ETHICAL COMMITTEE CLEARANCE

1) TITLE OF THE DISSERTATION: “A STUDY TO ASSESS THE CORRELATION BETWEEN THE KNOWLEDGE OF MOTHERS REGARDING WEANING AND NUTRITIONAL STATUS OF THEIR UNDER-FIVE CHILDREN WITH A VIEW TO DEVELOP AN INFORMATION BOOKLET AT SELECTED PRIMARY HEALTH CENTERS OF DAVANGERE DISTRICT.”

2) NAME OF THE CANDIDATE : Mrs. AMBIKA M.S. 1st Year M.Sc., Nursing Kumuda Institute of Nursing Sciences, Kumuda College of Nursing, S. Nijalingappa Layout, Davangere- 577 004.

3) SUBJECT : PAEDIATRIC NURSING

4) NAME OF THE GUIDE : MR. LOKESH D.C. M.Sc., (Nursing)

Deparmtnet of Child Health Nursing Kumuda Institute of Nursing Sciences Davangere – 577 004.

5) APPROVED / NOT APPROVED:

(If not approved, suggestion)

Mr. Shymon K. Principal, Medical Surgical Nursing, Kumuda College of Nursing, S. Nijalingappa Layout, Davangere – 577 004.

1

RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES

BANGALORE, KARNATAKA

PROFORMA FOR REGISTRATION OF SUBJECT FOR DISSERTATION

“A STUDY TO ASSESS THE CORRELATION BETWEEN THE

KNOWLEDGE OF MOTHERS REGARDING WEANING AND

NUTRITIONAL STATUS OF THEIR UNDER-FIVE CHILDREN

WITH A VIEW TO DEVELOP AN INFORMATION BOOKLET

AT SELECTED PRIMARY HEALTH CENTERS OF

DAVANGERE DISTRICT.”

Mrs. AMBIKA M.S.,

FIRST YEAR M.SC., NURSING,

PAEDIATRIC NURSING

KUMUDA INSTITUTE OF NURSING SCIENCES,

2

DAVANGERE – 577 004.

3

RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES,

BANGALORE, KARNATAKA, INDIA ANNEXURE – II

PROFORMA FOR REGISTRATION OF SUBJECTS FOR

DISSERTATION

1. NAME OF THE CANDIDATE AND

ADDRESS (IN BLOCK LETTERS)

Mrs. AMBIKA M.S.,

I YEAR M.Sc., NURSING,

KUMUDA INSTITUTE OF NURSING SCIENCES,

KUMUDA COLLEGE OF NURSING,

S. NIJALINGAPPA LAYOUT,

DAVANGERE-577 004.

2. NAME OF THE INSTITUTION KUMUDA INSTITUTE OF NURSING SCIENCES

3. COURSE OF THE STUDY AND

SUBJECT

FIRST YEAR M.SC., NURSING,

PAEDIATRIC NURSING

4. DATE OF ADMISSION 01-07-2011

5. TITLE OF THE TOPIC:

“A STUDY TO ASSESS THE CORRELATION

BETWEEN THE KNOWLEDGE OF MOTHERS REGARDING WEANING AND

NUTRITIONAL STATUS OF THEIR UNDER-FIVE CHILDREN WITH A VIEW TO

DEVELOP AN INFORMATION BOOKLET AT SELECTED PRIMARY HEALTH

CENTERS OF DAVANGERE DISTRICT.”

1

6. BRIEF RESUME OF INTENDED WORK

6.0 INTRODUCTION:

“Let us sacrifice our today so that our children can have a better tomorrow”

Abdul Kalam.

Nutritional status of the child plays vital role in the physical and mental development of

the children. Timely balanced feeding makes babies healthy. Healthy babies are future wealth of

nation. Inadequate and imbalance diet leaded to malnutrition which may cause various types of

infections. Generally nutritional status depends on food habits, socio-economic conditions,

tradition, culture and knowledge of the family .The knowledge about nutrition of the family

directly effects nutritional condition of family. Malnutrition makes a child susceptible to

infections and delays recovery, thus increasing mortality and morbidity. Every time an innocent

child suffers the curse of malnutrition, the responsibility goes to the mother the family and to the

community due to their faulty or no knowledge regarding the harmful effects of prelacteal

feeding, benefits of exclusive breast feeding and initiation of proper weaning at the correct time.

