An important part of the nutrition gap is the information gap.

Although poor economic condition does

stand in the way of improved nutrition, but, ignorance regarding nutrients needed by the body and cheap

foods which can provide them and better utilisation of the resources, are also partly responsible.It has

been realised that the poverty of knowledge is one of the major cause for poor nutrition among many

people in our country. For instance, most mothers are not so poor as not to be able to afford 50-100

grammes of green leafy vegetables to child daily, if they realise that this may make a difference between

blindness and normal vision. Similarly, many mothers will spend lot of money on commercial baby food

e.g. Farex, Cerealac or Lactogen, Milk Care etc., but won't realise the dangers associated with bottle

feeding and added cost due of expensive products, whereas, they can provide the similar or even better

nutrition to the baby if they use household food items etc. for weaning. Cicely Williams, who first

identified and described kwashiorkor, reports

that in west Africa malnutrition is due not to economic poverty, but to a poverty in knowledge of the

nutritional needs of a child. And in Kenya, reportedly, "practically every case of malnutrition is due to

ignorance, and only some are due to ignorance combined with poverty."

Objectives and Target Group

The objectives of nutrition education could be listed as under :
i) To develop nutrition advisory services and nutrition education of the public.
ii) To participate in co-ordinated community nutrition programmes with the cooperation of other
disciplines and agencies where feasible and necessary.

iii) To help develop supplementary feeding programme where necessary and provide continuing
consultant services to them.
iv) To improve nutritional levels in the community by these and other available means.

Objectives:

To assess dietary habits and nutrition knowledge levels of the adolescent girls from different
schools and to study the efficacy of two different nutrition education tools in improving their
nutrition knowledge in the classroom setting.

Design:

Purposive sampling technique was adapted for selecting the subjects in the study.
Setting:

Four secondary schools in Hyderabad, India.

Subjects:

In total, 164 adolescent girls belonging to eighth grade.

Interventions:

Two interventions (Intervention-1. Traditional method using print media such as folders leaflets
and charts; Intervetion-2. Audio-visual CD) were carried out in a classroom setting for the
experimental group.

Results:

FFQ data on dietary consumption of adolescent girls revealed more consumption of aerated
drinks, bakery items, fast foods and less consumption of millets irrespective of their socio-
economic conditions. However, consumption of vegetables, green leafy vegetables and fruits was
moderate. A significant improvement in the nutrition related knowledge was observed among the
experimental group after interventions-1 and -2 as compared to the baseline data. However, no
significant difference in the improvement of nutrition knowledge levels was observed with the
second intervention over the first intervention as already the children in the experimental group
gained knowledge through print media.

Conclusions:

Education on ill effects of aerated drinks, fast foods and the importance of nutrition during the
adolescent phase should be emphasized in future programmes.

Sponsorship:

The study was supported by the National Institute of Nutrition (Indian Council of Medical
Research), Hyderabad from the intramural funds.

Keywords:

adolescent girls, food frequency questionnaire (FFQ), nutrition education, classroom-based education

European Journal of Clinical Nutrition (2007) 61, 10811085; doi:10.1038/sj.ejcn.1602622; published online 7 February 2007

Dietary habits and effect of two different educational tools on nutrition

knowledge of school going adolescent girls in Hyderabad, India
Guarantors: GM Antony, GMS Rao and KVR Sarma.

1 1 1 2 1
D Raghunatha Rao , T Vijayapushpam , G M Subba Rao , G M Antony and K V R Sarma
Abstract
Background
Obesity is an emerging problem in Pakistan. The authors sought to determine
prevalence of obesity and malnutrition in school-going children, from grades 6th to 8th of
different schools of Karachi and assess associations that affect the weight of the
children.

Methodology/Principal Findings
A cross sectional study design with children studying in grades 6 th to 8th grade, in
different schools of Karachi. We visited 10 schools of which 4 consented; two subsidized
government schools and two private schools. A questionnaire was developed in
consultation with a qualified nutritionist. Height and weight were measured on
calibrated scales. A modified BMI criterion for Asian populations was used. Data was
collected from 284 students. Of our sample, 52% were found to be underweight
whereas 34% of all the children were normal. Of the population, 6% was obese and 8%
overweight. Of all obese children, 70% belonged to the higher socio-economic status
(SES) group, while of the underweight children, 63.3% were in the lower SES. Amongst
obese children in our study, 65% ate meat every day, compared to 33% of normal kids.

Conclusion
Obesity and undernutrition co-exist in Pakistani school-children. Our study shows that
socio-economic factors are important since obesity and overweight increase with SES.
Higher SES groups should be targeted for overweight while underweight is a problem of
lower SES. Meat intake and lack of physical activity are some of the other factors that
have been highlighted in our study.

