INTRODUCTION

“It shall be the policy of the state to provide services to children both before &
after birth, to ensure their physical, mental & 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”.

Children are the most important segments of a nation for the optimal physical,
mental, emotional development of its future worthy citizens. A nation’s health depends
on the healthy citizens. A healthy adult emerges from a healthy child. (National Journal
of Community Medicine, Volume 4, 2013)

Malnutrition continues to be a primary cause of ill health & mortality among

children in developing countries. It is a major health problem & accounts for about half
of all child deaths worldwide. About 150million children in developing countries are still
malnourished & more than half of underweight children live in south east Asia region.
The high levels of under nutrition in children in south east Asia pose a major problem
for child survival & development. (Rohilkhand Medical College & Hospital, Bareilly, U.P,
India- 2011)

Nutrition of the under five children is of paramount importance because the

foundation of our lifetime health, strength, vitality, intelligence & vitality is laid during
this period. (Datta Parul -2010)

Good nutrition is the fundamental basic right for the maintenance of positive
health. A proper diet is essential from early stage of life, children below age of 5 year
constitute over 20% of our population & also form a most vulnerable group. The
foundation of good health & sound mind are laid during this period of life. (National
Journal of Community Medicine - 2013)

Malnutrition is the condition that results primarily due to an inadequate amount

of food both in quantity & quality & also due to presence of infections specially Ari,
measles & worm infestation. Nutritional problems like malnutrition, anemia, vitamin A
deficiency, iodine deficiency, & obesity continues to plague large proportion of under
five children in India. ( Datta Parul – 2010 )

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 India is a home to 40% of world’s malnourished childrern 35% of developing
world low birth infants(IFPRI -2008). Every year 2 million children in India (UNICEF -
2009), accounting for one in five children death in the world.

Children are future of society & mothers are guardian of that future, knowledge
of mothers has an important role in the maintenance of nutritional status of the
children, hence, To secure the future of society, health & needs of their children is
utmost importance.( National Journal of Community Medicine – 2013 )

NEED OF THE STUDY:-

“prevention is better than cure”. (Renusood,1993)

Nutrition is an input to & foundation for health & development. Better nutrition
means stronger immune system which means less illness & better health. Healthy
children learn better. Healthy people are stronger, are more productive % are more able
to create opportunities to gradually break the cycles of poverty & hunger in a
sustainable way. Better nutrition is a prime entry point to ending poverty & a milestone
for achieving better quality of life. (Ponnu Thomas - 2012)

A child’s nutritional intake can have a great impact on their growth &
development as well as long term & short term health. A healthy balanced diet
containing adequate amount of nutrient & energy is essential for normal growth &
development & mental well being of children.(Theo bald Hannah,2007)

Balanced & sufficient nutritional intake is most essential for children to promote
growth & development, to protect & maintain health, to prevent nutritional deficiency
conditions and to prevent nutritional deficiency conditions and to reserve for starvation
& dietary stress.(Datta parul-2010)

The science of human nutrition is mainly concerned with defining the nutritional
requirements for promotion, protection & maintenance of health in all groups of
population.(park. K-2013)

Young children are active and grow rapidly required higher energy requirement
than adult. Achieving such higher energy requirement can be challenge for them as they
have small appetites. The food is essential to help the children to meet their health
needs.(Theo bald Hannah- 2007)

Globally child growth and health is recognized as an important indicator for

monitoring nutritional status and health in a population. Despite having enough food we

2
are unable to feed every child in the world and unfortunately many are left to die due
to hunger.( save the children, London-2012 )

Malnutrition is a disease created by relative or absolute deficiency or excess of

one or more nutrients. Malnutrition is a man made disease. This is a universal problem.
A large part of world population is suffering from malnutrition. Its major victims a
pregnant and lactating woman and children.( Swarnakar K.- 2010 )

Malnutrition has been defined as a “ pathological state resulting from a relative

or absolute deficiency or excess of one or more essential nutrients”. (Datta parul- 2010)

Malnutrition has been defined as the effect on the body due to insufficient
intake of energy, protein & other nutrients. Malnutrition is the most wide spread
condition affecting the health of children. (Nandaprakash. P., 2008, park. K., 2013)

In world nearly 870 million people suffers from malnutrition (UNNEWS- 2012)
9OCT-2012- almost 870 million people, one in eight suffering from chronic malnutrition.
This shows a sharp decline in the number of under nourished people over the past two
decades. (UNNEWS- 2012)

In India under five mortality rate is 56 million in 2012 where as under five
mortality rate is 126 million in 1990 which shows a gradual decline in under five
mortality. million where as neonatal mortality rate in 2012 is 31 million, infant mortality
rate in 2012 is 44 million where as infant mortality rate in 1990 is 88 million which
shows gradual decline in mortality rate but still need more attention.( UNICEF -2012 )

In India, annually it is estimated that about 1-83 million children die before
completing their fifth birthday. Currently IMR(<1 yr) is 69.50, out of 1000 infants die in
first year of their life. (sps bulle tm 2011).India contributes to about 5.6 million child
deaths everywhere. ( FAO STATITICS -2011 )

The worst performing state with more than 50% children under weight are
M.P(60%), Jharkhand(56.5%), Bihar(55.9%) (CENSUS- 2011)

Under five mortality rate in Orissa is 37.5%. maximum IMR in kandhamal &
minimum IMR in Balasore & Jharsugurah. (CENSUS-2011)

According to NFHS ,45% of under five children are stunted indicating malnutrition
while 20% are wasted taking both chronic & acute malnutrition, 40% of children are
among under five are under weight. (NFHS)

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 In India IMR is came down but is still higher in comparison to the developd
countries. It has been observed that in the last 5 to 6 yrs, the IMR has almost
stagnated.In odisha, ganjam district has prevalence of child mortality comparatively high.

Malnutrition is a “man made disease” which often starts at 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. ( Thomas Ponnu , 2012 )

Malnutrition is primarily due to dietary deficiency & secondarily due to disease

condition and malabsorption of food.( park. K.,2013 )

Malnutrition is primarily due to an inadequate intake of food both in quantity &

quality. Infections, especially ARI, diarrhea, measles, worm infestations lead to the
condition which increase in requirements for calories, proteins and other nutrients while
decreasing their absorption and utilization are considered as important cause of
malnutrition. ( Datta Parul - 2010 )

Malnutrition is inversely linked to father’s income, maternal occupation, mother’s

increased decision making power, better access to health care and higher house hold
income. Child malnutrition is strongly associated with house hold poverty. ( Firestone et
al, 2011)

Diarrheal diseases and poor dietary intakes are the principal causes of growth
failure in early childhood which proves that environmental factors like poverty and not
genetic or racial ancestry account f or most of the cause of malnutrition. ( Martorell
,2010 )

Besides poverty there are other factors that directly or indirectly affect the
nutritional status of children. Several studies showed that maternal education emerges as
a key element of an overall strategy to address malnutrition. ( Rohilkhand Medical
College & Hospital, Bareilly, U.P , India , 2011 )

Malnutrition makes the child more susceptible to infection, recovery is slower,

and mortality is higher, under nourished children don’t grow to their full potential of
physical & mental abilities. Malnutrition in childhood leads to stunted growth. ( Park. K.
– 2013 )

Under nourished children have lowered resistance to infection. They are more
likely to die from common childhood ailment like diarrheal diseases and respiratory

4
infections those who survive frequent illness saps their nutritional status & lacking them
to vicious of recurring sickness & faltering growth. ( CARE, 2005 )

Children with severe malnutrition are prone to suffer from acute recurrent
infections, oral thrush, septicem ia, and tuberculosis. They are unable to maintain body
temperature and may develop severe hypothermia, hypoglycemia and electrolyte &
other micronutrient deficiencies. ( Joshi M.C., 2011 )

Children with severe malnutrition develop acute complications like systematic or

local infections, severe dehydration, shock, dyselectrolytemia, hypoglycemia, CCF, bleeding
disorders, hepatic dysfunctions, sudden infant death syndrome & convulsions etc. & long
term complication like cachexia, growth retardation, mental subnormal ties, visual &
learning disabilities etc. ( Datta Parul , 2010 )

For prevention of malnutrition large scale programmes were initiated by

government. ICDS is a programme which was launched on 2nd October,1975. Though the
ICDS programme increases it’s beneficiaries in large number, the achievement not
satisfactory. ( Park .K.2013 )

Malnutrition can be prevented in primary level by health promotion measures

such as improvement of health of pre pregnant state, pregnant mothers, & lactating
mothers, by promoting exclusive breast feeding for 4 to 6 months, appropriate weaning
practices, nutrition education & nutrition counseling, birth spacing & regulating family
size, provision of nutrition supplementation from ICDS centers & schools. Other
measures include specific protection, early diagnosis, treatment, rehabilitation. (
Datta Parul - 2010 )

Malnutrition can be prevented by nutrition education, modification &

improvement of dietary intake before, during, & after pregnancy, supplementation of
diet, distribution of iron & folic acid tablets. Other measures include environmental
sanitation, safe water supply, food & personal hygiene, immunization, treatment of
minor ailments & health education. ( Gulani K.K - 2005 )

The health of the child depends upon the knowledge of mother, if mothers are
educated, malnutrition can be controlled to some extent. Health education has become
the most important tool in community health which informs, motivates, & helps people
to adopt & maintain the healthy practices & life styles. ( Ponnu Thomas – 2012 )

Nandaprakash.P (2008) found from survey that 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

5
focus on changing current knowledge, attitude & practice. This could improve the long
term health status of people in the communities.

Mishra . Rsk. et. al.(2011), conducted a study on knowledge of mothers regarding

prevention of malnutrition & found that mothers had very poor knowledge regarding
prevention of malnutrition.