6.1 NEED FOR THE STUDY:

Weaning is a process of gradual and progressive transfer of the baby from breast milk to

the what family diet. It does not mean discontinuing to breast feeding. Weaning begins from the

moment supplementary food is started and continues till the child is taken off the breast

completely. Infants in india thrive on breast milk alone up to six months of life and their growth

rate during this period is satisfactory. Breast milk alone is not able to provide sufficient amounts

of all the nutrients needed to maintain growth after the first six months. Increasing need of

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calories and protein of growing children cannot be met by the diminishing output of mother’s

milk. Milk is also a poor source of vitamin C and supplementation with fruit juice is essential.

Iron stores in liver of the infant would last only upto 4-6 months. Hence iron-rich foods should

be given atleast from six months onwards. Milk is also deficient in vitamin D. If the baby is to

maintain the expected rate of growth and remain healthy and well nourished, supplementary

feeding has to be resorted to round about the 6th month of life.1

The term weaning is derived from the Anglo-Saxon word wenian, which means "to

become accustomed to something different." The Concise Oxford Dictionary says to wean is "to

teach the sucking child to feed otherwise than from the breast." Weaning is often seen as the end

of something; however, it is more appropriately viewed as a beginning. We misuse the word

wean in the context of stopping other activities or habits; weaning is not the cessation of

breastfeeding but rather the addition of new foods.2

In the strictest sense of the word, weaning means getting a body used to drinking milk

from a cup instead of sucking milk from the breast or bottle; in the broader sense, it also means

getting the baby used to taking food by biting and Chewing instead of only by sucking; Weaning

is now discarded in favor of the phrase complementary feeding. To make weaning an easy

adjustment for a baby, it should be done gradually step by step.3

India is a third world war country, since independence, one of the gravest problems India

is confronting with is malnutrition among under – 5 children. About two-third of the under five

children of our country is malnourished. Among them, 5-8% are severally malnourished while

rest fall in the group of mild or moderate malnutrition. So it can be said that malnutrition is one

of the most widespread conditions affecting child health. The ‘germ’ of malnutrition ‘infects’ a

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foetus in the intra-uterine life due to lack of sufficient anternatal care on part of the mother. The

condition deteriorates further when after birth the infant is deprived of exclusive breast feeding

or initiation of wearing is delayed. Weaning should be started after the age of 6 months and

should contain energy rich semi sold food.4

Over 6 million deaths (55% of the 12 million children under 5 years of age) each year in

developing countries from infectious diseases, can be attributed to malnutrition. In the

developing world, one out of every 5 persons is chronically undernourished and about 200

million children under 5 years of age suffer from protein energy malnutrition1. Malnutrition

remains a global problem affect- ing development, particularly that of the under- privileged and

the poor. UNICEF has coined malnutrition a “silent emergency” that endangers children,

women, society and the future of mankind. Malnutrition is a major contributory factor to

mortality and morbidity. Its close association with diarrhoea, respiratory tract infection and

infectious diseases has been observed in many studies all over the world. There is a growing

realization that good and adequate nutrition is a necessary step in improving the quality of life.

The first few years of life are of paramount importance in laying the foundation of good health.

The effective measures for the prevention of malnutrition and protection against infection in

infancy is breast feeding and introduction of supplementary foods at proper age. Infant feeding

and weaning practices have cultural, social and economical roots making malnutrition more than

a medical problem. It has been indicated in many studies all over the world that these practices

are the subjects strongly influenced by customs, beliefs, superstitions, religion, cultural pattern,

mother’s education and socioeconomic status of the family. Malnutrition being the cause of

morbidity and mortality in under 5 years children has brought nutrition to the forefronts of

national and international concern. 5

4

Over 10.5 million deaths occur each year among children of under five years of age and

22 percent of these deaths occur in India. This proportion is substantially higher than other

countries. Malnutrition in children is widely prevalent in India. It is estimated that 5.7 million

children are underweight (moderate and severe) and more than 50 percent of deaths in 0 – 4

years are associated with malnutrition. The most vulnerable period for malnutrition is first 3

years (usually 6 months – 2 years of life). 6

In the world, the average infant mortality rate is 51.5 per 1000 live births. Among that

our country has the highest infant mortality rate estimated to be about 61.4 per 1000 live births.

