RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES, …



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|RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES, BANGALORE, KARNATAKA |

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|NAME OF THE CANDIDATE |

|AND ADDRESS |

|Mrs.SILIYA. K V |

|1ST YEAR M.Sc NURSING |

|RAJIV GANDHI COLLEGE OF NURSING |

|IIT CAMPUS, OPP. MEENAKSHI TEMPLE |

|BANNERGHATTA ROAD |

|BANGALORE – 76. |

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|NAME OF THE INSTITUTION |

|RAJIV GANDHI COLLEGE OF NURSING |

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|COURSE OF STUDY & SUBJECT |

|FIRST YEAR M.Sc NURSING |

|PAEDIATRIC NURSING |

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|DATE OF ADMISSION |

|01/06/2011 |

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|TITLE OF THE TOPIC |

|A STUDY TO ASSESS THE EFFECTIVENESS |

|OF STRUCTURED TEACHING PROGRAM |

|AMONG MOTHERS OF UNDER FIVE CHILDREN |

|ON KNOWLEDGE REGARDING VITAMIN |

|DEFICIENCY AND ITS PREVENTIVE MEASURES |

|IN A SELECTED URBAN AREA AT BANGALORE |

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|BRIEF RESUME OF INTENDED WORK |

|6.1 INTRODUCTION: |

|We are guilty of many errors and many faults, but our worst crime is abandoning the children, neglecting the foundation of life. Many of the things we |

|need can wait. The child cannot. Right now is the time his bones are being formed, his blood is being made and his senses are being developed. |

|“ T o him we cannot answer Tomorrow, His name is Today” |

|Gabriela Mistra |

|"Don't forget to take your vitamin!" "Eat your salad — it's packed with vitamins!" you've probably heard at least one parent say But what exactly are |

|vitamins? Vitamins and minerals are substances that are found in foods we eat. Your body needs them to work properly, so you grow and develop just like |

|you should. When it comes to vitamins, each one has a special role to play. Ingesting vitamins is extremely important to keep our bodies healthy, they |

|are essential to life (hence the name that comes from “vital” and “amines”) 1. Kids who eat balanced diets are probably getting all the vitamins and |

|minerals they need from the foods they eat, so supplementation usually isn't necessary. Children who are very picky may be missing out on some |

|nutrients, and there is growing research showing many children may not be meeting their vitamin needs2. |

|Whenever a man or woman plans to build a house for them and their family the very first thing they carry out is securing all the best materials which he|

|or she can afford. The same thing or matter is applicable to the most wonderful of the houses that is the human body. Basically we are the builders and |

|every day we select materials for building of our body. These materials are required to be chosen rightly in order to carry out the process of body |

|building very properly. This construction basically begins from the day we step in this world and it continues for our whole life. And in order to live |

|in strong house or strong body we need to select the right materials. So one should not allow anything which is inferior go inside their body. Only the |

|best things should be allowed to go inside the body.3 |

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|Vitamins by definition are the substances which we need in our body for its normal functioning. Basically the vitamins are required in our body for the|

|healthy growth; healthy vision, to make connective tissues much stronger and bones too become strong with the good consumption of vitamins. It also |

|helps us to fight against all the infections cancer and number of other disease. The presence of the right amount of vitamin in our body helps us to |

|heal wounds; it also prevents us from bleeding to death and to keep all the teeth strong and very healthy.3 |

|Vitamins are fetched entirely from the food and number of other plants. In order to get good quantity of vitamins we must select those foods which are |

|very good in the vitamin and protein content. Money should not be an issue when it comes over the good diet of your child. This is because of the fact |

|that no one can live long on the unbalanced diet. So one should eat and enjoy the taste of food which is full of vitamins and other materials which are |

|required for the body building3 |

|More than 254 million children suffer from vitamin deficiency worldwide in each year, 20-40 million children suffer from mild vitamin-A deficiency and |

|three million children from severe deficiency. World health organization estimates that 100 to 140 million children under the age of five may be living |