Awareness of mothers on her own child care is essential for normal growth,
development & survival. Hence the investigator is interested to assess the mother’s
knowledge on prevention of malnutrition.

STATEMENT OF THE PROBLEM:-

“A study to assess the knowledge of underfive mothers regarding prevention of
malnutrition among under five children in a selected community of Ankuli, Berhampur,
Ganjam, Odisha.”

OBJECTIVES:-
 To assess the knowledge of underfive mothers regarding prevention of
malnutrition among under five children.
 To find out the association of knowledge score of under five mothers
regarding prevention of malnutrition with their demographic variables.

HYPOTHESIS:-
There will be no significant association between knowledge score of underfive
mothers with their selected demographic variables.

ASSUMPTION:-
The study assumes that-

 The data collected from under five mothers are true.

 The researcher will get proper co-operation from the study sample.
 Mother knowledge can be measured by structured questionnaire.

LIMITATION:-

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  The study is limited with in time period.
 The study is limited to only under five mothers who are-
 Residents of Ankuli, Berhampur, Ganjam.
 Present during period of data collection.
 Able to read and write Odia.
 Willing to participate

OPERATIONAL DEFINITION:-
1) Assess:- statistical measurement of knowledge on prevention of
malnutrition among mothers of under five.

2) Knowledge:- refers to correct responses of mother of under five children

regarding prevention of malnutrition.

3) Mother:- A biological mother with one or more under five children.

4) Prevention:- refers to action taken to arrest the occurrence of nutritional

deficiencies disorder & early detection & treatment.

5) Malnutrition:- malnutrition has been defined as pathological state resulting

from relative or absolute deficiency or excess of one or more essential
nutrients.

SUMMARY:-
This chapter consists of introduction, need for the study, problem statement,
objective, assumption, limitation and operational definition.

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 REVIEW OF LITERATURE
This chapter deals with selected studies which are related to the objectives of
the proposed study. A literature review is written summary of the state of existing
knowledge of a research problem. The term literature review is defined as a broad,
comprehensive, in depth, systematic and critical review of scholarly publications,
unpublished printed or audio visual materials and personal communication.
( Sharma S. K. - 2005 )

The researcher reviews the research literature to develop research ideas, to

determine knowledge on a topic of interest, to provide a context for the study & to
justify the need for the study, consumers review & synthesize evidence based
information to gain knowledge & improve nursing practice. ( Sangaraju Siddama - 2008 )

The researcher presents the review of related literature which helps to study the
problem in depth. It also serves as a valuable guide to understand what has been done
& what is still unknown & untested. ( Nandaprakash p., 2008 )

The literature relevant for this study has been organized in the following sequence.

 Importance of nutrition among under fives

 Concept of malnutrition
 Morbidity & mortality of malnutrition among under five in
1. World
2. India
3. Odisha
 Factors related to malnutrition
 Effects of malnutrition among under five
 Prevention of malnutrition
 Role of mother in prevention of malnutrition
 Knowledge of mother regarding prevention of malnutrition among under fives
 Role of nurse in prevention of malnutrition among under fives

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IMPORTANCE OF NUTRITION AMONG UNDER FIVES:-
Childhood is a vital period of socialization process, that is transmission of
attitudes, customs & behavior. They are vulnerable to disease, death & disability owing
to their age, sex, place of living, socio-economic class & host of other variables. Certain
specific biological & psychological needs must be met to ensure the survival & healthy
development of the child & future adult. ( Shibulal A. , 2013 )

Rai saritha ( 2000 ) reported that provision of nutritional services is a component

of India’s national policy for children & all individual’s governmental & non-
governmental organizations are charged with the responsibility of child health & care.

According to national policy for children (1974), “ It shall be the policy of the
state to provide adequate services to children both before & after birth & through the
period of growth, to ensure their full physical, mental & 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 condition for their balanced growth”.

Balanced & sufficient nutritional intake is most essential for children to promote
optimal growth & development, to protect & maintain health, to prevent nutritional
deficiency conditions and various illness & to reserve for starvation & dietary stress. (
Datta Parul – 2013 )

Good nutrition is fundamental requirement for positive health, functional

deficiency & productivity. Nutritional status is internationally recognized as an indicator
of national development. ( Mitrashree et al, 2006 )

Good nutrition is essential for physical growth & development, intellectual

development & for learning & behavior development. Good nutrition is essential for
maintaining life. It is one of the main objectives of good nutrition for children to
promote optimal growth & development. ( Jeena Chacko, 2013 & Maryes George,2013)

UNICEF – 2012, shows that breast feeding can reduce rates of malnutrition &
mortality in children & educational programmes for mothers could have a large impact
on these rates.

A child’s nutritional intake can have a great impact on their growth &
development as well as both their short & long term health. A healthy balanced &
varied diet containing adequate amounts of nutrients & energy, coupled with sufficient

9
physical activity is essential for normal well being, growth & development of children.
Young children are active & grow rapidly which require higher energy requirement than
adults. ( Theobald Hannah, 2007 )

Nutrition of under five children is very important because foundation for life time
strength & vitality is laid during that period. Malnutrition during that period of early
growth can lead not only stunting of optimal growth but also sub optimal development
and poor neuro integration competence in children. ( Shah d, Sahdev, 2008 )

Nutrition has a global role to promote physical growth, enhance neuromotor

development, boost host defence to wards common day to day infection. ( Singh
Meherban, 2009 )

Good nutrition has a fundamental requirement for positive health & productivity.
Nutritional status is internationally recognized as an indicator of national development.
Nutrition is both input & output of the development process.

CONCEPT OF MALNUTRITION:-
Malnutrition is a syndrome was 1st described in Europe in 1906 by czorney &
killer as “MEHLNARSHADEN” or starchy dystrophy. Subsequently NORMET (1986) in
France and Dnodchina, PROCTOR (1927) in east Africa, WILLIAMS (1932,33,40) in west
Africa & payne ( 1933 ) have thrown further light on malnutrition.

Malnutrition has been defined as a “ pathological state resulting from a relative

or absolute deficiency or excess of one or more nutrients”. It comprises four forms
under nutrition, over nutrition, imbalance & the specific deficiency. ( Datta Parul - 2010 )

Globally, hunger & malnutrition are two of the most significant challenges. well
nourished healthy workforce is a precondition for successful economic & social
development. ( Strobe & Ferguson – 2011 )

Nutritional status of children today reflect a health productive generation in

future. Especially for under five children nutritional condition is a critical factor for
optimal growth. It should neither inadequate nor excessive. Improve nutrition & health
enhance learning abilities of children. ( Chavez Adolpo. et al, 2008 )

Under five children who are malnourished require special attention. The
nutritional status of under five children is a sensitive indicator of country’s health status
as well as economic condition. ( Ravan Israt, 2008)

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 Globally, malnutrition is a risk factor for illness & death, with millions of pregnant
women & young children being affected due to infections, poor & inadequate diet.
Malnutrition increases the risk & worsens the severity of infections. ( Muller & Krawinkel
- 2011 )

Infants & young children are most affected by malnutrition as they have
increased nutritional needs to support growth. Under nourished children, as well as
children with severe malnutrition, have a higher risk of dying than children with an
optimal nutritional status. ( Caulified et al – 2011, Torun & Chew - 2009 )

MORBIDITY & MORTALITY OF MALNUTRITION:-

“Malnutrition is a daunting problem for India’s spectacular growth”.

In the global concern for health, of health for all, promotion of proper nutrition
was one of the 8 element of Primary health Care. Mother’s literacy has a much higher
impact than father’s literacy on better nutritional status of children. Low birth weight,
higher birth order, faulty feeding habit have adverse effect on nutritional status of
children.

Malnutrition is the principal cause of the child’s mortality & morbidity. Half of all
children’s death should be tackled by preventing malnutrition. Children’s are the future
of the country & mothers are their guardian. Almost 11 million children will die before
the age of five, 4 million of them in the 1st month of life & large no. of them would
be prevented by promoting their good health. ( Indian Journal of Clinical practice – 2013 )

India where everything is in a large scale there malnutrition is in a daunting. An

estimated 200 million children are underweight at any given time with more than 6
million of those children suffering from the worst form of malnutrition. ( Indian Journal
of clinical practice – 2013 )

Expert of severe acute malnutrition estimated that malnutrition constitutes over

22% of India’s disease burden making malnutrition one of the nation’s largest health
threat. Prevalence of clinical malnutrition is found in the form of marasmus is found to
more than kwashiorkor.

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 On September 2013, UNICEF, WHO & the WORLD BANK updated their joint data
base on child malnutrition & released data base regarding stunting, underweight & over
weight globally.

Under 5 2000 2012 Prevalence 2000 2012 Global 2000 2012

children (million) (million) Of (%) (%) burden (million) (million)
suffering children due to
with suffering
with
Stunting - 162 stunting 33 25 stunting 197 62
Under - 99 Under 25 15 Under - -
weight weight weight
Wasting - 51 wasting - - wasting - -
Severe - 17 Severe - - Severe - -
wasting wasting wasting
Over - 44 Over 5 7 Over 32 40
weight weight weight

(TABLE - 1.1)

( JOINT DATA BASE OF WHO, UNICEF & WORLD BANK – 2013 )

In 2012, 56% all stunted children live in Asia, 36% in Africa, 67% of all
underweight children live in Asia, 29% in Africa. Over weight prevalence was highest in
southern Africa(18%), central Asia(12%) & southern America(7%).

According to UNICEF statistics mortality rate are-

UNDER FIVE UNDER FIVE UNDER FIVE INFANT NEONATAL
MORTALITY MORTALITY MORTALITY MORTALITY MORTALITY
RATE(TOTAL) RATE(MALE) RATE(FEMALE) RATE RATE
2012 56 54 59 44 31

(UNICEF STATISTICS - 2012 )

( TABLE - 1.2 )

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 There were 925 million people under nourished people in world in 2010, an
increase of 80 million since 1990.