In Karnataka, the IMR is about 58 per 1000 live births, in rural areas it is 70 per 1000 live births

and in urban areas it is 25 per 1000 live births.7

According to world face book 2010 estimation India is having highest IMR 50.78/1000

live births, among that Karnataka place top in south Indian states 43/1000 live births, compared

with 38/1000 live births in Maharashtra and 30/1000 live births in Tamil Nadu.8

A study was conducted on “Influence of infant feeding practices on nutritional

status of under five children” in urban anganwadi area, Allahabad. The information was

collected from 217 mothers of under five children by interview method and nutritional

assessment was done i.e., weight for age, height for age, weight for height. The results showed

that among 217 under five children, 36.4 percent had underweight, 51.6 percent had stunted

growth and 10.6 percent wasted. Proportions of underweight (45.5 percent) and stunting (81.8

percent) were found maximum among children aged 1 – 24 months, wasting was most prevalent

(18.2 percent) among children aged 37 – 48 months. They concluded that delayed initiation of

5

breast feeding, deprivation from colostrum and improper weaning are significant risk factors for

under nutrition among under five children.9

A study was conducted by the department of pediatrics of Medical Science and Guru Teg

Bahadur Hospital, Delhi,, to assess the practice of complementary feeding (CF) in infants 6

month to 2 year, knowledge of mothers regarding CF, and reasons for inappropriate CF

practices. CF practices were assessed in children aged 6 months to 2 years using semi-structured

questionnaire. Demographic profile and mothers knowledge regarding CF was recorded. Cause

of inappropriate CF was ascertained by open-ended questions. Among the 200 children studied,

32(16%) were not started on CF at all, and only 35 (17.5%) received CF from 6 months. Of the

168 who were started CF, mean age of starting feeds was 13.37 months. Quantity was adequate

in 42(25%) and consistency of food was thick in 64(38%) cases. Only 7(3.5%) mothers started

CF at proper time, in adequate quantity and with proper consistency. Knowledge of proper

timing was present in 46% of children, adequate quantity in 46.5% and thick consistency in

25.5%. Only 16(8%) mothers had proper knowledge of all three aspects of CF. Knowledge

regarding appropriate timing and consistency varied significantly with maternal education and

paternal education (Chi-square P< 0.05). On multiple logistic regression only maternal education

of graduate level correlated with knowledge of timing of CF (P=0.089. OR-3.5, CI 0.826-15.2).

Most common reason for inappropriate practice in 154 mothers who delayed feeds was "tried but

did not eat, vomits everything" (52%). They conclude that CF practices were inappropriate and

knowledge inadequate in majority of the children studied.10

The investigator during her clinical postings identified that many of the under-five

children admitted in pediatric ward were underweight and most of them had some form of

malnutrition on interviewing, she observed that many of the mother lacking adequate knowledge

6

about weaning, during literature review also the investigator found that very few studies are

conducted on correlation between the knowledge of mothers regarding weaning and nutritional

status of their under-five children. This motivated the investigator to choose this as her project

and to conduct a study to determine the knowledge of mother’s regarding weaning and

nutritional status of their under-five children with a view to develop an information booklet.

6.2 REVIEW OF LITERATURE:

Review of literature is a key in research process. According to Nancy burns, the review

of literature is a research report and it is a summary of current knowledge about a particular

problem and includes, what is known and not known about the problem. The literature is

received to summarize knowledge for use in practice or to provide basis for conducting a study.11

