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 Table of Contents  
ORIGINAL ARTICLE
Year : 2021  |  Volume : 8  |  Issue : 2  |  Page : 95-101

A study to assess the effect of supplementary nutrition on nutritional status of preschool children in selected Anganwadis, Bengaluru South


1 Department of Community Health Nursing, Mercy College of Nursing, Kottayam, Kerala, India
2 Department of Community Health Nursing, Dr. B. R Ambedkar Institute of Nursing, Bengaluru, Karnataka, India
3 Department of Community Health Nursing, College of Nursing, Adesh University, Bathinda, Punjab, India

Date of Submission20-May-2019
Date of Acceptance20-Oct-2019
Date of Web Publication27-Oct-2021

Correspondence Address:
M B Sunil
Department of Community Health Nursing, College of Nursing, Adesh University, Barnala Road, Bathinda, Punjab
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/cjhr.cjhr_55_19

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  Abstract 


Background of the Study: Protein energy malnutrition has been identified as a major health and nutrition problem in India. Hence, the investigator felt the need to evaluate the effectiveness of nutritional supplement among preschool children in selected Anganwadis, Bengaluru. Materials and Methods: Using purposive sampling technique, a total of 60 samples were selected with 30 in experimental and 30 in control group. Quasi-experimental design with pretest nutritional assessment and posttest nutritional assessment with control design is used. Results: The prereading mean weight score was 11.49 and the postreading score increased to 12.28. Similarly, the prereading mean score of height 94.32 increased to a mean score of 94.52 in posttest. While considering the head circumference of the preschool children, the pretest mean score of 47.82 changed to 48.03 during the posttest. During the pretest, the mean reading of mid-arm circumference was 14.67, which then increased to a mean value of 14.80 during the posttest. The chest circumference of the children was 50.85 during the pretest which then increased to 51.01 during the posttest. Thus, an overall improvement had occurred in the anthropometric measurements of preschool children even though statistically, it is not significant. Conclusion: The overall findings of the study revealed that there was a marked improvement in the anthropometric measurements of preschool children. Hence, it can be concluded that the nutritional supplement was effective in improving the nutritional status of the children.

Keywords: Anthropometric measurements, nutritional supplement, preschool children


How to cite this article:
Viswanath S, Thressiamma P M, Sunil M B. A study to assess the effect of supplementary nutrition on nutritional status of preschool children in selected Anganwadis, Bengaluru South. CHRISMED J Health Res 2021;8:95-101

How to cite this URL:
Viswanath S, Thressiamma P M, Sunil M B. A study to assess the effect of supplementary nutrition on nutritional status of preschool children in selected Anganwadis, Bengaluru South. CHRISMED J Health Res [serial online] 2021 [cited 2021 Nov 27];8:95-101. Available from: https://www.cjhr.org/text.asp?2021/8/2/95/329448




  Introduction Top


Children represent the wealth of the country. A nation is built on the bricks of today's healthy children. The business of the young one is to grow, and the process of growth requires good nutrition.[1]

Children constitutes the most important and vulnerable segment of our population. They are truly the foundation of our nation; hence, the focus of every citizen should be promoting their health and safeguard their interest. “A healthy child is sure future” is one of the themes of World Health Organization (WHO). Healthy children grow to become healthy adults, who are strong both in body and mind.[2]

Malnutrition is like an iceberg; most people in the developing countries live under the burden of malnutrition. Pregnant women, nursing mothers, and children are particularly vulnerable to the effects of malnutrition.[3]

Protein energy malnutrition (PEM) has been identified as a major health and nutrition problem in India. It occurs particularly in weaklings and children in the 1st years of life. It is not only an important cause of childhood morbidity and mortality but also leads to permanent impairment of physical and possibly of mental growth of those who survive.[1]

PEM is a global problem. Nearly 150 million children under 5 years in the world and 70–80 million under-five children in India suffer from PEM; nearly 20 million in the world and 4 million in India suffer from severe forms of PEM, namely marasmus, kwashiorkor, and marasmic kwashiorkor. Worldwide, at least 20 million of under-five children are overweight WHO experts meeting on childhood obesity.[3]

