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Phase-I
Situational analysis

Selection
of the subjects:

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Under Vadodara Mahanagar Seva Sadan there are four
zones i.e. East, West, North and South Zones. Out of four zones one zone i.e.
East Zone was purposively selected and from that one UHC Sawad was Purposively
selected. Under Sawad UHC there were 12 AWCs from that 6 AWCs was randomly
selected to get the sample size of 250 unmarried adolescent girls aged 15-19
years.  Total 250 school going and out of
school adolescent girls aged 15-19 years who gave written consent were enrolled
for the study. Data on Height, Weight, MUAC, WC,
Hb
(by UHC Lab technician), dietary practices by
semi-quantitative food frequency questionnaire and to compute consumption of
food groups/CU/ day, regularity of supply of
IFA/Iodised salt, food commodities & compliance of IFA, household salt
samples will be collected and iodization of salt will be determined through
salt testing kits, current practices regarding utilization of available services of the
target population.

Tools
and techniques used for the study was presented in Table______________

 

 Inclusion and Exclusion Criteria

 Inclusion Criteria

     
All unmarried Adolescent
girls (15-19 years) who give consent to enrol for the study.

 Exclusion criteria

     
Physically disabled adolescent
girls

     
Married adolescent girl

     
Who has thyroid

         

UHC
Profile:

Information
on staff pattern and avaibility, services provided under the urban health
centre, kind of services provided to the adolescent girls, availability and
compliance of IFA are collected using pre-tested semi structure questionnaire.
(Appendix)

Anganwadi
Profile:

 Information on
number of household and school going and out of school going adolescent girls registered
under AWC, and services provided to adolescent girls on mamta divas. (Appendix)

 

 

PDS
Profile:

Information
on number BPL, APL, AAY household register and availed services in last month,
supply of stock, current rate of food grains sold, observation of storage area.
(Appendix)

Background
Information:

Information on the socio- demographic
profile of the subject was collected using a pre-tested questionnaire.
Information regarding age, sex, religion, caste, type of family, total family
members, monthly income was collected. (Appendix).

Anthropometric
measurement:

To assess the prevalence
of under nutrition, by using 3 indices namely, BMI for age, Height for age, and
Weight for age (WHO 2007 standard) correct age, weight and height were assessed
using standard techniques. Age assessment: Age of the subjects were collected
from Aadhar card, school leaving certificate, birth certificate.

Weight
Measurement:

Weight is a key
anthropometric measurement of body mass. It is a sensitive indicator of
malnutrition and can be useful for estimating status of the individual.

Methodology:

A digital bathroom weighing scale was used to
take the weight of the subjects. It is a portable and can be conveniently used
in this field. The subjects were asked to stand erect on the scale without
touching anything with no heavy clothing or footwear and looking straight
ahead. The scale was set to zero before each measurement. The weight was taken
thrice to ensure accuracy and recorded to the nearest 0.100 kg. The scales were
calibrated periodically.

Height
Measurement:

Height is a linear
measurement of body made up of the sum four components: legs, pelvis, spines
and skull (Jelliffe 1966). A given deficit in height may represent a period of
growth failure in a person’s life.

 

Methodology:

 Height was measurements
using flexible non-stretchable fibre glass tap to an accuracy of 0.1 cms. The
tap was fixed vertically on a smooth wall of the class room perpendicular to
the ground, ensuring that the floor was smooth. The participants were asked to
stand erect with the shoulders, hips and heels touching the wall and with no
footwear, heels together and looking straight ahead. The head was held
comfortable erect, arms hanging loosely by the sides. A thin smooth scale was
held on the top of the subjects heads in the centre, crushing the hair at the
right angles to the tape and the height of the subjects read from the lower
edge of the rural to the nearest 0.1 cms.

 

Mid Upper Arm
Circumference (MUAC):         

Mid-upper
arm circumference (MUAC) is commonly used to determine the nutritional status
of adolescents and adults. It is widely used as an indicator of severe and moderately acute
undernutrition.

Methodology:

 Mid-upper arm circumference (MUAC) of the subjects were collected using
adult MUAC tab. It is
easy to carry to field sites, and requires minimal training.

 

Waist Circumference (WC):

Waist circumference (WC) is an
indicator of health risk associated with excess fat around the waist. A waist
circumference of 80 centimetres (31.5 inches) or more in women, is associated
with health problems such as type 2 diabetes, heart disease and high blood
pressure.

