Rajiv Gandhi University of Health Sciences, Bengaluru, Karnataka

RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES, BENGALURU, KARNATAKA.

SYNOPSIS PROFORMA FOR REGISTRATION OF SUBJECT FOR DISSERTATION

MR. ARUN SURENDRAN 1ST Year M Sc Nursing Child Health Nursing Year 2011-2013

BRITE COLLEGE OF NURSING BENGALURU-91

1 RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES, BENGALURU, KARNATAKA.

ANNEXURE-I

PROFORMA FOR REGISTRATION OF SUBJECT FOR DISSERTATION

1. NAME OF THE CANDIDATE Mr. ARUN SURENDRAN

& ADDRESS 1st YEAR M.Sc. ( NURSING ),

BRITE COLLEGE OF NURSING ,

#69, BWSSB COLONY, CHIKKAGOLLARAHATTI, MAGADI MAIN ROAD, VISHWANEEDAM POST, BENGALURU – 500 091.

2. NAME OF THE INSTITUTION BRITE COLLEGE OF NURSING ,

#69, BWSSB COLONY, CHIKKAGOLLARAHATTI, MAGADI MAIN ROAD, VISHWANEEDAM POST, BENGALURU – 500 091.

3. COURSE OF STUDY & I YEAR M.Sc. ( NURSING ), SUBJECT CHILD HEALTH NURSING.

4. DATE OF ADMISSION 1stJUNE 2011

5. TITLE OF THE TOPIC “A COMPARATIVE STUDY TO ASSESS THE KNOWLEDGE OF MOTHERS REGARDING GROWTH AND DEVELOPMENT OF SCHOOL GOING CHILDREN OF SELECTED URBAN AND RURAL AREA AT BANGALURU.”

6. BRIEF RESUME OF INTENDED WORK

2 INTRODUCTION

“ Children are the wealth of tomorrow- take care of them if you wish to have a strong India, everyday to meet various challenges”

-Jawaharlal Nehru

The child is the most precious possession of mankind, most loved and perfect in its innocence. The child represents that face of man which is always new. With every child we are born again and we play in the courtyard of the world in the bright sunshine of love and laughter.1

Our children are the future citizens of our country, in the lies the future of life. Whatever we invest in our child in terms of developing environment, both physical and emotional, is going to reap rich individuals in future. WHO dedicated the year 2003 toward the improvement of children through the announcement of World Health Day theme “shape the future of life” healthy environment of children2

A healthy child is an asset on which the nation remarks its progress. WHO has dedicated the year 2003 toward the improvement of children through an announcement of world day slogan “A healthy environment to the child” 3

The environment of children can be referred to holistic aspects of its influence- physical, social, intellectual, moral, emotional, spiritual and physiological areas. The conducive scenario of children reaches them to their peak achievement. One of the determinants in the child’s health in the pattern of his growth and development. The child’s experience is in first moments, months and years of life are very precious to the development. Every touch movement and emotion in a young child’s life translates into an expulsion of electrical and chemical activity in the interactions with parents, family members and other factors such as a adequate nutrition, good health and clean water. The development during the period sets the stage for later success in schools and the character of adolescence and adulthood4

3 Growth and development usually referred to a unit and express the sum of the numerous changes that take place during the life time of an individual. The child’s body becomes large and more complex. The personality simultaneously expands in the shape and complexity. Growth and development are influenced by the factors like genetic, endocrine, growth potentials, intrauterine life, emotional, nutritional, chronic diseases environmental, seasonal and socio-economic conditions5

Along with all the other factors nutrition is the important contribution in Indian children. Nutritional status in Karnataka (2001) shows 6.2% children belonging to severe under-nutrition, 45.4% with moderate category and 4% children in normal status level6

Physical growth during childhood and adolescence is an important indicator of health. Better growth leads to sound intellectual development. It determines the efficiency and productivity of an individual. The measurement of standing height and weight of school-going children annual check-up has become customary. It helps monitor the growth pattern over time; redefine normal values locally and identify high risk subjects for certain diseases7