Number of under nourished globally-

YEAR 1970 1980 1990 1995 2005 2007/2008
NUMBER - - 843 788 848 923
( MILLIONS )
PERCENAGE 37 28 20 - 16 17
IN
DEVELOPING
WORLD

( UNITED NATION STATISTICS-2010 )

(TABLE - 1.3)

Prevalence of malnutrition in states of India:-

STATE PREVALENCE OF MALNUTRITION

Bihar 70
U.P 66
M.P 63
Maharashtra 61
West Bengal 61
Odisha 40.4
Manipur 34
Kerala 32
Nagaland 32

( TABLE – 1.4 )

( UNICEF REGIONAL – 2011 )

According to the report, children in 2012, 48% of children under age of 5 years
are stunted ( too short for their age ) which indicate half of the country’s children are
chronically malnourished.

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 The report says that malnutrition is higher among children whose mothers are
uneducated or have less than 5 years of education. ( Children in 2012 )

The worst performing states with underweight children under 5 years of age are
M.P (60%), Jharkhand (56.5%) & Bihar (55.9%).

Under five mortality according to states:-

India has the world’s highest percentage of under five deaths, estimated in 2009.

STATE U5MR
U.P 94
M.P 89
Odisha 82
Assam 77
Bihar 78

(AHS- 2011 & CENSUS-2011)

( TABLE – 1.5 )

According to AHS-2011 & CENSUS-2011 9 high focus states of india in

malnutrition are Bihar, Chhattisgarh, Jharkhand, M.P, Odisha, Uttarkhand, U.P, Punjab,
Assam .

Nutritional status of children( < 5 yr), NFHS -3 ( 2005 – 2011 )

MALE FEMALE
% children stunted 48.1 48
( wt. for age )
% children wasted 20.5 19.1
( wt. For ht.)
% children under wt. 41.9 43.1
( wt. For age)

(TABLE – 1.6 )

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FACTORS RELATED TO MALNUTRITION:-
Malnutrition is primarily due to dietary deficiency & secondarily due to disease
condition and malabsorption of food. ( PARK. K. – 2013 )

Malnutrition is a “ man made disease” which often starts at the womb & ends in
the tomb. Malnutrition is defined by any nutritional disorder caused by an insufficiency,
unbalanced or excessive diet or impaired absorption or assimilation of nutrients by the
body. ( Thomas Ponnu – 2012 )

The causes of malnutrition are primarily due to dietary deficiency, secondarily due
to disease condition & mal absorption and other causes are ignorance, bad economy,
lack of immunization, beliefs, customs, unhygienic practices, superstition, large families &
population explosion. ( Gupta Suraj – 2010 )

The lack of food is not the sole cause of malnutrition. Lack of awareness and
knowledge about feeding amount, frequency, type of food etc. contributes significantly
to poor nutritional status among children even in families where adults meet their daily
requirements. ( Singh Arun – 2010 )

Malnutrition is the wide spread condition affecting the health of the children.
Scarcity of suitable foods, lack of purchasing power of the family as well as traditional
beliefs and taboos about what the baby should eat often lead to an insufficient
balanced diet, resulting in malnutrition. ( Wammanda R.D – 2009 )

Malnutrition is one of the leading cause of morbidity and mortality among under
five children. Risk factors for severe malnutrition are ignorance, family size, parent’s
education, poverty, residence, sex of the child & incomplete immunization were risk
factors of malnutrition. ( Joshi HS – 2010 )

K. Park(2013) stated that factors responsible for malnutrition are biological factors
such as stress, age, rate of growth, food intake, socio-cultural & ethnic back ground,
psychological factors such as anger & insecurity & environmental factors such as in
convenience, & environmental harm. A number of ecological factors influencing
malnutrition are infectious diseases such as diarrhea, intestinal parasites, measles,
whooping cough, malaria, T.B, cultural influences, poverty & lack of knowledge regarding
nutritive value of food, inadequate sanitary environment, large family size etc.

Ghai O.P.(2013) stated that the factors responsible for malnutrition are poverty,
low birth weight, infections, population growth means increase in birth rate, lack of
exclusive breast feeding, delayed weaning, introduction of artificial feeding & social

15
factors such as related pregnancies, inadequate child spacing, food taboos, broken homes
& separation of a child from his parents etc.

Gulani K.K.(2005) stated that malnutrition is primarily due to insufficient &

imbalanced diet & other causes are poverty & repeated infections like diarrhea, measles
etc.

Malnutrition continues to be a major health problem in world today. Lack of food

however is not always the primary cause of malnutrition. In many developing countries
diarrhea is the major factor, another factors are bottle feeding, poor sanitary conditions,
parental illiteracy, economic & political factors. ( Trowell et al – 2008 )

The etiology of malnutrition are primarily failure of lactation, improper weaning

practice, poverty, food taboos, incompetent & ignorant mother, lack of family planning &
secondarily lack of immunization, congenital diseases, mal absorption, metabolic & inborn
errors of metabolism & infections. ( Gorstein et al – 2008 )

Parthasarathy (2009), the familial causes of malnutrition are maternal illiteracy,

poor knowledge of child rearing, abrupt or early weaning, poverty, poor living & sanitary
condition, unemployment & alcoholism. The community causes are poverty, poor
educational status, inadequate medical facilities, cultural practices & beliefs, natural &
man made disease.The community & national causes have direct impact on the family &
individual child. Thus malnutrition is an end result of many ecological problem.

EFFECTS OF MALNUTRITION AMONG UNDER FIVES:-

Malnutrition makes the child more susceptible to infection, recovery is slower &
mortality is higher. Under nourished children do not grow to their full potential of
physical & mental abilities. It also leads to stunted growth. Malnutrition manifests the
clinical signs of micro nutrient & vitamin deficiencies. ( Park.K.-2013 )

Malnutrition cause different vitamin & mineral deficiency diseases like scurvy &
rickets etc., higher infant mortality rate, stunted growth, & improper development of
children, reduction of expectancy of life, reduced working capacity of person create
different diseases like kwashiorkor, marasmus, xerophthalmia, nutritional anemia & goiter
etc. ( Swarnakar K. – 2011 )

Malnutrition mainly causes nutritional marasmus & kwashiorkor. Marasmus is

characterized by gross wasting of muscle & subcutaneous tissue resulting in emaciation,

16
marked stunting & no edema & kwashiorkor is characterized by retarded growth,
psychomotor changes, edema, hepatomegaly, hair becomes thin, dry, brittle, easily
pluckable, sparse & skin shows erythema, hyper pigmentation, petechiae & ecchymosis
appear & children suffer from recurrent episodes of infection. ( Ghai O.P.-2013 )

Malnutrition causes impaired physical growth & development, increase morbidity

& mortality, impaired cognitive development & prone to different types of diseases.
Malnutrition causes decreased skeletal muscle infection, decreased gastro intestinal
function, decreased immune function & poor wound healing & increased morbidity &
mortality. Malnutrition causes stunting, overweight & under weight, impaired child
growth & development, diseases such as marasmus & kwashiorkor. ( Thomas Ponnu –
2012 , Shibulal A.-2013 )

Malnutrition increases the risk of infection & infectious disease and moderate
malnutrition weakens every part of the immune system. For example, it a major risk
factor in the onset of active tuberculosis, protein & energy malnutrition & deficiencies of
specific micro nutrients ( including Iron, Zinc and Vitamins ) increase susceptibility to
infection. Malnutrition affects HIV transmission by increasing the risk of transmission
from mother to child and also increasing replication of the virus. In communities or
areas that lack access to safe drinking water, these additional health risks present a
critical problem. ( Stiwaggon, Ellen – 2008 )

Malnutrition leads to impaired growth, deficiency of specific nutrients(iodine, vit.A,

iron &zinc ), diarrhea & other infectious disease. Under nutrition in childhood linked to
slower cognitive development & serious health impairement later in life that reduce the
quality of life & also the economic productivity of people. ( Saiton et al – 2009 )

Malnutrition affects the child more susceptible to infection, recovery is slower &
mortality is higher. Under nourished children don’t grow to their full potential for
physical & mental ability. Malnutrition in infancy and childhood leads to stunted growth.
It also manifest by clinical sign of micronutrient & vitamin deficiencies, oral thrush &
tuberculosis. Malnutrition leads to different types of complications such as hypoglycemia,
hypothermia, infections which leads to septicemia, dehydration & electrolyte imbalance,
CCF, severe anemia, convulsion, tremor, vitamin & mineral deficiency. ( Basvanthappa –
2008 )

17
PREVENTION OF MALNUTRITION:-
The prevention of malnutrition mainly depends upon the measures taken to
improving nutritional status of mother & children. It can be prevented in primarily level
by health promotion & good nutrition diet of pregnant & nursing mothers, promotion of
exclusive breast feeding up to 6 months, appropriate weaning practices & necessary
nutritional supplementations, nutrition education & nutrition counseling, improvement of
home economics, birth spacing, family planning, promotion of educational status of
woman, implementation of nutritional programmes, environmental sanitation and
immunization. other measures include early diagnosis, correction of malnutrition by
regular weight monitoring, detection of deviation from normal, early detection &
treatment of communicable diseases, deworming children, health education to the
parent & other family members. ( Datta parul-2010, Gulani K.K-2005, Park.K-2013 )

Antenatal care and diet:-

Antenatal care is the care of woman during pregnancy. The care of the baby should
be started from during fetus. Frequent contact with mother, improving her knowledge &
motivating her to the service available can her to achieve healthy baby. Lack of
antenatal care leads to low birth weight baby leads to malnutrition. ( Dutta D.C – 2010 )

