KRISHNA INSTITUTE OF MEDICAL SCIENCES TO BE DEEMED

UNIVERSITY, KARAD.

KRISHNA INSTITUTE OF NURSING SCIENCES, KARAD.

SYNOPSIS
Submitted To: Mrs. Nutan Potdar Asso. Prof. KINS, KARAD

Submitted By : Miss Jadhav Aishwarya Vilas 3rd yr. B.Bsc

Nursing KINS, KARAD.
Date

Problem Statement:
"Prevalence of undernutrition among under-five children and its
association with educational and occupational status of mothers
in an urban area of Karad".
 INTRODUCTION
Nutrition is defined as the science of food and its relationship to the
healthy. It is concerned mainly with the part played by nutrients in the growth of body,
development and maintenance1.
Undernutrition refers to a pathological state resulting from a relative or
absolute deficiency of one or more essential nutrients undernutrion is an imbalance
between the supply of calories and the demand of body for them to ensure optimal
growth and function2.

Adequate nutrition is needed in early childhood for the healthy growth,

proper organ formation and function. Economic growth and human development require
well-nourished populations who can learn new skills think critically and contribute to their
communities. Child malnutrition impacts cognitive function and contributes to poverty
through impeding individual's ability to lead productive lives. It is found that more than one-
third of under-five deaths are attributable to undernutrition 3.
The term undernutrition encompasses wasting, stunting and underweight.
Wasting is the inadequate weight for height and it reflects the acute undernutrition.
Stunting is the inadequate height for age and it reflects chronic
undernutrition.
Underweight is the inadequate weight for age and is a composite measure
of stunting and wasting. It can result from either acute or chronic or both. Early childhood,
that is the 1ST to 6 years are the most crucial period in the life, when the foundations are laid
for cognitive, social and emotional, language, physical / motor development and cumulative
lifelong learning4.
Globally, prevalence of underweight, stunting and wasting among under-
five children is 14.4%, 22.9% and 7.7% respectively 3, 5.
One in every three malnourished children of the world lives in India. As per
National Family Health Survey 4 TH (2015-16), prevalence of stunting, wasting and
underweight among under-five children in India is 38.4%, 21% and 35.7% respectively
( corresponding figure for National Family Health Survey 3 RD was 48%, 19.8% and 42.5 %
respectively). According to National Family Health Survey 4 TH the prevalence of stunting,
wasting and underweight among under-five children in Maharashtra is 34%, 26% and 36%
respectively (corresponding figure for National Family Health Survey 3 RD was 46%, 17% and
37% respectively)6.
Globally undernutrition is an underlying causes in the at least half of all
childhood deaths7.