Health and nutrition considerations in education planning. 1. Educational

consequences of health problems among school-age children

Joanne Leslie and Dean T. Jamison

Abstract

This paper utilizes recent findings to address, from the perspective of an educational
planner, the question of how educational systems can intervene to improve the health
and nutritional status of school-age children. Evidence is reviewed on the linkages
between health conditions and three of the most important educational problems in
developing countries-children who are unprepared to begin school at the usual age,
the failure of many students to learn adequately in school, and the unequal
participation in schooling by girls. It is clear that although less attention has been
paid to the health and nutrition status of school-age children than to that of children
of pre-school age or of adults, existing data are adequate to identify several
widespread problems among school-age children that have well established negative
consequences for school participation and performance. These problems include
chronic protein-energy malnutrition, iron-deficiency anaemia, iodine deficiency and
intestinal helminth infection. It was also observed that a number of other infectious
diseases, as well as disability, premature fertility, and substance abuse, are also likely
to undermine the health and educational success of many school-age children.

The present study relates to a survey of daily nutritional intake (total calories, protein, iron and
vitamin A) in 700 school going children belonged to different income groups in Patna. The
growth status of children was evaluated by applying anthropometric parameters. The result
showed that children of low-income group (LIG) families were deficient in all categories of daily
supply of nutrients. The most pronounced deficiency was vitamin A in which 61.80 per cent of
male and 59 78 per cent of female children of LIG families received less than 55 per cent of the
recommended daily allowance (RDA). Under each category of nutrient, children belonging to
HIG families also showed varying degree of deficiencies. The average height among children
was found to be slightly less than the standard recommended by the National Centre for Health
Statistics (NCHS). Average weight was observed to be slightly higher in comparison to the
NCHS standards which may be probably due to altered food habits among children. Nutritional
deficiencies in children of HIG families indicated that there was a lack of awareness of a
balanced and nutritious diet independent of the economic factor among families.( Perspectives
and Issues 28(1): 17-25, 2005 HEALTH AND NUTRITIONAL STATUS OF SCHOOL GOING
CHILDREN IN PATNA K. Kumari Department of Home Science, J.D. Women's College, Bailey
Road, Patna.)

Health and nutrition in early stages of human life determine, to a great extent, the physical and
mental well being of a person. In a developing country like India, poverty undoubtedly
constitutes a major factor for malnutrition in children, but lack of awareness of what constitutes a
balanced diet is also a factor, which needs to be considered. School going children of different
age groups form a vulnerable population where studies in respect of nutritional deficiencies
could be done with respect to the income groups of the parents. The study would reveal the kind
of nutritional deficiencies prevalent among the children and would also provide a comparative
picture whether these deficiencies were, confined only to children belonging to families with low
income. Earlier studies, have shown that the most commonly encountered deficiency is related to
protein-calorie malnutrition. The percentage of children in 4-13 years with protein-calorie
deficiency was less compared to total calorie (energy) deficiency, which ranged from 26.6 to
57.6 per cent. Similar trends have been reported by the Nutritional Monitoring Bureau, National
Institute Nutrition. The manifestations of malnutrition were evident with widespread incidence of
anemia and nutritional blindness among children. The present study was therefore undertaken to
determined nutritional status of children attending schools of Patna and from families with
varying socio-economic status.

The different dietary habits and nutritional status of Spanish schoolchildren have been analyzed.
Nutrition affects health throughout the life cycle, and it is best to begin to prevent harm early on.
Habits are formed early in life, and habits are a major determinant of food choice in later life.
Two trends in particular are worthy of mention in this regard: the progressive globalisation of the
food supply and the increase of food intake such as snacks, soft drinks and fast food, wich
tipically apport a significant part of daily diet. In Spain, young people are abandoning the
Mediterranean Diet in favour of industrial products, full of calories and saturated fatty acids
but low in nutritional components, wich is contributing to obesity and rising cholesterol levels.
Also, breakfast consumption has been identified as an important factor in the nutritional status of
children and in Spain we are observing that an increasing percentage of children are omitting
breakfast. ( Dietary habits and nutritional status of school aged children in Spain P. M.
Fernndez San Juan Jefe de Seccin de Componentes y Aditivos. Centro Nacional de
Alimentacin. Agencia Espaola de Seguridad Alimentaria. Espaa. Nutr Hosp. 2006;21(3):374-
378 ISSN 0212-1611 CODEN NUHOEQ S.V.R. 318 HABITOS ALIMENTARIOS Y ESTADO
NUTRICIONAL DE LOS NIOS EN EDAD ESCOLAR EN ESPAA)