Antenatal diet is an adequate diet which includes all types of calorie, proteins,
vitamins & minerals with required amount. ( Dutta D.C – 2010 )

Antenatal diet should be nutritious yet digestible. Antenatal foods should be rich in
protein & consumption of milk, green leafy vegetables & fruits should be increased
during pregnancy. Antenatal foods should be according to the likes & dislikes of a
pregnant woman. ( Swarnakar K. – 2011)

Nutrition education is one of the most drivers food security and dietary drivers
fixation. Nutrition programmes are effective by using mass media. The pregnant woman
must get two doses of tetanus toxoid during 16-36 wks. ( Gulani K.K – 2005 )

Breast feeding:-
Breast feeding is the best natural feeding & breast milk is the best milk. The basic
food of infant is mother’s milk. It is perfect food for infants and providesand provides

18
total nutrient requirement for the first six months of life. It prevents malnutrition &
allow the child to develop fully. ( Datta Parul – 2010 )

Breast milk contains all types nutrients which are essential for normal growth &
development of child up to six months of age and should continue up to at least 2
years of child. It also provides high immune power which can protect the child from
many diseases. So, it is important for the mother to give breast feeding to the baby
soon after birth and continue it exclusively for six months which will prevent
malnutrition later life. ( Gulani K.K – 2005, Park.K – 2013 )

Although exclusive breast feeding prevent malnutrition in large scale, but many
mothers not practicing exclusive breast feeding & colostrum feeding till now. So
improvement of knowledge of mothers is utmost important in prevention of
malnutrition. ( Thomas Ponnu – 2012 )

Weaning:-
Breast feeding alone is adequate & sufficient to maintain optimum growth &
development of an infant up to the age of 4 to 6 months. It is therefore, necessary to
introduce more concentrated energy riched nutritional supplements by this age. Infants
also required iron containing food supplements after this age to prevent iron deficiency
anemia.

Weaning or complementary feeding is the process of gradual & progressive

transfer of the baby from the breast feeding to usual family diet. Weaning does not
mean discontinuity of breast feeding, weaning foods are given in addition of breast feed
when the amount of breast feeding is inadequate.

The weaning food should be-

 Liquid at starting then semisolid & solid foods to be introduced gradually.

 Clean, fresh & hygienic, so that no infections can occur.
 Easy to prepare at home with the available food items & not costly.
 Easily digestible, easily acceptable & palatable for infants.
 High in energy density and low in bulk viscosity & contains all nutrients
necessary for the baby.
 Based on cultural practices & traditional beliefs.

( Datta Parul – 2010 )

19
 Weaning is the gradual withdrawal of the child from the breast. Weaning is to
motivate the child to accept normal feed in place of breast milk. Initially supplementary
feed should be given in small amounts, it should be gradually increased, at a time only
one new food item should be introduced, supplementary feeding should be given in
order i.e. first liquid, then semisolid & last solid form. Food should according to child’s
likes & dislikes. ( Swarnakar K. – 2011 )

Food hygiene:-
Food hygiene refers to cleanliness from production to consumption of food. It is
necessary to observe “food clean chain” under which management is done to keep food
free from contamination & infection during its production, storage, transportation,
preservation, cooking, serving or consumption. Personal hygiene should be observed
while serving & consuming food. ( Swarnakar K. – 2011 )

Food is a potential source of infection & is liable to contamination by micro-

organisms, at any point during its journey from the producer to the consumer. Food
hygiene, in its widest sense, implies hygiene in the production, handling, distribution &
serving of all types of food. The primary aim of food hygiene is to prevent food
poisoning & other food borne illnesses. ( Park K. – 2013 )

Mother has a vital role in maintenance of food hygiene. Mother has to take
care while purchasing & handling vegetables. Care should be provided to buy fresh
vegetables. Avoid purchasing rotten foods or foods with colour change. During cooking
all vegetables and fruits should be washed thoroughly prior to cut and it should be
boiled under the cover. Always use clean article for cooking. Hands should be washed
thoroughly with soap and water before cooking and feeding to children, the baby
utensils should be boil by deeping in hot water, cooked warm food should be provided,
left out food should not use again. Attention should given to wash the child’s hands
before feeding. ( Park K. – 2013 )

Weight monitoring:-
Regular weight checking & comparison to the normal standard helps to identify
the degree of malnutrition. The weight checking can be done in nearer hospitals, PHC,
sub center or Anganwadies. ( Datta Parul – 2010 )

20
 Normally every month the weight of the child during first year and later weight
can be recorded at three times interval, doctor should be consulted when the child
weight is reducing without any reason weight is static for continuously for 3 months or
any continuous illness.

Prevention & management of communicable diseases:-

The communicable diseases which include diarrhea, acute respiratory infections,
& worm infestations can be prevented by promotion of environment sanitation which
include safe water supply, safe disposal of excreta, avoid open field defecation, using
sanitary latrine, maintainance of food hygiene, immunization & promotion of exclusive
breast feeding. ( Swarnakar K. – 2011 )

Worm infestation:-
Worm infestation is a major threat to children now a days. Worm infestation
causes pain abdomen, abdominal distension, nausea, cough, loss of weight, growth
failure, anemia, vitamin deficiencies all of these lead to malnutrition.

Worm infestation can be prevented primarily by sanitary disposal of human

excreta, reduction of fecal contamination of the soil, provision of safe drinking water,
food hygiene, good personal hygiene, improving habits of handwashing before eating &
after defecation, avoidance of open field defecation & secondarily by effective drug
therapy of human reservoir & mass treatment with periodic dewarming at interval of 2
to 3 months. ( Datta Parul – 2010 )

Nutritional programmes:-
Government of India launched a number of programme to improve health status
of under fives.

Special nutrition programme:-

This programme was started in 1970-71 for children under 6 years of age,
pregnant & lactating mothers. Under this, the beneficiaries are given supplementary

21
nutrition for 300 days in a year. Under this programme every child should receive
300kcal & 20-25 gm. Protein every day. ( Swarnakar K. – 2011 )

Applied nutrition programme:-

This programme was started in 1963 by the govt. of India in collaboration with
FAO, UNICEF & WHO for improvement in the nutrition status of pregnant & lactating
women & children. ( Swarnakar K.- 2011 )

Vitamin A prophylaxis progamme:-

This programme is targeted to children under 6 yrs of age because according to
WHO, this age group children are more exposed to night blindness, bitot’s spots, corneal
ulcer & xerosis. Under this programme every child should receive 9 doses of vitamin A
solution till he attains 5 yr of age. Vitamin A capsules can also be given In place of
vitamin A solution. ( Swarnakar K. – 2011 )

Mid day meal programme:-

Mid day meal programme is also known as school launch programme. This
programme has been in operation since 1961 throughout the country. The main
objective of the programme is to attract more children to come to schools & retain
them so that literacy improvement of children can be brought about.

In mid day meal programme one-third energy & half of protein requirement of
the child should be brought in daily mid-day meal programme. ( Park K.- 2013 )

Balwadi nutrition programme:-

This programme is being organized by the central social welfare board from the
year 1970-71.

In this programme attempt is made to satisfy basic nutritional requirement of

children 3-5 yrs age group through the balwadi nutrition programme. It is ensured that

22
the child will get 300kcal & 12-15 gm. Protein per day under this programme.
( Swarnakar K. – 2011 )

ICDS programme:-
Integrated child development services(ICDS) programme was started in 1975 in
pursuance of national policy for children. There is a strong nutrition component in the
programme in the form of supplementary nutrition, vitamin A prophylaxis & iron & folic
acid distribution. The beneficiaries are preschool children below 6 yrs & adolescent girls
11 to 18 yrs, pregnant & lactating mothers. ( park K. – 2013 )

ROLE & KNOWLEDGE OF MOTHERS IN PREVENTION

OF MALNUTRITION:-
The education of woman, especially, has been found to play a central role in
improving the health of children. Mother’s nutrition related knowledge, attitudes and
practices tend to be strongly associated with children’s nutritional status.
( Kaori saito – 2009 )

In addition to education of woman, the health care seeking attitude of mothers,

how they utilize available health resources in response to their children’s illnesses, is
another factor that can affect children’s health & nutritional status but has been
neglected by the past studies. Evidence suggest that active health-care-seeking attitudes
of mother play a critical role in children’s wellness in developing countries. ( Sara
Bhattacharji – 2009 )

A study was conducted in six semi-arid villages of southern - India, on factors

associated with malnutrition shows that education level of mother has a significant
influence on improving the nutritional level of their children’s diet, specially through
effective meal planning & there by reducing the incidence & prevalence of malnutrition.
( Ryan – 2008 )

A study was conducted by Rathnayke & Weerhewa(2008) in srilanka, regarding

role of mothers in alleviating malnutrition found that income of mothers, family size,
children’s age, gender, birth order & the educational level of mothers are important
determinants in prevention of malnutrition.

23
 Wammanda R.D & Jeevika Weerhewa(2009) conducted a study with the objective
of the relationship between malnutrition & different roles played by mother in
prevention of malnutrition & found that, birth weight of the children, age, nutritional
awareness of mothers, their interest in the media & household income significantly
affected the child’s nutritional condition.

Gupta MC & Arora S (2010) conducted a study on the relation of childhood

malnutrition to the parent’s education & mother’s nutrition related knowledge ,attitude
& practice & found that there is a strong relation between nutritional status of children
& educational level of their mothers.

Bhat IA, Shah GN & Banopahyay DR Debasis (2011) carried a study “determine
whether maternal knowledge & practice with the nutritional status of infants” & found
that mothers, ehose infant, was well nourished had a higher level of knowledge than
those whose infants were moderate to severly malnourished. Thus health education is
required for mothers for prevention of malnutrition.