Undernutrition contributes to the death of 5.6 million children under-

five years in the developing world each year the equivalent of 10 children a minute 8.
Thus
children under five year constitute the most vulnerable segment of any community and
their nutritional status is a sensitive indicator of community health and nutrition 9.
Malnutrition is a factor in of the 13 million annual deaths of children under 5 years old. The
numbers of malnourished children under 5 years in the developing world rise from 168
million in 1975 to 184 million in 1990 but fell as a share of our developing country children
from 42% to 34%7. At present 2/3RD of the deaths of children around the world are directly
or indirectly associated with nutritional deficiencies overall nearly half of the young children
in India are underweight (47%) and stunted (46%) and one in every six children are wasted
(16%) 10. Malnutrition includes undernutrition, in which nutrients are under supplied. Under
nutrition can result from inadequate intake, malabsorption, abnormal synthesis, loss of
nutrients2.
A report came on time of India on February 4, 2010 tell that of the estimated 45000
children dying each year due to malnutrition in Maharashtra, only around 12000 are severe
malnutrition cases. The remaining 33000 children succumb due to mild or moderate
Malnutrition. Also, malnutrition is the underlying cause in about 480 of the 2850 maternal
deaths each year in the state.
At present in India 65% children under-five years of age are under weight. This includes 47%
moderate to severe cases, 18% severe, of these 16% have moderate to severe wasting and
46% moderate to severe stunting which is eventually affecting the Nation's growth and
development11.
 NEED FOR STUDY
Good nutrition means "maintaining a nutritional status that enables us to
grow well and enjoy good health." Poor nutrition leads to poor health.
In India, about 2/3 portion of the under 5 year children are malnourished
among them 5 to 8% are severely malnourished and others whole are in the group of mild
and moderate malnutrition. So it can be said that malnutrition is one of the most wide
spread condition affecting on child health 12.
Malnutrition affects the motor, sensory, cognitive and social
development. So, malnourished child will be less likely to benefit from the schooling 3.
Protein energy malnutrition is a widely prevalent form of malnutrition
among children under five year and is still the major problem in our country especially in
urban slums. A child under 5 years represents the vulnerable and vital target group where
malnutrition plays a pivotal role in their mortality and morbidity along with delayed mental
and motor development during important period of brain growth. The various risk factors
identified for undernutrition are related to the child, mother and largely their environment.
In view of the high prevalence of undernutrition, the objective of present study was to
estimate the prevalence of undernutrition among under-five children through
anthropometric measurements13.
At present the global scenario of hunger is 925 million people do not have
enough to eat, of which 98% of the world's hungry people live in developing countries. Out
of 925million hungry people 148 million are under five children, so it can be concluded that
hunger is leading to "food gap" and ultimately malnutrition.
Using the WHO Global Database on Child Growth and Malnutrition, which
covers 87% of the total population of under five year olds in developing countries, they
describes the worldwide distribution of protein energy malnutrition, based on nationally
representative cross- sectional data gathered between 1980 and 1992 in 79 developing
countries in Africa, Asia, Latin and America.
Malnutrition is a "man-made disease" which often starts in the womb and
ends in the tomb. It is a state where in adequate nutrients are not delivered to the sells to
provide the substrate for optimal functioning 14.
 REVIEW OF LITERATURE
The study was conducted by Laxmikant Purohit, Priyanka Sahu, and Lata B.
Godale in 2017. The topic was Nutritional status of under- five children in a city of
Maharashtra: a community based study. The aim and objectives of the study was to assess
prevalence of underweight, stunting and wasting among under-five children, to study
factors associated with underweight, stunting and wasting among under-five children. The
methods of the study were it was community based descriptive cross sectional study
conducted during January 2010 to December 2011 at Urban Health Center of the
Department of Preventive and Social Medicine catering approximately 27000 populations.
650 under-fives residing in urban field practice area were included in the study with the help
of Stratified random sampling technique. The results were 40.46% under five children were
stunted, 38.15% were underweight, and 16% were wasted. Proportion of under-five
children with undernutrition showed significant association with their age, socioeconomic
status, mothers' education. The study was concluded by maternal education of children was
significantly associated with under nutrition. Proportion of children with underweight
increases with decrease in socioeconomic status 15.
The study was conducted by Mohammadinia N, MSc, Sharifi Poor H, MSc,
Rezaei MA, MSc, Heydari Khayat N, and MSc in 2011. The topic was The Prevalence of
Malnutrition among Children under 5 Years old referred to Health Centers in Iranshahr
during 2010-2011.The aim of the study was to estimate the prevalence of malnutrition in
children under 5 years old in Iranshahr in 2011.Materials and methods of the study were
this is a cross sectional descriptive study .The sample consisted of 700 children less than 5
years old were randomly selected by cluster and quota method among health centers .The
child growth was measured based on NCHS-WHO charts .A questionnaire was used for data
collection .Data were analysed by SPSS Ver.18,using chi-square and logistic Regression tests
for comparing groups .The results were prevalence of stunting (height for age ) was 11.1%,
(disorder of growth =7.7%,severe malnutrition =3.4%) ,underweight (weight for age ) was
9.8%(disorder of growth =7%).Malnutrition has significant association with educational level
of parents ,parents' job. The study was concluded by although prevalence of malnutrition in
this study was lower than WHO statistic report, (30%) but this is locally important and
parents must be educated on nutritional value 16.
The study was conducted by Indrapal Ishwarji Meshram, Nimmathota
Arlappa, Nagalla Balakrishna, Kodavanti Mallikharjuna Rao, Avula Laxmaiah, and Ginnela
Nag Veera Brahmam in 2012. The topic was Trends in the prevalence of undernutrition,
nutrient and food intake and predictors of undernutrition among under five year tribal
children in India.The aim of study was to assess trends in nutritional status, nutrient and
food intake among under five year children. The methods used were it was a community
based cross sectional study carried out in tribal areas of India. A total of 14587 children, 0-5
years old were covered for nutritional assessment in terms of underweight, stunting and
wasting. The results were the prevalence of underweight and stunting had declined
significantly over the periods (49% vs 57%, 51% vs 58%, respectively) while the prevalence
of wasting remained similar (22% vs 23%). The risk for underweight and stunting was higher
among children of illiterate mothers and children from lowest and middle households
wealth index.In conclusion,undernutrition is a significant health problem among tribal
children and is associated with literacy status of mothers, household wealth index 17.
The study was conducted by Praveen Ganganahalli, Mahesh B Tondare and Prakash M
Durgawale in 2016. The topic was Nutritional assessment of private primary school children
in western Maharashtra: A cross-sectional study. The aim of study was to know the overall
nutritional status of the children of private primary school. The method was cross-sectional
study conducted among private primary school children from class 1st to 5th were assessed
for nutritional status and their mothers regarding knowledge about nutritious foods. The
results were study showed that 19.9% of private school children were undernourished, 8%
was grade 1st stunted whereas 10.2% were overweight and 5.7% obese. The study was
concluded by every child is a victim for dual burden of Malnutrition irrespective of socio-
economic status18.
The study was conducted by A Mittal, J Singh, and SK Ahluwalia in 2007. The topic was Effect
of maternal factors on nutritional status of 1-5 year old children in urban slum population.
The objective was to study the effect of various maternal factors on the prevalence of
underweight and stunting among 1-5 year old children in urban slum population. The
materials and methods were it was cross-sectional study conducted in urban slum
population. All 1-5 year children living in these slums were included, whose mother's
demographic profile, weight and height were recorded. The results were out of 482 children
who participated in study, 185(38.38%) had low weight for age whereas 222(46.06%) had
low height for age. Prevalence of malnutrition was more where mother's age was less than
20 years. Children of educated mothers were better nourished as compared to illiterate
ones. The conclusion was maternal factors significantly affect a child's nutritional status 19.
Problem Statement:
"Prevalence of undernutrition among under-five children and its association with
educational and occupational status of mothers in an urban area of Karad".
Objectives of the study:
> To find the prevalence of undernutrition among under five children using
anthropometric measurements.
> To assess the educational and occupational status of mothers in an urban area.
> To determine association of undernutrition among under 5 year children with
educational and occupational status of mothers.
Operational definitions:
1) Prevalence:
It refers to the total number of cases suffering with undernutrition among under-five
children in an urban area of Karad.
2) Undernutrition:
It denotes insufficient intake of energy and nutrients to meet an individual's needs to
maintain good health.
3) Association:
It refers to the relation between prevalence of undernutrition and the educational and
occupational status of mothers.
4) Under five children:
In this study under five children refers to the children who are less than 5 years of age and
residing in urban area of Karad.
5) Mother:
A women who are having children in the age group of 0-5 years.
Hypothesis:
H1: There will be a significant association between prevalence of undernutrition among
under-five children and educational and occupational status of mothers.
H2: There will be a significant association between prevalence of undernutrition and their
selected socio-demographic variable.