A study was conducted on Maternal child-feeding style during the weaning period:

association with infant weight and maternal eating style. A controlling maternal child-feeding

style has been show to have negative consequences for child weight and eating style for children

over the age of 12 months. Maternal restriction is associated with increased consumption of food

if given free access and child overweight. Pressure to eat conversely is associated with picky

eating and a lower child weight. In the current study, 642 mothers with a child aged 6-12

months completed a copy of the Child Feeding Questionnaire and reported infant and maternal

weight. Infant weight was positively correlated with maternal use of restriction, monitoring and

concern for infant weight. Moreover, mothers high in restraint, external and emotional eating

reported higher levels of concern for infant weight, restriction and monitoring and perceived

their infants to be larger. The findings suggest that the extent to which controlling feeding

practices are used is influenced by infant and maternal personal weight concerns even at this

7

early stage. Potentially, these early behaviors could have long term consequences for child

weight and eating style.12

A study was conducted on Factors associated with weaning practices in term infants: a

prospective observational study in Ireland. The study is based on The WHO recommends

exclusive breast-feeding and delaying the introduction of solid foods to an infant's diet until 6

months postpartum. However, in many countries, this recommendation is followed by few

mothers, and earlier weaning onto solids is a commonly reported global practice. Therefore, this

prospective, observational study aimed to assess compliance with the WHO recommendation and

examine weaning practices, including the timing of weaning of infants, and to investigate the

factors that predict weaning at ≤ 12 weeks. 401 eligible mothers were followed up at 6 weeks

and 6 months postpartum. Quantitative data were obtained on mothers' weaning practices using

semi-structured questionnaires and a short dietary history of the infant's usual diet at 6 months.

Only one mother (0.2%) complied with the WHO recommendation to exclusively breastfeed up

to 6 months. Ninety-one (22.6%) infants were prematurely weaned onto solids at ≤ 12 weeks

with predictive factors after adjustment, including mothers' antenatal reporting that infants

should be weaned onto solids at ≤ 12 weeks, formula feeding at 12 weeks and mothers' reporting

of the maternal grandmother as the principal source of advice on infant feeding. Mothers who

weaned their infants at ≤ 12 weeks were more likely to engage in other sub-optimal weaning

practices, including the addition of non-recommended condiments to their infants' foods.

Provision of professional advice and exploring antenatal maternal misperceptions are potential

areas for targeted interventions to improve compliance with the recommended weaning

practices.13

8

A descriptive study was conducted on weaning practices among the mothers of infants

in selected hospitals in Mangalore, on purposive sampling technique among 104 mothers of

infants in the age group of 6-12 months. The study revealed that (56.73%) majority of mothers

started weaning with liquid diet, which as fruit juice among 33.65% of mothers, where as

43.27% of mothers started with Ragi porridge. Among the total samples of mothers, 75 mothers

reported that they started weaning early to child whereas 6 month reported as late weaning, over

64% of mothers reported that due to inadequate breast milk started weaning early. The study

suggested to educate the mothers on weaning practices.14

A pre-experimental study was conducted on effectiveness of planned teaching

programme on knowledge and attitude on complementary feeding among mothers of infants in

Udupi. The study was done on 50 mothers with one group pre-test and post-test design , which

showed that the mean score of post-test attitude (68) was higher than the mean pre-test attitudes

and the mean post-test knowledge score(32) was higher than the pre test knowledge (14),

significantly (p<0.005) related with knowledge of mothers on complementary feeding between

pretest and post test scores. Finally the study suggested education on feeding among mothers of

infants.15

A cross sectional study was conducted to investigate the prevalence of under nutrition

among children 3.0- 5.9 years old in a rural area of West Bengal covered by the Integrated Child

Development Service scheme (ICDS) using composite Index of anthropometric failure (CIAF).

Randomly selected six ICDS centres of Chapra Block Nadia District, West Bengal, India were

Chosen. A total of 2016 children aged 3.0-5.9 years were studied. It was observed that boys were

heavier and taller than girls at all ages. Significant age differences existed in mean height and

weight in boys as well as in girls. Among the children 48.20%, 10.60% and 48.30% were

9

stunted, wasted and underweight. The CIAF showed a higher prevalence of under-nutrition with

60-40% of the studied children suffering from anthropometric failure.16

A cross-sectional community based study was conducted on gender inequality in

nutritional status among under-five children in a village in Hooghly district, West Bengal, to

examine the differences in nutritional status of under-five male and females and to determine the

bio-social factors associated with such differences. It was found that 55.9% , 51.4% and 42.3%

of the girls were underweight, stunted and wasted respectively, compared to 46.6%, 40.5% and