Ponnu Thomas(2012) conducted a Study on maternal knowledge on prevention of

malnutrition & found that mother’s had very poor knowledge on prevention of
malnutrition.

George Maryes(2013) conducted a study on “maternal knowledge on different

nutritional problems and their management” reveals that mother’s had good knowledge
on different nutritional problems and their management.

A mother is the principal provider of primary care that her child during first five
years of its life. The type of care she provides depends to a large extent on her
knowledge an understanding in same aspect of basic nutrition & health during past
decade evidence has accumulated from several studies that maternal education is an
important determinant of infant & child mortality. ( Khalil salman – 2011 )

A case control study was conducted in Mazowe on maternal knowledge on

malnutrition & found that mothers had very poor knowledge in comparing to mothers
of healthy child specially in it’s cause & prevention. ( Singh jai prakash - 2013 )

24
ROLE OF NURSE IN PREVENTION OF MALNUTRITION:-
Community health nurse play a important role in prevention of malnutrition by
providing nutrition education to the family, infant feeding, supplementary nutrition,
nutrition of pregnant & lactating mothers, informing about control of population,
immunization, promotion of kitchen garden, cooking methods, preservation of foods,
promoting production of food grains, proper implementation of mid day meal
programme, supplementary nutrition programme, balwadi & applied nutrition programme,
encourage woman’s education & effective use of mass communication.
( Swarnakar Keshav – 2011 )

Community health nurse play a very important role in prevention & control of
malnutrition by encouraging mothers & family members to monitor growth &
development of their children and to bring them to hospitals for regular health check
up, ensure 100 percent coverage of administration of vitamin A mega doses to children,
conducting nutrition education programme on breast feeding, weaning &
supplementation of diet, providing education on preservation of food, food hygiene,
enriching of family diet e.g. sprouting of gram, mixing cereals, pulses and vegetables,
variety of porridges etc., implementation of different national nutrition programmes like
integrated child development scheme, nutritional anemia prophylaxis programme, mid
day meal programme & other nutrition supplementary programmes. ( Gulani K.K.-2005 )

Community health nurse plays a important role in prevention of malnutrition at

community level by early detection of malnutrition & intervention, nutrition education,
promotion of education & literacy in the community & by adopting technical measures
such as iodination of common salt, prevention of night blindness through periodic
vitamin A supplementation & distribution of iron-folate tablets etc. , at community level
by implementing nutrition supplementation programme, by promoting nutrition
surveillance & by planning nutritional programme for community.
( Ghai O.P. – 2013 )

Measures to improve nutritional status of mother & children may be broadly in

direct & indirect nutrition, direct interventions cover a wide range of activities,
supplementary feeding programmes & distribution of iron & folic acid tablets,
enrichment of foods & nutrition education etc. indirect intervention include measures
such as control of communicable diseases through immunization, improvrment of
environmental sanitation, provision of clean drinking water, family planning, food
hygiene, education, nutrition surveillance, prevention & appropriate treatment of
diarrhea, measles & other infections in infancy & early childhood are important role to

25
reduce malnutrition rates, advice to mothers about exclusive breast feeding in first 4
months of life is very important. ( Datta Parul – 2010 )

According to Datta Parul – 2010, the child with severe malnutrition need
hospitalization for initial treatment of associated life threatening problems, correction of
metabolic abnormalities & follow up. Dietary management & other cares are health
education, nutrition counseling & demonstration & follow up should be there.

Community health nurse provide necessary guidance by regular home visit, so the
role of community health nurse in prevention of malnutrition is of prime importance. (
Swrnakar Keshav - 2011 )

26
 METHODOLOGY
Research methodology indicates the general pattern of organizing the procedure
for gathering valid & reliable data from investigation.

According to Polit Hungler & Beck, research methodology is a systematic way by

which research starts from the initial identification of the problem and procedures to its
final conclusion.

The methodology of the present study includes the choice of the research
approach and design setting of the study population sample and sampling techniques,
development of data collection procedure and plan for data analysis.

This chapter provides brief description of different steps taken to conduct the
study is to assess the knowledge of under five mothers regarding prevention of
malnutrition in Ankuli, Berhampur, Ganjam.

RESEARCH APPROACH:-
The descriptive survey approach was found to be most suitable to assess the
knowledge of under five mothers regarding prevention of malnutrition in Ankuli,
Berhampur.

Present study intends to find knowledge of under five mothers on prevention of

malnutrition and its relationship with selected factors, descriptive correlational survey
was thought to be most appropriate.

RESEARCH DESIGN:-
The research design is the master plan specifying the methods and procedures for
collecting & and analyzing the needed information in a research study.
( Sharma S.K. – 2013 )

Research design is the researcher’s overall plan for answering the research
question or testing the research hypothesis. ( Sharma s.k. – 2013 )

Descriptive correlational research design is choosen for the present study. In

the present study the investigator investigate the mothers of under five children
regarding prevention of malnutrition.

27
SETTING OF THE STUDY:-
The setting selected for the present study was Ankuli, Berhampur, Ganjam.

POPULATION:-
Population is the set of people or entities to which the results of a research are
to be generalized. (Sharma S.K. – 2013)

Population is a group of member possess specific characteristics that researcher is

interested in studying. ( Laura A Talbot – 1995 )

The term population refers to total items about the characteristics of studying. (
Rao Bhaskar - 2002 )

The population of present study comprised of 50 mothers of under five children

who were residing Ankuli village, Berhampur, Ganjam, Odisha.

SAMPLE AND SAMPLING TECHNIQUE:-

Sample-
Sample consists of a subset of units whidh comprise the population selected by
researcher to participate in their research project.

Sampling-
Sampling is the process of selecting a representative segment of the population
under study.

Sample size-
The sample comprised of 50 mothers of under five children who were living in
Ankuli village, Berhampur, Ganjam, Odisha.

28
Sampling technique-
Purposive sampling technique is a judgmental sampling technique, in which
researcher select subjects who are believed to be representative of the accessible
population.

INCLUSION CRITERIA FOR SELECTION OF THE

SAMPLE:-
The mothers who
 Were living in selected rural community.
 had one or more under five children.
 can able to understand Odia.
 Were willing to participate in the study.
 Were present during the period of data collection.

DATA COLLECTION TECHNIQUE TOOLS:-

Polite and Hungler ( 1999) stated that the questionnaire is relatively simple
method of assessing knowledge and least time consuming.

Interviewing the objects by questionnaires was considered to be the most

suitable for data collection

DEVELOPMENT OF TOOL:-
A data collection tool was formulated by-

 Review of research and non research literature related to importance of

nutrition for under fives, concept, cause, effect, prevention of
malnutrition.
 Discussion with experts.
 Survey of tools used in similar studies.

DESCRIPTION OF TOOLS:-
A closed questionnaire consists of two parts:

Section-A: Deals with demographic data of mothers of under five children.

Section-B: includes multiple choice questions regarding importance of nutrition for

under fives, cause, effect and prevention of malnutrition for under fives.

29
CONTENT VALIDITY OF THE TOOLS:-
Validity of systematic interview strategy was given to three nursing experts.
A few alteration and modification were made as per suggestions made by the experts
and there was 100% agreement of the experts.

DATA COLLECTION PROCEDURE:-

The data was collected from mothers from dt. 08.08.2014 to dt. 23.08.2014.

Following techniques to be followed during data collection period.

Prior to data collection written permission was obtained from the chief District
Medical Officer of Ankuli P.H.C and informed consent was taken from all mothers of
under five children prior to data collection.

The investigator was introduced herself to the mothers and explained the purpose
of the study, she was assumed that the confidentiality of the answers would be
maintained. The mothers are also approached politely by the investigator. An interview
schedule was held with the consent of subjects and questioning technique was used to
assess knowledge of sample subjects through structured questionnaire.

PLAN FOR DATA ANALYSIS:-

The collected data were organized, tabulated, and analyzed by using descriptive
statistics such as mean, percentage and standard deviations and inferential statistics.

SUMMARY:-
The study was undertaken in Ankuli village, Berhampur, Ganjam, odisha by using
purposive sampling technique, structure interview schedule was prepared to assess the
knowledge of mothers of under five children regarding prevention of malnutrition. Data
were plan to analyzed by descriptive and inferential statistics.

30
 DATA ANALYSIS AND INTERPRETATION
The analysis is the ordering of data into consistent parts in order to obtain
answers to research questions. ( Ram A 2001 )

Data analysis is the technique used to reduce, organize and give meaning to
data.

( Best & Khan, 2002 )

An exploratory research design with cross sectional survey approach was carried
out to assess the level of knowledge of underfive mothers regarding prevention of
malnutrition in a selected community ,Berhampur, Odisha. where data were collected
from 50 underfive mothers who were residents of Ankuli, Berhampur, Odisha using
convenient sampling technique.

Collected data were organized, tabulated, analyzed & interpreted by using

descriptive statistics based on the objectives of the study.

ORGANIZATION OF DATA:-
SECTION-I: Description oof demographic variables of the sample.

SECTION-II: Area wise distribution of mean, SD and mean percentage of knowledge

scores of underfive mothers regarding prevention of malnutrition.

SECTION-III: Percentage wise distribution of underfive mothers according to their level of

knowledge on prevention of malnutrition.

SECTION-IV: Hypothesis testing.

