EVALUATION OF SELECTED NUTRITION AND HEALTH PROGRAMMES IN TELANGANA STATE

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dc.contributor.advisorUMA DEVI, K
dc.contributor.authorVAHINI, S
dc.date.accessioned2020-10-03T05:45:42Z
dc.date.available2020-10-03T05:45:42Z
dc.date.issued2018
dc.description.abstractThe present study entitled “Evaluation of selected nutrition and health programmes in Telangana State” was undertaken to evaluate and enhance the functioning of Weekly Iron Folic Acid Supplementation, Anganwadi Centres and Nutrition Rehabilitation Centres. Under National Health Mission, 12 Nutrition Rehabilitation Centres (NRCs) had become functional in Telangana State for treatment and nutritional rehabilitation of children suffering from Severe Acute Malnutrition (SAM) along with medical complications. In congruence with the GOI guidelines, each NRC had one medical officer, one nutritionist-cum-counsellor, a staff nurse, and one cook-cum-attendant for the functioning of NRC Among the twelve medical officers, half of the medical officers were trained in the facility-based care of Severe Acute Malnutrition (SAM) children and rest was not trained. Nine (75%) nutritionist-cum-counselors were specialized in nutrition, two (17%) were from chemistry background and one from nursing. All the twelve nurses working in the NRCs were qualified from the General Nursing Midwifery (GNM). The medical social worker (MSW) position was vacant in the all 12 NRC units. All the Nutritionist - cum - counselors were trained in facility-based care of SAM children. Among the 12 NRCs, 4(33%) cook-cum-attender were given training related to preparation of therapeutic diet and preparation of food with locally available food materials. While the rest of 67% were untrained. Highest percentage of SAM children admitted to NRC were majorly below 3 yrs old indicating that infants and preprimary children were the most vulnerable group, susceptible for severe acute malnutrition. The incidence of SAM was found to be more or less equal among all castes, lowest being in minority groups. Less admission in NRC from tribal and urban areas could be due to low incidence of SAM or ignorance or non-willingness of people in these areas. The factors like mother’s age at primigravida, mother’s educational status, nutritional and health status during pregnancy and lactation period could be the possible reasons for the higher incidence of poor nutritional conditions of mothers (primi and second gravida). Too early pregnancies as in women between 18-22 yrs or too late pregnancies as in 33-37 yrs, which was obvious from the age of children admitted in NRCs (< 5yrs) xvii could be the other reasons for entry of children into SAM condition or at risk of nutritional and health problems. Low or no literacy of mothers as majority of the study group along with much higher percent of fathers being illiterate or semiliterate might have been one of the causes of severe acute malnutrition among children, also due to ignorance and improper child rearing practices. The parents of SAM children were majorly low wage earners and this factor could be attributed to the possibility of malnutrition of children and lack of affordability of treatment of illness and infections associated with malnutrition. The most common complications among SAM children were severe weakness with anorexia associated with fever and dehydration and convulsions in some cases. Hypothermia, hypo glycemic, unconsciousness, severe anaemia caused complications. Feeding the child on therapeutic formulas and treatment of the complications formed the immediate action in NRCs to save the child from mortality. The underlying causes of malnutrition among SAM children were inadequate food intake, low socio-economic status and illiteracy. Malnutrition because of low socioeconomic status, poor sanitation and illiteracy explained about the condition of their admitted child.. As the SAM children undergo treatment in NRC and were given nutritious therapeutic diet at regular intervals, there was a shift from severe acute malnourishment stage to moderate and mild degree of malnourishment and it was a slow and steady process. The admitted children had all 4 services of nutritional screening, assessment of feeding problems, feeding of modified diets and diet counseling sessions for mothers. It was observed that all the emergency essential medicines were available at NRCs. The children were treated for individualized health conditions, and the medicines were given to the children. The supply of medicines to the NRC seem to suffice the requirement and NRC had added advantage of other treatment facilities from the district hospitals. Nutrition counseling