drawn based on the findings of the

present study.

Protein energy malnutrition is one of the leading causes of childhood

morbidity. Since mothers are the primary caretakers of children, their knowledge

regarding the care of children with these conditions is very vital in reducing the

mortality and preventing complications. It is the responsibility of nursing personnel to

update the knowledge of mothers about protein energy malnutrition. PTP is one of the

most important method that can be used in community to educate people to improve

the knowledge of mothers of under-five children regarding protein energy

malnutrition.

The conclusions drawn based on the finding of study were

• The study findings revealed that in the post-test most of the mothers (66.67%)

had average knowledge and 33.33% had good knowledge. The overall mean

knowledge score was 13.86 with SD of 1.007. In the pre-test none of the

sample had good knowledge and the mean score was 9.1±2.16.

• The difference in mean pre-test and post-test knowledge score was statistically

significant(t29=9.69 P<0.05)

• There was no significant association between knowledge of mothers of under-

five children and selected demographic variables like age, education, income,

number of children, religion and type of family.

55
• The PTP was very much appreciated by the mothers and they expressed their

gratitude for providing information on PEM.

Nursing Implications

The study has several implications for nursing practice, nursing education,

nursing administration and nursing research.

Nursing education

Nursing education programmes should prepare nurses to understand the

importance of family-centred care, so that they will be able to plan best care for the

children. All the health team members/workers in the community must have social

consciousness and motivate the public in prevention of PEM by proper dietary

practices through health education programme. The study insists that the need for

educating mothers regarding PEM is an absolute necessity. Student nurses should be

actively involved in health education programmes in the hospital as well as in the

community setting. They should be prepared to identify the various health problems

and plan the teaching programmes based on the identified need.

Nursing practice

Health education is an important tool for the healthcare agency. It is consistent

with promoting health as well as reducing illness. The extended and expanded role of

the professional nurses emphasises more on the preventive and promotive aspects of

health. Paediatric nursing is all about children and their families. Community health

nurses are key persons of the health team; they play a major role in health promotion

and maintenance in the family and communities. It is a practicing profession; hence

the researchers generally integrate findings into practice.

56
 The gap between existing and expected level of knowledge of the mothers

indicates that there is an urgent need for education regarding health problems like

protein energy malnutrition. This will help them to improve their knowledge and

practice, and enable them to take precautions to protect themselves and their children.

The investigator as a nurse felt the need for nurses acting as facilitators to educate the

mothers who could be resource persons and help their children to meet the challenges

of the modern world.

For nurses who work in the community, it is of vital concern that she should

know about protein energy malnutrition, causes of protein energy malnutrition, and

knowledge level of the mothers which will help her to plan better health education

programmes. The PTP can be further developed in the form of an information

booklet, SIM, pamphlets, audio and videotape and made use in the hospital as well as

in the community to impart knowledge to the public. Every nurse has a responsibility

in teaching the public about maintenance of health and prevention of disease.

Nursing administration

India is a developing country and most of the people live in rural areas where

health facility is very minimum. Therefore, the administrative departments of nursing

service at the institutional, local, state and national level should focus their attention

and educate the public regarding the health problems faced by them.

Administration in both private and government sectors should take initiative

action to update the knowledge of health personnel regarding malnutrition. Health

administration should make use of the educational departments and provide awareness

programme to the public through:

57
• In-service education regarding malnutrition.

• Providing support to conduct the educational programmes.

• Use audio visual aids for conducting awareness programmes.

• Utilizing mass media to educate the public.

• Taking initiative in the production of cost effective health education materials.

• Public awareness programmes as a part of community health extension

programmes in the hospital.

Nursing research

Nurses need to be engaged in multidisciplinary research so that it would help

them to improve their knowledge and skills in handling the daily problems related to

health and illness. This would provide them information about various ways and

means to improve the quality of life. Nurses should conduct projects and researches in

the community, schools and hospitals which will help to improve the health of the

people and especially the vulnerable groups. They can develop a teaching module and

material on various aspects of protein energy malnutrition for mothers of under-five

children through in depth research studies. Large scale studies can be conducted with

regard to preventive measures like diet modification.

Limitations

• The sample was limited to 30.

• The study was limited to only mothers of under-five children.

58
• The study was limited to a selected community Mangalore.

• The study made use of purposive sampling; hence the generalization of the

findings is limited.

• Practice of the mothers is not assessed.

Suggestions

• Different methods can be used for assessing the knowledge of protein energy

malnutrition among mothers of under-five children.

• In-service education or self-instructional module can be provided to the

parents.

• Pre-primary teachers can be educated on protein energy malnutrition so that

they can identify the problem in children at the early stage and prevent

complications

Recommendations

On the basis of the study findings the following recommendations have been

made:

• A study guide can be prepared and given to the periphery level workers and

pre-school teachers so that they can impart knowledge to the mothers of

under-five children.

• Educational sessions on malnutrition and normal nutrition can be introduced

for teachers in the school so that they can assess the nutritional status of the

school children.

59
• Regular classes can be conducted for Anganwadi workers to refresh their

knowledge regarding malnutrition and encourage them to impart knowledge to

mothers of under- five children.

• A similar study can be undertaken on a larger sample for generalizing the

finding.

• A study can be conducted to assess the practice of mothers regarding nutrition

of children.

Summary

This chapter has brought out various implications for this study and also

provided suggestions for further studies. Researches like this should be encouraged so

that the mortality and morbidity of the children due to protein energy malnutrition

will be reduced. Many of the complications can be prevented by identifying the

factors which causes protein energy malnutrition in children.

60
 8. SUMMARY

Protein energy malnutrition remains a major problem in our society due to

lack of awareness of its effects on the community. The severe forms of malnutrition

are kwashiorkor and marasmus, which are the leading killers of our paediatric

population. The population most vulnerable to protein energy malnutrition is under-

five children. This is a preventable disease if parents have adequate knowledge.

Parents and health providers should be concerned about the causes, clinical

manifestation, diagnosis, prevention and management of protein energy malnutrition.

Mothers play a vital role in the care of children, as mother is the primary

caregiver and teacher. Thus, educating them can bring about prevention of various

health problems in young children.

The main aim of the present study was to assess the effectiveness of planned

teaching programme on knowledge regarding protein energy malnutrition among

mothers of under-five children in a selected rural community in Mangalore.

Objectives of the study

1. To determine the pre-test level of knowledge of mothers of under-five children

regarding protein energy malnutrition as measured by a structured interview

schedule.

2. To evaluate the effectiveness of planned teaching programme on knowledge

regarding protein energy malnutrition among mothers of under-five children in

terms of gain in mean post-test knowledge score.

61
3. To find the association between mean pre-test knowledge score and selected

demographic variables (age of mother, education, family income, number of

children, type of family and religion).

The study attempted to examine the following hypotheses which were tested at

0.05 level of significance.

H1 : The mean post-test knowledge score of mothers regarding protein energy

malnutrition will be significantly higher than their mean pre-test knowledge

score.

H2 : There will be significant association between the mean pre-test knowledge of

mothers and selected demographic variables.

Assumptions

1. Mothers of under-five children may have some knowledge regarding protein

energy malnutrition.

2. Planned teaching programme will be effective in improving the knowledge

regarding protein energy malnutrition.

3. Knowledge of mothers of under-five children may vary according to

demographic variables.

The key variable under the study were:

1. Knowledge level of mothers of under-five children regarding protein energy

malnutrition.

2. Planned teaching programme on protein energy malnutrition.

62
 Conceptual frame work of this study was based on general systems theory

with input, process, output, and feedback, first introduced by Ludwig Von Bertalanffy

(1968).

A pre- experimental one group pre-test post-test design was adopted to

determine the effectiveness of the PTP in terms of gain in mean post-test knowledge

score. Purposive sampling technique was used to select 30 mothers from Vamanjoor,

Mangalore. The following tools were used to collect the data:

Part I: Demographic proforma

Part II: Structured interview schedule to assess the knowledge of mothers of under-

five children regarding protein energy malnutrition.

The steps involved in the development of instrument were preparation of

blueprint content validity, pre-testing and testing of reliability. The coefficient of the

internal consistency was calculated by split half technique. The reliability of the tool

was 0.89, which indicates that the tool was reliable. Pilot study was conducted on 09th

June to 16th June 2011 among mothers of under-five children in Mallur community to

find out the feasibility of the study. No modification was found necessary.

The main study was conducted on 30 mothers from Vamanjoor community,

Mangalore from 26th july to 28th August. The obtained data was analysed and

interpreted based on the objectives and hypotheses of the study. The frequency and

percentage were used to analyse the sample characteristics, frequency percentage,

mean. Range, median, standard deviation and paired ‘t’ test were used to determine

the effectiveness of PTP. The association between pre-test knowledge score and

selected demographic variable were determined by Chi square test.

63
 Findings of the study proved that planned teaching programme was effective

in improving the knowledge of mothers of under-five children regarding protein

energy malnutrition.

The present study, in short, gave the researcher a new experience, a chance to

widen the knowledge and a venue to interact with mothers of under-five children. The

direction from the guide, various experts and cooperation of mothers played a major

role in successful completion of the study. The experience gained during this study

will motivate the investigator to take up further studies in the future.

64
 9. BIBLIOGRAPHY

1. Soreng V. Mitigating malnutrition. Health Action 2008;32-4.

2. Peter R, Botuka D, Joseph JS, Joseph L, Babu T. Child malnutrition in urban

slums: A distressing reality. Nightingale Nursing Times 2010 Jan;5(10):12-6.

3. Jeyagowri S, Kamala S. Mothers knowledge of protein energy malnutrition.

Nightingale Nursing Times 2009 Apr;6:43-5.

4. WHO. Alleviating protein energy malnutrition. Health Action 2006 Feb;9.

5. Muthumari P. Effectiveness of structured teaching programme on protein

energy malnutrition among mothers of under-five children. Nightingale

Nursing Times 2010 Jun;6(3):61-5.

6. Sreevani R. Malnutrition and mental development. Health Action 2006

Feb;13-5.

7. Dey I, Chaudhuri RN. Gender inequality in nutritional status among under-

five children in a village in Hoogly district, West Bengal. Indian J Public

Health 2008 Oct-Dec;52(4):218-20.

8. Abdellah FG, Levine E. Better Nursing care through nursing research.

London: McMillan Company; 1992.

9. Christensen PJ, Kenney JW. Nursing process, application of conceptual

model. Philadelphia: C. V. Mosby Company; 1990.

10. Basavanthappa BT. Nursing research. New Delhi: Jaypee Brothers Medical

Publishers; 2003.

65
11. Devi Anusuya V. A correlational study on knowledge on nutrition of under-

five children. Asian Journal 2011 Jan-Mar;1(1):15-7.

12. Peter R, Botuka D, Joseph JS, Joseph L, Babu T. Child malnutrition in urban

slums: A distressing reality. Nightingale Nursing Times 2010 Jan;5(10):12-6.

13. Singh MB, Lakshminarayana J. Childhood illnesses and malnutrition in under-

five children in drought affected desert area of western Rajasthan. [online].

Available from: URL:http://www.east_meditrr_health_j.com [accessed on

04.07.2011])

14. Saito K, Korzenik JR. A case-control study of maternal knowledge of

malnutrition and health-care-seeking attitudes in rural South India. Yale J Biol

Med 1997 Mar-Apr;70(2):149-60.

15. Mishra SK, Bastola SP, Jha B.Biochemical nutritional indicators in children

with protein energy malnutrition attending Kanti Children Hospital,

Kathmandu, Nepal. [Online]. Available from:

URL:http//www.pubmed.nih.nlm.com (accessed on 12.07.2011)

16. Adekunle L. The effect of family structure on a sample of malnourished urban

Nigerian children. [online]. Available from:

URL:http://[email protected] (accessed on 23.07.2011)

17. Kurup PJ, Khandekar R. Low birth weight as a determinant of protein energy

malnutrition in "0-5 years" Omani children of South Batinah region, Oman.

[online]. Available from: URL:http://www.pubmed.com. (Accessed on 14.07

2011).

66
18. Klunklin S, Channoonmuang K. Snack consumption in normal and

undernourished preschool children in Northeastern Thailand. [online].

Available from: URL:http://www.pubmed. [email protected] (accessed

on 12.07.2011).

19. Alasfoor D, Elsayed MK. Protein-energy malnutrition among preschool

children in Oman: results of a national survey. [online]. Available from:

URl:http://www.east_meditrr_health_j.com[accessed on 02.07.2011]

20. Senbanjo IO, Adeodu OO. Low prevalence of malnutrition in a rural Nigerian

community.[online]http.www//yahoo.senbanjo001.com [accessed on

04.07.2011]

21. Biswas S, Bose K, Mukhopadhyay A, Bhadra M. Prevalence of under-

nutrition among pre-school children of Chapra, Nadia district. Nightingale

Nursing Times 2009 Sep;67(3):269-79.

22. Abidoye RO, Sikabofori. A study of prevalence of protein energy malnutrition

among 0-5 years in rural Benue State, Nigeria. [online]. Available from:

URL:http://www.pubmed. [email protected](accessed on 12.07.2011)

23. Yadav RJ, Singh P. Nutritional status and dietary intake in tribal children of

Bihar. Indian Paediatrics 1999 Jan;36(1):37-42.

24. Oguz A, Gokalp AS. Incidence of malnutrition in children aged 0-6 years in

Sivas, an eastern province of Turkey. Indian Paediatrics 1990 Mar;27(3):257-

62.

67
25. Wang X, Höjer B. Stunting and 'overweight' in the WHO Child Growth

Standards - malnutrition among children in a poor area of China. [online].

Available from: URL:http://www.pubmed.public_health_nutr.com (accessed

on 10.07.2011).

26. Gautam B, Deb K. Serum zinc and copper level in children with protein

energy malnutrition. [online]. Available from: URL:http://www.Mymensingh

MedJ.com (accessed on 10.07.2011)

27. Tripathi MS, Sharma V. Assessment of nutritional status of pre-schoolers in

slum areas of Udaipur City. Indian J Public Health 2006 Jan-Mar;50(1):33-4.

28. Delpeuch F, Cornu A. Effect of moderate protein-energy malnutrition in

preschool children on various biochemical parameters. Use of biochemical

indicators for early detection of malnutrition. Ann Nutr Aliment

1979;33(3):429-41.

29. Patel D, Gupta P. Home-based rehabilitation of severely malnourished

children in resource poor setting. Indian Journal of Paediatrics 2010 Aug

7;47(8):694-701.

30. Oshikoya KA, Sammons HM. A systematic review of pharmacokinetics

studies in children with protein-energy malnutrition. Eur J Clin Pharmacol

2010; Oct;66(10):1025-35.

31. Radhakrishna KV, Kulkarni B, Balakrishna N. Composition of weight gain

during nutrition rehabilitation of severely undernourished children in a

hospital. [online]. Available from: URL:http://www.pubmed. Asia Pac J Clin

Nutr.com (accessed on 07.07.2011)

68
32. Shrivastava SP, Roy AK, Jana UK. Zinc supplementation in protein energy

malnutrition. Indian Paediatric 1993 Jun; 30(6):779-82.

33. Birem-Etchebes S, Gonzalez JP. Use of local food resources in the

rehabilitation of children with malnutrition in the Central African Republic.

East Mediterr Health Journal 2000 Mar-May;6(2-3):238-45.

