Knowledge and Practices regarding Prevention of Protein Energy Malnutrition among Mothers of under Five Children

Mrs. Sarika Yadav

Indian Nursing Council, SGT University

*Corresponding Author Email: sarikayadav06@rediffmail.com

ABSTRACT:

Background and Objective: Globally, PEM continues to be a major health burden in developing countries and the most important risk factor for illnesses and death especially among young children. The World Health Organization estimates that about 60% of all deaths, occurring among children aged less than five years in developing countries, could be attributed to malnutrition. In India, the major contributing factors are poverty and low social-economic status with low levels of education, poor sanitation and limited access to health services. Method: Descriptive survey approach was adopted to collect data. A structured interview schedule was prepared and administered to 100 mothers of under five children based on purposive sampling technique at the selected area of Gajipur, New Delhi. Result: Majority, 45.36 percent of mothers had knowledge related to general information of PEM, followed by 43.44 percent of the mothers who knew about causes, signs and symptoms of PEM. Majority 46.3 percent of the respondents had the right Dietary practice and 42 percent had the good practice of management of diarrhoea. There is significant association observed between knowledge and educational status of the mother. Interpretation and Conclusion: Overall findings showed that, the existing, knowledge and practice is found 45.52% and 41.66% on prevention of protein energy malnutrition. The enhancement in both knowledge and practice is greatly required on the following areas of exclusive breast milk, initiation of breast milk, continuous feeding of breast milk and good dietary practices are the multidisciplinary action it should involve an research team and the findings should be communicated through Journals and other media in order to enlighten nursing students.

KEYWORDS: Major health burden, Protein Energy Malnutrition, Mothers, Under Five Children illnesses and death.

INTRODUCTION:

“It shall be the policy of the state to provide services to children both before and after birth and through the period of growth, to ensure their physical, mental and social development. The state shall progressively increase the scope of such services so that within a reasonable time, all children in the country enjoy optimum conditions for their balanced growth”¹

Malnutrition is a global burden. More than 800 million people are undernourished. In the developing countries 150 million children are malnourished. In India the major contributing factors are poverty and low social-economic status with low levels of education, poor sanitation and limited access to health services and high levels of infectious diseases¹

Protein Energy Malnutrition (PEM) has been identified as a major health and nutrition problem in India. It occurs particularly in children in the first year of life. It is characterized by low birth weight.

India in the past few decades, has witness rapid progress in terms of industrialization and agricultural production. Yet malnutrition especially under nutrition continues to be a major problem of public health significance in the country. It is a major contributor to high rates of childhood mortality maternal mortality and morbidities in the community. Though poverty is a major underlying cause, scores of other factors such as socio-demographic, socio-economic socio-cultural and lifestyle practices contribute significantly to the problem of malnutrition.²

Growth faltering normally begins around six months of age, the time when, diet based predominantly on breast milk begins to include complementary foods, which when delivered inappropriately, results in growth faltering. Infants in Delhi display this pattern of malnutrition, those aged less than six months having a low prevalence of underweight (6%), compared to a much higher prevalence of underweight (39%) with those aged 6 to 11 months.³

Mother’s inadequate knowledge of nutrition leads to unsuitable feeding practices; this is further impeded by adherence to strict cultural beliefs/practices. To improve feeding practices, nutrition education should focus on changing current knowledge, attitudes and practices. This could improve the long-term health status of people in the community.³

OBJECTIVES:

Objectives of the study:

· To Assess Knowledge among Mothers of Under Five Children regarding Prevention Protein Energy Malnutrition.

· To Assess Practices among Mothers of Under Five Children regarding Prevention of Protein Energy Malnutrition.

· To Find the Association between Knowledge and Practice among Mothers of Under Five Children regarding Prevention of Protein Energy Malnutrition with selected demographical variables.

· To assess the correlation between knowledge and practices among Mothers of Under Five Children regarding Prevention of Protein Energy Malnutrition.

Hypothesis:

· H₀₁ – There will not be a significant association between the knowledge level and practices regarding prevention of PEM among mothers of under five children.

· H₀₂ - There will not be a significant association between the knowledge and practice level and selected demographical variables regarding prevention of PEM among mothers of under five children.

MATERIAL AND METHODS:

A quantitative descriptive survey approach was used to assess knowledge and practices among mothers of under five children regarding prevention of protein energy malnutrition. The present study was conducted at community health centre. the population comprised of mother of under five children residing at selected community area. The sample size was 100 mothers who met inclusion criteria. Purposive Random Sampling Technique is a type of non-probability sampling approach adopted for present study.

Sampling Criteria:

Mothers of under five children residing at selected community area, New Delhi. Mothers of under five children who are willing to participate in the study. Mothers who know Hindi / English are included . While Mothers who are not available during the period of data collection. Mothers who are not willing to participate were excluded.

Data collection tools and technique tools are given as under.

