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Go Back       Himalayan Journal of Nursing and Midwifery | Volume:1 Issue:1 | Feb. 18, 2022
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Knowledge of Mothers Regarding Vitamin A Requirement, Sources, Deficiencies and Its Prophylaxis among Under Five Children in Selected Area Boileauganj, District Shimla (H.P.)


Ms. Shivani*1, Dr. Pushpa Panwar2 and Mrs. Usha Thakur3

1M.Sc. Nursing, Community Health Nursing, S.N.G.N.C. IGMC Shimla, India

2Lecturer, Community Health Nursing, S.N.G.N.C. IGMC Shimla, India

3Clinical Instructor cum Sister Tutor S.N.G.N.C. IGMC Shimla, India

Article History

Received: 06.01.2022

Accepted: 15.02.2022

Published: 18.02.2022


Abstract: Background: Vitamin A deficiency is a major public health nutrition problem in developing countries. It is an essential nutrient needed in a small amount for the normal functioning of the visual system, growth and development, maintenance of epithelial cellular integrity, immune function, and reproduction. Presently, vitamin A supplementation is implemented through the prevailing network of primary health centers and sub-centers. The program was launched in 1970 to reduce the disease and prevent blindness due to vitamin A deficiency. Objective: The objective of the present study were (i) to assess the level of knowledge regarding vitamin A (ii) to develop and administer self- instructional module on vitamin A (iii) to evaluate the effectiveness of self- instructional module on vitamin A (iv) to find out the association between Pre-test knowledge scores with their selected demographic variables. Material and methods: A pre experimental study was conducted in September 2021 in urban area Boileuganj, Shimla. Sample of 60 mothers of fewer than five children were selected using convenience sampling technique. Data was collected by using self-structured questionnaire related to vitamin A. The gathered data was analysed by calculating mean, median, mean percentage, mean difference, standard deviation, paired t-test to evaluate the effectiveness of self-instructional module and chi square test to find association of knowledge with selected socio-demographic variables. Results: The study findings showed that post-test mean knowledge score regarding vitamin Arequirement, sources, deficiencies and its prophylaxis has statistically improved from 13.95± 3.968 in pre-test to 20.37 ±4.034 in post-test. Conclusion: Self-instructional module has improved post-interventional knowledge score of mothers of under five children in urban area Boileuganj, Shimla.


Keywords: Self-instructional module, Vitamin A, Mothers and under five children.

Copyright @ 2022: This is an open-access article distributed under the terms of the Creative Commons Attribution license which permits unrestricted use, distribution, and reproduction in any medium for non-commercial use (Noncommercial, or CC-BY-NC) provided the original author and source are credited.

INTRODUCTION

Vitamin A deficiency is a major public health nutrition problem in developing countries. It is an essential nutrient needed in a small amount for the normal functioning of the visual system, growth and development, maintenance of epithelial cellular integrity, immune function, and reproduction. Vitamin A deficiency occurs when body stores are depleted to the extent that physiological functions are impaired albeit clinical eye signs might not be evident.1


Presently, vitamin A supplementation is implemented through the prevailing network of primary health centers and sub-centers. The female multipurpose worker and other paramedics at the village level sub-health centers are responsible for administering vitamin A solutions.2 Pre-formed retinol is fat-soluble and well absorbed within the body and is found mainly in animal-based foods like liver, butter, cheese, eggs, salmon, mackerel, herring and is added to most fat spreads.3


Routine immunization services provide an efficient and sustainable delivery channel for vitamin A supplements. Studies show that combining delivery of vitamin A supplementation with immunization is safe and does not harm seroconversion of childhood vaccines.4 The program was launched in 1970 to reduce the disease and prevent blindness due to vitamin A deficiency. It was initially started in 7 states with severe problems.5


The role of breastfeeding and complementary feeding has also been examined. While exclusive breastfeeding is an adequate source of vitamin A for youngsters under six months aged, this alone can't be the sole source of vitamin D. Lastly, children with vitamin A deficiency have been considered more likely to develop anemia due to vitamin A playing a crucial role in red-blood-cell production and iron metabolism.6


Child survival and safe motherhood program emphasizes giving vitamin a prophylaxis up to three years of age only, contrary to the earlier practice of its administration up to six years of age, supported the idea of reduction of great manifestations of vitamin a deficiency three years aged onwards.7


OBJECTIVES OF THE STUDY

  • To assess the level of knowledge regarding vitamin A requirement, sources, deficiencies and its prophylaxisamong mothers of under five children in selected area Boileauganj, district Shimla (H.P.).

