Effectiveness of nutritional awareness in child diet among mothers of under five in anganwadi in Mysuru: A quasi-experimental study

ABSTRACT

Background:

Children are the most important assets to any country; their physical, mental, and emotional developments are crucial for future as they become citizens. Mothers’ knowledge on nutrition for kids plays a vital role in the health of the children. Regular interventions as counseling or discussions with the mothers will be an effective tool to counter under nutrition, malnutrition, and also micronutrient deficiencies. Our objective was to assess the effectiveness of nutritional awareness in child diet among the mothers of under five in anganwadis in Mysuru with pre- and post-awareness.

Materials and Methods:

It is a quasi-experimental study for a duration of 3 months. The sample size was 35, with convenient sampling, and the data were collected using a semi-structured, validated questionnaire from mothers whose children are enrolled in anganwadis. The data were analyzed using mean, Chi-square/Fischer test using SPSS version 22.

Results:

The mean score before and after awareness was 6.26 ± 0.701, and the post score was 6.83 ± 0.618. There was a significant association between birth order of the child enrolled and the post-awareness grades. There was also a statistical significance between mean scores of pre- and post-awareness.

Conclusion:

We can conclude from the above study that regular and objectified communication with the mothers is an effective strategy for the improvement of their awareness regarding child nutrition.

Introduction

Children are the most important assets to any country; their physical, mental, and emotional developments are crucial for future as they become citizens. Good nutrition of the under-five children is the foundation of their future health, strength, and intelligence.[1]

The mother is the principal provider and caretaker of the child under the age of 5 years, fulfilling the needs of the child. Poor feeding practices in infancy and early childhood are the main social obstacles in the healthy growth of the child. Hence, mothers’ knowledge on nutrition for kids plays a vital role in the health of the children. Here, behavior change interventions are key to providing appropriate information that could rectify these poor practices.[2,3] There may be many reasons for the reduced food frequency and hampered diet quality with most of them because of socio-economic conditions; the urban poor suffer more with the high cost, making it difficult for them to have adequate nutrition and leading to deterioration of the nutritional status.[4,5,6]

Interventions can take place in many forms, with mass media, lectures, and discussions. There are also small group discussions or counseling, which has been effective to increase the mother’s awareness and influence her behavior. This will keep her informed about introducing varied food categories, nutrition, and weight monitoring of the child.[7,8,9]

Regular interventions as counseling or discussions with the mothers will be an effective tool to counter under nutrition, malnutrition, and also micronutrient deficiencies by keeping the mother informed about the consequences of the food choices and what steps have to be taken to keep the child healthy.[10]

These interventions can be used as a pilot by the primary care givers to look at the high rates of malnourishment in the under-five children in anganwadis across the country. While the anganwadi workers may not be trained as the professional primary health care givers, they are more socially acceptable and know the people of the locality well. This makes the anganwadi workers an important link through which the discussions and interventions have to happen. Suggestions of local crops grown nearby, with the information of the price and availability, will help the mothers to be more aware of the nutritional choices available at their locality. With primary care givers, mainly the anganwadi workers regularly interacting with the mothers also develop a trusting bond and will adhere to the suggestions which will then lead to a change in diet pattern among the family.[11,12]

With the study, we would assess the effectiveness of nutritional awareness in child diet among the mothers of under five in anganwadis in Mysuru with pre- and post-awareness.

Materials and Methods

• a)Study design: quasi-experimental study
• b)Study duration: 3 months (January 2023 to March 2023)
• c)Sampling technique: Convenient sampling technique
• d)Sample size: 35
• e)Study setting and method of collection of data.
  • This study will be done in the seven anganwadis located in medhar block, Mysuru.
  • Study was done after obtaining necessary permission.
  • After obtaining consent from residents, data were collected from them. Data pertaining to the age, type of family, birth order, number of siblings, and socio-economic status are to be collected from them through pre-tested semi-structured open questionnaire.
  • A pre-intervention score will be obtained from the participants, and then a post-test will be done. The intervention will be for a duration of 2 months, with two sessions for each of the mothers in the duration of 2 months.

  The sessions will be focused group discussion, with the main focus on regular introduction of fruits in the child’s diet. Sessions will be in the form of group discussion and a written/digital document citing the usefulness of fruits in wadis in Mysuru with and on the growth and development and the socio-economic factors which can be done for between access. They will be given access to the fruits through makeshift orange selling points for the same.

• f)Study population: All the mothers who have enrolled their child to anganwadis and are willing to participate.
• g)Subject eligibility:
  • Inclusion criteria: All mothers who have registered their children in anganwadis and willing to participate in the study.
  • Exclusion criteria: Mothers who have psychiatric conditions and those who are not willing.
• h)Questionnaire: The questionnaire will have socio-demographic factors and questions related to their knowledge, attitude, and practices when it comes to nutrition for the child. A scoring will be given before and after the intervention, and the analysis will be done.

  It will have socio-demographic details, knowledge regarding their diet frequency chart, and information about orange usage and its basic nutrient value.

• i)Statistical analysis:

  Data obtained will be entered in MS Excel spread sheets, followed by analysis using SPSS version 22 (licensed to JSS Medical College). The demographic characteristics such as age, gender, occupation, and so on will be represented using arithmetic mean, standard deviation, and percentages. The possible associations between the selected demographic variables (age, gender, education) will be found out using Chi-square test.

