knowledge, attitude, practices and nutritional status of

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MEAL SCHEME IN GOVERNMENT SCHOOLS OF CHANDIGARH ... PROFESSOR, DEPT OF COMMUNITY MEDICINE, GMCH SEC-32, CHANDIGARH.

KNOWLEDGE, ATTITUDE, PRACTICES AND NUTRITIONAL STATUS OF STUDENTS AVAILING MID DAY MEAL SCHEME IN GOVERNMENT SCHOOLS OF CHANDIGARH AUTHORS - PRATAP THAKUR1, RAJ KAMAL PATHAK2, NAVEEN KUMAR GOEL3 1. ASSISTANT PROFESSOR, AKAL SCHOOL OF PUBLIC HEALTH & HOSPITAL ADMINISTARTION, ETERNAL UNIVERSITY, BARU SAHIB, HP, 2. PROFESSOR, DEPT. OF ANTHROPOLOGY, PANJAB UNIVERSITY, CHANDIGARH 3. PROFESSOR, DEPT OF COMMUNITY MEDICINE, GMCH SEC-32, CHANDIGARH

Introduction

Material & Methods

Education and learning depend on good nutrition and health. The National and the State governments have been implementing a number of poverty alleviation programmes for the overall socioeconomic development of the community and to mitigate the sufferings of the vast multitudes of the population at risk. Poor nutrition and health among schoolchildren contributes to the inefficiency of the educational system. Children with diminished cognitive abilities and sensory impairments naturally perform less well and are more likely to repeat grades and to drop out of school than children who are not impaired; they also enroll in school at a later age, if at all, and finish fewer years of schooling. The irregular school attendance of malnourished and unhealthy children is one of the key factors in poor performance. Even short-term hunger, common in children who are not fed before going to school, can have an adverse effect on learning. Children who are hungry have more difficulty concentrating and performing complex tasks, even if otherwise well nourished. The Government of India’s National Nutrition Policy, apart from setting nutrition goals to control and prevent malnutrition in the country started National Programme of Nutritional Support to Primary Education (NP-NSPE) as a Centrally Sponsored Scheme on 15th August 1995, initially in 2408 blocks in the country. By 1997-98 it was introduced in all blocks of the country. It was further extended in 2002 to cover children studying in EGS and AIE centers. Cooked mid-day meal is the popular name for the school meal programme which involves provision of lunch –free of cost to school children on all school days.

Objective

Stretching over an area of 114 sq. Kms. Chandigarh is unique, because it is the capital of two state governments, Punjab and Haryana. Chandigarh is a planned city, with a high standard of civic amenities. It has a total population of 10, 55,450 people. It includes 5, 80,663 males and 4, 74,787 females. The city has density of 9,258 persons per sq. km. As per the State Primary Census Abstract data 2011 released by the Census Department, the city has 97.3 per cent population living in urban areas and 2.74 per cent living in rural areas. Sampling Study Area: Government schools of Chandigarh Study Design: Cross-sectional school based survey Study Duration Five months (1st January to 31st May 2012) Study Population: Students of classes 6th, 7th and 8th Sample Size: 1274 Sampling Technique: It was a school based survey of students studying in classes 6th, 7th and 8th . There are 185 recognized schools in Chandigarh with 106 Government and 79 Private schools. The population parameter of the study was all government schools of Chandigarh. For representation each area, U.T Chandigarh was categorized into urban, rural and slums. Therefore 7 schools from urban area were enrolled. Similarly, 3 schools from rural area and 2 schools from slum were randomly selected from the list of all the schools present in respective areas. A randomly selected section of each class (6th, 7th and 8th) from selected schools was taken up for survey. It was ensured that boys and girls get equal representation.

Objective

a) To find out knowledge, attitude and practices of children availing mid day meal attending classes 6th, 7th and 8thof Govt. Schools scheme in government schools of Chandigarh.

