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ORIGINAL ARTICLE
Year : 2013  |  Volume : 3  |  Issue : 2  |  Page : 121-125

Impact of training workshop on knowledge about new WHO growth chart, severe acute malnutrition, and Infant and Young Child Feeding among final-year medical students


Department of Community Medicine, Rural Medical College and Pravara Rural Hospital of Pravara Institute of Medical Sciences (Deemed University), Loni, Dist. Ahmednagar, Maharashtra, India

Date of Submission28-Apr-2012
Date of Acceptance24-Jul-2012
Date of Web Publication3-Jun-2013

Correspondence Address:
Purushottam A Giri
Department of Community Medicine (PSM), Rural Medical College, Loni, Maharashtra - 413 736
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/2231-0738.112834

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   Abstract 

Background: According to reports of the Food Agricultural Organization (FAO), malnutrition is prevalent among nearly 460 million people, which is 15% of the world's population, and 300 million in Southeast Asia where they constitute one-third of the population. According to the report of the National Family Health Survey (NFHS-III), only one-fourth of the infants started breastfeeding within the first half hour of birth and 57% of mothers gave fluids in addition to breast milk within three days of delivery. Objectives: The present study was conducted to assess the knowledge about the new growth chart of the World Health Organization (WHO), severe acute malnutrition (SAM), and Infant and Young Child Feeding (IYCF) among final-year medical students. Materials and Methods: An interventional study was conducted from June 2010 to September 2010 by interviewing 118 final-year medical students. A predesigned and pretested questionnaire was used to collect the pre-workshop and post-workshop data. Questions were based on the knowledge about the new growth chart, SAM, and IYCF.The results were analyzed statistically using percentages, proportions, and Chi-square test. Results: In this study, only 15.2% students knew about the number of reference curves as per the new growth chart of the WHO, but after the workshop, 94.1% became aware of it ( P < 0.0001). Before the workshop, 21.2% students knew thedifference between marasmus and kwashiorkor, but after the workshop 88.1% were aware of it ( P < 0.0001). Only 51.7% students knew about the appropriate age for weaning, but after the workshop 97.5% were aware of it ( P < 0.0001). After the workshop, 87.3% students were aware of the type of feeding to be given during illnessfor infants older than 6 months ( P < 0.0001). Conclusion: Such interventional studies are important to increase the knowledge amongst the students, as the topic chosen was closely related to everyday life with respect to treatment of children, and advice on feeding, proper nutrition, and growth.

Keywords: Knowledge, new WHO growth chart, severe acute malnutrition, Infant and Young Child Feeding, medical students


How to cite this article:
Giri PA, Deshpande JD, Phalke DB. Impact of training workshop on knowledge about new WHO growth chart, severe acute malnutrition, and Infant and Young Child Feeding among final-year medical students. Int J Nutr Pharmacol Neurol Dis 2013;3:121-5

How to cite this URL:
Giri PA, Deshpande JD, Phalke DB. Impact of training workshop on knowledge about new WHO growth chart, severe acute malnutrition, and Infant and Young Child Feeding among final-year medical students. Int J Nutr Pharmacol Neurol Dis [serial online] 2013 [cited 2020 Jan 27];3:121-5. Available from: http://www.ijnpnd.com/text.asp?2013/3/2/121/112834


   Introduction Top


Worldwide, an estimated 852 million people are undernourished, with the majority (815 million) living in developing countries. [1] Malnutrition, with its two constituents of protein-energy malnutrition and micronutrient deficiencies, continues to be a major health-care burden in the developing countries. Similarly, malnutrition increases one's susceptibility to and severity of infections, and is thus a major component of illness and death from disease. [2] Infant-feeding practices constitute a major component of child care practices apart from socio-cultural, economic, and demographic factors. [3] Success in reducing malnutrition will be achieved through the availability of health-care services by well-trained personnel. The nutritional status of children under five is one of the indicators of household well-being and one of the determinants of child survival. [4] According to Food Agricultural Organization (FAO) reports, the main victims of malnutrition are children under the age of 15 years, and children below the age of five years are the hardest hit. Under five years of age, 35% deaths are due to malnutrition. About 11% of total DALYs (disability-adjusted life-years) are lost globally due to malnutrition and 60% deaths occur annually in children under five years of age. About two-thirds of these deaths are due to inappropriate feeding practices. Only 35% infants are exclusively breast-fed. [5] According to the report of the National Family Health Survey (NFHS- III), only one-fourth of the infants started breast-feeding within the first half hour of birth and 57% of the mothers gave other fluids in addition to breast milk within three days of delivery. The rate of exclusive breast-feeding is only 28%. [6] The growth chart was designed first by David Morley. Later, it was modified by the WHO. It is a visible display of the physical growth and development of the child. It is designed for a longitudinal follow-up of a child, so that the changes over time can be interpreted. Growth charts can be used for monitoring growth, as a diagnostic tool, tool for planning and policy making, educational tool, tool for action, tool for evaluation, tool for teaching, and as an epidemiological tool. Medical students are doctors in the making responsible for providing health-care services to the community in the near future. Hence, the present study was conducted to assess the knowledge about the new WHO growth chart, severe acute malnutrition (SAM), and Infant and Young Child Feeding (IYCF) among final-year medical students.