|with dangerously low vitamin-stores. More than four million children are worldwide exhibit sign of severe deficiency. In Karnataka 0.3% of children are |

|suffering from vitamin deficiency.4 |

|In India nearly 600 million children die from hunger and malnutrition each year and lack of essential vitamins and minerals also increased risk of dying|

|from child hood diseases. Millennium development goals set a target of decreasing rate of death among children under five by two-third between |

|1990-2015.between 1960and 1990 number of child death fell at a rate of 2.5 each year. Since 1990 phase load to just 1.5 percentage. WHO, UNICEF and IMCI|

|emphasis importance of improved diet and feeding practices.5 |

|India is home to 40 percent of the world’s malnourished children and 35 percent of the developing world’s, low-birth-weight infants; every year 2.5 |

|million children die in India, accounting for one in five deaths in the world. More than half of these deaths could be prevented if children were well |

|nourished. India’s progress in reducing child malnutrition has been slow. The prevalence of child malnutrition in India deviates further from the |

|expected level at the country’s per capita income than in any other large developing country.6 |

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|Karnataka has a population of 45 million; The state has a literacy rate of 56%. The food consumption patterns reveal that cereals and millets are the |

|main food items. However, protective foods (i.e. foods that are rich in proteins, vitamins and minerals) are consumed in lesser amounts. When compared |

|with the average Indian recommended dietary intake (RDI), the intake of energy in adults was found to be higher, as was protein. The average intake of |

|vitamins, however, was 50% less than the recommended dietary intake. An improvement in the nutritional status of rural adults has been observed in |

|recent years. Protein energy malnutrition, vitamin deficiency disorders are the major nutritional deficiencies among preschool children, in Karnataka.7|

|Malawi, The World Bank estimates that India is ranked 2nd in the world of the number of Children suffering from malnutrition, after Bangladesh (in |

|1998), where 47% of the children exhibit a degree of malnutrition. The prevalence of underweight children in India is among the highest in the world, |

|and is nearly double that of Sub-Saharan Africa with dire consequences for mobility, mortality, productivity and economic growth.27The UN estimates that|

|2.1 million Indian children die before reaching the age of 5 every year – four every minute – mostly from preventable illnesses such as |

|diarrhoea, typhoid, malaria, measles and pneumonia. Every day, 1,000 Indian children die because of diarrhoea alone. According to the 1991 census of |

|India, it has around 150 million children, constituting 17.5% of India's population, who are below the age of 6 years.8 |

|The 2011 Global Hunger Index (GHI) Report ranked India 15th, amongst leading countries with hunger situation. It also places India amongst the three |

|countries where the GHI between 1996 and 2011 went up from 22.9 to 23.7, while 78 out of the 81 developing countries studied, including Pakistan, Nepal,|

|Bangladesh, Vietnam, Kenya, Nigeria, Myanmar, Uganda, Zimbabwe and succeeded in.9 |

|In society children need extra care because they are our supreme assets. As the children of today form human resources of tomorrow this is all the more |

|because the role of human element is becoming more and more crucial in.10 |

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|6.2 NEED OF THE STUDY |

|In his Independence Day speech on 2011 August 15th to the nation, Prime Minister Manmohan Singh stated, “The problem of malnutrition is a matter of |

|national shame.... I appeal to the nation to resolve and work hard to eradicate malnutrition in five years”. |