The significant contribution made during the early ages of an individual’s life determines the whole some personality. The infant from mother’s lap becomes independent through exploration and steps up to toddler, pre-schooler, schooler, adolescent and then an adult. School age is an important in which the child the child learns through a formal teaching. A temporary or permanent home, a school away from home makes a child more learned and independent. The surrounding at home and school are going to make a great change in these children with their growth and development. One of the factors among these is the mother’s external employment which has both positive and negative effect on their growth and development. Traditionally, a women confined to home often lived the life of a domestic servant or even merely a child bearer. There was close contact between mother and child8.

6.1 NEED FOR THE STUDY

4 “Childhood is the world of miracle or of magic: it is as if creation rose luminously out of the night, all new and fresh and astonishing. Childhood is over the moment things are no longer astonishing. When the world gives you a feeling of "déjà vu," when you are used to existence, you become an adult” -Eugene Ionesco

A phenomenon peculiar to the pediatric age group is growth and development. Growth and development include not only physical aspect, but also intellectual emotional and social aspects. Normal growth and development take place with optimal nutrition; freedom from recurrent episodes of infection and adverse genetic and environmental influences9

School age children are more graceful than they were as pre-schoolers, and they are steadier on their feet. When they enter the school years, children begin to acquire the ability to relate a series of events and actions to mental representations that can express both verbally and symbolically. Daily relationships with age-mates provide the most important social interactions in the life of school-age children10

A study conducted by WHO to identify the stastical relationship between physical growth and development in children observed the stastically significant associations were noted between age of achievement of sitting without support and attained weight for age for length and BMI for age Z scores. An increase in of one unit of Z score in these indicators was associated with 3 to 6d acceleration in respective achievement age. Stasticslly significant associations also were noted between various milestone achievement age and growth when 3-6 mo and birth length for age z scores were entered jointly in the failure time models. In the analyses, one unit z-score increases in length for age was associated with 1 to 3dn delay in respective achievement age.11

To evaluate nutrition education intervention designed to improve infant growth and feeding practices. 11 randomly selected and 2 purposively selected villages of south Karnataka. Subjects: 138 Infants (n = 69 intervention) aged 5 -11 months. Families were administered a monthly questionnaire on feeding and child care behavior, and study infants were weighed at this time, using the SECA solar

5 scales, developed for UNICEF. These infants were also more likely to exhibit at least four positive feeding behaviors – intervention infants had a higher mean daily feeding frequency (more likely to be fed solids at least four times a day (OR = 4.35, 95% CI =1.96, 10.00), higher dietary diversity (more likely to receive a more diverse diet OR = 3.23, 95% CI = 1.28, 7.69), and were more likely to be fed foods suggested by the counselors such as bananas (OR = 10.00, 95% = 2.78, 33.3) compared to non- intervention infants. Nutrition education and counselling was significantly associated with increased weight velocity among girls and improved feeding behavior among both boys and girls. These results provide further evidence that community-based nutrition programs that emphasise appropriate feeding and care behavior can be used to prevent and address early childhood malnutrition in poor households12.

One among the important aspects that influence the child; growth and development is the home environment, the time, money and effort spent by parents and others in bringing about all round development in child decides on the future of the child. Mother being an initial caregiver brings a close attachment with the child. The ideal responsibilities bring hope in the child. According to Nock and Kingston, the time spent by the non-employed mothers with their pre-schoolers was not devoted to childcare to direct play, rather the mother was engaged in cooking and doing household chores at that time A longitudinal study on maternal labour force in New Zealand over 1265 children from birth to 18 years highlighted on positive association with the child’s academic achievements as compared to the non-paid working women13

The above mentioned literature and statitics reveals motivated the investigator to select the present study to compare the knowledge of mothers regarding growth and development of school going children in selected urban and rural areas of Bengaluru.