The early years of life are the most crucial period because the body develops the most, mentally and physically, and is most vulnerable to disease and illness. The children of India are malnourished because of factors attributed to over population, poverty, and destruction of the environment, lack of education, gender inequality, and inaccessible medical care. Poverty is a major cause of malnourishment because it limits the amount of food available to children causing wasting and a lack of vitamins, minerals, and nutritional value leading to stunting and low weight. Overpopulation is a serious problem linked to competition for food, shelter, and medical care and leads to malnutrition among children, especially in rural areas where access to medical care and food is limited.[4]

A study was conducted to assess the nutritional status of under-five children and to assess whether infant feeding practices are associated with the undernutrition in Anganwadi (AW) areas of urban Allahabad. Under-5-year-old children and their mothers in selected four AW areas of urban Allahabad (UP) participated in the study. Nutritional assessment by WHO criterion (SD-classification) using summary indices of nutritional status: weight-for-age, height-for-age, and weight-for-height were done. Normal test of proportions, Chi-square test for testing association of nutritional status with different characteristics, and risk analysis using odd ratios with 95% confidence intervals were also done. Among all under-five children surveyed, 36.4% underweight (<2SD weight- for -age), 51.6% stunted (<2SD height- for -age), and 10.6% wasted (<2SD weight- for -height). Proportions of underweight (45.5%) and stunting (81.8%) were found maximum among children aged 1324 months. Wasting was most prevalent (18.2%) among children aged 37–48 months [Figure 1], [Figure 2], [Figure 3], [Figure 4].[5]
Figure 1: Cylindrical graph showing comparison of pretest and posttest mean of anthropometric measurements in experimental group

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Figure 2: Bar graph showing comparison of pretest and posttest mean of anthropometric measurements in control group

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Figure 3: Bar graph showing the comparison of mean and standard deviation in experimental and control group during pretest

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Figure 4: Bar graph showing the comparison of mean and standard deviation in experimental and control group during posttest

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A study conducted on randomized clinical trials of the impact of a nutritional supplement“multimixture impact of a nutritional status of children enrolled at the preschoolers.” This is longitudinal, controlled intervention study of 24 preschools which were compared before and after an intervention. Longitudinal, controlled intervention study of 24 preschools which were compared before and after an intervention. The control and intervention groups were defined by drawing lots to choose schools that had previously been paired for nutritional status. The intervention consisted of the addition of 10 g of multimixture to the meals provided to children attending the 12 schools in the intervention group. Outcome measures include changes in z scores for the three nutritional indices and hemoglobin values over the 6-month period during which the supplement was added. A multilevel model was used for analyses.[6]

Education about nutrition, household food security, health services, and proper childcare is essential for the general population to improve the state of better nutrition among the children today. The government needs to spend more money on quality nutritional programs to improve the state of malnutrition, health services, education for females, and poverty. Trends show that the situation of childhood malnutrition has improved over recent years, but a serious and dedicated effort needs to be put forth to improve the health of children in India in a sustainable way.[7]

With this concept in view, an attempt is being made to prepare a protein supplement from locally available source such as Ragi, Jaggery, Green Gram dhal, and ground nut. The so-formulated supplements will evaluate on the growth and nutritional status of children of age group under 6 years.

Objectives of the study

  1. To assess the nutritional status of the preschool children by measuring the anthropometric measurements
  2. To determine the effectiveness of nutritional supplementation by measuring anthropometric measurements of preschool children
  3. To find out the association between the selected demographic variables and the nutritional status of preschool children.


Hypothesis

  • H0: There is no significant difference on the anthropometric measurements after providing the nutritional supplements to the preschool children
  • H1: There is significant difference on the anthropometric measurements after providing the nutritional supplements to the preschool children as measured by checking height, weight, head circumference, mid-arm circumference, and chest circumference at 0.05 level of significance.



  Materials and Methods Top


Research approach

Evaluative approach.

Research design

Quasi experimental.

Setting of the study

The study was conducted in six AWs, namely Udayapalaya, O.B. Choodahalli, Udayapalaya extension, Thathaguni, Agara, and Uthiri which comes under Kaggalipura Primary Health Centre (PHC), Bengaluru South.

Variables

Independent variable

Supplementary nutrition.

Dependent variables

Nutritional status of preschool children those who are attending AWs.

Population of the study

Malnourished preschool children attending AWs were the population for the study.