31
SECTION – I:
DESCRIPTION OF DEMOGRAPHIC DATA OF THE
SAMPLE

50%

45%
Percentage of underfive mothers

40%

35%

30%

25% <20 yr

20% 20 -25 yr
26 - 30 yr
15%

10%

5%

0%
<20 yr 20 -25 yr 26 - 30 yr
Age in year

Bar diagram showing percentage wise distribution of underfive mothers according to

their age group

( FIGURE - 1.1 )

Percentage wise distribution of underfive mothers according to their age group

shows that the highest similar percentage ( 46% ) of underfive mothers were between
the age group of 20 – 25yr and 26 – 30yr respectively, where as lowest percentage ( 8% )
of underfive mothers were below the age group of 20yr, However none of them ( 0% )
were in the age group of above 30yr.it reveals that most of the underfive mothers were
in the age group of 20 – 30yr.

32
 percentage
Percentage of underfive mothers

40%
35%
30%
25% Illeterate

20% Primary
15% Secondary
10% Higher Seondary
5% Graduation
0%
Illeterate Primary Secondary Higher Graduation
Seondary
Educational level of mothers

bar diagram showing percentage wise distribution of underfive mothers according to

their educational level

( FIGURE – 1.2 )

Percentage wise distribution of underfive mothers according to their educational

level shows that highest percentage ( 38% ) of mothers had secondary education and
lowest percentage ( 6% ) of them were illeterate, where as 28% of them had primary
education, 16% of them had highersecondary education and 12% of them had
graduation & above level of education. It reveals that almost all of the underfive
mothers were literate.

33
 100%

90%

80%

70%

60%

50%
90%
40%

30%

20%

10%
8%
0% 2%
House Wives Govt.employee Business

Bar diagram showing percentage wise distribution of underfive mothers according to

their occupational status

( FIGURE – 1.3 )

Percentage wise distribution of underfive mothers according to occupational

status shows that highest percentage ( 90 % ) of underfive mothers were housewives and
lowest percentage ( 2% ) of underfive mothers were doing business, where as 8% of
underfive mothers were govt. Employee and none of them ( 0% ) were private
employee. It reveals that most of the underfive mothers were housewives.

34
 Percentage of underffive mothers
100.00%
80.00%
60.00%
40.00%
20.00% <RS.1000
0.00% RS.1000-RS.3000
RS.3001-RS.5000
RS.>5000

Per capita family income per month

Bar diagram showing percentage wise distribution of underfive mothers accoding to

per capita family income per month

( FIGURE – 1.4 )

Percentage wise distribution of under five mothers according to their per capita
family income per month shows that highest percentage ( 88% ) of underfive mothers
had per capita family income per month is between Rs.1000 to Rs.3000, and lowest
percentage ( 2% ) of underfive mothers had per capita family income per month is above
Rs.5000,where as 6% of underfive mothers had per capita family income per month is
between Rs.3001 to Rs.5000 and 4% had per capita family income per month below
Rs.1000. It reveals that most of the underfive mothers had average socio-economic
status.

35
 6%

Vegeterian

Non-vegeterian

94%

Pie diagram showing percentage wise distribution of underfive mothers according to

their dietary pattern

( FIGURE – 1.5 )

Percentage wise distribution of underfive mothers according to their dietary

pattern shows that highest percentage ( 94% ) of underfive mothers were non-vegeterian
and lowest percentage ( 6%) of underfive mothers were vegeterian. It reveals that
almost all of the underfive mothers were non-vegeterian.

36
 32%

Nuclear family
68% Joint family

Pie diagram showing percentage wise distribution of underfive mothers according to

their type of family

( FIGURE – 1.6 )

Percentage wise distribution of underfive mothers according to their type of

family shows that highest percentage ( 68% ) of underfive mothers were belongs to
nuclear family and lowest percentage ( 32% ) of underfive mothers were belongs to joint
family and none of them ( 0% ) belongs to extended family. It reveals that majority of
the underfive mothers were belongs to nuclear family.

37
 Hindu

100%

Pie diagram showing percentage wise distribution of underfive mothers according to

their religion

( FIGURE – 1.7 )

Percentage wise distribution of underfive mothers according to their religion

shows that highest percentage ( 100% ) of underfive mothers were belongs to Hindu
religion and none of them belongs to Muslim, Christian or any other religion. It is due
to the area is a Hindu dominated area.

38
 32%

One Two

68%

Pie diagrm showing percentage wise distribution of underfive mothers according to the
no. Of underfive children

( FIGURE – 1.8 )

Percentage wise distribution of underfive mothers according to the no. of

underfive children shows that highest percentage ( 68% ) of under five mothers had one
underfive children and lowest percentage ( 32% ) of underfive mothers had two underfive
children, where as no one had three or above underfive children. It reveals that most of
the underfive mothers had one underfive children. It may be due to proper adaptation
of family planning methods in selected community of ankuli.

39
 37.87%

Boys
Girls

62.13%

Pie diagram showing percentage wise distribution of underfive mothers according to

the sex of underfive children

( FIGURE – 1.9 )

Percentage wise distribution of underfive mothers according to the sex of

underfive children shows that highest percentage ( 62.13% ) of underfive children were
girls where as lowest percentage ( 37.87% ) of underfive children were boys. It reveals
that most of the underfive children were girls.

40
 28%

Mass Media
62% 10% Newspaper
Healthpersonnel

Pie diagram showing percentage wise distribution of underfive mothers according to

the source of their previous information

( FIGURE – 1.10 )

Percentage wise distribution of underfive mothers according to source of previous

information rgarding prevention of malnutrition shows that highest percentage ( 62% ) of
underfive mothers got information from healthpersonnel and lowest percentage ( 10% )
of underfive mothers got information from newspaper, where as 28% of underfive
mothers got information from massmedia and no one got information from friends and
family members or any other sources. It reveals that health personnel was the major
source of information in prevention of malnutrition.

41
 SECTION – II :
AREA WISE ANALYSIS OF KNOWLEDGE SCORES OF
UNDERFIVE MOTHERS REGARDING PREVENTION OF
MALNUTRITION
TABLE – 2.1 :

A. Overall area wise knowledge score of underfive mothers regarding prevention of

malnutrition.

AREA MAXIMUM MEAN SD MEAN%

SCORE
Importance of 4 3.36 0.74 84%
nutrition
among
underfive
Developmental 8 6.06 1.62 75.75%
task
Cause & 5 3.5 1.02 70%
effect of
malnutrition
Prevention of 8 6.42 1.93 80.25%
malnutrition
Overall 25 19.32 2.86 77.28%

Area wise distribution of Mean, SD, Mean% of the knowledge scores shows that highest
mean score was ( 3.36 ±0.74 ) which was 84% of the total scores, obtained in the area
of “Importance of nutrition among underfive” where as lowest mean score
( 3.5±1.02 ) which is 70% of total score obtained in the area of “Cause & effect of
malnutrition”, However in another two area like “prevention of malnutrition” &
“Developmental task” the knowledge score was 80.25% & 75.75% respectively.

Further overall mean score was 77.28% showing good knowledge. It depict that
the underfive mothers had good knowledge in prevention of malnutrition among
underfive

42
 B. Overall analysis of level of knowledge of underfive mothers regarding prevention
of malnutrition

Overall analysis of knowledge of underfive mothers regarding prevention of

malnutrition reveals that highest and more or less similar that is 46% & 44% of
underfive mothers had good & excellent knowledge, where as only 10% of underfive
mothers had average knowledge. It shows underfive mothers had good knowledge in
prevention of malnutrition.

10%

44%

Average

46% Good
Excellent

43
SECTION – III:
ITEM WISE DISTRIBUTION OF PERCENTAGE OF
CORRECT RESPONSES OF UNDERFIVE MOTHERS
REGARDING PREVENTION OF MALNUTRITION
TABLE – 3.1 :

Item wise analysis of percentage of correct responses of underfive mothers on

importance of nutrition among underfives.

QUESTION ITEM CORRECT RESPONSES

NO. NUMBER PERCENTAGE
1 What is malnutrition? 39 78%
2 Why nutrition is important 38 76%
for underfive children?
3 Which age group children 41 82%
most affected by
malnutrition?
4 Which of the following 50 100%
nutrients are needed for
normal development of
child?

Item wise analysis of knowledge scores of underfive mothers regarding importance of

nutrition among underfives shows that the highest percentage ( 100% ) of underfive
mothers had correct responses on “Which of the following nutrients are needed for
normal development of child” & the lowest percentage ( 76% ) of underfive mothers had
correct responses on “Why nutrition is important for underfive children”, However 82%
of underfive mothers had correct responses on “Which age group children most affected
by malnutrition” and 78% of them had correct responses on “What is malnutrition”.

It reveals that underfive mothers had excellent knowledge on “Which of the

following nutrients are needed for normal development of child” and “Which age group
children most affected by malnutrition” and good knowledge on “What is malnutrition”
and “Why nutrition is important for underfive children”. (Table -3.1 )

44
TABLE – 3.2 :

Item wise analysis of percentage of underfive mothers regarding developmental task.

QUESTION NO. ITEM CORRECT RESPONSES

NUMBER PERCENTAGE
5 In which month birth weight of 12 24%
the child is doubled?
6 In which month birth weight of 38 76%
the child is tripled?
7 Which feeding is to be given 50 100%
importance soon after birth?
8 How long exclusive breast 48 96%
feeding to be continued?
9 In which month weaning is to 43 86%
be started?
10 How long breast feeding to be 40 80%
continued with supplementary
feeding?
11 What is the appropriate age of 28 56%
the infant to start whole boiled
egg?
12 In which month vit.A should be 44 88%
started in children?