34. Malekafzali H, Abdollahi Z, Mafi A, Naghavi M. Community-based

nutritional intervention for reducing malnutrition among children under 5

years of age in the Islamic Republic of Iran. [online]. Available from:

URL:http:/www.pubmed.Asia Pac J Clin Nutr.com (accessed on 09.07.2011)

35. Lobo RS. A study to evaluate the effectiveness of a planned teaching

programme regarding toilet training to mothers of children between 1-3years

in selected day-care centres at Mangalore. Unpublished Master of Science in

Nursing Thesis, Rajiv Gandhi University of Health Sciences, Bangalore 2003.

36. Wilson N. A study to evaluate the effectiveness of a structured teaching

programme among mothers of asthmatic children on home management of

children with Asthma in a selected hospital at Udupi District. Unpublished

Master of Nursing Thesis, MAHE University, 2000.

37. Francis I. A study to evaluate the effectiveness of PTP on knowledge of school

teachers regarding risk factors of coronary heart disease. Unpublished

dissertation, University of Mangalore, 1996.

38. Joseph P. Effectiveness of PTP on the care of adolescent girls with regard to

menstruation for mothers in selected communities in Kerala. Unpublished

69
 master of science in Nursing Thesis, Rajiv Gandhi University of Health

Sciences, Bangalore; 2001.

39. Thomas AT. Effectiveness of a PTP on pain management in children, for staff

nurses working in a selected hospital of Karnataka. Unpublished Master of

Science in Nursing Thesis, Rajiv Gandhi University of Health Sciences,

Bangalore; 2001.

40. Polit DF, Hungler BP. Nursing research, principles and method. 3rd ed.

Philadelphia: J B Lippincott Company; 2000.

41. Kothari CR. Research methodology methods and techniques. 2nd ed. New

Delhi: New Age International Publishers; 2004.

70
 Annexure 1
Permission for pilot study

71
 Annexure 2
Permission for main study

72
 Annexure 3
Letter seeking consent form participants

Dear participant,

I, Ponnu Thomas, M. Sc. Nursing student of Athena College of Nursing. As

part of my curriculum, I am conducting a study titled “A study to assess the
effectiveness of planned teaching programme on knowledge regarding protein
energy malnutrition among mothers of under-five children in a selected rural
community in Mangalore.”

The purpose of my study is to educate the mothers of under-five children

regarding Protein energy malnutrition. Therefore I request you to respond to the
questions being asked. Your answers will be kept confidential and will be used only
for the purpose of the study.

Thanking you, Ponnu Thomas

I am willing to participate in the study

____________________________
Signature of the participant

73
 CzsÀåAiÀÄ£ÀzÀ°è ¨sÁUÀªÀ»¸À®Ä ¸ÀªÀÄäw

DwäÃAiÀÄgÉÃ,

£Á£ÀÄ, ¥ÉÇ£ÀÄß xÁªÀĸï, CxÉ£Á PÁ¯ÉÃeï D¥sï £À¹ðAUï

EzÀgÀ JA. J¹ì. £À¹ðAUï «zÁåyð¤AiÀiÁVzÀÄÝ “ªÀÄAUÀ¼ÀÆj£À

UÁæ«ÄÃt ¥ÀæzÉñÀªÉÇAzÀgÉ LzÀÄ ªÀµÀðzÉƼÀV£À

ªÀÄPÀ̽gÀĪÀ vÁAiÀÄA¢gÀ ªÉÄÃ¯É ¥ÉÇæÃnãï

PÉÆgÀvɬÄAzÀ GAmÁUÀĪÀ C¥Ë²×PÀvÉAiÀÄ §UÉÎ

w¼ÀĪÀ½PÉAiÀÄ ²PÀët PÁAiÀÄðPÀæªÀÄzÀ ¥ÀjuÁªÀÄPÁjvÀé”

JA§ CzsÀåAiÀÄ£ÀªÀ£ÀÄß £ÀqɸÀÄwÛzÉÝãÉ.

F ¥ÀæAiÀÄÄPÀÛ ¤ªÀÄUÉ ¥Àæ±ÁߪÀ½AiÉÆAzÀ£ÀÄß

¤ÃqÀ°zÀÄÝ ¤ÃªÀÅ CzÀ£ÀÄß GvÀÛj¸À¨ÉÃPÁV

«£ÀAw¸ÀÄvÉÛãÉ. ¤ÃªÀÅ ¤ÃrzÀ ªÀiÁ»wAiÀÄ£ÀÄß

UË¥ÀåªÁVlÄÖ CzsÀåAiÀÄ£ÀPÉÌ ªÀiÁvÀæ §¼À¸À¯ÁUÀĪÀÅzÀÄ.

zsÀ£ÀåªÁzÀUÀ¼ÀÄ,

¥ÉÇ£ÀÄß xÁªÀĸï

£Á£ÀÄ F CzsÀåAiÀÄ£ÀzÀ°è ¨sÁUÀªÀ»¸À®Ä ¸ÀªÀÄäw¸ÀÄvÉÛãÉ

_________________
CzsÀåAiÀÄ£ÀzÀ°è ¨sÁUÀªÀ»¸ÀĪÀªÀgÀ ¸À»

74
 Annexure 4
Letter requesting expert opinion to establish content validity

From
Miss. Ponnu Thomas
II Year MSc. Nursing
Athena College of Nursing
Falnir Road, Mangalore – 575 001
To
Respected Sir/Madam/Sister
Subject: Requesting your valuable opinion and suggestions for establishing
content validity.
I am doing my M. Sc. (Nursing) in Paediatric Nursing at Athena College of
Nursing. As a part of my partial fulfilment of the Masters programme, I have selected
the below mentioned topic for the dissertation to be submitted to Rajiv Gandhi
University of Health Sciences.
Topic: “A STUDY TO ASSESS THE EFFECTIVENESS OF PLANNED
TEACHING PROGRAMME ON KNOWLEDGE REGARDING
PROTEIN ENERGY MALNUTRITION AMONG MOTHERS OF
UNDER-FIVE CHILDREN IN A SELECTED RURAL
COMMUNITY IN MANGALORE.”
I hereby enclose the following:
1. Objectives
2. Operational definitions
3. Blueprint of knowledge questionnaire
4. Structured Knowledge questionnaire
5. Criteria checklist for validation.
I request you to go through the items and give your valuable suggestions and
opinions to develop the content validity of the tool. Kindly suggest any modifications,
additions and deletions, if any in the remark column.
Thanking you

Place: Mangalore Yours sincerely,

Date: Miss Ponnu Thomas

75
 Annexure 5
Acceptance form for tool validation

Name: -----------------------------------------

Designation: -----------------------------------------

Name of the institution -----------------------------------------

Statement of acceptance /non acceptance to validate the tool.

Topic: “A study to assess the effectiveness of planned teaching programme on

knowledge regarding protein energy malnutrition among mothers of under-five
children in a selected rural community in Mangalore.”

Signature of the expert

Place:

Date:
Designation and address

76
 Annexure 6
Content validation of planned teaching programme

I hereby certify that I have validated the tool of Ms. Ponnu Thomas, IInd year
M. Sc Nursing Student, Athena college of Nursing who is undertaking the following
study:

Topic: “A study to assess the effectiveness of planned teaching programme on

knowledge regarding protein energy malnutrition among mothers of under-five
children in a selected rural community in Mangalore.”

Signature of the expert

Place:

Date:
Designation and address

77
 Annexure 7
Blueprint for structured knowledge questionnaire

Question No.
Sl.
No. Content Knowledge Comprehension Application Total %

1. Definition and 1, 2, 3 3 12
sources

2. Incidence and 4 5, 6 3 12
aetiology

3. Diagnosis and 7, 8, 9 10 4 16
clinical
manifestation

4. prevention 11, 17 13, 15 12, 14, 16 7 28

5. Management 19, 21 24, 25 18, 20, 22, 8 32

complication 23

Total 8 9 8 25 100

78
 Annexure 8
Tool - English

Part I: Demographic proforma

Instructions to the interviewer: Read the following items carefully and put a (√)
mark against the options given by participants.

Sample code: ________

1. Age of the child in years

a. 0-1 [ ]
b. 1-2 [ ]
c. 2-3 [ ]
d. 3-5 [ ]

2. Age of mother in years

a. <20 [ ]
b. 20-30 [ ]
c. >30 [ ]

3. Educational status of mother

a. Illiterate [ ]
b. Primary [ ]
c. Secondary [ ]
d. Higher secondary [ ]
e. Graduate and above [ ]

4. Family income per month (Rs)

a. <2000 [ ]
b. 2001-5000 [ ]
c. 5001-10000 [ ]
d. >10001 [ ]

5. Number of children
a. One [ ]
b. Two [ ]
c. Three [ ]
d. More than three [ ]

6. Religion
a. Hindu [ ]
b. Muslim [ ]
c. Christian [ ]
d. Any other [ ]

79
7. Type of family
a. Joint family [ ]
b. Nuclear family [ ]
c. Extended family [ ]

8. Duration of breast feeding

I child II child III child IV child

Less than 6 month

6 month-1 year

More than 1 year

Part II: Structured interview schedule to assess the knowledge regarding protein
energy malnutrition among mothers of under-five children

Instruction to the interviewer: Investigator will read the following questions

carefully and place a (√) mark against the answer given by the respondent. Each
correct answer carry one score.

1. The meaning of protein energy malnutrition indicates

a. Inadequate protein and energy [ ]
b. Inadequate vitamin and mineral [ ]
c. Inadequate fats and carbohydrate [ ]

2. The richest animal sources of protein are

a. egg [ ]
b. milk [ ]
c. meat [ ]

3. The richest vegetable sources of protein are

a. soyabean [ ]
b. carrot [ ]
c. beetroot [ ]

4. PEM is more common in

a. Children below five years [ ]
b. children between the age of 5 to 10 years [ ]
c. children above 10 years [ ]

5. The disease that leads to PEM is

a. Conjuctivitis [ ]
b. Chronic diarrhoea [ ]
c. allergy [ ]

80
6. The primary cause of marasmus is
a. inadequate dietary intake [ ]
b. fever [ ]
c. allergy [ ]

7. Wasting of muscles is present in

a. kidney disease [ ]
b. skin disease [ ]
c. marasmus [ ]

8. Dry and scaly skin present in

a. anaemia [ ]
b. hypertension [ ]
c. kwashiorkor [ ]

9. The condition in which child becomes thin and abdomen distended is

a. measles [ ]
b. marasmus [ ]
c. chicken pox [ ]

10. Anemia is prevented by providing a diet rich in

a. Iron and folic acid [ ]
b. Sugar and salt [ ]
c. Nuts and fruit [ ]

11. PEM can be prevented by

a. including protein and vitamins in diet [ ]
b. including fat and carbohydrate in diet [ ]
c. including protein and calories in diet [ ]

12. Dehydration can be prevented by

a. giving frequent food [ ]
b. restricting food [ ]
c. giving frequent fluids [ ]

13. The infectious disease can be prevented by

a. intake of fruits [ ]
b. immunization [ ]
c. intake of fluids [ ]

14. The following condition can be prevented by maintaining good hygiene

a. diarrhea and worm infestation [ ]
b. measles and mumps [ ]
c. chicken pox and malaria [ ]

81
15. PEM can prevented by
a. providing tasty food [ ]
b. providing nutritious food [ ]
c. providing high cost food [ ]

16. Hygienic measures to prevent infection include

a. proper hand washing [ ]
b. applying oil on the body [ ]
c. over cooking of food [ ]

17. Loss of heat from the body can be prevented by

a. covering with blanket [ ]
b. warm water bath [ ]
c. switch off the fan [ ]

18. The best time for starting weaning

a. after 1 year [ ]
b. after 3 months [ ]
c. after 6 months [ ]

19. Weaning should be initiated with

a. solid diet [ ]
b. liquid diet [ ]
c. semisolid diet [ ]

20. Baby with protein-energy malnutrition should be initiated with :

a. sugar free diet [ ]
b. salt free diet [ ]
c. milk based diet [ ]

21. Nutritious laddoo contains

a. Bengal gram, whole wheat, ground nut, jaggery [ ]
b. maize, Bengal gram, whole wheat,sugar [ ]
c. wheat, green gram, rice flour, jaggery [ ]

22. The choice of doctor which you will go first when the baby is suffering from
severe protein-energy malnutrition
a. paediatrician [ ]
b. cardiologist [ ]
c. surgeon [ ]

23. Oral rehydration solution should be provided for

a. diarrhoea [ ]
b. fever [ ]
c. constipation [ ]

82
24. The complication of protein energy malnutrition is
a. constipation [ ]
b. severe dehydration [ ]
c. jaundice [ ]

25. Vitamin A deficiency causes

a. blindness [ ]
b. scurvy [ ]
c. beriberi [ ]

Key answer for knowledge questionnaire

Q. No. Answer Q. No. Answer

1. a 19. b
2. c 20. c
3. a 21. a
4. a 22. a
5. b 23. a
6. a 24. b
7. c 25. a
8. c
9. b
10. a
11. c
12. c
13. b
14. a
15. b
16. a
17. a
18. c

Grading of knowledge score

Grade Score Percentage

Poor 0-8 0-32

Average 9-16 33-67

Good 17-25 68-100

83
 Annexure 9
«¨sÁUÀ 1: ªÉÊ0iÀÄQÛPÀ ªÀiÁ»w
¸ÀÆZÀ£É: ¤ªÀÄUÉ C£Àé¬Ä¸ÀĪÀ GvÀÛgÀzÀ ªÀÄÄAzÉ
UÀÄgÀÄvÀÄ ºÁQ GvÀÛj¹.
PÀæªÀÄ ¸ÀASÉå: ___
1. ªÀÄUÀÄ«£À ªÀAiÀĸÀÄì (ªÀµÀðUÀ¼À°è)
a. 0-1 [ ]
b. 1-2 [ ]
c. 2-3 [ ]
d. 3-5 [ ]

2. vÁ¬ÄAiÀÄ ªÀAiÀĸÀÄì (ªÀµÀðUÀ¼À°è)

a. 20 QÌAvÀ PÀrªÉÄ [ ]
b. 20-30 [ ]
c. 30 QÌAvÀ ºÉZÀÄÑ [ ]

3. vÁ¬ÄAiÀÄ «zÁå¨sÁå¸À
a. C«zÁåªÀAvÉ [ ]
b. ¥ÁæxÀ«ÄPÀ ±Á¯Á ²PÀët [ ]
c. »jAiÀÄ ¥ÁæxÀ«ÄPÀ ±Á¯Á ²PÀët [ ]
d. ¥ËæqsÀ ±Á¯Á ²PÀët [ ]
e. ¥ÀzÀ« CxÀªÁ CzÀQÌAvÀ ªÉÄîàlÖ ²PÀët [ ]

4. PÀÄlÄA§zÀ ªÀiÁ¹PÀ DzÁAiÀÄ (gÀÆ¥Á¬ÄUÀ¼À°è)

a. 2,000 QÌAvÀ PÀrªÉÄ [ ]
b. 2,001-5,000 [ ]
c. 5,001-10,000 [ ]
d. 10,000 QÌAvÀ ºÉZÀÄÑ [ ]

5. ªÀÄPÀ̼À ¸ÀASÉå
a. MAzÀÄ [ ]
b. JgÀqÀÄ [ ]
c. ªÀÄÆgÀÄ [ ]
d. ªÀÄÆgÀQÌAvÀ ºÉZÀÄÑ [ ]

6. zsÀªÀÄð
a. »AzÀÄ [ ]
b. ªÀÄĹèA [ ]
c. PÉæöʸÀÛ [ ]
d. EvÀgÀ [ ]