It is relatively easy to reach children through institutions such as schools. As a society, we have
the responsibility to do our best to protect young people. All of these reasons are good, and true.
However, they are in stark contrast to the increasing prevalence of poor diets and obesity among
young people. Changes in childrens diets cannot and should not be considered in isolation from
other social changes. The main streets of many of our cities and towns across Europe are coming
increasingly to contain the same retail and fast food outlets. Television programmes and
advertising cross borders. The aspirations of many young people are formed by an international
youth culture. Local tradition and culture play an ever decreasing part in the foods and meals
peoNOTA: Este trabajo fue presentado por la Delegacin espaola en la 9th Session Committee
of Experts on Nutrition, Food Safety and Consumer Health celebrada en el Consejo de Europa.
Estrasburgo, 14-15 de marzo de 2005. ple eat. In most European countries average income is
rising, and all these previously mentioned characteristics also are affecting Spanish school
children. The revolution in childrens lifestyles and dietary habits which has ocurred over the last
twenty-five years can be largely attributed to changes in the family environment and in the social
environment in general. Such changes include the increasing tendency for women to work
outside the home; the marked decline in birth rates and in size of families; the remarkable
advances in agriculture, fishing, and food technology (with the result that a wide range of foods
are now continuosly available); the rapid urbanization of the population, the universalization of
access to health services and education; the growing and homogenizing influence of television;
the ever earlier age at which children start school (where they tipically receive a significant
part of their daily diet); and the increasing disposable wealth of minors (allowing them to
purchase and consume foods without parental control). If should be stressed that a very
significant number of pre school and school aged children are subject to inadequate parental
supervision as regards the number of meals, snacks and amount of food consumed. This is
largely because many children are left alone at home for long periods each day, with no company
other than television, the game console, and the refrigerator packed with foods of every
description. In addition, many children do not have breakfast or lunch at home but rather in the
school dining hall or a nearby caf. In such circumstances, children tend to choose portable
snacks (sweets, cakes, soft drinks, etc.) to be eaten away from home, whether alone or with
friends. Family educational level and socioeconomic status have a marked effect on childrens
lifestyles and dietary habits. The mothers educational level is the one of the best predictors of
the type and quality of childs diet, although the fathers educational level may also have an
effect. A number of studies have found that children of better educated families tend to consume
more milk, dairy products, and fruit juice, and less sugar and processed fast food. Also, various
studies have shown that children of wealthier families tend to consume more protein, meat, fish,
milk, and green vegetables, whereas children of poorer families tend to have a higher caloric
intake and to consume more processed fast food, fats, and sugar. Similarly, childrens lifestyles
and dietary habits may be affected by habitat. In industrialized societies, the differences in diet
between urban and rural populations are gradually becoming less significant. Despite this, town
and city dwellers tend to have an easier access to a wider range of food. In addition, there are
differences related to differences in socioeconomic level and to the maintenance of traditional
dietary habits in rural areas (particularly as regards local agricultural or fisheries products). In the
recent studies carried out in Spain, urban children consume more meat, meat products, and
legumes, whereas rural children consumed more milk, green vegetables and fruits. Besides,
television clearly transmits a conflicting message as regards dietary habits. Television thus
encourages the consumption of certain foods and drinks, presented as socially prestigious, as
healthy (i.e: you can eat as much as you like), and/ or simply as tasty. The permissiveness
and tolerance of many parents further contributes to the tendency for children to eat TV meals.
It is estimated that Spanish children watch TV an average of 2 hours and 30 minutes per day,
which implies that during this time, a child aged between four and twelve years sees an average
of 54 advertisements. A large proportion of televised food advertisements are for highly
processed junk foods with limited nutritional value and high caloric content, and typically with
large amounts of fat (particularly saturated fats and trans-isomers fatty acid), free sugars,
cholesterol, and/or salt, and generally with little or no micronutrient content. The proportion of
TV advertised junk foods in a child diet has been shown to be correlated with the amount of time
the child spends watching television. The frequent, excessive, and indiscriminate consumption of
products of this type is likely to lead to dietary inadequacies in terms of both micro and
macronutrients as well as to excessive intake of chemical additives, with possible detrimental
effects on health. Dietary patterns in Spanish school children In many cases family dietary
patterns can be partially attributed to genetic factors and hereditary cultural factors. Dietary
patterns become established in children from about age 1-2 onwards and to a great extent persist