Item wise analysis of knowledge scores of underfive mothers regarding

developmental task shows that the highest percentage ( 100% ) of underfive mothers had
correct response on “Which feeding is to be given importance soon after birth” and the
lowest percentage ( 24% ) of underfive mothers had correct response on “In which
month birth weight of the child is doubled”. However 96% of underfive mothers had
correct response on “How long exclusive breastfeeding to be continued” and 88% of
them had correct response on “In which month vit.A should be started in children and
86% of them had correct response on “In which month weanig is to be started” and
80% of them had correct response on “How long breast feeding to be continued with
supplementary feeding” and 76% of them had correct response on “In which month
birth weight of the child tripled” and 56% of them had correct response on “What is
the appropriate age of the infant to start whole boiled egg”.

45
 It reveals that underfive mothers had excellent knowledge on “Which
feeding is to be given importance soon after birth”, “How long exclusive breast feeding
to be continued”, “In which month weaning is to be started” and “How long breast
feeding to be continued with supplementary feeding” and good knowledge on “In which
month birth weight of the child is tripled” whereas average knowledge on “What is the
appropriate age of the infant to start whole boiled egg” and good knowledge on “In
which month birth weight of the child is tripled” and less knowledge on “In which
month birth weight of the child is doubled”. ( Table – 3.2 )

TABLE – 3.3:

Item wise analysis of percentage of correct responses of underfive mothers regarding

cause & effect of malnutrition.

QUESTION NO. ITEM CORRECT RESPONSES

NUMBER PERCENTAGE
13 From the following, which 47 94%
factor is responsible for
malnutrition?
14 Which of the following is 41 82%
a false statement?
15 How to identify 38 76%
malnourished child?
16 What are the consequence 14 28%
of untreated chronic
malnutrition?
17 In which of the following 36 72%
conditions, oedema
appears in the body?

Item wise analysis of knowledge scores of underfive mothers regarding

Cause & effect of malnutrition shows that the highest percentage ( 94% ) of underfive
mothers had correct response on “From the following, which factor is responsible for
malnutrition” and the lowest percentage ( 28% ) of underfive mothers had correct
response on “What are the consequence of untreated chronic malnutrition”. However
82% of them had correct response on “Which of the following is a false statement” and

46
76% of them had correct response on “How to identify malnourished child” and 72% of
them had correct response on “In which of the following conditions, oedema appears in
the body”.

It reveals that underfive mothers had excellent knowledge on “From the

following, which factor is responsible for malnutrition” and “Which of the following is a
false statement” and good knowledge on “How to identify malnourished child” and “In
which of the following conditions, oedema appears in the body” however less knowledge
on “What are the consequence of untreated chronic malnutrition”. ( Table – 3.3 )

TABLE – 3.4:

Item wise analysis of percentage of correct responses of underfive mothers on

prevention of malnutrition.

QUESTION NO. ITEM CORRECT RESPONSES

NUMBER PERCENTAGE
18 Which is the ideal method 47 94%
of cooking vegetables?
19 What is multimix? 37 74%
20 What are the main 34 68%
ingredients of multimix?
21 How many year minimum 34 68%
gap should be required
between two children?
22 How to prevent worm 39 78%
infestation?
23 Which of the following care 49 98%
to be taken during
pregnancy to prevent
malnutrition of child after
birth?
24 How to keep utensils free 31 62%
from microorganism?
25 Why mother’s knowledge is 50 100%
more important in
prevention of malnutrition?

Item wise analysis of knowledge scores of underfive mothers shows that

highest percentage ( 100% ) of underfive mothers had correct response on “Why
mother’s knowledge is more important in prevention of malnutrition” and the lowest

47
percentage ( 62% ) of underfive mothers had correct response on “How to keep utensils
free from microorganism”. However 98% of underfive mothers had correct response on
“Which of the following care to be taken during pregnancy to prevent malnutrition of
child after birth” and 94% of underfive mothers had correct response on “Which is the
ideal method of cooking vegetables” and 78% of underfive mothers had correct response
and 74% of underfive mothers had correct response on “What is multimix” and 68% of
them had correct response on “What are the main ingredients of multimix” and “How
many year minimum gap should be required between two children”.

It reveals that underfive mothers had excellent knowledge on “Why

mother’s knowledge is more important in prevention of malnutrition” and “Which of the
following care to be taken during pregnancy to prevent malnutrition of child after birth”
“Which is the ideal method of cooking vegetables” and good knowledge on “How to
prevent worm infestation” and “What is multimix”, however average knowledge on
“What are the main ingredients of multimix” and “How many year minimum gap should
be required between two children” and “How to keep utensils free from
microorganism”. ( Table – 3.4 )

SECTION-IV:

48
H0 - There will be no significant association between knowledge level of underfive
mothers with their selected demographic variables.

TABLE – 4.1:

Sl No. Demographic Calculated Significance

variables x2 value
01 Age 2.98 Not significant
02 Education 0.03 Not significant
03 Occupation 1.74 Not significant
04 Per capita income per 1.26 Not significant
month
05 Dietary pattern 2.94 Not significant
06 Type of family 0.17 Not significant
07 Source of previous 2.82 Not significant
information

The x2 was calculated to find out the significance between knowledge score
of underfive mothers regarding prevention of malnutrition with their selected
demographic variables and found out that there is no significant association between
knowledge score of underfive mothers when compared with their selected demographic
variables such as Age, Education, Occupation, Per capita income per month, Dietary
pattern, Type of family and Source of previous information. Hence null hypothesis is
accepted.

SUMMARY:-
This chapter deals with analysis of data. This study help the investigator to
collect data, tabulated, analyzed & interpreted by using descriptive and inferential
statistics based on the objectives of the study & in designing the plan to draw of item
wise area data respectively.

49
 DISCUSSION, SUMMARY, CONCLUSION,
IMPLICATION & RECOMMENDATIONS
A cross sectional survey approach was carried out on 8.08.14 to 23.08.14 to
assess the knowledge score of underfive mothers regarding prevention of malnutrition of
the village Nuasahi, Ankuli, Berhampur, Ganjam, Odisha. Data were collected from 50
underfive mothers by convenient sampling technique using close ended questionnaires.

The collected data were tabulated, organized and analysed by using descriptive
and inferential statistics and presented in the form of tables and figures as per the
objective in the chapter – iv.

DISCUSSION
This chapter deals with the discussion of findings of the study as per objectives.
These are discussed under the following headings.

 Description of demographic characteristics of the underfive mothers.

 Description of Area wise distribution of mean, SD and Mean percentage
of knowledge score of underfive mothers regarding prevention of
malnutrition.
 Description of overall score of knowledge of underfive motherts.

Description of demographic characteristics of the underfive mothers:

 Percentage wise distribution of underfive mothers according to their age

group shows that the highest similar percentage ( 46% ) of underfive
mothers were between the age group of 20 – 25yr and 26 – 30yr
respectively, where as lowest percentage ( 8% ) of underfive mothers were
below the age group of 20yr,It reveals that most of the underfive mothers
were in the age group of 20 – 30yr which is supported by the study
findings of Sara Bhattacharji where he found most of the underfive
mothers belong to the age group of 20 – 30yr.
 Percentage wise distribution of underfive mothers according to their
educational level shows that highest percentage ( 38% ) of mothers had
secondary education and lowest percentage ( 6% ) of them were illiterate,
where as 28% of them had primary education, 16% of them had higher
secondary education and 12% of them had graduation & above level of
education. It reveals that almost all of the underfive mothers were literate

50
 which is contradictory to the study findings of Ponnu Thomas where he
found most of the underfive mothers were illiterate.

 Percentage wise distribution of underfive mothers according to occupational

status shows that highest percentage ( 90 % ) of underfive mothers were
housewives and lowest percentage ( 2% ) of underfive mothers were doing
business, where as 8% of underfive mothers were govt. Employee and
none of them ( 0% ) were private employee. It reveals that most of the
underfive mothers were housewives.

 Percentage wise distribution of under five mothers according to their per

capita family income per month shows that highest percentage ( 88% ) of
underfive mothers had per capita family income per month is between
Rs.1000 to Rs.3000, and lowest percentage ( 2% ) of underfive mothers
had per capita family income per month is above Rs.5000,where as 6% of
underfive mothers had per capita family income per month is between
Rs.3001 to Rs.5000 and 4% had per capita family income per month below
Rs.1000. It reveals that most of the underfive mothers had average socio-
economic status which is contradictory to the report of census - 2011.

 Percentage wise distribution of underfive mothers according to their

dietary pattern shows that highest percentage ( 94% ) of underfive mothers
were non-vegeterian and lowest percentage ( 6%) of underfive mothers
were vegeterian. It reveals that almost all of the underfive mothers were
non-vegeterian.

 Percentage wise distribution of underfive mothers according to their type

of family shows that highest percentage ( 68% ) of underfive mothers were
belongs to nuclear family and lowest percentage ( 32% ) of underfive
mothers were belongs to joint family and none of them ( 0% ) belongs to
extended family. It reveals that majority of the underfive mothers were
belongs to nuclear family.

 Percentage wise distribution of underfive mothers according to their

religion shows that highest percentage ( 100% ) of underfive mothers were
belongs to Hindu religion and none of them belongs to Muslim, Christian
or any other religion. It is due to the area is a Hindu dominated area.

51
  Percentage wise distribution of underfive mothers according to the no. of
underfive children shows that highest percentage ( 68% ) of under five
mothers had one underfive children and lowest percentage ( 32% ) of
underfive mothers had two underfive children, where as no one had three
or above underfive children. It reveals that most of the underfive mothers
had one underfive children. It may be due to proper adaptation of family
planning methods in selected community of ankuli.

 Percentage wise distribution of underfive mothers according to the sex of

underfive children shows that highest percentage ( 62.13% ) of underfive
children were girls where as lowest percentage ( 37.87% ) of underfive
children were boys. It reveals that most of the underfive children were
girls.