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|Malnutrition in India, as in other developing countries, results from a series of interrelated factors rooted in poverty, including a lack of access to |

|food, health care, safe water, sanitation services, and appropriate child feeding and caring practices. These interrelated factors are in turn |

|exacerbated by poor households’ and communities’ lack of access to human, financial, social, natural, and physical capital, combined with social |

|discrimination, lack of education.11 |

|“Every one who cares about the future of children and the development of nations should read this report” said UNICEF executive director Carol Bellamy. |

|“The overwhelming scope of the problem makes it clear that we must reach out to whole population and protect from the devastating consequences of |

|vitamin and mineral deficiency”.12 |

|Unless action against vitamin and mineral deficiencies move onto new level the developing world’s children will remain at risk of never reaching their |

|full potential, the report concludes. And the UN will not achieve its goals eradicating extreme poverty improving maternal health and reducing child |

|mortality by two-thirds by 2015.12 |

|While the number of children and woman who die because of vitamin and mineral deficiencies is great, greater still is the number of people who live with|

|these deficiencies and their consequences. The negative impact on their health is significant. More often than not they suffer multiple deficiencies |

|and, therefore, multiple impairments.13 |

|The global community should be outraged by the millions of children that either die or are disabled each year because of malnutrition. We know how to |

|prevent and treat it. The missing link is the political will to place nutrition squarely on the development agenda and to commit the necessary resources|

|to implement programs, particularly food fortification, that we know can deliver sustainable improvements not only to the current generation of people |

|at risk .14 |

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|At least two children die every minute of every day because they have not received the protection vitamin A supplementation can provide. In the span of |

|two decades, micronutrient supplementation programs have become a mainstream national health goal to reduce childhood mortality and morbidity in 70 |

|countries. The goal now must be to ensure that every vulnerable child receives the vitamin A they require.15 |

|Good nutrition, especially in the first years of a child's life, provides lifelong benefits in health, education and productivity. However, one in four |

|children under-five in the developing world approximately 148 million children – suffer from under nutrition. Affordable and proven micronutrient |

|interventions to address under nutrition exist. We must work collectively to scale up access to these micronutrients, so children everywhere have the |

|chance to reach their full potential and contribute to the development of their communities.16 |

|Every day, national economies suffer significant yet unnecessary losses in productivity due to vitamin and mineral deficiencies. In countries with the |

|highest numbers of people living with physical and intellectual impairments, the lost potential for economic growth is staggering.Mothers tending to |

|sick or disabled children lose days of work. Adults living with reduced energy and intelligence are unable to fully contribute to society.17 |

|Nutrients help in physical and mental growth of children and also help in preventing nutritional deficiency diseases.Education helps to increase |

|knowledge of mothers this helps to give the children required balanced diet and to plan a well balanced diet for family. Researcher need to assess the |

|knowledge of mothers and then educating the mothers about vitamins and its deficiency diseases and its importance in promoting physical and mental |

|health of children. |

|Researcher during his experience has also found that mothers had lack of knowledge regarding the prevention of vitamin deficiency disorders. So |

|investigator felt the need to assess the mother’s knowledge regarding prevention of vitamin deficiency disorders in under- five children and to impart |

|structured teaching programme to improve the mother’s knowledge Thus increasing health of children. |

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|6.3. REVIEW OF LITRATURE |

|Polit and Hungler(1999) review of literature can be described as “a critical summery of research on topic interest, generally prepared to put a research|

|problem in context or to identify gapes and weakness in prior studies so as to justify a new investigation”.18 |

|For better understanding of the topic review is categorised into : |

|General information about vitamin deficiency diseases of under-five children. |

|Study related to knowledge of mothers regarding vitamin deficiency diseases of under-five children. |

|Study related to prevention of vitamin deficiency diseases of under- five children. |

|Study related to effectiveness of structured teaching program to mothers. |

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|General information about vitamin deficiency diseases of under-five children. |

|There are two types of vitamins: fat soluble and water soluble. When you eat foods that contain fat-soluble vitamins, the vitamins are stored in the fat|

|tissues in your body and in your liver. They wait around in your body fat until your body needs them. Fat-soluble vitamins are happy to stay stored in |

|your body for awhile — some stay for a few days, some for up to 6 months! Then, when it's time for them to be used, special carriers in your body take |

|them to where they're needed. Vitamins A, D, E, and K are all fat-soluble vitamins. Water-soluble vitamins are different. When you eat foods that have |

