Rajiv gandhi university of health sciences, bangalore, karnataka proforma for registration of subject for dissertation




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RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES, BANGALORE, KARNATAKA

PROFORMA FOR REGISTRATION OF SUBJECT FOR DISSERTATION

TOPIC

UTILITY OF MID ARM CIRCUMFRENCE AND MID THIGH CIRCUMFERENCE IN IDENTIFYING PROTEIN ENERGY MALNUTRITION IN ANGANWADI CHILDREN OF 1 TO 5 YEARS OF AGE, IN AND AROUND SULLIA, D.K.



Dr. PARINITHA.N.P.,

POSTGRADUATE STUDENT,

DEPARTMENT OF PEDIATRICS,

K.V.G. MEDICAL COLLEGE AND HOSPITAL,

SULLIA (D.K.) – 574327. RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES

KARNATAKA, BANGALORE
ANNEXURE-II

PROFORMA FOR REGISTRATION OF SUBJECTS FOR DISSERTATION



1.


NAME OF THE CANDIDATE AND ADDRESS



DR. PARINITHA. N.P.

POST GRADUATE STUDENT

DEPARTMENT OF PEDIATRICS

K.V.G. MEDICAL COLLEGE AND

HOSPITAL, KURUNJIBHAG, SULLIA

(D.K)– 574327.


2.


NAME OF THE INSTITUTION



K.V.G. MEDICAL COLLEGE AND HOSPITAL, SULLIA.



3.


COURSE OF STUDY AND SUBJECT


M.D. PEDIATRICS



4.


DATE OF ADMISSION TO COURSE



29/05/2013


5.


TITLE OF TOPIC


UTILITY OF MID ARM

CIRCUMFERENCE & MID THIGH

CIRCUMFERENCE IN IDENTIFYING

PROTEIN ENERGY MALNUTRITION IN ANGANWADI CHILDREN OF 1 TO 5 YEARS OF AGE, IN AND AROUND SULLIA, D.K.”







BRIEF RESUME OF THE INTENDED WORK.

6.1 Need for the study:

NUTRITION "Nutrition is defined as the science of food and its relationship to health".1

MALNUTRITION derives from etymological origin, malus (bad) and nutire (nourish).2 It is a man made disease which often starts in the womb and ends in the tomb.2

Protein energy malnutrition is a spectrum having two different clinical manifestations kwashiorkor being one end of the spectrum and the marasmus at the other end.3

Children between one to five years of age are the most vulnerable section of population. They constitute 16.5% of total population whereas mortality in this age group constitutes 40% of total deaths in the country.4

Mathur et al5, Udani et al6 and Mittal et al7 found that the highest incidence of malnutrition is found in 6 months to 5 years age group.

Maternal malnutrition, low birth weight, recurrent infections, breast feeding practices, child rearing practices, conditioning influences, cultural influences, genetic factors ,environmental factors, socioeconomic factors are the important factors that lead to malnutrition.8

Rao et al9 reported that the critical period of malnutrition begins towards the end of the first year as there is inadequate knowledge about complementary feeds in caregivers and lack of the effective breast feeding.

Mathurs study attributed morbidities due to gastrointestinal disorders (59.4%), respiratory disorders (29.5%) and eruptive fevers (9.9%) to nutritional disorders in children below 5 years of age group. This may be the reason why malnutrition is more commonly seen up to 5 years of age.5

Nutritional status can be determined with the help of clinical examination of signs of nutritional deficiencies, dietary intake and anthropometry. When these methods are used in combination, provides better picture for assessment of nutritional status of children.1

Anthropometric measurements like weight, height, mid upper arm circumference, skin fold thickness, thigh circumference, head circumference and chest circumference are valuable indicators of nutritional status. Clinical examination is simplest, accurate and the most practical method of ascertaining nutritional status.1

Nutritional disorders in children of age less than 5 years in a developing country where deep root traditions, taboos and false beliefs have imprisoned the people, the problem of nutritional disorders is more acute and its impact is more in children. Therefore identifying PEM early in children of 1-5 years of age is required in the implementation of the preventive and the effective control measures of protein energy malnutrition.







6.2 Review of the literature:

The term PEM is defined by WHO as a range of pathological conditions arising from lack of protein and calories in varying proportions, occurring in children 1 to 5 years of age and commonly associated with infections. It comprises four forms undernutrition, overnutrition, imbalance and specific deficiencies.10

Roy et al11 documented that the prevalence of malnutrition was highest (74.19%) in the age group of 12-23 months, followed by 24-35 months (66.18%) and 36-59 months (60.47%).

The study done by Mathur et al5 revealed that, in age wise distribution 60.2% of children were 1-3 years and 15.9% were below 1 year, among them 61.3% were males. The mean age for males and females were 2.15 and 2.11 years respectively. 30.2% children had nutritional disorders such as anemias (18.3%), vitamin deficiencies (9.9%) and protein energy malnutrition (1.9%).