35.3% of the boys and a significantly higher proportion of malnutrition was found to be present

among female children of higher birth order and those belonging to families with lower per

capita income compared to the males.17

A longitudinal study was conducted on “Introduction of complementary foods to

infants within the first six months postpartum in Xinjiang, China. Information was collected

from 1219 mothers. The results showed that after discharge, the overall introduction rates of

water, cow’s milk and solid food were 23%, 2% and 6% before discharge, and 76%, 39% and

78% at six months. The rates were different between ethnic groups. Mothers from Uygur and

other minorities introduced cow’s milk earlier than Han mothers. Uygur mothers also introduce

solid foods earlier (10% pre discharge and 91% by six months) when compared to Han (3% pre

discharge and 85% by six months) and other minorities (4% pre discharge and 48% by six

months). The pattern of introduction of complementary foods in this region does not follow

internationally recognized practices, suggesting the need for further education of parents.18

A study was conducted to examine the association between mother's education,

complementary feeding practices and malnutrition amongst mothers attending outpatient clinics

in Islamabad. Mothers of 500 Pakistani infants attending the Pediatric Outpatient department at

10

the Federal Government Services Hospital, Islamabad completed pretested questionnaires on

mother's educational status and complementary feeding practices. A positive relationship was

found between the nutritional status of infants and educational status of mothers (P < 0.001). The

study revealed that the majority of infants with evidence of malnutrition belonged to the mothers

with virtually no school education. A similar relationship was observed between the educational

status of respondents and the introduction of complementary foods at an appropriate age (6

months) of infants (P < 0.001). The study conclude that Mother's education plays a vital role in

increased receptivity to knowledge and awareness related to nutritional requirements of their

infants.19

A cohort study was conducted on breast and complementary feeding practices in relation

to morbidity and growth in Malawian infants, UK. Babies’ weight, length, morbidity and feeding

patterns were recorded in 4 weekly intervals from birth to 52 weeks. the results revealed the

mean age at introduction of water was 2.5 month, complementary foods 3.4 months, solids 4.5

months, over 40% of infants received complementary foods by 2 month and 65% by 3 months,

infants with early complementary feeding had lower weight for age at 3-6 months (p<0.005) and

at 9 month (p=0.007). Early complementary feeding was significantly associated with increased

risk for respiratory infection (p<0.005), risk of eye infection. The study strongly recommended

health education on weaning among mothers.20

A randomized controlled study was conducted among 1500 children (640 rural, 840

urban) between 3 and 24 months of age, to examine feeding pattern of infants. As a result 48

per cent children are frequently breastfed up to 2 years of age. Semisolids are introduced in

about half the children (42 per cent) between 6 to 12 months. By 18 months most of them

11

were getting semisolids. Rice is commonly introduced first. Proprietary preparations of milk

and weaning foods are not in general use. Dilution of natural milk and improper preparation

are common irrespective of domicile, education and financial status.21

A descriptive cross-sectional study on mothers knowledge and practices regarding

weaning in Butagira, south Ethiopia. A total of 1,543 mother-child pairs were included in the

study, of which 1,052(68%) children were on weaning diet and 491(32%) were exclusively

breast feeding. The finding of the study revealed that among children who were already weaned,

40 percentage were reported to have been started on weaning food at the age of 4-6 months and

amongst children who were reported to be exclusively breast feeding 34 percentage were beyond

the age of seven months. The most commonly used weaning foods were cow’s milk, adult food,

sorghum water and cereal gruel. The most important reasons for mothers to start weaning were

reduction in the amount of breast milk and mother’s belief that the child is at the right age to start

weaning food. Thus the study demonstrate the presence of inappropriate weaning practices in the

area which needs appropriate intervention.22

6.2.1 STATEMENT OF THE PROBLEM:

“A study to assess the correlation between the knowledge of mothers regarding weaning

and nutritional status of their under-five children with a view to develop an information

booklet at selected primary health centers of Davangere district.”