   Materials and Methods Top


This pre and post-test interventional study was conducted from June 2010 to September 2010. A total of 125 final-year medical students (III MBBS, IV th term) studying at the Rural Medical College, Loni, Maharashtra, India who were willing to participate in the study were included. However, only 121 (96.8%) students participated in the study and three (2.4%) questionnaires could not be included for statistical analysis because of the lack of sufficient information. Hence a total of 118 medical students from the final year (III MBBS, IV th term) were included in the study.

A pre-designed and pre-structured questionnaire was used to collect the pre-workshop and post-workshop data. The questionnaire was pretested on a subsample of 30 students and modified, and necessary changes were made accordingly. Ethical approval was obtained from the institutional ethics committee. The language of the questionnaire was English and contained 30 questions. All the questions were objective in nature with 'Yes' or 'No' as the options, although a few questions were of multiple-choice type. The respondents were asked to circle the appropriate response given against each query. Questions were based regarding the knowledge about the new growth chart of the WHO, SAM, and IYCF. Demographic details like age and sex of the respondents were also recorded. The workshop was conducted in the auditorium of the medical college and consisted of a series of lectures and audiovisual presentations, followed by a question-answer session. Post-workshop data was collected.

Statistical analysis

Results were analyzed statistically using percentages, proportions and the chi-square test. Statistical significance was set at P ≤ 0.05.


   Results Top


It is evident from [Table 1] that there was significant improvement in knowledge about the new growth chart of the WHO among students after the workshop (P < 0.001). Only 15.2% students knew about the number of reference curves as per the WHO growth chart but after the workshop, 94.1% became aware of it (P < 0.0001). After the workshop, 94.9% students were aware about the more sensitive index for assessing growth in the new growth chart (P < 0.0001). Post-workshop, 88.9% students became aware about the first sign of protein-energy malnutrition as per the new growth chart of the WHO (P < 0.0001).
Table 1: Assessment of knowledge about new growth chart of the World Health Organization among the study population (n=118)

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It is seen from [Table 2] that only 21.2% students knew the difference between marasmus and kwashiorkor, but after the workshop, 88.1% became aware of it (P < 0.0001). Post workshop, 95.7% students were aware about the minimum calorie intake in case of mild to moderate malnutrition (P < 0.0001). Post workshop, the percentage of knowledge of the students about using Shakir's tape for diagnosing SAM increased from 18.6 to 84.7% (P < 0.0001).
Table 2: Assessment of knowledge about severe acute malnutrition among the study population (n=118)

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As observed from [Table 3], there was significant improvement in the knowledge about IYCF among students after the workshop (P < 0.001). Only 51.7% students knew about the appropriate age for weaning, but after the workshop, 97.5% became aware of it (P < 0.0001). Post workshop, 87.3% students were aware about infant feeding during illness (P < 0.0001). Similarly, after the workshop, the percentage of knowledge of the students about exclusive breast-feeding increased from 53.4 to 96.6% (P < 0.0001).
Table 3: Assessment of knowledge about infant and young child feeding (IYCF) among the study population (n=118)

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   Discussion Top


Globally, malnutrition is attributed to almost one-half of all child deaths. Survivors are left vulnerable to illnesses, stunted growth, and intellectual impairment. There are several studies on nutrition transition in Asia and the Pacific, as well as in the developing world in general. [7] In India, which is typically known for a large incidence of under nutrition, significant proportions of overweight and obese people now coexist with the undernourished; [8] so, as such, there is some evidence of emerging nutrition transition also. [9] Protecting lives and promoting optimum development of undernourished children is a human rights issue. Estimates from the most recent nationally representative survey indicates that 6.4% of the children below 60 months of age have a weight-for-height ratio below -3SD (SD: standard deviation). [6]

Growth assessment is the single measurement that best defines the health and nutritional status of children, because disturbances in health and nutrition, regardless of their etiology, affect growth of the child invariably. Problems of health and nutrition during childhood are the result of a wide range of factors, most of which, particularly in underprivileged populations, relate to unsatisfactory intake of food or severe and repeated infections, or a combination of the two. These conditions, in turn, are closely linked to the general standard of living and whether a population is able to meet its basic needs such as food, housing, and healthcare. [10] Growth assessment thus serves as a means for evaluating the health and nutritional status of children, just as it also provides an indirect measurement of the quality of life of an entire population. [10] The guideline of the WHO Child Growth Standards is being used widely as a tool in public health care and medicine, and by governmental and health-care organizations for monitoring the well-being of children and for detecting children or populations not growing properly or being under or over weight; it may require specific medical or public health-care responses. Successful management of the severely malnourished child requires both medical and social problems to be recognized and corrected. Education in nutrition and efficient nutrition-monitoring systems at all levels of care is essential. The diagnostic criteria proposed by the WHO and United Nations Children's Fund for SAM in children aged 6 to 60 months include any of the following: (i) weight-for-height below -3 SD or Z scores of the median WHO growth reference (2006); (ii) severe visible wasting; (iii) presence of bipedal edema; and (iv) mid-upper arm circumference below 115 mm. [11] The accurate measurement of the representative food intake of a child is a much tougher proposition than the assessment of immunization status, treatment for diarrhea or acute respiratory infections, measures of stunting and wasting, or school enrollment. [12]