Nearly all of undernourished are present in developing countries.12 It is seen most commonly in low socioeconomic status. 'Nutritional disorders' by social classification revealed that 86.1% were of social classes IV and V.5

PEM and micronutrient deficiency are major contributors for higher mortality rates from illness and diseases such as pneumonia, malaria, diarrhea and exanthematous fevers in developing world.13

Bhandari et al14 found that the nutrition parameters have a significant association with parental education, socioeconomic status, family size, environmental conditions and episodes of common diseases.

Malnutrition accounted for 58% of the total mortality in 2005 globally. In 2006, more than 36 million died of hunger or diseases due to deficiencies in micronutrients.15


Nutritional assessment is done by clinical examination, anthropometric measurement, functional assessment, assessment of dietary intake and indirect methods like vital statistics, assessment of ecology factor.1



Anthropometry is the single most portable, universally applicable, inexpensive, non invasive and gold standard method available to assess the proportion size of human body.16

The mid arm circumference remains fairly constant between 1 to 5 years of age. It is one of the age independent indicators. It is a useful indicator in screening large number of children during nutritional emergencies. It is not suitable for continued growth monitoring as it increases very slowly during 1 to 5 years of age. Normal value is 16.5- 17.5cm.16

Thigh circumference depends on the muscle mass of the child and indirectly on the weight of the child. Deviation from the expected weight will result in reduction in muscle mass, which can be used as an indicator to identify PEM.17

According to the study made by Mishra BK and Mishra S in Orissa, prevalence of malnutrition in children was 31% in rural and 27% in urban by midarm circumference.18

Tripathi MS and Sharma V conducted the study to determine the nutritional status of children in anganwadi in rajasthan by mid arm circumference, out of the total children, 61% were males and 39% were females. 56% of the total children were falling under PEM.19


6.3 Objectives of the Study:

1. To assess the nutritional status of Anganwadi children of 1 to 5 years of age in Sullia using

Indian Academy of Pediatrics classification.

2. To compare the utility of mid arm circumference and mid thigh circumference in detecting

malnourished children.






MATERIALS AND METHODS.

7.1 Source of Data Collection:

All children between 1-5 years of age who are enrolled in Anganwadis, Sullia(D.K) will be included in this study.



Study period: One year from December 2013-November 2014.

7.2 Method of Data Collection:

Anganwadis around Sullia will be listed initially. Using simple random sampling Anganwadis will be selected and all the children in selected Anganwadis will be studied. The permission of Child Development Program Officer (CDPO), Sullia and informed consent of the parents of the children will be taken before starting the study. Aims, objectives and procedures will be explained. Personal information of each child will be taken from Anganwadi records. Height, weight, mid arm circumference, mid thigh circumference and other nutritional anthropometric measurements will be taken. Data will be entered in the standardized proforma. Repeated visits will be made to ensure full coverage.


Inclusion criteria:

  1. All children between 1-5 years of age who are enrolled in Anganwadis, Sullia (D.K) will be included in this study.

Exclusion criteria:

  1. Children less than 1 year of age.

  2. Children more than 5 years of age.

  3. Children with known congenital anomalies.

  4. Children with any medical illness.

  5. Parents/guardians not willing to enroll the children in the study.

Study design: Cross sectional study.

Sample size:.

Different recent published studies from India suggest that the prevalence of malnutrition in Anganwadi children ranges from 40 to 60 percent.20, 21 Sample size of 500 is required with a confidence interval of 5% and confidence level of 95%.



Analysis of data:

The data will be analyzed using SPSS version 17. Descriptive statistics like frequencies, percentages, range of various parameters will be calculated, chi-square test and other appropriate statistical tests will be used.


Follow up:

No follow up is required as per norms of the study.


Follow up period:

Not applicable.



7.3 Does the study require any investigation\intervention to be conducted on patients\ humans\ animals? If so, please describe briefly:

Yes

7.4 Has ethical clearance been obtained from your institution in case of 7.3?

Yes, Ethical Committee clearance copy enclosed.




8.

REFERENCES.

  1. Park K editor. Textbook of preventive and social medicine, 20th ed, Jabalpur Banarsidos bhanot 2009; 526-578.

  2. Szajewska H, Warsaw. Malnutrition in developing countries- A changing face. Annals Nestle 2009; 67(2): 73-80.

  3. Harishankar, Shraddha Dwiwedi, Dabral SB, Walia DK. Nutritional status of children

under 6 years of age. Indian J Prev Soc Med 2004; 35(3&4): 156-162.

  1. Grangnolati M, Shekhar M, Gupta MD, Brendenkamp C, Lee YK. India’s

undernourished children: A call for reform & action: What are the dimension of

undernutrition problem in India? The world bank; 2005; 1: 6.