Data Collection Administering the questionnaire: - A Semi-structured questionnaire was administered to the students. They were briefed about the rules & regulations for filling the same. They were given 20 minutes to finish. Anthropometric measurements: - All the measurement were taken before meals. A calibrated Anthropometer was used to measure children after removing their shoes in erect position. Bathroom weighing scale was used to measure the weight of students in standing position with sweaters and shoes removed. Mid Upper Arm Circumference (MUAC) was taken with help of calibrated measuring tape Scholastic achievement: - Performance of children in First-term examination in present class was used to determine scholastic achievement. Marks were taken from school records and graded according to CBSE’s grading system for 6th , 7th and 8th ( Statistical Analysis: The data entry was done in MS excel. Statistical analysis was done with the help of SPSS 20. WHO Anthroplus software was used to find out nutritional status of children.

Results Socio-Demographic Profile Distribution of students by location of school

Attitude and Practices of students availing Mid-day scheme

Distribution of students age wise

Source of food in school Source Mid-day

Slum 15%

Urban 51%

Mid-day meal

7% 21%

27%

Rural 34%

Slum

10 and less

11

12

13

14

100.00

Sikh 14.84%

Others 0.71%

Girls

45.29%

Muslim

Sikh

Chrstan

Distribution of students class wise

32.18%

35.40%

30.93%

32.42% iv (Upper lower)

More food

223

17.50

Milk

222

17.43

Egg

96

7.54

Something else

66

5.18

Total

1274

100.00

Causes of students not taking mid-day meal regularly

30.53

Cause

Frequency

Percent

No problem

463

36.34

Don’t like taste

455

35.71

Poor-Hygiene

136

10.68

Food is less

111

8.71

Normal

311

24.41

Bad

21

1.65

Very bad

8

0.63

Total

1229

96.47

Parents don’t allow

109

8.56

3.53

Total

1274

100.00

1274

Distribution of grades achieved by students in mid-year examination Grades A1

Frequency 7

Percent 0.57

A2

69

5.61

B1

130

10.58

B2

214

17.41

C1

305

24.82

C2

336

27.34

D

160

13.02

E1

8

0.65

Total

1229

100.00

Height for age comparison against WHO Z-scores - All Children

Height for age comparison against WHO Z-scores - Girls & Boys

meal No. of Days

Frequency

Percent

1

107

8.40

2

104 104

6th

7th

8.16 8.16

4

59

4.63

5

58

4.55

6

797

62.56

Total

1229

96.47 3.53

meal at all Total

v (Lower)

100.00

BMI for age comparison against WHO Z-scores - All Children

BMI for age comparison against WHO Z-scores - Girls & Boys

From which class are you taking mid-day meal Class

Frequency

Percent

1

366

28.73

2

158

12.40

3

166

13.03

4

142

11.15

5

113

8.87

6

139

10.91

7

81

6.36

8

64

5.02

Total

1229

96.47

How many times a week you take Mid-day

Do not take mid-day 45

iii (Lower middle)

52.35

39.25

Hindu 77.79% Others

22.68%

ii (Upper Middle)

667

500

Total

0.55%

I (Upper)

Fruit

Good

3 0.55%

Percent

Association of scholastic achievement and stunting N Length/height-for-age (%) Grade % < -3SD % < -2SD A1 7 0 0 A2 69 4.3 17.4 B1 130 3.8 14.6 B2 214 8.9 26.2 B2 214 8.9 26.2 B2 214 8.9 26.2 C1 305 5.9 25.9 C2 336 9.2 28.3 D 160 8.1 30 E1 8 25 50 Total 1229 7.4 25.5

meal at all

Hindu

Distribution by SocioEconomic background

389

Do not take mid-day 45

Boys 54%

Boys

Frequency

Frequ Percent ency

15 and more

Muslim 4.95%

Girls 46%

1274

Choice

In your opinion how does food taste?

Religion wise distribution of students Chrstan 1.73%

36.34

Total

Very good

Distribution of students gender wise

463

3.53

Opinion Rural

60.13

Food only from home 45

28%

Urban

+ 766

Homemade food

6% 11%

What will you like to be added to menu?