7. PÀÄlÄA§zÀ «zsÀ
a. C«¨sÀPÀÛ PÀÄlÄA§ [ ]

84
 b. «¨sÀPÀÛ PÀÄlÄA§ [ ]
c. ¸ÀAAiÀÄÄPÀÛ PÀÄlÄA§ [ ]

ªÉÆzÀ JgÀqÀ£ ªÀÄÆg £Á®Ì£É

® Éà À£Éà Ã
ªÀÄUÀ ªÀÄUÀ ªÀÄUÀ ªÀÄUÀ
8. JzɺÁ®Är¹zÀ CªÀ¢ü Ä Ä Ä Ä
a. 6
wAUÀ½VAvÀ
ºÉZÀÄÑ
b. 6 wAUÀ½AzÀ
1 ªÀµÀð
c. 1 ªÀµÀðQÌAvÀ
ºÉZÀÄÑ

85
 «¨sÁUÀ 2: ¥Àæ±ÁߪÀ½
¸ÀÆZÀ£É: CzsÀåAiÀÄ£ÀPÁgÀgÀÄ ¥Àæ±ÉßUÀ¼À£ÀÄß N¢ ºÉý
¨sÁUÀªÀ»¸ÀĪÀªÀgÀÄ ¤ÃrzÀ GvÀÛgÀzÀ ªÀÄÄAzÉ
UÀÄgÀÄvÀÄ ºÁPÀĪÀgÀÄ.
1. ¥ÉÇæÃn£ï£À C¥Ë¶ÖPÀvÉ JAzÀgÉ
a. ¥ÉÇæÃn£ï ªÀÄvÀÄÛ ±ÀQÛ ¸ÁPÀµÀÄÖ
zÉÆgÉAiÀÄ¢gÀĪÀÅzÀÄ [ ]
b. «l«Ä£ï ªÀÄvÀÄÛ R¤eÁA±ÀUÀ¼ÀÄ ¸ÁPÀµÀÄÖ
zÉÆgÉAiÀÄ¢gÀĪÀÅzÀÄ [ ]
c. PÉƧÄâ ªÀÄvÀÄÛ ±ÀPÀðgÀ¦µÀ× ¸ÁPÀµÀÄÖ
zÉÆgÉAiÀÄ¢gÀĪÀÅzÀÄ [ ]

2. ¥ÉÇæÃnãï C¢üPÀ ¥ÀæªÀiÁtzÀ°ègÀĪÀ ¥ÁætÂd£Àå DºÁgÀ

a. ªÉÆmÉÖ [ ]
b. ºÁ®Ä [ ]
c. ªÀiÁA¸À [ ]

3. ¥ÉÇæÃnãï C¢üPÀ ¥ÀæªÀiÁtzÀ°ègÀĪÀ ¸À¸Àåd£Àå DºÁgÀ

a. ¸ÉÆÃAiÀiÁ©Ã£ï [ ]
b. PÁågÉmï [ ]
c. ©ÃmïgÀÆmï [ ]

4. ¥ÉÇæÃnãï£À C¥Ë¶ÖPÀvÉ PÀAqÀħgÀĪÀ ªÀAiÀĸÀÄì

a. 5 ªÀµÀðzÉƼÀUÉ [ ]
b. 5-10 ªÀµÀð [ ]
c. 10 ªÀµÀðzÀ §½PÀ [ ]

5. ¥ÉÇæÃnãï£À C¥Ë¶ÖPÀvÉUÉ PÁgÀtªÁUÀĪÀ PÁ¬Ä¯É

a. PÀAdAQÖªÉÊn¸ï [ ]
b. ¥ÀzÉà ¥ÀzÉà ¨ÉâüAiÀiÁUÀĪÀÅzÀÄ [ ]
c. C®fð [ ]

6. ªÀÄgÁ¸Àä¸ï PÁ¬Ä¯ÉUÉ ¥ÀæªÀÄÄR PÁgÀt

a. ¥Ë¶ÖPÀ DºÁgÀzÀ PÉÆgÀvÉ [ ]
b. dégÀ [ ]
c. C®fð [ ]

7. ªÀiÁA¸ÀRAqÀUÀ¼ÀÄ QëÃt¸ÀĪÀ PÁ¬Ä¯É

a. ªÀÄÆvÀæ¦AqÀzÀ PÁ¬Ä¯É [ ]
b. ZÀªÀÄð gÉÆÃUÀ [ ]
c. ªÀÄgÁ¸Àä¸ï [ ]

86
8. ZÀªÀÄð MtV zÉÆgÀUÁUÀĪÀ PÁ¬Ä¯É
a. gÀPÀۻãÀvÉ [ ]
b. C¢üPÀ gÀPÀÛzÉÆvÀÛqÀ [ ]
c. PÁé²AiÉÆÃgïPÀgï [ ]

9. ªÀÄUÀĪÀÅ QëÃtªÁV ºÉÆmÉÖ G§ÄâªÀ PÁ¬Ä¯É

a. zÀqÁgÀ [ ]
b. ªÀÄgÁ¸Àä¸ï [ ]
c. ¹qÀÄ§Ä [ ]

10. ¥ÉÇæÃnãï£À C¥Ë¶ÖPÀvÉAiÀÄ£ÀÄß ¥ÀvÉÛ ºÀZÀÄѪÀ

¸ÀÄ®¨sÀzÀ «zsÁ£À
a. vÀÆPÀ £ÉÆÃqÀĪÀÅzÀÄ [ ]
b. JzÉAiÀÄ ¸ÀÄvÀÛ¼ÀvÉ £ÉÆÃqÀĪÀÅzÀÄ [ ]
c. vÀ¯ÉAiÀÄ ¸ÀÄvÀÛ¼ÀvÉ £ÉÆÃqÀĪÀÅzÀÄ [ ]

11. gÀPÀۻãÀvÉ GAmÁUÀ¢gÀ®Ä DºÁgÀzÀ°è

AiÀÄxÉÃZÀÒªÁV EgÀ¨ÉÃPÁzÀ CA±À
a. PÀ©ât ªÀÄvÀÄÛ ¥sÉÇðPï DªÀÄè [ ]
b. ¸ÀPÀÌgÉ ªÀÄvÀÄÛ G¥ÀÅöà [ ]
c. ©ÃdUÀ¼ÀÄ ªÀÄvÀÄÛ ºÀtÄÚ ºÀA¥À®ÄUÀ¼ÀÄ [ ]

12. ¤dð°ÃPÀgÀtªÀ£ÀÄß vÀqÉUÀlÄÖªÀ «zsÁ£À

a. DUÁUÀ DºÁgÀ ¤ÃqÀÄwÛgÀĪÀÅzÀÄ [ ]
b. DºÁgÀ ¤ÃqÀĪÀÅzÀ£ÀÄß PÀrªÉÄ ªÀiÁqÀĪÀÅzÀÄ [
]
c. DUÁUÀ zÀæªÁºÁgÀ ¤ÃqÀĪÀÅzÀÄ [ ]

13. ¸ÁAPÁæ«ÄPÀ gÉÆÃUÀUÀ¼À£ÀÄß vÀqÉUÀlÄÖªÀ «zsÁ£À

a. ºÀtÄÚ ºÀA¥À®ÄUÀ¼À ¸ÉêÀ£É [ ]
b. gÉÆÃUÀ¤gÉÆÃzsÀPÀ ®¹PÉ ¤ÃqÀĪÀÅzÀÄ [ ]
c. zÀæªÁºÁgÀ ¸ÉêÀ£É [ ]

14. £ÉʪÀÄð®å PÁ¥ÁqÀĪÀÅzÀjAzÀ F PɼÀV£À

PÁ¬Ä¯ÉAiÀÄ£ÀÄß vÀqÉUÀlÖ§ºÀÄzÀÄ
a. ¨Éâü ªÀÄvÀÄÛ ºÀļÀzÀ ¨ÁzsÉ [ ]
b. zÀqÁgÀ ªÀÄvÀÄÛ PÉ¥ÀàmÉ [ ]
c. ¹qÀÄ§Ä ªÀÄvÀÄÛ ªÀįÉÃjAiÀiÁ [ ]

15. ¥ÉÇæÃn¤£À C¥Ë¶ÖPÀvÉAiÀÄ£ÀÄß vÀqÉUÀlÄÖªÀ «zsÁ£À

a. gÀÄaPÀgÀ DºÁgÀ ¤ÃqÀĪÀÅzÀgÀ ªÀÄÆ®PÀ [ ]
b. ¥Ë¶ÖPÀ DºÁgÀ ¤ÃqÀĪÀÅzÀgÀ ªÀÄÆ®PÀ [ ]
c. zÀĨÁj DºÁgÀ ¤ÃqÀĪÀÅzÀgÀ ªÀÄÆ®PÀ [ ]

87
16. ¸ÁAPÁæ«ÄPÀ gÉÆÃUÀUÀ¼À£ÀÄß vÀqÉUÀlÄÖªÀ
£ÉʪÀÄð®å «zsÁ£À
a. PÉÊUÀ¼À£ÀÄß ¸ÀjAiÀiÁV vÉƼÉAiÀÄĪÀÅzÀÄ [
]
b. ªÉÄÊUÉ JuÉÚ wPÀÄ̪ÀÅzÀÄ [ ]
c. DºÁgÀªÀ£ÀÄß ºÉZÀÄÑ ¨ÉìĸÀĪÀÅzÀÄ [ ]

17. zÉúÀzÀ GµÀÚvÉ £ÀµÀÖªÁUÀĪÀÅzÀ£ÀÄß vÀqÉAiÀÄĪÀ

«zsÁ£À
a. PÀA§½ ºÉÆzÀÄÝPÉƼÀÄîªÀÅzÀÄ [ ]
b. ©¹ ¤Ãj£À°è ¸ÁߣÀ ªÀiÁqÀĪÀÅzÀÄ [ ]
c. ¥sÁå£ï Dj¸ÀĪÀÅzÀÄ [ ]

18. ¥ÀÇgÀPÀ DºÁgÀ ¤ÃqÀĪÀÅzÀ£ÀÄß DgÀA©ü¸À®Ä

¥Àæ±À¸ÀÛ ¸ÀªÀÄAiÀÄ
a. 1 ªÀµÀðzÀ §½PÀ [ ]
b. 3 wAUÀ¼À §½PÀ [ ]
c. 6 wAUÀ¼À §½PÀ [ ]

19. ¥ÀÇgÀPÀ DºÁgÀªÁV ¤ÃqÀ®Ä DgÀA©ü¸À¨ÉÃPÁzÀ DºÁgÀ

a. WÀ£À DºÁgÀ [ ]
b. zÀæªÀ DºÁgÀ [ ]
c. CgÉ WÀ£À DºÁgÀ [ ]

20. ¥ÉÇæÃn£ï£À C¥Ë¶ÖPÀvɬÄAzÀ £ÀgÀ¼ÀĪÀ ªÀÄUÀÄ«UÉ

¤ÃqÀ¨ÉÃPÁzÀ DºÁgÀ
a. ¹»AiÀiÁVgÀzÀ DºÁgÀ [ ]
b. G¥ÀÅöà ºÁPÀzÀ DºÁgÀ [ ]
c. ºÁ°¤AzÀ vÀAiÀiÁj¹zÀ DºÁgÀ [ ]

21. ¥Ë¶ÖPÀ ¯ÁqÀÄ«£À°ègÀĪÀ ªÀ¸ÀÄÛUÀ¼ÀÄ

a. PÀqÀ¯É, UÉÆâü, £É®UÀqÀ¯É, ¨É®è [ ]
b. eÉÆüÀ, PÀqÀ¯É, UÉÆâü, ¸ÀPÀÌgÉ [ ]
c. UÉÆâü, ºÉ¸ÀgÀÄ, CQÌ »lÄÖ, ¨É®è [ ]

22. wêÀæ ¥ÀæªÀiÁtzÀ ¥ÉÇæÃn£ï C¥Ë¶ÖPÀvɬÄAzÀ

£ÀgÀ¼ÀĪÀ ªÀÄUÀĪÀ£ÀÄß vÉÆÃj¸À¨ÉÃPÁzÀ ªÉÊzÀågÀÄ
a. ªÀÄPÀ̼À vÀdÕgÀÄ [ ]
b. ºÀÈzÀAiÀÄ vÀdÕgÀÄ [ ]
c. ±À¸ÀÛç aQvÁì vÀdÕgÀÄ [ ]

23. M. Dgï. J¸ï. ¤ÃqÀ¨ÉÃPÁzÀ ¸ÀAzÀ¨sÀð

a. ¨ÉâüAiÀiÁzÁUÀ [ ]
b. dégÀ §AzÁUÀ [ ]
c. ªÀÄ®§zÀÞvÉ GAmÁzÁUÀ [ ]

88
24. ¥ÉÇæÃnãï£À C¥Ë¶ÖPÀvɬÄAzÀ GAmÁUÀĪÀ ¸ÀªÀĸÉå
a. ªÀÄ®§zÀÞvÉ [ ]
b. wêÀæ ¤dð°ÃPÀgÀt [ ]
c. PÁªÀiÁ¯É [ ]

25. «l«Ä£ï JAiÀÄ PÉÆgÀvɬÄAzÀ GAmÁUÀĪÀ PÁ¬Ä¯É

a. PÀÄgÀÄqÀÄvÀ£À [ ]
b. ¸ÀÌ«ð [ ]
c. ¨Éj¨Éj [ ]

89
 Annexure 10
Criteria checklist for validation of the tool

Instructions: Kindly go through the items in the structured interview schedule and
give your valuable suggestions regarding accuracy, relevancy and appropriateness of
the content. If there are any suggestions or comments, please mention in the remarks
column.

Q. No. Agree Disagree Remarks

Section I: Demographic proforma

Section II (A): Structured knowledge questionnaire.

10

11

90
Q. No. Agree Disagree Remarks

12

13

14

15

16

17

18

19

20

21

22

23

24

25

Any other suggestions:

91
 Annexure 11
Criteria checklist for validation of the PTP

Sl. No. Content Agree Disagree Remarks

1. Introduction

2. Definition

3. Sources

4. Incidence

5. Etiology

6. Diagnosis

7. Clinical manifestation

8. Prevention

9. Management

10. Complication

Any other suggestions:

92
 Annexure -12

PTP-ENGLISH

A LESSON PLAN ON PROTEIN ENERGY

MALNUTRITION

Presented by: Ms Ponnu Thomas

2nd year MSC(N)

ACON

93
Name of the teacher: Ms Ponnu Thomas

Subject: Protein energy malnutrition

Method of teaching: lecture cum discussion

AV aids: Chart, flash cards

Previous knowledge of mothers: Mothers have some general knowledge regarding protein energy malnutrition

Time: 45 minutes

Group: Mothers of under-five children

Venue: Community

94
General objective

By the end of the class mother will gain knowledge about protein energy malnutrition, and acquire a skill in giving care to these children
and develop a positive attitude towards children with protein energy malnutrition.

Specific objective

By the end of the class, mothers will be able to

♠ define protein energy malnutrition

♠ define protein
♠ define energy
♠ discuss the function of proteins
♠ list down the sources of protein
♠ explain the incidence of protein energy malnutrition
♠ explain the causes of protein energy malnutrition
♠ enlist the types of protein energy malnutrition
♠ describe the clinical manifestations of protein energy malnutrition
♠ list down the diagnosis of protein energy malnutrition
♠ explain the preventive measures of protein energy malnutrition
♠ describe the management of protein energy malnutrition
♠ discuss the complications of protein energy malnutrition

95
 Teaching
Specific learning
objective time Content activity AV aids Evaluation

Introducing 1 min Introduction

the topic
Good nutrition is essential for the comprehensive development of
child. Malnutrition is a major paediatric problem and it is responsible
for high rates of morbidity and mortality. Malnutrition is a great
challenge for under developing countries.