6.2 REVIEW OF LITERATURE

The review of literature is presented under the following areas:-

1. Growth and development of School going children in urban area

6 2. Growth and development of School going children in rural area 3. Comparative studies related to growth and development in urban and rural area

1. GROWTH AND DEVELOPMENT OF SCHOOL GOING CHILDREN IN URBAN AREA

A study conducted for assessing “Growth standards for poor urban children” In order to estimate the importance of a variety of environmental and dietary factors as determinants of growth in a group of 123 poor Peruvian urban children between 2 and 19 years old, we found it necessary to express anthropometric measurements in units that were not age- or sex-dependent. Some CATch-up" gains in relative height and weight were apparent in preschool children but more impressive gains in both linear and ponderal growth, relative to the Boston data, were evident between 8 and 13.5 years in girls and 10 and 17 years in boys.. Racial and regional differences in patterns of growth must be taken into account in the interpretation of anthropometric and nutritional data14.

A study reveals that “Physical growth trend of Chinese children under 7 years in urban area” To analyze the physical growth changes in Chinese children aged from 0 to 7 years old during the past 30 years. Four national physical growth surveys of the children under 7 years old were undertaken in the same urban and suburban areas of nine main cities in China from 1975 to 2005. cities. Random cluster sampling method was used. The children aged from 0 to 7 years old were classified into 22 groups by age. Totally, 158 400, 152 874, 157 362 and 138 775 healthy children were examined in 1975, 1985, 1995 and 2005 respectively. The physical growth of Chinese children had been much improved during the past 30 years and the secular trend should be still continuing at an accelerated growth stage15.

2. GROWTH AND DEVELOPMENT OF SCHOOL GOING CHILDREN IN RURAL AREA

7 A study for assessing the growth of infants and children in China, growth of China s infants and children has improved since the introduction of economic reforms. After 1979, secular increases in both weight and length have been observed. In certain industrial centers, infant lengths have caught up to international standards. Overall prevalence of underweight and stunting have declined. However, the health benefits from economic growth have not been shared equally among the Chinese population. Therefore, although economic reform has stimulated improvements in the growth of Chinas children, continued development and attention is needed in disadvantaged areas and populations. Public education is also necessary for China s children to avoid the diet-related diseases frequently seen in the west16.

3. COMPARITIVE STUDY RELATED TO GROWTH AND DEVELOPMENT OF SCHOOL GOING CHILDREN IN URBAN- RURAL AREA

A study reveals that the Nutritional status comparison of rural with urban school children in Faisalabad District, Pakistan. This study was undertaken in order to assess the nutritional and growth status of male and female school-going children aged 6-12 years from rural and urban areas in Pakistan. Data were collected from male and female school-going children aged 6-12 years in and around Faisalabad, Pakistatan. Among the urban children, 33% were below the standard for height (stunted), and 32.3% were below the standard for weight (underweight); 32.7% were wasted. Of the rural children, 40.9% were stunted, 64.7% were underweight and 33.3% were wasted. The rural female group was the most affected and malnourished with 61.8% stunted and 84% underweight; 67.1% were wasted17.

8 A study conducted on “Urban-rural differences in the growth of Peruvian children”. The growth characteristics of children from four villages in northern Peru were compared with those of poor urban children in the capital city, in who short stature but generally satisfactory weight for height relationships after infancy had been demonstrated. Rural girls caught up with the urban girls in height during childhood but did not match them in weight until late adolescence. Their weight to height ratios were consistently lower after 1 year of age, most strikingly between 2 and 5 years of age, and did not approach or match those of the urban girls until adolescence. Such urban-rural and sex differences, if typical and current, might well call for very different remedial measures at different ages in each of the populations18. A study on “Urban-rural contrasts in the growth status of school children in Oaxaca, Mexico”. reveals that The growth status of school children resident in an urban colonia and in a rural indigenous community in Oaxaca, southern Mexico, was considered in the context of two objectives, current status and the magnitude of urban-rural differences over a span of about 30 years. The magnitude of the urban- rural difference in girls was greater in 2000 than 30 years earlier for body mass, height, sitting height, leg length and BMI. Urban-rural differences for arm and arm muscle circumferences and the triceps skin fold were slightly smaller over the interval19