Tool-1 - Demographic Data

Tool -2 - Knowledge Questionnaires

Tool- 3 - Practice Check list

The tool was prepared after extensive review of literature. Tool 2 had 30 statements covering the knowledge of items. The area included were definition of nutrition, importance of nutrition, meaning of protein energy malnutrition, causes of protein energy malnutrition, signs and symptoms of protein energy malnutrition and prevention of protein energy malnutrition. Tool 3 had 15 items to assess the practice related i.e. Breast Feeding Practices, Weaning Practices, Dietary Practices and Management of Diarrhoea. The content validity of the tool was established by experts’ opinion. The tool was sent to 03 experts, in each are (Pediatrics Department-2, Community Health Nursing - I) were selected on the basis of their qualification, experience and interest in the problem area. Reliability of the tool was established by using split half method with Spearman-Brown Prophecy Formula methods

Data Collection Procedure:

After taking Prior permission from the department written consent has been obtained from mothers’ of under-five children. Tools were administered to 100 mothers of under five children and face-to-face interview was conducted with subjects by using the structured interview schedule. Participants were given ample time to respond. For each correct response a score of `one’ and for every wrong response a `zero’ was awarded

Data Analysis:

Responses pertaining to variables (i) demographic characteristics (ii) knowledge and practice of prevention of protein energy malnutrition was transferred in to the Microsoft excel sheets, analyzed using SPSS. Chi square and Correlation was used to find out the association between knowledge and practice. Majority of 37 percent of mothers were in the age group of 21-30 years, followed by 30 percent of mothers were in the age group of 20 and below, 27 percent of mothers were in the age group 31-40 and only 6 percent of mothers were in the age group of more than 40 years. Majority of 47 percent of mothers belonged to Joint Family followed by 44 percent of mothers belonged to Nuclear Family and only 9 percent belongs to Extended Family. 52 percent of mothers belonged to Hindu Religion followed by 25 percent of mothers belonged to Muslim Religion, 13 percent belongs to Sikh Religion and only 10 percent belongs to Christian Religion. majority 42 percent of mothers are House wife’s, followed by equal 21 percentage belongs any other occupation and private employee and only 16 percent are government employee

According to table-1 depicts the knowledge score of among mothers of under five children regarding prevention of PEM related to meaning, definition and importance of Nutrition, causes of PEM, signs and symptoms of PEM, and prevention of PEM. (Fig –1).

Findings of above the table-1 shows that highest 45.36 percent of knowledge score in the area of knowledge related to general information of protein energy malnutrition, followed by 43.44 percent of knowledge score in the area of knowledge related to causes, sign and symptoms of PEM.

Further knowledge score was 39.58 percent in the knowledge related to prevention and management of PEM. However an overall mean percent of knowledge score was found to be 45.52 percent.(Fig-1)

Table-1. Area Wise Knowledge Scores of Mothers Among Under Five Children Regarding Prevention Of Protein Energy Malnutrition

S. NO	AREA	MAX SCORE	MEAN	SD	PERCENTAGE
					MEAN	SD
1	Knowledge Related To General Information	8	3.63	1.331	45.36	16.63
2	Knowledge Related To Causes, Sign And Symptoms Of Protein Energy Malnutrition Among Under Five Children	10	3.91	1.615	43.44	17.94
3	Knowledge Related To Management And Prevention Of Protein Energy Malnutrition.	12	4.75	1.930	39.58	16.08
4	Total	30	12.29	4.88	45.52	18.07

Fig:1 : Area Wise Knowledge Scores of Mothers Among Under Five Children Regarding Prevention Of Protein Energy Malnutrition

Table-2 Area Wise Practice Score of Mothers Among Under Five Children Regarding Prevention of PEM n=100

S. NO	AREA	MAX SCORE	MEAN	SD	PERCENTAGE
					MEAN	SD
1	Breast Feeding Practices	4	1.42	0.987	35.5	24.67
2	Weaning Practices	2	0.79	0.743	39.5	37.15
3	Dietary Practices	6	2.78	1.260	46.3	21
4	Management of Diarrhoea	3	1.26	0.917	42	30.56
5	Total	15	6.25	3.91	41.66	26.06

Fig-2: Area Wise Practice Scores of Mothers Among Fewer Than Five Children Regarding Prevention Of Protein Energy Malnutrition

Table- 3. Association Between Knowledge And Practice Score n=100

	Number of subjects	Min	Max	Percent		95% confidence interval for mean		R	Df	P value
				MEAN	SD	LOWER	UPPER
KNOWLEDGE	30	29	60	45.52	18.07	45.31	58.79	0.761	44	P<0.001
PRACTICE	15	26	54	41.66	26.06	42.1	61.23

Table-2 depicts that Area wise practice score of mothers of under five children regarding prevention of PEM related to practices of breast feeding, weaning practices, dietary practices and management of diarrhoea (Fig – 2).

Findings of the above table-2 reveal that majority 46.3 percent of the mother knew right dietary practices, followed by 42 percent of the mothers knew the management of diarrhoea.