|water-soluble vitamins, the vitamins don't get stored as much in your body. Instead, they travel through your bloodstream. Whatever your body doesn't |

|use comes out when you urinate (pee).So these kinds of vitamins need to be replaced often because they don't stick around! This crowd of vitamins |

|includes vitamin C and the big group of B vitamins — B1 (thiamine), B2 (riboflavin), niacin, B6 (pyridoxine), folic acid, B12 (cobalamine), biotin, and |

|pantothenic acid.19 |

|Diseases due to vitamin deficiency are Keratinizing metaplasia - Due to vitamin A deficiency the epithelial lining of respiratory passage becomes rough |

|dry and keratinized. Xerosis - Dryness of skin and conjunctiva due to a vit A deficiency.Xerophthalmia - Dry and lustreless cornea and conjunctiva due |

|to a vit A deficiency.Bitots's spot - White or greasy triangular deposits on the bulbar conjunctiva adjacent to the lateral margin of the cornea due to |

|vitamin A deficiency. Keratomalacia - Xerosis and ulceration of the cornea resulting from severe vit A deficiency.Nyctalopia or Night blindness - Poor |

|vision at night due to decreased synthesis of Rhodopsine in absence of vit A. Phrynoderma or Toad skin - Thick and scaly skin due to vit A deficiency. |

|Xerostomia - Non-secretion of salvia due to destruction of saliva secreting cells in absence of vit A20 |

|Gena valgum or Knock knee - Due to vit D deficiency in children legs are deformed and curved inward so that the knees are close together, knocking as |

|the person walks, with the ankles widely separated. Bowleg - A deformity of children due to vit D deficiency in which one or both legs are bent outward |

|at the knee.Rickety rosary - The cartilaginous portion of the ribs swell in children due to vit D deficiency. Scoliosis - Sideways deviation of the |

|backbone in children due to vit D deficiency. Pigeons breast – Due to vit D deficiency the lower part of the sternum, xyphoid process project outward |

|conically by lengthening of the costal cartilage. Harrison’s sulcus - A depression develops on both sides of the chest wall of a child between the |

|pectoral muscles and lower margin of the rib cage due to vit D deficiency in children. Craniotabs - Due to vitamin D deficiency in children ossification|

|of the bones of skull does not take place properly as a result of the presence of soft bone at various points on the skull. Pot belly - Due to vitamin D|

|deficiency in children muscle of belly do not developed properly, as a result the belly muscles become nonelastic, therefore belly protrudes |

|outward.Ricket - Due to vitamin D deficiency among children the bones do not harden  |

|and are malformed. Osteomalacia - Softening of bones in adults due to vitamin D deficiency. Osteoporosis - Loss of bony tissue in adults due to vitamin |

|D deficiency as a  |

|result bones become brittle.21 |

|Muscular dystrophy - Muscle fails of contract due to vit E deficit Exudative diathesis - Due to vit E deficiency exudation of fluid takes place from |

|cells and tissues of various parts of the body. Ceroid pigmentation - In children vit E deficiency leads to deposition of excessive  |

|pigment at various places on the body. Blood vomiting in new-born - Due to vit K deficiency bleeding the mouth of newborn baby. Beriberi - A disease of |

|the peripheral nervous system due to deficiency of vit B1. Wet beriberi - In this type there is an accumulation of tissue fluid within body. Dry |

|beriberi - In this type paralysis of the limbs take place.Wernick's encephalopathy - In adult vit B1 deficiency leads to mental confusion or delirium in|

|combination with paralysis of the eye muscles and an uneasy gait.Nystagmus - Due to vit B1 deficiency in adults disorders of the brain occurs |

|and thereby rapid involuntary movement of the eye takes place.. Cheilosis - Due to vit B1 deficiency lips become swollen, cracked with bright |

|red colour.Stomatitis - Inflammation of the mucus lining of the mouth with the painful white ulcers on cheeks, tongue and gum occur due to vit B1 |