Results

Table 1 shows socio demographic details of the study participants, that 41.7% of mothers belonged to 26-30years and religion wise they preferred Hinduism with 58.3%. Education status, 55.6% of mothers studied in primary and 63.9% fathers studied till high school. 91.7% of the mothers were housewife. 30.6% family had 3 members and 27.8% of families have 4 members. 44.4% of children are of the first birth order who have been enrolled in anganwadi.

Table 1.

Socio-demographic variables of mothers

Variable	Frequency	Percentage
Age
20-25	13	36.1
26-30	15	41.7
>30	7	19.4
Religion
Hindu	21	58.3
Muslim	14	38.9
Mothers Education
Primary	20	55.6
High School	15	41.7
Fathers Education
Primary	5	13.9
High School	23	63.9
Degree	7	19.4
Mothers Occupation
Housewife	33	91.7
Coolie	2	5.6
Family Size
3	11	30.6
4	10	27.8
5	8	22.2
6	4	11.1
7	2	5.6
Birth Order
1	16	44.44
2	13	36.1
3	6	16.66
Family Type
Nuclear	27	75
Joint	8	22.2

Table 2 shows a total of 23 mothers belonged to good knowledge and 12 belonged to complete grade level. (grades done by a self-constructed validated scale).

Table 2.

Association of Pre test scores with the variables

Variable	Pre Test grades		P
	Good	Complete
Age
20-25	9	4	0.903
26-30	10	5
>30	4	3
Religion
Hindu	13	8	0.561
Muslim	10	4
Mother’s Education
Primary	12	8	0.411
High School	11	4
Fathers Education
Primary	4	1	0.438
High School	16	7
Degree	3	4
Family Size
3	9	2	0.497
4	5	5
5	6	2
6	2	2
7	1	1
Birth Order
1	13	3	0.259
2	7	6
3	3	3
Type of Family
Nuclear	18	9	0.827
Joint	5	3

*Chi-square/fischer test done

In pre awareness stage, there was no statistical significant association between any of the socio demographic variables and the grades.

Table 3 checks the association of post test scores with variables. In the post awareness stage, there was a statistical significance between the birth order of the child enrolled in the anganwadis and the post awareness grades.

Table 3.

Association of Post test scores with variables

Variable	Post Test grades		P
	Good	Complete
Age
20-25	4	9	0.768
26-30	3	12
>30	1	6
Religion
Hindu	7	14	0.071
Muslim	1	13
Mother’s Education
Primary	4	16	0.642
High Scool	4	11
Fathers Education
Primary	3	2	0.147
High Scool	4	19
Degree	1	6
Family Size
3	5	6	0.359
4	2	8
5	1	7
6	0	4
7	0	2
Birth Order
1	7	9	0.012
2	1	12
3	0	6
Type of Family
Nuclear	8	19	0.08
Joint	0	8

Table 4 shows the mean score pre awareness was 6.26+-.701 and post score was 6.83+-0.618.

Table 4.

Mean scores of pre and post awareness among mothers

Scoring	Mean	Standard deviation
Pre test (total score)	6.26	0.701
Post test (total score)	6.83	0.618

Table 5 shows that there is a statistical difference between mean scores of pre and post awareness.

Table 5.

Difference between mean scores of pre and post awareness

Paired difference	Mean	Standard deviation	df	Sig. (2-tailed)
Pre test- Post test score	-0.571	0.655	34	0.000

Discussion

The study showed that the majority (65.7%) of the mothers had good knowledge with regard to the nutritional knowledge, which is comparable to the study done by Bamji MS et al., which shows that mothers had good knowledge, but interventions given by the primary care givers and physicians have helped in improving the KAP of the mothers. Information on balanced diet, nutrients of food, right cooking practices, and initial management of common diseases has been effective in changing the diet practices of the mother and child.[13]

Post awareness, there was a transition in the grade levels, with 27 (77%) of the mothers increasing their grades to complete levels, which is the highest in our scoring, which is in line with a study done by et al., where there is significant improvement in KAP and utilization of services, followed by the awareness given to mothers. This has been done with various programs as well. Mothers who have been in contact with the primary care givers have shown that their utilization of the services in anganwadis as well their nutritional status is well monitored and accordingly managed in difficult situations. They would also be very adaptive to the new changes implemented by the primary care givers; with the information received first hand, they have more available time and also can make the changes in behavior early on, making policy implantation very much practical.[14,15]

Our study has shown a statistically significant difference in the pre- and post-awareness, which is similar to a study done by Dunneram Y et al., which showed there was a rise of nutritional knowledge among the mothers from 3% to 31% irrespective of the maternal age and other factors. Sustained efforts over time and a continuous engagement of mothers and the primary care givers will show an improvement in the nutritional status of the children and mothers.[7]

The less number sample size along with the topography of the study which is conducted only in one locality makes it very difficult to generalize the findings of the study to a larger population. This is also an interventional study which needs to be followed up for more months in a longitudinal manner to check whether there are more changes in scores over time and the other associated factors associated with the process.

Conclusion

We can conclude from the above study that regular and objectified communication with the mothers is an effective strategy for the improvement of their awareness regarding child nutrition. A community approach awareness has to be implemented, for the mothers, in the anganwadis or near their community to make them aware, which may in turn help in the growth of the child.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.