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.

• 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.

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

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

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

Table 4: Comparison of Pre-Test and Post-Test Knowledge Score Regarding Vitamin A

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

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

Table 4 shows that in pre-test the mean score was 13.95, SD 3.968 whereas in post-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 depicts that there was a significant association between pre-test knowledge score and selected demographical variable i.e. age (c² = 6.087) at ‘p’<0.05 level and educational qualification (c² = 14.491) at ‘p’<0.01 level.

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

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

There was no significant association between pre-test knowledge score and selected demographical variable i.e., religion (c² = 0.700), occupation (c² = 1.668), Dietary pattern (c² = 0.782), type of family (c² = 2.081), family income (c² = 1.564), no. of under five children (c² = 0.814) and source of information (c² = 1.255).

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.

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.).

1. World Health Organization. Global Prevalence of Vitamin A Deficiency. WHO, 1995. World Health Organization, https://www.who.int/nutrition/publications/micronutrients/vitamin_a_deficiency/WHO_NUT_95.3/en/. Accessed May 2020.

2. Kapil, U. and H.P. Sachdev. "Massive dose vitamin A programme in India-Need for a targeted approach." The Indian Journal of Medical Research, vol. 138, no. 3, Sept. 2013, p. 411. National Center for Biotechnology Information, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3818610/. Accessed October 2021.

3. Office of Dietary Supplements. Vitamin A. National Institutes of Health, 2021, http://ods.od.nih.gov/factsheets/VitaminA-HealthProfessional. Accessed October 2021.

4. World Health Organization. Vitamin A Supplementation. WHO, https://www.who.int/immunization/programmes_systems/interventions/vitamin_A/en/index1.html/. Accessed May 2020.

5. World Health Organization. Micronutrient Deficiencies. WHO, https://www.who.int/nutrition/topics/vad/en/. Accessed May 2020.

6. Chaudhry, A.B. et al. "Risk factors for vitamin A and D deficiencies among children under five in the state of Palestine." Conflict and Health, vol. 12, no. 1, Dec. 2018, pp. 1–2. BioMed Central, https://doi.org/10.1186/s13031-018-0148-y. Accessed October 2021.

7. Khandait, D.W. et al. "National Vitamin A Prophylaxis Programme: Need for change in current age strategy." The Indian Journal of Pediatrics, vol. 66, no. 6, Nov. 1999, pp. 825–829. Springer, https://link.springer.com/article/10.1007/BF02723845. Accessed October 2021.