6.3 OBJECTIVES OF THE STUDY:

1. To assess the knowledge of mothers regarding weaning.

12

2. To assess the nutritional status of the under-five children.

3. To identify the correlation between the knowledge of mothers regarding weaning and

nutritional status of their under-five children.

4. To identify the association between selected socio demographic variables with the

knowledge of mothers regarding weaning.

5. To identify the association between selected socio demographic variables with the

nutritional status of under-five children.

6.3.1 OPERATIONAL DEFINITIONS:

1. Assess: Assess refers to recognition of nature and interrelationship between knowledge

of mothers regarding weaning and nutritional status of their under-five children.

2. Correlation: Correlation refers to statistically measured interrelationship between

knowledge of mothers regarding weaning and nutritional status of their under-five

children.

3. Knowledge: knowledge refers to the awareness of mothers regarding weaning diet as

measured by self reported questionnaire or interview schedule.

4. Mothers: Mothers refers to those who are having under-five children, fulfilling inclusive

and exclusive criteria.

5. Weaning: Weaning refers to systematic introduction of liquid, semi solid and solid foods

along with breast milk at appropriate time to provide adequate nutrient food to infants.

6. Nutritional status: nutritional status refers to recognition of the extent to which under-

five children are nourished based on recommendations of Gomez classification through

13

the measurement of weight, expected weight and percentage of nutritional status as

following:

Between 90 and 110% - normal nutritional status.

Between 75 and 89% - 1st degree, mild malnutrition.

Between 60 and 74% - 2nddegree, moderate malnutrition.

Under 60% - 3rddegree, severe malnutrition.

7. Under-five children: Children aged between 0 to 5 years of age.

8. Information booklet: information booklet refers to health education literature prepared

for the mothers of under-five children regarding problem associated with weaning meant

for self directed learning with the credit of one hour.

6.3.2 ASSUMPTION:

1. Mothers are having knowledge regarding weaning.

2. Self administered questionnaire and interview schedule can measures the knowledge of

mothers regarding weaning.

6.3.3 HYPOTHESIS:

H1: There will be significant correlation between the knowledge score of mothers regarding

weaning and nutritional status of their under-five children at selected primary health centers of

Davangere district.

H2: There will be significant association between selected socio demographic variables with

knowledge of mothers regarding weaning.

14

H3: There will be significant association between selected socio demographic variables with

nutritional status of their under-five children.

6.3.4 SAMPLING CRITERIA:

INCLUSION CRITERIA:

1) The mothers who are having under-five children.

2) The mothers who are willing to participate in this study.

3) The mothers who are able to speak Kannada, English.

4) The mothers who are available at the time of date collection.

EXCLUSION CRITERIA:

1) The mothers who are severely ill at the time of data collection.

2) The children who are severely ill at the time of data collection.

3) The mothers who are not available at the time of date collection.

6.3.1 DELIMITATION:

1) The study is limited only to knowledge instead of other determinants of behavior like

attitude and practice.

2) The study is limited only to 60 samples.

7. MATERIALS AND METHODS

7.1 SOURCE OF DATA:

Mothers of under-five children at selected primary health centers of Davangere district.

15

7.2 METHOD OF DATA COLLECTION:

1) Research approach : Non- experimental approach.

2) Research Design : Co-relational survey design.

3) Setting : Selected primary health centers of Davanger

4) Population : Mothers of under-five children seeking health

care services from selected primary health centers

of Davangere.

5) Sample : Mothers of under-five children who are all

fulfilling the inclusive and exclusive criteria.

6) Sample Size : 60

7) Sampling Technique : convenient sampling.

8) Method of data collection : self reported method of data collection.

Tool for the data collection : Self administered questionnaire or structured interview

schedule.

16

METHOD OF DATA ANALYSIS:

1. The descriptive statistics will be used for data analysis that is measures of central

tendency like mean, median, percentage and measures of dispersion like range,

standard deviation, graphical and diagrammatic.

2. The inferential statistic will be used like Karl pearson’s co efficient of correlation,

chi-square test and ANOVA.

Duration of study: 16 moths.

Duration of intervention to: 4 weeks

Duration of data collection: 8 weeks

VARIABLES:

1. Dependent variable: knowledge of mothers regarding weaning and nutritional status of

their under-five children.