STATEMENT OF PROBLEM “ A COMPARATIVE STUDY TO ASSESS THE KNOWLEDGE OF MOTHERS REGARDING GROWTH AND DEVELOPMENT OF SCHOOL GOING CHILDREN IN SELECTED RURAL AND URBAN COMMUNITIES AT BENGALURU”

6.3OBJECTIVES 1) To assess the knowledge level regarding growth and development among the mothers of school going children in selected urban areas by structured knowledge questionnaire.

9 2) To assess the knowledge level regarding growth and development among the mothers of school going children in selected and rural areas by structured knowledge questionnaire. 3) To compare the knowledge level regarding the growth and development during among the mothers of school going children, using statistical analysis.

6.3.1 HYPOTHESIS

H1 There will be significant difference between the knowledge scores of mothers of school going children in rural and urban areas regarding growth and development.

6.3.2 VARIABLES 1. Independent variable: Growth and development of school going children. 2. Dependent variable: Level of knowledge of mothers of school going children regarding growth and development 3. Attribute variables: Age, education, occupation, family, income, source of information.

6.4 OPERATIONAL DEFINITIONS a) Comparative Study: Refers to systematic determination of variation among two sample groups. b) Mother: A women with one or more school going children and is involved in their care. c) Growth: Increase the physical size of the children. d) Development: A significant event, occurrence, or change. e) School going children: The children between 6 -12 years of age. f) Knowledge: Correct verbal responses of the mothers to the knowledge items. g) Urban: It refers to a geographical area with 10000 or more population of different age group residing in a city or town. h) Rural: It refers to a geographical area with 500-5000 population of different age groups residing in village or outskirts of a city or town.

6.5 ASSUMPTION

10 It is assumed that,

1. The mothers of school going children have less knowledge regarding growth and development.

2. The knowledge of mothers on growth and development of school going children vary with the demographic variable of the mothers.

6.6 LIMITATIONS 1) The study is limited to those mothers who are all having school going children at selected urban and rural communities, Bengaluru. 2) The study is limited to the mothers of school going children who are willing to participate in the study. 3) The study is limited to mothers of school going children who are available during the period of data collection.

7. MATERIALS AND METHODS 7.1 Sources of Data: The mothers of school going children at selected urban and rural areas, Bengaluru. 7.1.1 Research Approach : Comparative research approach 7.1.2 Research design : Qualitative study design. 7.1.3 Setting : Selected urban and rural areas, Bengaluru. 7.1.4 Sample size : 100(each 50 in rural and urban area)

7.1.5 Inclusion criteria: The mothers who are:  Having school going children.  Willing to participate in the study.  Available during the time of data collection.  Able to read and write Kannada. 7.1.6 Exclusion criteria The mothers who are:

11  Having illness during data collection.  Attended the related study previously.  Having pre-schoolers. 7.2 Method of collection of data 7.2.1 Sampling technique: Purposive sampling. 7.2.2 Tool of research: Structured knowledge questionnaire Structured knowledge questionnaire will be constructed in two parts. Part I - Demographic data. Part II- Knowledge based structured questionnaire regarding growth and development among mothers of school going children. 7.2.3 Collection of data 1. The written permission will be obtained from the concerned authority, prior to the data collection. 2. Samples will be collected by purposive sampling techniques. 7.2.4 Investigator introduces himself to collect the data from the mothers of school going children. Structured knowledge questionnaire is used to assess the knowledge of mothers of school going children regarding growth and development.

7.2.5 Method of data analysis and presentation

1. The investigator will use descriptive and inferential statistics to analyse the data. 2. The analyzed data will be presented in the form of tables, diagrams and graphs.