Define protein 2 min Definition Teacher Chart on What is the

energy Protein energy malnutrition refers to group of a condition such as explains the definition of definition of
malnutrition marasmus, kwashiorkor that may develop in varying degree due to mothers protein protein energy
listens energy malnutrition
inadequate intake of food containing protein and carbohydrate.
malnutrition,
protein,
energy.

Define protein 1 min Protein

The term, protein refers to nitrogenous compounds composed of
one or more chains of amino-acids and forming an essential part of
living organism.

Define energy 1 min Energy

It refers to energy for doing work.

96
 Teaching
Specific learning
objective time Content activity AV aids Evaluation
Discuss the 1 min Functions of protein Teacher Chart shows List down any
functions of 1. For growth and development. explain the the functions 2 functions of
protein 2. For repair and maintenance of the body tissues. mothers of protein protein
listens
3. For synthesis of antibodies and hormones.
List down the 2 min Sources of protein Teacher Charts on List any four
sources of • Animal sources: Milk, meat, egg, chicken, liver. explains the sources of sources of
protein mother protein protein
• Plant sources: Pulses, soyabean contains 40% of protein, nuts, listens content
greengram dhal, red gram dhal
foods.
Explain the 1 min Incidence of protein energy malnutrition teacher Charts shows what is the
incidence of Studies in India have reported the incidence of malnutrition to be explains the pictures incidence of
protein- as much as 30-40% in children under five years of age, and 7.6% of and the of protein protein energy
energy these children have severe malnutrition and has marasmus and mother energy malnutrition
malnutrition kwashiorkor. Thus, the majority of these children have mild to listens malnutrition
moderate PEM.
Explain the 5 min Aetiology Teacher Charts shows What are the
causes of explains the causes of causes of
• Infectious diseases: This is important factor responsible for
protein energy about the protein protein energy
malnutrition .certain infectious disease like diarrhoea, measles, causes of
malnutrition intestinal parasites contributes to malnutrition. During infections energy malnutrition
protein malnutrition
child’s appetite will be impaired. Metabolic demands for protein energy
during infection are higher. malnutrition
mothers
listen

97
 Teaching
Specific learning
objective time Content activity AV aids Evaluation

• Socio-economic factor: Poor socio –economic status of the family

contributes the malnutrition in developing countries. Malnutrition
is the bye product of poverty, ignorance, insufficient education ,
lack of knowledge regarding the nutritive value of foods
inadequate sanitary environment , large family size etc.
• Faulty food habits and feedings: During weaning period enteric
infection are most common in weaning period providing diluted
and dirty formula contributing to malnutrition. During first few
months of life inadequate breast milk contributes to malnutrition
during the first year of life. Lack of exclusive breast feeding for
first 6 months make the child prone to early onset of malnutrition.
In most rural households, introduction of solid or musky food is
delayed, often beyond one year. Unhygienic feeding practices in
the preparation of millk formula result in frequent episodes of
diarrhea and diminished absorption of food by the infant.
• Working mother: Higher proportions of the mothers of
malnourished children are daily labourers who find little time to
take care of childs feeding and rearing. More often mothering is
done by an elder siblings.
• Inequitable distribution of food in the family: Less food is
available in poor households. But even the little availability of food
is distributed unequally among different members of the family.

98
 Teaching
Specific learning
objective time Content activity AV aids Evaluation

• Low birth weight: Malnourished mothers have a high incidence

low birth weight and growth retarded babies with poor nutritional
reserve .
• Family size: Large family size and higher birth order results in
higher incidence of malnutrition.
• Congenital disorders: Certain congenital disorders like cleft lip,
hydrocephalus, renal disorders contributes to malnutrition.
• Cultural influences: The family as well as relegion plays an
important role in shaping the food habits .parents often with hold
food supplements or dilute the milk during episodes of diarrhea.

Explain the 2 min Types Teacher charts shows what is

types of Marasmus: In this condition there is loss of weight of more than 50 defines the pictures kwashiorkor
protein energy percent of the expected weight for given age, with severe wasting of marasmus of protein and marsmus
malnutrition muscles and loss of subcutaneous fat of body. and energy
kwashiorkor malnutrition
Kwashiorkor: Kwashiorkor or severe protein energy malnutrition mothers
refers to a combination of oedema, lethargy, and growth failure. it listen
occurs due to deficiency of proteins and calories.

99
 Teaching
Specific learning
objective time Content activity AV aids Evaluation

Describe the 2 min Clinical manifestation of PEM Teacher charts shows What are the
clinical explains the pictures clinical
Clinical manifestation of marasmus
manifestations mother of clinical manifestations
• Complete loss of subcutaneous fat from buttocks, abdomen and listens manifestation of PEM
medial aspect of thighs arms and even the face
• Gross wasting of muscle and subcutaneous tisssue
• The face has a prematurely aged look
• The cheeks and temples are hollow, due to complete loss of fat
• Loss of elasticity
• Child may be irritable
• Constipation in the early period often followed by recurrent
diarrhoea
• Child may be apathetic
• Irritable
• Abdomen is distended

100
 Teaching
Specific learning
objective time Content activity AV aids Evaluation

Clinical manifestations of kwashiorkor

• retardation of growth and hair changes
• diarrhoea
• pitting oedema
• muscle wasting with retention of subcutaneous fat
• dry and scaly skin
• hair is scanty commonly brownish or less black than usual in
Indians
• This children are under growth failure inspite of oedema
• Permanent physical and mental retardation and have intellectual
impairment
• flaky point dermatosis
• anemia is present
• deficiency of vitamin A is required

101
 Teaching
Specific learning
objective time Content activity AV aids Evaluation

List down the 1 min Diagnosis of protein energy malnutrition Teacher What are the
diagnosis of explains diagnostic
☺ Dietary history: Dietary history including history of breast feeding
PEM , weaning, food habits, presence of illness etc. mothers measures of
listen protein energy
☺ Clinical features: early diagnosis and management of infections, malnutrition
worm infestations and common childhood illnesses(ARI, diarrhea)
☺ Anthropometry
Weight is the simplest and most widely used and the reliable index.
Midarm circumference: midarm circumference,between the ages of 1-
5 years should a mid arm circumference of less than 12.5 cm are
considered be more than 13.5 cm. Those with malnourished. Children
with mid arm circumference between 12.5 and 13.5 cm are termed
border line.
☺ Blood investigation: total blood count, serum protein
☺ Urine investigation: urinary hydroxyprotein, creatnine ratio
• Radiology may reveal some retardation of bone

102
 Teaching
Specific learning
objective time Content activity AV aids Evaluation

Explain the 10 min Prevention Teacher Flash cards list any

preventive explain on preventive preventive
PEM can be prevented and controlled by comprehensive approach
measures of involving about measures aspect of
protein energy preventive PEM
malnutrition • promotion of exclusive breast feeding till 6 months to prepare from measures of
base of child health and promotes nutritional status. protein
• Weaning energy
malnutrition
4 to 6 Weaning to be initiated with fruit juice.within one or
months two week new food to be introduced with suji, mashed
banana, boiled potato etc.

6 to 9 Soft mixture of rice and dal, pulses, mashed and boiled

months potato, mashed fruits like banana, mango, papaya,
etc.egg yolk can be given from 6 to 7 month
onwards.curd and khir can be introduced from 7 to 8
month onwards. By the age of 6 to 9 months the infant
can enjoy peices of cucumber, and carrot. breast
feeding should be continued.

9 to 12 Fish, meat, chicken can be introduced during this

months period. The infant can eat everything cooked at home
but spices and condiments should be avoided. Feeds
need not to be mashed but should be Soft, and well
cooked foods. Breast feeding to be continued.

103
 Teaching
Specific learning
objective time Content activity AV aids Evaluation

12 to 18 Child can take all food cooked in the family and need
months half amount of mothers diet. Breast feeding to be
continued

18 month Child can take all food cooked in family.

onwards

Preparation of bajra food

Bajra(sajje)=50 gm
Green gram dal(hesaru bele)=3 teaspoons
Skim milk powder=2 teaspoons
Groundnuts=2 teaspoons
Til seeds=2 teaspoon
Sugar or salt to taste
Method
Mix all the powders together with skim milk powder with boiling
water or milk or desired thickness. Add salt or sugar.
• family planning: adequate timing should be allowed between two
pregnancies.

104
 Teaching
Specific learning
objective time Content activity AV aids Evaluation

• immunization : vaccine preventable diseases can be prevented by

immunization.
• oral rehydration solution: early detection and treatment of
diarrhoea and other infectious diseases
• deworming of children with antehelmenthic drugs.

Describe the 5 min Management Teacher charts on What are the

management explains management home care
• Continue breast feeding for at least 2 years.
of PEM and mother of PEM management
• Provide small and frequent diet to prevent distension of the listens measures of
stomach PEM
• Keep the baby warm to prevent heat loss
• Keep the child away from any kind of infections( diarrhea, acute
respiratory tract infection, malaria)
• Continue immunization upto age.
• Gentle care of skin is required to prevent breaks and infection.
• Vitamin A deficiency can be prevented by administration of
vitamin A 1,00,000 IU along with measles vaccination at 9 months
of age followed by four more doses of 2 lakhs units every 6 month
interval(18,24, 30 and 36 months) upto 3 years of age.

105
 Teaching
Specific learning
objective time Content activity AV aids Evaluation

Dietary management
Milk based diet cannot be tolerated by some malnourished infants
in the first few days due to transient lactose intolerance .if tolerated
, milk based diet are most suitable at the beginning of the
treatment.
Sugar and oil should be added to provide extra calories.
Include green leafy vegetables, soups, banana, groundnut, butter,
pulses, fish, cereals, meat, milk etc.
The child should be fed frequently. Donot restrict the feed in fevers
and diarrhea.
Discuss the 2 min Complication Teacher Charts on What are the
complications • Hypoglycaemia explains complications complications
of PEM mother protein of protein
• Hypothermia listens energy energy
• Septicaemia malnutrition malnutrition
• Dehydration and electrolyte imbalance
• Congestive cardiac failure
• Severe anaemia
• Convulsion
• Vitamin and mineral deficiency

106
 Teaching
Specific learning
objective time Content activity AV aids Evaluation

Conclusion
Protein energy malnutrition has been identified as a major public
health and nutrition problem in India. It is no wonder that the growing
incidence of hunger and malnutrition should have come to the
forefront of international concern.

Bibliography
1. Datta Parul. Paediatric nursing. Jaypee publishers. Second edition:
Newdelhi; 2009.
2. Manivanan c. Text book of nursing. Emmess medical publishers.
second edition: Bangalore; 2010.
3. Gulani K.K. community health nursing. kumar publishers. First
edition: Newdelhi; 2008.
4. Kamalam. Community health nursing practice. Jaypee Publishers.
First edition: Newdelhi; 2005.
5. Parthasarthy A, Menon PSN, gupta pyush, nair MKC. IAP text
book of paediatrics. jaypee publishers: fourth edition;2010.
6. Darshan Sohi. A text book of nutrition. P.k jain. Second
edition:jalandhar; 2009.
7. Elizabeth. K E. Nutrition and child development. Third
edition:Hyderabad;2004.

107
 Annexure 13
PTP-Kannada
²PÀëQAiÀÄ ºÉ¸ÀgÀÄ: ¥ÉÇ£ÀÄß xÁªÀĸï
«µÀAiÀÄ: ¥ÉÇæÃn£ï£À PÉÆgÀvɬÄAzÀ GAmÁUÀĪÀ C¥Ë¶ÖPÀvÉ
PÀ°¸ÀĪÀ «zsÁ£À: ¥ÀæªÀZÀ£À ªÀÄvÀÄÛ ZÀZÉð
zÀȱÀå ±ÁæªÀå ¸ÁzsÀ£ÀUÀ¼ÀÄ: ZÁmïð, ¥sÁè÷åµï PÁqïð
vÁAiÀÄA¢jUÉ EgÀĪÀ w¼ÀĪÀ½PÉ: ¥ÉÇæÃn£ï£À PÉÆgÀvɬÄAzÀ GAmÁUÀĪÀ C¥Ë¶ÖPÀvÉAiÀÄ §UÉÎ
vÁAiÀÄA¢jUÉ ¸Àé®à w¼ÀĪÀ½PÉ EgÀÄvÀÛzÉ
CªÀ¢ü: 45 ¤«ÄµÀUÀ¼ÀÄ
¥ÀAUÀqÀ: LzÀÄ ªÀµÀðzÉƼÀV£À ªÀÄPÀ̼À vÁAiÀÄA¢gÀÄ
CzsÀåAiÀÄ£À £ÀqɸÀĪÀ ¸ÀܼÀ: ¸ÀªÀÄÄzÁAiÀÄ

108
ªÀÄÆ® GzÉÝñÀ
F PÁAiÀÄðPÀæªÀÄzÀ §½PÀ vÁAiÀÄA¢jUÉ ¥ÉÇæÃn£ï£À PÉÆgÀvɬÄAzÀ GAmÁUÀĪÀ
C¥Ë¶ÖPÀvÉAiÀÄ §UÉÎ w¼ÀĪÀ½PÉ zÉÆgÉvÀÄ vÀªÀÄä ªÀÄPÀ̼À DgÉÊPÉAiÀÄ°è CzÀ£ÀÄß
§¼À¹PÉƼÀÄîªÀgÀÄ.
¤¢ðµÀÖ GzÉÝñÀUÀ¼ÀÄ
F ²PÀët PÁAiÀÄðPÀæªÀÄzÀ §½PÀ vÁAiÀÄA¢gÀÄ:
• ¥ÉÇæÃn£ï£À PÉÆgÀvɬÄAzÀ GAmÁUÀĪÀ C¥Ë¶ÖPÀvÉAiÀÄ£ÀÄß ¤gÀƦ¸ÀĪÀgÀÄ.
• ¥ÉÇæÃnãï£À ¤gÀÆ¥ÀuÉ ¤ÃqÀĪÀgÀÄ.
• ±ÀQÛAiÀÄ ¤gÀÆ¥ÀuÉAiÀÄ£ÀÄß ¤ÃqÀĪÀgÀÄ.
• ¥ÉÇæÃnãï£À PÁAiÀÄðUÀ¼À£ÀÄß «ªÀj¸ÀĪÀgÀÄ.
• ¥ÉÇæÃnãï£À ªÀÄÆ®UÀ¼À£ÀÄß ¥ÀnÖ ªÀiÁqÀĪÀgÀÄ.
• ¥ÉÇæÃnãï£À PÉÆgÀvɬÄAzÀ GAmÁUÀĪÀ C¥Ë¶ÖPÀvÉ PÀAqÀħgÀĪÀ ¥ÀæªÀiÁtªÀ£ÀÄß
«ªÀj¸ÀĪÀgÀÄ.
• ¥ÉÇæÃn£ï£À PÉÆgÀvɬÄAzÀ GAmÁUÀĪÀ C¥Ë¶ÖPÀvÉUÉ PÁgÀtUÀ¼À£ÀÄß «ªÀj¸ÀĪÀgÀÄ.
• ¥ÉÇæÃn£ï£À PÉÆgÀvɬÄAzÀ GAmÁUÀĪÀ C¥Ë¶ÖPÀvÉAiÀÄ «zsÀUÀ¼À£ÀÄß ¥ÀnÖªÀiÁqÀĪÀgÀÄ.
• ¥ÉÇæÃn£ï£À PÉÆgÀvɬÄAzÀ GAmÁUÀĪÀ C¥Ë¶ÖPÀvÉAiÀÄ ®PÀëtUÀ¼À£ÀÄß «ªÀj¸ÀĪÀgÀÄ.
• ¥ÉÇæÃn£ï£À PÉÆgÀvɬÄAzÀ GAmÁUÀĪÀ C¥Ë¶ÖPÀvÉAiÀÄ£ÀÄß ¥ÀvÉÛ ºÀZÀÄѪÀ
«zsÁ£ÀUÀ¼À£ÀÄß «ªÀj¸ÀĪÀgÀÄ.
• ¥ÉÇæÃn£ï£À PÉÆgÀvɬÄAzÀ GAmÁUÀĪÀ C¥Ë¶ÖPÀvÉAiÀÄ£ÀÄß vÀqÉUÀlÄÖªÀ «zsÁ£ÀUÀ¼À£ÀÄß
«ªÀj¸ÀĪÀgÀÄ.
• ¥ÉÇæÃn£ï£À PÉÆgÀvɬÄAzÀ GAmÁUÀĪÀ C¥Ë¶ÖPÀvÉAiÀÄ ¤¨sÁªÀuÉAiÀÄ£ÀÄß «ªÀj¸ÀĪÀgÀÄ.
• ¥ÉÇæÃn£ï£À PÉÆgÀvɬÄAzÀ GAmÁUÀĪÀ C¥Ë¶ÖPÀvɬÄAzÀ GzÀ㫸ÀĪÀ ¸ÀªÀĸÉåUÀ¼À£ÀÄß
«ªÀj¸ÀĪÀgÀÄ.