Sample and sampling technique

All first-degree and second-degree malnourished children between 2 and 6 years of age were selected from six AWs, namely Udayapalaya, Udayapalaya extension O.B. Choodahalli, Thathaguni, Agara, and Uthiri which comes under Kaggalipura PHC as experimental group and control group. The lowest age understudy was 2 years and the highest was 6 years.

All the first- and second-degree malnourished children between 2 and 6 years were selected from three AWs, namely Thathaguni, Agara, and Uthiri which comes under Kaggalipura PHC as control group.

Purposive sampling technique was found to be suitable for the present study.

Sampling criteria (Indian Academy of Pediatrics classification)

Before the selection of the samples, all children attending these AWs were listed and assessed by checking the anthropometric measurements using fully calibrated digital weighing scale and inch tape to identify the children with first- and second-degree malnutrition as per Indian Academy of Pediatrics (IAP) classification. The children were graded as per IAP classification presented below.

Indian Academy of Pediatrics classification

  • Grade I – 80%–71% of the expected weight
  • Grade II – 70%–61% of the expected weight
  • Grade III – 60%–51% of the expected weight
  • Grade IV – <50% of the expected weight.


Selection and development of tool

The tool used for the study were

  1. Demographic data
  2. Weighing scale to record the weight of the children
  3. Diet plan
  4. Observation check list to assess the anthropometric measurements of the preschoolers. It has relevant, very relevant, needs modification, not relevant.


Description of the tool

Diet plan

The diet used by the researcher is a nutritional supplement of a mixture of ragi, jaggery, green gram dhal, and ground nut. It mainly 100 g of nutritional supplement which consists of ragi, jaggery, green gram dhal, and ground nut in a proportion of 40:30:20:10 which provides 300 kcal and 11 g protein/day. The implementation of the nutritional supplement was started on 14.03.11 and completed by 24.04.11 in-between 10 am and 11 am every day. The total duration of the study was 40 days [Table 1], [Table 2], [Table 3], [Table 4], [Table 5], [Table 6].
Table 1: Description of research design

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Table 2: The description of selected demographic variables of respondents in experimental and control group in respect of age

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Table 3: Comparison of pre- and post-test mean, median, range, and standard deviation of anthropometric measurements in experimental group

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Table 4: Comparison of pre- and post-test mean, median, range, and standard deviation of anthropometric measurements in control group

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Table 5: Comparison of mean and standard deviation in experimental and control group during pretest

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Table 6: Comparison of mean and standard deviation in experimental and control group during posttest

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Observation check list

It includes biodata of the child, weight assessment chart recommended by WHO, and periodical weight assessment chart. This will be followed throughout the study. Further, the nutritional supplementation and the periodical weight assessment were recorded by the investigator.

Ethical considerations

The proposal for the study was approved by the Institutional Review Board of the College of Nursing. The researcher approached all children at AW and explained the nature of the study to AW teacher and parents. They were informed that participation in the study was voluntary and they could withdraw from it at any time. Anonymity and confidentiality of the collected data were also assured. An information sheet with details of the study was given to the teacher and parents. Opportunities for asking questions about the study were provided. Those children parents were asked to sign the consent form. All data collected were kept strictly confidential.

Statistical analysis

The data were analyzed using descriptive and inferential statistics to find the effectiveness of nutritional supplementation of the individual child. Descriptive statistics was used to compare the difference between the anthropometric measurements in relation to age, gender, and degree of malnutrition. Graphs and tables were used to present the findings. Inferential statistics, i.e., paired, t-test was used to compare the effectiveness of nutritional therapy between pretest and posttest weight scores, heights scores, mid-arm circumference, chest circumference, and head circumference of first- and second-degree malnourished children. P < 0.05 was considered as statistically significant.


  Results Top


T-test was calculated to analyze the difference in pretest and posttest values on anthropometric measurements. From the above observations, it is clearly evident that no areas in the anthropometrical measurements were significant (P > 0.001). Hence, the null hypothesis related to difference of pretest and posttest overall mean scores is accepted, and the statistical hypothesis was rejected.