7.3 Does the study require any investigation to be conducted on patients or other human or animals? If so please describe briefly? Yes, [Comparative study of mothers of school going children]

7.4 Has ethical clearance has been obtained from your institution?

 Yes, Consent will be obtained from concerned authority.

12  Privacy, confidentiality and anonymity will be guarded.  Scientific objectivity of the study will be maintained with honesty and impartiality.

8. List of references:

1. Sailian K. Child labour and prevention. Journal of community medicine 1998 Aug; 38(2):72-3. 2. Bhan MK, AroraNK.Growth and development of children. Indian journal pediatricy.2003; 58(5):650. 3. UNICEF. The state of the World’s children. Health Action. 2003; 35. 4. WHO. The state of the World’s children. Health Action. 2001; 46 5. Piyush G. Essential pediatric nursing. 1st ed. New Delhi: AP Jain co; 2004: 115-19. 6. India Development Gateway. [Internet].2007 [citied 2010, Sep]. Available from: http//www.indg.in/health/facts-for-life. 7. Singh, Vasanth and Bachan. Growth and development of children Indian J Pediatr. 2001 Dec; 68(12): 8. Fernades L. Personality development in children.Pediatr.2008 Jan;15(1):3-5

13 9. Park K. Text book of Preventive and Social Medicine. 19th ed. Jabalpur (India): M/s Banarsidas Bhanot Publishers; 2007: 116-18. 10. Dorothy R, Barbara A. Text book of Pediatrics.6th ed. New Delhi: Saurabh Pvt.Ltd; 2008:163-64. 11. WHO Multicentre growth reference study group. Relationship between physical growth and motor development in the WHO child growth standards. Acta Paediatrica.2006; 450:96-101. 12. Kilaru A., Griffiths P.L. Community-based Nutrition Education for Improving Infant Growth in Rural Karnataka. Indian Pediatrics 2005; 42:425- 32. 13. Nock and Kingston. Child safety and prevention of accident. The Nursing Journal of India.2003; 4(2)25. 14. Graham GG, MacLean WC. Growth standards for poor urban children. Am J Clin Nutr 2009 Mar; 32(3):703-10.

15.Li H, Zhang YQ, Zhu ZH. Physical growth trend of Chinese children under 7 years old, in 1975 - 2005].Zhonghua Yu Fang Yi Xue Za Zhi. 2009 Mar; 43(3):182-6.

16. Sit CS, Yeung DL. Growth of infants and children in China. Indian Pediatr. 1999 May; 36(5):464-75.

17. Anwer I, Awan JA. Nutritional status comparison of rural with urban school children in Faisalabad District, Pakistan. Anwer clinic, Faisalabad, Pakistan. [email protected].

18.Graham GG, MacLean WC Urban-rural differences in the growth of Peruvian children. Am J Clin Nutr. 2008 Feb; 33(2):338-44.

19. Reyes ME, Tan SK, Malina RM. Urban-rural contrasts in the growth status of school children in Oaxaca, Mexico. Ann Hum Biol. 2003 Nov-Dec; 30(6):693- 713.

14 9 Signature of Candidate

10 Remarks of the Guide The study is feasible and of genuine interest of the student 11 Name & Designation Of 11.1 Guide Mrs. PRAMILA, M Sc (N) Professor Brite college of nursing

Chikkagollarahatti, Bengaluru -560091 11.2 Signature

15 11.3 Co-Guide Mrs. Latha Lecturer Brite College of Nursing Chikkagollarahatti, Bengaluru -560091 11.4 Signature

11.5 Head of the Department Mrs. PRAMILA, M Sc (N) Lecturer Brite college of nursing

Chikkagollarahatti, Bengaluru -560091

11.6 Signature

12 12.1 Remarks of the The study is feasible and of genuine Principal interest of the student 12.2 Name and Signature