 Percentage wise distribution of underfive mothers according to source of

previous information rgarding prevention of malnutrition shows that highest
percentage ( 62% ) of underfive mothers got information from
healthpersonnel and lowest percentage ( 10% ) of underfive mothers got
information from newspaper, where as 28% of underfive mothers got
information from massmedia and no one got information from friends and
family members or any other sources. It reveals that health personnel was
the major source of information in prevention of malnutrition.

Area wise distribution of Mean, SD and Mean percentage of knowledge

score of underfive mothers regarding prevention of malnutrition:
Area wise distribution of Mean score shows that highest mean score ( 3.36
± 0.74 ) which is 84% of total score obtained in the area of “Importance of nutrition
among underfive”, where as lowest mean score ( 3.5 ± 1.02 ) which is 70% of total score
obtained in the area of “Cause & effect of malnutrition” which is supported to the
study conducted by Khalil Salman (2011 ). In his study he got mother’s had good
knowledge in the area of “importance of nutrition among underfive”, whereas study
findings of HS Joshi(2010) was contradictory to the study. In his study he got mother’s
had less knowledge on “Cause & effect of malnutrition”.

Description of overall score of knowledge level of underfive mothers:

Overall level of knowledge score of underfive mothers regarding prevention of
malnutrition shows that most of the underfive mothers had good knowledge regarding

52
prevention of malnutrition which is supported by the study findings of Siddamma
Sangaraju where he got mothers having good knowledge regarding prevention of
malnutrition.

Item wise distribution of underfive mother’s knowledge regarding

prevention of malnutrition:
Item wise distribution of underfive mother’s knowledge on importance of
nutrition among underfive shows that almost all(100%) of underfive mother’s responded
correctly for the item “Which of the following nutrients are needed for normal
development of child”, However 82% of them gave correct response on “Which age
group children most affected by malnutrition” and the lowest percentage 76% of them
gave correct response on “Why nutrition is important for underfive children” and 78% of
them had correct response on “What is malnutrition”. It reveals that underfive mothers
had excellent knowledge on “Which of the following nutrients are needed for normal
development of child” and “Which age group children most affected by malnutrition”
and good knowledge on “What is malnutrition” and “Why nutrition is important for
underfive children”. (Table -3.1 )

Item wise distribution of underfive mother’s knowledge on developmental

task shows that almost all(100%) of underfive mother’s responded correctly for the item
“Which feeding is to be given soon after birth” and the lowest percentage ( 24% ) of
underfive mothers had correct response on “In which month birth weight of the child is
doubled”. However percentage varies from 56% to 96% in the form of 96% of underfive
mothers had correct response on “How long exclusive breastfeeding to be continued”
and 88% of them had correct response on “In which month vit.A should be started in
children and 86% of them had correct response on “In which month weanig is to be
started” and 80% of them had correct response on “How long breast feeding to be
continued with supplementary feeding” and 76% of them had correct response on “In
which month birth weight of the child tripled” and 56% of them had correct response
on “What is the appropriate age of the infant to start whole boiled egg”.

It reveals that underfive mothers had excellent knowledge on “Which

feeding is to be given importance soon after birth”, “How long exclusive breast feeding
to be continued”, “In which month weaning is to be started” and “How long breast
feeding to be continued with supplementary feeding” and good knowledge on “In which
month birth weight of the child is tripled” whereas average knowledge on “What is the
appropriate age of the infant to start whole boiled egg” and good knowledge on “In

53
which month birth weight of the child is tripled” and less knowledge on “In which
month birth weight of the child is doubled”. ( Table – 3.2 )

Item wise distribution of underfive mother’s knowledge on “Cause & effect of

malnutrition” reveals that the almost all( 94% ) of underfive mothers had correct
response on “From the following, which factor is responsible for malnutrition” and the
lowest percentage ( 28% ) of underfive mothers had correct response on “What are the
consequence of untreated chronic malnutrition”. However percentage varied from 72% to
82% in the form of 82% of them had correct response on “Which of the following is a
false statement” and 76% of them had correct response on “How to identify
malnourished child” and 72% of them had correct response on “In which of the
following conditions, oedema appears in the body”.

It reveals that underfive mothers had excellent knowledge on “From the

following, which factor is responsible for malnutrition” and “Which of the following is a
false statement” and good knowledge on “How to identify malnourished child” and “In
which of the following conditions, oedema appears in the body” however less knowledge
on “What are the consequence of untreated chronic malnutrition”. ( Table – 3.3 )

Item wise distribution of underfive mother’s knowledge on “prevention of

malnutrition” reveals that almost all( 100% ) of underfive mothers had correct response
on “Why mother’s knowledge is more important in prevention of malnutrition” and the
lowest percentage ( 62% ) of underfive mothers had correct response on “How to keep
utensils free from microorganism”. However 98% of underfive mothers had correct
response on “Which of the following care to be taken during pregnancy to prevent
malnutrition of child after birth” and 94% of underfive mothers had correct response on
“Which is the ideal method of cooking vegetables” and 78% of underfive mothers had
correct response and 74% of underfive mothers had correct response on “What is
multimix” and 68% of them had correct response on “What are the main ingredients of
multimix” and “How many year minimum gap should be required between two
children”.

It reveals that underfive mothers had excellent knowledge on “Why

mother’s knowledge is more important in prevention of malnutrition” and “Which of the
following care to be taken during pregnancy to prevent malnutrition of child after birth”
“Which is the ideal method of cooking vegetables” and good knowledge on “How to
prevent worm infestation” and “What is multimix”, however average knowledge on
“What are the main ingredients of multimix” and “How many year minimum gap should
be required between two children” and “How to keep utensils free from
microorganism”. ( Table – 3.4 )

54
Hypothesis testing:
The x2 was calculated to find out the significance between knowledge score
of underfive mothers regarding prevention of malnutrition with their selected
demographic variables and found out that there is no significant association between
knowledge score of underfive mothers when compared with their selected demographic
variables such as Age, Education, Occupation, Per capita income per month, Dietary
pattern, Type of family and Source of previous information. Hence null hypothesis is
accepted which is contradictory to the study findings of Dash Bijayalaxmi, in her study
null hypothesis is rejected and statistical hypothesis is accepted.

SUMMARY
An exploratory cross sectional survey approach was carried out in Nuasahi, Ankuli,
Berhampur, Ganjam, where data were collected from 50 underfive mothers regarding
prevention of malnutrition.

The collected data were analyzed by using descriptive and inferential statistics.
The findings were summarized as follows.

 Highest percentage ( 46% ) of underfive mothers were between the age group of
20 – 30 yr.
 Highest percentage ( 38% ) of underfive mothers were educated up to secondary
level of education.
 100% of underfive mothers were Hindu from which 94% of underfive mothers
were non-vegeterian.
 Highest percentage ( 68% ) of underfive mothers were belongs to nuclear family,
from which highest percentage ( 88% ) had per capita income per month is
between Rs.1000 to Rs.3000.
 Highest percentage ( 68% ) of underfive mothers had one underfive children from
which highest percentage ( 62.13% ) of underfive children were girls.
 Highest percentage ( 62% ) of underfive mothers got information regarding
prevention of malnutrition from health personnel.

CONCLUSION:
From the findings it can be concluded that highest percentage of underfive mothers
were between the age group of 20 to 30 yrs, all underfive mothers were Hindu, highest
percentage of underfive mothers had up to secondary level of education and highest
percentage of underfive mothers had income between Rs.1000/- to Rs.3000/- and

55
highest percentage of underfive mothers were non-vegeterian, highest percentage of
underfive children were girls, highest percentage of underfive mothers got information
regarding prevention of malnutrition from health personnel.

Underfive mothers had good knowledge regarding prevention of malnutrition.

overall, underfive mothers had 46% good knowledge regarding prevention of malnutrition
and 44% of them had excellent knowledge regarding prevention of malnutrition.

IMPLICATION:
Nursing Services:

 Based on the findings a community health nurse can educate the mothers who
are having poor knowledge regarding prevention of malnutrition & assess specially
those underfives for presence of malnutrition.
 Nursing personnel gave emphasis on that area where the underfive mothers had
poor knowledge.
 Nursing students can create awareness among the mothers regarding prevention
of malnutrition among underfives in community.

Nursing Education:

 A community health nurse can used this finding to teach other nursing personnel
like ASHA & Anganwadi workers for enhancing their knowledge regarding
prevention of malnutrition.
 Nursing student can be taught regarding types of malnutrition, it’s cause, effect
and prevention of malnutrition by which they can properly educate the underfive
mothers.

Nursing Research:

 The findings of the study can be utilized for conducting further research to assess
the actual practice of underfive mothers on prevention of malnutrition among
underfive and find out the association between knowledge & practice.
 Based on the findings a separate study can be conducted in different areas like
Breast feeding, Weaning and Antenatal care for prevention of malnutrition.

56
RECOMMENDATIONS:
On the basis of the findings of the study, the following recommendation have been
made for further study.

 A similar study can be conducted on larger sample to generalize findings.

 A comparative study can be conducted on knowledge of prevention of
malnutrition among underfives between urban and rural mothers.
 A study can be conducted to observe the actual practice of the underfive
mothers on prevention of malnutrition among underfives.
 An experimental study can be conducted to find to find out the effectiveness of
any module on knowledge of underfive mothers regarding prevention of
malnutrition.

SUMMARY:
This chapter deals with the discussion, summary, conclusion and implication
of the study and recommendation for further studies.

57
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JOURNALS

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58
16. Mathad Sri Bijaya, study on management of malnutrition, Indian Journal of
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WEBSITE

17. Morbidity and mortality of underfive accrding to CENSUS REPORT 2011.com

18. Incidence and prevalence of malnutrition among underfive in India according to
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25. Malnutrition in states of India according to UNICEF Regional – 2011 report.com

59