throughout life. The diets of younger children tend to be more similar to that of their parents than
the diets of older children. It is thus important to try to ensure that childrens diets are as varied
as possible from an early age. A diet comprising many different nutrients as well as a many
different flavours, textures, and colours will not only ensure adequate nutrition and development
but will also encourage acquisition of the capacity to make appropriate choices between food
items. Such diet training is particularly critical for children at the pre-school stage because this
is the period during which the child learns to exercise control over his or her impulses and
environment. In addition, during this period the child begins to take notice of the organoleptic
qualities of food, to prefer some foods over others, to be fussy at mealtime, to not be hungry, to
get bored by too much of the same, and to be scared of certain foods. And adequate family diet
is good for the childs health and provides a solid foundation for the future, when the child will
gradually come to spend more time away from home, at school and elsewhere. In such
environments, the child will be Hbitos nutricionales en nios espaoles Nutr Hosp.
2006;21(3):374-378 375 increasingly exposed to the often unhealthy dietary habits of his of her
peers. Breakfast consumption has been identified as a important factor in the nutritional well-
being of children. Several studies have indicated that omission of breakfast or consumption of an
inadequate breakfast is a factor contributing to poor school performance and to dietary
inadequacies that are rarely compensated for in other meals of the day. Differences have also
been observed in the nutrient density of the breakfast meal, depending on whether it was
consumed at school or at home. Also, previous studies have shown that the diets of obese people
are less nutritionally sound than those of normal weight people, and that they omit breakfast
more frequently, as well as eating a less nutritional breakfast. Since both early eating habits and
early obesity may persist into adulthood, the relationships between dietary habits and body
weight during the school years may have a lifelong significance. Obese children, especially girls,
omitted breakfast more frequently and ate smaller amounts of grain products at breakfast, in
comparison to normal-weight children. The energy supplied by breakfast, measured as a
percentage of energy expenditure, was lower in the obese than in the normal weight children,
and their breakfasts were lower in carbohydrates, thiamine, niacin, vitamin B6 , vitamin D, and
iron. In Spain more than 20% of children go to school every morning without any breakfast or
with an inadequate meal. Of course, children who skip breakfast at home often have money to
buy a substitute; typically, however, such substitutes are of low nutritional quality. Recent studies
indicate that obese children have less satisfactory breakfast habits than normal weight children
do. To some extent, this may reflect the poorer overall quality of the diets of the overweight
subjects. It is also possible however that an inadequate breakfast may contribute to the making of
poorer food choices throughout the rest of the day, thereby promoting obesity. Since better
breakfast habits have been associated with better overall diets, it is desirable to promote and
facilitate the eating of adequate breakfast by schoolchildren, especially those who are
overweight. Obese people tend to show a stronger preference for fatty foods, and especially
sweet fatty foods, than thin people; even in people of normal weight, they tend to have a positive
correlation between the degree of preference for fatty foods and the fat content of the body.
School aged children and adolescents in particular tend to eat many snack as a result of their
greater independence from the family, their tendency to be away from home for much of the day,
and their typically significant disposable wealth; children in these age groups often replace
breakfast, and sometimes lunch, with snacks. Children who snack frequently tend to eat
relatively small amounts of the higher quality foods typically present in main meals. Our review
of recent literature on the dietary habits of school aged Spanish children reveals similar
tendencies (i.e., high intakes of total fats, and especially monounsaturated fats and cholesterol,
free sugars and low intakes of carbohydrates). The woman of the family unit must know the key
to a healthy and balanced diet to transmit the message correctly, and for that reason cardiologists
have spread this message in small towns around Spain, with the hope of keeping traditional
healthy nutritional habits in the countryside although they have already changed in the urban
population. Unfortunately, and following the trend of other countries, children and young people
in Spain are leading unhealthy lifestyles, noticeable in their poor nutrition habits. Thus, for
Spanish ten-year-olds, the prevalence of obesity is only greater in Europe among children in
Italy, Malta and Greece. The average concentration of cholesterol among the young Spanish
population is 173 mg/dl for both sexes, according the various epidemiological studies performed.
This is a worrying figure, considering that in Spain CLDL values over 135 mg/dl among young
people are already considered high. For that reason, the Ministry of Health and Consumer Affairs
of Spain has drawn up the Strategy for Nutrition, Physical Activity and Prevention of Obesity
(NAOS Strategy), which aims to improve diet and to encourage the regular practice of some
physical activity by all citizens, paying special attention to prevention during childhood. It has
been demonstrated that there is a high probability that an obese child will become an obese adult