Assumptions:
The investigator assumes that:

1) The under five children may suffer from undernutrition.

2) The under five children may not suffer from undernutrition.

Variables under the study:

A) Demographic Variable: Educational, occupational status, area of residence number of
under-five year children, previous source of information.
B) Dependent Variable: Prevalence of undernutrition.
Delimitation:
The study is delimited to finding the prevalence of undernutrition among under-five year
children and its association with educational and occupational status of mothers in urban
area of Karad.
Materials of method:

• Source of data:
The data will be collected from under five year children and their mothers residing in an
urban area of Karad.
• Research Design:
As the study aims at finding the association between two variables, prevalence of
undernutrition and educational and occupational status of mothers. Co- relational
design is used for the present study.
• Research Setting:
The present study will be conducted in an urban area of Karad.
• Population:
The study population consisted of children 1-5 Years of age and residing in urban area
of Karad along with their mothers.
• Sample:
A sample consists of subject of units that comprises the population for the present
study.
In the present study sample consists of under-five year children and their mothers
residing in an urban area of Karad.

Method of data collection:

• Sample technique:
Convenient sampling technique will be used to select the under-
five year children.
• Sample size:
In Maharashtra, the prevalence of underweight among under five children was 36%
(National Family Health Survey-4).The optimal sample size was 88 on the basis of 36%
prevalence of underweight children using the following formula, n = Z 2pq / L2 Where n =
sample size
Z = standard normal variable at 95% level of significance = 1.96 P = prevalence of
underweight = 36% q = no underweight rate = 100 - p =64%
L = allowable error = 10% n = (1.96) 2 (36) (64) / (10)2 = 88
For the purpose of the study a sample size of 88 subjects was taken.
• Criteria for sampling :
1. Inclusion criteria for sampling
The study includes the under five children
> Who are available at the time of data collection
> Who are willing to participate in the study
> Mothers of under five children who know the Marathi language 2. Exclusion
criteria for sampling
The study excludes the under five children
> Who are not present at the time of data collection
> Who are not willing to participate in the study
Development of Data Tool:

The tool consist of structured demographic data and the assessment tool of
anthropometric measurement , check list to assess physical signs indicative of
malnutrition are formed to find the prevalence of undernutrition among under five
children.
Validity: Tools will be validated by the experts.