  • To develop and administer self- instructional module on vitamin A requirement, sources, deficiencies and its prophylaxis among mothers of under five children in selected area Boileauganj, district Shimla (H.P.).

  • To evaluate the effectiveness of self- instructional module on vitamin A requirement, sources, deficiencies and its prophylaxis among mothers of under five children in selected area Boileauganj, district Shimla (H.P.).

  • To find out the association between Pre-test knowledge scores with their selected demographic variables.


MATERIALS AND METHODS:

Research Approach: Quantitative Research

Research Design: Pre-Experimental Research Design

Setting of the study: Selected area boileuganj, shimla

Study duration: September 2021

Study population: Mothers of under five children

Sample size: 60 mothers of under five children

Sampling Technique: Convenience Sampling Technique


Informed consent/assent was taken from mothers of under five children and confidentiality of the mothers was also maintained.


Inclusive Criteria: The mothers who are having under five children and available at the time of data collection


Exclusion Criteria: The study excludes mothers who are not residing in Boileauganj, not willing to participate in the study and mothers whose are not having under five children.


Development of Tool: self- structured knowledge questionnaire


Description of Tool

Section A: It deals with demographic variables such as age, educational qualification, religion, occupation, dietary pattern, type of family, monthly family income, number of under -five children in the family, source of information regarding vitamin A.


Section B: It consists of 30 self-structured knowledge Questionnaire regarding vitamin A.


Validity of tool: By the experts in this field.


Permission: obtained from the concerned councillor, Urban area Boileauganj


Ethical Consideration: Ethical approval was taken from the ethical committee of Sister Nivedita Govt. Nursing College, IGMC, Shimla, for conducting the pilot study as well as the final study.


Data collection: The data was collected in the month of September 2021. The self structured questionnaire was given to the mothers of under five children. Pre-test was conducted and there after self- instructional module was administered. Post test was conducted after one week. The data was presented in the master data sheet.


Data analysis: With appropriate statistical test in terms of mean, frequency, standard deviation, mean percentage, paired t-test and chi-square test were used for analysis of obtained data. The level of significance chosen was p 0.001, p0.01 and p≤0.05.


RESULTS

Table 1: Frequency and Percentage Distribution of Mothers of Under Five Children According to Demographic Variables.



n=60

Demographic Variables

f

%

Age (years)



18- 25

13

21.7

25-33

41

68.3

33- 41

6

10.0

Educational qualification



Primary

1

1.7

Middle

3

5.0

Matriculate

9

15.0

Senior secondary

26

43.3

Graduate

19

31.7

Post graduate and above

2

3.3

Religion



Hindu

57

95.0

Sikh

3

5.0

Occupation



Homemaker

42

70.0

Private job

7

11.7

Government job

5

8.3

Business

6

10.0

Dietary pattern



Vegetarian

52

86.7

Non- vegetarian

7

11.7

Ovo- vegetarian

1

1.7

Type of family



Nuclear

49

81.7

Joint

10

16.7

Extended

1

1.7

Family income (Rs./month)