in the future. Finally, young people in Spain are abandoning the Mediterranean Diet in favour
of industrial products and fatty foods, full of calories but low in nutritional value, which is
contributing to their rising cholesterol levels. A special warning is dedicated to children and
teenagers, teaching them that one key to a healthy adult life is good nutrition, starting in
childhood. Nutrition surveys in Spanish school children A summary of the main findings of
nutrition surveys in Spanish school children are given below with more detailed information.
There is a high percentage of children that do not have breakfast (13%) or breakfast is not
adequate. Twenty four percent of school aged children have breakfast watching television, while
11% have breakfast with the family and 46% have breakfast alone. The majority of Spanish
school children reported having for breakfast whole milk (65%), semi-skimmed milk (13%),
skimmed milk (9%), white bread (84%), cereals (50%) and cookies. Only twenty four percent of
those children that usually have breakfast eat the three groups of recommended food (dairy
products plus cereals plus fruit). 376 Nutr Hosp. 2006;21(3):374-378 P. M. Fernndez San Juan
The main information source concerning food and nutrition are the family, television, the school,
the doctor and friends, in this order. In Spain the average of hours watching television are 46% of
children 1-2 hours per day, 19% of children 2-3 hours per day and 7% of children more than 3
hours per day. Television clearly transmits a conflicting message as regards dietary habits in
Spanish school children. The mean daily energy intakes were higher than recommended. There is
an unbalance in the intake of macronutrients, with a higher than recommended caloric
contribution due to fats (40%) and proteins (16%) and a lower than recommended intake of
carbohydrates (44%). The high protein consumption shows the predominant intake of animal
origin food. The average proportion of food energy derived from saturated fatty acids intake was
16.5%, from monounsaturated fatty acids 18.5% and from polyunsaturated fatty acids 5.0%. The
average intake of cholesterol is also higher than recommended. Average intakes of almost all
vitamins from food sources (excluding dietary supplements) were above reference levels.
However, average intakes for a number of minerals were below references and including
Magnesium, Iron and Zinc. The average intake of Calcium is insufficient specially in children
eleven years old and older. The nutritional status of Spanish school children was generally good
and there are no evidences of malnutrition. The foods most commonly consumed by spanish
school children were pasta and rice, soft drinks, juices and fruits (bananas, apples and
oranges), cakes, tomato, snacks and fast-food. They rejected vegetables (29%), legumes (14%)
and fish (12%). The most commonly consumed types of meat were chicken, beef and pork. Only
2% of children have eggs or fish daily. The majority of them usually have soft drinks (average
253 234 ml/day) although the proportion of coke type beverages are increasing with age
respect to juices. In the last years Spanish school children were taller and heavier (high BMI)
than in previous surveys, suggesting that activity levels fell as they got older. According to a
study recently carried out in 15 European countries, Spain is one of the countries where the least
amount of physical activity is performed. It is also stressed that the number of hours that children
and adolescents spend playing on the computer or with video games has increased dramatically.
Most worrying is the phenomenon of obesity in Spanish infant and adolescent population (2-24
years), already at 13.9%, and overweight of 26.3%. The highest figures are detected in
prepuberty and, more specially in the 6 to 12 years age group, with a prevalence of 16.1%
(ENKID Study). Finally, when the rest of countries are approaching to the model of
Mediterranean Diet, I think that Spanish school children in many cases are moving away from
it. Conclusions The data of studies suggest that an inadequate breakfast may contribute to the
making of poorer food choices throughout the rest of the day, thereby promoting obesity. Also,
omitting breakfast interferes with cognition and learning in school children. It is necessary to
increase daily physical activity, because together with diet, it is the other factor causing obesity
in a sedentary lifestyle. Recent studies of dietary habits in Spanish school children reveals
tendencies such as high intakes of total fats, saturated fatty acids, cholesterol, free sugars and low
intakes of complex carbohydrates. Spanish school children are abandoning the Mediterranean
Diet in favour of industrial products and fatty foods, full of calories but low in nutritional
properties, which is contributing to their obesity and the rising cholesterol levels found.
References 1. Serra Majem L, Aranceta J: Estudio Enkid. La primera investigacin de mbito
nacional e individual sobre hbitos de consumo y alimentacin en la poblacin infantil y juvenil
espaola. Ed. Masson, Barcelona (1998-2000). 2. Ortega RM, Requejo AM, Lpez-Sobaler AM:
Differences in the breakfast habits of overweight/Obese and normal weight schoolchildren.
International Journal Vitamin and Nutrition Research 1998; 68(2):125-132. 3. Tojo R, Leis R,
Recarey D, Pavn P: Dietary habits of preschool and school aged children: health risks and
strategies for intervention. Unidad de Investigacin en Nutricin y Desarrollo Humano de
Galicia. Departamento de Pediatra, Complejo Hospitalario Universitario de Santiago, Hospital
General de Galicia; Universidad de Santiago de Compostela, Espaa. 4. Encuesta Nacional de