Methodology:

Remove clothes from the waist line, stand with feet shoulder width apart
(25 to 30 centimetres or 10 to 12 inches) and back straight, Locate the top of
the hip bone. This is the part of the hip bone at the side of the waist not at
the front of the body, Use the area between the thumb and index finger to feel
for the hip bone at the side of the waist. Align the bottom edge of the
measuring tape with the top of the hip bone, Wrap the tape measure all the way
around the waist. Ensure that the tape measure is parallel to the floor and not
twisted. Take two normal breaths and on the exhale of the second breath tighten
the tape measure so it is snug but not digging into the skin. Take the measure
of the waist to the nearest 0.5 cm (1/4 inch).

 

 

 

 

 

 

Body Mass Index (BIM)

BMI helps to indicate the current nutritional status of individual.
BMI has been recommended by WHO (1995) as an indicator of choice for under
nutrition in individual.

BMI is calculated by the formula

BMI = Weight (Kg)

            Height (m)2

 

Given in the form (Appendix
2).

Nutritional Status
Assessment 

Weight and height are the parameters for the
assessment of nutritional status. Anthropometry is widely used, as it is
inexpensive and non-invasive measure to know the general nutritional status of
an individual or a population. Anthropometric indices used were:

v  Weight-for-Age
(Underweight)

v  Height/Length-for-Age
(Stunting)

v  BMI – for – Age
(Thinness)

 

Once height and weight have been correctly
measured and age has been recorded, nutritional status can be assessed by using
standardized age- and specific growth reference to calculate height for age
Z-scores (HAZ), weight for age Z-scores (WAZ), weight for height Z-scores (WHZ)
and Body Mass Index-for-age z-scores (BMIZ).

Z-scores of these indices were used to classify
children (boys and girls) in different nutritional categories using WHO (2007)
growth standards in the following manner: Given in the form (Appendix).

 

 

 

 

 

 

 

 

 

 

 

 

 

Knowledges and Practices:

Information about the knowledge and
practices of adolescent girls was obtained using pre-tested semi-structured questionnaire
on following topics. (Appendix)

·        
Anemia

·        
Undernutrition

·        
Dietary practices

Consumption
of various various food group per/CU/day ( 24 hours dietary recall )

Consumption of various food groups was done using diet
survey for one day using 24 hour recall of all the subjects.

Total quantity of each ingredient food item for
consumed was noted in terms of household measures or numbers and consumption of
food was calculated by per adult consumption unit given by (ICMR, 1989) (appendix)
Food intake was calculated by dividing the mean intake of each food item by the
total family consumption units from household measure raw amount in gms was
calculated for each food group.

Table
no.  Method for calculation of food items
gm/cu/day

 

Age/Sex/Physiological
group

CU

Adult
male- moderate activity

1.2

Adult
female- moderate activity

0.9

Adolescents
(12-21 years)

1.0

Children-
9-12 years

0.8

Children-
7-9 years

0.7

Children-
5-7 years

0.6

Children-
3-5 years

0.5

Children-
1-3 years

0.4

 

The total number of consumption units in each family
is first calculated based on the information on age, sex, activity, and
physiological status of all the individuals in the family. The number of
consumption units will be less than the total number of members in the family.
We can calculate intake of each of food per consumption unit as follows:

Intake of each food/CU/Day = Raw amount of each
food/No. of consumption unit

Food
Frequency questionnaire

The food frequency questionnaire included a checklist
of basic food groups such as cereals grains, white roots tubers and plantains,
pulses (beans, peas and lentils), Nuts and seeds, milk and milk products, meat,
poultry and fish, dark green leafy vegetables, other vitamin A rich fruits and
vegetables, other vegetables, others fruits, discretionary foods and its
frequency consumed by adolescent girl. (appendix)

 

TOOLS
AND TECHNIQUES: Following standard tools and
techniques will be used

PARAMETERS

TOOLS

Height,
weight, MUAC and Waist circumference

By
(References)- Waist circumference (International Diabetes Federation
classification for South Asians)
BMI
(Asian Pacific criteria for South Asians)
MUAC
( UNICEF supply catalogue)

Hb

By
Hemochroma plus machine
Cut
offs of Hb-WHO classification

Dietary
practices

By
Pre-tested semi quantitative food frequency questionnaire and to compute
consumption of food groups/CU/day
Semi
quantitative adapted from maternal and child survival program and dietary
diversity score from minimum dietary diversity for women: a guide to
measurement

Iodized
salt testing

By
Iodized Salt testing Kit

Profile
of ASHA and MAS

By
Pre-tested semi-structured questionnaire

Knowledge
and practices of ASHA and selected representative of MAS

By
Pre-tested semi-structured questionnaire

 

 

 

 

 

 

 

 

 

 

 

 

Phase
– II(A) Identification of the training needs
of ASHAs and selected members of MAS and development of training module.