was given by the nutritionist-cum-counsellor to almost 92% of the mothers /caretakers, while 8% were counselled by cook-cum-attender. Food demonstrations help the mothers to make special therapeutic and nutritious foods for improving the condition of malnourished children. Combinations of cereal, pulse, vegetable, oil along with milk and milk products can be demonstrated using proper cooking methods. Nutritional counselling to the mothers is very important to make them understand the causes of malnutrition, growth pattern in children, importance of nutritious food and nutritional requirements of their children. Visual aids are important for nutrition education and the materials used for imparting nutrition knowledge by the NRC. As the follow up period increased from 15 days to 30 days and further to 90 days, the percent follow up cases visiting NRC has declined. Community mobilization through the key personnel plays a major role to comply with follow up visits to NRC. Marginalized population should be reached through volunteers, ASHA workers, Anganwadi teachers and other community health workers, to bring awareness on existence and services of facility-based management of SAM children at the Nutrition Rehabilitation Centre. These personnel should also monitor the follow up visits of the discharged children to the NRC and help clients to comply with all three follow up visits. xviii The NRC units in every district had attached bathrooms and a separate hand wash area. In all 12 NRCs hand washing facilities in the ward were well utilized, staff consistently washed hands thoroughly with soap. Nails of staff were clean and washing hands before handling food was practiced by staff in all 12 NRCs. The staff had provision for hand wash and they maintained cleanliness and hygiene during the preparation, handling and distribution of food. Maintaining personal hygiene of children and mothers is very essential to prevent growth of microbes, contamination and subsequent spread of infections. More precautions have to be taken by NRCs to maintain bed hygiene, personal hygiene and sanitation of the place of stay of the malnourished children whose resistance to infections /immunity levels are already too low. Floor dust, food leftovers and packaging materials often dumped in dustbins attract insects and rodents, which were cleaned on a regular basis in the NRCs. Overall, general maintenance of the wards was clean and tidy. Immediate washing of food plates/ dishes prevent flies in the vicinity and washing dishes with hot water removes grease and makes them thoroughly clean. In general, mothers were given instructions on personal hygiene. They were explained about the importance of washing hands and maintaining personal hygiene. Most of the mothers/caretakers were satisfied with the cleanliness and services provided in NRCs. As per the ward procedures, the children were screened by the medical officer for any medical complications before they were admitted into the NRC and treated accordingly. Necessary antibiotics were given and noted on the daily care chart in all NRCs. Supplementation of folic acid, vitamin A and multi vitamin tablets was done daily and recorded in all 12 NRCs. The surroundings of NRCs were welcoming and cheerful only in 9 centres. Mothers/caregivers were offered sufficient space to sit and sleep, and they were taught and encouraged to be involved in child care, staff were consistently courteous to mothers in all the centres. During recovery, the children were stimulated, encouraged to move and play also child friendly environment was provided. Walls were brightly painted and decorated in all 12 NRCs. None of the NRCs could achieve the expected weight gain among admitted children, which might be due to the short duration of stay in NRC and the infections and health complications associated with malnourishment of children. Moreover, acute malnutrition and associated complications do not facilitate easy weight gain especially in short duration rehabilitation as in NRCs. There was a significant weight gain during the nutrition rehabilitation period in NRC, the expected weight gain of 15% above the admission weight could not be achieved. The targeted 15% weight gain is possible only by increase in the duration of stay in NRC for 20 to 25 days. Increase in the quantity of food supplementation to achieve 15% weight gain might not be possible because the malnourished child’s capacity to eat food is limited due to lack of appetite and associated infections and diarrhea. As the age increased, there seem to be a constant gain in weight among NRC admitted children in a linear approach. The inception of WIFS in selected schools started in a periodical