Reliability: Reliability will be done.

Tool for Data Collection:

Section I: Demographic data

Section II: To assess undernutrition of the child - Assessment of

Anthropometric measurement of child - Height, Weight, Mid Arm Circumference,
Chest circumference, Body Mass Index.

Section III: Check list to assess the Physical signs indicative of Malnutrition

Ethical Permission:

• Ethical permission will be taken from the ethical committee of KIMSDU

• The permission will be obtained from the Principal of Nursing College KINS.
• The permission will be taken from the concerned Head master of selected
primary schools of Karad.
Data Collection Procedure:

• After availing permission from the ethical committee of KIMSDU, Principle of

Nursing College KINS, Head master of selected primary schools of Karad the data
collection will be started.
• The parents of under-five children will be informed about study.
• The demographic data collection of child and family will be done using the
interview method by researcher.
Data Analysis:

Data will be organized and analysed by using statistical methods.

• Demographic data will be analysed by frequency and percentage.

• Numerical data obtained from the sample will be organised and summarised with the help
of descriptive statistics like percentage, mean, median and standard deviation.
• Comparison of prevalence of undernutrition among under-five children with educational
and occupational status of mothers will be done by‘t’ test.
• Identification of relationship between the prevalence of undernutrition among under-five
children and educational, occupational status of mothers will be done by chi-square test.

REFERENCE:
1) Park K. Parks Textbook of preventive and social medicine 24TH edition Jabalpur :
Banarsidas Bhanot 2017 page no. 646-78
2) Katsilambros N. Clinical Nutrition in practices 8tH edition New York : John Wiley and
Sons 2011 page no. 37
3) Levels and Trends in Child Malnutrition, World Health Organization and UNICEF
Available from: https://data.unicef.org/resources/joint-child-malnutrition-estimates2017-
edition/
4) Government of India. Children in India 2012- A Statistical Appraisal [Internet]. New
Delhi: Ministry of Statistics and Programme Implementation, Government of India;
September 2012 [cited on 2017 Aug 17]. Available from: http://mospi.nic.in/sites/ default/
files/ publication_reports/Children_in_India_2012-rev.pdf
5) World Bank. Prevalence of underweight, weight for age [Internet]. Washington DC: The
World Bank; 2017 [Cited 2017 Aug 18]. Available from: https://data.worldbank.org/
indicator/ SH.STA.MALN.ZS
6) International Institute for Population Sciences. National Family Health Survey-4 (2015-
16) - India Fact Sheet [Internet]. Mumbai: Ministry of Health and Family Welfare,
Government of India; 2016 [Cited 2017 Aug 21]. Available from:
http://rchiips.org/NFHS/pdf/NFHS4/India.pdf
7) de Onis M, Blossner M, Borghi E, Frongillo EA, Morris R Estimates of global prevalence of
childhood underweight in 1990 and 2015. JAMA.2004;291:2600-6.
8) Progress for children, a report card on Nutrition, Number.4,2006. [cited 2011/1/16];
Available from: www.unicef.org/progress for children/2006n4/.
9) Sachdev HPS.Assessing child malnutrition-some basic issues. Bull Nutr Foundations
India.1995;16:1-5.
10) Benjamin Caballero, Global Patterns of Child Health: The role of Nutrition. Annals
of Nutrition and Metabolism 2002;46 (Suppl.1):3-7
11) Park K Park's Textbook of Preventive and Social Medicine, 20 th edition, Jabalpur :
Banarsidas Bhanot Publishers ; 2009.P.472,800,552
12) Principles of Parenting: Meeting children's needs 1995. Available at : http
://www.aces.edu/pubs/docs/H/HE-0685/
13) Dewey K. Guiding principles for complementary feeding of the breastfed child.
Geneva: World Health Org, 2003.
14) Sreevani R. Malnutrition and mental development. Health Action 2006 Feb ;13-5.
15) Laxmikant Purohit, Priyanka Sahu, and Lata B. Godale International Journal of
Community Medicine and Public Health Purohit L et al. Int J Community Med Public
Health. 2017 Apr;4(4) page no.1171-1178 http://www.ijcmph.com
16) Mohammadinia N, Sharifi Poor H, Rezaei MA, Heydari Khayat N JOHE, Autumn
2012; 1 (3) page no.139 to 149
17) Indrapal Ishwarji Meshram, Nimmathota Arlappa, Nagalla Balakrishna, Kodavanti
Mallikharjuna Rao, Avula Laxmaiah, and Ginnela Nag Veera Brahmam Asia Pac J Clin
Nutr 2012;21 (4) page no.568-576
18) Praveen Ganganahalli, Mahesh B Tondare and Prakash M Durgawale National
Journal of Community Medicine | Volume 7 | Issue 2 | Feb 20161 Available at :
http:www.njcmindia.org, page no.97 to 100
19) A Mittal, J Singh, and SK Ahluwalia Indian Journal of Community Medicine Vol. 32,
No. 4, October 2007, page no.264 to 268
 QUESTIONNAIRE
"Prevalence of undernutrition among under-five children and its association with
educational and occupational status of mothers in an urban area of Karad."