Prevalence of anemia among school going children (< 12 years of age) in selected
slum schools of Bhubaneswar, Odisha. 1 Sujata Mohapatra, 2 Soma Maity, 3Binati
Behera, 4 Sailabala Mohanty BSN, RN, RM1, 2, 3, MSN, BSN, RN, RM4 Msc Nursing
2nd Year (Community Health Nursing)1, 2,3 Lecturer, Department of Community
Health Nursing4 , SUM Nursing College, SOA University Abstract: The purpose of the
study is to assess the prevalence of Anemia among school going children of
selected slum schools of Bhubaneswar, Odisha. Anemia is a common problem
throughout the world and iron deficiency is the most prevalent nutritional deficiency
in the world. It affects mainly the poorest segment of the population. An exclusive
review of literature helped in preparation of data collection tools to assess the level
of hemoglobin among school children.This study was conducted at the selected
schools of slum area in Bhubaneswar. Sample size was 385. Study subjects were
school children

The design of the study was Non-Experimental Descriptive

Design /Survey approach which was carried out in a group of 385 students selected
by Non-Probability Convenience Sampling technique from selected slum schools of
Bhubaneswar.A structured Questionnare was administerd to collect demographic
data & data on level of hemoglobin was collected by Sahlis method at Urban Health
Training Centre, IMS & SUM Hospital laboratory.The students & school authority were
assured for their confidentiality of their response.The analysis of the obtained data
was based on the objective of the study .Descriptive & inferential statistics was
used for data analysis & data interpretation. Results of the study revealed that 55%
of the sample are male & 45% of the sample are female, 42% of the sample are
Christian, 53% of the sample are Hindu & 5% of the sample are Muslim, 22% of the
sample are in the group of 0-6 years, 32% of sample are in the group of 6-8 years &
46% of sample are 8-12 years, educational qualification of mother, 15% of the
sample were in the group of illiterate, 35% of sample were in the group of primary,
40% of sample are in the secondary group & 10% sample are in the higher
secondary group, 36% of the sample were in the group of business, 34% of sample
are in the group of service, 04% of sample are in the farmer group & 26% sample
are in the Labourer group, 59% of the sample were in the group of nuclear family,
41% of sample were in the group of joint family, 32% of the sample are not anemic
& 58% of sample are anemic. After analysis & interpretation of data a leaflet
regarding how to improve hemoglobin level through supplimenting balance diet was
developed & communicated to the parents & school authority as more number of
students are staying in school hostel. Key words: Anemia, School going children,
Nutritional anemia, Iron

J Health Popul Nutr. 2014 Jun; 32(2): 237248.

PMCID: PMC4216960

Relationship between Mothers Nutritional Knowledge in Childcare

Practices and the Growth of Children Living in Impoverished Rural
Communities
Mahama Saaka

Author information Copyright and License information

This article has been cited by other articles in PMC.

ABSTRACT
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INTRODUCTION

The prevalence of chronic malnutrition among under-five children remains persistently high in
Ghana. For example, in the Northern Region of Ghana, 32.5% of children below five years are
stunted, 12.9% wasted, and 21.8% underweight (1). Inadequate childcare practices are
fundamental to addressing malnutrition among children. Poor maternal education (formal and
informal) has been identified as a major constraint to good childcare practices in Ghana (2). A
well-resourced, targeted and coordinated nutrition education can improve maternal nutritional
knowledge, healthcare-seeking behaviours, and practices significantly. Consequently, a number
of health-related non-governmental organizations, including Catholic Relief Services (CRS),
Adventist Development and Relief Agency (ADRA), World Vision International (WVI), and the
Ghana Health Service (GHS) have been promoting proper childcare practices, including
appropriate infant-feeding practices and management of childhood illnesses, such as diarrhoea.
Health and nutrition messages are usually targeted to mothers, most of whom have not received
formal education. These women usually patronize health services at antenatal clinics and child
welfare centres (CWC). Additionally, patronage of preventive health services provides an
opportunity to improve care practices through both preventive healthcare (immunization,
antenatal care for the mother, etc.) as well as management of childhood morbidity. Effective
utilization of knowledge and skills gained from health and nutrition education is, therefore,
expected to improve the health and nutritional status of children through improved knowledge
and care practices. However, there are limited data on the impact of nutrition education,
especially in women who have not received formal education. Care behaviour choices are
mediated by knowledge as well as by resource availability. Practices and behaviours of
individuals are influenced by knowledge, awareness and skill levels. Even in households with
similar levels of access to disposable income and resource, there is a wide variation in nutritional
outcomes of children (3), which tends to suggest that factors other than resources are responsible
for nutritional status of children. Adequate childcare is an underlying factor for optimal growth.
Caregiving behaviours that provide conducive environment within which children are raised are
central to nutritional outcomes of children, and policy attention to them has been recommended
by the International Conference on Nutrition (4).