7001-10000

18

30.0

>10000

42

70.0

No. of under five children in the family



One

45

75.0

Two

15

25.0

Source of information related vitamin-A



Friends

15

25.0

Mass media

7

11.7

Health personnel

38

63.3

Table 1 depicts that with regard to age, majority 41(68.3%) study subjects were in the age group of 25-33 years, 13(21.7%) were in 18-25 years and 6(10%) were in the age group of 33-41 years. With respect to educational qualification,26(43.3%) subjects were educated up to senior secondary, 19(31.7%) were graduate,9(15%) study subjects were up to matriculation,3(5%)were educated up to middle standard,2(3.3%)study subjects were studied postgraduate and above and 1(1.7%) were qualified up to primary level. As per religion, majority 57(95%) of study subjects were Hindu followed by 3(5%) of study subjects were Sikhs. Maximum number of study subjects i.e. 42(70%) were homemaker, 7(11.7%) study subjects were doing the private job, 6(10%) were doing business, 5(8.3%) were doing government job. Largest share of study subjects i.e. 52(86.7%) were vegetarian, 7(11.7%) were non-vegetarian and 1(1.7%) were ovo-vegetarian. With regard to type of family, majority 49(81.7%) subjects were from the nuclear family, 10(16.7%) subjects were from joint family and 1(1.7%) were from extended family. As per monthly income, 42(70%) were having a monthly family income of more than Rs. 10000 and 18(30%) were having a monthly family income of Rs. 70001-10000. As per the number of under-five children in the family, the majority 45(75 %) of respondents had only one and 15(25%) of respondents had two under-five children in the family. Analyzing the source of information, 38(63.3%) of study subjects had information from health personnel followed by 15(25%) of study subjects had information from friends and 7(11.7%) subjects had information from mass media.


Table 2: Frequency and Percentage Distribution Pre-Test Level of Knowledge Regarding Vitamin A




n=60

Level of Knowledge

Knowledge score

f

%

Good

24-30(>75)

2

3.3

Average

15-23(50-75)

23

38.3

Below average

0-15(<50)

35

58.3

Table 2 depicts that in pre-test score, 2(3.3%) had good knowledge score.23 (38.3%) had average knowledge score. 35(58.3%) had below average score.

Table 3: Frequency and Percentage Distribution Post-Test Level of Knowledge Regarding Vitamin A




n=60

Level of Knowledge

Knowledge score

f

%

Good

24-30(>75)

15

25.0

Average

15-23(50-75)

39

65.0

Below average

0-15(<50)

6

10.0

Table 3 shows in post-test 15(25%) had good knowledge, 39 (65%) had average knowledge and 6(10%) had below average knowledge.

Table 4: Comparison of pre-test and post-test knowledge score regarding vitamin A









n=60

Knowledge

Mean ± S.D.

Mean%

Range

MD

df

Paired t-test

p’ value

Table value

Pre-test

13.95± 3.968

45.5%

6-24

6.417

59

17.562

.001*

2.00

Post-test

20.37± 4.034

67.90%

12-28

**= Significant at 0.01 level, Level of significance p≤0.05


Table 4 shows that in pre-test the mean score was 13.95, SD 3.968 whereas inpost-test the mean score was 20.37, SD 4.034 and the mean difference was 6.417. Range for pre-test was 6-24 and for post-test, it was 12-28.Paired t- test value was 17.562 and table value was 2.00 at degree of freedom 59 and significance level ≤0.05. The calculated t-test value was more than table value which shows significance. Hence it was revealed that self-instructional module was effective in increasing the knowledge of mothers of under five children. Hence H1 was accepted


Table 5: Association between the Pre-Test Knowledge of Mothers with Their Socio-Demographic Variables.








n=60

Variables

Below average

Average

Good

df

2 value

Table Value

p’ value

Age (years)








18- 25

5

7

1

2

6.087

5.99

.050*

25-33

25

15

1


33- 41

5

1

0


Educational qualification








Primary

0

1

0

5

14.491

11.07

.004**

Middle

2

1

0


Matriculate

9

0

0


Senior secondary

16

10

0


Graduate

7

10

2


Post graduate and above

1

1

0


Religion








Hindu

33

22

2

1

.700

3.841

.574

Sikh

2

1

0





Occupation








Homemaker

24

16

2

3

1.668

7.815

.713

Private job

5

2

0





Government job

3

2

0





Business

3

3

0





Dietary pattern








Vegetarian

31

19

2

2

.782

5.991

1.00

Non- vegetarian

3

4

0





Ovo- vegetarian

1

0

0





Type of family








Nuclear

30

18

1

2

2.081

5.991

.390

Joint

4

5

1





Extended

1

0

0





Family income (Rs./month)








7001-10000

12

6

1

1

1.564

3.841

.211

>10000

23

17

1





No. of under five children in the family








One

26

18

1

1

.814

3.841

.367

Two

9

5

1





Source of information related vitamin-A








Friends

9

5

1

2

1.255

5.991

.501

Mass media

2

5

0





Health personnel

24

13

1





*=Significant at ≤0.05 level, **= Significant at <0.01 level.