[Table 7] shows the association between sociodemographic variables and the posttest weight of the preschool children. It reveals that the Chi-square value between the posttest weight of the experimental group was found to be significant with the age of the preschool children.
Table 7: Association between posttest weight of experimental group and selected demographic variables

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[Table 8] shows the association between sociodemographic variables and the posttest height of the preschool children. It reveals that the Chi-square value between the posttest heights of the experimental group was found to be highly significant with the age of the preschool children.
Table 8: Association between posttest height of experimental group and selected demographic variables

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  Discussion Top


About 33.33% of the samples in experimental and control group were between 3 and 4 years, 30% of the samples in experimental and control group were between 4 and 5 years, 26.7% of the samples were between 2 and 3 years in both groups, and the rest were between 5 and 6 years. In experimental group, 30% were male and 70% were females. In control group, 43.3% were males and 56.7%were females.

During the mean pretest weight of the group was 11.49. After administering the nutritional supplement for a period of 40 days, the mean posttest weight increased to 12.28. Thus, it was evident that the nutritional supplement program was effective while considering the weight of the preschool children.

The mean pretest height score of the samples was 94.32. The mean posttest height score of the samples increased to 94.52 after the administration of nutritional supplement program. The mean pretest score of the mid arm circumference of the samples was 14.67; after the administration of nutritional supplement program, the mean posttest score of mid-arm circumference was 14.80.

The mean pretest head circumference score of the samples was 47.82. After the administration of nutritional supplement, the mean posttest head circumference was 48.03.

The mean pretest score of the chest circumference of the samples was 50.85. The mean posttest score of the samples after the administration of nutritional supplement was 51.01.

Thus, it is clearly stated that there is a marked improvement in all the readings in anthropometric measurements such as weight, height, mid-arm circumference, head circumference, and chest circumference. These findings were consistent and the findings of other research studies in which they found a positive change in anthropometric readings after nutritional supplementation.

There was also significant difference between mean pretest score and the mean posttest scores in all areas. It is evident from the findings that the administration of nutritional supplementation program improves the physical characteristics of a child.

T-test was calculated to analyze the difference in pretest and posttest values on anthropometric measurements. It is clearly evident that no areas in the anthropometrical measurements were significant (P > 0.001). Hence, the null hypothesis related to difference of pretest and posttest overall mean scores is accepted, and the statistical hypothesis was rejected.


  Conclusion Top


Overall, the pretest findings showed that all the children were having first-degree or second-degree malnutrition. The implementation of nutritional supplement to the preschool children helped the children improve their nutritional status in terms of weight, height, head circumference, chest circumference, and mid-arm circumference. The posttest findings revealed that there is a marked improvement in the anthropometrical measurements, especially the weight of the preschool children. Although the nutritional supplementation is not statistically significant as it was conducted only for a period of 40 days, major and minor differences were notified after the implementation of the administration of nutritional supplement. Similar study can be undertaken with a large number of samples and for longer time duration to generalize the findings.

Acknowledgment

Authors would like to thank all the participants who consented to participate in the study. Authors also thank the Anganwadi teachers who helped in collecting data.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Park K. Text Book of Preventive and Social Medicine. 19th ed. Jabalpur: Banarsidas Bhanot Publishrs; 2007. p. 416, 506.  Back to cited text no. 1
    
2.
Stanhope M, Lanceter J. Community and Public Health Nursing. 6th ed. Mosby Publcations; 2000. p. 626-30.  Back to cited text no. 2
    
3.
Hockenberry MJ. Wong's Essentials of Pediatric Nursing. 7th ed. Elsevier Publications; 2007. p. 422-3.  Back to cited text no. 3
    
4.
Roa KS. An Introduction to Community Health Nursing. 4th ed. B.I Publications Pvt., Ltd.; 2004. p. 203-42.  Back to cited text no. 4
    
5.
Ray SK, Biswas AB, et al. Rapid assessment of nutritional status and dietry pattern in Muncipal area. Indian J Community Med 2000;25.  Back to cited text no. 5
    
6.
Gigente DP, Buchmeitz M, et al. The American Society for Nutritional Sciences. (2007). 2003:133:4010s-20s.  Back to cited text no. 6
    
7.
Hackett M, Melgar-Quiñonez H, Alvarez MC. Household food insecurity associated with stunting and underweight among preschool children in Antioquia, Colombia. Rev Panam Salud Publica 2009;25:506-10.  Back to cited text no. 7
    


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4]
 
 
    Tables

  [Table 1], [Table 2], [Table 3], [Table 4], [Table 5], [Table 6], [Table 7], [Table 8]



 

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