2. Independent variable: socio demographic variables like parity, birth order, age,

educational status, economic status, type of diet, type of family and religion.

7.3 Does the study require any investigations or interventions to be conducted on

patients or other humans or animals?

Yes: Investigation is in the form of assessment of knowledge regarding weaning and

nutritional status of their under-five children.

7.4 Has ethical clearance been obtained from your institution?

Yes: Permission obtained from institutional review committee.

17

8. BIBLIOGRAPHY:

1. B.T.Basavanthappa .Community Health Nursing. Jaypee publication. New Delhi. Second

edition. 2008:P: 505.

2. Brylin Highton: Weaning as a natural process. LEAVEN, Vol. 36. No. 6, December

2000-January 2001, PP: 112-114. Available on: http://www.llli.org/llleaderweb/

lv/lvdec00jan01p112.html

3. Helizabeth B Hurlock. Child growth and development. Tata Mc Graw publications. New

Delhi. 5th ed. 2007: P: 697.

4. S. Chatterjee and S. Saha : A Study On Knowledge And Practice Of Mothers Regarding

Infant Feeding And Nutritional Status Of Under-Five Children Attending Immunization

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nutrition-and-wellness/volume-5-number-1/

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Mothers Regarding Child Feeding. Biomedical volume 21:2005.PP: 71-75.Available on:

http://www.thebiomedicapk.com/articles/40.pdf

6. Ann Ashworth, Alan Jackson, ‘Focusing on Malnutrition management to improve child

survival in India’ Journal of the Indian Academy of pediatrics. June 2007; 44 (6) : p.413.

Available on: http://medind.nic.in/ibv/t07/i6/ibvt07:6p413.pdf

7. Park K, Textbook of Preventive Social Medicine, 2000, 16 th edition, Banarsidas, Bhanot

Publishers; Jabalpur; pp.367, 386-387.

18

8. The Hindu, “Infant mortality rate on infants”, Thursday , Jan 07, 2010

9. Dinesh Kumar, Goel N.K, Poonam C, Mittal, Purnima, Misra, “Influence of infant

feeding practices on nutritional status of under five children”. Indian journal of pediatrics

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Indian J pediatr.2008 Jan;75(1):49-53. Available on :http://www.ncbi.nlm.nih.gov

/pubmed/18245935

11. Burns nancy, Grover K susan, “Text Book of Undestanding Nursing Research,” 2nd ed.

WB Saunders Company, Philadelphis. p:34-35

12. Brown A, Leem: Maternal child feeding style during the weaning period: Association

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Available on : http://www.ncbi.nlm.nih.gov/pubmed/21385639.

13. Terrant RC, Younger KM, Sheridan – Periram, White MJ, Kerney JM: Factors associated

with weaning practice in term infants: a prospective observational study in Ireland Br J

Nutr. 2010 Nov: 104 (10): 1544-54 Available on: http://www.ncbi.nlm.nih.gov/

pubmed/20598218.

14. Arun kumar Jindal: Weaning Practices among mothers in selected hospitals in

Mangalore. The nursing journal of India. Volume C. No. 8 august 2009. Available on:

http://www.tnaionline.org/august-09/10.htm.

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15. Anjalin Dsouza, et al. Manipal College of Nursing: effectiveness of planned teaching

programme on knowledge and attitude on complementary feeding among mothers of

infants in Udupi. 2009. The Nursing Journal of India, vol. C. No 11. Available on:

http://www.tnaionline.org/nov-09/4.htm.

16. Biswas S, Bose K, Mukhopadhyay A, Bhadra M. Prevalence of under-nutrition among

pre-school children of Chapra, Nadia district, West Bengal, India, measured by

composite index of anthropometric failure (CIAF). Anthropol Anz 2009 Sep;67(3):269-

79. Available on: http://www.ncbi.nlm.nih.gov/pubmed/20405700.

17. Dey I, Chaudhuri RN :Gender inequality in nutritional status among under-five children

in a village in Hoogly district, West Bengal. Indian J Public Health 2008 Oct-Dec;

52(4):PP. 218-220. Available on: http://www.ncbi.nlm.nih.gov/pubmed/19189827.

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