Table 5 depicts that there was a significant association between pre-test knowledge score and selected demographical variable i.e age (2=6.087) at ‘p’<0.05 level and educational qualification (2=14.491) at ‘p’<0.01 level.


There was no significant association between pre-test knowledge score and selected demographical variable i.e religion (2=.700), occupation (2=1.668),Dietary pattern (2=.782), type of family (2=2.081), family income (2=1.564), no. of under five children(2=.814) and source of information (2=1.255).


DISCUSSION

In present study, 3.3% had good knowledge, 38.3% had average knowledge and 58.3% had below average knowledge regarding Vitamin A was average and needed further improvement.


To see the comparison within the group between pre-test and post-test knowledge score, paired “t” –test was used. The pre-test range was 6-24, mean was 13.95, standard deviation was 3.968, mean percentage was 45.5 and in post-test range was 12-28, mean was 20.37, standard deviation was 4.034, mean percentage was 67.90. The mean post-test knowledge score (20.37) was higher than mean pre-test knowledge score (13.95).The mean percentage pre-test knowledge score was 45.5%. In the post-test mean percentage knowledge score was 67.90%. The mean percentage was 22.4%.The calculate “t” test value (17.562 Significant*) was greater than the table value (2.00) at 0.005 level of significance.


Hence, H1 was accepted. It can be inferred that the self-instructional module was effective in increasing the knowledge.


The chi square value shows that there was that the significant association between knowledge of mothers of under five children with age and educational qualification. Whereas there are non-significant association between religion, occupation, dietary pattern, type of family, family income, number of under five children in the family and source of information related vitamin A.


CONCLUSION

The main focus of the study was to assess the effectiveness of self-instructional module on knowledge regarding vitamin A among mothers of under five children in selected area Boileauganj, district Shimla (H.P.). As vitamin A deficiency is one of the nutritional problems in India. Children below 5 years are more vulnerable to this deficiency. So greater attention should be paid to increase the knowledge of mothers of under five children. There was a significant difference in the level of knowledge score between pre-test and post-test score after administering self-instructional module. The mean knowledge score in pre-test was 13.95 which were increased in post-test to 20.37 after implementation of self-instructional module. Hence, the study findings concluded that the administration self-instructional module had significantly improved the knowledge of mothers of under five children in selected area, Boileuganj, Shimla (H.P.).


REFRENCES

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  2. Kapil U, Sachdev HP. Massive dose vitamin A programme in India-Need for a targeted approach. The Indian journal of medical research. 2013 Sep;138(3):411. [Cited 21 October 2021]. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3818610/

  3. Office of Dietary Supplements - Vitamin A [Internet]. Ods.od.nih.gov. 2021 [cited 21 October 2021]. Available from: http://ods.od.nih.gov/factsheets/VitaminA-HealthProfessional

  4. WHO | Vitamin A supplementation [Internet]. WHO. World Health Organization; [cited 2020 May 7]. Available from: https://www.who.int/immunization/programmes_systems/interventions/vitamin_A/en/index1.html/

  5. WHO | Micronutrient deficiencies [Internet]. WHO. World Health Organization; [cited 2020 May 8]. Available from: https://www.who.int/nutrition/topics/vad/en/

  6. Chaudhry AB, Hajat S, Rizkallah N, Abu-Rub A. Risk factors for vitamin A and D deficiencies among children under-five in the state of Palestine. Conflict and health. 2018 Dec;12(1):1-2. [cited 2021Oct21]. Available from: https://doi.org/10.1186/s13031-018-0148-y/

  7. Khandait DW, Vasudeo ND, Zodpey SP, Kumbhalkar DT, Koram MR. National Vitamin A Prophylaxis Programme: need for change in current age strategy. The Indian Journal of Pediatrics. 1999 Nov;66(6):825-9. [cited 2021Oct21]. Available from: https://link.springer.com/article/10.1007/BF02723845



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