5. Mathur JS, Mehrotra SK, Maheshwari BB. Nutritional disorder among children below

Five years in a rural community. Indian J Pediatr 1974; 41: 184.

6. Udani PM. Morbidity and mortality of child in protein energy malnutrition. Indian J

Child Health 1962; 11: 239.

7. Mittal VS, Agarwal KN. Observation on nutritional megaloblastic anemia in early

childhood. Indian J Med 1969; 57: 730.

8. Siddiq O, Bhargava A. Health and nutrition in emerging Asia 1998; 16(1): 31-71.

9. Rao KS, Swaminathan MC, Swarup S, Patavardahan VN. Protein malnutrition in south

India. Bull.WHO 1959; 20: 603.

10. Jelliffe DB. The assessment of nutritional status of the community, WHO Monograph.

1966; Sr. No. 53.

11. Ray SK, Biswas AB, Gupta SD, Mukherjee D. Rapid assessment of Nutritional Status

and Dietary pattern in Municipal area. Indian J of Com Med 2001; 1: 25.

12. FAO. World Hunger and Poverty Facts and Statistics 2010 [Online]. Available from:

http://www.fao.org/publications/sofi/en. [Accessed 27 Oct 2013].

13. Caballero B, Maqbool A, Walker WA, Watkins JB, Duggan C, eds. International

Nutrition. In: Nutrition in Pediatrics. London: BC Decker Inc 2003: 195- 204.

14. Bhanderi D, Choudhary SK. An Epidemiological study of health and Nutritional status

of under five children in semi-urban community of Gujarat. Department of Community

Medicine, Pramukh Swami Medical College, Karamsad, Anand, Gujarat 2006;

50(4):213-219.

15. Ziegler J. The United Nations Special Rapporteur on the Right to Food for 2000 to

March 2008 [Online]. Available from: http://library.thinkquest.org/C002291/high/

present/stats.htm. [Accessed 2013 Oct 27].

16. Elizabeth KE editor, Nutrition and child development, 4th ed Hyderabad Paras Medical

2010: 168.

17. Kulkarni Ml editor, Clinical Methods in Pediatrics, 1st ed N.Delhi Jaypee brothers

2005: 102.

18. Kishori B, Mishra S. Nutritional anthropometry and preschool child feeding practices

in working mothers of central Orissa. Stud Home Comm Sci 2007; 1(2): 139-144.

19. Tripathi MS, Sharma V. Assessment of nutritional status of pre schoolers in slum areas

of Udaipur city. Indian J Public Health 2006; 50(1): 33-34.

20. Baranwal K, Gupta VM, Mishra RN, Prakash S, Pandey. On Factors influencing the

nutritional status of under five children in urban- slum area of Varanasi. Indian J

Com Health 2009- 2010; 21(2).

21. Agarwal K, Kushwah A, Kushwah, Agarwal RHS, Rajput LP. Dietary analysis and



assessment of nutritional status of pre-school children of urban and rural population.

Indian J Nutr Diet 2001; 38: 231-235.





9.


SIGNATURE OF CANDIDATE




10.


REMARKS OF THE GUIDE





11.


11.1 NAME AND DESIGNATION OF GUIDE


11.2 SIGNATURE OF THE GUIDE



Dr. VIJAY KUMAR.B

Professor and HOD,

Department of Pediatrics, K.V.G. Medical College and Hospital, Sullia, D.K







11.3 HEAD OF THE DEPARTMENT

11.4 SIGNATURE OF THE HEAD OF THE DEPARTMENT


Dr. VIJAY KUMAR.B

Professor and HOD,

Department of Pediatrics,

K.V.G Medical College and Hospital, Sullia, D.K.




12.

12.1 REMARKS OF THE PRINCIPAL:








12.2 PRINCIPAL SIGNATURE





ETHICAL COMMITTEE CLEARANCE

1.

TITLE OF DISSERTATION:

UTILITY OF MIDARM CIRCUMFERENCE & MID THIGH CIRCUMFERENCE IN IDENTIFYING PROTEIN ENERGY MALNUTRITION IN CHILDREN OF 1 TO 5 YEARS OF AGE, IN AND AROUND SULLIA, D.K.”

2.

NAME OF THE CANDIDATE:

Dr. PARINITHA. N.P

3.

NAME OF THE GUIDE:

Dr. VIJAY KUMAR. B

4.

APPROVED/NOT APPROVED: APPROVED


5.


LAW EXPERT MR .KRISHNAMURTHY, ADVOCATE.






PRINCIPAL

K.V.G MEDICAL COLLEGE AND HOSPITAL, SULLIA.


CASE PROFORMA FOR UTILITY OF MID ARM & MID THIGH CIRCUMFERENCE IN IDENTIFYING PROTEIN ENERGY MALNUTRITION IN ANGANWADI CHILDREN IN AND AROUND SULLIA, D.K.