SECTION I: Demographic Data

INSTRUCTIONS:

Kindly read the question carefully and place a tick mark (V) in the most appropriate

choice.

1) Name of the child :-

2) Age:-

3) Sex:-

4) Address:-

5) Name of the guardian:-

6) Type of the family: - a) Nuclear

b) Joint

c) Others

7) Religion: - a) Hindu

b) Muslim

c) Christian

d) Others

8) Diet: - a) Vegetarian diet

b) Mixed diet

9) Occupation of Mother: - a) Housewife

b) Private employee

c) Government employee

d) Self employee
10) Monthly family income (in Rupees) a) Below Rs 10000

b) Rs 10001 to 30000

c) Rs 30001 to 50000

d) Rs 50001 and above

11) Educational status of Mother :-a) No formal education

b) Primary school education

c) Secondary school education

d) Graduation

e) Post graduation

12) Number of children in the family: - a) One

b) Two

c) Three

d) Four or more

13) Number of under-five children in the family: - a) One

b) Two

c) Three

d) Four or more

14) Immunisation status of children: - a) Completely immunised

b) Partially immunised

c) Not immunised

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Section II: To assess undernutrition of the
child- Assessment of Anthropometric
measurement of child - Height, Weight, Mid Arm
Circumference, Chest circumference, Body Mass
Index.

Age of the Child :-

Gender-

Anthropometric Data
Measurement Reading

Height (cm)
Weight (kg)
Mid-arm circumference (cm)
Chest circumference (cm)
Body Mass Index (cm)

Weight for Age (%) =Weight of the child / Weight of normal child of same age x 100

If, weight for age is: >90% = Normal nutritional status 76-90% = 1 st degree

malnutrition 61-75% = 2nd degree malnutrition < 60% = 3rd degree malnutrition

Height for Age (%) =Height of the child / Height of normal child of same age x 100

If, height for age is: >95% = Normal

90-95% = Mild malnutrition 85-90% = Moderate malnutrition

< 85% = Severe malnutrition

 Body Mass Index = Weight (KG) / Height (m) 2

Section III: Check list to assess,

Physical signs indicative of Malnutrition
Body Area Normal Appearance Signs Associated with Malnutrition
Whether Malnutrition
present or absent in child
Hair Shiny, firm, not easily Lack of natural shine, dull and dry, thin
plucked and spare, easily plucked
Face Lumpiness, flakiness of skin, swollen,
Skin colour uniform, scaling of skin around nostrils
smooth, healthy
appearance, not swollen
Eyes Pale conjunctivae, redness of eyelids,
Bright, clear, shiny, no bitot's spots, redness and moist, dryness
sores at corners, pale of eye, dull appearance, soft cornea,scar
eye membrane, redness on cornea
Lips Redness and swelling of mouth or lips
Smooth, not chapped, especially at corners of mouth
not swollen or swelling,
scarlet and raw tongue,
smooth tongue
Teeth No cavities, no pain
May be missing or erupting abnormally,
grey or black spots, cavities
Nails Firm, pink Nails are spoon-shaped, brittle, ridged
nails
LETTER SEEKING CONSENT FROM THE PARTICIPANT

Dear participant,
I am the student of 3rd year Basic BSC Nursing at Krishna Institute of
Nursing Sciences, Karad. As a part of my curriculum I am doing the Research on "Prevalence
of undernutrition among under-five children and its association with educational and
occupational status of mothers in an urban area of Karad".
Here with we seek your consent for willing participant in this study. If you
consent for the same you will be required to answer questions of demographic data and fill
of form of your personal data which will be coded to secure your identity and we assure you
that your answer will be kept confidential and used for only research purpose.
Thanking You.

Yours sincerely,

Jadhav Aishwarya

Krishna Institute of Nursing Sciences

Karad

Date:

Place: Karad

I undersigned consent to willingly participate in this study.

Signature of the participant:
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