The findings the above tabel-2 shows that 39.5 percent of the mothers had right practices of weaning followed by 32.5 percent of mothers had right practices of weaning. However an overall mean percent of practice score was found to be 41.66 percent.(Fig-2).

Fig -3: Association Between Knowledge And Practice

This study shows that the mean ± SD of score was observed Knowledge score was 45.52 ± 18.07 and Practice score was 41.66 ± 26.06. The difference in knowledge and practice score however is not statistically significant (r=0.071 at p< 0.001 level). It indicates that there is no difference in Knowledge and Practices among mothers of under five children regarding prevention of protein energy malnutrition.

RESULT:

Majority, 45.36 percent of mothers had knowledge related to general information of PEM, followed by 43.44 percent of the mothers who knew about causes, signs and symptoms of PEM. Majority 46.3 percent of the respondents had the right Dietary practice and 42 percent had the good practice of management of diarrhoea. There is significant association observed between knowledge and educational status of the mother

DISCUSSION:

The findings of the study revealed the overall knowledge mean score percent of mothers is 45.52 percent. The area wise mean knowledge score of mothers regarding prevention of protein energy malnutrition reveals that 45.36 percent of mothers were aware of causes, signs and symptoms of PEM, followed by 43.44 percent of the mothers who knew general information about PEM and only 39.58 percent of mother are aware about management and prevention of PEM.M. This finding is compared with study conducted by Ighogboja SI reported that 126 (32.0%) mothers believed malnutrition was caused by lack of good food, while 86 (231.5%) thought it was an act of God, 67% associated diarrhoea and 35.8% associated bronchopneumonia with malnutrition and study conducted by Alasfoor D, Elsayed MK, Alqasmi AM, Malamkar P, Sheth M, Prakesh N reported that 7% of children had wasting, 10.6% had stunt growth &17.9% had underweight.

The present study reveals that overall mean percent of practice of mothers was found to be 41.66 percent.

Findings of present study revealed that 46.3 percent of the respondents had the right dietary practices, followed by 42 percent of respondents have right practices of management of diarrohea, 39.5 percent of respondents had right weaning practices and only 35.5 percent of respondents have right practices of breast feeding.

Result of study shows that the mean ± SD of score was observed Knowledge score was 45.52 ± 18.07 and Practice score was 41.66 ± 26.06. The difference in knowledge and practice score however is not statistically significant (r=0.071 at p< 0.001 level). It indicates that there is no difference in Knowledge and Practices among mothers of under five children regarding prevention of protein energy malnutrition. Hence the null hypothesis (H₀₁) is accepted hypothesis is accepted.

The findings of present study shows that there was no statistically significant association found between the knowledge scores among mother of under five children regarding protein energy malnutrition and the demographic variables such as age, religion, type of family, income, occupation, under five children in family, immunization status of children and source of health information at 0.05 level of significance, except in education and residence area. Hence, the null hypotheses (H₀₂) partially accepted and the research hypotheses were partially rejected. Thus, it was interpreted that the knowledge scores of the mothers of under five children were influenced by education at status and area of residence. And also there was no statistically significant association found between the practice scores among mother of under five children regarding protein energy malnutrition and the demographic variables such as age, religion, type of family, income, education, occupation, under five children in family, immunization status of children and source of health information at 0.05 level of significance, except in area of residence. Hence, the null hypotheses (H₀₂) partially accepted and the research hypotheses were partially rejected. Thus, it was interpreted that the knowledge scores of the mothers of under five children were influenced by education at status and area of residence.

RECOMMENDATIONS:

On the basis of the findings of present study, the following recommendations have been made for further study.

1. A similar study can replicated on a large sample to generalize the findings.

2. A similar study can be conducted to determine the reliability of the teaching plan.

3. A similar study can be conducted to compare the knowledge and practice level of mothers between rural and urban communities.

4. A structured teaching programmes can be prepared to enhance the knowledge and practice of mothers regarding prevention of malnutrition.

5. To prepare teaching modules on different aspects of malnutrition, to be used by the nurse in community when giving health education

IMPLICATIONS:

1. The nurse administrator can formulate policies and procedures regarding prevention of protein energy malnutrition. They should organize and implement ongoing education and in-service programmes regarding prevention of protein energy malnutrition. Nursing conferences and group discussions could be organized by the administrator periodically.

2. A Nurse Educator should provide ample opportunity for students to educate mothers and provide care in both urban and rural communities and clinical setting, the curriculum should include advance made in Maternal and Child Health Practices.

3. It can be included in the health education programme in family, group of community and maternal and child health clinics, at sub-centre level and centre level.

4. Attention of health personnel and community health workers is required to motivate the family members and community persons.

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Received on 07.07.2015 Modified on 09.10.2015

Accepted on 26.11.2015 © A&V Publications all right reserved

Asian J. Nur. Edu. and Research 6(1): Jan.- Mar.2016; Page 96-100

DOI: 10.5958/2349-2996.2016.00020.3