In the present study, only 15.2% students knew about the new growth chart of the WHO. Only 21.2% students knew thedifference between marasmus and kwashiorkor, but after the workshop, 88.1% became aware of it. About 51.7% students knew about at the appropriate age for weaning, but after the workshop, 97.5% were aware of it. Post workshop, the percentage of knowledge of the student about exclusive breast-feeding increased from 53.4 to 96.6%. Malnutrition remains one of the most common causes of morbidity and mortality among children throughout the world. Faulty feeding practices affect the health and nutritional status of infants and young children adversely, resulting in varying degrees of malnutrition that affects almost half of the children of the nation. Medical students are responsible for providing health-care services to the community in the near future. Successful management of the severely malnourished child does not require sophisticated facilities and equipment or highly qualified personnel. It does, however, require that each child be treated with proper care and affection, and that each phase of treatment be carried out properly by appropriately trained and dedicated health-care workers.


   Conclusion Top


Such interventional studies are important to increase the knowledge amongst the students, as the topic chosen was closely related to everyday life with respect to treatment of children, and advice on feeding, proper nutrition, and growth. The training program must be able to communicate the message in a simple and lucid manner.


   Acknowledgment Top


The authors express their heartfelt gratitude to the Management, Pravara Medical Trust and The Principal, Rural Medical College, Loni, Maharashtra, India. They also acknowledge the help and support of Dr. Ashok Kumar, Associate Professor in the Department of Paediatrics. Last but not the least; they are indebted to the final-year medical students for their assistance during data collection for the study.

 
   References Top

1.World Health Organization. World Health Report 2002: Reducing Risks, Promoting Healthy Life. WHO, Geneva: 2002 pp. 7-14.  Back to cited text no. 1
    
2.World Health Report 2003, WHO, Geneva. For malnutrition: Pelletier DL, Frongillo EA, and Habicht JP. 'Epidemiologic evidence for a potentiating effect of malnutrition on child mortality'. Am J Public Health 1993; 83(8):1130-33.  Back to cited text no. 2
    
3.Murray CJL, Lopez AD. Global mortality, disability, and the contribution of risk factors: Global Burden of Disease Study. Lancet 1997;349:1436-42.  Back to cited text no. 3
    
4.Thomas D, Strauss J, Henrique M. Child survival, height for age and household characteristics in Brazil. J Dev Econ1990;33:197-234.  Back to cited text no. 4
    
5.Food and Agriculture Organization of the United Nations. Undernourishment around the world. In: The state of food insecurity in the world 2004. The Organization: Rome; 2004.  Back to cited text no. 5
    
6.International Institute for Population Sciences, 2006. IIPS: Mumbai, India: National Family Health Survey (NFHS-3); 2005-2006.  Back to cited text no. 6
    
7.Popkin BM. The nutrition transition in low income countries: An emerging crisis. Nutr Rev 1994;52:285-98.  Back to cited text no. 7
    
8.International Institute for Population Sciences and ORC Macro 2000. IIPS: Mumbai, India: National Family Health Survey (NFHS-2); 1998-99.  Back to cited text no. 8
    
9.Shetty PS, James WP. Body Mass Index: A Measure of Chronic Energy Deficiency in Adults, Food and Agriculture Organization, Food and Nutrition: Rome: FAO; 1994. p. 56.  Back to cited text no. 9
    
10.Krishnan M, Rajalakshmi PV, Kalaiselvi K. A study of protein energy malnutrition in the school girls of a rural population. Int J Nutr Pharmacol Neurol Dis 2012;2:142-6.  Back to cited text no. 10
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11.WHO Child Growth Standards and the Identification of Severe Acute Malnutrition in Infants and Children. A Joint Statement by the World Health Organization and the United Nations Children's Fund, 2009. Available from http://www.who.int/nutrition/publications/severemalnutrition/9789241598163/en/index.html. [Last accessed on 2011 June 15].  Back to cited text no. 11
    
12.Hoddinott J, Haddad L, Does female income share influence household expenditures? Evidence from the Cote d'Ivoire. Oxford Bull Econ Statist 1995;57:77-96.  Back to cited text no. 12
    



 
 
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  [Table 1], [Table 2], [Table 3]



 

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