 Profile of
ASHA :

Total 7 ASHA profile was taken using pre- tested semi-
structured questionnaire, information on age, education, occupation, total
number of household covered, total years of experience, training received,
meeting conducted with MAS and frequency of meeting  and kind of helps is being provided by MAS
members. Knowledge and practices on anemia and malnutrition (Appendix).

MAS profile:

 MAS
profile and knowledge and practices of 
MAS representatives was taken using pre-tested questionnaire (Appendix
). Under the one MAS committee there are total 10 members are there from
that  2 MAS representative which included
Sabhya Sachiv and any other MAS  Member
were interviewed to assess their knowledge and practices regarding MAS,
anaemia, malnutrition. Information on their contribution in delivering services
to adolescent girls (Appendix).

Development of the training cum monitoring module:

 Based
on the knowledge and practices of ASHAs and MAS representatives training cum
counselling module was developed (see in Appendix).

Development of Training cum counselling module:

Training cum counselling module was developed for ASHAs
and MAS members for further counselling to adolescent girls. (see in Appendix).

 

 

 

 

 

 

 

 

 

PHASE-II
(B) To Build the Capacities of ASHAs and Selected Members of MAS

Capacity
building:

3 days training program for ASHAs and MAS
representatives was conducted in November 2017 at Sawad UHC in which 6 ASHAs
and _____ MAS representative was trained by research students and action plan was
prepared in which each MAS members has to monitoring two adolescent girls which
are enrolled in the first phase, monitoring and counselling module was
distributed to all the members who had received training (training schedule:
see in appendix_). Impact of training was evaluated by pre-test and post-test (see
in appendix______) 

For further training of all the remaining MAS members,
2 days training was given by trained ASHAs and MAS representatives and
counselling module was given to the remaining MAS members.

After a month refresher training will be given to all
the ASHAs and MAS members.

        

 

Sr.no.

Name
of the ASHA

Total
MAS committee

Total
MAS member

Total
MAS representative

Total
trained members

Total
MAS members trained by ASHA and MAS representatives

ASHA

MAS
representative

1.

Jignisha
ben

1

10

2

1

 

9

2.

Jayshree
ben

2

20

4

1

 

3.

Hansa
ben

2

20

4

1

 

10

4.

Urmila
ben

2

20

4

1

 

15

5.

Parul
ben

2

20

4

1

 

12

6.

Naina
ben

1

10

2

1

 

7

 

 

 

 

 

 

 

Phase-III
Supportive Supervision

Supportive supervision of MAS members will be done by
research student, each MAS member has to counsel two adolescent girls twice in
a week i.e. They have to counsel 8 times in a month for 3 consecutive months from
the date of training received. And there by research student and ASHA will do
supportive supervision of MAS members during there counselling session.

Counselling schedule of ASHAs and  MAS members 

Name of the ASHA

Counselling days

Jignisha ben

Wednesday, Friday 

Jayshree ben

Tuesday, Saturday 

Hansa ben

Tuesday, Saturday 

Urmila ben

Monday, Thursday

Parul ben

Monday, Thursday

Naina ben

Wednesday, Friday 

 

To
evaluate the impact of community engagement strategy after 3 months post data
will be collected on knowledge, dietary and utilization of health services
practices of target population. (Appendix)

 

Statistical
Analysis:

     
The obtained data
will be entered in personal computer and then it will be analyzed using
appropriate software.

     
Frequency
distribution and percentage will be calculated for all qualitative parameters

     
Means, standard
deviation & standard errors will be calculated for all the quantitative parameters.

     
WHO Growth chart used to
Z score

     
Paired’ test will
be used to assess the differences between the means of the same group before
and after the intervention period.

 

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