phase, but by 2013 officially all schools and AWCs were introduced with WIFS. But several schools and AWCs did not have any data on inception or implementation of WIFS programmes. Data on non-school going children in Khammam, Karimnagar and Ranga Reddy districts could not be obtained as there were no signs of implementation of WIFS in these areas. xix In any caste group, percent of school going children was higher than non-school going children. Children from BC community were found to be highest percent of school going children followed by SCs, STs, OCs and minority. Among the NSG children BCs formed the highest percent followed by SCs, STs, OCs and minorities in the decreasing order. No data on caste was available from 40% of NSG group. The responses on consumption of IFA tablets could be based on previous supplementation and not at the time of survey. In many schools it was found that only once the supply of IFA tablets was mentioned by the school authorities. By annual dose of albendazole for deworming has been given in these schools and the compliance of supply and consumption of albendazole was better than IFA tablets. Least consumption of albendazole was seen among the children in Hyderabad. Children from Karimnagar and Hyderabad do not seem to be knowledgeable about purpose and importance of deworming and their consumption also was less compared to other districts. The major discomforts noticed with the intake of IFA tablet among few students were stomach pain and vomiting. The districts of Nizamabad, Karimnagar, Hyderabad and RangaReddy had no supply of compliance cards to the children and across the state these compliance cards were filled only by 6% of the school children. The responses on consumption of IFA tablets and compliance from the NSG children was nil or very poor from Khammam, Karimnagar, RangaReddy and Hyderabad. Though consumption of IFA and albendazole tablets was seen in less percentage of children, they were positive about the health benefits of the supplementation and expressed no discomfort with IFA tablets. There was no supply of compliance cards, children were not discouraged of consumption of supplementation and around 43% NSG children were exposed to nutrition education through sample balanced diet sheets and charts on iron and vitamin C rich foods. More responses have come from the districts of Adilabad, Nizamabad, Mahabubnagar and Warangal. In both schools and anganwadi centres the supply of IFA tablets for the purpose of adolescent children was irregular, no follow up from Health department, no registers and records maintained, the recommended updated class report (Format 2), updated monthly report (Format 3) of schools and compliance cards for adolescence were not found/supplied and educational charts on iron, vitamin C and balanced diet went underground without use. Since there was no consistency in the supplies of IFA tablets, tablets being expired, no supply or guidance in maintaining registers, records and formats and overall failure of the monitoring system, the programme of Weekly Iron and Folic acid Supplementation (WIFS) requires revamp and revival in all the districts of Telangana state. Since the children are in a phase of rapid growth, gain in weight and height are natural but highly influenced by the food intake both in terms of quantity and quality. Supplementary nutrition in AWCs not only provided quality food but also developed positive attitude, knowledge and improved acceptance to a great extent. The results of weight and height gain among children below 6 years after education intervention and observed feeding showed that not much improvement has occurred except for weight gain in 12-35months in Warangal. The results suggest the need for evaluating and monitoring the feeding practices at home and educating mother to give proper breakfast, inclusion of milk, balanced meal and diet plans in future. Mere monitoring of AWCs is not sufficient to bring improvement in child’s growth and development. Improvement with attitudinal change in health and nutrition habits of the mothers and children shall positively and constructively improve their nutritional status.en_US
dc.identifier.citationD 10,354en_US
dc.identifier.urihttps://krishikosh.egranth.ac.in/handle/1/5810152225
dc.keywordsEVALUATION OF SELECTED NUTRITION AND HEALTH PROGRAMMES IN TELANGANA STATEen_US
dc.language.isoEnglishen_US
dc.publisherPROFESSOR JAYASHANKAR TELANGANA STATE AGRICULTURAL UNIVERSITYen_US
dc.subFood and Nutritionen_US
dc.themePh.Den_US
dc.these.typePh.Den_US
dc.titleEVALUATION OF SELECTED NUTRITION AND HEALTH PROGRAMMES IN TELANGANA STATEen_US
dc.typeThesisen_US
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