109
 zÀȱÀå
PÀ°¸ÀĪÀ- ±ÁæªÀå
¤¢ðµÀÖ ¸ÀªÀÄ PÀ°AiÀÄĪ ¸ÁzsÀ£À ªÀiË®åªÀi
GzÉÝñÀ AiÀÄ «µÀAiÀÄ À «zsÁ£À UÀ¼ÀÄ Á¥À£À
«µÀAiÀÄz 1 ¤. ¥Àæ¸ÁÛªÀ£É
À ªÀÄUÀÄ«£À ¨É¼ÀªÀuÉUÉUÉ ¥Ë¶ÖPÀ DºÁgÀ
¥Àæ¸ÁÛªÀ£ CUÀvÀå. C¥Ë¶ÖPÀvÉAiÀÄÄ ªÀÄPÀ̼À°è
É C£ÁgÉÆÃUÀå ªÀÄvÀÄÛ ªÀÄÈvÀÄå«UÉ
¥ÀæªÀÄÄR PÁgÀt. §qÀzÉñÀUÀ¼À°è
C¥Ë¶ÖPÀvÉAiÀÄÄ §ÈºÀzÁPÁgÀªÁV ¨É¼É¢zÉ.
¥ÉÇæÃn£ï£ 2 ¤. ¤gÀÆ¥ÀuÉ ²PÀëQ ZÁmïð ¥ÉÇæÃnãï
À ¥ÉÇæÃn£ï ªÀÄvÀÄÛ ±ÀPÀðgÀ¦µÀ×zÀ «ªÀj¸ÀÄvÁ £À
PÉÆgÀvɬ PÉÆgÀvɬÄAzÀ GAmÁUÀĪÀ ªÀÄgÁ¸Àä¸ï ÛgÉ, PÉÆgÀvɬ
ÄAzÀ ªÀÄvÀÄÛ PÁé²AiÉÆÃPÀðgï PÁ¬Ä¯ÉUÀ¼À£ÀÄß vÁAiÀÄA¢ ÄAzÀ
GAmÁUÀÄ ¥ÉÇæÃnãï£À PÉÆgÀvɬÄAzÀ GAmÁUÀĪÀ gÀÄ GAmÁUÀÄ
ªÀ C¥Ë¶ÖPÀvÉ J£ÀÄßvÉÛêÉ. D°¸ÀÄvÁÛ ªÀ
C¥Ë¶ÖPÀv gÉ C¥Ë¶ÖPÀv
ÉAiÀÄ£ÀÄ ÉAiÀÄ£ÀÄ
ß ß ¤gÀƦ¹.
¤gÀƦ¸ÀĪ
ÀÅzÀÄ
¥ÉÇæÃnä 1 ¤. ¥ÉÇæÃnãï

110
 zÀȱÀå
PÀ°¸ÀĪÀ- ±ÁæªÀå
¤¢ðµÀÖ ¸ÀªÀÄ PÀ°AiÀÄĪ ¸ÁzsÀ£À ªÀiË®åªÀi
GzÉÝñÀ AiÀÄ «µÀAiÀÄ À «zsÁ£À UÀ¼ÀÄ Á¥À£À
£À ¥ÉÇæÃnÃ£ï ¸ÁgÀd£ÀPÀ¢AzÀ ªÀiÁqÀ®àlÖ
¤gÀÆ¥ÀuÉ zÉúÀzÀ ¨É¼ÀªÀtÂUÉUÉ ¨ÉÃPÁUÀĪÀ
¤ÃqÀĪÀÅ CUÀvÀåªÁzÀ CA±À.
zÀÄ
±ÀQÛAiÀÄ 1 ¤. ±ÀQÛ
¤gÀÆ¥ÀuÉ £ÀªÀÄUÉ ±ÀQÛAiÀÄ CªÀ±ÀåPÀvɬÄzÉ.
¤ÃqÀĪÀÅ
zÀÄ

¥ÉÇæÃnãï 1 ¤. ¥ÉÇæÃnä£À PÁAiÀÄð ²PÀëQAiÀÄ ZÁmïð ¥ÉÇæÃnä

£À 1. zÉúÀzÀ ¨É¼ÀªÀtÂUÉ ªÀÄvÀÄÛ «PÁ¸À. Ä £À JgÀqÀÄ
PÁAiÀÄðU 2. fêÀPÉÆñÀUÀ¼À£ÀÄß «ªÀj¸ÀÄvÁ PÁAiÀÄðU
À¼À£ÀÄß ¸ÀĹÜwAiÀÄ°èqÀĪÀÅzÀÄ. ÛgÉ À¼À£ÀÄß
«ªÀj¸ÀĪÀ vÁAiÀÄA¢ ¥ÀnÖ
3. ¥ÀæwgÉÆÃzsÀPÀ PÀtUÀ¼ÀÄ ªÀÄvÀÄÛ
ÅzÀÄ gÀÄ ªÀiÁr.
ºÁªÉÆðãÀÄUÀ¼À GvÀàwÛ.
D°¸ÀÄvÁÛ
gÉ
¥ÉÇæÃnãï 2 ¤. ¥ÉÇæÃnä£À ªÀÄÆ®UÀ¼ÀÄ ²PÀëQAiÀÄ ZÁmïð ¥ÉÇæÃnä
£À • ¥ÁætÂd£Àå DºÁgÀ: ªÀiÁA¸À, ºÁ®Ä, ªÉÆmÉÖ, Ä £À
ªÀÄÆ®UÀ ¦vÀÛd£ÀPÁAUÀ. «ªÀj¸ÀÄvÁ ªÀÄÆ®UÀ

111
 zÀȱÀå
PÀ°¸ÀĪÀ- ±ÁæªÀå
¤¢ðµÀÖ ¸ÀªÀÄ PÀ°AiÀÄĪ ¸ÁzsÀ£À ªÀiË®åªÀi
GzÉÝñÀ AiÀÄ «µÀAiÀÄ À «zsÁ£À UÀ¼ÀÄ Á¥À£À
¼À£ÀÄß • ¸À¸Àåd£Àå DºÁgÀ: ¢ézÀ¼À zsÁ£ÀåUÀ¼ÀÄ, ÛgÉ ¼À£ÀÄß
¥ÀnÖ ¸ÉÆÃAiÀiÁ©Ã£ï, ©ÃdUÀ¼ÀÄ, ºÉ¸ÀgÀÄ ¨ÉüÉ, vÁAiÀÄA¢ ¥ÀnÖ
ªÀiÁqÀĪÀ gÁeÁä. gÀÄ ªÀiÁr.
ÅzÀÄ D°¸ÀÄvÁÛ
gÉ
¥ÉÇæÃnãï 1 ¤. ¥ÉÇæÃnãï£À PÉÆgÀvɬÄAzÀ GAmÁUÀĪÀ ²PÀëQAiÀÄ ZÁmïð ¥ÉÇæÃnãï
£À C¥Ë¶ÖPÀvÉ PÀAqÀħgÀĪÀ ¥ÀæªÀiÁt Ä £À
PÉÆgÀvɬ LzÀÄ ªÀµÀðzÉƼÀV£À 30-40% ªÀÄPÀ̼À°è «ªÀj¸ÀÄvÁ PÉÆgÀvɬ
ÄAzÀ ¥ÉÇæÃnãï£À PÉÆgÀvɬÄAzÀ GAmÁUÀĪÀ ÛgÉ ÄAzÀ
GAmÁUÀÄ C¥Ë¶ÖPÀvÉ PÀAqÀħgÀÄvÀÛzÉ. EªÀgÀ°è 7.6% vÁAiÀÄA¢ GAmÁUÀÄ
ªÀ ªÀÄPÀ̼À°è wêÀæ C¥Ë¶ÖPÀvÉ EzÀÄÝ gÀÄ ªÀ
C¥Ë¶ÖPÀv PÁé²AiÉÆÃPÀðgï ªÀÄvÀÄÛ ªÀÄgÁ¸Àä¸ï D°¸ÀÄvÁÛ C¥Ë¶ÖPÀv
É PÁ¬Ä¯ÉUÀ¼ÀÄ GAmÁUÀÄvÀÛªÉ. ºÉaÑ£À gÉ É PÀAqÀÄ
PÀAqÀħg ªÀÄPÀ̼À°è C®à ¥ÀæªÀiÁtzÀ C¥Ë¶ÖPÀvÉ §gÀĪÀ
ÀĪÀ PÀAqÀħgÀÄvÀÛzÉ. ¥ÀæªÀiÁtªÉ
¥ÀæªÀiÁtªÀ µÀÄÖ?
£ÀÄß
«ªÀj¸ÀĪÀ
ÅzÀÄ
¥ÉÇæÃn£ï£ 5¤. ¥ÉÇæÃnãï£À PÉÆgÀvɬÄAzÀ GAmÁUÀĪÀ ²PÀëQAiÀÄ ZÁmïð ¥ÉÇæÃn£ï£

112
 zÀȱÀå
PÀ°¸ÀĪÀ- ±ÁæªÀå
¤¢ðµÀÖ ¸ÀªÀÄ PÀ°AiÀÄĪ ¸ÁzsÀ£À ªÀiË®åªÀi
GzÉÝñÀ AiÀÄ «µÀAiÀÄ À «zsÁ£À UÀ¼ÀÄ Á¥À£À
À C¥Ë¶ÖPÀvÉUÉ PÁgÀtUÀ¼ÀÄ Ä À
PÉÆgÀvɬ • ¸ÁAPÁæ«ÄPÀ gÉÆÃUÀUÀ¼ÀÄ: ¸ÁAPÁæ«ÄPÀ «ªÀj¸ÀÄvÁ PÉÆgÀvɬ
ÄAzÀ gÉÆÃUÀUÀ¼ÀÄ C¥Ë¶ÖPÀvÉUÉ ¥ÀæªÀÄÄR ÛgÉ ÄAzÀ
GAmÁUÀÄ PÁgÀt. ¨Éâü, zÀqÁgÀ, PÀgÀĽ£À°è vÁAiÀÄA¢ GAmÁUÀÄ
ªÀ ¥ÀgÉÆÃ¥ÀfëUÀ¼À ¨É¼ÀªÀtÂUÉ EvÁå¢ gÀÄ ªÀ
C¥Ë¶ÖPÀv C¥Ë¶ÖPÀvÉ PÁgÀtªÁUÀÄvÀÛªÉ. ¸ÁAPÁæ«ÄPÀ D°¸ÀÄvÁÛ C¥Ë¶ÖPÀv
ÉUÉ gÉÆÃUÀUÀ½UÉ vÀÄvÁÛzÀ ªÀÄPÀ̽UÉ gÉ ÉUÉ
PÁgÀtUÀ¼ ºÀ¹ªÀÅ PÀrªÉÄAiÀiÁUÀÄvÀÛzÉ. CªÀgÀ PÁgÀtUÀ¼
À£ÀÄß zÉúÀPÉÌ ¥ÉÇæÃnãïUÀ¼À CªÀ±ÀåPÀvÉ ÉãÀÄ?
«ªÀj¸ÀĪÀ C¢üPÀªÁVgÀÄvÀÛzÉ.
ÅzÀÄ
• DyðPÀ ¹Üw: §qÀvÀ£ÀªÀÅ C¥Ë¶ÖPÀvÉAiÀÄ
ªÉÄÃ¯É £ÉÃgÀ ¥ÀjuÁªÀÄ ©ÃgÀÄvÀÛzÉ.
§qÀvÀ£À, ¤®ðPÀë÷å,
«zÁå¨sÁå¸À«®è¢gÀĪÀÅzÀÄ, ¥Ë¶ÖPÀ DºÁgÀzÀ
§UÉÎ w¼ÀĪÀ½PÉ E®è¢gÀĪÀÅzÀÄ,
PÉƼÀPÀÄ ¥Àj¸ÀgÀ ªÀÄvÀÄÛ PÀÄlÄA§zÀ°è
C¢üPÀ ¸ÀzÀ¸ÀåjgÀĪÀÅzÀÄ C¥Ë¶ÖPÀvÉUÉ
PÁgÀt.
• C¸ÀªÀÄ¥ÀðPÀ DºÁgÁ¨sÁå¸ÀUÀ¼ÀÄ: ¥ÀÇgÀPÀ
DºÁgÀPÉÌ ºÉZÀÄÑ ¤ÃgÀÄ ¨ÉgɸÀĪÀÅzÀÄ,

113
 zÀȱÀå
PÀ°¸ÀĪÀ- ±ÁæªÀå
¤¢ðµÀÖ ¸ÀªÀÄ PÀ°AiÀÄĪ ¸ÁzsÀ£À ªÀiË®åªÀi
GzÉÝñÀ AiÀÄ «µÀAiÀÄ À «zsÁ£À UÀ¼ÀÄ Á¥À£À
C¥Ë¶ÖPÀ ¥ÀÇgÀPÀ DBDgÀ ªÀÄPÀ̼À°è
C¥Ë¶ÖPÀvÉAiÀÄ£ÀÄß GAlĪÀiÁqÀÄvÀÛªÉ.
ªÉÆzÀ® PÉ®ªÀÅ wAUÀ¼À°è JzɺÁ®Ä
¸ÁPÀµÀÄÖ zÉÆgÉAiÀÄ¢gÀĪÀÅzÀÄ
C¥Ë¶ÖPÀvÉ PÁgÀtªÁUÀÄvÀÛzÉ. ªÉÆzÀ® DgÀÄ
wAUÀ¼ÀÄ JzɺÁ°£À §zÀ®Ä ¨ÉÃgÉ DºÁgÀ
¤ÃrzÀgÉ C¥Ë¶ÖPÀvÉ GAmÁUÀÄvÀÛzÉ.
UÁæ«ÄÃt ¥ÀæzÉñÀUÀ¼À°è WÀ£À
DºÁgÀªÀ£ÀÄß ªÀÄUÀÄ«UÉ MAzÀÄ ªÀµÀð
zÁnzÀ §½PÀ ¤ÃqÀ¯ÁUÀÄvÀÛzÉ.