I General information of child:

Date of visit:

Serial no:

Anganwadi name:

Name of the child:

Date of Birth:

Sex: Male/ Female

Father’s name:

Mother’s name:

Caste: sc/st/obc/others

Religion: Hindu/Muslim/Christian/Others

Address:


II Nutritional assessment of child:

  1. Anthropometry:

Weight (KG):

Height (cm):

Head circumference (cm):

Mid Arm circumference (cm):

Mid Thigh circumference (cm):

Chest circumference (cm):



B. Clinical Examination:

1. Visible signs of wasting (Thin old man face, loose skin, prominent ribs): Present/ Absent

2. Pedal edema: Present/ Absent.

3. Hair: Normal/ hypopigmented/ Thin & Sparse/ Easily Pluckable/ Flag Sign.

4. Face: Normal/ Diffuse Depigmentation/ Naso- Labial Dyssebacea/ Moon like.

5. Eyes:

a. Conjunctiva: Normal/ PaleConjunctiva/ Xerosis/ Bitot’s Spots.

b. Cornea: Normal/ Xerosis/ Keratomalacia.

c. Vision: Normal/ Difficulty in seeing in night times.



6. Glands:

7. Lips: Normal/ Angular stomatitis/ Cheilosis.

8. Tongue: Normal/ Pale& Atrophied/ Red beefy / Fissured/ Geographic.

9. Teeth: Normal/ Mottled Enamel/ Caries.

10. Skin: Normal/ Scaling/Follicular Hyperkeratosis/ Hyperpigmented/ Petechiae/Poor wound healing.

11. Nails: Normal/ Pallor/ Koilonychia/ Transverse Ridging.

12. Rachitic Changes: Absent/ Knock knees/ Bow legs/ Epiphyseal enlargement/ Beading of ribs/ Pigeon Chest.

13. Gums: Normal/ Swollen/ Bleeding.

14. Systemic Examination:

a. Gastrointestinal: Normal/ Hepatomegaly/ Splenomegaly.

b. Nervous: Normal/ Psychomotor changes/ Sensory Loss/ Motor weakness/ Loss of Position sense/ Loss of vibratory sense/ Loss of ankle & knee jerks.

c. Cardio vascular: Cardiac enlargement/ Tachycardia/bradycardia.

d. Respiratory: Air entry b/l equal/ Type of breath sound/ Added sounds.

15. Spinal Posture: Normal/ Kyphosis/ Scoliosis/lordosis.

16. Other signs related to Nutrition Specify:

III. Risk factors for malnutrition:

1. Informant: Mother/ Father/ Other specify:

2. Head of the Household: Mother/ Father/ Other specify:

3. Father’s Occupation:

4. Mother’s Occupation:

5. Current Marital Status of parents: Living together/ divorced/ Father dead/ Mother dead.

6. Type of Family: Nuclear/ Joint.

7. Father’s Education:

8. Mother’s Education:

9. Total number of family members:

10. Total Family income per month (Rs):

11. Total Expenditure on food per month:

12. Total no of children for couple: Boys: Girls:

13. Present child Birth order:

14. Age of the elder child born before present child:

15. Is Child suffering from any medical illness: If yes, Duration:

INFORMED CONSENT

I Dr. Parinitha.N.P, Post graduate student in Department of Pediatrics conducting a dissertation work for award of MD degree in Pediatrics.

The topic for the study is “UTILITY OF MID ARM CIRCUMFRENCE & MID THIGH CIRCUMFERNCE IN IDENTIFYING PROTEIN ENERGY MALNUTRITION IN ANGANWADI CHILDREN OF 1 TO 5 YEARS OF AGE, IN AND AROUND SULLIA, D.K.

Objectives of the study:

1. To assess the nutritional status of Anganwadi children of 1to5 years of age in Sullia using IAP classification.

2. To compare the utility of mid arm circumference and mid thigh circumference in detecting malnourished children.

I have been told in a language that I understand ( ) about the study. I have been told that this is for a dissertation procedure, that my son/daughter’s participation is voluntary and he/she reserves the full right to withdraw from the study at my own initiative at any time, without having to give any reason. Confidentiality will be maintained and only be shared for academic purposes.

I hereby give consent to participate in the above study. I am also aware that I can withdraw this consent at any later date, if I wish to. This consent form being signed voluntarily indicates agreement to participate in the study, until I decide otherwise. I understand that I will receive a signed and dated copy of this form.

I have signed this consent form, before my participation in this study.

Signature of the parent/guardian:

Date: Place:

Signature of the witness:

Date: Place:

I hereby state that the study procedures were explained in detail and all questions were fully and clearly answered to the above mentioned participant /his/her relative.

Investigator’s signature: Date:



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