Frequency Percent meal

Scholastic and Nutritional achievement

Do not take mid-day meal 45 at all Total

1274

3.53

1274

100.00

100.00

8th

References  Bhoite R, Iyer U. Magnitude of malnutrition and iron deficiency anemia among rural school children: An Appraisal. Asian J Exp Biol Sci. 2011, 2(2):354–361.  Sati V, Dahiya S. Nutritional assessment of rural school-going children (7-9 years) of Hisar district, Haryana. Scientific reports. 2012; 1(7):1-4.  The essential package: Twelve interventions to improve the health and nutrition of school-age children.World food programme [ Internet] : New York [ Cited 12 July 2014] Available from: http://www.un.org/esa/socdev/poverty/PovertyForum/Documents/The%20Essential%20Package.pdf.  Rosso JMD, Marek T. Class Action: Improving School Performance in the Developing World through Better Health and Nutrition. Washington: World Bank Publications; 01 Jan 1996.  Policy Brief: School Health and Nutrition: Manoff Group; Washington: December 2009 [Cited 1 July 2014] Available from: http://www.manoffgroup.com/documents/SchoolhealthandnutritionpolicybriefENGDec09.pdf.  Rosso JMD. Investing in school and health and nutrition in Indonesia. Washington, DC: World Bank; 2009. [Cited 10 june 2014] Available from: http://documents.worldbank.org/curated/en/2009/10/12521174/investing-school-health-nutritionindonesia.  Deodhar YD, Mahandiratta S, Ramani KV, et al. An evaluation of mid-day meal scheme. J Ind School Political Economy. 2010; 22(1-4): 34-38.  Sharma S, Passi SJ, Thomas S, et al Evaluation of mid-day meal programme in MCD schools. Nutrition foundation of India. Delhi: Municipal Corporation Of Delhi; 2006. Scientific Report 18.[Cited 2 July 2014] Available from: http://www.mdm.nic.in/Files/Initiatives%20&%20Case%20Studies/NUTRITION_%20FOUNDATION_%20 OF_%20INDIA.pdf.

Summary & Conclusions It was found 60.13 % of the students were taking food from mid-day meal programme as well as bringing home cooked food 36.33% students reported that they take only mid-day meal at school 3.53% of the students took only home cooked food 36.34% reported that they had no problem with the food and they were taking it regularly 35.71% reported that they don’t like taste 62.56% of the students were taking food regularly six days a week whereas only 8.40% students took MDMs only once Most of the respondents 28.73% reported that they are taking mid-day meal from 1st class 59.42 %( 757) children liked Kadi-Chawal as their favourite recipe with, 32.50%, 30.53% and 37.21% reporting it to be very good Most of students 52.35 %( 667) wanted fruits to be added to their diet other 17.50 %( 223) wanted quantity of food to be increased Out of total 1229 students taking mid-day meal scheme 27.34% students secured C2 grade in first term examination Scholastic performance was seen to be directly linked to nutritional status. In our study, lowest prevalence of stunting was found in Students who were achieving high grades. On trying to find out relation of malnutrition with socio-economic variables it was found that Stunting (-2SD) has highest prevalence in Lower class (42.9%) and it decreases with increasing socioeconomic status. Severe stunting was also highest among lower class at 14.9%. Thinness (-2SD) has highest prevalence among upper middle class at 24.4% where as severe thinness (-3SD) was highest among upper class at 7.3%. It was lowest among Lower class. Obesity (+2SD) has highest prevalence among Lower middle class i.e. 2.2%. The study revealed that Chandigarh is facing problem of adolescent malnutrition. Malnutrition is affecting mostly the people of poor socio-economic group.09-16 is an age group which will take responsibility of our country’s future. These adolescents are facing double edged problem as malnutrition also affects educational performance The positive finding is that Students like their meals which proves it is meeting some objectives though not all of them as revealed by poor scholastic scores and high prevalence of malnutrition.

Acknowledgement This poster would not have been possible without the support of many people. I will like to express gratitude to my teachers, staff members and management who were helpful and offered support and guidance. Without their guidance this poster would not have been successful.

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