ªÀÄPÀ̼À DºÁgÀ vÀAiÀiÁj¸ÀĪÁUÀ

£ÉʪÀÄð®å PÁ¥ÁqÀ¢gÀĪÀÅzÀjAzÀ
ªÀÄUÀÄ«UÉ DUÁUÀ ¨Éâü GAmÁUÀÄvÀÛzÉ
ªÀiÁvÀæªÀ®è ªÀÄUÀÄ«£À zÉúÀPÉÌ
DºÁgÀªÀ£ÀÄß »ÃjPÉƼÀî®Ä
¸ÁzsÀåªÁUÀĪÀÅ¢®è.
• vÁ¬Ä PÉ®¸ÀPÉÌ ºÉÆÃUÀĪÀÅzÀÄ:
C¥Ë¶ÖPÀvɬÄAzÀ §¼À®ÄªÀ ºÉaÑ£À ªÀÄPÀ̼À
vÁAiÀÄA¢gÀÄ PÀÆ°AiÀiÁ¼ÀÄUÀ¼ÁVzÀÄÝ

114
 zÀȱÀå
PÀ°¸ÀĪÀ- ±ÁæªÀå
¤¢ðµÀÖ ¸ÀªÀÄ PÀ°AiÀÄĪ ¸ÁzsÀ£À ªÀiË®åªÀi
GzÉÝñÀ AiÀÄ «µÀAiÀÄ À «zsÁ£À UÀ¼ÀÄ Á¥À£À
CªÀjUÉ ªÀÄPÀPÀî DgÉÊPÉ ªÀiÁqÀ®Ä
¸ÁPÀµÀÄÖ ¸ÀªÀÄAiÀÄ zÉÆgÉAiÀÄĪÀÅ¢®è.
ºÉaÑ£À ¸ÀAzÀ¨sÀðUÀ¼À°è »jAiÀÄ ªÀÄPÀ̼ÀÄ
¸ÀtÚ ªÀÄPÀ̼À£ÀÄß £ÉÆÃrPÉƼÀÄîvÀÛªÉ.
• PÀÄlÄA§zÀ J®èjUÀÆ ¸ÀªÀÄ¥ÀæªÀiÁtzÀ°è
DºÁgÀ zÉÆgÉAiÀÄ¢gÀĪÀÅzÀÄ: §qÀ
PÀÄlÄA§UÀ¼À°è ¸ÁPÀµÀÄÖ Hl
zÉÆgÉAiÀÄĪÀÅ¢®è. EgÀĪÀ DºÁgÀªÀ£ÀÄß
««zsÀ ¸ÀzÀ¸ÀåjUÉ ¸ÀªÀÄ¥ÀæªÀiÁtzÀ°è
¤ÃqÀ¯ÁUÀĪÀÅ¢®è.
• PÀrªÉÄ ºÀÄlÄÖ vÀÆPÀ: C¥Ë¶ÖPÀvɬÄAzÀ
§¼À®ÄªÀ vÁAiÀÄA¢jUÉ PÀrªÉÄ ºÀÄlÄÖ
vÀÆPÀzÀ ªÀÄvÀÄÛ UÀ¨sÀðzÀ°è ¸ÀjAiÀiÁV
¨É¼ÉAiÀÄzÀ ªÀÄPÀ̼ÀÄ ºÀÄlÄÖvÀÛªÉ.
• PÀÄlÄA§zÀ UÁvÀæ: PÀÄlÄA§zÀ UÁvÀæ
zÉÆqÀØzÁzÀµÀÄÖ C¥Ë¶ÖPÀvÉAiÀÄ ¸ÁzsÀåvÉ
ºÉZÀÄÑ.
• d£ÀäzÀvÀÛ PÁ¬Ä¯ÉUÀ¼ÀÄ: ¹Ã¼ÀÄ vÀÄn,
ºÉÊqÉÆæøɥsÁ®¸ï, ªÀÄÆvÀæ¦AqÀzÀ
PÁ¬Ä¯ÉAiÀÄAxÀ d£ÀäzÀvÀÛ PÁ¬Ä¯ÉUÀ¼ÀÄ

115
 zÀȱÀå
PÀ°¸ÀĪÀ- ±ÁæªÀå
¤¢ðµÀÖ ¸ÀªÀÄ PÀ°AiÀÄĪ ¸ÁzsÀ£À ªÀiË®åªÀi
GzÉÝñÀ AiÀÄ «µÀAiÀÄ À «zsÁ£À UÀ¼ÀÄ Á¥À£À
C¥Ë¶ÖPÀvÉ PÁgÀtªÁUÀÄvÀÛªÉ.
• ¸ÀA¥ÀæzÁAiÀÄUÀ¼ÀÄ: PÀÄlÄA§ ªÀÄvÀÄÛ
zsÀªÀÄð DºÁgÁ¨sÁå¸ÀUÀ¼À ªÉÄïÉ
ªÀĺÀvÀÛgÀ ¥ÀjuÁªÀÄ ©ÃgÀÄvÀÛªÉ.
¸ÀjAiÀiÁzÀ ¸ÀªÀÄAiÀÄPÉÌ ¥ÀÇgÀPÀ DºÁgÀ
¤ÃqÀĪÀÅzÀ£ÀÄß DgÀA©ü¸ÀĪÀÅzÀÄ CxÀªÁ
ºÉZÀÄÑ ¤ÃgÀÄ ¨ÉgɹzÀ ¤ÃgÀÄ ¤ÃqÀĪÀÅzÀÄ
¨ÉâüUÉ PÁgÀtªÁUÀÄvÀÛzÉ.
¥ÉÇæÃn£ï£ 2 ¤. ¥ÉÇæÃnãï£À PÉÆgÀvɬÄAzÀ GAmÁUÀĪÀ ²PÀëQAiÀÄ ZÁmïð PÁé²AiÉÆ
À C¥Ë¶ÖPÀvÉAiÀÄ «zsÀUÀ¼ÀÄ Ä ÃPÀðgï
PÉÆgÀvɬ • ªÀÄgÁ¸Àä¸ï: ªÀÄgÁ¸Àä¸ï PÁ¬Ä¯É EgÀĪÀ «ªÀj¸ÀÄvÁ ªÀÄvÀÄÛ
ÄAzÀ ªÀÄPÀ̼À vÀÆPÀªÀÅ CªÀgÀ ªÀAiÀĹìUÉ ÛgÉ ªÀÄgÁ¸Àä¸ï
GAmÁUÀÄ EgÀ¨ÉÃPÁzÀ ªÀAiÀĹì£À CzsÀðzÀ¶ÖgÀÄvÀÛªÉ. vÁAiÀÄA¢ JAzÀgÉã
ªÀ F ªÀÄPÀ̼À ªÀiÁA¸ÀRAqÀUÀ¼ÀÄ gÀÄ ÀÄ?
C¥Ë¶ÖPÀv QëÃtªÁUÀÄvÀÛªÉ. D°¸ÀÄvÁÛ
ÉAiÀÄ gÉ
• PÁé²AiÉÆÃPÀðgï: EzÀÄ wêÀæ ¥ÀæªÀiÁtzÀ
«zsÀUÀ¼À
¥ÉÇæÃnãï£À PÉÆgÀvɬÄAzÀ GAmÁUÀĪÀ
£ÀÄß
C¥Ë¶ÖPÀvÉAiÀÄ PÁ¬Ä¯ÉAiÀiÁVzÀÄÝ ªÉÄÊ
¥ÀnÖªÀiÁq
H¢PÉƼÀÄîªÀÅzÀÄ, ¤gÁ¸ÀQÛ, ªÀÄvÀÄÛ
ÀĪÀÅzÀÄ
¨É¼ÀªÀtÂUÉ E®è¢gÀĪÀÅzÀÄ EzÀgÀ

116
 zÀȱÀå
PÀ°¸ÀĪÀ- ±ÁæªÀå
¤¢ðµÀÖ ¸ÀªÀÄ PÀ°AiÀÄĪ ¸ÁzsÀ£À ªÀiË®åªÀi
GzÉÝñÀ AiÀÄ «µÀAiÀÄ À «zsÁ£À UÀ¼ÀÄ Á¥À£À
®PÀëtUÀ¼ÀÄ.
¥ÉÇæÃn£ï£ 2 ¤. ¥ÉÇæÃnãï£À PÉÆgÀvɬÄAzÀ GAmÁUÀĪÀ ²PÀëQAiÀÄ ZÁmïð ¥ÉÇæÃn£ï£
À C¥Ë¶ÖPÀvÉAiÀÄ ®PÀëtUÀ¼ÀÄ Ä À
PÉÆgÀvɬ ªÀÄgÁ¸Àä¸ï «ªÀj¸ÀÄvÁ PÉÆgÀvɬ
ÄAzÀ ÛgÉ ÄAzÀ
• ¥ÀȵÀ×, GzÀgÀ, vÉÆqÉ, vÉÆüÀÄ ªÀÄvÀÄÛ
GAmÁUÀÄ vÁAiÀÄA¢ GAmÁUÀÄ
ªÀÄÄRzÀ°è£À PÉƧÄâ PÀgÀUÀĪÀÅzÀÄ.
ªÀ gÀÄ ªÀ
C¥Ë¶ÖPÀv • ªÀiÁA¸ÀRAqÀUÀ¼ÀÄ QëÃt¸ÀĪÀÅzÀÄ. D°¸ÀÄvÁÛ C¥Ë¶ÖPÀv
ÉAiÀÄ • ªÀÄÄR ªÀAiÀĸÁìzÀªÀgÀAvÉ PÁtĪÀÅzÀÄ. gÉ ÉAiÀÄ
®PÀëtUÀ¼ ®PÀëtUÀ¼
À£ÀÄß ÀÄ
«ªÀj¸ÀĪÀ AiÀiÁªÀŪ
ÅzÀÄ ÀÅ?
• PÉ£Éß ªÀÄvÀÄÛ ºÀuÉAiÀÄ §¢UÀ¼ÀÄ UÀĽ
©Ã¼ÀĪÀÅzÀÄ.
• ªÉÄÊ ¹Üw¸ÁÜ¥ÀPÀvÀé
PÀ¼ÉzÀÄPÉƼÀÄîªÀÅzÀÄ.
• ªÀÄUÀÄ gÀZÉÑ »rAiÀÄĪÀÅzÀÄ.
• DgÀA¨sÀzÀ°è ªÀÄ®§zÀÞvÉ PÁt¹PÉÆAqÀÄ

117
 zÀȱÀå
PÀ°¸ÀĪÀ- ±ÁæªÀå
¤¢ðµÀÖ ¸ÀªÀÄ PÀ°AiÀÄĪ ¸ÁzsÀ£À ªÀiË®åªÀi
GzÉÝñÀ AiÀÄ «µÀAiÀÄ À «zsÁ£À UÀ¼ÀÄ Á¥À£À
ªÀÄÄAzÉ ¥ÀzÉà ¥ÀzÉÃ
¨ÉâüAiÀiÁUÀĪÀÅzÀÄ.
• ªÀÄUÀÄ ¥ÀæwQæAiÉÄ
ªÀåPÀÛ¥Àr¸À¢gÀĪÀÅzÀÄ.
• ºÉÆmÉÖ G©âgÀĪÀÅzÀÄ.
PÁé²AiÉÆÃPÀðgï
• ¨É¼ÀªÀtÂUÉ PÀÄApvÀªÁUÀĪÀÅzÀÄ.
• PÀÆzÀ°£À°è §zÀ¯ÁªÀuÉ PÁt¸ÀĪÀÅzÀÄ.
• zÉúÀzÀ AiÀiÁªÀÅzÉà ¨sÁUÀªÀ£ÀÄß
MwÛzÁUÀ UÀĽ ©Ã¼ÀĪÀÅzÀÄ.
• zÉúÀzÀ°è PÉƧÄâ EzÀÝgÀÆ
ªÀiÁA¸ÀRAqÀUÀ¼ÀÄ QëÃt¸ÀĪÀÅzÀÄ.
• ZÀªÀÄð MtV QvÀÄÛ §gÀĪÀÅzÀÄ.
• PÀÆzÀ®Ä PÀrªÉÄAiÀiÁV PÀAzÀÄ §tÚPÉÌ
wgÀÄUÀĪÀÅzÀÄ.
• ªÉÄÊ ¨ÁvÀÄPÉƼÀÄîªÀÅzÀÄ.
• zÉÊ»PÀ ªÀÄvÀÄÛ ªÀiÁ£À¹PÀ ¨É¼ÀªÀtÂUÉ
PÀÄApvÀªÁUÀĪÀÅzÀÄ.

118
 zÀȱÀå
PÀ°¸ÀĪÀ- ±ÁæªÀå
¤¢ðµÀÖ ¸ÀªÀÄ PÀ°AiÀÄĪ ¸ÁzsÀ£À ªÀiË®åªÀi
GzÉÝñÀ AiÀÄ «µÀAiÀÄ À «zsÁ£À UÀ¼ÀÄ Á¥À£À
• gÀPÀۻãÀvÉ.
• «l«Ä£ï JAiÀÄ PÉÆgÀvÉ.
¥ÉÇæÃn£ï£ 1 ¤. ¥ÉÇæÃn£ï£À PÉÆgÀvɬÄAzÀ GAmÁUÀĪÀ ²PÀëQAiÀÄ ¥ÉÇæÃn£ï£
À C¥Ë¶ÖPÀvÉAiÀÄ£ÀÄß ¥ÀvÉÛ ºÀZÀÄѪÀ Ä À
PÉÆgÀvɬ «zsÁ£ÀUÀ¼ÀÄ «ªÀj¸ÀÄvÁ PÉÆgÀvɬ
ÄAzÀ • DºÁgÀPÀæªÀÄ: JzɺÁ®Ä ¤ÃqÀÄ«PÉ, ¥ÀÇgÀPÀ ÛgÉ ÄAzÀ
GAmÁUÀÄ DºÁgÀ ¤ÃrPÉ, DºÁgÁ¨sÁå¸ÀUÀ¼ÀÄ, PÁ¬Ä¯É vÁAiÀÄA¢ GAmÁUÀÄ
ªÀ EvÁå¢UÀ¼À §UÉÎ w½zÀÄPÉƼÀÄîªÀÅzÀÄ. gÀÄ ªÀ
C¥Ë¶ÖPÀv D°¸ÀÄvÁÛ C¥Ë¶ÖPÀv
• PÁ¬Ä¯ÉAiÀÄ ®PÀëtUÀ¼ÀÄ: ¸ÉÆÃAPÀÄ
ÉAiÀÄ£ÀÄ gÉ ÉAiÀÄ£ÀÄ
GAmÁVgÀĪÀÅzÀ£ÀÄß DgÀA©üPÀ ºÀAvÀzÀ°è
ß ¥ÀvÉÛ ß ¥ÀvÉÛ
¥ÀvÉÛ ºÀaÑ aQvÉì ¤ÃqÀĪÀÅzÀÄ, ºÀļÀ
ºÀZÀÄѪÀ ºÀZÀÄѪÀ
¨ÁzsÉ, ªÀÄvÀÄÛ ±Áé¸ÀPÉÆñÀzÀ ¸ÉÆÃAPÀÄ,
«zsÁ£ÀUÀ «zsÁ£ÀUÀ
¨Éâü EgÀĪÀÅzÀ£ÀÄß ¥ÀvÉÛ
¼À£ÀÄß ¼ÀÄ
ºÀZÀÄѪÀÅzÀÄ.
«ªÀj¸ÀĪÀ AiÀiÁªÀŪ
ÅzÀÄ • vÀÆPÀ £ÉÆÃqÀĪÀÅzÀÄ, vÉÆý£À ÀÅ?
¸ÀÄvÀÛ¼ÀvÉAiÀÄ£ÀÄß C¼ÉAiÀÄĪÀÅzÀÄ. 1-
5 ªÀµÀðzÉƼÀV£À ªÀÄPÀ̼À vÉÆý£À
¸ÀÄvÀÛ¼ÀvÉAiÀÄÄ 13.5 ¸ÉAn«ÄÃlgïVAvÀ
C¢üPÀªÁVgÀ¨ÉÃPÀÄ. vÉÆý£À ¸ÀÄvÀÛ¼ÀvÉ
12.5 ¸ÉAn«ÄÃljVAvÀ PÀrªÉÄ EzÀÝgÉ D

119
 zÀȱÀå
PÀ°¸ÀĪÀ- ±ÁæªÀå
¤¢ðµÀÖ ¸ÀªÀÄ PÀ°AiÀÄĪ ¸ÁzsÀ£À ªÀiË®åªÀi
GzÉÝñÀ AiÀÄ «µÀAiÀÄ À «zsÁ£À UÀ¼ÀÄ Á¥À£À
ªÀÄUÀÄ«£À°è C¥Ë¶ÖPÀvÉ GAmÁVgÀÄvÀÛzÉ.
• gÀPÀÛ¥ÀjÃPÉë: gÀPÀÛPÀtUÀ¼À JtÂPÉ,
gÀPÀÛzÀ°è£À ¥ÉÇæÃnä£À ¥ÀæªÀiÁtzÀ
¥ÀjÃPÉë.