|deficiency.Glossitis - Inflammation of the tongue takes place and sticky exudation from scalp.. Erythroid hyperplasia - Anaemia caused by destruction of|

|haemopoietic cells of red bone marrow due to vit B2 deficiency. Chromitrichia - Hair becomes greyish due to vit B3 deficiency.Pellegra - Scaly |

|dermatitis of exposed surfaces due to vit B5 deficiency. Pernicious anaemia - Anaemia due to absence of vit B12 in diet. Scurvy - Swollen bleeding gums |

|due to vit C deficiency.21 |

|ANI Jul 16, 2011, 02.51pm IST[pic]A new study has found that vitamin c is required for the proper functioning of the eyes and the brain. The findings |

|could have implications for diseases, like scurvy, glaucoma, and epilepsy.We found that cells in the retina need to be bathed' in relatively high doses |

|of vitamin C, inside Oregon Health and Science University's Vollum InstituteBecause the retina is part of the central nervous system, this suggests |

|there's likely an important role for vitamin C throughout our brains, to a degree we had not realized before, he said. The brain has special receptors, |

|called GABA-type receptors that help modulate the rapid communication between cells in the brain.GABA receptors in the brain act as an inhibitory brake |

|on excitatory neurons in the brain. The OHSU researchers found that these GABA-type receptors in the retinal cells stopped functioning properly when |

|vitamin C was removed. Because retinal cells are a kind of very accessible brain cell, it's likely that GABA receptors elsewhere in the brain also |

|require vitamin C to function properly, stated von Goff. And because vitamin C is a major natural antioxidant, it may be that it essentially preserves |

|the receptors and cells from premature breakdown, he added.The study was recently published in the Journal of Neurosciience22 |

|Kheth Cheng M O (2011, Natural News) A new study shows that children with psychosis and other severe mental health disorders also have twice as much |

|vitamins children who are mentally healthy. The study, presented to the American by researchers from the Oregon Health and Science University in |

|Portland showed that 21 percent of children with symptoms of severe psychiatric problems had vitamin D levels below what the American Academy of |

|Pediatrics recommends. That level compared with 14 percent of children who participated in the National Health and Nutrition Examination Survey III, a |

|population-based study that assessed the nutrition and health status of both children and adults in the U.S."That is 50 percent more than children in a |

|normal population, so based on our findings this means that 1 out of 5 kids with severe mental illness has low vitamin D levels”.23 |

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|A study shows lack of vitamin B12 (cobalamin) during the formative first six years of life could result in long-term reduced cognitive function. |

|Researchers from the Nutrition and Food Research Institute in Zeist, Netherlands, studied children who had been raised on a strictly vegan macrobiotic |

|diet until age six. The children ate a lacto vegetarian or omnivorous diet after that age. Between ages 10 and 16, the 48 adolescents underwent a series|

|of tests designed to determine cognitive function. They were compared with 24 adolescents fed omnivorous diets from birth. The psychological tests were |

|designed to measure fluid intelligence, spatial ability, concentration, short-term memory, psychomotor development and information-processing speed. |

|Although all of the early macrobiotic children had been consuming vitamin B12 for several years before the test, almost two-thirds were found to be B12 |

|deficient as determined by either low serum cobalamin or an elevated concentration of methylmalonic acid, a marker for B12 deficiency. Almost a third |

|still had B12 intakes below 50 percent of the Recommended Daily Allowance. The control subjects, all of whom had normal B12 status, performed better on |

|most psychological tests — including those measuring fluid intelligence, spatial ability and short-term memory — than those who had been macrobiotic. |

|Those who were still deficient in B 12 performed worst of all. 24 |

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|The prevalence of night blindness, an early in dictator of vitamin A deficiency, was assessed in children attending a diarrheal disease hospital in |

|Bangladesh. Five per cent of 2971 children between 1 and 10 years complained of night blindness and 47 per cent of these children as against 6 per cent |

|of children without night blindness also had ocular signs of vitamin A deficiency (p. ................
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