The fundamental role of care to child nutrition has been well-established since 1990 through
UNICEF Model of Care. To provide care adequately, caregivers require education (both formal
and informal), time, and support (e.g. control of resources). In the Ghanaian context, it remains
unclear what the relationship is between the nutritional knowledge of non-literate mothers and
nutritional status of their children. One would expect that mothers knowledge of child nutrition
and childcare practices would have a significant effect on their children's nutritional status.
However, there are conflicting study results on this.

Whereas some studies have reported that maternal nutritional knowledge is positively associated
with the nutritional status of children (5-7), others have also shown that adequate knowledge per
se is not always translated into appropriate actions (8-10). Understanding the factors that
determine the translation of adequate child health and nutritional knowledge into appropriate
action in impoverished environment might help design more effective interventions against
malnutrition. It remains unclear whether giving mothers adequate knowledge on proper childcare
practices has an independent impact on child growth. This study, therefore, investigated the
relationship between mother's knowledge level in childcare practices and nutritional status of
preschool children living in impoverished rural communities of Northern Ghana.

Statement of the problem

In Ghana, health and nutrition education is a common intervention targeted to mothers, most of
whom have not received formal education. However, inadequate empirical evidence exists on the
relationship between nutritional knowledge of non-literate mothers and nutritional status of their
children. Although maternal education is an important determinant of nutritional status of
children, it remains unclear whether mother's practical knowledge about nutrition has an
independent effect on child growth. Furthermore, the factors that influence translation of
acquired knowledge into practice are not well-understood. It is this knowledge gap that this study
attempts to address.
Research questions

i. What is the level of maternal knowledge in recommended childcare practices

in the study population?

ii. Does household socioeconomic status influence mother's ability to translate

acquired knowledge into practice in order to improve the nutritional status of
children in impoverished rural communities of Ghana?

iii. Is there a direct link between child growth and a composite childcare
knowledge index?

Study objectives

The main aim of the study was to assess the relationship between maternal nutritional knowledge
in childcare practices and child growth among children aged 0-36 month(s) in Northern Ghana.

The specific objectives of the study were to: (i) assess mothers knowledge level in
recommended childcare practices relating to nutrition; (ii) investigate whether translation of
acquired health and nutritional knowledge into practice is dependent on the socioeconomic status
of the household in impoverished rural communities; (iii) assess the nutritional status of infants
and young children aged 0-36 month(s); and (iv) build a composite childcare knowledge index
and investigate its relationship with nutritional indicators in children.

Significance of the study

In order for policy-makers to better promote change and improve children's wellbeing in
impoverished communities, it is necessary to provide more insight into the relationship between
maternal knowledge and child health outcomes. The circumstances under which acquired
knowledge is put into practice are all important in deciding on possible interventions. This study
attempts to fill this knowledge gap.

Go to:

PLoS One. 2015 Nov 20;10(11):e0142301. doi: 10.1371/journal.pone.0142301. eCollection 2015.

Association between Maternal and Child Nutritional Status in

Hula, Rural Southern Ethiopia: A Cross Sectional Study.
Negash C1, Whiting SJ2, Henry CJ2, Belachew T3, Hailemariam TG1.

Author information
Abstract

BACKGROUND:
Maternal and child under nutrition is highly prevalent in low-income and middle-income countries, resulting in

substantial increases in mortality and overall disease burden. The aim of this baseline survey was to determine the

association between selected maternal characteristics, maternal nutritional status and children's nutritional status.

METHODS AND FINDINGS:

A survey with a cross sectional design was conducted between September and October 2012 in Hula, Ethiopia. The

study subjects were 197 mothers of children between the ages of 6 and 23 months. Weight and height (mothers) or

recumbent length (children) were measured using calibrated, standardized techniques. Seven percent of children

were below -2 weight for height Z score (WHZ), 11.5% were below -2 height for age Z score (HAZ) and 9.9% were

below -2 weight for age Z score (WAZ). Maternal anthropometrics were associated with child nutritional status in the

bivariate analysis. Maternal BMI (r = 0.16 P = 0.02) and educational status (r = 0.25 P = 0.001) were correlated with

WHZ of children while maternal height (r = 0.2 P = 0.007) was correlated with HAZ of children. After multivariate

analysis, children whose mothers had salary from employment had a better WHZ score (P = 0.001) and WAZ score

(P<0.001). Both maternal BMI and maternal height were associated with WHZ (P = 0.04) and HAZ (P = 0.01) score of

children.