• ªÀÄÆvÀæ ¥ÀjÃPÉë.
• gÉÃrAiÀiÁ®f ¥ÀjÃPÉë¬ÄAzÀ J®Ä§ÄUÀ¼À
¨É¼ÀªÀtÂUÉ PÀÄApvÀªÁVgÀĪÀÅzÀ£ÀÄß
¥ÀvÉÛ ºÀZÀѧºÀÄzÀÄ.
¥ÉÇæÃn£ï£ 10 ¤. ¥ÉÇæÃn£ï£À PÉÆgÀvɬÄAzÀ GAmÁUÀĪÀ ²PÀëQAiÀÄ ZÁmïð ¥ÉÇæÃn£ï£
À C¥Ë¶ÖPÀvÉAiÀÄ£ÀÄß vÀqÉUÀlÄÖªÀÅzÀÄ Ä À
PÉÆgÀvɬ • DgÀÄ wAUÀ¼ÁUÀĪÀªÀgÉUÉ ªÀÄUÀÄ«UÉ «ªÀj¸ÀÄvÁ PÉÆgÀvɬ
ÄAzÀ JzɺÁ®Ä ªÀiÁvÀæ ¤ÃqÀĪÀÅzÀÄ. ÛgÉ ÄAzÀ
GAmÁUÀÄ vÁAiÀÄA¢ GAmÁUÀÄ
• ¥ÀÇgÀPÀ DºÁgÀ ¤ÃrPÉ.
ªÀ gÀÄ ªÀ
C¥Ë¶ÖPÀv − 4-6 wAUÀ¼ÀÄ: DgÀA¨sÀzÀ°è ºÀtÂÚ£À gÀ¸À D°¸ÀÄvÁÛ C¥Ë¶ÖPÀv
ÉAiÀÄ£ÀÄ ¤ÃqÀ¨ÉÃPÀÄ. MAzÉgÀqÀÄ ªÁgÀUÀ¼À §½PÀ gÉ ÉAiÀÄ£ÀÄ
ß gÀªÉ, dfÓ ¥ÀÅr ªÀiÁrzÀ ¨Á¼É ºÀtÄÚ, ß
vÀqÉUÀlÄ D®ÆUÀqÉØ ¤ÃqÀ§ºÀÄzÀÄ. vÀqÉUÀlÄ

120
 zÀȱÀå
PÀ°¸ÀĪÀ- ±ÁæªÀå
¤¢ðµÀÖ ¸ÀªÀÄ PÀ°AiÀÄĪ ¸ÁzsÀ£À ªÀiË®åªÀi
GzÉÝñÀ AiÀÄ «µÀAiÀÄ À «zsÁ£À UÀ¼ÀÄ Á¥À£À
ÖªÀ − 6-9 wAUÀ¼ÀÄ: C£Àß ªÀÄvÀÄÛ ¨ÉÃ¼É «Ä±Àæ ÖªÀ
«zsÁ£ÀUÀ ªÀiÁr ¤ÃqÀĪÀÅzÀÄ, dfÓ ¥ÀÅr ªÀiÁrzÀ «zsÁ£ÀUÀ
¼À£ÀÄß D®ÆUÀqÉØ, ªÉÆmÉÖAiÀÄ ºÀ¼À¢ ¼À£ÀÄß
«ªÀj¸ÀĪÀ EvÁå¢UÀ¼À£ÀÄß 6-7 wAUÀ¼À°è «ªÀj¹
ÅzÀÄ ¤ÃqÀ§ºÀÄzÀÄ. 7-8 wAUÀ¼À°è ªÉƸÀgÀÄ
ªÀÄvÀÄÛ ¥ÁAiÀĸÀ ¤ÃqÀ§ºÀÄzÀÄ. §½PÀ
ªÀÄļÀÄî ¸ËvÉ, PÁågÉmï ¤ÃqÀ§ºÀÄzÀÄ.
¥ÀÇgÀPÀ DºÁgÀzÀ eÉÆvÉUÉ
JzɺÁ®Är¸ÀÄwÛgÀ¨ÉÃPÀÄ.
− 9-12 wAUÀ¼ÀÄ: F ªÀAiÀĹì£À°è «ÄãÀÄ,
ªÀiÁA¸À ¤ÃqÀ§ºÀÄzÀÄ. ªÀÄ£ÉAiÀÄ°è
vÀAiÀiÁj¹zÀ SÁgÀ«®èzÀ AiÀiÁªÀÅzÉÃ
DºÁgÀªÀ£ÀÄß ¤ÃqÀ§ºÀÄzÀÄ.
DºÁgÀªÀ¸ÀÄÛUÀ¼À£ÀÄß dfÓ ¥ÀÅr
ªÀiÁqÀ¨ÉÃPÁV®è DzÀgÉ CªÀÅ
ªÉÄvÀÛVgÀ¨ÉÃPÀÄ. JzɺÁ®Är¸ÀĪÀÅzÀ£ÀÄß
ªÀÄÄAzÀĪÀj¸À¨ÉÃPÀÄ.
− 12-18 wAUÀ¼ÀÄ: F ªÀAiÀĹì£À°è ªÀÄUÀÄ
vÁ¬ÄAiÀÄÄ ªÀiÁqÀĪÀ HlzÀ CzsÀð ¥Á®£ÀÄß
w£ÀߧºÀÄzÀÄ. JzɺÁ®Är¸ÀĪÀÅzÀ£ÀÄß

121
 zÀȱÀå
PÀ°¸ÀĪÀ- ±ÁæªÀå
¤¢ðµÀÖ ¸ÀªÀÄ PÀ°AiÀÄĪ ¸ÁzsÀ£À ªÀiË®åªÀi
GzÉÝñÀ AiÀÄ «µÀAiÀÄ À «zsÁ£À UÀ¼ÀÄ Á¥À£À
ªÀÄÄAzÀĪÀj¸À¨ÉÃPÀÄ.
− 18 wAUÀ¼À £ÀAvÀgÀ: ªÀÄ£ÉAiÀĪÀgÀÄ
¸Éë¸ÀĪÀ J¯Áè DºÁgÀªÀ£ÀÄß ªÀÄUÀÄ«UÉ
¤ÃqÀ§ºÀÄzÀÄ.
¥Ë¶ÖPÁA±À¨sÀjvÀ ®qÀÄØ«£À vÀAiÀiÁjPÉ
ºÉ¸ÀgÀÄ ¨ÉÃ¼É 16 UÁæA
UÉÆâü 40 UÁæA
£É®UÀqÀ¯É 10 UÁæA
¨É®è 20 UÁæA
«zsÁ£À
• ºÀÄjzÀ UÉÆâü, ºÉ¸ÀgÀÄ ¨ÉüÉ, ªÀÄvÀÄÛ
£É®UÀqÀ¯ÉAiÀÄ£ÀÄß eÉÆvÉAiÀiÁV CgɬÄj.
• ¸Àé®à ¤ÃjUÉ ¨É®è ºÁQ PÀÄ¢¹ CgÉzÀ «Ä±ÀætPÉÌ
¨Égɹ gÀÄ©â.
• CUÀvÀå«zÀÝgÉ ¸Àé®à JuÉÚ CxÀªÁ vÀÄ¥Àà
¨Égɹ UÀÄAqÀV£À ®qÀÄØUÀ¼ÁV ªÀiÁr.
• F ®qÀÄØUÀ¼À£ÀÄß ºÀ®ªÁgÀÄ
ªÁgÀUÀ¼ÀªÀgÉUÉ ¤ÃqÀ§ºÀÄzÀÄ.

122
 zÀȱÀå
PÀ°¸ÀĪÀ- ±ÁæªÀå
¤¢ðµÀÖ ¸ÀªÀÄ PÀ°AiÀÄĪ ¸ÁzsÀ£À ªÀiË®åªÀi
GzÉÝñÀ AiÀÄ «µÀAiÀÄ À «zsÁ£À UÀ¼ÀÄ Á¥À£À
¨ÁeÁæ (¸ÀeÉÓ) AiÀÄ w£À¸ÀÄ
¨ÁeÁæ (¸ÀeÉÓ) 50 UÁæA
ºÉ¸ÀgÀÄ ¨ÉÃ¼É 3 ZÀªÀÄZÀ
ºÁ°£À ºÀÄr 2 ZÀªÀÄZÀ
£É®UÀqÀ¯É 2 ZÀªÀÄZÀ
J¼ÀÄî 2 ZÀªÀÄZÀ
gÀÄaUÉ vÀPÀ̵ÀÄÖ ¸ÀPÀÌgÉ CxÀªÁ G¥ÀÅöà
«zsÁ£À
• J¯Áè ªÀ¸ÀÄÛUÀ¼À£ÀÄß ¥ÀÅr ªÀiÁr ºÁ°£À
ºÀÄrAiÉÆqÀ£É ¨Égɹ PÀÄ¢AiÀÄĪÀ ¤ÃgÀÄ
CxÀªÁ ºÁ°UÉ ¸ÉÃj¹ PÀzÀqÀ¨ÉÃPÀÄ. gÀÄaUÉ
vÀPÀ̵ÀÄÖ ¸ÀPÀÌgÉ CxÀªÁ G¥ÀÅöà
ºÁPÀ¨ÉÃPÀÄ.
• PÀÄlÄA§ AiÉÆÃd£É: ªÀÄPÀ̼À £ÀqÀÄªÉ 18-
23 wAUÀ¼À CAvÀgÀ«gÀ¨ÉÃPÀÄ.
• gÉÆÃUÀ¤gÉÆÃzsÀPÀ ®¹PÉ: ¤AiÀÄ«ÄvÀªÁV
gÉÆÃUÀ¤gÉÆÃzsÀPÀ ®¹PÉ ¤ÃqÀ¨ÉÃPÀÄ.
• M. Dgï. J¸ï.: ¨Éâü CxÀªÁ ¸ÁAPÁæ«ÄPÀ

123
 zÀȱÀå
PÀ°¸ÀĪÀ- ±ÁæªÀå
¤¢ðµÀÖ ¸ÀªÀÄ PÀ°AiÀÄĪ ¸ÁzsÀ£À ªÀiË®åªÀi
GzÉÝñÀ AiÀÄ «µÀAiÀÄ À «zsÁ£À UÀ¼ÀÄ Á¥À£À
gÉÆÃUÀUÀ¼À£ÀÄß DgÀA¨sÀzÀ°èAiÉÄÃ
¥ÀvÉÛ ºÀaÑ M. Dgï. J¸ï. ¤ÃqÀ¨ÉÃPÀÄ.
• ºÉÆmÉÖ ºÀļÀUÀ½UÉ OµÀzsÀ ¤ÃqÀ¨ÉÃPÀÄ.
¥ÉÇæÃn£ï£ 5 ¤. ¤¨sÁªÀuÉ ²PÀëQAiÀÄ ZÁmïð ¥ÉÇæÃn£ï£
À • JzɺÁ®Är¸ÀĪÀÅzÀ£ÀÄß JgÀqÀÄ ªÀµÀðUÀ¼À Ä À
PÉÆgÀvɬ ªÀgÉUÉ ªÀÄÄAzÀĪÀj¸À¨ÉÃPÀÄ. «ªÀj¸ÀÄvÁ PÉÆgÀvɬ
ÄAzÀ ÛgÉ ÄAzÀ
• ºÉÆmÉÖ G§âzÀAvÉ DUÁUÀ ¸Àé®à
GAmÁUÀÄ vÁAiÀÄA¢ GAmÁUÀÄ
¥ÀæªÀiÁtzÀ°è Gt¸ÀÄwÛgÀ¨ÉÃPÀÄ.
ªÀ gÀÄ ªÀ
C¥Ë¶ÖPÀv • ªÀÄUÀĪÀ£ÀÄß §mÉÖAiÀÄ°è ¸ÀÄwÛ ¨ÉZÀÑUÉ D°¸ÀÄvÁÛ C¥Ë¶ÖPÀv
ÉAiÀÄ Ej¸À¨ÉÃPÀÄ. gÉ ÉAiÀÄ
¤¨sÁªÀuÉAi • ªÀÄUÀÄ«UÉ ¸ÁAPÁæ«ÄPÀ gÉÆÃUÀ ¤¨sÁªÀuÉ
ÀÄ£ÀÄß GAmÁUÀzÀAvÉ ªÀÄÄ£ÉßZÀÑjUÉ ªÀ»¹ (¨Éâü, ºÉÃUÉ?
«ªÀj¸ÀĪÀ ±Áé¸ÀPÉÆñÀzÀ ¸ÉÆÃAPÀÄ, ªÀįÉÃjAiÀiÁ).
ÅzÀÄ • ¸ÀªÀÄAiÀÄ ¸ÀªÀÄAiÀÄPÉÌ
gÉÆÃUÀ¤gÉÆÃzsÀPÀ ®¹PÉ ¤Ãr.
• ªÉÄÊUÉ UÁAiÀÄUÀ¼ÁUÀzÀAvÉ
ªÀÄÄ£ÉßZÀÑjPÉ ªÀ»¹.
• «l«Ä£ï JAiÀÄ PÉÆgÀvɬÄzÀÝgÉ «l«Ä£ï J