CONCLUSION:

Having a mother with better nutritional status and salaried employment is a benefit for the nutritional status of the

child. The interrelationship between maternal and child nutritional status stresses the value of improving maternal

nutritional status as this should improve both maternal and child health outcomes. Therefore strategies to improve

nutritional status of children should also include improving the nutritional status of the mother and empowering her

financially.

2011 Apr 13;11 Suppl 3:S25. doi: 10.1186/1471-2458-11-S3-S25.

Impact of maternal education about complementary feeding

and provision of complementary foods on child growth in
developing countries.
Imdad A1, Yakoob MY, Bhutta ZA.

Author information
Abstract

BACKGROUND:
Childhood undernutrition is prevalent in low and middle income countries. It is an important indirect cause of child

mortality in these countries. According to an estimate, stunting (height for age Z score < -2) and wasting (weight for

height Z score < -2) along with intrauterine growth restriction are responsible for about 2.1 million deaths worldwide in

children < 5 years of age. This comprises 21 % of all deaths in this age group worldwide. The incidence of stunting is

the highest in the first two years of life especially after six months of life when exclusive breastfeeding alone cannot

fulfill the energy needs of a rapidly growing child. Complementary feeding for an infant refers to timely introduction of

safe and nutritional foods in addition to breast-feeding (BF) i.e. clean and nutritionally rich additional foods introduced

at about six months of infant age. Complementary feeding strategies encompass a wide variety of interventions

designed to improve not only the quality and quantity of these foods but also improve the feeding behaviors. In this

review, we evaluated the effectiveness of two most commonly applied strategies of complementary feeding i.e. timely

provision of appropriate complementary foods ( nutritional counseling) and education to mothers about practices of

complementary feeding on growth. Recommendations have been made for input to the Lives Saved Tool (LiST)

model by following standardized guidelines developed by Child Health Epidemiology Reference Group (CHERG).

METHODS:

We conducted a systematic review of published randomized and quasi-randomized trials on PubMed, Cochrane

Library and WHO regional databases. The included studies were abstracted and graded according to study design,

limitations, intervention details and outcome effects. The primary outcomes were change in weight and height during

the study period among children 6-24 months of age. We hypothesized that provision of complementary food and

education of mother about complementary food would significantly improve the nutritional status of the children in the

intervention group compared to control. Meta-analyses were generated for change in weight and height by two

methods. In the first instance, we pooled the results to get weighted mean difference (WMD) which helps to pool

studies with different units of measurement and that of different duration. A second meta-analysis was conducted to

get a pooled estimate in terms of actual increase in weight (kg) and length (cm) in relation to the intervention, for input

into the LiST model.

RESULTS:

After screening 3795 titles, we selected 17 studies for inclusion in the review. The included studies evaluated the

impact of provision of complementary foods ( nutritional counseling) and of nutritional counseling alone. Both these

interventions were found to result in a significant increase in weight [WMD 0.34 SD, 95% CI 0.11 - 0.56 and 0.30 SD,

95 % CI 0.05-0.54 respectively) and linear growth [WMD 0.26 SD, 95 % CI 0.08-0.43 and 0.21 SD, 95 % CI 0.01-0.41

respectively]. Pooled results for actual increase in weight in kilograms and length in centimeters showed that

provision of appropriate complementary foods ( nutritional counseling) resulted in an extra gain of 0.25 kg ( 0.18) in

weight and 0.54 cm ( 0.38) in height in children aged 6-24 months. The overall quality grades for these estimates
were that of 'moderate' level. These estimates have been recommended for inclusion in the Lives Saved Tool (LiST)

model. Education of mother about complementary feeding led to an extra weight gain of 0.30 kg ( 0.26) and a gain

of 0.49 cm ( 0.50) in height in the intervention group compared to control. These estimates had been recommended

for inclusion in the LiST model with an overall quality grade assessment of 'moderate' level.

CONCLUSION:

Provision of appropriate complementary food, with or without nutritional education, and maternal nutritional

counseling alone lead to significant increase in weight and height in children 6-24 months of age. These interventions

can significantly reduce the risk of stunting in developing countries and are recommended for inclusion in the LiST

tool.