124
 zÀȱÀå
PÀ°¸ÀĪÀ- ±ÁæªÀå
¤¢ðµÀÖ ¸ÀªÀÄ PÀ°AiÀÄĪ ¸ÁzsÀ£À ªÀiË®åªÀi
GzÉÝñÀ AiÀÄ «µÀAiÀÄ À «zsÁ£À UÀ¼ÀÄ Á¥À£À
OµÀzsÀªÀ£ÀÄß PÉÆr¹.
DºÁgÀPÀæªÀÄ
• ºÁ°£À C®fð¬Ä®è¢zÀÝgÉ ºÁ°£À°è ¨ÉgɹzÀ
DºÁgÀªÀ£ÀÄß ¤ÃqÀ§ºÀÄzÀÄ.
• DºÁgÀPÉÌ ¸ÀPÀÌgÉ ªÀÄvÀÄÛ JuÉÚ ¨Égɹ
ªÀÄUÀÄ«UÉ C¢üPÀ ±ÀQÛ zÉÆgÉAiÀÄĪÀAvÉ
ªÀiÁqÀ¨ÉÃPÀÄ.
• ¸ÉÆ¥ÀÅöà vÀgÀPÁj, ¸ÀÆ¥ï, ¨Á¼É ºÀtÄÚ,
£É®UÀqÀ¯É, ¨ÉuÉÚ, ¨ÉüÉPÁ¼ÀÄ, «ÄãÀÄ,
zsÁ£ÀåUÀ¼ÀÄ, ªÀiÁA¸À ªÀÄvÀÄÛ ºÁ®Ä ¤Ãr.
• ªÀÄUÀÄ«UÉ DUÁUÀ Gt¸ÀÄwÛgÀ¨ÉÃPÀÄ.
dégÀ CxÀªÁ ¨Éâü EzÀÝgÉ DºÁgÀ
¤ÃqÀĪÀÅzÀ£ÀÄß PÀrªÉÄ ªÀiÁqÀ¨ÉÃr.
¥ÉÇæÃn£ï£ 2 ¤. ¥ÉÇæÃn£ï£À PÉÆgÀvɬÄAzÀ GAmÁUÀĪÀ ²PÀëQAiÀÄ ZÁmïð ¥ÉÇæÃn£ï£
À C¥Ë¶ÖPÀvɬÄAzÀ GzÀ㫸ÀĪÀ ¸ÀªÀĸÉåUÀ¼ÀÄ Ä À
PÉÆgÀvɬ • gÀPÀÛzÀ°è ¸ÀPÀÌgÉAiÀÄ CA±À «ªÀj¸ÀÄvÁ PÉÆgÀvɬ
ÄAzÀ PÀrªÉÄAiÀiÁUÀĪÀÅzÀÄ. ÛgÉ ÄAzÀ
GAmÁUÀÄ vÁAiÀÄA¢ GAmÁUÀÄ
• zÉúÀzÀ GµÀÚvÉ PÀrªÉÄAiÀiÁUÀĪÀÅzÀÄ.
ªÀ gÀÄ ªÀ

125
 zÀȱÀå
PÀ°¸ÀĪÀ- ±ÁæªÀå
¤¢ðµÀÖ ¸ÀªÀÄ PÀ°AiÀÄĪ ¸ÁzsÀ£À ªÀiË®åªÀi
GzÉÝñÀ AiÀÄ «µÀAiÀÄ À «zsÁ£À UÀ¼ÀÄ Á¥À£À
C¥Ë¶ÖPÀv • £ÀAdÄ. D°¸ÀÄvÁÛ C¥Ë¶ÖPÀv
ɬÄAzÀ • ¤dð°ÃPÀgÀt ªÀÄvÀÄÛ zÉúÀzÀ°è ®ªÀuÁA±À gÉ É¬ÄAzÀ
GzÀ㫸ÀĪ PÀrªÉÄAiÀiÁUÀĪÀÅzÀÄ. GzÀ㫸ÀĪ
À À
• ºÀÈzÀAiÀÄ ¸ÀÛA¨sÀ£À.
¸ÀªÀĸÉåU ¸ÀªÀĸÉåU
À¼À£ÀÄß • gÀPÀۻãÀvÉ. À¼ÀÄ
«ªÀj¸ÀĪÀ • ¦ümïì. AiÀiÁªÀŪ
ÅzÀÄ • «l«Ä£ï ªÀÄvÀÄÛ R¤eÁA±ÀUÀ¼À PÉÆgÀvÉ. ÀÅ?

¸ÀªÀiÁ¦Û
¥ÉÇæÃnãï£À PÉÆgÀvɬÄAzÀ C¥Ë¶ÖPÀvÉ
GAmÁUÀĪÀÅzÀÄ ¨sÁgÀvÀzÀ°è PÀAqÀħgÀĪÀ
¥ÀæªÀÄÄR PÁ¬Ä¯É. vÀPÀÌ
G¥ÀPÀæªÀÄUÀ¼À£ÀÄß PÉÊUÉƼÀÄîªÀÅzÀjAzÀ
ªÀÄPÀ̼À°è C¥Ë¶ÖPÀvÉ GAmÁUÀĪÀÅzÀ£ÀÄß
vÀqÉAiÀħºÀÄzÀÄ.

126
 zÀȱÀå
PÀ°¸ÀĪÀ- ±ÁæªÀå
¤¢ðµÀÖ ¸ÀªÀÄ PÀ°AiÀÄĪ ¸ÁzsÀ£À ªÀiË®åªÀi
GzÉÝñÀ AiÀÄ «µÀAiÀÄ À «zsÁ£À UÀ¼ÀÄ Á¥À£À

127
Annexure 14

128
129
130
131
132
 Annexure 15
List of Validators

1. Mrs. Prema
Professor
Fr. Muller College of Nursing
Mangalore.
2. Mrs. Veena Tauro
Professor, Deaparment of paediatric Nursing
Masood College of nursing
Mangalore
3. Mrs. Theresa Leonilda Mendonsa
Professor, Department of Paediatric Nursing
Laxmi Memorial College of Nursing
Balmatta, Mangalore
4. Sr. Winnifred D’Souza
Professor, Department of Paediatric Nursing
Fr. Muller college of Nursing
Kankanady, Mangalore
5. Dr. Shridhar
Associate Professor in Paediatrics [Instructor BLS/ACLS/PALS]
Fr. Muller medical College
Mangalore
6. Mrs. Chitra
Professor, Department of Paediatric Nursing
Unity College of Nursing
Mangalore
7. Mrs. Renilda Shanthi lobo
Professor
City College of Nursing
Mangalore
8. Mrs. Baby Naik
Professor & HOD of paediatrics
Manipal College of Nursing
Mahe, Manipal
9. Mrs. Janet Sequira
Asst. Professor
St. Anns College of Nursing
Mulki, Mangalore
10. Dr.Sanjeev Rai
HOD and Professor in Paediatrics
Fr. Muller medical college
Mangalore
11. Mrs. Sujatha Ramu
Professor, Department of Child Health Nursing
Indira College of Nursing
Falnir, Mangalore

133
134
135
 Annexure 17
Statistical formulas

1. Mean

x=
∑x
n

2. Standard deviation

∑(x − x )
2

SD=
n

3. Karl Pearson’s Correlation Coefficient

r=
∑ (x − x )( y − y )
∑ (x − x ) ∑ ( y − y )
2 2

4. Spearman-Brown Prophecy formula

2r
r1=
1+ r

5. Chi-square test with 2 X 2 contingency table

N ( ad − bc ) 2
χ2=
( a + b )(c + d )( a + c )(b + d )

6. Chi-square test with Yates correction

N [| ad − bc | −( N / 2]2
χ2=
( a + b )(c + d )( a + c )(b + d )

7. Paired ‘t’ test

t=
d
d=
∑d σd =
∑ (d − d ) 2

σd 2 n n
n

136
 Annexure 16
Master data sheet
Demographic proforma Pre-test
1 2 3 4 5 6 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25
1 b c b b b b 0 1 0 0 0 0 0 0 0 1 0 1 1 0 1 1 1 0 0 1 0 1 0 0 0
2 c c b a a b 0 0 1 1 1 0 0 1 0 0 1 0 0 1 1 1 0 1 0 0 0 0 1 1 0
3 b a b a b b 0 0 1 0 0 0 0 0 0 1 0 1 1 0 1 0 1 0 0 1 1 0 0 0 0
4 c b c b a b 0 1 0 0 1 0 1 1 1 0 0 1 0 0 0 1 0 0 0 0 0 0 1 0 0
5 b c b b a a 0 1 0 0 0 1 0 0 0 1 0 0 1 1 0 0 1 0 1 0 0 1 1 0 0
6 b b c c c a 0 0 0 1 1 0 0 1 1 0 0 0 0 1 0 1 0 1 0 1 0 1 0 0 1
7 b c d c c b 0 0 0 1 1 0 0 0 0 1 1 0 0 0 0 0 0 0 1 0 1 1 0 0 0
8 b e b b a b 1 0 1 1 1 1 0 0 1 1 1 0 0 0 1 1 1 1 1 0 0 1 0 0 0
9 c b b c c a 0 0 0 1 0 0 0 0 0 0 0 0 1 1 0 1 0 1 0 1 0 1 0 1 0
10 b c c d b c 0 1 0 0 0 0 0 0 0 0 1 1 0 0 1 1 0 0 1 0 0 1 1 0 0
11 b a b b c a 1 1 0 0 0 0 0 0 0 0 0 0 0 1 1 1 1 0 0 0 0 1 0 0 0
12 c b c c c a 0 1 0 0 0 1 1 0 0 0 0 1 0 1 1 0 0 0 0 1 1 1 0 0 0
13 a b d c c b 0 0 1 1 1 0 0 0 0 1 0 0 0 1 0 0 0 1 1 0 0 1 0 0 0
14 c b c b a a 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 0 0 0 0 1 0 0 0
15 c b c c c b 1 0 1 0 1 0 1 0 0 1 0 0 0 0 0 1 1 0 0 0 0 1 0 0 0
16 b c b c c a 0 0 0 1 0 0 0 0 0 1 0 0 0 0 0 1 0 1 0 1 0 0 1 1 0
17 b b c b b a 0 1 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 1 0 1 0 0 0
18 a b b a b b 1 1 1 0 0 0 1 0 0 1 0 1 1 0 0 1 1 0 1 0 0 0 1 0 0
19 b c c a a a 1 1 0 0 0 0 0 0 0 0 0 1 1 0 0 1 1 0 1 0 0 0 0 0 0
20 b b b b a b 0 0 1 1 0 1 0 0 0 1 1 1 0 1 0 0 0 0 1 0 0 0 0 1 0
21 c c c a c a 1 1 1 0 0 0 0 0 0 1 1 0 1 0 1 1 1 0 0 0 1 1 0 0 0
22 b b a b a b 0 1 0 0 1 0 0 0 0 1 0 0 1 0 0 0 0 0 1 0 0 1 0 0 0
23 b b a b b a 0 0 1 1 0 1 1 0 0 0 0 0 1 0 1 1 0 0 0 0 1 0 0 0 0
24 b a b a b b 1 0 1 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 1 0 0 0 0 0
25 b c b a b a 0 0 0 0 0 0 0 0 1 0 1 0 0 0 1 0 0 0 1 0 1 1 1 0 0
26 b b b a c b 1 1 0 0 1 1 0 1 1 0 0 0 1 0 0 0 0 1 1 1 1 0 0 0 1
27 b e d b a c 1 1 0 1 0 0 1 0 0 0 1 0 1 1 0 1 1 0 0 1 0 0 0 0 0
28 b b b a a a 1 0 0 0 0 0 0 0 0 0 1 0 0 1 1 0 0 1 0 1 0 0 0 0 1
29 b d c a a b 1 1 0 0 0 0 0 0 0 1 0 1 1 0 1 0 1 0 1 0 0 1 0 0 0
30 b a a a a a 1 0 0 0 1 0 0 0 0 0 0 0 1 1 0 1 0 0 1 0 0 1 1 0 0

129
 Post-test
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25
1 1 0 0 1 1 0 1 1 0 1 1 0 0 1 1 1 0 0 1 1 1 1 1 1
1 0 1 1 1 0 1 1 0 1 0 1 1 1 1 1 1 1 1 1 0 1 1 0 0
1 0 1 0 0 0 1 0 1 0 0 1 0 1 0 0 0 1 0 1 0 0 1 0 1
0 1 1 0 1 0 0 1 1 0 1 0 0 1 0 1 0 1 0 1 1 0 0 0 0
0 1 1 1 0 0 1 0 0 1 0 1 0 0 1 1 0 1 1 0 1 0 1 0 1
0 1 1 0 1 1 1 1 1 0 0 1 1 1 0 1 0 1 1 0 0 1 1 1 1
0 1 1 0 1 0 0 1 0 1 1 0 1 1 0 0 1 0 1 1 0 1 0 1 1
1 1 1 0 1 1 0 0 1 1 1 1 1 1 1 0 1 1 1 1 1 1 1 0 0
0 1 0 0 0 1 0 1 0 1 0 0 1 0 0 1 1 0 1 0 0 1 0 1 0
0 1 1 0 1 1 0 1 0 1 1 0 0 0 1 1 1 0 0 1 1 0 1 1 0
1 0 1 1 0 1 0 0 0 1 0 1 0 1 0 1 0 0 1 1 0 1 1 0 0
1 1 0 1 1 0 1 1 0 1 0 1 1 0 1 1 0 1 0 1 1 0 1 0 0
0 0 1 1 0 1 1 1 0 1 1 0 1 0 1 0 1 0 1 0 0 0 1 0 1
1 0 1 1 0 1 0 0 1 0 0 0 1 0 0 0 1 0 0 1 0 1 0 1 0
1 1 0 1 1 0 1 0 1 1 0 1 1 0 1 1 1 0 1 1 0 0 1 1 1
1 0 0 1 1 0 1 0 1 0 1 0 0 1 1 0 0 1 0 1 0 0 0 0 0
1 1 0 1 1 0 1 1 0 1 0 1 0 1 1 0 1 1 0 0 1 1 1 1 1
1 1 0 1 1 0 0 1 0 1 0 0 1 0 0 1 0 0 1 0 0 1 0 0 0
1 0 1 1 0 1 0 1 0 1 1 0 1 1 0 1 1 0 0 1 1 1 1 0 0
0 1 1 1 0 1 1 0 1 0 1 0 1 1 1 0 1 1 1 0 1 1 1 1 1
1 0 1 0 1 1 0 0 1 0 1 0 0 1 1 0 1 1 1 0 1 0 1 0 0
0 1 0 1 0 1 1 0 1 1 0 0 1 0 1 0 0 0 1 1 0 1 0 0 1
0 0 0 0 1 0 0 1 1 0 0 1 0 1 0 0 1 1 0 1 0 0 1 0 0
0 0 0 0 1 0 1 0 0 1 1 0 1 0 0 1 1 0 1 0 0 1 0 0 1
1 1 1 1 1 0 1 0 1 1 0 1 1 0 0 1 1 1 1 1 1 1 1 0 1
1 0 1 0 0 1 0 0 1 0 1 0 1 1 0 1 0 1 1 0 1 0 0 0 1
0 1 0 1 1 0 1 0 0 1 1 1 1 0 1 1 1 1 1 1 1 1 1 1 0
1 1 1 0 1 0 1 0 1 0 0 1 0 0 0 1 0 0 1 0 1 1 0 1 0
1 1 0 1 1 0 1 1 0 1 1 1 1 1 0 1 1 0 1 1 0 1 1 0 1
1 0 1 1 1 0 1 0 1 1 0 1 1 0 0 1 0 0 1 1 0 1 0 0 0

130